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PHYG 209 > Blood > Flashcards

Blood Flashcards

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1
Q

What are the main blood functions?

A
  1. Transport:
    - Nutritive
    - Respiratory
    - Excretory
    - Hormone
    Temperature regulation
  2. Acid-Base balance:
    - Normal pH range
  3. Protective:
    - some blood cells and some proteins
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2
Q

What is the composition of blood (%)?

A

55% Plasma (liquid part)
45% Erythrocytes/RBC
Buffer layer (WBC and platelets)

*Plasma counts ECF (plasma) and ICF (inside blood cells)

around 7% of body mass

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3
Q

What are the terms for:
Normal blood volume
Lower blood volume
Higher blood volume

A

Normal = Normovolemia
Lower = Hypovolemia
Higher = Hypervolemia

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4
Q

What is the Hematocrit?

A

Clinical index
Percentage of blood volume occupied by RBC

Measured with column –>
height of RBC/hiegh of whole *100%

Normal Ht = 45%

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5
Q

Voir p.12 for example

A
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6
Q

What is the global composition of plasma?

What is the main difference between composition of Plasma and ISF

A
  1. more than 90% = water
  2. ions
  3. Nutrients (Glucose, amino acids, lipids) wastes (urea, lactic acid, etc.)
  4. Resp. Gases: O2, CO2 (in small concentration because rapid exchanges with other parts of the body)
  5. proteins (colloid) = 7g%
    - Albumins 60%
    - Globulins 35%
    - Fibrinogen 5%

*Main difference = presence of protein in plasma

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7
Q

What are the different ways to separate Plasma proteins?

A
  1. Differential Precipitation by Salts
  2. Sedimentation in Ultracentrifuge
  3. Electrophoretic Mobility (most clinically used)
  4. Immunological Characteristics
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8
Q

How does electrophoresis work?

A

1 of the ways to separate plasma proteins

Fractionation method based on mvt of charged particles along voltage gradient (migrate from anod- to catod+)

Rate of migration influenced by number and distribution of charges + by MW of each protein

Make stains –> area under peak in scan = concentration in blood

When concentration changes –> disease

Voir p.17-18

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9
Q

Where do the plasma proteins come from?

A

Liver:
Albumin, Fibrinogen, Globulins (a1, a2, b)

Lymphoid Tissue:
y Globulins (bc they are antibodies)

*When liver diseased –> plasma protein level decrease

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10
Q

What is the shape, the MW range, the concentration and COP of the different plasma proteins?

A

Albumin:
small oval, 69Kd, 4g%, 20 mm Hg

Globulins:
heterogenous, 90-800Kd, 2.7g%, 5 mm Hg

Fibrogen:
long fiber(oval), 350Kd, 0.3g%, < 1mm Hg

*total of 7g% (= 7g/dl = 70g/L?)

*total odf 25 mm Hg

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11
Q

What in the role of plasma proteins?

A

Determine distribution of fluid between plasma and ISF compartment by controlling transcapillaries dynamics

(ISF doesn’t have proteins)

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12
Q

What is the difference between the cell membrane and the cappillary walls?

A

Cell membrane = impermeable to ions

Capillary walls =
freely permeable to H2O and ions

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13
Q

What is the approximated concentration of ions in ECF?

A

0.9g% solution of NaCl = 300 Osm (6.7 atm or 5100 mm Hg)

*ECF = ISF + Plasma
*Ions = diffusible

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14
Q

How is osmolarity calculated?

A

1 M of solution = 1mol/L = x g/L –> Molarity
concentration in g/L / 1M =

Osmolarity = when dissolved (ions separated)
if seperated into 3 ions, Osm = 3xMolarity
*Practice calculating

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15
Q

What is required to have a net flow of water between compartments?

A

Has to be a difference in osmotic pressure (between both sides of capillary walls)

*Only Non-diffusible solutes contribute to the effective o.p. (can’t go through the capillary wall bc else, become =lly distributed)
Plasma proteins = non-diffusible proteins (only in plasma)

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16
Q

What is the main difference between ISF and Plasma?

How does the net flow change?

A

The presence of plasma protein –> non-diffusible

They then create osmotic effect –> Colloid Osmotic/Oncotic Pressure (C.O.P.) of Plasma = 25 mm Hg

If COP changes, net flow changes:
If COP ↑, water flow into Plasma (to ↓ concentration)
If COP ↓, water flow into ISF (to ↑ plasma concentration that just ↓)

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17
Q

Which are the 2 major forms of fluid tranport across the capillary wall?

A
  1. The COP fo plasma determines amount water move into/out of capillaries
  2. Bulk Flow: flow of molecules subjected to pressure difference

magnitude of Bulk Flow directly proportional to hydrostatic pressure difference

Filtration across porous membrane (like sieve)

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18
Q

What are the 2 important transport mechanism across capillaries?

How are these forces refered to?

A

STARLING FORCES
1. Filtration:
push out fluid from inside capillaries

  1. Osmotic Flow: (due tu plasma prots)
    pull in/retain fluid inside capillaries
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19
Q

What is th capillary bed?

A

site where exchanges take place between plasma and ISF
Filtration in 1st half and absorption in 2nd half

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20
Q

How do nutrients, wastes, O2 and CO2 move in and out of the capillaries?

A

by simple diffusion

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21
Q

What do starling forces determine?

How much is filtered out and reabsorbed directly?

A

Distribution of EFC volume between Plasma and ISF

90% bc 10% is drained by lymphatic vessels

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22
Q

How are the wall of lymphatic vessels?

A

Single layer of endothelial cells

Highly permeable to all ISF constituents (including proteins which may have leaked out of plasma)

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23
Q

What is considered part of the lymphatic system?

A

Lymph nodes
Thymus
Spleen
Bone marrow

Converges and drained into larg veins in the chest

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24
Q

What impacts the colloid osmotic pressure?

A

The NUMBER of osmotically active molecules/unit volume (not size or charge)

Each protein fraction = osmotic pressure:

Directly related to concentration in plasma

Inversly related to molecular weight

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25
Which are the factors that influence the trasncapillaries dynamics?
1. Hydrostatic pressure 2. C.O.P 3. Capillary permeability (some may become more permeable and allow some proteins to go in ISF) 4. Lymphatic drainage
26
What is EDEMA? What are the conditions leading to it?
accumulation of excess fluid in interstitial space 1. ↑ Hydrostatic pressure 2. ↓ Plasma proteins (COP) 3. ↑Capillary permeability 4. X obstruction of lymphatic drainage
27
What can cause a decreased COP? Voir slides 63-65 pour autres choses
1. Failure to synthesis plasma proteins (ex: liver disease) 2. Sever malnutrition (no amino acids) 1st to 2nd baby syndrom --> Kwashiorkor
28
What is the role of plasma proteins?
1. Major role in determining the distribution of fluid between the plasma and ISF by controlling transcapillaries dynamics 2. Contribute to viscosity of plasma (maintenance of blood pressure) 3. Contribute to buffering power of plasma (normal pH range aroung 7.4)
29
What is the function of: fibrinogen and some globulins? y-globulins (immunoglobulins)? Albumins and some globulins?
fibrinogen and some globulins: clotting y-globulins (immunoglobulins): specific resistance to infection Albumins and some globulins: carriers for lipids, minerals, hormones
30
What is the word that refers to the production of blood cell? to the production of RBC? to the production of platelets? to the production of WBC?
all blood cells: Hematopoiesis RBC: Erythropoiesis platelets: Thrombopoiesis WBC: Leukopoiesis
31
What is the process of Hematopoiesis? Which are the sites of Hematopoiesis?
pluripotent hematopoietic stem cell are differentiated into Lymphoid stem cells or Myeloid stem cells under influence of HGFs Myeloid then in redifferentiated into erythrocytes and many other Leukocytes 1. Pluripotential Stem Cell do self-replication (inducer) --> division 2. They are diferentiated by stimulant? into committed Stem Cells (Leukocytes, Platelets/Thrombocytes and Erythrocytes) Yolk sac (1 month and 9 months) and Liver and Spleen (3-7 months) for prenatal Postnatal --> Bone marrow (axial skeleton)
32
What are Cytokines? What is the specific/important one in our blood?
Proteins or peptides which are released by one cell and affect the growth, development and activity of another cell Hematopoietic Growth Factors (HGFs) influence proliferation and differentiation of blood cell precursors
33
What is the fonction of Erythrocytes?
Facilitate transport of respiratory gases between lungs and cells
34
What shape do Erythrocytes have and what the characterstics of it? How many are there in the body?
Biconcave disk Shape due to presence of spectrin (fibrous protein) Adantages of that shape: 1. Maximal surface area and minimal diffusion distance for volume --> more efficient O2 and CO2 diffusion 2. High flexibility (squeeze through narrow capillaries) Male --> 5.1-5.5x 10^6 / microL Female --> 4.5-4.8 x 10^6/ microL *Rate of production = rate of destruction = environ 2 x 10^6/sec *In RBC no ribosome nor nucleus, just solutes dissolved in water (33% Hb)
35
What 2 enzyme systems do RBC have?
Glycolytic enzymes --> generate Energy Carbonic Anhydrase --> CO2 transport
36
How does Hb (hemoglobin) interact with O2? *Voir p.86-87 schema
Each molecule of Hb can bind with max 4 O2 molecules When combined with O2 = OXYHb When released from Hb = DeoxyHb (needs feritin to bind??)
37
What are Hb functions?
1. Transport O2 2. Transport CO2 3. Act as a buffer
38
Where is hemoglobin in the blood? What are the advantages of that?
Inside the cell (RBC) instead of dissolved in plasma Advantages: 1. reduce? Plasma viscosity 2. re Plasma COP 3. re Loss via Kidney * Solubility of O2 in plasma = very low: 0.3 mL O2/100mL plasma but in blood, bc Hb carrying capacity = 20mL O2/ 100mL blood
39
Which are the factors affectiong the ability of Hb to bind and release O2?
1. Temperature 2. Ionic Composition 3. pH 4. pCO2 5. Intracellular enzyme concentration
40
How does the RBC change to be differentiated from Stem cell (18μm) to Erythrocyte (7μm)?
1. Decease in size 2. Loss of nucleus 3. Accumulation of Hb
41
What are reticulocytes?
Reticulocytes = immature RBC Reticulocyte count reflects the amount of effective erythropoiesis in bone marrow Normal count < 1%
42
What factors determine the # of RBC?
1. O2 requirements 2. O2 availability
43
What happens when we go up in altitude?
pO2 (mm Hg) decreases --> less availability RBC increase --> be able to carry more
44
What is Erythropoietin? How is its production regulated?
A glycoprotein hormone/cytokine produced largely by the kidney Hypoxia (not enough O2) stimulates its release --> may come from ↓ # RBC, ↓ availability of O2, ↑ tissue demand for O2 *Erythrpoiesis regulated by release of not of Erythropoietin in kidney depending on its O2 supply --> goes in plasma to bone marrow where RBC produced --> maintain of HOMEOSTASIS
45
What happens in case of severe accidental hemorrhage?
1. ↓ Hb available for O2 transport 2. ↓ supply of O2 to kidneys 3. ↑ production and release of erythropoietin 4. ↑ produciton of erythrocyte precursors in bone marrow 5. ↑ discharge of young erythrocytes in blood 6. ↑ More Hb for O2 transport
46
On which cell does erythropoietin act?
EPO stimulates proliferation of Committed stem cells (already committed to becoming RBC), does not act of pluripotent stem cells Accelerated maturation from committed stem cells ot reticulocytes (not from reticulocytes to mature RBC)
47
What effects do hormones have on erythropoietin?
testosterone ↑ release of EPO testosterons ↑ sensitivity of RBC precursors to EPO Estrogen ha opposite effects *This is why men have more RBC than women
48
What is the lifespan of RBC? How are they disposed of?
120 days (nothing prolonges it!!) Old RBC are recognized and removed by phagocytosis by macrophages in the spleen (some in the liver) Some also hemolyze in the blood stream When phagocytosed, old RBC are digested (cell membrane) by enzymes in cytoplasme of macrophage and contente released in its cytoplasme
49
What happens when the content of RBC is released after it has been phagocytosed by a macrophage? Voir p.119
Hb is divide back into heme and globin Globin --> amino acid pool (reutilized for protein synthesis) Heme --> oxydized into another pigment Biliverdin (green) --> Bilirubin (yellow) --> into liver which converts it into bile (with other things) --> intestianl tract (color fecal matter) Iron picked up by Transferrin (albumin) bc toxic and reused as non-toxic way --> if no immediate need, stored in Liver, Spleen, Gut
50
What quantity of bilirubin must be present in plasma? What effect does a high quantity will have? How does it happen?
1mg/dL in plasma --> gives the yellow cooler If concentration is to high --> jaundice (Icterus) Causes: 1. Because excessive Hemolysis 2. Hepatic Damage (liver damage) 3. Bile duct obstruction (carries bile from Liver to intestinal tract) Neonatal jaundice --> excess of blood cells --> to much bilirubin --> can penetrate into brain if not treated
51
What are the clinical indices for RBC?
1. # of RBC 2. Amount of Hb 3. Hematocrit
52
Does a low of high hematocrit always mean there is anemia or polycythemia?
No, because plasma fluctuates with the amount of water in the body High hematocrit = polycemia OR dehydratation Low hematocrit = Anemia OR fluid retention
53
What is polycythemia? what are the 2 types? WHat is the problem with polycythemia?
When the hematocrit is to high > 18g% Hb or > 6x10^6 RBC/µL Normal = 16g% or %-5.5x10^6 RBC/µL Relative --> due to ↓ plasma volume Absolute : 1. Physiological 2. Pathological Problem: ↑ blood vicosity --> sluggish blood flow --> blood clots
54
What can cause physiological (absolute) polycythemia ?
*Too high hematocrit secondary to ↑ O2 needs, ↓O2 availability - high altitude - ↑ physical activity - chronic lung disease (ex: emphysema) - heavy smoking (high CO in blood)
55
What can cause pathological (absolute) polycythemia ?
*Too high hematocrit - Tumors of cells producing Erythropoietin - Unregulated Production by Bone Marrow Polycythemia vera - 7-8x10^6 RBC/uL or Ht 70%
56
What is anemia ?
↓ in the oxygen-carrying capacity of blood 1. RBC count ↓ (< 4x10^6/uL for male, < 3.2x10^6/uL for female) 2. Hb content ↓ (<11g% for male, < 9g% for female)
57
What are the different types/classifications of anemia?
Morphologic: - Microcytic (<80 u cube) --> smaller - Normcytic (80-94) - Macrocytic (> 94) --> larger - Normochromic (33%) --> darker bc 1/3 volume is Hb - Hypochromic (< 33%) --> less Hb
58
What are the Etiologic Classes of Anemia?
1. Diminished Production 2. Ineffective Maturation 3. Increased Destruction
59
What are the 3 types of diminished production (Etiologic Classification of Anemia)?
3 causes: 1. Abnormal site: Aplastic (hypoplastic) Anemia Problem with functionning of stem cells in bone marrow Etiology(causes): unknown, exposure to radiation, chemicals or drugs Classification: Normocytic, Normochromic 2. Abnormal stimulus: Stimulation failure Etiology: renal disease Classification: Normocytic, Normochromic 3. Inadequate raw materials: Iron deficiency Anemia (most common) Etiology: - ↑ (infant, ado, pregnancy bc muscle growth for example) - Inadequate supplies du to : loss Fe in hemorrhage, Dietary deficiency, failure to absorb Fe Classification: Microcytic, Hypochromic
60
What is the distribution of iron in our body? And our daily intake?
Total amount = 4g 65% Hb, 30% stored, 5% myoglobin, 1% enzymes Daily intake in diet : about 15-20 mg Daily absorption from gut: 1mg for male , 2mg for females
61
How much iron is requiered for normal erythropoiesis? And released in normal RBC destruction?
erythropoiesis requires 25 mg/day normal RBC destruction releases 25 mg/day : 1mg lost, 24 mg recycled so 1mg/d (for male) and 2mg fo female is requiered to be absorbed by the guts
62
What are the proportion of iron (Fe) in the blood? What portion of Fe is lost in blood?
1g Hb contains 3.5 mg Fe and 15g Hb/100mL blood so 50mg Fe/100mL of blood Menstrual loss = 50 mL blood/month = 25mg Fe So lose 25mg Fe/month in period + 28mg Fe/months (bc 1mg/day in RBC destruction) = aroung 50 mg/months so 2mg/day for female
63
What is the etiology and classification of Anemia caused by Ineffective Maturation? (maturation failure anemia)
Etiology : deficiency in vitamine B12 (usually absorption failure) and Folic Acid (usually dietary absence) (both required for synthesis of DNA) Classification: Macrocytic, Normochromic Voirp.145 for vitamine B12 absorption in IF-B12 complex (intrinsic factor has to be secreted)
64
What is anemia caused by survival disorders (Failure to survive)?
Etiology (cause): Congenital: - Abnormal membrane structure of RBC (less flexible, more fragile, will breakup in narrow capillaries, sphere shape instead of dumb-bell) - Abnormal Enzyme systems - Abnormal Hb structure (ex: Thalassemia - deficiency synthesis of globin amino acids) Acquiered: - Toxins - Drugs - Antibodies
65
What are the 3 general causes of anemia?
- Failure to produce - Failure to mature - Failure to survive
66
What word describes and accumulation of blood in tissues? What word discribes the arrest of bleeding? What mechanisms are included in the primary and secondary responses of this phenom?
accumulation of blood in tissues = Hematoma arrest of bleeding = Hemostasis Pimary Hemostasis = Vascular response + platelet reponse Secondary Hemostasis = clot formation
67
What are the 4 steps of hemostasis?
1. Vascular injury 2. Vasoconstriction 3. Platelet Plug Formation 4. Blood Clot Formation (remains until healing has occured)
68
What happens in the Vasoconstriction phase of hemostasis?
1. nervous reflex Opposed endothelial cells stick together 2. myogenic response smooth muscle cells in vessel wall respond to injury by contracting 3. Chemical vasoconstrictors
69
What happens in the Vasoconstriction phase of hemostasis?
platelets (white thrombus) form plug to block the blood from flowing out of the constricted vessel 1. Adhesion von Willebrand Factor provoke adhesion and activation 2. Activaiton and release of cytokines 3. Aggregation Collagen will bind and activate platelets Platelets factors are released and attract more platelets 4. Consolidation When platelet clot formed, consolidate by releasing Thromboxane A2, membrane of platelets also releases ADP and serotonin (vasoconstrictors) and von Willebrand Factor releases PF3 (phospholipids) revoir p.160
70
What is the platelet's structure? Who are they produced?
2-4um diameter No nucleus Many granules --> factors for vasoconstriction, platelet aggregation, clotting, growth, etc. Many filaments, mitochondria, microtubule, etc. Life span: 7-10 days 250 000/uL Pluripotential stem cells --> Committed stem cells (15-20um) (Trombopoietin mostly from liver) --> nucleus divide but doesn't separate (megakaryocytes, 60-80um) in Bone Marrow --> little fragments with cell membrane and granules break off and go into blood stream
71
What are platelets functions?
1. Release vasoconstrictors 2. Form Platelets plug 3. Release Clotting factors 4. Participate in clot retraction 5. Promote Maintenance of Endothelial Integrity
72
What is Petechiae?
breakup of capillaries under skin = small red/purple spots
73
What can cause an abnormal primary hemostatic response (prolonged bleeding)
1. Failure of blood vessels to constrict 2. Platelets deficiencies - Numerical < 75, 000/uL - functional (congenital, acquired) *acquiered: Aspirin (in small doses) inhibits synthesis and release of TXA2

PHYG 209 (6 decks)

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