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Year 1: Patho/Pharm > Haematology PATHO > Flashcards

Haematology PATHO Flashcards

1
Q

What is the composition of blood after centrifuge separation

A

45% Cellular (RBC)

1% Buffy coat (leukocytes (WBC), platelets)

55% Plasma (90% water,

10% solutes (albumin, globulins, clotting factors, electrolytes)

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2
Q

List the functions of blood

A

Gas exchange (Co2, O2)

nutrient and waste transport

acid-base balance

thermoregulation

haemodynamic stability

hemostasis (blood clotting)

immune system

Endocrine system

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3
Q

Most abundant blood cell and function

A

Erythrocytes (RBC)
45% of blood

oxygen, carbon dioxide
iron store
acid-base balance

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4
Q

Most abundant blood protein and function

A

Albumin

oncotic pressure
drug transportation

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5
Q

Types of blood proteins and function

A

Albumin
- oncotic pressure
- drug transport

Immunoglobulins
- IgM (innate), IgG (adaptive), IgE (parasite/hypersensitivity), IgA (secretory)

Clotting factors
- Fibrinogen - cross link platelet plug

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6
Q

Anuclear blood cell

A

RBC
- no nucleus
- no organelles
- no mitochondrea
- heme ring
- flexible disc shape
- lifespan 120 days

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7
Q

Cellular fragments in blood

A

Platelets
- cellular fragments
- originate from megakaryocytes in the bone marrow

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8
Q

Two types of leukocytes

A
  1. Granular (Granulocytes)
  • eosinophils (parasitic, hypersensitivity reactions)
  • basophils (allergic reactions)
  • neutrophils (first responders innate immunity)
  • granules of histamine, degranulate during immune response
  1. Agranulocytes
  • B cells (plasma cells, produce immunoglobulins, adaptive humoral immunity)
  • T Cells (helper T cells, killer T cells, adaptive cellular immunity)
  • NK Cells (innate immune response)
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9
Q

Immature blood cells are called

A

BLASTS

myeloblasts

erythroblasts

megakaryoblasts

lymphoblasts

  • not usually found in circulation, unless pathology exists

Ex. immature neutrophils, neutroblasts will be released by bone marrow if system is overwhelmed by infection or inflammation, left shift

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10
Q

Mature blood cells are called

A

Cytes

erythrocytes
thrombocytes
megakaryocytes
lymphocytes

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11
Q

Function of cytokines

A

Cytokines are signal molecules, promote cellular development

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12
Q

Types of cytokine signals

A

autocrine - same cell
paracrine - neighbour cell
endocrine - far away organ/cell

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13
Q

Haematopoetic cytokines

A

Granulocyte colony stimulating factor (G-CSF)
- platelets
- neutrophils

Granulocyte macrophage colony stimulating factor (GM-CSF)
Myeloblasts (neutrophils, basophils, eosinophils, monocytes)

erythropoetin (EPO)
erythrocytes

thrombopoetin (TPO)
thrombocytes
IL-11
platelets

IL3,9, G-CSF, GM-CSF
myeloid stem cells (precursor of both myeloblasts, lymphoblasts)

IL1
Erythroblasts

IL3
myeloblasts - granulocytes
IL5,6
lymphoblasts - B cells
IL7
lymphoblasts - T Cells

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14
Q

Differential diagnosis elevated WBC?

A

Neutrophils
- acute inflammation
- acute infection

basophils
- type I hypersensitivity reaction (asthma, allergies)
- release cytokines IL which activate plasma cells to secrete IgE

eosinophils
- phagocytize IgE-antigen complexes
- parasite reaction
- type I hypersensitivity reaction

Elevated BLASTS
- cancer?

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15
Q

Neutropenia

A

Low neutrophil
< 500
immunocompromised

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16
Q

Prevention platelet activation

A

Prostaglandins released by endothelial cells prevent platelet activation
PGI2

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17
Q

Promotion platelet activation

A
  • collagen
  • ADP
  • PAF, platelet activating factor
  • thrombin
  • activaiton of IIb/IIIa receptor
  • binds to fibrinogen creating cross links and platelet plug
  • also binds clotting factors VWF, IX, V
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18
Q

Activated platelet form

A
  • sticky
  • flat
  • adhere to ECM
  • release 1. dense bodies (ADP, calcium, serotonin), 2. alpha granules (fibrinogen, V)
  • promotes cross linking
  • attracts more platelets
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19
Q

RBC structure

A

2 alpha, 2 beta polypeptides
4 protoporphyrin rings
4 heme groups
4 iron (Fe2+ unbound by oxygen)

20
Q

Where is majority of the bodies iron stored?

A

Erythrocytes 70%
ferritin stores liver

21
Q

Where is heme broken down?

A

heme broken down to bilirubin
recycled in liver
glucuronate attached and excreted in urine or feces

22
Q

Function of folate

A

purine DNA/RNA synthesis
closure of neural tube during pregnancy

23
Q

Types of anemia

A
  1. macrocytic anemia
  2. microcytic anemia
  3. anemia chronic disease (normocytic anemia)
24
Q

Function of vitamin B12

A

myelination of nerves
low vitamin B12 - demyelination and spasticity

25
Q

Function of Iron

A

carrier of oxygen in the RBC

26
Q

GI malabsorption can lead to anemia
Examples

A

alcoholism
drugs
crohn’s disease
UC disease
short bowel
etc.

27
Q

Laboratory findings of iron deficiency anemia

A

low RBC
low hemoglobin

low serum iron
low ferritin
high transferrin binding capacity

low MCV < 80
low MCHC (hypochromic)

28
Q

laboratory findings of folic acid deficient anemia

A

low RBC
low hemoglobin

high MCV > 100 (macrocytic)
normal MCHC (normochromic)

low serum folate
high homocysteine
low or normal Vitamin B12 (needed for folate activation)

29
Q

Laboratory findings of vitamin B12 deficient anemia

A

low RBC
low hemoglobin
high MCV > 100
normal MCHC

low serum vitamin B12
high methylmalonic acid level
normal or low folate
normal, low, or no intrinsic factor

30
Q

laboratory findings of anemia of chronic disease

A

low RBC
low hemoglobin

normal or high iron
normal MCV
normal MCHC
or low MCV, low MCHC

31
Q

Cause of anemia for chronic disease

A

low RBC production
low RBC lifespan
increase demand RBC

32
Q

3 systems involved in hemostasis

A
  1. vasculature - vasoconstriction
  2. platelets - platelet activation, adhesion, aggregation, platelet plug
  3. coagulation factors - coagulation cascade (intrinsic, extrinsic, common), and fibrin clot formation
33
Q

4 events of hemostasis

A

PRIMARY HEMOSTASIS
1. vasoconstriction VSM - serotonin, histamine, calcium

  1. platelet plug formation
    - activation, adhesion, aggregation

SECONDARY HEMOSTASIS
3. coagulation cascade and fibrin clot formation
- intrinsic, extrinsic, common
- prothrombinase complex

  1. clot dissolution
    - TPA (Tissue plasminogen activator)
    - APC (activated protein C) and protein S
    - Anti-thrombin and endogenous heparin
34
Q

Platelet activation

A

ADP
TXA2
Collagen
thrombin (IIa)
PAF

35
Q

Inhibition of platelet activation

A

PGI2
prostaglandin I2

36
Q

Platelet adhesion

A

“glue” = von willebrand factor VWF

binds GPIb receptor
activates platelets
results in expression of IIb/IIIa receptors
leads to platelet release reaction

alpha granules - fibrinogen, V (VWF)
dense bodies - serotonin, calcium, ADP

37
Q

Platelet aggregation

A

cross linking of platelets via fibrinogen mesh

VWF + GPIIa/IIIb + Fibrinogen

38
Q

3 phases of Secondary hemostasis

A

formation fibrin through intrinsic/extrinsic coagulation cascade

  1. initiation
  2. amplification
  3. propagation
39
Q

Fibrin clot formation
Common pathway

A

X –> Xa
II –> IIa (thrombin)
Fibrinogen –> Fibrin
XIII stabilizes fibrin

40
Q

Coagulation cascade extrinsic pathway

A

Tissue factor VII –> VIIa
X –> Xa
IX –> IXa

Xa
II –> IIa
Fibrinogen –> FIbrin

*Tissue factor activates both the X and the IX

41
Q

Coagulation cascade intrinsic pathway

A

XII –> XIIa
XI –> XIa
IX –> IXa
X –> Xa
II -> IIa
fibrinogen –> Fibrin

endogenous to the blood vessels

42
Q

Propagation and amplification

A

IIa
activates IX
activates V
activates VIII

VII
activates IX

43
Q

Drug that inhibits intrinsic pathway

A

Heparin
binds and activates anti-thrombin

anti-thrombin binds clotting factors
X, II (thrombin) - common pathway
XII, XI, IX - intrinsic pathway

measure aPTT
activated partial thromboplastin time

44
Q

Drug that inhibits extrinsic pathway

A

warfarin
inhibits formation of vitamin K dependent coagulation factors - IX , X, VII, II
extrinsic pathway
measured with INR (prothrombin time)

45
Q

Inhibition of coagulation
natural physiology

A

anti-thrombin
- made by liver
- circulation 2-3 days
- binds heparin
- binds to coagulation factors XII, IX, IX, X, II

Thrombomodulin + Activated protein C + protein S
- binds and inactivates V, VIII

TPA
- tissue plasminogen activator
- breakdown of fibrin to D Dimers

46
Q

Virchows Triad

A
  1. injury - endothelial
  2. hypercoagulation state
  3. stasis - blood flow
47
Q

Why does inflammation promote coagulation?

A

CK
creatine kinase
blocks anti-thrombin, thrombomodulin, activated protein C and protein S
results in decrease in fibrinolysis

Year 1: Patho/Pharm (39 decks)

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