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NUR516 > Hematology > Flashcards

Hematology Flashcards

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1
Q

How much blood is in the body?

A

6 quarts (5.5 L)

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2
Q

List the functions of blood

A
  1. Delivery of substances needed for cellular metabolism
  2. Removal of wastes of cellular metabolism
  3. Defense against invading microorganisms
  4. Regulation of body temp
  5. Maintenance of acid-base balance
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3
Q

What % of whole blood is plasma?

A

55%

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4
Q

What % of whole blood is formed elements?

A

45%

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5
Q

List the 3 types of plasma proteins

A
  1. Albumin
  2. Globulins
  3. Fibrinogen
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6
Q

Albumin

A

Plays a role in vascular, transport, & metabolic processes

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7
Q

List 3 types of globulin plasma proteins

A
  1. Alpha
  2. Beta
    A &B helps transport iron, fat soluble (lipids)
  3. Gamma
    Immunoglobulins or Ab that help fight infection
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8
Q

Fibrinogen

A

Plays a role in clotting

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9
Q

All plasma proteins are manufactured by what organ?

A

liver

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10
Q

Formed elements

A

Suspended in plasma
Finite lifespan (limited)
Originate from stem cells

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11
Q

List examples of formed elements

A

Erythrocytes (RBCs)
Leukocytes (WBCs)
-Granular
-Agranular
Thrombocytes (PLTs)

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12
Q

Erythrocytes (RBCs)

A

Most abundant
Make up ~ half of the blood volume
Play a role in tissue oxygenation

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13
Q

Erythrocytes (RBCs) contains

A

Hemoglobin
-Gases → Mainly transports O2 throughout the body & minor role of carrying CO2
-Electrolyte → imbalances can effect how O2 is transported
-Regulates diffusion through the cell membrane

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14
Q

List some characteristics of erythrocytes (RBCs)

A

Biconcave disc
Has no nucleus
Flexible
Has no cytoplasmic organelles (No protein synthesis)
Life span of 120 days

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15
Q

RBCs concave structure is…

A

Ideal for gas exchange & diffusion in & out of the cell

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16
Q

RBCs have ____ ____ to move throughout the body

A

Reversible deformity

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17
Q

List the different types of Hgb

A
  1. Hb A → Adult (normal)
    -Oxygen carrying protein
  2. Hb F → fetal
  3. Hb S → sickle cell
  4. Hb A1c → Glycosylated
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18
Q

Hemoglobin molecule is composed of…

A

4 polypeptide chains
- Alpha 1, Alpha 2
- Beta 1, Beta 2

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19
Q

1 Hgb molecule carries how many oxygen atoms?

A

1 Hgb molecule carries 4 oxygen atoms

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20
Q

Iron → Hemoglobin → O2

A

Synthesis of hemoglobin (Hgb) is greatly dependent on availability of iron

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21
Q

How can we as humans get iron?

A

Iron comes from diet or is recycled

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22
Q

What happens to aged RBCs?

A

They are broken down in the spleen & iron returns to bone marrow for new RBCs

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23
Q

A lack of iron results in…

A

A lack of Hgb in each RBC which results in low O2 carriage in the blood

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24
Q

Break down of the term “hemoglobin”

A

Heme → iron
Globin → protein

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25
Where are phagocytic cells located?
Spleen Liver Bone marrow Lymph nodes
26
Where are RBCs destroyed?
Liver & spleen
27
Destruction of RBCs: Recycling to form new RBCs
Iron from heme group is recycled & reused to create new RBCs & globulin chains break down into individual AA to be recycled & build new proteins
28
List the steps of destruction of RBCs
Heme broken down into → bilirubin → transported in blood bound to plasma proteins → until it reaches the liver where it's made water soluble to be eliminated from body via bile
29
Unconjugated bilirubin
Yellow pigment produced when RBCs break down
30
Conjugated bilirubin
Water-soluble form of bilirubin that is produced by the liver & excreted in the bile
31
Abnormal RBC destruction in circulation
Hgb remains in plasma Combines w/ protein in plasma (haptoglobin) & other proteins (i.e. albumin)
32
What may happen during RBC destruction in circulation associated with haptoglobin?
Haptoglobin may exceed ability of plasma proteins to bind → free haptoglobin in blood → excreted via urine
33
Free haptoglobin in the blood is known as _____
Hemoglobinemia
34
List example conditions that occur from abnormal destruction of RBCs
Hemolytic anemia Hemolytic transfusion reaction
35
What is erythropoiesis
A specific series of steps in the BM that leads to the synthesis of mature RBCs
36
What do all RBCs start out as?
Pluripotent stem cells in the bone marrow → stimulated to become an erythroid precursor cell
37
Explain what happens in the series that erythroid precursor cells go through
goes through series of changes until it becomes a mature RBC released by the BM
38
What is an immature RBC called?
Reticulocyte
39
What form of RBCs have NO genetic material?
Mature RBCs
40
What are the nutritional requirements for adequate synthesis of healthy RBCs?
Protein Iron Vitamin B12 Folic acid
41
Iron as a nutritional element
Main nutritional elements for Hgb synthesis
42
What types of pts might you see high RBC levels?
Patients with chronic hypoxia → i.e. COPD
43
Reticulocyte count
good indicator of BM activity, because it represents recent production of RBCs
44
What does a high reticulocyte count indicate?
Indicates that BM is working hard to keep up with RBC loss -I.e. of causes: Anemia & cancer
45
Spleen
Highly vascular organ, considered "graveyard of RBCs" Also an organ of immunity
46
Role of the spleen
Removes aged, lysed, & dead RBCs from circulation
47
What happens to RBCs in the spleen?
Broken down into their component parts, which are recycled to make new RBCs
48
The spleen sequesters...
Abnormally shaped & hemolyzed RBCs & destroys them
49
How does splenomegaly occur?
Occurs when there is a large amount of RBC breakdown occurring in the body
50
Leukocytes (WBCs) Normal range & function
NR: 5,000 to 10,000/ μL Function → to combat inflammation & infection
51
Two types of leukocytes & their subsections
**Granulocytes:** - neutrophils - eosinophils - basophils **Agranulocytes:** - lymphocytes - monocytes
52
Immature WBCs (timeline)
Start as myeloblast → promyelocyte → myelocyte → loss of capacity for mitosis → metamyelocytes → band cell → segmented neutrophil → that eneters blood → enters tissues (1-2 days)
53
Immature WBCs → left shift
Increased #s of immature neutrophils most common cause is inflammation can also be seen in some marrow disorders (leukemia) or severe BM injury
54
How are cells classified?
Based on their stage of maturation
55
Thrombocytes (platelets)
Large megakaryocytes → come from myeloid stem cells
56
Thrombocytes form the ____ _____
platelet plug
57
What do thrombocytes look like?
Disc shaped without a nucleus
58
Thrombopoietin
Hormone that is chief regulator of PLT production & are synthesized by liver Stimulated by ↓ # PLTs in BM
59
How much of PLTs are squestered in the spleen?
1/3
60
Senescent platelets
Aged PLTs that have lost function & less able to respond to clotting factors Cleared by splenic macrophages after average lifespan of 7-10 days
61
When assessing for bleeding what changes to the skin should you look for?
Petechiae Purpura Ecchymosis Spontaneous bleeding
62
Petechiae
Pinpoint red-purple areas of bleeding that resemble a rash
63
Purpura
Larger purple areas of bleeding
64
Ecchymosis
Bruise
65
Spontaneous bleeding
I.e. Nosebleed (epistaxis)
66
What do CBCs look at?
WBCs Hemoglobin Hematocrit Platelets
67
What is included in WBC part of CBC?
Neutrophils Lymphocytes Monocytes Eosinophils Basophils Immature granulocytes, absolute Neutrophils, absolute
68
What is included in hematocrit on CBC?
Mean corpuscular volume (MCV) Red cell distribution width (RDW) Mean corpuscular Hgb concentration (MCHC) Mean cell Hgb (MCH)
69
Mean corpuscular volume (MCV)
size of RBC
70
Red cell distribution width (RDW)
range in size & shape of RBC
71
Mean corpuscular Hgb concentration (MCHC)
concentration of Hgb (color)
72
Mean cell Hgb (MCH)
Mass of RBC
73
What does a BMP look at?
Sodium (Na) Potassium (K) Chloride (Cl) CO2 BUN/ creatinine Glucose EGFR Anion gap
74
What is the anion gap?
Related to acid-base balance of electrolytes
75
What does a CMP include?
**Same as BMP** Plus: -AST (SGOT) -ALT (SGPT) -Alkaline phosphatase -Total protein -Albumin -Bilirubin
76
List the different iron studies
Iron level Ferritin Transferrin Total iron binding capacity (TIBC)
77
Iron level:
Measures amount of iron bound to Hgb **Not helpful alone**
78
Ferritin:
Measure of iron stores Inflammation may cause levels to increase
79
Transferrin:
Iron transport protein takes Fe back to the BM
80
List 4 other lab studies to look at
Vitamin B12 Folic acid Hgb electrophoresis Comprehensive metabolic profile (CMP)
81
Hgb electrophoresis
Looks at the globin chains
82
CMP measures...
14 proteins, electrolytes, enzymes, & minerals in the blood
83
CMP is a BMP plus
Calcium Albumin Total protein Liver function studies (AST, ALT, ALP, Bili)

NUR516 (36 decks)

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