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Phase 1 Cardio > 2 > Flashcards

2 Flashcards

1
Q

Who discovered main blood groups?

A

Karl Landsteiner

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2
Q

What are the main blood groups?

A

A, B & O

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3
Q

Name the 5 main antibodies (also known as agglutinins) :

A 
IgG
IgM
IgA
IgE
IgD
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4
Q

Which two of the Ig antibodies are larger in size?

A

IgM and IgA

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5
Q

Certain antibodies naturally occur in the blood from what age?

A

6 months old

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6
Q

Which antibodies are usually involved in the ABO grouping system?

A

IgM

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7
Q

Which system carries D C c E e antigens?

A

Rh system

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8
Q

A group of …… genes are inherited from each parent.

A

Rh (C,D or E antigens)

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9
Q

Which antigen is responsible for most clinical issues associated with the Rh system?

A

D antigen

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10
Q

A person can be RhD+ (D antigen is present) or ………..

A

RhD- (D antigen is not present)

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11
Q

The D allele is dominant so the genotype will either be…..

A

DD or Dd

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12
Q

Rh antibodies rarely occur …………

A

naturally

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13
Q

Before giving blood transfusion to a patient, a ………….. must be carried out.

A

crossmatch

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14
Q

Explain what a blood transfusion is.

A

The infusion of blood product from a donor to a recipient.

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15
Q

The compatibility of the donor and recipient is paramount. The ………… on their …….. may differ, causing problems eg. transfusion reactions.

A

proteins, RBCs

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16
Q

Outline the 3 steps of cross-matching blood.

A

1) mix the donor and recipient blood
2) incubate the mixtures at various temperatures
3) check for agglutination within the samples

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17
Q

What are some characteristics of an ideal donor?

A

-Age 17-70
-Weight > 50kg
-Not pregnant/lactating
-No risk behaviour (piercings, tattoo, risky sex, homosexual sex, acupuncture) within last 12 months
-Hb > 134g/L men
Hb > 120 g/L women
-no live vaccinations within last 2 months

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18
Q

Immune antibodies are given by…

A

transfusion or trans-placental pass during pregnancy

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19
Q

Immune antibodies are usually ………… but can be ………..

A

IgG

IgM

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20
Q

Which antibodies are the only ones capable of trans-placental pass from mother to fetus?

A

IgG

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21
Q

Immune antibodies usually react at ………. temperatures.

A

Warm eg. 37 degrees Celsius

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22
Q

What is the most important immune antibody?

A

Rh antibody: anti-D

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23
Q

Explain the importance of RhD- in pregnancy.

A

If a women has the dd genotype, they are RhD-.
This means they do not carry the D antigen. The baby however carries paternal antigens, for example the D antigen, so may be RhD+.
The mother will be exposed to the D antigen in the baby’s red blood cells, and IgG anti-D will be produced, as the D antigen is a foreign antigen to the mother.
The anti-D can cross the placenta and haemolyse the baby’s RBCs.

The first baby is unaffected since it takes time for antibodies to be produced- the mother is said to be sensitised.
However if a second baby is also RhD+, antibodies will be produced by the mother immediately, and these can reach the baby via the placenta. They will destroy the baby’s RBCs resulting in haemolysis of foetus/newborn. This is Rhesus Disease.
This may lead to anaemia/jaundice.

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24
Q

How are RhD- women treated in pregnancy?

A

Anti-D antibody is given to all RhD- mothers to prevent sensitisation. This will prevent her from producing the antibodies herself.

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25
Q

What are the 7 main things transfused?

A 
Packed Red Cells
Platelets
FFP
Cryoprecipitate
Factor concentrates
Immunoglobulins
Human Albumin Solution
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26
Q

What does it mean when a Red blood cell is packed?

A

Plasma depleted

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27
Q

How long does it take to transfuse packed red cells?

A

usually 2-3 hours

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28
Q

How are platelets harvested?

A

They are by cell separators or from individual units of blood.

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29
Q

Platelets have to be stored at ………. …………

A

room temperature

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30
Q

Over what period of time are platelets transfused?

A

30 mins

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31
Q

What platelet count is usually aimed for?

A

> 10 but aim for >20

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32
Q

FFP (fresh frozen plasma) is stored at < ………….

A

-30 degrees Celsius

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33
Q

What does FFP contain?

A

coagulation proteins and inhibitors.

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34
Q

Indications that a platelet transfusion is needed:

A
  • thrombocytopenia

- disordered platelet function & actively bleeding

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35
Q

Indications that a FFP transfusion is needed:

A
  • dilutional coagulopathy
  • liver disease
  • DIC
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36
Q

What is DIC?

A

Disseminated intravascular coagulation.

A condition where blood clots are excessively formed in the body’s blood vessels.

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37
Q

Cryoprecipitate is rich in …………..

A

fibrinogen (clotting factor 1)

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38
Q

What is an immunoglobulin transfusion used for?

A

Treating immunodeficiencies.

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39
Q

What is transfused as a physiological plasma expander and how does it work?

A

Human Albumin Solution (HAS).
It is used to increase the oncotic pressure in the recipients blood.
It can also reduce oedema.

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40
Q

Early risks of transfusion:

A 
Allergic reactions
Pyrogenic reactions (rise in temp)
ABO incompatibility
Bacterial contamination
Coagulopathy 
Circulatory overload
Post transfusion purpura 
Transfusion related acute lung injury (TRALI)
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41
Q

Later risks of transfusion:

A 
Prion infection
RhD sensitisation
Delayed transfusion reaction
Transfusion related iron overload
Viral infection (Eg. Hep B/HIV)
42
Q

Alternatives to blood transfusions:

A

Iron deficiency alone is not an indication therefore try IV iron first or tablets

Stop precipitating drugs (eg. antiplatelets/anticoagulants)

Intra-operative cell salvage & re-infusion + tranexamic acid

Erythropoietin

43
Q

What is intra operative cell salvage?

A

A medical procedure involving recovering blood lost during surgery and re-infusing it into the patient. It is a major form of autotransfusion.

44
Q

…………………. is a process wherein a person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood. There are two main kinds of autotransfusion: Blood can be autologously “pre-donated” before a surgery, or alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device.

A

Autotransfusion

45
Q

What does Erythropoietin do?

A

It is a medicine which helps the body to produce more red blood cells.

46
Q

Is Erythropoietin given a lot?

A

No. It doesn’t work to avoid the need for transfusion, however may be offered if you cannot have transfusion (eg. due to religious beliefs) or because the type of blood needed isn’t available.

47
Q

Define Gastrulation:

A

The mass movement and invagination of the blastula to form the three layers ectoderm, mesoderm and endoderm.

48
Q

Which layer is most of the cardiovascular system derived from?

A

Mesoderm

49
Q

There is some contribution to what from the ectoderm?

A

The cardiac neural crest.

50
Q

What does the first heart field develop into?

A

The left ventricle.

51
Q

What does the second heart field develop into?

A

Outflow tract, right ventricle and atria.

52
Q

What are some examples or cardiac transcription factors?

A 
Nkx2.5
MEF2
GATA
Hand 
Tbcx
53
Q

Primitive heart tube formation is the first step of what?

A

Cardiac formation.

54
Q

At which day does the primitive heart tube form?

A

Day 21.

55
Q

Name the parts of the heart tube from top to bottom.

A 
Truncus arteriosus
Bulbus cordis
Primitive ventricle
primitive atria
Sinus venosus
56
Q

What does the Bulbus cordis form?

A

Most of the right ventricle and parts of the outflow tracts for the aorta and pulmonary trunk.

57
Q

What forms most of the left ventricle?

A

The Primitive ventricle

58
Q

What does the primitive atria form?

A

The anterior parts of the left & right atrium.

59
Q

What forms the superior vena cava and part of the right atrium?

A

The Sinus venosus

60
Q

What does overexpression of Nkx2.5 cause?

A

An increase in heart size.

61
Q

What is caused if GATA4 is prevented from being transcribed?

A

Cardia bifida (failure of endocardial tubes to fuse)

62
Q

What is the second step of cardiac formation?

A

Cardiac looping.

63
Q

Preventing which transcription factor prevents looping?

A

Fog-1

64
Q

All vertebrate hearts have ……………. ventricle (unless mutation occurs).

A

leftward

65
Q

The third step in cardiac formation is cardiac ………

A

Septation.

66
Q

What happens during cardiac septation?

A

Masses of tissue grow from the sides of the AV canal, partitioning it into 2 separate openings (the left and right atrioventricular canals)

67
Q

What tissue grows either side of the AV canal during cardiac septation?

A

Endocardial cushions.

68
Q

Why do we need circulation?

A
  • every cell in the body needs to be bathed in fluid and within 2mm of a source of oxygen
  • it reproduces the extracellular environment of primitive uni/multicellular organisms in the primeval ocean
69
Q

What happens if vessels are larger than 2mm with regards to being near to a source of oxygen?

A

They have their own blood supply (vasa vasorum)

70
Q

Capillaries are …..-……. microns in diameter.

A

3-40

71
Q

Capillaries can continuous or discontinuous. Which is more common?

A

Continuous

72
Q

What is a continuous capillary?

A

Capillaries that have a continuous endothelial lining. There are tight junctions between endothelial cells and intercellular clefts to allow small molecules to pass.

73
Q

Where are continuous capillaries found?

A

Generally found within the nervous system and in fat and muscle tissue.

74
Q

What are fenestrated capillaries?

A

They have small openings in their endothelium (fenestra) which are 80-100 nm in diameter. Fenestra have a permeable membrane which is diaphragm like and spanned with fibrils.

75
Q

Where are fenestrated capillaries found.

A

In tissues where a large amount of molecular exchange occurs, such as the kidneys, small intestine and endocrine glands.

76
Q

What are discontinuous/sinusoidal capillaries?

A

These have endothelial linings with multiple fenestrations which are 30-40 nm in diameter. They allow blood cells and serum proteins to pass through the wall as the fenestrations have no diaphragm and have either a discontinuous or non existent basal lamina.

77
Q

Where are sinusoidal/discontinuous capillaries found?

A

Mainly found in the liver, between epithelial cells and hepatocytes.
Can also be found in the sinusoids of the spleen where they are involved infiltering antigens, defective RBCs and microorganisms out of the blood.
Can also be found in lymph nodes, bone marrow and some glands of the endocrine system.

78
Q

What is aortic coarctation?

A

Congenital narrowing of the descending aorta.

79
Q

What happens if the aortic coarctation is too tight?

A

The baby goes into heart failure.

80
Q

During the formation of the circulation, around day 17, there is the formation of ………… …………….

A

Blood islands

81
Q

What is a blood island?

A

extraembryonic mesoderm core of haemoblasts surrounded by endothelial cells.

82
Q

What commences on day 18 of embryonic development, regarding development of the circulation?

A

Vasculogenesis commences.

Angioblasts form angioblastic cords throughout the embryonic disk.

83
Q

What 2 things drive embryonic vessel development?

A
  • Angiogenic growth factors

- Repulsive signals

84
Q

Give 2 examples of angiogenic growth factors involved in embryonic vessel development:

A
  • vascular endothelial growth factor (VEGF)

- Angiopoietin 1 & 2

85
Q

Give 2 examples of repulsive signals involved in embryonic vessel development:

A
  • Plexin/semaphorin signalling

- Ephrin/Eph interactions

86
Q

What does the first aortic arch develop into?

A

Degenerates and becomes a small part of the maxillary (jaw).

87
Q

What does the second aortic arch develop into?

A

Degenerates and becomes artery to stapedius (inner ear).

88
Q

What does the 3rd aortic arch develop into?

A

3rd aa + part of dorsal aorta => distal internal carotid

3rd aa => common carotid and proximal internal carotid

89
Q

What does the right 4th aortic arch develop into?

A

R 4th aa + 7th intersegmental artery => right subclavian

90
Q

What does the right dorsa aorta develop into?

A

The right arm artery.

91
Q

What does the left 4th aortic arch develop into?

A

L 4th aa => arch of aorta

92
Q

What does the left dorsal aorta develop into?

A

The descending aorta.

93
Q

What does the right 6th aortic arch develop into?

A

Pulmonary artery/trunk.

94
Q

What does the left 6th aortic arch develop into?

A

Ligamentum arteriosum from ductus arteriosus

95
Q

What 3 complications can occur during development of the circulation?

A

1) Double aortic arch- encasing trachea/oesophagus
2) Right sided aorta
3) Aortic coarctation

96
Q

Circulation develops from ………… via Vasculogenesis and angiogenesis.

A

Mesoderm

97
Q

Some people have the gene that results in the synthesis of the A antigen on the surface of red blood cells. Some have the gene that results in the synthesis of B antigen. Those who have neither are said to have…………….

A

O-type erythrocytes.

98
Q

Type A individuals have anti-B antibodies in their plasma, and type B individuals have ……….. antibodies in their plasma.

A

anti-A

99
Q

A and B antigens are ……………….

A

co-dominant.

100
Q

Type AB individuals have ……….. in their plasma.

A

Neither anti-A or anti-B antibodies.

This makes type AB a universal recipient.

101
Q

Type O individuals have ……………. in their plasma.

A

both anti-A and anti-B antibodies.

This makes type O a universal donor.

102
Q

The O antigen is …………

A

recessive

Phase 1 Cardio (3 decks)

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