PHYSIOLOGY Flashcards
1
Q
where are bone marrow biopsy/aspirates taken from
A
PSIS
2
Q
bone marrow hyperplasia definition
A
increased bone marrow production
3
Q
bone marrow dysplasia definition
A
disordered bone marrow production
4
Q
bone marrow hypoplasia definition
A
decreased bone marrow production
5
Q
bone marrow aplasia definition
A
no bone marrow production
6
Q
hypercellular bone marrow definition
A
increased cell production (eg RBCs) from bone marrow
7
Q
hypocellular bone marrow definition
A
decreased cell production (eg RBCs) from bone marrow
8
Q
what is in yellow marrow
A
fat
9
Q
what is in red marrow
A
the haemopoietically active bit
10
Q
whats the normal ratio of red to yellow marrow
A
50:50
11
Q
what does yellow>red marrow mean
is it hypo or hypercellular
A
bone marrow suppression
hypocellular (the red bit is the active bit)
12
Q
causes of hypocellular bone marrow
A
drug induced aplasia
aplastic anaemia
13
Q
what does red>yellow marrow mean
is it hypo or hypercellular
A
bone marrow over activation
hypercellular (the red bit is the active bit)
14
Q
causes of hypercellular bone marrow
A
peripheral destruction of cells eg hypersplenism, autoimmune haemolytic anaemia
15
Q
what is immunophenotyping of cells used for
A
to tell which lineage a cell has come from
by looking at antigen expression
16
Q
what does -cytosis mean
A
high …
17
Q
what does -philia mean
A
high …
18
Q
what does -penia mean
A
low …
19
Q
which cells have the ability to self renew
A
stem cells
20
Q
which hormone produced by the kidney regulates the production of RBCs
A
EPO (erythropoietin)
21
Q
which hormone regulates production of platelets
A
thrombopoietin
22
Q
where does haematopoiesis start in the fetus
A
yolk sac
23
Q
which bones does haematopoiesis occur in in the fetus
A
all bones
24
Q
which bones does haematopoiesis occur in in the adult
A
skull ribs sternum proximal humerus pelvis proximal femur
25
where do you get bone marrow samples from in children
tibia
26
how long do RBCs live for
3-4 months
27
what is the process of making RBCs called
erythropoiesis
28
another name for RBCs
erythrocytes
29
what is the function of RBCs
to carry oxygen in the blood to tissues
30
how is most oxygen transported in the blood
| what % is bound to haemoglobin
60% dissolved as bicarbonate
30% transported by binding to haemoglobin
10% dissolved in solution
31
apart from directly binding O2 to hemoglobin, what other function does RBCs have in transporting O2 in the blood
RBCs are need to make bicarbonate (which is how 60% of O2 is transported)
32
what are the RBC precursors (in order) (4 precursors)
stem cells
common myeloid progenitor cell
erythroblast/normoblast
reticulocyte
then erythrocyte (RBC)
33
what genetic material does an erythroblast contain
has a nucleus
34
what genetic material does a reticulocyte contain
has RNA
35
what genetic material does an erythrocyte contain
none!
36
what do reticulocytes look like in comparison to RBCs
bigger
| more purple
37
as RBCs develop during erythropoiesis, what is added to each of the cell types to form the next
what is taken away, by what process
haemoglobin is added
genetic material is removed = enucleation
38
when is EPO produced by the kidneys
hypoxia (occurs with anaemia)
39
what happens to RBC production in kidney failure
decreased = anaemia
bc kidneys cant sense hypoxia = cant produce EPO = no negative feedback to compensate for anaemia
40
what does EPO (erythropoietin) directly do
causes erythroid hyperplasia = increased RBC production in bone marrow
41
what shape are RBCs
biconcave
42
do RBCs have a nucleus
no - no DNA, enucleation occurs to produce RBCs
43
do RBCs have mitochondria
no
44
the nucleus of what cell type should be the same size as a RBC
nucleus of lymphocyte = same size as RBC
45
in the mitochondria, what 2 things combine to make a haem group
Fe2+ and photoporphyrin ring
46
what do haem groups bind with to make haemoglobin
where does this happen
globin
in the cytoplasm
47
in adults (HbA) what are the 4 haemoglobin subunits
2 alpha
| 2 beta
48
in fetus (HbF) what are the 4 haemoglobin subunits
2 alpha
| 2 gamma
49
which state must iron be in for O2 to bind to
Fe2+
if Fe3+ needs to be reduced
50
where is iron absorbed
duodenum
51
is haem iron or non-haem iron better absorbed
haem iron
non-haem iron is in plants (veggie diet)
52
iron transporter between duodenal epithelium and blood stream (for iron to be transported in blood)
ferroportin
53
how is free iron transported round the body in the blood
as transferrin
54
where is the majority of the bodys iron
where else is it
70% in haemoglobin
rest; liver, bone marrow, macrophages etc
55
why must Fe2+ be bound (ie to oxygen or transferrin)
otherwise free radical production
56
in what form is iron stored in the liver
ferritin (also small amount in blood as ferritin)
57
which parts of the body have transferrin receptors (hence transferrin can transport iron there)
liver
| bone marrow
58
marker of circulating iron
transferrin
59
marker of iron stores
serum ferritin - small amount of ferritin in blood is representative of the ferritin stores in liver/macrophages
60
excretion of iron
doesn't happen naturally
| need iron chelating drugs to excrete in urine/faeces
61
how many oxygens bind to 1 haemoglobin subgroup
how many oxygens bind to 1 RBC
1 O2 per subgroup
4 O2 per RBC (bc 4 subgroups)
62
how does oxygen bind to RBCs
what does this mean
what shape of curve does this produce on a graph
by cooperative binding
once one O2 has bound, there is increased affinity for the next O2 to bind = allosteric effect
sigmoidal curve
63
does fetal Hb saturate more or less at the same pO2 compared to adult Hb
saturates more at same pO2 = bc needs to take O2 from maternal circulation
64
methods of shifting O2-Hb curve to the right (ie increasing O2 binding when higher O2 demands)
increase temp
increase CO2
increase DPG
DEcrease pH - rest are increase!
65
what shunt generates DPG
what is this important for
rapapoport-lubering shunt
shifts the O2-Hb curve to the right = increases O2 binding
66
how much O2 does 1g of saturated Hb bind
1.34ml O2
67
where are RBCs destructed
spleen
68
what cells remove old RBCs from circulation and take them to the spleen for destruction
macrophages
69
in RBC destruction, what are globin chains broken down into
amino acids
70
in RBC destruction, what are the haem groups broken down to
porphyrin ring and Fe2+
71
in RBC destruction, after haem has broken down into porphyrin ring and Fe2+, what is the porphyrin ring broken down into
then what
haem
then porphyrin ring (+ Fe2+)
then biliverdin
then bilirubin
72
after RBC destruction, where is bilirubin taken to, what happens to it
bilirubin taken to liver
| liver conjugates bilirubin = excreted in bile (urine and faeces)
73
if there is no mitochondria in RBC, where do they get their energy from
glycolysis (needs glucose)
74
what chemical prevents the oxidation of Fe2+ to Fe3+by free radicals
NADH
75
what chemical prevents the formation of free radical forming (which is important to prevent oxidative damage to RBCs)
what is this chemical made form
what is the rate limiting enzyme involved in its formation
glutathione (GSH)
made from NADPH
G6PD is the rate limiting enzyme
76
function of WBCs
fight infection
77
3 categories of WBCs
monocytes
lymphocytes
granulocytes (3)
78
3 types of granulocytes
neutrophils
basophils
eosinophils
79
where do you find monocytes
in circulation
in the tissues they are called macrophages
80
where do you find macrophages
in tissues
in the circulation they are called monocytes
81
WBC
| larger horseshoe shaped nucleus
monocyte
82
what does a monocyte look like
| how many nuclei
large single horseshoe shaped nucleus
mono= one nucleus
83
function of monocytes/macrophages
phagocytosis
84
types of lymphocyte
NK cells
T cells
B cells
dendritic cells
85
where are T cells made
thymus
| T cells = Thymus
86
where are B cells made
bone marrow
| B cells = Bone marrow
87
what do mature lymphocytes look like
| what do activated lymphocytes look like
mature lymphocytes - small, condensed nucleus, rim of cytoplasm
activated lymphocyte - large, 'open' nucleus, lots of cytoplasm
88
when are lymphocytes 'activated'
viral infection
89
lymphocytes with lots of cytoplasm and an 'open' nucleus
activated lymphocytes = viral infection
90
what should the lymphocyte nucleus be the same size as
RBC
91
when do you get lymphocytosis (high lymphocytes)
viral infection
childrens infection
CLL
92
are granulocytes in the myeloid or lymphoid lineage
myeloid
93
are platelets in the myeloid or lymphoid lineage
myeloid
94
are RBCs in the myeloid or lymphoid lineage
myeloid
95
are lymphocytes (NK cells, B cells, T cells, dendrites) in the myeloid or lymphoid lineage
lymphoid
96
eosinophil appearance
granule stain
nucleus shape
granules stain red
| bi lobed nucleus
97
neutrophil appearance
granule stain
nucleus shape
```
neutral stain (don't colour)
segmented nucleus (hence polymorph)
```
98
basophil appearance
granule stain
nucleus shape
granules stain dark blue (Basophils = Blue)
| nucleus is obscured by granules
99
eosinophil function
parasitic infection
| hypersensitivity IgE reaction (allergy)
100
basophil function
hypersensitivity IgE reactions (contains histamine)
RARE in circulation
101
neutrophil function
phagocytosis
chemoattraction of other immune cells
margination (stick to vessel walls)
102
which type of granulocyte is least common in circulation
basophils
103
what is the circulating version of a mast cell
basophils
104
another name for neutrophils
polymorphs
105
which type of granulocyte is most common in circulation
neutrophil
106
how long is the life span of a neutrophil
clinical significance of this
7-8 hours
in pancytopaenia (bone marrow failure), neutropenia is the first symptom (RBCs last 3 months)
107
how do steroid cause neutrophilia (high neutrophils)
inhibit margination of neutrophils to vessel walls = more in circulation (not actually ore made)
108
neutrophilia aetiology
infection
trauma
steroids
109
life span of platelets
clinical significance of this
7-10 days
need to stop anti platelet (aspirin) 1 week before surgery
110
function of platelets
stop bleeding via primary haemostasis
111
platelet precursor
megakaryocyte
112
how are platelets made from megakaryocytes
'budding' cytoplasm 'buds off' = platelet
| rest of cell remains in bone marrow
113
what are plasma cells
mature B cells that have returned to bone marrow
114
where are lymphoid cells made
primary lymphoid tissues - thymus and bone marrow
115
primary lymphoid tissues
thymus and bone marrow
116
after production in primary lymphoid tissues (thymus and bone marrow) where do lymphoid cells go
secondary lymphoid organs - lymph nodes, spleen, tonsils
117
what does the lymph node filter
lymphatic fluid
118
what does the spleen filter
blood
119
where does lymph from L torso and arms drain
between L subclavian and jugular veins
120
where does lymph from R torso and arms and lower limbs drain
thoracic duct (between the R subclavian and jugular veins)
121
causes of enlarged lymph nodes (4)
local infection
systemic inflammation - TB, autoimmune
malignancy
other stuff - sarcoidosis, SLE
122
enlarged cervical lymph nodes with atypical lymphocytes
local infection
EBV (glandular fever)
atypical lymphocytes = viral infection
123
are lymph nodes painful in local infection
yes
| bc fast growing
124
types of malignancy that can present as enlarged lymph nodes
haematological - lymphoma, leukaemia
| metastatic
125
most common cause of enlarged lymph nodes
local infection (though always consider malignancy)
126
are lymph nodes painful if malignancy cause
no
bc slow growing
127
consistency of lymph nodes in lymphoma
soft/rubbery
other causes = hard
128
what aetiology of enlarged lymph nodes causes irregular consistency of hard lymph nodes
metastatic cancer
129
lymph node biopsy; predominantly B cells
autoimmune condition
| infection
130
lymph node biopsy; predominantly T cells
viral infection
| drugs - phenytoin
131
lymph node biopsy; predominantly phagocytes
tumour
132
what is accumulation of lymph fluid in the peritoneal cavity called
what causes it
chylous ascites
caused by trauma/obstruction of lymphatic system
133
causes of splenomegaly
infection eg EBV
portal congestion
haemotological disease eg lymphoma, leukaemia, haemolytic anaemia
inflammatory conditions
134
how can splenomegaly present on the skin
| how does it occur
jaundice
hypersplenism = increased function of spleen =increased destruction of RBCs = increased RBC degradation products (bilirubin) = liver cant cope = accumulation of bilirubin = jaundice
135
how does hyposplenism present on histology
what are they
how do they occur
Howell joly bodies
RBCs with small fragments of DNA
they are normal RBCs but are usually removed by the spleen, so hyposplenism = underactive spleen = doesn't remove them
