TEST 1 Flashcards
Fibrinogen
A protein converted into fibrin to form thrombus and clot
Plasma
Fluid portion of blood (about 55% of whole blood)
-Contains various proteins; albumin, globulin, fibrinogen, other factors, electrolytes, waste products and nutrients
What is site of hematopoiesis
The bone marrow
In adults blood cell formation is usually limited to
Pelvis, ribs, vertebrae and sternum
Extrameduallary hematopoiesis
When disease causes marrow distruction, the liver and spleen resume production of blood cells
What cells are in bone marrow?
Stem cells
Stem cells
-Differentiate into ?
Self replicating
differentiate into myeloid or lympoid cells
Lymphoid stem cells produce
T or B lymphocytes
Myeloid cells differentiate into
Erythrocytes
Leukocytes
Platelets
All blood cells are derived from
Myeloid cells
Stroma
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
What are the 3 primary cell types that make up blood?
Erythrocytes (RBC)
Leukocytes (WBC)
Thrombocytes (platelets)
*40-45% of blood volume
Hematopoiesis
formation and maturation of blood cells
*primary site is bone marrow
WBC - major function
Fights infection
Monocyte - major function
Enters as macrophage, highly phagocytotic especially against fungus. Immune surveillance
Neutrophil - major function
preventing or limiting bacterial infection via phagocytosis
Eosinophil - major function
Allergic reactions (neutralizes histamine); digest foreign proteins
Basophil - major function
Contains histmaine, hypersensitivity reactions
lymphocyte - major function
integral component of immune system
T lympocyte - major function
Type of immunity?
Cell mediated immunity. Recognized material as “foregin”
B lymphocyte - major function
Humoral immunity, many mature into plasma cells to form antibodies
Plasma cell - major function
Secretes immunoglobulin (antibody) most mature form of b lymphocyte
RBC - major function
Carries hemoglobin to provide oxygen to tissues
Platelet (thrombocyte) - major function
Fragment of
Provides basis for
Avg lifespan
Fragment of megakaryocyte; provides basis for coagulation. Maintain hemostasis. Avg lifespan 10 days
Fibrinolysis
Process of breakdown of fibrin clot
Hemoglobin
Iron containing protein of RBC; deliver oxygen to tissues
Reticulocytes
Slightly immature RBC
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
Oxyhemoglobin
Primarily found in
Oxygen bound to hemoglobin
Primarily found in arterial blood
*brighter red than hemoglobin w/o oxygen
In venous blood, hemoglobin combines with
hydrogen ions produced by cellular metabolism and buffers acid
Whole blood normally contains –g of hemoglobin per –ml of blood
15g of hemoglobin per 100ml of blood
Erythropoietin
-Produced primarily by?
Hormone produced primarily by kidney; necessary for making new RBCs
*This hormone increased when kidney detects low levels of oxygen
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
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
How is iron lost?
Feces, bile, blood or mucosal cells in intesting
Normal findings of iron in blood?
50-250 ug/dl
Vit b12 and folate are required for synthesis of
DNA in RBCs.
Both are derived from diet
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
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
Older erythrocytes are removed from blood by
Reticuloendothelial cells in liver and spleen
- some hemoglobin is recycled. some broken down into bilirubin and secreted
What two categories are leukocytes divided into?
Normal blood count for leukocytes?
Granulocytes and lymphocytes
4000-11000 cells/mm3
Granulocytes - define
3 types
Defined by presences of granules in cell
Eosinophils, basophils, neutrophils
Color these stain
Eosinophils
Basophils
Neutrophils
- Eosinophils -Bright red granules
- -Basophiles - deep blue
- Neutrophil - pink-violet
Physical characteristic of neutrophil
Multiple lobes (2-5)
2X the size of RBC
Band cell
Less mature granulocyte, single lobed elongated nucleus
*increased band cells sometimes called “left shift”
Myelopoiesis
Formation and maturation of cells stemming from myeloid cell
Cytokines
Proteins produced by leukocytes vital to regulation of hematopoiesis, apoptosis and immune responses
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
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.
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
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
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
B LYMPHOCYTES - primary function
turn into plasma cells then produce antibodies (immunoglobins Igs) which destory foregin molecules by several mechanisms
HUMORAL IMMUNITY
What wbc functions in hypersensitivity of reactions?
Parasites?
Eosinophils and basophils
Eosinophils - parasites
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
Plasma - define
Consists of
After cellular elements are removed from blood, remaining liquid is plasma
*consists of clotting factors, nutrients, enzymes, waste and gas
If plasma is allowed to clot, remaining fluid is
Serum
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
Albumin important for
Mainenance of fluid balance within vascular system
*creates osmotic force to keep fluid within the vascular space
Reticuloendothelial system
Complex system of cells capable of phagocytosis
Macrophages give rise to histiocytes?
3 types
Phagocytotic cells present in loose connective tissue
*Kupper cells - liver
*Peritoneal macrophages
*Alveolar macro - lungs
Opsonins
formed by spleen
Promote phagocytosis of neutrophils
Spleen forms what antibody after exposure to antigen?
IgM
Hemostasis
Process of preventing blood loss from intact vessels and stopping bleeding from severed vessel
Primary hemostasis
Secondary hemostasis
Primary - Vessel constricts, platelets aggregate, plug is formed, coagulation factors converted to active
Secondary - Formation of fibrin which anchors plug
Extrinsic pathway
Release of thromboplastin from tissue
Prothromnin > thrombin > fibrinogen > fibrin
Intrinsic pathway
collagen that lines vessels is exposed
Prothromnin > thrombin > fibrinogen > fibrin
Slower than extrinsic
Process of a clot breaking down
Plasminogen lyses fibrin by forming plasmin which digests fibrinogen >fibrin> products released into circulation
Most common blood tests for hematologic studies
CBC and peripheral blood smear
Hematocrit
% of blood volume consisting of RBCs
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)
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
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
A single unit of blood contains —ml of blood and –of anticoagulant
450 ml blood
50ml anticoag
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
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
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
PRODUCT / MADE OF /CONSIDERATION
Lymphocytes -
Cryoprecipitate
AHF
Lymphocytes - Stimulate graft vs host disease effect
Cryop- Von willebrand disease, hypofibrinogenemia, hemophila A
AHF - Hemophilia A
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
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
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
STANDARD DONATION
Position?
What site?
How much removed
Semirecumbent
ANtecubital fossa
450ml takes less than 15 mins
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
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
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
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
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,
Anemia
A condition characterised by lower than normal hemoglobin levels
Hyperproliferative anemias occur when
Bone marrow produces inadequate number of erythrocytes
Reticulocyte
Immature RBC
Causes of hypoproliferative anemia may include
Bone marrow damage from chemicals, medication, lack of important factors that promote erythrocyte production, lack of nutrients
Types of Hypoproliferative anemia
(5)
Iron deficiency
Vit b12 def
Folate def
Decreased erythropoietin productions
Cancer/inflam
Types of hemolytic anemias
(5)
Altered erythropoiesis (sickle cell, thalassemia)
Hypersplenism
Drug induced anemia
Autoimmune anemia
Mechanical heart valve-related anemia
Functional iron deficiency
when total body iron stores are adequate but the amount of iron delivered to erythroid precursors is inadequate
Ferrous sulfate side effects
GI - constipation, cramping, nausea, vomiting
Taking with vit C can increase absorption
Avoid antacids and dairy products
Normochromic and Normocytic
RBC of normal color and size
Pancytopenia
Anemia, Neutropenia and thrombocytopenia
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
What are risks with long term use of corticosteroids with Aplastic anemia
Assoc with bony abnormalities; aspectic necrosis and osteopenia
Poikilocytosis
Erythrocytes that are abnormally shaped
Pernicious anemia
Anemia is assoc with lack of intrinsic factor
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.
Complications of transfusions
Site infection, thrombosis. Hepatitis, delayed hemolytic transfusion reactions, iron overload
What is the distinction between sickle cell crisis and hemolytic reaction?
With hemolytic reaction pt becomes more anemia after transfusion than before
Hypochromia
Abnormal decrease in hemoglobin content of erythrocytes
M
Microsytosis
SMaller than normal sized RBC
Screening for hepatocellular carcinoma includes
Monitoring alpha fetoprotein levels and serial abdominal ultrasounds
Causes of neutropenia
Decreased production of neutrophils
Ineffective granulocytopoiesis
Increased destruction of neutrophils
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
Arthropathy
when pt with hemophilia have reduced range of motion, impaired functioning and chronic pain
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)
AMINOCAPROIC ACID
Mgmt in mild mucosal bleeding
Inhibits dissolution of thrombus at site of bleeding
Heparin induced thrombocytopenia
Complication of heparin
Formation of antibodies againsts the heparin platelet complex.
*Stop heparin and start another anticoag
**Argatroban - approved to treat
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)
Antithrombin def
AT is a protein that inhibits thrombin and certain coag factors. / Can be aquired by 4 mechanisms:
- Accelarated consumption of AT, (DIC)
- Decreased synthesis of AT (hepatic dysfunction)
- Increased excretion of AT (nephrotic syndrome)
- Medication induces (estrogens)
Sites of thrombis are deep veins in legs and within mesentery
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
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
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
