c) Beta globulins
d) Alpha globulins
*Albumin, produced by the liver, makes up 60% of plasma proteins and is the main contributor to osmotic pressure.
Alpha & beta globulins, fibrinogen, gamma globulins, and albumin
1. Main contributor to osmotic pressure
2. Necessary for coagulation
3. Transport proteins that binds lipids, metal ions, and fat-soluble vitamins.
4. Antibodies released by plasma cells during immune response.
2. Fibrinogen: Necessary for coagulation.
3. Alpha & Beta globulins: Transport proteins that binds
lipids, metal ions, and fat-soluble vitamins.
4. Gamma globulins: Antibodies released by plasma cells
during immune response.
b) Heme group
c) Amino acids of globin
a) Hemopoietic stem cell (hemocytoblast)
d) Polychromatic erythroblast
d) Bone Marrow
a) A portion of the heme group
a) the pancreas
b) the kidneys
c) the liver
d) the spleen
*As RBCs are broken down, their hemoglobin is recycled. Bilirubin is a yellow pigment that results from the degradation of the heme groups and is released to the blood. The liver cells pick up the bilirubin and secrete it in bile. Once bile is secreted into the intestine, the bilirubin is converted to urobilinogen and is excreted with the feces.
a) decreased tissue demand for oxygen
b) an increase number of RBCs
c) moving to a lower altitude
d) hypoxia of EPO-producing cells
b) collagen fibers
a) Prothrombin activator
*The final steps in coagulation result in prothrombin activator catalyzing the conversion of prothrombin into thrombin and thrombin catalyzing the conversion of fibrinogen into fibrin. Fibrin serves as the scaffolding for tissue repair.
Heparin, Erythropoietin, Spectrin, Interleukins & CSFs, and Prostaglandin derivates such as Thromboxane A2
1. Produced by platelets
2. A fibrous protein that gives shape to an RBC plasma
3. Hormone that stimulates production of RBCs
4. Stimulates WBC production
5. Natural anticoagulant found in basophils
2. A fibrous protein that gives shape to an RBC plasma
3. Hormone that stimulates production of RBCs-
4. Stimulates WBC production- Interleukins & CSFs
5. Natural anticoagulant found in basophils- Heparin
a) liver disease
b) severe hypocalcemia
c) vitamin K deficiency
d) vascular spasm
An ambulance arrives at the scene of an automobile accident, having been summoned by an in-vehicle security system. What the emergency personnel find is like a scene from a horror film. Maggie Silvers, the apparent driver of the car, is sitting, slumped next to the vehicle, with blood covering her shirt and hands. Her car has clearly hit a tree: a branch is sticking into the driver’s window, and the airbag has been deployed. Maggie looks dazed, and as the paramedics approach she says with a mixture of panic and relief, “There’s blood everywhere!” Maggie is only semi-lucid as she babbles on about pushing out the broken glass in her car window.
Maggie, a 48-year-old woman, is, indeed, bleeding profusely from multiple left-arm cuts and an especially deep laceration on her left upper arm. The paramedics stop the bleeding and move her quickly to the ambulance, after noting no other apparent injury. Her systolic blood pressure is 80 mm Hg (low), and her diastolic is not audible (too low to hear). Her heart rate is 122 bpm (very rapid), and her skin is pale and clammy, indicating peripheral vasoconstriction (narrowing of her blood vessels, particularly in the skin) and circulatory shock-like signs. On the way to the hospital, a paramedic begins transfusing normal saline solution (NSS; water with some NaCl, similar to body fluids, given directly into her vein).
A fast hematocrit (HCT) test upon Maggie’s arrival to the emergency department (ED) indicates that her HCT is low, but normal. Several vials of Maggie’s blood are also sent to the lab for blood tests and typing. Two liters of NSS are transfused over the next hour while the ED physician sutures her deepest, left-upper-arm laceration. Despite no further bleeding since the paramedics treated her at the scene, Maggie’s next HCT, tested one hour after the original HCT, drops to below normal. Aside from her present health problem, Maggie is otherwise healthy. She is admitted to the hospital for overnight observation.
The three types of formed elements of blood are ________.
a) plasma proteins, erythrocytes, and leukocytes
b) erythrocytes, leukocytes, and plasma
c) leukocytes, plasma proteins, and platelets
d) leukocytes, platelets, and erythrocytes
*The three formed elements are leukocytes, platelets, and erythrocytes. When blood is separated by centrifuge, these components settle to the bottom of the tube. Together, they are referred to as the packed cell volume.
The two most abundant components of whole blood, in order of most abundant and second-most abundant, are _________.
a) leukocytes, erythrocytes
b) plasma, erythrocytes
c) plasma, leukocytes
d) erythrocytes, platelets
*Approximately 55% of whole blood is the nonliving plasma. Erythrocytes make up about 45% of whole blood. Together, leukocytes and platelets make up less than 1% of whole blood.
Maggie’s cuts are successfully treated, and the physician elects not to transfuse any blood products. A week later she visits her primary physician to have her sutures removed, and her hematocrit has improved. Calculate this HCT: the total volume is 5 ml, and the plasma volume is 3.4 ml. Is it normal?
a) 32%. This value is low for a woman.
b) 32%. This value is normal for a woman.
c) 74%. This value is high for a woman.
d) 46%. This value is normal for a woman.
*In this question, students must calculate packed cell volume by subtracting the plasma volume value from the total blood volume (5 – 3.4 = 1.6 ml); then, 1.6/5 ml × 100 = 32%. The normal hematocrit in healthy females is approximately 42% ± 5%, and in a healthy male, it is 47% ± 5%.
Assuming all of the following fluid-replacement options are equal (with respect to risks, availability, and cost), which would be the most optimal for Maggie when you consider her significant blood loss?
a) normal saline solution (no RBCs, just water and NaCl that is the approximate consistency of plasma minus the proteins)
b) whole blood (blood that is the normal consistency of blood in the body)
c) packed cells (concentrated RBCs with most plasma removed)
d) free water (no added solutes)
*The optimal replacement is whole blood because the patient has lost red blood cells and plasma in equivalent amounts. That is, she needs both RBCs and plasma replacement.
A test tube of Maggie’s blood goes unused in the lab, and the stagnant blood coagulates. This is due to which pathway of blood clotting?
a) extrinsic pathway
b) intrinsic pathway
*The test-tube blood is outside the body, so factors in the blood itself (intrinsic), such as activated platelets, are responsible for initiating the clotting sequence.
In the laboratory, the technician determines Maggie’s blood type. Maggie’s blood agglutinates in anti-A antibodies, but has no reaction in anti-B or anti-D antibodies. What is Maggie’s blood type?
*Agglutination in anti-A antibodies indicates there are A antigens on Maggie’s RBCs. The absence of reaction in anti-B antibodies indicates that there are no B antigens, and so the ABO blood type is A. No agglutination in anti-D antibodies indicates that there are no D antigens on Maggie’s RBCs and, therefore, the Rh is negative.
What blood type(s) can Maggie safely receive?
B+ and O+
A- and O-
*Clearly A- matches her blood type; her plasma, therefore, has anti-B antibodies that will destroy any RBCs with B antigens on their surfaces. She can also receive O-; O will not cause a transfusion reaction because it has no B antigens on the surfaces of the RBCs. Rh+ blood cannot be safely infused because Maggie may have developed (e.g., through pregnancy with an Rh+ baby) anti-D antibodies, which would cause a transfusion reaction with Rh+ blood.
If Maggie needed a blood transfusion immediately upon her arrival to the ED, before her blood type could be established, what type could be safely transfused?
No blood type can be safely transfused into every person.
*Type O blood has no A or B antigens on the RBC surface, so, no matter the antibodies in the recipient’s plasma, there will not be a transfusion reaction with O blood. Rh- blood will not have D antigens on the RBC surface, so anti-D antibodies in the recipient’s plasma will not cause a transfusion reaction with Rh- RBCs.
The infusion of mismatched blood causes a “transfusion reaction” in which the infused RBCs go through __________.
a) inflammation-induced anticoagulation
b) excessive coagulation
d) agglutination and hemolysis
*In a transfusion reaction, the infused RBCs are attacked by the recipient’s plasma agglutinins (antibodies), causing the cells to “clump” (agglutinate) and clog smaller blood vessels. They eventually rupture (hemolysis), releasing Hb into the bloodstream. The free Hb can accumulate in the kidneys, potentially leading to acute renal failure and death.
The “fast hematocrit” involves withdrawing a very small amount of blood via a finger prick into a thin capillary tube, spinning the sample in a centrifuge so that it separates into its components, and then measuring the components. In Maggie’s case, the total blood volume in the capillary tube is 20 mm, the packed cell volume (red blood cells) is 7.1 mm, and the plasma portion measures 12.9 mm. Calculate Maggie’s first hematocrit.
*Hematocrit is the percentage of total blood volume that is comprised of RBCs. Using the centrifuge on a sample of blood separates out the heavier components (mostly RBCs) from the lighter plasma, and each component can then be measured. Knowing a sample’s total amount in any unit (total blood volume) and the packed cell volume (in the same units), one can calculate the HCT.
In the ED, blood is withdrawn from the vein and into a test tube. The packed cell volume (RBCs) is 1.45 ml, and the plasma volume is 3.55 ml. Calculate Maggie’s hematocrit in the ED.
*In order to calculate HCT, one must know two of these three values: packed cell volume, total blood volume, plasma volume. Packed cell volume + plasma volume = total blood volume.
Explain why the HCT drops despite no further loss of blood.
Why do you think paramedics gave normal saline solution (NSS) and not blood in the ambulance?
Why might a physician be reluctant to order a blood transfusion for Maggie, or for any patient for that matter, unless absolutely necessary?
Any blood transfusion carries with it an increased risk of transfusion reaction, though crossmatch screening processes are strict when followed.
Though rare (due to thorough screening procedures), blood may carry blood-borne diseases such as hepatitis, human immunodeficiency virus, malaria, etc.
Given time, an otherwise healthy body has the ability to replace its own red blood cells.
Blood is more expensive to obtain, process, and store than saline solution.
Despite no blood transfusion, Maggie’s hematocrit improves by the time she visits her physician for the removal of her sutures a week later. [See multiple choice question 3 for the calculation.] She is adequately hydrated. Explain the physiological mechanism for the improvement in her hematocrit.
Besides the HCT, what other component of blood could be measured to give a better understanding of oxygen-carrying capacity? Explain your answer.
Explain the relationship between Maggie’s low blood pressure (when the paramedics first examine her) and her blood loss. How are her rapid heart rate and pale, clammy skin related to her low blood pressure?