Ch. 19.1 Flashcards
Define Hematology
Study of blood
Adults have how many L and gallons of blood?
4-6 liters = 1.5 gallons
What are the 3 main functions of blood?
- Transport - 02, C02, nutrients, waste, hormones, stem cells
- Protection - inflammation, limit infection, destroy micororg and cancer cells, neutralize toxins, clotting
- Regulation - Fluid balance, stabilize PH, temp control
What is the normal PH for blood?
What % of body weight does blood make up?
High 02 shows what color?
Low 02 shows what color?
How much volume does a male and female have of blood?
Ph for blood - 7.35-7.45
8% of total body weight
High 02 is scarlet
Low 02 is dark red
Males 5-6 liters, females 4-5 liters
What are the 2 major components of blood and their %’s?
Plasma (55%) matrix of blood
Formed elements (45%) blood cells and fragments
What is serum?
Plasma without the clotting factors
What are the proteins in the blood plasma and what is their function?
Albumin - maintain osmotic pressure, hydrophobic carrier
Globulins - Antibodies, transport (binds to molecules such as hormones), clotting factors
Fibrinogen - Convert to fibrin during clot formation
What are the “other” substances in the blood plasma besides proteins?
Ions: Sodium, potassium, calcium, chloride, bicarbonate
Nutrients: glucose, carbohydrates, amino acids
Waste: lactic acid, urea, creatinine
Gases: oxygen and carbon dioxide
Define viscosity
Resistance of a fluid to flow / thick, sticky
*whole blood is 4.5-5.5 times more viscous than water
*plasma 2 times more viscous than water
Define osmolarity
total molarity (concentration) of those dissolved particles that cannot pass through the blood vessel wall
*if osmolarity is too high blood absorbs too much water
Erythrocytes
Life span?
Have organelles?
Blood type determined by?
Main function?
Can it grow or divide?
Erythrocytes
life span 120 days
Lost nearly all organelles during development/ no nucleus or mitochondria
Blood type determined by surface proteins
Main function: GAS TRANSPORT
Anucleate- cannot grow or divide
Define: Anucleate
cannot synthesize new proteins, grow or divide
One RBC contains how many Hb?
1 RBC contains 250 million Hb
*can carry 1 billion 02 molecules
Each Hemoglobin (Hb) molecule consists of:
Hb molecule consists of:
- *Heme group** - 02 binds to Iron in center
- *Globins** - 4 protein chains (2 alpha, 2 beta)
What is Hematocrit?
Normal % in males and females
RBC counts in males and females
Hematocrit is the % of whole blood that is RBC
Males - 42-52%, Females 37-48%
RBC count in males 4.6-6.2 million, females 4.2-5.4 million
What is Carbonic anhydrase?
and the process of transport and exchange of carbon dioxide?
Carbonic anhydrase is a reaction converting C02 and H20 into protons and bicarbonate
As the body produces C02 it diffuses into the blood into RBC. It comes into contact with Carbonic anhydrase and it combines C02 with water which makes it dissociate into H2C03 which turns into H+ + Hc03-.
The RBC spits out Hc03- and brings in Cl-. Now Hc03 is floating in blood outside of RBC.
The rest of the C02 rides on hemoglobin or in plasma
How many RBCs are produced each second?
How long is their life span and development time?
Erythroblasts multiply and synthesize what?
2.5 million RBC are produced each second
avg lifespan of 120 days, 3-5 days to develop
Erythroblast multiply and synthesize hemoglobin
Define: Erythropoiesis
What are the steps?
Erythropoiesis - process of formation of RBC (15 days)
Hematopoietic stem cell -> Myeloid stem cell -> proerythroblast -> basophilic erythroblast -> polychromatic erythroblasts -> orthochromatic erythroblast (eject organelles creating concave shape)
What causes Hypoxia?
What causes an increase in blood viscosity?
Hypoxia is from too few RBC’s
Increase in blood viscosity is from too many RBC’s
The balance between RBC production and destruction depends on what 2 things?
- Hormonal controls - Erythropoietin (stimulates formation of RBC’s)
- Dietary requirements - Iron, Vit b12, folic acid, Vit c, copper
What are some causes of Hypoxia?
Hemorrhage or increased RBC destruction
Insufficient hemoglobin (iron deficiency)
Reduced availability of 02 (high altitude or lung problems)
Describe the process for erythrocyte homeostasis
(fixing kidney hypoxia)
Drop in RBC causes kidney hypoxia
Kidneys produce erythropoietin which stimulates bone marrow to produce more RBC
RBC count increases in 3-4 days
What happens to the parts of RBC when it breaks down?
Iron binds and is stored for future use
Heme is degraded to bilirubin -> liver secretes bilirubin in the bile into intestines where it is degraded into urobilinogen. It’s transformed into stercobilin and leaves in feces
Globin is metabolized into amino acids and released into circulation
What is Jaundice?
Yellowing of skin when too much bilirubin is present in the blood
*increased bilirubin when the liver is malfunctioning or RBCs are being rapidly destroyed
What is anemia?
What causes it?
(4 things)
Decrease in number of RBC’s or hemoglobin
- *Hematocrit** is low, person tired and blue
- *Nutritional**: not enough iron or b12
- *Hemorrhagic**: losing large quantities of blood
- *Aplastic**: not producing enough RBC
What is sickle cell disease?
Genetically abnormal RBCs
*abnormal hemoglobin, cells break easily and becomes logged in vessels
What is polycythemia?
What is polycythemia vera?
What is secondary polycythemia?
What is blood doping?
Abnormal high number of RBC
*increased blood viscosity, pressure and clotting which can lead to heart attack
Polycythemia vera is bone marrow cancer leading to excess RBC’s; treatment is therapeutic phlebotomy
2ndary polycythemia: caused by low 02 or increased EPO production
Blood doping: athletes remove, store and reinfuse RBCs before an event to increase O2 levels for stamina
What are leukocytes?
What % in total blood volume?
How many in ul/blood?
Nuclei?
Function?
White blood cell
Make up <1% of total blood volume
4800-10800 wbc/ul blood
Complete cell with nuclei
Function: defense against disease
WBC move by the following characteristics
What is Diapedesis?
What is amoeboid motion?
What is positive chemotaxis?
When WBC move through walls of capillaries
Amoeboid motion is crawling like-type of movement by the protrusion of cytoplasm
Positive chemotaxis is the movement of cells towards a higher concentration of a stimulating (chemical) substance
What is leukocytosis?
WBC count over 11,000/mm3
*normal increase in response to infection
*abnormal if it consistently is over 11,000 (parasitic infections, AIDS, leukemia)
Erythrocyte Disorders
What is Thalassemias?
What is sickle cell anemia?
What is anemia?
Thalassemias - One globin chain is faulty or absent. RBCs are thin, delicate and deficient in hemoglobin
Sickle cell anemia - Mutated hemoglobin, cresent shaped, rupture easily and block vessels
*people with sickle cell do not contract malaria
Anemia - abnormally low 02 carrying capacity to support normal metabolism
What are the following types of anemia?
Hemorrhagic anemia?
Chronic herrhagic anemia?
Iron deficiency anemia?
Pernicious anemia?
Renal anemia?
Hemorrhagic anemia - rapid blood loss (severe wound)
Chronic herrhagic anemia - slight but persistent loss (hemorrhoids, bleeding ulcer)
Iron deficiency anemia - low iron intake or impaired absorption. Produces Microcytes (small, pale, cannot synthesize Hb)
Pernicious anemia- low dietary intake of b12 (an autoimmune disease-macrocytes)
Renal anemia - lack of EPO, kidneys cannot produce EPO
Define: Neutrophils
Nucleus?
% of WBC?
Granules stain with what dyes?
Phagocytic?
Function:
Granulocyte - WBC
Nucleus is lobular (2-5 lobes)
50-70%
Granules stain with basic and acidic dyes
Very phagocytic
Bacterial slayers. granules contain defensins (enzymes or antimicrobial proteins), kills microbes with respiratory bursts (bleach or hydrogen peroxide)
Define: Eosinophils
Nucleus
% of WBC?
Granules stain with what dyes?
Phagocytic?
Function:
Granulocytes - WBC
The nucleus has 2 lobes, resembling sunglasses
2-4%
Granules stained by acid
Phagocytic
Function: release enzymes on parasitic worms, play a role in allergies and asthma, immune response modulators
Define: Basophils
Nucleus?
% of WBC?
Granules stain with what dyes?
Phagocytic?
Function:
Granulocyte - WBC
Nucleus deep purple, see more granules
0.5-1%
Granules stain with a basic dye
Phagocytic
Function: secrete histamine (vasodilator) - speed flow of blood to an injured areas & secrete Heparin (anticoagulant) promotes mobility of other WBC in the area
Define: Lymphocytes
Nucleus?
% of WBC?
Found where?
Function and types?
Agranulocyte - WBC
Dark purple circular nuclei w/ thin rim of cytoplasm
25%
Found in lymphoid tissue (lymph nodes, spleen) and a few circulate in blood
DESTROY CELLS / specific immunity
T cells - act against virus-infected cells and tumor cells
B cells - give rise to plasma cells, which produce antibodies
Define: Monocytes
Nucleus?
% of WBC?
Function:
Agranulocyte
Dark purple, kidney or U shaped nuclei
3-8%
Increased number if infection. Leave blood stream and turn into macrophages and phagocytize pathogens and debri
What is Leukopoiesis?
What 2 chemicals stimulate leukopoiesis?
All leukocytes originate from what cell?
What are the 2 branches of pathways to produce all WBC?
Leukopoiesis is the production of WBC
The 2 chemicals that stimulate leukopoiesis are interleukins and colony-stimulating factors (CSF)
Leukocytes originate from hemocytoblasts stem cells
Hemocytoblast stem cell -> lymphoid stem cell -> lymphocytes
OR
Hemocytoblast stem cell -> myeloid stem cells -> all other WBC
What is the process for granulocyte production from myeloid stem cell?
- *Myeloid stem cell**
- *Myeloblast**
- *Promyelocytes** - accumulate lysosomes
- *Myelocytes** - accumulate granules
- *Band cells** - nuclei curved
- *Mature** - nuclei become segmented before being released into the blood
*10x more in bone marrow then blood
3X’s more WBC are formed then RBC due to shorter life
What is the process for Agranulocyte production from myeloid stem cell?
Monocytes dervied from myeloid line
Lympocytes - lymphoid stem cells-> precurser->lymphocyte
(Monoblast->promonocyte->monocyte)
Disorders of WBC
Leukopenia?
Leukocytosis?
Infectious Mononucleosis?
Leukemia?
Leukopenia - low WBC below 5000/ul
-Causes: radiation, poisons, infectious disease, drugs
Risk: elevated risk of infection
- *Leukocytosis** - high WBC above 10,000/ul
- Causes: infection, allergy and disease
Infectious Mononucleosis - viral infection which elevates the number of lymphocytes in blood
Causes: Epstein Barr virus
Leukemia- cancer of blood-forming cells in bone marrow
Condition involving overproduction of abnormal WBC
*cannot fight infection
What are Thrombocytes?
Normal count?
3 functions in clotting?
Live span?
Platelet formation is regulated by?
Thrombocytes - platelets are fragments of megakaryocytes
Normal count is 150,000 - 400,000
- Formation of platelet plugs. 2. Formation of clots. 3. Circulating platelets are inactive
life span is 10 days
Regulated by thrombopoietin
What is Hemostasis?
What are the 3 phases?
Hemostasis is the cessation of bleeding
-
Vascular spasm - vasoconstriction of the damaged vessel
*direct injury to smooth muscle, chemicals released, pain reflex -
Platelet plug formation - collagen is exposed and platelets stick to collagen, platelets release chemicals which cause more platelets to stick
* *von willebrand factor*
3. Coagulation - Fibrin forms a mesh which traps RBC and platelets forming the clot
What are the Extrinsic and Intrinsic pathways for coagulation?
The extrinsic pathway is damaged to the outside of the vessel.
*Thromboplastin is released outside of damaged vessel + Factors = Factor X
The intrinsic pathway is damaged to the inside of the vessel.
Contact with collagen of the damaged vessel, activated factors until factor X
Each pathway cascades towards and ends with activation of factor X
What is the process of coagulation from the common pathway?
Factor X, Factor V, phospholipids, Ca2+ form Prothrombinase
Prothrombinase converts prothrombin to thrombin
Thrombin converts fibrinogen to fibrin
Fibrin strands form the structural basis of clot
What are the 3 stages to remove a clot?
- Actin and Myosin in platelets contract
- Contraction squeezes serum from clot
- Draws ruptured vessel walls together
Platelet-derived growth factor (PDGF) released by platelets and does what?
Vascular endothelial growth factor (VEGF) does what?
Plasminogen in clot is converted to
PDGF - stimulates division of smooth muscle cells and fibroblast to rebuild vessel wall
VEGF - Stimulated endothelial cells to multiply and restore endothelial lining
Plasminogen is converted to plasmin which promotes cleavage of clot
Antithrombin III does what?
Endothelial cells secrete what 2 antithrombic substances?
Inactivates any unbound thrombin that escapes into blood stream
NO and prostacyclin
Disorders of blood clotting
Hemophilia?
Thrombus?
Embolus?
Anticoagulants?
List 3 anticoagulants
Hemophilia - Genetic absence of clotting factors
Sex linked/more in males
Thrombus- Blood clot formed in an unbroken vessel
more often in veins
Embolus - Moving blood clot
- *Anticoagulants** - substances that inhibit clot formation
- *Aspirin* - reduces the stickiness of platelets
- *Heparin* - blocks actions of thrombin and fibrinogen
- *Coumadin* - interferes with vit K in the coagulation cascade
Thromboembolic disorder?
Bleeding disorders?
Thrombocytopenia?
Impaired liver function?
Hemophilia?
Thromboembolic disorders: result in undesirable clot formation
Bleeding disorders: abnormalities that prevent normal clot formation
Thrombocytopenia: Deficient number of circulating platelets
Impaired liver function: Inability ti synthesize clotting factors
* vit K deficiency, hepatitis, cirrhosis
Hemophilia: herediatry bleeding disorders (A,B,C)
What is Desseminated intravascular coagulation (DIC)
Involves both widespread clotting and severe bleeding
* Can occur in septicemia, incompatible blood transfusions or complications in pregnancy
Define:
Antigen
What are antigens referred to as
Antibodies are referred to as
How is your blood type determined?
Antigen - anything percieved as foregin that can generate an immune response (unique to the individual)
Aglutinogens because they promote agglutinination
Antibodies are agglutinins. Found in plasma. Made at 2 months of age
Your blood type is determined by the presence or absence of antigens on RBC
What is Erythroblastosis fetalis or hemolytic disease of newborn?
Occurs if mother is Rh- and has formed antibodies and is pregnant with 2nd Rh+ child
Treatment: RhoGAM is given to pregnant Rh- women
Diagnostic blood test
Differential WBC count?
Prothrombin time & platelets counts
CMP
CBC
Differential WBC count - looks at relative proportions of each WBC
Prothrombin time & platelets counts - assess hemostasis
Comprehensive Medical Panel - blood chemistry profile that checks various blood chemical levels
Complete Blood Count - checks formed elements, hematocrit, hemoglobin
