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Blood & Lymph > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

The “buffy coat” layer consists of…

A
  • WBCs

- platelets

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2
Q

The plasma layer of blood consists of … (4)

A
  • proteins
  • lipids
  • carbohydrates
  • salts
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3
Q

Erythropoietin is a __________ produced by the __________

A

hormone, kidney

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4
Q

3 possible causes of anemia

A
  • not making enough RBCs
  • destroying RBCs faster than making them
  • blood loss
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5
Q

G6PD deficiency

A
  • defects in enzymes leading to hemolytic anemia (can’t produce the energy you need)
  • precipitated Hb
  • “bite” cells
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6
Q

Thalassemia results from a(n) _________ of alpha and beta chains

A

imbalance

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7
Q

Leukemia involves cancer in the ___________ while lymphoma involves cancer in the ___________

A

bone marrow and blood; lymph nodes and lymphoid tissue

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8
Q

Hemostasis (blood clotting) involves the interaction of …(3)

A
  • platelets
  • endothelium
  • coagulation proteins
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9
Q

Platelets are cell fragments of ____________

A

megakaryocytes

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10
Q

measured components of a CBC

A

Hb, RBC count, WBC count, platelet count, mean platelet volume

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11
Q

calculated components of a CBC

A

hematocrit, MCV, MCH, MCHC, red cell distribution width, absolute counts of leukocytes

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12
Q

mean corpuscular volume (MCV)

A

-average volume of RBCs

MCV = Hct/RBC

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13
Q

mean corpuscular hemoglobin (MCH)

A

-content (weight) of Hgb of the average red cell

MCH = Hgb/RBC

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14
Q

mean corpuscular hemoglobin concentration (MCHC)

A

-average concentration of Hgb in a given volume of packed red cells
MCHC = Hgb/Hct

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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
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16
Q

Which cells are nucleated and which cells are anucleated?

A

nucleated: lymphocytes, monocytes, granulocytes
anucleate: erythrocytes, platelets

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17
Q

Thrombocytosis

A

too many platelets

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18
Q

Neutrophilia

A

too many neutrophils

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19
Q

Neutropenia

A

too few neutrophils

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20
Q

What are the most abundant white cells in the peripheral blood?

A

neutrophils

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21
Q

Which WBC has a bi-lobed nucleus?

A

eosinophil

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22
Q

Leukocyte absolute count equation

A

DIFF# = (DIFF% x WBC)/100

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23
Q

Can you assess the maturity of a fetus’ lungs by ordering a CBC?

A

yes

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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

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25
Q

Toll-like receptors recognize _________

A

PAMPs (foreign motifs)

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26
Q

NF-kB allows transcription of _________________

A

pro-inflammatory genes

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27
Q

What is the bridge between innate and adaptive immunity?

A

dendritic cells

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28
Q

Cytokines and chemokines are molecules of __________

A

inflammation

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29
Q

What 3 measurements are used to define the existence of anemia?

A
  • Hgb concentration
  • Hct
  • RBC count
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30
Q

What is the reticulocyte index?

A

how many times baseline you are producing of reticulocytes

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31
Q

What are some symptoms of anemia?

A

shortness of breath, fatigue, rapid heart rate, pallor, dizziness, claudication, angina (cardiac problems)

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32
Q

What are some signs of anemia?

A

tachycardia (fast heart rate), tachypnea (fast breathing), dyspnea (difficulty breathing), pallor

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33
Q

Fe is more soluble at (low/high) pH

A

low

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34
Q

T/F: There is no active excretion mechanism for Fe

A

true (controlled by absorption)

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35
Q

_________ controls how much ferroportin there is

A

hepcidin

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36
Q

Do the following factors increase or decrease iron absorption?

  • low pH
  • gastroferrin
  • vitamin c
  • phytates, oxalates
  • erythropoiesis
A
  • low pH: increases
  • gastroferrin: increases
  • vitamin c: increases
  • phytates, oxalates: decrease
  • erythropoiesis: increases
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37
Q

Fe is stored in __________

A

ferritin

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38
Q

_________ is released from hepatic cells during inflammation and results in an increased accumulation of ________ but a decreased amount of _________

A

hepcidin, ferritin, ferroportin

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39
Q

Hemochromatosis is a deficiency in _________

A

hepcidin

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40
Q

With Fe depletion, what happens to …?

  • marrow Fe
  • transferrin
  • serum ferritin
  • Fe absorption
A
  • marrow Fe: decreases
  • transferrin: increases
  • serum ferritin: decreases
  • Fe absorption: increases
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41
Q

With Fe deficiency, Hgb synthesis (increases/decreases), Hct (increases, decreases), and cell proliferation (increases, decreases)

A

decreases, decreases, decreases

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42
Q

In which group is the prevalence of iron deficiency highest?

  • infants/toddlers
  • adolescent males
  • adolescent females
  • post-menopausal females
  • adults
A

adolescent females (followed by infants/toddlers)

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43
Q

In iron deficient anemia, the MCV (increases/stays the same/decreases)

A

decreases (microcytic)

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44
Q

What 3 organ systems are damaged with iron overload?

A
  • cardiac (arrhythmia, failure)
  • liver (dysfunction, failure)
  • endocrine (diabetes)
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45
Q

Hemoglobin with iron in the ferric form is called…

A

methemoglobin

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46
Q

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

A

less, higher

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47
Q

What happens to an oxygen dissociation curve with…?

  • decreased pH:
  • increased CO2 concentration:
  • increased temperature:
  • increased 2,3-BPG
A

shifts to the right for all

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48
Q

Hb Gower 1 and 2 and Hb Portland are (higher/lower) affinity Hbs produced in the embryo

A

higher

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49
Q

Hb F dominates after ___ weeks gestation and binds 2,3-BPG (better/worse) than HbA

A
  • 2 weeks

- worse (shifts curve to the left)

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50
Q

HbA2 is elevated in … (4)

A
  • beta-thalassemia
  • sickle cell
  • hyperthyroidism
  • megaloblastic anemia
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51
Q

What is Heinz body anemia?

A

unstable hemoglobins

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52
Q

Hb Koln has a mutation in the ________ chain and shifts the oxygen dissociation to the _________

A

beta, left

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53
Q

Hb Poole has a mutation in the _________ chain

A

gamma (goes away after birth)

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54
Q

Treatment for unstable Hb involves…

  • transfusions?
  • folic acid?
A

folic acid

55
Q

RBC count (increases/decreases) with high oxygen affinity hemoglobins

A

increases (O2 bound more tightly to Hb, doesn’t get to tissues, more RBCs produced to compensate for “hypoxia”)

56
Q

Cyanosis comes from…(3)

A
  • too much deoxyhemoglobin
  • too much methemoglobin (Fe3+ can’t carry O2, curve shifts left)
  • sulfhemoglobinemia (acquired from drugs, toxins)
57
Q

Hb M

A
  • mutation in alpha or beta chain, making Fe3+ resistant to reduction
  • chronic methemoglobin
58
Q

What is the treatment for acute methemoglobinemia?

A

methylene blue (artificial electron acceptor)

59
Q

Do you look red or blue with CO poisoning?

A

red (binding curve shifted left)

60
Q

What does pulse oximetry measure?

A

absorption (660nm - deoxyhemoglobin is maximal; 940 - oxyhemoglobin is maximal)

61
Q

When does hematopoiesis occur in the liver (and spleen)?

A

4-5 months gestation until around birth

62
Q

The least abundant cell type with the shortest lifespan is…

A

neutrophils (7 hours, 70 billion)

63
Q

Multipotent hematopoietic stem cells can become ___________ or ___________

A

myeloid or lymphoid stem cells

64
Q

How long does maturation of a RBC take?

A

about a week

65
Q

Describe characteristics of…

  • pronormoblast:
  • basophilic normoblast:
  • polychromatophilic normoblast:
  • orthochromic normoblast:
  • reticulocyte:
A
  • 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
Q

Megakaryopoiesis leads to formation of…

A

platelets

67
Q

Granulopoiesis leads to formation of…

A

neutrophils, basophils, eosinophils

68
Q

How long do neutrophils spend in…?

  • mitotic pool
  • maturation/storage
  • bone marrow overall
  • periphery
A
  • mitotic pool: 3-5 days
  • maturation/storage: 5-7 days
  • bone marrow overall: 8-12 days
  • periphery: 10 hours
69
Q

Describe the characteristics of…

  • myeloblasts
  • promyelocytes
  • myelocytes
  • metamyelocytes
  • bands
  • segmented neutrophil
A
  • 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
Q

IL-5 causes a promyelocyte to differentiate into _________ , IL-3 causes it to differentiate into _________, and SCF causes it to differentiate into _________

A
  • eosinophil (bilobed nuclei)
  • basophil (dark granules)
  • mast cell (found in tissue, not blood; smaller granules)
71
Q

Describe the characteristics of…

  • monoblast
  • pro-monocyte
  • monocyte
A
  • monoblast: purple granules, sometime vacuoles
  • pro-monocyte: frilly skirt cytoplasm, condensed/twisted nucleus
  • monocyte: kidney-shaped nucleus, vacuoles
72
Q

Describe the characteristics of…
-lymphoblast
-lymphocyte
-

A
  • lymphoblast: large NC ratio, open chromatin, hematodomes

- lymphocyte: smaller, condensed chromatin, no nucleoli, little cytoplasm

73
Q

What is the difference between a biopsy and aspirate?

A

biopsy: cohesive
aspirate: not cohesive

74
Q

______ cells stay the same over a lifespan but ________ vary

A

white cells, lymphocytes

75
Q

What are some causes of hypercellular bone marrow?

A
  • increased proliferation due to hypoxia

- decrease in hematopoietic growth factors

76
Q

What are some causes of hypocellular bone marrow?

A
  • autoimmune attack
  • viral attack on marrow
  • hematopoietic neoplasms
  • malnourishment
77
Q

__________ are the circulating equivalent of mast cells

A

basophils

78
Q

Mononuclear cells include __________ and ___________

A

monocytes, lymphocytes

79
Q

___________ makes eosinophils able to kill parasites

A

major basic protein

80
Q

Where in the lymph node are antibodies made?

A

cortex (come from B cells), deep cortex has T cells

81
Q

What is a Peyer Patch and where is it located?

A
  • small intestine

- decides what gets let in and if something that forces its way in should be considered a threat

82
Q

What is an antigen?

A
  • gets recognized by immune system

- generates antibodies

83
Q

What is an immunogen?

A

the best thing that we can inject in people and get a response

84
Q

What is a tolerogen?

A

a form of antigen that you won’t make an immune response to

85
Q

TNF decreases production of ________ and _________

A

iron, erythropoietin

86
Q

Lead decreases synthesis of …

A

protoporphyrin (ring that iron should go in the middle of)

87
Q

Without kidney function, there is no production of…

A

erythropoietin (precursor to RBCs)

88
Q

Lab findings of chronic inflammation or infection

A
  • mild anemia
  • normocytic or microcytic
  • decreased Fe, EPO, reticulocyte count
89
Q

Lab findings of lead intoxication

A
  • mild anemia
  • microcytic
  • decreased reticulocyte count
  • inhibited Hb synthesis
90
Q

Lab findings of renal insuffiency

A
  • moderate to severe anemia
  • normocytic
  • decreased EPO, reticulocyte count
91
Q

Lab findings of endocrine insufficiency or overactivation

A
  • all: decreased reticulocyte count and index
  • hypothyroidism: mild anemia, normochromic, normocytic
  • hyperthyroidism: normocytic
  • adrenal: mild anemia, normocytic
92
Q

When should you use EPO to treat anemia?

A
  • absolute deficiency

- decrease of cytokine out of proportion to hematocrit level

93
Q

What is sideroblastic anemia?

A

impaired production of protoporphyrin or incorporation of Fe

-accumulation of Fe in mitochondria

94
Q

Folate and vitamin B12 deficiencies lead to ineffective ____________ and result in _________ anemia

A

erythropoiesis, megaloblastic anemia

95
Q

Fe gets absorbed in _________, folate in __________, and vitamin B12 in ________

A
  • duodenum
  • jejunum
  • terminal ilium (stored in liver)
96
Q

Causes of vitamin B12 deficiency

A
  • autoimmune disease
  • intrinsic factor deficiency
  • malabsorption
  • defective transport/storage
  • metabolic defect
97
Q

Causes of folate deficiency

A
  • dietary insufficiency
  • malabsorption
  • drugs and toxins
  • inborn errors of folate metabolism
  • increased demands (i.e.: pregnancy)
  • increased loss or metabolism
98
Q

Lab test findings for folate and vitamin B12 deficiency

A
  • anemia
  • increased MCV
  • low reticulocyte count and index
  • unconjugated bilirubin, LDH
99
Q

Hb Portland 1 and Hb Portland 2

A

both are embryonic Hb

1: zeta2, gamma2
2: zeta2, beta2

100
Q

Hb Gower 1 and Hb Gower 2

A

both are embryonic Hb

1: zeta2, epsilon2
2: alpha2, epsilon2

101
Q

Hb Barts

A

tetramer of gammas

102
Q

Clinical manifestations of thalassemias

A
  • small RBCs (low MCVs)
  • low MCH, MCHC
  • uniform RBCs
  • increased RBC production
103
Q

common alpha-thal for African and Asian

A

African: (a-/a-)
Asian: (aa/–)

104
Q

What is the Hb electrophoresis of alpha-thal like?

A

normal (alpha is part of every Hb so no relative decreases)

105
Q

HbE results from a point mutation of _______ to _______

A

glu to lys

106
Q

What is the Hb electrophoresis of beta-thal like?

A
  • increased HbA2 (or F if mild)

- no HbA in Cooley’s

107
Q

Treatments for Cooley’s anemia (3)

A
  • transfusion
  • induction of fetal Hb
  • BMT
108
Q

Differentiate iron deficiency and thalassemia based on RBC and RDW

A

Fe deficiency: low RBC, high RDW

thalassemia: high RBC, normal RDW

109
Q

Beta-thal has increased Hb____

A

HbA1

110
Q

Structural Hb variants (point mutations)

  • S
  • C
  • E
A
  • 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
Q

Penicillin is given prophylactically to children with Sickle Cell to …

A

prevent infection, splenic dysfunction, death

112
Q

Head to toe complications of sickle cell

A

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
Q

What medicine is there for sickle cell?

A

hydroxyurea (reduces frequency of acute pain, mortality (proportional to increase in HbF, but no improvement for organ function)

114
Q

There is the most _____ antibody in blood

A

IgG

115
Q

epitope

A

specific part of antigen that interacts with specific part of antibody

116
Q

idiotype

A

An antibody that recognizes just one antibody in your body (making it like an antigen)

117
Q

How many individual polypeptide chains are there in IgA?

A

10 (4 light, 4 heavy, 1 J, 1 secretory)

118
Q

The first antibody to respond to a new antigen is ____

A

IgM

119
Q

What is the only antibody that the human fetus makes?

A

IgM

120
Q

_____ antibody crosses from mother to placenta

A

IgG

121
Q

_____ is the antibody that is protected in secretions

A

IgA

122
Q

How is a differential performed?

A
  • make blood film (wedge, cover slip, spinner)
  • air dry, fix in methanol
  • Wright-Giemsa stain
  • microscopy
123
Q

What are the 5 types of immunopatholgy?

A

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
Q

What is the total WBC count?

A

4.5-10.5 x 10^9/L

125
Q

How do lymph nodes differ from normal endothelium?

A

high and cuboidal as opposed to flat

126
Q

Is agglutination or precipitation a more sensitive test?

A

agglutination

127
Q

What are some clinical lab tests for hemolysis?

A
  • morphology
  • reticulocyte count
  • bilirubin
  • Hb
  • haptoglobin
  • methemalbumin metheme
  • enzymes
128
Q

What is the most abundant protein in the cytoskeleton?

A

spectrin

129
Q

What are some signs of hereditary spherocytosis?

A
  • anemia
  • intermittent jaundice
  • splenomegaly
130
Q

Unconjugated hyperbilirubinemia is a sign of…

A

hereditary spherocytosis

131
Q

G6PD leads to ____________ because of an inability to replenish ___________

A

extravascular hemolysis, glutathione

132
Q

What is a toxoid?

A

a harmless form of a toxin that retains its immunegeniticity

133
Q

What is the half-life of IgG?

A

3 weeks

134
Q

____________ are normally the largest cells in a peripheral smear

A

monocytes

Blood & Lymph (3 decks)

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