Heme 01: Intro To Blood

Front 1

What are the functions of blood?

Back 1

- Convey nutrients and waste
- Hormones (endocrine)
- Gases O2 and CO2

Front 2

What percent of body weight does blood make up? How many liters?

Back 2

5% of body weight = ~5L

Front 3

What kind of tissue is blood?

Back 3

Specialized CT:
- Extracellular matrix = plasma
- Cellular components = RBCs, WBCs, platelets

Front 4

How can you separate the components of blood?

Back 4

Centrifugation in presence of heparin (prevents clot formation)

Front 5

What are the layers of the blood after centrifugation?

Back 5

Top
- Plasma
- WBCs
- RBCs
- Blue Band Clay
Bottom

Front 6

What is the fluid supernatant phase after centrifugation when heparin IS present?

Back 6

Plasma

Front 7

What are the components of the plasma? What percentage do they make up?

Back 7

- Water (~90%)
- Protein (~10%)
- Salts
- Gases

Front 8

What proteins are in the plasma?

Back 8

- Albumin
- Globulins (α and β transporters; γ antibodies)
- Clotting proteins
- Complement
- Lipoproteins

Front 9

What is the fluid supernatant phase after centrifugation when heparin IS NOT present?

Back 9

Serum

Front 10

How do you obtain the serum?

Back 10

Fluid supernatant phase remaining after clotting, followed by centrifugation to remove clotting factors and blood cells (aka formed elements)

Front 11

How do you obtain the plasma?

Back 11

Fluid supernatant phase after centrifugation in presence of heparin (to prevent clotting)

Front 12

What are the types of blood cells?

Back 12

- Erythrocytes (RBCs)
- Leukocytes (WBCs)

Front 13

What are the types of Leukocytes?

Back 13

Granulocytes:
- Neutrophils
- Eosinophils
- Basophils
Agranulocytes:
- Monocytes
- Lymphocytes

Front 14

What is the normal range for RBCs and WBCs?

Back 14

- RBCs: 4.6 - 6.1 x 10^6 / µL
- WBCs: 4.0-10.0 x 10^3 / µL

Front 15

What is the average percent of the following WBCs:
- Neutrophils
- Lymphocytes
- Monocytes
- Eosinophils
- Basophils

Back 15

- Neutrophils: 60%
- Lymphocytes: 22%
- Monocytes: 10%
- Eosinophils: 7%
- Basophils: 1%

Front 16

On a differential, which kind of blood cell is ~60% of the WBCs? What range is normal?

Back 16

Neutrophils (34-71%)

Front 17

On a differential, which kind of blood cell is ~22% of the WBCs? What range is normal?

Back 17

Lymphocytes (19-53%)

Front 18

On a differential, which kind of blood cell is ~10% of the WBCs? What range is normal?

Back 18

Monocytes (5-12%)

Front 19

On a differential, which kind of blood cell is ~7% of the WBCs? What range is normal?

Back 19

Eosinophils (0-7%)

Front 20

On a differential, which kind of blood cell is ~1% of the WBCs? What range is normal?

Back 20

Basophils (0-1%)

Front 21

What is the term for determining the relative amount of WBCs?

Back 21

Differential Count

Front 22

What is the term for determining the relative amount of WBCs and additional blood components?

Back 22

Complete Blood Count (CBC)

Front 23

What is the size of an erythrocyte? What is the term for this size?

Back 23

7.5 µm diameter = internal standard size

Front 24

What is the shape of an erythrocyte? Why?

Back 24

Biconcave disk, allows for increased surface area for respiration

Front 25

What is found within an erythrocyte?

Back 25

- No nucleus in mature RBCs
- No organelles in cytoplasm
- Hemoglobin (33%)

Front 26

What is fetal hemoglobin made of? Adult hemoglobin?

Back 26

- Fetal: α2χ2 (until end of pregnancy)
- Adult: α2β2

Front 27

What can bind to hemoglobin, what is it called then?

Back 27

- Oxyhemoglobin = Hb + O2
- Carboxyhemoglobin = Hb + CO2

Front 28

What enzyme converts CO2 --> Carbonic Acid --> HCO3-?

Back 28

Carbonic Anhydrase

Front 29

What are the components of the erythrocyte plasma membrane?

Back 29

Integral proteins span lipid bilayer
- Band 3 (anion transporter)
- Ankyrin

Front 30

What is the function of Band 3?

Back 30

Anion transporter that exports HCO3- and binds Ankyrin

Front 31

What is the function of Ankyrin?

Back 31

Maintains biconcave shape of RBCs to "anchor" to the sub-plasmalemmal network

Front 32

What happens if there is a mutation in Ankyrin?

Back 32

Spherocytosis

Front 33

What happens in Spherocytosis? Cause?

Back 33

- RBCs are spherical, which causes problems in RBC distribution and turnover
- Caused by mutations in protein that maintain biconcave shape (ankyrin)

Front 34

What is found on the outer membrane of the RBCs?

Back 34

Antigens - carbohydrates (A and b) and individual proteins (Rh)

Front 35

How many members are there of the blood group system?

Back 35

33

Front 36

When does a patient have antibodies against a RBC antigen?

Back 36

If they DON'T have those antigens on their RBCs

Front 37

What is the lifespan of an RBC?

Back 37

120 days

Front 38

How many times does a RBC pass through a patients' capillary network during its lifetime?

Back 38

10^5 times

Front 39

What happens in anemia?

Back 39

Lower than normal RBC count

Front 40

What happens in polycythemia?

Back 40

Increased RBC number (hematocrit value >55%)

Front 41

What happens in erythrocytosis?

Back 41

Increased RBC mass (hematocrits value >55%)

Front 42

What can be responsible for hematocrit value >55%?

Back 42

- Polycythemia - increased RBC number
- Erythrocytosis - increased RBC mass

Front 43

What happens in β thalassemia?

Back 43

- β gene is mutated and protein is not made
- Affected adults have HbF instead of HbA

Front 44

What happens in sickle cell anemia?

Back 44

β-globin mutation (glutamic acid GAA --> valine GTA)

Front 45

What are WBCs doing in the blood?

Back 45

"Passing through" on their way to their working destination which is in the tissue spaces of the body

Front 46

How do leukocytes move through the tissues?

Back 46

Diapedesis

Front 47

What are the granulocyte WBCs?

Back 47

- Neutrophils
- Eosinophils
- Basophils

Front 48

What is the other name for Neutrophils? Why are they named as such?

Back 48

- AKA Polymorphonuclear Leukocytes (polymorphonuclear nucleus created by degradation of nuclear lamins during granulocyte development)
- Named for "neutral" staining which is neither eosinophilic or basophilic

Front 49

What causes the Polymorphonuclear Nucleus in Neutrophils?

Back 49

Nuclear lamina are degraded during granulocyte development

Front 50

What types of granules are in Neutrophils?

Back 50

- Lysosomal
- Specific (non-staining)

Front 51

What is the function of Neutrophils?

Back 51

* Kill bacteria:
1) Release specific granules --> degrades ECM --> degrades bacteria
2) Phagocytize bacteria
3) Release hydrolytic enzymes to create a respiratory burst (initiated by NADPH oxidase), which kills bacteria

Front 52

Neutrophils:
- Lifespan
- Size
- Percent of circulating WBCs

Back 52

- A few days
- 12 µm
- 34-71%

Front 53

What happens if there is a mutation in NADPH oxidase gene? What is this important for?

Back 53

- Causes persistent bacterial infections
- Important for killing of bacteria by neutrophils

Front 54

Eosinophils:
- Lifespan
- Size
- Percent of circulating WBCs

Back 54

- 2 weeks
- 1 µm
- 0-7%

Front 55

What is the shape of the nucleus in Eosinophils?

Back 55

Bi-lobed, not highly segmented like neutrophils

Front 56

What kind of granules are in Eosinophils?

Back 56

- Lysosomes
- Specific Granules (red = eosinophilic) contains Major Basic Protein

Front 57

What are the contents of Eosinophils?

Back 57

Crystalloid center that contains major basic protein

Front 58

What is the function of Eosinophils?

Back 58

- Kill parasites via major basic protein
- Phagocytize Ab:Ag complexes
- Secrete leukotrienes

Front 59

What does it mean if you have elevated Eosinophils?

Back 59

Parasitic infection or an allergic reaction (eg, asthma)

Front 60

What happens in an asthma attack?

Back 60

- Leukotrienes recruit eosinophils to lungs and induce them to make more leukotrienes

Causes:
- Blood vessel leakiness --> edema
- Bronchiolar cells --> constriction of airway
- Mucous glands --> mucus buildup

Front 61

Basophils:
- Lifespan
- Size
- Percent of circulating WBCs

Back 61

- Long-lived, a few years
- > 12 µm diameter
- 0-1%

Front 62

What is the shape of the basophil nucleus?

Back 62

Irregular, obscured by granules

Front 63

What is in the basophil specific granules?

Back 63

- Heparin
- Histamine

Front 64

What type of cell in tissues is similar to basophils in the peripheral blood?

Back 64

Mast Cells

Front 65

What activates basophils/mast cells?

Back 65

- Antigen invades causing a plasma cell to make IgE
- IgE binds to IgE-receptor on basophil/mast cell membrane, where it remains until later in life
- Later when same Ag is re-introduced, immediately binds IgE leading to degranulation

Front 66

What are the functions of basophils and mast cells?

Back 66

- Release specific granules (histamine and heparin)
- Release leukotrienes

Causes:
- Blood vessel leakiness --> circulatory shock
- Bronchiolar constriction --> respiratory insufficiency

Front 67

Which of the granulocytes has "memory"?

Back 67

Basophils - they last for a few years

Front 68

What are the types of Agranulocytes?

Back 68

- Monocytes
- Lymphocytes

Front 69

Monocytes:
- Lifespan
- Size
- Percent of circulating WBCs

Back 69

- Several months in tissue
- 15 µm
- 5-12%

Front 70

What is the largest WBC? How big?

Back 70

Monocytes - 15 µm

Front 71

What is the shape of the nucleus in a monocyte?

Back 71

Indented or horse-shoe shaped

Front 72

What is the function of monocytes?

Back 72

- Migrate into tissues and differentiate into macrophages --> phagocytosis
- Present antigens to lymphocytes during immune response

Front 73

What are the names of macrophages in:
- Lungs
- CT
- Liver
- CNS
- Bone
- Spleen

Back 73

- Lungs: dust cells
- CT: histiocytes
- Liver: Kupffer cells
- CNS: microglia
- Bone: osteoclasts
- Spleen: sinusoidal lining cells

Front 74

What is the size of lymphocytes?

Back 74

< 10 µm (variable depending on level of activity)

Front 75

How do you distinguish the types of Lymphocytes?

Back 75

B and T cells based on immunohistochemical detection of surface markers

Front 76

What are the functions of B and T lymphocytes?

Back 76

- Complementary function, defending against foreign invaders and cancer cells
- Immunologic memory - respond to only one antigen

Front 77

What do B lymphocytes differentiate into?

Back 77

Plasma cells that release antibodies

Front 78

What are platelets made from?

Back 78

Fragments of cytoplasm of giant precursor cells found in bone marrow called Megakaryocytes (i.e. cells with huge nuclei)

Front 79

What is the size of platelets and how many per µL?

Back 79

Small ~ 2 µm (300,000/µL)

Front 80

What is found in a platelet?

Back 80

- Granulomere - dark central region w/ granules containing clotting factors and growth factors (e.g. PDGF)
- Hyalomere - peripheral light region w/ parallel microtubules

Front 81

What does the Granulomere of the platelet look like and what is in it?

Back 81

Dark central region w/ granules containing clotting factors and growth factors (e.g. PDGF)

Front 82

What does the Hyalomere of the platelet look like and what is in it?

Back 82

Peripheral light region w/ parallel microtubules

Front 83

What is on the platelet membrane?

Back 83

Receptors

Front 84

What are the clinical concerns regarding platelets?

Back 84

- Thromboembolism
- Thrombocytopenia (too few platelets, ~50,000/µL)