Chapter 27: Structure and Function of the Hematologic System MULTIL! CH"IC!
1. What is the most abundant class of plasma protein? a. Globulin c. Clotting factors b. Albumin d. Complement proteins ANS: B
Albumin (approimatel! "#$ of total plasma protein at a concentration of about % g&dl' is the most abundant plasma protein. )S: 1
*+,: age -%"
. What is the effect of lo/ plasma albumin? a. Clotting factors decrease0 thus increasing the chance o f prolonged bleeding. b. ,e/er immunoglobulins are s!nthesied0 thus impairing the immune function. c. 2ess iron is stored0 thus increasing the incidence of iron deficienc! anemia. d. 3smotic pressure decreases0 thus /ater mo4es from the capillaries to the
interstitium. ANS: 5
6n the case of decreased production (e.g.0 cirrhosis0 other diffuse li4er diseases0 protein malnutrition' or ecessi4e loss of albumin (e.g.0 certain 7idne! diseases0 etensi4e burns'0 the reduced oncotic pressure leads to ecessi4e mo4ement of fluid and solutes into the tissues and decreased blood 4olume. )he other options op tions are not accurate descriptions of the effect of lo/ plasma albumin. )S: 1
*+,: age -%"
8. What is the life span of an er!throc!te (in days)? days)? a. # to 8# c. 1## to 1# b. "# to -# d. ## to %# ANS: C
Because it cannot undergo mitotic di4ision0 the er!throc!te has a limited life span of approimatel! 1# da!s. )S: 1
*+,: ages -%9-%;
%. Which statement concerning er!throc!tes is true? true? a. +r!throc!tes contain a nucleus0 mitochondria0 and ribosomes. b. +r!throc!tes s!nthesie proteins. c. +r!throc!tes ha4e the abilit! to change shape to s
*e4ersible deformit! enables the er!throc!te to assume a more compact torpedoli7e shape0 s
)S: 1
*+,: age -%;
=. Granuloc!tes that contain granules of 4asoacti4e a mines0 such as histamine0 are called: a. Neutrophils c. >onoc!tes b. +osinophils d. Basophils ANS: 5
Basophils contain c!toplasmic granules that hold an abundant miture of biochemical mediators0 including histamine0 chemotactic factors0 proteol!tic en!mes0 and an anticoagulant (heparin' (see ,igure 980 C '. '. )his is not an accurate description of an! of the other options. )S: 1
*+,: age -%-
". Which of the follo/ing are formed elements of the blood that are not cells but are a re dis7shaped
c!toplasmic fragments essential for blood clotting? clo tting? a. >onoc!tes c. >acrophages b. latelets d. +r!throc!tes ANS: B
latelets (thromboc!tes' are not true cells but are dis7shaped c!toplasmic fragments that are essential for blood coagulation and control of bleeding. )his description is not accurate for an! of the other options. )S: 1
*+,: ages -=#-=1
9. Blood cells that differentiate into macrophages are 7no/n as: a. >onoc!tes c. +osinophils b. Neutrophils d. Basophils ANS: A
3nl! monoc!tes migrate into a 4ariet! of tissues and full! mature into tissue macrophages and m!eloid dendritic cells (see )able 98'. )S: 1
*+,: age -=#
;. Without prior eposure to an antigen0 /hich cells are able to destro! some t!pes of tumor cells
and some 4irusinfected cells? a. 2!mphoc!tes b. lasma cells
c. >ega7ar!oc!tes d. Natural 7iller (N' cells
ANS: 5
N cells0 /hich resemble large granular l!mphoc!tes0 7ill some t!pes of tumor cells (in 4itro' and some 4irusinfected cells /ithout being induced b ! pre4ious eposure to these antigens. )his capabilit! is not true of the other options. )S: 1
*+,: age -=#
-. What is the life span of platelets (in days)? days)? a. 1# c. -# b. 8# d. 1# ANS: A
A platelet circulates for approimatel! 1# da!s and ages. >acrophages of the mononuclear phagoc!te s!stem0 mostl! in the spleen0 remo4e platelets. )S: 1
*+,: age -=1
1#. ,etal hematopoiesis occurs in /hich structure? a. Gut c. Bone marro/ b. Spleen d. )h!mus ANS: B
)he spleen is the largest of the secondar! l!mphoid organs and the site of fetal hematopoiesis. )S: 1
*+,: age -=1
11. What is the conse
Splenic absence from an! cause (e.g.0 atroph!0 traumatic traumatic in@ur!0 remo4al because of disease' has se4eral secondar! effects on the bod!0 among them an increase in morphologicall! defecti4e blood cells in the circulation0 confirming the spleens role in remo4ing old or damaged cells. )his description of the conse
*+,: ages -=1-=
1. 5uring an infection0 /h! do l!mph nodes enlarge and become tender? a. B l!mphoc!tes proliferate. b. )he nodes are inflamed. c. )he nodes fill /ith purulent eudate. d. )he nodes are not properl! functioning. ANS: A
)he B l!mphoc!te proliferation in response to significant antigen (e.g.0 during infection' ma! result in l!mph node enlargement and tenderness (reacti4e l !mph node'. )his description is not accurate for the other options. )S: 1
*+,: age -=%
18. Which blood cells are the chief phagoc!tes ph agoc!tes in4ol4ed in the earl! inflammation process? a. Neutrophils c. +osinophils b. >onoc!tes d. +r!throc!tes ANS: A
Neutrophils are the chief phagoc!tes of earl! inflammation. )S: 1
*+,: age -%-
1%. Which blood cells are biconca4e in shape and ha4e the capacit! to be re4ersibl! deformed?
a. Neutrophils b. >onoc!tes
c. +osinophils d. +r!throc!tes
ANS: 5
)he er!throc!tes sie and shape are ideall! suited to its function as a gas carrier. A red red blood cell (*BC' is a small dis7 /ith t/o uni
*+,: age -%;
1=. Which hemoglobin is made from oidied ferric iron (,e8' and lac7s the abilit! to bind
o!gen? a. 5eo!hemoglobin b. 3!hemoglobin
c. >ethemoglobin d. Gl!cos!lated hemoglobin
ANS: C
Without reacti4ation reacti4ation b! methemoglobin reductase0 the ,e8containing hemoglobin (methemoglobin' cannot bind o!gen. )his capabilit! is not true of the other t!pes of hemoglobin mentioned. )S: 1
*+,: age -"1
1". )he absence of parietal cells /ould pre4ent the absorption of an essential nutrient necessar! to
pre4ent /hich t!pe of anemia? a. 6ron deficienc! b. ernicious anemia
c. ,olic acid deficienc! anemia d. Aplastic anemia
ANS: B
5ietar! 4itamin B1 is a large molecule that re
*+,: age -"
19. Which nutrients are necessar! for the s!nthesis of 5NA and the maturation of er!throc!tes? a. rotein and niacin c. Cobalamin (4itamin B1' and folate b. 6ron and 4itamin B" (p!ridoine' d. antothenic acid and 4itamin C ANS: C
Cobalamin and folate are necessar! for the s!nthesis of 5NA and for the maturation of er!throc!tes. )he remaining options are not necessar! for these processes to occur. )S: 1
*+,: age -" E )able 9"
1;. Which nutrients are necessar! for hemoglobin s!nthesis? a. rotein and niacin c. Cobalamin (4itamin B1' and folate b. 6ron and 4itamin B" (p!ridoine' d. antothenic acid and 4itamin C ANS: B
6ron and B" (p!ridoine' are necessar! for hemoglobin s!nthesis (see )able 9"'. )he remaining options are not necessar! for hemoglobin s!nthesis.
)S: 1
*+,: age -" E )able 9"
1-. *ec!cling of iron from er!throc!tes is made possible b! /hich of the follo/ing? a. )ransferrin c. Apoferritin b. Femosiderin d. +r!thropoietin ANS: A
)ransferrin )ransferrin is rec!cled (transferrin c!cle' in the follo/ing manner: (1' the transferriniron comple binds to a transferring receptor on the er!throblasts er!throblasts plasma membrane (' the comple mo4es into the cell b! receptormediated endoc!tosis (8' iron is released (dissociated' from transferrin and (%' the dissociated transferrin is returned to the bloodstream for reuse. )he other options do not present an accurate description of the rec!cling of er!throc!tic iron. )S: 1
*+,: ages -"8-"%
#. B! /hich structure are mature er!throc!tes remo4ed from the bloodstream? a. 2i4er c. )h!mus b. 2!mph d. Spleen 2!mph nodes n odes ANS: 5
After approimatel! 1## to 1# da!s da !s in the circulation0 old er!throc!tes are remo4ed b ! tissue macrophages0 primaril! in the spleen. )S: 1
*+,: age -"
1. Which substance is used to correct the chronic anemia associated /ith chronic renal failure? a. 6ron c. Cobalamin (4itamin B1' b. +r!thropoietin d. ,olate ANS: B
3ne of the most significant ad4ances in the stud! of hematopoietic gro/th factors has been the de4elopment of er!thropoietin for indi4iduals /ith chronic renal failure. )he other options are not associated /ith the treatment of chronic anemia. )S: 1
*+,: ages -"#-"1
. What is the role of thromboane A ()HA' in the secretion stage of hemostasis? a. Stimulates the s!nthesis of serotonin. b. romotes 4asodilation. c. Stimulates platelet aggregation. d. romotes formation of c!cloo!genase. ANS: C
latelet aggregation is primaril! stimulated b! )HA and adenosine diphosphate (A5'0 /hich induce functional fibrinogen receptors on the platelet. )he other options do not present an accurate description of the role of thromboane A. )S: 1
*+,: age -"-
8. Which of the follo/ing is the role of nitric oide (N3' in hemostasis?
a. b. c. d.
Stimulates the release of fibrinogen to maintain the platelet plug. Stimulates the release of clotting c lotting factors I and I66. Causes 4asoconstriction and stimulates platelet aggregation. Controls platelet acti4ation through c!clic adenosine monophosphate (cA>'J mediated signaling.
ANS: 5
+ndothelial cell N3 synthase N3 synthase produces produces N30 /hich controls platelet acti4ation through cA> mediated signaling. )he other options do not present an accurate description of the role of N3 in hemostasis. )S: 1
*+,: age -"" E ,igure 91;
%. )he drug heparin acts in hemostasis b! /hich processes? a. 6nhibiting thrombin and antithrombin 666 (A)666' b. re4enting the con4ersion of prothrombin to thrombin c. Shortening the fibrin strands to retract the blood clot d. 5egrading the fibrin /ithin blood clots ANS: A
Clinicall! administered heparin or heparin sulfate (on the surface of endothelial cells' binds to A)666 A)666 and induces a conformational change that greatl! enhances en hances its acti4it!. Knder normal conditions0 the presence of endothelial cell heparin h eparin sulfate and a4ailable A) A)666 in the circulation cooperate to protect the 4essels from the effects of spontaneousl! acti4ated thrombin. )he other options do not accuratel! describe the role heparin pla!s in hemostasis. )S: 1
*+,: age -9#
=. What is plasmins role in the clotting process? a. Stimulates platelet aggregation. b. 6nhibits platelet adhesion and aggregation. c. re4ents the con4ersion of prothrombin to degrade the fibrin /ithin blood clots. d. 5egrades the fibrin /ithin blood clots. ANS: 5
lasmin (also called fibrinase called fibrinase or fibrinolysin or fibrinolysin'' is a serine protease that degrades fibrin pol!mers in clots. 6t is not capable of the functions described in the remaining options. options. )S: 1
*+,: ages -91-9
". What does pol!c!themia at birth indicate? a. F!poia in utero c. Congenitall! absent spleen b. 5!sfunctional bone marro/ d. 5eh!dration in utero ANS: A
)he h!poic intrauterine en4ironment stimulates er!thropoietin production in the fetus and accelerates fetal er!thropoiesis0 producing pol!c!themia (ecessi4e proliferation of er!throc!te precursors' of the ne/born. )he other options are not related to pol!c!themia. )S: 1
*+,: age -9=
9. Where are upffer cells located?
a. idne!s b. 2i4er
c. ancreas d. Spleen
ANS: B
)he li4er macrophages are the onl! o nl! location for upffer cells. )S: 1
*+,: age -=# E age -" E )able 98
;. Where are 2angerhans cells found? a. S7in b. 6ntestinal lining
c. idne! d. )h!roid
ANS: A
3f the a4ailable options0 onl! the s7in is the location for 2angerhans cells. )S: 1
*+,: age -=# E )able 98
-. What is the role of collagen in the clotting process? a. 6nitiates the clotting cascade. c. Stimulates fibrin. b. Acti4ates platelets. d. 5eacti4ates fibrinogen. ANS: B
6n the clotting process0 collagen pro4ides a particularl! strong stimulus to acti4ate platelets. Collagen does not bring about an! of the other options. )S: 1
*+,: age -"-
8#. Which form of iron (,e' can be used in the formation of normal hemoglobin? a. ,e c. ,e8 b. ,e d. ,e% ANS: B
6t is crucial that the iron be correctl! charged onl! reduced ferrous iron (,e' can bind o!gen in the lungs and release it in the tissues. )S: 1
*+,: age -"1
81. Where are al4eolar macrophages found? a. S7in b. Breasts
c. Gastrointestinal tract d. 2ungs
ANS: 5
)he lung is the onl! location for al4eolar macrophages. )S: 1
*+,: age -=# E )able 98
8. What changes to the hematologic s!stem s !stem is related to age? a. latelet adhesi4eness decreases. b. 2!mphoc!te 2!mphoc!te function decreases. c. Cellular immunit! increases. d. +r!throc!te reproduction accelerates. ANS: B
Blood composition changes little /ith age. A dela! in er!throc!te replenishment ma! occur after bleeding0 presumabl! because beca use of iron deficienc!. de ficienc!. 2!mphoc!te 2!mphoc!te function appears to decrease /ith age. articularl! affected is a decrease in cellular immunit!. latelet adhesi4eness probabl! increases /ith age. )S: 1
*+,: age -9=
88. What is the function of er!throc!tes? a. )issue o!genation b. Femostasis
c. 6nfection control d. Allerg! response
ANS: A
+r!throc!tes are solel! responsible for tissue o!genation. )S: 1
*+,: ages -%9-%;
MULTIL! #!S"$S!
8%. Which characteristics allo/ er!throc!tes to function as gas carriers? (Select all that apply.) a. ermanent shape b. Compactness c. *e4ersible deformabilit! d. resence of h!peracti4e mitochondria e. Biconca4it! ANS: C0 +
A red blood cell (*BC' is a small dis7 /ith t/o uni
*+,: age -%;
8=. Which statements about plasma proteins are correct? (Select all that apply.) a. ro4ide clotting factors. b. )ransport trigl!cerides. c. S!nthesie complement proteins. d. Create h!drostatic pressure. e. )ransport cholesterol. ANS: ANS: A0 B0 B0 C0 C0 +
lasma proteins do not create h!drostatic h !drostatic pressure. )he other options are all accurate statements regarding plasma proteins. )S: 1
*+,: ages -%=-%9
8". What are the primar! anticoagulant mechanisms? (Select all that apply.) a. Antithrombin 666 b. )issue factor path/a! inhibitor c. Fematopoiesis d. rotein C e. hagoc!tosis
ANS: A0 B0 B0 5
)he ma@or regulator! factors that control hemostasis reside /here the greatest probabilit! of clotting /ould occurLon the endothelial cell surface. )he primar! anticoagulant mechanisms include thrombin inhibitors (e.g.0 antithrombin 666'0 tissue factor inhibitors (e.g.0 tissue factor path/a! inhibitor'0 and mechanisms for degrading acti4ated clotting factors (e.g.0 protein C'. Fematopoiesis and phagoc!tosis are processes that are not related to anticoagulation. )S: 1
*+,: age -9#
89. Which statements are true regarding true regarding the role of the endothelium in clot formation? (Select all
that apply.) a. )he surface of the endothelium produces plasma protease inhibitors. b. lasma protease inhibitors assist in pre4enting clot formation. c. )hrombomodulin is a protein that is con4erted on the surface of endothelial cells. d. rotein A binds to thrombomodulin. e. Acti4ated protein C enhances the adhesion abilit! of neutrophils. ANS: A0 B0 B0 C
)he surface of the endothelium produces plasma protease inhibitors to resist clot formation. )hrombomodulin is a membrane thrombinbinding protein matter and is co n4erted to acti4ated protein C (see ,igure 91;' on the surface of endothelial cells. rotein C in the circulation binds to thrombomodulin. Acti4ated protein C inhibits the adhesion of neutrophils to the endothelium. )S: 1
*+,: ages -9#-91
8;. Which statements characterie albumin? (Select all that apply.) a. *etains sodium to maintain /ater balance. b. ro4ides colloid osmotic pressure. c. 6s s!nthesied in the li4er. d. 6s a carrier for drugs that ha4e lo/ /ater solubilit!. e. 6s a small molecule ANS: B0 C0 C0 5
Albumin is Albumin is a plasma protein produced b ! the li4er. 6t ser4es as a carrier molecule for the normal components of blood0 as /ell as for drugs that ha4e lo/ solubilit! in /ater (e.g.0 free fatt! acids0 lipidsoluble hormones0 th!roid hormones0 bile salts'. Albumin molecules are large and do not diffuse freel! through the 4ascular 4 ascular endothelium0 thus the! maintain the critical colloidal osmotic pressure (or oncotic pressure' that regulates the passage of /ater and solutes into the surrounding tissues (see Chapters 1 and 8'. )S: 1
*+,: age -%"
M%TCHI$&
Match the descriptions with the corresponding corresponding terms. MMMMMM A. Clotting Clotting MMMMMM B. *ed blood cell de4elopment MMMMMM C. *ed blood cell destruction MMMMMM 5. latelet formation
MMMMMM +. Blood cell production 8-. %#. %1. %. %8.
+ndomitosis Femostasis Fematopoiesis +r!thropoiesis hagoc!tosis
8-. ANS: 5 )S: 1 *+,: age -"= >SC: 5uring thrombopoiesis0 thrombopoiesis0 the mega7ar!oc!te mega7ar!oc!te progenitor is programmed to undergo undergo an endomitotic cell c!cle called endomitosis0 during /hich 5NA replication of platelets occurs. %#. ANS: A )S: 1 *+,: age -"= >SC: Femostasi Femostasiss is defined defined as arrest of bleeding bleeding.. %1. ANS: + )S: 1 *+,: age -=% >SC: Blood cell production production (hematopoiesis' (hematopoiesis' is ongoing0 ongoing0 occurring in the li4er and spleen of the fetus and onl! in bone marro/ (medullar! ( medullar! hematopoiesis' hematopoiesis' after birth. %. ANS: B )S: 1 *+,: age -=>SC: 6t /as not until the the 1;=#s that the bone bone marro/ /as identified as the the site of er!thropoiesis0 er!thropoiesis0 or the de4elopment of red blood cells. %8. ANS: C )S: 1 *+,: age -=# >SC: >onoc!tes and macrophages are acti4e acti4e phagoc!tes that that participate participate in the immune and inflammator! responses. )he! also ingest dead or defecti4e host cells0 particularl! blood cells.
