Chapter 19: Blood , Chapter 20: The Heart , Chapter 21: Blood Vessels and Circulation

Which type of specialized tissue is blood?

Fluid connective tissue

What two components make up blood?

Plasma + Formed Elements (cell and cell fragments)

What is the main component of plasma?

Water (92%)

Other: Plasma Proteins (7%), Other Solutes (1%)

Which formed element is the most abundant in blood?

Erythrocytes – “Red Blood Cells” (RBCs) (99.9%)

Define hematocrit.

Hematocrit (Hct): the percentage (%) of red blood cells within a sample of whole blood

What occurs during hematopoiesis?

Hematopoiesis (hemopoiesis): the process of producing formed elements

List the three major plasma proteins in plasma.

Albumins (60%) – most abundant

Globulins (35%)

Fibrinogens (5%)

List the three types of formed elements (Know their abbreviations).

Red Blood Cells (RBCs) – “erythrocytes” (most abundant)

White Blood Cells (WBCs) – “leukocytes”

Platelets (PLT) – “thrombocytes”

Which vein, located superior to the olecranon, is commonly used for venipuncture?

Median cubital vein

For what purpose would an arterial puncture be used?

Arterial puncture “arterial stick” – can be used for blood gas analysis, and indicator of lung function.

- generally drawn at radial or brachial arteries

Which organ synthesizes and releases 90% of plasm proteins?

Liver

What are erythrocytes?

Erythrocytes: red blood cells (RBCs)

Why are RBCs red in color?

Contains hemoglobin (a red pigment) which binds and transports the respiratory gases O2 and CO2

Human RBCs do not contain organelles. What cellular processes are affected by this?

RBCs are anucleate (without nuclei) so they cannot divide, synthesize structural proteins or enzymes, or repair damage.

What two gases are transported by hemoglobin?

O2 (oxygen) & CO2 (carbon dioxide)

If every protein chain of hemoglobin has a heme associated with it, how many heme molecules and iron molecules are contained in one molecule of hemoglobin?

4 hem units & 4 Iron (Fe+) molecules

- each hem molecule holds an iron ion

What is oxyhemoglobin?

Oxyhemoglobin (HbO2): when a heme iron (Fe) ion interacts with oxygen (O2)

- oxygen = bright red

What is deoxyhemoglobin?

Deoxyhemoglobin: a hemoglobin molecule when iron (Fe) is not bound to oxygen (O2)

- no oxygen (O2) = dark red

Compare oxygen binding capacities of adult vs fetal hemoglobin.

Fetal hemoglobin: binds to oxygen more readily; “steals” oxygen from bloodstream to placenta

Adult hemoglobin: not as readily  

What is carbaminohemoglobin?

Carbaminohemoglobin: hemoglobin (alpha and beta chains) bound to carbon dioxide

What is anemia?

Anemia: condition in which there is a decrease in the hematocrit and/or the hemoglobin (Hb) content of the RBCs (no ability to carry oxygen).

- (individuals may become weak, lethargic, or confused.)

What is erythropoiesis and where does it occur?

Erythropoiesis: the formation of red blood cells (RBCs) in myeloid tissue (red bone marrow)

Which immature blood cell, accounting for less than 1% of the RBC population, is found in the blood?

Reticulocyte

Which hormone directly stimulates erythropoiesis?

Erythropoietin (EPO) – secreted by the kidneys

Released:

- during anemia

- blood flow to kidneys decrease

- oxygen content of air in lungs decreases (disease or high altitudes)

- respiratory surfaces of the lungs are damaged.

What is hypoxia?

Hypoxia: a low oxygen level in tissues

What is the intrinsic factor and what is its function? Where is it produced?

Intrinsic factor: a glycoprotein produced by the stomach in order to absorb Vitamin B12; w/o B12 cell division cannot occur resulting in “pernicious anemia”

What is pernicious anemia caused by?

caused from Vitamin B12 deficiency

What is hemolysis?

Hemolysis: the rupturing or breakdown of red blood cells

* “lys” = the breakdown of*

Define hemoglobinuria

Hemoglobinuria: red or brown urine due to high Hb content (abnormally high hemolysis in bloodstream)

Define hematuria

Hematuria: the presence of RBCs in the urine due to kidney or blood vessel damage. (blood in urine)

What is jaundice?

Jaundice: caused when the bile ducts of the liver are blocked and the liver cannot absorb or excrete bilirubin causing a yellow pigmentation.

What molecule causes the yellowing of the eyes and skin?

Bilirubin

What is iron-deficiency anemia?

Iron-deficiency anemia: impairment in iron reuptake or metabolism in the diet; insufficient iron in the body affecting the formation of RBCs

Which three of the greater than 50 blood antigens are most important when blood typing?

A, B, and Rh (or D)

Blood Types and Cross Reactions: (surface antigens & antibodies)

Type A

Antigens: A

Antibodies: anti-B

Type B

Antigens: B

Antibodies: anti-A

Type AB (universal receiver)

Antigens: A & B

Antibodies: none (neither anti-A nor anti-B)

Type O (universal donor)

Antigens: none (neither A nor B)

Antibodies: anti-A and anti-B

*universal donor, but not a universal receiver*

Rh (or D)

based on the presence or absence of Rh antigen

Rh+

Antigens: Rh

Antibodies: no anti Rh antibodies

Rh-

Antigens: no Rh surface antigens

Antibodies: anti-Rh antibodies

If type B blood is mistakenly given to a person with type A blood, what will occur?

Because type B has anti-A antibodies, the RBCs will agglutinate (clump) when attacking; potentially causing blockages of blood flow to different organs or tissues.

What is a transfusion?

Transfusion: the process of transferring whole blood or blood plasma from one person to another.

What occurs to RBC if there is a transfusion reaction?

If there is a transfusion rection (cross-reaction) the RBCs agglutinate and may also hemolyze.

- Clumps and fragments of RBCs under attack forming drifting masses that can plug small blood vessels in vital organs (kidneys, lungs, hearts, or brain) causing major damage.

What is cross match testing used for?

Cross match testing: involves exposing the doners RBCs to a sample of the recipient’s plasma to reveal significant cross-reactions involving surface antigens other than A, B, or Rh between the doners antigens and the plasma antibodies.

(finding best match for receiver)

In emergency situations, which blood type is given because it is considered the "universal donor"?

Type O

What is the scientific name for hemolytic disease of the newborn (HDN)?

Erythroblastosis fetalis  

When does HDN occur?

HDN occurs due to a cross-reaction between fetal and maternal blood types. It develops when an Rh- negative mother carries and Rh+ positive fetus (typically in the second pregnancy)

Why doesn't HDN usually occur during a first pregnancy of an RH- mother and Rh+ fetus?

about 20% of Rh(-) females who carried Rh(+) children become sensitized within 6 months of delivery. Because the anti-Rh antibodies aren't produced in significant amounts until after delivery, the first infant wont be affected.

What drug is administered to prevent an Rh- mother from being sensitized to an Rh+ baby's antigen during the first pregnancy?

RhoGAM

What is diapedesis (also known as emigration)?

Diapedesis (“emigration”): the process of WBCs squeezing between adjacent endothelial cells (blood vessels) and entering the surrounding tissues after the WBCs are marginated and activated in the bloodstream.

- crucial for immune response

What is positive chemotaxis?

Positive chemotaxis: when all WBCs are attracted to specific chemical stimuli. It guides WBCs to invading pathogens, damages tissues, and other active WBCs.

What are two groups of white blood cells (WBCs) based on their appearance after staining?

- Granular leukocytes

- Agranular leukocytes

List three types of WBC granulocytes

- Neutrophils (most numerous of the WBCs)

- Eosinophils

- Basophils

list two types of agranulocytes.

- Monocytes (the monster cell that engulfs debris and pathogens)

- Lymphocytes

Which four types of WBCs are part of the body’s non-specific defenses?

- Neutrophils (elevated during bacterial infections)

- Eosinophils (elevated during parasitic infections)

- Basophils

- Monocytes

“Never Eat Burnt Mac and cheese”

Which three types of WBCs cells are capable of phagocytosis? Hint: the book calls them microphages and macrophages.

- Monocytes (macrophages)

- Eosinophils (microphages)

- Neutrophils (microphages)

*M.E.N are capable*

Neutrophils can undergo a respiratory burst. What is a respiratory burst?

Respiratory burst: a rapid release of reactive oxygen species (ROS) from immune cells due to a neutrophil encountering a bacterium and quickly engulfing the invader increasing the metabolic rate.

What two chemicals are released after a respiratory burst occurs?

- hydrogen peroxide (H2O2)

- superoxide anions (O2-)

What two toxic compounds are released by eosinophils?

- Nitric oxide

- Cytotoxic enzymes

Which two conditions will cause an increased number of eosinophils?

- parasitic infections

- allergic reactions

What two molecules are found in basophil granules?

Histamine: dilates the blood vessels

Heparin: prevents blood clotting

What are monocytes called after they enter the tissues?

Macrophages

What type of adaptive immunity is T lymphocyte (T cell) related?

Cell-mediated immunity – defense mechanism against invading foreign cells and coordinating the immune response.

(Helper T Cells)

What type of adaptive immunity is B lymphocyte (B cell) related?

Humoral immunity – defense mechanism that involves the production of antibodies

(Killer B Cells)

What are plasma cells and what do they secrete?

Plasma cells: differentiated B cells that synthesize and secrete antibodies.

Which cells carry out immune surveillance and are important in preventing cancer?

Natural killer (NK) cells – destroy abnormal cells

Define leukopenia

Leukopenia: insufficient or low WBC count

Define leukocytosis.

Leukocytosis: excessive or high WBC count

What is the difference leukopoiesis and lymphocytopoiesis?

Leukopoiesis: production of WBCs

Lymphocytopoiesis: production of lymphocytes

What is the scientific name for platelets?

Platelets (PLT) - “thrombocytes”

What is the major role of platelets?

MAJOR FUNCTION:

- Releasing chemicals important for the clotting process

OTHER FUNCTIONS:

- Temporarily patch damages vessels walls

- Reduce the size of break in a vessel wall

What are megakaryocytes?

Megakaryocytes: large nucleated cells in red bone marrow that break up to form platelets

What is hemostasis?

Hemostasis: the stopping of bleeding

What enzyme converts soluble fibrinogen to insoluble fibrin?

Thrombin

Which ion and which vitamin affect almost every aspect of the clotting process?

Calcium (Ca) ions & Vitamin K

- any disorder that lowers the plasma Calcium (Ca) concentration will impair blood clotting.

What is fibrinolysis?

Fibrinolysis: the process of dissolving a blood clot

*Remember “lys” – the removal or breakdown*

What is thrombocytopenia?

Thrombocytopenia: platelet (thrombocytes) count is too low

- *most common reason for bleeding*

What is hemophilia?

Hemophilia – disorder in which the blood does not clot properly

- (Affects more males than females)

HOMEWORK QUESTIONS:

Whole blood for testing in a clinical laboratory is usually collected from

a superficial vein

Which plasma protein transports fatty acids and some hormones?

albumin

The most abundant proteins in blood plasma are

albumins

Blood that has clotting proteins removed is termed

serum

You have spent 24 hours traveling from the U.S to New Zealand, on quite a few airplanes with many stops. Because of the stress, changes in time zones, and short blocks of time between planes, you find yourself tired with a headache when you arrive. You are severely dehydrated. A hematocrit value of your blood would be ________ than normal because ________.

higher; you have less blood plasma volume

Each molecule of heme contains a single ion of what element?

iron

Jane has been taking the antibiotic chloramphenicol for a few weeks as treatment for a serious bacterial infection. There is a possibility that a future side effect of long-term antibiotic therapy could affect the bone marrow leading to severe changes in her hematocrit. The result is

aplastic anemia (failure to produce red blood cells).

All the circulating red blood cells in a healthy adult originate in the

red bone marrow

Surgical removal of the stomach could cause

pernicious anemia

Eileen is a strict vegan and therefore eats no animal products. She develops an anemia that her doctor thinks is caused by a nutritional deficiency. Which of the following is the likeliest candidate?

- vitamin B6 deficiency

- vitamin K deficiency

- iron-deficiency anemia

- aplastic anemia

- sickle cell anemia

iron-deficiency anemia

________ is a condition in which the oxygen-carrying capacity of the blood is reduced.

Anemia

A bruise appears as a greenish spot in the skin because

the heme group in the hemoglobin has broken down into biliverdin

The waste product bilirubin is produced from

heme molecules lacking iron

________ are immature erythrocytes that are present in the circulation.

Reticulocytes

Mrs. Higgins needs to have major surgery. Two weeks before the surgery, her doctor prescribes EPO. Which of the following statements best explains his reason for doing

this?

By prescribing EPO, the doctor can stimulate Mrs. Higgins's body to produce an overabundance of RBCs, which can be harvested and saved for her surgery.

Red blood cells carry __________ to the lungs and __________ to the tissues.

carbon dioxide; oxygen

Antigens of the surface of red blood cells are also called ________ and antibodies in the blood plasma are also called ________.

agglutinogens; agglutinins

The clumping of red blood cells, when the specific antibody against the antigen on the cells is added, is called

agglutination

In an emergency situation when you have no time to wait for cross-matched blood you could give a patient type ________ until the cross-match is available.

O negative