Blood and Lymph Flashcards
1
Q
What is a liquid connective tissue that consists of cells surrounded by extracellular matrix?
A
Blood
2
Q
What are the three general functions of blood?
A
Transportation
Regulation
Protection
3
Q
What does blood transport?
A
Oxygen Carbon dioxide nutrients heat waste hormones
4
Q
What does blood regulate in the body?
A
pH
Heat
Blood osmotic pressure
5
Q
How does the blood protect the body?
A
Blood Clots Disease (WBC) -phagocytosis -antibodies -interferons -complement
6
Q
What is the temperature of blood?
A
100.4F or 38C
7
Q
What is the pH of blood?
A
7.35 to 7.45
8
Q
How much of the total body weight does blood constitute for?
A
8%
9
Q
What is the average blood volume for males and females?
A
M- 5-6L
F- 4-5L
10
Q
Whole blood is composed of what two parts?
A
Blood plasma
Formed Elements
11
Q
What percentage of blood is formed elements?
A
45%
12
Q
What is a liquid extracellular matrix that contains dissolved substances?
A
Blood plasma
13
Q
Formed elements of the blood are what?
A
Cells and cell fragments
14
Q
What percentage of formed elements is made up of red blood cells?
A
99%
15
Q
What constitutes 1% of formed elements?
A
White blood cells and platelets
16
Q
Plasma is what percentage of the blood volume?
A
55%
17
Q
What is the percentage of total blood volume occupied by red blood cells?
A
Hematocrit
18
Q
What is the normal range of HCT for males and females?
A
M- 42-52%
F- 37-47%
19
Q
What is the buffy coat made up of?
A
WBC and platelets
20
Q
What does blood plasma consist of and what are the percentages?
A
91.5% water
7% protein
1.5% solutes
21
Q
Where are proteins in the blood synthesized?
A
mainly in the liver
22
Q
What is the most plentiful plasma proteins?
A
Albumins-54%
Fibrinogen-7%
23
Q
What oxygen-carrying protein is contained by RBCs and gives red pigmentation of the cell?
A
Hemoglobin
24
Q
Hemoglobin carries about what percentage of carbon dioxide in the blood?
A
23%
25
What is the RBC count for males and females?
M- 5.4m
| F- 4.8m
26
RBCs live for how long?
120 days
27
What is the normal level of WBCs in the body?
5-10k/uL
28
What is the life span of a WBC?
few hours to days
29
What is the main differences of WBCs and RBCs?
WBCs-have nuclei and organelles do not contain hemoglobin
30
What are the two classifications of WBCs?
Granular and agranular
31
What are the granular leukocytes?
Neutrophils
Eosinophils
Basophils
32
Neutrophils account for what percentage of WBCs and carry out what action?
50-70%
Phagocytosis
-destroy bacteria with lysozymes, defensins and strong oxidants
33
What percent of WBCs is Eosinophils and what is their function?
1-5%
Suppress effects of histamine
Phagocytizes antigen-antibody complexes
Destroys certain parasitic worms
34
What percentage of WBCs are Basophils and what is their function?
0-1%
| Releases heparin, histamine and serotonin to intensify inflammatory response in allergic reactions
35
What are the agranular leukocytes?
Lymphocytes
| Monocytes
36
Lymphocytes include what cells?
T
B
Natural Killer
37
What percentage of all WBCs are leukocytes and what is their function?
```
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
```
38
Monocytes are what percentage of WBCs and what is their function?
1-6%
Phagocytic
-transform to a fixed histiocyte or wondering macrophage
39
What is the normal platelet count in an adult?
150k to 400k/uL
40
Platelets live for how long?
5-9 days
41
Platelets form platelet plugs during hemostasis that do what?
Release chemicals to promote vascular spasm and blood clotting
42
What is the process by which the formed elements of blood develop?
Hemopoiesis
43
What is the primary site of hemopoiesis?
Red bone marrow
44
What type of cells have the capacity to develop into different cell types?
pluripotent stem cells
45
Stem cells can further differentate into what cell lines?
myeloid and lymphoid
46
What cells can myeloid stem cells differentiate into?
```
Red cells
Platelets
Mast Cells
Eosinophils
Basophils
Neutrophils
Monocytes
```
47
Lymphoid stem cells develop in the marrow but mature in lymphatic tissue are what?
T cells
B Cells
Natural Killer Cells
48
Immature cells in peripheral blood are known as what?
Bands and Blasts
49
What is a left shift? And what does it indicate?
>10% bands
| body is fighting infection over long period of time that doesn't allow bone marrow to keep up
50
Blast, the most immature cells, are associated with what?
myelodysplastic disorders
51
What in the blood loss mechanism must be quick, localized to the region of damage and carefully controlled?
Hemostatic response
52
What is defined as a sequence of responses that stops bleeding when vessels are injured?
Hemostasis (stasis-standing still)
53
What are the three mechanisms that can reduce loss of blood?
Vascular spasm
Platelet plug
Blood clotting
54
What response occurs when the smooth muscles of the vessel wall contract?
vascular spasm
55
What are the steps of a platelet plug formation?
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
56
What is the straw-colored liquid called that is plasma without the clotting proteins?
Serum
57
What is the insoluble protein fibers that make up a clot called?
Fibrin
58
What is the process of clot formation called?
Clotting or coagulation
59
What elements do clotting factors include?
```
Calcium ions (Ca2+)
Potassium (K)
```
60
Clotting factors are identified by what?
Roman numerals
61
What are the steps of the common pathway?
1-Prothombinase is formed
2-Prothombinase converts prothrombin into enzyme thrombin
3-Thrombin converts fibrinogen into insoluble fibrin
62
What forms the threads of a clot?
Fibrin
63
What habit can interfere with the production of fibrin?
Smoking
64
What is the consolidation or tightening of a fibrin clot that pulls the edge of damaged vessels closer called?
Clot retraction
65
Fibroblasts form what in the rupture area?
Connective tissue
66
What is the enzymatic breakdown of fibrin in a clot called?
Fibrinolysis
67
What is the inactive plasma enzyme created when a blood clot is formed called?
plasminogen
68
Plasminogen is activated to form plasmin that does what?
Digest and dissolves fibrin threads, removing the clot.
69
What can roughen endothelial surfaces of a blood vessel?
Atherosclerosis
Trauma
infection
70
What is clotting in an unbroken vessel called?
Thrombosis
71
What is the term for a thrombus that has dislodged and swept away in blood?
Embolus
72
What is the most common site for a embolus to be lodged?
Lungs
73
Antigens on a RBC are composed of what?
Glycolipids and glycoproteins
74
Antigens that occur in characteristic combinations are called?
Agglutinogens
75
There are at least how many blood groups?
24
76
What are the two major blood groups?
ABO and RH
77
What is the ABO blood group based on?
A and B antigens
78
ABO type may appear where else other than blood?
saliva and body fluids
79
Blood plasma contains antibodies that react with A or B antigens called?
Agglutinins
80
RBCs with the Rh antigen are designated what?
Rh+ or Rh Positive
81
When an Rh- person receives Rh+ blood the immune system will make what?
Antigen D antibodies
82
What are some of the blood products used for blood transfusions?
```
Fresh Whole Blood
Packed RBCs
Leukocyte poor blood
Autologous Packed RBC
Frozen RBCs
```
83
What is the advantage of fresh whole blood?
Presence of RBCs, plasma and platelets in 1:1:1 ratio
84
What are indications of use for FWB?
```
Massive hemorrhage (more than 10 units needed)
Cardiac surgery
```
85
FWB must be ABO and Rh specific. What is the exception?
Identified low titer O donor
86
Whole blood walking blood bank must identify what percentage of crew and documented on what?
10%
| DD572
87
What is the blood product most commonly used to raise hemoglobin?
Packed RBCs
88
One unit of packed RBCs will bring up hemoglobin by how much?
1 g/dL
89
Guidelines suggest giving Packed RBCs when hemoglobin fails below what value?
7-8/dL
90
Ratio for transfusion must consist of what?
Ratio 1:1:1 of:
Packed RBCs
FFP
Platelets
91
Leukocyte poor blood or leuko-reduced blood is used to reduce what?
Leukoagglutination reaction
platelet alloimmunization
TRALI
Cytomegaly virus
92
How long can autologous packed RBCs be stored?
35 days, depending on anticoagulant
93
Frozen RBCs can be frozen for how long?
10 years
94
What is used to deglycerolize a blood unit in about 1 hour?
ACP215
95
A deglycerolized unit can be stored for how long after deglycing?
14 days
96
Before transfusion what must happen with donor and recipient blood?
Type and cross-match
97
What happens when antibodies interact with incompatible red cells?
immediate lysis
98
Hemolytic Reactions mostly occur due to what?
clerical errors
99
Signs and symptoms of hemolytic reaction?
```
fever
chills
backache
headache
apprehension (impending doom, hypotension, cardiovascular collapse
tachycardia
generalized bleeding
```
100
What actions are taken during hemolytic reaction?
Stop transfusion
Vigorous hydration
Forced diuresis with mannitol
101
Symptoms of leukoagglutinin reaction?
Fever and chills within 12 hrs post transfusion
| cough and dyspnea
102
Treatment of leukoagglutinin reaction?
Acetaminophen 500-600mg PO
Diphenhydramine 25mg PO or IV
Hydrocortisone 1mg/kg IV
103
What occurs during Graft versus Host Disease?
lymphocytes in transfused blood will engraft in some recipients and an allo-immune attack against tissues occurs
104
What can be done to prevent graft vs host disease?
Use blood that has been irradiated
105
What does the lymphatic system consist of?
```
Lymph
Lymph nodes
Lymphatic nodules
Lymphatic vessels
Spleen
Red bone marrow
Thymus
```
106
What type of tissue is lymphatic tissue?
Reticular connective tissue
107
What is the main difference between interstitial fluid and lymph vs blood plasma?
interstitial and lymph contain less protein than blood
108
How much interstitial fluid is filtered from blood into tissue spaces each day?
20 liters
109
How much interstitial fluid is filtered daily from arterial end of capillaries returns to the blood by reabsorption at the venous end of capillaries?
17 liters
110
What amount of fluid is passed through lymphatic vessels and is returned to the blood?
3 liters
111
What are the three primary functions of the lymphatic system?
Drain excess interstitial fluid
Transport dietary lipids
Carry out immune response
112
What dietary lipids are transported in the lymphatic system and absorbed by the GI tract into the blood?
K
A
D
E
113
What are the two main channels that lymph passes through?
thoracic duct and right lymphatic duct
114
What duct drains lymph from the right upper side of the body?
right lymphatic duct
115
What are the two pumps that aid the flow of lymph?
Skeletal
| Respiratory
116
What are the two primary lymphatic organs?
Red bone marrow
| Thymus
117
What are secondary lymphatic organs?
Lymph nodes
Spleen
Lymphatic nodules
118
Where are immature T cells located?
Red bone marrow
119
Where are T cells matured?
Thymus
120
What are areas of heavy concentration for lymph nodes?
mammary glands, axillae and groin
121
Lymph nodes contain what cells?
```
B
T
Dendritic
Macrophages
Plasma
```
122
What is the largest single mass of lymphatic tissue in the body?
spleen
123
What are the two pulps in the spleen?
Red and white pulp
124
Which splenic pulp houses B and T cells that carry out immune responses?
White
125
What is an egg-shaped mass of lymphatic tissue that is not surrounded by a capsule?
Lymphatic nodules
126
Where are lymphatic nodules found?
```
mucous membrane of:
GI
Urinary
Reproductive
Respiratory airways
```
127
What are you born with that includes barriers of the first and second line of defense?
innate immunity
128
What type of immunity involves lymphocytes?
Adaptive immunity
129
What are the two types of adaptive immunity?
Cell-mediated
| antibody mediated
130
What is the first line of innate immunity?
skin and mucous membrane
131
What is the 2nd line of defense?
```
Antimicrobial substances
Phagocytes
NK Cells
Inflammation
Fever
```
132
What proteins are produced with lymphocytes, macrophages and fibroblasts are infected with viruses?
interferons
133
What are the four antimicrobial substances?
Interferons
Complement System
Iron-binding proteins
Antimicrobial proteins
134
What are examples of how the complement system works?
Cytolysis
Chemotaxis
Opsonization
135
What are the four signs of inflammation?
redness
pain
heat
swelling
136
Fever occurs to do what action?
Intensify effects of interferons
inhibit growth
speed up reactions that aid repair
137
What is an antigen?
any foreign substance:
```
microbe
food
drug
pollen
tissues
```
138
Lack of reaction against self- tissues is called what?
self tolerance
139
What are the two major types of T cells?
Helper T
| Cytotoxic T
140
What occurs in cell-mediated immunity?
Cytotoxic T cells directly attack invading antigens
141
What occurs in antibody-mediated immunity?
B cells transform into plasma cells that synthesize and secrete antibodies
142
What type of cell aids both immune responses?
Helper T Cells
143
Cell mediated immunity is effective against what?
Intracellular pathogens (virus, bacteria, fungi)
Some cancer cells
foreign tissue transplants
144
Antibody mediated immunity works mainly against what?
extracellular pathogens
145
Which type of immunity is also referred to humoral immunity?
antibody-mediated immunity
146
Clonal selection is what?
lymphocyte proliferates and differentiates in response to specific antigens
147
Where does clonal selection occur?
secondary lymphatic organs and tissues
148
What are the two types of cells that stem from clonal selection?
Memory and effector cells
149
Antigens induce what cells to secrete proteins known as antibodies?
plasma cells
150
What shapes can antibodies form?
T and Y shape
151
What group of plasma proteins do antibodies belong to?
Globulins
152
What are the five different classes of immunoglobulins?
```
IgG
IgA
IgM
IgE
IgD
```
153
What immunoglobulin is the first to appear, is short lived and may indicate a recent infection?
IgM
154
Where are IgA antibodies found?
Breast milk
155
What must happen for an adaptive immune response to occur?
B and T cells must recognize a foreign antigen
156
What are two causes of anemia?
Poor diet
| Bleeding
157
What are the anemic levels in males and females?
M-Less than 41%
| F-Less than 37%
158
What are symptoms of anemia?
Lymphadenopathy
Hepatosplenomegaly
Bone tenderness
Smooth tongue
159
What labs would you use to dx anemia?
CBC w/ Diff
| Iron with total iron binding capacity
160
What value of ferritin would indicate iron deficiency anemia?
<12 mcg/L
161
What are the two types of anemias?
Iron Deficiency
| Vitamin B12 Deficiency
162
What are s/s of iron deficient anemia?
smooth tongue, brittle nails, cheilosis or angular stomatitis
craving for ice chips
163
What is the medication and dose for oral iron?
Ferrous sulfate
| 325gm x3 daily for 3-6 months
164
What are contraindications for ferrous sulfate?
hemolytic anemia
peptic ulcer disease
ulcerative colitis
165
What patient education would you give when you prescribe ferrous sulfate?
constipating and black stool
166
What type of anemia is identified by hypersegmented neutrophils on blood smear?
B12 deficiency
167
B12 levels are below what in an anemic patient?
Serum b12 <100 pg/mL
168
What is the daily absorption of B12?
5mcg
169
The liver contains how much stored vitamin b12?
2000-5000mcg
170
B12 deficiency usually develops how long after absorption ceases?
3 years
171
What are causes of B12 Anemia?
```
Vegan
Abdominal Surgery
Fish tapeworm
Pancreatic insufficiency
Crohn disease
```
172
What are the physical finding for b12 deficiency?
Glossitis
Anorexia
Diarrhea
Pale, paresthesia and balance problems (late)
173
What is the hallmark seen on CBC w/ Diff for B12 deficient patients?
megaloblastic anemia (large RBCs)
174
What is the treatment for a b12 deficient patient?
IM injection
Daily first week
weekly first month
monthly for life
175
What is the disposition of a b12 deficient patient?
Medevac late stage
| hematologist early stage
176
What are the congenital disorders of coagulation?
Hemophilia A
Hemophilia B
HIV or Hep C
177
Hemophilia A involves what coag factor?
VIII
178
Hemophilia B involves what coag factor?
IX
179
What is a systemic process with the potential for causing thrombosis and hemorrhage?
Disseminated intravascular coagulation (DIC)
180
What are common causes of DIC?
*Sepsis
*Malignancy
*Trauma
Obstetrical complications
Intravascular hemolysis
Heat stroke, crush inj, snake bite (less common)
181
What is the disposition for a DIC patient?
Medevac
182
What medications would you give a DIC patient?
Heparin
| Coumadin
183
What s/s would you have with a DIC patient?
```
Bruising (w/o MOI)
Bleeding in joint spaces
Epistaxis
Bleeding from eyes
Heavy vaginal bleeding for prolonged periods
```
184
What labs would you collect for a DIC patient?
PT
PTT
INR
CBC
185
What percentage of black men are affected by G6PD?
10-15%
186
What is a hereditary enzyme defect caused by RBCs inability to deal with oxidative stress?
G6PD
187
What are precipitants from denatured oxidized hemoglobin called?
Heinz bodies
188
Heinz bodies lead to membrane damage and are removed by what?
spleen
189
G6PD is caused by what?
Infection
| Drugs-Primaquine or Aspirin
190
Treatment includes what for G6PD?
Avoid oxidant
Patient Education
Red dog tag
Transfusion(severe)
191
What percent of American blacks carry sickle cell gene?
8%
192
What is the hematocrit level for sickle cell patients?
20-30%
