Blood is considered to be a liquid connective tissue. It consists of a
non-cellular matrix and a collection of cells (formed elements) that are
suspended within the matrix. The matrix is called plasma and is made up of
water, proteins, dissolved gases and other dissolved chemicals such as
electrolytes, nutrients, vitamins and hormones. The cellular part of blood
can be divided into three categories: (1) red blood cells {RBCs} or
erythrocytes, (2) white blood cells {WBCs} or leukocytes and (3) platelets
or thrombocytes. The ratio of the plasma to cellular components is about 55%
plasma to 45% cells. If a sample of blood is placed in a capillary tube and
spun in a centrifuge, the plasma and cellular elements distribute themselves
as shown in the figure. When the blood is spun the heavier elements are
moved to the bottom against the clay plug while the lighter plasma remains
at the top. The buffy coat consist of white blood cells which are lighter
than RBCs and much less numerous.
Reds blood cells are significant, among other reasons, for their ability to
carry oxygen from the lungs to the cells that make up the tissues of the
body. The oxygen is carried bound to a special molecule called hemoglobin.
Red blood cells are usually described as biconcave discs. RBCs are among the
smallest cells in the body, with only sperm cells being smaller. RBCs are
produced in the bone marrow in a process called erythropoiesis. When RBCs
enter the circulation they have lost their nucleus, which gives them the
biconcave depression. Without a nucleus, the cells have a limited lifespan.
The average RBC only lasts for 120 days before it is removed from the
circulation by macrophages in the liver and spleen.
White blood cells are part of the body's immune system and serve to protect
the body from disease. Unlike RBCs, white blood cells do not carry oxygen
and they do have a nucleus. There are five subdivisions of WBCs: (1)
neutrophils, (2) eosinophils, (3) basophils, (4) monocytes and (5)
lymphocytes. Each subdivision plays a specific role in the body's immune
response.
The third group of formed elements is the platelets. Platelets play a role
in hemostasis or blood clotting. Whenever a blood vessel breaks
something must stop the flow of blood from the vessel. Platelets working in
conjunction with clotting proteins found in the plasma can block the flow of
blood. Platelets are not cells; instead they are fragments of larger cells
called megakarocytes. Platelets lack a nucleus and contain few cytoplasmic
elements. The lifespan of a platelet is about 9 or 10 days. So like RBCs
they need to be produced continually and rapidly.
Match the word in Column A with its contextual meaning in Column B.
A
B
1. Bound
2. Clotting
3. Conjunction
4. Considered
5. Continually
6. Lasts
7. Lifespan
8. Lost
9. Made up of
10. Role
11. Spun
12. Suspended
A. Accepted as (true)
B. Mixed together
C. Consists of or composed of
D. Rotated
E. Attached
F. Extruded / removed
G. Survives
H. How long something lives
I. Something's function in a larger more complex activity
J. Transition of blood from liquid to solid
K. Working together
L. To work without stopping
Anemia: The blood carries a reduced
amount of oxygen. This can be caused by reduced number of RBCs or a reduced
amount of hemoglobin inside each RBC. (an = without, emia = blood condition) Anticoagulant: A chemical that can prevent clot formation. Drugs such
as heparin and coumadin are used to prevent or reduce clotting in people who
have artificial heart valves (which can induce clots) or conditions such
vein inflammation. Heparin and EDTA can be added to blood samples to prevent
clotting. While calcium chelators are added to blood drawn for transfusions
to keep it in liquid form until it is used. Aplastic anemia: A type of anemia that results from the failure of
bone marrow to produce RBCs and WBCs. Bacteriemia: Presence of bacteria in the blood. Clot: Term used to describe a semisolid mass of cells and proteins
that forms to stop bleeding from a broken blood vessel. Differential WBC count: A measure in which the percentage of each
type of WBC is reported. Typical values: neutrophils 40-60%, lymphocytes
20-40%, monocytes 4-8%, eosinophils 1-3%, basophils 0-1%. (phil = love) Erythrocyte: Scientific name for a red blood cell. (erythro = red,
cyte = cell) Erythropoiesis: Term to describe the process of red blood cell
formation in bone marrow. Erythropoietin: Hormone produced by the kidneys that controls
erythropoiesis. People with kidney disease are often anemic because they
fail to produce the hormone. Fibrinogen: A protein produced by the liver that circulates in the
plasma as a plasma protein. When fibrinogen encounters activated platelets
it attaches and is converted into fibrin as part of the clotting process. Hematocrit: A commonly measured blood value. The blood is spun in a
centrifuge and the ratio of packed RBCs to the total volume is reported as
the hematocrit. The abbreviation for hematocrit is Hct. The value is
normally reported at a percentage is as Hct = 48. Normal values: males (38%
- 51%), females (36% - 47%). (hemato = blood, crit = to separate) Hemoglobin: A large 4 part protein combined with 4 molecule
containing iron (Fe). The iron can bind reversibly with oxygen. Hemoglobin
is intensely colored and is what gives blood its color. Hemoglobin is
routinely measure during blood work. Normal values: males (14 -- 18 g /dl),
females (12 -- 16 g / dl). Each red blood cell contains about 300 million
molecules of hemoglobin. (hemo = blood) Hemolytic disease of the newborn: This is an anemia seen in newborns
and is usually caused by an incompatible Rh factor between the child's blood
and the mother's blood. Antibodies produced by the mother, in response to
the child blood, destroy many of the child's RBCs which causes anemia.
Hemophilia: An X-linked genetic condition, seen primarily in males,
which prevents normal blood clotting. (philia = to love) Hemorrhage: The term means to bleed from a broken, cut or ruptured
blood vessel. (rrhage = to break) Hemorrhagic anemia: Reduced oxygen carrying capacity due to loss of
blood through bleeding. Hemostasis: This term refers to the body's ability to stop blood flow
from a broken or cut blood vessel. Don't confuse the term with homeostasis.
(hemo = blood, stasis = stop) Leukocyte: Scientific name for a white blood cell. (leuko = white,
cyte = cell) Normochormic: A description of blood that has the normal amount of
hemoglobin. A common variation is hypochromic which means blood with less
than normal amounts of hemoglobin. (normo = normal, chormic = color, hypo =
less / under) Normocytic: A description of blood that has the normal amount of
erythrocytes. (cytic = cells) Normovolemic: A description of normal blood volume. Variations
include hypovolemic / hypovolemia. (volemic = volume) Packed red blood cells: When whole blood is spun in a centrifuge and
the plasma is then removed, the remaining volume is called packed cells or
packed red blood cells. When a transfusion is needed, it is sometime
preferable to give only RBCs instead of whole blood. Platelets: These are small cell fragments (without a nucleus) that
have the ability to cluster in areas of vessel injuries and create a
physical barrier to blood flow through the injured vessel. The also contain
chemicals that can initiate blood clotting which involves the conversion of
fibrinogen into fibrin. Polycythemia: A condition in which too many RBCs are produced and the
RBC count and hematocrit becomes much higher than normal. Hct can be over
70% and RBC counts can be greater than 8 million cells / mcl. The condition
makes the blood very viscous and puts an extra strain on the heart because
of the extra resistance to blood flow caused by the increased viscosity.
(poly = many, cyth = cells, emia = condition of the blood) Red blood cell count: A commonly measure blood value which reports
the number of erythrocytes per microliter of whole blood volume. Normal
values: males (4.7 ? 61 million cells / mcl), females (4.2 -- 5.4 million
cells / mcl). The abbreviation for microliter is mcl or ul. Reticulocytes: Immature red blood cells that still have their
nucleus. Normally reticulocytes extrude their nucleus and become
erythrocytes outside the circulation and then the erythrocyte enters the
circulation. For this reason, reticulocytes are rarely seen in stained blood
smears. However, when erythropoiesis is taking place at an accelerated rate
some reticulocytes enter the circulation and extrude their nucleus there.
When reticulocytes are seen in the circulation it is a sign of rapid RBC
production. (reticulo = network, cyte = cell) Septicemia: Blood infection caused by a pathogenic bacterium. Thrombocytes: The term is often used interchangeably with the word
platelet ? although platelet is becoming the preferred term for humans. In
other animals, thrombocytes carry out hemostasis functions, but the cell is
nucleated. (thrombo = clump / clot) Transfusion: The process of taking blood from one person and giving
it to someone else. To be successful the blood type of the donor and
recipient has to be carefully matched. White blood cell count: A blood measure which reports the total
number of leukocytes. Normal values: 5000 -- 10000 cells / mcl.
Instructions: complete the sentences below with prepositions from
the box. Some prepositions can be used more than once.
to / on / by / inside / from / in / among / below /
under / with / at / above / instead of / until / around /
underneath / between / in spite of / rather than /in addition to /
through / of
____ A+ blood, an A+ person can also receive A-, O+ and O- blood.
____ taking iron tablets, it's better to eat more leafy green
vegetables as treatment _____ iron deficiency anemia.
____ the dangers of blood doping, many athletes continue to use the
technique.
A normal male Hct is ____ 45%.
Blood flowing ____ blood vessels does not clot because platelets don't
normally interact ____ the normal healthy endothelial lining the ____
blood vessels.
For certain blood measures, EDTA is used as an anticoagulant ______ of
heparin.
Hemoglobin is found _____ erythrocytes.
Hemophilia is caused _____ a chromosomal defect.
Most blood samples are taken ____ the median cubital vein.
People who live ____ high altitudes may have _____ normal hematocrits.
Platelets cluster ____ areas where a blood vessel has been damaged.
Platelets form a physical barrier ____ blood flow _____ a broken blood
vessel.
Polycythemia puts an extra strain ____ the heart.
Red blood cells are ____ the smallest cells ____ the body.
Send the blood sample ____ the lab right away.
The lab results will not be back ____ 5 pm tomorrow.
When you spin a blood sample, the layer ____ the bottom is the layer
of RBCs.
When you spin a blood sample, the layer ____ the plasma and the RBCs
is the buffy coat.
When you spin a blood sample, the layer ____ the plasma is the buffy
coat.
Women ____ hematocrits _____ 38% may show symptoms of anemia.
Instructions: work with a partner. One person
can read the part of the doctor and the other person can read the part of
the patient.
D: Good morning Ms. Smith.
P: Good morning Doctor.
D: How can I help you today?
P: Well, I've been feeling really rundown lately. I don't seem to have
any stamina and the littlest things seem to wear me out completely. It seems
like I barely have the strength to go to work.
D: When did this start?
P: I guess it started about two months ago.
D: That's quite a while. Did this come on slowly or quickly?
P: Well it came on me slowly. At first I thought it was just normal fatigue from a busy life. But I never seemed to get stronger
-- I never
seemed to get my energy back, even after a restful weekend.
D: Have you had any recent illnesses -- anything like a cold or flu?
P: No.
D: How about allergies -- have you had any hay fever?
P: No.
D: Have you been under any unusual stress lately -- problems at work or
at home?
P: No, everything is about the same.
D: Have you started taking any new medications?
P: No -- nothing new since the last time I saw you -- 6 months ago.
D: Okay -- well let me do a quick examination -- I want to take your
temperature, check your blood pressure and listen to your heart and lungs.
P: Okay.
D: Well your blood pressure is normal and your lungs sound clear
however
your heart rate is a little fast.
P: What about my temperature?
D: Oh, that's fine too.
P: So what do you think?
D: When I was looking in your throat I noticed that your mucosa and gums
seem a little pale. Your conjunctiva also seems pale.
P: What does that mean?
D: It likely means that you are anemic -- which would explain your
fatigue. I'm going to have the nurse take some blood and send it to the lab
for a complete blood work up.
P: How did I become anemic?
D: Has there been any change in your periods -- has the bleeding been
heavier than normal?
P: No, they seem to be about the same.
D: When did you finish your last period?
P: About 4 days ago.
D: Okay -- Well, sometimes heavier periods can lead to anemia
-- but
since you haven't noticed a change, I suspect that your problem is nutrition
anemia. So until I get the results of your blood work, I going to recommend
that you make some dietary changes.
P: What kinds of changes?
D: Here is a list of foods that are rich in iron. I would like for you
to try to incorporate more of these foods into your daily diet.
P: Should I take an iron supplement?
D: For now -- no. After I see the results of your blood work I may change
my mind but for now I'm not recommending a supplement.
P: Okay.
D: I'll have your results back in a couple of days. After I have looked
them over I will give you a call. We'll discuss the results and if I need to
see you again we'll schedule an appointment.
P: Okay.
D: If it turns out to be nutritional anemia, I think the change in diet
will be all that is needed. And I think you will feel much better in about
two weeks.
P: Sounds wonderful.
D: So if there is nothing else -- I'll talk to you in a couple of days.
P: Great, thanks for your time.
D: Please give this blood work request form to the nurse -- she will draw your
blood and then you will be done.
P: I hate giving blood!
D: You're not alone.
P: I bet -- well, see you later.
D: No problem.
P: Bye.
D: Bye -- and don't forget to eat lots of leafy greens.
Instructions: Reread the interview and then,
working with a partner, try to recreate the interview using some of the
question variations below -- then switch roles and recreate the interview
again using other question variations.
What seems to be the problem?
How can I help you today?
What brings you in today?
When did the problem start?
Did the problem come on slowly or quickly?
How long have you had this problem?
Has there been any change in your medications since I saw you last?
Are you taking any new medications?
Have you had a recent cold or flu?
Have you had any recent problems with allergies?
Are you allergic to anything?
Have you had any problems with your monthly periods?
Have you had any unusual cramping associated with your periods?
Instructions: working with a partner, try to
recreate the interview. Don't just reread it – try to do the interview using
your own question and answer variations while using the same basic case
profile.
Instructions: Review the interview and find line numbers that correspond to
the interview elements listed below. In some cases different aspects of the
same interview element may be addressed in different parts of the interview
? one such case has been done as an example. The questions in the table
below are not in the sequence of the interview.
Interview element / Line numbers
Patient greeting.
Request for information on patients chief complaint
Request for information on patients current and recent health
[9, 11 & 29]
Quick health review with prompts to help patient remember any problems
Request for information about medications being taken by patient
Request for information about changes in stress.
Informing the patient about what is going to happen next in the office
visit
Request for information regarding monthly cycle
Explaining the basis for the initial diagnosis
Providing an initial diagnosis
Explaining what additional procedures are needed to confirm the
diagnosis
Request for change is diet
Offering an initial prognosis
Recommendations for new diet
Providing patient written information about recommended diet changes
1. What is the patient's chief complaint?
2. Based on the interview, what is the minimum and maximum age you would
predict for this patient?
3. When did this patient last see this doctor?
4. How long has the patient been experiencing the chief complaint?
5. Describe the onset of the CC.
6. What is the initial diagnosis?
7. Describe the intended treatment plan.
8. What blood parameters do you think will particularly important?
9. Why is the doctor interested in the patient's monthly cycle?
Instructions: Work with a partner to complete
the two scenarios. After completing the first scenario, switch roles and
complete the second scenario.
Scenario A:
Doctor – Initiate a phone
conversation with the patient. (1) explain that the blood work confirms
nutritional anemia (2) reinforce the need for diet change (3) name some
specific foods to include in the diet and recommend a one-a-day vitamin that
contains iron (4) reiterate the prognosis (5) tell the patient to call if
the prognosis does not evolve as expected (6) conclude the conversation.
Patient – Ask relevant and realistic questions in response to the
information the doctor provides.
Scenario B:
Doctor – Initiate a phone
conversation with the patient. (1) explain that the blood work did not
confirm your initial diagnosis (2) explain that the results are consistent
with hemorrhagic and nutritional anemia (3) explain that most likely her
periods have been heavier but she didn’t recognize it and that is the cause
of the problem (4) you want to her come in for some additional tests in the
next few days (5) have the patient contact your receptionist to make an
appointment (6) reassure the patient that she is in no immediate danger and
while her blood value are low, they are not dangerously low (7) respond to
any questions (8) conclude the conversation.
Patient – Ask relevant and realistic questions in response to the
information the doctor provides.
Instructions: Work with a partner to write questions that
would generate the listed responses from a patient.
Then put the Q and A in
what you think is the most logical sequence.
Compare your sequence with
other groups.
Questions
Responses
Sequence
1
At first the bruises where small and would be gone in 4 or 5 days --
but they've been getting bigger and lasting longer.
2
I first noticed it about a month ago.
3
I'm 33.
4
I'm married with 2 children -- my boy is 2 and my daughter is 4.
5
I've been getting these terrible bruises whenever I bump into
something ? even little bumps give me a bruise the size of a credit
card.
6
Is this going to heart much?
7
m-i-s-h-n-a-r
8
My name is Amanda Mishnar.
9
No, I don't take any medicines.
10
No, I haven't had any illnesses in at least a year.
Instructions: Match the words or phrases in
column A with there contextual meaning in column B.
All words or phrases in
column A can be found in bold print in the Doctor / Patient interview.
A
B
1. rundown
2. no stamina
3. fatigue
4. lungs sound clear
5. gums
6. pale
7. blood work up
8. heavier than normal
9. lead to
10. blood work
11. rich in iron
12. incorporate
13. iron supplement
14. draw your blood
A. A collection of tests preformed on a
blood sample
B. A medicine (sometimes over-the-counter) containing iron
C. Can cause / can bring about something
D. Energy level falls quickly
E. Light color / lacking normal color intensity
F. More bleeding than usual
G. More iron than in normal foods
H. No abnormal respiratory sounds
I. No energy
J. Blood tests
K. Tired / feeling of being tired
L. Tissue at the margin of the teeth
M. To make part of something
N. To take blood from a person
Instructions: Read the text and fill in the blanks with the missing articles
(a / the).
Then work with a partner to complete the blood donor / recipient
compatibility table.
Blood Typing
Red blood cells have over 50 antigens on their membrane surface. Three have
special significance and are used to designate ____ person's blood type.
____ three antigens are A, B and D (Rh).
This
combination of antigen produces ____ 8 blood types that most people are
familiar with. ____ D antigen (Rh) is expressed as (+; plus sign) if it is present on
____ RBC or as (-; negative sign) if it is absent. These blood types also determine whose
blood a person can receive in ____ blood transfusion. Before ____
transfusion can take place ____ donor's blood must be tested against ____ recipient's blood to make sure it is compatible; this process is called ____
type and cross match. This is necessary because in addition to ____ antigens on
____ surface of RBCs, people also have antibodies in ____ plasma portion of
their blood that can react with ____ antigens on an RBC. It is critical that
____ antibodies in ____ recipient's blood be compatible with
____ antigens on ____
surface of ____ donors RBCs. ____ antibodies ____
person carries in their blood do not react with their own RBC antigens but
can potentially react with antigens from another person's blood if their
blood is of ____ different type. ____ table below shows ____ four main blood
types and ____ antigens and antibodies present in ____ plasma for each type.
It is worth mentioning at this point that Type O blood means that ____ RBCs
have neither antigen A nor B. That is why it is possible for them to have
both antibodies. A person with type AB has both ____ A antigen and ____ B
antigen on each of their RBCs. For that reason, they cannot have either
antibody in their plasma. Normally ____ person who is D- / Rh- does not
carry ____ anti-Rh antibody, however, blood is usually typed as if they did.
This is done to prevent D- / Rh- people from developing ____ antibody after
exposure to D+ / Rh+ blood.
Check your answers:
Listing Activity (Blood typing)
Instructions: Work with a partner and complete
the transfusion compatibility table by placing a (☺) in the compatible boxes.
One has been done as an example.
Most of the words come from the Clinical Corner
section.
Pronounce each word and decide what sound the "g" makes.
Then write
the word in the appropriate box on the right.
Although
Anticoagulant
Becoming
Bleeding
Carrying
Centrifuge
Clotting
Containing
Cough
Drug
During
Fibrinogen
Fragments
Genetic
Gives
Greater
Hemoglobin
Hemorrhage
Higher
Interchangeably
Large
Oxygen
Percentage
Remaining
Rough
Sign
Taking
Through
"g" has a soft "j" sound
"g" has a hard sound
"g+h" is silent
"g" is not silent and not hard or soft
"g+h" has an "f" sound
Listen to pronunciations:
Look back at the words in each box. Do you see
a pattern? Check and see if the following rules apply.
The sound of "g" depends on the letter that follows it in a word. If the
letter is "e" / "i" / "y" the sound is usually soft. If "g" is followed by
any other letter or a space, then the sound is hard. (Note the difference
between RAG (a piece of cloth you clean with) and RAGE (to be extremely
upset).
If the desired sound is hard but the following letter would make the sound
soft, a "u" is sometimes inserted to prevent the rule from being broken.
GUITAR - the "g" has a hard sound, however, if the "u" is removed the "g"
would have a soft sound and would sound like JITAR. The same effect can be achieved by doubling the "g" and in BIGGER.
The "g" in words that end in "ing" has a unique sound - neither hard nor
soft. The "g" in words that have a "g+h" can be silent or have an "f" sound. Although = silent "g+h" Cough = "g+h" has the "f" sound
Instructions: Watch the video on hemostasis, then answer the
questions to test your comprehension.
Disclaimer: This YouTube video provides a very nice
clear presentation of the topic. I appreciate the authors efforts. At
the end of the video the author chooses to very briefly and tastefully
express his religious orientation. While his beliefs don't coincide with
mine and may not coincide with yours, his video remains a nice teaching
tool.
Instructions: Take the self-test below and see
how well you remember the information presented in this unit.
1. Erythrocytes do not have: Check your answer
a. Nuclei
b. Plasma membranes
c. Hemoglobin
d. All the above
2. The element ____ is associated with carrying oxygen and _____ ions
are essential for blood clotting. Check your answer
a. Iron / calcium
b. Iron / oxygen
c. Sodium / calcium
d. Potassium / iron
3. There are ____ types of leukocytes. Check your answer
a. 2
b. 3
c. 4
d. 5
4. Hemophilia is an inherited disease that affects blooding clotting. Check your answer
a. True
b. False
5. Which of the following hematocrit ranges would be considered normal? Check your answer
a. 10 -- 100%
b. 10 -- 30%
c. 43 -- 46%
d. 50 -- 60%
6. The prefix 'leuko' means: Check your answer
a. Red
b. White
c. Blue
d. Blood
7. The suffix 'phila' means: Check your answer
a. To love
b. To hate
c. White
d. Cell
8. Erythropoietin is produced by the: Check your answer
a. Liver
b. Kidney
c. Spleen
d. Bone marrow
9. Erythropoiesis takes place in the: Check your answer
a. Liver
b. Kidney
c. Spleen
d. Bone marrow
10. The prefix 'hemo' means: Check your answer
a. Blood
b. Red
c. White
d. Cell
11. The prefix 'hypo' means: Check your answer
a. Blood
b. Under
c. Clump
d. To separate
12. The condition associated with reduced oxygen carrying ability is
called: Check your answer
a. Polycythemia
b. Hemophilia
c. Anemia
d. Hemorrhage
13. The layer of white blood cells between the RBCs and the plasma in a
spun hematocrit tube is called the: Check your answer
a. Leukocyte layer
b. Buffy coat
c. Packed cells
d. Thrombocytes
14. The average lifespan of a RBC is about: Check your answer
a. 4 months
b. 3 weeks
c. 90 days
d. 1 year
15. Fibrinogen is a ____ protein produced by the ____: Check your answer
a. Blood / spleen
b. Plasma / liver
c. Bone / bone marrow
d. Cellular / platelets
consist of white blood cells which are lighter
than RBCs and much less numerous.
Reds blood cells are significant, among other reasons, for their ability to
carry oxygen from the lungs to the cells that make up the tissues of the
body. The oxygen is carried bound to a special molecule called hemoglobin.
Red blood cells are usually described as biconcave discs. RBCs are among the
smallest cells in the body, with only sperm cells being smaller. RBCs are
produced in the bone marrow in a process called erythropoiesis. When RBCs
enter the circulation they have lost their nucleus, which gives them the
biconcave depression. Without a nucleus, the cells have a limited lifespan.
The average RBC only lasts for 120 days before it is removed from the
circulation by macrophages in the liver and spleen.
pe.
____ three antigens are A, B and D (Rh).
The same effect can be achieved by doubling the "g" and in BIGGER.
