chapters 13,14,11 Flashcards
1
Q
Whole blood consists of: %’s
A
55% plasma
45% formed elements
2
Q
55% of whole blood is plasma, which consists of
A
water 91.5% solutes 1.5% proteins 7% - albumin - fibrinogen - globulins
3
Q
45% of whole blood consists of formed elements which consists of
A
erythrocytes: 4.2-6.2 million
Platelets: 140,000-340,000
Leukocytes: 5,000-10,000
4
Q
Leukocytes breaks down into
A
neutrophils: 57-67% eosinophils basophils lymphocytes: 25-33% monocytes
5
Q
alpha globulin transports
A
bilirubin
lipids
steroids
6
Q
beta globulin transports
A
iron
copper
7
Q
gamma globulin
A
contains anitbody molecules
8
Q
fibrinogen
A
inactive precursor of fibrin, which forms framework of bloodclots.
9
Q
1/3 of platelets reserved in
A
spleen
10
Q
erythrocytes functions
A
transport O2
Remove CO2
buffer blood pH
no cytoplasmic organelles, nucleus, mitochondria, or ribosomes
live 80-120 days
reversible deformity: biconcave and torpedo-like
11
Q
platelets are fragments..
A
cytoplasmic fragments of megakaryocytes.
12
Q
hematopoiesis
A
developmental process of pluripotential stem cells.
RBC. neutrophils
eosinophils. basophils
monocytes. platelets
13
Q
hematopoises occurs
A
in bone marrow
14
Q
hematopoiesis can be accelerated by
A
increase in differentiation of daughter cells
increase number of stem cells
conversion of yellow bone marrow to red marrow.
15
Q
erythropoietin
A
hormone secreted by kidney to stimulate erythrocyte production
16
Q
erythrocyte development stages
A
erythroblast
reticulocyte
erythrocyte
17
Q
reticulocyte
A
small disk with no nucleus
leaves bone marrow and enters blood stream to where it matures to an erythrocyte.
18
Q
hemoglobin synthesis
A
2 pairs of polypeptide chains; globins
- each with an attached heme molecule composed of iron
19
Q
where is iron found in body
A
67% total body iron bound to heme
30% stored bound to ferritin
3%: lost daily
20
Q
nutrition requirements for erythropoiesis
A
iron: hemoglobin
vitamins: b12, folate, b6
21
Q
how is b12 absorbed
A
required intrinsic factor in stomach
- secreted by parietal cells
22
Q
stimulant of erythopoiesis
A
low oxygen saturation
23
Q
red cell destructions
A
80%-90% in spleen and liver
broken down into amino acids and iron is recycled
byproduct is bilirubin
-conjugated in liver and excreted in bile
- increased RBC destruction = increased bilirubin = jaundiice
24
Q
anemia clinical manifestations
A
decreased O2 carrying capacity tissue hypoxia compensatory mechanisms - inc. pulmonary and cardiac function -inc. O2 extraction selective tissue perfusion (short-term) increased RBC production long-term
25
anemia s/s
fatigue
weak
tachycardia
exertional dyspnea
26
moderate to severe anemia s/s
hypotension. tachycardia
vasoconstriction. murmur
pallor. angina
tachypnea. heart failure
dyspnea muscle cramps
headache. dizzy
27
aplastic anemia
normocytic-normochromic anemia
stem cell disorder
dec. in hematopoietic tissue in bone marrow
pancytopenia
28
acquired aplastic anemia comes from
ebstein-Barr
HIV
Dengue
29
Familial aplastic anemia
fanconi constitutional pancytopenia
pancreatic deficiency in children
putative hereditary defect in cellular uptake of folate.
30
pancytopenia (aplastic anemia) s/s
```
RBC:
weakness
fatigue
pallor
dyspnea
palpitations, murmurs
WBC:
fever, chills
bacterial infections
PLATELETS:
petechiae
bruising
bleeding
```
31
aplastic anemia treatment
bone marrow transplant
maintenance of essential hemoglobin and platelets
prevention and management of infection
no transplant: immunosuppression, stimulation of hematopoiesis, bone marrow regeneration.
32
anemia of chronic renal failure
impaired erythropoietin production
impaired excretory function
- hemolysis, bone marrow depression, blood loss
33
anemia of chronic renal failure treatment
dialysis
administer erythropoietin
monitor hct and hgb
replacement of b12, iron, and folate (restricted diet)
34
where are clotting factors synthesized
liver
35
granulocytes
phagocytes:
- neutrophils
- eosinophils
- basophils
- mast cells
All granular
36
agranulocytes
phagocytes:
- monocytes
-macrophages
Immunocytes:
- lymphocytes (B & T)
- natural killer cells (granular)
37
granulocytes
```
digestive enzymes:
- kill microorganisms
- catabolize debris
Biochemical mediators
- inflammatory
- immune functions
```
38
Eosinophils
allergic reactions
| parasites
39
basophils
vasoactive amines:
- histamin
- serotinin
- heparin
40
mast cells
histamine, chemotactic factors and cytokines
| acute/chronic inflammation, fibrotic disorders, wound healing
41
monocyte/macrophage
ingest and destroy microorganisms and foreign material, debris, and defective/ dead cells.
42
lymphopoiesis
B cells
T cells
fully mature in blood stream
43
stimulation of platelets
thrombopoiten
44
pediatric blood cell counts
higher than adult levels at birth
lymphocytes count higher at birth
platelets normal
45
3 main components of hemostasis
vasculature: endothelial cells
platelets
clotting factor
46
primary hemostasis
vascular damage
vasoconstriction
platelet plug
47
secondary hemostasis
coagulation cascade
| blood clot
48
tertiary hemostasis
clot dissolution
| fibrinolysis
49
extrinsic system
tissue factors
vitamin K
VII
50
intrinsic system
```
platelets
XII
Xi
Vitamin K
IX
VIII
```
51
where extrinsic and intrinsic meet
Factor X
52
prothrombin
inactive precursor to thrombin
53
thrombin
acts upon fibrinogen to make active form fibrin.
54
Prostaglandin derivatives: positive hemostasis regulation
thromboxane
- platelets
- inc. fibrinogen receptors, cause degranulation, vasoconstriction
- aggregation
55
Negative hemostasis regulation
```
prostacyclin
- endothelial cells
- inhibit degranulation
- vasodilation
Nitric oxide
- endothelial cells
- vasodilation , inhibits adhesion/ aggregation
```
56
lysis of blood clots
t--PA
plasminogen-> plasmin
- degrading enzyme
fibrin degradation
57
megaloglastic anemia
large stem cells
defective DNA synthesis
- dec. vitamin b12 or folate
58
pernicious anemia
```
Macrocytic- normochromic
Lack of IF from gastric parietal cells
- no vitamin b12 absorption
slow onset
- nerve demyelination
```
59
sickle cell anemia
hypochromic anemia
genetic defect of hemoglobin synthesis
sickled cells cause vascular occlusion
severe anemia, RBC of different shapes, sizes, and recurrent painful episodes
60
iron deficiency anemia
```
microcytic hypochromic anemia
most common world wide
inadequate dietary intake/ blood loss
insufficient iron delivery/use
brittle, thin, coarsely ridged, and spoon-shaped nails
red, sore and painful tongue
```
61
sideroblastic anemia
microcytic-hypochromoic
anemia due to mitochondiral metabolism of Fe, unable to use iron.
splenomegaly and hepatomegaly
ringed sideroblasts within the bone marrow
- RBC contain Fe granules that have not been synthesized into Hb
62
thalassemia
microcytic-hypochromic
increased RBC destruction
alpha or beta globin synthesis impaired
polypeptide chain with deficient synthesis of alpha or beta globins
63
faconi anemia
normocytic-normochromic anemia
genetic alteraion
defects in DNA repair
64
hemolytic anemia
```
normocytic-normochromic anemia
accelerated destruction of RBC
- inherited
- autoimmune
- drug- induced
-- penicillin, cephalosporins
-- Quinidine
- a-methyldopa
```
65
Anemia of chronic disease
```
reduced response to EPO
AIDS
rheumatoid arthritis
lupus
hepatitis
renal failure
- dec. RBC life span
- ineffective bone marrow response
- altered iron metabolism
```
66
polycythemia
overproduction of RBC
67
relative polycythemia
dehydration
| fluid loss
68
absolute polycythemia
1st: abnormality of bone marrow stem cells (vera)
2nd: increased EPO in response to chronic hypoxia
69
Polycythemia vera stages
1: prediagnostic by symptomatic
2: initial remission with treatment
3: myeloid-metaplasia (myelofibrosis)
4: acute leukemia
hypervolemic: reactive to increased RBC
70
qualitative leukocyte disorders
disruption of cellular function in cellular defense
| - phagocytes, respond to antigen
71
hematologic leukocyte disorders
infectious mononucleosis
leukemia
lymphoma
72
infectious monomucleosis
acute: self-limiting infection of B lymphocytes.
- eventually develop an immune response.
caused by Epstein-Barr virus
73
leukemia
malignant disorder of blood/blood forming organs (bone marrow)
increased proliferation
genetic: translocation between 9 and 22
74
acute leukemia
presence of undifferentiated usually blast cells
75
chronic leukemia
predominant cell is mature but does not function normally
76
acute lymphocytic leukemia (ALL)
>30% lymphoblasts in bone marrow/ blood
| most common in children
77
acute myelogenous leukemia (AML)
abnormal proliferation of myeloid precursors
| - immature blast replacement of normal cells
78
Chronic myelogenous leukemia (CML)
myeloproliferative disorder
| - polycythemia vera
79
Chronic lymphocytic leukemia (CLL)
accumulation of B lymphocytes
| failure to develop into plasma cells
80
hodgkin lymphoma
localized to single axial group
reed-sternberg cells in the lymph nodes
mesenteric nodes rarely involved
orderly spread
81
non-hodgkin lymphoma
```
chromosome translocations
viral and bacterial infections
environmental agents
immunodeficiencies
autoimmune disorders
Clonal expansion of B, T, and NK cells
multiple periphery nodes
mensenteric nodes commonly involved
sporatic spread
```
82
thrombocytopenia
platelet count less than 100,000
83
immune thrombocytopenic purpura (ITP)
autoimmune
| increased platelet destruction
84
thrombotic thrombocytopenic purpura (TTP)
platelets aggregate and occlude arterioles and capillaries
all platelets are being used up
- less circulating
85
Disseminated intravascular coagulation (DIC)
```
widespread activation of thrombin
- activates fibrin
- clot formation
multiple thrombi
release of TF or thromboplastic agents
injury to endothelial cells
acute bleeding vs chronic thrombotic complications
```
86
geriatric blood cell findings
```
RBC life span normal
RBC replaced less quickly
- less iron
Lymphocyte function decreased with age
Platelets more sticky
```
87
protein C and S are pro-thrombotic
false
| anti-thrombotic
88
synthesis of coagulation factors occurs
liver
89
with the exception of factor III, all coagulation factors are plasma proteins that circulate in the blood stream in an inactive state T/F
True
90
heparin inactivates
thrombin
- inhibition of clotting factor function
- useful in DIC
91
fibrinolysis occurs in response to
plasmin
92
philadelphia chromosome is diagnostic for
CML
93
benign growth of cells is characterized by?
hyperplasia
94
protooncogene
portion of gene controlling protein synthesis
| -off position
95
oncogene
activated protooncogene
| - one mutation: continuous cell growth and division in cancer
96
P53
initiates DNA repair
97
tumor suppressor genes
produce proteins that inhibit cellular division
| -mutation: requires 2 gene mutations to trigger a role in cancer
98
challenges to treating cancer
traditional cancer therapies target all proliferating cells in the body
cancer is very heterogeneous disease
genetic instability
- adapt to new conditions, drug resistance.
