JONES- EXAM 1

:)

What is blood?

blood= plasma (fluid part) + formed elements (all the cells/cytes in the pic)

Blood proteins are mainly produced by what organ? List some examples of blood proteins.

• primarily produced by the liver

• examples

  • albumins

  • globulins

  • fibrinogen

What is the main function of albumin proteins?

• colloid oncotic pressure

• transport

• viscosity

• pH

When we say we are “measuring serum” what are we actually measuring?

plasma minus fibrinogens

What is hemopoiesis?

production of blood (RBC, WBC, and platelets)

All cells in the blood start from a hematopoietic _________ ____________.

stem cell

Where are most RBC’s made in adults?

bone marrow

Lymphoid tissues (thymus, tonsils, spleen, nodes) produce ________________.

lymphocytes

What is the most abundant formed element/ blood cell in the body?

RBCs or “Erythrocytes”

What is hematocrit? How do we measure it (FYI)? What is the normal range?

• hematocrit is the # of RBC’s in the blood

• FYI: measured by taking a blood sample—> spin it —> the RBC’s settle at the bottom and you measure the % of the blood sample that is at the bottom

• NORMAL RANGE: 42-47%

What are the functions of RBCs/erythrocytes?

• CARRY OXYGEN FROM LUNGS TO TISSUES

• carry CO2 from tissues to lungs

What is special about the structure of RBCs/erythrocytes?

• bi-concave disc

• spectrin cytoskeleton—> allows RBC’s to be bouncy

Inside RBC’s, what protein is responsible for gas transport? (responsible for carrying 98% of O2)

HEMOGLOBIN!!

What is the normal range of Hgb in the body?

15-18 g/dL

Describe the structure of hemoglobin:

• _____ subunits/chains

• each subunit has a ________

• 4 subunits

• each subunit has a heme

The heme group of each subunit on hemoglobin has what kind of binding sites? What bind to these binding sites?

each heme has IRON binding sites where O2 BONDS

Normal adult hemoglobin has what kind of chains?

2a, 2b

How many oxygen atoms bind to 1 hemoglobin?

4 O2

What is erythropoiesis?

production of red blood cells

What are the intermediate cells between becoming a stem cell and a mature RBC?

stem cell—> CFU —> erythroblast—> reticulocyte—> erythrocyte

In order for a stem cell to become a CFU (colony-forming-unit-erythroid cells) WHAT HORMONE IS ESSENTIAL!!!!!!!!!!!!!!!!

EPO or erythropoietin

About 0.5-1.5% of reticulocytes are circulating in the blood. What does this mean? If there was a high % of reticulocytes in the blood what would that mean?

• reticulocytes in the blood means they escape before maturing

  • FYI is normal to have some reticulocytes in the blood

• high % of reticulocytes in the blood means that more RBC synthesis is stimulated

EPO is mainly released from the kidney when?

when we need RBC’s/ don’t have enough oxygen

How many days does it take to go from a stem cell to a mature RBC’s?

30 days

What are some other requirements for RBC formation?

• iron

• b-12

• folic acid

• amino acids

What is hemolysis? What happens to the heme group when an RBC dies?

• rupture of RBC

• what happens when a RBC dies? Hgb dies, and the heme is broken down into bilirubin and excreted

What is MCV? What does it signify? What is the normal value?

mean corpuscle volume- it’s the average size of your red blood cells

• normal value- 87

What is anemia?

decrease # of RBC’s

What type of anemia is when there are larger cells/ larger MCV?

macrocytic/megaloblastic anemia

What type of anemia is when there are smaller cells/ smaller MCV?

microcytic anemia

What type of anemia is when the cells are normal size, but there’s a low #?

normocytic anemia- can be hemolytic if also high reticulocytes

Fill in the following table about causes of different anemias:

Type	Causes
Microcytic with low/normal # of RBC’s
Microcytic with high # of RBC’s
Normocytic
Macrocytic

Type	Causes
Microcytic with low/normal # of RBC’s	IRON-DEFIENCY ANEMIA lead poisoning others: anemia bc of chronic inflammation, sideroblastic anemia
Microcytic with high # of RBC’s	THALASSEMIAS
Normocytic	HEMOLYTIC ANEMIAS BONE MARROW DISORDERS—> Aplastic and hypoblastic anemias others: hypersplenism, anemia bc of chronic disease
Macrocytic	VITAMIN B-12 DEFICIENCY FOLATE DEFICIENCY

Why do thalassemias lead to an increased # of RBC’s?

• thalassemias are characterized by a disorder within the Hgb

• If the Hgb is not functioning right, then the RBC can’t carry oxygen as well

• this stimulates EPO release

• more RBC’s are made, but they still can’t function and carry oxygen properly

What is polycythemia? What are the causes?

• polycythemia: an increase in # of RBC’s

• causes: cancer of the bone marrow, dehydration, emphysema, altitude, exercise—→ ALL OF THESE INCREASE EPO

Compare hypoblastic and aplastic anemia:

hypoblastic—> decline in # of RBC’s

aplastic—> complete cessation of erythropoiesis

What is sickle cell anemia? List a pharm tx for sickle cell.

• a hemoglobin defect—> we can’t make the beta chains of hemoglobin

• RBC’s instead of being round become a sickle shape instead and clump together

• tx: Hydroxyurea: stimulates HgF (y) and decrease HbS (beta chains)

What are red blood cell antigens?

What do they do?

What are red blood cell antigens? proteins on the surface of RBC’s

What do they do? determine blood type

All blood types technically have what antigen?

H antigen

What are the different blood types and their corresponding antigens?

• example: type A has what antigen?

• type A- A antigens

• type B- B antigens

• type AB- A and B antigens

• type O- NO A or B ANTIGENS

For each blood type what kind of antibodies do they have?

• type A: Anti-B antibodies

• type B: Anti-A antibodies

• type AB: NO ANTIBODIES

• type O: Anti-B and Anti-A antibodies

(people produce antibodies AGAINST the antigens they don’t have

What does Rh+ and Rh- refer to?

• the D antigen!

• Rh+ = have the D antigen

• Rh- = no D antigen, might MAKE anti-D ANTIBODIES

How does a person make anti-D antibodies?

form ONLY when an Rh- person is exposed to Rh+ blood

PRACTICE:

A 26-year-old Rh-negative woman is pregnant for the first time. Her fetus is Rh+. What is must be done during her pregnancy?

a. no treatment is necessary

b. give Rhogan

c. monthly blood tests and checkups

a- (this is the mother’s first pregnancy and she is Rh-negative. even though the fetus is Rh-positive, the mother hasn’t and won’t develop antibodies until the mother and fetus’s blood mix at birth)

PRACTICE:

A 31-year-old Rh-negative woman is pregnant and already has Rh antibodies from a previous pregnancy. Her fetus is Rh+. What is must be done during her pregnancy?

a. no treatment is necessary

b. give Rhogan

c. monthly blood tests and checkups

b. (the mother needs a medication to stop the Rh antibodies from attacking the fetus)

What cells produce platelets?

megakaryocytes

What is the primary job of platelets?

form a plug to seal off damaged vessels

What factor is ESSENTIAL in platelet adhesion and fibrin formation?

vWF

Briefly summarize the factors involved in the intrinsic to common pathway:

Intrinsic: XII—> XI—> IX—> VIII—> X—> active X

Common: prothrombin—> thrombin—> fibrinogen —→ fibrin

What type of bleeding disorder is this:

• most common inherited disorder

• decreased adhesion of platelets and fibrin formation

vWF disease

Hemophilia A is a deficiency in WHAT CLOTTING FACTOR? ************

factor VIII

Hemophilia B (Christmas disease) is a deficiency in WHAT CLOTTING FACTOR?

factor IX

Hemophilia C (Rosenthal’s) is a deficiency in WHAT CLOTTING FACTOR?

factor XI

Vitamin K deficiency leads to increased clotting time and effects what factors?

II, VII, IX, X

Liver disease leads to increased clotting time and effects what factors? (i don’t think that important)

V, VII, IX, X, XI, XII, fibrinogen and prothrombin