Chapter 18

Edema and ascites accumulation occurs with

...

List some functions of proteins in plasma

...

List possible permissible transfusion options.

1) A blood to AB blood 2) O blood to AB blood 3) O blood to B blood

Iron metabolism (steps - from absorption in the intestine until it is distributed to be used in the body)

1) Absorbed Fe2+ binds to transferrin in plasma 2) Some transferrin releases Fe2+ for storage in the liver 3) Fe2+ binds apoferritin to be stored as ferritin 4) remaining trnasering goes to other organs where Fe2+ is used

A person with blood type B was accidentally given a transfusion of blood type A. List the consequences of this transfusion reaction.

1) Agglutinated RBCs block small blood vessels 2) Hemolysis of RBCs occurs and hemoglobin is released over the next few hours to days.

List some causes of hypoxemia.

1) COPD 2) abrupt increases in activity level 3) Emphysema

List some consequences of anemia.

1) Decreased blood osmolarity 2) Decreased blood viscosity 3) Hypoxia

Describe normal erythrocytes.

1) Discoidal cells with a biconcave shape 2) Contain hemoglobin to transport gases like oxygen

Normal Blood Sample (order of abundance)

1) Erythrocytes 2) Platelets 3) Leukocytes (total) 4) Neutrophils 5) Lymphocytes 6) Monocytes 7) Eosinophils 8) Basophils

List some nutrients necessary for erythropoiesis to occur.

1) Folic Acid 2) Vitamin C 3) Copper

List in order the stages of erythropoiesis from least to differentiated to most differentiated.

1) Hemopoietic stem cell 2) colon-forming unit 3) erythroblast 4) reticulocyte 5)erythrocyte

Main steps of development of WBCs or leukopiesis

1) Hemopoietic stem cells (HSE) 2) Colony forming units (CFU) 3) Precursor cells (i.e. myeloblasts, monoblasts) 4) Mature cells

Explain a mechanism whereby hypoxemia can be corrected.

1) Hypoxemia is detected by the kidneys and results in the secretion of erythropoietin 2) Hypoxemia is detected by the liver and results in the secretion of erythropoietin.

Erythrocytes (RBCs)

1) Lives for an average 120 days 2) About 20mL of packed RBCs are produced per day 3) About 2.5 million red cells are formed per second 4) production of RBCs normally takes 3 to 5 days

Name some conditions that are associated with clotting disorders.

1) Malnutrition 2) Hemophilia 3) Leukemia 4) Gallstones

The clinical values for the RBC and hemoglobin content of the blood differ significantly between women and men. List three factors that explain the difference.

1) Men have less body fat 2) androgens stimulate RBC production 3) women sustain menstrual losses

List components of a platelet.

1) Mitochondria 2) Lysosomes 3) Granules

List functions of macrophages.

1) Phagocytize dead cells 2) Present antigens 3) Destroy foreign antigens

List in order the events that occur during fibrinolysis.

1) Prekallikrein is converted to kallikrein 2) Kallikrein catalyzes the formation of plasmin 3) Plasmin dissolves the blood clot

List some functions of platelets.

1) Promote clotting and also initiate dissolution of clots 2) release vasoconstrictors 3) release factors that attract WBCs

Name three clinical measurements that express the blood's ability to carry oxygen.

1) RBC count 2) Hemoglobin concentration 3) Hematocrit

List two features of reticulocytes that differ from a mature blood cell.

1) RBCs are more numerous; only 0.5-1.5% of circulating blood cells are reticulocytes 2) Reticulocytes have polyribosomes; RBCs do not

List two characteristics of monocytes.

1) The cytoplasm contains sparse, fine granules (even though they are considered agranulocytes) 2) The nucleus is large and clearly visible, ovoid, kidney-shaped, or horseshoe-shaped.

The following statement(s) are true regarding coagulation.

1) The extrinsic mechanism requires fewer steps to activate factor X 2) In most cases of bleeding both the extrinsic and intrinsic mechanisms work simultaneously to contribute to hemostasis

List several reasons why erythropoiesis decreases with age.

1) The kidneys atrophy and produce less EPO 2) Elderly people tend to get less exercise and eat less well. 3) Gastric atrophy may occur, reducing intrinsic factor secretion.

List in order the events of platelet plug formation.

1) Upon contact with collagen of a broken vessel, platelets grow long spiny pseudopods 2) Platelets adhere to exposed collagen and other platelets 3) The pseudopods then contract and draw the vessel walls together 4) This mass of platelets forms a platelet plug

Indicate which of the following are the correct values of some characteristics of blood.

1) Volume in females 4-5L males 5-6L 2) Osomlarity: 280-296 m0sm/L 3) Total WBC count: 5,000-10,000/ul 4) pH 7.35-7.4

List possible causes of hypoplastic or aplastic anemia

1) Vruses 2) Radiation 3) Drugs and poisons (arsenic, mustard gas) 3) Autoimmune diseases

List some causes of hemolytic anemia.

1) blood type incompatibilities 2) sickle cell disease, thalassemia, malaria 3) snake and spider venom 4) penicillin allergy

List some causes of leukocytosis.

1) dehydration 2) infection 3) allergy

List some risks associated with polycythemia

1) increased blood volume 2) increased blood viscosity 3) high blood pressure

The buffy coat contains:

1) lymphocytes 2) granulocytes 3) agranulocytes 4) platelets NOT: erythrocyetes

Organize the sequence of events that lead to disposal of the heme during RBC recycling.

1) macrophages remove the iron 2) macrophages convert the heme into biliverdin 3) a yellow-green pigment called bilirubin is formed

Albumin is the most abundant plasma protein. List its functions.

1) maintenance of osmolarity 2) solute transport 3) pH buffering of plasma

Name three mechanisms that prevent inappropriate clotting.

1) platelet repulsion caused by prostacyclin 2) Presence of anticoagulants such as heparin and antithrombin 3) dilution of clotting factors

Blood does:

1) transport a variate of nutrients 2) help to stabilize the pH of extracellular fluids 3) participate in the initiation of blood clotting 4) help to regulate body temperature DOES NOT: produce plasma hormones

List ways that the body uses iron.

1)The bone marrow uses Fe2+ for hemoglobin synthesis. 2) The muscles use Fe2+ to make they myoglobin. 3) Nearly all cells use Fe2+ to make electron-transport molecules (cytochromes) in their mitochondria.

Hemoglobin consists of ____ protein chains.

2 alpha and 2 beta

Erythropoiesis takes approximately ____ to complete.

3-5 days

A molecule of hemoglobin can transport up to _____ molecules of oxygen

4

Each hemoglobin molecule has ____ heme group(s) and ____ globin molecule(s).

4;4

How many leukocytes are found in a normal sample of blood?

5,000 to 10,000 WBCs/microliter

Name the erythrocyte-bound antigens used to determine the most common type of blood typing.

A & B

Anti-B agglutinins are found in people with which blood type(s)?

A and O

Describe tissue thromboplastin.

A compound released by damaged tissue that initiates the extrinsic clotting pathway.

Describe leukemia

A form of cancer that results in very high numbers of leukocytes and their precursors in the blood.

What causes sickle cell disease?

A hereditary hemoglobin defect

Describe vascular spasm.

A short-lived mechanism in which the damaged vessel narrows to minimize blood loss.

Describe lymphocytes

A small cell with large round nucleus

The blood type ____ is sometimes called the universal recipient.

AB

Hemoglobin HbA2

About 2.5% of adult hemoglobin; contains two alpha globin chains and two delta globin chains.

When an antibody binds to more than one antigen-bearing cell, the result is clumping of the cells, called _______.

Agglutination

List types of globulin found in the plasma.

Alpha, Gamma, Beta

Sara is an abuser of antacids. List possible side effect for the excessive use of antacids.

Antacids could decrease the absorption of iron by the intestine ( stomach acid converts most Fe3+ to Fe2+, the only form that can be absorbed by the small intestine).

Coumadin/Warfarin

Antagonizes vitamin K

Septicemia

Bacteria in the blood stream accompanying infection elsewhere in the body.

Regulation:

Bicarbonate buffers acids and bases, Vasoconstriction and vasodilation due to temperature changes

Name the compounds that are converted into bile pigments in the liver.

Bilirubin and biliverdin

EDTA

Binds calcium ions and prevent them from participating in the coagulation reactions.

Transportation:

Blood carries oxygen to the tissue of the body, Movement of urea to the kidneys, Movement of carbon dioxide from respiring tissue to the lungs, Distribution of absorbed nutrients throughout the body,Mechanism of hormone distribution

The cardiovascular system includes:

Blood vessels and Heart

A patient finally visits his doctor after experiencing several months of lethargy, low grade infections and bone pain. The doctor performs blood work and notes an abnormally high number of leukocytes. List the most likely diagnosis.

Chronic leukemia

Disseminated intravascular coagulation (DIC)

Clotting and hemorrhaging limitted to one organ or occurring throughout the body.

Lymphocyte

Differentiate into cells that produce antibodies, Include B and T cell subpopulations, include memory cell lines,Destroy cancerous and viral infected cells, Agranular, minimal cytoplasm to nucleus ratio

Mature cells

Eosinophil, Basophil, Neutrophil, Monocyte, B lymphocyte, T lymphocyte, NK cell

Infectious mononucleosis

Epstein-Barr virus affects B-Lymphocytes. It is transmitted by kissing. Causes fever, fatigue, sore throat.

Name the formed element of the blood that transports both oxygen and carbon dioxide.

Erythrocytes

Name the most abundant formed element of the blood.

Erythrocytes

Name the first procoagulant that the extrinsic and intrinsic pathways have in common.

Factor X

Hemolytic disease of the newborn is frequently observed in the first pregnancy of an Rh negative woman and an Rh positive fetus.

False (The mother's body is not exposed to the Rh antigen until the placenta separates at birth, therefor she does not produce significant antibodies until after delivery.)

One colony stimulating factor increases the production of all types of leukocytes.

False (There is a different CSF for each subgroup of leukocytes. This enables the body to respond more specifically to the immune challenge.)

There is no treatment or preventative treatments for the hemolytic disease of the newborn (HDN)

False (there are a number of preventative treatments for HDN, including the administration of anti-D antibodies to the mother and fetal blood transfusions)

A, B, AB and O are the only blood groups.

False (there are at least 100 other blood groups with more than 500 antigens.)

Hypoxemia can occur transiently, but it always associated with disease conditions.

False - (hypoxemia can occur when activity level abruptly increases)

Hemoglobin HbF

Fetal hemoglobin; contains two alpha globin chains and two gamma globin chanins; it binds oxygen tightly.

Name the plasma component that is not present in serum.

Fibrinogen

Protection:

Formed elements help destroy pathogens, Globulins sequester and contribute to the elimination of infectious agents, Platelets mechanically and chemically work to plug holes in blood vessels due to trauma

Plasma (componets):

Glucose, Chloride, Antibodies, Gamma globulins, Albunin, Fibrinogen, Hormones

Myeloblast (precursor cell)

Granulocytes

____ is a sex-linked blood clotting disorder that is more common in men than women.

Hemophilia

____ anemia is more common in women because of blood loss during menses

Hemorrhagic

Thalassemia

Hereditary anemia common in people of Mediterranean decent; Alpha or beta hemoglobin is normal.

Under normal circumstances only 0.5-1.5% of the circulating blood cells are reticulocytes. Explain when this number might increase.

In case of a patient with excessive blood loss.

Explain why anemia often results from kidney failure.

In kidney failure, synthesis of erythropoietin declines.

Neutrophil

Increase in number during bacterial infections, 3-5 lobed nucleus, granular, Most common leukocyte,

Eosinophil

Increase in number during parasitic infections, Granular, two-lobed nucleus, the second least common leukocyte

Monocyte

Involved with immune clearance, Differentiate into dendritic cells that produce antibodies, agranular horseshoe, or irregular shaped nucleus, Largest leukocyte

Describe the heme group

Iron-containing groups that bind oxygen.

A function that is not performed by the circulatory system.

It absorbs lipids through lacteals in the digestive system.

Describe how bilirubin is processed after it is synthesized.

It binds to albumin, added to bile in the liver, and converted into urobilinogen in the intestine.

Describe the fate of bilirubin in the intestine.

It is converted to urobilinogen

Describe hemolysis.

It is the rupture of RBC, causing release of hemoglobin and leaving the plasma membranes empty.

Describe clot retraction.

It occurs when fibrin threads contract to pull the edges of the wound together.

Colony-Stimulating-Factors initiate the formation of which cells?

Leukocytes

____ is the process of development of white blood cells.

Leukopoiesis

______ is a cancerous disease in which large numbers of leukocytes and their undifferentiated precursors are released into the blood.

Lukemia

______ leukemia is typified by uncontrolled production of agranulocytes (lymphocytes and monocytes) and agranulocyte precursors.

Lymphoid

Albumin is the most abundant plasma protein. List its functions.

Maintenance of osmolarity, pH buffering of plasma, solute transport

Define hematoma.

Mass of clotted blood in the tissues.

Precursor cells

Monoblast, Lymphoblast, Promonocyte, Neutrophilic Promyelocyte, B prolymphocyte

Monoblast (precursor cell)

Monocyte

The blood type considered to be the universal donor is_____.

O

Explain why only red blood cells are destroyed in the spleen.

Old cells rupture in the narrow channels of the spleen because they are no longer flexible or resilient.

____ anemia is caused by a lack of intrinsic factor and/or vitamin B12

Pernicious

Define hemostasis.

Physiological process that controls excessive bleeding.

Define thrombocytopenia.

Platelet count below 100,000

Describe the pathway of differentiation leading to the production of a single class of formed element.

Pluripotent stem cell -> colonly forming unit -> magakarocyte

Identify the characteristic shared by all leukocytes.

Presence of a nucleus

Prothrombin (alpha globulin)

Promotes blood clotting

List some functions of the circulatory system.

Protection (limits spread of infection) Regulation (buffers acids and bases) Transport (nutrients, gases, etc.)

Formed Elements:

Red blood cells, Erythrocytes, Leukocytes, White blood cells, Platelets, Monocytes, Neutrophils

Name the stage of the erythrocyte development when the RBCs are released into the blood.

Reticulocyte

Name a condition that can be caused by emphysema, high altitude, hypoxemia, and dehydration.

Secondary polycythemia

Old blood cells usually die as they pass through what organ?

Spleen

Describe the role of colony stimulating factors.

Stimulate the development of specific cells.

Describe the role of erythropoietin.

Stimulates RBC production

Aspirin

Suppresses the formation of the elcosanoid thromboxane A2.

Vascular spasm

The first stage in hemostasis, involves vasoconstriction

Coagulation

The last stage in hemostasis, also know as clotting, involves the conversion of fibrinogen to fibrin, includes intrinsic and extrinsic mechanisms

Hemoglobin HbA

The most common type in the adult; contains two alpha globin chains and two beta globin chains.

Define hemopoiesis.

The process of formation of all the blood formed elements

Platelet plug formation

The second stage in hemostasis, Involves endothelial collagen exposure, Involves degranulation and serotonin, thromboxane A2 and ADP< includes a vast enzymatic cascade of proteins produced by the liver

Describe what happens to RBC fragments after cells are ruptured in the spleen and liver.

They are recycled by macrophages

Explain how spectrin and actin function in the red blood cells.

They give the cell membrane more resilience and more durability

Describe erythrocytes.

They lack internal organelles and perform anaerobic fermentation. They lose organelles during maturation, so by the time they're consider erythrocytes, they lack organelles.

Name the function of hemopoietic tissues.

They produce the formed elements of the blood.

_____ is the condition in which the platelet count is less than 100,000.

Thrombocytopenia

Describe the function of an antibody.

To bind to an antigen and mark it for destruction.

______ is a plasma protein that binds to iron so it can be transported to the bone marrow, liver and other tissues.

Transferrin

Describe the function of transferrin

Transferrin transports iron in the blood.

Ceruloplasmin (alpha globulin)

Transports cooper

Haptoglobulin (alpha globulin)

Transports hemoglobin released by dead erythrocytes.

Leukocytes differ from erythrocytes in that they retain their organelles throughout life.

True

The ABO blood type O-positive is the most common human blood type in the United States.

True

Both erythropoiesis and leukopoiesis begin with the same pluripotent stem cell.

True ( both processes begin with hemocytoblasts)

Incompatibility of one person's blood with another results from the action of plasma antibodies against the RBCs antigens.

True - blood types and transfusion compatibility are a matter of interactions between plasma proteins (antibodies and antigens in erythrocytes.

Name the two blood types that include the presence of anti-A agglutinins in the plasma of these individuals.

Type O and Type B

List an example of nitrogenous wastes transported in the plasma.

Urea

Basophil

Vasodilatory and anticoagulatory function, least common leukocyte, large U-shaped nucleus that contains large granuels

Name the physical characteristics of blood that affect circulatory function

Viscosity and Osmolarity

Describe when transfusion reactions occur.

When donated blood reacts to the recipient's agglutinins.

In the intrinsic pathway, the reaction begins with Factor____.

XII

Fibrin threads are cross-linked into a fibrin polymer by factor ____.

XIII

Name the component(s) of an erythrocyte that improves the cell's resilience and durability

actin and spectrin

Resulting in different blood types, red blood cells have specific antigens on their surfaces called_____.

agglutinogens

In addition to water, the plasma consists of:

albumins, globulins, and fibrinogen, electrolytes, nutrients and organic wastes

The cascade of enzymatic reactions in coagulation acts as an _____ mechanism to ensure rapid clotting of blood.

amplifying

Hemolytic disease of the newborn results from:

an Rh incompatibility

A generalized condition in which there is too little hemoglobin or too few erythrocytes is ______.

anemia

Name the most common Rh antigen

antigen D

The complete cessation of erythropoiesis due to the destruction of myeloid tissue is associated with _____ anemia.

aplastic

In the liver, excess iron binds to protein called ______ to form the storage form of iron called ____.

apoferritin; ferritin

The blood cell _____ is the granulocyte whose granules contain heparin and histamine.

basophil

Anti-A and anti-B antibodies can:

bind to several different cells

Antigens on the surface of the erythrocyte membranes determine:

blood type

Hemostasis typically involves ____ mechanisms of coagulation.

both extrinsic and intrinsic

Carbonic anhydrase is the enzyme that catalyzes the reaction combining water with _____ to form carbonic acid.

carbon dioxide

The ____ system consists of the heart, blood vessels, and blood. The ____ system consists only of the heart and blood vessels.

circulatory; cardiovascular

Describe clotting factors.

clotting factors initiate a cascade of reactions

The interaction of protein factors to produce a clot is called______.

coagulation

Proteins in the plasma contribute to the _____ of the blood.

colloid osmotic pressure

Blood viscosity ______ in cases of anemia; in cases of protein deficiency it ______.

decreases; decreases

The leukocyte that has a nucleus comprised of two large lobes and a cytoplasm with abundant rosy to orange-colored granules is a(n)

eosinophil

Leukocytes called ____ function to destroy large parasites.

eosinophils

The complete blood count (CBC) provides information about:

erythrocyte, leukocyte and platelet counts

The term _____ is defined as the production of red blood cells.

erythropoiesis

Anemia may occur as a result of a decrease in secretion of _____ in patients with kidney failure.

erythropoietin

When detected____is produced and secreted.

erythropoietin

The release of clotting factors by damaged blood vessels and perivascular tissues initiates the ____ pathway of coagulation.

extrnsic

A clot is formed by a mesh frame work of the protein called:

fibrin

The pathway will end with the production of ____.

fibrin

This blood clot consists of a meshwork formed of the protein called______.

fibrin

As a result of coagulation, the plasma protein called ____ is converted to fibrin.

fibrinogen

A transfusion reaction can cause death of the individual because:

free hemoglobin can block the kidney tubules and cause death from acute renal failure.

Antibodies are a class of plasma proteins called_____, which are secreted by plasma cells

gamma globulins

Iron is transported from the stomach to the intestine bound to the protein called ______.

gastroferritin (produced by the stomach, which binds to iron and is then transported to the small intestine)

Neutrophils, basophils and eosinophils are the three types of leukocytes called:

granulocytes

The percentage of the blood's volume composed of erythrocytes is called the:

hematocrit

Name the discipline that specifically deals with the study of blood.

hematology

A(n) ______ is a mass of clotted blood in the tissues.

hematoma

Iron is critical for the synthesis of ______, the oxygen-carrying protein in red blood cells.

hemoglobin

The pigmented protein that transports gases in the blood is called ______.

hemoglobin

All formed elements in the blood are produced through the process of _____.

hemopoiesis

The general term for limiting blood loss from an injured vessel is _____.

hemostasis

If the blood osmolarity is too ____ the bloodstream will absorb too much water, resulting in an elevated blood pressure.

high

Severe extensive burns, starvation and liver disease can lead to:

hypoproteinemia

The clotting cascade that originates from within the blood itself is called the ______ pathway.

intrinsic

Release of factor XII by platelets initiates the ____ mechanism of coagulation.

intrinsic (since the blood cells themselves release the factor, it is considered intrinsic.)

Anemia may occur in the elderly because of gastric atrophy which may decrease secretion of _____, or kidney atrophy which may decrease the secretion of ________.

intrinsic factor; erythropoietin

Thrombosis

is the abnormal clotting of blood in an unbroken vessel.

Sodium

is the most common ion found in the plasma and is the solute wit the greatest influence on osmolarity of the blood.

High levels of bilirubin in the blood lead to a condition called_____.

jaundice

Each activated enzyme in the pathway produces a ____ number of molecules.

large

A decrease in the production of clotting factors is a side effect of:

liver disease

Lymphoblast (precursor cell)

lymphocytes

A ____ is a giant precursor cell with a multi-lobed nucleus which fragments to form platelets.

megakaryocyte

The largest type of leukocyte found circulating in the blood is the____.

monocyte

Formation of blood cells in the bone marrow is called _____ hemopoiesis.

myeloid

Thus the correction of hypoxemia is controlled by a_____feedback loop.

negative

When hypoxemia is detected, a mechanism of correction is initiated: erythropoietin is secreted by the kidneys and liver and the rate of erythropoiesis accelerates. This is an example of a(n):

negative feedback control

Cells called_____ are leukocytes with fine, reddish to purple (violet) granules containing lysozyme.

neutrophils

This will result in an increase of____transport throughout the body.

oxygen

Most plasma proteins are produced in the liver, except gamma globulins which are produced by ______.

plasma cells

A ___ is the smallest formed element and is derived from megakaryocytes.

platelet

The reproduction of fibroblasts and smooth muscles during injury repair is triggered by ____.

platelet-derived growth factor

When collagen in the wall of a blood vessel is exposed as a result of injury, ________ adhere and develop long, spiny pseudopods which draw the vessel walls back together.

platelets

An excess of red blood cells is called ______.

polycythemia

Clotting factors produced by the liver are called ______.

procoagulants

The hormone will stimulate the read bone marrow to ____ RBC's.

produce

Blood vessel linings are very smooth and coated with the chemical ____, which prevents platelet adhesion and unwanted clotting.

prostacyclin (platelet repellant)

Factor X combines with factors III and V to produce _____, which in turn converts prothrombin to thrombin.

prothrombin activator

The process by which clots become compact is called clot

reaction

Vitamin B12, copper and folic acid are:

required for erythropoiesis

Blood loss stimulates accelerated erythropoiesis. This may cause an increase in the number of _____ circulating in the blood.

reticulocytes

About 25%-40% of platelets are stored in the _____.

spleen

List the organ that stops producing RBCs at birth, but continues to produce lymphocytes in the adult.

spleen

Explain the role of the liver in the circulatory system.

the liver produces most of the plasma proteins

Blood type is determined by

the presence or absence of A and B antigens on the surface of RBCs

Antithrombin is a plasma protein produced by the liver that works to deactivate ____.

thrombin

A(n) ____ is a blood clot that breaks loose and travels in the blood stream.

thromboembolus

_____ is the process of platelet formation.

thrombopoiesis

A blood clot that forms in an undamaged vessel is called a(n)________. If it breaks loose and travels through the blood stream it is called a(n)_____.

thrombus; embolus

Hypoxia is inadequate oxygen____and can be detected by the kidneys and liver.

transport

Erythrocyte (red blood cells)

transportation of respiratory gases

____ is the resistance of fluid to flow resulting from the cohesion of its particles

viscosity

The first hemopoietic tissues in the human embryo are found in the:

yolk sac