Chapter 10 - Blood and Circulation Flashcards
1
Q
Why is blood important to all systems?
A
transports oxygen & nutrients required for cell metabolism, removal of wastes, immune system/maintain homeostasis
2
Q
What are the two separate circulations
A
Pulmonary circulation (allows for exchange of oxygen & CO2 in the lungs), systemic circulation (exchange of nutrients and wastes between blood and cells of the body)
3
Q
Arteries
A
transport blood away from the heart into the lungs or to body tissues
4
Q
Arterioles
A
Control the amount of blood flowing into the capillaries through vasoconstriction or dilation
5
Q
Capillaries
A
very small vessels organized in numerous networks that form the microcirculation. Blood flows very slowly through capillaries.
6
Q
What determines the amount of blood flowing from the arterioles into the individual capillaries?
A
Precapillary sphincters do, depending on the metabolic needs of the tissues
7
Q
Flow of blood in veins
A
capillary beds –> venules –> larger veins (capacitance vessels)
8
Q
What does blood flow in the veins depend on?
A
skeletal muscle action, respiratory movements, and gravity. Valves in larger veins in arms and legs are important. Respiratory movements assist the movement of blood through the trunk.
9
Q
Tunica intima
A
endothelial layer, is the inner layer of blood vessels. simple squamous epithelium
10
Q
Tunica Media
A
layer of smooth muscle that controls the diameter and lumen size (diameter) of the blood vessel, is the middle layer.
11
Q
Tunica Adventitia (externa)
A
outer connective tissue layer. Connective tissue with fibrocytes, collagen (type I), and elastic fibers
12
Q
Autoregulation
A
Controls localized vasodilation or vasoconstriction in arterioles.
A reflex adjustment in a small area of a tissue or an organ, which varies depending on the needs of the cells in the area.
13
Q
What system controls vasomotor tone at all time?
A
SNS, even at rest to ensure continued circulation of blood
14
Q
What is the pH of blood?
A
7.35-7.45
15
Q
How much blood does the adult body contain?
A
5L
16
Q
Hematocrit
A
proportion of cells (essentially erythrocytes) in blood and indicates the viscosity of the blood. Percent by volume of cellular elements in blood.
17
Q
Plasma
A
Clear yellowish fluid remaining after the cells have been removed
18
Q
Serum
A
Refers to the fluid and solutes remaining after the cells and fibrinogen have been removed
19
Q
Where do all red blood cells originate from?
A
The red bone marrow
20
Q
How do the various blood cells develop?
A
from a single stem cell (pluripotential hematopoietic stem cell) during the process of hemopoiesis or hematopoiesis.
21
Q
Dyscrasia
A
A pathological condition of the blood that usually refers to disorders involving the cellular components of blood
22
Q
What is Erythropoietin?
A
A hormone that originates in the kidney & stimulates erythrocyte production in the red bone marrow in response to tissue hypoxia, or insufficient oxygen available to cells.
23
Q
What is hemoglobin?
A
globin portion, two pairs of amino acid chains, and four heme groups, each containing a ferrous iron atom, to which the oxygen molecule can attach.
24
Q
How is CO2 transported in the blood?
A
transported as bicarbonate ion in the buffer pair.
25
Hemochromatosis
"iron overload”; results in large amounts of hemosiderin accumulating in the liver, heart, and other organs, causing serious organ damage.
26
What removes old/damaged blood cells?
Liver and spleen
27
Hemolysis of erythrocyte
Hemoglobin --> Heme & Globin
Globin - amino acids are recycled.
HEME --> Iron & Bilirubin
Iron recycled to bone marrow or stored.
Bilirubin is unconjugates, transported with serum albumin in the blood to the liver where is conjugates with glucuronic acid --> then secreted as bile
28
Leukopoiesis
Production of WBC
29
How does Leukopoiesis work?
Stimulated by colony-stimulating factors produced by cells such as macrophages and T lymphocytes.
30
5 types of lymphocytes
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Lymphocytes
Neutrophils
Basophils
Eosinophils
Monocytes
```
31
Lymphocytes
Make up 30-40% of the WBCs. B and T lymphocytes are significant in the immune response. Cell mediated humoral immunity
32
Neutrophils
Most common leukocyte; 50-60% of WBCs; survive only 4 days; first response to any tissue damage and commence phagocytosis.
Immature neutrophil called “band” or “stab”
Increase in numbers by bacterial infection
33
Basophils
Migrate from blood and enter tissue to become mast cells that can release histamine and heparin. Inflammatory response
34
Eosinophils
Combat the effects of histamine
| Increased by allergic reactions and parasitic infections. Allergic response.
35
Monocytes
Can enter the tissue to become macrophages, which act as phagocytes when tissue damage occurs. largest cells in the circulation. Phagocytosis.
36
Thrombocytes
“platelets”, essential part of the blood clotting process or hemostasis.
Not cells; small, irregularly shaped, non-nucleated fragments from large megakaryocytes.
37
Process of Blood Clotting/Hemostasis
Vasoconstriction/vascular spam of blood vessels. In small blood vessels, this decreases blood flow and may allow a platelet plug to form.
Thrombocytes tend to adhere to the underlying tissue at the site of injury and, if the blood vessel is small, can form a platelet plug in the vessel. Platelet clot.
In larger vessels, blood clotting or coagulation mechanism is required through a sequence of reactions.
38
Clot formation/coagulation sequence
Damaged tissues and platelets release factors that stimulate a series of reactions involving numerous clotting factors ultimately producing prothrombin activator (PTA) --> prothrombin (factor II) converted into thrombin & fibrinogen (factor I) is converted into fibrin threads --> fibrin mesh forms to trap cells, making a thrombus to stop flow of blood. Clot gradually sinks or retracts pulling the edges of damaged tissue closer together and sealing the site
39
Which minerals are important for synthesis of clotting factors/in the process?
Vitamin K and calcium
40
How is inappropriate thrombus formation prevented?
Coagulation inhibitors such as anti-thrombin III circulate in the blood. Heparin & Natural Fibrinolytic process
41
Heparin
anticoagulant that is released from basophils or mast cells in the tissues and exerts its major action by blocking thrombin. Does not dissolve clots but prevents further growth of thrombus.
42
Natural Fibrinolytic process
Inactive plasminogen circulated in the blood. Following injury, it can be converted by tissue plasminogen activator and streptokinase through a sequence of reactions, into plasmin. Plasmin then breaks down fibrin and fibrinogen. Localized event only.
43
Hematocrit
Percent by volume of cellular elements in blood
44
Hemoglobin
Amount of hemoglobin per unit volume of blood
45
Mean corpuscular volume (MCV)
Indicates the oxygen-carrying capacity of blood
46
Prothrombin time (PT) and partial thromboplastin time (PTT)
Measure function of various factors in coagulation process
International normalized ratio (INR) is a standardized version.
47
What do anemias cause?
A reduction in oxygen transport in the blood due to a decrease in hemoglobin content.
48
Types of Anemia
Iron deficiency, Pernicious, Hemolytic, Sickle Cell
49
What sequence of events does an oxygen deficit lead to?
Less energy production in cells, compensation via tachycardia and peripheral vasoconstriction, [fatigue, pallor, dyspnea, tachycardia], decreased regen of epithelial cells causes digestive tract to be inflammed and ulcerated (stomatitis), inflamed and cracked lips, dysphagia. Angina during stressful situations if O2 to heart is diminished. CHF.
[less energy production in cells, compensation mechanisms, general signs of anemia)
50
Iron deficiency anemia
Insufficient iron impairs hemoglobin synthesis. Very common. Microcytic, hypochromic RBCs
51
Causes of iron deficiency anemia
low dietary intake, chronic blood loss, impaired duodenal absorption of iron, severe liver disease
52
S/S of Iron deficiency anemia
```
Pallor of skin and mucous membranes
Fatigue, lethargy, cold intolerance
Irritability
Degenerative changes
Stomatitis and glossitis
Menstrual irregularities
Delayed healing
Tachycardia, heart palpitations, dyspnea, syncope
```
53
Pernicious Anemia
i.e. Vitamin B12 Deficiency/Megoblastic Anemia
Lack of B12 because lack of intrinsic factor secreted by gastric mucosa. Characterized by large, immature, nucleated erythrocytes which carry less hemoglobin and have a shorter life span.
54
What causes Pernicious Anemia
Genetic factors implicated. Often accompanies chronic gastritis. May also be an outcome of gastric surgery.
55
Manifestations in addition to those for normal anemia of Pernicious Anemia
Tongue is typically enlarged, red, sore, and shiny.
Digestive discomfort, often with nausea and diarrhea
Feeling of pins and needles, tingling in limbs
56
What does vitamin B12 do?
Needed for the function and maintenance of neurons. promotes maturation of erythrocytes in the bone marrow
57
Hemolytic anemia
Result from excessive destruction of RBCs, or hemolysis, leading to low erythrocyte count and low total hemoglobin.
58
Sickle cell anemia
Type of hemolytic anemia.
- Genetic condition
- Autosomal
- Incomplete dominance
- Anemia occurs in homozygous recessive.
- Abnormal hemoglobin (HbS)
59
In addition to basic anemia sickle cell anemia shows
Hyperbilirubinemia, jaundice, gallstones caused by high rate of hemolysis
60
S/S of sickle cell anemia
Severe pain because of ischemia of tissues and infarction
Pallor, weakness, tachycardia, dyspnea
Hyperbilirubinemia—jaundice
Splenomegaly
Vascular occlusions and infarctions: In lungs = Acute chest syndrome, In smaller blood vessels = Hand-foot syndrome
Delay of growth and development
Congestive heart failure
61
Thalassemia
Type of hemolytic anemia.
results from genetic defect where one or more genes for hemoglobin are missing or variant.
Interferes with the production of the globin chains, and therefore, the amount of hemoglobin synthesized and the number of RBCs is reduced.
- accumulation of the other available chains, damaging the RBCs.
62
Thalassemia Beta
Autosomal dominant inheritance. Most common form.
63
S/S Thalassemia
- Child’s growth and development are impaired directly by the hypoxia and indirectly by the fatigue and inactivity.
- Hyperactivity in the bone marrow leads to invasion of bone and impairs normal skeletal development.
- Heart failure develops as a result of the compensation mechanism increasing cardiac work load.
64
What indicates a blood clotting disorder?
Persistent bleeding from gums, repeated epistaxis, petechiae, purpura and eccymosis, hemarthrosis, hemoptysis (coughing blood), hematemsis (vomiting blood), blood in feces, anemia, feeling faint/anxious, low BP, rapid pulse
Spontaneous bleeding or excessive bleeding following minor tissue trauma
65
Hemophilia A
Classic hemophilia - deficit or abnormality of factor VIII
Most common inherited (x-linked recessive). Prolonged bleeding after minor tissue trauma, spontaneous bleeding into joints, possible hematuria or blood in feces
66
Von Willebrand Disease
Most common hereditary clotting disorder. S/S include skin rashes, frequent nosebleeds, easy bruising, bleeding of gums, abnormal menstrual bleeding
67
Disseminated Intravascular Coagulation
involves both excessive bleeding and excessive clotting. Complication of many primary problems (obstetrical complications, infections, carcinomas, major trauma)
68
Thrombophilia
Group of inherited or acquired disorders
Risk of abnormal clots in veins or arteries
Sometimes cause by another primary condition.
69
Myelodisplastic Syndrome
Diseases that involve inadequate production of cells by the bone marrow. S/S anemia, idiopathic or after chemo/radiation
70
Neoplastic Blood Disorders
Polycythemia, Leukemias
71
Primary polycythemia
Polycythemia vera - Increased production of erythrocytes and other cells in the bone marrow. Serum erythropoietin levels are low.
72
Secondary polycythemia
erythrocytosis - increase in RBC in response to prolonged hypoxia, increased erythropoietin secretion, Compensation mechanism to provide increased oxygen transport
73
S/S polycythemia
```
Distended blood vessels, sluggish blood flow
Increased blood pressure
Hypertrophied heart
Hepatomegaly
Splenomegaly
Dyspnea
Headaches
Visual disturbances
Thromboses and infarctions
```
74
Leukemia in general
Uncontrolled WBC production in bone or lymph nodes
Other hemopoietic tissues are reduced.
One or more types of leukocytes are undifferentiated, immature, and nonfunctional.
Large numbers released into general circulation
Infiltrate lymph nodes, spleen, liver, brain, other organs
75
Acute Leukemias
ALL and AML -
High proportion of immature nonfunctional cells in bone marrow and peripheral circulation
Onset usually abrupt , marked signs of complications
Occurs primarily in children and younger adults
76
Chronic leukemias (CLL and CML)
Higher proportion of mature cells
Insidious onset
Mild signs and better prognosis
Common in older adults
77
S/S acute leukemia
```
Usual signs at onset.
Frequent or uncontrolled infections
Petechiae and purpura
Signs of anemia
Severe and steady bone pain
Weight loss, fatigue, possible fever
Enlarged lymph nodes, spleen, liver
Headache, visual disturbances, drowsiness, vomiting
```
78
S/S Chronic Leukemia
Tends to have a more insidious onset, with milder signs, and may be diagnosed during a routine blood check. Early signs include fatigue, weakness, and frequent infections.
79
Complications of leukemia
```
Opportunistic infections, including pneumonia
Sepsis
Congestive heart failure
Hemorrhage
Liver failure
Renal failure
CNS depression and coma
```
80
ALL - malignant cell & primary age group
Acute lymphocytic leukemia
B-lymphocytes
Young children
81
AML - malignant cell & primary age group
Acute myelogenous leukemia
Granulocytic stem cells
Adults
82
Chronic lymphocytic leukemia - malignant cell & primary age group
B-lymphocytes
| Adults > 50
83
Chronic myelogenous leukemia - malignant cell & primary age group
Granulocytic stem cells
| Adults 30-50
84
Acute monocytic leukemia
Monocytes
| Adults
85
Hairy cell leukemia
B-lymphocytes
| Males > 50
86
Composition of bloods
Plasma (plasma proteins), Cellular components (erythrocytes, leukocytes, thrombocytes (platelets)
87
What are the types of leukocytes?
granulocytes/agranulocytes
88
What are the granulocytes? Agranulocytes?
Neutrophils, eosinophils, basophils.
Lymphocytes, monocytes
89
Proteins in plasma
Albumin (osmotic pressure of blood), globulins (antibodies), fibrinogen (clotting)
90
Presence of antigen D in plasma membrane equals? absence?
Rh (+)
Rh (-)
91
Complete blood count
Includes total red blood cells (RBCs), white blood cells (WBCs), and platelets
92
Leukocytosis
increased WBCs . Associated with inflammation or infection
93
Leukopenia
Decreased WBSs. Associated with some viral infections, radiation, chemotherapy
94
Morphology
Observed with blood smears
Shows size, shape, uniformity, maturity of cells
Different types of anemia can be distinguished.
95
Reticulocyte count
Assessment of bone marrow function
96
Chemical analysis
Diagnostic test.
| Determines serum levels of components, such as iron, vitamin B12, folic acid, cholesterol, urea, glucose
97
Bleeding time
Measures platelet function
98
Prothrombin time (PT) and partial thromboplastin time (PTT)
Measure function of various factors in coagulation process
| International normalized ratio (INR) is a standardized version.
99
Blood therapies
Whole blood, packed red blood cells, packed platelets (anemia/thrombocytopenia)
Plasma or colloid volume expanding solutions (maintain blood volume)
Artificial blood products
Epoetin alfa (artificial erythropoietin, before Sx, anemia related to cancer, chronic renal failure)
Bone marrow or stem cell transplantation (some cancers, severe immunodeficiency, severe blood cell diseases)
Drug treatment (aids clotting)
100
Dyscrasia
A pathological condition of the blood that usually refers to disorders involving the cellular components of blood
101
Aplastic anemia
Impairment or failure of bone marrow, may be temporary or permanent. Often ideopathic but could be caused by myelotoxins, viruses (hep C), genetic abnormalities. Blood counts indicate pancytopenia . Failure to identify cause and treat effectively is life-threatening!
102
Multiple myeloma
Neoplastic disease that involves increased production of plasma cells in bone marrow.
Unknown cause
Occurs in older adults
Production of other blood cells is impaired
Multiple tumors in bone
Loss of bone
Severe bone pain
Prognosis poor, with short life expectancy
