Patho unit 3 ch19

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Patho unit 3 ch19
2013-10-01 14:11:45
Patho unit ch19

Patho unit 3 ch19
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  1. Blood plasma
    • Straw colored liquid portion of unclotted blood
    • 55-60% of blood volume
    • 92% water
    • 8% solutes
    •   -7% plasma proteins: Albumins, Globulins, Fibrinogen
    •   -1% other solutes: electrolytes, nutrients, gases, hormones, wastes
  2. Albumin
    • A low-molecular-weight plasma protein synthesized in the liver
    • contributes to blood viscosity and maintains blood pressure
    •   - does not diffuse freely across the vascular endothelium
    • Acts on an osmotically-active carrier molecule- carries billiruben
  3. clotting factors
    • Soluble factors (protiens) that are activated to produce a insoluble clot
    • Fibrinogen (factor 1) is the most plentiful
    • They promote clotting in a cascading fashion
  4. Red blood Cells (RBC)/ Erythrocytes
    • lifespan 80-120 days
    • Functions in gas transport
    • high surface-to-volume ratio
    • reversible deformity
  5. Why would a biconcave disc be a better shape for a RBC than a sphere?
    it has a high surfac-to-volume ratio
  6. Hematocrit (Hct)
    • % of whole blood volume occupied by red blood cells
    • Females: 38-46% 
    • Males: 40-54%
  7. Hemoglobin (Hgb)
    • Oxygen carrying molecule
    • Heme (4) +4 globin proteins
    • 14-16 g/dl
  8. RBC count
    4.00-6.00 x 106/mm3
  9. Lymphatic system
    • A system consisting of organs and lymph vessels through which lymphatic fluid passes.
    • It functions to:
    •  -drain interstitial fluid
    •  -Transport dietary lipids absorbed by the GI tract to the blood 
    •  -Facilitate an immune response
  10. Lymphatic Organs
    • Primary: Thymus, bone marrow
    • Secondary: spleen, lymph nodes, tonsils, and Pever Patches of the small intestine
    • Lymph organs ling the hematologic and immune system.
  11. structures in the lymphatic system
    • Lymph Vessels- pass through lymph nodes
    • Lymph Nodes- full of WBCs waiting for invaders
    • Right and left lymphatic duct
    • Tonsils
    • spleen
    • Thymus
    • Bone marrow
  12. Spleen
    • Filters and cleanses the blood from foreign invaders
    • Contains masses of lymphoid tissue (whit pulp)
    • Remove old or damaged cells from the blood
    • Storage area for extra blood that can be released by sympathetic stimulation
    • Storage of platelets, up to 1/3 of blood supply
  13. Lymph Nodes
    • Serve as filters for lymph fluid
    • Foreign objects are trapped and destroyed
    • Important groups of lymph nodes: submandibular, cervical, axillary, inguinal
    • Lymph node enlargement may often indicate a pathological condition
  14. Hematopoiesis
    • Formed element production
    • Cells are formed in red bone marrow from pluripotent stem cells and mature in bone marrow or lymphoid tissue (spleen, thymus, tonsils, lymph nodes)
  15. Totipotent
    • a cell that can produce any kind of cell
    • Ex: Fertilized egg
  16. Pluripotent stem cells
    can become many different things (cells) but not everything
  17. Unipotent
    gives rise to only one thing
  18. Impotent/ terminally differentiated cells
    cant produce cells anymore.
  19. Hematopoiesis and cytokines
    Hematopoietic cells will develop, proliferate, and differentiate if they are provided with specific growth factors (Colony stimulating factors)
  20. Colony stimulating factors (CSF)
    • These cytokines act as hormones to stimulate the proliferation of progenitor (early) cells
    • Specific CSFs are necessary for growth of myeloid, erythroid, lymphoid and megakaryocitic cells
  21. Hematopoiesis and cytokines
    See table in study guide. p.113
  22. Alpha and Beta globulins
    Act individually as carrier molecules. Collectively, they control blood osmotic pressure
  23. Gamma globulins
    Immunoglobulins or antibodies. Made by plasma cells (activated B lymphocytes)
  24. Granulocytes
    Neutrophils, Eosinophils, Basophilsmost die doing their jobslife span .5-9 days
  25. Agranulocytes
    Monocytes/Macrophages, Lymphocyteslymphocytes live from days to decadesmonocytes live for several monthsphagocytes or immunocytes
  26. Leukocytosis
    • Increase in WBC count >10 thousand (10 x 10^3/mm^3)
    • *Normal physiological response to disease, up to a certain point
    • Occurs in both viral and bacterial infections
  27. Leukopenia
    • Decrease in WBC count < 5 thousand (5 x 10^3/mm^3)
    • *Never a normal response
  28. G-CSF (Granulocyte colony stimulating factor)
    • Cell Origin: Macrophage, fibroblastCell
    • Stimulated: Granulocytes
  29. GM-CSF (Granulocyte, Monocyte colony stimulating factor)
    • Cell Origin: T cellCell
    • Stimulated: Neutrophil, Macrophage
  30. Intrinsic pathway
    Activated by contact with the injured vessel (collagen and endothelium)
  31. Common pathway
    Extrinsic and Intrinsic converge here with Factor X
  32. Thrombocytes (Platelets)
    • Cell fragmants
    •   -150-400x10/mm3
    • originate from megakaryocytes
    • Aids in clotting by clumping (agglutination) and the release of biochemical mediators
    • Thrombocytopenia: Low platelet count
    • Thrombocytosis: Increased platelet count
  33. the clotting cascade
    • positive feedback system
    • Begins with the activation of several soluble, inactive clotting factors stimulated in cascading fashion
    • Two main pathways:
    •   -Extrinsic Pathway- activated by things out side of us
    •   -Intrinsic Pathway- activated by things inside of us
    • Both systems or pathways merge at a common point, forming the common pathway
    • coagulation is usually fast and localized
  34. Stages of coagulation
    • Extrinsic and intrinsic activation 
    • the common pathway begins with the formation of prothrombinase (prothrombin activator)
    • The prothrombin activator activates prothrombin to thrombin
    • Thrombin induces the formation of fibrin from fibrinogen
  35. Clot Retraction
    • After 30-6- min, the platelets contract 
    •   -platelets contain actin and myosin proteins
    •   -this squeezes out the serum
    • The clot becomes impacted and the edges of the blood vessel are brought closer together
    • Healing is also begining
    • -Smooth muscle cells & fibroblasts are stimulated to divide
    • Endothelial cells begin to restore endothelial lining of the vessel
    • Now the clot has to remove
    •   -Fibrinolysis- breaking apart the clot
  36. Fibrinolysis
    • Removing a clot
    • Large amounts of plasminogen (a plasma protein) are incorporated into clots
    • when endothelial cells produce tissue plasminogen activator (TPA), it causes the plasminogen to become plasmin
    • Factors within the coagulation cascade (factor XII and thrombin) also change plasminogen into its active form, plasmin
    • Either way when plasmin is formed it digests clots
    •   -TPA ("clot buster") is widely used in stroke/MI patients.
  37. Bone Marrow biopsy
    • Small amounts of bone marrow tissue are removed from the bone and observed microscopically 
    • Usually collected from the posterior iliac crest
    • Assists in the diagnosis of: anemias, leukemias, platelet, disorders, immunoglobulin disorders, etc
  38. Complete Blood Count
    • White blood cell (WBC) count
    • Whit blood cell differential
    • Red blood cell (RBC) count
    • Hemoglobin
    • Hematocrit
    • Platelet count
    • MCV
    • MCH
    • MCHC
    • Red cell distribution width (RDW)
  39. Whit blood cell differential
    • Physicians use the percentage of the individual white blood cells in the blood to aid in the diagnosis of specific diseases 
    •   -
  40. Coagulation tests
    • Prothrombin Time/ International Normalized ratiio (PT/NR)
    •   -Measures the extrinsic pathway
    •   -Usually to check status after anticoagulent administration
    • Activated Patial Thromboplastin Time (APTT)
    •   -Measures the intrinsic pathaway
    • Bleeding Time
    •   Measures platelet function, not platelet number
    •   -New instrumentation is replacing this test
  41. Reticulocyte count
    • Low retic count (<0.5%) indicates low rate of erythropoiesis
    • High retic count (>1.5%) indicates high rate of erythroopoiesis