Hematopoiesis, Erythropoiesis, & Bilirubin (Quiz 1) Flashcards
1
Q
What is hematopoiesis/hemopoiesis?
A
-production and development of all blood cells
-immature precursor cells develop into mature blood cells in the bone marrow
-all cellular blood components derived from hematopoietic stem cells
2
Q
hemato=
A
blood, cells
3
Q
poiesis=
A
production
4
Q
In embryonic development, the bone marrow derived from mesenchymal tissue from the….
boards q
A
mesoderm
5
Q
The hemopoietic system is involved in production, maturation, and destruction of blood. What organs are a part of this system?
A
-bone marrow
-thymus
-liver
-spleen
-lymph nodes
6
Q
omni=
A
whole
7
Q
Which stem cells can give rise to any of the 220 cell types found in an embryo and occur for only a limited time in early mammalian embryos?
A
totipotent/omnipotent stem cells
8
Q
pluri=
A
many
9
Q
Which stem cells can give rise to all cell types that make up the body, except the placenta?
A
pluripotent stem cells
10
Q
Which stem cells can develop into a limited number of cell types in a particular lineage and are found in bone marrow?
A
multipotent stem cells
11
Q
uni=
A
one
12
Q
Which stem cells have a limited ability to differentiate and are committed to making one type of cell?
A
unipotent stem cells
13
Q
Which stem cells are an immature cell that can develop into all types of blood cells: WBCs, RBCs, platelets/thrombocytes, and have the property of self renewal and, through cell division and differentiation, form populations of progenitor cells that are committed to the main marrow cells lines?
A
hematopoietic stem cells
14
Q
Is bone marrow vascular or avascular?
test q
A
highly vascular
15
Q
What is the main function of bone marrow?
A
produce blood cells and store fat
16
Q
What are the 2 types of bone marrow?
A
red and yellow
17
Q
Do kids have mostly red or yellow bone marrow?
A
red
18
Q
Do adults have mostly red or yellow bone marrow?
A
yellow
19
Q
Which bone marrow is considered active?
A
red marrow
20
Q
Which bone marrow is considered inactive?
A
yellow marrow
21
Q
What stem cells are found in red marrow?
test q
A
hematopoietic stem cells
22
Q
What are the adult sites of hematopoiesis?
test q
A
bone marrow of:
-skull
-ribs
-sternum
-vertebral column
-pelvis
-proximal ends of femur
23
Q
Which bone marrow helps spleen and liver to remove old damaged cells from circulation?
A
red marrow
24
Q
Which bone marrow has mostly adipose cells?
A
yellow marrow
25
T/F: when blood supply is extremely low, yellow marrow can be converted to red marrow
true, this happens in patients with hemolytic anemia, chronic blood loss, or aplastic anemia
26
After what age does yellow marrow begin to convert to red marrow?
7 y/o
27
extra=
outside
28
medullary=
bone marrow
29
What is extramedullary hematopoiesis?
test q
hematopoiesis that occurs outside of bone marrow
30
When is it normal to have extramedullary hematopoiesis?
test q
during the embryonic period because of the yolk sac, which will turn into liver
31
If someone does have extramedullary hematopoiesis, what are the organs involved?
spleen, liver, and lymph nodes
32
What is erythropoiesis?
production of RBCs
33
Erythropoiesis is stimulated by what?
test q
decreased oxygen in circulation (hypoxia)
34
What are some causes of hypoxia?
-high altitude
-blood loss
-respiratory distress like COPD or choking
35
What is the abbreviation for erythropoietin (hormone that stimulated BM to produce RBCs)?
EPO
36
Where is EPO produced?
test q
kidney
37
Hypoxia is sensed first by what organ?
kidney
38
EPO is produced and secreted by kidney. EPO then stimulated what to produce RBCs?
quiz 1 q
bone marrow
39
If EPO is stimulated when it is not needed then this person has...
a benign or malignant tumor which can cause secondary polycythemia/compensatory polycythemia
40
Maturation of RBCs takes _________ days
7-9
41
The more mature a RBC is = the more.....
oxygen carrying capacity it has (and the more pink its going to be)
42
Most RBCs enter the blood as mature or immature RBCs?
mature RBCs
43
What are the 5 characteristics seen in RBCs during erythropoiesis
1) reduction in the cell size as the cell matures
2) more cytoplasm, less nucleus as the cell matures= increased amount of functional hemoglobin
3) staining reaction of the cytoplasm changes from blue/gray to pinkish red (polychromatic, Wrights Stain)
4) decrease in the amount of RNA and DNA. The pinker the RBC become the more oxygen carrying capability it has
5) nuclear size decreases as RBC matures. Initially, the nucleus is large and gets smaller as the RBC matures. Eventually nucleus is extruded from RBC
After 120 days, loss of enzymes in RBC membrane= macrophages engulfing RBC for destruction in spleen
44
Is bilirubin toxic?
yes
45
Bilirubin levels are used as an indicator of ______________ function
hepatobillary (liver, gallbladder, pancreas, billary tract)
46
Bilirubin in blood and urine can provide early indication of what?
-liver disease
-hepatitis
-cirrhosis
-hemolytic anemia
-obstruction of the biliary tract (gallstones, cancer)
47
What is kernicterus (bilirubin encephalopathy)?
-increase levels of bilirubin
-bilirubin induced neurological damage resulting from elevated serum bilirubin
-bilirubin accumulates in the grey matter of the CNS
-irreversible neuro damage and death
48
How long does it take for liver/hepatic functions to fully mature postpartum?
2+ weeks
49
What are the early signs and symptoms of kernicterus?
-jaundice
-poor feeding
-irritability
-lethargy
-apnea
-high pitched crying
-hypotonia
-arching of the back and neck
50
What are the long term complications of kernicterus?
-hearing loss
-cerebral palsy
-learning difficulties
-involuntary twitching
-problems maintaining normal eye movements
-poor development of teeth
51
What are the 2 forms of bilirubin?
1) unconjugated/ indirect bilirubin
2) conjugated/ direct bilirubin
52
Which bilirubin is non-soluble in water (cannot be found in urine)?
unconjugated/ indirect bilirubin
53
Which bilirubin is water soluble (can be found in urine)?
conjugated/ direct bilirubin
54
Is a small amount of bilirubin in blood normal?
yes
55
Hyperbilirubinemia causes....
jaundice/ icterus (yellowish pigmentation) of the skin, conjunctival membranes, sclera, and other mucosa
56
Is small amount of bilirubin in urine normal?
NO
57
If bilirubinuria does occur, what type of bilirubin is it?
conjugated/direct bilirubin
58
What color will urine be if theres bilirubin in it?
dark yellow/orange color
59
What is the normal range of bilirubin in the blood?
test q
0.2-0.8 mg/dL of unconjugated/indirect bilirubin
60
What are the 12 steps of bilirubin metabolism?
1)Macrophages in RES breakdown RBC/Hb/heme into 3 parts: iron, globin, and heme
2) iron is stored and reused to make more RBCs
3) globin chains become AAs for reuse
4) heme/porphyrin ring becomes unconjugated bilirubin
5) uptake of unconjugated bilirubin binds with albumin and is transported through blood to liver
6) conjugation occurs in the hepatocytes, unconjugated bilirubin is conjugated to glucuronic acid (now called conjugated bilirubin)
7) excretion occurs when conjugated bilirubin moves from liver through the biliary channels into the small intestine along with bile, bilirubin is a major constituent of bile
8) intestinal bacteria break down conjugated bilirubin into urobilinogen and stercobilinogen. Urobilinogen and stercobilinogen give feces brown color
9) 90% of the urobilinogen is excreted by the feces
10) some urobilinogen and stercobilinogen reabsorb from the gut and enters portal blood
11) some of that urobilinogen travels through the liver and biliary channel again
12)
the rest of that urobilinogen is transported by blood to the kidney and excreted into the urine. Therefore, it is normal to have a small amount of urobilinogen in the urine!!!
61
Macrophages in RES break down RBCs/Hb/heme into 3 parts. What are the 3 parts?
iron, globin, and heme
62
heme- heme oxygenase=
biliverdin
63
biliverdin- biliverdin reductase=
unconjugated bilirubin
64
Unconjugated bilirubin binds with what plasma protein to be transported through blood to the liver?
albumin
65
Where does conjugation of bilirubin occur?
hepatocytes
66
What color is bile?
orange green color
67
What breaks down conjugated bilirubin into urobilinogen and stercobilinogen?
intestinal bacteria
68
What gives feces the brown color?
urobilinogen and stercobilinogen
69
What percentage of urobilinogen is excreted by the feces?
90%
70
How do we categorize jaundice?
by where it occurs
71
What are the 3 types of jaundice?
1) prehepatic/ hemolytic jaundice
2) hepatic jaundice
3) posthepatic/obstructive jaundice
72
Prehepatic jaundice is due to an excess of what?
RBC breakdown so excess unconjugated bilirubin
reminder that hemolysis is excess RBC breakdown
73
excess RBC breakdown=
excess unconjugated bilirubin (in blood and liver)
74
Which jaundice is this?
-increased bilirubin conjugated in the liver will be excreted in excess amounts in the intestine, and an excess of urobilinogen will be produced
-the excess amount of urobilinogen will then be excreted through the kidney
-there is increased urobilinogen in the urine because of the increased amount of bilirubin being conjugated by the liver***
prehepatic/hemolytic jaundice
75
What are the causes of prehepatic/hemolytic jaundice?
-increased hemolysis (RBC destruction)
-hemolytic anemias (hemolytic disease of the newborn, sickle cell disease, pernicious anemia, hereditary spherocytosis, G6PD, malaria, thalassemia, B12 deficiency)
76
What is the most common jaundice?
prehepatic/hemolytic jaundice
77
Which jaundice would have these blood lab findings?
-increased total bilirubin
-increased unconjugated bilirubin
-normal conjugated bilirubin
prehepatic/hemolytic jaundice
78
Which jaundice would have these urine/stool lab findings?
-no bilirubinuria
-increased urobilinogen
-orange/dark yellow color urine
-dark brown stool
prehepatic/hemolytic jaundice
79
Hepatic jaundice is the result of what?
liver damage
80
Hepatic jaundice may mimic what?
preheptaic or posthepatic jaundice, or even both
81
Which jaundice is this?
-hepatocellular damage (conditions that damage hepatocytes, impair the livers ability to conjugate and excrete bilirubin)
-impaired conjugation (damaged hepatocytes= reduction in the conjugation of bilirubin, leading to an accumulation of unconjugated bilirubin in the blood)
-decreased excretion (damaged hepatocytes may also impair the excretion of conjugated bilirubin into bile, leading to an accumulation of conjugated bilirubin in the blood)
-leakage of bilirubin (in severe liver damage, conjugated bilirubin can leak back into the bloodstream from damaged hepatocytes)
-if the liver becomes cirrhotic, it compresses the intrahepatic portions of the biliary tree and causes a degree of obstruction
-hepatocytes are limited in moving bilirubin
hepatic jaundice
82
What are the causes of hepatic jaundice?
hepatocyte injury from:
-liver cirrhosis
-alcoholic hepatitis
-viral hepatitos
-primaru biliary cirrhosis
-liver cancer
-neonatal jaundice (immature liver is unable to conjugate bilirubin well)****
83
Which jaundice would have these blood lab findings?
-increased total bilirubin
-increased conjugated AND unconjugated bilirubin
hepatic jaundice
84
Which jaundice would have these urine and stool lab findings?
-bilirubinuria
-decreased, normal, or increased urobilinogen
-stool is pale or brown colored
hepatic jaundice
85
Post hepatic/obstructive jaundice is caused by an obstruction, usually in the....
common bile duct
86
Which jaundice is this?
-unconjugated bilirubin moves to liver and becomes conjugated and gets stuck
-conjugated bilirubin cannot get to the intestines so it backs up from liver to blood causing jaundice and gets filtered through the kidneys to be excreted in urine which causes bilirubinuria
-no urobilinogen is made
Post hepatic/obstructive jaundice
87
no urobilinogen =
light colored stool
88
What are the causes of post hepatic/obstructive jaundice?
-gallstones (cholelithiasis)
-common bile duct obstruction
-inflammation of the ampulla/pailla of vater
-tumors
-pancreatitis
-pancreatic cancer
-pancreatic cysts or scarring
-swelling of lymph glands near the bile ducts
89
Which jaundice would have these blood lab findings?
-increased total bilirubin
-increased conjugated bilirubin
-normal unconjugated bilirubin
post hepatic/obstructive jaundice
90
Which jaundice would have these urine/stool lab findings?
-massive amounts of bilirubinuria
-normal or decreased urobilinogen
-light/chalky color stool
post hepatic/obstructive jaundice
91
Neonatal jaundice is what type of jaundice?
quiz 1 q
hepatic jaundice (increased unconjugated bilirubin)
92
What is neonatal jaundice?
-normal baby with jaundice
-normal amount of bilirubin breakdown
-liver is not fully functional yet so it cannot get unconjugated bilirubin to the liver
-baby will have increased unconjugated bilirubin
93
What is the other name for hemolytic disease of the newborn?
boards q
erythroblastosis fetalis
94
What type of jaundice is hemolytic disease of the newborn/erythroblastosis fetalis?
quiz 1 q
prehepatic/hemolytic jaundice (increased unconjugated bilirubin)
95
What is hemolytic disease of the newborn/erythroblastosis fetalis?
-Rh neg mom, Rh pos baby
-mom develops Abs to attack baby's RBCs, which causes hemolysis
-baby will have kernicterus, jaundice, serve anemia, and potentially be a stillbirth
-kernictuerus is bilirubin encephalopathy where bilirubin can cross BBB and deposit in the brain particularly in areas like the basal ganglia and brainstem nuclei
-kernicterus symptoms include: lethargy, poor feeding, high pitched cry, hypotonia, opisthotonos (arching back), seizures, abnormal eye movements
-late stages of kernicterus can result in cerebral palsy, hearing loss, gaze abnormalities, cognitive impairment, motor abnormalities, developmental delays, and dental enamel hypoplasia
96
Neonatal jaundice and hemolytic disease of the newborn/erythroblastosis fetalis both have increased ________________ bilirubin
unconjugated
neonatal is bc of immature liver
hemolytic disease of the newborn/erythroblastosis fetalis is bc of Rh incompatibility
97
Which disease is a genetic hyperbilirubinemia/hepatic disorder?
Gilbert's disease (its a gene mutation)
98
Gilbert's disease has increased _________________ bilirubin
unconjugated
99
Gilbert's disease may be mistaken for?
hepatitis
100
Formation of gallstones in the gallbladder
test q
cholelithiasis
101
Gallstones in the common bile duct
choledocholithiasis
102
Acute or chronic inflammation of the gallbladder, impacted gallstones in the cystic duct causing painful distention
cholecystitis
103
Rare form of small bowel obstruction caused by impaction of gallstones within the lumen of the small intestine
gallstone ileus
104
How would you diagnose gallbladder disorders?
test q
-chalky stool
-abdominal ultrasound
-steady gripping or gnawing pain in the RUQ near rib cage and radiate to upper back
-fatty foods may cause edema and discomfort
-positive murphys sign
105
What are the 6 Fs representing risk factors of gallbladder disorders?
test q
female, 40, fertile, fat, fair, family hx of gallstones
106
What is the most common test performed to evaluate gallbladder abnormalities?
abdominal ultrasound
107
What is a HIDA scan?
-hepatobiliary imunodiacetic acid scan
-imaging test used to view gallbladder, bile ducts, and small intestine
108
The sites of hematopoiesis in the embryo are ________ and __________
yolk sac, liver
109
Some components essential for RBC development are:
-iron
-B12
-B9
-heme
110
The pinker the RBC becomes, the more....
oxygen carrying capacity
111
As the RBC matures, the size becomes....
smaller
112
As the RBC matures, it has more ____________ and less ____________
cytoplasm, nucleus
113
The more cytoplasm the RBC has, the more....
functional Hb
114
As the RBC matures, the staining reaction goes from ___________ to ___________
blue/gray, pinkish-red
115
Nuclear size _____________ as the RBC matures
decreases
116
Eventually the nucleus is ___________ from the maturing RBC
extruded
117
What are NRBCs?
nucleated RBCs
118
Should a normal healthy person have NRBCs in their peripheral blood?
no!!!
