优质血液讨论课要点.docx

优质血液讨论课要点.docx

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优质血液讨论课要点

第三章血液

一、目的和要求

了解血量、血液的组成和有形成分的功能。

熟悉血液的理化特性。

掌握生理性止血机制，血液凝固及纤维蛋白溶解。

二、重点和难点

重点:

血液的理化特性、红细胞的生理特征与功能、红细胞生成的调节、血小板的生理特性与功能、生理性止血的机制、凝血基本过程、抗凝血系统及其作用、纤维蛋白溶解系统及纤溶过程。

难点：

凝血因子、凝血途径、抗凝血系统及其作用。

三、讲授内容和要点

血液的组成、理化特性及血液的功能。

红细胞的生理特性与功能。

红细胞生成的调节。

白细胞的生理特征和功能。

血小板的生理特性。

生理性止血的基本过程。

凝血因子、外源性和内源性凝血途径。

抗凝血系统及其作用、纤维蛋白溶解系统及纤溶过程。

四、自学内容和要点

白细胞和血小板的生成和调节。

白细胞、血小板的破坏。

血型与输血原则。

五、参考复习题

1.正常人的血量是如何计算？

试述血浆蛋白的种类及其生理功能。

2.试述血液的生理特性和红细胞的生理特性。

红细胞有何功能？

3．缺乏铁、维生素B12和叶酸引起的贫血有何不同？

为什么

4.血浆晶体和胶体渗透压主要由哪些物质形成？

各有何生理功能？

当将细细胞分别置于高渗、低渗、等渗但不等张和等渗等张溶液中，其容积发生何改变？

5.试述生理性止血的基本过程，详述其机制。

6.试述血凝的基本过程的三个步骤。

内、外源凝血系统有何不同特点？

两系统间有何关系？

7.当人生活在海平面时，为何外周血中的红细胞（RBC）数能维持相对稳定？

当人生活在海平面进入4000M高原生活六个月，RBC数有何变化？

为什么？

8.血液在正常人心血管内为何不凝？

怎样加快、延缓和防止血凝？

为何医生在进行外科手术前要先给病人补充维生素Ｋ？

9.如果已知某人血型为Ａ或Ｂ，能否用其来测定未知血型？

为何同型血相输还需作交叉配血？

10.血小扳有何生理特性？

其主要功能是什么？

试述血小板在生理性止血中的作用。

11．抗凝系统有哪些抗凝物质组成？

各有何作用？

其机制是什么?

12.简述纤溶系统的组成及纤溶过程。

纤溶系统与血液凝固系统有何

关系？

六、名词

血浆（plasma）、血细胞（bloodcells）、血浆蛋白（plasmaprotein）、红细胞（erythrocytes）、白细胞（leukocytes）、血小板（platelets）、血细胞比容（hematocrit）、粘度（viscosity）、晶体渗透压（crystalosmoticpressure）、胶体渗透压（colloidosmoticpressure）、等张溶液（isotonicsolution）、造血（hempooiesis）、可塑变形性（plasticdeformation）、红细胞的悬浮稳定性（suspensionstability）、红细胞沉降率（erythrocytesedimentationrate，ESR）、红细胞叠连（rouleauxformation）、渗透脆性（osmoticfragility）、趋化性（chemotaxis）、生理性止血（hemostasis）、血液凝固（bloodcoagulation）、纤维蛋白溶解（fibrinolysis）、血清（serum）

TeachingProgramandkeypoints

Definethefollowingtermsorphrases

ESR,Hemostasis,Fibrinolysis,Hematocrit,Surfaceactivation,Thesuspensionstabilityofredcells,Bloodcoagulation,Internalenvironment,Diapedisisofwhitebloodcell,Intrinsicpathwayofbloodclotting,Osmoticfragilityofredcell,Bloodvolume,Bloodsendimentationrate（ESR）,Chemotaxis,Clottingfactor,Bloodcoagulation,Anticoagulant,Osmoticfragilityofredcell,Bloodgroup,Lysisofbloodclot,Fibrinolysis,

Brieflyanswer

1.Statebrieflytheeventsinhemostasis

2.Statebrieflytheregulatoryfactorsofproductionofredcellsandtheiractions

3.Whybloodcoagulationdoesnottakeplaceinnormalbloodvessels?

4.Describebrieflytheroleplateletplaysinhemostasis

5.Definebloodcoagulationandstatebrieflytheessentialstepsofbloodcoagulation

6.Statebrieflythephysiologicalcharacteristics

7.Describebrieflythedifferencebetweenplasmaandserum

8.Describebrieflytheessentialprocessoffibrinolysis

ThoughtQuestions

1.Whataretheeventsinhemostasis?

Describethemechanismsbywhich

theseeventsinhemostasisoccur.

2.Whatarethethreestepsofbloodcoagulation?

3.Whyistheconcentrationofredbloodcellinthebloodkeptrelativeconstantwhenapersonlivesatagivenlevel?

4.Whenapersonmovesfromsea-leveltoamountainof4000-metershighandlivesthereforsixmonths,whatwillhappentohisorherredcellconcentration?

5.Whydoes’ntbloodclottingoccurinnormalcardiovascularsystem?

6.Howtoaccelerate,slowdown,andpreventbloodfromcoagulation?

7.WhydodoctorsdetermineliverfunctionsofpatientsandgivesomeinjectionsofvitaminKbeforeoperation?

8.Ifaperson’sbloodgroupisknown（sayA,orB）,isitpossibletoidentitytheunknownbloodgroupsofotherpersons?

Andhowtheyareidentified?

9.Whatarethecharacteristicsofplatelets?

Andwhatisthephysiologicalfunctionofplatelets?

10.Whatisthedifferencebetweenintrinsicandextrinsicpathways?

Andwhatistherelationbetweenthetwo?

11.Whyisitnecessarytoperformcross-matcheventhoughthesamegroupistransfused?

12.Whenredcellsareplacedinhypoosmoticsolution,hyperoosmoticsolutionandisotonicsolutionrespectively,whatwillhappentotheredbloodcell?

13.Whydoesnotmentrualbloodclot?

14.Whatisosmoticpressure?

Whatistheeffectofhyper-,hypo-osmolalityandonthecellvolume?

15.Whatisthefunctionofplasmacrystalandcolloidosmoticpressure?

Multichoicequestions:

TherearefiveanswersforeachquestionmarkedA,B,C,DandE.Onlyoneansweriscorrect,youhavetochoosethebestanswertothequestionandthenblackenthecorrespondingletterwithapencil

1.Inanadultperson,redbloodcellsareproducedmainlyby

A.Liver

B.Spleen

C.Bonemarrowofallbonesthroughoutthebody

D.Thebonemarrowofmembranousbones

E.Thethymus

2.LackofvitaminB12leadsto

A.Perniciousanemia

B.Microcyticanemia

C.Aplasiaanemia

D.Sicklecellanemia

E.Hemolyticanemia

3.Whichisthefactorthataccelerateserythrocytesedimentationrate（ESR）?

A.Increasednumberofredbloodcellintheblood

B.Increasednumberofwhitebloodcellintheblood

C.Increasednumberofplateletsintheblood

D.Increasedamountofalbuminintheblood

E.Increasedamountofglobulinintheblood

4.Whichofthefollowingmeasurescanpreventsbloodfromclotting?

A.Addingsomewood-dustintotheblood

B.Smoothingtheinnersurfaceofbloodcontainer

C.Puttingbloodinthetesttubeinice-bath

D.Removingfreecalciumionsfromtheblood

E.Makingtheinnersurfaceofacontainerunwettable

5.Thefactorthatinitiatestheintrinsicpathwayistoactivate

A.FIIIB.FIVC.FXIID.FXE.FVII

6.Aperson’sserumcontainsagglutininB,thatperson’sbloodgroupis

A.AB.BC.OD.ABE.AorO

7.Releaseoferythropoietinismainlydependenton

A.Numberofredbloodcells

B.Bloodvolume

C.Numberofwhitebloodcells

D.Oxygenationoftissue

E.Numberofplatelets

8.Underwhichofthefollowingconditions,redbloodcellsmaintaintheirvolume?

A.Whentheyareplacedinisosmoticureasolution（1.9%ureasolution）

B.Whentheyareplacedin0.9%NaClsolution

C.Whensodiumpumpisinactivated

D.Whentheyareplacedinisoosmoticbutnotisotonicsolution

E.Whentheyareplacedinsea-water

9.Whichofthefollowingclottingfactorsinitiatesextrinsicpathway?

A.FXIIB.FIIIC.FVD.FXE.FXIII

10.Addinghomogenateoflungtissuetoblood

A.Willacceleratebloodclottingprocess

B.Willslowdownbloodclottingprocess

C.Willpreventbloodclotting

D.Willnotaffectbloodclottingprocess

E.Willcausehemolysis

11.Alltheclottingfactorsarepresentinthebloodexcept

A.FIIB.FIIIC.FVIIID.FXIIE.FX

12．ThenormalpHvalueinthebloodis

A.6.9-7.5B.7.2-7.5C.7.35-7.45D.7.25-7.45E.7.1-7.2

13.Erythropoietinactsto

A.Promoteproliferationanddifferentiationofhemopoieticstemcells

B.PromoteproliferationanddifferentiationofBFU-E

C.PromoteproliferationanddifferentiationofCFU-E

D.Promotematurationofprogenitorredcells

E.Promotereleaseofredcellsfrombonemarrow

14.Thenormaltotalbloodvolumeofanormalpersonaccountsfor

A.7-8%ofbodyweight

B.7-8ofextracellularfluid

C.7-8%oftotalbodyfluid

D.7-8%ofintracellularfluid

E.7.8%ofconnectivetissue

15.Theprinciplesubstancethatformsplasmacolloidosmoticpressureis

A.Na+B.Cl-C.AlbuminD.GlobulinE.Fibrinogen

16.HemophiliaAisduetolackof

A.FXIB.FIXC.FVIIID.FXIIE.FV

17.Theprinciplesubstancesthatformsplasmaosmoticpressureare

A.K+B.HCO3-C.Cl-andNa+D.AlbuminE.Globulin

18.Inwhichofthefollowingsolutions,partialhemolysisofnormalredcellstakeplace?

A.0.85%B.1.9%C.0.4%D.0.3%E.5%glucose

19.Lackofintrinsicfactorleadsto

A.Microcyticanemia

B.Maganocyticanemia

C.Hemolyticanemia

D.Aplasticanemia

E.Sickleanemia

20.Underwhichofthefollowingconditions,ESRisincreased?

A.Anincreaseinalbuminintheplasma

B.Anincreaseinlecithinintheplasma

C.Anincreaseinglobulinintheplasma

D.Adecreaseinfibrinogenintheplasma

E.Adecreaseincholesterolintheplasma

21.Whichofthefollowingsolutionsisbothisoosmoticandisotonic?

A.0.7%NaCl

B.0.9%ofNaCl

C.5%ofglucose

D.0.85%ofNaCl

1.9%ofurea

22.LackofvitaminB12leadsto

A.Microcyticanemia

B.Perniciousanemia

C.Hemolyticanemia

D.Aplasticanemia

E.Sickleanemia

23.Whichofthefollowingfactorsacceleratesthebloodcoagulation?

Adecreaseintemperature

Adecreaseinbloodcalciumconcentration

Addingsomeheparinintotheblood

Addingsometissuehomogenate

Providingsmoothsurfaceofcontainercontainsblood

24.Thefluidexpressedoutfrombloodclotis

A.ICFB.ECFC.PlasmaD.SerumE.Tissuefactor

25.Whichofthefollowingfactorshasnothingtodowithplateletaggregation?

A.ADPfromtissue

B.ADPfromplatelet

C.FIIIfromdamagedtissue

D.TXA2synthesizedbyplatelet

E.Collagen

26.Thefactorthatpromotestherouleauxformationofredbloodcellsis

A.Thenumberofredcells

B.Hbconcentration

C.Increasedplasmaalbuminandglobulinconcentration

D.Increasedplasmaglobulinandfibrinogenconcentration

E.Increasedcrystalsubstancesintheplasma

27.Prothrombinactivatoriscomposedof

A.FV,Xa,Ca2+andPF3

B.FXIIa,XIa,IXaandVIII

C.FIII,VIIandCa2+

D.FI,II,andCa2+

E.XIIa,III,andII

28.Thecorrectdescriptionabouttheactionofheparinis

A.ItincreasestheaffinityofantithrombinIIIforthrombin

B.Itinactivatestheactivityofthrombindirectly

C.Itblockstheformationofprothrombinactivators

D.Itpreventstheactivationofintrinsicpathway

E.Itpreventtheactivationofextrinsicpathway

29.Theprinciplehormonethatregulatestheproductionofredbloodcellsis

A.Androgen

B.Estrogen

C.EPO

D.GH

E.Thyroidhormone

30.WhenredbloodcellsfromapersonwhoseESRisincreasedintothenormalserum,ESRwill

A.Notchange

B.Accelerate

C.Returntonormal

D.Firstreturntonormalandthendecrease

E.Firstreturntonormalandthenincrease

31.Thewrongdescriptionaboutthephysicalandchemicalcharacteristicsis

A.