Pathology Lesson 5 Flashcards
(224 cards)
1
Q
What percentage of plasm is water?
A
90%
2
Q
What are six substances dissolved in plasma?
A
- Nutrients
- Salts
- Respiratory gases
- Hormones
- Proteins
- Waste products
3
Q
Plasma is what percentage of the whole blood volume?
A
approximately 55%
4
Q
Plasma combines with interstitial fluid to form most of the volume of what?
A
extracellular fluid (ECF)
5
Q
What contribute an important role in the protein-binding of drugs?
A
Plasma proteins
6
Q
Where are the majority of plasma proteins synthesized?
A
Liver
7
Q
Plasma proteins are used to transport __________ and to make _________.
A
- molecules
- enzymes
8
Q
What plasma protein plays a major role in blood clotting?
A
Fibrinogen (and other clotting factors)
9
Q
What is the most abundant plasma protein?
A
Albumin
10
Q
What does albumin regulate? What does this maintain?
A
- Osmotic pressure
- to maintain appropriate distribution of fluids between compartments
11
Q
What kind of plasma protein is albumin?
A
Carrier protein
12
Q
What are globulins? What is their function?
A
- Antibodies
- Help protect the body from foreign antigens
13
Q
Leukocytes are crucial in the body’s what?
A
Defense against disease
14
Q
True or False:
Leukocytes are incomplete cells lacking a nucleus.
A
False
(Leukocytes are complete cells with a nucleus and organelles)
15
Q
What is diapedesis?
A
Leukocytes’ ability to move into and out of blood vessels.
16
Q
Leukocytes move by what kind of motion?
A
Ameboid motion
17
Q
What can leukocytes respond to? What is this called?
A
- Chemicals released by damaged tissues
- Chemotaxis
18
Q
What are the three main WBCs involved in phagocytosis?
A
- Neutrophils
- Eosinophils
- Monocytes
19
Q
What is pus?
A
An exudate associated with infected wounds
20
Q
What is pus a mixture of?
A
- Dead neutrophils
- Cellular debris
- Other waste products
21
Q
What is pus caused by?
A
Pyogenic bacteria
22
Q
What is the normal WBC count?
A
4,000 - 11,000 cells/mm blood
23
Q
What is leukopenia?
A
Abnormally low WBC count
24
Q
What is leukopenia caused by?
A
May be caused by drugs / disease process
25
Leukopenia predisposes a patient to what?
infections
26
What is leukocytosis and what does it often indicate?
- WBC above 11,000
- **bacterial** infection
27
What is neutrophilia?
Abnormally high number of neutrophils
28
What is released into the blood when demand for neutrophils is greater than the supply?
Bands (immature neutrophils)
29
What is a very high neutrophil count also known as?
Left shift
30
What is whole blood?
All formed elements and plasma.
31
What may be done to blood for clinical purposes?
May be separated or fractioned
32
What is the total blood volume in adult males?
5-6 liters
33
What is the total blood volume in adult females?
4-5 liters
34
What are the two physical characteristics of blood?
* Color range
* pH
35
What color is oxygen-rich blood?
Scarlet red
36
What color is oxygen-poor blood?
Dull red
37
What must the pH of blood remain between?
**7.35 - 7.45**
38
What is a buffer?
Any substance reversibly binding hydrogen ions
39
What are three kinds of buffer?
* Chemical
* Respiratory
* Renal
40
What are three kinds of chemical buffers?
* Bicarbonate H2CO3
* Phosphate
* Proteins
41
What are five functions of the blood?
* Delivers O2, nutrients, and hormones
* Removes metabolic wastes
* Aids in:
* Body temp regulation
* Body fluid pH
* Fluid volume in fluid compartmets
* Clotting mechanisms
* Immune system functions
42
Blood carries O2 from what to what?
lungs --\> tissues
43
Blood carries CO2 from what to what?
tissues --\> lungs
44
Where does blood carry hormones to?
Target tissues
45
Blood carries metabolic wastes from what to what?
cells --\> excretion sites
46
What are two ways that blood distributes nutrients?
* Absorbed through digestive tract
* Released from storage in adipose tissue or liver
47
What are two ways that blood distributes hormones?
* Steroid / Thyroid bound to plasma proteins
* Polypeptides / proteins dissolved
48
How does the blood stabilize body temperature?
Blood absorbs heat generated by active skeletal muscles
↓↓
Redistributes it to other tissues
49
Why is blood flow directed to skin surface?
Promote heat loss
50
When is blood flow restricted to brain and temperature-sensitive organs?
When we need to conserve heat
51
What is another name for red blood cells?
Erythrocytes
52
What is the main function of RBCs?
Carry oxygen
53
What are four properties of the anatomy of circulating erythrocytes?
* Bioconcave disks
* Essentially bags of hemoglobin
* Anucleate (no nucleus)
* Contain very few organelles
54
For every white blood cell, how many red blood cells are there?
1,000
55
How long do red blood cells live for?
120 days
56
What are two function effects of a red blood cell's bioconcave disk?
* Large surface area to volume ratio
* Enables bending and flexing to squeeze through narrow capillaries
57
What is the function of the large surface area to volume ratio of red blood cells?
Increases rate of diffusion between plasma and cytoplasm.
58
True of False:
Erythrocytes do not undergo cell division.
True
59
Erythrocytes do not synthesize what two things?
Proteins or enzymes
60
Why can't RBC's provide their own energy?
What do they rely on for their energy?
- no mitochondria --\> no Kreb's cycle --\> no ATP
- rely on glucose obtained from surrounding plasma
61
How long does it take a RBC to do one round-trip through the circulatory system?
Less than 1 minute
62
True or False:
A RBC's ride through the circulatory system is easy-going.
False
(It is exposed to severe physical stress)
63
Why do RBCs have a short life-span? What is that life-span?
- No repair mechanism
- Around 120 days
64
What percentage of RBCs are replaced each day?
1%
65
How many new RBCs enter the system per second?
3 million
66
What are four physical stressors on RBCs?
* Forced through vessels
* Bounce off vessel walls
* Collide with other RBCs
* Squeezed through tiny capillaries
67
# Fill in the blanks:
**1) Hemocytoblast**
↓
2)\_\_\_\_\_\_\_\_\_\_\_\_\_
↓
3)\_\_\_\_\_\_\_\_\_\_\_\_\_
↓
4)\_\_\_\_\_\_\_\_\_\_\_\_\_
↓
5)\_\_\_\_\_\_\_\_\_\_\_\_\_
↓
6)\_\_\_\_\_\_\_\_\_\_\_\_\_
↓
7) **Erythrocyte**
**1) Hemocytoblast**
↓
_2) Proerythroblast_
↓
_3) Early Erythroblast_
↓
_4) Late Erythroblast_
↓
_5) Normoblast_
↓
_6) Reticulocyte_
↓
**7) Erythrocyte**
68
What are reticulocytes?
Immature erythrocytes
69
Where do reticulocytes develop / mature?
in the blood
70
How long does a reticulocyte circulate before maturing into a RBC?
around one day
71
Reticulocytes typically account for what percentage of total of red blood cells?
1%
72
What makes a reticulocyte different from a RBC?
Hasn't developed into bioconcave disc morphology
73
What is the primary site of hematopoieses?
Red bone marrow
74
Where is red bone marrow found in infants?
Most bones
75
Where is red bone marrow found in adults?
* Vertebrae
* Ribs
* Sternum
* Skull
* Sacrum
* Pelvis
\*Also in spongy bone at ends of long bones
76
What kind of bone marrow do we have at birth?
Red bone marrow
77
As we age, what happens to our red bone marrow?
Much is converted to yellow marrow
78
What is yellow bone marrow?
Fatty substance found in hollow cavity of long bones.
79
Yellow marrow can be converted to red marrow when what happens?
Extreme blood loss
80
How many hemoglobin molecules are found on one erythrocyte?
250 million
81
What is hemoglobin?
Iron-containing protein
82
How does hemoglobin bind to oxygen?
Strongly, but reversibly
83
Each hemoglobin molecule has how many oxygen binding sites?
4
84
Hemoglobin makes up what percentage of intracellular proteins?
About 97%
85
What is the function of hemoglobin?
Binds to / carries respiratory gasses
86
What is hemoglobin formed from?
2 pairs of globular proteins:
ɑ and β
87
What does each subunit of hemoglobin contain?
A single heme molecule
88
What happens to RBCs before hemolysis can occur?
Phagocytes
89
Where are three places that phagocytosis occurs?
* Liver
* Spleen
* Bone marrow
90
What happens to hemoglobin following phagocytosis?
It's recycled
91
In hemoglobin recycling, what is loose heme converted to? What color is it?
- Biliverden
- green
92
In hemoglobin recycling, what is biliverdin converted to? What color is it?
- Bilirubin (waste byproduct)
- orange-yellow pigment
93
In hemoglobin recycling, when bilirubin is released into circulation, what is it absorbed by?
Hepatocytes
94
In hemoglobin recycling, how is bilirubin excreted?
Via feces (most) and urine (some)
95
In hemoglobin recycling, what is disassembled into component amino acids via metabolism?
Globin
96
In hemoglobin recycling, what happens to globin after it is disassembled?
Released back into circulation for reuse by other cells
97
In hemoglobin recycling, where is iron from the heme molecule stored? When is it released into the bloodstream?
- stored in macrophage
- when needed
98
In hemoglobin recycling, when iron is released back into the bloodstream, what does it bind to?
Transferrin (special plasma protein)
99
In hemoglobin recycling, what is used in synthesis of new hemoglobin molecules for production of new RBCs?
Amino acids (from globin) and transferrin (bound to iron)
100
What are thrombocytes?
Membrane enclosed packets of cytoplasm
101
What are thrombocytes derived from?
Megakaryocytes
102
What do thrombocytes contain?
Enzymes and clotting factors
103
How long do thrombocytes circulate?
9-12 days
104
What are thrombocytes removed by?
Phagocytes
105
When are thrombocytes replaced?
Continuously
106
What do thrombocytes play a big role in?
Vascular clotting system
107
What is the normal thrombocyte count?
(Important!!)
150 - 500,000 / ɥl blood
108
# Fill in the blanks:
**1) Hemocytoblast**
↓
2) \_\_\_\_\_\_\_\_\_\_\_\_\_\_
↓
3) \_\_\_\_\_\_\_\_\_\_\_\_\_\_
↓
4) \_\_\_\_\_\_\_\_\_\_\_\_\_\_
↓
**5) Platelets**
**1) Hemocytoblast**
↓
_2) Megakaryoblast_
↓
_3) Promegakaryocyte_
↓
_4) Megakaryocyte_
↓
**5) ****Platelets**
109
What is thrombocytosis and what is it due to?
- Platelet count exceeds 1,000,000
- Due to accelerated platelet formations
110
What three things cause thrombocytosis?
* Infection
* Inflammation
* Malignancy
111
How many thrombocytes categorize thrombocytopenia? What is it due to?
- Less than 80,000 count
- Inadequate platelet production
(or)
Excessive platelet destruction
112
What are five signs / symptoms of thrombocytopenia?
* Bleeding gums
* Nosebleeds
* Easy bruising
* Petechiae
* **Hematuria / hematochezia**
113
What is idiopathic thrombocytopenic purpura (ITP)?
- Isolated thrombocytopenia
- It is an autoimmune disease when IgG binds to platelets
↓↓
Platelets destroyed in spleen by macrophages
114
True or false:
With ITP, there is systemic illness.
False
115
True or false:
With ITP, the spleen is not palpable.
True
116
What are three characteristics of the acute form of ITP?
* Usually in childhood
* Follows viral infection
* Self-limiting
117
What are six signs / symptoms of ITP?
* Purpura
* Petechia
* Hemorrhagic bullae in mouth
* Low platelet count: may be \< 10,000
* Other RBC indices normal (unless mild anemia from bleeding)
* Megathrombocytes (large immature platelets) on peripheral smear
118
What are three characteristics of chronic ITP?
* Occurs in younger adults
* Unkown etiology
* 2:1 femal predominance
119
What are three treatments for chronic ITP?
* Prednisone
* Hi-dose IV immunoglobulin (IgG)
* Slenectomy
120
What is polycythemia?
Overproduction of red blood cells
121
What are the two types of polycythemia?
Relative and Absolute
122
What does relative polycythemia result from?
Dehydration
↓↓
Fluid loss leads to relative increases of RBC counts and Hgb and Hct values
123
What are two forms of absolute polycythemia?
Primary absolute and secondary absolute
124
What is primary absolute polycythemia?
Abnormal excess of erythrocytes - neoplastic, nonmalignant bone marrow stem cell proliferations
125
What is primary absolute polycythemia also known as?
Polycythemia vera (PV)
126
What is secondary absolute polycythemia?
* increase in erythropoietin production as physiologic response to chronic hypoxia
* increase in erythropoietin production in response to erythropoietin-secreting tumors
127
In polycythemia vera, what is the hematocrit?
As high as 80%
128
In polycythemia vera, what happens to blood volume and how does this affect the blood's viscosity??
- may double
- increased
129
When is the peak incidence with polycythemia vera?
60-80 y/o
130
What are seven common signs / symptoms of polycythemia vera?
* Headaches
* Weakness
* Vertigo
* Tinnitus
* Pruritis
* Splenomegaly
* Hepatomegaly
131
What are two uncommon signs / symptoms of polycythemia vera?
* Hypertension
* Thrombosis
132
What are four PV treatments?
* Phlebotomy
* Hydroxyurea
* Interferon
* Radiation
133
What are the four steps in hemostasis and tissue repair?
* Vasoconstriction
* Platelet plug formation
* Coagulation
* Clot retraction and dissolution
134
What is hemostasis?
Restriction of fluid losses at injury sites
135
What does blood contain that responds to breaks in vessel walls? What does this initiate?
- enzymes and factors
- clotting process
136
True or false:
Clots act as permament patches to stop blood loss.
False
(Clot acts as a temporary patch to prevent further blood loss)
137
What kind of feedback is platelet activation - positive or negative?
Positive
138
What are the three stages of coagulation?
1. Coagulation cascade
2. Prothrombin --\> Thombin
3. Fibrinogen --\> Fibrin
139
What is a one word definition for coagulopathy?
disorder
140
What two things do platelets contain?
Actin and myosin
141
What three things does PDGH (Platelet-driven growth factor) stimulate?
* Smooth muscle
* Endothelial cells
* Fibroblasts
142
What does heparin do?
Inactivates thrombin
143
What does aspirin do?
Prevents platelet aggregation
144
What does Wafarin (Coumadin) do?
Inhibits enzymes (Vitamin K)
145
What is dabigatran (Pradaxa)?
Direct thrombin inhibitor
146
What is multiple myeloma? What are three characteristics?
B Cell cancer
* One clonal line - usually IgG
* Bence-Jones protein in urine
* Lytic bone lesions
147
True or false:
Anemia is a disease.
False
| (It is not a disease)
148
What is the definition of anemia?
Decrease in Hgb / Hct level from an individual's baseline value.
149
Why does anemia develop?
* Underproduction (hypoproliferative marrow)
* Increased destruction (less than normal 120 day life span)
* Blood loss
* Combination of underproduction and shortened life span
150
What are six symptoms and signs?
* Pallor - often notcied by friends or relatives
* Weakness / Fatigue
* Shortness of breath (SOB) or Dyspnea on Exertion (DOE)
* Dizziness / Lightheadedness
* Tinnitus or pounding / wooshing in ears
* Asymptomatic - often seen when anemia develops slowly or is chronic and stable
151
What are six presenting signs of anemia?
* Tachycardia
* Tachypnea
* Jaundicae (hemolysis)
* Peripheral Neuropathy (pernicious anemia)
* Splenomegaly
* Pallor of nail beds and conjunctiva
152
What do veggies give us that is important for preventing anemia?
Folic acid
153
What do meats give us that is important for preventing anemia?
B12
154
What disease can cause low B12?
Crohn's Disease
155
What disease can cause Fe deficiency?
Ulcerative Colitis
156
What are five important historical questions conerning anemia?
* Change in bowel habits
* Dietary habits
* Abdominal disease or Bowel surgery
* Medications
* Renal disease
157
What two changes in bowel habit are important to detecting anemia?
- melena
- hematochezia
158
What are the three most import parts of the summary of work up for anemias?
* RBC Indices
* Retic
* P-Smear
159
What may a change in Hgb reflect what two things?
* Altered plasma volume
* Underlying physiologic conditions with different oxygen needs
160
What are four examples of when Hgb may reflect altered plasma volume?
* pregnancy
* massive splenomegaly
* Burn pt
* Dehydrated pt
161
What are three examples of when Hgb count may reflect underlying physiologic conditions with different oxygen needs?
* Emphysematous pt
* L-R cardiac shunt
* Hypothryoidism
162
What is key in practical classification of anemia?
Reticulocyte count
163
What constitues an anemia as microcytic?
MCV level \<80 fl
164
What constitutes an anemia as macrocytic?
MCV \>100 fl
165
What are two major microcytic anemias?
- Iron deficiency anemia
- Thalassemia
166
What are six other microcytic anemias other than iron deficiency or Thalassemia?
* X-linked sideroblastic anemia
* Lead poisoning
* Anemia of chronic disease-RA
* Hodgkin lymphoma
* Castleman disease
* Myelofibrosis with myeloid metaplasia
167
What is the total amount of iron in a healthy person?
How much circulates as Hgb and how much is stored?
- 3-4g
- 2/3 circulates and 1/3 is stored
168
What is the daily requirement of iron for a man / postmenopausal woman?
Menstruating woman?
Pregnant / lactating woman?
- 1 mg/d
- 2 mg/d
- 3 mg/d
169
How much iron do we take in a day and how much is actually absorbed?
- 10-20 mg daily
- only 5-10%
170
How much is iron absorption increased in iron deficiency?
x 5
171
What is the most sensitive test for iron deficiency?
Ferriting (20-200 ug/dl)
172
What are four circumstances in which there is an increase in Ferritin despite iron deficiency?
* as part of acute phase reaction
* infection / inflammation
* malignancy
* hepatic inflammation / necrosis
173
What are four tests for iron deficiency?
* MCV
* Serum iron
* Serum TIBC
* Ferritin
174
How long must you treat iron deficiency to replenish Fe stores?
At least 6 months beyond Hgb level returns to normal
175
What are six reasons for refractory of iron therapy?
* Non-compliance
* Absorption inhibition (Food, tea, antacid, drug)
* Absorption impaired (Gastric surgery, small bowl mucosa disease)
* Wrong therapy (enteric coated pills, spansules)
* Ongoing blood loss
* Wrong diagnosis
176
What constitutes an anemia as normocytic?
MCV 80-100 fl
177
What is a normocytic anemia?
Stem cell defect / decreased erthryopoieses
178
What are four intrinsic causes of normocytic anemias?
* Aplastic anemia
* PNH (paroxysmal nocturnal hemoglobinuria)
* Fanconi's
* MDS (myelodysplastic syndromes)
179
What is Sickle Cell Anemia?
Hb S - from genetic mutation
180
What does Hb S react with to cause sickling?
Deoxygenations
181
What kind of anemia is sickle cell anemia?
Hemolytic
182
What kind of crisis can be caused by sickle cell anemia?
Vasoocclusive crisis
183
Is there a cure for sickle cell anemia?
NO
184
Sickle cell anemia is the most common cause of hemolytic anemia in who?
African Americans worldwide
185
What percentage of blacks carry sickly cell anemia trait?
What is this trait considered?
- 4%
- Autosomal recessive
186
What state is sickle cell disease? What state is only the trait?
- Homozygotic
- Heterozygotic
187
People with sickle cell anemia have very high counts of what? What happens if they don't?
- Retic counts
- If not, then marrow is dysfunctional which can lead to aplastic crisis
188
True or false:
Patients with sickle cell anemia have a shorter than normal lifespan.
False
| (They have normal lifespans)
189
People with sickle cell anemia can have painless what?
Hematuria
190
What should you absolutely not give to sickle cell anemia patients?
Iron
191
A non-function spleen in sickle cell anemia patients lead to a high incidence of what?
Pneumococcal and salmonella infections
192
When should you consider hospitilization of patients with sickle cell anemia?
* Severe long episode of pain
* Tachycardia
* Hypoxia
* Low hemoglobin or hematocrit
* Increased WBC count
* Temp \> 101
* Hypotension
* New infiltrates on CXR
193
What is leukemia?
- Cancer of white blood cells
- malignant disorder of blood and bone marrow
194
Leukemia is named according to what? What are these two types?
- Cell type
- Myelocytic, Lymphocytic
195
True or false:
Leukemia can be either acute or chronic.
True
196
In leukemia, what is there an excessive accumulation of?
Abnormal white blood cells
197
What is acute leukemia?
Presence of undifferentiated or immature cells
198
Who is acute leukemia often found in?
Children and young adults
199
What is the progression of acute leukemia?
Rapid progression / morbidity / mortality
200
What is chronic leukemia?
Predominant cell is mature but does not function normally
201
What is the progression of chronic leukemia?
Progression over months to years - may only require monitoring
202
Who is chronic leukemia often found in?
Typically older adults
203
There are many signs and symptoms of leukemia. Name at least seven of them.
* Anemia
* Bleeding
* Purpura
* Petechia
* Ecchymosis
* Hemorrhage
* Thrombosis
* Infection
* Weight loss
* Bone pain
* Hepatomegaly
* Splenomegaly
* Lymphadenopathy
* DIC (disseminated intravascular coagulation)
204
What is the percentage of water in infants?
73% or more
205
True or false:
Total water content of humans increases throughout life.
False
| (Declines throughout life)
206
Healthy males are what percentage of water? Females?
60%
50%
207
What is the difference between females and males in terms of body fat and skeletal muscle?
Females have higher body fat and smaller amount of skeletal muscle than males.
208
In old age, what is the percentage of body weight?
45%
209
Intracellular fluid takes up what amount of water contained in cells?
2/3rds
210
What are the two major subdivisions of extracellular fluid?
Plasma and interstitial fluid
211
Besides water, what are six other ECFs?
* Lymph
* CSF
* Eye humors
* Synovial fluid
* Serous fluid
* GI secretions
212
What is the universal solvent?
Water
213
Solutes are broadly classified into what to categories?
Electrolytes and nonelectrolytes
214
What are some electrolytes?
* Inorganic salts
* All acids and bases
* Some proteins
215
What are examples of nonelectrolytes?
* Glucose
* Lipids
* Creatinine
* Urea
216
Which has greater osmotic power, electrolytes or nonelectrolytes?
Electrolytes
217
What moves according to osmotic gradients?
Water
218
In terms of water, what must happen to remain properly hydrated?
Water intake must equal water output
219
What is the breakdown of water output?
* Urine - 60%
* Feces - 4%
* Insensible losses - 28%
* Sweat - 8%
220
Increases in plasma osmolality trigger thirst and release of what hormone?
Antidiuretic Hormone (ADH)
221
What three things is the hyopthalamic thirst center stimulated by?
* A decline in plasma volume of 10-15%
* Increases in plasma osmolarity of 1-2%
* Via baroreceptor input, angiotensin II, and other stimuli
222
What are baroreceptors?
Alert the brain of increasses in blood volume (hence increased blood pressure)
223
What four things happen when baroreceptors alert the brain of increases in blood volume?
* Sympathetic nervous system impulses to the kidneys decline
* Afferent arterioles dilate
* Glomerular filtration rate rises
* Sodium and water output increase
224
What can baroreceptors also be viewed as?
Sodium receptors
