Unit 4A Anatomy Chapter 18 and 19

Following a motor vehicle accident, a patient is rushed to the emergency department with multiple traumatic injuries, causing severe bleeding. The patient's condition is critical, and there is no time for determining his blood type. What type of blood is transfused, and why?

In emergency situations, blood type O− will be infused until cross matching can be done. Blood type O− is called the universal donor blood because the erythrocytes have neither A nor B antigens on their surface, and the Rh factor is negative.

In preparation for a scheduled surgery, a patient visits the hospital lab for a blood draw. The technician collects a blood sample and performs a test to determine its type. She places a sample of the patient's blood in two wells. To the first well she adds anti-A antibody. To the second she adds anti-B antibody. Both samples visibly agglutinate. Has the technician made an error, or is this a normal response? If normal, what blood type does this indicate?

The lab technician has not made an error. Blood type AB has both A and B surface antigens, and neither anti-A nor anti-B antibodies circulating in the plasma. When anti-A antibodies (added to the first well) contact A antigens on AB erythrocytes, they will cause agglutination. Similarly, when anti-B antibodies contact B antigens on AB erythrocytes, they will cause agglutination.

Path of blood flow to the heart

1. Deoxygenated blood from body enters right atrium through superior and inferior vena cava 2. Right atrium fills, contracts, forcing blood through tricuspid valve into right ventricle 3. Tricuspid valve closes, right ventricle contracts forcing blood into pulmonary artery to lungs 4. In lungs blood loses carbon dioxide and gains oxygen 5. Oxygenated blood returns from lungs to left atrium through pulmonary veins 6. Left atrium fills, contracts, forcing blood through bicuspid valve into left ventricle 7. Bicuspid valve closes and oxygenated blood is pumped out of left ventricle through aorta to body

Layers of the heart

1. Epicardium- Outer layer, protects heart by reducing friction 2. Myocardium- Middle layer, muscle 3. Endocardium- Inner layer

4 Chambers of the heart

2 Atria- Top, collect blood (right and left atrium) 2 Ventricles- Bottom, pump blood (right and left ventricle)

Normal wbc count

5,000-10,000 wbc/cubic mm (high wbc count means infection)

Blood type AB

A and B antigens, no antibodies; "universal recipient"

One of the more common adverse effects of cancer chemotherapy is the destruction of leukocytes. Before his next scheduled chemotherapy treatment, a patient undergoes a blood test called an absolute neutrophil count (ANC), which reveals that his neutrophil count is 1900 cells per microliter. Would his healthcare team be likely to proceed with his chemotherapy treatment? Why?

A neutrophil count below 1800 cells per microliter is considered abnormal. Thus, this patient's ANC is at the low end of the normal range and there would be no reason to delay chemotherapy. In clinical practice, most patients are given chemotherapy if their ANC is above 1000.

Diapedesis

Ability of wbc to squeeze between capillary cells to leave the bloodstream

Atherosclerosis

Accumulation of fatty deposits in arteries; may initiate inappropriate clotting

The process in which antibodies attach to antigens, causing the formation of masses of linked cells, is called ________: a. sensitization b. coagulation c. agglutination d. hemolysis

Agglutination

Interleukins are associated primarily with which of the following?: a. production of various lymphocytes b. immune responses c. inflammation d. all of the above

All of the above

Globulins

Alpha and beta transport lipids and fat soluble vitamins; gamma act as antibodies

Hemolytic disease of the newborn is a risk during a subsequent pregnancy in which ________.: a. a type AB mother is carrying a type O fetus b. a type O mother is carrying a type AB fetus c. an Rh+ mother is carrying an Rh− fetus d. an Rh− mother is carrying a second Rh+ fetus

An RH- mother is carrying a second RH+ fetus

T and B lymphocytes ________.: a. are polymorphonuclear b. are involved with specific immune function c. proliferate excessively in leukopenia d. are most active against parasitic worms

Are involved with specific immune function

Adults

Blood cells produced in red bone marrow; liver and spleen can produce blood cells if necessary

Thrombus

Blood clot forming abnormally in a blood vessel

Which of the following statements about blood is true?: a. Blood is about 92 percent water. b. Blood is slightly more acidic than water. c. Blood is slightly more viscous than water. d. Blood is slightly more salty than seawater.

Blood is slightly more viscous than water

Hemoglobin

Broken down into heme (Fe) and globin (protein)

Leukemia

Cancer of wbc; too many wbc which don't function properly, low rbc and low platelets; bleed easily

The first heart sound represents which portion of the cardiac cycle?: a. atrial systole b. ventricular systole c. closing of the atrioventricular valves d. closing of the semilunar valves

Closing of the atrioventricular valves

Systole

Contraction

Myocardial Infraction

Heart attack

Hemophilia is characterized by ________.: a. inadequate production of heparin b. inadequate production of clotting factors c. excessive production of fibrinogen d. excessive production of platelets

Inadequate production of clotting factors

Blood Doping

Injecting additional blood cells or EPO to increase the oxygen available for muscles (intended for patients with kidney failure, cancer, or anemia)

Which of the following statements about erythropoietin is true?: a. It facilitates the proliferation and differentiation of the erythrocyte lineage. b. It is a hormone produced by the thyroid gland. c. It is a hemopoietic growth factor that prompts lymphoid stem cells to leave the bone marrow. d. Both a and b are true.

It facilitates the proliferation and differentiation of the erythrocyte lineage

Which of the following statements about albumin is true?: a. It draws water out of the blood vessels and into the body's tissues. b. It is the most abundant plasma protein. c. It is produced by specialized leukocytes called plasma cells. d. All of the above are true.

It is the most abundant plasma protein

Phlebotomist

Person who draws blood

Coronary artery disease due atherosclerosis

Plaque or fat buildup Treatment: Excercise, low fat diet, and possibly medication

Erythrocytes

Red blood cells-biconcave discs (extra indentation on both sides) with increased SA to carry oxygen; lose nucleus in most

Diastole

Relaxation; filling of heart

Which chamber initially receives blood from the systemic circuit?: a. left atrium b. left ventricle c. right atrium d. right ventricle

Right atrium

A young woman has been experiencing unusually heavy menstrual bleeding for several years. She follows a strict vegan diet (no animal foods). She is at risk for what disorder, and why?

She is at risk for anemia, because her unusually heavy menstrual bleeding results in excessive loss of erythrocytes each month. At the same time, her vegan diet means that she does not have dietary sources of heme iron. The non-heme iron she consumes in plant foods is not as well absorbed as heme iron.

Hemostasis

Stoppage of bleeding

Coronary Arteries

Supply blood to heart muscle

Why is the left ventricular wall thicker than the right?

The left ventricle has to pump blood to the rest of the body

Which of the following statements about mature, circulating erythrocytes is true?: a. They have no nucleus. b. They are packed with mitochondria. c. They survive for an average of 4 days. d. All of the above

They have no nucleus

Which of the following lists the valves in the order through which the blood flows from the vena cava through the heart?: a. tricuspid, pulmonary semilunar, bicuspid, aortic semilunar b. mitral, pulmonary semilunar, bicuspid, aortic semilunar c. aortic semilunar, pulmonary semilunar, tricuspid, bicuspid d. bicuspid, aortic semilunar, tricuspid, pulmonary semilunar

Tricuspid, pulmonary semilunar, bicuspid, aortic semilunar

The first step in hemostasis is ________.: a. vascular spasm b. conversion of fibrinogen to fibrin c. activation of the intrinsic pathway d. activation of the common pathway

Vascular spasm

A lab technician collects a blood sample in a glass tube. After about an hour, she harvests serum to continue her blood analysis. Explain what has happened during the hour that the sample was in the glass tube.

When blood contacts glass, the intrinsic coagulation pathway is initiated. This leads to the common pathway, and the blood clots. Within about 30 minutes, the clot begins to shrink. After an hour, it is about half its original size. Its heavier weight will cause it to fall to the bottom of the tube during centrifugation, allowing the lab technician to harvest the serum remaining at the top.

Rh+

contains the D antigen and other Rh antigens

Rh-

does not contain the D antigen or Rh

Cyanotic

low oxygen or increased carbon dioxide in blood

Pus

wbc, dead bacteria and damaged body cells

A patient was admitted to the burn unit the previous evening suffering from a severe burn involving his left upper extremity and shoulder. A blood test reveals that he is experiencing leukocytosis. Why is this an expected finding?

Any severe stress can increase the leukocyte count, resulting in leukocytosis. A burn is especially likely to increase the proliferation of leukocytes in order to ward off infection, a significant risk when the barrier function of the skin is destroyed.

Most blood enters the ventricle during ________.: a. atrial systole b. atrial diastole c. ventricular systole d. isovolumic contraction

Atrial diastole

A patient has been experiencing severe, persistent allergy symptoms that are reduced when she takes an antihistamine. Before the treatment, this patient was likely to have had increased activity of which leukocyte?: a. basophils b. neutrophils c. monocytes d. natural killer cells

Basolphils

A patient has thalassemia, a genetic disorder characterized by abnormal synthesis of globin proteins and excessive destruction of erythrocytes. This patient is jaundiced and is found to have an excessive level of bilirubin in his blood. Explain the connection.

Bilirubin is a breakdown product of the non-iron component of heme, which is cleaved from globin when erythrocytes are degraded. Excessive erythrocyte destruction would deposit excessive bilirubin in the blood. Bilirubin is a yellowish pigment, and high blood levels can manifest as yellowed skin.

A molecule of hemoglobin ________.: a. s shaped like a biconcave disk packed almost entirely with iron b. contains four glycoprotein units studded with oxygen c. consists of four globin proteins, each bound to a molecule of heme d. can carry up to 120 molecules of oxygen

Consists of four globin proteins, each bound to a molecule of heme

Atrioventricular valves

Controls the flow of blood between the atrium and ventricle on each side of the heart

The production of healthy erythrocytes depends upon the availability of ________.: a. copper b. zinc c. vitamin B12 d. copper, zinc, and vitamin B12

Copper, zinc, and vitamin B12

Pericardium

Covers heart, contains serous fluid

Sickle cell anemia

Genetic disorder; abnormal form of hemoglobin

RhoGAM injection

Given to Rh- women within 72 hours of delivering an Rh+ baby

Lipoproteins

HDL (high density lipoprotein), LDL (low density lipoprotein- major cholesterol carrying lipoprotein)

Nicotine

High poisonous, increases BP

Body temperature

High=high heart rate, low=low heart rate

Sinoatrial node(S-A node) "pacemaker"

Initiates heartbeat

Thrombocytes are more accurately called ________.: a. clotting factors b. megakaryoblasts c. megakaryocytes d. platelets

Platelets

Angina pectoris

Pressure or pain in the chest; could be due to stress or clot blocking blood flow

Embolus

Blood clot breaks free and is carried away by blood flow; can block blood flow

True or false: The buffy coat is the portion of a blood sample that is made up of its proteins

False. The buffy coat is the portion of blood that is made up of its leukocytes and platelets.

Fibrinogen

Helps in blood coagulation

Erythroblastsis fetalis

If an Rh- woman gets pregnant with a second Rh+ fetus, antibodies will cross the placenta and attack its rbcs RhoGAM injection is given to Rh- woman within 72 hours of delivering an Rh+ baby

People with ABO blood type O ________.: a. have both antigens A and B on their erythrocytes b. lack both antigens A and B on their erythrocytes c. have neither anti-A nor anti-B antibodies circulating in their blood plasma d. are considered universal recipients

Lack both antigens A and b on their erythrocytes

Auscultation

Listening to the heart with a stethoscope

Hypochromic anemia

Low iron in diet

The cardiovascular centers are located in which area of the brain?: a. medulla oblongata b. pons c. mesencephalon (midbrain) d. cerebrum

Medulla oblongata

Albumins

Most abundant plasma protein; maintain osmotic pressure of blood

Which of the following is unique to cardiac muscle cells?: a. Only cardiac muscle contains a sarcoplasmic reticulum. b. Only cardiac muscle has gap junctions. c. Only cardiac muscle is capable of autorhythmicity d. Only cardiac muscle has a high concentration of mitochondria.

Only cardiac muscle is capable of autorhythmicity

Which valve separates the left atrium from the left ventricle?: a. mitral b. tricuspid c. pulmonary d. aortic

Mitral

Physiologic jaundice

Newborns, large number of rbc breakdown after birth; immature liver cells excrete bilirubin into bile (treated with UV light)

Destruction of rbc

Rbcs become fragile with age and become damaged; macrophages in liver and spleen break them down

Electrocardiogram (ECG or EKG)

Records electrical changes in myocardium during cardiac cycle