Chapter 25 - Hematological System

Front 1

The cellular components of blood are

Back 1

erythrocytes (RBC's), leukocytes (WBC's), and platelets ( platelets are not complete cells, rather they are fragments of large cells called megakaryocytes

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Erythrocytes

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Red Blood Cells (RBC's)

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Leukocytes

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White Blood Cells (WBC's)

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Plasma accounts for what percentage of blood volume?

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55-60%

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Examples of plasma proteins

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albumin, globulins, fibrinogen, transferin and ferritin

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What do plasma proteins do?

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they increase the oncotic pressure and viscosity of the plasma, thus maintaining the blood pressure - that is why we use albumin as a plasma expander

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Albumin

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binds to and carries other molecules, such as bilirubin, sulfa, and hormones

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Globulins

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are other proteins, the most abundant of which are immunoglobulins (antibodies)

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Fibrinogen

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is the molecule from which fibrin is made for clotting blood

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Transferrin

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carries iron in the blood stream, and ferritin binds iron and stores it

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Proteins

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are important for providing osmotic pressure in the plasma, maintaining the blood pressure - they can also act as buffers to maintain the acid-base balance in the blood

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Plasma electrolytes include

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sodium, potassium, calcium, magnesium, chloride, phosphate, and sulfate

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Serum differs from plasma

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it has had fibrinogen extracted to form a clot

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RBC's contain

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hemoglobin a protein that carries oxygen from the lungs to the tissues

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What does hemoglobin do?

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it is a protein that carries oxygen from the lungs to the tissues

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Mature RBC's

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do not contain a nucleus - they have an indented center like TUMS - the shape gives them a greater surface-to-volume ratio - providing more surface area for gas exchange

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Hematocrit

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is the ratio of the RBC volume to the whole (RBC + plasma) volume

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What do Red blood cell indices test for?

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they are three values on a CBC that help identify anemias

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What are the Red blood cell indices?

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1. MVC (mean corpuscular volume) = Hct/RBC count - size
2. MCH (mean corpuscular hemoglobin) = Hgb/Hct - color
3. MCHC (mean corpuscular hemoglobin concentration)

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What is the role of WBCs

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they are cells of the immune system - they defend the body against infection and remove dead or injured cells or cellular debris

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WBCs include

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granulocytes

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Another name for Neutrophils

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polymorphonuclear neutrophils or polys, or PMNs

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What do neutrophils do?

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they are the primary phagocyte in the early inflammation reaction - they are made and stored in the bone marrow and are attracted to the site of inflammation by chemotactic factors released by the mast cells

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Mature polys or neutrophils

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have a multi-lobed nucleus (hence the name) and can no longer divide

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Immature polys or neutrophils are also called

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bands - they have nuclear lobules that have not completely formed and have a horseshoe shape

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Eosinophils

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have coarse granules which stain red - they ingest antigen-antibody complexes, and are induced by IgE to attack parasites - they also participate in allergic reactions

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Basophils

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have granules that stain deep blue - they function similarly to mast cells - although their function is not completely understood

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Mast cells

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are produced in the bone marrow and are present mostly in connective tissue below epithelial tissues

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Agranulocytes

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do not contain lysosomal granules in their cytoplasm

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Monocytes

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are large cells that are the precursors to macrophages - they are formed in the bone marrow and are released into the blood stream - they ingest and process antigens so they can be recognized by T and B lymphocytes - they are involved in the activation of the acquired immune system

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Macrophages

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are larger than monocytes - they are active phagocytes and they initiate the immune system

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Lymphocytes

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are smaller cells - they are the primary cells of the immune response - most of them are located in the lymphatic tissue with a small percentage in the blood - T cells, B cells, Plasma cells (mature B cells that produce antibodies), and Natural Killer cells

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What makes up the MPS (mononuclear phagocyte system)

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monocytes and macrophages

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Platelets are actually

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cell fragments - they come from the fragmentation of huge cells called megakaryocytes

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Megakaryocytes

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break down into cell fragments called platelets

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Platelets are involved

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in blood coagulation and control bleeding - they do not have a nucleus so they cannot divide

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Where do platelets circulate?

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in the blood and are stored in the spleen

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What are the primary lymphoid organs

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Thymus and Bone Marrow

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What are the secondary lymphoid organs

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spleen, lymph nodes, adenoids, tonsils, and Peyer's patches

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Hematopoiesis

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blood cell production

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Hematopoiesis involves

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cell proliferation by mitotic division and maturation or differentiation - the cells arise from stem cells and growth is regulated by a number of growth factors

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Where is erythrocyte development in older children and adults

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bone marrow

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What is the function of the erythrocyte

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gas transport to and from tissue cells and lungs

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In the fetus erythrocyte development

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begins in the yolk sac, then moves to the fetal liver and spleen, and later to the bones marrow

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Erythrocyte proliferation is stimulated by

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erythropoietin which is primarily made in the pertubular cells of the kidney

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Where is erythropoietin made

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pertubular cells of the kidney

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Reticulocytes

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are maturing erythrocytes - they have lost their nucleus but still have mitochondria and ribosomes or fragments thereof (fragments of RNA)

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Erythroid progenitor cells develops into

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a reticulocyte which develops into a erythrocyte

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An increase in reticulocyte number indicates

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erythropoietin activity

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What does hypoxia (from anemia, high altitude, or pulmonary disease) do?

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it stimulates transcription of the erythropoietin gene in the peritubular kidney cells resulting increased production of erythropoietin - it then travels to the bone marrow to stimulate production of RBC's

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What is the normal life span of an erythrocyte?

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100-120 days

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Where are erythrocytes broken down?

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spleen

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Hemoglobin

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is the oxygen-carrying protein of the erythrocyte

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Hemoglobin is composed of

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two alpha and two beta polypeptide chains (globulins) and four complexes of iron and protoporphyrin (heme)

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Protoporphyrin

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heme

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Each heme can carry how many oxygen (O2) molecules?

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one so each hemoglobin molecule can carry 4 oxygen

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What are the main components required for the generation of mature erythrocytes (RBCs)

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1. Protein and amino acids
2. Vitamin B12
3. Folic Acid
4. Vitamin B6
5. Vitamin B2
6. Vitamin C
7. Vitamin E
8. Iron

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Why do we need proteins and amino acids to make RBCs?

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to build the globulins and the plasma membrane - deficiency causes frail cells and hemolytic anemia

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A deficiency in proteins and amino acids causes

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frail cells and hemolytic anemia

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Why do we need Vitamin B 12 to make RBCs?

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for synthesis of DNA and maturation of RBCs - deficiency causes macrocytic anemia

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A deficiency in Vitamin B12 causes?

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macrocytic anemia

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Why do we need Folic Acid to make RBCs?

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similar to B12 - synthesis if DNA and maturation of RBC's - deficiency causes macrocytic anemia

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Why do we need Vitamin B6 for RBC production?

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for heme synthesis (to make the heme group) - deficiency causes microcytic-hypochromic anemia

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A deficiency in Vitamin B6 causes?

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microcytic-hypochromic anemia

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Why do we need Vitamin B2 (riboflavin) to make RBC's?

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it is essential for oxidative reactions and to make the heme group - deficiency causes normocytic-normochromic anemia

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A deficiency in Vitamin B2 causes?

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normocytic-normochromic anemia

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Why do we need Vitamin C for RBC production?

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assists iron absorption from the gut and maintains iron in its ferrous (Fe++) form - deficiency causes normocytic-normochromic anemias

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A deficiency is Vitamin C causes?

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normocytic-normochromic anemias

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Why do we need Vitamin E for RBC production?

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it is needed for heme synthesis - a deficiency causes hemolytic anemia

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A deficiency in Vitamin E causes?

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hemolytic anemia

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Why do we need iron for RBC production?

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it is a component of heme - a deficiency causes iron deficiency anemia - a microcytic-hypochromic anemia

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A deficiency in iron causes?

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iron deficiency anemia - a microcytic-hypochromic anemia

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Macrocytic-normochromic anemia

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large abnormally shaped cells - normal hemoglobin concentrations (increase in MVC and normal MCH)
1. Pernicious anemiia - lack of Vitamin B12
2. Folate deficiency anemia - lack of folate

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Microcytic-hypochromic anemia

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small abnormally shaped cells and reduced hemoglobin concentrations (decrease in MVC and decrease in MCH)
1. Iron deficiency anemia - lack of iron for hemoglobin production
2. Thalassemia - impaired hemoglobin synthesis - don't want to give iron

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Normocytic-normochromic anemia

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normal size and normal hemoglobin concentration (normal MVC and normal MCH)
1. Aplastic anemia - insufficient erythopoiesis
2. Hemorrhagic - acute blood loss
3. Hemolytic anemia - premature destruction of mature erythrocytes
4. Sickle cell anemia - abnormal hemoglobin synthesis
5. Anemia of chronic disease - abnormally increased demand for new erthrocytes

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In addition to heme in the blood where else is it found?

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in muscle cells (in myoglobin)

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Iron is stored by

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binding to ferritin in hepatic cells and to transferrin, which transports it through the blood

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Platelets form

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the intial plug to initiate hemostasis

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A blood clot forms

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from the activation of the coagulation cascade

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Coagulation cascade

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is a series of enzyme reactions in which each coagulation factor is converted to its active form by the preceding factor until fibrin is formed - fibrin forms a protein mesh that forms a stable plug

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Bleeding disorder is caused by

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an absence of a clotting factor by mutation of its gene

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Clotting factors II, VII, IX, and X are made

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in the liver and require Vitamin K as a cofactor in the synthesis process

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What does liver dysfunction or Vitamin K deficiency cause?

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it leads to a decreased production of factors II, VII, IX or X and may lead to a bleeding disorder

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What drug do we give to block the production of Factors II, VII, IX or X

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coumadin