Blood & Blood Disorders Flashcards
Blood is specialized ________ tissue derived from the _______ germ layer
connective
mesodermal / mesenchymal
The process of blood formation is known as ________
hematopoiesis / hemopoiesis
The major bones containing bone marrow generating blood cells are __________
flat bones of axial skeleton - sternum, ribs, pelvic bones
vertebrae
skull
The functions of blood are _________
- carrying O2 and CO2
- buffering and enabling metabolic reactions
- elimination of waste
- delivery of nutrients
- distribution of hormones and other chemical messengers
- clotting and prevention of excessive bleeding
- immune defense
Whole blood is composed of _________
plasma - amino acids, nutrients, proteins, nitrogenous waste, electrolytes, gases
formed elements - WBCs, platelets, RBCs
Red bone marrow functions to ________
Yellow bone marrow functions to ________
generate formed elements of blood
nourish and support red bone marrow
Myelophthisis is __________. This process is seen in disorders such as __________
the degeneration of red bone marrow with the substitution by yellow bone marrow
blood / bone marrow cancers
Active bone marrow is generally termed ________
myeloid
When pluri-potent stem cells develop into white blood cell colonies, they differentiate into ________ progenitors and ______ progenitors
myeloid progenitors
lymphoid progenitors
Myeloid stem cells mature into what types of white blood cells?
monocytes, neutrophils, basophils, eosinophils
Lymphoid stem cells mature into what types of white blood cells?
T lymphocytes
B lymphocytes
Cancer of white blood cells are generally termed ______ and are categorized as either _____________ or __________
leukemia
myeloid/myelogenous/myelocytic
lymphoid/lymphocytic/lymphoblastic
List major endocrine hormones involved in hematopoiesis and their origins
erythropoietin - derives form KD
thrombopoietin - derives from LV
testosterone - derives from testicles/ovaries/adrenal glands
(Thrombin will activate production of fibrin from fibrinogen molecules, supplied by the liver - blood clotting)
Explain the difference in normal Hematocrit levels between males and females
Testosterone is more abundant in males than in females leading to more RBC production
Hematocrit is _________ and is measured in ______
the packed volume of formed elements (mainly RBCs) per volume unit of whole blood
percentage
The normal value range of Hct in a female is ___ ; in a male it is ___
37-46%
41-53%
What is hemoglobin concentration per volume of blood (Hb)?
A measure of the total amount of the oxygen-carrying protein in the blood, which generally reflects the number of red blood cells in the blood
What is Mean Corpuscular Volume (MCV)?
a measurement of the average size of a single red blood cell
Macrocytic
Microcytic
Normocytic
What is Mean corpuscular hemoglobin (MCH)?
a calculation of the average amount of hemoglobin inside a single red blood cell
Hyperchromic
Hypochromic
Normochromic
What is Mean corpuscular hemoglobin concentration (MCHC)?
a calculation of the average concentration of hemoglobin inside a single red blood cell
What is Red cell distribution width (RDW)?
a calculation of the variation in the size of RBCs
Variety in size is ether high or low
What is the difference between plasma and serum?
serum is plasma that has clotting factors removed
List the immediate precursor for each of the following:
erythrocyte
thrombocyte
neutrophil
reticulocyte
megakaryocyte
band cell
Leukocytosis is _________. It usually signifies excess of what type of WBC?
an excess amount of WBCs in the blood
neutrophils
List examples of excessive white blood cells types
neutrophilia, lymphocytosis, eosinophilia, basophilia, reticolocytosis, bandemia, thrombocytosis
Leukopenia is _______
a deficient amount of WBCs
An excess of RBCs or all lines of blood cells is called ________
polycythemia
Define anemia
a state of a diminished count of erythrocytes and/or content of hemoglobin
Anemia can result from one or more of 3 basic mechanisms: _________________
- blood loss
- deficient erythropoiesis (nutrient deficit)
- excessive hemolysis (sickle cell anemia, thalassemia, malaria, auto-immune, etc.)
Describe iron deficiency anemia
lack of iron leads to insufficient hemoglobin production
RBCs are smaller than normal and have an increased zone of central pallor
There is also increased anisocytosis (variation in RBC size) and poikilocytosis (variation in shape)
Describe folate deficiency anemia
lack of folate leads to large red blood cells (deficient production of DNA) and can lead to macrocytic (megaloblastic) anemia
Describe B12 (Cyanocobalamin) Deficiency anemia
lack of B12 leads to large red blood cells(deficient production of DNA) and can lead to macrocytic (megaloblastic) anemia
Describe pernicious anemia
It is a special type of B12 deficiency anemia due to deficient absorption of vitamin B12. It is caused by auto-immune injury of gastric mucosa w/ the atrophy of parietal cells (produces intrinsic factor complex - carrier protein for B12)
Describe aplastic anemia
a rare disease in which the bone marrow, and the hematopoietic stem cells that reside there, are damaged,. causing a deficiency of all three blood cell types
The most common cause of iron deficiency anemia within the USA is __________
chronic bleeding (genito-urinary or gastro-intestinal)
Describe the character of RBCs in iron deficiency
microcytic and hypochromic RBCs
List signs and symptoms of iron deficiency anemia
glossy tongue, nail deformities (koilonychia), pagophagia, pica
How is iron deficiency anemia diagnosed?
TIBC test (Total Iron-Binding Capacity) along with serum iron test
In iron deficiency, the storage of iron (in the form of _____ ) is ______, while TIBC is _________
ferritin
depleted
increased
The major storage source of iron in the body is _____. TIBC measures __________
ferritin
binding of iron to transferrin
List major nutritional sources of:
Iron
Vitamin B12
Folate
- liver, meat, shellfish
- shellfish, liver, fish
- green leafy vegetables, liver, legumes
List general steps of hemostasis
1) initial brief vasospasm
2) temporary platelet plug formation
3) coagulation cascade
4) clot retraction
5) clot dissolution
In temporary platelet plug formation, platelet adhesion requires presence of _____ a glycoprotein manufactured by ________ and ______.
vWF (von Willebrand factor)
endothelium of blood vessels
liver
In addition to its role in temporary platelet plug formation, vWF also _________
is a complex carrier for clotting factor VIII
Instrinsic coagulation cascade is initiated ________
Extrinsic coagulation cascde is initiated ________
Both coagulation cascades lead to common step of ________ and production of ________.
within an injured blood vessel
when the blood is exposed to the surrounding injured tissues (trauma)
factor X activation
thrombin
In hemostasis, thrombin will activate production of _____ from ______, supplied by the liver
fibrin
fibrinogen
Platelets are _______ and function to ________
anuclear cellular fragments of megakaryocytes
initiate clotting process (coagulation cascade)
Bandemia is _______ and suggests __________
What are BLASTS? If you see BLASTS what does this suggest?
increase in immediate precursor cells for neutrophils (polys)
initial stage of an acute bacterial infection
BLASTS are immature WBC (undifferentiated WBC should not see in the blood it belongs in the bone marrow). We can assume leukemia.
Reticulocytosis is an indication of _______ and suggests _________
anemia or hypoxia
chronic bleeding, respiratory pathology, smoking, change of altitude
Relative polycythemia is due to ________
diminished plasma volume (dehydration)
Absolute polycythemia is subdivided into _______ and _______
primary - bone marrow malignancy
secondary - renal cell carcinoma w/ excess EPO or hypoxia
Normocytic and normochromic anemia suggests ________
anemia of chronic disease or acute blood loss
Deficiency of Vitamin B12 (aka __________) leads to accumulation of pro-inflammatory amino acid __________. This substance contributes to ______ injury and eventually to chronic _________
cyanocobalamin
homocysteine
vascular
ischemic heart disease and other chronic vascular pathological events
Deficiency of Vitamin B12 is known to result in significant _______ deficit, which may progress to irreversible _________
neurological
peripheral neuropathies, dementia, loss of coordination
What is the prognosis if B12 defciency is mistaken for folate deficiency and treated exclusively with folic acid supplementation?
Anemia might improve but neurological deficit will likely become irreversible
Sickle cell anemia is ___________ anemia which is caused by _______ on the gene coding for _________. It is of an _________ inheritance mode
hereditary hemolytic
point mutation
beta chain of adult Hemoglobin A
autosomal-recessive
Instead of normal Hemoglobin A, sickle cell anemia leads to production of _______, which is prone to ______ which in turn leads to ________
Hemoglobin S
crystallization
sickling of the RBCs in peripheral circulation
Sickling is an event of RBCs becoming ________. It prompts ________ and leads to ________
rigid and assuming “ice pick” shapes
thrombosis
generalized ischemia
The major pathogenesis of sickle cell anemia is __________
generalized hemolysis with thrombosis and ischemia
Major factors contributing to sickling of RBCs in SC anemia are __________
hypoxia, acidosis, stress, dehydration
Clinical presentations of sickle cell anemia include ___________
severe jaundice/icterus, priapism, trophic ulcers, neuropathies
Hemophilia A and B are both hereditary disorders of ___________ inheritance mode. Von Willebrand disease is hereditary disorder of ________ inheritance mode
X-linked recessive
mostly autosomal
Hemophilia A presents with deficiency of ________
Hemophilia B presents with deficiency of _________
Von Willebrand diseases presents with deficiency of _________
clotting factor VIII
clotting factor IX
vWF (qualitative or quantitative)
Hemophilia A and B are diagnosed by ___________
clinical presentations, prolonged bleeding times, genetic testing
Von Willebrand disease is diagnosed by __________
essaying certain clotting factors and investigating bleeding times
The therapeutic approach for bleeding disorders in general is based on ______________
replenishment of the deficient component needed for proper clotting to occur
Which bleeding disorder is known as Christmas disease? why?
Hemophilia B was first reported in the medical literature in 1952 in a patient with the name of Stephen Christmas
The most common leukemia of childhood is ________
ALL - Acute Lymphocytic Leukemia
Philadelphia chromosome is the mutual translocation between _________ and is found in 95% of cases of ______ and 5% of cases of __________
chromosome 9 and 22
CML - chronic myeloid leukemia
ALL - acute lymphocytic leukemia
Reed-Sternberg cells are __________ and are a characteristic feature of _________
bi-nucleated immature B lympthocytes
Hodgkin’s lymphoma
List major signs of leukemias and lymphomas
painless lymphodenopahty, bruising, nose bleeds, fatigue, fluctuating tidal fever, profuse sweating, “stubborn” infections
Multiple Myeloma is a cancer of __________ cells
monoclonal plasma cells
In Multiple Myeloma, ____ cells, which are __________, are immature and spread indefinitely within the bone and peripheral blood, secreting ______ that clamp together and form ________, obstructing peripheral circulation and especially ___________
plasma
activated B lymphocytes
abnormal fragments of antibodies
Bence-Jones proteins
kidney tubules
How does Hodgkin’s lymphoma differ from non-Hodgkin’s lymphoma?
Hodgkin’s lymphoma is cancer of lymphatic structure only
Non-Hodgkin’s lymphomas can have a simultaneous component of lymphocytic leukemia as well
Multiple Myeloma presents with ____________
initial onset - bone pain worse at night (dull, gnawing, fixed pain)
immuno-deficiency - chronic infections
abnormal indurations
Hemolytic anemias can be caused by ___________
infections, genetic disease
Folate deficiency is more common than Vitamin B12 deficiency because __________
folate cannot be readily stored in the body
Primary absolute polycythemia is aka _______________
Polycythemia Rubra Vera
