Structural and Functional Organization of Blood Flashcards

1
Q

What kind of tissue is blood, and what are its functions?

A

Liquid connective tissue surrounded by extracellular matrix.

Transportation, regulation, and protection.

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2
Q

Describe “Transportation”

A

Blood transports O2 from the lungs to cells in the body, and CO2 from cells in the body to the lungs.

It also carries waste from the GI tract to body cells, heat and waste products away from cells, and hormones from endocrine glands to other body cells.

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3
Q

Describe “Regulation”

A

Blood helps regulate the pH of body fluids.

  • Water in plasma has heat absorbing, coolant properties, and can variate its flow rate through the skin to help adjust pressure.
  • Blood osmotic pressure also influences the water content of cells.
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4
Q

Describe “Protection”

A

Blood clots in response to an injury which protects against excessive blood loss.

WBCs protect against disease via phagocytosis and producing proteins called antibodies.

Blood contains additional proteins, called interferons and complement, which also help protect against disease.

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5
Q

What is the temperature and pH of blood?

A

38C/100.4F

Slightly alkaline, ranges from 7.35-7.45.

It constitutes 8% of the total body weight, and is denser and more viscous than water.

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6
Q

What is the average blood volume for males and females?

A

Males: 5-6L

Females: 4-5L

The difference is due to body size.

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7
Q

What two portions is whole blood composed of, and what are their percentages?

A

55% blood plasma, a liquid extracellular matrix that contains dissolved substances.

45% formed elements, which are cells and cell fragments.

  • More than 99% of the formed elements are RBCs.
  • The remaining 1% consists of WBCs and platelets.
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8
Q

What is hematocrit?

A

The percentage of RBCs within total blood volume.

It is expressed as a percentage.

Males: 42%-52%.
Females: 37%-47%.

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9
Q

What is the Buffy Coat?

A

It is made up of WBCs and platelets (the <1% of total blood volume).

It is a very thin layer that lies between packed RBCs and blood plasma in centrifuged blood.

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10
Q

What is blood plasma composed of?

A

91.5% water, 7% proteins, 1.5% solutes.

Proteins in the blood are synthesized by the liver.

The most plentiful plasma proteins are albumins, which account for 54% of all plasma proteins.

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11
Q

What are RBCs composed of?

A

RBCs (aka erythrocytes) contain hemoglobin, which is an O2 carrying protein.

Hgb is a pigment that makes blood red.

It also transports 23% of the CO2 in blood.

A healthy adult male has 5.4 million RBC/uL of blood, and a female has 4.8 million.

RBCs only live for 120 days.

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12
Q

How are WBCs different compared to RBCs, and what do they do?

A

WBCs (leukocytes) have a nuclei and a full complement of other organelles. They do not have Hgb.

The average content is 5,000-10,000/uL and are classified as either granular or agranular, depending on whether they contain cytoplasmic granules.

They live for a few hours to a few days.

They combat pathogens and other foreign substances in the body.

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13
Q

What are the granular and agranular WBCs?

A

Granular:

  • Neutrophils
  • Eosinophils
  • Basophils

Agranular:

  • Lymphocytes
  • Monocytes
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14
Q

Neutrophils

A

50-70% of all WBCs - they are the most abundant.

They destroy bacteria with lysozyme, defensins, and strong oxidants.

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15
Q

Eosinophils

A

1-5% of WBCs.

They suppress the effects of histamine in allergic reactions and can destroy parasitic worms.

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16
Q

Basophils

A

0-1% of WBCs.

They release heparin, histamine and serotonin which intensifies inflammatory response in allergic reactions.

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17
Q

Lymphocytes

A

T cells, B cells and Natural Killer Cells, constitutes 20-40% of WBCs.

They mediate immune response, including antigen antibody reaction.

  • B cells transform into plasma cells that secrete antibodies.
  • T cells attack viruses, cancer cells and transplanted tissue cells.
  • NKC attack a wide variety of microbes and some tumor cells.
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18
Q

Monocytes

A

1-6% of WBCs.

They are phagocytic and will transform into a fixed histiocyte or a wandering macrophage.

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19
Q

How many platelets per uL are in blood, what do they do, and how long do they live?

A

150K-400K/uL

They form a platelet plug during hemostasis, release chemicals for vascular spasm and blood clotting.

They live for 5-9 days.

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20
Q

What is the primary site of hemopoiesis?

A

Red bone marrow

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21
Q

What cells have the capacity to develop into different cell types?

A

Pluripotent Stem Cells.

They will differentiate into either Myeloid or Lymphoid cells.

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22
Q

What cells can myeloid cells differentiate into?

A
Red cells
Platelets
Eosinophils
Mast cells
Basophils
Neutrophils
Monocytes

They mature in red bone marrow.

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23
Q

What cells can lymphoid cells differentiate into?

A

T cells, B cells, NKCs. They mature in the lymphatic tissues.

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24
Q

What do you call immature neutrophils?

A

Bands.

> 10% is considered abnormal and may be due to a left shift. This is because the body has been fighting an infection so long that the bone marrow cannot keep up and starts to send out immature neutrophils to fight infection.

A left shift is a poor prognosis.

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25
Q

What is the most immature myeloid cell?

A

Blast cells. These are associated with myeloid disorders like cancer.

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26
Q

Hemostasis

A

A sequence of responses that stops bleeding when blood vessels are injured.

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27
Q

What are the three mechanisms that can reduce blood loss from blood vessels?

A

Vascular spasm

Platelet plug formation

Blood clotting

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28
Q

Vascular spasm

A

Smooth muscle contracting in response to damage to a blood vessel.

It reduces blood loss for several minutes to several hours while other hemostatic mechanisms begin to work.

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29
Q

Platelet Plug Formation

A

Platelets change drastically and quickly when they come into contact with damaged blood vessels. They come together to form a plug that helps fill the gap in the injured vessel wall.

Lots of stickiness is involved here.

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30
Q

Blood Clotting

A

Blood (a liquid) removed from the body thickens and forms a gel. Eventually the gel separates from the liquid.

Serum is a straw-colored liquid that is plasma without clotting proteins.

The gel is called a clot and consists of a network of insoluble protein fibers called fibrin.

31
Q

What are the clotting factors?

A

Calcium ions (Ca2)

Enzymes from liver cells released into the blood.

Molecules associated with platelets or released by damaged tissues.

32
Q

Step 1 of Clotting

A

Prothrombinase is formed.

33
Q

Step 2 of clotting

A

Prothrombinase converts prothrombin (II) into the enzyme thrombin with the help of Vitamin K.

34
Q

Step 3 of Clotting

A

Thrombin converts soluble fibrinogen (I) into insoluble fibrin.

  • Fibrin forms the threads of the clot (a lattice like structure)
  • Cigarrete smoke contains a substance that interferes with this step.
35
Q

What is clot retraction?

A

The consolidation or tightening of the fibrin clot.

36
Q

What occurs simultaneously with coagulation?

A

Fibrinolysis

When a blood clot is formed, an inactive plasma enzyme called plasminogen is incorporated into the clot. The plasminogen is activated into plasmin, which then digests and dissolves fibrin threads thus removing the clot.

37
Q

What do the surfaces of RBCs contain?

A

A genetically determined assortment of antigens (aka agglutinogens) composed of glycolipids and glycoproteins.

38
Q

Describe the ways blood is categorized into types

A

Depending on the presence or absence of antigens, blood is categorized into blood groups.

Within a group there can be two or more types.

There are 24 blood groups and more than 100 antigens. The two major blood groups are ABO and Rh.

39
Q

Blood plasma contains what substance that reacts with A or B antigens?

A

Antibodies (aka agglutinins).

Anti-A antibody reacts with antigen A.

Vice versa with B.

40
Q

How is blood that contains the Rh antigen designated?

A

Rh+ (i.e. B+).

41
Q

T/F: Under normal circumstances, blood does not contain anti-Rh antibodies.

A

True.

However, if an Rh- person receives Rh+ blood transfusion, the immune system starts to make anti-Rh antibodies that remain in the blood.

This will cause a transfusion reaction the next time they receive Rh+ blood.

42
Q

Why are blood transfusions given?

A

To raise the Hgb levels in patients with anemia or blood loss.

The types of transfusions are:

Fresh Whole Blood
Packed RBCs
Leukocyte Poor Blood
Autologous Packed RBCs
Frozen RBCs
43
Q

What is the “perfect ratio”?

A

1:1:1 ratio of RBCs, plasma, and fresh platelets. This is the advantage of Fresh Whole Blood transfusions. It also retains all of its clotting factors.

44
Q

When should you use Fresh Whole Blood transfusions and what are the limitations?

A

Massive hemorrhage when more than 10 units are needed.
Cardiac surgery.

Must be ABO and Rh specific unless low titer O unit donors available.

45
Q

What transfusion is most commonly used to raise Hgb?

A

Packed RBCs.

Each unit contains 300mL, 200mL of which is RBCs.

One unit will bring Hgb up by 1 g/dL.

These should be given when Hgb falls below 7-8 g/dL.

Use a 1:1:1 ratio of packed RBCs, fresh frozen plasma, and platelets during transfusion.

46
Q

What are most blood products today low in?

A

Leukocytes. Most blood products are Leuko-reduced during donation and are thus leukocyte poor.

This reduces the incidence of leukoagglutination reactions, platelet alloimmunization, transfusion related lung injuries, and CMV exposure.

47
Q

What kind of blood transfusions can patients scheduled for major surgeries use?

A

Autologous Packed RBCs.

These patients can donate their own blood to transfuse if needed. Units can be refrigerated up to 35 days or longer depending on what kind of anticoagulant was used.

48
Q

What type of blood transfusion is typically used on CRTS platforms?

A

Frozen RBCs.

They maintain frozen storage of O units while they deploy. DOD guidelines allow units to be glycerolized and frozen for up to 10 years.

One ACP 215 machine can deglycerolize (colloquially known as deglizzinate) one unit in one hour.

After deglycing a unit, the blood is ready for transfusion or can be held in a fridge for 14 days.

49
Q

What must be done before a transfusion?

A

The recipient’s and donor’s blood must be typed and cross-matched to avoid hemolytic transfusion reactions.

A and B antigens are the most important because these antibodies can cause immediate lysis of incompatible red cells.

50
Q

What antigen does 15% of the population lack?

A

D antigen.

The anti-D antibody is not naturally present. If you introduce this antigen to a person who is D negative or Rh negative they will form antibodies to it. Next time they receive a D+ or Rh+ transfusion, they will have a severe hemolytic reaction.

51
Q

Hemolytic transfusion reactions typically are caused by what?

A

Incompatible mismatches in the ABO system because of clerical errors and mislabeled specimens.

The severity depends on the dose of incompatible red cells given.

52
Q

Death occurs in _____ transfused units, and is typically seen in what patients?

A

1 in 1.8 million

Surgical patients under anesthesia.

53
Q

Signs and symptoms of a hemolytic transfusion reaction

A

Fever and chills with headache and backache.

Apprehension, dyspnea, hypotension, cardiovascular collapse.

Patients under anesthesia will not have these symptoms, but may be tachycardia, have generalized bleeding or oliguria.

54
Q

Treatment of a hemolytic transfusion reaction

A

Stop transfusion immediately

Vigorously hydrate to prevent acute tubular necrosis

Forced diuresis with mannitol may help prevent or minimize acute kidney injury.

55
Q

Leukoagglutinin Transfusion Reaction

A

Most transfusion reactions are reactions to the antigens present on the transfused passenger leukocytes in patients who have been sensitized to leukocyte antigens through prior transfusions or pregnancies.

56
Q

Leukoagglutinin Transfusion Reaction

A

Most transfusion reactions are reactions to the antigens present on the transfused passenger leukocytes in patients who have been sensitized to leukocyte antigens through prior transfusions or pregnancies.

57
Q

Symptoms of a Leukoagglutinin Reaction

A

Fever and chills within 12 hours after transfusion

Cough and dyspnea in severe cases

CXR will show transient pulmonary infiltrates, and Hgb will rise despite the reaction because no hemolysis occurs.

58
Q

Treatment of a Leukoagglutinin Reaction

A

Acetaminophen 500-600mg PO
Diphenhydramine 25mg PO or IV
Hydrocortisone 1mg/kg IV

Patients that experience these episodes despite being given leukoreduced blood should receive leukopoor or washed blood products to prevent these reactions.

59
Q

What transfusion reaction is almost always due to allogeneic plasma proteins rather than to leukocytes?

A

Hypersensitivity Reactions

60
Q

Symptoms of a hypersensitivity reaction

A

Urticaria or bronchospasm may develop soon after transfusion.

61
Q

Treatment of a hypersensitivity reaction

A

Give washed or frozen RBCs to avoid future severe reactions.

62
Q

Contaminated blood

A

Bacteria can invade blood during collection process.

-1 in 30K RBC donations and 1 in 5K platelet donations are contaminated.

63
Q

Gram positive bacteria causes what reactions in blood transfusions?

A

Fever and bacteremia, but it rarely causes sepsis syndrome.

64
Q

Gram negative bacteria will cause what reactions during blood transfusions?

A

Septic shock, acute DIC, and acute kidney injury due to endotoxins.

This is usually fatal.

65
Q

What can reduce the occurrence of infectious diseases being transmitted through blood?

A

Blood is tested and screened for viral markers and diseases.

Questionnaires reduce those with high risk behaviors and environmental exposure.

66
Q

Graft vs. Host Disease

A

Allogeneic passenger lymphocytes in transfused blood will engraft in some recipients and mount an auto-immune attack against tissues expressing discrepant antigens.

67
Q

Graft vs. Host Disease Symptoms and Findings

A

Fever, rash, diarrhea, hepatitis, lymphadenopathy, severe pancytopenia.

Outcome is usually fatal.

This occurs mostly in patients with immune defects, malignant lymphoproliferative disorders, solid tumors treated with chemotherapy or immunotherapy, treatment with immunosuppressant drugs, or older patients undergoing cardiac surgery.

68
Q

Treatment of Graft vs. Host Disease

A

Utilize blood that has been irradiated to prevent lymphocyte proliferation.

69
Q

What reaction occurs in 1 out of every 5,000 transfusions?

A

Transfusion Related Acute Lung Injury (TRALI)

It is associated with allogeneic antibodies in the donor plasma that bind to recipient leukocyte antigens.

It is clinically defined as non-cariogenic pulmonary edema after blood transfusion without other explanation.

70
Q

What patients are most susceptible to TRALI?

A

Surgical and critically ill patients.

71
Q

How is the risk of TRALI reduced?

A

Through the use of male only plasma donors.

Only 1-5% of male donors have anti leukocyte antibodies in their serum while females have 10-20%.

72
Q

Blood group A and blood group B have what antibodies?

A

Group A has B antibodies.

Group B has A antibodies.

73
Q

Blood group O has what antigens and what antibodies?

A

Blood group O has no antigens.

Blood group O has A and B antibodies.

74
Q

Blood group AB has what antibodies?

A

Blood group AB has no antibodies.