Patho ch 23 - Hematoloy

Pathophysiology Ch 23 - alterations in hematologic functions & anemias

Which factors are vitamin K dependent?

II, VII, IX, X (2, 7, 9, 10)

What protease catalyzes the conversion of plasminogen into plasmin, the primary enzyme involved in dissolving blood clots (thrombolysis)?

tissue plasminogen activator

which form of anemia is due to a decrease in red blood cells when the body can't absorb enough vitamin B-12?

pernicious anemia

what happens to globin during hemoglobin metabolism?

it is broken down into amino acids that are reuptaken

what happens to protoporphyrin IX (9) during hemoglobin metabolism?

it converts to biliverdin, then to bilirubin, which is transported to the liver to be excreted in bile in the stool

what happens to iron (Fe3+) during hemoglobin metabolism?

binds to transferrin, enters the bloodstream, and is transported to either the bone marrow or the liver

What is the average lifespan of a red blood cell (erythrocyte)?

4 months/120 days

Which substance dissolves clots?

plasmin

What is the order of events of coagulation?

prothrombin activator is formed, prothrombin converts to thrombin, thrombin converts fibrinogen to fibrin, fibrin strands form the clot

which subendothelial factor is essential for platelets aggregation/adhesion?

von willebrand factor

which type of anemia is caused by the deficiency of all types of blood cells due to failure of bone marrow development or bone marrow damage?

aplastic anemia

what are the 3 pathways for coagulation?

intrinsic, extrinsic, common

what is the order of events for hemostasis?

vascular spasm, platelet plug formation, coagulation, clot retraction, thrombolysis

what are the products of heme breakdown in hemoglobin metabolism?

iron (Fe3+) is reuptaken and protoporphyrin IX (9) is formed

hemoglobin metabolism

globin --> amino acid (reuptaken)

heme --> Fe3+ (reuptaken) and protoporphyrin IX (9)

protoporphyrin IX (9) --> biliverdin --> bilirubin --> bile, transported to liver for excretion in stool

iron (Fe3+) binds to transferrin, enters the bloodstream, goes to bone marrow or liver

Thrombopoietin is secreted by the _____ for differentiating stem cells into _____

liver; platelets

How does oxygen mostly travel in the blood?

bound to the heme portion of hemoglobin

What ion is necessary for the clotting process?

Ca2+ (calcium)

formation of red blood cells (erythrocytes) occurs in the _____ and damaged or old red blood cells are broken down in the _____

red bone marrow; spleen

The sum of plasma and formed elements is called:

whole blood

What is the mean salinity of blood?

0.85%

what is the pH of blood?

7.4

what is the approximate temperature of blood?

38C or 100.4F

the activation of factor X (10) requires the activated factor _____ and factor _____

IX (9), VIII (8)

the activation of factor _____ requires the activated factor IX (9) and factor VIII (8)

X (10)

the stoppage of bleeding is termed:

hemostasis

which vitamin is essential for activating/making clotting factors?

vitamin K

the formed elements are:

erythrocytes, leukocytes, platelets (thrombocytes)

bilirubin bound to albumin is termed:

unconjugated bilirubin

bilirubin bound to glucuronic acid is termed:

conjugated bilirubin

when blood oxygen levels fall below normal range, the _____ detect this, and secrete the hormone _____ which targets the _____ to increase RBC production. The process of making new RBC's is termed _____

kidneys; erythropoietin; bone marrow; erythropoiesis

which form of anemia is due to a mutated form of hemoglobin distorting the red blood cells into a crescent shape at low oxygen levels?

sickle cell anemia

which form of anemia is characterized by too few healthy red blood cells due to too little iron in the body?

iron deficiency anemia

which form of anemia is due to hemolysis, the abnormal breakdown of red blood cells, either in the blood vessels or elsewhere in the human body?

hemolytic anemia

what plasma protein is responsible for the blood's colloid osmotic pressure (aka oncotic pressure) and is produced by the liver?

albumin

the plasma protein albumin is responsible for the blood’s _____ and is produced by the _____

colloid osmotic pressure (aka oncotic pressure), liver

Blood is _____ and _____ combined. the extracellular matrix of blood is the _____

plasma; formed elements; plasma

plasma accounts for _____ of any given blood volume

55%

_____ accounts for 55% of any given blood volume

plasma

formed elements accounts for _____ of any given blood volume

45%

_____ accounts for 45% of any given blood volume

formed elements

of the 45% formed elements in a blood volume, _____ are RBCs (erythrocytes), this is called the ______ level

44%, hematocrit

of the 45% _____ in a blood volume, 44% are _____, this is called the hematocrit level

formed elements, RBCs (erythrocytes)

the other 1% of the formed elements are ____ and _____

platelets and WBCs (leukocytes)

if the hematocrit value is less than 44%, the patient may be _____

anemic

iron is transported by _____

transferrin

iron is stored in the form of _____

ferritin

ferritin is the storage form of _____

iron

storage form of old or degraded iron is _____

hemosiderin

hemosiderin is the storage form of _____

old or degraded iron

the two stages of hemostasis

primary and secondary

primary hemostasis includes which step(s) of hemostasis

vasospasm and platelet plug formation

vasospasm and platelet plug formation are part of which stage of hemostasis

primary

secondary hemostasis includes which step(s) of hemostasis

activation of the coagulation cascade

activation of the coagulation cascade is part of which stage of hemostasis

secondary

when a platelet adheres to von willebrand factor, the platelet _____, releases its _____, and secretes _____

swells, pseudopod, thromboxane A2

_____ is the chemical platelets release in order to recruit other platelets - (prothrombotic)

thromboxane A2

a temporary projection of the cell's cytoplasm, used for movement, feeding, and other functions (referring to platelets in this case)

pseudopod

in order to produce fibrin strands, the ______ need to be activated

extrinsic and intrinsic pathways

hemophilia A is caused by a deficiency in factor _____

8 (VIII)

_____ is caused by a deficiency in factor 8 (VIII)

hemophilia A

hemophilia B is caused by a deficiency in factor _____

9 (IX)

_____ is caused by a deficiency in factor 9 (IX)

hemophilia B

_____ is primarily produced by endothelial cells, which line the blood vessels

tissue plasminogen activator (TPA)

tissue plasminogen activator (TPA) is primarily produced by _____, which line the blood vessels

endothelial cells

the treatment of choice for a patient suffering from complications due to a blood clot (ex: CVA) is =

tissue plasminogen activator (TPA)

functional inability of the blood to supply the tissues with adequate oxygen for proper metabolic function is termed

anemia

_____ is the hormone produced by the kidneys that stimulates bone marrow to produce new RBCs (erythropoiesis)

erythropoietin (EPO)

erythropoietin (EPO) is the hormone produced by the _____ that stimulates _____ to produce more RBCs (erythropoiesis)

kidneys; bone marrow

intrinsic clotting pathway starts _____

within the blood vessel

extrinsic clotting factor starts ______

outside the blood vessel

heparin and warfarin are _____ drugs

anticoagulant

two examples of anticoagulant drugs are

heparin and warfarin

fibrinolysis is the _____

breakdown of a clot

_____ is not a disease but rather the expression of an underlying disorder or disease

anemia

protein in RBCs that carry oxygen

hemoglobin

% of blood that is RBCs is termed

hematocrit

immature RBC is termed

reticulocyte

average size of an RBC is termed

mean corpuscular volume

mean corpuscular volume is what

average size of an RBC

mean cell hemoglobin concentration is what =

how much hemoglobin is in an RBC

how much hemoglobin is in an RBC =

mean cell hemoglobin concentration

_____ of an RBC is determined by how much hemoglobin it carries, aka its mean cell hemoglobin concentration

chromaticity (color)

chromaticity (color) of an RBC is determined by its how much hemoglobin it carries, aka its _____

mean cell hemoglobin concentration

sizing classification of RBC: microcytic =

less than 80 MCV

sizing classification of RBC: less than 80 MCV =

microcytic

sizing classification of RBC: normocytic =

80-100 MCV

sizing classification of RBC: 80-100 MCV =

normocytic

sizing classification of RBC: macrocytic =

more than 100 MCV

hemoglobin concentration/chromaticity (color) classification of RBC: normal hemoglobin content, normal color =

normochromic

hemoglobin concentration/chromaticity (color) classification of RBC: normochromic =

normal hemoglobin content, normal color

hemoglobin concentration/chromaticity (color) classification of RBC: less hemoglobin content, pale color =

hypochromic

hemoglobin concentration/chromaticity (color) classification of RBC: hypochromic =

less hemoglobin content, pale color

dizziness, pallor, leg cramps, neurological symptoms, and fatigue are generalized symptoms of ____

anemia

macrocytic normochromic anemia is going to involve either a _____ or _____ deficiency which causes faulty DNA synthesis, leads to enlarged cells

folate, b12

_____ anemia is going to involve either a folate or B12 deficiency which causes faulty DNA synthesis, leads to enlarged cells

macrocytic normochromic

macrocytic normochromic anemia is also known as

megaloblastic anemia

the cause of macrocytic normochromic anemia is ______ due to a deficiency of folate or b12

defective DNA synthesis

in macrocytic normochromic anemia, a B12 deficiency is caused by lack of _____ (can be autoimmune or non-autoimmune) or it can be caused by _____ causing malabsorption of B12.

intrinsic factor, dietary issues

a glycoprotein produced by parietal cells in the stomach that's essential for vitamin B12 absorption in the small intestine

intrinsic factor