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From Flashcardlet > 2 A&P Chapter 17 > Flashcards

2 A&P Chapter 17 Flashcards

1
Q

How is the body distributed between solids and liquids?

A

40% solids, 60% liquids

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2
Q

How are the body’s liquids distributed?

A

1/3 extracellular fluid, 2/3 intracellular fluid

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3
Q

How are the body’s extracellular fluid distributed?

A

80% interstital, 20 % plasma

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4
Q

Where does blood exit the heart?

A

Through arteries

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5
Q

Where does oxygen deficient blood flow to return to the heart?

A

Into veins

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6
Q

What is the only kind of liquid tissue?

A

blood

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7
Q

What is found in the buffy coat?

A

Leukocytes and platelets

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8
Q

What does a centrifuge tube of blood look like, and what are the percentages?

A

Straw colored plasma on type 55%, thin white buffy coat less than 1%, red hematocrit 45%

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9
Q

What is the “blood fraction”

A

Hematocrit

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10
Q

What is the male range for hematocrit?

A

47 +/- 5%

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11
Q

What is the female range for hematocrit?

A

42 +/- 5%

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12
Q

Why is the male range for hematocrit higher than females?

A

Testosterone stimulates EPO

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13
Q

Why is the female range for hematocrit lower than males?

A

Blood loss in menstruation

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14
Q

How do you determine the hemoglobin level from the hematocrit value?

A

Divide the hematocrit by 3

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15
Q

What color is oxygen rich blood?

A

Scarlet

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16
Q

What color is oxygen deficient blood?

A

Dark red

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17
Q

What is the pH of blood?

A

7.35-7.45

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18
Q

Blood constitutes what percentage of the body’s weight?

A

8%

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19
Q

How many liters of blood are in the female and male body?

A

Males have 5-6 L

Females have 4-5 L

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20
Q

What is the temperature of blood?

A

38 degrees C, 100.4 degrees F (1 degree higher than body temperature)

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21
Q

What are the three functions of blood?

A
  1. Distribution
  2. Regulation
  3. Protection
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22
Q

What types of distribution functions does blood perform? (3)

A
  1. Delivers oxygen from lungs and nutrients from GI tract to cells
  2. Transport waste to lungs and kidneys
  3. Transports hormones to organs
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23
Q

What types of regulation functions does blood perform? (3)

A
  1. Maintains body temperature through vasodilation and constriction
  2. Maintains pH in tissues as blood proteins act as buffers to prevent changes from 7.4
  3. Maintains adequate fluid volume in circulation, proteins prevent loss into tissue spaces
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24
Q

What types of protection functions does blood perform? (2)

A
  1. Preventing blood loss through clotting

2. Prevents infection

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25
Q

If plasma is only 20% of the ECF, why is it important to us?

A

It is the most accessible fluid in the body available for analysis

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26
Q

What are the percentages of the the components of plasma?

A

92% water, 7% proteins, 1% other

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27
Q

What are the plasma proteins? (4)

A
  1. Albumin
  2. Globulin
  3. Fibrinogen
  4. Regulatory proteins
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28
Q

What percentage is albumin out of all the plasma proteins?

A

60%

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29
Q

What are the functions of albumin?

A
  1. Carrier to shuttle molecules through circulation
  2. Blood buffer to maintain pH
  3. Contributes to plasma’s osmotic pressure by regulating the water movement between the interstital space and the blood
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30
Q

What percentage is globulin out of all the plasma proteins?

A

36%

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31
Q

What is the function of globulin?

A

Alpha and beta globulins bind, support, and protect water insoluble molcules, hormones, ions, and fat soluble vitamins

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32
Q

What does gamma globulin do?

A

Immunoglobulin or antibodies are made by B lymphocytes

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33
Q

What percentage is fibrinogen of all the plasma proteins?

A

4%

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34
Q

What does fibrinogen do?

A

It is a clotting factor, that is converted to fibrin strands

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35
Q

What is the other 1% of plasma made of?

A

Electrolytes, waste products, nutrients, respiratory gases, Ca+, K+, Magnesium, other solutes

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36
Q

Where are most plasma proteins produced?

A

Liver

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37
Q

What is serum?

A

When fibrinogen and clotting factors are removed from plasma

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38
Q

What is the only complete cell?

A

Leukocyte

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39
Q

Which formed elements are cell fragments?

A

Platelets

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40
Q

Do blood cells divide?

A

No, only stem cells divide continuously in red bone marrow

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41
Q

What is rouleaux?

A

The lining up of RBCs as they pass through small blood vessels

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42
Q

RBCs make up what percentage of the formed elements?

A

99%

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43
Q

What is the shape and color of RBCs?

A

Circular, biconcave, pink with lighter shade in the center

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44
Q

What does an erythrocyte lack?

A

Nucleus

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45
Q

What is spectrin?

A

Cytoskeletal protein that maintains the biconcave shape but the spectrin net is deformable, allowing RBC flexibility

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46
Q

How much oxygen does a RBC pick up and take to cells? How much CO2 does the RBC take back to the lungs?

A

98% oxygen, 20% carbon dioxide

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47
Q

What percentage of hemoglobin is a RBC?

A

97% hemoglobin

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48
Q

Why is a RBC biconcave shaped?

A

It has a high surface area/volume ratio for better transportation of oxygen

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49
Q

How does a RBC make energy?

A

Through anaerobic respiration so that the RBC does not use up any of the oxygen it is carrying

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50
Q

How does the number of RBCs effect viscosity?

A

The more RBCs, the higher the viscosity

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51
Q

What type of people have highly viscous blood?

A

Chronic smokers

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52
Q

Why do RBCs have antioxidant enzymes?

A

To degrade harmful free radicals

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53
Q

What are normal hemoglobin levels for males and females?

A

Male 13-18 g/dl

Female 12-16 g/dl

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54
Q

What are the components of hemoglobin?

A

Red heme pigment and a globin protein

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55
Q

What does the globin protein look like?

A

Globin has 4 polypeptide chains with a ring like heme on each

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56
Q

What does the heme group look like?

A

The heme group has an iron molecule in the center

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57
Q

How many molecules of oxygen can hemoglobin carry?

A

4

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58
Q

How many molecules of hemoglobin does a RBC have?

A

250 million

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59
Q

How many molecules of oxygen can a RBC carry?

A

1 million (because 4x250 million)

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60
Q

What does saturated mean? Unsaturated?

A

Saturated is oxygenated

Unsaturated is deoxygenated

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61
Q

What is the normal type of hemoglobin, and what polypeptide chains does it contain?

A

Hemoglobin A1 has 2 alpha and 2 beta chains

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62
Q

What is a less common kind of hemoglobin and what polypeptide chains does it contain?

A

Hemoglobin A2 has 2 alpha and 2 delta chains

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63
Q

What polypeptide chains does Hemoglobin F contain?

A

Fetal hemoglobin has 2 alpha and 2 gamma chains

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64
Q

What type of hemoglobin do sickle cell RBCs have?

A

Hemoglobin S

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65
Q

Why has sickle cell anemia persisted?

A

It is a recessive gene that helps the population better survive malaria

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66
Q

What is the chance of a child having sickle cell anemia if both parents are carriers of the gene, but do not show the gene?

A

1/4

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67
Q

What is HbAIc? What is it used for diagnostically?

A

People with diabetes mellitus have 2-3 times more HbAIc; a measurement of HbAIc is used as an index of metabolic control of diabetes

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68
Q

What is a glycosylated hemoglobin?

A

Glycosylate means the link of sugar to protein; HbAIc is a glycosylated hemoglobin

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69
Q

What is created when RBCs pick up oxygen in the lungs and oxygen binds to the iron?

A

Oxyhemoglobin

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70
Q

What color is oxyhemoglobin?

A

Ruby red

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71
Q

What is created when oxygen is released to the tissues?

A

Deoxygemoglobin

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72
Q

What color is deoxygemoglobin?

A

Dark red

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73
Q

How well is oxygen bound to iron?

A

Very weakly

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74
Q

When does CO2 bind on the hemoglobin?

A

It attaches to the amino acid, not the iron

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75
Q

What is created when CO2 binds to hemoglobin?

A

Carbaminohemoglobin

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76
Q

How many new blood cells are created every day?

A

10 billion

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77
Q

What is the term for blood cell formation?

A

Hematopoiesis

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78
Q

Where does hematopoiesis occur?

A

Red bone marrow

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79
Q

What are blood sinusoids?

A

Reticular CT of the red bone marrow borders these wide capillaries

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80
Q

As blood cells mature, where do they move to?

A

They move through the sinusoids into the blood stream

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81
Q

Which cell do all blood cells arise from?

A

Hematopoietic stem cell

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82
Q

What signals the commitment pathway of a stem cell?

A

Membrane receptors responding to hormones or growth factors, which push towards specialization

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83
Q

What molecule can compete with oxygen at the iron?

A

Carbon monoxide, which has a better affinity to bind

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84
Q

How long does erythropoiesis take?

A

About 15 days

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85
Q

How many RBCs are made per second in healthy people?

A

2 million

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86
Q

What is the order for differentiating cells into a RBC?

A
  1. Hematopoietic stemm cell
  2. Proerythroblast
  3. Basophilic erythroblast
  4. Polychromatic erythroblast
  5. Normoblast
  6. Reticulocyte
  7. Erythrocyte
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87
Q

Which cell in the process produces a lot of ribosomes?

A

Basophilic erythroblast

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88
Q

Which cell in the process accumulates iron and forms hemoglobin?

A

Polychromatic erythroblast

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89
Q

Which cell in the process ejects the nucleus?

A

Normoblast

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90
Q

Which cell in the process degenerates it’s organelles?

A

Reticulocyte

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91
Q

How long does it take a reticulocyte to mature into an erythrocyte?

A

2 days

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92
Q

What do reticulocyte counts determine?

A

They provide a guess at the rate of RBC formation

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93
Q

What percentage of RBCs are reticulocytes?

A

1-2%

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94
Q

What is nitric oxide?

A

A potent vasodilator that bind to hemoglobin and clears the pathway for blood, so more oxygen can reach the tissues

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95
Q

What components are required for erythropoiesis?

A
  1. Protein
  2. Lipid
  3. Carbohydrate
  4. Iron from diet
  5. Vitamin B12
  6. Folate
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96
Q

What are vitamin B12 and folate needed for?

A

DNA synthesis

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97
Q

What results with a lack of B12 and folate?

A

Macrocytic/Megaloblastic anemia

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98
Q

What results from a lack of intrinsic factor?

A

Pernicious anemia

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99
Q

Why does someone with sickle cell anemia have a higher retic count?

A

Because the bone marrow is rushing the production of RBCs and so retics slip into the blood stream more frequently

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100
Q

What is erythropoietin?

A

A glycoprotein hormone that stimulates the formation of RBCs

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101
Q

Where is EPO produced?

A

Kidneys (some in liver)

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102
Q

How do the kidneys know to produce more EPO?

A

When the kidneys become hypoxic, oxygen sensitive enxymes are unable to degrade the hypoxia inducible factor (HIF).
As the amount of HIF accumulates, it triggers the synthesis of EPO

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103
Q

What else stimulates the production of EPO in the male body?

A

Testosterone

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104
Q

What are some other factors that influence EPO production? (6)

A
  1. Blood loss in hemorrhage
  2. Not enough hemoglobin per RBC
  3. Decreased availability of oxygen in the enviro
  4. Inadequate cardiac pumping
  5. Lung disease
  6. Anemia
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105
Q

What might influence the decrease in EPO production? (2)

A

Too many RBCs in the blood stream or too much oxygen

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106
Q

What is the rate of erythropoiesis controlled by?

A

The cells’ ability to transport enough oxygen to meet demand, not the number of RBCs

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107
Q

How is the amount of iron distributed throughout the body, in percentages?

A

50% in hemoglobin
25% in heme containing proteins
25% in liver (ferritin and hemosiderin)

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108
Q

When iron is transported in the blood, what protein is it bound to?

A

Transferrin

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109
Q

What two substances is hemoglobin broken down into?

A

Heme and globin

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110
Q

What happens when globin is broken down?

A

It is broken down into amino acids that are reused for protein synthesis

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111
Q

What happens to iron when heme is broken down?

A

The iron from the heme group is stored as ferritin or hemosiderin in the liver, and bound to transferrin as it travels there.

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112
Q

What happens to the rest of the heme group when it is broken down?

A
  1. Biliverdin
  2. Bilirubin in the liver
  3. Bilirubin is secreted to intestine in bile
  4. Bilirubin becomes urobilinogen to urobilin in the kidney, excreted in urine
  5. Bilirubin becomes urobilinogen to stercobilin which is excreted in the feces
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113
Q

What are the five steps of the EPO seesaw?

A
  1. Stimulus is hypoxia
  2. Kidney releases EPO
  3. EPO stimulates the red bone marrow
  4. Enhanced erythropoiesis increases the RBC count
  5. Oxygen carrying ability of the blood increases
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114
Q

What is the normal level (average) for hemoglobin?

A

15 g/dl

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115
Q

What is the level of hemoglobin at which patients are considered profoundly anemic?

A

6 g/dl

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116
Q

What is anemia?

A

The blood’s oxygen carrying capacity is too ow to support normal metabolism

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117
Q

What are the symptoms of anemia?

A
  1. Fatigue
  2. Pallor
  3. Shortness of breath
  4. Chills
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118
Q

What are three reasons a person might be anemic?

A
  1. Blood loss from hemorrhage
  2. Not enough RBCs produced
  3. Too many RBCs destroyed
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119
Q

What is hemorrhagic anemia and how is it treated?

A

The blood’s oxygen carrying capacity is low due to blood loss. It is treated by replacing the blood

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120
Q

Why would someone not have enough RBCs produced?

A

Due to a lack of raw materials or the failure of bone marrow

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121
Q

What are blood cells called in iron deficiency anemia and what function do they lack?

A

RBCs are called microcytes because they are small and pale. They cannot synthesize normal hemoglobin levels

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122
Q

What is pernicious anemia?

A

An autoimmune disease that destroys the cells of the stomach mucosa. These cells are ones that produce the intrinsic factor that is needed for B12 production

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123
Q

What are RBCs called in pernicious anemia and why?

A

RBCs are called macrocytes because B12 is needed for RBCs to divide

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124
Q

What is renal anemia?

A

A lack of EPO, which causes a decrease in RBC production

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125
Q

What is aplastic anemia?

A

The destruction or inhibition of red bone marrow from drugs, chemicals, ionizing radiation (chemotherapy), or viruses. There is also a defect in clotting and immunity

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126
Q

What happens to precursor cells in aplastic anemia?

A

Precursor cells in the bone marrow are not told to make RBCs

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127
Q

What is hemolytic anemia?

A

RBCs rupture prematurely caused by a hemoglobin abnormality, mismatched blood transfusion, infection, or autoimmune disease

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128
Q

What are two types of hemolytic anemias that are due to a hemoglobin abnormality?

A

Thalassemia and sickle cell anemia

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129
Q

What is Thalassemia?

A

Seen in Mediterraneans, one globin chain is absent or faulty. It is classified by which globin chain is missing

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130
Q

What is sickle cell anemia?

A

Abnormal hemoglobin (HbS) results from a change in one of the 146 amino acids in the blogin chain. The Hb becomes spiky, which causes the abnormal shape in the RBC

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131
Q

When does the RBC change into a sickle shape in sickle cell anemia

A

The chains link together under low oxygen conditions, forming a stiff rod, which causes the RBC to become sickle shaped when they unload oxygen

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132
Q

What are the symptoms of sickle cell anemia? (4)

A

Pain in the bones and chest, shortness of breath, stroke, and infection

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133
Q

What happens in the blood vessels with sickle cell anemia?

A

The RBCs rupture, clump together, and occlude the blood vessels

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134
Q

What is polycythemia?

A

An abnormal excess of RBCs causing and increased blood viscosity, causing the blood to flow like sludge

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135
Q

What is polycythemia vera?

A

Bone marrow cancer, with a high RBC count

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136
Q

How is polycythemia treated?

A

Removing some blood and replacing it with saline, therefore thinning the blood

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137
Q

What is secondary polycythemia?

A

Less oxygen is available or EPO production is increased

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138
Q

Who has secondary polycythemia?

A

Smokers or people living at high altitudes

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139
Q

What is blood doping?

A

Artificially induced polycythemia, red cells are drawn off then replaced days before an event, so the oxygen carrying capacity of the blood is increased due to a higher hematocrit. This causes increased endurance and speed in athletes

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140
Q

What are the risks of blood doping?

A

Stroke and heart failure due to high viscosity

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141
Q

Which formed elements are true cells?

A

Leukocytes

142
Q

What is the average range of WBCs per mm3?

A

4,800-10,800

143
Q

What percent of the blood volume is WBCs?

A

Less than 1%

144
Q

What is diapedesis?

A

Adhesion molecules called selectins on the endothelial cells of capillaries bind to the receptors on WBCs called integrins, which allow the WBCs to slip in and out of the capillaries

145
Q

Once out of the blood, how do RBCs move?

A

By amoeboid motion

146
Q

What is amoeboid motion?

A

The WBCs form flowing cytoplasmic extensions that push them along

147
Q

What is positive chemotasix?

A

WBCs follow chemical trails left from damaged cells to pinpoint the areas of infection and injury

148
Q

What is leukocytosis?

A

WBC count of 11,000 or more, in response to infection

149
Q

What is leukopenia?

A

Too few WBCs

150
Q

What are the two types of leukocytes?

A

Granulocytes and agranulocytes

151
Q

What is the distinguishing characteristic between granulocytes and agranulocytes?

A

Granulocytes have obvious membrane bound cytoplasmic granules

152
Q

What is the phrase to remember the most abundant to least abundant WBCs?

A

Never let monkeys eat bananas

153
Q

What is the order of WBCs from most abundant to least abundant?

A 
Neutrophil
Leukocyte
Monocyte
Eosinophil
Basophil
154
Q

What WBCs are granulocytes?

A

Neutrophil, Basophil, Eosinophil

155
Q

What are the characteristics of granulocytes?

A

Spherical shaped, larger, short lived, lobed nuclei, phagocytic

156
Q

What percentage of WBCs are neutrophils?

A

50-70%

157
Q

What are bands?

A

The immature form of neutrophils seen in the blood

158
Q

What does the cytoplasm of a neutrophil have?

A

Fine granules that contain hydrolytic enxymes and antimicrobial proteins, or defensins

159
Q

What does a neutrophils nucleus look like?

A

3-6 lobed

160
Q

What is the neutrophil’s main job?

A

Bacteria slayers, chemically attracted to the sites of inflammation, active phagocytes

161
Q

What is the respiratory burst?

A

Cells metabolize oxygen to produce potent germ killing oxidizing substances, like bleach and hydrogen peroxide

162
Q

What is defensin lysis?

A

Occurs when defensin forms peptide spears that puncture microbe containing cells

163
Q

Where are neutrophils found in the blood vessels?

A

They migrate towards the sides of blood vessels

164
Q

What are neutrophil’s life spans?

A

They die rapidly, within a few hours to a few days

165
Q

What cells are usually increased in numbers with leukocytosis?

A

Usually more neutrophils due to their response to inflammation or bacterial infections

166
Q

What percentage of WBCs are eosinophils?

A

2-4%

167
Q

What does an eosinophil’s nucleus look like?

A

2 lobes connected by a broad band

168
Q

What does an eosinophil’s cytoplasm look like?

A

Large coarse granules in the cytoplasms containing digestive enzymes

169
Q

What kind of enzymes do eosinophils granules lack?

A

Enzymes to degrade bacteria

170
Q

What do eosinophil’s enzymes usually degrade?

A

They lead the attack on parasitic worms that are too large to be phagocytized

171
Q

How do eosinophil’s play a role in allergic response?

A

They are a key control cell in the inflammatory response, helping break down the complexes that produce the response

172
Q

What is an eosinphil’s life span?

A

8-12 days

173
Q

Where do eosinophil’s reside?

A

In loose CT in the intestinal or respiratory mucosae

174
Q

Which WBCs are the rarest, and what percentage do they make up?

A

Basophils are .5-1% of all WBCs

175
Q

What does the cytoplasm of a basophil look like?

A

Large coarse granules that cover up the nucleus

176
Q

What substances are found in the granules of a basophil?

A

Histamine and heparin

177
Q

What is heparin?

A

An anticoagulant

178
Q

What is histamine?

A

An inflammatory chemical that acts as a vasodilator, causing the immune system to become leaky and produce an allergic response. It also attracts other WBCs to the inflamed site

179
Q

What cells are similar to basophils?

A

Mast cells

180
Q

What does the nucleus of a basophil look like?

A

Bilobed, U or S shaped

181
Q

How long do basophils live?

A

From hours to days

182
Q

What cells are agranulocytes?

A

Lymphocytes and monocytes

183
Q

What percentage of all WBCs are lymphocytes?

A

20-25%

184
Q

Which WBCs are the smallest?

A

Lymphocytes

185
Q

Where are lymphocytes usually found?

A

The majority are located in the lymphoid tissue

186
Q

What does the nucleus of a lymphocyte look like?

A

Very large, taking up most of the cytoplasm

187
Q

What is the leukocytes major function?

A

Immunity

188
Q

What are the two types of leukocytes?

A

T and B

189
Q

What are T lymphocytes?

A

Immune response by acting directly against virus infected cells and tumor cells

190
Q

What are B lymphocytes?

A

Give rise to plasma cells which produce antibodies

191
Q

What percent of all WBCs are monocytes?

A

3-8%

192
Q

What is the largest leukocyte?

A

Monocyte

193
Q

What does the cytoplasm of a monocyte look like?

A

Abundant cytoplasm

194
Q

What does the nucleus of a monocyte look like?

A

U or kidney shaped

195
Q

What is the function of a monocyte?

A

To defend against viruses, intracellular bacterial parasites, and chronic infections

196
Q

What happens to a monocyte when it leaves the blood?

A

Turns into a macrophage

197
Q

Within 48 hours, what happens at the site of the infection?

A

Monocytes are the predominant cell at the site of injury

198
Q

— in tissue, — in blood

A

Macrophage in tissue, monocyte in blood

199
Q

What is the most potent phagocyte?

A

Monocyte, can digest much more than a neutrophil

200
Q

How are monocytes helpful in immunity?

A

Antigen processing and presentation to T helper cells

201
Q

How is leukopoiesis stimulated?

A

By chemical messengers acting as either paracrines or hormones

202
Q

What are the two chemical messengers that act in leukopoiesis?

A

Interleukins and colony stimulating factors

203
Q

What do interleukins and colony stimulating factors do?

A

They both prompt WBC precursors to divide and mature, and enhance protective potency of mature WBCs

204
Q

What cells do myeloid stem cells mature to?

A

Eosinophil, neutrophil, basophil, monocyte

205
Q

What cells do lymphoid stem cells mature to?

A

Lymphocytes

206
Q

What are the 5 steps of the maturation of WBCs (myeloid line)?

A 
Myeloid stem cell
Myeloblast
Promyelocyte
Myelocyte
Band cells
207
Q

At what stage do granules appear?

A

Myelocyte

208
Q

What what stage do nuclei arc?

A

Band cell

209
Q

What are cytokines?

A

Small glycoporteins that act as paracrines and autocrines which stimulate progenitor cells in the bone marrow; they decide which cell the stem cell will mature into

210
Q

What cells produce cytokines?

A

Cells in the red bone marrow, leukocytes, macrophages, fibroblasts, and endothelial cells

211
Q

What what stage do problems with leukemia present?

A

Myeloid or lymphoid stem cell stage (the stem cells aren’t told to mature into something)

212
Q

What is another name for the hematopoeitic stem cell?

A

Hemocytoblast

213
Q

Where are most of the mature granulocytes stored in the body?

A

Bone marrow, stores 10X more than the blood

214
Q

Where do T and B lymphocytes mature?

A

B mature in the bone marrow, T mature in the thymus

215
Q

What two disorders result in the overproduction of leukocytes?

A

Leukemia and infectious mononucleosis

216
Q

What is leukopenia?

A

A low WBC count

217
Q

What is leukopenia induced by?

A

Drugs, like anticancer agents and glucocorticoids

218
Q

What happens to WBCs with leukemia?

A

Cells remain unspecialized and proliferate out of control, impairing the red bone marrow function

219
Q

What is acute leukemia?

A

When the problem is derived from stem cells, usually seen in children

220
Q

What is chronic leukemia?

A

When the problem occurs later in cell stages, usually seen in the elderly

221
Q

What are the symptoms of leukemia?

A

Bone pain, anemia, bleeding, fever, and weight loss

222
Q

What does death from leukemia result from?

A

Internal hemorrhage and infection

223
Q

What virus causes infectious mononucleosis?

A

Epstein-Barr virus

224
Q

What WBC is in excessive with mononucleosis?

A

Agranulocytes

225
Q

What are the symptoms of mononucleosis?

A

Tried, achy, low grade fever, and chronic sore throat

226
Q

How do we treat mononucleosis?

A

No cure, it runs its course within a few weeks

227
Q

What are thrombocytes?

A

Cytoplasmic fragments of extraordinarily large cells called megakaryocytes

228
Q

What is the lifespan of a platelet?

A

5-10 days

229
Q

What is the normal range of platelet count?

A

150,000-400,000

230
Q

What substance do the granules of platelets contain?

A

Chemicals that act in clotting

231
Q

What do platelets function in?

A

They stick to damaged vessels to form a temporary plug

232
Q

What is thrombopoietin?

A

A hormone that regulates the production of platelets

233
Q

Where is thrombopoietin made?

A

Liver

234
Q

How does a megakaryocyte get so big?

A

It repeatedly divides but cytokinesis never occurs

235
Q

How are platelets formed from the megakaryocyte?

A

The megakaryocyte presses against the sinusoid sending cytoplasmic extensions through the walls into the blood. The extensions rupture, releasing platelet fragments

236
Q

What are some substances found in platelets?

A
  1. Serotonin
  2. Calcium
  3. Enzymes
  4. Platelet derived growth factor
  5. Clotting factors
  6. ADP/ATP
237
Q

Where are the substances found in platelets located inside the cell fragment?

A

Within many vesicles

238
Q

What do the enzymes of platelets make?

A

Thromboxane A2 and fibrin stabilizing factor

239
Q

What is platelet derived growth factor?

A

A hormone that can cause proliferation of vascular endothelial cells, vascular smooth muscle, and fibroblasts to divide and rebuild the vessel wall

240
Q

What is hemostasis?

A

The process of stopping bleeding

241
Q

What are the three steps to hemostasis?

A
  1. Vascular spasm
  2. Platelet plug formation
  3. Coagulation
242
Q

What is a vascular spasm?

A

The damaged blood vessels respond to injury by constricting

243
Q

What factors trigger vascular spasm? (3)

A

Direct injury to vascular smooth muscle, chemicals from endothelial cells and platelets, and reflex initiated by local pain receptors

244
Q

Where is the vascular spasm most effective ?

A

Small blood vessels

245
Q

How long does vascular spasm last for?

A

Minutes to hours

246
Q

What is the platelet plug?

A

Platelets aggregate forming a temporary seal

247
Q

What do endothelial cells release during the platelet plug formation?

A

Prostacyclin and nitric oxide

248
Q

What is the abbreviation for prostacyclin?

A

PGI2

249
Q

What do nitric oxide and prostacyclin do?

A

They inhibit platelet aggregation, restricting aggregation to the site of injury

250
Q

What substance promotes platelet aggregation?

A

Thromboxane A2

251
Q

Where do platelets adhere to? What substances causes this?

A

Platelets adhere to exposed collagen due to the von Willebrand factor

252
Q

What does the von Willebrand factor do?

A

It is a plasma protein that stabilizes bound platelets by forming a bridge between the collagen and the platelets

253
Q

What happens when platelets release ADP and TXA2?

A

It activates other platelets

254
Q

What happens when platelets release serotonin and TXA2?

A

Vasoconstriction of the blood vessels along with increased platelet aggregation

255
Q

Where is TXA2 derived from?

A

Arachidonic acid in the platelet cell membrane

256
Q

What happens when ADP and TXA2 combine?

A

It makes other platelets sticky

257
Q

What type of system is the platelet plug formation?

A

Positive Feedback - one of very few positive feedback systems in the body!

258
Q

What occurs during the third step of coagulation?

A

Blood clotting, a reinforcement of the platelet plug with fibrin threads, which act like glue for the platelets

259
Q

What is another word for clotting factors?

A

Procoagulants

260
Q

Where are most of the clotting factors produced?

A

Liver

261
Q

What happens to clotting factors when they are activated?

A

They turn into enzymes

262
Q

How does activation occur during the coagulation phase?

A

In a cascade - when the clotting factor activates it becomes a catalyst for the next step in the cascade

263
Q

Why does clotting occur in a cascade (what makes the enzymes become activated)?

A

Enzymes become activated when one peptide is sheared off

264
Q

What are the two pathways in which coagulation is initiated by?

A

Extrinsic or intrinsic

265
Q

Which pathway is more common to start coagulation?

A

Extrinsic

266
Q

What is needed to initiate both the intrinsic and extrinsic pathways?

A

The negative membrane of platelets containing platelet factor 3 (phosphatidylserine)

267
Q

Where do the intrinsic and extrinsic pathways converge?

A

At factor X

268
Q

What four substances combine to create the prothrombin activator?

A

Factor X, PF3, Ca, Factor V

269
Q

How long does it take for the clot to form once prothrombin is present?

A

10-15 seconds

270
Q

Why are the pathways called intrinsic and extrinsic?

A

The intrinsic pathway uses substances found within the blood. The extrinsic pathway is initiated by substances found outside of the blood

271
Q

What are the characteristics of the intrinsic pathway?

A

Slower, more intermediate steps

272
Q

What is the intrinsic pathway?

A 
XII is exposed to collagen - XIIa
XIIa + XI
XIa + IX
IXa + VIII
X
273
Q

What is the extrinsic pathway triggered by?

A

Exposure to tissue factor, III, found in tissues under damaged endothelium

274
Q

What are the characteristics of the extrinsic pathway?

A

Faster, fewer intermediate steps

275
Q

How long does it take for a clot to form with the extrinsic pathway?

A

15 seconds

276
Q

What is the extrinsic pathway?

A

Tissue Factor + VII
VIIa
X

277
Q

What element of the extrinsic pathway also contributes to the intrinsic pathway?

A

Factor VII helps initiate the intrinsic pathway also

278
Q

What is created with X and V combine?

A

Prothrombinase

279
Q

What is prothrombinase?

A

It initiates the final common pathway

280
Q

What element is needed overall for the coagulation pathways to occur?

A

Ca+2

281
Q

Which vitamin is needed for the formation of some clotting factors?

A

K

282
Q

Which clotting factors need vitamin K to synthesis?

A

II, VII, IX, X

283
Q

Which clotting factor is the antihemophilic factor?

A

VIII

284
Q

What is the final common pathway?

A

X+V produce prothrombinase which catalyzes prothrombin into thrombin. Thrombin then catalyzes fibrinogen into fibrin. XIII is the fibrin stabilizing factor

285
Q

What happens to fibrin once the final common pathway is finished?

A

It polymerizes into strands which glue patelets together and make a web

286
Q

What type of gene is the gene for hemophilia?

A

X linked recessive, so the mother is a carrier, and her son has a 50% of showing the gene

287
Q

What is the thrombin feedback loop?

A

Without it, the body would not make enough thrombin, so the process loops around with XI, VIII, and platelets (XII is not needed to initiate the pathway again)

288
Q

What occurs during clot retraction?

A

Platelets contract and pull on surrounding fibrin strands, squeezing serum from the mass, compacting the clot and drawing the edges together

289
Q

What substances make clot retraction possible?

A

Platelets contain actin and myosin

290
Q

What are three mechanisms that limit the spread of clots?

A
  1. Tissue Factor Pathway inhibitor (TFPI)
  2. Thrombin bind to thrombomodulin
  3. Antithrombin III
291
Q

What to the tissue factor pathway inhibitor do?

A

It binds to the TF/VIIa complex, preventing X from being activated

292
Q

What does thrombin binding to thrombomodulin do?

A

It inactivates VIIIa and Va

293
Q

What does antithrombin do? What activates it?

A

It inactivates thrombin, and it is activated by heparin

294
Q

What is fibrinolysis?

A

The removal of unneeded clots when healing occurs

295
Q

Why is fibrinolysis needed?

A

Because small clots will continue forming, eventually causing a blockage of the vessel

296
Q

What is plasmin?

A

Fibrin digesting enzyme

297
Q

What activates plasmin?

A

Plasminogen

298
Q

How is plasminogen activated?

A

Plasminogen sits in a clot until signals activate it. The presence of a clot causes the endothelial cells to secrete tissue plasminogen activator (tPA)

299
Q

What does tPA do?

A

Converts plasminogen to plasmin

300
Q

What are two homeostatic mechanisms that prevent clots from getting too large?

A
  1. Swift removal of clotting factors

2. Inhibition of activated clotting factors

301
Q

When does a clot stop forming (when it reaches…)?

A

When it reaches normally flowing blood

302
Q

When might thrombin become inactivated?

A

When it starts to flow into normal circulation

303
Q

What three mechanisms prevent undesirable clotting?

A
  1. Platelets don’t stick to smooth, intact endothelium
  2. NO and PGI2 prevent aggregation
  3. Vitamin E quinone is a coagulant
304
Q

What is a thromboembolic disorder?

A

When the body forms undesirable clots

305
Q

What is a thrombus?

A

A clot that develops and persists in an unbroken blood vessels

306
Q

What is an embolus?

A

The thrombus breaks away from the vessel wall and free floats

307
Q

What is an embolism?

A

When the embolus hits a blood vessel that is too small and obstructs it

308
Q

What conditions promote undesirable aggregation?

A

Conditions that roughen the blood vessels endothelium, like atherosclerosis or inflammation;
Also conditions with slow moving blood, like bed ridden patients

309
Q

What are four anticoagulant drugs used to prevent undesirable clotting?

A

Aspirin, warfarin, coumadin, heparin

310
Q

What is thrombocytopenia?

A

The number of circulating platelets is deficient

311
Q

What does thrombocytopenia cause?

A

Widespread, spontaneous bleeding from small blood vessels all over the body

312
Q

What are two markers on the skin that indicate thrombocytopenia?

A

Petechiae and perpura

313
Q

Why might a liver disorder result in a bleeding disorder?

A

The liver makes clotting factors

314
Q

Which clotting factor is deficient with Hemophilia A?

A

VIII

315
Q

Which clotting factor is deficient with Hemophilia B?

A

IX

316
Q

Which clotting factor is deficient with Hemophilia C?

A

XI

317
Q

What is disseminated intravascular coagulation?

A

Characteristic of thromboembolic and bleeding disorders, widespread clotting in intact blood vessels and residual blood is unable to clot, resulting in blockage and severe bleeding

318
Q

How much blood loss results in weakness and palor?

A

15-30% of blood volume

319
Q

How much blood loss results in shock and death?

A

More than 30% of blood volume

320
Q

What is a whole blood transfusion used for?

A

When blood loss is rapid and substantial

321
Q

What are packed red cells used for?

A

When restoring the body’s oxygen carrying capacity

322
Q

What is an antigen?

A

Glycoprotein marker on RBC that identifies it as unique

323
Q

What is another word for antigen?

A

Agglutinogen

324
Q

What is another word for antibody?

A

Agglutinin

325
Q

What does agglutinate mean? What can result from agglutination?

A

Antibodies bind to antigens causing RBCs to clump and possibly occlude the vessel

326
Q

What are the common Rh antigens?

A

D, C, E

327
Q

What percentage of people carry the D antigen?

A

85%

328
Q

What happens if an Rh- person receives Rh+ blood? What does the body do?

A

They start to make anti Rh antibodies - the body will not attack the RBCs the first time, but it will the second time

329
Q

What is another name for hemolytic disease of the newborn?

A

Erythroblastosis fetalis

330
Q

What happens in erythroblastosis fetalis?

A

A pregnant Rh- woman has a Rh+ baby. The woman begins to make anti Rh antibodies after the pregnancy. If her second baby is Rh+, the woman’s antibodies will cross through the placenta and destroy the baby’s RBCs

331
Q

What can a woman be treated with after she has a Rh+ baby if she is Rh-?

A

RhoGAM, which can block the mother’s immune response

332
Q

What is a transfusion reaction?

A

Mismatched blood is infused, and the recipient’s plasma agglutinins attack the donor RBCs

333
Q

What are three things that happen to the blood with a transfusion reaction?

A
  1. Transfused cells can’t transport oxygen
  2. Cells clump in blood vessels and hinder blood flow
  3. Circulating hemoglobin from the destruction of donor RNCs goes to the kidneys causing cell death and renal failure
334
Q

What are some symptoms of a transfusion reaction?

A

Fever, chills, low BP, nausea, increased HR, general toxicity

335
Q

Which blood group is the universal donor?

A

O

336
Q

Which blood group is the universal recipient?

A

AB

337
Q

See Lab cards for Blood Typing

A

See Lab Cards

338
Q

What are autologous transfusions?

A

The patient pre-donates his blood, and restoring his blood volume begins with replacing the isotonic salt solution

339
Q

What is the prothrombin time?

A

Assesses the ability of blood to clot

340
Q

What is SMAC?

A

A chemistry profile measuring electrolytes, glucose, and liver or kidney disorder markers

341
Q

What is a CBC?

A

Counts the different types of formed elements, hematocrit, hemoglobin content, and the size of RBCs

342
Q

Why does a fetus produce HbF?

A

Because Hb F has a higher affinity for oxygen

343
Q

What happens to some organs if the body is in severe need of blood formation?

A

The spleen and liver can regain their ability to form blood cells. Yellow bone marrow can also transfer into red bone marrow temporarily to make blood cells

344
Q

What are the two types of artificial blood?

A
  1. Polyheme

2. Oxycyte

345
Q

What is polyheme made from?

A

It is a substitute made from human or animal hemoglobin

346
Q

What is oxycyte made from/

A

It is a completel synthetic substitute, made from perfluorocarbons

347
Q

Why is using perfluorocarbons beneficial?

A

PFCs have the highest gas dissolving capacity of any liquid, allowing much more oxygen to be carried

348
Q

What is polyheme’s shelf life?

A

No more than 12 months

349
Q

What is the benefit of using polyheme over oxycyte?

A

It is twice as expensive but can be used at room air

350
Q

What is required when using oxycyte?

A

Supplemental oxygen, which can be toxic at high concentrations

351
Q

Which substitute is universally compatible?

A

Polyheme

From Flashcardlet (133 decks)

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