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Flashcards in Test 3 Deck (138):
1

Pathway for platelet development

Stem cell ->

megakaryoblast ->

megakaryocyte ->

Megakaryocyte breakup ->

Platelet

2

First cell identified as platelet

Megakaryoblast

3

Platelets are anuclear which means

They cannot replicate

4

Normal circulating platelet concentration

150,000-450,000 mm3

5

Half life of platelet

8-12 days

6

5 mechanisms of achieving hemostasis

Vascular constriction

Platelet plug formation

Blood coagulation/clot

Fibrin formation and repair of vessel

Clot lysis

7

2 methods of achieving vascular constriction after trauma to blood vessel

Pain and SNS reflexes (release epi and NE)

Thromboxane released from platelet

8

The greater the trauma

The greater the amount of vasoconstriction

9

Platelets become activated when

Contact damaged vascular endothelium and collagen in blood vessel wall

10

When actin, myosin, and thrombosthenin contract in platelet

Clotting factors are released

11

ADP and thromboxane A2 result in

Activation of other platelets

12

As more platelets are activated

Fibrinogen receptors expressed to form platelet plug

13

Treatment for Von Willebrand factor deficiency

VWF concentrate

DDVAP

Cryoprecipitate

14

Normally which dominates anticoagulants or procoagulants

Anticoagulants

15

After injury which predominates anticoagulants or procoagulants

Procoagulants

16

Procoagulants should predominate where after and injury

Locally at site of injury

17

End of step 1 of coagulation

Formation of prothrombinase (prothrombin activator)

18

End of step 2 of coagulation

Prothrombin converted to thrombin

19

End of step 3 of coagulation

Fibrinogen to fibrin fibers = enmesh platelets, blood cells and plasma to

FORM THE CLOT

20

Extrinsic pathway aka

Tissue factor pathway

21

Intrinsic pathway aka

Contact activation pathway

22

At factor _____ extrinsic and instrinsic pathway become the common pathway

X

23

If blood vessel ruptures which pathway activated

Both intrinsic and extrinsic

24

Extrinsic clotting pathway until common pathway

Tissue damage = thromboplastin and Factor VII release

Combine and add Ca =

Activated factor X

25

Intrinsic clotting pathway until factor X

Contact with collagen of damaged blood vessel =

Activated factor XII=

Activated factor XI =

Add Ca = activated factor IX=

Activated factor X

26

At factor ______ the 3 steps of clotting are in motion

X

27

Coagulation factors are synthesized where

In the liver

28

Common pathway can feed into which pathway

Intrinsic

29

For prothrombinase to convert prothrombin to thrombin what must be present

Sufficient Ca

30

Vitamin K dependent clotting factors

VII

IX

X

31

Sources of vitamin K

Diet

Synthesis by E. coli in the colon

32

In step 3 of coagulation what is required for thrombin to convert fibrinogen into fibrin fibers to form the clot

Ca

33

Meshwork of fibrin fibers entrapping platelets, blood cells, and plasma

Clot

34

MOA of clot retraction

Actin, myosin, thrombothenin and Ca cause fluid expression

35

Clot lysis begins by

Plasminogen in clot

36

Plasminogen activation

Once tissue is injured, tissue plasminogen activator (TPA) is released

37

Function of TPA

Converts plasminogen to plasminogen

38

Function of plasmin

Digests fibrin fibers and procoagulants

39

Function of Thrombomodulin

Binds thrombin to prevent coagulation in normal blood vessels

40

Function of Antithrombin III

Combines and inactivates thrombin

41

Endogenous heparin is synthesized and secreted by

Mast cells (tissue spaces)

Basophils (blood)

42

Endogenous heparin removes factors

VII, IX, X, XI, XII

43

Heparin effects which clotting factors

Activated VII, IX X

Factor XI, XII

Thrombin

44

Coumadin acts on which factors

VII, IX, X

Prothrombin

45

D dimer test assesses

For degredation products

46

PT/INR measure which pathway

Extrinsic and common pathway

Coumadin therapy

47

PTT measures

Intrinsic and common pathway

Heparin therapy

48

Common factors to all conditions resulting in DIC

Hypotension

Hypoxemia

Acidosis

49

Transfuse platelets depends on

Quantitative and Qualitative measures

50

FFP contains

All factors involved in coagulation

51

Do platelets have to be ABO compatible

No

52

Does FFP have to be ABO compatible

Yes

53

Reversal of vitamin K antagonists (Coumadin)

FFP

54

Reversal of heparin

Protamine

55

Cryoprecitpiate contains

Fibrinogen, vWF, factor VIII, factor XIII

56

Any substance that can elicit and immune response

Antigen

57

All living cells express _____ on their cell membranes

Antigens

58

Antigenic determinant

Each can elicit a different response from the immune system

Epitopes

59

Epitopes are related to

Antigens

60

Purpose of antigens

Differentiate self from non-self

61

Type A RBC has which antigens and antibodies

Antigen A

Anti-B antibody

62

Type B RBC contains which antigens and antibodies

Antigen B

Anti-A antibodies

63

Type AB RBC contains which antigens and antibodies

Antigens A and B

No antibodies

64

Type O RBC contains which antigens and antibodies

No antigen

Anti-A and anti-B antibodies

65

Universal recipient RBC

Type AB

66

Universal Donor RBC

Type O

67

Universally plasma receipient

Type O

68

Universal plasma donor

Type AB

69

Each person inhibits ____ MHCs from each parent for a total of ____ MHCs

6

12

70

MHCs are expressed on

All uncleared body cells

71

Fx of MHC

Allow immune system to differentiate self from non-self antigens

72

Expressed on all nucleated body cells

Combine with intracellular antigens to form a complex displayed on the cell surface

MHC Class I

73

MHC Class I interact with which T cell

Cytotoxic (CD8) T cells

74

Expressed on antigen presenting cells

Endocytose foreign antigens, break them down and combine with them

Complex presented to other immune cells

MHC Class II

75

MHC Class II interact with which T cells

Helper (CD4) T cells

76

Antibodies are produced

By B-lymphocytes/plasma cells

In response to antigens

77

Each antibody is

Antigen specific

78

Region of antibody that is the same on every antibody

Constant region of heavy and light chains

79

75% of all antibodies

Activates complement system and promotes phagocytosis

Second antibody to respond to antigen

Responds to bacteria, fungi, viruses, and toxins

IgG (gamma globulin)

80

Largest size antibodies

First antibody to respond to antigens

Responsible for blood transfusion reactions

IgM

81

Second most abundant antibodies

Activates the complement system

Present in body secretions

IgA

82

Major antibodies in allergic and inflammatory responses

IgE

83

3 main functions of lymphatic system

Fluid balance

Lipid absorption

Defense

84

Most lymph fluid returned to the L or R side

L side

85

3 categories of polymorphonuclear granulocytes WBCs

Neutrophils

Eosinophils

Basophils

86

Majority of leukocytes

Neutrophils

87

Neutrophils are responsible for

Phagocytosis

Release chemotactants and pyrogens

88

Primarily involved in allergic reactions and parasitic invasion

Eosinophils

89

Secrete histamine and heparin in the blood stream

Basophils

90

Synthesize and secrete histamine and heparin in the tissues

Mast cells

91

B-lymphocytes are responsible for which immunity

Humoral immunity

92

Responsible for cell mediated immunity

T-lymphocytes

93

_____________ T cells slow down or stop the immune response

Suppressor T cells

94

After leaving the vascular system transformed into macrophages

Monocytes

95

Function of macrophages

Phagocytosis

Compose the tissue macrophage system

96

Function similar to cytotoxic T cells

Respond to tumor formation and virally infected cells

Natural Killer Cells

97

Derived from B lymphocytes and secrete antigen specific antibodies

Plasma cells

98

Myeloblast becomes

Granulocytes

(Basophils, eosinophils, neutrophils)

99

2 classes of granulocytes

Basophils

Eosinophils

Neutrophils

100

Classes of agranulocytes

Lymphocyte

Monocytes

101

4 functions of biochemical mediators to promote inflammation

Vasodilation

Vascular permeability

Attracting WBCs

Stimulating phagocytosis

102

Histamine leads to

Local vasodilation

Increased vascular permeability

103

Bradykinin leads to

Local vasodilation

Increased vascular permeability

Chemotaxis

Stimulation of pain receptors at area of injury

104

To inhibit release of eicosanoids

Give steroids of glucocorticoids

Inhibits both pathways of prostaglandins and leukotriene production

105

Interferon function

Enhance NK cell activity

106

Tumor necrosis factor function and side effects

Enhances coagulation

Extremely pro-inflammation, pro-catabolic, pro-sleep

107

Interleukins function

Promote development and differentiation of T and B lymphocytes

108

Classical pathway of complement system begins when

Antibody binds with antigen

109

Alternative pathway of complement system becomes active when

Protein C3 becomes activated

110

Non-specific response to cell damage

May or may not involve foreign antigens

Inflammatory response

111

Specific response to exogenous or endogenous antigens

Immune response

112

Immune response involves

T and B lymphocytes

B responds to antigens in body fluids

Cytotoxic T responds to antigens in body cells

113

Interleukin 1 function

Stimulates helper T cells (attracts them to macrophage)

114

Interleukin 2 function

T cell growth factor

Causes proliferation of T cell

115

Interleukin 4 function

Differentiation and replication of B cell

116

Interleukin 5 function

Stimulates differentiation of B cell into plasma cell

117

Interleukin 6 function

Promotes antibody production from plasma cell

118

Passive acquired immunity

Recipient does not develop antibodies on own

Ex mother to fetus, antibody infusion

119

Active natural acquired immunity

Exposure to antigens in environment

Ex get sick and develop antibodies

120

Active artificial acquired immunity

Artificial antigen presentation

Ex immunizations

121

Functions f idiotypes

Slow down and stop the immune system

122

Most frequently encountered hypersensitivity reaction during anesthesia

Type 1 (allergy)

Anaphylaxis, asthma

123

Type 1 hypersensitivy reaction aka and mediated by

Allergy

IgE

124

Type II hypersensitivity reaction aka. Mediated by

Cytotoxic

IgG, IgM, complement mediated

125

Example of type II hypersensitivity reaction

ABO incompatibility

126

Type III hypersensitivity reaction aka and mediated by

Immune complex

IgG, complement, neutrophil mediated

127

Ex of type III hypersensitivity reaction

RA, lupus

128

type IV hypersensitivity reaction aka. Mediated by

Cell-mediated

T cell

129

Ex of type IV hypersensitivity reaction

MS

130

Stable patients w/o evidence of bleeding transfuse at platelet count of

<10,000

131

Prophylaxis for invasive procedures (LP, central line, liver biopsy, major surgery) transfuse platelets at

<50,000

132

If pt given massive transfusion,transfuse platelets at

<75,000

133

Patients having surgery on the eye or in CNS transfuse platelets at

<100,000

134

Elevated D dimer is indicative of

Increased/excess fibinolysis and coagulopathies

135

Variable portion of the antibody must

Match the receptor site on the antigen

136

Wha that’s the most potent and widespread anti-inflammatory effects

Phospholipase A2 inhibitors (steroids)

137

Anaphylactic reactions are indicative of a

Secondary immune response related to memory lymphocytes

138

Plasma cells produce antibodies in a

Primary immune response