CH. 17 Blood
With a patient that is administered an injection of erythropoietin (EPO) you would expect to see ________. increased white blood cell count decreased white blood cell count increased hematocrit decreased hematocrit
increased hematocrit
Bilirubin is released into the bloodstream as old or damaged red blood cells are broken down by macrophages. Which organ is responsible for removing bilirubin from the blood stream? spleen liver pancreas kidneys
liver As RBCs are broken down, the heme of their hemoglobin is split off from globin. Its core of iron is salvaged and stored for reuse. The balance of the heme group is degraded to bilirubin, a yellow pigment that is released into the blood. Liver cells pick up the bilirubin and in turn secrete it (in bile) into the intestine, where it is metabolized to urobilinogen. Most of this degraded pigment leaves the body in feces, as a brown pigment called stercobilin.
Loss of fibrinogen within the plasma would most likely cause which of the following? edema (swelling) fever with pain loss of blood clotting pallor (pale skin)
loss of blood clotting
A lack of intrinsic factor, leading to a deficiency of vitamin B12 and causing an appearance of large pale cells called macrocytes, is characteristic of ________. pernicious anemia polycythemia sickle-cell anemia aplastic anemia
pernicious anemia
What is a hematocrit? A hematocrit is the percentage of erythrocytes in a whole blood sample. A hematocrit is the percentage of all formed elements in a whole blood sample. A hematocrit is the percentage of plasma in a whole blood sample. A hematocrit is the percentage of leukocytes and platelets in a whole blood sample.
A hematocrit is the percentage of erythrocytes in a whole blood sample. Although the percent sign is usually omitted, the hematocrit, which in this figure is 45, is the percentage of erythrocytes in whole blood. The total height of material is divided by the height of the erythrocyte layer.
A patient with type A positive blood can, in theory, safely donate blood to someone with ________ blood. A positive, A negative, O positive, or O negative A positive or O positive A positive, A negative, AB positive, or AB negative A positive or AB positive
A positive or AB positive
Which ABO blood type is considered to be the universal recipient? AB O B A
AB Type AB blood is considered to be the universal recipient because neither anti-A or anti-B antibodies (agglutinins) are present.
A person who lacks agglutinogen A but has agglutinogen B would have blood type __________. A O B AB
B Agglutinogens are glycoproteins found on the surface of erythrocytes. Someone with type B blood has agglutinogen B (but not A) on the surface of their erythrocytes.
Which of the following scenarios could result in HDN (hemolytic disease of the newborn)? O-positive female pregnant with a B-positive baby A-positive female pregnant with a B-positive baby B-negative female pregnant with an AB-positive baby AB-negative female pregnant with an AB-negative baby
B-negative female pregnant with an AB-positive baby Hemolytic disease of the newborn (HDN) can develop when an Rh-negative mother carries an Rh-positive fetus. Unlike anti-A and anti-B antibodies, anti-Rh antibodies are not preformed (i.e., a person doesn't produce them until they've been exposed to Rh-antigens for the first time). This initial exposure can occur when the Rh-negative mother carries her first Rh-positive baby. The first such pregnancy usually results in the delivery of a healthy baby. But during this pregnancy and particularly during delivery, the mother may be sensitized by her baby's Rh-positive antigens that pass into her bloodstream. If so, she will form anti-Rh antibodies unless treated with RhoGAM during pregnancy and around the time of delivery. RhoGAM is a serum containing anti-Rh antibodies. By agglutinating the Rh factor, it blocks the mother's immune response and prevents her sensitization. If the mother is not treated and becomes pregnant again with another Rh-positive baby, her antibodies will cross through the placenta and destroy the baby's RBCs, producing the condition known as hemolytic disease of the newborn (HDN).
Which image shows the type of leukocyte responsible for antibody production? E B C D
D The leukocyte in image D may directly target pathogens or produce antibodies
Choose the incompatible transfusion. Donate type A blood to a recipient with type AB blood. Donate type O blood to a recipient with type AB blood. Donate type B blood to a recipient with type AB blood. Donate type B blood to a recipient with type O blood.
Donate type B blood to a recipient with type O blood. A person with type B blood can only give blood to people of type AB and B blood. The type O recipient has anti-A and anti-B antibodies in their plasma, which would produce a transfusion reaction with the B-antigens from the type B blood.
Why is blood considered a connective tissue? It acts as an adhesive layer between tissue types. It develops from mesenchyme. It is found in all areas of the body. It allows for chemical signals from one area of the body to reach another.
It develops from mesenchyme.
Choose the statement that is true concerning hemoglobin. It is composed of four protein chains and four heme groups. When hemoglobin is not bound to oxygen, it appears blue. It can bind a maximum of three oxygen molecules. It is found in the plasma portion of blood.
It is composed of four protein chains and four heme groups.
You are awaiting the white blood cell differential results for a patient who presented with a ruptured appendix and peritonitis. Which type of leukocyte do you expect to be most elevated over its normal value? Neutrophils Monocytes Eosinophils Lymphocytes
Neutrophils Neutrophils are the body's bacteria slayers, so you would expect more of them to be present during a serious acute bacterial infection like the one your unfortunate patient has.
Which blood type is generally called the universal donor? A positive B negative O negative AB positive
O negative
Which of the following represents a difference between extrinsic and intrinsic blood clotting pathways? One leads to the formation of prothrombin activator and the other does not. One involves calcium ions, while the other does not. One is faster than the other. One can be triggered by tissue damage, while the other cannot.
One is faster than the other. The extrinsic pathway is faster than the intrinsic pathway, which has many intermediate steps.
Which of the following is FALSE regarding the role of platelets in hemostatic reactions? Platelets release the only chemical factors that can initiate coagulation. Platelets release chemicals that attract and bind other platelets. Platelets do not stick to intact endothelial cells. Platelets adhere to exposed collagen fibers.
Platelets release the only chemical factors that can initiate coagulation. Platelet chemicals initiate the intrinsic pathway, but tissue factors released from damaged endothelium start the extrinsic pathway for coagulation in motion.
What will happen if an adult patient with type A blood is given a transfusion with type AB blood? The patient will stop making anti-B agglutinins so that the blood can be successfully incorporated into the patient's blood supply. The patient's blood type will change from type A to type AB due to the additional type B agglutinogens of the transfused blood. The patient will respond normally, since type AB blood and type AB blood both contain the same type A agglutinogens. The anti-B agglutinins in the patient's blood plasma will attack the healthy AB blood cells by binding to the B agglutinogens.
The anti-B agglutinins in the patient's blood plasma will attack the healthy AB blood cells by binding to the B agglutinogens. The transfused type AB blood contains both type A and type B agglutinogens, and the patient's type A blood contains anti-B plasma agglutinins.
Why is liver dysfunction associated with bleeding disorders? The liver synthesizes vitamin K, which is needed to produce four of the clotting factors. The liver is the primary source of platelets, which are needed in sufficient numbers to produce the platelet plug. The liver is the primary source of clotting factors, which are required in sufficient numbers for coagulation. The liver is the primary source of calcium ions, which are required for all phases of hemostasis.
The liver is the primary source of clotting factors, which are required in sufficient numbers for coagulation. Bleeding disorders can occur when the liver cannot synthesize its usual supply of procoagulants. Most clotting factors are plasma proteins synthesized by the liver. They are numbered I to XIII according to the order of their discovery; as a result, the numerical order does not reflect their reaction sequence. All (except tissue factor) normally circulate in blood in inactive form until mobilized. Although vitamin K is not directly involved in coagulation, this fat-soluble vitamin is required for synthesizing four of the clotting factors.
If a patient with type B blood received a transfusion of AB blood, which of the following would occur? The patient's A antigens (antiglutinogens) will agglutinate with the anti-A antibodies (agglutinins) in the donor blood. The patient's B antigens (antiglutinogens) will agglutinate with the anti-B antibodies (agglutinins) in the donor blood. The patient's anti-A antibodies (agglutinins) will agglutinate with the A antigens (antiglutinogens) in the donor blood. The patient's anti-B antibodies (agglutinins) will agglutinate with the B antigens (agglutinins) in the donor blood.
The patient's anti-A antibodies (agglutinins) will agglutinate with the A antigens (antiglutinogens) in the donor blood.
Which is NOT true of leukocytes? They are the only formed elements that are true cells. They all contain easily recognizable membrane-bound cytoplasmic granules. They account for less than 1% of total blood volume. They move by amoeboid motion.
They all contain easily recognizable membrane-bound cytoplasmic granules.
Which of the following best explains how platelets enter the blood? They are formed in and released by the thymus. They form in the blood itself as it passes through the lungs. They are formed in the spleen and are released directly into the blood. They are passed through the wall of a bone marrow capillary.
They are passed through the wall of a bone marrow capillary. Megakaryocytes place platelets in the blood by passing them through the wall of sinusoidal capillaries (with large openings in their walls) in the bone marrow.
Which of the following statements is true? Type A blood can safely be given to recipients with type B blood. A person with type O blood produces both type A and type B antigens (agglutinogens). A person with type AB blood produces both anti-A and anti-B antibodies (agglutinins). Type O blood can safely be given to recipients with type B blood.
Type O blood can safely be given to recipients with type B blood. Type O blood, which does not contain either A or B agglutinogens, will not cross react with the anti-A agglutinins found in a recipient person with type B blood.
What prevents fibrin from forming a mesh in a healthy, unbroken blood vessel? The speed at which blood circulates prevents the accumulation of platelets and fibrin strands. When thrombin is not bound to fibrin, it is inactivated by antithrombin. Fibrinogen is restricted to sites where platelets have aggregated. The formation of a fibrin mesh depends on the blood being exposed to air.
When thrombin is not bound to fibrin, it is inactivated by antithrombin. Thrombin could initiate fibrin mesh formation if it were not deactivated in the normal blood circulation. Antithrombin III, a plasma protein, and other anticoagulants help prevent thrombin from activating fibrinogen into fibrin.
A person with an extremely high count of neutrophils is likely suffering ________. polycythemia a bacterial infection a viral infection anemia
a bacterial infection
Which blood component primarily contributes to plasma osmotic pressure? gamma globulin blood borne nutrients electrolytes albumin
albumin
Which part of the hemoglobin molecule binds carbon dioxide for transport? iron heme group amino acids of the globin spectrin
amino acids of the globin The heme groups and iron ions are binding points for oxygen, while carbon dioxide binds to and is carried by the globin polypeptides. The combined form is called carbaminohemoglobin.
In the case of severe blood loss in a patient with an unknown blood type, which of the following would be the best treatment to restore the patient's blood volume and oxygen carrying capacity? an immediate transfusion of type O blood an immediate intravenous provision of an isotonic saline solution an immediate transfusion of blood plasma an immediate transfusion of type AB blood
an immediate transfusion of type O blood Type O blood cells contain no agglutinogens. For this reason, type O blood is considered the universal donor and theoretically can be given to anyone
Athletes can use industry-produced EPO as a performance-enhancing drug to increase the effects of their naturally-produced EPO. These athletes will experience ______. decreased production of EPO by their kidneys decreased erythropoiesis decreased reticulocyte counts None of the listed responses is correct.
decreased production of EPO by their kidneys EPO (erythropoietin) is a powerful hormone secreted by the kidney. Its synthesis is activated by renal tissue hypoxia and inhibited by normal tissue oxygenation.
The process of clot formation requires the activation of most clotting factors into __________. hormones enzymes polymerizing proteins sticky versions that aggregate to form a platelet plug
enzymes Clotting factors are proteins that, upon changing shape at activation, become enzymes that can further activate another clotting factor in the reaction cascade.
Which type of leukocyte provides protection against parasitic worms? neutrophil basophil lymphocyte eosinophil
eosinophil The most important role of eosinophils is to lead the counterattack against parasitic worms, such as flatworms and roundworms that are too large to be phagocytized.
Which of the formed elements is present in the greatest concentration? granular leukocytes platelets erythrocytes agranular leukocytes
erythrocytes The erythrocytes (red blood cells) make up about 45% of whole blood.
Which of the following is not a functional characteristic of leukocytes? diapedesis erythropoiesis positive chemotaxis amoeboid motion
erythropoiesis Erythropoiesis refers to the production of red blood cells (erythrocytes) and is not a function of leukocytes
Which of the following would NOT lead to a bleeding disorder? thrombocytopenia impaired liver function vitamin K deficiency excess calcium in the diet
excess calcium in the diet Calcium is essential for clotting pathways; a deficiency (not an excess) of calcium could lead to a bleeding disorder.
Which plasma constituent is the main contributor to clotting? fibrinogen beta globulins albumin alpha globulins
fibrinogen Fibrinogen comprises 4% of plasma and is an important component in the process of blood clotting
How many oxygen molecules can be transported by one hemoglobin molecule? two four eight
four Each iron atom on a heme group can bind reversibly with one oxygen molecule.
Which of the following plasma proteins is improperly matched with its function? gamma globulins: lipid transport fibrinogen: clotting albumin: osmotic pressure alpha globulin: transport of metal ions and fat-soluble vitamins
gamma globulins: lipid transport Gamma globulins are also called immunoglobulins (or antibodies) and are part of the immune response
What part of the pathway to produce platelets is shared with other formed elements? lymphoid stem cell reticulocyte megakaryoblast hematopoietic stem cell (hemocytoblast)
hematopoietic stem cell (hemocytoblast) The hematopoietic stem cell (hemocytoblast) is the stem cell for all blood-formed elements
The special type of hemoglobin present in fetal red blood cells is ________. hemoglobin A hemoglobin B hemoglobin F hemoglobin S
hemoglobin F
Which of the following might trigger erythropoiesis? hypoxia of EPO-producing cells an increased number of RBCs moving to a lower altitude decreased tissue demand for oxygen
hypoxia of EPO-producing cells
With a patient who is administered an injection of colony stimulating factor (CSF), you would expect to see ________. increased white blood cell count increased red blood cell count decreased red blood cell count decreased white blood cell count
increased white blood cell count
Lipids (either nutrients or hormones) are insoluble in water but are found traveling in the plasma of the blood. Which of the following is the most likely explanation for this? enzymes in the plasma convert lipids to soluble forms lipids are carried in plasma bound to soluble plasma transport proteins lipids are carried inside blood cells lipids are carried only in the lymph which is primarily composed of unsaturated fats
lipids are carried in plasma bound to soluble plasma transport proteins
All of the following can be expected with polycythemia EXCEPT ________. increased blood volume high blood pressure low blood viscosity high hematocrit
low blood viscosity
If a person is severely dehydrated you would expect to see all of the following EXCEPT ________. higher hematocrit lower immunity higher blood viscosity lower plasma levels
lower immunity
The cells responsible for producing platelets are called ________. lymphoid stem cells myeloblasts megakaryocytes monoblasts
megakaryocytes
A newborn with type A blood would have which agglutinins present in the plasma immediately after birth? anti-A agglutinins anti-B agglutinins both anti-A and anti-B agglutinins neither anti-A nor anti-B agglutinins
neither anti-A nor anti-B agglutinins Newborns lack any agglutinins (antibodies) for the first few months after birth
Identify the leukocytes in the figure in order. eosinophil, neutrophil, monocyte, basophil, lymphocyte neutrophil, basophil, eosinophil, monocyte, lymphocyte neutrophil, eosinophil, basophil, lymphocyte, monocyte monocyte, eosinophil, lymphocyte, lymphocyte, neutrophil
neutrophil, eosinophil, basophil, lymphocyte, monocyte This is the correct order. Notice that A-C are granular, while D and E are agranular. The groups can then be distinguished by looking at cell size, granule color, and nucleus shape
Which of the following leukocyte is not correctly matched with its function? neutrophils: produce antibodies monocytes: develop into macrophage lymphocytes: immune response against viral infections basophils: inflammation
neutrophils: produce antibodies Neutrophils are active phagocytes that ingest bacteria and some fungi. Antibodies are produced by certain types of leukocytes
Which of the following anemias is correctly matched with its description? aplastic anemia: results from excessive blood loss hemolytic anemia: results from inadequate iron intake pernicious anemia: results from a vitamin B12 deficiency hemorrhagic anemia: results from red blood cells rupturing
pernicious anemia: results from a vitamin B12 deficiency Pernicious anemia does result from a vitamin B12 deficiency. The deficiency may be the result of inadequate dietary intake of vitamin B12, or the lack of intrinsic factor (produced in the stomach), which is required for absorption of vitamin B12 in the intestines.
During which phase in erythrocyte development does the color of hemoglobin overcome the color of the stained ribosomes? phase 1 phase 2 phase 3.
phase 2 During phase 2, the cell's buildup of reddish hemoglobin overwhelms the blue color of the ribosomes
What enzyme is responsible for dissolving the blood clot after regeneration of the vessel wall is complete? plasminogen plasmin thrombin fibrinogen
plasmin The critical natural "clot buster" is a fibrin-digesting enzyme called plasmin, which is produced when the plasma protein plasminogen is activated. Plasminogen is incorporated into a forming clot, where it remains inactive until appropriate signals reach it. Fibrinolysis begins within two days and continues slowly over several days until the clot finally dissolves.
Which step of hemostasis involves activation of formed elements in the blood? fibrin mesh formation vascular spasm fibrinolysis platelet plug formation
platelet plug formation Platelets are formed elements that are activated by damaged tissue. Platelets form a temporary plug preventing blood loss.
In a centrifuged sample of blood, what should not be in the plasma portion of the sample? albumin electrolytes platelets fibrinogen
platelets Platelets are dense enough that they should be in the buffy coat layer of centrifuged blood.
A mismatch of blood types during a transfusion is dangerous because ________. white blood cells from the donor's blood cause inflammation clotting factors in the donor's blood will cause unwanted clots known as thrombus antibodies in the donor's plasma will attack and kill the recipient's healthy blood cells preformed antibodies in the recipient's blood will bind and clump (agglutinate) the donated cells
preformed antibodies in the recipient's blood will bind and clump (agglutinate) the donated cells
Which of the following would you expect to have the least effect on hematocrit percentage? injection with erythropoietin (EPO) living at higher altitude prolonged or excessive fever dehydration
prolonged or excessive fever
Blood reticulocyte counts provide information regarding ________. clotting ability of the blood rate of erythrocyte formation rate of platelet formation WBC ability to defend the body against disease
rate of erythrocyte formation
Hemostasis is important for __________. stoppage of bleeding red blood cell recycling red blood cell production white blood cell production
stoppage of bleeding Hemostasis leads to stoppage of bleeding. The hemostasis response is fast, localized, and controlled. It involves clotting factors and substances released by damaged tissue and platelets.
What specifically determines a person's ABO blood group? the presence or absence of blood plasma A or B agglutinogens the presence or absence of anti-A or anti-B agglutinins in the blood cell plasma membrane the presence or absence of A, B, or O markers specifically found in the blood cell glycocalyx the presence or absence of A or B agglutinogens in the blood cell plasma membrane
the presence or absence of A or B agglutinogens in the blood cell plasma membrane ABO blood groups are determined by the presence or absence of agglutinogens type A and type B.
What protein involved in coagulation provides the activation for the final step in clotting? fibrinogen thrombin fibrin prothrombin activator
thrombin Thrombin catalyzes the conversion of fibrinogen into fibrin. This is the final step in coagulation.
What factor stimulates platelet formation? G-CSF erythropoietin PDGF thrombopoietin
thrombopoietin Platelet formation (thrombopoiesis) is stimulated by thrombopoietin.
What substance released from damaged endothelium triggers the extrinsic coagulation pathway? tissue factor (TF) or factor III prostacyclin platelet factor 3 (PF3PF3) prothrombin activator
tissue factor (TF) or factor III Tissue factor, released from damaged endothelial cells, activates the extrinsic coagulation pathway.
What is the major function of the vascular spasm that occurs as the first step of hemostasis? to cause the damaged part of the body to pull away from the cause of tissue damage to force the release of clotting factors from surrounding tissues into the bloodstream to help initiate coagulation to initiate a pain signal to the CNS that will alert the body to the damaged tissue to reduce blood loss
to reduce blood loss Damaged arteries can allow for tremendous blood loss. Vascular spasms help reduce that blood loss by greatly constricting especially smaller blood vessels in the damaged area.
