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Blood and Lymph Flashcards

1
Q

What is a liquid connective tissue that consists of cells surrounded by extracellular matrix?

A

Blood

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2
Q

What are the three general functions of blood?

A

Transportation
Regulation
Protection

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3
Q

What does blood transport?

A 
Oxygen
Carbon dioxide
nutrients
heat
waste
hormones
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4
Q

What does blood regulate in the body?

A

pH
Heat
Blood osmotic pressure

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5
Q

How does the blood protect the body?

A 
Blood Clots
Disease (WBC)
-phagocytosis
-antibodies
-interferons
-complement
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6
Q

What is the temperature of blood?

A

100.4F or 38C

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7
Q

What is the pH of blood?

A

7.35 to 7.45

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8
Q

How much of the total body weight does blood constitute for?

A

8%

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9
Q

What is the average blood volume for males and females?

A

M- 5-6L

F- 4-5L

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10
Q

Whole blood is composed of what two parts?

A

Blood plasma

Formed Elements

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11
Q

What percentage of blood is formed elements?

A

45%

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12
Q

What is a liquid extracellular matrix that contains dissolved substances?

A

Blood plasma

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13
Q

Formed elements of the blood are what?

A

Cells and cell fragments

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14
Q

What percentage of formed elements is made up of red blood cells?

A

99%

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15
Q

What constitutes 1% of formed elements?

A

White blood cells and platelets

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16
Q

Plasma is what percentage of the blood volume?

A

55%

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17
Q

What is the percentage of total blood volume occupied by red blood cells?

A

Hematocrit

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18
Q

What is the normal range of HCT for males and females?

A

M- 42-52%

F- 37-47%

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19
Q

What is the buffy coat made up of?

A

WBC and platelets

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20
Q

What does blood plasma consist of and what are the percentages?

A

91.5% water
7% protein
1.5% solutes

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21
Q

Where are proteins in the blood synthesized?

A

mainly in the liver

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22
Q

What is the most plentiful plasma proteins?

A

Albumins-54%

Fibrinogen-7%

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23
Q

What oxygen-carrying protein is contained by RBCs and gives red pigmentation of the cell?

A

Hemoglobin

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24
Q

Hemoglobin carries about what percentage of carbon dioxide in the blood?

A

23%

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25
Q

What is the RBC count for males and females?

A

M- 5.4m

F- 4.8m

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26
Q

RBCs live for how long?

A

120 days

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27
Q

What is the normal level of WBCs in the body?

A

5-10k/uL

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28
Q

What is the life span of a WBC?

A

few hours to days

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29
Q

What is the main differences of WBCs and RBCs?

A

WBCs-have nuclei and organelles do not contain hemoglobin

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30
Q

What are the two classifications of WBCs?

A

Granular and agranular

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31
Q

What are the granular leukocytes?

A

Neutrophils
Eosinophils
Basophils

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32
Q

Neutrophils account for what percentage of WBCs and carry out what action?

A

50-70%
Phagocytosis
-destroy bacteria with lysozymes, defensins and strong oxidants

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33
Q

What percent of WBCs is Eosinophils and what is their function?

A

1-5%
Suppress effects of histamine
Phagocytizes antigen-antibody complexes
Destroys certain parasitic worms

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34
Q

What percentage of WBCs are Basophils and what is their function?

A

0-1%

Releases heparin, histamine and serotonin to intensify inflammatory response in allergic reactions

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35
Q

What are the agranular leukocytes?

A

Lymphocytes

Monocytes

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36
Q

Lymphocytes include what cells?

A

T
B
Natural Killer

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37
Q

What percentage of all WBCs are leukocytes and what is their function?

A 
20-40%
Mediates immune responses
B cells transform to plasma
T cells attack viruses, cancer and transplanted cells
NK cells attack microbes and tumor cells
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38
Q

Monocytes are what percentage of WBCs and what is their function?

A

1-6%
Phagocytic
-transform to a fixed histiocyte or wondering macrophage

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39
Q

What is the normal platelet count in an adult?

A

150k to 400k/uL

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40
Q

Platelets live for how long?

A

5-9 days

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41
Q

Platelets form platelet plugs during hemostasis that do what?

A

Release chemicals to promote vascular spasm and blood clotting

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42
Q

What is the process by which the formed elements of blood develop?

A

Hemopoiesis

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43
Q

What is the primary site of hemopoiesis?

A

Red bone marrow

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44
Q

What type of cells have the capacity to develop into different cell types?

A

pluripotent stem cells

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45
Q

Stem cells can further differentate into what cell lines?

A

myeloid and lymphoid

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46
Q

What cells can myeloid stem cells differentiate into?

A 
Red cells
Platelets
Mast Cells
Eosinophils
Basophils
Neutrophils
Monocytes
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47
Q

Lymphoid stem cells develop in the marrow but mature in lymphatic tissue are what?

A

T cells
B Cells
Natural Killer Cells

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48
Q

Immature cells in peripheral blood are known as what?

A

Bands and Blasts

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49
Q

What is a left shift? And what does it indicate?

A

> 10% bands

body is fighting infection over long period of time that doesn’t allow bone marrow to keep up

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50
Q

Blast, the most immature cells, are associated with what?

A

myelodysplastic disorders

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51
Q

What in the blood loss mechanism must be quick, localized to the region of damage and carefully controlled?

A

Hemostatic response

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52
Q

What is defined as a sequence of responses that stops bleeding when vessels are injured?

A

Hemostasis (stasis-standing still)

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53
Q

What are the three mechanisms that can reduce loss of blood?

A

Vascular spasm
Platelet plug
Blood clotting

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54
Q

What response occurs when the smooth muscles of the vessel wall contract?

A

vascular spasm

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55
Q

What are the steps of a platelet plug formation?

A

Platelets contact and stick to damage vessel via collagen fibers
Platelets interact with each other and liberate chemicals
Chemicals activate nearby platelets and sustain vascular spasm
Eventually enough platelets form a mass called platelet plug

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56
Q

What is the straw-colored liquid called that is plasma without the clotting proteins?

A

Serum

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57
Q

What is the insoluble protein fibers that make up a clot called?

A

Fibrin

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58
Q

What is the process of clot formation called?

A

Clotting or coagulation

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59
Q

What elements do clotting factors include?

A 
Calcium ions (Ca2+)
Potassium (K)
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60
Q

Clotting factors are identified by what?

A

Roman numerals

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61
Q

What are the steps of the common pathway?

A

1-Prothombinase is formed
2-Prothombinase converts prothrombin into enzyme thrombin
3-Thrombin converts fibrinogen into insoluble fibrin

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62
Q

What forms the threads of a clot?

A

Fibrin

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63
Q

What habit can interfere with the production of fibrin?

A

Smoking

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64
Q

What is the consolidation or tightening of a fibrin clot that pulls the edge of damaged vessels closer called?

A

Clot retraction

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65
Q

Fibroblasts form what in the rupture area?

A

Connective tissue

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66
Q

What is the enzymatic breakdown of fibrin in a clot called?

A

Fibrinolysis

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67
Q

What is the inactive plasma enzyme created when a blood clot is formed called?

A

plasminogen

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68
Q

Plasminogen is activated to form plasmin that does what?

A

Digest and dissolves fibrin threads, removing the clot.

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69
Q

What can roughen endothelial surfaces of a blood vessel?

A

Atherosclerosis
Trauma
infection

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70
Q

What is clotting in an unbroken vessel called?

A

Thrombosis

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71
Q

What is the term for a thrombus that has dislodged and swept away in blood?

A

Embolus

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72
Q

What is the most common site for a embolus to be lodged?

A

Lungs

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73
Q

Antigens on a RBC are composed of what?

A

Glycolipids and glycoproteins

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74
Q

Antigens that occur in characteristic combinations are called?

A

Agglutinogens

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75
Q

There are at least how many blood groups?

A

24

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76
Q

What are the two major blood groups?

A

ABO and RH

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77
Q

What is the ABO blood group based on?

A

A and B antigens

78
Q

ABO type may appear where else other than blood?

A

saliva and body fluids

79
Q

Blood plasma contains antibodies that react with A or B antigens called?

A

Agglutinins

80
Q

RBCs with the Rh antigen are designated what?

A

Rh+ or Rh Positive

81
Q

When an Rh- person receives Rh+ blood the immune system will make what?

A

Antigen D antibodies

82
Q

What are some of the blood products used for blood transfusions?

A 
Fresh Whole Blood
Packed RBCs
Leukocyte poor blood
Autologous Packed RBC
Frozen RBCs
83
Q

What is the advantage of fresh whole blood?

A

Presence of RBCs, plasma and platelets in 1:1:1 ratio

84
Q

What are indications of use for FWB?

A 
Massive hemorrhage (more than 10 units needed)
Cardiac surgery
85
Q

FWB must be ABO and Rh specific. What is the exception?

A

Identified low titer O donor

86
Q

Whole blood walking blood bank must identify what percentage of crew and documented on what?

87
Q

What is the blood product most commonly used to raise hemoglobin?

A

Packed RBCs

88
Q

One unit of packed RBCs will bring up hemoglobin by how much?

89
Q

Guidelines suggest giving Packed RBCs when hemoglobin fails below what value?

90
Q

Ratio for transfusion must consist of what?

A

Ratio 1:1:1 of:
Packed RBCs
FFP
Platelets

91
Q

Leukocyte poor blood or leuko-reduced blood is used to reduce what?

A

Leukoagglutination reaction
platelet alloimmunization
TRALI
Cytomegaly virus

92
Q

How long can autologous packed RBCs be stored?

A

35 days, depending on anticoagulant

93
Q

Frozen RBCs can be frozen for how long?

94
Q

What is used to deglycerolize a blood unit in about 1 hour?

95
Q

A deglycerolized unit can be stored for how long after deglycing?

96
Q

Before transfusion what must happen with donor and recipient blood?

A

Type and cross-match

97
Q

What happens when antibodies interact with incompatible red cells?

A

immediate lysis

98
Q

Hemolytic Reactions mostly occur due to what?

A

clerical errors

99
Q

Signs and symptoms of hemolytic reaction?

A 
fever
chills
backache
headache
apprehension (impending doom, hypotension, cardiovascular collapse
tachycardia
generalized bleeding
100
Q

What actions are taken during hemolytic reaction?

A

Stop transfusion
Vigorous hydration
Forced diuresis with mannitol

101
Q

Symptoms of leukoagglutinin reaction?

A

Fever and chills within 12 hrs post transfusion

cough and dyspnea

102
Q

Treatment of leukoagglutinin reaction?

A

Acetaminophen 500-600mg PO
Diphenhydramine 25mg PO or IV
Hydrocortisone 1mg/kg IV

103
Q

What occurs during Graft versus Host Disease?

A

lymphocytes in transfused blood will engraft in some recipients and an allo-immune attack against tissues occurs

104
Q

What can be done to prevent graft vs host disease?

A

Use blood that has been irradiated

105
Q

What does the lymphatic system consist of?

A 
Lymph
Lymph nodes
Lymphatic nodules
Lymphatic vessels
Spleen
Red bone marrow
Thymus
106
Q

What type of tissue is lymphatic tissue?

A

Reticular connective tissue

107
Q

What is the main difference between interstitial fluid and lymph vs blood plasma?

A

interstitial and lymph contain less protein than blood

108
Q

How much interstitial fluid is filtered from blood into tissue spaces each day?

109
Q

How much interstitial fluid is filtered daily from arterial end of capillaries returns to the blood by reabsorption at the venous end of capillaries?

110
Q

What amount of fluid is passed through lymphatic vessels and is returned to the blood?

111
Q

What are the three primary functions of the lymphatic system?

A

Drain excess interstitial fluid
Transport dietary lipids
Carry out immune response

112
Q

What dietary lipids are transported in the lymphatic system and absorbed by the GI tract into the blood?

113
Q

What are the two main channels that lymph passes through?

A

thoracic duct and right lymphatic duct

114
Q

What duct drains lymph from the right upper side of the body?

A

right lymphatic duct

115
Q

What are the two pumps that aid the flow of lymph?

A

Skeletal

Respiratory

116
Q

What are the two primary lymphatic organs?

A

Red bone marrow

Thymus

117
Q

What are secondary lymphatic organs?

A

Lymph nodes
Spleen
Lymphatic nodules

118
Q

Where are immature T cells located?

A

Red bone marrow

119
Q

Where are T cells matured?

120
Q

What are areas of heavy concentration for lymph nodes?

A

mammary glands, axillae and groin

121
Q

Lymph nodes contain what cells?

A 
B
T 
Dendritic
Macrophages
Plasma
122
Q

What is the largest single mass of lymphatic tissue in the body?

123
Q

What are the two pulps in the spleen?

A

Red and white pulp

124
Q

Which splenic pulp houses B and T cells that carry out immune responses?

125
Q

What is an egg-shaped mass of lymphatic tissue that is not surrounded by a capsule?

A

Lymphatic nodules

126
Q

Where are lymphatic nodules found?

A 
mucous membrane of:
GI
Urinary
Reproductive
Respiratory airways
127
Q

What are you born with that includes barriers of the first and second line of defense?

A

innate immunity

128
Q

What type of immunity involves lymphocytes?

A

Adaptive immunity

129
Q

What are the two types of adaptive immunity?

A

Cell-mediated

antibody mediated

130
Q

What is the first line of innate immunity?

A

skin and mucous membrane

131
Q

What is the 2nd line of defense?

A 
Antimicrobial substances
Phagocytes
NK Cells
Inflammation
Fever
132
Q

What proteins are produced with lymphocytes, macrophages and fibroblasts are infected with viruses?

A

interferons

133
Q

What are the four antimicrobial substances?

A

Interferons
Complement System
Iron-binding proteins
Antimicrobial proteins

134
Q

What are examples of how the complement system works?

A

Cytolysis
Chemotaxis
Opsonization

135
Q

What are the four signs of inflammation?

A

redness
pain
heat
swelling

136
Q

Fever occurs to do what action?

A

Intensify effects of interferons
inhibit growth
speed up reactions that aid repair

137
Q

What is an antigen?

A

any foreign substance:

microbe
food
drug
pollen 
tissues
138
Q

Lack of reaction against self- tissues is called what?

A

self tolerance

139
Q

What are the two major types of T cells?

A

Helper T

Cytotoxic T

140
Q

What occurs in cell-mediated immunity?

A

Cytotoxic T cells directly attack invading antigens

141
Q

What occurs in antibody-mediated immunity?

A

B cells transform into plasma cells that synthesize and secrete antibodies

142
Q

What type of cell aids both immune responses?

A

Helper T Cells

143
Q

Cell mediated immunity is effective against what?

A

Intracellular pathogens (virus, bacteria, fungi)
Some cancer cells
foreign tissue transplants

144
Q

Antibody mediated immunity works mainly against what?

A

extracellular pathogens

145
Q

Which type of immunity is also referred to humoral immunity?

A

antibody-mediated immunity

146
Q

Clonal selection is what?

A

lymphocyte proliferates and differentiates in response to specific antigens

147
Q

Where does clonal selection occur?

A

secondary lymphatic organs and tissues

148
Q

What are the two types of cells that stem from clonal selection?

A

Memory and effector cells

149
Q

Antigens induce what cells to secrete proteins known as antibodies?

A

plasma cells

150
Q

What shapes can antibodies form?

A

T and Y shape

151
Q

What group of plasma proteins do antibodies belong to?

152
Q

What are the five different classes of immunoglobulins?

A 
IgG
IgA
IgM
IgE
IgD
153
Q

What immunoglobulin is the first to appear, is short lived and may indicate a recent infection?

154
Q

Where are IgA antibodies found?

A

Breast milk

155
Q

What must happen for an adaptive immune response to occur?

A

B and T cells must recognize a foreign antigen

156
Q

What are two causes of anemia?

A

Poor diet

Bleeding

157
Q

What are the anemic levels in males and females?

A

M-Less than 41%

F-Less than 37%

158
Q

What are symptoms of anemia?

A

Lymphadenopathy
Hepatosplenomegaly
Bone tenderness
Smooth tongue

159
Q

What labs would you use to dx anemia?

A

CBC w/ Diff

Iron with total iron binding capacity

160
Q

What value of ferritin would indicate iron deficiency anemia?

161
Q

What are the two types of anemias?

A

Iron Deficiency

Vitamin B12 Deficiency

162
Q

What are s/s of iron deficient anemia?

A

smooth tongue, brittle nails, cheilosis or angular stomatitis
craving for ice chips

163
Q

What is the medication and dose for oral iron?

A

Ferrous sulfate

325gm x3 daily for 3-6 months

164
Q

What are contraindications for ferrous sulfate?

A

hemolytic anemia
peptic ulcer disease
ulcerative colitis

165
Q

What patient education would you give when you prescribe ferrous sulfate?

A

constipating and black stool

166
Q

What type of anemia is identified by hypersegmented neutrophils on blood smear?

A

B12 deficiency

167
Q

B12 levels are below what in an anemic patient?

A

Serum b12 <100 pg/mL

168
Q

What is the daily absorption of B12?

169
Q

The liver contains how much stored vitamin b12?

A

2000-5000mcg

170
Q

B12 deficiency usually develops how long after absorption ceases?

171
Q

What are causes of B12 Anemia?

A 
Vegan
Abdominal Surgery
Fish tapeworm
Pancreatic insufficiency
Crohn disease
172
Q

What are the physical finding for b12 deficiency?

A

Glossitis
Anorexia
Diarrhea
Pale, paresthesia and balance problems (late)

173
Q

What is the hallmark seen on CBC w/ Diff for B12 deficient patients?

A

megaloblastic anemia (large RBCs)

174
Q

What is the treatment for a b12 deficient patient?

A

IM injection
Daily first week
weekly first month
monthly for life

175
Q

What is the disposition of a b12 deficient patient?

A

Medevac late stage

hematologist early stage

176
Q

What are the congenital disorders of coagulation?

A

Hemophilia A
Hemophilia B
HIV or Hep C

177
Q

Hemophilia A involves what coag factor?

178
Q

Hemophilia B involves what coag factor?

179
Q

What is a systemic process with the potential for causing thrombosis and hemorrhage?

A

Disseminated intravascular coagulation (DIC)

180
Q

What are common causes of DIC?

A

*Sepsis
*Malignancy
*Trauma
Obstetrical complications
Intravascular hemolysis
Heat stroke, crush inj, snake bite (less common)

181
Q

What is the disposition for a DIC patient?

182
Q

What medications would you give a DIC patient?

A

Heparin

Coumadin

183
Q

What s/s would you have with a DIC patient?

A 
Bruising (w/o MOI)
Bleeding in joint spaces
Epistaxis
Bleeding from eyes
Heavy vaginal bleeding for prolonged periods
184
Q

What labs would you collect for a DIC patient?

A

PT
PTT
INR
CBC

185
Q

What percentage of black men are affected by G6PD?

186
Q

What is a hereditary enzyme defect caused by RBCs inability to deal with oxidative stress?

187
Q

What are precipitants from denatured oxidized hemoglobin called?

A

Heinz bodies

188
Q

Heinz bodies lead to membrane damage and are removed by what?

189
Q

G6PD is caused by what?

A

Infection

Drugs-Primaquine or Aspirin

190
Q

Treatment includes what for G6PD?

A

Avoid oxidant
Patient Education
Red dog tag
Transfusion(severe)

191
Q

What percent of American blacks carry sickle cell gene?

192
Q

What is the hematocrit level for sickle cell patients?

IDC Stuff (67 decks)

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