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Flashcards in Blood and vessels Deck (314):
1

5 functions of blood

transport (waste, nutrients, oxygen), temperature regulation, immunity, communication, defense

2

plasma contents (7)

water, nutrients, electrolytes, proteins (albumin, globulins, fibrinogen), nitrogenous wastes, hormones, gases

3

what does differential blood count do

show percentage of WBC type in blood sample

4

normal differential blood count neutrophil

40-60%

5

normal differential blood count lymphocyte

20-40%

6

normal differential blood count monocyte

2-8%

7

normal differential blood count eosinophil

1-4%

8

normal differential blood count basophil

0.5-1%

9

normal differential blood count band (young neutrophil)

0-3%

10

neutrophil levels raised in (5)

bacterial infection, inflammation, haemorrhage, infarction, trauma/surgery/burns

11

neutrophil levels decreased in

viral infection

12

lymphocyte levels raised in (5)

viral infections, glandular fever, TB, syphilis, whooping cough

13

lymphocyte levels decreased in (3)

AIDS, steroid therapy, post chemo/radiotherapy

14

eosinophil levels raised in (3)

asthma, allergy, parasitic infection

15

monocyte levels raised in (2)

acute chronic infections (e.g. TB), malignant disease

16

basophil levels raised in (6)

viral infection, malignancy, haemolysis, post-splenectomy, urticaria, hypothyroidism

17

histology of platelet (2)

very small, blood clotting

18

histology of monocyte (2)

macrophage, B shaped nucleus

19

lymphocyte histology (3)

similar to monocyte, circular nucleus, darker staining

20

neutrophil histology (2)

big nucleus, multilobed nucleus

21

basophil histology (4)

2 nuclear lobes, not easily distinguishable, granular, lighter staining

22

eosinophil histology (4)

2 nuclear lobes, easily distinguishable, granular, darker staining

23

neutrophils wander in

connective tissues

24

2 methods of neutrophil bacteria killing

phagocytosis and digestion, bactericidal chemical cloud

25

neutrophil enzymes catalyse which reaction

respiratory burst

26

in presence of bacteria, neutrophil lysosomes migrate to cell surface and

degranulate

27

respiratory burst (neutrophil) - neutrophil rapidly absorbs

oxygen

28

respiratory burst (neutrophil) - oxygen reduced to

superoxide anions

29

respiratory burst (neutrophil) - superoxide anions react with hydrogen to produce

hydrogen peroxide

30

respiratory burst (neutrophil) - chloride ions in tissue fluid form

hypochlorite

31

respiratory burst (neutrophil) - 3 highly toxic chemicals produced

hypochlorite, hydrogen peroxide, superoxide anions

32

eosinophils most numerous in

mucous membranes

33

eosinophils concentrated at sites of (3)

allergy, imflammation, parasitic infection

34

eosinophils help kill parasites (e.g. tape worms) by producing (2 chemicals, 1 other)

superoxide, hydrogen peroxide, toxic chemicals (e.g. neurotoxin)

35

eosinophils promote action of which 2 cells

basophils and mast cells

36

eosinophils secrete enzymes that degrade and limit the action of

histamine (and other inflammatory chemicals)

37

basophils secrete chemicals that aid the mobility and action of

other leukocytes

38

basophils secrete (3)

leukotrienes, histamine, heparin

39

function of leukotrienes

activate and attract neutrophils and eosinophils

40

functions of histamine (3)

vasodilator, increases blood flow, speeds delivery of leukocytes to area

41

function of heparin

anticoagulant

42

5% of circulating blood lymphocytes are (2)

natural killer cells and stem cells

43

80% of circulating blood lymphocytes are

T cells

44

15% of circulating blood lymphocytes are

B cells

45

monocytes are in

blood

46

monocytes in connective tissues are known as

macrophages

47

erythrocyte function (2)

oxygen delivery, carbon dioxide transportation

48

erythrocyte shape

discoidal

49

erythrocytes doesn't have (2)

nucleus, organelles

50

erythrocyte method of ATP production

anaerobic fermentation

51

2 cytoskeletal proteins in erythrocytes

spectrin, actin

52

percentage of erythrocyte that is Hb

33%

53

Hb has which 4 globins

2 alpha chains, 2 beta chains

54

each Hb chain has

haem group

55

what does haem group do

binds oxygen to ferrous ion

56

percentage of carbon dioxide transported by Hb

5%

57

adult form of haemoglobin

HbA

58

foetal form of haemoglobin

HbF

59

HbF has two what chains instead of beta chains

gamma chains

60

do gamma or beta chains have higher oxygen affinity

gamma

61

tests for Hb (2)

haematocrit, finger prick test

62

percentage of HbA which is HbA2

2.5%

63

HbA2 has what instead of beta chains

delta chains

64

percentage of HbA which is HbAO

92-94%

65

percentage fo HbA which is HbA1

6-8%

66

HbA1 beta chain has additional what

glucose group

67

erythropoiesis takes how long

~3-5 days

68

four major developments in erythropoiesis

reduction in cell size, increase in cell number, synthesis of Hb, loss of nucleus and organelles

69

in erythropoiesis, pluripotent stem cell develops into

erythrocyte colony-forming unit

70

erythrocyte colony-forming unit has receptors for

erythropoietin

71

function of erythropoietin

stimulates erythrocyte colony-forming unit to transform into erythroblast (normoblast)

72

erythrocyte- colony-forming unit transforms into

erythroblast (normoblast)

73

erythroblasts (normoblasts) multiply and synthesise

Hb

74

once Hb synthesised, nucleus shrivels and

is discharged from cell

75

once nucleus is discharged from normoblast with Hb, cell known as

reticulocyte

76

reitculocyte enters

circulating blood

77

once in blood, cells from erythropoiesis are known as

mature erythrocytes

78

multipotent stem cells in red bone marrow are known as

haemocytoblasts

79

sites of haemopoiesis as embryo (5)

yolk sac (first 8 weeks of development) then to liver, spleen, thymus and bone marrow

80

sites of haemopoiesis as child (2)

liver and spleen

81

site of haemopoiesis as adult

red bone marrow

82

red bone marrow is found in which bones (2)

flat and long bones

83

myeloid stem cells develop into (2)

RBCs and several classes of WBCs

84

lymphoid stem cells develop into

lymphocytes

85

after reticulocytes enter blood stream, how long does it take for complete maturation into mature RBCs

24 hours

86

erythrocyte life span

100-120 days

87

after 120 days, what erythrocyte damage is detected by phagocytes

plasma membrane rupture / other damage

88

types of agglutinogens (2)

A or B

89

Blood group A has which antigens on RBCs

A antigens

90

Blood group A has which antibodies in plasma

anti-B

91

Blood group B has which antigens on RBCs

B antigens

92

Blood group B has which antibodies in plasma

anti-A

93

Blood group O has which antigens on RBCs

no antigens

94

Blood group O has which antibodies in plasma

A and B antigens

95

Blood group AB has which antigens on RBCs

A and B antigens

96

Blood group AB has which antibodies in plasma

no antibodies

97

A and B are

codominant

98

O is

recessive

99

Anti-A and Anti-B antibodies are usually what type of antibody

IgM

100

O individuals can also produce which type of ABO antibodies

IgG

101

Rh+ is

dominant

102

Rh- is

recessive

103

Rh gene is one gene (RHD) located where

chromosome 1

104

precursor to ABO blood group antigens are

H antigens

105

Absence of H antigen is similar to which blood group

O

106

Gene for H antigen where

chromosome 19

107

ABO locus is where

chromosome 9

108

macrophages of where (3) play role in recycling RBC components

liver, spleen, bone marrow

109

during haemolysis, Hb breaks down and alpha and beta chains are filtered by

kidneys

110

breakdown of Hb, haem group is stripped of iron and converted to

biliverdin

111

breakdown of Hb, haem group is stripped of iron and converted to biliverdin which is then converted to

bilirubin

112

bilirubin is released into blood stream and binds to

albumin

113

bilirubin and albumin transported to liver and excreted as

bile

114

Haemoglobinuria definition

urine red/brown due to excess RBC breakdown

115

Haematuria definition

intact RBCs in urine

116

Haematuria occurs after (2)

kidney damage or damage to vessel along urinary tract

117

jaundice definition

bile duct blocked/liver unable to absorb bilirubin -> bilirubin diffuses into peripheral tissues --> yellow colour

118

location of spleen

left hypochondriac region, inferior to diaphragm, posterolateral to stomach.

119

spleen protected by which ribs

10-12

120

spleen indentations

gastric area and renal area

121

spleen of hilum penetrated by (3)

splenic artery, splenic vein, lymphatic vessels

122

parenchyma of spleen has two types of tissue

red pulp, white pulp

123

red pulp contains

sinuses gorged with concentrated erythrocytes

124

white pulp contains

lymphocytes and macrophages aggregated with sleeves along small branches of splenic artery

125

consequence of splenectomy

more vulnerable to infection

126

innervation of spleen

splenic plexus

127

spleen has what type of circulation

open

128

open circulation meaning

blood squeezes through walls of sheathed capillaries into sinuses

129

sinus of spleen drain into

larger sinuses

130

larger sinuses of spleen drain into

splenic vein

131

splenic vein drains into

hepatic portal vein

132

splenic artery branches

repeatedly through parenchyma

133

larger arteries of spleen surrounded by

fibrocollagenous sheath

134

fibrocollagenous sheath of spleen disappears in

smaller branches

135

smaller branches of spleen form

smaller arterties

136

smaller arteries of spleen give off

number of short branches at right angles

137

short branches given off by smaller arteries are known as

penicilliary arteries

138

penicilliary arteries end in

sheathed capillaries

139

sheathed capillaries of spleen have

blind-ending

140

yellow bone marrow develops

adipose tissue

141

5 mechanisms of venous return to the heart

pressure gradient, gravity, skeletal muscle pump, thoracic (respiratory pump), cardiac suction

142

venous pressure gradient favours blood flow in which direction?

back towards heart

143

pressure gradient and venous return increase when (2)

blood volume increases and general widespread vasoconstriction

144

Skeletal muscle pump --> in limbs, veins are ... and ... by muscles

surrounded and massaged

145

Skeletal muscle pump - contracting muscles squeeze blood out of compressed part of vein - what ensures blood flow in only one direction?

valves

146

thoracic (respiratory) pump aids flow of venous blood from... to ...

from abdominal to thoracic cavity

147

cardiac suction happens during

ventricular systole

148

during ventricular systole, chordae tendinae of AV valves pull cusps, expanding atrial space. This creates

suction which draws blood from venae cavae and pulmonary veins

149

define circulatory shock

cardiac output insufficient to meet body's metabolic needs

150

two types of circulatory shock

cardiogenic shock, low venous return shock

151

cardiogenic shock caused by

inadequate pumping of heart

152

3 main types of low venous return shock

hypovolemic shock, obstructed venous return shock, venous pooling (vascular) shock

153

definition of low venous return shock

cardiac output low because too little blood returning to heart

154

most common type of low venous return shock

hypovolemic shock

155

definition hypovolemic shock

loss of blood volume due to trauma, haemorrhage, bleeding ulcers, burns, dehydration

156

definition of obstructed venous return shock

when blockage e.g. tumour, aneurysm blocks vein so blood flow is impeded on return to heart

157

definition of venous pooling (vascular) shock

normal total blood volume but too much blood accumulating in limbs

158

septic shock definition

bacterial toxins trigger vasodilation and increase capillary permeability

159

compensated shock definition

body trying to compensate for blood loss

160

decompensated shock definition

body's mechanisms unable to continue compensating for blood loss

161

in compensated shock, hypotension triggers which reflex

baroreflex

162

in compensated shock, baroreflex triggers production of...

angiotensin II

163

angiotensin II from baroreflex triggers..

vasoconstriction

164

in compensated shock, falling or fainting means gravity restores blood flow to

brain

165

in decompensated shock, myocardial ischaemia and infarction lead to weakened heart and

cardiac output further reduced

166

in decompensated shock, poor circulation leads to

disseminated intravascular coagulation, congested vessels and therefore reduced venous return

167

in decompensated shock, ischaemia and acidosis of brainstem lead suppression of ... which leads to loss of vasomotor tone > vasodilation > drop in BP > cardiac output reduced

vasomotor and cardiac centres

168

internal bleeding definition

damage to artery or vein allows blood to collect in surrounding environment

169

causes of internal bleeding (7)

blunt trauma (compression of internal organs), deceleration trauma (shift of organs upon deceleration), fractures (bone marrow = site of blood production), pregnancy, medication, spontaneous, alcohol abuse

170

usual treatment of internal bleeding

surgery to repair site of damage and rectify cause

171

short term cardiovascular response to low blood volume and haemorrhage

elevate BP

172

long term cardiovascular response to low blood volume and haemorrhage

restoration of blood volume

173

elevation of BP can be achieved by .... and .... reflexes increased cardiac output and causing peripheral vasoconstriction > increases heart rate

carotid and aortic reflexes

174

elevation of BP can be achieved by stress and anxiety which stimulate .... nervous system headquarters in hypothalamus

sympathetic

175

elevation of BP, stimulation of the sympathetic nervous system headquarters triggers further increase in vasomotor tone > constricts arterioles > raises BP. Vasoconstriction mobilises .... which improves ....

venous reserve ... venous return

176

elevation of BP, sympathetic activation stimulates the adrenal medulla to secrete ... and .... which increases cardiac output and extends peripheral vasoconstriction

adrenaline and noradrenaline

177

elevation of BP, sympathetic activation stimulates posterior pituitary to release .... and stimulates production of .... which enhances vasoconstriction

ADH .... angiotensin II

178

long term cardiovascular response to low blood volume and haemorrhage include

decline in capillary BP (recall of fluid from interstitial spaces) , aldosterone and ADH promote fluid retention and reabsorption at kidneys, thirst increases and digestive tract absorbs additional water, erythropoietin stimulates RBC production

179

3 signs of shock:

low BP, low body temperature, rapid pulse (often weak and thready)

180

treatment of shock in hospital (7)

IV (blood or blood products), medication to increase BP and CO, heart monitoring, Swan-Ganz catheterisation, stopping bleeding, blood transfusion or alternatives

181

Swan-Ganz catheter is what type of catheter?

pulmonary artery catheter

182

3 uses of Swan-Ganz catheter

detect sepsis and heart failure, monitor effects of drugs and treatment

183

Swan-Ganz catheter directly measures pressure in (3)

right atrium, right ventricle, pulmonary artery

184

Swan-Ganz catheter measures wedge pressure of

left atrium (filling pressure)

185

Swan-Ganz catheter has what type of tip?

balloon

186

Swan-Ganz catheter can distinguish between what two types of shock

hypovolemic and cardiogenic

187

Preferred neck site of insertion of Swan-Ganz catheter (4 veins)

Right Internal Jugular > Left Subclavian > Right Subclavian > Left Internal Jugular

188

Left subclavian vein for Swan-Ganz catheter does not require catheter to

pass course at acute angle to enter superior vena cava

189

In addition to the neck, Swan-Ganz catheter can be inserted into (2)

wrist, leg (femorally)

190

what kind of route is used for left heart catheterisation

arterial

191

what kind of route is used for right heart catheterisation

venous

192

fractures of lower limb should be considered potential cause of

hypovolemic shock

193

splintage of fractures can reduce

blood loss

194

later complications of fractures include (4)

fat embolism, DVT, PE, infection

195

compartment syndrome definition

bleeding into closed fascial space

196

compartment syndrome takes up to how many hours to develop

48

197

compartment syndrome is common in significant ..... fractures although it is possible in .... fractures too

closed; open

198

compartment syndrome symptoms (5)

pain despite analgesia, extreme pain when moving toes, pallor, pulselessness, paraesthesia

199

treatment of compartment syndrome (3)

oxygen by mask, fluid into veins, fasciotomy

200

possible complications of compartment syndrome (6)

permanent nerve damage, permanent muscle damage, permanent scarring, loss of limb, infection, kidney failure

201

respiratory acidosis from

hypoventilation

202

respiratory alkalosis from

hyperventilation

203

respiratory acidosis is due to

imbalance of ventilation-perfusion rates - too much CO2 left in blood stream

204

respiratory alkalosis is due to

imbalance of ventilation-perfusion rates - too much CO2 removed from body

205

buffer definition

any mechanism that resists change in pH by converting strong acid/base into weak one

206

metabolic acidosis can be from (2)

lactic acid production or base loss (e.g. diarrhoea)

207

metabolic alkalosis is rare but can result from (2)

overuse of bicarbonates or from loss of stomach acid

208

type 1 respiratory failure oxygen and carbon dioxide levels

low oxygen, normal or low carbon dioxide

209

type 2 respiratory failure oxygen and carbon dioxide levels

low oxygen, high carbon dioxide

210

bicarbonate buffer system is a solution of

carbonic acid and bicarbonate ions

211

bicarbonate buffer system equation

CO2 + H2O H2Co3 HCO3- + H+

212

phosphate buffer system equation

H2PO4- HPO4(2-) + H+

213

phosphate buffer system is .... that bicarbonate buffer system

stronger

214

phosphate buffer system is more important where? why?

renal tubules; closer to optimum pH

215

renal tubules secrete ........... into tubular fluid where it binds to .........., ........... and ........... > excreted in urines

hydrogen ions; bicarbonate, ammonia, phosphate buffers

216

hydrogen ions travel in form of ....... and ......

carbonic acid and water molecules

217

in leukopoiesis, myeloblasts develop into

3 types of granulocytes (neutrophils, eosinophils, basophils)

218

in leukopoiesis, monoblasts develop into

monocytes

219

in leukopoiesis, monoblasts look identical to

myeloblasts

220

in leukopoiesis, lymphoblasts develop into

all types of lymphocyte

221

in leuokopoiesis, stem cells have receptors for specific .......... which respond to specific needs

colony stimulating factors

222

tunica intima/interna =

endothelial lining and surrounding layer of connective tissue

223

in arteries, tunica intima/interna has elastic fibres =

internal elastic membrane

224

tunica media =

smooth muscle and loose connective tissue

225

tunica media is bound to tunica interna and tunica externa by

collagen fibres

226

in small artery, thickest layer is

tunica media

227

tunica media separated from tunica externa by elastic fibres =

external elastic membrane

228

tunica externa / adventitia =

connective tissue sheath

229

in arteries, tunica externa/adventitia made of (2)

collagen and elastic fibres

230

in veins, tunica externa/adventitia made of (2)

smooth muscle and elastic fibres

231

thickest layer in veins is

tunica externa/adventitia

232

elastic arteries are also known as

conducting arteries

233

in elastic arteries, tunica media is mainly elastic not

muscle

234

major branches of elastic arteries (2)

aorta, pulmonary trunk

235

muscular arteries are also known as

distribution arteries

236

muscular arteries distribute blood to (2)

skeletal muscles and organs

237

superficial muscular arteries are important as

pressure points (pulses)

238

arterioles have a poorly defined

tunica externa

239

arterioles have varying degrees of

smooth muscle

240

venules collect blood from

capillary beds

241

smallest venules lack

tunica media

242

in medium sized veins, tunica media is thin and lacks

muscle

243

in medium sized veins, the thickest layer is the

tunica externa

244

in medium sized veins, the tunica externa has

longitudinal bundles of elastic and collagen

245

large veins have a thick tunica externa made of

elastic and collagen

246

large veins have slender

tunica media

247

examples of large veins (2)

venae cavae and tributaries

248

valves are found in (2)

venules and medium sized veins

249

capillaries are a .............................. inside a ............

endothelial tube, thin basement membrane

250

capillaries have absent (2)

tunica media, tunica externa

251

continuous capillaries supply

most regions of body

252

some continuous capillaries have ........ which restrict permeability

tight junctions

253

fenestrated capillaries have ..... that penetrate endothelial lining which allows rapid exchange between ..... and ....

pores; plasma and interstitial fluid

254

sinusoids resemble

fenestrated capillaries

255

sinusoids are flattened and ........ shaped

irregularly

256

in sinusoids, basement membrane is

thin/absent

257

entrance to each capillary guarded by

precapillary sphincter

258

precapillary sphincter controls

where blood flows within plexus

259

if more than one artery supplies capillary bed they are known as

collaterals

260

collaterals fuse before arterioles at

arterial anastomoses

261

direct connections between arterioles and venules are known as

arteriovenous anastomoses

262

creatinine = waste product of

muscle metabolism

263

creatinine produced from

creatine

264

creatinine is filtered out of blood by

kidneys

265

high creatinine levels lead to reduced

kidney function

266

hyperkalaemia can indicate

reduced kidney function

267

hyperkalaemia is when plasma potassium what level

>5.5mmol/L

268

blood pressure equation

CO X peripheral resistance

269

cardiac output definition

volume of blood expelled from heart/min

270

equation for cardiac output

stroke volume X HR

271

capillary hydrostatic pressure definition

force exerted by fluid pressing against capillary wall

272

venous pressure definition

pressure within venous system

273

total peripheral resistance is affected by (3)

turbulence, blood viscosity, vascular resistance

274

vascular resistance is affected by friction which is determined by

diameter and vessel length

275

elastic rebound forces blood towards

capillaries

276

mean arterial pressure equation

(1/3 pulse pressure) + diastolic pressure

277

pulse pressure =

systolic - diastolic BP

278

high BP means .... is 6X more likely

stroke

279

high BP means ... is 3X more likely

cardiac death

280

high BP means .... is 2X more likely

peripheral arterial disease

281

secondary hypertension =

cause of hypertension known

282

primary hypertension =

cause of hypertension unknown

283

9 risk factors of hypertension

age, family history, african/ caribbean origin, high salt intake, lack of exercise,overweight, smoking, lots of alcohol, stress

284

4 stages of hypertension

stage 1, stage 2, sever, hypertensive emergency/malignant hypertension

285

stage 1 hypertension =

BP = 140/90 + ambulatory 135/85

286

Stage 2 hypertension =

BP = 160/100 + ambulatory 150/95

287

sever hypertension =

systolic = 180+ / diastolic 110+

288

hypertensive emergency/ malignant hypertension =

acute impairment of organs, can result in irreversibly damage to organ

289

rebound hypertension =

when stop taking drugs to reduce BP - 30-50% genetic, 50% environmental

290

hypertension can lead to fainting because there is an increase in adrenaline binding to ... ....... ......... which causes dilation of skeletal muscle arteries and reduction in blood flow and pressure to the brain

beta2- adrenergic receptors

291

global prevalence hypertension

40%

292

hypertension more prevalent in younger men than women, but women catch up as get

older

293

5% CO2 carried in blood as ..... as

dissolved

294

90% CO2 transported as hydrated

carbonic acid

295

chloride shift =

chloride into Hb and bicarbonate out via antiport (chloride-bicarbonate exchanger)

296

oxygen utilisation coefficient usually

~22%

297

4 factors affecting rate of oxygen unloading

ambient PO2, temperature, Bohr effect, bisphosphoglycerate

298

temperature and oxygen unloading

higher temp > oxyhaemoglobin dissociation curve shifts to right > increased oxygen unloading

299

bohr effect and oxygen unloading

more carbon dioxide produced by tissues > increase in hydrogen ions > weakened Hb oxygen bond > increased oxygen unloading

300

Haldane effect =

low levels of HbO2 > blood transports more carbon dioxide

301

hypocapnia =

low blood PCO2

302

hypercapnia =

high blood PCO2

303

hypoxic drive due to long term

hypoxaemia

304

hypoxic drive means respiration is driven by

low PO2

305

hypoxia =

low oxygen reaching tissues

306

hypoxic hypoxia =

lack of oxygen in blood flow to tissues

307

hypoxic hypoxia usually due to

inadequate breathing

308

anaemic hypoxia =

low Hb levels reduce oxygen carrying capacity of blood - many causes

309

Stagnant (circulatory) hypoxia =

lack of blood flow to tissues

310

Histiotoxic anaemia =

adequate oxygen inhaled and delivered to tissues, tissues just cannot utilise oxygen

311

Metabolic hypoxia =

more demand for oxygen by tissues than normal - from raises metabolism e.g. sepsis

312

5 symptoms of hypoxia

dizziness, dyspnoea, confusion, tachycardia, cyanosis

313

6 causes of hypercapnia

hypoventilation, diminished consciousness, lung disease, rebreathing exhaled carbon dioxide, exposure to high carbon dioxide environment, initial effect of sleep apnoea > respiratory acidosis

314

5 symptoms of hypercapnia

hand flaps, flushed skin, hyperventilation, dyspnoea, reduced neural activity