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Toledo PT Blood Physiology
Toledo PT Blood Physiology
128
Physiology
Graduate
09/13/2009

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Term
What do you remove from the whole blood to create plasma?
Definition
RBC, leukocytes, platelets.
Term
What is removed from plasma to create serum?
Definition
Fibrinogen and other clotting factors.
Term
Plasma volume of total blood
Definition
55%
Term
Erythrocyte (hematocrit) percentage of total blood.
Definition
45%
Term
Plasma Volume Equation
Definition
Total Blood - RBC volume
Term
Hematopoiesis
Definition
refers to the production of blood cells.
Term
What regions of the body produce blood cells
Definition
bone of chest, base of skull, & upper ends of humerus and femur.
Term
Pluripotent Hematopoietic Cells
Definition
all blood cells are descendants from these cells.
Term
Hematopoietic Growth Factors
Definition
They stimulate proliferation and differentiation of various progenitor cells at multiple points.
Term
Lymphoid Stem Cell
Definition
Will differentiate only into lymphocyte
Term
Myeloid Stem Cell
Definition
will differentate into all other cells except for lymphocyte.
Term
GM-CSF
Definition
Granulocytes, monocytes
Term
Blood proteins in plasma or serum
Definition
Albumin (60%), Immunoglobins(37%), Fibrinogen(3%)
Term
Leukocyte percent distribution
Definition
Neutrophils (50-70%), Eosinophils (1-4%), Basophils (<1%), Monocytes(2-8%), Lymphocytes(20-40%).
Term
RBC concentration
Definition
5 million/ mm3
Term
What structures are RBCs lacking compared to normal cells
Definition
They do not have mitochondria, nucleus, other organelles.
Term
Spectrin
Definition
Consists of a & B chains. Bound to the cell membrane by integral proteins called protein 3 & glycophorin.
Term
Hemoglobin
Definition
major molecule in the red cell cytoplasm.
Term
Heme
Definition
4 pyrrole rings = porphyrin ring
Term
Heme synthesis
Definition
glycine + succinyl-CoA --> g-aminolebvulinic acid.
Term
What enzyme catalyzes the formation of g-aminolebyvulinic acid
Definition
g-ALA synthase
Term
What reaction does PBG synthase catalyze?
Definition
2 g-aminolevulinate -ALA to porphobilinogen.
Term
What reaction occurs to directly form hemoglobin?
Definition
protoporphyrin IX, Iron + globin -> hemoglobin.
Term
What reaction occurs to directly form hemoglobin?
Definition
protoporphyrin IX, Iron + globin -> hemoglobin.
Term
What enzymes are essential for DNA synthesis?
Definition
VitB12 & Folic Acid. If they are not present the cell will become anemic.
Term
What are the 4 globin proteins
Definition
HbA1, HbA2, HbF, HbA1c
Term
Consequnces of abnormality of structure of globins
Definition
Compromised of O2 binding, susceptible to destruction, sickle hemoglobin (HbS).
Term
HbA1 subunits
Definition
2a + 2B
Term
HBA2
Definition
2a + 2delta
Term
HbF
Definition
2a + 2(gamma)
Term
What state does iron need to be in to bind with O2
Definition
Ferrous state. (Fe2+).
Term
If iron is in the ferric state, what form of hemoglobin is formed?
Definition
Methemglobin
Term
Consequences of Methemglobin
Definition
Cannot bind with O2, Higher concedntration leads to cyanosis.
Term
How does NADH aid iron in the glycolytic pathway?
Definition
Helps Fe remain in the ferrous state.
Term
How does 2,3 diphosphoglycerate help with hemoglobin?
Definition
produced through glycolytic pathway. reduces affinity of Fe for O2 and helps O2 delivery to O2-consuming tissue. Hypoxic condition leads to increased synthesis of 2,3 synthesis of 2,3-DPG.
Term
What body structures remove aged RBC?
Definition
removed by macrophages in liver, spleen and bone marrows.
Term
What protein carries Iron extracellularly?
Definition
transferrin
Term
What protein is billirubin broken down to?
Definition
plasma albumin.
Term
What are the casues of anemia?
Definition
blod less, increased destruction of RBC, decreased production of RBC.
Term
Symptoms of Anemia
Definition
Pallor, weakness, dyspnea, tachycardia.
Term
What are methods of assessing anemia?
Definition
Hemoglobin, RBC number, RBC size, RBC color, RBC shape.
Term
Mean Cell Volume (MCV)
Definition
average volume of RBC expressed in femtoliters. indication of size of size of RBC
Term
Mean Cell Hemoglobin (MCH)
Definition
average content of Hb per RBC, expressed in picograms. indicatino of the color of RBC.
Term
Mean Cell Hemoglobin concentration
Definition
average concentratino of Hb in a given volume of packed RBC.
Term
Aplastic Anemia
Definition
Due to bone marrow failure: causes pancytopenia, anemia, leukopenia & thrombocytopenia.
Term
What are the secondary causes of aplastic anemia?
Definition
High-dose radiation and chemotherapy Tx, exposure toxic chemicals, certain drugs, autoimmune disorders.
Term
What are s.s. of aplastic anemia?
Definition
uncontrolled infections, bleeding tendency, weakness, chronic fatigue.
Term
Tx of Aplastic Anemia?
Definition
Bone marrow transplantation for idiopathic cuases, withdrawal of toxic drugs.
Term
What percent of total iron is stored in Hb?
Definition
80%.
Term
What are the main storage sites for iron in the body?
Definition
liver, spleen, bone marrow, skeletal muscle.
Term
How is iron used as an enzyme component in the body?
Definition
In cytochrome in the mitochondria.
Term
Where is iron absorbed in the body?
Definition
Duodenum
Term
what is the primary regulation of Fe?
Definition
Dietary intake of iron.
Term
Iron transporter on apical side?
Definition
DMT1 (divalent metal transporter1), Heme transporter.
Term
Iron transporters at basolateral side?
Definition
Ferroportin 1, Hephaestin.
Term
Iron regulators
Definition
Hepcidin: synthesized by the liver; negative effect on ferrosportin 1
Term
Consequences of Iron deficiency anemia
Definition
impeded heme synthesis, smaller RBC: microcytic RBC, Less Hb contained in RBC: hypochromic, more common in women than in men.
Term
Causes of iron deficiency anemia
Definition
chronic blood loss: ulcer or menstruation, inadequate iron intake(rare), malabsorption wth GI diseases, celiac, increased demand of iron: pregnancy, infancy.
Term
Tx of iron deficiency anemia
Definition
increase iron intake or correct other causes.
Term
Causes of Megaloblastic Anemia
Definition
caused by deficiency of Vit. B12 or folic acid. leads to ineffective erythropoiesis, incrased destructino of abnormally large RBC.
Term
What happens in megaloblastic Anemia?
Definition
nucleuses of megaloblasts do not grow and remain enlarged.
Term
What is typical size of a megaloblast?
Definition
>100 fl: macrocytic RBC
Term
T/F. Vit B12 is not associated w/ neurological diseases due to demyelination of spinal cord.
Definition
False. Vit B12 is associated with spinal cord demyelination.
Term
T/F. Folate is directly associated with neurological diseases.
Definition
False. Folate is NOT directly associated with neurological disorders.
Term
What happens to HbS when deoygenated?
Definition
undergoes polymerization and becomes susceptible to sequestration & hemolysis within spleen. microvascular obstruction and ischemic damage.
Term
Tx of Sickle Cell Anemia?
Definition
Hydroxyurea & butyrate, which increases HbF, are used to prevent sickling of HbS.
Term
What causes Sickle cell anemia
Definition
gene mutation on chain. Valine is substituted for glutamic acid at 6th position of the B-chain.
Term
What are the guidlines for exercising with Sickle Cells
Definition
constant hydration, avoid diuretic beverages, avoid strenuous exercise in hot and humid conditions, avoid high altitude exposure, avoid repeated high interval training w/ brief recovery.
Term
Spherocytosis
Definition
hereditary disease (autosomal dominant), RBCs lack spectrin major structural protein in cell membrane, lack of cytoskeleton proteins, round up to form spheres instead of biconcave disks. less deformable and less adaptable to microcirculation. Susceptible to hemolysis in the spleen.
Term
What is the treatment of spherocytosis?
Definition
Splenectomy
Term
Thalassemia
Definition
Genetic defect for synthesis of globin chains of HbA at a normal rate.
Term
What is B- Thalassemia?
Definition
defect in genes responsible forB chain synthesis. MCHC is low: hypochromic & microcytic.
Term
What is a-thalassemia?
Definition
defect in genes responsible for a chain synthesis.
Term
What is a-thalassemia?
Definition
defect in genes responsible for "a" chain synthesis. less hemoglobin in RBC: hypochromic.
Term
T/F. There is a cure for thalassemia?
Definition
False. There is no cure for thalassemia.
Term
Normocytic, normochromic anemia
Definition
normal cell size, and color. common after massive blood loss.
Term
Microcytic, hypochromic anemia
Definition
RBCs are small and pale, common with iron deficiency.
Term
Macrocytic, normochrmoic anemia
Definition
RBCs are large but normal color, common with deficienc of vitamin B12 or folic acid.
Term
Erythrocytosis
Definition
increased # of RBC > 5.5 millions/ ul (normal 5 millions/ ul); Hct > 55%.
Term
What is Polycythemia and possible causes?
Definition
Erythrocytosis; can be caused by reduced plasma volume(relative) or by increased total RBC mass (absolute)
Term
Absolute poylcythemia
Definition
(primary polycythemia) neoplastic disease of RBC precursors, hyperviscosity of blood, hypertension is present, bone marrow is hypercellular.
Term
Secondary polycythemia
Definition
due to elevated secretion of erythroppoietin, compensatory or reactive hyperplasia of RBC precursors, common in prolonged hypoxia (high altitude living), associated with lung or congenital heart disease.
Term
Normal leukocyte counts
Definition
7000/ ul
Term
Leukopenia
Definition
Reduced WBC count 1000/ul or less. most common form is neutropenia. can be caused by inadequate granulopoiesis.
Term
What is the treatment for leukopenia
Definition
antibiotics for short term leukopenia.
Term
What are the two causes of leukopenia
Definition
inadequate granulopoiesis with bone marrow failure or chemotherapy agents. can be caused by accelerated removal or destruction of neutrophils with immune-mediated injury to neurtophils.
Term
Reactive Leukocytosis
Definition
Increased # of WBC> 10,000/ul due to common reactions with infectino or immune reaction.
Term
Which form of leukocytosis is associated with bacterial infection?
Definition
Neutrophilic Leukocytosis.
Term
This form of leukocytosis is associated with allergic reactions
Definition
Eosinophillic leukocytosis.
Term
Monocytosis
Definition
w/ chronic infection ex.) tuberculosis.
Term
Lymphocytosis
Definition
often associated with chronic immunologic stimulation.
Term
Infectious Mononucleosis
Definition
Count of leukocytes rises significantly: monocytes and lymphocytes. Rise to 50-70% from 35%. Caused by Epstein-Barr virus. infects B-lymphocytes, producing reactive lymphocytosis of B cells.
Term
s./s. of mononucleosis
Definition
fever, sore throat, enlarged lympho nodes, presence of antibody against EBV, splenomebgaly.
Term
Tx. Mononucleosis
Definition
Rest and driniking plenty of H2O.
Term
Thrombocytopenia
Definition
<70,000 platelets.
Term
T/F. pts with thrombocytopenia have normal prothrombin time and normal partial thromboblastin time
Definition
T.
Term
T/F. There is a prolong bleeding time in pts with thrombocytopenia
Definition
T.
Term
What are the causes of thrombocytopenia?
Definition
production problem w/ bone marrow failure or injury: aplastic anemia, bone marrow infiltration w/ tumor, & post-bone marrow transplantation. Antibody-mediated destruction:Autoimmune disorders w/antibody-mediated destruction. Excesive consumption: conditions that cause disseminated intravascular coagulation such as infections, tumors.
Term
T/F Thrombocytopenia commonly occurs with TBb because of the immune-mediated injury of platelets or HIV-mediated suppression of megakaryocytes.
Definition
False. All is true but occurs in association with AIDS.
Term
What are 3 neoplastic diseases of WBC
Definition
leukemias, lymphomas, multiple myelomas.
Term
Leukemia
Definition
means white blood. involves WBC precursors in the bone marros. there is an increased num ber of malignant WBCs in the periperal blood.
Term
Lymphomas
Definition
involves lymphocytes and their precursors, and lymph nodes.
Term
Multiple myelomas
Definition
it is the malignant diseases of plasma cells.
Term
Acute leukemia
Definition
characterized with rapid growth of immature blood cells, which makes the bone marrow unable to produce healthy blood cells. if untreated, pt will die within weeks or months.
Term
Chronic Leukemia
Definition
characterized with the excessive build up of relatively mature, but still abnormal, blood cells. typically takes months to years for the progress of teh dieseases.
Term
Acute lymphcytic leukemia common occurence
Definition
most common in children younger than 5 yrs old
Term
Acute mylogenous leukemia
Definition
it occurs inall ages, but more common in old ages.
Term
Chronic lymphocytic leukemia
Definition
rare in young ages , but it rises progrssively with advancing ages.
Term
Chronic mylogenous leukemia
Definition
rarely occurs before adolescence. incidence increases with advancing ages.
Term
Clinical features of leukemia
Definition
bone marros is infiltrated with malignant cells, peripheral blood contains immature blood cells, overwhelming infection is the most common cause of death. anemia, recurrent infections, & uncontrollable bleeding due to reduced production of normal RBC, WBC & platelets.
Term
Lymphomas
Definition
accounts for 5% of all malignant human cancers. Cancer cells originate from lymph nodes in lmphatic system.
Term
Can a cancer be determined if it is lymphoma or leukemia if there are cancer cells found in both the lymph nodes and in the bone marrow.
Definition
False. It cannot be determined.
Term
Where do most of lymphoid neoplasms in western countries originate?
Definition
B-cell origin.
Term
Hodgkin's Leukemia
Definition
localized to single axial group of nodes, i.e. cervical lymph nodes or mediastinal lymp nodes. orderly spread by contiguity, extranodal involvement uncommon, gian cells (Reed-Sternberg cells).
Term
Non-hodgkin's lymphomas
Definition
multiple peripheral node, noncontiguous spread, extranodal involvemtn common, no Reed-Sternberg cells.
Term
What is normal range for bleeding time after a sustained inury?
Definition
2-9 minutes.
Term
Prothrombin Time
Definition
tests the adequcy of the extrinsic and common coagulation pathway: 12-15 sec for normal.
Term
Partial Thromboplastin time
Definition
this tests the adequacy of the intrinsic and common coagulation pathway. over 39s are generally abnormal.
Term
What are the major events in hemostasis?
Definition
injyr causes vascular constriction-> platelets become activated by thrombin and aggregate at the site of injury -> fibrin -> fibrin mesh forms and entraps platelet plug -> the disoolution of the clot by plasmin
Term
Hemophilia
Definition
deficiency of clotting facgtors. 70-80%. inherited & 20-30%^ spontaneous mutation. X-linked recessive trait.
Term
Hemophilia A
Definition
deficiency of VIII. more common than hemophilia B
Term
Hemophilia B
Definition
deficiency of IX.
Term
S./S. of Hemophilia
Definition
bruised easily, uncontrollable bleeding w/ trauma or surgery. joint deformities are common due to repeated hemarhtrosis. PTT longer than normal. IX & VIII are intrinsic pathway. PT: normal IX &VIII are not involved in extrinsic pathway.
Term
Von Willerbrand Disease (vWD)
Definition
Von willerbrand factor is deficient. most common inherited bleeding disorder. deiciency of vWF causes defective platelet adhesion and leads to deficiency of VIII. type I vWD is most common and inherited as an autosomal dominant trait.
Term
What does vWF do for the body?
Definition
it stabillizes and carries VIII. causes adhesion of platelets via GpIb receptors on platelets.
Term
Anticoagulatns
Definition
Heparin binds and activates antithrombin II, which inhibits serine proteasse activity of clotting factors.
Term
Coumadin
Definition
inhibits coagulatino by inhibiting the formatino of active forms of vitamin Kdependent clotting factors II, VII, IX, X.
Term
Plasminoge activators
Definition
convert plasminogen to plasmin, which degrade fibrin. tPA & streptokinase.
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