Module 1: Hematology Physiology

Question 0

T or F: All individuals produce antibodies to the AB carbohydrate antigen that they lack.

Answer 0

T

Question 1

ABO blood group is based on carbohydrate antigens present on RBC membrane either as _______ or ________.

Answer 1

Glycoprotein; Glycosphingolipids

Question 2

Predict the blood type of the following:
1. Ag - -
    Ab antiA, antiB
2. Ag A
    Ab antiB
3. Ag B
    Ab antiA
4. Ag A, B
    Ab - -

Answer 2

1. O
2. A
3. B
4. AB

Question 3

Why are agglutinins produced in people who do not have the respective agglutinogens in their red blood cells?

Answer 3

Small amounts of these agglutinogens enter through food and bacteria which initiate the production of agglutinins

Question 4

Rh blood group has 6 antigens. These are..

Answer 4

C, D, E, c, d, e

Question 5

Most widely prevalent among the 6 Rh antigens

Answer 5

D

Question 6

T or F: Hemolytic disease of the newborn usually manifests i. The second Rh+ baby.

Answer 6

T

Question 7

Two ways of identifying blood types

Answer 7

Forward

Reverse

Question 8

Identify antigen by antisera

Answer 8

Forward typing

Question 9

Identify isoagglutinin in serum

Answer 9

Reverse typing

Question 10

Matches donor blood unit to recipient’s blood

Answer 10

Cross-matching

Question 11

T or F: Cross-matching should always be done even in mergency cases.

Answer 11

F, may not be done in emergency cases (give type-specific)

Question 12

Blood transfusion products

Answer 12

Whole blood
Packed red blood cells
Platelet concentrate
Fresh frozen plasma
Cryosupernate
Cryoprecipitate

Question 13

Increases oxygen-carrying capacity

Answer 13

Whole blood; Packed red blood cells

Question 14

T or F: Whole blood is ideal for cases of acute hemorrhage of more than 25% of blood volume.

Answer 14

T

Question 15

T or F: Packed red blood is given to patients with anemia but without symptoms.

Answer 15

F, should be given to those with anemia and symptoms (dizziness, inc heart rate, difficulty breathing)

Question 16

Reduces risk of mucosal bleeding

Answer 16

Platelet concentrates

Question 17

Thresholds for transfusion:
Patient w/o fever or infection
Patient w/ fever or infection
Undergoing invasive procedure

Answer 17

5,000
10,000
50,000

Question 18

Contains stable coagulation factors and plasma proteins

Answer 18

Fresh frozen plasma

Question 19

These inactivate factors V and VIII

Answer 19

Protein C

Question 20

Used for correction of coagulopathies including rapid reversal of warfarin, supplying deficient plasma proteins, treatment of TTP

Answer 20

Fresh frozen plasma

Question 21

Supplies fibrinogen, factor VIII and von Willebrand factor

Answer 21

Cryoprecipitate

Question 22

Each unit of cryoprecipitate contains ____ units of factor VIII

Answer 22

80

Question 23

Contains factor IX

Answer 23

Cryosupernate

Question 24

Adverse reactions to transfusion can be..

Answer 24

Immunologic Non immunologic Infections

Question 25

Immunologic reactions to transfusion?

Answer 25

``` Febrile nonhemolytic transfusion reactions Allergic reactions Anaphylaxis Graft versus host disease Transfusion-related acute lung injury Posttransfusion purpura ```

Question 26

Non immunologic reactions to transfusion:

Answer 26

``` Fluid overload Hypothermia Electrolyte imbalances Iron overload Hypotensive reactions Immunomodulation ```

Question 27

Infections related to transfusion?

Answer 27

Viral (hepB/C, HIV, CMV etc) | Bacterial contamination

Question 28

Aids in prevention of bloodloss

Answer 28

Hemostasis

Question 29

Stages of hemostasis

Answer 29

Reflex vasoconstriction Primary hemostasis Secondary hemostasis Clot retraction or Clot dissolution

Question 30

Results in immediate reduction in bleeding

Answer 30

Reflex vasoconstriction

Question 31

Mechanisms of reflex vasoconstriction

Answer 31

Local myogenic spasm-strongest contributor Local autocoid factors from platelets and injured tissues Nervous reflexes

Question 32

Formation of platelet plug

Answer 32

Primary hemostasis

Question 33

Responsible for hemostasis of small vessels

Answer 33

Primary hemostasis

Question 34

Primary hemostasis involves..

Answer 34

Platelets (key player) Blood vessel wall VWF

Question 35

Platelets are also called

Answer 35

Thrombocytes

Question 36

Platelets originate from

Answer 36

Megakaryocytes

Question 37

T or F: Platelets can reproduce.

Answer 37

F

Question 38

Normal platelet count

Answer 38

150,000 to 450,000

Question 39

Function in platelets: actin and myosin fibers

Answer 39

Contraction (also thrombosthenin)

Question 40

Function in platelets: ER and golgi

Answer 40

Calcium storage

Question 41

Function in platelets: mitochondria

Answer 41

Produces ATP and ADP

Question 42

Function: Fibrin-stabilizing factor

Answer 42

Stabilizes fibrin network

Question 43

Function in platelets: surface glycoproteins

Answer 43

Causes platelet adherence to injured tissue and collagen

Question 44

Stages in the formation of platelet plug

Answer 44

Platelet adhesion Platelet activation Platelet aggregation

Question 45

Platelet adhesion

Answer 45

Platelets come in contact with exposed subendothelium Platelets secrete these in their membranes: Glycoprotein Ib-IX - bind vWF Glycoprotein Ia/IIb - bind collagen

Question 46

Platelet activation

Answer 46

Platelet develops pseudopods Platelets release thromboxane A2, ADP, PAF and serotonin which activates other platelets Platelet activate its collagen receptor Glycoprotein IIb/IIIA after vWF binds to Gp Ib

Question 47

Platelet aggregation

Answer 47

Fibrinogen in the blood ( and vWF in the subendothelium) bind to the platelet receptor glycoprotein IIb/IIIA Formation of loose platelet plug Fibrin fibers strengthen platelet plug

Question 48

If platelet count <50,000

Answer 48

Bleeding

Question 49

If platelet count <10,000

Answer 49

May be lethal

Question 50

Formation of fibrin through the coagulation cascade

Answer 50

Secondary hemostasis

Question 51

Coagulation cascade is divided into

Answer 51

Extrinsic pathway | Intrinsic pathway

Question 52

Factor I

Answer 52

Fibrinogen

Question 53

Factor II

Answer 53

Prothrombin

Question 54

Factor III

Answer 54

Tissue factor

Question 55

Factor IV

Answer 55

Calcium

Question 56

Factor V

Answer 56

Proaccelerin; labile factor

Question 57

Factor VII

Answer 57

Serum prothrombin conversion accelerator; stable factor

Question 58

Factor VIII

Answer 58

Antihemophilic factor A

Question 59

Factor IX

Answer 59

Antihemophilic factor B; Christmas factor

Question 60

Factor X

Answer 60

Stuart factor

Question 61

Factor XI

Answer 61

Plasma thromboplastin antecedent; antihemophilic factor C

Question 62

Factor XII

Answer 62

Hageman factor

Question 63

Factor XIII

Answer 63

Fibrin-stabilizing factor

Question 64

Prekallikrein

Answer 64

Fletcher factor

Question 65

High-molecular weight kininogen

Answer 65

Fitzgerald factor

Question 66

Initiates coagulation cascade

Answer 66

Extrinsic pathway

Question 67

Amplifies the cascade

Answer 67

Intrinsic pathway

Question 68

Extrinsic pathway: Clotting can occur in __ sec.

Answer 68

15

Question 69

Intrinsic pathway: Clotting occurs in __ min

Answer 69

1-6

Question 70

In which part of the coagulation cascade does the intrinsic and extrinsic pathways converge?

Answer 70

Factor Xa-mediated generation of thrombin from prothrombin

Question 71

During clot retraction, fibrin clot is invaded by _______ which subsequently form _________ around the clot.

Answer 71

Fibroblasts; connective tissue

Question 72

T or F: Calcium from platelet stores also contribute to clot retraction.

Answer 72

T

Question 73

Mediated by anticoagulant and thrombolytic mechanisms

Answer 73

Clot dissolution

Question 74

What are the factors involved in the coagulation cascade?

Answer 74

Calcium Vit K Anticoagulant mechanisms

Question 75

T or F: Calcium is involved in ALL steps in the cascade.

Answer 75

F, except the first two steps in the intrinsic pathway

Question 76

Required to produce prothrombin in the liver

Answer 76

Vit K

Question 77

Anticoagulant mechanisms

Answer 77

Endothelium Intravascular anticoagulants Lysis of blood clot

Question 78

Binds thrombin thereby reducing free thrombin

Answer 78

Thrombomodulin

Question 79

Inactivates thrombin

Answer 79

Antithrombin III

Question 80

Increases the activity of antithrombin III hundredfold to thousandfold

Answer 80

Heparin

Question 81

T or F: Our body has high concentrations of heparin.

Answer 81

F, low

Question 82

Give some causes of severe bleeding

Answer 82

Liver diseases Vit K deficiency Hemophilia A Hemophilia B

Question 83

Factor VIII deficiency

Answer 83

Hemophilia A

Question 84

Factor IX deficiency

Answer 84

Hemophilia B

Question 85

Causes of excess coagulation

Answer 85

Protein C and S deficiency | Disseminated intravascular hemolysis

Question 86

Deficiency of hemoglobin in the blood either from too few RBCs or too little hemoglobin

Answer 86

Anemia

Question 87

Blood loss anemia: morphology of RBCs?

Answer 87

Acute: normal Chronic: microcytic, hypochromic

Question 88

What time of anemia is caused by Vit B12 deficiency?

Answer 88

Megaloblastic anemia

Question 89

Iron deficiency anemia: RBC morohology?

Answer 89

Microcytic, hypochromic

Question 90

What type of anemia is caused by failure of the bone marrow activity?

Answer 90

Aplastic anemia

Question 91

Rapid destruction of RBCs due to abnormal morphology or from attack of antibodies against RBCs

Answer 91

Hemolytic anemia

Question 92

Causes of hemolytic anemia

Answer 92

Hereditary spherocytosis Sickle cell anemia Erythroblastosis fetalis

Question 93

Excess red blood cells

Answer 93

Polycythemia

Question 94

Polycythemia causes increased blood viscosity which leads to

Answer 94

Cyanosis/plethora, strokes

Question 95

Types of polycythemia

Answer 95

Physiologic: occurs in high altitudes, smokers | Polycythemia vera: genetic abnormality inRBC precursors

Question 96

Hypersensitivity reactions

Answer 96

Types I, II, III, IV

Question 97

Most common among the hypersensitivity reactions

Answer 97

Type I

Question 98

Immune reactants for each type

Answer 98

I- IgE II and III- IgG IV- TH1 cells, TH2 cells, CTL

Question 99

Antigen for Type II?

Answer 99

Cell or matrix-associated antigen *other types are soluble antigens, except Type IV ( CTL) - cell associated antigen

Question 100

Mast cell activation

Answer 100

Type I

Question 101

Macrophage activation

Answer 101

Type IV (TH1 cells)

Question 102

Eosinophil activation

Answer 102

Type IV (TH2 cells)

Question 103

Cytotoxicity

Answer 103

Type IV (CTL)

Question 104

FcR+ cells

Answer 104

Type II and III

Question 105

Type I: Example of hypersensitivity reaction

Answer 105

Allergic rhinitis Asthma Systemic anaphylaxis

Question 106

Type II: Examples of hypersensitivity reactions

Answer 106

Drug allergies (eg. Penicillin)

Question 107

Type III: Examples of hypersensitivity reactions

Answer 107

Serum sickness | Arthus reaction

Question 108

Type IV: Examples of hypersensitivity reactions

Answer 108

TH1: contact dermatitis, tuberculin reaction TH2: chronic asthma, chronic allergic rhinitis CTL: contact dermatitis

Question 109

Immunodeficiency can be

Answer 109

Congenital | Acquired