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Semester 2 Case Studies > Case 7 > Flashcards

Case 7 Flashcards

1
Q

what does blood regulate

A

body temp
pH
solutes
restricts osmosis into tissues

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2
Q

how long do erythrocytes survive in the circulation

A

120 days

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3
Q

what are erythrocytes broken down by

A

the liver and spleen

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4
Q

what is formation of erythrocytes controlled by

A

erythropoietin

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5
Q

where is erythropoietin produced by

A

kidneys in response to low oxygen levels

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6
Q

what does each molecule of haem contain

A

an iron atom

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7
Q

how many molecules of oxygen does haem bind

A

one

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8
Q

what does haemoglobin consist of

A

four peptide chains or globins and four haem molecules. it is a balance of alpha and beta chains

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9
Q

what does proliferation of RBC precursors require

A

DNA synthesis

protein synthesis

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10
Q

what two B-complex vitamins play a critical role

A
  1. folate 950-1000ug/day (required for synthesis pf purines and pryimidines)
  2. vitamin B12 - required for snyhrisis of some amino acids
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11
Q

anaemia value for men

A

<13.5 g/dl

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12
Q

anaemia value for women

A

<11.5 g/dl

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13
Q

symptoms of anaemia

A
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14
Q

anaemia based on what causes:

A
  • failure of production
  • defective red cells
  • loss/destruction of red cells
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15
Q

anaemia based on red cell size

A
  • microcytic
  • normocytic
  • macrocytic
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16
Q

acute blood loss

A

dilution to maintain circulation volume

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17
Q

chronic blood loss

A

peptic ulcers, menorrhagia, piles, worms etc

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18
Q

what deficiencies cause anaemia

A 
iron 
vitamin 12 
folate 
protein 
vitamin C
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19
Q

approach to the investigation of anaemia

A
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20
Q

levels of high red cells and increased production

A

polycythemia

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21
Q

what is saline solution in giving blood

A

SAGM which stands for saline-adenine-glucose-mannitol.

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22
Q

how much plasma does standard red cell component contain

A

20mls

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23
Q

What is large MCV a sign of

A

dtysfunctioning bone marrow

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24
Q

signs of polycythemia

A

red/bluish skin
complex
twin to twin transfusion

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25
Q

what is a low white cell count called

A

leukopenia

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26
Q

what is having too many platelets called

A

thrombosis cytosis

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27
Q

what is too little platelets called

A

thrombocytopenia

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28
Q

what is bone marrow a site of

A

postnatal haematopoiesis

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29
Q

leukemia types

A
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30
Q

how many children cured from ALL

A

85% of children

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31
Q

how many children cured from AML

A

70% cured

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32
Q

morphology of AML

A

auer rods, cytoplasmic granules

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33
Q

morphology of ALL

A

no auer rods or granules

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34
Q

how much of blood is formed elements - cells

A

45%

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35
Q

how much is white blood and platelets

A

less than 1%

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36
Q

diagram of haematopoieses

A
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37
Q

lifespan of platelets

A

9-10 days

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38
Q

lifespan of leukocytes

A

a few days to a few years

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39
Q

how many new red blood cells and platelets a day

A

175 billion

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40
Q

where is earliest site of haematopoieiss

A

the yolk site

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41
Q

when does it change from primary to secondary

A

at 2 months

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42
Q

where does haumatopoeisis move after yolk sac

A

foetal liver and spleen

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43
Q

2-7 months where does haematopoeiisis take place

A

liver and spleen

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44
Q

5-9 months where does haematopoiesis take place

A

bone marrow

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45
Q

where in the adult does haematopoieis take place

A

vertebrae, ribs, sternum, skull, sacrum and pelvis and demur

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46
Q

at birth what type of bone marrow is present

A

red bone marrow

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47
Q

what kind of tissue is red marrow

A

haemotopoietic tissue

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48
Q

stromal cells:

A

connective tissue cells of any tissue - fibroblasts, fat cels, endothelial cells, reticulum cells and macrophages

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49
Q

what do stromal cells express

A

adhesion molecules, signal the differential cell, secrete growth factors

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50
Q

what is the state of quiescence

A

a state of reversible growth arrest

51
Q

what kind of cells are haemopoeitc cells

A

self renewal cells and at least some of their daughter cells will be haemopoietic stem cells so the pool of stem cell is not depleted

52
Q

where do all blood cells originate from

A

bone marrow

53
Q

what cell type do all cells originate from

A

HSC - capable of self renewal and differentiating into other cells

54
Q

what cells do pluripotential haematopoieitc stem cells give rise to

A

lymphoid stem cells which give rise to lymphocytes

55
Q

what do myeloid stem cells give rise to

A 
neutrophils 
eosinophils 
basophils 
monocytes 
erythrocytes 
platelets
56
Q

what is another name for a myeloid stem cell

A

CFU-GEMM cell

57
Q

what does CFU stand for

A

colony forming unit

58
Q

what does the G stand for

A

granulocytes

59
Q

what does the e stand for

A

erythrocytes

60
Q

what do the two M’s stand for

A

monocyte and megakaryoxcyte

61
Q

erythropoiesis mechanism

A

Proerythroblast: large cell with cytoplasm that stains dark blue
Gives rise to erythroblasts (early and late)
Normoblasts: smaller cells cytoplasm starting to stain lighter blue, late normoblasts have extruded nucleus (haemoglobin production takes place before it Is lost, 65% of production has taken place by this stage)
Reticulocyte: contains some ribosomal RNA, circulates in peripheral blood (1-2 days)
ENDPOINT: mature erythrocyte: RNA lost
duration: approx 7 days
Lifespan: 120 days
175 billion produced per day

62
Q

RBC growth factor and size

A

7.5um and erythropoietin

63
Q

thrombopoiesis

A

process of endomitosis is produce megakaryoblasts
Replication of chromosomes occurs but cells don’t divide (endomitotic replication)
Cells become larger
Only fully mature, endomitosis ceases resulting in granulated cytoplasm
Process takes 2-3 days
Each megakaryocyte “fragments” produces around 4000 platelets

Platelets: 
no nucleus 
2-3um in diameter 
Haemostasis 
Granules 
Thrombopoietin
64
Q

monopoiesis

A

monoblast: first committed cell
Promonocyte: large cell with indented nucleus only found in bone marrow
monocytes staty for 20-40 hours in peripheral blood circulation
Nucleus: kidney shape
Monocytes migrate to tissues and mature into macrophages

65
Q

granulopoeisis

A

Myeloblast: varying size, large nucleus and no cytoplasmic granules
Form promyelocytes: primary cytoplasmic granules
Myelocytes: smaller cells with specific cytoplasmic granules, no noticeable nucleoli
Metamyelocytes: indented or horse-shoe nucleus, lots of cytoplasmic granules

66
Q

neutrophils

A

band neutrophils form neutrophils - distinct nuclear lobes (2-5)
Enter circulation at this stage and mature in circulation
Mature neutrophils (polymorphonuclear neutrophils): ingest microorganisms, help defence of body
Approx 14 days for myeloblasts to form mature cells which are released into peripheral blood
Average lifespan in circulation is around 5 days with a further 1-2 days in tissues
Most abundant white blood cell

67
Q

basophils

A

usually two nuclear segments, cytoplasmic granules contain heparin and histamine
Rare in normal peripheral blood (less than 1% of leukocytes)
Mature into tissues to form mast cells??
Mast cells: lifespan weeks to months
Both play a role in hypersensitivity - release inflammatory molecules such as histamine
Life span thought to be around 60-70 hours

68
Q

eosinophils

A

larger cytoplasmic granules, tend not to have more than 3 nuclear lobes
1-4% of circulating leukocytes
Provide protection against parasites
Involved in allergic responses
Around 8-12 hours lifespan in circulation
Further 8-12 days in tissue

69
Q

what type of stain is used for blood

A

Romanowsky type stain

70
Q

lymphopoiesis

A 
lymphocyte production 
T lymphocyte tend to mature in thymus 
B Lymphocytes differentiation in foetus occurs in liver but in adults occurs in bone marrow 
B lymphocytes mature in to plasma cells 
Plasma cells are formed in lymph nodes
71
Q

what transcription factor regulates myeloid lineage cells

A

PU.1 -protein that in humans is encoded by the SPI1 gene.

72
Q

what transcription factor regulates differentiation along eryhtopoeitic and megakaryocytic cell lineages

A

GATA.1

73
Q

growth factors that play a role in haematopoiesis

A

SCF stem cell factor
GM-CSF granulocyte macrophage colony-stimulating factor
G-CSF granulocyte colony-stimulating factor
M-CSF macrophage colony-stimulating factor
Interleukin 3
Interleukin 5
Erythropoietin
Thrombopoeitin

74
Q

erythropoietin

A

regulates erythropoiesis
Mainly synthesised in kidneys and liver
Reduction in red cell number results in decreased oxygen to tissues
Development of hypoxia in kidneys and liver
Leads to increased production of red blood cells
This corrects hypoxia and EPO synthesis switched off

75
Q

thrombpoitein

A

mainly produced in the liver

Stimulates megakaryocytic and platelet production

76
Q

stem cell factor synthesis

A

synthesises with cytokines such as IL3 and GM-CSF to increase proliferation of stem cells

77
Q

interleukin 3

A

works in conjunction with GM-CSF to proliferate most haempoeitic progenitor cells

78
Q

what is IL5 produced by

A

produced by T lymphocytes

79
Q

GM-CSF

A

necessary for growth and development of granulocuye and macrophage progenitor cells. also stimulates myeoblasts and mono blasts

80
Q

M-CSF

A

plays a role in proliferation and differentiation of haemopoietic stem cells to produce monocytes and macrophages

81
Q

G-CSF

A

is similar to M-CSF but acts on the precursor cells which give rise to granulocytes

82
Q

journey of blood in transfusion

A 
donor 
NHS blood and transplant 
Hospital blood bank 
ward area
patient
83
Q

haemoglobin levels safe to give blood

A

men: >135g/L
women: >125g/L

84
Q

what viral tests are carried out on the blood

A 
syphilis 
HIV 
hep b
hep c 
hep e
85
Q

what specific virus will be looked for on the first visit in giving blood

A

HTLV

86
Q

why will a small number of patients be tested for cytomegalovirus CMV

A

because some patients need CMV negative blood firstly being neonates and pregnant women

87
Q

how much of blood is plasma

A

55%

88
Q

what is plasma mixed with

A

cryoprecipitate -a plasma-derived blood product for transfusion that contains fibrinogen (factor I), factor VIII, factor XIII, von Willebrand factor, and fibronectin.

89
Q

what is cryoprecipitate

A

rich in fibrinogen and derived from plasma
fresh frozen [plasma imported
if have an inherited blood disorder that doesn’t have a clotting factor means you have to use important plasma

90
Q

where are pooled platelets from

A

4 different donors

91
Q

red cell transfusion

A

provided in leucodepleted ‘units’ measuring approximately 280ml
Each unit of red cell rises the Hb by approx 10g/L
Transfused over 2-4 hours
Patients should receive written information prior to receiving a blood transfusion including the risks of reaction and viral transmission
Storage: Temp - 4 degrees +/- 2 degrees
Shelf life: up to 35 days

92
Q

platelet transfusion

A

each ‘ATD’ - adult therapeutic dose is ‘pooled’ from 4 different platelet donations
One ATD of platelets would be expected to rise the platelet count by 20-40 x10 to the power of 9, we can check this by doing an increment
Given over 30 mins
Storage: agitation
Temp: 20-24 degrees
Shelf life: 5 days (7 days if bacterial screening)

93
Q

red cell groups

A
94
Q

what is Leinsteiner’s ale

A

if you have got a blood group antigen on your red cell surface then you will have the opposite antibody in your plasma

95
Q

forward typing sampling method

A

adding patient’s red cells to the first four columns
Does the patient have A antigen expressed on the cell surface?
Does it have B?
Does it have D? Don’t call them Rhesus anymore as associating with monkeys

96
Q

how to tell if antigen is present in the blood test

A

there is a line at top which means its present and if its at the bottom its not present

97
Q

what is the reverse group function of a blood test for typing

A

adding patients plasma to the two end columns
Does the patient have anti-A?
Does the patient have anti-B?

98
Q

the Kleinhauer test

A

when a baby is born to a D negative mum, we take a sample from the mum after we find out if baby is positive or negative
If baby is negative there is no issue
But if baby is positive then we do this test to quantify any foetal blood we can see in mothers circulation
Add an acid buffer to the blood film and by doing so it will denature adults’ haemoglobin, the baby has HbF (foetal) differentiate between cells of mother and baby
HbA cells will all denature and become ghosts, and HbF cells will show up and know therefore they are from the baby

99
Q

what happens if D positive cells go into negative D mum

A

need to provide anti D for mum to mop up the D positive cells as we don’t want mum to form anti D herself. if she does, subsequent pregnancies can result in haemophiliac disease of the baby. means that they can attack the baby cells if they recognise them as not self and make the baby incredibly unwell

100
Q

what is flow cytrometry

A

looking at the use of immunoglobulins to stick on to proteins and looking for expression of the D proteins. more accurate.

101
Q

how to reduce infection risk

A 
donor lifestyle questionnaire 
Cleaning and preparing the donor arm 
Diversion pouch - first part goes into a different sack which puts the first bit of blood that touches the skin and do tests on this part
Donor viral testing 
Leucodepletion 
non-UK plasma and viral activation 
Platelets- BACT/ALERT 
CMV negative components (neonates and pregnant women) 
Avoid unnecessary transfusion
102
Q

TACO checklist

A
103
Q

NICE quality standards 2016

A
104
Q

oxygen delivery

A

oxygen content of arterial blood x cardiac output

105
Q

carriage of oxygen in solution

A

oxygen not very soluble in plasma
About 3ml O2 per litre
Resting O2 of 250ml/min
With 100% oxygen extraction need resting cardiac output of 80L/min

106
Q

what is the resting cardiac output

A

5L/min

107
Q

how much oxygen can a gram of Hb hold

A

1.3 mls

108
Q

oxygen content of arterial blood

A

200ml/L

109
Q

what happens when O2 binds with heme

A

general reconfiguration of the whole molecule when 02 binds and when changes from T shape to R shape

110
Q

oxygen content of arterial blood equation

A

(haemoglobin conc x % saturation of Hb) + dissolved O2

111
Q

effect of temp on saturation

A

middle line is the norm
Right shifting means there is a reduced affinity of O2 for Hb
Left shifting reflects an increased affinity of O2 for Hb so that at the same partial pressure you have an increase in saturation
increased temp means decreased affinity, curve shifts to the right and for the same PO2, saturation is reduced

112
Q

effect of pH on saturation

A

decreased pH (increased acidity)
decreased affinity
shift to the right
for there same PO2, saturation is reduced

113
Q

what is best pH and temp for offloading of O2 in tissues

A

decreased pH and increased temp both favour offloading of O2

114
Q

effect of 2,3 DPG

A

increased 2,3DPG we have deceased affinity and shift to the right
reduce the binding of oxygen to Hb
stored blood is low in 2,3DPG and so has a high affinity for oxygen

115
Q

changes in global chains with development

A
116
Q

muscle oxygen stores

A

myoglobin

117
Q

how many times great is CO affinity for Hb than O2

A

250 times

118
Q

principles of pulse oxumetry

A

red line indicates it is full saturated and deoxygenated blood absorbs more red light and has a blue colour

119
Q

pulse wave of oximetry

A
120
Q

why is HbS so prevalent in SA and Asia

A

because it provides an advantage against malaria

121
Q

haemoglobin and iron metabolism

A
122
Q

what is the predominant type of haemoglobin found in a foetus

A

HbF

123
Q

iron transportation etc

A

Liver secretes apotransferrin into the bile, which flows through the bile duct into the duodenum, where it enters the duodenal circulation:
The intestinal cells secrete free iron into the duodenal circulation.
The apotrasferrin binds with the free iron forming transferrin.
The iron is loosely bound in the transferrin and, consequently, can be released to any tissue cell at any point in the body.

Transferrin is then transported to the liver or the bone marrow:
Liver: here it enters the hepatocytes and combines with apoferritin, forming ferritin (storage molecule).
Bone Marrow: here it binds to receptors on the erythroblasts, delivering iron to the mitochondria for the production of haemoglobin.

Semester 2 Case Studies (11 decks)

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