Vol.3-Ch.9 "Hematology"

Question 1

Where does blood cell creation (HEMATOPOIESIS ) differ in location from fetus to adult?

Answer 1

As a fetus it takes place in everywhere but the bone marrow (in the liver, spleen, lymph nodes, and thymus (extramedullary hematopoiesis). But by the 4th month the bone marrow begins to produce as well.

After birth the bone marrow becomes the primary blood cell production with the additional help of just the liver and spleen.

By adulthood, blood cell is ONLY created in the bone marrow (intramedullary hematopoiesis)

Question 2

What is Hematopoiesis?

Answer 2

A process in which cellular components of blood are formed by the differentiation of a PLURIPOTENT STEM CELL.

Question 3

Pluripotent stem cells can form _____ _____ ____ ____, which then in turn can form _____ ____ that ultimately mature into _____(6)

Answer 3

Pluripotent stem cells can form MYELOID MULTIPOTENT STEM CELLS, which then in turn can form UNIPOTENT PROGENITORS, that ultimately mature into WHITE BLOOD CELLS (all types) RED BLOOD CELLS, & PLATELETS

Question 4

What role do the Kidney, Liver and Spleen play in blood?

Answer 4

The Kidneys (a to a lesser extent the liver) produce ERYTHROPOIETIN, the hormone responsible for red blood cell production.

The Liver removes toxins and produces many of the clotting factors and proteins in plasma.

The Spleen is an important part of the immune system and has cells that scavenge abnormal blood cells and bacteria.

Question 5

What is the normal volume of blood, and how much of the overall body weight is that?

Blood mass is largely determines by ___ & ___?

Normally the body can handle about ____ loss of blood, but with compensatory factors in a young healthy adult the body can compensate successfully for a loss of _____ blood.

Answer 5

There is normally an average of 85mL of blood per Kg, and this normally equates about 6% of the body mass.

Blood mass is largely determines by the amount of Red cells and plasma volume

Normally the body can handle about 0.5L loss of blood, but with compensatory factors in a young healthy adult the body can compensate successfully for a loss of 25-30% of blood.

Question 6

What are the 4 main components that make up blood?

Answer 6

• Plasma
• Red blood cells
• White blood cells
• Platelets

Question 7

What % of plasma is water?
proteins?
electrolytes, gases, and chemical messengers?

Answer 7

Plasma is:

• 90-92% water
• 6-7% proteins
• 2-3% electrolytes, gases, and chemical messengers

Question 8

What and where is Albumin?

What is it useful for?

Answer 8

Albumin is a large cell molecule that cannot pass in and out of the membranes easily which is good because its presence in plasma helps retain water for the capillaries through Osmotic Pull or Oncotic Pressure.

Adversely electrolytes can pass in and out with ease

Question 9

Red blood cells are _____.

They contain hemoglobin which are comprised of 4 subunits called _____ that each bond to a _____.

When fully saturated a hemoglobin can carry _____mL of O2 ; the body uses up about _____ of O2 per Kg of body weight every MINUTE.

Answer 9

Red blood cells are biconcave disks that DO NOT have a nucleus.

They contain hemoglobin which are comprised of 4 subunits called GLOBIN that each bond to a HEME (iron containing molecule).

When fully saturated a hemoglobin can carry 1.34mL of O2 ; the body uses up about 4mL of O2 per Kg of body weight every MINUTE.

Question 10

The lower the pH (more acidic) of blood the Oxygen Dissociation curves to the ____ meaning that it _____ O2 more easily.

The high the pH (more alkalotic) of blood the Oxygen Dissociation curves to the _____ meaning that it _____ O2 more easily.

Answer 10

The lower the pH (more acidic) of blood the Oxygen Dissociation curves to the RIGHT meaning that it GIVES UP O2 more easily.

The high the pH (more alkalotic) of blood the Oxygen Dissociation curves to the LEFT meaning that it HOLD ON TO O2 more easily.

Question 11

What is the Bohr Effect?

Answer 11

It is the tendency of CO2 saturated blood to want to diffuse into the alveoli in the lungs, allowing the O2 breathed in the bond to the hemoglobin via the heme.

Likewise when the O2 saturated blood reaches the body tissues, the CO2 from the tissues wants to bind to the hemoglobin so it forces the release of O2 at the tissues.

(Remember that Hemoglobin has a higher affinity for CO2 than O2)

Question 12

What are 4 different things that may affect the Oxygen Dissociation Curve? (or what affects hemoglobin’s oxygen affinity)

Answer 12

• pH
• PCO2
• Concentration of 2,3 Biphosphoglycerate
• Temperature
  (high temps = lessened affinity for O2 ; lower temps = increase affinity for O2)

Question 13

Hemoglobin has an ____ times more affinity for CO over O2.

Even if 1 CO molecule binds to a hemoglobin, how does that effect the other 3 O2 molecules.

Answer 13

Hemoglobin has an 200-250 times more affinity for CO over O2.

Even if 1 CO molecule binds to a hemoglobin, it alters the hemoglobin so that it holds on the O2 molecules also attached so that it is harder for them to be released.

Question 14

What does a shift to the RIGHT on the Oxygen-Hemoglobin Dissociation Curve mean?

A shift to the LEFT means?

Answer 14

To the RIGHT = a DECREASE in hemoglobin’s affinity to O2

To the LEFT= a INCREASE in hemoglobin’s affinity to O2

Question 15

What senses and stimulates the production of red blood cells (ERYTHROPOIESIS)?

What can cause a decrease in RBCs

Answer 15

RENAL CELLS sense hypoxia and then secrete ERYTHOPOIETN (hormone) to stimulate the bone marrow to start producing more RBCs.

Hemorrhaging, hemolysis (destruction of RBCs), or Sequestering of RBCs can all decrease the count of RBCs

Question 16

What contains cells that will scavenge and remove damaged or abnormal red blood cells? what are the cells called?

Answer 16

The Liver and Spleen have MACROPHAGES that are specialized white blood cells that will scavenge and remove damaged or abnormal red blood cells.

Question 17

What are the 3 ways that you can measure the amount of RBCs?

Answer 17

• You can take the RBC count in millions per cubic millimeter (mm^3) which gives the total body count of blood ; usually measures between 4.2-6 million/mm^3
• Hematocrit is the packed cell volume of RBCs per unit of blood. Taken by putting a sample of blood in a test tube and putting it in a centrifuge. Since RBCs are the heaviest blood component (b/c of the iron containing molecule heme in hemoglobin) it will sink to the bottom leaving a thin line of white blood cells separating the RBCs and the plasma (on top). You then take the percentage volume of RBCs against the total volume in the tube and get a % which is normally between 40-52%
• you can also take a measurement of Hemoglobin present which is normally 12-15g/dL in men and is 10.5-14g/dL in women

Question 18

White blood cells can move very freely in blood but some choose not to and would rather adhere to vessel walls until they are called upon. These are called ____ leukocytes. Other stimulate chemical or immune responses.

Answer 18

White blood cells can move very freely in blood but some choose not to and would rather adhere to vessel walls until they are called upon. These are called MARGINATED leukocytes. This property also allows them to squeeze through vessel walls (via DIAPEDESIS) to follow chemical messengers (CHEMOTAXIS) directly to an area of infection.

Question 19

White blood cell count is normally _____ but can rise up to _____ per microliter of blood. Insinuating an infection is present,

Answer 19

White blood cell count is normally 5k-9k but can rise up to 16k per microliter of blood. Insinuating an infection is present,

Question 20

White blood cells originate in bone marrow from Undifferentiated stem cells through LEUKOPOIESIS which respond to specific growth factors that allow them to differentiate into what 3 categories?

Answer 20

• Granulocytes
• Monocytes
• Lymphocytes

Question 21

What are the 6 stages of Granulocyte cell formation and what gives them their distinct coloration for each types?

Answer 21

Granulocytes start as a MYELOBLAST 
then form into a PROMYELOCYTE,
to METAMYELOCYTE, 
to BAND FORM 
and lastly a MATURE FORM

A BASOPHIL absorbs basic stains and has BLUE granules

A EOSINOPHIL absorbs acidic stains and has RED granules

A NEUTROPHIL absorbs neither acidic nor basic stains and has blue and pink stains

Question 22

What are the 3 types of granulocytes?

What do they do?

Answer 22

• Basophil:
  Function mostly in allergic reactions. They house all
  the HISTAMINE released for an allergic reaction as
  well as HEPARIN that breaks down clots.
• Eosinophil:
  They can inactivate the chemical mediators of acute
  allergic reactions (regulate anaphylactic response).
  And also contain Major Basic Protein (MBP) that is
  released with an antibody to specifically fight off
  PARASITE infections.
• Neutrophil:
  Primary fighter of infections. They leave blood stream
  via Diapedesis to engulf and kill microorganisms via
  phagocytosis.

** Neutropenia is low count of neutrophils which can lead to an infection being able to kill the host

Question 23

What do Monocytes do?

Answer 23

They are the “garbage collectors” of the immune system and engulf foreign invaders and dead neutrophils.

They can also secrete growth factors to stimulate production of granulocytes and RBCs

Also they can fight tumor cells and participate in tissue repair

Question 24

What do Lymphocytes do?

What are the 2 main types?

Answer 24

They are the primary cells involved in the immune response. They have no staining or granules but they do have specialized surface receptor sites specific to a single antigen, ready to respond quickly if the antigen comes back.

• T cells:
  mature in the Thymus and are responsible for cell
  mediated, or cellular immunity. Once activated by an
  antigen they are responsible for generating
  EFFECTOR cells that cause delayed-type
  hypersensitivity reactions (graft rejections, organ
  rejections, etc)
• B cells:
  produce antibodies to combat infections and
  allergens through humoral immunity

Question 25

What is an autoimmune disease?

Answer 25

It is when the body makes antibodies against it’s own tissues

Question 26

How are Platelets (Thrombocytes) formed?

What do they do?

Answer 26

They are fragments of larger cells called Megakaryocytes.

Megakaryocytes come from unindifferintiated stem cells in bone marrow that when combined with thrombopoietin (hormone) simulates them to turn into Megakaryocytes. Once Megakaryocytes mature they break up into Thrombocytes aka Platelets.

When platelets come into contact with injured tissue they secrete a substance that makes them “sticky” which leads to them aggregating to the injured area and tissue surrounding it to form a Clot. As they aggregate they also initiate the first signal that starts the blood clotting system. Platelets usually last 7-10 days before being removed from circulation by the spleen.

Question 27

What are the first 3 things that happen when a vessel is damaged and begins to bleed?

Answer 27

• Smooth muscle fibers contract in the vessel walls (tunica media) which decreases the size of the whole and makes clotting easier
• Next the platelets begin to stick to the damaged area and form a platelet clot (which is unstable) by adhering to the exposed collagen that normally is not exposed unless there is wall damage
• Lastly the signals sent out by the damaged tissue and the aggregating platelets calls for the liver proteins Prothrombin and Fibrinogen to be released to come make the unstable clot stable. Fibrin forms a weave like structure to make the clot more stable.

Question 28

The coagulation cascade can be summarized as:

a more exact version

Answer 28

1.A: INTRINSIC PATHWAY: Tissue damage release
substances that lead to the formation of prothrombin
activator. (damage came from inside)

B: EXTRINSIC PATHWAY: Tissue damage causes
platelet aggregation and the formation of
prothrombin activator. (damage came from outside)

2. COMMON PATHWAY: The prothrombin activator in the presence of calcium converts prothrombin to thrombin
3. THROMBIN: in the presence of calcium, thrombin converts fibrinogen to stable fibrin which then traps blood cells and more platelets to form a more stable clot

Question 29

Fibrinolysis VS Thrombosis

Answer 29

Thrombosis is the formation of a clot

Fibrinolysis is the dismantling or “lysing” of a clot ; once a clot is formed it starts releasing a chemical messenger called plasminogen which gets converted into plasmin which is capable of lysing clots.

Question 30

Vitamin ____ can lead to an increase in clotting capability and blood _____ can cause clotting to being.

Answer 30

Vitamin K can lead to an increase in clotting capability and blood stagnation can cause clotting to being.

Question 31

Type A blood types have: ?antigen ?antibody
Type B blood types have: ?antigen ?antibody
Type AB blood types have: ?antigen ?antibody
Type O blood types have: ?antigen ?antibody
+ blood types are positive for what antigen?

Answer 31

Type A blood types have: A antigen and B Antibody
Type B blood types have: B antigen and A Antibody
Type AB blood types have: A & B antigens
Type O blood types have: A & B Antibodies

If a person has a + blood type they are positive (+) for the Rh antigen, likewise if they don’t have the antigen they are -

(remember that antigens are the ones that want to start fights and the blood types are names after their fighters) and O is named after having 0 fighters)

O- is ultimate donor and AB+ is ultimate recipient

if the 2 peoples blood does not coagulate, then they are cleared for a transfusion

Question 32

What is Erythroblastosis Fetalis?

Answer 32

Is is a condition in which a mother with a + blood type has a - blood type fetus then the mothers blood will often cause a fatal reaction with the fetus’

Question 33

TREATMENT FOR BLOOD TRANSFUSION REACTIONS IS ON PG 379, GIVE IT ANOTHER READ!

Answer 33

TREATMENT FOR BLOOD TRANSFUSION REACTIONS IS ON PG 379, GIVE IT ANOTHER READ!

Question 34

What is Anemia?

Answer 34

Anemia is the most common RBC disease and is classified as a hematocrit of less than 37% in women or less than 40% in men. Although both usually remain asymptomatic until the reach below 30%.

It is usually a sign (not a disease itself) that something else is wrong that is effecting the RBC production or hemoglobin quality.

The end result of this is hypoxia, and the severity of hypoxia usually depends on the severity and acuity of the anemia

Question 35

What is Hemolytic Anemia?

Answer 35

Anemias that result from the destruction of RBCs.

These can be hereditary (like sickle cell) or acquired (through drug/environmental effects)

Question 36

Sickle cell disease VS sickle cell trait?

Answer 36

Sickle cell disease is when there is only production of sickle cells (hard, C, shaped RBCs) and no normal RBCs

Sickle cell trait is when there is production of both sickle cells and normal RBCs

Question 37

Why is sickle cell disease so destructive?

Answer 37

Because it can cause slugging of the blood which leads to obstruction of blood flow to various tissues and organs causing multiple organ problems.

It can also cause VASOOCLUSIVE CRISIS in which it can completely block blood flow

Thankfully sickle cells only last for 10-20 days as opposed to 120 for healthy RBCs

Question 38

What are 3 specific problems that can arise with Sickle Cell Disease?

Answer 38

• Vassooclusive Crisis:
  Complete blockage of blood flow causing Ab pain,
  priapism, pulmonary probs, renal infarctions, cerebral
  infarctions
• Hematologic Crisis:
  A severe fall in hemoglobin, sequestration of RBCs in
  the spleen, and probs in the bone marrow including
  shut down
• Infectious Crisis:
  it often causes immunosuppression leaving them
  vulnerable to infection, this is most often the cause of
  death

Question 39

What is Polycythemia?

Answer 39

It is the abnormally high count of Hematocrit, when it is above 50%! It can occur secondary to dehydration but the main problem is that it greatly increases the chances of Thrombosis, which is the main killer in Polycythemia

Question 40

The _____ is the main blood component protecting against a bacterial or fungal infection. A reduction in _____ predisposes the pt to bacterial and fungal infections.

Answer 40

Neutrophils (Neutropenia)

Knowing the count of Neutrophils is the best indicator to how the entire WBC population is doing

Question 41

What is the normal count of WBCs per cubic millimeter of blood.

Low white blood cells = _____
High white blood cells = _____

Answer 41

5,000-9,000

Low white blood cells = Leukopenia

High white blood cells = Leukocytosis
(A presence of 30,000+ WBCs is called a Leukemoid Reaction and is indicative of a problem with excess WBC production, however a count of 10,800-23,000 can be a sign of a bacterial infection, especially if they are mostly “bands” or “segs” which are immature neutrophils)

Question 42

What is Leukemia?

Answer 42

It is cancer of the hematopoietic cells, causing abnormal production of WBCs in bone marrow

Question 43

What is Lymphoma?

What are the 2 types?

Answer 43

It is cancers of the lymphatic system

Hodgkin’s and Non-Hodgkin’s Lymphoma
(Hodgkin’s has a much better survivability)

Non-H usually presents with painless swelling of the lymph nodes, while H usually has no related symptoms

Question 44

What is Thrombocytosis?

Polycythemia Vera?

Answer 44

Thrombocytosis is an increase in the number of platelets, usually from increased production

Polycythemia Vera is the increase production of both platelets AND RBCs.

Pts with Thrombocytosis are usually asymptomatic

Question 45

What is Thrombocytopenia?

Acute Idiopathic Thrombocytopenia Purpura (ITP)?

Answer 45

Thrombocytopenia is a decrease in platelet count. Either from decreased production, sequestration of platelets in the spleen, destruction of platelets, or any combo of the 3.

Acute Idiopathic Thrombocytopenia Purpura (ITP) is destruction of platelets caused by the body’s own immune system.

Question 46

What is Hemophilia?

What are the 2 main types?

Answer 46

Hemophilia is a disorder in which one of the proteins necessary for blood clotting is missing or defective.
It is a sex-linked hereditary bleeding disorder that is passed on through the X chromosome. (for females with 2 x’s they must both carry the gene, but boys with one x and one y only need the one defective x)

• Hemophilia A:
  Is a deficiency of factor VIII, most common
  hemostatic disorder, but less severe than B
• Hemophilia B:
  Is a deficiency of factor IX (Christmas Disease)

Question 47

What is hemarthrosis?

Answer 47

It is a common hemophilia related problem where there is bleeding into a joint space

Question 48

Pts with Hemophilia will still produce vasoconstriction and platelet aggregation so what do you need to be wary of?

Answer 48

The platelet plug will not be stable b/c of the deficiency of factor VIII so you must be wary of re-bleeds or prolonged bleeding

Question 49

What is Von Willebrand’s Disease?

Answer 49

In addition to being low on factor VIII it is also low on a sub-factor of factor VIII called VIII:vWF which decreases the platelets ability to aggregate. (and remember VIII decreases the amount of fibrin there so its already a loosely aggregated platelet plug)

Question 50

REREAD DISSEMINATED INTRAVASCULAR COAGULATION AND MULTIPLE MYELOMA ON PG 388

Answer 50

REREAD DISSEMINATED INTRAVASCULAR COAGULATION AND MULTIPLE MYELOMA ON PG 388