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TEST 1 Flashcards

1
Q

Fibrinogen

A

A protein converted into fibrin to form thrombus and clot

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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

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3
Q

What is site of hematopoiesis

A

The bone marrow

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4
Q

In adults blood cell formation is usually limited to

A

Pelvis, ribs, vertebrae and sternum

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5
Q

Extrameduallary hematopoiesis

A

When disease causes marrow distruction, the liver and spleen resume production of blood cells

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6
Q

What cells are in bone marrow?

A

Stem cells

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7
Q

Stem cells
-Differentiate into ?

A

Self replicating
differentiate into myeloid or lympoid cells

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8
Q

Lymphoid stem cells produce

A

T or B lymphocytes

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9
Q

Myeloid cells differentiate into

A

Erythrocytes
Leukocytes
Platelets

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10
Q

All blood cells are derived from

A

Myeloid cells

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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

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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

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13
Q

Hematopoiesis

A

formation and maturation of blood cells
*primary site is bone marrow

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14
Q

WBC - major function

A

Fights infection

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15
Q

Monocyte - major function

A

Enters as macrophage, highly phagocytotic especially against fungus. Immune surveillance

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15
Q

Neutrophil - major function

A

preventing or limiting bacterial infection via phagocytosis

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16
Q

Eosinophil - major function

A

Allergic reactions (neutralizes histamine); digest foreign proteins

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17
Q

Basophil - major function

A

Contains histmaine, hypersensitivity reactions

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18
Q

lymphocyte - major function

A

integral component of immune system

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19
Q

T lympocyte - major function
Type of immunity?

A

Cell mediated immunity. Recognized material as “foregin”

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20
Q

B lymphocyte - major function

A

Humoral immunity, many mature into plasma cells to form antibodies

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21
Q

Plasma cell - major function

A

Secretes immunoglobulin (antibody) most mature form of b lymphocyte

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22
Q

RBC - major function

A

Carries hemoglobin to provide oxygen to tissues

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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

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24
Q

Fibrinolysis

A

Process of breakdown of fibrin clot

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25
Q

Hemoglobin

A

Iron containing protein of RBC; deliver oxygen to tissues

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26
Q

Reticulocytes

A

Slightly immature RBC

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27
Q

Hemoglobin molecule is made up of

A

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

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28
Q

Oxyhemoglobin

Primarily found in

A

Oxygen bound to hemoglobin

Primarily found in arterial blood

*brighter red than hemoglobin w/o oxygen

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29
Q

In venous blood, hemoglobin combines with

A

hydrogen ions produced by cellular metabolism and buffers acid

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30
Q

Whole blood normally contains –g of hemoglobin per –ml of blood

A

15g of hemoglobin per 100ml of blood

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31
Q

Erythropoietin

-Produced primarily by?

A

Hormone produced primarily by kidney; necessary for making new RBCs

*This hormone increased when kidney detects low levels of oxygen

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32
Q

To make new RBC, bone marrow requires?

A

Iron, vit B12, folate, pyriodoxine (b6), protein and other factors

  • a deficiency results in low RBC production and anemia
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33
Q

Avg adult total body content of iron?
Iron is stored as?
When required, iron is released into

A

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

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34
Q

How is iron lost?

A

Feces, bile, blood or mucosal cells in intesting

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35
Q

Normal findings of iron in blood?

A

50-250 ug/dl

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36
Q

Vit b12 and folate are required for synthesis of

A

DNA in RBCs.
Both are derived from diet

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37
Q

Where is folate absorbed at?
Where can we get vit b 12 from?
Where is vit B12 absorbed

A

Folate absorbed at proximal sm intestine
Vit b12 from animal sources
Vit b12 combines with intrinsic factor and absorbed in distal ileum

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38
Q

Vit B and folate deficiencies are characterized by

A

Production of abnormally large erythrocytes called megaloblasts
*they get trapped in bone marrow which results in MEGALOCBLASTIC ANEMIA

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39
Q

Older erythrocytes are removed from blood by

A

Reticuloendothelial cells in liver and spleen

  • some hemoglobin is recycled. some broken down into bilirubin and secreted
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40
Q

What two categories are leukocytes divided into?
Normal blood count for leukocytes?

A

Granulocytes and lymphocytes
4000-11000 cells/mm3

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41
Q

Granulocytes - define
3 types

A

Defined by presences of granules in cell
Eosinophils, basophils, neutrophils

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42
Q

Color these stain
Eosinophils
Basophils
Neutrophils

A
  • Eosinophils -Bright red granules
  • -Basophiles - deep blue
  • Neutrophil - pink-violet
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43
Q

Physical characteristic of neutrophil

A

Multiple lobes (2-5)
2X the size of RBC

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44
Q

Band cell

A

Less mature granulocyte, single lobed elongated nucleus

*increased band cells sometimes called “left shift”

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45
Q

Myelopoiesis

A

Formation and maturation of cells stemming from myeloid cell

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46
Q

Cytokines

A

Proteins produced by leukocytes vital to regulation of hematopoiesis, apoptosis and immune responses

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47
Q

Monocytes - define
size?
Active in?
Effective against?

A

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
Q

Lymphocytes - define
2 types /produced?
Where complete their maturatiin?

A

Small cells with scanty cytoplasm
T lymphocytes - thymus
B lymphocytes - marrow
*Complete maturation in lymph nodes after exposure to antigen.

49
Q

NK cells - define
When activated?
Secrete?

A

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
Q

Major function of neutrophils?
Arrive at site — after onset of inflammatory reaction
2nd cell that follows neutrophils?

A

Phagocytosis
Neutrophils arrive at site within 1 hr
2nd cell to arrive = Monocyte

51
Q

T lymphocytes - primary function

A

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
Q

B LYMPHOCYTES - primary function

A

turn into plasma cells then produce antibodies (immunoglobins Igs) which destory foregin molecules by several mechanisms

HUMORAL IMMUNITY

53
Q

What wbc functions in hypersensitivity of reactions?
Parasites?

A

Eosinophils and basophils
Eosinophils - parasites

54
Q

Platelet production in regulated by what hormone?
Each megakaryocyte has capacity to produce how many platelets

A

Throbopoietin - stimulates production and maturation of megakaryocytes from myeloid stem cell

*2000 platelets

55
Q

Plasma - define
Consists of

A

After cellular elements are removed from blood, remaining liquid is plasma

*consists of clotting factors, nutrients, enzymes, waste and gas

56
Q

If plasma is allowed to clot, remaining fluid is

A

Serum

57
Q

Plasma protiens consist primarily of?
3 types of globulins
Alpha and beta functions?

A

Albumin and globulins
Alpha, beta, and gamma
*transport globulins and clotting factors

58
Q

Albumin important for

A

Mainenance of fluid balance within vascular system
*creates osmotic force to keep fluid within the vascular space

59
Q

Reticuloendothelial system

A

Complex system of cells capable of phagocytosis

60
Q

Macrophages give rise to histiocytes?
3 types

A

Phagocytotic cells present in loose connective tissue

*Kupper cells - liver
*Peritoneal macrophages
*Alveolar macro - lungs

61
Q

Opsonins

A

formed by spleen
Promote phagocytosis of neutrophils

62
Q

Spleen forms what antibody after exposure to antigen?

A

IgM

63
Q

Hemostasis

A

Process of preventing blood loss from intact vessels and stopping bleeding from severed vessel

64
Q

Primary hemostasis
Secondary hemostasis

A

Primary - Vessel constricts, platelets aggregate, plug is formed, coagulation factors converted to active
Secondary - Formation of fibrin which anchors plug

65
Q

Extrinsic pathway

A

Release of thromboplastin from tissue
Prothromnin > thrombin > fibrinogen > fibrin

66
Q

Intrinsic pathway

A

collagen that lines vessels is exposed
Prothromnin > thrombin > fibrinogen > fibrin
Slower than extrinsic

67
Q

Process of a clot breaking down

A

Plasminogen lyses fibrin by forming plasmin which digests fibrinogen >fibrin> products released into circulation

68
Q

Most common blood tests for hematologic studies

A

CBC and peripheral blood smear

69
Q

Hematocrit

A

% of blood volume consisting of RBCs

70
Q

BONE MARROW ASPIRATION/BIOPSY
-Needed when?
-Aspirated from where?
-Biopsy from where?
-Complications?

A

-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
Q

THERAPEUTIC APHERESIS
Define
Why used?

A

-Blood taken and specific component removed, remaining blood return to pt
*Harvest stem cells, plasma for transfusions. removing dangerous substance

72
Q

Hematopoietic stem cell transplantation
Define?
Used in what conditions?

A

*donor stem cells transplanted
Used in pt with severe aplastic anemia, leukemia and thalassema.
*provide longer remission for multiple myeloma

73
Q

A single unit of blood contains —ml of blood and –of anticoagulant

A

450 ml blood
50ml anticoag

74
Q

Can be stored at what temp for how long
RBC
Platelets
Plasma

A

RBC 4C/39.2F for 42 days
Platelets room temp for 5 days
Plasma frozen for 1 year

75
Q

PRODUCT / MADE OF /CONSIDERATION
WHOLE BLOOD
PRBC
Platelets (random)

A

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
Q

PRODUCT / MADE OF /CONSIDERATION

Platelets - single donor
Plasma
Granulocytes

A

Platelets - used for repeated treatments
Plasma - Bleeding in pt with coag fact def
Granulocytes - Neutropenia severe

77
Q

PRODUCT / MADE OF /CONSIDERATION

Lymphocytes -
Cryoprecipitate
AHF

A

Lymphocytes - Stimulate graft vs host disease effect
Cryop- Von willebrand disease, hypofibrinogenemia, hemophila A
AHF - Hemophilia A

78
Q

PRODUCT / MADE OF /CONSIDERATION

Factor IX concentrate
Factor IX complex
Albumin

A

Factor IX concentrate - Hemophila B
Factor IX complex - Hereditary factor def, hemophila A
Albumin - Hypoproteinemia, burns, volume expansion

79
Q

PRODUCT / MADE OF /CONSIDERATION

IV gamma-globulin
Antithrombin III concentrate

A

IV gamma - hypogammaglobulinemia, ITP, primary immunodeficiency
Antithrombin - AT III def w/ or at risk for thrombosis

80
Q

Minimal require for blood donation

A

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
Q

STANDARD DONATION
Position?
What site?
How much removed

A

Semirecumbent
ANtecubital fossa
450ml takes less than 15 mins

82
Q

Afebrile nonhemolytic reaction
Define
Diag by?
Symptoms

A

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
Q

ACUTE HEMOLYTIC REACTION
Define
Symptoms

A

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
Q

Transfusion associated circulatory overload (TACO)
Define
Signs

A

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
Q

If transfusion overload happens what are interventions
Mild?
Severe?

A

Mild - slow rate of infusion and administer diuretic
Severe - Pt upright with feet in dependent position, transfusion stopped, notify provider

86
Q

Transfusion related acute lung injury TRALI
Define
Symptoms

A

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
Q
A
88
Q

Anemia

A

A condition characterised by lower than normal hemoglobin levels

89
Q

Hyperproliferative anemias occur when

A

Bone marrow produces inadequate number of erythrocytes

90
Q

Reticulocyte

A

Immature RBC

91
Q

Causes of hypoproliferative anemia may include

A

Bone marrow damage from chemicals, medication, lack of important factors that promote erythrocyte production, lack of nutrients

92
Q

Types of Hypoproliferative anemia
(5)

A

Iron deficiency
Vit b12 def
Folate def
Decreased erythropoietin productions
Cancer/inflam

93
Q

Types of hemolytic anemias
(5)

A

Altered erythropoiesis (sickle cell, thalassemia)
Hypersplenism
Drug induced anemia
Autoimmune anemia
Mechanical heart valve-related anemia

94
Q

Functional iron deficiency

A

when total body iron stores are adequate but the amount of iron delivered to erythroid precursors is inadequate

95
Q

Ferrous sulfate side effects

A

GI - constipation, cramping, nausea, vomiting
Taking with vit C can increase absorption
Avoid antacids and dairy products

96
Q

Normochromic and Normocytic

A

RBC of normal color and size

97
Q

Pancytopenia

A

Anemia, Neutropenia and thrombocytopenia

98
Q

Antithymocyte globulin (ATG)

A

-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
Q

What are risks with long term use of corticosteroids with Aplastic anemia

A

Assoc with bony abnormalities; aspectic necrosis and osteopenia

100
Q

Poikilocytosis

A

Erythrocytes that are abnormally shaped

101
Q

Pernicious anemia

A

Anemia is assoc with lack of intrinsic factor

102
Q

Symptoms of pernicious anemia

A

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
Q

Complications of transfusions

A

Site infection, thrombosis. Hepatitis, delayed hemolytic transfusion reactions, iron overload

104
Q

What is the distinction between sickle cell crisis and hemolytic reaction?

A

With hemolytic reaction pt becomes more anemia after transfusion than before

105
Q

Hypochromia

A

Abnormal decrease in hemoglobin content of erythrocytes

106
Q

M

Microsytosis

A

SMaller than normal sized RBC

107
Q

Screening for hepatocellular carcinoma includes

A

Monitoring alpha fetoprotein levels and serial abdominal ultrasounds

108
Q

Causes of neutropenia

A

Decreased production of neutrophils
Ineffective granulocytopoiesis
Increased destruction of neutrophils

109
Q

Lymphopenia

A

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
Q

Arthropathy

A

when pt with hemophilia have reduced range of motion, impaired functioning and chronic pain

111
Q

DESMOPRESSIN

A

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
Q

AMINOCAPROIC ACID

A

Mgmt in mild mucosal bleeding
Inhibits dissolution of thrombus at site of bleeding

113
Q

Heparin induced thrombocytopenia

A

Complication of heparin
Formation of antibodies againsts the heparin platelet complex.
*Stop heparin and start another anticoag
**Argatroban - approved to treat

114
Q

Hyperhomocysteinemia

A

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
Q

Antithrombin def

A

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
Q

Protein C def

A

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
Q

Protein S def

A

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
Q

Antiphospholipid antibody syndrome

A

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

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