Hematology Flashcards
blood
plasma/water = 55%
formed elements = 45%
* Chief Function: delivery of substances needed for cellular metabolism, removal of waste, defense against microorganisms and injury, maintenance of acid-base balance
- body contains 6 liters
plasma
- fluid component of blood - 90% water, 10% solutes
- contains proteins and electrolytes
plasma proteins
- All made in liver*
- albumin: most abundant, carriers and control plasma oncotic pressure. carry calcium. pull fluid into capillaries
- globulins: carrier proteins and immunoglobins (antibodies). hemoglobin, thyroglobulins
- Clotting factors: mainly fibrinogen
cells (formed elements)
erythrocytes - red blood cells
leukocytes - white blood cells
thrombocytes - platelets
erythrocytes (RBCs)
- carry hemoglobin, deliver o2 to tissues
- most abundant cell in the body
- 120 day life cycle (3-4 months)
- bioconcavity = lots of surface area, moldable shape (squeeze through liver, blood vessels smoothly)
leukocytes (WBCs)
- defend the body against infection and remove debris
- Granulocytes: baso (induce inflame) , eso (regulate inflame with histamine), neutros (phagocytosis). inflammatory and immune functions.
- agranulocytes: monos/macros, lymphocytes T, B and NK
Thrombocytes (platelets)
- cell fragments
- disk-shaped cytoplasmic fragments
- essential for blood coagulation and control of bleeding
- thrombopoietin - main regulator of platelets
- released by liver and stimulate production of platelets
- after trauma, internal hemmhorage
Spleen
- filters blood
- largest secondary lymphoid organ
- contains t and B cells (macrophages)
- phagocytosis of old, damaged, and dead blood cells
- blood storage (released during trauma)
- “lymph node” to cardio system
- mono = infected spleen
- if spleen ruptures – bad blood explodes throughout the body
- if you don’t; have a spleen – lymph nodes, liver help out
lymph nodes
- part of the immune system and hematologic systems
- facilitates maturation of lymphocytes - T and B and Macros are in lymph organs to kill bad cells
- transports lyphatic fluid back to circulation
cleanses lyphatic fluid or microorganisms and foreign particles
Mononuclear Phagocyte System (MPS)
- consists of monocytes in blood and mature macrophages in tissues
- ingest and destroy microorganisms and foreign material
- MPS is mostly liver and spleen
Hematopoiesis
- process of blood cell production
- erythrocytes = rbc formation
- two stages: mitosis and maturation/differentiation
Bone Marrow: myeloid tissue. red and yellow bone marrow when born, adults have active bone marrow in pelvic, vertebrae, cranium, ribs, humorous, femur
Erythropoiesis
- erythrocytes derived from erythroblasts (normoblasts)
- maturation stimulated by erythropoietin EPO kidneys
- quantity of hemoglobin increases and the nucleus decreases in size “packet of hemoglobin”
- number of cirrculatiing RBCs in healthy people remain constant
- ## hypoxia - stimulates the production and release of erythropoetin - increases production of RBCs
Hemoglobin
- oxygen carrying protein of the erythrocyte
- RBCs have 4 heme groups (300-400 hemoblobins)
- ## heme contains iron, brinds to o2 = red
Hemoglobin Synthesis
- proteins and amino acids are needed
- B12 and folate = lifespan of RBCs
- iron and copper are needed to make RBCs
destruction of aged RBCs
- aged red cells (senescent) are destroyed by macrophages of the MPS
- primarily destroyed in the spleen
- liver takes over if the spleen isn’t functioning correctly
- globin chains are broken down into amino acids
- porphyrin is reduced to bilirubin, transported to the liver, and secreted in the bile
leukopoesis
- leukocytes arise from stem cells in bone marrow
- granulocytes mature in bone marrow
- agranulocytes are released into the bloodstream before they fully mature
- activated when they leave the blood stream and are put to work
thrombopoesis
- endomitosis - platelet formation
- megakaryocyte undergoes nuclear phase of cell division but fails to undergo division and explodes – releases platelets
- only activated or “turned on” when needed. turn sticky when needed, not always
- thrombopoetin regulates platelets leves
- platelets circulate for 10 days before losing their functional capacity - then removed by spleen/liver
Hemostasis
- to arrest or stop bleeding
- after trauma, injury, loss of blood
- requires: platelets, clotting factors, blood flow ad shear forces, endothelial cells, fibrinolysis
STEPS:
- vascular spasm/vasoconstriction: blood vessel injury, constricts to slow blood loss
- platelet plug formation: not permanent
- Coagulation/formation of fibrin clot: fibrin protein, hold everything in place on vessel wall.
Hemostasis: Platelet Plug Formation
- Activation: exposure to collagen and reacts with platelets
- calcium is essential for platelet activation - adhesion: productes platelet plug stickiness
- von Hillebrand factor - stickiness activation - activation (again): release chemotaxis to get more platelets and calcium
- aggregation: stick together, temporary plug
- Secretion: Granules release: seratonin, coagulation factors, calcium histamine
4 Players in classical pathway coagulation
thrombinogen, thrombin, fibrinogen, fibrin
* “ogen/pro” means not activated yet
VII vs VIIa
without a = in blood
with a = activated
coagulation cascade
extrinsic: activated when tissue factor (TF) (Tissue thromboplastin) is released by damaged endothelial cells
intrinsic: activated when factor XII contacts sub endothelial substances (collagen) exposed by vascular injury
extrinsic pathway
- trauma, scape, pierce
- TF - 7 - 10
- can also activate intrinsic pathway
TF –> VII –> VIIa –> X –> classical pathway (thrombinogen/prothrombin - Xa -> thrombin –> fibrinogen –> fibrin
intrinsic pathway
- damaged endothelium & exposed collagen
- 12 - 11 - 9 - 8 - 10
- atherosclerosis, inflammation, hypertension, infection
exposed collagen –> XII –> XIIa –> XI –> XIa –> IX –> IXa –> VIII –> VIIIa –> X –> Xa –> thrombin –> fibrinogen –> Fibrin
clot retraction
- fibrin strands shorten, become denser and stronger to approximate the edges of the injured vessel and site of injury
- platelets within clot and actin-like contractile proteins in platelets
- pulls wound/tissues together to facilitate repair
virchow’s triad - causes of thrombosis
inadvertent clot formation
- changes in bood vessel wall - endothelial damage
- changes in blood flow - blockage, decreased blood flow, clot
- changes in blood composition: overproduction or RBCs, dehydration (thick blood), overproduction of clotting factors. increase in Vitamin K
thrombosis
thrombotic disease: overproduction of clots
- plasma breaks down thrombosis
fibrinolysis
lysis of blood clots
- fibrinolytic system
- plasminogen and plasmin - cuts plasma strands apart and left with fibrinodegredation products (indicator of clot breakdown, thombitic disease)
- fibrin degradation products - D-dimers: measure of thrombosis
cytosis
- increased cell count, pathologic
- erythrocytosis (polycythemia)
- leukocytosis - infection
- thrombocytosis - platelets, increased coagulation
cytopenia (penia)
- decreased cell count
- erythrocytopenia - decreased RBCs, anemia
- leukocytopenia - decreaed WBCs, immuno compromised
- thrombocytopenia - decreased platelets, hemmhoraging, bleeding out
anemia
physiolgic - reducted O2 carrying capability
- classic symptoms: fatigue, weakness, dyspnea, pallor
- low RBC function
- Low RBC count
- Cytic = size - macrocytic, microcytic, normocytic (good size)
- Chromic = hemoglobin content - normochromic and hypochromic. no hyper chromic
anisocytosis
red cells are present in various sizes
poikilocytosis
red cells are preset in various shapes
koilonychia
spooned nails
- result of hypo chromic anemia
macrocytic-normochromic anemias
- megaloblastic anemias
- too big but normal amounts of hemoglobin
- b12 and folate deficiency
- affects RBC lifespan
- defective DNA synthesis
pernicious anemia
- results in B12 deficiency (macrocytic normochomic)
- lack of intrinsic factor from gastric parietal cells (required for b12 absorption, produced in stomach and absorbed in small intestine)
- causes: can’t produce B12 or don’t eat enough
- treatment: IM shots because if eaten the stomach can use it anyways or HIGH doses of oral B12
- manifestations: neurologic, nerve demyelination, loss of appetite, abdominal pain, beefy red tongue, icterus, splenic enlargement
folate deficiency anemia
- dietary deficiency (macrocytic normochormic anemia)
- no neuro manifestations
- not dependent on any other factor
- absorption of folate occurs in the small intestine
- treatemnt = daily oral administration of folate
microcytic-hypochromic anemias
- small and not enough hemoglobin
- red cells that are abnormally small and contain reduced amounts of hemoglobin
- related to: disorders of iron metabolism, porphyrin and heme synthesis, global synthesis
iron-deficiency anemia
- most common anemia (microcytic-hypochromic)
- nutritional iron deficiency
- metabolic or functional deficiency
- progression of iron deficiency causes: brittle, thin, coarsely ridge and spoon shaped nails, red/sore/painful tongue strawberry tongue
sideroblastic anemia
- bad mitochondrial functioning decreases hemoglobin
- ineffective iron uptake and resulting in dysfunctional hemoglobin synthesis
- diagnostic: ringed sideroblasts in bone marrow (erythroblasts that contain iron granules that have not been synthesized into hemoglobin)
thalassemia
- autosomal recessive trait, inherited anemia
- genetic disorder that produces malformed hemoglobin chains
- produce less hemoglobin and have low number of RBCs
- mediterranea decent
- everyone is a carrier but 25% actually show it
normocytic-normochromic anemias
- “right size, right amount just not enough of them”
- red cells that are relatively normal in size and hemoglobin content but insufficient in NUMBER
aplastic anemia
low count of RBCs, either pancytopenia (all blood cells are low) or pure red cell aplasia (not making enough RBCs in bone marrow)
- bone marrow issue - radiation, chemo, leukemia
posthemmorhagic anemia
- acute blood loss
- ## internal hemmohorage
hemolytic anemia
overdestroyed RBCs
- spleen or liver issue
- accelerated desturction of red blood cells
- apenomegaly = mono
- autoimmune hemolytic anemias - pallor, increased bilirubin in blood, jaundice
sickle cell anemia
- autosomal recessive disorder that distorts hemoglobin proteins, genetic
- decrease o2 carrying, get stuck in places
- sickle during times of hypoxia
anemia of chronic inflammation
- mild to moderate anemia seen in: AIDS, RA, lupus, hepatitis, renal failure, malignancies
polycythemia
overproduction of RBCs
- relative polycythemia: result of dehydration, low blood volume increases hematology reading but really there is less of everything
- absolute polycythemia - true overproduction of RBCs. abnormality of stem cells in bone marrow (polythemia vera) or increase in erythropoietin in response to hypoxia or inappropriate response to erythropoietin- secreting tumors
- treatment: blood donation
leukocytosis
too many WBCs
- normal physiologic response to stressors (infection)
leukopenia
not normal and not beneficial
bone marrow issue, treatment and drugs cause immunosupression
infectious mononucleosis
infection of B cells by EBV - acute, self-limiting infection of B cells transmitted by saliva through personal contact - spleen enlarges - epstein barr virus -
leukemia
cancers of excessive accumulation of leukemic cells in marrow
- T, B and NK cells are precursors
- acute leukemia: presence of undifferentiated or immature cells, blast cells
- chronic leukemia: predominant cell is mature and does not function normally, tumor cells
acute lympocytic leukemia ALL
most common in children
chronic myelogenous leukemia CML
philadelphia chromosome
chronic lymphocytic leukemia CLL
most common in adults
Lymphadenopathy
swelling, inflammation of lymph node
lymphoma
cancer of lymph system
- hodkin - reed sternberg cells
- nonhodkin - c neoplasms, t and nk cell neoplasms
burkitt’s lymphoma
3rd word
arises from EBV or HIV
lesions of submandibular lymph nodes
albumin
largest protein molecule in blood, oncotic pressure, carrier
hypocalcemia
hypoabuminemia is most common cause. liver disease or failure
thrombocytopenia
thrombocytopenia: platelet count < 150000
Thrombocythemia: platelet count > 400000
alterations of coagulation
- von Hillebrand factor deficiency
- vitamin k deficient - vit k increase coagulation
- liver disease: all plasma proteins are made in liver
- hemophilia A: deficiency in factor VII
- hemophelia B: deficiency in factor IX Christmas disease
disseminated intravascular coagulation DIC
death is coming
- highly fatal
- clotting and hemorrhage simultanously occur and end up bleeding out
