Exam 2 (ch. 13 & 15) Flashcards
What is the function of the blood?
- Transport (CO2, O2, nutrients, hormones)
- Immune system response
- Plasma proteins needed to help maintain BP, temp. -regulation, coagulants and the complement system
Plasma vs. serum
Plasma is all the liquid portion of the blood. Serum is all the liquid portion of the blood, but without coagulation proteins
Cells and cell fragments are within what part of the blood?
plasma
Why do we say “cellular ELEMENTS of human blood”?
Because some are cells, some are parts of cells
Erythrocytes
RBC
- primary job is to transport O2
- most numerous cells
Erythroblasts
Precursor cell of erythrocytes in bone marrow
Hemoglobin
Oxygen-carrying protein formed by the developing red cell.
Cellular elements of human blood
Erythrocytes (RBC)
Leukocytes (WBC)
Thrombocytes (platelets/fragments)
What are the components of erythrocytes
erythroblasts
hemoglobin
Hematopoesis
the normal making of cells in the blood
Bone marrow is what type of stem cell?
Multipotent stem cell
What are the 2 main lineages of hematopoiesis?
- Myeloid Lineage
- makes thrombocytes, PMNS, mast cells, macrophages, RBC - Lymphoid Lineage
- makes all lymphocytes
What is normal/healthy hemoglobin called?
HbA –> hemoglobin A (adult)
What is the structure of hemoglobin?
- alpha globin chain (x2)
- beta globin chain (x2)
Where does synthesis of hemoglobin take place?
mitochondria and cytosol of RBC
Heme
Structural chemical group in the middle of each heme is iron, which is where the O2 binds
Erythropoiesis
The formation and development of RBC
Substances needed for erythropoiesis
- protein
- vitamin B12
- folic acid (one of the vitamin B groups)
- iron
Where is iron in the body stored?
75% of iron is found in RBC, the rest is stored in the liver, bone marrow, and spleen
Where does iron uptake take place?
Iron uptake is controlled in the gut
What is Hepcidin?
It is a protein in the gut that is made by the liver; it affects the GIs uptake of iron
What is RBC production regulated by?
RBC production is regulated by oxygen content of the arterial blood
Erythropoietin (EPO)
Made by the kidneys; EPO is released by the kidneys and it affects the bone marrow stimulating the production of RBC
Where are RBC removed at?
spleen and liver
*when destroyed, we recycle iron and beta-globin as amino acids; heme is eliminated at bilirubin
Anemia
Abnormally low hemoglobin
Causes of anemia
- Low HgB in RBC
2. Low RBC count
How might you diagnose anemia
- Complete blood count (CBC)
- RBC indices (color, count, size, volume) - Visual inspection
- Reticulocyte - Hb< 12 g/dl blood
Reticulocyte
An immature RBC characterized by still having organelles
- body kicks RBC out of bone marrow to soon in order to increase O2
- RBc do not have organelles; right before a RBC is kicked out of the bone marrow, it loses it’s nucleus/organelles
Anemia: morphologic classification
classification is based on red cell appearance which can suggest the etiology of anemia
Normocytic anemia
RBC with normal size and appearance
Macrocytic anemia
RBC that are larger than normal
- folic acid deficiency (green leafy)
- vitamin B12 deficiency (animal products)
Microcytic anemia
RBC smaller than normal
Hypochromic anemia
reduced hemoglobin content
Hypochromic microcytic anemia
RBC smaller than normal and reduced hemoglobin content
Symptoms of anemia
fatigue
cyanosis (blue tint)
increased pica (appetite for non-food)
headache
Causes of anemia
- Iron-deficiency Hemorrhage
- Insufficient RBC production
- Hemolytic anemia
- Chronic disease
- Aplastic anemia
Most common type of anemia
Iron-deficiency anemia
When you see Iron-deficiency anemia, what morphologic classification should you think of
Hypochromic microcytic anemia
Iron-deficiency anemia: pathogenesis
- Inadequate iron in diet
- Infants during periods of rapid growth
- Adolescents with bad diet
- Inadequate reutilization of iron present in red cells due to chronic blood loss (periods, ulcer/cancer in GI tract) `
Iron-deficiency anemia: treatment
Primary focus: learn cause of it
- direct treatment towards cause than symptoms
- administer supplementary iron
Macrocytic anemia is a of what what?
megaloblastic anemia
Why are the deficiencies of vitamin B12 and folic acid an issue in Macrocytic anemia?
They are both required for normal hematopoesis, DNA replication, and the deficiencies may affect other cells as well such as WBC/platelets
What morphological classification of anemia does this statement describe: Mature RBC formed are larger than normal or macrocytes
Macrocytic anemia
Pernicious Anemia
Lack of intrinsic factors in the stomach which results in Macrocytic anemia
- vitamin B12 combines with intrinsic factors in stomach and is absorbed in ileum
Pernicious Anemia: Causes
- Gastric resection and bypass: vitamin B12 is not absorbed
- Distal bowel resection or disease: impaired absorption of vitamin B12 intrinsic factor complex
- May develop among elderly because they produce less hydrochloric acid in stomach
- Autoimmune: associated with autoantibodies against gastric mucosal cells and intrinsic factor
Conditions that depress bone marrow function
- Anemia of chronic disease
a. mild suppression of bone marrow function
b. cannot find cause - Aplastic Anemia
a. marrow injured by radiation, anti-cancer drugs, chemicals or autoantibodies - Cancer
a. Bone marrow infiltrated by tumor or replaced by fibrous tissue
Hemolytic Anemia
Premature destruction of RBC
Characteristics of Hemolytic Anemia
- Active bone marrow trying to increase RBC count
- Increased EPO
- Increased reticulocytes
Causes of Hemolytic Anemia
genetic and non-genetic defects
Genetic Hemolytic Anemia: Sickle cell disease
Pathophysiology = HbS
- autosomal RECESSIVE (2 copies)
- missense (misbase) mutation on Beta globin chain
- RBC sickle
- Microinfarcts
due to mutation
Non-genetic Hemolytic Anemia: Acquired Hemolytic Anemia
- Normal red cells but are unable to survive due to “hostile environment”
- attacked and destroyed by antibodies
- destruction of red cells by mechanical trauma
- passing through enlarged spleen (splenomegaly)
- in contract with some part of artificial heart valve
Polycythemia
Too many RBC
Polycythemia: types
- Primary
a. in bone marrow
b. bone marrow malignancy
c. overproduction of RBC, WBC, platelets - Secondary
a. outside of bone marrow
b. reduced arterial O2 saturation leads to compensatory increase in RBC
- lung cancer
- life at altitude
- increase in EPO
Polycythemia complications
Increase in clots, blood is more viscous which causes heart to work harder leading to heart failure
Polycythemia treatments for each type
Primary = drugs that suppress marrow function Secondary = periodic removal of excess blood
Hemorrhagic Anemia
Loss of iron –> loss of O2 carrying capacity
Hemorrhagic Anemia types
- Acute
- due to trauma or wounds - Chronic
- periods
- intestinal bleeding
- presents as iron-deficiency anemia
What is the main threat to acute Hemorrhagic Anemia
low BP and low blood volume –> could go into shock
Primary Thrombocytopenia
- associated with platelet antibodies
- bone marrow produces platelets, but they are rapidly destroyed
- encountered in children and subsides after short time
- tends to be chronic in adults
Secondary Thrombocytopenia
- Damage to bone marrow from drugs or chemicals
- Bone marrow infiltrated by leukemic cells or metastatic carcinoma
Thrombocytopenia
a low blood platelet count.
Primary function of lymphatic system
Provide immunologic defenses against foreign material
lymph nodes
Bean-shaped structures consisting of a mass of lymphocytes
Explain how lymph works
As lymph flows though the nodes, phagocytic cells filter out and destroy microorganisms and foreign matter
Leukopenia
Deficiencies in the quality and quantity of leukocytes.
- always abnormal
- low WBC count predisposes people to infections
Leukocytosis
Increased number of leukocytes.
- normal protective response to stressors
- benign or malignant
What are some malignancies of leukocyte function
lymphoma or leukemia
Infectious Mononucleosis (Mono)
Infection to leukocytes.
- acute, self limiting infection of B lymphocytes transmitted by saliva through personal contact
What causes Infectious Mononucleosis (Mono)
Epstein-Barr virus (EBV)
- B cells have an EBV receptor site
What is Infectious Mononucleosis (Mono) characterized by?
enlarged, tender lymph nodes
Hematologic malignancies: Leukemias
Malignant disease involving WBC precursors in bone marrow, peripheral blood (acute and chronic)
- can be from either the myeloid or lymphoid lineage
Hematologic malignancies: lymphomas
Malignant disease involving lymphocytes
- non-hodgkins lymphoma
- hodgkins lymphoma
Hematologic malignancies: Myeloma
Malignant disease of plasma cells.
- Tumor may be solitary or multifocal
- most patients over 45 yrs
Leukemias (in depth)
- Malignant disorder of the blood and blood-forming organs
2. Uncontrolled proliferation of malignant leukocytes
What hematopoietic cells can give rise to leukemia?
Any type of hematopoietic cells can give rise to leukemia, but the most common types are…
a. granulocytic (types of WBCs)
b. lymphocytic
c. monocytic (macrophages)
What are the classifications of leukemias
- maturity
2. cell types
Clinical features of leukemia
Impairment of bone marrow function.
Leukemic cells crowd out normal cells, causing…
- Anemia: inadequate red cell production
- Thrombocytopenia: causes bleeding
- Infections from inadequate number of normal WBCs
Infiltration of organs by leukemic cells causes…
- Splenomegaly (enlarged spleen)
- Hepatomegaly (enlarged liver)
- Lymphadenopathy: enlarged lymph nodes
Types of Leukemias
- Acute lymphocytic leukemia (ALL)
- Acute myelogenous leukemia (AML)
- Chronic myelogenous leukemia (CML)
- Chronic lymphocytic leukemia (CLL)
Myeloid Malignancies
Arise from myeloid progenitor cells called myeloblast, which are not normally present in the blood
Acute myeloid leukemia (AML)
- rapidly progressive
- age associated
- leading cause of leukemia deaths in adults
Chronic myeloid leukemia (CML)
- slowly progressive
- associated with translocation between chromosomes 9 and 22
Acute lymphocytic leukemia (ALL)
- most common form of leukemia in children
a. sudden onset
b. leading cause of cancer deaths in children
What is Acute lymphocytic leukemia (ALL) characterized by?
Too many immature lymphoid cells that are poorly functioning
- mostly B cells
Acute lymphocytic leukemia (ALL): symptoms
Recurrent infections, weakness, anemia, bruising, fatigue
Acute lymphocytic leukemia (ALL): treatment
chemotherapy
Chronic lymphocytic leukemia (CLL)
- Age associated
- adults - Most common leukemia in the US in prevalence
- Slow growing
Chronic lymphocytic leukemia (CLL): symptoms
Asymptomatic for many years
Predisposed to infections
What do malignant cells often infiltrate
lymph nodes, spleen, thymus, or bone marrow, but also may involve other organs
Non-Hodgkin’s Lymphomas
- risk increases with age
- 6th most common cancer in US
- cancer cells can spill over into blood and can present as leukemia (need to distinguish where the cancer is coming from)
What organs does Non-Hodgkin’s Lymphomas involve
lymph nodes, bone marrow, spleen, thymus, but can be of an extranodal origin
Hodgkin’s Lymphoma
Most common malignant neoplasm of Americans 10-30 years of age.
What is Hodgkin’s Lymphoma characterized by
Reed-Sternberg cells
- B cells gone awry
- Epstein Barr Virus is a risk factor
Non-Hodgkin’s Lymphomas vs Hodgkin’s
- BOTH present as painless enlargement of lymph nodes
- Hodgkin arises in single lymph node or chain or nodes, spreading predictably, rather than spreading widely
- Hodgkin rarely involves structures other than lymph nodes (1/3 NHL other organs)
- NHL = more aggressive
- NHL more common
- NHL increasing, while Hodgkin’s decreasing in US
Where do malignant plasma cells proliferate?
bone marrow
Pathophysiology of Myeloma
a. functionally useless antibodies
- breakdown of antibodies
- light chains are toxic to kidneys
b. Impaired humoral immunity
- hypogammaglobulinemia (antibodies)
c. anemia
d. most common cause of death infection or renal failure
Treatment of Leukemia/Lymphoma
Depends on age, severity, and type
a. chemo and radiation are first line of defense, but overtime, cancer may become resistant so you may need to use a different drug
b. HSC stem cell transplantation from bone marrow; need to match HLA. A major concern for this is Graft vs. host disease
US leading cause of death
- heart disease
- cancer
- chronic lower respiratory disease
Leading cause of death worldwide
- heart disease
- stroke
- chronic obstructive pulmonary disease
Most morbidity and mortality of the lung associated with what lifestyle factor?
smoking and pollution
What is the structure of the respiratory system?
trachea
bronchi
bronchioles
alveoli
Alveoli function
O2 and CO2 exchange
Production of surfactant
Respiration: function
- Ventilation: the physical movement of air in and out of the lungs
- Gas exchange: at lungs; CO2 out, O2 in, gas exchange occurs at the tissues
Describe gas exchange
Gases diffuse between blood, tissues, and pulmonary alveoli due to differences in their partial pressures
Partial pressure
the pressure that would be exerted by one of the gases in a mixture if it occupied the same volume on its own.
Requirements for efficient gas exchange
- Large capillary surface area in contact with alveolar membrane
- Unimpeded diffusion acros alveolar membrane
- Normal pulmonary blood flow
- Normal pulmonary alveoli
Pleura
each of a pair of serous membranes lining the thorax and enveloping the lungs
Visceral vs parietal pleura
Visceral = right on lung (inside) Parietal = line thoracic cavity (outside)
Pleural cavity
space between lungs and chest wall; in between visceral and parietal pleura
Intrapleural pressure
The pressure within the pleural cavity
- normally lesser than intrapulmonary pressure
- vacuum, no air in or out
- hold lungs open
Dyspnea
difficulty breathing; shortness in breath
Apnea
without breathing
Tachypnea
increase in breathing rate (ventilation)
Hemoptysis
coughing up blood
Cyanosis
blue coloring on body due to lack of O2 in blood
Pulmonary function tests
- Percussion: tapping around lungs (to see if hallow)
- Auscultation: listening to lungs with stethoscope
- Spirometry: measures lung volumes and capacities (RV, VC, FEV1)
Pneumothorax
Presence of air in pleural cavity; leads to a collapsed lung
Atelectasis
Incomplete expansion of the lung
Obstructive Atelectasis
Obstruction of conducting airway; foreign bodies, mucus plugs
Compression Atelectasis
Compression of lung by liquid, solid, gas within pleural space; can result in sudden death
Diagnosis of Atelectasis
X-Ray - the affected lung appears dense
Pneumonia
Inflammation of the lungs
- leading cause of death in elderly and children
Pneumonia may be due to…
- virus
- bacteria*
- fungi
- mycoplasma
How might you detect Pneumonia
- auscultation
- chest X ray
Predisposing factors of Pneumonia
Any condition associated with poor lung ventilation and retention of bronchial secretions
Post-op Pneumonia
accumulation of mucous secretions in bronchi
Aspiration Pneumonia
Foreign body, food, vomit
Clinical features of pneumonia
fever, cough, purulent sputum, pain on respiration, shortness of breath
Walking Pneumonia
Can still do activities (job, school)
- fever is not as high
Walking Pneumonia cause
Mycoplasma –> lives inside cells so it can be hard for immune system to see it
Walking Pneumonia treatment
Need specific type of antibiotic cause it is a specific type of bacteria
Bronchiectasis
Pathologic dilation of airways due to weakening walls
What repeated chronic infections is Bronchiectasis typically associated with
- decrease ability to move mucus
- distended bronchioles retain more mucus secretions
- creates an environment for bacterial growth
Chronic Obstructive Airway Disorders
Group of disorders characterized by reduced airflow and impaired gas exchange
- progressive
- poor reversibility
- increasing prevalence in US
What are Chronic Obstructive Airway Disorders often associated with?
inflammatory conditions of the lungs
Two classifications of Chronic Obstructive Airway Disorders
Emphysema
Chronic Bronchitis
COPD signs and symptoms
large amount of mucous coughing dyspnea tight chest barrel chest
Diagnosis of COPD
Spirometry: if you see a decrease in FEV1 of VC
Chronic Bronchitis
Inflammation of medium sized walls (bronchioles)
Emphysema
Abnormal permanent enlargement of the alveoli, they weaken and eventually rupture
- enlargement of air spaces
- loss of lung elasticity
- irreversibility destruction of alveoli
Chronic Bronchitis symptoms
- persistent cough for at least 3 month for 2 consecutive years
- irritants in lungs
- excessive mucus
Complications of COPD
- Respiratory failure
a. acidosis
b. arrhythmia due to hypoxia - Right side heart failure
- more infections such as pneumonia
- acute respiratory failure
- lung cancer
Asthma
Bronchospasm (bronchioles get smaller)
- obstructive disease
- dyspnea and wheezing on expiration
Describe how Asthma is in most cases, an allergic basis
Type 1 hypersensitivity
- mast cells release inflammatory mediators –> spasm smooth muscle –> recruit more WBC (eosinophils)
Asthma treatment
- avoid the allergen
- drugs that dilate bronchial walls: epinephrine (beta agonist inhalers)
- reduce inflammation (corticosteroid inhalers)
- drugs that block release of mediators from mast calls
Neonatal Respiratory Distress Syndrome
a. Progressive respiratory distress soon after birth
Neonatal Respiratory Distress Syndrome: Pathogenesis
Inadequate surfactant in lungs
- alveoli do not expand normally during inspiration
- tends to collapse during expiration
Neonatal Respiratory Distress Syndrome: at-risk groups
- premature infants
- infants delivered by C-section
- infants born to diabetic mothers
Neonatal Respiratory Distress Syndrome: treatment
Before delivery –> adrenal corticosteroids to mother
After delivery –> oxygen + surfactant to baby
Adult Respiratory Distress Syndrome (ARDS)
Associated with alveolar damage
- alveolar epithelium
- vascular endothelium
Types of Adult Respiratory Distress Syndrome (ARDS)
- Damage due to decrease blood flow to lungs (shock)
- Direct damage to pulmonary capillaries
a. inhalation of irritants
b. gastric aspiration
Result of Adult Respiratory Distress Syndrome (ARDS)
Hypoxemia (low O2 in blood) which results in organ failure
Treatment of Adult Respiratory Distress Syndrome (ARDS)
- Treatment of underlying conditions
- Supportive care (fluids)
- Oxygen therapy (to increase O2 levels in blood)
Leading cause of cancer death in both men and women
Lung cancer
Classifications of Lung Cancer
- Small Cell (SCLC)
- only see this in smokers - Non-small Cell (NSCLC)
Lung cancer etiology
a. Cigarette smoking (80-90%) of lung cancers
- non-smokers = 10-15% of lung cancers
b. Radon gas
c. Asbestos
d. Pollution (second hand smoke)
e. Genetics
Why is lung cancer do deadly?
Because by the time someone shows symptoms, it already metastasized
- 60% will die within the first year
Symptoms of lung cancer
- unexplained cough
- weight loss
- coughing up blood
- loss of appetite
What facilitates metastasis in lung cancer?
Rich lymphatic and vascular network in lungs facilitates metastasis
What are common sites for metastatic cancer
breast, prostate, colon
