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2nd block > Hematology 2 > Flashcards

Hematology 2 Flashcards

1
Q

What is hemostasis?

A

Stoppage of bleeding in a quick and localized fashion when blood vessels are damaged

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2
Q

_____________ prevents hemorrhage , loss of a large amount of blood from vessels

A

Hemostasis

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3
Q

What are 3 mechanisms to reduce epblood loss?

A
  • Vascular spasm
  • platelet plug formation
  • Blood clotting((coagulation= formation of fibrin threads)
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4
Q

What can activate hemostasis?

A

Injury to blood vessels, endothelial lining, pierced vessels, inflammation

Exposure to substances released from damaged cells and platelets - bacterial toxins

Exposure to foreign substances during bleeding

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5
Q

Describe vascular spasms

A

Damage to arteries or arterioles causes the circular smooth walls to contract. This reduces blood loss for several hours, allowing other Nemo static operations to occur

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6
Q

What are the 3 steps in platelet plug formation?

A
  1. Platelet adhesion
  2. Platelet release reaction
  3. Platelet aggression
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7
Q

Platelets store chemicals needed for platelet plug formation in granules. Differentiate the types of granules and their contents

A

Alpha granules

  • clotting factors
  • platelet derived growth factor

Dense granules
- ADP, ATP, Ca+2, serotonin, fibrin-stabilizing factor, enzymes that produce thromboxane A2

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8
Q

What is the purpose of platelet derived growth factor?

A

Cause proliferation of vascular endothelial cells, smooth muscle and fibroblasts to repair damaged vessels

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9
Q

Describe platelet adhesion

A

Platelets stick to exposed collagen underlying damaged endothelial cells in vessel wall

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10
Q

Describe platelet release reaction

A

Platelets become activated by adhesion

Extend projections to make contact and interact with other platelets

Release thromboxane A2 and ADP which activates other palate lets and other platelets

Serotonin and thromboxane A2 are vasoconstrictors, decreasing blood flow through the injured vessel

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11
Q

Describe platelet aggregation

A

Activated platelets stick together and recruit ADP as well as activate new platelets to form a mass called a platelet plug

Plus reinforced by fibrin threads formed during clotting process

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12
Q

What is a blood clot?

A

A network of insoluble protein fibers called fibrin in which red blood cells, white blood cells and platelets are trapped

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13
Q

What are clotting factors?

A

Substances that activate molecules in a sequential fashion in the clotting cascade

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14
Q

What is a blood clotting cascade ?

A

Complex cascade of enzymatic reactions

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15
Q

Briefly describe the 3 phases of blood clotting (coagulation)

A
  1. Formation of prothrombinase by the extrinsic or intrinsic pathway

The following are part of the common pathway:

  1. Prothrombinase converts the enzyme prothrombin to thrombin
  2. Thrombus cinverts soluble fibrinogen into insoluble fibrin. Fibrin forms the threads of the clot which holds it together.
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16
Q

Describe the extrinsic pathway

A

Thromboplastin (tissue factor) leaks from damaged tissue into blood

Tissue factor starts sequence of reactions that leads to activation of Factor X.

Activated Factor X combines with Factor V in presence of Ca +2 to form prothrombinase

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17
Q

Contrast the speed and triggers of the intrinsic and extrinsic pathways.

A

Extrinsic pathway: rapid and triggered by tissue trauma

Intrinsic pathway: slower and triggered by exposed by underlying connective tissue

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18
Q

Describe the intrinsic pathway

A

Blood contacting underlying tissue activates Factor XII

This eventually leads to activation of factor X combines with Factor V to form prothrombinase

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19
Q

Describe the common pathway

A

Prothrombinase facilitates the conversion of prothrombin to thrombin

Thrombin converts fibrinogen to fibrin bad activates fibrin stabilizing factor XIII

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20
Q

What is clot retraction?

A

Platelets pull on fibrin threads causing a clot retraction

Trapped platelets release factor 13 which stabilizes the fibrin threads.

The torn edges of the vessels are pulled closer together

Fibroblasts and endothelial cells repair the wound

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21
Q

Which 4 clotting factors require Vitamin K for synthesis?

A

Clotting factors 2,7,9 and 10

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22
Q

Why are babies given vitamin K supplements?

A

Vitamin K is produced by bacteria in the colon. Babies do not have a functional colon

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23
Q

What is the importance of Vitamin K?

A

Essential in blood clotting

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24
Q

Name and give the functions of the 4 anticoagulants

A

Prostacyclin: inhibit platelet aggregation

Antithrombin: inhibits thrombin

Heparin: inhibits thrombin

Activated protein C: inhibits clotting factors

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25
Q

What is fibronolysis?

A

The dissolution of clot

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26
Q

Describe fibrinolysis

A

Dissolves small, inappropriate clots and clots at a site of damage once the damage is repaired

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27
Q

What is plasminogen?

A

An inactive enzyme incorporated into clot during formation

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28
Q

How is plasminogen used in fibrinolysis?

A

Plasminogen is activated to plasmin(fibrinolysis) and dissolves a clot by digesting fibrin threads and inactivating substances such as fibrinogen, prothrombin and Factors V, VIII and XII

29
Q

Differentiate a thrombus and an embolus

A

Thrombus- A clot formed

Embolus- thrombus can break away from vessel wall and enter blood stream

30
Q

What are possible causes of thrombosis?

A

Roughened endothelial surfaces

Atherosclerosis

Hypertension

Infection

Stasis of blood

Hypercoagulability states

31
Q

What are the purpose of thrombolytics? Give some examples

A

Breakdown clots

Streptokinase

T-PA

32
Q

What is the purpose of anticoagulants. Give two examples of anticoagulant medication

A

Prevent clot formation.

Warfarin: blocks vitamin K

Heparin

33
Q

What is the function of antiaggregants? Give an example

A

Prevents platelet aggregation

-Aspirin

34
Q

What is blood transfusion?

A

Transfer of whole blood or blood components (red blood cells or blood plasma only) into the bloodstream or directly into the red bone marrow

35
Q

Give 3 reasons for a blood transfusion

A
  • Alleviate anemia
  • To increase blood volume, such as after a hemorrhage
  • To improve immunity
36
Q

What happens when there is a transfusion with the wrong blood type?

A

Leads to hemolysis of RBCs : transfusion reaction

37
Q

People with Rh antigens on RBC surface are ________ and normal blood plasma

A

Rh+

Contains no anti-Rh antibodies

38
Q

Under what circumstances are anti Rh anyibidies developed?

A

Develop only in Rh- blood type and only under exposure to antigen such as in:

  • transfusion of positive blood
  • during a pregnancy with a positive blood type fetus
39
Q

Transfusion reaction upon _____ __________ to the antigen results in

A

2nd Exposure

Hemolysis of the RBCs in the donated blood

40
Q

There is an Rh- mother and Rh+ fetus which will have mixing of the blood at birth. How can the creation of antibodies from the mother be prevented?

A

Give the mother a Rhogam shot

41
Q

How does a rhogam shot work?

A

Binds to loose fetal blood and removes it from her body before she reacts

42
Q

What are the symptoms of anemia?

A

Oxygen carrying capacity of the blood is reduced

Fatigue, cold intolerance, paleness due to lack of oxygen for ATP and heat production

43
Q

What is iron deficiency anemia?

A

Lack of absorption of iron or loss of iron

44
Q

What is megaloblastoc anemia?

A

Deficiency in vitamin B12 or folic acid

45
Q

What is pernicious anemia?

A

Lack of intrinsic factor or B12 absorption

46
Q

What is hemorrhagic anemia?

A

Loss of RBCs due to bleeding

47
Q

What is hemolytic anemia?

A

Defects in the cell membranes cause rupture

48
Q

What is thalassemia anemia?

A

Hereditary deficiency of hemoglobin

49
Q

What is aplastic anemia?

A

Destruction of bone marrow(radiation/toxins)

50
Q

What are symptoms of severe anemia?

A

Fainting
Chest pain
Angina
Heart attack

51
Q

What is sickle cell disease?

A

Genetic mutation causes abnormal Hemoglobin molecule Hb-S.

When oxygen levels are low, Hb-S form long stiff, rod like structures that bend the erythrocytes into a sickle cell shape

52
Q

What are consequences of sickle cell?

A

Sickle cells rupture easily-> hemolysis, patient may die in 10-20 days

The bone marrow cannot make enough RBCs fast enough to replace the lost ones

53
Q

Contrast anemia for those who have a single sickle cell gene with those who have two sickle cell gene?

A

Two genes- have severe anemia

One gene- have minor problems

54
Q

What are treatments for anemia?

A
  • Analgesics to relieve pain
  • Aggressive hydration/re-hydration
  • oxygen to reduce hypoxia
  • Antibiotics to counter infections
  • folic acid
  • Blood transfusions
55
Q

What is the life expectancy for people with anemia?

A

53- males

58-females

56
Q

What is hemophilia?

A

Inherited deficiency of clotting factors( the royal disease)

57
Q

Contrast Hemophilia A, B and C

A

Hemophilia A- lacks factor VIII and is most common

Hemophilia B -lacks factor IX

Hemophilia C less severe because alternate clotting factors sexist?

58
Q

What are forms of treatment for Hemophilia?

A

Transfusions of fresh plasma or concentrates of missing clotting factor

59
Q

What are the 4 types of leukemia ?

A

Acute myelogenous leukemia(AML)

Acute lymphoblastic leukemia(ALL)

Chronic myelogenous leukemia( CML)

Chronic lymphoblastic leukemia(CLL)

60
Q

What is Chronic leukemia?

A

Accumulation of , Mature WBC in bloodstream because they do not die

Classified by the type of white blood cell most prominent- myelocytic, lymphocytic

61
Q

What is acute leukemia?

A

Uncontrolled production of immature leukocytes

Crowding out of red bone marrow cells by production of immature WBC

Prevents production of RBC and platelets

62
Q

What are some uses for stem cells?

A

Bone marrow transplant

Cord blood transplant

Used to treat aplastic anemia, certain types of leukemia, lymphoma, thalassemia, sickle cell anemia, hemolytic anemia and various types of cancers

63
Q

How to perform a bond marrow transplant?

A
  1. The defective red bone marrow is destroyed. By high doses and chemotherapy and whole body radiation. This destroys cancer cells and reduces patients immunity, reducing the chance of transplant rejection
  2. Red bone marrow from a donor is removed from the iliac crest under general anesthesia with a syringe and is then injected into the patients vein like blood transfusion
64
Q

What happens to a bone marrow transplant?

A

Injected marrow migrates to the recipients bone marrow cavities where the donors stem cells multiply

65
Q

What are the disadvantages of bone marrow transplants?

A

The recipient is extremely susceptible to infections

Transplanted red bone may produce T cells that attack the recipients tissues

Patient will need to take immunosuppressants for life

66
Q

What is graft vs host disease?

A

When transplanted bone marrow produces T cells that attack recipients tissues

67
Q

What is cord blood transport?

A

The umbilical cord connects mother to her baby

Stem cells may be removed from the umbilical cord shortly after birth

Stem cells are removed from the cord with a syringe and then frozen

68
Q

What are the advantages of using cord blood transplant over bone marrow transplant?

A
  • easy to collect
  • more abundant
  • Less likely to cause graft-vs-host disease
  • Can be stored indefinitely in cord blood banks

2nd block (6 decks)

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