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Pathophysiology - MD > Week 3 - Blood > Flashcards

Week 3 - Blood Flashcards

1
Q

Blood Function

A

transport of O2 + CO2
protection - restricts fluid loss from damaged BV (platelets + clotting proteins)
regulation - of pH, electrolyte composition (interstitial fluid), body temp
-provides mechanism for rapid transport (nutrients, waste products, respiratory gases)

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2
Q

Blood is powered by…

A

the pumping action of the heart

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3
Q

Hemoglobin

A

oxygen carrying protein found in RBCs
-approx 280 million hemoglobin molecules in blood
-pigment containing iron (changes color based on oxygenation)
-globulin portion: transports CO2, carbonic anyhrase, nitric oxide
-heme groups (4): transport O2 (iron requred for O2 transport); each bound to a polypeptide; 4 binding sites for O2

within RBCs

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4
Q

COPD in Relation to Hemoglobin

A

hypoxemia stimulates erythropoeitin
-hemoglobin will appear both blue and red

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5
Q

Hemoglobin + O2

A

hemoglobin + O2 = weak bond

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6
Q

Hemoglobin + CO

A

hemoglobin + CO = strong bond
-binds 200x more avidly than O2

knocks O2 off of hemoglobin

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7
Q

Nitric Oxide

A

inactivated by Hemoglobin

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8
Q

Circulatory System

A

composed of cardiovascular system + lymphatic system

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9
Q

Cardiovascular System

Characteristics + Function

A

BV, heart + blood
function : transport nutrients, gases, hormones to cells and pick up wastes for transport for excretion

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10
Q

Lymphatic System

Characteristics + Function

A

network of vessels that return fluid escaped from blood vessels to bloodstream
-lymphocytes + lymphoid tissue
-fight against infections and provide immunity to disease
-detrimental -> metastases of cancer easily circulate

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11
Q

Blood Cells

Blood Composition

A

formed cells (34-54%)
-platelets/WBCs (“buffy coat”) = 0.1%
-RBCs = 99.9%

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12
Q

Plasma

Blood Composition

A

fluid portion and fibrinogen (46-63%)

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13
Q

pH of Blood

A

7.35-7.45

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14
Q

Blood Volume

Male v. Female

A

female: 4-5 L
male: 5-6 L

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15
Q

CBC

(“spun down”)

A

-plasma: 55% of whole blood
-“buffy coat” : <1% (platelets + WBCs)
-RBCs = 45%

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16
Q

Packed Cell Volume

A

RBC count / approximation of hematocrit %

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17
Q

Hematocrit

A

approximation of RBCs
-normal = 45%

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18
Q

Why are there less RBCs in females than males?

A

menstruation

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19
Q

Albumin

(Plasma Protein)

A

plasma proteins contributing to osmotic pressure of plasma
-transports lipids and steroid hormones
-aids w/ electrical components, pumps, and pressure gradients to keep everything in the body moving

most abundant

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20
Q

Plasma

A

-regulates body temp
-contains electrolytes
-transports blood cells, digestion and hormones

(90% water, nonliving part of blood)

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21
Q

RBC Function

A

-transport O2 from lungs to tissues
-transport CO2 from tissues to lungs

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22
Q

Components of RBCs

A

hemoglobin, lipids, ATP, carbonic anhydrase

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23
Q

Erythrocytes

A

transport O2 from lungs to tissues and CO2 from tissues to lungs
-production of HCO3 due to RBC carbonic anyhydrase
-made in red bone marrow (long bones, cranial bones, ribs, sternum and vertebrae)
-biconcave shape to squeeze through small spaces (30% more surface area for diffusion of O2 across membrane)
-lifespan = 100-120 days
-no organelles, ribosomes or nuclei

components: Hemoglobin, lipids, ATP, carbonic anhydrase

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24
Q

Leukocytes

A

WBCs for immune system defense

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25
Q

Platelets

(Function)

A

stops bleeding from damaged vessel (hemostasis)
-vascular spasm
-formation of platelet plug
-blood coagulation

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26
Q

Platelets

(Characteristics)

A

cell fragments necessary for hemostasis (clotting) shed from megakaryocytes
-remain functional for 10 days (removed by macrophages)
-do not leave blood (1/3 stored in spleen + released due to splenic contraction)

thrombocytes

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27
Q

Components of Plasma

A

90% H2O, 6-8% plasma proteins, 1% electrolytes (Na+/Cl-)
-nutrients (ex. glucose and amino acids)
-hormones (ex. cortisol and thyroxine)
-wastes (ex. urea)
-blood gases (ex. CO2 and O2)

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28
Q

Plasma Proteins

A

most produced in the liver (6-8% the plasma’s weight)
-albumins
-globulins (alpha, beta, gamma)
-fibrinogen
-functions: buffer pH, maintain osmotic pressure, antibodies, clotting factors

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29
Q

H2O

Plasma

A

90%; transport medium carrying heat

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30
Q

Electrolytes

Plasma

A

-membrane excitability
-osmotic distribution of fluid between ECF + ICF
-buffer pH changes

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31
Q

Nutrients, wastes, gases, hormones

Plasma

A

transported within the blood

blood gas CO2 plays role in acid-base balance

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32
Q

Plasma Proteins

Plasma

A

-exert osmotic effect (albumins) important in distribution of ECF between vascular and interstitial compartments
-buffer pH changes
-transport of hormones
-antibodies (gamma/immunoglobulins)
-clotting factors (fibrinogen)

albumins, globulins, fibrinogen

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33
Q

Albumins

Plasma Proteins

A

transport many substances, contribute most to colloid pressure

most abundant plasma protein

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34
Q

Alpha and Beta Globulins

Plasma Proteins

A

transport may water insoluble substances; clotting factors are alpha and beta; inactive precursor molecules (ex. angiotensin)

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35
Q

Alpha Globulins

Plasma Proteins

A

carries thyroid hormones
ex. angiotensin

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36
Q

Beta Globulins

Plasma Proteins

A

lipoprotein carrying Cholesterol + iron (Fe)

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37
Q

Gamma Globulins

Plasma Proteins

A

antibodies

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38
Q

Fibrinogen

Plasma Proteins

A

inactive precursor for fibrin meshwork of a clot

produced in liver

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39
Q

Hematopoiesis

(aka Hemopoiesis)

A

process of blood cell production

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40
Q

Stem Cell

A

cell in which all formed elements (other cells) are derived from

ability to develop into many different cell types

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41
Q

Reticulocyte

A

reticulocyte -> erythrocyte
-remain reticulocyte for 1-2 days in circulation
-make up 1-2% of erythrocytes

immature RBCs

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42
Q

Reticulocytes in Sickle Cell Patients

A

immature RBCs kicked out prematurely to keep up with production of RBCs

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43
Q

Lymphoblast

A

develops into lymphocytes

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44
Q

Proerythroblast

A

proerthyroblast -> early erythroblast -> late erythroblast -> normoblast -> reticulocyte -> erythrocyte
-committed cells (progenitor cells)
-activated by erythropoietin
-eject nucleus to turn into reticulocyte

in red marrow; develops into RBC

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45
Q

Myeloblast

A

myeloblast -> promyelocyte -> myelocyte -> metamyelocyte -> band cell -> [baso/neutro/eosino-phil]
develops into basophils, neutrophils, and eosinophils

eventually form leukocytes

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46
Q

Monoblast

A

monoblast -> promonocyte -> monocyte
develops into monocytes

enlarge and form macrophages

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47
Q

Megakaryoblast

A

megakaryoblast -> promegakaryocyte -> megakaryocyte -> platelets
-develops into platelets

(clotting)

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48
Q

Genesis of Erythrocytes

A

proerthyroblast -> early erythroblast -> late erythroblast -> normoblast -> reticulocyte -> erythrocyte

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49
Q

Genesis of Leukocytes

A

myeloblast -> promyelocyte -> myelocyte -> metamyelocyte -> band cell -> [baso/neutro/eosino-phil]

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50
Q

Regulation of total number of RBCs + platelets in circulation by…

A

negative feedback system
-increase WBC types based on response to pathogen

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51
Q

Besides the heart, the majority of blood goes…

A

to the brain, liver and kidneys

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52
Q

Kidney Function in Blood

A

stimulates marrow to increase RBC production if blood / O2 flow is low
-hypoxia in kidneys stimulates release of erythropoietin
-get 20% of blood volume w/ every heart beat
-production stops once kidney has received full 20% (negative feedback loop)

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53
Q

Control of Erythropoiesis by Kidneys: Process

A
  1. Kidneys detect reduced O2 carrying capacity of blood
  2. Less O2 delivered to kidneys -> secretion of hormone erythropoietin into the blood
  3. Erythropoietin stimulates erythropoiesis by bone marrow
  4. Additional circulating erythrocytes increase O2 carrying capacity
  5. Increased O2 carrying capacity relieves initial stimulus that triggered erythropoietin secretion
  6. Production of erythropoietin stops once kidney has received their 20% of oxygenated blood supply
54
Q

Erythropoietin

A

hormone stimulating RBC production

55
Q

Anemia

A

refers to below normal O2 carrying capacity of blood
(about 30% hematocrit)

characterized by low hematocrit/low Hb

56
Q

Microcytic Anemia

(Nutritional Anemia)

A

iron deficiency

57
Q

Macrocytic Anemia

(Nutritional Anemia)

A

low B12 or folate

58
Q

Megaloblastic Anemia

(Nutritional Anemia)

A

B9 (folic acid) deficiency

impaired DNA/RNA synthesis -> cells grow without dividing

59
Q

Pernicious Anemia

A

lack of intrinsic factor
-genetic
-atrophic gastritis, loss of parietal cells, gastric bypass, gastrectomy

60
Q

Aplastic Anemia

A

chemotherapy agents, radiation, etc.
-bone marrow shuts off

61
Q

Renal Anemia

A

renal (kidney) failure
-lack of erythropoietin

62
Q

Hemorrhagic Anemia

A

-GI: bleeding, ulcer, GERD
-menstruation
-bleeding disorders

63
Q

Hemolytic Anemia

A

ex. sickle cell

64
Q

Polycythemia

A

characterized by too many circulating RBCs and elevated hematocrit
-two types: primary & secondary

about 70% hematocrit

65
Q

Primary Polycythemia

(Polycythemia Vera)

A

caused by tumor like condition of bone marrow
-erythropoiesis proceeds at uncontrolled rate

66
Q

Secondary Polycythemia

A

erythropoietin induced adaptive mechanism to improve blood’s oxygen carrying capacity in response to prolonged oxygen delivery to tissues
-occurs normally in people living at high altitudes + COPD

67
Q

Myeloid Stem Cells form:

A

-RBCs
-platelets
-monocytes
-neutrophils (bacterial infection)
-eosinophils (allergic reaction)
-basophils

68
Q

Lymphoid Stem Cells form:

A

lymphocytes

69
Q

Leukocytes

A

WBCs for immune defense
-function outside of bloodstream in loose connective tissue
-have a nucleus
-larger than RBCs
-produced in bone marrow
-lifespan: 12 hour-several years
-two types: granulocytes + agranulocytes

70
Q

Granulocytes

Leukocytes

A

-Neutrophils (40-70%)
-Eosinophils (1-4%)
-Basophils (0-1%)

71
Q

Agranulocytes

Leukocytes

A

-Lymphocytes (20-45%)
-Monocytes (4-8%)

72
Q

Leukocyte Function

A
  1. defend against invading pathogens
  2. identify and destroy cancer cells
  3. removes worn out cells and tissue debris
73
Q

Differential WBC Count

A

-contains formed elements (platelets, leukocytes, erythrocytes)
-Granulocytes (neutrophils, eosinophils, basophils)
-Agranulocytes (lymphocytes + monocytes)

74
Q

Neutrophils

(polymorphonuclear granulocyte)

Leukocytes

A

-function: phagocytic cells destroy bacteria
-60-70% volume
-blue granules/nucleus w/ interconnected lobes
-most numerous + important WBC
-1st wave of cells in inflammation

75
Q

Eosinophils

(polymorphonuclear granulocyte)

Leukocytes

A

-function: role in allergic reactions, detoxify chemicals, reduce inflammation, attack parasitic worms
-2-4%
-bilobed nuclei; pink or yellow granules containing digestive enzymes

76
Q

Eosinophilia

A

increase in circulating eosinophils due to:
-allergic rxns
-asthma
-hay fever
-parasitic worm infection

77
Q

Basophils

(polymorphonuclear granulocyte)

Leukocytes

A

-function: inflammation
-<1%
-release heparin (clears fat from blood) + histamine to increase inflammatory response
-bilobed nuceli w/ large purple granules full of chemical mediators for inflammation

least numerous

78
Q

Heparin

(Basophils)

Leukocytes

A

-blood thinner
-clears fat from the blood
-activates anti-thrombin 3
-prevent clotting of blood samples
-used as anticoagulant drug

79
Q

Histamine

(Basophils)

Leukocytes

A

increases capillary permeability
-released due to allergic rxn

80
Q

Lymphocytes (B + T)

(mononuclear agranulocyte)

Leukocytes

A

-function: effective in fighting serious infections; act against specific molecule (antigen)
-20-25%
-dense purple staining round nucleus with little cytoplasm

main fucntional cells of adaptive immune system

81
Q

B Lymphocytes

Leukocytes

A

plasma cells -> antibodies
-antibody mediate (humoral) immunity

82
Q

T Lymphocytes

Leukocytes

A

directly destroy virus invaded cells and cancer cells
-do not produce antibodies
-punch holes in victim cell
-cell mediated immunity

83
Q

Monocytes

(mononuclear agranulocyte)

Leukocytes

A

-function: transform into macrophages; phagocytic cells
-4-8%
-largest leukocyte; kidney shaped nucleus
-emerge from bone marrow while immature
-circulate for 1-2 days
-mature/enlarge in resident tissues to become macrophages (65% in liver)
-lifespan = several months. -years

84
Q

What cell type would increase with a bacterial infection?

A

neutrophils

85
Q

What cell type would increase with a viral infection?

A

lymphocytes

86
Q

What cell type would increase with a parasitic infection?

A

eosinophils

87
Q

Thrombocytes

(Platelets)

A

cell fragments pinched off from megakaryocytes in red bone marrow
-important in preventing blood loss (platelet plugs, promotion of clots)
-lack nuclei
-organelles w/ enzymes for generating energy
-high conc. of actin and myosin
-lifespan = 10 days
-do not leave blood (1/3 stored in spleen; released upon splenic contraction)

88
Q

Thrombopoietin

A

hormone produced by liver increases number of megakaryocytes
-increase platelet production

89
Q

Growth Factors

A

needed to regulate differentiation and proliferation of different stem cells
-erythropoietin (RBCs)
-thrombopoietin (platelets)
-colony stimulating factors/CSFs + interleukins (WBCs)

90
Q

Heme

A

prosthetic group (Fe2+)
-acts as cofactor delivering O2 to tissues
-reversibly binds
-coenzyme = attached temporarily
-prosthetic group = attached permanently

91
Q

Carbon Monoxide (CO) + Hemoglobin

A

pushes O2 off hemoglobin
-brain is deprived of O2
-no O2 circulating

92
Q

Sulf-Hb

Abnormal Hemoglobin

A

forms due to increased sulfur in blood (irreversible reaction)

93
Q

Carboxy-Hb

Abnormal Hemoglobin

A

CO2 replaces O2 and binds 220x tighter than O2

ex. smokers -> acidic state

94
Q

Met-Hb

Abnormal Hemoglobin

A

contains oxidized Fe3+ that cannot carry O2

95
Q

Fetal Hemoglobin (HbF)

A

higher affinity for O2 than HbA (adult)
-maternal Hb (HbA) delivers HbF across placenta (fetal circulation)

96
Q

Erythropoiesis

A

production of RBCs; occurs in red bone marrow
-controlled by CNS neurotransmitters (found in hypothalamus)

stimulated by kidneys

97
Q

Erythropoiesis: Process

A
  1. starts in red bone marrow with proerythroblast
  2. cells near the end of development eject nucleus -> reticulocyte
  3. develop into mature RBC in 1-2 days
  4. negative feedback balances production with destruction
  5. controlled condition is amount of oxygen delivery to tissues
  6. hypoxia stimulates release of erythropoietin
98
Q

Spleen Function in Blood

A

removes old erythrocytes from circulation

99
Q

Negative Feedback System in Blood

(Kidneys)

A

stops the secretion of erythropoietin once O2 delivery to kidneys returns to normal (20%)

100
Q

Hemostasis

A

platelets role in stopping bleeding
-damaged BV sends signals for platelets -> vasoconstrict -> platelet plug -> clot reinforces plug
-3 steps:
1. vascular spasm
2. formation of plateelt plus
3. blood coagulation (clotting)

101
Q

Step 1:

Damage to BV -> Vascular Spasm

Hemostasis

A

immediate constriction of BV to minimize blood loss
-vessel walls press together (sticky/adherent)

102
Q

Step 2:

Platelet Plug Formation

Hemostasis

A

platelets attach to exposed collagen
-aggregation of platelets causes release of chemical mediators (ADP and Thromboxane A2)
-ADP = attracts more platelets
-Thromboxane A2 = powerful vasoconstrictor promoting aggregation and increased ADP

positive feedback loop

103
Q

Thromboxane A2

(Platelet Plug)

Hemostasis

A

powerful vasoconstrictor promoting aggregation and increasing ADP

104
Q

ADP

(Platelet Plug)

Hemostasis

A

attracts more platelets

105
Q

Prostacyclin

(Platelet Plug)

Hemostasis

A

inhibits platelet aggregation on normal, undamaged endothelium

106
Q

Step 3:

Blood Coagulation

(clot formation/cascade)

A

transformation of liquid blood to solid -> clot reinforces the plug (ex. scab)
1. activation of prothrombinase
2. conversion of prothrombin -> thrombin
3. conversion of fibrinogen -> fibrin (instrinsic clotting path)

extrinsic and intrinsic pathways

107
Q

Fibrin

A

meshwork of the clot
-contraction of platelets pulls damaged vessel close together

forms from fibrinogen by intrinsic clotting pathway

108
Q

Clotting Factors

A

always present in blood plasma (inactive form)

109
Q

Clotting Cascade

A

12 clotting factors leading to final conversion of fibrinogen -> stabilized fibrin mesh
-induced by vessel damage that exposes collagen
-converts fibrinogen to fibrin by instrinsic clotting pathway

110
Q

Intrinsic Pathway

(Clotting Casacde)

A

activated by contact w/ exposed collagen/stops internal bleeding
-7 steps
-sets off with Factor 12 (Hageman factor)

111
Q

Extrinsic Pathway

(Clotting Casacde)

A

-requires contact w/ tissue factors external to blood
-4 steps
-full break in the vessel (more dangerous/important)
-tissue thromboplastin released from traumatized tissue activates Factor X

112
Q

Intrinsic Pathway: Steps

(Clotting Cascade)

A
  1. Inactive factor 12 activated by damaged vessel -> Active Factor 12 (Hageman Factor)
  2. Inactive Factor 11 is activated by Factor 12 -> Active Factor 11
  3. Ca2+ (Factor 4) activates Factor 9
  4. Ca2+, Factor 8 & PF3 activate Factor 10
  5. Ca2+, Factor 5 & PF3 activate prothrombin (Factor 2) to Thrombin
  6. Fibrinogen (factor 1) activated by Thrombin -> Fibrin (loose mesh)
  7. Thrombin activates Factor 13 -> Fibrin (stabilized mesh)
  8. Entrapment of blood cells -> clot
113
Q

Extrinsic Pathway: Steps

(Clotting Cascade)

A
  1. Tissue damage -> tissue Thromboplastin (Factor 3)
  2. Ca2+ & Factor 7 activate Factor 10
  3. Ca2+, Factor 5 & PF3 activate prothrombin (Factor 2) to Thrombin
  4. Fibrinogen (factor 1) activated by Thrombin -> Fibrin (loose mesh)
  5. Thrombin activates Factor 13 -> Fibrin (stabilized mesh)
  6. Entrapment of blood cells -> clot
114
Q

Thrombus

A

abnormal intravascular clot attached to vessel wall

115
Q

Plasmin

Clot Dissolution

A

“fibrin splitting” enzyme that dissolves clot

breaks down Fibrin meshwork

116
Q

Plasminogen

Clot DIssolution

A

inactive pre-cursor activated by Factor 12 (Hageman Factor)

117
Q

Fibrinolysis

A

clot dissolved by activity of plasmin

118
Q

Emboli

A

freely floating clots

119
Q

Factors Causing Thromboembolism

(3)

A
  1. roughened vessel surface w/ atherosclerosis (build up on inside = not smooth, causes embolism -> turbulent blood flow knocks off plaque/plugs something -> triggers clotting path)
  2. stagnant blood forms clot; slow moving blood (broken leg -> DVT)
  3. occassionally triggered by release of tissue thromboplastin into blood from large amounts of traumatized tissue
  4. imbalances in clotting-anti-clotting system
120
Q

Hemophilia

A

excessive bleeding caused by deficiency of clotting factor
-cannot form clotting pathway -> bleed non-stop, not clot forms

commonly Factor 8 deficiency

121
Q

Thrombocyte Deficiency

A

low platelets
-can also lead to diffused hemorrhages

122
Q

Von Wildebrand’s Disease

A

condition causing extended or excessive bleeding
-often genetic (inherited)
-deficiency or impairment of Von Wildebrand Factor (vWF)
-vWF = allows platelets to stick to collagen (bridge for glycoprotein and collagen)
-cannot complete cascade = bleed

123
Q

vWF

(von Wildebrand Factor)

A

allows platelets to stick to collagen (bridge for glycoprotein and collagen)

124
Q

Blood Grouping

A

determined by antigens (agglutinogens) on RBC surface

125
Q

Agglutination

(clumping)

A

antibodies (agglutinins) bind to RBC antigens

can also lead to hemolysis (rupture) of RBCs

126
Q

Type A Blood

A

A antigens, anti-B antibodies

127
Q

Type B Blood

A

B antigens, anti-A antibodies

128
Q

Type AB Blood

A

A + B antigens, no antibodies

129
Q

Type O Blood

A

no antigens, anti-A + anti-B antibodies

130
Q

Rh +

A

have Rh factor
-most of population

131
Q

Rh -

A

do not have Rh factor

132
Q

Hemolytic Disease of Newborn (HDN)

A

mother produces anti-Rh antibodies (during first childbirth) that cross placenta (during second childbirth) and cause agglutination and hemolysis of RBCs

Pathophysiology - MD (7 decks)

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