A&P Bio 103B Mastering HW Blood

What is the average normal pH range of blood?
a) 7.35-7.45
b) 7.75-7.85
c) 4.65-4.75
d) 8.35-8.45
a) 7.35-7.45
Which plasma constituent is the main contributor to osmotic pressure?
a) Fibrinogen
b) Albumin
c) Beta globulins
d) Alpha globulins
b) Albumin

*Albumin, produced by the liver, makes up 60% of plasma proteins and is the main contributor to osmotic pressure.

Match the words in the left column to the appropriate blanks in the sentences on the right.
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.

1. Albumin: main contributor to osmotic pressure.
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.
Which part of the hemoglobin molecule binds carbon dioxide for transport?
a) Spectrin
b) Heme group
c) Amino acids of globin
d) Iron
c) Amino acids of globin
What is a young, anucleate erythrocyte called?
a) Hemopoietic stem cell (hemocytoblast)
b) Reticulocyte
c) Proerthroblast
d) Polychromatic erythroblast
b) Reticulocyte
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What part of the body does erythropoietin (EPO) target to increase erythropoiesis?
a) Liver
b) Lungs
c) Kidneys
d) Bone Marrow
d) Bone marrow
What part of the hemoglobin molecule is recycled to form bile?
a) A portion of the heme group
b) Ferritin
c) Globin
d) Iron
a) A portion of the heme group
Bilirubin is cleared from the body by __________.
a) the pancreas
b) the kidneys
c) the liver
d) the spleen
c) the liver
*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.
Which of the following might trigger erythropoiesis?
a) decreased tissue demand for oxygen
b) an increase number of RBCs
c) moving to a lower altitude
d) hypoxia of EPO-producing cells
d) hypoxia of EPO-producing cells
During which event of hemostasis do clotting factors (procoagulants) assist with the transformation of blood from a liquid to a gel? Select from letters A-D. Figure 17.13 Events of hemostasis on p. 646
a
b) collagen fibers
c) platelets
d) fibrin
D
What “clot buster” enzyme removes unneeded clots after healing has occurred during fibrinolysis?
a) Thrombin
b) Plasminogen
c) Fibrin
d) Plasmin
d) Plasmin
What protein involved in coagulation provides the scaffolding for tissue repair?
a) Prothrombin activator
b) Fibrin
c) Thrombin
d) Fibrinogen
b) Fibrin

*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.

Match the following.
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
membrane
3. Hormone that stimulates production of RBCs
4. Stimulates WBC production
5. Natural anticoagulant found in basophils
1. Produced by platelets- Prostaglandin derivates such as
Thromboxane A2
2. A fibrous protein that gives shape to an RBC plasma
membrane- Spectrin
3. Hormone that stimulates production of RBCs-
Erythropoietin
4. Stimulates WBC production- Interleukins & CSFs
5. Natural anticoagulant found in basophils- Heparin
All of the following conditions impair coagulation except ________.

a) liver disease
b) severe hypocalcemia
c) vitamin K deficiency
d) vascular spasm

d) vascular spasm
Clinical Case Study: Blood Everywhere: A Case on Blood
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.
Case Study part A

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

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.

Case Study part B

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

b) plasma, erythrocytes

*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.

Case Study part C

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.

a) 32% this value is low 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%.

Case Study part D

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)

b) whole blood (blood that is the normal consistency of the blood in the body)

*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.

Case Study part E

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

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.

Case Study part F

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?

B-
A+
A-
B+

A-

*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.

Case Study part G

What blood type(s) can Maggie safely receive?
B+ and O+
A- and O-
O- only
A- only

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.

Case Study part H

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?
O+
No blood type can be safely transfused into every person.
O-
AB-

O-

*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.

Case Study part I

The infusion of mismatched blood causes a “transfusion reaction” in which the infused RBCs go through __________.
a) inflammation-induced anticoagulation
b) excessive coagulation
c) erythropoiesis
d) agglutination and hemolysis

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.

Case Study part J

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.

6.1/19.0 × 100 = 35.5% (low normal).

*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.

Case Study part K
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.
1.45 + 3.55 = 5.0 (total blood volume); 1.45/5.0 × 100 = 29% (low).
*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.
Case Study part L
Explain why the HCT drops despite no further loss of blood.
*When Maggie bled profusely, she lost equal amounts of RBCs and plasma. However, when the doctors replaced the loss they used NSS only; so, although total blood volume and plasma volume increased, RBCs were not replaced. Thus, RBC volume did not increase proportionally with water volume. The percentage of RBCs to total blood volume (HCT) dropped. The HCT is influenced by hydration status of the body.
Case Study part M
Why do you think paramedics gave normal saline solution (NSS) and not blood in the ambulance?
*Normal saline was given because the most immediate known problem was Maggie’s low blood pressure due to the loss of blood volume. She was showing signs of circulatory shock. Low blood pressure could diminish adequate perfusion to vital organs. A rapid NSS infusion will restore some volume and improve blood pressure. Also, NSS, unlike blood, can be easily stored on the ambulance, does not require special refrigeration, and has a longer shelf life. It is usually abundantly available (compared to blood) and presents no risk of a transfusion reaction.
Case Study part N
Why might a physician be reluctant to order a blood transfusion for Maggie, or for any patient for that matter, unless absolutely necessary?
*Blood is sometimes (and in some communities) in short supply and should be used only when 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.
Case Study part O
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.
*When RBCs are lost, HCT drops, and this leads to low oxygen delivery to the tissues (hypoxia). Hypoxia is a signal for the kidney to secrete erythropoietin (EPO). EPO is a hormone that targets red bone marrow to produce more red blood cells, which then restores HCT to normal. This is a negative feedback mechanism.
Case Study part P
Besides the HCT, what other component of blood could be measured to give a better understanding of oxygen-carrying capacity? Explain your answer.
*Hemoglobin (Hb) is an index of oxygen-carrying capacity; it is the actual molecule within an RBC that binds oxygen. A normal Hb value for healthy females is 12-16 g/100 ml of blood, and for healthy males it is 13-18 g/100 ml. Typically, HCT and Hb are measured and evaluated together to give a fuller hematological understanding.
Case Study part Q
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?
*Maggie lost a significant amount of blood volume due to bleeding. When blood volume drops, blood return to the heart is diminished (decreased preload), and cardiac output drops. Blood pressure is determined by cardiac output (stroke volume × heart rate) and peripheral vascular resistance. So, when cardiac output is diminished, the blood pressure drops. It’s helpful to recognize primary versus secondary (compensatory) responses. The drop in blood pressure in this case is a primary effect of significant blood loss. A secondary and compensatory effect is for heart rate to increase in an attempt to restore cardiac output, and increased peripheral vasoconstriction, in order to maintain perfusion pressure. These compensations (an effort to maintain circulatory homeostasis) are driven by the sympathetic nervous system. A rapid heart rate and clammy skin are physiological signs of cardiac and peripheral vascular compensation, respectively. Students should begin to identify hallmark signs of shock (decomposition or loss of homeostasis). In this case, it is due to the loss of blood known as hemorrhagic or circulatory shock.
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