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3154 Haematology > IC1 Blood > Flashcards

IC1 Blood Flashcards

1
Q

Blood collected w anticoagulants (e.g., heparin, citrate, EDTA) consists of:

A

Plasma (55%)

Formed elements
- Buffy Coat (1%)
- Erythrocytes (45%)

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2
Q

Plasma contains:

A

Water (92%)

Proteins (7%) made in the liver

  • Albumin - transport lipids + osmotic pressure
  • Immunoglobulins - transport + immune function + clotting
  • Fibrinogen - clotting
  • Regulatory proteins (enzymes, hormones)

Solutes (<1%)

  • Ions/electrolytes - osmotic pressure, vital cell activity
  • Organic nutrients (e.g., glucose, carbohydrates, AAs, fatty acids, lipids) - ATP pdn, cell growth and maintenance
  • Organic metabolic waste (e.g., urea, uric acid, ammonium, creatinine, bilirubin)
  • Gases
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3
Q

Buffy coat contains:

A
  1. Leukocytes (NLMEB)
  2. Platelets/Thrombocytes
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4
Q

Compare amount of erythrocytes in males vs females

Compare hematocrit percentage.

A

Males more because

  • Stimulatory effect of androgen on bone marrow, enhances erythropoiesis
  • No monthly blood lost during menstrual period

Hematocrit - RBC vol / total blood vol

  • Male: 46%
  • Female - 42%
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5
Q

Low hematocrit may suggest

A

anemia

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6
Q

High hematocrit may suggest

A

polycythemia

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7
Q

Blood collected w/o anticoagulants consists of:

A
  • Serum (protein rich, lacks fibrinogen)
  • Blood clot (fibrin-containing network trapping blood cells)
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8
Q

Blood characteristics:
- Volume
- % body weight
- pH
- Color - oxygenated and deoxygenated
- Temp

A
  • Volume: 5-6L (M), 4-5L (F)
  • 8% of body weight
  • pH 7.35-7.45 (slightly alkaline)
  • Colour: scarlet/bright red (oxy), deep/dark red (deoxy or carbaminogemoglobin)
  • Temp: 38dc (slightly hotter than body temp)
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9
Q

Blood tissue type

A

Connective tissue

*Comprise cells + gels + fibres
*Blood is the ONLY fluid tissue in the body

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10
Q

Functions of blood

A
  • Transportation (O2, CO2, nutrients, wastes, hormones)
  • Regulation (body temp, pH, ion composition of interstitial fluids)
  • Protection (blood clotting, immune function)
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11
Q

What is a convenient method to examine blood cells

A

Blood smear
- view under microscope to reveal components of formed elements (RBCs + WBCs)

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12
Q

Red blood cells
- Lifespan

A
  • Generated in red bone marrow, enter circulation for 3-4 months
  • Worn out RBCs removed by macrophages or destroyed in liver, spleen or bone marrow
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13
Q

Red blood cells
- Shape
- Diameter and thickness
- Explain advantages of its shape

A

Biconcave disc
- diameter 6-8um
- thickness 2um

=> Large SA for easy diffusion of O2 and nutrients
=> Allow flexibility to enter/exit capillaries (3-4um)
=> Smooth flow through stack formation

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14
Q

Red blood cells
- Histology

A

Lack nuclei and most organelles

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15
Q

Red blood cells
- Function

A
  • Respiratory gas transport
  • Buffer pH in blood
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16
Q

Red blood cells
- components that transport respiratory gases

A

Hemoglobin (Hb) - transports O2
Carbonic Anhydrase - transports CO2

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17
Q

Red blood cells
- Hemoglobin

A

Globin + Heme

Globin:

  • 4 folded polypeptide chains, 2a and 2B chains
  • each chain binds 1 heme group

Heme:

  • Pigment
  • Each heme group contains 1 iron, which binds 1 O2 molecule
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18
Q

Red blood cells
- How many molecules of O2 does one hemoglobin transport?

A

4

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19
Q

Red blood cells
- Explain why small reduction in hematocrit can have large effect on the body

A

1 RBC transports 10^9 O2 molecules, hence small reduction in hematocrit can result in large reduction in oxygen in the body

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20
Q

Red blood cells
- What is sickle cell disease?

A

Sickle cell disease

  • mutation of Hb B chain, result in HbS
  • HbS molecules polymerize and aggregate when deoxygenated (low O2 conditions), aggregate to CRESCENTS that rupture the RBC membrane
  • SIckled erythrocytes are spindle shape
  • Incr blood viscosity
  • Shorted lifespan

HbS carrier is resistant to malaria since harder for parasite to infect the RBC

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21
Q

What are the two types of leukocytes?

A
  • Granulocytes (neutrophils, eosinophil, basophil)
  • Agranulocytes (lymphocytes, monocytes)
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22
Q

Neutrophils
- Lifespan

A

10h

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23
Q

Neutrophils
- Shape, size

A

12-15um in diameter (bigger than RBCs)

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24
Q

Neutrophils
- Histology

A

Polymorphonuclear (PMN)

  • Nucleus has 3-5 obes connected by fine strands

Granulocyte

  • Cytoplasm packed with pale “neutral coloured” granules containing bactericidal compounds
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25
Q

Neutrophils
- Functions

A
  • Highly mobile, first WBCs to arrive at acute inflammation/phagocytosis
  • Specialized in attacking and digesting bacteria that have been ‘marked’ for destruction
  • Increase neutrophils seen in bacterial infection
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26
Q

Eosinophils
- Lifespan

A

Minutes to days
Move to tissue after a few hours

27
Q

Eosinophils
- Shape/size

A

Similar to neutrophils: 12-15um diameter (larger than RBCs)

28
Q

Eosinophils
- Histology

A

Polymorphonuclear (PMN)

  • bilobed nucleus

Granulocyte

  • reddish-orange granules
29
Q

Eosinophils
- Function

A
  • Phagocytosis antibody-coated bacteria, protozoa, cellular debris
  • Exocytosis of toxic compounds onto surface of target
  • Increase in parasitic infection
30
Q

Basophils
- Histology

A

Polymorphonuclear (PMN)

  • usually bilobed, obscured

Granulocyte

  • Deep purple/blue granules
31
Q

Basophils
- Functions

A
  • Migrate to injury sites to discharge contents of the granules (e.g., histamine, heparin) that enhance local inflammation
  • Involved in inflammatory reactions during immune response, as well as in acute and chronic allergic reactions (e.g., anaphylaxis, asthma(
32
Q

Monocytes
- Shape/size

A

13-25um diameter (almost twice as big as RBC)

33
Q

Monocytes
- Histology

A
  • Large nucleus, eccentrically placed, oval or kidney-shaped
34
Q

Monocytes
- Lifespan

A

Stay in circulation for 24h before entering other tissues to become macrophages

35
Q

Monocytes
- Function

A
  • Generate tissue macrophage
  • Phagocytosis and digest protozoa, virus, aged cells
  • Antigen presentation
36
Q

Lymphocytes
- Shape/size

A

Slightly larger than RBCs (6-8um)

37
Q

Lymphocytes
- Histology

A

Thin halo of cytoplasm around a relatively large nucleus

38
Q

Lymphocytes
- Can T and B lymphocytes be differentiated on blood smear?

A

No

39
Q

Lymphocytes
- Where do T and B lymphocytes mature?

A

T lymphocytes from red bone marrow migrate to thymus for maturation

B lymphocytes mature in the red bone marrow

40
Q

Platelets
- Normal range

A

200,000 - 400,000 /uL

Thrombocytopenia: Platelet count <100,000 cells/mm3 (100 x 109/L)

41
Q

Platelets
- shape/size

A

flattened disk-like cell fragments of about 1-4um

megakaryocyte 160um => give rise to 2000-3000 platelets

42
Q

Platelets
- lifespan

A

9-12 days (~7 days?)
Removed by splenic phagocytes

43
Q

Platelets
- Histology

A
  • non-nucleated cell fragments
  • purple-stained and granular appearance on blood smear
44
Q

Red bone marrow is the site for ______ and ________

A

Hematopoiesis

  • Meshwork of vascular sinuses and highly branched fibroblasts with the interstices packed with hematopoietic cells that produce billions of RBCs, WBCs, and platelets daily

Removal of worn-out RBCs

  • Along with spleen and liver
45
Q

Red bone marrow is found in?

A

Flat, irregular bones: sternum, vertebrae, hip bones, ribs
Ends (epiphysis) of adult femur, humerus

As we age, hematopoiesis becomes restricted to the flat/irregular bones

Marrows in the shaft/diaphysis of long bones become yellow bone marrow (fat tissue)

46
Q

Erythropoiesis

  • Replacement of RBC: how many RBC per second
A

2-3million RBC /sec

47
Q

Erythropoiesis

  • Where?
A

Fetus: yolk sac, then liver, spleen, lymph node
<5y: all bone marrow
5-20y: bone marrow in ribs, sternum, vertebrae, proximal ends of long bones
>20y: bone marrow in ribs, sternum, vertebrae

48
Q

Erythropoiesis control

  • Erythropoietin (growth factor) is released by _____
  • It’s release is regulated by ______
  • What are some conditions that might trigger erythropoietin release?
A
  • Kidney (90%), Liver (10%)
  • Regulated by tissue oxygenation (low O2 to kidney => more erythropoietin release => incr rate of erythropoiesis) *Negative feedback
  • hypoxia, decreased O2 availability, incr tissue demand for oxygen, anemia, reduced blood flow to kidney, blood donation
49
Q

Erythropoiesis

Functions of Erythropoietin:

A
  • Stimulate hematopoietic stem cells to form proerythroblasts
  • Enhances proliferation rate of proerythroblasts and erythroblasts
  • Enhances Hb synthesis
  • Incr RBC pdn 10 fold
50
Q

Erythropoiesis process

Hematopoietic stem cells in red bone marrow give rise to proerythroblasts which develop into erythroblasts in 3 steps

A
  1. Ribosome synthesis in early erythroblasts
  2. Hb accumulation in late erythroblasts and normoblasts
  3. Ejection of nucleus and formation of reticulocytes (immature RBCs)

=> Reticulocytes continue Hb synthesis, leave bone marrow and differentiate to mature erythrocytes in the blood

51
Q

Normal reticulocyte range

What might high/low reticulocyte count suggest?

A

Normal range: 0.8-1%

High: acute blood loss, hemolysis, thus resulting in erythropoiesis occurring higher than normal (reticulocytosis)

Low: suggests defect erythropoiesis, failure of bone marrow such as aplastic anemia

52
Q

Breakdown products of RBC:

A

Iron

  • recycled, reused in bone marrow OR stored in the liver as ferritin or hemosiderin
  • iron is bound to transferrin and released to blood from liver as needed for erythropoiesis

Globin

  • metabolizes into amino acids and released into circulation

Heme

  • Degraded to bilirubin, excreted via liver and bile into urine and fece
53
Q

Dysregulated erythropoiesis results in either ______ or _______

A

Anemia
Polycythemia

54
Q

Anemia is defined as:

A

Reduction below normal capacity of the blood to carry oxygen due to reduction of erythrocyte numbers and/or reduction of Hb functions

  • Low hematocrit
  • Low RBC counts
55
Q

Types of anemia include:

A
  • Nutritional anemia (lack of iron, folic acid, vit B12, intrinsic factor)
  • Aplastic anemia (bone marrow failure)
  • Renal anemia (lack of EPO due to kidney disease)
  • Hemorrhagic anemia
  • Malaria (plasmodium falciparum ruptures RBC)
  • Sickle cell anemia (mutation in B globin gene, crescent/spindle shape RBC that rupture)
  • Erythroblastosis fetalis (Rh+ RBC of second fetus destroyed by anti-Rh antibodies of Rh- mother)
  • Thalessemia (low pdn of Hb)
56
Q

Consequence of anemia

A
  • Reduction in RBC conc. result in less viscous blood
  • Blood flows faster through the tissues releasing insufficient O2
  • Resulting hypoxia widens blood vessels and reinforces the effect

=> Increased workload for the heart could lead to cardiac arrest

57
Q

Polycythemia is defined by

A

Excess in circulating erythrocytes

  • elevated hematocrit
  • elevated RBC count
58
Q

Primary VS Secondary Polycythemia

Normal RBC: 5 x 10^9 RBC/ml

A

Primary: 7-8 x 10^9 RBC/ml

  • Caused by tumor or tumor-like condition in bone marrow

Secondary: 6-7 x 10^9 RBC/ml

  • Erythropoietin-induced, adaptive mechanism to improve O2 carrying capacity of the blood
  • E.g., high altitudes

Other conditions such as dehydration can elevated hematocrit as well

59
Q

Consequence of polycythemia

A
  • very viscous blood
  • potential plugging of capillaries
  • insufficient O2 delivery to tissues

=> incr workload for heart, lead to cardiac arrest as well

60
Q

Complete blood count components

A
  • Hb
  • MCV: mean corpuscular volume (size)
  • MCH: mean corpuscular hemoglobin (color)
  • MCHC: mean corpuscular hemoglobin concentration
  • RCW: red cell distribution width (anisocytosis, iron deficient anemia)
61
Q

Leukocyte disorders

  • Leukopenia
A

Too few leukocytes, lead to opportunistic infections

May be caused by radiation, chemotherapy, chemicals, viral infections etc.

62
Q

Leukocyte disorders

  • Leukocytosis
A

Elevated leukocytes

Can be a normal response to bacterial or viral invasion

Or can indicate cancer of WBCs

63
Q

Leukocyte disorders

  • Leukemia/Lymphoma
A

Cancers of white blood cells

Leukemia: liquid cancer in blood
Lymphoma: liquid cancer in lymphatic system - bone marrow

WBCs produced are not functional, causing immune deficiency => infections, anemias, hemorrhage

Treatment: irradiation, chemotherapy, bone marrow transplant

3154 Haematology (14 decks)

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