Hematology I Flashcards
What type of drug is Warfarin?
Anti-coagulant
% breakdown of Plasma, Buffy coat, and Erythrocytes:
Plasma - 55%
Buffy coat -
What layers of blood are considered the “formed elements”?
RBC's Buffy coat (includes leukocytes, platelets, and thrombocytes)
Name 3 Plasma Proteins:
Albumins
Globulins
Fibrinogen
What is serum?
Plasma minus clotting factors
Name 3 things that make up the Plasma?
Water
Solutes
Plasma Proteins
What fraction of body weight is blood?
8%
How much blood in an adult body?
4-6 Liters
What is the normal amount of RBC’s in a hematocrit?
45%
A low hematocrit suggests…
A hig hematocrit suggests…
Anemia
Polycythemia
What is the best method for evaluating and identifying immature and abnormal cells in the blood?
Blood smear
A normal blood smear is spaced…
evenly
What are the two functions of the RBC biconcave disc?
Increase surface area
Increase flexibility
Are platelets cells?
No.
*fragments fo megakaryocytes
Where do megakaryocytes come from?
Break off in bone marrow
T/F
A platelet plug is another name for a blood clot
False
Precursors to clots (but sometimes all yo need)
What does a stained neutrophil nucleus look like?
3-5 lobes
Thin strands chromatin connecting
What is the most common type of WBC?
Neutrophils
The defining characteristic of a neutrophil is…
define unequivocally
Complex shape of nucleus
T/F
Neutrophils lack granules
False
small granules in cytoplasm
What is the primary function of neutrophils?
Defense against Bacteria and Fungi
What formed element usually has a 2 lobed nucleus?
Eosinophil
What is the main function of eosinophil?
Parasitic defense
*many dark staining granules
What is the appearance of the nucleus in Basophils?
Granulocytes?
2-3 lobes
Deeply blue or red-violet
What leukocyte has the most numerous granulocytes?
Eosinophils
How to distinguish between eosinophils and basophils?
Eosinophils: Defined 2 lobed nucleus, more granules
Basophils: 2-3 undefined lobes
What leukocyte mediates inflammatory rxns of allergy?
Basophils
What are basophils called after they migrate into tissues?
Mast Cells
What chemical do basophils (mast cells) carry that cause allergy symptoms?
Histamine
What often has a c-shaped nucleus and is never lobed or round?
Monocytes
T/F
Monocytes have granules and lobes
False
No granules, no lobes
Besides the c-shaped nucleus and being agranulocytes, what is another feature of Monocytes?
Golgi apparatus
*appears as white area “negative image”
What is the smallest WBC?
Lymphocytes
T/F
B and T lymphocytes have small nuclei
False
*Both large (and indistinguishable between the two)
What lymphocyte produces antibodies?
B lymphocytes
What lymphocytes direct the immune response through chemical intermediaries?
What lymphocyte produces enzymes that directly harm pathogen?
T-helper (CD4)
Cytotoxic (CD8)
What is the 3rd type of Lymphocyte (other than B and T)?
NK - Natural Killer
What 2 proteins do Natural Killer cells secrete through granules that cause cell death?
Perforin
Granzyme
What test panel measures cell counts, Hb, and Hematocrit?
11 tests
Complete Blood Count
CBC
What test panel measures Proteins, electrolytes, etc?
14 tests
Comprehensive Metabolic Panel
CMP
What is the term for low WBC count?
Leukokemia
What are immature neutrophils called?
Band neutrophils
What is seen in acute or chronic lymphocytic leukemia?
Increased Lymphocytes
What makes up 1/3 mass RBC’s?
Hemoglobin
What is the measurement of the average size of RBC’s?
What test panel is this part of?
Mean Corpuscular Volume (MCV)
CBC (complete blood count)
What causes Macrocytic RBC’s?
B12 deficiency
What type of RBC is seen in iron deficient anemia?
Microcytic
What does MCH stand for and what panel is it part of?
Mean Corpuscular Hemoblobin
CBC - Complete Blood Count
*Large RBC higher Hb count
MCH depends on ______, while MCHC is ______
RBC size
independent of size
Mean Corpuscular Hemoglobin Concentration reveal two pathologies: either _____ or _____.
Hypochromia - diluted Hb inside RBC
(stain lighter)
Hyperchromia - concentrated Hb inside RBC
(stain darker)
What CBC test reveals RBC size variation?
RDW - Red Cell Distribution Width
The amount of variation in RBC size is called…
The variation in shape is called…
Normal range:
Anisocytosis
Poikilocytosis
11-15%
Thrombocytosis:
Thrombocytopenia:
too much platelet
too little
What test in the CBC calculated average size of platelets?
MPV - mean platelet volume
What blood panel test usually requires fasting?
CMP - Comprehensive Metabolic Panel
What is fasting hyperglycemia associated with?
Diabetes mellitus (type I or II)
Too much/too little sodium is called:
Hypernatremia
Hyponatremia
What role does Na play in the small intestine?
Glc absorption facilitator
Too much/too little Potassium is called:
Hyperkalemia
Hypokalemia
T/F
Potassium and Chloride are essential for acid base balance
True
Enzyme activation and Blood clotting both rely on what cation?
Calcium
What is the most prevalent anion in the blood?
Chloride
What 2 type of neurotransmitter does chloride facilitate?
GABA
Glycine
What maintains oncotic pressure and transports thyroid hormones and bilirubin?
Albumin
T/F
Albumin competitively binds Calcium ions
True
T/F
Albumin acts as a buffer
True
What nitrogenous waste product increases if kidneys aren’t working?
Creatinine
vs. creatine phosphate
What gives urine its straw color?
Urea
What 2 enzymes, if elevated in the blood, suggest liver damage?
ALT - Alanine aminotransferase
AST - Aspartate aminotransferase
*Both involved in AA catabolism
What 3 things elevate ALP (Alkaline phosphatase)?
Liver damage
Gall stones
Bone damage
Elevation of what suggests liver damage?
ALP - Alkaline phosphatase
What is the hydrophobic waste product of Hb metabolism?
Bilirubin
In what 3 organs are old RBC’s processed?
Liver
Spleen
Bone marrow
Where is all bilirubin excreted?
Liver
What can too much bilirubin lead to?
Jaundice
hyperbilirubinemia
What 4 types of lipid are tested in the lipid panel?
LDL
HDL
Triglycerides
Total cholesterol
What lipid test indicates coronary or vascular disease?
cholesterol
2 Types of cholesterol
Endogenous (from liver)
Exogenous (diet)
What might work differently in people that have high cholesterol?
HMG-CoA reductase negative feedback
What drug shuts down cholesterol synth?
Statins like Lipitor or Crestor
What is the only way cholesterol is excreted?
Bile
What will high Niacin do?
raise HDL (with flushing)
What 2 factors lead to plaque formation?
LDL and Triglycerides
*more for LDL
What is the normal range serum for triglycerides?
35-160
What causes RBC’s to settle more quickly when measuring Erythrocyte Sedimentation Rate?
inflammation - from many sources
Specifically Rouleaux Stacks
What causes Rouleaux stacking?
Inflammatory mediators produced by liver and immune system
Westergren tube:
tube for ESR
What test can suggest Temporal Arteritis?
chronic inflammation of large arteries of the head
ESR
Erythrocyte Sedimentation Rate
What test can diagnose Diabetes?
Hemoglobin A1C
*glc attaches for cell’s life
5 things that fail in diabetes:
eyes kidneys nerves heart blood vessels
An A1C over _____ suggests diabetes.
Fasting Plasma Glc over ____ suggests diabetes.
6.5%
126
What liver produced protein is a marker for inflammation?
CRP
C-reactive Protein
What blood marker is just as effective in predicting cardiac risk as cholesterol?
CRP
C-Reactive Protein
CRP levels:
low risk CVD
Intermediate
High risk CVD
T/F
Periodontal disease is related to diabetes
True
T/F
There is a strong association between periodontal disease and cardiovascular disease
True
If someone has periodontal disease, what 3 tests should be run?
Lipid Panel
Blood glucose (fasting and A1C)
CRP (c-reactive protein)
Where are RBC’s made?
Red bone marrow
In what 3 areas is red bone marrow found in adults?
Flat bones
Irregular bones
Epiphyses of long bones
Where is yellow marrow found?
medullary cavity long bones
Where are RBC’s made in the fetus?
Liver
Spleen
*can occur in adults with certain diseases
What do pluripotential stem cells first divide into in forming cells?
Progenitor cells
What is the most important growth factor controlling erythropoiesis?
EPO
erythropoietin
What 2 organs release EPO?
Kidneys
Liver
*Mostly Kidneys
How do RBC’s enter the circulation?
as Reticulocytes
What are the 4 essential ingredients for producing normal RBC’s?
AA’s
Fe
Folic acid
B12
*there are types of anemia associated with each of these
How do reticulocytes appear in a blood smear?
Freckled
Describe the negative feedback loop for EPO
RBC increase
more oxygen
kidneys sense
EPO drops
*Hypoxia will reverse
How many different proteins are in RBC cell membrane?
10-15
What are 6 types of integral proteins in RBC’s?
Band 3 Glycophorins Aquaporin-1 GLUT 1 Na/K pumps Ion channels
What is the function of the Band 3 integral protein in RBC’s?
Bicarbonate for Chloride
anion transport
(one for one)
*25% total mem. protein
What is the function of Glycophorin?
Negatively charged, reduces interaction of red cells with one another and others
What integral protein gets glucose inside RBC’s?
GLUT-1
Name 4 peripheral/cytoskeletal proteins that flexibility and resiliency.
(all inside cell)
Ankyrin
Protein 4.1
Protein 4.2
Spectrin
What disease causes sphere-shaped RBC’s?
Hereditary spherocytosis
*smaller and lack pale center on smear
What % CO2 is transported as carbamino-Hb?
30%
Each Hb has -SH in ____ form and Fe in ____ form.
reduced
reduced
What happens when ionic gradients fail in RBC’s?
Spherocyte
membrane malfunction
T/F
Glucose metabolism relies exclusively on Cytosolic Proteins.
True
What is the primary function of NADH in RBC?
Keeps Fe in reduced state
Fe 2+
What is the primary function of NADPH in RBC?
maintains Reduced Glutathione
*essential for maintaining structure
What does 1 molecule of glc yeild in RBC?
2 ATP
2 NADH
What alternate pathway is entered by about 10% of glc in RBC?
What does this produce?
PPP
(hexose monophosphate shunt)
NADPH
What is THE enzyme of the PPP (yielding NADPH)?
Glucose-6-phosphate dehydrogenase
What links the PPP to glycolysis?
Glc-6-P
*if oxidized enters PPP
If Glc-6-P is oxidized it enters _____
If isomerized it _____
PPP
proceeds through glycolysis
(Frc-6-P)
What is the lifespan of RBC?
90-120 days
Dead RBC is removed from circulation by what 2 organs?
Liver
Spleen
What is the waste product of RBC degradation?
Bilirubin
What osmotic pressure shrinks RBC
What swells?
Hypertonic
Hypotonic
What NaCl solution is isotoinic with plasma?
0.9%
Henderson-Hasselbach:
pH = pKa + log [HCO3-] / [CO2]
20: 1
7. 4
How much mEq/L of protons are made daily?
50-100
3 blood buffers
Bicarbonate (carbonic anhydrase rxn)
Phosphate
Proteins (albumin, Hb)
How does the blood regulate temperature?
Sympathetic - vasoconstrict
(if cold)
Parasympathetic - vasodilate
(warm)
*alpha 1 mediated vessels
Warm blood is ____ to the body surface in warm temps.
Shunted
