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What is the main function of the formed elements in blood?
What is the main function of the formed elements in blood?
What is the primary composition of blood plasma?
What is the primary composition of blood plasma?
What is the primary function of albumin in blood plasma?
What is the primary function of albumin in blood plasma?
What is the approximate percentage of erythrocytes in whole blood?
What is the approximate percentage of erythrocytes in whole blood?
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What is the primary function of blood in the body?
What is the primary function of blood in the body?
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What is the approximate pH range of blood?
What is the approximate pH range of blood?
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What is the function of leukocytes in blood?
What is the function of leukocytes in blood?
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What is the average volume of blood in a male adult?
What is the average volume of blood in a male adult?
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What is the characteristic of blood color when it has high oxygen content?
What is the characteristic of blood color when it has high oxygen content?
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What is the main function of hemoglobin in erythrocytes?
What is the main function of hemoglobin in erythrocytes?
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What is the shape of an erythrocyte?
What is the shape of an erythrocyte?
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What is the percentage of erythrocytes that contain mitochondria?
What is the percentage of erythrocytes that contain mitochondria?
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What is the process of oxygen unloading in tissues called?
What is the process of oxygen unloading in tissues called?
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What is the origin of most blood cells?
What is the origin of most blood cells?
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What is the term for the formation of all blood cells?
What is the term for the formation of all blood cells?
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What is the term for the stem cell that gives rise to all formed elements?
What is the term for the stem cell that gives rise to all formed elements?
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What is the name of the stem cell that transforms into a myeloid stem cell during erythropoiesis?
What is the name of the stem cell that transforms into a myeloid stem cell during erythropoiesis?
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What is the result of having too few red blood cells in the body?
What is the result of having too few red blood cells in the body?
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What is the hormone that stimulates the production of red blood cells in response to hypoxia?
What is the hormone that stimulates the production of red blood cells in response to hypoxia?
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What is the effect of erythropoietin on red blood cell production?
What is the effect of erythropoietin on red blood cell production?
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What is the effect of high oxygen levels on erythropoietin production?
What is the effect of high oxygen levels on erythropoietin production?
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What is the result of having too many red blood cells in the body?
What is the result of having too many red blood cells in the body?
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What is the approximate number of red blood cells produced every second?
What is the approximate number of red blood cells produced every second?
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What is the primary role of iron in erythropoiesis?
What is the primary role of iron in erythropoiesis?
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What is the cause of pernicious anemia?
What is the cause of pernicious anemia?
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What is the characteristic shape of red blood cells in sickle cell anemia?
What is the characteristic shape of red blood cells in sickle cell anemia?
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What is the purpose of transfusion in sickle cell anemia treatment?
What is the purpose of transfusion in sickle cell anemia treatment?
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What is the function of vitamin B12 and folic acid in erythropoiesis?
What is the function of vitamin B12 and folic acid in erythropoiesis?
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What is the result of aplastic anemia?
What is the result of aplastic anemia?
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What is the term for the premature lysis of red blood cells?
What is the term for the premature lysis of red blood cells?
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What is the effect of transfusion on sickle cell anemia patients?
What is the effect of transfusion on sickle cell anemia patients?
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What is the genetic disorder characterized by the absent or reduced production of one globin chain?
What is the genetic disorder characterized by the absent or reduced production of one globin chain?
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What is the treatment for sickle cell anemia that induces the formation of fetal hemoglobin?
What is the treatment for sickle cell anemia that induces the formation of fetal hemoglobin?
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What is the primary cause of polycythemia vera?
What is the primary cause of polycythemia vera?
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What is the function of therapeutic phlebotomy in polycythemia vera?
What is the function of therapeutic phlebotomy in polycythemia vera?
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What is the percentage of hematocrit that may be reached in polycythemia vera?
What is the percentage of hematocrit that may be reached in polycythemia vera?
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What is the characteristic of a monocyte?
What is the characteristic of a monocyte?
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What is the name of the process by which white blood cells are produced from bone marrow?
What is the name of the process by which white blood cells are produced from bone marrow?
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What is the characteristic of granulocytes?
What is the characteristic of granulocytes?
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What is the percentage of lymphocytes in the blood?
What is the percentage of lymphocytes in the blood?
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What is the reason why there are more white blood cells produced than red blood cells?
What is the reason why there are more white blood cells produced than red blood cells?
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What is the developmental sequence of agranulocytes?
What is the developmental sequence of agranulocytes?
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What is the purpose of using hematopoietic hormones in cancer patients?
What is the purpose of using hematopoietic hormones in cancer patients?
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What is the lifespan of a monocyte?
What is the lifespan of a monocyte?
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What is the purpose of using hematopoietic hormones in AIDS patients?
What is the purpose of using hematopoietic hormones in AIDS patients?
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What is a common precursor shared by monocytes and neutrophils?
What is a common precursor shared by monocytes and neutrophils?
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What type of cells are involved in myeloid leukemia?
What type of cells are involved in myeloid leukemia?
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What is the primary cause of death in leukemia patients if left untreated?
What is the primary cause of death in leukemia patients if left untreated?
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What is the name of the virus that causes infectious mononucleosis?
What is the name of the virus that causes infectious mononucleosis?
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What is the term for a condition characterized by an abnormally low number of white blood cells?
What is the term for a condition characterized by an abnormally low number of white blood cells?
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What is the term for a type of leukemia that involves the proliferation of later cell stages and primarily affects older people?
What is the term for a type of leukemia that involves the proliferation of later cell stages and primarily affects older people?
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What is a common symptom of infectious mononucleosis?
What is a common symptom of infectious mononucleosis?
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What is the primary function of platelets in the blood?
What is the primary function of platelets in the blood?
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What is the normal range of platelets in a microliter of blood?
What is the normal range of platelets in a microliter of blood?
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What is the role of thrombopoietin in platelet formation?
What is the role of thrombopoietin in platelet formation?
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What is the first step in the clotting process?
What is the first step in the clotting process?
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What is the function of von Willebrand factor in platelet plug formation?
What is the function of von Willebrand factor in platelet plug formation?
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What is the effect of prostacyclins on platelet plug formation?
What is the effect of prostacyclins on platelet plug formation?
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What is the origin of platelets in the blood?
What is the origin of platelets in the blood?
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What is the role of nitric oxide in platelet function?
What is the role of nitric oxide in platelet function?
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What is the effect of serotonin on platelet plug formation?
What is the effect of serotonin on platelet plug formation?
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What is the term for the process of stopping bleeding?
What is the term for the process of stopping bleeding?
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What is the trigger for the intrinsic pathway of coagulation?
What is the trigger for the intrinsic pathway of coagulation?
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What is the role of thrombin in phase 3 of coagulation?
What is the role of thrombin in phase 3 of coagulation?
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What is the function of factor XIII in coagulation?
What is the function of factor XIII in coagulation?
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What is the result of the coagulation process?
What is the result of the coagulation process?
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What is the role of vitamin K in coagulation?
What is the role of vitamin K in coagulation?
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What is the difference between the intrinsic and extrinsic pathways of coagulation?
What is the difference between the intrinsic and extrinsic pathways of coagulation?
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What is the function of prothrombin activator in coagulation?
What is the function of prothrombin activator in coagulation?
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What is the result of the formation of fibrin strands in coagulation?
What is the result of the formation of fibrin strands in coagulation?
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What is the trigger for the extrinsic pathway of coagulation?
What is the trigger for the extrinsic pathway of coagulation?
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What is the primary function of clot retraction?
What is the primary function of clot retraction?
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What is the role of plasminogen in fibrinolysis?
What is the role of plasminogen in fibrinolysis?
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What is the primary function of tissue plasminogen activator (tPA) in fibrinolysis?
What is the primary function of tissue plasminogen activator (tPA) in fibrinolysis?
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What is the result of clot retraction?
What is the result of clot retraction?
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What stimulates the division of smooth muscle cells and fibroblasts during vessel repair?
What stimulates the division of smooth muscle cells and fibroblasts during vessel repair?
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What happens to serum during clot retraction?
What happens to serum during clot retraction?
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When does fibrinolysis typically begin?
When does fibrinolysis typically begin?
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What is the term for a clot that develops and persists in an unbroken blood vessel?
What is the term for a clot that develops and persists in an unbroken blood vessel?
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What is the primary purpose of anti-coagulant drugs?
What is the primary purpose of anti-coagulant drugs?
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What is the term for a deficit in the number of circulating platelets?
What is the term for a deficit in the number of circulating platelets?
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What is the diagnostic platelet count for thrombocytopenia?
What is the diagnostic platelet count for thrombocytopenia?
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What is the treatment for thrombocytopenia?
What is the treatment for thrombocytopenia?
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What is a common cause of impaired liver function that affects blood coagulation?
What is a common cause of impaired liver function that affects blood coagulation?
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What is the primary symptom of hemophilia A?
What is the primary symptom of hemophilia A?
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What is a consequence of disseminated intravascular coagulation?
What is a consequence of disseminated intravascular coagulation?
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What is the treatment for hemophilia A?
What is the treatment for hemophilia A?
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What is a possible cause of disseminated intravascular coagulation?
What is a possible cause of disseminated intravascular coagulation?
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What is the effect of liver disease on vitamin K absorption?
What is the effect of liver disease on vitamin K absorption?
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Study Notes
Blood Functions
- Transporting oxygen and nutrients to body cells
- Transporting metabolic wastes to lungs and kidneys for elimination
- Transporting hormones from endocrine organs to target organs
- Protecting against blood loss and infection
- Regulating body temperature
- Maintaining normal pH buffers
- Maintaining adequate fluid volume in the circulatory system
Composition of Blood
- Blood is the only fluid tissue in the body
- Consists of plasma and formed elements (type of connective tissues)
- Cells are suspended in plasma
- Formed elements include erythrocytes, leukocytes, and platelets
Blood Layers
- Erythrocytes (red blood cells) make up 45% of whole blood (47% in males, 42% in females)
- Plasma makes up 55% of whole blood
- White blood cells and platelets in the buffy coat make up less than 1% of whole blood
Physical Characteristics and Volume
- Blood is a sticky, opaque fluid with a metallic taste
- Color varies with oxygen content (scarlet red with high oxygen, dark red with low oxygen)
- pH ranges from 7.35 to 7.45
- Average volume of blood in males is 5-6 liters, and in females is 4-5 liters
Blood Plasma
- Blood plasma is a straw-colored, sticky fluid
- Composed of approximately 90% water
- Contains over 100 dissolved solutes, including nutrients, gases, hormones, wastes, proteins, and inorganic ions
- Proteins produced mainly by the liver, including albumin, which makes up 60% of plasma proteins
- Albumin functions as a carrier of other molecules, blood buffer, and contributes to plasma osmotic pressure
Formed Elements
- Formed elements include red blood cells, white blood cells, and platelets
- White blood cells are the only complete cells, while red blood cells lack nuclei and organelles
- Platelets are cell fragments
- Most formed elements have a short lifespan of only a few days in the blood stream
- Most blood cells originate from bone marrow and do not divide
Erythrocytes (Red Blood Cells)
- Erythrocytes have a diameter of 7.5 micrometers and play a crucial role in gas transport
- They consist of a plasma membrane and spectrin, which allows for flexibility and shape change
- Characteristics include a biconcave shape, 97% hemoglobin content, and lack of mitochondria
- Functions include gas transport, with hemoglobin binding to oxygen
- The red hue of erythrocytes gives blood its red color
- Hemoglobin is composed of 4 polypeptides: 2 alpha and 2 beta
- There are 4-6 million erythrocytes per microliter of blood
- Oxygen loading in the lungs is called oxyhemoglobin, while oxygen unloading in tissues is called deoxyhemoglobin
- 20% of carbon dioxide in the blood binds to hemoglobin, forming carbaminohemoglobin
Hematopoiesis and Hematopoietic Stem Cells
- Hematopoiesis is the formation of all blood cells
- Hematopoietic stem cells, also known as hemocytoblasts, give rise to all formed cells
- Committed cells cannot change their cell type
- New blood cells enter the sinusoids
Erythropoiesis
- Erythropoiesis is the formation of red blood cells, which have a lifespan of 15 days
- The process involves the transformation of a hematopoietic stem cell into a myeloid stem cell, then a proerythroblast, followed by a series of divisions and maturation stages
Maturation Stages
- Proerythroblast divides into basophilic erythroblast, which synthesizes ribosomes and stains blue
- Basophilic erythroblast develops into polychromatic erythroblast, characterized by a red hue with pink and blue areas
- Polychromatic erythroblast matures into orthochromatic erythroblast, which contains hemoglobin and turns pink
Regulation and Requirement of Erythropoiesis
- Too few red blood cells lead to hypoxia
- Too many red blood cells increase blood viscosity
- Approximately 2 million red blood cells are produced every second
- Erythropoiesis is regulated by hormonal controls and dietary requirements
Hormonal Controls
- Erythropoietin is a blood hormone released by the kidney
- Hypoxia-induced factor can be accumulated due to hypoxia and hormonal control
- Causes of hypoxia include hemorrhage, pneumonia, and iron deficiency
- Erythropoietin is inhibited by erythrocytes and high oxygen levels
- Testosterone enhances erythropoietin production
Dietary Requirements for Erythropoiesis
- Amino acids, lipids, and carbohydrates are necessary for erythropoiesis
- Iron is essential, but it needs to bind with protein to avoid toxicity
- Iron is stored in cells called ferritin and hemosiderin
- Transferrin transports iron in the blood
Vitamins and Anemia
- Vitamin B12 and folic acid support rapidly dividing cells
- Anemia can be caused by hemorrhage, iron deficiency, chronic hemorrhagic anemia, pernicious anemia, and renal anemia
Types of Anemia
- Pernicious anemia: an autoimmune disease that destroys the intrinsic factor, leading to the inability to absorb B12
- Renal anemia: occurs when the kidneys fail to produce erythropoietin
- Aplastic anemia: caused by the destruction or inhibition of red bone marrow, often due to drugs, chemicals, radiations, or viruses
- Hemolytic anemias: premature lysis of red blood cells, often caused by incompatible transfusion, infections, or hemoglobin abnormalities
Thalassemias
- A genetic disorder resulting in abnormal globins
- Typically found in people of Mediterranean ancestry
- Characterized by the absence of one globin chain
- Red blood cells are thin and deficient in hemoglobin
Sickle Cell Anemia
- Caused by Hemoglobin S or mutated hemoglobin
- Only one amino acid is incorrect in the beta chain out of 146 amino acids
- Red blood cells become crescent-shaped when oxygen levels are low
- Misshapen red blood cells rupture easily and block small vessels
- More prevalent in black people
- Individuals with 2 copies of Hb-s develop sickle-cell anemia, while those with 1 copy have a milder disease and a better chance of surviving malaria
- Treatments include transfusion, inhaled nitric oxide, stem cell transplants, gene therapy, and hydroxyurea to induce fetal hemoglobin formation
Erythrocyte Disorders
- Polycemia is a condition characterized by an excess of red blood cells and increased blood viscosity, leading to sluggish blood flow.
- Polycythemia vera is a type of bone marrow cancer that causes an overproduction of red blood cells, resulting in a high hematocrit level (up to 80%).
- Therapeutic phlebotomy is a treatment for polycythemia vera.
Causes of Polycemia
- Low oxygen levels can lead to polycemia.
- Increased EPO (erythropoietin) production can also cause polycemia.
Leukocytes
- Leukocytes are complete cells with a shorter lifespan compared to red blood cells.
- There are three main components of leukocytes: basophils, eosinophils, and neutrophils.
Agranulocytes
- Agranulocytes consist of lymphocytes and monocytes.
- Lymphocytes make up 25% of leukocytes and are divided into two types: T-lymphocytes (cell-mediated, originating from the thymus) and B-lymphocytes (antibody-producing, originating from bone marrow).
- Monocytes are rare, making up 3-8% of leukocytes, and have a kidney-shaped nucleus that later develops into macrophages.
Leukopoiesis
- Leukopoiesis is the production of white blood cells from bone marrow, involving the action of interleukins and colony-stimulating factors.
Leukocyte Development
- Leukocytes originate from hemocytoblasts, which give rise to lymphoid stem cells and myeloid stem cells.
- Lymphoid stem cells produce lymphocytes, while myeloid stem cells produce other elements.
Granulocyte Production
- Myeloblasts produce myelocytes.
- Promyelocytes produce lysosomes.
- Myelocytes produce granules.
- Band cells produce nuclei that form a carved arc shape.
- Mature granulocytes have segmented nuclei and are released into the blood, with 10 times more stored in the bone marrow than in the blood.
Agranulocyte Production
- Agranulocyte production occurs in the following stages: monoblast → promonocyte → monocyte
- Monocytes can live up to several months
Hematopoietic Hormones
- EPO (Erythropoietin) and CSF (Colony-Stimulating Factor) are hematopoietic hormones used clinically
- These hormones can stimulate bone marrow in cancer patients receiving chemotherapy or stem cell transplants
- They are also used to increase protective immune responses in AIDS patients
Leukocytes Disorders
- Leukocytes disorders include overproduction of abnormal white blood cells, such as leukemia and infectious mononucleosis.
- Leukopenia is a condition characterized by an abnormally low number of white blood cells, which can be drug-induced.
Leukemia
- Leukemia involves the cloning of white blood cells, with myeloid leukemia involving myeloblast descendants and lymphocytic leukemia involving lymphocytes.
- Acute leukemia derives from stem cells and primarily affects children.
- Chronic leukemia involves the proliferation of later cell stages and is prevalent in older people.
- Without treatment, all leukemia are fatal, with death resulting from internal hemorrhage or overwhelming infections.
- Cancerous cells fill the red bone marrow, leading to leukemia.
Treatment of Leukemia
- Treatments for leukemia include irradiation, antileukemia drugs, and stem cell transplants.
Infectious Mononucleosis
- Infectious mononucleosis is a highly contagious viral disease, usually seen in young adults.
- It is caused by the Epstein-Barr virus and results in high numbers of typical agranulocytes.
- The disease involves lymphocytes that become enlarged, and was originally thought to involve monocytes, hence the name mononucleosis.
- Symptoms of infectious mononucleosis include sore throat, low fever, tiredness, and achy feelings.
Platelets
- Cytoplasmic fragments of megakaryocytes with a blue-staining outer region and purple granules
- Granules contain serotonin, calcium, enzymes, ADP, and platelet-derived growth factor (PDGF), which help in the clotting process
- Normal platelet count is between 150,000 to 400,000 platelets/mcl of blood
- Circulating platelets are kept inactive and mobile by nitric oxide (NO)
- Platelet formation is regulated by thrombopoietin
- Formed in the myeloid line from megakaryoblast (stage I megakaryocyte)
Platelet Formation
- Stage IV megakaryocyte sends cytoplasmic projections into the lumen of a capillary
- Projections then break off into platelet fragments
Hemostasis
- Fast series of reactions to stop bleeding
- Requires clotting factors and substances released by platelets and injured tissues
- Three steps involved in the clotting process: vascular spasm, platelet plug formation, and coagulation
Vascular Spasm
- Vessel responds to injury with vasoconstriction triggered by direct injury to vascular smooth muscle, chemicals released by endothelial cells, and pain reflexes
- Most effective in smaller blood vessels
Platelet Plug Formation
- Platelets stick to collagen fibers exposed when a vessel is damaged
- Prostacyclins and nitric oxide secreted by endothelial cells prevent platelet sticking
- Von Willebrand factor helps stabilize platelet-collagen adhesion
- Activated platelets swell, become spiked and sticky, and release chemical messengers: • ADP causes more platelets to stick and release their contents • Serotonin and thromboxane A2 enhance vascular spasm and platelet aggregation
Coagulation Process
- Coagulation reinforces the platelet plug with fibrin threads, transforming blood from a liquid to a gel-like state.
Coagulation Factors
- There are 13 clotting factors (procoagulants) involved in the coagulation process, numbered I to XIII in the order of their discovery.
- Vitamin K is necessary for the synthesis of four clotting factors.
Phase 1 of Coagulation
- Coagulation can be initiated by either the intrinsic or extrinsic pathway.
- The intrinsic pathway is triggered by negatively charged surfaces, such as activated platelets, collagen, or glass.
- The extrinsic pathway is triggered by exposure to tissue factor (TF) and is a faster pathway.
- Both pathways cascade towards the activation of factor X.
Phase 1 of Coagulation (Factor X Activation)
- Factor X combines with calcium and platelet factor 3 and factor 5 to form prothrombin activator.
Phase 2 of Coagulation
- Prothrombin activator catalyzes the transformation of prothrombin to the active enzyme thrombin.
Phase 3 of Coagulation
- Thrombin converts soluble fibrinogen to fibrin, forming the structural basis of the clot.
- Fibrin makes the plasma become gel-like and traps formed elements passing by.
- Thrombin, along with calcium, activates factor XIII, the fibrin-stabilizing factor, which cross-links fibrin and strengthens the clot.
Anticoagulants and Blood Coagulation
- Anticoagulants are factors that inhibit blood coagulation, and can also refer to drugs that prevent clotting.
Clot Formation and Stabilization
- A clot must be stabilized and removed after the damaged area has been repaired.
- Clot retraction occurs within 30-60 minutes, where actin and myosin in platelets contract, pulling on fibrin strands and squeezing serum from the clot.
- Serum is plasma minus the clotting proteins.
Clot Retraction and Vessel Repair
- Clot retraction draws ruptured blood vessel edges together, preparing for repair.
- Platelet-derived growth factor (PDGF) is released by platelets, stimulating the division of smooth muscle cells and fibroblasts to rebuild the blood vessel wall.
Fibrinolysis and Clot Removal
- Fibrinolysis is the process of removing clots after repair is completed, starting within 2 days and continuing for several days until the clot is dissolved.
- Plasminogen, a plasma protein trapped in the clot, is converted to plasmin, a fibrin-digesting enzyme.
- Tissue plasminogen activator (tPA), factor XII, and thrombin all play a role in the conversion process.
Thromboembolic Disorders
- Undesirable clot formation can lead to tissue death by blocking circulation
- Thrombus: a clot that develops and persists in an unbroken blood vessel
- Embolus: a thrombus that is freely floating in the bloodstream
- Embolism: an embolus that obstructs a vessel
Treatment of Thromboembolic Disorders
- Anti-coagulant drugs are used to prevent undesirable clotting, such as:
- Aspirin
- Heparin
- Warfarin
Bleeding Disorders
- Abnormalities that prevent normal clot formation
- Thrombocytopenia: a deficit of circulating platelets
- Petechiae: a result of spontaneous widespread hemorrhage
Causes of Thrombocytopenia
- Suppression or destruction of red bone marrow, such as:
- Malignancy
- Radiation
- Drugs
Diagnosis and Treatment of Thrombocytopenia
- Platelet count less than 50k/ul is diagnostic
- Treatment: transfusion of concentrated platelets
Impaired Liver Function
- Inability to synthesize procoagulant factors can be caused by vitamin K deficiency, hepatitis, or cirrhosis
- Liver disease can prevent the liver from producing bile, leading to impaired absorption of fat and vitamin K
Hemophilia
- Hemophilia refers to a group of hereditary bleeding disorders
- Hemophilia A: most common type, caused by factor VIII deficiency
- Hemophilia B: caused by factor IX deficiency
- Hemophilia C: milder form, caused by factor XI deficiency
- Symptoms: prolonged bleeding, especially into joint cavities
- Treatment: injection of genetically engineered factors, eliminating the need for plasma transfusion and the risk of contracting hepatitis or HIV
Disseminated Intravascular Coagulation (DIC)
- Involves both widespread clotting and severe bleeding
- Widespread clotting occurs in intact blood vessels, blocking blood flow
- Severe bleeding follows due to depletion of clotting factors
- Can occur in:
- Septicemia
- Incompatible blood transfusions
- Complications in pregnancy
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Learn about the vital functions of blood, including transporting oxygen and nutrients, and its composition, including plasma and formed elements.