Hem/Onc Flashcards
Source of energy for erythrocytes
Glucose (90% glycolysis, 10% HMP)
RBC transporter that allows RBCs to export bicarb and transport CO2 from periphery to lungs
Cl-/HCO3- antiporter
ANisocytosis
Varying sizes of RBC
Pikilocytosis
Varying shapes of RBC
Life span of plts
8-10 d
Dense granule of plts contents
ADP, Ca2, Serotonin
Alpha granule of plts contents
vWF, fibrinogen, fibronectin
Storage of plt pool
1/3 in spleen
Low platelets/plt fxn –>
Petiechiae
vWF receptor
GpIb (attach)
Fibrinogen receptor
GIIb/IIIa (aggregate)
Blue color in retics…
Residual rRNA
Neutrophil specific granule contents
Leuk Alk PHos, collagenase, lysozyme, lactoferrin
Azurophilic granule contents
In neuts – proteinases, acid phos, MPO, b-glucuronidase
Hypersegmented neuts in
Vit B12/folate def
More band cells means
More myeloid proliferation (CML, bacterial infxn)
Neutrophil chemotactic agents
C5a, IL8, LTB4, kallikrein, PAF
Activates macs
Gamma interferon
Lipid A binds…
From bacteria LPS binds CD14 on macs –> septic shock
Eosinophils produce
Histaminase, MBP (helminthotoxin), eosinphil peroxidase, eosinophil cationic protein, eosinophil derived neurotoxin
Causes of eosinophilia
Neoplasia, Asthma, Allergic process, Chronic adrenal insufficiency, Parasites
Basophil granules contain
Heparin (anticoag), histamine (vasodilator)
Basophils can synthesize
Leukotrienes – not preformed!
Basophilia can mean
Myeloproliferative disease, like CML
Mast cell from same precursor as
Basophils
Mast cell releases
Histamine, heparin, tryptase, and eosinophil chemotactic factors
Drug that prevents mast cell degranulation and use
Cromolyn sodium – asthma prophylaxis
B cell markers
CD19, CD20,CD21
T cell markers
Tc: CD3, CD8
Th: CD3, CD4
T reg: CD3, CD28
Majority of circulating lymphs are…
T cells (80%)
Plasma cell cancer
Multiple myeloma
Fetal erythropoesis
Yolk sac (3-8wks) Liver (6wk-birth) Spleen (10-28 wks) Bone marrow (18wk-adult) Young Liver Synthesizes Blood
Embryonic globins
L and E
Fetal hemoglobin
a2gamma2
Adult hemoglobin
a2b2
Why does HbF have a higher affinity of O2?
Less avid binding of 23 BPG –> can extract oxygen from maternal hemoglobin across placenta
HbA2
a2d2 – small amounts in adult
ABO abs are
IgM
Rh abs are
IgG
Presentation of ABO hemolytic disease in newborn (rare)
Mild jaundice in neonate w/in 24 hrs of birth – tx phototherapy or exchange transfusion
Order of furthest migration on a gel for hemoglobins
A (normal hemoglobin B chain – HbA)
F (normal hg gamma chain – HbF)
S (sickle cell hemoglobin B chain – HbS)
C (Hemoglobin C B chain – HbC)
Intrinsic (contact activation) pathway
Collagen/basement membrane/activated platelets –> 12>11>9 and 8…
Tissue factor (extrinsic) pathway
7>…
Combined pathway
X & V>2>1> cross linking via 13
Require calcium/phospholipid
9 to 9a, 9a+8a to X-->Xa, 7-->7a-->+cofactor to catalyze X-->Xa Xa+Va to catalyze II-->IIa 13 to crosslink
Kinin cascade
HMWK > activates 12
via kallikrien–>bradykinin –> vasodilation, permeability and pain
Inhibited by Warfarin
2,7,9,10 C,S
Hemophilia A def
Factor 8 – XR
Hemophilia B
Factor 9 – XR
Hemophilia C
Factor 11 –AR
Vit K in coagulation
Reduced via epoxide reductase to become cofators in gamma glutamyl carboxylation to make mature/active coag cascade components
VIt K def
Low fact II, 7, 9, 10, pC, pS
vWF carries/protects
Factor 8
Protein C cleave and inactivates
Va and 8a w/ help of pS
Antithrombin inhibits activated
2,7,9,10,11,12; principal targets are thrombin and Xa
Heparin acts by
Enhancing activity of antithrombin
Factor V leiden mutation
Factor V that cannot be inhibited by protein C –> hypercoagulability
Plasminogen–>
via tPA to plasmin –> fibrinolysis – cleavage of fibrin mesh, destruction of coag factors
Platelet plug formation
Endothelial damage –> transient vasoconstriction (neural stim reflex and endothelin released) –> vWF binds exposed collagen (from Weibel Palade bodies of endothelial cells and a granules of plts –> plts bind vWF via GpIb and undergo conformational change –> release ADP (helps plts adhere, binds P2Y12 receptor to induce GpIIbIIIa expresion on plt), Ca, and TXA2 –> Fibrinogen binds GpIIb/IIIa receptors to link platelets
Proaggregation factors
TXA2 from plts, slower blood flow, increased platelet agg
Antiaggregation factors
PGI2 and NO from endothelial cells, faster blood flow, less platelet aggregation
How does aspirin cause anticoag?
Irreversible inhib of COX in plts –> no TXA2 synthesis
These inhibit GpIIb/IIIa direction
Abiciximab, eptifibatide, tirofiban
Action of ristocetin
Activates vWF to bind GpIb – failure of assay with vWD and Bernard Soulier syndrome
Inhibit P2Y12 receptor
Clopidogrel, prasugrel, ticlodipine