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The Developing Human > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q
A
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2
Q

Megalocyte contains 3 embrionic forms

A

Megalocyte embryonic forms are:

1-Glower 1:

2-GLower 2: 5-12 weeks

3-Portland 5-12 weeks

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2
Q

Fetal HGB

HGF

Fetal HGB has 2 alphas & 2 Gamma

Adult HGb has 2 alpha and 2 Beta

A

Begins to form 6-12 weeks GA

Higher affinity for O2-Does not release Oxygen readily

Does Not contain 2,3 DPG

(our cells don’t have a higher affinity for oxygen, so it’s not a problem for us)

BUT in the fetus, holds on and shifts to the left requiring higher concentrations of oxygen before they will release it

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2
Q

vasoconstriction

A

when you have physical injuty to a blood vessel

-contractile response narrowing the vessel

occurs by direct mechanical stimulation

-small arterioles or arterie-the lumen of the BV actually closes and stops the bleeding

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2
Q

PT > 17 seconds at any Gestation

AND a PTT -45-50 in term infants is a concern

A

PTT measures ALL factors except XIII & XIII

abnormal if any factor is 20-40% of normal

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3
Q

failure to give vitamin K

A

causes bleeding diathesis at 3-4 dys of age

=use of abx may decrease/interfere with prodution of vitamin K

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4
Q

Process of RBC Development

A

Same in the hepatic and myeloid period

Erythropoietin pkays a part-it stimulates stem cells to become precursor of hte erythrcytes

-Stem Cells differentiate into early and late

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4
Q

Production of cells

A

Eosinophils at 10-21 weeks

basophils at 10 weeks

Macrophages 10-16 weeks

Monocytes 12-16 weeks

T-Lymphocytes at 7 weeks

B-Lymphocytes at 8 weeks

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5
Q

Hepatic Period

THis is how the liver takes on the production of blood cells

A
  • 1 1/2 months and peaks at 3-5 months thru 10 months
  • Spleen-Contributes at 2 1/2 months
  • peaking at 4 month
  • and then decreasses by the end of the 4th month
  • By the end of the 4th moth, the spleen will contribute to the production of

1-lymphocytes

2-erythrocytes

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6
Q

Mast Cells

A

Found in Bone Marrow, spleen and Thymus

Similar in appearahce to basophils

RELEASE HISTAMINE IN RESPONSE TO TISSUE DAMAGE

when histamine is released, leads to reddening ad warming of skin

other substrated released include K+, bradykined, serotonin and prostaglandin

K+ is released by dying tissue

bradykinen activates pain receptors

PGE-sonstriction of smooth muscle

All participate in inflammation response

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6
Q

IgG

A

Only class that crosses the placenta

Produced and Synthesized 10-12 weeks GA

A 30 weeks, secretory IgA appears

IgG offers protection the 1st few months of life

Mose importand immunoglobulin

tranferred from mother to infant

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7
Q

granulopoietin

Neutrophils

A

is important for granulocyte production

regulates granulocyte production

-controls movement from the bone marrow to the blood of the neutrophil;

those that are not needed, adhere to art of the vessel wall i the marginal pool and they stay there util they are needed

-mature neutrophils -50% circulate freely in circulation and 50% adhere to the wall of the vessel and remain part off the marginal pool

Cells that are attatched to the vessel wall are not included in the WBC count

the differential only represents half of the circulating

-when there is a demand for neutrophils, the mature cells are released first and if there isn’t enough, there in an increase in the # of bands

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9
Q

Hepatic Period

A
  • 1 1/2 months
  • peaks 3-5 months thru 10 months
  • begins with RBC production in the embryonic Liver
  • Stem cells migrate from the yolk sac to the Liver
  • Some stem cells migrate to the liver that arise indelendently and not from the yolk sack
  • Liver grown Rapidly from 7-8th week
  • by the 9th week, the liver accounrs for 10% of the total body weight of the fetus (liver is the main organ that’s producing blood cells)
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10
Q

Myeloid Period

A

production of all cells escalate

  • we will see mature RBC week after marrow develops
  • significant quantities by 17 weeks
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10
Q

Mature RBC’s Do NOT have a nucleus

(CFU-E) differentiate into a normoblast, gain HGB and become a retic

A

Immature RBC’s DO HAVE a nucleus

-once it is 34% concentrated, the nuleus goes away making immature retic and then 1-2 days later, the RBC is mture

Retics are immature RBCs

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11
Q

HGB Levels

A

term-lowest at 8-12 weeks (11.4)

preterm - lowest at 4-8 weeks (7-10)

not prevented by supplements

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12
Q

Heematopoietic stem cells are precursors to/for

-erythrocyte

lymphocyte

granulocyte

monocyte

megakaryocyte

A

megakaryocytes are precursors or platelets and are preset in the liver at 5-6 weeks

-platelets can be found in the blood by 11 weeks GA

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13
Q

FIBRINOLYSIS

A

USED IN MI PATIENTS; DOSOLVES CLOTS

CLOT LIQUIFIES DUE TO PLASMIN (PROTEOLYTIC ENZYME)

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14
Q

Erythropoietin

A

After birth, the EPO levels decrease dramatically du to an increase in PaO2 levels relative to the levels the fetus was exposed to in utero

  • later because of tissue hypoxia, we will see an increase in EPO production, resulting in physiologic anemia (3rd week in term and end of 2 week in preterm)
  • Physiologic anemia increases the production of EPO
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14
Q

ANC

A

=% SEGS = 5OF IMMATURE CELLS (metas, Myelos, bands) x WBC

ANC < 1350 suspect infection

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15
Q

parameters

A

RBC- 4.6-5.2 milliom/mm3

Nucleated RBC can be seen in the NB’s first 24 hours

Stress at delivery affect the # of RBC’s present

(as more immature rbc are being produced and disappear within ays in term and by 1 week in preterm)

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16
Q

when do platelets start circulating?

A

by 8 weeks

increases with GA

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17
Q

WBC-Myelopoiesis

A

1-produced in the bone marrow and lymphatic tissue thru the promeylocyte, myelocyte and metamyclocyte stages

2-enter circulation at the polymophonuclear stages as pMC as neutrophils

3- WBC’s are carried in the circulation to extravascular rissues-part of the immature system

4-Myelopoiesis is associated with WBC production and hematopoiesis/erythropoiesis is associated with RBC production

5)-development of WBC’s

Mylecopoieses begins

RBC’s 1st them WBC’s

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17
Q

T-Lymphocytes

A

release lymphokines that recruit phagocytes, stimulate lymphocytes and macrophages which inhibit viral repication

a) interferon
b) interleukin

are the most familiar types or lymphokine

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17
Q

Vitamin K

A

respinsible for carboxylation of glutamine acid residues in amino acid terminal portion ofprotein molecule

-study clotting factors; learn that ca+ is important in the clotting process

cannot have appropriate clotting without ca+, so carboxilation

  • results in allowing protein to bind with Ca+ions and converts factors to thrombus formation
  • needed for thrombus formation

brotein to bind with Ca+ ions converts factors to thrombus formation

-glutamic acid coe=mes from glutomate which is essential amino acid

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18
Q

Reticulocytes Become

MATURE RBC’s

A

Normally takes 48 hours for retic to become ature erythrocyte

  • mature erythrocyte DOES NOT have a nucleus
  • Nucleus is lost when the HGB becomes 34% saturated with Oxygen
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18
Q

PMN

SEGS

Polymrphonuclear

A

segmented neutrophils

mature neutrophils

sometimes called poly’s or segs

immature forms seen in healthy NN first 2-3 days of life

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18
Q

Cachectin

A

TNF

Tumor necrosis factor

responsble for fever

a) macrophage hormone
b) produced in the presence of endotoxin
c) inhibits the triglyceride clearance and faulty lipid metabolism

Compromises nourishment of bacteria and alters lipid metabolism

Causes muscle wasting

Negative nitrogen balance

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19
Q

Erythrocyte Indices

A

MCV=Mean Cell Volume=average size and volume of a single RBC

a) MCV decreases as GA progresses
b) normal range = 107-120

Increase MCV-MACROCYTE

Decreased MCV-MICROCYTE

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20
Q

I:T

A

Band to seg ration in amarillo >.3

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21
Q

Blood sampling

A

how/where site can lter the values

cap hgb values 2-3 greater than venous

arterial hgb are 0.5 greater than venous

hgb, hct and RBC-heelstick is 5-25% higher than venous or arterial

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22
Q

WBC counts

A

crying increases and can shift to the left

arteria

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23
Q

Neutrophils are non-specific

A

best defense a baby has because there isn’t enough immunoglobulin IgG (mom to baby in last trimester, baby may not get enough if preterm)

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24
Q

2 types of T-Lymphocytes

A

Helper and supresser

1-Helper-stimulate helper cells which stimulate antibody production

2-supresser T Cells-turn off antibody reactions

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25
Q

BLOOD CLOTTING

A

complex process

cascade of reactions

-factors are synthesized inn liver as Vit K

Vit K clotting factors given after delivery

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27
Q

RBC Development

A

RBC Production is regulated by EPO

-EPO doesn’t cross the placents (baby has to produce own EPO)

EPO increases 19 weeks to term

From 20 weeks-EPO is Primarily produced in the liver, rather than the kidney

FROM 30 weeks on, the fetus reacts to hypoxia with Increased EPO production

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29
Q

Lymphocytes

A

Are initially produced in the fetal liver and lymphoid tissue, then to thalmus, spleen and then to the bone marrow

29
Q

Neutrophile Stages of Development

A

Promylelocytes stage-cells produce NONSPECIFIC granules

Myelocyte Stage: Specifi Granules are Produced

Metamyelocytes: spends 7-8 days ina strage pools before it matures

Neutrophils-Dont require previous exposure to an antigen-they just destroy it

29
Q

IgM & IgA

A

Directly responsible for antibodies against bacteria NOT passively transferred from placenta

-Secretory IgA is an early defense against local infections-present in Human Milk

30
Q

Erythrocyte Maturation

A

RBC’s undergo specific changes in composition during hematopoieses

Stem cell

*

Precursor Stages

*

Reticulocyte

*

Mature RBC

PRECURSOR STAGES: are mesoblastss and megaloblast

31
Q

Thymus and Lymph Nodes

A

4th month

Peaks at 6 months and continues

-primarily involved with the development of lymphocytes

(which is Lymphopoiesis)

Immature WBC’c Develop

32
Q

Monocytes

“Quite Important”

A
  • slightly inrease during the first 12 hours after birth, then decrease
  • transformed into macrophages in the tissues (lungs, alveol

2- THe ACTION of the monocyte-lears id blood cells, cellular debris opsinized bacteria, antigen, antibody coplexes and activating clotting factors

34
Q

DEVELOPMENT OF WBC’S AND PLATELETS

A

development of WBC & Platelets

-begins in the liver at 5-7 weeks

Spleen at 8 weeks

Thymus at 10 weeks

Lymph Nodes at 12 weeks

35
Q

capilarry vs venous

A

more marked with decrease GA and after large transplacental transfusion, infants with acidosis, hypotension and severe anemia

36
Q

NATURAL KILLER CELLS

A

cells lack immunologic specification

T-Lymphocytes but lack any characteristics of T or B Cells

kills cells of any origin or microbial strain or species

38
Q

Retic count = ## of immature RBC’s to the total RBC’s

A

a) expressed as a %
b) 28 wks 5-10%
c) 34 wks-3-10%
d) full term 3-7%
e) 1 week post term 0-1%

39
Q

Erythrocyte Indices

MCHC: Volume of Hgb in average RBC 31-36% of adult calues at 6 months

A

MCCHC

Mean corpuscular hgn CONCENTRATION

Concentration if hgb per sincel rbc calculated from the amount of hgb/100ml of cells

Increase and decrease same as MCH

39
Q

PLATELETS

A
  • small, non nucleated, dic-shaped cells
  • aid in homeostasis, coagulation and thrombus formation
  • derived from megakaryocytes in bone marrow

circulate 7-10 before removal

  • in the absence of injury, they circulate freely without adherence or aggregation with other platelets
  • normal value 100k-300k

15% pretemn levels > 150k first month

39
Q

Clotting pathways

A

intrinsic-activated by vascular tissue injury-damage to endothelium

-Extrinsic-activated by epithelial cell injuty and release of thromboplastin

Both converge on activation of Factor V-cleage of prothrombin and thrombin

=ll intrinsic factors are decreased in NB

-activity further decrease with GA

40
Q

HCT

Volume of RBC’s found in 1 dl of blood

A

a) expressed as a %
b) 51-56% ranges
c) Hct increases after first few hour

(Intravascular to interstitial space)

42
Q

When needed, there are bands

A

it takes a while for the bands to mature

so, in addition to mature neutrophils being released, we have immature neutrophils (bands) released

1st the mature, then the immature

43
Q

HGB

Influenced by GA and birthweight

A

a) higher in NB (16.6-17.5)
b) increases by 6 g/dl in first 24-48 hours
c) decreases by end of the first week
d) higher levels seen in infants with hypoxiam IUGR, Post-term (influenced by GA and birthweight)
e) lower levels found in preterm infants (15.9)

f) increase in reticulocytes or # of nucleated RBC’s suggest compensation and may indicate anemia ( check H&H, retics and HX…? hemolytic disease)

g) persistent reticulycytosis (increase in anount of retics) may indicate chroni blood loss or hemolysis
h) RBC=# mature RBC
i) nucleated RBC=# immature RBC’s present

43
Q

Homeostasis

A

Arrest from bleeding

3 processes

a) vasoconstriction
b) platelet aggregation
c) blood clotting

44
Q

B-Lymphocites

A

Humoral Immunity

Proliferation and maturation is iniatiated by specific antigen and helper T-Cells

=Stimulation then differentiation into plasma cells

=plasma cells produce immunoglobulins

_b-lymphocytes, plasma cells and antibodies are all a part of humoral immunity

Their FUNCTION is to synthesize speific immunoglobulins’

46
Q

Platelets

A

Initially formed in the yolk sac at 5-6 weeks

at 8 weeks in liver

and circulating Increases in number of platelets with GA

47
Q

Life Span of the RBC

A

Adult = 100-120 days

Full term = 60-70 days

preterm = 35-50 days

There is a differention due to a large size of the RBC in preterm infant and cylindrical shape make cells more prone to destruction by the spleen

49
Q

One of the most important defenses in neonatatal Function

A

NONSPECIFIC PHAGOCYTOSIS

51
Q

CBC and Differential

A

a) In wbc-Nucleated RBC couned as WBC;s

formula to correct wbc

Total WBCx100

ofNRBC +100

= Corrected WBC

52
Q

Ig1 and Ig3

A

do not respond to a specific Antgen

a) acts as opsonins
b) opsonization_coats antigen so it’s unrecognizable so that it can be taken care of by the neutrophils, PMS, monocytes and macrophages
- brings all of these bacteria fighting cells to the antigen
c) non-specific antigen fighter; enhances protection

53
Q

Granulocytes

Eosinophils

A

Eosinophils

a) same functions as neutrophils (phagocytosis)
b) present when there is an allergic or anaphylactic rection
c) benign eos of prematurity may be seen in ifnats who receive TPN Blood or with ETT intubation
d) 1-3% of total WBC

54
Q

cap and venous=poor circulation and vensous stasis

A

arterial vs venous=passage of plasma to interstitial space in capilarry bed

56
Q

Myeloid Period

A

Begins at 4 months

  • bone marrow that is now the main producer of bloodcells
  • maun area is the fatty area in the core of the long bones-
  • long bones in the fetus and NB are cartlinageous, so ther eis a small marrow volume

so, if there needs to be a production of RBC/s, then the liver and spleen can be reactiated to help produce RBC’s

-tht’s why there is overlapping of the mesoblastic, hepatic and myeloid periods of production; it’s a safety net

continues to increase the production of blood cells thru out life

57
Q

factors dependent upon Vit K for synthesis

A

4 factors II, VII, IX and X

Protein C-protease antocoagulant

Protein S-Cofactor for activation of Protein C

59
Q

Erythrocte indices

A

MCH- mean cell corpuscular HGB

  • Average amount or WEIGHT od single HGB/RBC
    a) paallels decrese in MCV
    b) increase MCH-Hyperchromic
    c) decrease MCH Hypochromic
61
Q

Mesoblastic period

A

14-19 days

peaks at 6 weeks

  • blood cells formed in blood islands in the secondary yolk sac
  • Primitive cells in the island form primitive blood vessels
  • blood forms in the yolk sac until the 3rd month of gestation
62
Q

LYMPHOCHTES

A

Thymus driven

T-Lymphocytes

a) envolved with hypersensitivity reaction-graft vs host and delayed hypersensitivity response

Bone Marrow Derived “B”

a) responsible for production and secretion of immunoglobulins and antibodies

63
Q

Hematologic system arises along with the CVS

CVS earliest system to fx

Blood cell production occurs in 3 phases

  • Phases Overlap
  • During each phase
  • there are alterations in the cell composition
    • Changes in the site of the production of cells
A

3 Stages

1-Mesoblastic Period

2-Hepatic Period

3-Myeloid Period

64
Q

Neutrophils are NOT specific

A

recognize invader organism as foreign

66
Q

HGF

A

-30 weeks-90-100%

30-32-% of HGF decreases and HGA increases

40 weeks: 50-75% HGF

6 monthd 5-8%

1 yr is 1%

67
Q

Platelet aggregation

A

damage to the endothelium of blood vessels causes platelets to adhere to each other

  • releases adp and A2 (causing adherence)
  • Continues until BV become blocked by a mass of aggregate platelets;

NN at a igher risk for bleeding due to platelet aggrefation to to a decrease in thrombaxanw A2

68
Q

Release of Neutrophils

A

Seem to be Controlled by colony stimulating factor and granulopoietin

GRANULOPOIETIN IS IMPORTANT FOR GRANULOCYTE PRODUCTION

70
Q

POLYCYTHEMIA AND HYPERVISCOSITY

A

polycythemia > 65% or Hgb >22

due to chronic hypoxia, fluid shifts and delayed cord clamping

response: increae EPO production (growth restriction and Increase hyperbilirubinemia)

71
Q

WBC’s include

A

GRANULOCYTES

(neutrophils, eosinophils, basophils)

LYMPHOCYTES

MONOCYTES

72
Q

Normoblast gain Hgb and become mature RBC’s

A

When the HGB concentration reaches 3

%, the nucleus of that cell is lost and the cell then becomes a reticuocyte (immature RBC)

1-2 days later, after the reticulocyte is produed, the retic becomes a mature RBC

73
Q

PROcess of RBC

A

Burst forming units come first (BFU-E)

Colony forming units (CFU-E)

Then (CFU-E) differentiate into microblast, gain

CFU-E=differentiates into normoblast, gain Hgb and become mature RBC’s

74
Q

antivoagulants

A

remove CA+ ions from solutions’inhibit synthesis of Vit K dependent factors

75
Q

T-Lymphocytes-

A

Make up cell mediated immunity

respond to specific antigens

major histocompatibility complex antigens-are responsible for recognistion of foreign antibodies

76
Q
A
77
Q

full term and pre term infants-have decrease clotting factors

A

facots V & VIII are higher than adult values but decrease in infants <31 weeks

the more preterm, the less/lower the clorrig ffactor

and a decrease in functiona ability of fibrinogen, so they have a decrease in the abiluty to form clots

78
Q

Granulocytes

Neutrophils

A

Most abundant

60% total WBC

a) main job is phagocytoses
b) production is increased with stress
c) increases at burth, then decreases
d) 1st phagocytic cells ro reach the infected area
e) stages of development

Myeloblast

Promyelocyte

Myelocyte

metamyelocyte

Band

PMN

79
Q

Lymphocytes

A

Lymphocytes

Initial produced from the liver and lumph tissue

  • from the thymus at 7-10 weeks
  • spleen and bone marrow at 10 weeks
80
Q

CBC

A

2/3 infectious have a NL CBC

diagnostic CLUE

WBC 1st cell to reach the site of infection

need a diff

low counts are more common than high ones

Left shift as reference to predominance of immature forms (myelos, meta, bands)

82
Q

Remember that the liver is still producing RBC and if the fetus needs more RBC’s, then the liver can produce and the spleen will kick in causing

HEPATOSPLENOMEGALY

because it’s working overtime to produce blood in there is maternal fetal incomatabilities

A

Erythroblastosis Fetalis

causes hepatosplenomegaly

83
Q

Bone Marrow is the major site for blood production AFTER 6 months of age

A

Will produce granulocutes and megakaryocytes

occurs in the long bones; liver and spleen can kik in to help

85
Q

Immunoglobulins

5 types

Synthesized in response for specific antigens

A

IgG

IgM

IgA

IgD

IgE

86
Q

Fibrinolysis activity

A

Increases at birth

decreases to adult values by 4-6 hours of age

can be severely depressed in the preterm infants with RDS and asphyxia

87
Q

physiological anemai

in both FT and PT

A

normal decrease in HGB first 2-4 months

-due to supression of hematopoiesis wich is controlled by erythropoitin

cause-supression of hemapoietin and RBC production decrease

balanced by a gradual shift to the right in OxyHgb curve due to increaeing amounts of 2,3 DPG

reestablished when tissue needs more o2

88
Q

GRANULOCYTES

BASOPHILS

A

1 Basophils-important in inflammatory response

a) least numerous
b) .1-1% of total WBC’s
c) fuction is Chemotaxis, phagocytoses

released by histamine producing cells

participates in delayed hypersensitivity reactions

89
Q

In infants, there is a PROLONGED

A

PT

TT

PTT

90
Q

Neutrohils:

in circulation replaced 25 times every 24 hours

Do not return tot he bone marrow

randonly enter the tissues and will engulf and kill backeria where needed

Margical pool-from the marginal pool, neutrophils will eter tissues and the body to carry out their function

A
91
Q

in NN, whole blood clotting times are = or shorter than adult values DESPITE prolonged PT, PTT and TT

A

REASON:

overbalance or tendency of thrombus formation despite normal clotting times

DETERMINE Ca+ LEVELS; CA+ IS AN INSITE INTO WHETHER THERE IS A CLOTTING PROBLEM

The Developing Human (2 decks)

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