Structural and Functional Organization of Blood Flashcards
1
Q
What is a liquid connective tissue that consists of cells surrounded by an extracellular matrix?
A
Blood
2
Q
What are the three general functions of blood?
A
- Transportation
- Regulation
- Protection
3
Q
Blood transports what from the lungs to cells throughout the body?
A
oxygen
4
Q
What waste product does blood carry away from the cells of the body?
A
carbon dioxide
5
Q
What are some additional functions of blood?
A
- Carries nutrients from the GI tract to the body cells
- Carries heat and waste products away from the cells
- Carries hormones from endocrine glands to other body cells
6
Q
True or False
Blood helps regulate the pH of body fluids
A
True
7
Q
True or False
Blood helps regulate body temperature
A
True
The heat-absorbing and coolant properties of the water in blood plasma and its variable rate of flow through the skin help adjust body temperature
8
Q
Blood clots in response to what?
A
Injury
protects the body from excessive loss from the cardiovascular system
9
Q
What protects against disease by carrying on phagocytosis and producing proteins called antibodies?
A
White blood cells
10
Q
What additional proteins does blood contain?
A
- interferons
2. complement
11
Q
What is the relative temperature of blood?
A
38 C (100.4 F)
12
Q
What is the blood’s pH level?
A
slightly alkaline ranging from 7.35 - 7.45
13
Q
Blood constitutes what percent of the bodies total weight?
A
8%
14
Q
What is the blood volume for an average-sized adult male and female?
A
Male: 5 - 6 liters (1.5 gal)
Female: 4 - 5 liters (1.2 gal)
15
Q
What two portions is whole blood composed of?
A
- Blood plasma
2. Formed elements
16
Q
What is a liquid extra cellular matrix that contains dissolved substances
A
blood plasma
17
Q
What are formed elements?
A
cells and cell fragments
18
Q
What percent of the blood is made of formed elements?
A
45%
19
Q
Pale, colorless white blood cells (WBCs) and platelets occupy less than what percent of total blood volume?
A
1%
20
Q
What is the remaining 55% of the blood volume?
A
Plasma (liquid portion of the blood)
21
Q
What is the hematocrit?
A
the percentage of total blood volume occupied by red blood cells
22
Q
What is the normal hematocrit range for males and females?
A
Males: 42% - 52%
Females: 37% - 47 %
23
Q
- made up of the WBCs and platelets which are less than 1% of the total blood volume
- a very thin layer that lies between the packed RBCs and blood plasma in centrifuged blood
A
What is the buffy coat?
24
Q
What is the breakdown of blood plasma?
A
- 91.5% water
- 7% proteins
- 1.5% solutes other than proteins
25
Proteins in the blood are mainly synthesized where?
the liver
26
What is the most plentiful plasma protein?
Albumin
account for about 54% of all plasma proteins
27
What contains the oxygen-carrying protein hemoglobin?
1. Red blood cells (RBCs)/Erythrocytes
28
What is the pigment that gives blood its red color?
Hemoglobin
29
True or False
Hemoglobin transports about 23% of the carbon dioxide in the blood
True
30
How many RBCs does a healthy adult male and female have?
male: 5.4 million RBC/uL of blood
female: 4.8 million RBC/uL of blood
31
What is the lifespan of red blood cells?
about 120 days
32
How many white blood cells are usually in the body?
5000-10,000/uL
33
What is the purpose of white blood cells?
Combat pathogens and other foreign substances that enter the body
34
What is the difference between red blood cells and white blood cells (leukocytes)?
1. have nuclei and a full complement of other organelles
| 2. do not contain hemoglobin
35
What are the classification of WBCs?
1. Granular
2. Agranular
depends on whether or not they contain chemical-filled cytoplasmic granule (vesicle) that are made visible by staining when viewed through a light microscope
36
Are these granular or agranular leukocytes?
1. Neutrophils
2. Eosinophils
3. Basophils
Granular
37
What cell is this?
1. 50-70% of all WBCs
2. Nucleus has 2-5 lobes, cytoplasm has very fine lilac granules
3. Phagocytosis - destroy bacteria with lysozymes, defensins and strong oxidants
Neutrophils
38
What cell is this?
1. 1-5% of all WBCs
2. Nucleus usually has 2 lobes, cytoplasm full of large, red-orange granules
3. suppresses effects of histamine in allergic reactions, phagocytizes antigen-antibody complexes and destroys certain parasitic worms
Eosinophils
39
What cell is this?
1. 0-1% of all WBCs
2. Nucleus has two lobes, has large cytoplasmic granules that appear deep blue-purple
3. releases heparin, histamine and serotonin that intensifies the inflammatory response in allergic reactions
Basophils
40
Are these granular or agranular leukocytes?
1. lymphocytes
2. monocytes
3. platelets
agranular
41
What cell is this?
1. T cells, B cells and Natural Killer cells
2. 20-40% of all WBCs
3. Nucleus is round or slightly indented. The cytoplasm forms a thin rim around the nucleus that appears sky blue.
4. Mediates immune responses, including antigen antibody reactions. B cells will transform into plasma cells that secrete antibodies. T cells attack invading viruses, cancer cells and transplanted tissue cells. While Natural killer cells attack a wide variety of microbes and certain spontaneously arising tumor cells.
Lymphocytes
42
What cell is this?
1. 1-6% of all WBCs
2. nucleus is kidney shaped or horseshoe shaped, cytoplasm is blue-gray and has a foamy appearance
3. phagocytic (will transform into a fixed histiocyte or a wandering macrophage)
Monocytes
43
What cell is this?
1. 150,000-450,000/uL
2. Cell fragments that live for 5-9 days, they contain many vesicles but no nucleus.
3. Form platelet plug during hemostasis, release chemicals that promote vascular spasm and blood clotting.
Platelets
44
What is the process by which the formed elements of blood develop?
Hemopoiesis (also called hematopoiesis)
45
What is the primary site of hemopoiesis (blood cell production)?
red bone marrow
46
What has the capacity to develop into different cell types?
Pluripotent stem cells
47
With stimulation by specific hormones, Pluripotent stem cells will further develop into what two cell lines?
1. Myeloid
| 2. Lymphoid
48
Myeloid cells come in several specific types of cells which mature in the bone marrow. What are they?
1. red cells
2. platelets
3. eosinophils
4. mast cells
5. basophils
6. neutrophils
7. monocytes
49
Lymphoid stem cells begin development in bone marrow but mature where?
lymphatic tissues
50
Lymphoid stem cell types:
1. T cells
2. B cells
3. Natural Killer cells
51
Immature cells in peripheral blood
Bands
1. Immature neutrophils.
2. Nucleus has horseshoe shape and has not developed enough to be a segmented neutrophil
3. more the 10% suggests long-term infection, body sending out immature neutrophils to fight infection
52
Immature cells in peripheral blood
Blast
1. associated with myelodyplastic disorders
2. cytopenias with hyper-cellular bone marrow
3. morphologic abnormalities in one or more hematopoietic cell lines
53
What is HEMOSTASIS ?
1. sequence of response that stops bleeding when blood vessels are injured
2. hemostatic response must be quick, localized to the region of damage, and carefully controlled
54
What are the three mechanisms that can reduce loss of blood from blood vessels?
1. vascular spasm
2. platelet plug formation
3. blood clotting (coagulation)
55
What is the loss of a large amount of blood from the vessels?
Hemorrhage
56
True or False
When successful, hemostasis prevents hemorrhage, but extensive hemorrhage from larger vessels usually require medical intervention
True
57
Blood loss mechanisms
1. when a blood vessel is damaged, smooth muscle in its wall contracts immediately
2. reduces blood loss for several minutes to several hours, during which time the other hemostatic mechanisms begin to operate
Vascular Spasms
58
Blood loss mechanisms
When platelets come into contact with damaged parts of blood vessels, their characteristics change and they come together to form a plug that helps fill the gap in the injured blood vessel wall
Platelet plug formation
59
Blood loss mechanisms
1. series of chemical reaction that culminates in the formation of fibrin threads
2. complex process in which various chemicals known as clotting factors activate each other
Blood clotting (coagulation)
60
What is serum?
straw-colored liquid, plasma minus the clotting proteins
61
What does a clot consist of?
a network of insoluble protein fibers called fibrin in which the formed elements of blood are trapped
62
What happens when blood clots to easily?
a thrombosis can form, clotting in an unbroken vessel
63
What happens when blood takes to long to clot?
hemorrhage
64
Clotting (coagulation) factors include:
1. calcium ions (Ca2+)
2. several enzymes that are made by liver cells and released into the blood
3. various molecules associated with platelets or released by damaged tissues
65
Clotting occurs in how many stages?
three stages
66
Clotting Stages
Step 1
Prothrombinase is formed
67
Clotting Stages
Step 2
Prothrombinase converts prothrombin (a plasma protein formed in the liver with the help of vitamin K) into the enzyme thrombin
68
Clotting Stages
Step 3
Thrombin converts soluble fibrinogen (another plasma protein made by the liver) into insoluble fibrin.
a. Fibrin forms the threads of the clot (lattice structure like a net).
b. Cigarette smoke contains substances that interfere with this step.
69
What happens once the clot is formed?
Plugs the ruptured area of the blood vessel and stops blood loss
70
What is consolidation or tightening of the fibrin clot?
Clot retraction
The fibrin threads attached to the damaged surfaces of the blood vessel gradually contract as platelets pull on them.
71
True or False
As the clot retracts, it pulls the edges of the damaged vessel closer together,
decreasing the risk of further damage
True
72
What forms connective tissue in the ruptured area of a blood vessel and what begins to repair the vessel lining?
1. fibroblasts
| 2. endothelial cells
73
When does fibrinolysis occur?
at the same time as coagulation
74
What is fibrinolysis?
Inactive plasminogen being activated into plasmin. Once activated, plasmin begins to digest and dissolve fibrin threads, removing the clot.
75
What is clotting in an unbroken vessel called?
thrombosis
a. the clot itself if called a thrombus (may dissolve spontaneously)
76
What is a blood clot, bubble of air, fat from broken bones, or a piece of debris transported by the bloodstream?
Embolus
77
Where is the most common site for an embolus to become lodged?
the lungs
| pulmonary embolism
78
The surface of red blood cells contain a genetically determined assortment of antigens called what?
Agglutinogens
79
What are Agglutinogens composed of?
glycolipids and glycoproteins
80
Blood is characterized into different blood groups based on what?
the presence or absence of various antigens
81
How many blood groups and how many antigens can be detected on the surface of red blood cells?
1. 24 blood groups
| 2. 100 antigens
82
Two major blood groups
ABO and Rh
83
ABO Blood Group is based on what two antigens?
A and B
84
ABO Blood Group
A Blood
RBCs display only antigen A
85
ABO Blood Group
B Blood
RBCs only display antigen B
86
ABO Blood Group
AB Blood
RBCs display both A and B antigens
87
ABO Blood Group
O Blood
RBCs display neither antigen A or B
88
In what percentage of the population can soluble antigens of the ABO type appear in saliva and other body fluids?
80%
89
Blood plasma usually contains what that reacts with the A and B antigens if the two are mixed?
Antibodies and Antigens
90
Anti-A antibody reacts with what antigen?
Antigen A
91
Anti-B antibody reacts with what antigen?
Antigen B
92
True or False
You have antibodies that react to your own antigens
False
You DO NOT have antibodies that react with your own antigens, but you do have antibodies for any antigens your RBCs lack
93
If you have type A blood, what kind of antigens would you have on the surface of your RBCs, and could you receive type B blood?
1. A antigens
| 2. No, you would have anti-B antibodies in your blood plasma
94
People whos RBCs have the Rh antigen are designated what? What about those who lack the Rh antigen?
1. Rh + (positive)
| 2. Rh - (negative)
95
Under normal circumstances does plasma contain anti-Rh antibodies?
No
96
What happens when an Rh- person receives a Rh+ blood transfusion?
the immune system starts to make anti-Rh antibodies that remain in the blood
97
What are blood transfusions used for?
Raise hemoglobin levels in patients with anemia or to replace loses after episodes of acute bleeding
98
What are the different types of blood transfusions?
1. Fresh whole blood
2. Packed RBCs
3. Leukocyte poor blood
4. Autologous Packed RBCs
5. Frozen RBCs
99
Blood transfusions
Fresh whole blood
1. advantage of whole blood transfusion is the simultaneous presence of RBCs, plasma, and fresh platelets
2. 1 to 1 to 1 ratio
3. retains all clotting factors
100
Fresh whole blood donors
must be ABO type and Rh specific unless low titer O unit donors have been previously drawn or identified
101
How much of the crew must be identified for a walking blood bank?
10 percent of the entire crew
102
Blood transfusions
Packed RBCs
1. most commonly used to raise hemoglobin
2. Each unit is 300ml, 200ml consist of RBCs
3. one unit will raise hemoglobin 1 g/dL
103
For critically ill patients, what are the current guidelines for administering packed RBCs?
begin administration once hemoglobin falls below 7-8g/dL
104
What is the ratio of transfusion for packed RBCs?
for every unit of packed RBCs given you should give a unit of FFP and unit of platelets for a 1 to 1 to 1 ratio.
105
Blood transfusions
Leukocyte poor blood
1. most products today are leukocyte poor
2. Leuko reduced blood reduce incidence of leukoagglutination reactions,
platelet alloimmunization, transfusion related acute lung injury and CMV exposure.
106
Blood transfusions
Autologous Packed RBCs
Patients scheduled for elective surgery may donate their own blood to
transfuse if it becomes necessary.
107
How long can Autologous Packed RBC units be stored?
Units can be stored in refrigerator up to 35 days or longer depending on anticoagulant used. After that unit should be frozen.
108
Blood transfusions
Frozen RBCs
Current DoD guidelines allow units to be glycerolized and frozen for up to 10 years. Casualty receiving ships and the larger amphibious ships maintain frozen storage of O units while they deploy
109
One ACP215 instrument can deglycerolize how many units in an hour?
1. one
| 2. After deglycing a unit the blood is ready for transfusion or can be stored in refrigerator for an additional 14 days.
110
What must be done before transfusion to avoid hemolytic transfusion reactions?
compatibility testing
111
What are the only factors tested prior to transfusion?
ABO and Rh
112
About what percent of the population lack the D antigen?
15%
113
What would the reaction be if you introduced the D antigen to someone who is D negative or Rh negative?
Antibodies will form and the next transfusion containing the antigen can cause a severe hemolytic reaction due to lysis of the cells
114
What are the most severe hemolytic transfusion reactions?
acute, involving incompatible mismatches in the ABO system
115
What is the most common cause of hemolytic transfusion reactions?
clerical errors and mislabeled specimens
116
Where are the most severe reactions seen with hemolytic transfusion reactions?
surgical patients under anesthesia
117
Sign and symptoms of a hemolytic transfusion reaction
1. Fever and chills with backache and headache.
2. Sense of impending doom, dyspnea, hypotension, and cardiovascular collapse
*3. Pts under anesthesia will not manifest these symptoms and the first
indication may be tachycardia, generalized bleeding or oliguria.
118
Death occurs in what percent of patients due to ABO incompatibility with hemolytic transfusion reactions?
4%
119
Lab findings for hemolytic transfusion reactions
1. RECHECK EVERYTHING
2. Coagulation panels to see evidence of acute kidney injury or acute DIC.
3. Hgb will be elevated resulting in hemoglobinuria.
120
Treatment for hemolytic transfusion reaction
1. stop transfusion immediately
2. Vigorously hydrate patient to prevent acute tubular necrosis
3. Forced diuresis with mannitol may help prevent or minimize acute kidney injury
121
Leukoagglutinin reactions
Most transfusion reactions are not hemolytic but represent reactions to antigens present on transfused passenger leukocytes in patients who have been sensitized to leukocytes antigens through previous transfusions or pregnancy.
122
Leukoagglutinin reaction symptoms
1. Fever and Chills within 12 hours after transfusion
| 2. Cough and dyspnea in severe cases
123
Leukoagglutinin reaction lab findings
1. Chest radiograph may show transient pulmonary infiltrates.
2. Hemoglobin rises by expected amount despite reaction because there is no hemolysis
124
Leukoagglutinin reaction treatment
1. Acetaminophen 500-600mg orally
2. Diphenhydramine 25mg orally or IV
3. Hydrocortisone 1mg/kg IV
125
Hypersensitivity Reactions
These reactions are almost always due to exposure to allogeneic plasma proteins rather than to leukocytes
126
Hypersensitivity Reaction symptoms
Urticaria or bronchospasms may develop during or soon after transfusion
127
Hypersensitivity Reactions lab findings and treatment
1. Hypersensitivity reaction including anaphylactic shock may develop in patients who are IgA deficient because antibodies to IgA in the patient serum will react against the IgA in the transfused blood product.
2. washed or frozen rbc’s to avoid future severe reactions
128
What happens when a patient is given a transfusion of gram positive bacteria contaminated blood products?
fever and bacteremia but rarely causes sepsis syndrome
129
What happens when a patient is given a transfusion of gram negative bacteria contaminated blood products?
will often cause septic shock, acute DIC and acute kidney injury due to endotoxins and this is usually fatal
130
Allogeneic passenger lymphocytes in transfused blood will engraft in some recipients and mount an allo-immune attack against tissues expressing discrepant HLA antigens
Graft versus host disease
131
Graft versus Host Disease symptoms
1. Fever, rash, diarrhea, hepatitis, lymphadenopathy, and severe pancytopenia
2. Usually fatal
132
Occurs mostly in patients with immune defects, malignant lymphoproliferative disorders, solid tumors treated with chemotherapy or immunotherapy, treatment with immunosuppressive drugs or older patients undergoing cardiac surgery.
Graft versus Host Disease findings
133
What kind of blood products should be given to patients that are at high risk for transfusion associated Graft versus Host disease?
Irradiated blood products
134
About how many RBC and platelet donations are contaminated?
1. RBC 1-30,000
| 2. Platelet 1-5,000
135
Transfusion Related Acute Lung Injury (TRALI)
non-cardiogenic pulmonary edema after blood product transfusion without other explanation.
136
How often does Transfusion Related Acute Lung Injury (TRALI) occur?
Occurs in 1 out of every 5,000 transfusions.
137
Who is most susceptible to Transfusion Related Acute Lung Injury (TRALI)?
Surgical and critically ill patients
138
Transfusion Related Acute Lung Injury (TRALI) treatment
supportive care
139
What reduces the risk for TRALI ?
use of male only plasma donors when possible because only 1-5% of male donors have antileukocyte antibodies in their serum
