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BB Lec M1.2 Flashcards

1
Q

State three areas of RBC biology that are crucial for normal erythrocyte survival and function

A
  1. Normal chemical composition and structure of the RBC membrane
  2. Hemoglobin structure and function
  3. RBC metabolism
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2
Q

Give me the components of the RBC Membrane

A

A semipermeable lipid bilayer supported by a mesh-like protein cytoskeleton structure

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3
Q

MAIN LIPID COMPONENT of the RBC Membrane

A

Phospholipids

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4
Q

What is the biochemical composition of the RBC membrane

A

52% protein, 40% lipid, and 8% carbohydrate

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5
Q

RBC life span

A

120 Days

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6
Q

The biochemical composition of the RBC maintains a critical role in two RBC characteristics. What are these characteristics?

A

RBC Deformability and RBC Permeability

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7
Q

When there is a loss of membrane deformability, there is a loss of (1) _____ and decrease of (2) _______.

A

(1) Loss of ATP (Adenine triphosphate)
(2) Decrease of phosphorylation of spectrin

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8
Q

What is spectrin?

A

A protein that maintains the stability and structure of the cell membrane and the shape of a cell

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9
Q

Accumulation or increase in the deposition of membrane ______ also results in membrane rigidity and loss of pliability.

A

Calcium

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10
Q

What is the organ that functions in extravascular sequestration?

A

Spleen

They are in charge of the removal of aged, damaged, or less deformable RBCs or fragments of their membrane. Meaning if the RBC membrane is not deformable, they are at a disadvantage going through smaller blood vessels, which later on damages the RBC, resulting in the removal or sequestration of the spleen.

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11
Q

Loss of the viable red cell membrane results in the formation of these type of abnormal red cells.

A

Spherocytes and Bite Cells

Note that survival of these cells are shortened

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12
Q

One of the permeability properties of the RBC membrane and the active RBC cation transport prevents is ____

A

Colloid hemolysis

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13
Q

TRUE OR FALSE:

Any abnormality that increases permeability or alters cationic transport may increase RBC survival.

A

FALSE

If RBC membrane is more permeable and cationic transports accumulates, RBC storage lesion may form, which shortens RBC survival.

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14
Q

TRUE OR FALSE:

The RBC membrane is freely permeable to water and cations.

A

FALSE

They are freely permeable to water and ANIONS

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15
Q

Give me 2 example of cations

A

Sodium (Na+) and Potassium (K+)

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16
Q

What are the two variable being maintained by controlling the intracellular concentrations of sodium and potassium

A

RBC volume and water homeostasis

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17
Q

What is the erythrocyte intracellular-to-extracellular ratios for Na+?

A

1:12

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18
Q

What is the erythrocyte intracellular-to-extracellular ratios for K+?

A

25:1

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19
Q

How many cationic pumps are actively transporting Na+ out of the cell and K+ into the cell, requiring energy in the form of ATP?

A

300

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20
Q

It is a cytoplasmic calcium-binding protein, and is speculated to control these pumps and to pre-vent excessive intracellular Ca2+ buildup.

A

Calmodulin

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21
Q

Between Na+ and K+ in a normal case, what cation goes out and in of an RBC?

A

Na+ (Sodium) should go out of the cell and K+ (Potassium) should go into the cell.

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22
Q

Between Na+ and K+ in an abnormal case, what cation goes out and in of an RBC?

A

Na+ (Sodium) stays in the cell and K+ (Potassium) stays out of the cell.

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23
Q

Low Affinity to Oxygen

A

Tensed Form 2,3-DPG

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24
Q

High Affinity to Oxygen

A

Relaxed Form 2,3-DPG

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25
Q

Why are RBCs’ metabolic pathways are mainly anaerobic?

A

Due to the following:
- The function of the RBC is to deliver oxygen, not to consume it. -
- Because the mature erythrocyte has no nucleus and there is no mitochondrial apparatus
- For oxidative metabolism, energy must be generated almost
exclusively through the breakdown of glucose.

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26
Q

State the 3 ancillary pathways of the RBC

A
  • Pentose phosphate pathway
  • Methemoglobin reductase pathway
  • Luebering-Rapoport shunt
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27
Q

Main RBC Metabolism Pathway

A

Glycolytic Pathway

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28
Q

What is the process of Glycolytic Pathway and explain it.

A

Glycolysis – Conversion of Glucose to Pyruvate

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29
Q

Glycolysis generate (1) ___ of ATP, while pentose phosphate pathway provides (2) ___ energy.

A

(1) 90%
(2) 10%

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30
Q

This pathway permits the accumulation of an important RBC organic phosphate, 2,3-diphosphoglycerate

A

Luebering-Rapoport shunt

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31
Q

The amount of ______ found within RBCs has a significant effect on the affinity of hemoglobin for oxygen and therefore affects how well RBCs function post-transfusion.

A

2,3-DPG

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32
Q

Primary function of Hemoglobin

A

Gas transport (O2 to tissues & CO2 excretion)

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33
Q

The unloading of oxygen by hemoglobin is accompanied by widening of a space between (1) _____ and the binding of 2,3-DPG with the formation of (2) ____

A

(1) β chains
(2) Anionic Salt Bridges

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34
Q

What is the Storage Time if Citrate-phosphate dextrose (CPD) is added? Is it an anticoagulant or additive?

A

21 Days (Anticoagulant)

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35
Q

Allosteric changes that occur as the hemoglobin loads and unloads oxygen are referred to as the ____

A

Respiratory Movement

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36
Q

What is the Storage Time if Citrate-phosphate-double-dextrose (CP2D) is added? Is it an anticoagulant or additive?

A

21 Days (Anticoagulant)

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37
Q

The dissociation and binding of oxygen by hemoglobin are NOT DIRECTLY PROPORTIONAL to the partial pressure of oxygen (pO2) in its environment but instead exhibit a ______.

A

Sigmoid Curve Relationship a.k.a hemoglobin-oxygen dissociation curve

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38
Q

What happens to 2,3-DPG if there is a shift to the left result in hemoglobin-oxygen dissociation curve?

A

Decrease

REMEMBER! (pacheck kay ma’am may problem sa book)
– Pag shift to the left, lahat decrease maliban sa pH and Abn Hb
– Pag shift to the right, pH lang ang decrease

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39
Q

RBC viability is a measure of ____ RBC survival following transfusion.

a. In vitro (Outside or Inside?)
b. In vivo (Outside or Inside?)

A

b. In vivo (Inside)

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40
Q

The U.S. Food and Drug Administration (FDA) requires an average 24-hour post-transfusion RBC survival of more than ___.

A

75%

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41
Q

To maintain optimum viability, blood is stored in the liquid state between ______ for a specific number of days

A

1°C and 6°C

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42
Q

The loss of RBC viability has been correlated with the _____, which is associated with various biochemical changes

A

Storage lesion

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43
Q

In RBC Storage Lesions state if these characteristics are increased or decreased (Except O2 Dissocation form: Left or Right?).

(a) Viable cells (%)
(b) Glucose
(c) ATP
(d) Lactic acid
(e) pH
(f) 2,3-DPG
(g) Oxygen dissociation curve
(h) Plasma K+
(i) Plasma hemoglobin

A

(a) Viable cells (%) - Decrease
(b) Glucose - Decrease
(c) ATP - Decrease
(d) Lactic acid - Increase
(e) pH - Decrease
(f) 2,3-DPG - Decrease
(g) Oxygen dissociation curve - Shift to the Left
(h) Plasma K+ - Increase
(i) Plasma hemoglobin - Increase

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44
Q

It has been reported that within the ___ hour after transfusion, most RBC clearance occurs.

A

First hour

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45
Q

Approximately ______ mg of iron are contained in one RBC unit.

A

220 to 250

46
Q

What is the Storage Time if Acid citrate-dextrose (ACD-A) is added? Is it an anticoagulant or additive?

A

21 Days (Anticoagulant)

47
Q

What is the Storage Time if Citrate-phosphate-double-dextrose (CP2D) is added? Is it an anticoagulant or additive?

A

21 Days (Anticoagulant)

48
Q

What is the Storage Time if Citrate-phosphate-dextrose-adenine (CPD-A) is added? Is it an anticoagulant or additive?

A

35 Days (Anticoagulant)

49
Q

All blood stored in all (1) ___ preservatives becomes depleted of 2,3-DPG by the (2) ___ week of storage.

A

(1) CPD
(2) Second

50
Q

The 2,3-DPG concentrations after transfusion have been reported to reach normal levels as early as __ hours post-transfusion.

A

6 hours

51
Q

Added to RBCs after removal of plasma?

A

Additive solutions

52
Q

Storage material where the majority of blood is stored.

A

Polyvinyl Chloride (PVC) Plastic Bags

53
Q

Currently approved additive solutions.

A

AdSol (AS-1) (Baxter Healthcare)
Nutricel (AS-3) (Pall Corporation)
Optisol (AS-5) (Terumo Corporation)

54
Q

What causes blood units to be more viscous?

A

High hematocrit

55
Q

What component of additive solutions protects RBCs against storage related hemolysis?

A

Mannitol

56
Q

3 main benefits of AdSols.

A
  1. Extends the shelf-life of RBCs to 42 days by adding nutrients
  2. Allows for the harvesting of more plasma and platelets from the unit
  3. Produces a packed RBC of lower viscosity that is easier to infuse
57
Q

What is the advantage of plastic bag containers over glass containers?

A

It promotes respiration which makes the storage time of RBCs longer.

58
Q

AdSols reduce hematocrit levels to around __% to __% with a volume of approx. 300-400 mL

A

55, 65

59
Q

Additive solutions maintain 2,3-DPG throughout its storage time. In RBCs stored with primary anticoagulant preservatives, 2,3-DPG is not depleted by the second week of storage.
a. Statement 1 is true. Statement 2 is false.
b. Statement 1 is false. Statement 2 is true.
c. Both statements are true.
d. Both statements are false.

A

D.
None of the AdSols maintain 2,3-DPG throughout its storage time.
In RBCs stored only with primary anticoagulant preservatives, 2,3-DPG is depleted by the second week of storage.

60
Q

Shelf life of plasma if frozen at temperature <-25 deg. C

A

3 years

61
Q

What is the maximum shelf life of autologous units and rare blood types once RBCs are frozen?

A

10 years

62
Q

What cryoprotectant is used for RBCs that are less than 6 days old?

A

20% or 40% glycerol protectant / Glycerol

63
Q

What is the normal freezing temperature?

A

-65 deg. C

64
Q

What are the two concentrations of glycerol that are used to freeze RBCs?

A
  1. High-concentration glycerol (40% weight in volume [wt/vol])
  2. Low-concentration glycerol (20% wt/vol)
65
Q

Most blood banks that freeze RBCs use the ___

A

high-concentration glycerol technique

66
Q

Each unit of whole blood collected contains 450 mL of blood and ___ of anticoagulant or 500mL of blood and ___ anticoagulant.

A

63mL, 70mL

67
Q

During deglycrolization , the cryoprotectant is systematically replaced with decreasing concentrations of saline. What are the concentrations?

A

12% saline followed by 1.6% saline and finally washing with 0.2% dextrose normal saline.

68
Q

What is the purpose of the deglycrolization process before transfusing frozen cells?

A

To prevent cells accompanied by hypertonic glycerol and RBC lysis.

69
Q

What should be monitored to ensure adequate deglycerolization?

A

Osmolality

70
Q

Upon the addition of glycerol or saline solutions, the outdating period of thawed RBCs has been ___

A

24 hours

71
Q

RBCs in CPD or CPDA-1 are glycerolized and frozen within _____ of whole blood collection

A

6 days

72
Q

This is the process of enhancing and restoring ATP and 2, 3- DPG levels by metabolic alterations.

A

RBC Rejuvenation

73
Q

RBCs (liquid state) when stored in CPD, CPDA-1, and AS-1 storage solutions can be rejuvenated at outdated or up to _____ after outdated.

A

3 days

74
Q

What is the rejuvenating agent used for RBC rejuvenation?

A

Rejuvesol

75
Q

What are the contents of Rejuvesol?

A

phosphate, inosine, and adenine

76
Q

Rejuvenated RBCs must be washed before infusion to remove the ____ (which is toxic) and transfused within _____.

A

inosine, 24 hours

77
Q

Shelf life of platelet.

A

5 DAYS

78
Q

State the two main reasons for the 5-day shelf life.

A
  1. Bacterial contamination at incubation of 22 degree celsius
  2. Loss of platelet quality
79
Q

Main functions of platelet.

A

Blood coagulation
Treat or prevent bleeding

80
Q

Approximately ___ to ___ of the platelet inventory is discarded either by the blood supplier or the hospital blood bank.

A

20%, 30%

81
Q

Platelets are stored at __ to ___

A

20°C, 24°C

82
Q

What is the purpose of continuous agitation of the platelets?

A

To facilitate oxygen transfer into the platelet bag and oxygen consumption by the platelets.

83
Q

The loss of platelet quality during storage is known as the _____

A

platelet storage lesion

84
Q

What is the the principal buffer during the storage of platelet concentrates (PCs) in plasma?

A

bicarbonate

85
Q

Rejuvenated RBCs may be prepared up to __ days after expiration when stored in CPD, CPDA-1, and AS-1 storage solutions.

A

3 Days

86
Q

When the bicarbonate buffers are depleted during platelet concentrate storage, the pH rapidly falls to <6.2, what does it mean?

A

Loss of platelet viability
Membrane integrity

87
Q

True or False. The pH change to less than 6.2 is irreversible.

A

True

88
Q

What is the key parameter for retaining platelet viability in vivo when platelets were stored at 20 degC to 24 degC?

A

Maintaining pH

89
Q

Quality-control measurements for platelet concentrates.

A

Platelet concentrate volume
Platelet count
pH of the unit
Residual leukocyte count

90
Q

How is visual inspection done for platelets? What is the expected result?

A

platelet swirl (no visible aggregation)

91
Q

TRUE OR FALSE

Immediately before distribution to hospitals, a visual inspection is made that often includes an assessment of platelet swirl (no visible aggregation). The presence of platelet swirling is associated with the loss of membrane integrity during storage, resulting in the loss of discoid shape with irreversible sphering.

A

FALSE

No platelet swirling, meaning there is an aggregation, meaning there is a loss of membrane integrity during storage.

92
Q

In Vitro platelet assays in relation with in vivo survival

A

pH
Shape change
Hypotonic shock response
Lactate production
Partial pressure of oxygen

93
Q

What is the current trend in preparing platelet concentrates from whole blood?

A

platelet apheresis

94
Q

Used to measure platelets after transfusion and serves as an assessment for the effectiveness of the transfusion. Measure of the expected increase in platelets following a platelet transfusion

A

CCI or corrected count increment

95
Q

Failure to achieve acceptable increase in platelet count following platelet transfusion.

A

Refractory

96
Q

Platelet Storage Lesion Characteristics (Increase or Decrease)

(a) Lactate
(b) pH
(c) ATP
(d) Loss of Swirling Effect (Discoid to Spherical)
(e) Degranulation
(f) Platelet Activation Markers
(g) Platelet Aggregation

A

(a) Lactate - Increase
(b) pH - Decrease
(c) ATP - Decrease
(d) Loss of Swirling Effect (Discoid to Spherical) - Decrease
(e) Degranulation - Increase
(f) Platelet Activation Markers - Increase
(g) Platelet Aggregation - Drop in response to some agonists

97
Q

A pool of 6 platelet concentrates should achieve an increment of _____ to _____/μL in an average adult.

A

30,000, 50,000

98
Q

Platelet count must be measured within ___ hour after transfusion.

A

1

99
Q

______ refers to the increase in platelets following a transfusion. ______ is based on the patient’s size and the number of platelets transfused.

A

Count increment, Correction

100
Q

CCI is usually determined __ to __ minutes after transfusion

A

10 to 60

101
Q

Currently, greater than ___ of platelet transfusions are from apheresed platelets and about ___ are pools of whole blood-derived platelets (WBD)

A

92%
8%

102
Q

Formula for CCI

A

CCI = (postcount/uL – precount/uL) × body surface area (m2) /platelets transfused x 10^11

103
Q

Factors to Be Considered When Using 5-Day Plastic Storage Bags

A
  • Temperature control of 20°C to 24°C
  • Careful handling of plastic bags
  • Residual plasma volumes recommended for the storage of platelet concentrates from whole blood (45 to 65 mL)
  • For apheresis platelets, the surface area of the storage bags needs to allow for the number of platelets that will be stored.
104
Q

If the CCI is >____ /uLit is a good increment and if it is <____/uL it indicates that the patient has platelet refractories.

A

10,000 ; 5,000

105
Q

Platelet concentrates should contain a minimum of ____ platelets in a volume of between 45mL and 65mL

A

5.5 x 10^10

106
Q

Platelet expiration time (FDA)?

A

midnight of day 5

107
Q

Purpose of glycerol in RBC Freezing

A

Acts as a cryoprotectant that preserves RBC membrane viability in freezing

108
Q

Most common infectious complication of transfusion?

A

Sepsis due to contaminated platelets

109
Q

What is the importance of glucose-6-phosphate dehydrogenase?

A

Pentose Phosphate Pathway (PPP) is used to produce NADPH.

110
Q

Glutathione is responsible for detoxifying ___? What generates glutathione?

A

hydrogen peroxide (H2O2), NADPH

111
Q

True or False. In the ferric state of iron, iron cannot bind to oxygen, which renders hemoglobin useless.

A

True

mls 3H (12 decks)

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