Blood and Anemia Flashcards by Jordan Cyr

What is the composition of blood?

plasma (55%):
-water (92%)
-proteins (7%)
-salts
-lipids (cholesterol)
-carbohydrates (glucose)
-gases (O2, CO2)
cells (45%):
-RBC (4.5million/mcL)
-WBC (5000-10000/mcL)
-granulocytes
-neutrophils (60-70%)
-eosinophils (1-3%)
-basophils (1%)
-monocytes (4-8%)
-lymphocytes (20-40%)
-platelets (150,000-400,000/mcL)

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What is the hematocrit?

volume fraction that is cells after centrifugation

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What are the sites of hematopoiesis in adults? Children? Fetus?

adult: calvarium, vertebrae, ribs, sternum, pelvis
child: bones
fetus: bones, liver, spleen

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What is the basic cell of the eight major hematopoietic lineages? What can this cell differentiate into?

stem cells
stem cells can become CLP or CMP
CLP–>T cell or B cell
CMP–>RBC, platelets, basophil, eosinophil, neutrophil, monocyte, osteoclast

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Describe the intrinsic pathway of the coagulation cascade.

starts with vessel damage
XII–>XIIa
XI–>XIa (via XIIa)
IX–>IXa (via XIa)
X–>Xa (via XIa)
II–>IIa (via Xa)
fibrinogen–>fibrin (via Xa)

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Describe the extrinsic pathway of the coagulation cascade.

starts with trauma
VII–>VIIa
X–>Xa (via VIIa)
II–>IIa (via Xa)
fibrinogen–>fibrin (via IIa)

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What makes up the common pathway of the coagulation cascade?

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What is the role of anticoagulants?

reduce the risk of blood clots which can cause stroke, pulmonary embolism or MI in patients with AF, VTE, ACS, orthopedic surgery

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What is the MOA of warfarin?

blocks the vitamin-K dependent processes of producing factors II, IX, VII, X
INR monitoring is essential

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Which clotting factor is prothrombin?

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What is the MOA of apixaban, rivaroxaban, and edoxaban?

factor Xa inhibitors

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What is the MOA of heparin?

binds to and activates antithrombin, inactivating factor Xa and IIa
may be used during acute DVT and MI management

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What is the MOA of enoxaparin and LMWH?

reduced anti-factor IIa activity relative to anti-factor Xa activity
more favourable benefit-risk ratios
better PK
less microvascular bleeding and bleeding risk compared to UFH

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What is the MOA of dabigatran?

direct thrombin inhibitor

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True or false: ASA is an anticoagulant

false
its an antiplatelet, sometimes used in combo with DOACs

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What are examples of antiplatelet drugs?

platelet aggregation inhibitors:
-ASA and COX-inhibitors
oral thienopyridines:
-clopidogrel, prasugrel, ticagrelor, ticlopidine
glycoprotein platelet inhibitors:
-abciximab, eptifibatide, tirofiban
protease-activated receptor-1 antagonists
-vorapaxar
miscellaneous:
-dipyridamole (nucleoside transport inhibitor and PDE3 inhibitor)
-cilostazol (PDE3 inhibitor)

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What is the function of erythrocytes?

transport of oxygen from lungs into peripheral tissues

What is the structure of hemoglobin?

four heme groups and four globins
-adult: two alpha, two beta
-fetal: two alpha, two gamma

What is anemia?

reduction of hemoglobin in the blood to below-normal levels
-<13g/dL in males
-<11.5g/dL in females

What might anemia be associated with?

abnormal hemoglobin: abnormal hematopoiesis
reduced # of RBC: decreased hematopoiesis
structural abnormalities of RBC: abnormal hematopoiesis
may be a consequence of increased loss or destruction of RBC

Which vitamins, minerals, and macronutrients could be associated with decreased hematopoiesis?

iron deficiency
vitamin B12 deficiency
protein deficiency

What is a genetic disorder that can cause abnormal hematopoiesis?

sickle cell anemia

What are examples of bleeding that can put a person at risk for increased loss or destruction of RBC?

prolonged menstrual bleeding
peptic ulcer

What is the morphology of a normal RBC?

biconcave disk
7mcm

Provide morphologies of RBC and an example with each.

normocytic, normochromic anemia -dilutional anemia microcytic, hypochromic anemia -iron deficiency macrocytic, normochromic anemia -deficiency of B12 and/or folic acid anemias associated with abnormal RBC shape: -elliptocytosis, spherocytosis, sickle cell anemia

Provide examples of the many different symptoms of anemia.

eyes: yellowing skin: pale, cold, yellowing respiratory: shortness of breath muscular: weakness intestinal: changed stool color central: fatigue, dizziness, fainting (severe cases) blood vessels: low bp heart: palpitations, tachycardia, angina or MI (severe) spleen: enlargement

What might cause decreased hematopoiesis?

bone marrow failure -aplastic anemia -myelophthisic anemia deficiency of nutrients: -B12 and folic acid (megaloblastic anemia) -protein

What usually causes abnormal hematopoiesis?

genetic abnormalities -sickle cell anemia, thalassemia

What might cause increased loss and destruction of RBC?

bleeding intrasplenic sequestration immune hemolysis infections (malaria) hemolytic anemia

Describe hemolytic anemia.

increased RBC destruction intracorpuscular defects: -structural abnormalities -sickle cell anemia, thalassemia, hereditary spherocytosis extracorpuscular defects: -antibodies, infectious agents, mechanical factors

What is the most common form of anemia?

iron deficiency anemia

What is the etiology of iron deficiency anemia?

increased loss of iron (chronic bleeding) inadequate iron intake or absorption increased iron requirements: -babies, adolescents, adult women, pregnant women

True or false: folate is a fat-soluble vitamin

false water-soluble type of vitamin B (B9)

What are sources of folic acid?

green leafy vegetables citrus pulses

What is the role of folate?

folic acid works with B12 and vitamin C in protein and DNA metabolism formation of red and white blood cells

What are contributors to folate deficiency?

diseases in which folic acid is not well absorbed -Celiac or Crohns excessive alcohol overcooked fruits and veg hemolytic anemia or kidney dialysis medicines (phenytoin, sulfasalazine, TMP/SMX)

True or false: WBC disorders are usually a result of abnormal function

false usually a result of abnormal number

What might cause neutrophilia?

increased marrow activity: -bacterial infections -acute inflammation -leukemia release from marrow pool: -stress -corticosteroids -endotoxin exposure demargination into blood: -bacterial infections -hypoxemia -stress -corticosteroids -exercise

What might cause neutropenia?

decreased marrow activity: -drugs -radiation -megaloblastic anemia -aplastic anemia -marrow replacement by tumor decreased neutrophil survival -sepsis -viral or rickettsial infection -immune destruction via drug -immune destruction via antibodies

What might cause lymphopenia?

immunodeficiency (AIDS corticosteroids toxic drugs Cushings

What might cause lymphocytosis?

medium to large, atypical lymphocytes predominant: -viral infections -active immune response -lymphoma, leukemia small, mature lymphocytes predominant: -chronic infections (TB) -autoimmune diseases (myasthenia gravis) -metabolic diseases (Addisons disease) -lymphoma, leukemia immature cells predominant: -leukemia, lymphoma