Hematology and fetal circulation Flashcards
What is hematocrit and what percentage of blood is this
Hematocrit are red blood cells (erythrocytes)
47% in males, 42% in females
Describe reasons that a patient might present with high or low hematocrit
High: High iron, blood doping
Low: Anemia, blood loss
What is 55% of the blood made of
Plasma- whole blood
What is 1% of whole blood made of
buffy coat- leukocytes, platelets
Which cells make all of the blood cells
HSC’s- hematopoietic stem cells
What are the 2 pools of progenitor cells
Myeloid- RBC’s, megakaryocytes (make platelets), eosinophils, basophils, neutrophils, monocytes
Lymphoid- make lymphocytes
What is the makeup (in percent) of RBC to WBC in the bone marrow
75% WBC (progenitor or maturing)
25% maturing RBCs (Progenitors or maturing)
What is the makeup of RBCs vs WBCs in circulation
500x as many RBCs in circulation vs WBCs
Where does extramedullary hematopoiesis occur
liver and spleen
Where do we find bone marrow in bones in kids vs adults
kids- all through cavities of bones
adults- only ends of long bones and in flat bones
What are platelets
fragments of megakaryocytes
What cell is the most abundant in the blood
RBC’s
What leukocyte is the most abundent in the blood
neutrophils
How much of plasma is made of plasma proteins
8%
Life span of RBCs/erythryocyes
120 days
How do RBCs make ATP
anaerobically
Function of erythryocytes bi-concave shape
Allow for swelling, flexibility to push through capilaries, increased surface area
structure of adult hemoglobin
2 alpha, 2 beta polypeptide chains (4 total)
an iron (heme) group on each chain (4 total)
What is the test that measures the terminal valine on each beta chain of hemoglobin to measure the 1-2 month average glucose level?
Hemoglobin A1c
What is the biggest factor to determine how much oxygen binds to hemoglobin
the amount of oxygen present that is creating the diffusion gradient
What are the 2 factors that make it harder for oxygen to bind to hemoglobin
high levels of 2,3, BPG or Hydrogen ions
- These both compete w oxygen
What is the significance of carbon monoxide and hemoglobin
Carbon monoxide competes with oxygen to bind on hemoglobin, and binds 200x stronger than oxygen(greater affinity)
Structure of fetal hemoglobin
Hemoglobin F: 2 alpha chains, 2 gamma hemoglobin chans
Stronger affinity for oxygen than hemoglobin A
Does hemoglobin A or hemoglobin F have a stronger affinity?
Hemoglobin F has a stronger affinity for oxygen
What are RBCs produced in response to
Blood loss, high altitude, aerobic exercise training, low o2 levels
List the pathway for RBC production
Chemoreceptors in kidneys sense low 02 levels–> release EPO–> stimulate production
Where is iron stored after RBC distruction
Liver
What is the heme group used to make after RBC destruction
Bilirubin which is stored in the gallbladder for digestion use
What is jaundice pathologically
buildup of biliruben in the blood
What is the treatment for jaundice
phototherapy- convert biliruben to lumiruben to get rid of it from the blood
If you have stem cell damage, what is the resulting anemia
aplastic anemia
What anemia is common after chemotherapy
aplastic anemia
If you have the distruction of RBCs or loss from bleeding, what type of anemia is this
hemolytic anemia (can be an autoimmune disorder
What occurs when a glutamine is exchanged for a valine in terms of anemia?
sickle cell anemia- changes shape of hemoglobin
What occurs in hemoglobin with sickle cell anemia
hemoglobin clumps more, higher prevalence in black and hispanic people
If you have a lack of hemoglibin due to an inherited blood disorder, what is this
thalassemias
What is on the tail of an A antigen
N-acetylgalactososomine
What is on the tail of the B antigen
glactose
What is on the tail of the antigen on O blood
It does not have anything in addition to the H antigen (every type has H antigen, but nothing extra)
What antigen is Rh factor
Antigen D
What is universal recipient
AB+ (no antibodies)
What is universal donor
O- (no antigens)
What do endothelial cells release when they are injured
5-HT
What causes the vascular spasm?
Direct injury to smooth muscle, disrupted endothelial cells, local pain receptors stimulated
What activates platelets
When platelets contact collagen they activate (swell and become sticky)
What do platelets release when activated
ADP, Serotonin, Thromboxane A2
End goal of phase 1 of coagulation
Prothrombin activator (Xa) (10a)
End goal of phase 2 of coagulation
Thrombin
End goal of phase 3 of coagulation
Fibrin
End goal of stabilization of coagulation
13a
What are the 2 pathways in phase 1, and what do both lead to the formation of?
intrinsic and extrinsic (both lead to the formation of factor X, which forms Xa)
What occurs in phase 2 of coagulation
Factor Xa (prothrombin activator) converts prothrombin into thrombin
What occurs in phase 3 of coagulation
thrombin converts fibrinogin ( soluble) into fibrin (insoluble)
Which phase of coagulation requires Ca
stabilization
What is the clot buster, and what activates it?
Plasmin is clot buster (remove clot), activated form of plasminogen, activated by Tissue Plasminogin Activator (TPA)
Describe DIC
Uncontrolled clotting in all vessels, followed by bleeding due to the rest of the blood not being able to clot
What causes DIC
sepsis, incompatable blood transfusions, pregnancy
What does DIC lead to
multiple organ failure, death
Describe thrombocytopenia
low platelet count leads to bleeding in small vessels all over the body (petechiae)
Platelet count under 50,000/ul blood
Treatment of thrombocytopenia
platelet infusion
Causes of imparied liver function related to blood disorders
Vitamin K deficiency (common in newborns)
Hepatitis or cirrhosis –> reduction of bile to absorb vitamin K, reduction in plasma proteins
Hemophilias description and treatment
Hereditary bleeding disorder, missing one or more clotting factor
Treated with clotting factor transfusion ( most are x-linked recessive)
Describe blood volume restoration when not in a hospital
Severe bleeding causes a low blood volume and in an emergency no time for blood typing or matching. Need to replace immediately, so use normal saline or electrolytes
Describe the uterine blood flow in pregnancy
No pregnancy- arteries connect to capillaries and veins, no shuts
Preegnant- trophoblast invasion- bore holes in endometrium into maternal sinuses
post-partum- return to non-pregnant state
Describe the fetal circulation of oxygenated blood
Placenta–>umbilical vein–>through the liver–>IVC–>R atrium–>Foramen ovale–>L atrium–>L ventrical–>Aorta–>Head
Describe the fetal circulation of deoxygenated blood
Upper body/head–>SVC–>R atrium–>R ventricle–>Pulm artery–>Ductaus arteriosus–>Aorta–>feet and umbilical arteries
