Download PHY REV 1 HEM - neutralposture

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REVIEW OF HEMATOPOEITIC SYSTEM PHYSIOLOGY
T / F / Answer
Year 1/Sem 2 MBBS Batch 2011/12
Statements or Questions
All cellular elements in the blood are derived from …………………………………..
Erythropoietin (EPO), a cytokine, is a hormone produced by the …………. (90%) that functions
as a targeted erythroid growth factor. Another 10% of EPO is produced by the ……………..
………………………………. and ………………………are two dietary factors necessary for proper
red cell production.
Chemical signals such as ………………………….and …………………… are uniquely responsible
for promoting a specific lineage of cell; targeting specific cell stages and then control replication,
clonal or lineage selection, right up to maturation rate and growth inhibition of stem cells.
Individuals with beta thalassemia fail to produce ……………………..
In thalassemias, the structure of the hemoglobin is normal but fewer molecules are produced.
Because globin production is down but iron uptake continues, the body may develop an excess
amount of iron, which can be seen in the form of ………………………………… granules within
the cells.
Vitamin B12 is absorbed in the stomach with the help of …………………………………..and
Vitamin B12 deficiency leads to ………………………………………….
The EPO through the receptors on the …………………………….., the youngest red cell
precursor in the bone marrow; has the ability of to stimulate RBC production.
…………………………………………….. is a stem cell dysfunction, that produces too many blood
cells, both white and red. Hematocrit can go as high as …………………………% causing higher
viscosity of blood and resistance to flow.
Polycythemia vera is easily treated by removing some blood if the hematocrit
goes above 55%. This treatment is known as therapeutic bloodletting.
Polycythemia vera can occur in people who live in hypoxic conditions at high altitude.
Thalassemia, an inherited disease, is a kind of leukemia.
In people who have been taking large doses of oral antibiotics, there is sometimes a deficiency of
Vit ……..?
…………………………..of the bone marrow secrete growth factors [CSF-1, M-CSF), GM-CSF,
and G-CSF] necessary to maintain multipotent stem cells and to promote their growth and
division into committed stem cells of various lines.
Serum is plasma minus the ……………………………and it is formed during …………………….
Pathological condition in which the coagulation pathways are hyperstimulated, either excessive
fibrin disposition or excess fibrinolysis.
Two integral proteins in the red cell structure that house red cell antigens.
………………………is used to define decrease in hemoglobin content of the RBCs.
In which conditions can you see elliptocytes?
A red cell inclusion that originates as a result of denatured hemoglobin.
Large variation in the size of RBCs is referred to as ……………………….while the presence of
irregularly shaped RBCs is referred to as ……………………………
Life span of RBCs; 120 days but life span for neutrophils is ……………………………………..
White cells have a much [ higher / lower ] rate for normal hematopoiesis.
As anemia develops and becomes more severe, the patient becomes symptomatic and the
kidney senses hypoxia due to a decreased …………………..level.
In an anemic event, ……………………. (stress reticulocytes, large polychromatophilic red cells)
and nucleated red cells, will be observed in the peripheral blood smear.
The …………………………………… consists of 9 components of hematological data to interpret
and review in relation to the health of the bone marrow, represented by the numbers and types of
cells in the peripheral circulation; including WBC count, RBC count, platelet count, Hgb,
hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular Hgb (MCH), mean
corpuscular Hgb content (MCHC), and red cell distribution width (RDW).
A decreased ………………………… count may also be seen in aplastic conditions, where the
production of either white or red cells or both is seriously impaired, thus making it an important
indicator of bone marrow function.
EPO production is increased in response to hypoxia (anemia), and …………… ……………….in
the bone marrow (the condition in which there are more red cell precursors than white cell
precursors being produced) is clear evidence of rapid generation.
One of the most stable CBC parameters over time and it Increases as a result of transfusion,
reticulocytosis, and hyperglycemia is ………………………….
Morphological classification of anemias is determined by the red cell indices. For example,
…………………., ………………….anemias are characterized by an MCV of greater than 100 fL.
Patients on ……………………… drugs are asked to take daily vitamin supplements lacking
Vitamin K as well as restrict eating foods rich in Vitamin K, such as cabbage, broccoli, and liver.
The tightening of fibrin clot in such a way that the ruptured area of the vessel gets smaller and
smaller, thus decreasing hemorrhage is known as ………………………………..
Lack of Vit B12 and folic acid (Vit B9) results in diminished quality of DNA and consequently
failure of nuclear maturation, division and proliferation and finally, RBC becomes larger than
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normal, developing into ……………………………. and shorter life-span (~40 days).
Intrinsic factors which combine with Vit B12, is secreted by the …………(? cells ) …………… of
the gastric gland.
When RBCs reached the end of their lifespan, they will be destroyed by the ……………………
system and the free iron liberated can be stored in the ………………………..pool or reused for
formation of Hb.
Synthesis of hemoglobin begins when RBC is in the ………………………… stage and continues
into the reticulocytes stage, at which point the cell leaves the bone marrow and passes into the
bloodstream.
Transferrin is ingested via endocytosis into the erythroblasts along with the bound iron, which is
then delivered directly to the ………..……………..where heme is synthesized.
It is not known where in the kidney is EPO formed, but one possibility is the ……………….......
When there is serious infection, total lifespan of granulocytes is often (prolonged / shortened).
Neutrophils and macrophages are guided by ……………………….to move through the tissues to
get to the inflamed areas.
Mast cells and basophils liberate heparin which prevents blood coagulation, as well as histamine,
……………and …………………; which contribute to the inflammation process.
The intrinsic clotting path way is initiated when Factor ……. (………………Factor) is activated by
contact with exposed collagen at the damaged vessel surface or by contact with foreign surface.
The extrinsic clotting pathway is initiated when Factor …... activated halfway the intrinsic
pathway; is then activated by tissue thromboplastin released from damaged tissue.
………………. causes platelets to aggregate in positive-feedback fashion.
Factor ……… stabilizes the clot at the end of the clotting cascade.
State the blood abnormalities based on these causes. [Q46-53]
Associated with living at high altitudes such as the Alps or Himalayas
Deficiency of intrinsic factor
Lack of iron for sufficient hemoglobin synthesis
Bone marrow destruction
Excessive rupture of circulating RBCs
Inadequate secretion of Erythropoietin
Tumor-like condition of the bone marrow
Abnormal loss of blood
A situation with widespread clotting in which bacteria or their toxins initiate the clotting cascade.
When no longer needed, clots are dissolved by ………………………., the fibrinolytic factor also
activated by exposed collagen.
Three main steps in hemostasis are
(i) ……………………………………
(ii) ……………………………………
(iii) ……………………………………
Target cells of the …………………. include body cells invaded by virus and cancer cells.
Bone marrow will greatly slow down or even stop production of WBCs when it is exposed to
(i)……………………………………………………………………
(ii)……………………………………………………………………
Platelets are derived from cells called ……………… and its production is regulated by …………
Timed test to measure the blood’s ability to clot is ………………………..and ……………………..
Patients on drug therapy such as Coumadin will have (increased/decreased) blood clotting time,
while monitoring the effectiveness of ………………reflects the well being of thromboplastin
system.
Fresh, green, leafy vegetables including spinach, cabbage, lettuce, broccoli, kale, cauliflower is
rich with Vit K (a.k.a ………………………….factor) while meats, clams, oysters, seafood, eggs,
milk contain Vit …………. (aka …………………………………………..factor)
Splenectomy leads to (increased/decreased) number of platelets.
COPD and higher altitude can cause an (increased/decreased) level of hemoglobin.
A patient suffering from systemic lupus erythematosus has renal and hepatic damage. How
might that damage affect her blood?
 Her kidneys may not make enough ………., causing her to be ……………..
 Her liver may not make enough ……….., causing her to bleed more profusely.
(ADP, fibrinogen, thromboxane A2, serotonin, platelet-derived growth factor) is NOT normally
found inside platelets.
Platelet plug doesn’t continue to develop and expand over the surface of adjacent normal vessel
lining because activated platelets release ADP to further stimulate the release of ……………..and
……………. which profoundly inhibit platelet aggregation.
Unwanted/Inappropriate clot are prevented from forming because fibrin is quickly disposed of by
fibrinolytic activity of plasmin activated by ………………………………
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Normal form of hemoglobin in adults, HbA have (higher/lower) affinity to oxygen than HbF while
the abnormal form of hemoglobin, ………………caused RBC to warp into fragile, sickle-shaped
cells.
The first effective drug therapy approved for treatment for sickle-cell anemia, is hydroxyurea.
What would the action of this drug be?
……………………………………. is carried out by cytotoxic T cells, in which they seek and
recognize tumor antigens and destroy the tumor cells.
When there is extreme emergency where crossmatching cannot be done, blood group
……………..can be transfused.
In a mismatched blood transfusion, where group A blood is transfused into a person who has B
group blood, [donor’s/recipient’s] RBCs are clumped and lysed but the [donor’s/recipient’s]
RBCs are not harmed.
Choose one answer: A shift in the oxygen-hemoglobin dissociation curve to the right occurs in
[hypothermia / acidosis / fetal hemoglobin].
During hemoglobin recycling in the spleen, heme is initially converted into…………………………..
The heme portion of hemoglobin is eventually to converted into …………………………in the
large intestine and into urobilin in the kidney.
The clotting factor that plays an important role in activating two positive feedback loops to
accelerate coagulation.
Bleeding time is [increased/decreased] in blood transfusion, von Willebrand's disease and
disseminated intravascular coagulation (DIC).
The blood pH is ……….. The blood volume would be around 5 liters and there would be between
5 and 7 x109 leukocytes per liter.
Ratio of platelet to RBC is ……………. And main clotting factors are secreted by the ………….
Platelets aggregate in the presence of X and prostacyclin antagonizes the action of X.
Q: X is most probably …………………………………
Macrocytic anemia develops due to deficiency in …………..and ……………….
Reticulocytes count [increases / diminishes] in hemolytic anemia and [increases / diminishes] in
bone marrow hypoplasia.
The substance which is the major cause of pain in an acute inflammatory response: ……………..
Senescent RBCs contribute heme for new Hb synthesis. Iron released by macrophages is
transported if ferric state in plasma bound to …………………, which is then internalized by cells
ad then reduced to ferrous state; incorporated into new heme or stored as ……………………. A
portion of this stored substance is catabolised to ………………….. , an insoluble crystalline
compound, whose accumulation can result in damage to vital organs.
Neutrophils engulf invading bacteria by phagocytosis, facilitated by host defence proteins known
as ……………………; followed by vacuolization, which activated membrane NADPH oxidase
leading to secretion of superoxide in a process called …………………………………..
High-affinity FcE receptors are expressed on the membranes of cells such as ……..………….and
………………………which bind to antigen-complexed IgE; thus initiating phagocytosis of antigen
and killing of pathogen.
For question 89-92 :
Given that a patient has the following data;
hematocrit = 45%, RBC count = 5 x1012 cells/L and hemoglobin content = 150 g/L.
[Note : Each gram of Hb can combine with and transport 1.34 mL of oxygen, and for each 1 mm of Hg of arterial oxygen
pressure
(PaO2), there is 0.003 mL of oxygen dissolved in a deciliter of blood.]
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Find the mean corpuscular (cell) volume, MCV. [1 fL = 10-15 L]
Find the mean corpuscular (cell) hemoglobin (MCH) value.
Find the mean corpuscular (cell) hemoglobin concentration (MCHC) value.
Oxygen carrying capacity (OCC) is the maximum amount of oxygen that can be carried in a
deciliter (100 mL) of blood (bound to Hb or dissolved in plasma).
OCC = (blood hemoglobin x 1.34) + (0.003 x PaO2).
Find the OCC of the patient.
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ESR can be an important diagnostic index, significantly elevated in patients with infection,
autoimmune diseases, and inflammatory diseases. It implies that cells tend to sediment faster
when concentration of plasma protein increases. One explanation is that high plasma protein
favours cell stacking i.e the ……………………formation and hence elevate ESR.
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A patient who came to the emergency room with a broken leg at first showed WBC count of 22 x
103/mm3. Six hours later, his second WBC count was 7 x 103/mm3. This suggests that the initial
WBC count in the first test was due to [inflammatory response / mechanical trauma].
Table of some normal test values:
Test
RBC count
Hematocrit
Hemoglobin, blood
Mean corpuscular volume MCV
Reticulocyte count
Platelet count
WBC count
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Normal values
M : 4.3 - 5.9 million/mm3.
F : 3.5 - 5.5 million/mm3.
M : 41- 53%
F : 36 - 46%
M : 13.5 -17.5 g/dL
F : 12 – 16 g/dL
25.4 – 34.6 pg/cell
0.5 – 1.5 % of red cells
150 000- 400 000/mm3.
4500-11 000/mm3.
Lab values of a 64-year-old man:
RBC count = 8.5 million/mm3
Hemoglobin = 21 g/dL
Hematocrit = 60%
Plasmaosmolality = 295mOsm/L (…which is normal)
Other complaints: dizziness and visual disturbance. Which is the most likely explanation for this
presentation?
What would be the recommended treatment for this above patient?
A dentist noticed an unusual sore on the lip of his patient, but there is no pain or drainage. It was
learnt later that the patient was admitted to the hospital with violent shaking chill. Lab values of
this patient are
Hematocrit = 30%
Platelet count = 400 000/mm3.
WBC count = 3100/mm3.
Lymphocytes = 68%
Neutrophils = 20%
A. Dehydration
B. Vit B12 deficiency
C. Polycythemia
D. End-stage renal disease
A. Non-treatable infection
B. Acute leukemia
C. Aplastic anemia
D. Leucopenia
Which is the most likely explanation for this presentation?
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Lab values of a 4-year-old girl who came in with severe, uncontrolled nosebleed.
Hemoglobin = 4.6 g/dL
WBC count = 4000/mm3.
Platelet count = 14 000/mm 3.
Reticulocyte count = 0.1%
Other complaint: Temperature 39°C, pale, numerous small bruises on limbs, and has received
treatment for an ear infection 6 months ago. Which is the most likely explanation for this
presentation?
Lab values of a 25-year-old African American from Los Angeles, who came in 3 hours after an
onset of severe back and chest pain, which started while he was skiing.
Hemoglobin = 11 g/dL
WBC count = 22 000/mm3.
Reticulocyte count = 25%
He had the same symptoms 5 years ago when he was at a northern region in America. Which is
the most likely explanation for this presentation? He could be having …………………………
A 40-year-old man came to the ER with a 2-week history of diarrhea which has progressively
worsened over last several days. He has minimal urine output and is warded for dehydration. His
stool specimen is positive for parasitic eggs. Which type of WBC would show elevation in his
blood smear?
A. Hereditary spherocytosis
B. sickle cell anemia
C. aplastic anemia
D. hemolytic anemia
A. Hereditary spherocytosis
B. sickle cell anemia
C. polycythemia
D. End-stage renal disease