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HemOnc Week 1 > ICL 1.1: Blood & Hematopoiesis > Flashcards

ICL 1.1: Blood & Hematopoiesis Flashcards

1
Q

what are the functions of the blood?

A
  1. respiration: transporting oxygen and CO2 between lungs and tissues
  2. nutrition: transport of absorbed food materials
  3. excretion: transport of metabolic waste to kidneys, lungs, skin and intestines for removal
  4. maintenance of the normal acid-base balance
  5. regulation of water balance through effects of blood on the exchange of water between the circulation fluid and the tissue fluid
  6. regulation of body temperature by distribution of body heat
  7. defense against infection by WBC and antibodies
  8. transport of hormones and regulation of metabolism
  9. transport of metabolites
  10. coagulation
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2
Q

what are the three components of blood when you centrifuge blood?

A
  1. plasma (top)
  2. buffy coat
  3. RBC (bottom)
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3
Q

what are the components of the plasma layer of blood?

A
  1. water (93%)
  2. proteins: albumins, globulins, fibrinogen, regulatory proteins
  3. other: electrolytes, nutrients, gases, waste, hormones
    nutrients: glucose, AA, lipids, cholesterol, vitamins
    waste: urea, creatinine, bilirubin
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4
Q

what is in the buffy coat of blood?

A
  1. platelets (120-300 thousand/mmˆ3)

2. leukocytes: neutrophils, lymphocytes, monocytes, eosinophils, basophils

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5
Q

what is in the RBC layer of blood?

A

RBCs lol

this is the hematocrit! it’s 40% of the spun volume

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6
Q

what’s the difference between Hb and hematocrit?

A

Hgb = amount of Hb protein (g/dL)

Hct = packed cell volume (volume of RBCs/volume blood)

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7
Q

what is plasma?

A

basically everything

plasma = serum + fibrinogen and other clotting proteins

anti-coagulated blood is spun in centrifuge to separate cells from plasma

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8
Q

what is serum?

A

serum = plasma - fibrinogen - clotting proteins

blood is allowed to clot, separating serum from clotting proteins and cells

serum is what we get metabolic panels from like figuring out somebody’s electrolyte levels!

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9
Q

what proteins are in plasma?

A
  • albumins
  • globulins
  • clotting factors
  • complement proteins
  • lipoproteins
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10
Q

what do you do if someone has a deficiency of multiple coagulation factors?

A

give them a transfusion of fresh frozen plasma (FPP) to replace clotting factors!

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11
Q

what is warfarin?

A

aka Coumadin - used as anticoagulant

when someone ODs on these medications you can give them FPP to replace clotting factors

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12
Q

what is the total protein made of?

A

mostly albumin and gamma globulins

it’s the TP of the plasma proteins

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13
Q

what do high or low total protein levels signify?

A

high TP = hypergammaglobulinemia

can get serum protein electrophoresis (SPEP) to separate out proteins and see which ones are elevated

low TP = liver failure or malnutrition

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14
Q

What is the source and function of albumen?

A

Liver

Maintains colloid osmotic pressure

Protein transport

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15
Q

What is the source and function of alpha and beta globulin?

A

Liver

Transport

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16
Q

What is the source and function of gamma globulin?

A

Plasma cells

Make up antibodies for immunity/defense

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17
Q

What is the source and function of clotting factors

A

Liver

Coagulation

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18
Q

What is the source and function of complement proteins?

A

Liver

Microorganism destruction

Inflammation

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19
Q

What is the source and function of lipoproteins?

A

Liver

Lipid transport

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20
Q

What are the common components of stains?

A

Eosin: acidic, red/pink (stains cytoplasmic components)

Methylene blue: basic (stains acidic components like nucleic acids)

Azure: stains cytoplasmic granules containing proteins and proteoglycans

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21
Q

What’s the average WBC concentration?

A

5-10,000/mm^3

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22
Q

What’s the average lifespan of a WBC?

A

5 days in circulation

A few hours once they’re extravascular in the tissues

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23
Q

What’s the average concentration of RBCs?

A

4.6-6.2 million/mm^3

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24
Q

What’s the average concentration of platelets in the blood?

A

150-400 thousand/mm^3

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25
Q

What’s the lifespan of a platelet?

A

14 days

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26
Q

When does hematopoiesis start?

A

Prenatally!

Starts 2 weeks after conception in the yolk sac

Then the liver starts making RBCs around 6 weeks followed by the liver (second trimester)

Then bone marrow makes RBC in 3rd trimester and throughout life

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27
Q

What is a compensatory mechanism for RBC production when there’s something wrong with the bone marrow?

A

Liver and spleen can start to make RBCs when the BM is destroyed or in myeloproliferative diseases

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28
Q

In adulthood, where specifically does hematopoiesis occur?

A

Medullary cavity of bones in the axial skeleton = vertebrae, ribs, pelvis, femur

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29
Q

What’s the maturation sequence of RBCs?

A

Blast, basophilic erythroblast, polychromatophilic erythroblast, orthochromic erythroblast, polychromatophilic RBC (reticulocyte), mature RBC

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30
Q

What’s the maturation of WBCs?

A

Myeloid: blast, progranulocyte, myelocyte, metamyelocyte, band, neutrophil (or eo or baso)

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31
Q

What causes pluripotent stem cells to differentiate into specific things?

A

Under the influence of specific cytokines, pluripotent stem cells will turn into either common myeloid stem cells or common lymphoid stem cells

Lymphoid stem cells will then turn into plasma cells, NK cells and T cells

Myeloid cells will then turn into eosinophils, basophils, RBCs, monocytes/macrophages, leukocytes, platelets

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32
Q

What are the most important growth factors for stem cells?

A

SCF (c-KIT ligand)

Flt3-ligand

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33
Q

What are the most important growth factors for granulocytes?

A

GM-CSF

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34
Q

What are the most important growth factors for eosinophils?

A

IL-5

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35
Q

What are the most important growth factors for monocytes?

A

M-CSF

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36
Q

What are the most important growth factors for RBC?

A

Erythropoietin

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37
Q

What are the most important growth factors for megakaryocytes/platelets?

A

Thrombopoietin

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38
Q

What are the most important growth factors for B cells?

A

Flt3L

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39
Q

What are the most important growth factors for T cells?

A

IL-7

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40
Q

What are the most important growth factors for NK cells?

A

IL-15

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41
Q

What’s the diameter of a RBC?

A

6-9 microns

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42
Q

What’s the average concentration of Hb in men and women?

A

13.-17 g/dl in men

12-15 g/dl in women

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43
Q

What’s the normal RBC count in men and women?

A
  1. 3-6 million/mm^3 in men

3. 5-5 million/mm^3 in women

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44
Q

What does RBC carbonic anhydrase do?

A

Rapidly inter-converts CO2 and water into carbonic acid acid, protons and bicarbonate ions

Important in buffering H+ ions to maintain pH

This can effect serum K+: in metabolic acidosis, patients can become hyperkalemic

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45
Q

Congenital loss of an RBC’s biconcave shape may lead to which of the following diseases?

  1. hemophilia
  2. Hereditary spherocytosis
  3. Pernicious anemia
  4. Thrombocytosis
  5. Von willebrand disease
A

Hereditary spherocytosis

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46
Q

What is herediary spherocytosis?

A

Congenital disorder of RBCs resulting from mutations in RBC cytoskeleton proteins and proteins that attach the cytoskeleton to the cell membrane

Mutations in proteins like spectrin and ankyrin make the membrane cytoskeleton unstable and the RBCs are more likely to lyse

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47
Q

Why is an RBC’s lactic-like structure advantageous?

A

Enhanced ability to maneuver through small blood vessels

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48
Q

What are the components of HbA and % of Hb?

A

96%

2 alpha chains, 2 beta chains, 4 Fe-containing hemes

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49
Q

What replaces oxygen when it’s released from Hb?

A

When oxygen is released 2,3-disphosphoglycerate replaces it to make deoxyHb

50
Q

What color is oxygenated vs. deoxygenated blood?

A

Oxygenated, arterial = red

Deoxygenated, venous = blood

51
Q

What’s the structure of HbA2 and % of Hb?

A

2%

2 alpha chains, 2 delta chains

52
Q

What’s the structure of HbF and % of Hb?

A

1%

2 alpha and 2 gamma

53
Q

What transmembrane proteins are in the RBC membrane?

A
  • glycophorins A, B,C,D
  • ion channels for Na+, K+, Ca+2
  • band 3 transports Cl- and HCO3-
54
Q

What makes up the RBC membrane?

A
  • transmembrane proteins
  • cytoskeleton proteins
  • surface carbohydrates
55
Q

What cytoskeleton proteins are in the RBC membrane?

A

Ankyrin, spectrin, band 4.1

Membrane defects cause hereditary spherocytosis

56
Q

What do surface carbohydrates on RBC do?

A

Determine blood group and Rh type!

O,A,B,AB

Important for transfusion

57
Q

How do WBC exit the vascular space?

A

Diapedesis

How they make it through basement membrane to get into tissue spaces

58
Q

What are the two groups of WBCs?

A

Granulocytes: neutrophils, eosinophils, basophils
- segmented nucleus, cytoplasmic specific granules

Mononuclear cells: lymphocytes, monocytes
- non-segmented nucleus, no specific granules

59
Q

What’s the normal WBC count in adults?

A

4500-11,000 cells/mm^3

60
Q

What type of WBC is most common?

A

Neutrophils

61
Q

What’s the % and absolute count of neutrophils?

A

57-67% of WBC

2500-7400 cells/mm^3

62
Q

What’s the % and absolute count of lymphocytes?

A

25-33%

1,125-3630 cells/mm^3

63
Q

What’s the % and absolute count of monocytes?

A

3-7%

135-770 cells/mm^3

64
Q

What’s the % and absolute count of eosinophils?

A

1-3%

45-330 cells/mm^3

65
Q

What’s the % and absolute count of basophils?

A

<1%

<110 cells/mm^3

66
Q

What are the characteristics of neutrophils?

A

Multi-lobed nucleus

Motile

Phagocytic (due to lysosomes and granules)

Condense chromatin in nucleus = no protein synthesis

Few organelles in cytoplasm

67
Q

What help with neutrophil diapedesis?

A

Selections and ICAM-1 adherence

68
Q

What helps neutrophils with chemotaxis?

A

Chemotaxis = traveling from one place to another

IL-1 and TNF

69
Q

How do neutrophils phagocytize and destroy bacteria in connective tissue spaces?

A

Via reactive oxygen compounds = free radicals

70
Q

What enzyme helps neutrophils phagocytize bacteria? What test can be done to check if a neutrophil has this enzyme? What disease do you get if you don’t have this enzyme?

A

NADPH oxidase

Chronic granulomatous disease results from NADPH oxidase deficiency

PMNs are unable to kill bacteria and these giant inflammatory granules build up

Nitro blue tetrazolium test tells you if a PMN has NADPH oxidase

71
Q

What do the primary granules of neutrophils contain?

A

Azurophilic granules = primary granules

Peroxidase & lysozyme

72
Q

What do the secondary granules of neutrophils contain?

A

Specific granules = secondary granules

Collagenase, phospholipase, lactoferrin, lysozyme, alkaline phosphatase, vitamin B12-binding protein, phagocytin

73
Q

What do the tertiary granules of neutrophils contain?

A

Gelatinase & cathepsin

74
Q

What does an elevated neutrophil count indicate?

A

Bacterial infection

75
Q

Are neutrophils smaller or larger than RBC?

A

Larger

76
Q

Why are neutrophils one of the quickest responders to an inflammation?

A

Half of all neutrophils in the blood are marginated to the blood vessel wall

77
Q

If a woman has large RBCs and hypersegmented neutrophils in her blood smear and she is a vegan and says she’s fatigued. What vitamin deficiency does she probably have?

A

Vitamin B12

Deficiency can cause megaloblastic anemia and hypersegmented neutrophils

B12 is in animal products like fish, meat, poultry, eggs

78
Q

What does the nucleus of an eosinophil look like?

A

Bi-lobed

79
Q

What do eosinophils do?

A

Important for moderating allergic reactions and killing parasitic words

80
Q

What do specific granules of eosinophils contain?

A

Crystalline core (internum) and a less dense matrix (externum)

Internum: major basic protein, eocationic protein, eo-derived neurotoxin

Externum: aryl sulfatase, histaminase

81
Q

Which compounds in the specific granules of eosinophils help fight parasitic infections?

A

major basic protein and eocationic protein

82
Q

Are eosinophils bigger or smaller than neutrophils?

A

Bigger!

Eosinophil > neutrophil > RBC

12-17 micrometers

83
Q

What color do eosinophils stain? Why?

A

They have large acidophilic specific granules so they stain bright red!

Eosin is acidic and stains stuff pink so if the granules are acidophilic then they’ll turn pink

84
Q

What cytokine is important for eosinophil production and release from bone marrow?

A

IL-5

85
Q

What chemical influencers allow for eosinophil chemotaxis?

A

Histamine, leukotrienes, eosinophil chemotactic factor

86
Q

What’s the pneumonic for eosinophil function?

A

NAACP

Neoplasia, allergy, asthma, collagen vascular diseases, parasites

Eosinophils function in allergic reactions, inflammatory reactions and parasitic worm invasion - they inactivate some inflammatory substances like histamine

Neoplasia = uncontrolled growth of cells in the body (cancer)

87
Q

What substance will help the eosinophil find its way to the right place in the body?

A

Eosinophil chemotactic factor

ECF is released by other WBCs to attract eosinophils to the site of action in the body

88
Q

What substances kill parasites and degrade antigen-antibody complexes?

A

Peroxidases and hydrolases

89
Q

What does the basophil nucleus look like?

A

S shaped nucleus

2-3 irregularly shaped lobes

90
Q

What is the function of basophils?

A

Act as an initiator in the inflammatory process and allergic reactions

They are involved in production of mediators of inflammation like:

  • platelet-activating factor
  • leukotrienes
  • prostaglandins: SRS-A slow reacting substance of anaphylaxis, bradykinins, TNF, interleukins
91
Q

What do the specific granules of basophils have?

A
  • Histamine
  • heparin
  • eosinophil chemotactic factor
  • peroxidase
  • condroitin sulfate
92
Q

What color do the granules of basophils stain?

A

Deep blue stained granules (basic)

Usually the granules cover up the nucleus and you can’t see it

93
Q

What do basophils do in tissues?

A

They bind IgE when antigen contact occurs and then the basophils release granules

94
Q

What does histamine do?

A

Causes vasodilation, smooth muscle contraction, leaky blood vessels

These reactions all mediate allergic and anaphylactic reactions in tissues

95
Q

What medical condition do you suspect if there’s ever basophilia?

A

It’s rarely seen since basophils make up such a small portion of the blood

But when it does happen you usually suspect leukemia = blood cancer

96
Q

What’s the main component of basophil specific granules?

A

Histamine and heparin

Other: lysosomal enzymes, peroxidase, eosinophil and neutrophil chemotactic factors

97
Q

What do monocytes do?

A

In the blood they’re monocytes but then they enter the connective tissue space and become macrophage

  1. They produce cytokines
  2. Can present antigens to T-cells
98
Q

What is the largest type of WBC?

A

Monocytes

20 micrometer

99
Q

What does the monocytes nucleus look like?

A

Kidney bean shape/u-shape but one lobe!

Lots of cytoplasm

“Raked” chromatin

100
Q

When a monocytes encounters a microbe what does it do to get rid of it?

A

Ingests/phagocytose the microbe

Completely engulfs substance and removes it from circulation

101
Q

What types of things to monocytes phagocytose?

A

Old RBC, antigens, foreign particulate material including bacteria

102
Q

What is a granuloma?

A

A collection of macrophages that are fused together into one giant macrophage

Usually happens in tuberculosis and fungal infections

103
Q

How big are lymphocytes?

A

Usually small, just a little bigger than RBCs

About 10% are bigger and have more cytoplasm, more free ribosomes and more mitochondria = usually activated lymphocytes

104
Q

What does the nucleus of a lymphocyte look like?

A

Spherical nucleus

Abundant dark staining condensed chromatin

Not a lot of cytoplasm can be seen

Basophilic = stains blue/purple

Nucleus takes up most of the cell!!

105
Q

What are the types of lymphocytes?

A
  1. B-lymphocytes (15%)
  2. T-lymphocytes (80%)
  3. NK cells (5%)
106
Q

What do B-lymphocytes do?

A
  • humoral immunity: antibody mediated immunity
  • activated B-cells produce plasma cells which then produce antibodies
  • antibodies circulated throughout body by blood and lymph
107
Q

What do T-lymphocytes do?

A
  • cell immunity
  • helper T cells and T-regulatory cells are required to activate B-cells
  • cytotoxic T cells directly kill foreign/virus infected cells
108
Q

What do NK cells do?

A

Attack virus infected cells, cancer cells or transplanted cells without need for stimulation

Aka they’re innate

109
Q

Where are lymphocytes produced?

A

All produced in the bone marrow but T-cells go to the thymus to mature

110
Q

What part of the immune system are the different types of lymphocytes?

A

B and T cells = adaptive immune system

NK cells = innate immune system

111
Q

What cell marker identifies a helper T cell?

A

CD4

112
Q

What cell marker do all T cells have?

A

CD3

113
Q

What cell marker do cytotoxic T cells have?

A

CD8

114
Q

What cell marker do regulatory T cells have?

A

CD25

115
Q

What cell marker to NK cells have?

A

CD56

116
Q

Do platelets have a nucleus?

A

No but they do have organelles!

117
Q

Where do platelets come from?

A

They fragment off of megakaryocytes in the bone marrow! That’s why they don’t have nucleus

118
Q

What’s the function of platelets?

A

Primary hemostatic plug in damaged blood vessels

Secondary hemostasis is the coagulation cascade

119
Q

What disease is characterized by abnormal platelet adhesion?

A

Bernard-Soulier syndrome

Platelet receptor GpIb is congenitally lost

GpIb allows platelets to adhere themselves tot he injured blood vessel in an attempt to achieve hemostasis

120
Q

What is Glanzmann thrombasthenia?

A

Platelet aggregation or clumpin is abnormal due to lack of GpIIb/IIIa receptors

121
Q

A patient has a rash all over her lower extremeties. She has thrombocytopenia. What can be found in the alpha granules of the platelets?

A

Growth factors, adhesion molecules, von Willebrand factor, fibrinogen

Dense granules have ADP, ATP, serotonin and Ca+2

HemOnc Week 1 (32 decks)

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