Chapter 3: Blood

Question 1

Proerythroblast

Answer 1

precursor for erythrocyte (with large nucleus)- produced in long bone marrow?

Question 2

Erythropoietin

Answer 2

hormone (found in kidney/liver) that stimulates RBC production in bone marrow. Vit. B12 and folic acid are important in producing mature RBC

Question 3

Aplastic Anemia

Answer 3

if bone marrow does not produce enough RBC

Question 4

Pernicious Anemia

Answer 4

lack of Vit. B12 and folic acid in diet or poor absorption= low RBC

Question 5

Hemoglobin

Answer 5

in RBC, function to transport oxygen/CO2

• iron and protein compound
• each heme molecule carries 1 O2

Question 6

Polycythemia

Answer 6

elevated hematocrit (could be caused by living in high elevation, pulmonary disease, etc)

Question 7

Anemia

Answer 7

low RBC count (could be caused by blood loss, RBC production failure, or RBC destruction)

Question 8

Hematocrit on Bypass

Answer 8

22-30% considered normal on bypass (lowers because of dilution- which provides better capillary perfusion)

Question 9

Hemolysis

Answer 9

destruction of RBC membrane- release hemoglobin

• creates plasma free hemoglobin and releases the intracellular K
• if occlusion is too loose= turbulence (Reynolds Number > 2,000)
• they want laminar flow
• best way to set occlusion- column of arterial fluid 30 inches above roller head, tighten until it drops 1 cm per minute

Question 10

Diapedesis

Answer 10

passage of WBC through the walls of blood vessels

Question 11

WBCs are characterized by:

Answer 11

presence or lack of granules in cytoplasm
1) granulocytes contain granules (neutrophils 60%, basophils 1%, eosinophils 3%)
2)agranulocytes lack granules ( lymphocytes 30%, monocytes 6%)
Order: N L M E B

Question 12

Leukocytosis

Answer 12

increased WBC count (normally with infection)

-above 5,000-10,000 per cubic millimeter

Question 13

Leukopenia

Answer 13

abnormal decrease in WBC count (could be caused by drug reaction, radiation, etc)
-below 5,000-10,000 per cubic millimeter

Question 14

Neutrophils

Answer 14

• granulocytes, produced by bone marrow
• engulf (phagocytosis) foreign bodies
• remove bacteria, cell debris, solid particles
• can move from capillary to tissue

Question 15

Neutrophilia

Answer 15

increase in neutorphils (above 7500 per cubic millimeter)

Question 16

Neutropenia

Answer 16

low neutrophil count (below 1,500 per cubic mm)

• linked to leukemia, infections, low b12, chemotherapy)
• also more likely to contract infections

Question 17

Eosinophils

Answer 17

• granulocytes, 2 lobed WBC

- increase with allergies and parasites

Question 18

Eosinophilia

Answer 18

increase in eosinophils (> 500 per cubic mm)

-Hyperesoinophilia- increase due to no apparent cause

Question 19

Basophils

Answer 19

• granulocytes, contain nucleus and granules
• release heparin and histamines to keep vessels open at sites of pathogens
• only 1% of WBC!

Question 20

Basophilia

Answer 20

increase number in basophils (>100 per cubic mm)

-numbers increase with bone marrow disease and decrease with severe allergic reactions

Question 21

Monocytes

Answer 21

• become macrophages when leave blood stream and enter tissue- engulf pathogens and foreign particles
• they arrive second to site after neutrophils
• largest WBC

Question 22

Lymphocytes

Answer 22

production of antibodies (B and T cells)

Question 23

Lymphocytosis

Answer 23

increase in lymphocytes >4,500 per cubic mm

Question 24

Lymphocytopenia

Answer 24

decrease in lymphocytes < 1500 per cubic mm

Question 25

B Cells and T Cells

Answer 25

lymphocytes - B cells- exposed to antigen/allergen, moves to spleen/lymph nodes and produces plasma/memory cells - T cells- killer cells, assist B cells and secrete chemicals

Question 26

Platelets/thrombocytes

Answer 26

- no nucleus or hemoglobin, surface negatively charged, produced in bone marrow (megakaryocytes) as broken fragments of cytoplasm - necessary for clotting - --phospholipid membrane aids in clotting factors= platelet factor 3 - --releases vasoconstrictor= thromboxane A2 - -DO NOT give platelets on bypass - normal count is 150,000-350,000 per cubic mm - count decreases 20-65% after CPB

Question 27

Thrombocytopenia

Answer 27

-low platelet count (<50,000)

Question 28

Cell suffix (number wise) - philia - cytosis - penia

Answer 28

philia- increase cytosis- increase penia- decrease

Question 29

Plasma

Answer 29

- 91.5% water and comprises 55% of blood - mostly comprised of albumin and plasma proteins - function is to transport blood cells, platelets - contains electrolytes, clotting factors, proteins glucose, fats, bilirubin, globulins, and gases - very important for protein balance between interstitial space (colloid osmotic pressure)

Question 30

Plasmapheresis and Plateletpheresis

Answer 30

separation of plasma or platelets from blood and returned to body

Question 31

Potassium

Answer 31

- intracellular (98% of total K is intracellular) - needed for cardiac muscle contractions - insulin brings K and glucose into the cell (insulin levels are low during hypothermic bypass, so blood glucose/K increases) - if K is high AND not peeing, consider giving insulin - hyperkalemia will cause irregular heart contractions - Normal K levels are 3.5-5 mEq/L

Question 32

Calcium

Answer 32

- contractility, clotting, neurotransmission | - blood calcium is regulated by parathyroid hormone and Vit D

Question 33

Magnesium

Answer 33

- intracellular - competes with calcium - controlled by kidney

Question 34

3 Phases to Forming a Clot

Answer 34

1) vascular- constriction of vessels at injury 2) platelet aggregate and release factors to aid in vasoconstriction 3) clotting factors/cascade

Question 35

Intrinsic vs. Extrinsic Pathway

Answer 35

- intrinsic= initiated by foreign substance - extrinsic= initiated by tissue injury * both combine into the common pathway with Factor X

Question 36

Heparin

Answer 36

- increases antithrombin 3 (which inactive- stops production of thrombin) - --stops fibrinogen from becoming fibrin and prothrombin from becoming thrombin - also binds to cofactor 2 to inactivate thrombin - half-life= 1-2 hours (increased during hypothermia, decreased during rewarming) - elimination by kidneys (so impaired renal function can prolong heparin function) - bolusing heparin at beginning of case can decrease SVR and BP by 10-20% - bovine or porcine

Question 37

Anti-thrombin III Deficienc

Answer 37

- if no response to initial heparin dose, redoes | - if no response, give 2 units of FFP or ATIII

Question 38

Protamine

Answer 38

- binds to heparin to inhibit and allows clotting - from salmon sperm - 1-1.3 mg per 100 units of heparin given - given slowly to prevent reactions (5 /min): hypotension, bradycardia, increase CVP/PAP (increase chance of reaction if DMI, seafood allergy, or past protamine exposure) - shorter halflife than heparin- 5 min?