TEST 1 Flashcards
1
Q
Fibrinogen
A
A protein converted into fibrin to form thrombus and clot
2
Q
Plasma
A
Fluid portion of blood (about 55% of whole blood)
-Contains various proteins; albumin, globulin, fibrinogen, other factors, electrolytes, waste products and nutrients
3
Q
What is site of hematopoiesis
A
The bone marrow
4
Q
In adults blood cell formation is usually limited to
A
Pelvis, ribs, vertebrae and sternum
5
Q
Extrameduallary hematopoiesis
A
When disease causes marrow distruction, the liver and spleen resume production of blood cells
6
Q
What cells are in bone marrow?
A
Stem cells
7
Q
Stem cells
-Differentiate into ?
A
Self replicating
differentiate into myeloid or lympoid cells
8
Q
Lymphoid stem cells produce
A
T or B lymphocytes
9
Q
Myeloid cells differentiate into
A
Erythrocytes
Leukocytes
Platelets
10
Q
All blood cells are derived from
A
Myeloid cells
11
Q
Stroma
A
all tissue within the marrow that is not directly involved in hematopoiesis
*produces colony stimulating factors needed for hemtopoiesis
*other cells in stroma: fibroblasts, osteoclasts, osteoblasts, endothelial cells
12
Q
What are the 3 primary cell types that make up blood?
A
Erythrocytes (RBC)
Leukocytes (WBC)
Thrombocytes (platelets)
*40-45% of blood volume
13
Q
Hematopoiesis
A
formation and maturation of blood cells
*primary site is bone marrow
14
Q
WBC - major function
A
Fights infection
15
Q
Monocyte - major function
A
Enters as macrophage, highly phagocytotic especially against fungus. Immune surveillance
15
Q
Neutrophil - major function
A
preventing or limiting bacterial infection via phagocytosis
16
Q
Eosinophil - major function
A
Allergic reactions (neutralizes histamine); digest foreign proteins
17
Q
Basophil - major function
A
Contains histmaine, hypersensitivity reactions
18
Q
lymphocyte - major function
A
integral component of immune system
19
Q
T lympocyte - major function
Type of immunity?
A
Cell mediated immunity. Recognized material as “foregin”
20
Q
B lymphocyte - major function
A
Humoral immunity, many mature into plasma cells to form antibodies
21
Q
Plasma cell - major function
A
Secretes immunoglobulin (antibody) most mature form of b lymphocyte
22
Q
RBC - major function
A
Carries hemoglobin to provide oxygen to tissues
23
Q
Platelet (thrombocyte) - major function
Fragment of
Provides basis for
Avg lifespan
A
Fragment of megakaryocyte; provides basis for coagulation. Maintain hemostasis. Avg lifespan 10 days
24
Fibrinolysis
Process of breakdown of fibrin clot
25
Hemoglobin
Iron containing protein of RBC; deliver oxygen to tissues
26
Reticulocytes
Slightly immature RBC
27
Hemoglobin molecule is made up of
4 subunits. Heme attached to globin chain
*Iron is present in the heme portion
*important property of heme is the ability to bidn to oxygen loosely and reversibly
28
Oxyhemoglobin
Primarily found in
Oxygen bound to hemoglobin
Primarily found in arterial blood
*brighter red than hemoglobin w/o oxygen
29
In venous blood, hemoglobin combines with
hydrogen ions produced by cellular metabolism and buffers acid
30
Whole blood normally contains --g of hemoglobin per --ml of blood
15g of hemoglobin per 100ml of blood
31
Erythropoietin
-Produced primarily by?
Hormone produced primarily by kidney; necessary for making new RBCs
*This hormone increased when kidney detects low levels of oxygen
32
To make new RBC, bone marrow requires?
Iron, vit B12, folate, pyriodoxine (b6), protein and other factors
* a deficiency results in low RBC production and anemia
33
Avg adult total body content of iron?
Iron is stored as?
When required, iron is released into
3g
Stored as ferritin
Released into plasma, binds to transferrin and transported into membranes of erythrocyte percursor cells within the marrow, where it is incorporated into hemoglobin
34
How is iron lost?
Feces, bile, blood or mucosal cells in intesting
35
Normal findings of iron in blood?
50-250 ug/dl
36
Vit b12 and folate are required for synthesis of
DNA in RBCs.
Both are derived from diet
37
Where is folate absorbed at?
Where can we get vit b 12 from?
Where is vit B12 absorbed
Folate absorbed at proximal **sm intestine**
Vit b12 from animal sources
Vit b12 combines with intrinsic factor and absorbed in **distal ileum**
38
Vit B and folate deficiencies are characterized by
Production of abnormally large erythrocytes called megaloblasts
*they get trapped in bone marrow which results in **MEGALOCBLASTIC ANEMIA**
39
Older erythrocytes are removed from blood by
Reticuloendothelial cells in liver and spleen
* some hemoglobin is recycled. some broken down into bilirubin and secreted
40
What two categories are leukocytes divided into?
Normal blood count for leukocytes?
Granulocytes and lymphocytes
4000-11000 cells/mm3
41
Granulocytes - define
3 types
Defined by presences of granules in cell
Eosinophils, basophils, neutrophils
42
Color these stain
Eosinophils
Basophils
Neutrophils
- Eosinophils -Bright red granules
- -Basophiles - deep blue
- Neutrophil - pink-violet
43
Physical characteristic of neutrophil
Multiple lobes (2-5)
2X the size of RBC
44
Band cell
Less mature granulocyte, single lobed elongated nucleus
*increased band cells sometimes called "left shift"
45
Myelopoiesis
Formation and maturation of cells stemming from myeloid cell
46
Cytokines
Proteins produced by leukocytes vital to regulation of hematopoiesis, apoptosis and immune responses
47
Monocytes - define
size?
Active in?
Effective against?
Leukocytes with a single lobed nuclues and granule free cytoplasm "agranulocyte"
-Largest
-Macrophages active in spleen, liver, peritoneum and alveoli
- Effective against: fungi and viruses, also digest aged rbcs
48
Lymphocytes - define
2 types /produced?
Where complete their maturatiin?
Small cells with scanty cytoplasm
T lymphocytes - thymus
B lymphocytes - marrow
*Complete maturation in lymph nodes after exposure to antigen.
49
NK cells - define
When activated?
Secrete?
Lymphocytes that accumulate in lymphoid tissue
When activated serve as killers of virus infected and cancer cells
*Secrete cytokines to mobilized T and B cells into action
50
Major function of neutrophils?
Arrive at site --- after onset of inflammatory reaction
2nd cell that follows neutrophils?
Phagocytosis
Neutrophils arrive at site within 1 hr
2nd cell to arrive = Monocyte
51
T lymphocytes - primary function
Attack foreign material, directly or by releasing lymphokines to enhance activity of phagocytic cells
-Responsible for delayed allergic reactions, rejection of foreign tissue (transplant) and destruction of tumor cells
**CELLULAR IMMUNITY**
52
B LYMPHOCYTES - primary function
turn into plasma cells then produce antibodies (immunoglobins Igs) which destory foregin molecules by several mechanisms
**HUMORAL IMMUNITY**
53
What wbc functions in hypersensitivity of reactions?
Parasites?
Eosinophils and basophils
Eosinophils - parasites
54
Platelet production in regulated by what hormone?
Each megakaryocyte has capacity to produce how many platelets
Throbopoietin - stimulates production and maturation of megakaryocytes from myeloid stem cell
*2000 platelets
55
Plasma - define
Consists of
After cellular elements are removed from blood, remaining liquid is plasma
*consists of clotting factors, nutrients, enzymes, waste and gas
56
If plasma is allowed to clot, remaining fluid is
Serum
57
Plasma protiens consist primarily of?
3 types of globulins
Alpha and beta functions?
Albumin and globulins
Alpha, beta, and gamma
*transport globulins and clotting factors
58
Albumin important for
Mainenance of fluid balance within vascular system
*creates osmotic force to keep fluid within the vascular space
59
Reticuloendothelial system
Complex system of cells capable of phagocytosis
60
Macrophages give rise to histiocytes?
3 types
Phagocytotic cells present in loose connective tissue
*Kupper cells - liver
*Peritoneal macrophages
*Alveolar macro - lungs
61
Opsonins
formed by spleen
Promote phagocytosis of neutrophils
62
Spleen forms what antibody after exposure to antigen?
IgM
63
Hemostasis
Process of preventing blood loss from intact vessels and stopping bleeding from severed vessel
64
Primary hemostasis
Secondary hemostasis
Primary - Vessel constricts, platelets aggregate, plug is formed, coagulation factors converted to active
Secondary - Formation of fibrin which anchors plug
65
Extrinsic pathway
Release of thromboplastin from tissue
Prothromnin > thrombin > fibrinogen > fibrin
66
Intrinsic pathway
collagen that lines vessels is exposed
Prothromnin > thrombin > fibrinogen > fibrin
Slower than extrinsic
67
Process of a clot breaking down
Plasminogen lyses fibrin by forming plasmin which digests fibrinogen >fibrin> products released into circulation
68
Most common blood tests for hematologic studies
CBC and peripheral blood smear
69
Hematocrit
% of blood volume consisting of RBCs
70
BONE MARROW ASPIRATION/BIOPSY
-Needed when?
-Aspirated from where?
-Biopsy from where?
-Complications?
-Need info to assess how RBC beening formed and quality and quanitity of them
-Iliac crest and sometimes sternum (5ML)
-Posterior iliac crest
Complications: bleeding and infection (avoid aspirin)
71
THERAPEUTIC APHERESIS
Define
Why used?
-Blood taken and specific component removed, remaining blood return to pt
*Harvest stem cells, plasma for transfusions. removing dangerous substance
72
Hematopoietic stem cell transplantation
Define?
Used in what conditions?
*donor stem cells transplanted
Used in pt with severe aplastic anemia, leukemia and thalassema.
*provide longer remission for multiple myeloma
73
A single unit of blood contains ---ml of blood and --of anticoagulant
450 ml blood
50ml anticoag
74
Can be stored at what temp for how long
RBC
Platelets
Plasma
RBC 4C/39.2F for 42 days
Platelets room temp for 5 days
Plasma frozen for 1 year
75
**PRODUCT / MADE OF /CONSIDERATION**
WHOLE BLOOD
PRBC
Platelets (random)
**Whole blood** - volume replacement (used in significant bleeding
**PRBC** - Rbc w/ little plasma, some platelets and WBC / symptomatic anemia
**Platelets** - Bleeding due to low platelets
76
**PRODUCT / MADE OF /CONSIDERATION**
Platelets - single donor
Plasma
Granulocytes
**Platelets** - used for repeated treatments
**Plasma** - Bleeding in pt with coag fact def
**Granulocytes** - Neutropenia severe
77
**PRODUCT / MADE OF /CONSIDERATION**
Lymphocytes -
Cryoprecipitate
AHF
**Lymphocytes** - Stimulate graft vs host disease effect
**Cryop**- Von willebrand disease, hypofibrinogenemia, hemophila A
**AHF** - Hemophilia A
78
**PRODUCT / MADE OF /CONSIDERATION**
Factor IX concentrate
Factor IX complex
Albumin
**Factor IX concentrate** - Hemophila B
**Factor IX complex** - Hereditary factor def, hemophila A
**Albumin** - Hypoproteinemia, burns, volume expansion
79
**PRODUCT / MADE OF /CONSIDERATION**
IV gamma-globulin
Antithrombin III concentrate
**IV gamma** - hypogammaglobulinemia, ITP, primary immunodeficiency
**Antithrombin** - AT III def w/ or at risk for thrombosis
80
Minimal require for blood donation
At least 110lb
wait 8 week between whole donations
Temp not exceed 37.5C / 99.6F
Systolic 80-180
Diastolyic 50-100
Hemoglobin at least 12.5
81
STANDARD DONATION
Position?
What site?
How much removed
Semirecumbent
ANtecubital fossa
450ml takes less than 15 mins
82
Afebrile nonhemolytic reaction
Define
Diag by?
Symptoms
Caused by antibodies to donor leukocytes that remain in unit of blood
*most common type of transfusion reaction
**diag made through exclusion
SYMPTOMS: Chills and fever, begins 2 hrs after transfusion begins
83
ACUTE HEMOLYTIC REACTION
Define
Symptoms
Dangerous and life threatening, when donor blood is incompatable
* Most rapid hemolyis occurs in ABO incompatibility
* Symptoms: fever, chills, low back pain, nausea, chest tightness, dyspnea and anxiety. Vascular collapse may results
84
Transfusion associated circulatory overload (TACO)
Define
Signs
Too much blood infused too quickly, hypervolemia can occur
*for pt who are already at risk for circulatory overload, diuretics are given / can develop as last as 6 hr after
**Signs**: dyspnea, orthopnea, tachycardia, increase bp, sudden anxiety, jugular vein distension, crackles in base of lungs, hypoxemia. Pulmonary edema. TRALI
85
If transfusion overload happens what are interventions
Mild?
Severe?
Mild - slow rate of infusion and administer diuretic
Severe - Pt upright with feet in dependent position, transfusion stopped, notify provider
86
Transfusion related acute lung injury TRALI
Define
Symptoms
development of acute lung injury occuring within 6 hours of transfusion
*most common cause of transfusion related death
Interstital and intra-alveolar edema, sequestration of WBC within pulmonary capillaries
Signs: abrupt, acute SOB, hypoxia, hypotension, fever,
87
88
Anemia
A condition characterised by lower than normal hemoglobin levels
89
Hyperproliferative anemias occur when
Bone marrow produces inadequate number of erythrocytes
90
Reticulocyte
Immature RBC
91
Causes of hypoproliferative anemia may include
Bone marrow damage from chemicals, medication, lack of important factors that promote erythrocyte production, lack of nutrients
92
Types of Hypoproliferative anemia
(5)
Iron deficiency
Vit b12 def
Folate def
Decreased erythropoietin productions
Cancer/inflam
93
Types of hemolytic anemias
(5)
Altered erythropoiesis (sickle cell, thalassemia)
Hypersplenism
Drug induced anemia
Autoimmune anemia
Mechanical heart valve-related anemia
94
Functional iron deficiency
when total body iron stores are adequate but the amount of iron delivered to erythroid precursors is inadequate
95
Ferrous sulfate side effects
GI - constipation, cramping, nausea, vomiting
Taking with vit C can increase absorption
Avoid antacids and dairy products
96
Normochromic and Normocytic
RBC of normal color and size
97
Pancytopenia
Anemia, Neutropenia and thrombocytopenia
98
Antithymocyte globulin (ATG)
-Used in Aplastic anemia
Purified gamma-globulin solution obtained from rabbits or horses immunized with human T lymphocytes
**Side effects** - Fever and chills, anaphylaxis
99
What are risks with long term use of corticosteroids with Aplastic anemia
Assoc with bony abnormalities; aspectic necrosis and osteopenia
100
Poikilocytosis
Erythrocytes that are abnormally shaped
101
Pernicious anemia
Anemia is assoc with lack of intrinsic factor
102
Symptoms of pernicious anemia
smooth, sore, red tongue and mild diarrhea. Extremely pale, particularly in mucous membranes. May become confused and have paresthesias in extremities. Difficultly maintaining balance.
W/o treatment, heart failure assoc with severe anemia my result.
103
Complications of transfusions
Site infection, thrombosis. Hepatitis, delayed hemolytic transfusion reactions, iron overload
104
What is the distinction between sickle cell crisis and hemolytic reaction?
With hemolytic reaction pt becomes more anemia after transfusion than before
105
Hypochromia
Abnormal decrease in hemoglobin content of erythrocytes
106
# M
Microsytosis
SMaller than normal sized RBC
107
Screening for hepatocellular carcinoma includes
Monitoring alpha fetoprotein levels and serial abdominal ultrasounds
108
Causes of neutropenia
Decreased production of neutrophils
Ineffective granulocytopoiesis
Increased destruction of neutrophils
109
Lymphopenia
lymphocyte cound less than 1500/mm
- as a result of exposure to ionizing radiation, long term use of corticosteriods, uremia, infection, neoplasms, some protein losing enteropathies which may cause lymphocytes from GI tract to be lost.
** severe can result in bacterial infections or opportunistic infections
110
Arthropathy
when pt with hemophilia have reduced range of motion, impaired functioning and chronic pain
111
DESMOPRESSIN
Used to prevent bleeding assoc with dental or surgical
-Provides increase in factor VIII coag
-IV infusion or intranasally
-Hyponatremia and seizure may occur (if longer than3days)
112
AMINOCAPROIC ACID
Mgmt in mild mucosal bleeding
Inhibits dissolution of thrombus at site of bleeding
113
Heparin induced thrombocytopenia
Complication of heparin
Formation of antibodies againsts the heparin platelet complex.
*Stop heparin and start another anticoag
**Argatroban - approved to treat
114
Hyperhomocysteinemia
Endothelial lining of blood vessels are denuded, which can lead to thrombus formation specifically VTE.
Can be hereditary but can also occur as folate def and Vit B def (which are cofactors in homocysteine metabolism)
115
Antithrombin def
AT is a protein that inhibits thrombin and certain coag factors. / Can be aquired by 4 mechanisms:
1. Accelarated consumption of AT, (DIC)
2. Decreased synthesis of AT (hepatic dysfunction)
3. Increased excretion of AT (nephrotic syndrome)
4. Medication induces (estrogens)
Sites of thrombis are deep veins in legs and within mesentery
116
Protein C def
Vit K dependent enzyme synthesized in liver when activeated inhibits coagulation.
When protein C is low risk of thromis increases
Pateints with Proteins C def, get warfin they can get warfarin induced skin necrosis
117
Protein S def
APC requires protein S to activate certain clotting factors. When defi risk of thrombis increases
* have a greater risk for recurrent venous thrombosis in early life
* freq occur in axillary, mesenteric and cerebral veins
Warfarin skin necrosis also possible
118
Antiphospholipid antibody syndrome
Antibodys to phospholipids are common causes of thrombophilia.
Reduce lvls of annexin V.
Lupus and anticardiolipin antibodies
Primary assoc with hepatitis C, HIV, syphilis, malaria
