Blood Disorders

Question 1

Blood is constituted by ______% of plasma and ______% of formed elements.

Answer 1

55; 45

Question 2

Plasma is 90% of __________ and 10% of _____________, _____________, carbohydrates, minerals.

Answer 2

water; proteins; electrolytes

Question 3

The formed elements are nearly ________% of _______ __________ cells and =< 2% of _________ ___________ cells and platelets.

Answer 3

100; red blood; white blood

Question 4

What’s another name for platelets?

Answer 4

Thrombocytes

Question 5

What are the main blood functions (5)?

Answer 5

1) Transport oxygen
2) Transport nutrients
3) Regulate body temperature
4) Protect against foreign pathogens
5) Actively participate in the coagulation process

Question 6

Hematopoiesis is the production of formed elements. True or False?

Answer 6

True

Question 7

How many blood cells are approximately produced daily?

Answer 7

More than 100 billion.

Question 8

Hematopoiesis occurs mostly in the ________ ____________.

Answer 8

bone marrow

Question 9

All cells derived from a single hematopoietic stem cell. True or False?

Answer 9

True

Question 10

The differentiation depends on certain elements such as ______________ and hormones (e.g.: erythropoietin and thrombopoietin)

Answer 10

cytokines

Question 11

Hemoglobin is a tetramer with ______ alfa and _____ beta subunits, containing each one of them one _________ group where the oxygen will bind.

Answer 11

2; 2; heme

Question 12

The circulation half-time of erythrocytes is 120 days and their production is controlled by erythropoietin. True or False?

Answer 12

True

Question 13

Once they lost their function, erythrocytes are removed from the circulation by the __________.

Answer 13

spleen

Question 14

WBC can be divided into ____________________ and granulocytes.

Answer 14

non-granulocytes

Question 15

Monocytes are __________________ that act on the tissues and develop into ________________ or dendritic cells. They present ______________.

Answer 15

non-granulocytes; macrophages; antigens

Question 16

Lymphocytes are ___________________. Lymphocytes (T cells and B cells) are trained to recognise and tolerate “self”. During development (in the __________ for T cells and bone marrow for ___ cells), they undergo selection processes. If a lymphocyte reacts strongly to “self”, it’s eliminated or inactivated. This prevents _______________ diseases.

When lymphocytes detect foreign antigens (proteins on pathogens), they become activated. B cells produce _____________. T cells either kill infected cells (_____________ T cells) or help coordinate the immune response (___________ T cells).

Answer 16

non-granulocytes; thymus; B; autoimmune; antibodies; cytotoxic; helper

Question 17

Neutrophils are ______________ and are the most common type of wbc. They have multi-loaded nuclei, present very fine cytoplasmatic ______________ containing highly active enzymes (e.g.: __________________). Their circulation half-time is 6h up to some days and their main function is to kill bacteria through _________________.

Answer 17

granulocytes; granules; myeloperoxidase; phagocytosis

Question 18

Basophils are _______________ with pale nuclei and a bi-lobed or tri-lobed nucleus. Their circulation half-time is a few hours up to some days and their main functions are to act in case of _____________, secrete ________________ against hypersensitivity, release ______________ to dilate blood vessels and attract immune cells to the lesion, and release _____________ (anticoagulant) to promote the mobility of their wbc.

Answer 18

granulocytes; allergies; anticoagulants; histamine; heparin

Question 19

Eosinophils are _______________ with a bi-lobed nucleus and with a circulation half-time of _____ up to ______ days.

Their main functions are to kill parasytes and inducing _____________ reactions and release ___________ from their granulates to kill pathogens.

Answer 19

granulocytes; 8; 12; allergic; toxins

Question 20

Platelets are anucleate fragments from megakaryocyte. True or False?

Answer 20

True

Question 21

Most of the platelets are in the ___________. However they are also trapped inside the ___________.

Answer 21

blood; spleen

Question 22

What’s the circulation half-time of the platelets?

Answer 22

10 days

Question 23

What is the main function of the platelets?

Answer 23

To act on the hemostasis/coagulation.

Question 24

Platelets’ membranes are rich in _______________ which influence the function of the coagulation system.

They contain _______________ that allow their adhesion to endothelial cells (platelet adhesion). Their intracellular dense and alpha granules can release activators of platelet activity once the platelet activation occurs upon exposure to ____________, adenosine diphosphate or _____________.

Answer 24

phospholipids; receptors; thrombin; collagen

Question 25

Once activated, platelets change their shape from discoid to ______________ with filopodial extensions and finally to a __________ shape.

Answer 25

spherical; flat

Question 26

Define hemostasis.

Answer 26

It's a biological mechanism to stop bleeding. The intervenients are platelets, endothelial cells, tissue factor-bearing cells (TF) and coagulation factors. These work to form a complex of cross-linked fibrin and platelets to stop the hemorrhage.

Question 27

There is an important balance between prothrombotic and antithrombotic factors through a well-regulated coagulation system. True or False?

Answer 27

True

Question 28

The majority of the coagulation factors are produced in the spleen. True or False?

Answer 28

False. They are produced in the liver.

Question 29

Factor XIII (fibrin-stabilising factor) derives from ____________.

Answer 29

platelets

Question 30

Factor VIII (antihemophilic factor) derives from _______________ cells.

Answer 30

endothelial

Question 31

Factors II, ______, _______ and X depend on ___________________, a hepatic enzyme dependent on vitamin K.

Answer 31

VII; IX; gammacarboxylase

Question 32

What's the name of the hepatic enzyme that's dependent on vitamin K?

Answer 32

Gammacarboxylase

Question 33

Some medicines act to inhibit vitamin K activity, namely ______________ _______________.

Answer 33

warfarin anticoagulant

Question 34

What are the 3 main steps of hemostasis?

Answer 34

1) Primary hemostasis 2) Secondary hemostasis 3) Fibrinolysis

Question 35

Primary hemostasis involves ______________ and platelet adhesion and activation at lesion site.

Answer 35

vasoconstriction

Question 36

Secondary hemostasis involves the formation of fibrin involving the classical coagulation cascade, divided into ____________, ______________ and _______________.

Answer 36

initiation; amplification; propagation

Question 37

The coagulation cascade can be divided into intrinsic (triggered by the internal damage of the vessel), ______________ (triggered by trauma) and common pathway.

Answer 37

extrinsic

Question 38

Fibrinolysis is the breaking down of fibrin into its degradation products, mainky through the action of a plasmin, a catalytic enzyme. True or False?

Answer 38

True

Question 39

O factor Va, com _______, permite que o factor Xa converta a protrombina (____) em trombina (____). A trombina converte o fibrinogénio (I) em fibrina (Ia), que forma uma rede que inclui mais plaquetas e hemácias, formando um _______________.

Answer 39

Ca2+; II; IIa; coágulo

Question 40

Which factors are involved in the intrinsic pathway?

Answer 40

XIIa, XIa, IXa and VIIIa

Question 41

Which factors are involved in the extrinsic pathway?

Answer 41

III and VIIa

Question 42

Factors _______ and ______ form a complex in the intrinsic pathway.

Answer 42

VIIIa; IXa

Question 43

Factors _______ and ______ form a complex in the extrinsic pathway.

Answer 43

VIIa; III

Question 44

Factor III is called ________________.

Answer 44

thromboplastin (or tissue factor)

Question 45

Which factors are involved in the common pathway of coagulation?

Answer 45

Xa, Va, IIa, Ia and XVIIIa

Question 46

Define prothrombin time (PT).

Answer 46

It evaluates extrinsic and common pathways (depending on tissue factor). Allows to assess the effect of warfarin. Normal values: 12-13 s

Question 47

Tissue factor is released by the damaged tissues. True or False?

Answer 47

True

Question 48

Define activated partial thromboplastin time (aPTT).

Answer 48

It evaluates intrinsic and common pathways (independent of the tissue factor). Normal values: 30-50 s

Question 49

What is it called when hemoglobin levels are too high?

Answer 49

Polycythemia

Question 50

What's anisocytosis?

Answer 50

It's a type of anemia characterised by erythrocytes with a non uniform size.

Question 51

What's poikiloicytosis?

Answer 51

It's a type of anemia characterised by erythrocytes with a non uniform shape.

Question 52

Macrocytic anemia is characterised by a ___________ mean corpuscular volume.

Answer 52

larger

Question 53

One of the common causes of macrocytic anemia is ________ ___________.

Answer 53

liver disease

Question 54

One of the common causes of microcytic anemia is ________ ____________.

Answer 54

iron deficiency

Question 55

One of the common causes of normocytic anemia is __________ ______ __________ ___________.

Answer 55

anemia of chronic disease

Question 56

What is the most typical cause of macrocytic anemia?

Answer 56

Abnormal nuclear maturation or higher fraction of young erythrocytes.

Question 57

Define megaloblastic anemia.

Answer 57

Megaloblastic anemia is a type of macrocytic anemia characterized by large, abnormal red blood cell precursors (megaloblasts) in the bone marrow.

Question 58

Megaloblastic anemias are possibly linked to vitamin deficiencies (_____________ _______ or ___________ __________) and hepatic disorders. Also associated to alcohol consumption.

Answer 58

vitamin B12; folic acid

Question 59

How does alcohol consumption erythropoiesis?

Answer 59

* Direct toxic effect over the bone marrow, leading to ineffective erythropoiesis; * Folate deficiency – alcohol interferes with the absorption, metabolism and storage of folate, a crucial element involved in DNA synthesis. Its deficit results in impaired cell division, resulting in larger erythrocytes; * Liver dysfunction – chronic alcohol consumption can affect the normal liver function, disrupting the storage and processing of vital nutrients such as vitamin B12. Moreover, the ability of liver to produce erythropoietin can also be compromised.

Question 60

Where is erythropoietin produced?

Answer 60

It is produced in the liver.

Question 61

What is the most typical cause of microcytic anemia?

Answer 61

Abnormal hemoglobin production (less hemoglobin or different molecules).

Question 62

Define thalassemia.

Answer 62

Thalassemia is an inherited blood disorder that affects your body's ability to produce hemoglobin and healthy red blood cells. Autosomal recessive disease that led to reduced or absent hemoglobin chains, resulting in imbalanced or impaired erythrocytes production.

Question 63

Where are the mutations for alpha thalassemia?

Answer 63

In the HBA1 and HBA2 genes in chromosome 16.

Question 64

Where are the mutations for beta thalassemia?

Answer 64

In the HBB gene in chromosome 11.

Question 65

What are the 3 main causes of normocytic anemia?

Answer 65

1) Decreased numbers of red cell percursors. 2) Low levels of erythropoietin. 3) Chronic inflammatory diseases that affect the availability of iron.

Question 66

Autoimmune ______________ anemias in which antibodies cause erythrocytes destruction.

Answer 66

hemolytic

Question 67

What's sickle cell anemia?

Answer 67

Hemoglobin changes and obliterates the erythrocytes resilience.

Question 68

Polycythemia is the same as ________________.

Answer 68

erythrocytosis

Question 69

Erythrocytosis can be a consequence of _____________ erythropoietin production (such as in smokers and people living in higher altitudes, whose low blood oxygen levels stimulate erythropoietin production).

Answer 69

increased

Question 70

Erythrocytosis can be a consequence of _________________, which is a syndrome that leads to an increased erythrocytes mass and consequently low ______________.

Answer 70

polycythemia; erythropoietin

Question 71

In primary polycythemia (polycythemia vera), red blood cell production is dependent on EPO. True or False?

Answer 71

False

Question 72

In secondary polycythemia, the red blood cell production is exacerbated because there are high levels of EPO. True or False?

Answer 72

True

Question 73

Viral infections can lead to _______________.

Answer 73

leukopenia

Question 74

Leukocytosis can be caused by inflammation, ________________, stress responses, ___________, _______________, etc.

Answer 74

infection; trauma; leukemia

Question 75

When neutrophil levels are high, it is a case of ________________.

Answer 75

neutrophilia

Question 76

When neutrophil levels are low, it is a case of ________________.

Answer 76

neutropenia

Question 77

Thrombocytosis can be caused by viral infections. True or False?

Answer 77

False. Thrombocytopenia can be caused by viral infections.

Question 78

Hemophilia B is more common than hemophilia A. True or False?

Answer 78

False

Question 79

Hemophilia A is characterised by a deficiency of factor ______. Hemophilia B is characterised by a deficiency of factor ______.

Answer 79

VIII; IX

Question 80

What's the von Willebrand factor?

Answer 80

It's a blood glycoprotein crucial for blood clotting and is the primary protein deficient in von Willebrand disease (VWD). It facilitates platelet adhesion to damaged blood vessel walls and stabilises coagulation factor VIII. vWF is synthesised by endothelial cells and megakaryocytes.

Question 81

Where is the von Willebrand factor produced?

Answer 81

It is synthesised by endothelial cells and megakaryocytes.

Question 82

What's the other name for consuptive coagulopathy?

Answer 82

Disseminated intravascular coagulation (DIC)

Question 83

What's DIC?

Answer 83

There is widespread activation of the clotting system, leading to both the excessive formation of blood clots and the consumption of clotting factors and platelets. The clotting process becomes uncontrolled, leading to the formation of microclots throughout the bloodstream, which can cause blockages in small blood vessels, resulting in organ dysfunction. As the clotting factors and platelets are consumed in the formation of these microclots, bleeding tendencies emerge due to the depletion of these vital components of the clotting system.

Question 84

What conditions (5) can cause DIC?

Answer 84

- Overwhelming infections - Massive hemorrhage - Trauma - Obstetric complications - Severe burns

Question 85

What's the most common form of anemia?

Answer 85

Iron deficiency anemia

Question 86

What are the possible causes of iron deficiency anemia?

Answer 86

1. Deficient intake of iron: dietary problems, poor absorption (e.g. celiac disease, Helicobacter pilori infection, gastric bypass surgery, etc…). 2. Blood loss : menstrual or pregnancy blood loss, gastrointestinal complications (ulcers, cancer, intestinal inflammatory disease, …), bleeding disorders.

Question 87

Iron is primarily absorbed at _______________.

Answer 87

duodenum

Question 88

When there is an anemic scenario, the body will attempt to increase the ________ uptake. The same will happen in a hypoxia and iron deficiency state. Moreover, the iron can also be recycled from the senescent ______________. The passage from iron accumulation places to plasma is regulated by _____________. Hepcidin binds to _______________ inducing its internalisation and ______________ degradation. Lower levels of iron, will decrease the levels of hepcidin, such as ferroportin are expressed on enterocytes membranes and allow the transfer of iron from the enterocytes membrane to the plasma.

Answer 88

iron; erythrocytes; hepcidin; ferroportin; lysosomal

Question 89

What are the clinical manifestations (6) of iron deficiency anemia?

Answer 89

- Tiredness - Weakness - Shortness of breath - Pale skin and mucosa - Tachycardia - Fragile skin appendages

Question 90

Glossitis is the name given to a swollen and inflamed ____________. Achlorhydria is the absence of _____________ acid.

Answer 90

tongue; stomach

Question 91

Pica (often, people crave for non-alimentary products such as clay or dirt) is a clinical manifestation of iron deficiency anemia. True or False?

Answer 91

True

Question 92

Childhood anemia affects the ____________ capacity of the children for unsure reasons so far. It is a _____________ condition.

Answer 92

cognitive; reversible

Question 93

Quando o ferro é necessário (anemia/hipóxia), a hepcidina ____________ e a ferroportina ____________ --> mais ferro no sangue.

Answer 93

diminui; aumenta

Question 94

Quando há excesso de ferro, a hepcidina _____________, ferroportina é bloqueada --> menos ferro a circular.

Answer 94

aumenta

Question 95

A bilirrubina direta (____________) é produzida no fígado a partir da bilirrubina ___________ (não conjugada), que é um produto da quebra das _____________. A bilirrubina direta é ____________ em água e é eliminada pela __________, enquanto a bilirrubina indireta não é solúvel em água e precisa de ser transportada pela _____________ no sangue para o fígado.

Answer 95

conjugada; indireta; hemácias; solúvel; bílis; albumina

Question 96

As anemias hemolíticas acompanham-se geralmente de icterícia secundária à hiperbilirrubinémia direta. Verdadeiro ou Falso?

Answer 96

Falso. Acompanham-se de hiperbilirrubinámia indireta.