S8- blood Flashcards
Blood contains…
the volume in body is…
RBC, WBC, plasma, platemets
5L
Arteries:
arterioles, venules, cappillaries
veins
oxygen rich and bring blood from heart to organs and tissues
small vessels and diameter and maximise blood-tissue interaction
oxygen poor and return blood from organs to heart and then to lungs to re-oxygenate
5 functions of blood
- hydration
- delivery of nutrients and oxygen and distribution of endocrine hormones
- regulation of body temperature and pH
- fight infection: immune response
- prevent blood loss
the most abundant blood cell is…they contain…
arythrocyte (RBC)
haemoglobin which regulates oxygen transport
4 examples of endocrine hormones (secreted by specific endocrine glands into blood)
- insulin- beta cells in pancreas
- Oestrogen/ progesterone/ testosterone- ovary/testes
- vasopressin (hormone that maintains osmolality/ conc of dissolved particles)- posterior pituitary lobe
- adrenalin- adrenal medulla
blood maintains body temperature through…
Endorsing and distributing heat through vasodilation and constriction
blood maintains pH through
proteins and solutes within plasma that act as buffers to prevent changes in pH
blood maintains fluid volume through
ions and proteins that act to prevent fluid loss into the interstital spaces
WBC contribute to…
in the blood plasma, the…system is activated to fight infection
immune response against infection (all WBC) and allergic reaction (eosinophils and basophils)
complement system (plasma proteins react together to trget pathogens and induce a series of inflammatory responses)
5 types of WBC are:
lymphocytes
Monocytes
eosinophil
Basophil
neutrophil
platelets are…
in blood coagulation pathway, a…clot is formed through the formation of…
small anucleate blood cells that clump together
fibrin
thrombin (enzyme that maintains blood clotting)
all blood cells are derived from…in the…
Called:…
one common progenitor
bone marrow
the multipotential haematopoietic stem cell
2 major lineages are:
and they produce…different types of blood cells
myeloid and lymphoid
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tools that help in diagnosis of haemotological disorders
Blood films and peripheral smears
3 most abundant blood plasma proteins
- albumin (35-50 g/L)- filler
- immunoglobulins (25 g/L)- fighting infection
- fibrinogens (3-5 g/L)- involved in clotting
hematocrit is….
percentage of RBC in blood
serum is…
plasma is…
they are used for the measurements of…
Serum= plasma - clotting factors
plasma= serum + clotting factors
clinical markers
blood groups are a classifications based on…
the 2 systems that are the most significant ans clinically relevant are…
mixing of incomaptible blood leads to…
antigens
ABO and Rh
endogeneous antibodies to react with antigens of RBC membranes
antigens=
antibodies=
agglutinogens
agglutinins
Blood group A has…antigens on RBC and…antobodies in plasma
Blood group B has…antigens on RBC and…antobodies in plasma
A antigens and anti-B antibodies
B antigens and anti-A antibodies
Group O is a….
Group AB is a…
universal donor (no antigens on RBC)
universal recipient (no antibodies in blood)
when agglutinins bind to agglutinogens on foreign RBC, it causes….which is the…
agglutinated RBC block…
agglutination
aggregation and lysis of incompatible RBCs
small vessels
heamolysis is….and it occurs due to…
it can lead to…
Break down of RBC
incompatibility of blood type
Hypotension, kidney failure, DIC (Disseminated intravascular coagulation- leads to bleeding- overactive clotting blocks vessels)
Rhesus (Rh) blood groups are based on an…
Rh+ is….while Rh- is…
ion-channel antogen on the RBC membrane
Common
rare
(Rh- is more common in west than in asia or Africa)
Rh+ contains…antigens while Rh- doesnt contain them
in Rh-, antibodies against… are produced after…
Rh antigens
antibodies against Rh+ RBCs
Rh+ is exposed to Rh- blood
haemolytic syndrome in foetus/ newborn is most common in…mothers and…babies
first pregnancy is safe because of the…and so the mother is not exposed to the…
Rh- mother (doesnt have antigen) and Rh+ baby (has antigen on RBC)
placenta-blood barrier
Rh agglutinogens until the time of childbirth due to placenta tearing (abortion/ miscarriage/ trauma)
generation of anti-Rh antibodies in mother means there will be an…in the second pregnancy
The antibodies will cross the placenta and…the RBC of the baby- born with…
treatment ussed:…
immune reaction
destroy
severe anemia (due to lack of RBC)
Anti-Rh gamma (symbol) globulin to mask the Rh agglutinogens (destroy or hide antigens from mothers immune system)
hemostasis is the process that…
maintains flowing blood in a flowing state and confined to the circulatory system
hemorrhage is the process of…
Bleeding
thrombosis is the process of…
Clotting
fibrinolysis is the process of…
clot dissolution
the stages of heamostatic response:
- vascular spasm
- platelet plug formation
- Coagulation cascade
- fibrinolysis
vascular spasm is…
*vasoconstriction= limits blood
smooth muscle contracts and causes the narrowing of vessel to reduce blood flow (vasal restriction)
primary heamostasis is when…
platelet activation and degranulation occur
collagen and…are secreted by injured endothelium
platelets will bind to…this will recruit more…and form…
Von Willebrand factor
receptors on VWF
platelets
Plug
2 types of granules in platelets are:
thromboxame A2 is synthasised by activated platelets and stimulates activation of more platelets
- dense= produce ATP, ADP, serotonin and Ca2+ (help platelet activation/ +ve feedback)
- alpha= fc4/ heparin antagonist, plasminogen activator inhibitor PAL-1, platelet derived growth factor, chemokine (help coagulation and wound healing)
steps in reaction to vascular trauma:
- vasoconstriction= reduction of blood flow to area
- platelet activation and adhesion to collagena nd von willebrand factor
- platelet shape changes
- granule release (increased local conc of platelet activators, coagulation factors, vasoconstrictors)= all act to amplify haemostatic response
- primary plug formed and initial blood loss stopped
primary response vs secondary response
- platelet, endothelial, fibrinogen (defects= immediate bleeding)
- Circulating enzymes, platelets, fibrin (defects= delayed bleeding)
the coagulation cascade mostly uses…
proteins made by liver to activate fibrinogens into fibrin (which holds the platelet plug in place)
3 parts of the coagulation cascade are:
- intrinsic= triggered by negatively charged surfaces such as glass/silia, polyphosphate released by platelets, misfolded proteins
- extrinsic= triggered by tissue factor
- Common
intrinsic pathway includes:
Fc XII (activated by platelets prekallikrein= kallikrein) -> FcXII a ->FcXI = FcXI a ->FcIX = FcIX a
fcIX a+ fcVIII+ Ca2+ +PL-> activates fcX
(Fc 12 to fc 11 to fc9 +fc8 to fc10)
extrinsic pathway includes:
tissue damage produces tissue factor (fc III)
fcVII from blood binds to it
Activates fcVII -> fcVII a -> fcX
fc3 to fc7 to fc10
common pathway includes:
Fc Xa (+ fc V +PL +Ca2+)-> activate prothrombin to thrombin (fcII)
thrombin activates:
1. Fibrinogen (soluble in blood plasma) to fibrin (insoluble)
2. fcXIII ->fcXIII a
FcXIIIa cause fibrin to cross-link= make stable fibrins +increase its resistance to fibrinolysis (create fibrin nesh that hold plug in place)
tissue factor is…and the master regulator that triggers…
it is expressed on cell membrane of…cells
transmembrane receptor protein
coagulation
perivascular cells (cells surrounding blood vessels ie: on smooth muscle cells and fibroblasts)
deficiency in fcIX=
Deficiency in fcVIII=
deficiency in fcXIII leads to…
deficiency in fcV leads to…
deficiency in vWF leads to…
deficiency in fcXI leads to…
deficiency of fcXII leads to…
9= heamophelia B
8= heamophelia A
13= severe spontaneous bleeding, miscarriage and poor wound-healing
5= severe spontaneous bleeding
moderate to severe bleeding
11= Mild bleeding
12= no bleeding
the complexes TF+fc7, fc9+fc8, fc10+fc5 are all…dependant
for exaample it is needed for carboxylation of 8, 9 and 10 to allow…to bind and formation of…complexes on the activated…membrane
vitamin K
Ca2+
enzyme
platelet
bleeding is caused by dysfunctional…and…
thrombosis is caused by overactive…and…
platelets and coagulation
platelets= arteries
coagulation= venous
4 examples of arterial thrombosis:
- Myocardial infraction (MI, heart)
- Atrial fibrillation (AF, heart)
- peripheral vascular disease (PVS, leg)
- stroke (brain)
2 examples of venous thrombosis:
- deep vein thrombosis (DVT, arm/leg)
- pulmonary embolism (PE, lungs)
atherosclerotic plaque rupture is a…
this leads to local…of cardiac tissue
Inflammatory disorder with deposition of lipids, oxidative stress= with time plaques rupture and induce thrombotic events
necrosis (death)
(Atherosclerosis thickening or hardening of the arteries)
example of venous thrombosis disease:
deep vein thrombosis (DVT)
- blood clot in deep vein (low blood flow)- often in legs (above knee or below it) or arms
- fibrin and erythrocyte rich
- driven by excess thrombin in areas around valves
in DVT, part of blood clot can..and travel around body and block smaller vessels such as…
break free (called embolism)
pulmonary embolism (PE)= most dangerous pathology associated with DVT
symptoms of DVT:
- calf swelling
- pain
- lack of venous return
- associated odema (fluid out of blood)
3 catogeries of causes of thrombosis:
- vessel wall injury
- Stasis
- hyperciagulability
risk factors for thrombosis:
immobilization
Surgery
Cancer
pregnancy
oral contraceptives
Genetics (deficiencies in coagulation inhibitors/ V leiden factor mutation)
wells score for DVT shows:
Score >2= DVT is likely
Score <2= DVT is unlikely
bleeding disorders can be:
- acquired= trauma, surgery, infection, other diseases. Sepsis, aneurysm rupture
- inherited= caused by congenital disorder
loss of lots of blood causes…
consequences are:
systemic hypotension (low blood pressure)
- reduced cardiac filling
- reduced tissue perfusion
- loss of RBC and oxygn carrying capacities= hypoxemia (low oxygen levels)
- circulatory shock
example of an acquired bleeding disorder:
the two steps are:
Disseminated intravascular coagulation (DIC)
1. too much clotting= uses up platelets and factors by forming small clots all around body (progressive)= hemostasis out of control
2, too little clotting= bleeds with slightest injury
DIC is caused by…
Infection -> systemic sepsis -> uncontrolled TF exposed (cause clotting)
DIC originates in the…leading to…
coagulation cascade is activated…
factors are consumed at a rate faster than…
platelets are consumed at a rate faster than…
microvasculature
organ dysfunction
Inappropriately
the liver can synthesise them
the bone marrow megakayocytes cam synthesise them
3 examples of inherited bleeding disorders:
- Platelet dysfunction
- coagulation factor deficiency of haemophilia (severe)
- thrombovytopenia (mild)
platelet dysfunction can be due to: (3 reasons)
- defects in platelet-vessel wall interaction- von willebrand syndrome (most common bleeding disorder= platelets do not stick to site of injury) or Bernard-soulier syndrome
- defects in platelet-platelet interaction (glanzmann thrombasthenia/ congenital afibrinogenemia)
- defects in platelet granules, secretion and signal transduction (Wiskott-Aldrich syndrome)
haemophilia has 2 types:
it is…recessive disorder
Around…% of haemophilia are new mutations
the major problem is…
A= fc8
B= fc9
X-linked= expressed in males and females are carriers
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insufficient thrombin generation
symptoms of haemophilia:
- bruising
- hemarthrosis (joint bleeding and destruction)
ways to treat haemophilia:
blood transfusions can give blood-born pathogens and development of autoimmune diseases
clotting time (APPT and TT) restored by mixing with normal plasma
replacement of fc8 to achieve haemostasis
3 pathways to investigate bleeding disorders:
APTT= activated partieal thromboplastin time (intrinsic)
PT= prothrombin time (extrinsic)
TT= thrombin time (common)
for missing factor, the clotting time will be…
bleeding time is corrected by…
possible deficient factors are added to idnetify which…
if no correlation after mixing with normal plasma= implies…
Prolonged
mixing with healthy plasma
normalise the clotting time
inhibitors
in full blood count test results:
- haemoglobin=
- HCT=
- MCV=
- PLATELET COUNT=
- WHITE CELL COUNT=
- NEUTROPHILS=
- LYMPHOCYTES=
