hematology Flashcards
How much blood is in the body?
6 quarts (5.5L)
What are the 5 functions of blood?
- delivery of substances needed for cellular metabolism
- removal of wastes of cellular metabolism
- defense against invading microorganisms
- regulation of body temp
- maintenance of acid-base balance
What are the three main plasma proteins?
albumin
globulins
fibrinogen
Where are the 3 plasma proteins manufactured?
the liver
What are the 3 main roles of albumin?
- maintaining vascular integrity & fluid balance
- transporting substances throughout the body
- acts in metabolism of drugs and other substances
What plasma proteins maintain vascular integrity & fluid balance?
albumin
What plasma protein transports substances throughout the body?
albumin
What plasma protein plays a role in metabolism of drugs and other substances?
albumin
What are the 3 types of globulins?
alpha, beta, & gamma
What do globulins do?
carry hormones & substances throughout the body; play a role in immune response
What does the plasma protein fibrinogen play a role in?
clotting
formed elements are suspended in _______
plasma
formed elements have a _______ lifespan
finite
What do formed elements originate from?
stem cells
What are the three major cell types considered to be formed elements?
erythrocytes (RBCs)
Leukocytes (WBCs) - granular & agranular
thrombocytes (PLTs)
What type of cell is the most abundant in blood?
erythrocytes (RBCs)
erythrocytes make up about _____ of the blood volume
half
What is the main role of RBCs?
tissue oxygenation
What protein is found in RBCs?
hemoglobin
What 3 things does hemoglobin help regulate?
- gases
- electrolytes
- regulate diffusion through the cell membrane
what kind of cells are flexible biconcave discs?
RBCs
do RBCs have a nucleus?
no
Do erythrocytes have cytoplasmic organelles?
no
what is the lifespan of a RBC?
120 days
do RBCs perform protein synthesis?
no
What are the 5 characteristics of RBCs?
- biconcave discs
- no nucleus
- flexible
- no cytoplasmic organelles(no protein synthesis)
- lifespan of 120 days
RBCs have a ________ structure ideal for ____ exchange & diffusion in & out of cell
concave; gas
RBCs have the (reversible/irreversible) deformity to move through the body
reversible
What are the 4 types of hemoglobin?
HB A
HB F
HB S
HB A1C
what hemoglobins are normal adult oxygen carrying proteins?
HB A
What hemoglobin is fetal hemoglobin?
HB F
What hemoglobin is found in sickle cell?
HB S
What hemoglobin is glycosylated & related to diabetes?
HB A1C
What is a hemoglobin molecule composed of?
4 polypeptide chains
Alpha 1 & alpha 2
beta 1 & beta 2
How many oxygen atoms does 1 HGB molecule carry?
4
What is synthesis of hemoglobin greatly dependent on?
the availability of iron
What are the two ways we get iron?
comes from diet or is recycled
how is iron recycled?
aged RBCs are broken down in the spleen and iron returns to bone marrow for new RBCs
What does a lack of iron result in?
a lack of HGB in each RBC and results in low oxygen carriage in the blood
What does heme mean?
iron
What does globin mean?
protein
How are RBCs destroyed?
by phagocytic cells
in what 4 places are RBCs destroyed?
- spleen
- liver
- bone marrow
- lymph nodes
What parts of the RBC is recycled?
iron & amino acids from globin chains
How are destroyed RBCs excreted?
- cell broken down in the spleen
- heme is converted to unconjugated bilirubin
- unconjugated bilirubin is attached to plasma proteins(albumin)
- plasma proteins transport unconjugated bilirubin to the liver
- in the liver unconjugated bilirubin is then conjugated with glucuronic acid & makes conjugated bilirubin
- conjugated bilirubin is water soluble and is not excreted in the feces & urine
How does destruction of RBCs in circulation work?
- hemoglobin is free in the plasma
- combined with proteins in the plasma (haptoglobin) & other proteins (albumin)
- hemoglobin may be too plentiful and exceed the ability of plasma proteins to bind which results in free hemoglobin in the blood (hemoglobinemia)
- excess hemoglobin is excreted through the urine (hemoglobinuria)
What are examples of situations where destruction in circulation occurs?
hemolytic anemia
hemolytic transfusion reaction
what is a specific series of steps in the bone marrow that leads to the synthesis of mature RBCs?
erythropoiesis
all RBCs begin as ____________ stem cells in the bone marrow that is stimulated to become ________ _________ cells
pluripotent; erythroid precursor cells
What do erythroid precursor cells go through until it becomes a mature erythrocyte released by the bone marrow?
a series of changes
What kind of blood cell has no genetic material in its mature state?
RBCs
What are the 4 major nutritional requirements for adequate synthesis of healthy RBCs?
- protein
- iron
- vitamin B12
- folic acid
_____ is the main nutritional element needed for hemoglobin synthesis
iron
Those with chronic hypoxia typically have (high/low) RBC levels
high
What is a reticulocyte count a good indicator of ?
bone marrow activity
why is a reticulocyte count a good indicator of bone marrow actiivty?
it represents recent production of RBCs
What does a high reticulocyte count indicate?
indicates that the bone marrow is working hard to keep up with RBC loss
what are examples of causes of high reticulocyte count?
anemia & cancer
What is a highly vascular organ, considered to be the graveyard of RBCs?
the spleen
what organ is an organ of immunity and involved in RBC destruction?
spleen
What does the spleen do?
removes aged, lysed, & dead RBCs from circulation
What happens in the spleen?
RBCs are broken down into their component parts, which are recycled to make new RBCs
What organ sequesters abnormally shaped & hemolyzed RBCs & destroys them?
the spleen
When does splenomegally occur?
when thee is a large amount of RBC breakdown occurring in the body
What does the “leuko” mean?
white
What does “Cytes” mean?
cells
What is the normal range for WBC count?
5k -10k
What is the function of WBCs?
to combat inflammation & infection
What are the types of WBCs?
granulocytes
- neutrophils
- eosinophils
- basophils
agranulocytes
- lymphocytes
- monocytes
What is a left shift or shift to the left?
a high number of bands in circulation
When does a shift to the left occur?
in severe acute infection or inflammation
- mostly in inflammation
- can be seen in some marrow disorders (leukemia) or severe bone marrow injury
Why does a shift to the left occur?
the bone marrow cannot keep up with the body’s need for mature neutrophils, so it releases bands
What type of cells have round & distinctive multi-lobar nuclei?
granulocytes
all granulocytes can be ____________ because of the ____________ granules
phagocytic; cytoplasmic
What can specific granules do?
bind neutral, basic or acidic dye components
What are azurphilic granules?
like lysosomes; store enzymes that are used to digest microorganisms
What are the names that mature neutrophils may be referred to as?
polymorphonuclear leukocytes (polys)
segmented neutrophils (Segs)
What can immature neutrophils be called?
neutroblasts
What is the major roles of neutrophils?
phagocytosis
what cells are the first responders to any acute or chronic inflammation/injury?
neutrophils
What cells are responsible for host defense against invaders?
neutrophils
What percentage of WBCs do neutrophils account for?
60-70%
how long do neutrophils live?
2-5 days
when do neutrophils typically die?
die 1-2 days after migrating to the site of injury/inflammation
What percentage of WBCs are eosinophils?
1-3%
What are the two primary roles of eosinophils?
- ingest antigen-antibody complex
- mediate vascular effects of histamine & seratonin in allergic reactions
How are eosinophils though to help?
by releasing chemicals which detoxify the agent causing the reaction
In what other reaction do eosinophils work?
parasitic reactions
how do eosinophils work in parasitic reactions?
by attaching themselves to the parasite & then release hydrolytic enzymes to kill it
What kind of granulocyte is least abundant?
basophils (<2%)
What do basophils play a major role in?
allergic reactions
basophils play a role in allergic reactions and what?
a role in the prevention of blood clots
What three things do granules in basophils contain?
heparin
histamine
other inflammatory mediators
What kind of cells are basophils structurally similar to?
mast cells
What are the three types of granulocytes?
neutrophils
basophils
eosinophils
What are the 2 types of agranulocytes?
lymphocytes
monocytes
do agranulocytes have cytoplasmic granules?
no
What kind of lymphocytes were first discovered in birds?
B lymphocytes
What do B lymphocytes become?
antibody producing plasma cells
What kind of immunity are B lymphocytes a part of?
part of humoral mediated immunity
Where are T lymphocytes differentiated?
the thymus
What are the two types of T lymphocytes?
T helper cells (CD4) - activate other cells
cytotoxic T cells (CD8)
what part of immunity are T lymphocytes involved in?
part of cellular immunity
What do natural killer cells do?
destroy foreign cells
in what kind of immunity are natural killer cells involved?
innate & natural immunity
What are the 3 classes of lymphocytes?
B cells
T cells
NK cells (natural killer)
What do monocytes/macrophages play a role in?
acute & chronic inflammation
immunity
What kind of cells take longer to reach site of injury/inflammation?
monocytes/macrophages
Where do monocytes/macrophages live?
live in the tissue, not just the blood
What happens to monocytes during the inflammatory response?
monocytes leave the blood vessels & transform into macrophages at tissue site to perform phagocytosis
What cells will monocytes/macrophages activate?
T lymphocytes
Where are thrombocytes made?
in large megakaryocytes which come from myeloid stem cells
What do thrombocytes form at the site of injury to stop bleeding?
form the platelet plug
What cells are disc-shaped without a nucleus?
thrombocytes
What is thrombopoietins main role?
chief regulatory of production
where are thrombocytes synthesized?
the liver
What is thrombopoietin stimulated by?
low number of platelets in the bone marrow
about a ______ of all platelets are sequestered in the spleen
third
What is the lifespan of a platelet?
7-10 days
how are dead platelets cleared?
senescent platelets are cleared by splenic macrophages
What are the 4 signs of bleeding?
- petechiae
- purpura
- ecchymosis
- spontaneous bleeding
What are pinpoint red-purple areas of bleeding that resemble a rash called?
petechiae
What are large purple areas of bleeding called?
purpura
What is ecchymosis?
a bruise
What is an example of spontaneous bleeding?
nosebleed (epistaxis)
What white blood cells are analyzed in a CBC?
neutrophils
lymphocytes
monocytes
eosinophils
basophils
immature granulocytes, absolute
neutrophils, absolute
What else is analyzed in a CBC?
hemoglobin
hematocrit
- mean corpuscular volume (MCV) = size of RBC
- red cell distribution width (RDW)= range in size & shape of RBC
- mean corpuscular hemoglobin concentration (MCHC) = concentration of Hgb (color)
- mean cell hemoglobin (MCH) = mass of RBC
platelets
What is included in a basic metabolic profile (BMP)?
sodium
potassium
chloride
CO2
BUN/CR
glucose
EGFR
anion gap (r/t acid-base balance of electrolytes)
What is included in a comprehensive metabolic profile?
everything in a BMP plus:
AST(SGOT)
ALT(SGPT)
alkaline phosphatase
total protein
albumin
bilirubin
What are the 4 types of iron studies?
iron level
ferritin
tranferrin
total iron binding capacity (TIBC)
What does iron level measure?
measures amount of iron bound to hemoglobin
- not helful alone
What does ferritin measure?
- measure of iron stores
- inflammation may cause levels to increase
What is transferrin?
a transport protein that takes iron back to marrow
What other labs can be draw for hematology?
vitamin B12
folic acid
hemoglobin electrophoresis
comprehensive metabolic profile
What does hemoglobin electrophoresis do?
looks at globin chains
What does a comprehensive metabolic profile measure?
measures 14 proteins, electrolytes, enzymes, & minerals in the blood
What is a BMP plus calcium, alvumin, total protein, & liver function studies (AST, ALT, ALP, bilirubin)?
a comprehensive metabolic profile
