Chapter 1 Organization of Blood Flashcards
Liquid connective tissue that consists of cells surrounded by extracellular matrix
Blood
Three general functions of blood
Transportation
Regulation
Protection
Blood transports ______ from the lungs to cells throughout the body
Oxygen
Blood transports ______ from cells to the lungs
Carbon dioxide
Carries nutrients from the GI tract to body cells
Heat and waste products away from cells
Transports hormones from endocrine glands to other body cells
Blood
Regulates the pH of body fluids
Blood
The heat-absorbing and coolant properties of ____ in blood plasma help adjust body temperature
Water
Influences the water content of cells
Blood osmotic pressure
Protects against excessive loss from the cardiovascular system
Blood clots
Protect against disease by carrying on phagocytosis and producing proteins called antibodies
WBCs
Additional proteins in blood that helps protect against disease
Interferons and complement
Temperature of blood
38C (100.4F)
pH of blood
7.35 to 7.45
Blood constitutes about __% of the total body weight
8%
Blood volume in the average-sized adult male
5-6 liters (1.5 gal)
Blood volume in the average-sized female
4-5 liters (1.2 gal)
Differences of blood volume is due to:
Body Size
Whole blood is composed of two portions
Blood Plasma
Formed elements
Liquid extracellular matrix that contains dissolved substances
Plasma
Cells and cell fragments
Formed elements
Blood is __% formed elements
45%
More than __% of formed elements are red blood cells, the rest consist of white blood cells and platelets
99%
Plasma makes up what percentage of blood?
55%
Percentage of total blood volume occupied by red blood cells
Hematocrit
HCT for males
42%-52%
HCT in females
37%-47%
Buffy coats, <1% of total blood volume, is made up of:
WBCs and platelets
Where does the buffy coat lie in centrifuged blood?
Between the packed RBCs and blood plasma
Blood plasma is what % of water, proteins, and solutes
91.5% water
7% proteins
1.5% solutes
Proteins in the blood (plasma proteins), are synthesized mainly by the:
Liver
Most plentiful plasma proteins, make up 54% of all plasma proteins
Albumins
Erythrocytes
RBCs
Oxygen-carrying protein
Hemoglobin
Gives blood the red pigment color
Hemoglobin
Hemoglobin transports __% of the carbon dioxide in the blood
23%
Adult males RBC volume
5.4 million
Adult female RBC volume
4.8 million
Red blood cell lifespan
120 days
Volume of WBCs
5-10k
Lifespan of WBCs
Few hours to a few days
Leukocytes
WBCs
What do WBCs have that RBCs do not have?
Nuclei and organelles
What do RBCs have that WBCs do not?
Hemoglobin
WBCs are classified as either:
Granular
Agranular
Granular leukocytes
Neutrophils
Eosinophils
Basophils
Agranular leukocytes
Lymphocytes
Monocytes
50-70% of all WBCs
Neutrophils
Nucleus has 2-5 lobes.
Cytoplasm has very fine lilac granules.
Phagocytosis: Destroy bacteria with lysozymes, defensins and strong oxidants.
Neutrophils
1-5% of all WBCs
Eosinophils
Nucleus usually has 2 lobes, cytoplasm full of large, red-orange granules.
Suppresses effects of histamine in allergic reactions, phagocytizes antigen-antibody complexes and destroys certain parasitic worms
Eosinophils
0-1% of all WBCs
Basophils
Nucleus has two lobes, has large cytoplasmic granules that appear deep blue purple.
Releases heparin, histamine and serotonin that intensifies the inflammatory response in allergic reaction
Basophils
20-40% of all WBCs
Lymphocytes
Nucleus is round and slightly indented.
Cytoplasm forms a thin rim around the nucleus that appears sky blue.
Mediates immune responses, including antigen antibody reactions.
- B Cells secrete antibodies
- T Cells attack invading viruses, cancer, and transplanted tissue
- Natural Killer cells attack a wide variety of microbes and tumor cells
Lymphocytes
1-6% of all WBCs
Monocytes
Nucleus is kidney shaped or horseshoe shaped, cytoplasm is blue-gray and has a foamy appearance
Phagocytic: Will transform into a fixed histiocyte or a wandering macrophage.
Monocytes
WBC:
Deep blue-purple
Basophil
WBC:
Large, red-orange granules
Eosinophils
WBCs:
Very fine lilac granules
Neutrophils
WBC:
Thin rim around the nucleus, appears sky blue
Lymphocytes
WBC:
Blue gray foamy appearance
Monocytes
WBC:
Destroy bacteria
Neutrophils
WBC:
Suppresses effects of histamine in allergic reactions
Destroys certain parasitic worms
Eosinophils
WBC:
Intensifies responses to allergic reactions
Basophils
WBC:
Mediate immune responses
Lymphocytes
WBC:
Phagocytic: Will transform into a fixed histiocyte or a wandering macrophage
Monocytes
Volume of platelets per micro liter
150,000-450,000
Lifespan of platelets
5-9 days
The process by which the formed elements of blood develop
Hemopoiesis (Hematopoiesis)
Primary site of hemopoiesis and continues as the source of blood cells after birth and throughout life
Red bone marrow
Capacity to develop into different cell types
Pluripotent stem cells
Pluripotent stem cells are stimulated by specific hormones and will differentiate into 2 cell lines
Myeloid
Lymphoid
Myeloid stem cells differentiate further into what types of cells?
RBCs
Platelets
Eosinophils
Mast cells
Basophils
Neutrophils
Monocytes
Lymphoid stem cells begin development in bone but mature in:
Lymphatic tissue
Immature neutrophils. Nucleus has horseshoe shape and has not developed enough to be a segmented neutrophil
Bands
Percentage of bands considered abnormal
> 10%
Associated with myelodysplastic disorders
- Cytopenias with hyper-cellular bone marrow
- Morphologic abnormalities in one or more hematopoietic cell lines
Blast
A sequence of responses that stops bleeding when blood vessels are injured
Hemostasis
Three mechanisms can reduce loss of blood from vessels
Vascular spasm
Platelet plug formation
Blood clotting (coagulation)
Loss of a large amount of blood from vessels
Hemorrhage
Can prevent hemorrhage from smaller blood cells
Hemostasis
Vascular spasm reduces blood loss for how long?
Several minutes to several hours
What allows platelets to stick to damaged vessels and form a platelet plug?
Stick to collagen fibers and then release chemicals
Straw-colored liquid, called serum, is:
Plasma minus the clotting proteins
Series of chemical reactions that culminates in the formation of fibrin threads
Coagulation
Clotting factors include:
1) Calcium ions (Ca2+)
2) Several enzymes that are made by liver cells and released into the blood
3) Various molecules associated with platelets or released by damaged tissues
Many clotting factors are identified by:
Roman numerals
Three stages of clotting
Step 1: Prothrombinase is formed
Step 2: Prothrombinase converts prothrombin (plasma protein formed by the liver with vitamin K) into the enzyme thrombin
Step 3: Thrombin converts soluble fibrinogen (another plasma protein made by the liver) into insoluble fibrin
Forms the threads of the clot (Lattice structure like a net)
Fibrin
Contains substances that interfere with stage 3 of clotting formation; conversion of fibrinogen
Cigarette smoke
Forms connective tissue in the ruptured area and new endothelial cells repair the vessel lining
Fibroblasts
Occurs simultaneously as coagulation occurs
- Site of roughness inside the vessel
- Plasminogen is incorporated into the clot
- Plasmin begins digesting and dissolving fibrin threads
Fibrinolysis
Surfaces of RBCs contain a genetically determined assortment of antigens, agglutinogens, is composed of:
Glycolipids and glycoproteins
There are at least __ blood groups and more than ___ antigens that can be detected on the surface of RBCs
24 blood groups
100 antigens
Two major blood groups
ABO
Rh
ABO blood group is based on what two antigens?
A & B
People whose RBCs display only antigen A have are type:
A
People whose RBCs display only antigen B are type:
B
People whose RBCs display A and B antigens are type:
AB
People whose RBCs display neither antigen A nor B are type:
O
Percentage of the population that have ABO type:
80%
Blood plasma antibodies that react to A or B antigens if the two are mixed
Agglutinins
If you have type A blood (A antigens on your RBCs), what antibodies would be in your blood plasma?
B
Rh blood group is named so because the Rh antigen, Rh factor, was first found in the blood of:
Rhesus Monkey
RBCs who have Rh antigen
Rh+
RBCs who lack the Rh antigen
Rh-
Why would blood transfusions be given to patients with anemia?
To raise hemoglobin levels
RBCs, plasma, platelets in a 1:1:1 ratio
Fresh whole blood
Indications for use of fresh whole blood
Massive hemorrhage when more than 10 units are expected
Cardiac surgery
Walking blood bank is what percentage of the crew?
10%
Form that is filled for walking blood bank
DD 572
Size of packed RBCs
300mL, 200mL consists of RBCs
One unit of packed RBCs will usually bring up hemoglobin by:
1 g/dL
When should you give packed RBCs to critically ill patients?
When their hemoglobin falls below 7-8g/dL
For every unit of packed RBCs given you should give a unit of:
FFP and platelets (1:1:1) ratio
Leukocyte reduced blood reduces the incidence of:
Leucoagglutination reactions
Platelet alloimmunization
Transfusion related to acute lung injury & CMV exposure
Patients scheduled for elective surgery and donate their own blood to transfuse is called:
Autologous
Units of autologous packed RBCs can be refrigerated up to how many days?
35
Frozen RBCs:
DoD guidelines allow units to be glycerolized and frozen for up to:
10 years
Casualty receiving ships and the larger amphibious ships maintain frozen storage of what units while on deployment?
O units
Can deglycerolize one unit in about 1 hour
ACP215 instrument
After deglycing a unit of blood, it can be transfused or stored in the refrigerators for an additional __ days.
14
Before transfusion, the recipient and donor’s blood need to be typed and cross-matched to avoid:
Hemolytic transfusion reactions
Most important antigens. Everyone who lacks one or both of these antigens has the corresponding IgM antibody in their serum.
Can cause immediate lysis of incompatible red cells.
A & B antigens
Rh is also known as:
D antigen
15% of the population lacks this antigen and is not naturally present
D antibody
O negative mothers are provided what after delivery of Rh positive offspring?
Rho-gham
Most severe Transfusion reactions involve mismatches in what system?
ABO
Hemolytic transfusion reactions are mostly due to:
Clerical errors and mislabeled specimens
When hemolysis occurs it is rapid and intravascular, releasing ______ into the plasma
Hemoglobin
Death occurs in __ in 1.8 million transfused units.
Most severe reactions are those seen in surgical patients under anesthesia.
1
Signs and symptoms of hemolytic transfusion reactions:
Fever, chills, backache, headache
Apprehension (sense of impending doom)
Dyspnea
Hypotension
Cardiovascular collapse
Pts under anesthesia will not manifest typical signs and symptoms of hemolytic transfusion reactions. Their first indication will be:
Tachycardia
Generalized bleeding
Oliguria
Severe cases of hemolytic transfusion reactions may present with:
DIC (Disseminated intravascular coagulation)
Acute kidney injury from tubular necrosis
Death occurs in __% of acute hemolytic reactions due to ABO incompatibility
4%
Hemolytic transfusion reaction:
What lab will be elevated?
Hgb, resulting in hemoglobinuria
Treatment for hemolytic transfusion reaction:
Stop transfusion immediately
Vigorously hydrate patient to prevent acute tubular necrosis
Forced diuresis with mannitol to prevent acute kidney injury
Signs and symptoms:
Fever and chills within 12 hours after the transfusion
Cough and dyspnea in severe cases
Leucoagglutinin reaction
Lab findings for leucoagglutinin reaction
Chest radiograph may show transient pulmonary infiltrates
Hgb rises by expected amount despite reaction because there is no hemolysis
Treatment for:
Leucoagglutinin reactions
Acetaminophen 500-600mg PO
Diphenhydramine 25mg PO/IV
Hydrocortisone 1mg/kg IV
Hypersensitivity reactions are mainly due to:
Exposure to allogeneic plasma proteins
Symptoms of hypersensitivity reactions
Urticaria or bronchospasms may develop during or soon after transfusion
Transfusion:
Anaphylactic shock may develop in patients who are IgA deficient because:
Antibodies to IgA in the patient serum will react against the IgA in the transfused blood product
Treatment for hypersensitivity reaction patients
Washed or frozen RBCs to avoid future severe reactions
RBC donations are contaminated
1 out of 30,000
Platelet donations are contaminated
1 out of 5,000
Transfusion of contaminated products with gram positive bacteria symptoms:
Fever and bacteremia; Rarely causes sepsis
Transfusions contaminated with gram negative with cause:
Septic shock
Acute DIC
Acute kidney injury
Allogeneic passenger lymphocytes in transfused blood will engraft in some recipients and mount an allo-immune attack against tissues expressing discrepant HLA antigens
Graft vs Host Disease
Symptoms of Graft vs Host Disease
Fever, rash, diarrhea, hepatitis, lymphadenopathy, and severe pancytopenia
Outcome is usually fatal
Occurs mostly in patients with immune defects, malignant lymphoproliferative disorders, solid tumors treated with chemotherapy or immunotherapy, treatment with immunosuppressive drugs or older patients undergoing cardiac surgery
Graft vs Host Disease
Treatment for Graft vs Host Disease
Utilizing blood that has been irradiated to prevent lymphocyte proliferation
What blood products should be given to those above patients that are at high risk for transfusion associated Graft vs Host disease?
Irradiated blood products
Transfusion Related Acute Lung Injury (TRALI) occurs in __ out of 5,000 transfusions
1
Clinically defined as non-cardiogenic pulmonary edema after a blood product transfusion without other explanation
Transfusion Related Acute Lung Injury (TRALI)
How do you reduce the risk of TRALI?
Use male only plasma donors (only 1-5% have antileukocyte antibodies)
