Blood and vessels Flashcards
1
Q
5 functions of blood
A
transport (waste, nutrients, oxygen), temperature regulation, immunity, communication, defense
2
Q
plasma contents (7)
A
water, nutrients, electrolytes, proteins (albumin, globulins, fibrinogen), nitrogenous wastes, hormones, gases
3
Q
what does differential blood count do
A
show percentage of WBC type in blood sample
4
Q
normal differential blood count neutrophil
A
40-60%
5
Q
normal differential blood count lymphocyte
A
20-40%
6
Q
normal differential blood count monocyte
A
2-8%
7
Q
normal differential blood count eosinophil
A
1-4%
8
Q
normal differential blood count basophil
A
0.5-1%
9
Q
normal differential blood count band (young neutrophil)
A
0-3%
10
Q
neutrophil levels raised in (5)
A
bacterial infection, inflammation, haemorrhage, infarction, trauma/surgery/burns
11
Q
neutrophil levels decreased in
A
viral infection
12
Q
lymphocyte levels raised in (5)
A
viral infections, glandular fever, TB, syphilis, whooping cough
13
Q
lymphocyte levels decreased in (3)
A
AIDS, steroid therapy, post chemo/radiotherapy
14
Q
eosinophil levels raised in (3)
A
asthma, allergy, parasitic infection
15
Q
monocyte levels raised in (2)
A
acute chronic infections (e.g. TB), malignant disease
16
Q
basophil levels raised in (6)
A
viral infection, malignancy, haemolysis, post-splenectomy, urticaria, hypothyroidism
17
Q
histology of platelet (2)
A
very small, blood clotting
18
Q
histology of monocyte (2)
A
macrophage, B shaped nucleus
19
Q
lymphocyte histology (3)
A
similar to monocyte, circular nucleus, darker staining
20
Q
neutrophil histology (2)
A
big nucleus, multilobed nucleus
21
Q
basophil histology (4)
A
2 nuclear lobes, not easily distinguishable, granular, lighter staining
22
Q
eosinophil histology (4)
A
2 nuclear lobes, easily distinguishable, granular, darker staining
23
Q
neutrophils wander in
A
connective tissues
24
Q
2 methods of neutrophil bacteria killing
A
phagocytosis and digestion, bactericidal chemical cloud
25
neutrophil enzymes catalyse which reaction
respiratory burst
26
in presence of bacteria, neutrophil lysosomes migrate to cell surface and
degranulate
27
respiratory burst (neutrophil) - neutrophil rapidly absorbs
oxygen
28
respiratory burst (neutrophil) - oxygen reduced to
superoxide anions
29
respiratory burst (neutrophil) - superoxide anions react with hydrogen to produce
hydrogen peroxide
30
respiratory burst (neutrophil) - chloride ions in tissue fluid form
hypochlorite
31
respiratory burst (neutrophil) - 3 highly toxic chemicals produced
hypochlorite, hydrogen peroxide, superoxide anions
32
eosinophils most numerous in
mucous membranes
33
eosinophils concentrated at sites of (3)
allergy, imflammation, parasitic infection
34
eosinophils help kill parasites (e.g. tape worms) by producing (2 chemicals, 1 other)
superoxide, hydrogen peroxide, toxic chemicals (e.g. neurotoxin)
35
eosinophils promote action of which 2 cells
basophils and mast cells
36
eosinophils secrete enzymes that degrade and limit the action of
histamine (and other inflammatory chemicals)
37
basophils secrete chemicals that aid the mobility and action of
other leukocytes
38
basophils secrete (3)
leukotrienes, histamine, heparin
39
function of leukotrienes
activate and attract neutrophils and eosinophils
40
functions of histamine (3)
vasodilator, increases blood flow, speeds delivery of leukocytes to area
41
function of heparin
anticoagulant
42
5% of circulating blood lymphocytes are (2)
natural killer cells and stem cells
43
80% of circulating blood lymphocytes are
T cells
44
15% of circulating blood lymphocytes are
B cells
45
monocytes are in
blood
46
monocytes in connective tissues are known as
macrophages
47
erythrocyte function (2)
oxygen delivery, carbon dioxide transportation
48
erythrocyte shape
discoidal
49
erythrocytes doesn't have (2)
nucleus, organelles
50
erythrocyte method of ATP production
anaerobic fermentation
51
2 cytoskeletal proteins in erythrocytes
spectrin, actin
52
percentage of erythrocyte that is Hb
33%
53
Hb has which 4 globins
2 alpha chains, 2 beta chains
54
each Hb chain has
haem group
55
what does haem group do
binds oxygen to ferrous ion
56
percentage of carbon dioxide transported by Hb
5%
57
adult form of haemoglobin
HbA
58
foetal form of haemoglobin
HbF
59
HbF has two what chains instead of beta chains
gamma chains
60
do gamma or beta chains have higher oxygen affinity
gamma
61
tests for Hb (2)
haematocrit, finger prick test
62
percentage of HbA which is HbA2
2.5%
63
HbA2 has what instead of beta chains
delta chains
64
percentage of HbA which is HbAO
92-94%
65
percentage fo HbA which is HbA1
6-8%
66
HbA1 beta chain has additional what
glucose group
67
erythropoiesis takes how long
~3-5 days
68
four major developments in erythropoiesis
reduction in cell size, increase in cell number, synthesis of Hb, loss of nucleus and organelles
69
in erythropoiesis, pluripotent stem cell develops into
erythrocyte colony-forming unit
70
erythrocyte colony-forming unit has receptors for
erythropoietin
71
function of erythropoietin
stimulates erythrocyte colony-forming unit to transform into erythroblast (normoblast)
72
erythrocyte- colony-forming unit transforms into
erythroblast (normoblast)
73
erythroblasts (normoblasts) multiply and synthesise
Hb
74
once Hb synthesised, nucleus shrivels and
is discharged from cell
75
once nucleus is discharged from normoblast with Hb, cell known as
reticulocyte
76
reitculocyte enters
circulating blood
77
once in blood, cells from erythropoiesis are known as
mature erythrocytes
78
multipotent stem cells in red bone marrow are known as
haemocytoblasts
79
sites of haemopoiesis as embryo (5)
yolk sac (first 8 weeks of development) then to liver, spleen, thymus and bone marrow
80
sites of haemopoiesis as child (2)
liver and spleen
81
site of haemopoiesis as adult
red bone marrow
82
red bone marrow is found in which bones (2)
flat and long bones
83
myeloid stem cells develop into (2)
RBCs and several classes of WBCs
84
lymphoid stem cells develop into
lymphocytes
85
after reticulocytes enter blood stream, how long does it take for complete maturation into mature RBCs
24 hours
86
erythrocyte life span
100-120 days
87
after 120 days, what erythrocyte damage is detected by phagocytes
plasma membrane rupture / other damage
88
types of agglutinogens (2)
A or B
89
Blood group A has which antigens on RBCs
A antigens
90
Blood group A has which antibodies in plasma
anti-B
91
Blood group B has which antigens on RBCs
B antigens
92
Blood group B has which antibodies in plasma
anti-A
93
Blood group O has which antigens on RBCs
no antigens
94
Blood group O has which antibodies in plasma
A and B antigens
95
Blood group AB has which antigens on RBCs
A and B antigens
96
Blood group AB has which antibodies in plasma
no antibodies
97
A and B are
codominant
98
O is
recessive
99
Anti-A and Anti-B antibodies are usually what type of antibody
IgM
100
O individuals can also produce which type of ABO antibodies
IgG
101
Rh+ is
dominant
102
Rh- is
recessive
103
Rh gene is one gene (RHD) located where
chromosome 1
104
precursor to ABO blood group antigens are
H antigens
105
Absence of H antigen is similar to which blood group
O
106
Gene for H antigen where
chromosome 19
107
ABO locus is where
chromosome 9
108
macrophages of where (3) play role in recycling RBC components
liver, spleen, bone marrow
109
during haemolysis, Hb breaks down and alpha and beta chains are filtered by
kidneys
110
breakdown of Hb, haem group is stripped of iron and converted to
biliverdin
111
breakdown of Hb, haem group is stripped of iron and converted to biliverdin which is then converted to
bilirubin
112
bilirubin is released into blood stream and binds to
albumin
113
bilirubin and albumin transported to liver and excreted as
bile
114
Haemoglobinuria definition
urine red/brown due to excess RBC breakdown
115
Haematuria definition
intact RBCs in urine
116
Haematuria occurs after (2)
kidney damage or damage to vessel along urinary tract
117
jaundice definition
bile duct blocked/liver unable to absorb bilirubin -> bilirubin diffuses into peripheral tissues --> yellow colour
118
location of spleen
left hypochondriac region, inferior to diaphragm, posterolateral to stomach.
119
spleen protected by which ribs
10-12
120
spleen indentations
gastric area and renal area
121
spleen of hilum penetrated by (3)
splenic artery, splenic vein, lymphatic vessels
122
parenchyma of spleen has two types of tissue
red pulp, white pulp
123
red pulp contains
sinuses gorged with concentrated erythrocytes
124
white pulp contains
lymphocytes and macrophages aggregated with sleeves along small branches of splenic artery
125
consequence of splenectomy
more vulnerable to infection
126
innervation of spleen
splenic plexus
127
spleen has what type of circulation
open
128
open circulation meaning
blood squeezes through walls of sheathed capillaries into sinuses
129
sinus of spleen drain into
larger sinuses
130
larger sinuses of spleen drain into
splenic vein
131
splenic vein drains into
hepatic portal vein
132
splenic artery branches
repeatedly through parenchyma
133
larger arteries of spleen surrounded by
fibrocollagenous sheath
134
fibrocollagenous sheath of spleen disappears in
smaller branches
135
smaller branches of spleen form
smaller arterties
136
smaller arteries of spleen give off
number of short branches at right angles
137
short branches given off by smaller arteries are known as
penicilliary arteries
138
penicilliary arteries end in
sheathed capillaries
139
sheathed capillaries of spleen have
blind-ending
140
yellow bone marrow develops
adipose tissue
141
5 mechanisms of venous return to the heart
pressure gradient, gravity, skeletal muscle pump, thoracic (respiratory pump), cardiac suction
142
venous pressure gradient favours blood flow in which direction?
back towards heart
143
pressure gradient and venous return increase when (2)
blood volume increases and general widespread vasoconstriction
144
Skeletal muscle pump --> in limbs, veins are ... and ... by muscles
surrounded and massaged
145
Skeletal muscle pump - contracting muscles squeeze blood out of compressed part of vein - what ensures blood flow in only one direction?
valves
146
thoracic (respiratory) pump aids flow of venous blood from... to ...
from abdominal to thoracic cavity
147
cardiac suction happens during
ventricular systole
148
during ventricular systole, chordae tendinae of AV valves pull cusps, expanding atrial space. This creates
suction which draws blood from venae cavae and pulmonary veins
149
define circulatory shock
cardiac output insufficient to meet body's metabolic needs
150
two types of circulatory shock
cardiogenic shock, low venous return shock
151
cardiogenic shock caused by
inadequate pumping of heart
152
3 main types of low venous return shock
hypovolemic shock, obstructed venous return shock, venous pooling (vascular) shock
153
definition of low venous return shock
cardiac output low because too little blood returning to heart
154
most common type of low venous return shock
hypovolemic shock
155
definition hypovolemic shock
loss of blood volume due to trauma, haemorrhage, bleeding ulcers, burns, dehydration
156
definition of obstructed venous return shock
when blockage e.g. tumour, aneurysm blocks vein so blood flow is impeded on return to heart
157
definition of venous pooling (vascular) shock
normal total blood volume but too much blood accumulating in limbs
158
septic shock definition
bacterial toxins trigger vasodilation and increase capillary permeability
159
compensated shock definition
body trying to compensate for blood loss
160
decompensated shock definition
body's mechanisms unable to continue compensating for blood loss
161
in compensated shock, hypotension triggers which reflex
baroreflex
162
in compensated shock, baroreflex triggers production of...
angiotensin II
163
angiotensin II from baroreflex triggers..
vasoconstriction
164
in compensated shock, falling or fainting means gravity restores blood flow to
brain
165
in decompensated shock, myocardial ischaemia and infarction lead to weakened heart and
cardiac output further reduced
166
in decompensated shock, poor circulation leads to
disseminated intravascular coagulation, congested vessels and therefore reduced venous return
167
in decompensated shock, ischaemia and acidosis of brainstem lead suppression of ... which leads to loss of vasomotor tone > vasodilation > drop in BP > cardiac output reduced
vasomotor and cardiac centres
168
internal bleeding definition
damage to artery or vein allows blood to collect in surrounding environment
169
causes of internal bleeding (7)
blunt trauma (compression of internal organs), deceleration trauma (shift of organs upon deceleration), fractures (bone marrow = site of blood production), pregnancy, medication, spontaneous, alcohol abuse
170
usual treatment of internal bleeding
surgery to repair site of damage and rectify cause
171
short term cardiovascular response to low blood volume and haemorrhage
elevate BP
172
long term cardiovascular response to low blood volume and haemorrhage
restoration of blood volume
173
elevation of BP can be achieved by .... and .... reflexes increased cardiac output and causing peripheral vasoconstriction > increases heart rate
carotid and aortic reflexes
174
elevation of BP can be achieved by stress and anxiety which stimulate .... nervous system headquarters in hypothalamus
sympathetic
175
elevation of BP, stimulation of the sympathetic nervous system headquarters triggers further increase in vasomotor tone > constricts arterioles > raises BP. Vasoconstriction mobilises .... which improves ....
venous reserve ... venous return
176
elevation of BP, sympathetic activation stimulates the adrenal medulla to secrete ... and .... which increases cardiac output and extends peripheral vasoconstriction
adrenaline and noradrenaline
177
elevation of BP, sympathetic activation stimulates posterior pituitary to release .... and stimulates production of .... which enhances vasoconstriction
ADH .... angiotensin II
178
long term cardiovascular response to low blood volume and haemorrhage include
decline in capillary BP (recall of fluid from interstitial spaces) , aldosterone and ADH promote fluid retention and reabsorption at kidneys, thirst increases and digestive tract absorbs additional water, erythropoietin stimulates RBC production
179
3 signs of shock:
low BP, low body temperature, rapid pulse (often weak and thready)
180
treatment of shock in hospital (7)
IV (blood or blood products), medication to increase BP and CO, heart monitoring, Swan-Ganz catheterisation, stopping bleeding, blood transfusion or alternatives
181
Swan-Ganz catheter is what type of catheter?
pulmonary artery catheter
182
3 uses of Swan-Ganz catheter
detect sepsis and heart failure, monitor effects of drugs and treatment
183
Swan-Ganz catheter directly measures pressure in (3)
right atrium, right ventricle, pulmonary artery
184
Swan-Ganz catheter measures wedge pressure of
left atrium (filling pressure)
185
Swan-Ganz catheter has what type of tip?
balloon
186
Swan-Ganz catheter can distinguish between what two types of shock
hypovolemic and cardiogenic
187
Preferred neck site of insertion of Swan-Ganz catheter (4 veins)
Right Internal Jugular > Left Subclavian > Right Subclavian > Left Internal Jugular
188
Left subclavian vein for Swan-Ganz catheter does not require catheter to
pass course at acute angle to enter superior vena cava
189
In addition to the neck, Swan-Ganz catheter can be inserted into (2)
wrist, leg (femorally)
190
what kind of route is used for left heart catheterisation
arterial
191
what kind of route is used for right heart catheterisation
venous
192
fractures of lower limb should be considered potential cause of
hypovolemic shock
193
splintage of fractures can reduce
blood loss
194
later complications of fractures include (4)
fat embolism, DVT, PE, infection
195
compartment syndrome definition
bleeding into closed fascial space
196
compartment syndrome takes up to how many hours to develop
48
197
compartment syndrome is common in significant ..... fractures although it is possible in .... fractures too
closed; open
198
compartment syndrome symptoms (5)
pain despite analgesia, extreme pain when moving toes, pallor, pulselessness, paraesthesia
199
treatment of compartment syndrome (3)
oxygen by mask, fluid into veins, fasciotomy
200
possible complications of compartment syndrome (6)
permanent nerve damage, permanent muscle damage, permanent scarring, loss of limb, infection, kidney failure
201
respiratory acidosis from
hypoventilation
202
respiratory alkalosis from
hyperventilation
203
respiratory acidosis is due to
imbalance of ventilation-perfusion rates - too much CO2 left in blood stream
204
respiratory alkalosis is due to
imbalance of ventilation-perfusion rates - too much CO2 removed from body
205
buffer definition
any mechanism that resists change in pH by converting strong acid/base into weak one
206
metabolic acidosis can be from (2)
lactic acid production or base loss (e.g. diarrhoea)
207
metabolic alkalosis is rare but can result from (2)
overuse of bicarbonates or from loss of stomach acid
208
type 1 respiratory failure oxygen and carbon dioxide levels
low oxygen, normal or low carbon dioxide
209
type 2 respiratory failure oxygen and carbon dioxide levels
low oxygen, high carbon dioxide
210
bicarbonate buffer system is a solution of
carbonic acid and bicarbonate ions
211
bicarbonate buffer system equation
CO2 + H2O H2Co3 HCO3- + H+
212
phosphate buffer system equation
H2PO4- HPO4(2-) + H+
213
phosphate buffer system is .... that bicarbonate buffer system
stronger
214
phosphate buffer system is more important where? why?
renal tubules; closer to optimum pH
215
renal tubules secrete ........... into tubular fluid where it binds to .........., ........... and ........... > excreted in urines
hydrogen ions; bicarbonate, ammonia, phosphate buffers
216
hydrogen ions travel in form of ....... and ......
carbonic acid and water molecules
217
in leukopoiesis, myeloblasts develop into
3 types of granulocytes (neutrophils, eosinophils, basophils)
218
in leukopoiesis, monoblasts develop into
monocytes
219
in leukopoiesis, monoblasts look identical to
myeloblasts
220
in leukopoiesis, lymphoblasts develop into
all types of lymphocyte
221
in leuokopoiesis, stem cells have receptors for specific .......... which respond to specific needs
colony stimulating factors
222
tunica intima/interna =
endothelial lining and surrounding layer of connective tissue
223
in arteries, tunica intima/interna has elastic fibres =
internal elastic membrane
224
tunica media =
smooth muscle and loose connective tissue
225
tunica media is bound to tunica interna and tunica externa by
collagen fibres
226
in small artery, thickest layer is
tunica media
227
tunica media separated from tunica externa by elastic fibres =
external elastic membrane
228
tunica externa / adventitia =
connective tissue sheath
229
in arteries, tunica externa/adventitia made of (2)
collagen and elastic fibres
230
in veins, tunica externa/adventitia made of (2)
smooth muscle and elastic fibres
231
thickest layer in veins is
tunica externa/adventitia
232
elastic arteries are also known as
conducting arteries
233
in elastic arteries, tunica media is mainly elastic not
muscle
234
major branches of elastic arteries (2)
aorta, pulmonary trunk
235
muscular arteries are also known as
distribution arteries
236
muscular arteries distribute blood to (2)
skeletal muscles and organs
237
superficial muscular arteries are important as
pressure points (pulses)
238
arterioles have a poorly defined
tunica externa
239
arterioles have varying degrees of
smooth muscle
240
venules collect blood from
capillary beds
241
smallest venules lack
tunica media
242
in medium sized veins, tunica media is thin and lacks
muscle
243
in medium sized veins, the thickest layer is the
tunica externa
244
in medium sized veins, the tunica externa has
longitudinal bundles of elastic and collagen
245
large veins have a thick tunica externa made of
elastic and collagen
246
large veins have slender
tunica media
247
examples of large veins (2)
venae cavae and tributaries
248
valves are found in (2)
venules and medium sized veins
249
capillaries are a .............................. inside a ............
endothelial tube, thin basement membrane
250
capillaries have absent (2)
tunica media, tunica externa
251
continuous capillaries supply
most regions of body
252
some continuous capillaries have ........ which restrict permeability
tight junctions
253
fenestrated capillaries have ..... that penetrate endothelial lining which allows rapid exchange between ..... and ....
pores; plasma and interstitial fluid
254
sinusoids resemble
fenestrated capillaries
255
sinusoids are flattened and ........ shaped
irregularly
256
in sinusoids, basement membrane is
thin/absent
257
entrance to each capillary guarded by
precapillary sphincter
258
precapillary sphincter controls
where blood flows within plexus
259
if more than one artery supplies capillary bed they are known as
collaterals
260
collaterals fuse before arterioles at
arterial anastomoses
261
direct connections between arterioles and venules are known as
arteriovenous anastomoses
262
creatinine = waste product of
muscle metabolism
263
creatinine produced from
creatine
264
creatinine is filtered out of blood by
kidneys
265
high creatinine levels lead to reduced
kidney function
266
hyperkalaemia can indicate
reduced kidney function
267
hyperkalaemia is when plasma potassium what level
>5.5mmol/L
268
blood pressure equation
CO X peripheral resistance
269
cardiac output definition
volume of blood expelled from heart/min
270
equation for cardiac output
stroke volume X HR
271
capillary hydrostatic pressure definition
force exerted by fluid pressing against capillary wall
272
venous pressure definition
pressure within venous system
273
total peripheral resistance is affected by (3)
turbulence, blood viscosity, vascular resistance
274
vascular resistance is affected by friction which is determined by
diameter and vessel length
275
elastic rebound forces blood towards
capillaries
276
mean arterial pressure equation
(1/3 pulse pressure) + diastolic pressure
277
pulse pressure =
systolic - diastolic BP
278
high BP means .... is 6X more likely
stroke
279
high BP means ... is 3X more likely
cardiac death
280
high BP means .... is 2X more likely
peripheral arterial disease
281
secondary hypertension =
cause of hypertension known
282
primary hypertension =
cause of hypertension unknown
283
9 risk factors of hypertension
age, family history, african/ caribbean origin, high salt intake, lack of exercise,overweight, smoking, lots of alcohol, stress
284
4 stages of hypertension
stage 1, stage 2, sever, hypertensive emergency/malignant hypertension
285
stage 1 hypertension =
BP = 140/90 + ambulatory 135/85
286
Stage 2 hypertension =
BP = 160/100 + ambulatory 150/95
287
sever hypertension =
systolic = 180+ / diastolic 110+
288
hypertensive emergency/ malignant hypertension =
acute impairment of organs, can result in irreversibly damage to organ
289
rebound hypertension =
when stop taking drugs to reduce BP - 30-50% genetic, 50% environmental
290
hypertension can lead to fainting because there is an increase in adrenaline binding to ... ....... ......... which causes dilation of skeletal muscle arteries and reduction in blood flow and pressure to the brain
beta2- adrenergic receptors
291
global prevalence hypertension
40%
292
hypertension more prevalent in younger men than women, but women catch up as get
older
293
5% CO2 carried in blood as ..... as
dissolved
294
90% CO2 transported as hydrated
carbonic acid
295
chloride shift =
chloride into Hb and bicarbonate out via antiport (chloride-bicarbonate exchanger)
296
oxygen utilisation coefficient usually
~22%
297
4 factors affecting rate of oxygen unloading
ambient PO2, temperature, Bohr effect, bisphosphoglycerate
298
temperature and oxygen unloading
higher temp > oxyhaemoglobin dissociation curve shifts to right > increased oxygen unloading
299
bohr effect and oxygen unloading
more carbon dioxide produced by tissues > increase in hydrogen ions > weakened Hb oxygen bond > increased oxygen unloading
300
Haldane effect =
low levels of HbO2 > blood transports more carbon dioxide
301
hypocapnia =
low blood PCO2
302
hypercapnia =
high blood PCO2
303
hypoxic drive due to long term
hypoxaemia
304
hypoxic drive means respiration is driven by
low PO2
305
hypoxia =
low oxygen reaching tissues
306
hypoxic hypoxia =
lack of oxygen in blood flow to tissues
307
hypoxic hypoxia usually due to
inadequate breathing
308
anaemic hypoxia =
low Hb levels reduce oxygen carrying capacity of blood - many causes
309
Stagnant (circulatory) hypoxia =
lack of blood flow to tissues
310
Histiotoxic anaemia =
adequate oxygen inhaled and delivered to tissues, tissues just cannot utilise oxygen
311
Metabolic hypoxia =
more demand for oxygen by tissues than normal - from raises metabolism e.g. sepsis
312
5 symptoms of hypoxia
dizziness, dyspnoea, confusion, tachycardia, cyanosis
313
6 causes of hypercapnia
hypoventilation, diminished consciousness, lung disease, rebreathing exhaled carbon dioxide, exposure to high carbon dioxide environment, initial effect of sleep apnoea > respiratory acidosis
314
5 symptoms of hypercapnia
hand flaps, flushed skin, hyperventilation, dyspnoea, reduced neural activity
