Unit 1 Flashcards
1
Q
The “buffy coat” layer consists of…
A
- WBCs
- platelets
2
Q
The plasma layer of blood consists of … (4)
A
- proteins
- lipids
- carbohydrates
- salts
3
Q
Erythropoietin is a __________ produced by the __________
A
hormone, kidney
4
Q
3 possible causes of anemia
A
- not making enough RBCs
- destroying RBCs faster than making them
- blood loss
5
Q
G6PD deficiency
A
- defects in enzymes leading to hemolytic anemia (can’t produce the energy you need)
- precipitated Hb
- “bite” cells
6
Q
Thalassemia results from a(n) _________ of alpha and beta chains
A
imbalance
7
Q
Leukemia involves cancer in the ___________ while lymphoma involves cancer in the ___________
A
bone marrow and blood; lymph nodes and lymphoid tissue
8
Q
Hemostasis (blood clotting) involves the interaction of …(3)
A
- platelets
- endothelium
- coagulation proteins
9
Q
Platelets are cell fragments of ____________
A
megakaryocytes
10
Q
measured components of a CBC
A
Hb, RBC count, WBC count, platelet count, mean platelet volume
11
Q
calculated components of a CBC
A
hematocrit, MCV, MCH, MCHC, red cell distribution width, absolute counts of leukocytes
12
Q
mean corpuscular volume (MCV)
A
-average volume of RBCs
MCV = Hct/RBC
13
Q
mean corpuscular hemoglobin (MCH)
A
-content (weight) of Hgb of the average red cell
MCH = Hgb/RBC
14
Q
mean corpuscular hemoglobin concentration (MCHC)
A
-average concentration of Hgb in a given volume of packed red cells
MCHC = Hgb/Hct
15
Q
What does a manual differential add?
A
- morphology of RBCs, WBCs, and platelets
- abnormal formed elements in blood
- relative or absolute quantification of different WBC populations
16
Q
Which cells are nucleated and which cells are anucleated?
A
nucleated: lymphocytes, monocytes, granulocytes
anucleate: erythrocytes, platelets
17
Q
Thrombocytosis
A
too many platelets
18
Q
Neutrophilia
A
too many neutrophils
19
Q
Neutropenia
A
too few neutrophils
20
Q
What are the most abundant white cells in the peripheral blood?
A
neutrophils
21
Q
Which WBC has a bi-lobed nucleus?
A
eosinophil
22
Q
Leukocyte absolute count equation
A
DIFF# = (DIFF% x WBC)/100
23
Q
Can you assess the maturity of a fetus’ lungs by ordering a CBC?
A
yes
24
Q
What is the difference between PAMPs and DAMPs?
A
PAMPs (pathogen-associated molecular patterns): the bug that innate immunity can produce a response to
DAMPs (damage-associated molecular patterns): components of our own body that innate immunity can produce a response to when they are expressed unnaturally
25
Toll-like receptors recognize _________
PAMPs (foreign motifs)
26
NF-kB allows transcription of _________________
pro-inflammatory genes
27
What is the bridge between innate and adaptive immunity?
dendritic cells
28
Cytokines and chemokines are molecules of __________
inflammation
29
What 3 measurements are used to define the existence of anemia?
- Hgb concentration
- Hct
- RBC count
30
What is the reticulocyte index?
how many times baseline you are producing of reticulocytes
31
What are some symptoms of anemia?
shortness of breath, fatigue, rapid heart rate, pallor, dizziness, claudication, angina (cardiac problems)
32
What are some signs of anemia?
tachycardia (fast heart rate), tachypnea (fast breathing), dyspnea (difficulty breathing), pallor
33
Fe is more soluble at (low/high) pH
low
34
T/F: There is no active excretion mechanism for Fe
true (controlled by absorption)
35
_________ controls how much ferroportin there is
hepcidin
36
Do the following factors increase or decrease iron absorption?
- low pH
- gastroferrin
- vitamin c
- phytates, oxalates
- erythropoiesis
- low pH: increases
- gastroferrin: increases
- vitamin c: increases
- phytates, oxalates: decrease
- erythropoiesis: increases
37
Fe is stored in __________
ferritin
38
_________ is released from hepatic cells during inflammation and results in an increased accumulation of ________ but a decreased amount of _________
hepcidin, ferritin, ferroportin
39
Hemochromatosis is a deficiency in _________
hepcidin
40
With Fe depletion, what happens to ...?
- marrow Fe
- transferrin
- serum ferritin
- Fe absorption
- marrow Fe: decreases
- transferrin: increases
- serum ferritin: decreases
- Fe absorption: increases
41
With Fe deficiency, Hgb synthesis (increases/decreases), Hct (increases, decreases), and cell proliferation (increases, decreases)
decreases, decreases, decreases
42
In which group is the prevalence of iron deficiency highest?
- infants/toddlers
- adolescent males
- adolescent females
- post-menopausal females
- adults
adolescent females (followed by infants/toddlers)
43
In iron deficient anemia, the MCV (increases/stays the same/decreases)
decreases (microcytic)
44
What 3 organ systems are damaged with iron overload?
- cardiac (arrhythmia, failure)
- liver (dysfunction, failure)
- endocrine (diabetes)
45
Hemoglobin with iron in the ferric form is called...
methemoglobin
46
With a shift to the right in the oxygen dissociation curve, oxygen binds (more/less) tightly and it takes a (higher/lower) partial pressure to saturate Hb to the same level
less, higher
47
What happens to an oxygen dissociation curve with...?
- decreased pH:
- increased CO2 concentration:
- increased temperature:
- increased 2,3-BPG
shifts to the right for all
48
Hb Gower 1 and 2 and Hb Portland are (higher/lower) affinity Hbs produced in the embryo
higher
49
Hb F dominates after ___ weeks gestation and binds 2,3-BPG (better/worse) than HbA
- 2 weeks
| - worse (shifts curve to the left)
50
HbA2 is elevated in ... (4)
- beta-thalassemia
- sickle cell
- hyperthyroidism
- megaloblastic anemia
51
What is Heinz body anemia?
unstable hemoglobins
52
Hb Koln has a mutation in the ________ chain and shifts the oxygen dissociation to the _________
beta, left
53
Hb Poole has a mutation in the _________ chain
gamma (goes away after birth)
54
Treatment for unstable Hb involves...
- transfusions?
- folic acid?
folic acid
55
RBC count (increases/decreases) with high oxygen affinity hemoglobins
increases (O2 bound more tightly to Hb, doesn't get to tissues, more RBCs produced to compensate for "hypoxia")
56
Cyanosis comes from...(3)
- too much deoxyhemoglobin
- too much methemoglobin (Fe3+ can't carry O2, curve shifts left)
- sulfhemoglobinemia (acquired from drugs, toxins)
57
Hb M
- mutation in alpha or beta chain, making Fe3+ resistant to reduction
- chronic methemoglobin
58
What is the treatment for acute methemoglobinemia?
methylene blue (artificial electron acceptor)
59
Do you look red or blue with CO poisoning?
red (binding curve shifted left)
60
What does pulse oximetry measure?
absorption (660nm - deoxyhemoglobin is maximal; 940 - oxyhemoglobin is maximal)
61
When does hematopoiesis occur in the liver (and spleen)?
4-5 months gestation until around birth
62
The least abundant cell type with the shortest lifespan is...
neutrophils (7 hours, 70 billion)
63
Multipotent hematopoietic stem cells can become ___________ or ___________
myeloid or lymphoid stem cells
64
How long does maturation of a RBC take?
about a week
65
Describe characteristics of...
- pronormoblast:
- basophilic normoblast:
- polychromatophilic normoblast:
- orthochromic normoblast:
- reticulocyte:
- pronormoblast: large, dark blue cytoplasm, open chromatin
- basophilic normoblast: smaller, condensed chromatin, gaining cytoplasm
- polychromatophilic normoblast: mature, condensed chromatin
- orthochromic normoblast: dark nucleus, pink cytoplasm
- reticulocyte: some RNA, no nucleus, round
66
Megakaryopoiesis leads to formation of...
platelets
67
Granulopoiesis leads to formation of...
neutrophils, basophils, eosinophils
68
How long do neutrophils spend in...?
- mitotic pool
- maturation/storage
- bone marrow overall
- periphery
- mitotic pool: 3-5 days
- maturation/storage: 5-7 days
- bone marrow overall: 8-12 days
- periphery: 10 hours
69
Describe the characteristics of...
- myeloblasts
- promyelocytes
- myelocytes
- metamyelocytes
- bands
- segmented neutrophil
- myeloblasts: large, open chromatin
- promyelocytes: dense primary granules
- myelocytes: perinuclear hof (little golgi) - white bulge, mature granules
- metamyelocytes: kidney bean shaped nucleus
- bands: more prominent kidney bean shaped nucleus
- segmented neutrophil: pink cytoplasm, multiple nuclei
70
IL-5 causes a promyelocyte to differentiate into _________ , IL-3 causes it to differentiate into _________, and SCF causes it to differentiate into _________
- eosinophil (bilobed nuclei)
- basophil (dark granules)
- mast cell (found in tissue, not blood; smaller granules)
71
Describe the characteristics of...
- monoblast
- pro-monocyte
- monocyte
- monoblast: purple granules, sometime vacuoles
- pro-monocyte: frilly skirt cytoplasm, condensed/twisted nucleus
- monocyte: kidney-shaped nucleus, vacuoles
72
Describe the characteristics of...
-lymphoblast
-lymphocyte
-
- lymphoblast: large NC ratio, open chromatin, hematodomes
| - lymphocyte: smaller, condensed chromatin, no nucleoli, little cytoplasm
73
What is the difference between a biopsy and aspirate?
biopsy: cohesive
aspirate: not cohesive
74
______ cells stay the same over a lifespan but ________ vary
white cells, lymphocytes
75
What are some causes of hypercellular bone marrow?
- increased proliferation due to hypoxia
| - decrease in hematopoietic growth factors
76
What are some causes of hypocellular bone marrow?
- autoimmune attack
- viral attack on marrow
- hematopoietic neoplasms
- malnourishment
77
__________ are the circulating equivalent of mast cells
basophils
78
Mononuclear cells include __________ and ___________
monocytes, lymphocytes
79
___________ makes eosinophils able to kill parasites
major basic protein
80
Where in the lymph node are antibodies made?
cortex (come from B cells), deep cortex has T cells
81
What is a Peyer Patch and where is it located?
- small intestine
| - decides what gets let in and if something that forces its way in should be considered a threat
82
What is an antigen?
- gets recognized by immune system
| - generates antibodies
83
What is an immunogen?
the best thing that we can inject in people and get a response
84
What is a tolerogen?
a form of antigen that you won't make an immune response to
85
TNF decreases production of ________ and _________
iron, erythropoietin
86
Lead decreases synthesis of ...
protoporphyrin (ring that iron should go in the middle of)
87
Without kidney function, there is no production of...
erythropoietin (precursor to RBCs)
88
Lab findings of chronic inflammation or infection
- mild anemia
- normocytic or microcytic
- decreased Fe, EPO, reticulocyte count
89
Lab findings of lead intoxication
- mild anemia
- microcytic
- decreased reticulocyte count
- inhibited Hb synthesis
90
Lab findings of renal insuffiency
- moderate to severe anemia
- normocytic
- decreased EPO, reticulocyte count
91
Lab findings of endocrine insufficiency or overactivation
* all: decreased reticulocyte count and index
- hypothyroidism: mild anemia, normochromic, normocytic
- hyperthyroidism: normocytic
- adrenal: mild anemia, normocytic
92
When should you use EPO to treat anemia?
- absolute deficiency
| - decrease of cytokine out of proportion to hematocrit level
93
What is sideroblastic anemia?
impaired production of protoporphyrin or incorporation of Fe
| -accumulation of Fe in mitochondria
94
Folate and vitamin B12 deficiencies lead to ineffective ____________ and result in _________ anemia
erythropoiesis, megaloblastic anemia
95
Fe gets absorbed in _________, folate in __________, and vitamin B12 in ________
- duodenum
- jejunum
- terminal ilium (stored in liver)
96
Causes of vitamin B12 deficiency
- autoimmune disease
- intrinsic factor deficiency
- malabsorption
- defective transport/storage
- metabolic defect
97
Causes of folate deficiency
- dietary insufficiency
- malabsorption
- drugs and toxins
- inborn errors of folate metabolism
- increased demands (i.e.: pregnancy)
- increased loss or metabolism
98
Lab test findings for folate and vitamin B12 deficiency
- anemia
- increased MCV
- low reticulocyte count and index
- unconjugated bilirubin, LDH
99
Hb Portland 1 and Hb Portland 2
both are embryonic Hb
1: zeta2, gamma2
2: zeta2, beta2
100
Hb Gower 1 and Hb Gower 2
both are embryonic Hb
1: zeta2, epsilon2
2: alpha2, epsilon2
101
Hb Barts
tetramer of gammas
102
Clinical manifestations of thalassemias
- small RBCs (low MCVs)
- low MCH, MCHC
- uniform RBCs
- increased RBC production
103
common alpha-thal for African and Asian
African: (a-/a-)
Asian: (aa/--)
104
What is the Hb electrophoresis of alpha-thal like?
normal (alpha is part of every Hb so no relative decreases)
105
HbE results from a point mutation of _______ to _______
glu to lys
106
What is the Hb electrophoresis of beta-thal like?
- increased HbA2 (or F if mild)
| - no HbA in Cooley's
107
Treatments for Cooley's anemia (3)
- transfusion
- induction of fetal Hb
- BMT
108
Differentiate iron deficiency and thalassemia based on RBC and RDW
Fe deficiency: low RBC, high RDW
| thalassemia: high RBC, normal RDW
109
Beta-thal has increased Hb____
HbA1
110
Structural Hb variants (point mutations)
- S
- C
- E
- S: glu to val (Sickle cell: HbSS)
- C: glu to lys (Sickle cell: HbSC, Hemolytic anemia: HbCC)
- E: glu to lys (thalassemia: HbE B thal, Sickle cell: HbSE)
111
Penicillin is given prophylactically to children with Sickle Cell to ...
prevent infection, splenic dysfunction, death
112
Head to toe complications of sickle cell
stroke, retinopathy, acute/chronic lung disease, spleen infarcts (increased risk for infection) or sequesters blood, nephropathy, avascular necrosis in hip, pain in extremities, leg ulcers
113
What medicine is there for sickle cell?
hydroxyurea (reduces frequency of acute pain, mortality (proportional to increase in HbF, but no improvement for organ function)
114
There is the most _____ antibody in blood
IgG
115
epitope
specific part of antigen that interacts with specific part of antibody
116
idiotype
An antibody that recognizes just one antibody in your body (making it like an antigen)
117
How many individual polypeptide chains are there in IgA?
10 (4 light, 4 heavy, 1 J, 1 secretory)
118
The first antibody to respond to a new antigen is ____
IgM
119
What is the only antibody that the human fetus makes?
IgM
120
_____ antibody crosses from mother to placenta
IgG
121
_____ is the antibody that is protected in secretions
IgA
122
How is a differential performed?
- make blood film (wedge, cover slip, spinner)
- air dry, fix in methanol
- Wright-Giemsa stain
- microscopy
123
What are the 5 types of immunopatholgy?
Type 1: immediate hypersensitivity (allergy)
Type 2: autoimmune
Type 3: make antibody against a soluble agent
Type 4: T cell mediated
chronic frustrated immune response: not self but can't get rid of it (i.e.: gut bacteria)
124
What is the total WBC count?
4.5-10.5 x 10^9/L
125
How do lymph nodes differ from normal endothelium?
high and cuboidal as opposed to flat
126
Is agglutination or precipitation a more sensitive test?
agglutination
127
What are some clinical lab tests for hemolysis?
- morphology
- reticulocyte count
- bilirubin
- Hb
- haptoglobin
- methemalbumin metheme
- enzymes
128
What is the most abundant protein in the cytoskeleton?
spectrin
129
What are some signs of hereditary spherocytosis?
- anemia
- intermittent jaundice
- splenomegaly
130
Unconjugated hyperbilirubinemia is a sign of...
hereditary spherocytosis
131
G6PD leads to ____________ because of an inability to replenish ___________
extravascular hemolysis, glutathione
132
What is a toxoid?
a harmless form of a toxin that retains its immunegeniticity
133
What is the half-life of IgG?
3 weeks
134
____________ are normally the largest cells in a peripheral smear
monocytes
