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95% of volume in formed elements is red blood cells
5% of volume in formed elements is WBC's
formed elements chief functions 1.delivery of substances needed for cell metablosim,2.defence.3.acid base balance
all types of blood cells are formed where in the bone marrow
red bone marrow found in membranous bone such as vetebra,pelvis, sternum and ribs
Yellow marrow produces some WBC's but composed mainly of connective tissue and fat
Lymph nodes produce pymphocytes and antibodies
Spleen stores bld and produces lymphocytes, plasma cells and antibodies
liver blood forming organ during intrauterine life, important in coagulation
Plasma clear portion of bld, 92% water, contains proteins such as albumin, globlin, and fibrinogen
Albumin most plentiful protein,keeps h2o concentrationlow so water diffuses well
globulins (alpha,beta,gamma)transports proteins and provides immunity
Fibrinogen responsible for bld clotting
RBC's most abundant cells in the body, responcible for tissue oxygenation,composed mainly of water and red protein hemoglobin-each RBC contains 270 million hemoglobin molecules, norm 4.2-6.2 million cells
RBC's life span 120 days
hemogobin each molecule carries 4 oxygen molecules, normal amount is 15g/100 ml
WBC normal count 5000-10,000
hematocrit the fraction of the total volume of blood that consists of red blood cells, normally about 45%
norm male hematocrit 40-54%
female hematocrit norm 38-47%
hemoglobin normal for men 13.5-18g/100ml,females 12-16g/100ml
Reticulocyte count shows rate of RBC production-<0.5%=deceleration in process, >1.5 % =acceleration of RBC formation
Monocytes make up 5% of total WBC
Lymphocytes make up 27.5% of WBC
Neutrophils make up 65% of WBC
Eosinophils and basophils together make up 2.5%
Differential count (diff) identifies the different types of leukocytes (WBC'S) present in the blood-identified by shape,appearance of nucleus,color of cytoplasm n presence n color of granules
Platelets (thrombocytes) plug the leak and allow other cells to stick to them and form clot
Hemostasis the initial phsyilogical response to wounding that causes bleeding to cease
Physiology of Hemostasis vasoconstriction, formation of platelet plug, coagulation, and the growth of fibrous tissue
vasoconstriction of vessel is sustained for 10 minutes
Clotting time is normally 7-10 minutes
Prothrombin time (PT) measures the clotting time of plasma (the extrinsic clotting cascade)-used to monitor pts taking certain drugs and evaluates the presence of factors V,X,VII,prothrombin and fibrinogen-
Partial prothromboplastin time (PTT) screens for hemophilia and othe clotting dx, measures the integrity of the extrinsic clotting cascad, which is effected by blood thinners
Coagulation progresses within 3-6 minutes after injury to vessel
clot retracts and is sealed within 30minutes
Blood clotting mechanism 1.prothrombin activator is formed in response to injury,2.it stumulates conversion of prothrombin to thrombin,3. thrombin in the presence of Ca++ converts fibrinogen to fibrin threads
ASA affects decreases platelet activity
Warfarin supresses the abilty of the liver to make certain clotting factors
Anemia condition in which the hemoglobin or erythrocytes in the blood is below normal-not a disease but a symptom of one
Anemia Causes chronic or acute blood loss, decreaased production of erythrocytes, n increased destruction of erythrocytes
Disorders of RBC's Anemia polycythemia sickle cell disease
Disorders of WBC's Hodgkins disease Non-hodgkins disease Leukimia Leukopenia multiple myolomas
Disorders of Hemostsais Disseminated intravascular coagulation (DIC) thrombocytopenia
Iron deficiency anemia the lack of iron prevents the bone marrow from making enough hemoglobin for RBC's, iron gives hemoglobin the ability to bind to oxygen-most common cause is bld loss from menstration or intestinal bldg
Lack of folic acid is the most common form o vitamin deficiency anemia
Hemolytic anemia premature destruction of RBC's in the bld (hemolysis)is the cause.can be a result of inherited disorder,acquired later in life
Inherited disorders can occur as a result of abnormal rigidity of the cell membrane,becomes trapped usually in the spleen
Acquired disorders 1.mechanical forces (abn bld vessel linings or clots,2.autoimmune disorders,3.disease (malaria)
Anemia S/S fatigue,HA,sore mouth or tongue,brittle nails,breathlessness CP
Leukemia an abnormal proliferation of WBC's occuring in the bone marrow,the excess crowds and impairs normal production,common in white ppl,cause unknown,acute or chronic
Acute leukemia begin proliferating at an early stageof their development(immature cells)
Chronic Leukemia an abnormal proliferation of more mature but not fully differenciated cells
Lymphocytic or lymphoblastic indicates that the cancerous change takes place in a type of marrow cell that forms lymphocytes
Myelogenous or myeloid indicates that the cell change takes place in a type of marrow cell that normally matures to form red cells, some white cells and platelets
Acute lymphocytic leukemia & acute myelogenous leukemia composed of blast cells, progress rapidly without tx.
Chronic leukemias have few or no blast cells,progress slowly
Leukemia S/S abd fullness,bleeding,bone pain.elevated body temp,enlargement of lymph nodes and liver ,spleen and testes,fatigue,bruising, HA,weight loss
Blood transfusion complications Allergy reaction,disease,fever,circulatory overload,iron overload,lung injury,hemolytic reactiongraft versus host disease
Lymphoma any neoplastic disorder of the lymphoid tissue,all are malignant and can metastisize-result from acquired genetic injury to the DNA of a single cell
Hodgkins disease painless progressive enlargement of lymphoid tissue found maily in he lymph nodes and slpeen, unknown cause, more common in males, peak incidence at 20-29 & 55-70yrs,confirmed by presence of REED STERNBERG cells-one of the most curable cancers
Hodgkins S/S swollen lymph nodes in neck,axillae or groin,fatigue,chills and night sweats,severe itching, cough,weightloss,SOB,CP
Non Hodgkins lymphomas vary in malignancy and activity of abn cells,ranked by low,intermediate n high based on agressiveness of the dx.
Burkitt's lymphoma childhood cancer, in africa its associated w/eptein barr,TX radiation,bone marrow transplant
Stem cell a cell whos daughter cells may develop into other cell types, reside in marrow and circulate in bld.
Autologous transplants transplant uses patients own marrow
Allogenic transplant uses marrow from donor
Polycythemia increase in the Total RBC mass of the blood,
Secondary polycythemia natural responce tp chronic hypoxia-may be naturally present in ppl who live in high altitudes, due to reduced air pressure
Primary polycythemia(polycythemia vera) unknown reasons-rare,causes blood to thicken,occurs in pts >50 yrs ,S/S blurred vision,dizzy,itching,HA,HTN,splenomegaly,red hands n feet
Apparent polycythemia from dehydration
Erythropoietin this hormone stimulates RBC production in the bone marrow
Disseminated intravascular coagulopathy a comlication of severe injury,trauma, or disease,common abn clotting disorder.Disrupts the balance among procoagulants,inhibitors,thrombus formation and lysis-S/S=SOB, bleeding,hypotension, hypoperfusion
DIC-First phase characterised by free thrombin in the bld, fibrin deposits, and aggregation of platelets
DIC-Second phase hemmorrage caused by the depletion of clotting factors=myulti system organ failure from bleeding and coagulation disorders caused by:loss of platels,fibrinolysis,fibrin degradation
Hemophilia uncoontrolled bleeding and involves the loss of bleeding control mechanisms
Hemophilia A deficiency in factor VIII esscential in the process of blood clotting
Hemophilia B (christmas disease) less common,
Hemophilia S/S bleeding into joints, deep muscles, the urinary tract and intracranial sites are most common-CNS bleeding is the major cause of deaths for pts with heophilia
Thrombocytopenia low platelet count, normal levels 150,000-450,000. levels at 20,000-30,000 causes bldg with minor trauma,levels <20,000 causes spontaneous bldg. S/Spetechiae, purpura,prolonged bldg,heavy menses flow
Idiopathic Thrombocytopenic purpura (ITP) when antibodies attack and destroy the bodys platelets for unknown reasons
Thrombotic thrombocyopenic purpura (TTP) a life threatning dx that occurs when small bld clots form suddenly throughout the body, resulting in cardiac hemmorrage and death-associated w/pregnancy,cancer,chrmo,hiv/aids,and Rx drugs TX:CORTICOSTEROIDS (prednisone)
Sickle cell disease inherited bld disorder that affects RBC's. most common type is sickle cell anemia-S/S delayed growth in children,jaundice,priaprism,splenomegaly,stroke-produces abnormal type of hemoglobin called hemoglobin S
sICKLE CELL CRISIS a blockage of flow to various tissues and organs due to the cells being unable to pass through tiny vessels causing vasooclisiveness-S/S=weakness, CP,SOB,ABD pain,bony deformities, icteric(jaundice sclera,fever,arthralgia(joint pain)
Aplastic Crisis bone marrow temporarily stop producing RBC's
Hemolytic crisis the RBC;s break down too rapidly tp be replaced adequately
Splenic sequestration usually in childhood, difficulty that occurs when bld becomes trapped in the spleen
Multiple Myeloma a malignant neoplasm of the bone marrow,the tumor is composed of plasma cells, destroys bone tissue (especially in flat bones)
In myeloma the neoplastic cells produce large amounts of protein (M protein) that affect the viscosity of the bld.coagulated protein accumalate in tissues and organs-kidney failure occurs due to build up, plasma proliferation is confined to the bone marrow
Created by: rebeccabelleth