LAB REPORT #6: CARDIOVASCULAR SYSTEM

Biology I, Pre-Health Sciences – Durham College, Fall 2020

/40 marks

EVALUATION NOTES

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PART 1 – ADDERALL: THE STUDY DRUG?

DISCLAIMER: This content is not intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health provider with any questions you
may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it
because of something you have read in this lab manual.

Introduction
Carrie is a first-year student in Durham College’s
Practical Nursing program. It is the night before a
large test in one of her hardest courses (Anatomy and
Physiology). While she has been keeping up with the
material, the amount of content is starting to
overwhelm her. She decides to join a last minute
study group on-campus with 2 of her classmates,
Nadia and Tamika.
As the hours pass, Carrie, Nadia and Tamika work
together to study the important chapters and quiz [ Source – USA Herald ]
each other on potential test questions. They become
worried, however, when it gets to be midnight and
only half of the content has been covered. As a group, they make a game-time decision to
pull an all-nighter, rationalizing that if they work efficiently, they can get all the material
covered before their 8:10 am test. To fight off fatigue and to keep their minds active, Nadia
and Tamika suggest taking Adderall (amphetamine), a prescription medication typically used
to treat people with Attention Deficit Hyperactivity Disorder (ADHD). Tamika explains that she
recently got pills from her younger brother who has ADHD and that this stimulant really helps
keep her stay focused and alert. She mentions that she’s taken 2 or 3 low-dose pills ‘loads of
times’ and that she’s never experienced any negative side effects. Nadia even pipes up to
say that it helped her get 90’s in the Pre-Health Sciences program and that she found it safe
to use even despite having a rare blood disorder, sickle-cell anemia. Carrie is a bit hesitant,
but their rationale seems reasonable. After all, nursing tests in this course require a 60% or
higher to pass. If she doesn’t do well on this test, she has no idea what she will say to
her parents if she fails out. She realizes she’s made her decision – she swallows 2 pills.
By 1 am Carrie begins to feel more in control. The 3 of them have ploughed through an entire
chapter already and they feel as awake and alert as ever. They start to think that maybe
things will turn out OK after all. Just as Carrie turns the page to start the next chapter, Nadia
pipes up and says, “Hey, I feel a little funny.” “Weird,” says Tamika, “I feel a little ‘off’ myself.”
After a bit of probing, Nadia admits that her vision is getting a bit blurry and that her heart is

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racing a mile a minute. Tamika confesses that she feels kind of dizzy and disoriented. They
decide to go outside to get some fresh air. Soon after, Carrie gets a frantic text from Tamika
– Nadia has passed out walking down a flight of stairs. An ambulance has been called.
Carrie grabs her books and races down to meet them.
She arrives to find Nadia still unconscious and Tamika tearfully explaining to paramedics
what happened. When they ask if Nadia was on any medications, Tamika pauses but then
says, “No.” Knowing that Nadia’s life could potentially be in danger, Carrie decides to cut in
and tell the paramedics that all 3 of them had taken several pills of Adderall an hour before.
As paramedics load Nadia into their truck, they recommend that they also accompany them
to the hospital for examination. Carrie locks eyes with Tamika and nods - she too was now
experiencing dizziness, disorientation, and nausea. In the ambulance,Tamika texts her
brother (the one she got the pills from) to see if the dose per pill had recently changed. He
texts back a few minutes later. He forgot to tell her – his prescription had recently changed.
His pills now contained approximately twice as much active drug compared to before.

Procedure

A. BLOOD TESTS

Patients who are suspected of amphetamine overdose often undergo a battery of blood tests
before specific treatment options can be recommended. Many of these are standard
procedures for all admitted patients and include blood-typing, complete blood counts (CBCs),
and tests for the presence of amphetamine in the blood. While this list is by no means
extensive, 2 tests were performed to collect data about Carrie, Tamika and Nadia’s current
medical conditions.
Blood typing:
1. Take a look at the sample images below to see what blood looks like when it has
undergone agglutination (clumping of red blood cells). Notice that agglutinated blood
appears “clumpy” or “grainy.”

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2. Next, remember that the blood type of an individual can be determined by examining if
blood agglutinates in the presence of anti-A, anti-B, and anti-Rh antibodies as described:

RULE 1: Agglutination occurs when antibodies bind to antigens on the surface of a red
blood cell.
• Blood that agglutinates in the presence of anti-A antibodies contains A antigens.
• Blood that agglutinates in the presence of anti-B antibodies contains B antigens.
• Blood that agglutinates in the presence of anti-Rh antibodies contains Rh antigens.

RULE 2: The antigens on the red blood cell determine the “type” of blood. E.g. Blood
with A antigens and B antigens but no Rh antigens is Type AB Rh- blood.

3. Next, imagine that the following protocol has been carried out for you: Blood typing
plates were obtained and labeled. Drops of blood from Carrie, Tamika and Nadia was
mixed with either anti-A, anti-B or anti-Rh antibodies, as shown below:

4. (6 marks) Use the information in Questions 1-3 to complete the table below:

Patient Y/N - Did agglutination occur? Blood

Blood Anti-A antibody Anti-B antibody Anti-Rh antibody Type
YES NO YES B-positive
Carrie
YES YES YES O-positive
Tamika
NO YES NO A-negative
Nadia

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Inspect blood under the microscope:

5. Recall that when Nadia arrived to the hospital she was unconscious. As doctors couldn’t
collect a medical history directly from her, they questioned Nadia and Carrie to see if they
were aware of any medically relevant information. Luckily, both Nadia and Carrie
remembered that Nadia had mentioned she had sickle-cell anemia, a genetic disease
that lowers hemoglobin and red blood cell counts within the body and gives red blood
cells a characteristic “sickle” or crescent shape. As treatment options for amphetamine
overdose could vary for people with this condition, Nadia’s doctors decide to re-examine
Nadia’s blood under the microscope to determine if she does in fact have sickle cell
anemia.

a. Slide A: Blood from person who is healthy imaged using the 40X objective

(1.5 marks) Match the letter

in the image to the terms
below:
_A___ red blood cell
__B__ white blood cell
__C__ platelet

b. Slide B: Blood from a person with sickle-cell anemia imaged using the 40X
objective

(1 mark) Match the letter in

the image to the type of cell
below:

__A cell with healthy shape

__B__ cell with sickle-shape

Sickle Cell Image Reference

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 c. Blood from Nadia imaged using the 40X objective

(0.5 mark) Classify Nadia’s

blood as either “healthy” or
“sickle-cell anemia:
_Sickle-cell
anemia___________

(2 marks) Justify your answer using 2 pieces of evidence collected directly from
the microscopy images:

Reason 1: _In the picture you can see some misshapen red blood cells, almost
like a half moon. __________________________________________________

Reason 2: _The patient also does not have very many red blood cells either
which is an indicator of sickle cell anemia.

B. TREATMENT

Treatment options for people with amphetamine overdose can vary depending on the
severity of the symptoms. Patients who are extremely agitated may be sedated with
benzodiazepines. Imaging tests may be ordered to determine if any organ damage has
occurred. Many people will receive IV fluids. More severe conditions such as seizures,
hyperthermia, or myocardial infarction (heart attack) may require medications. After their
initial assessment, Tamika and Carrie still experience intense symptoms of agitation and
disorientation but fortunately, they do not seem to be experiencing more severe
symptoms. It is recommended that they both receive IV fluids and continue to rest and be
monitored. Nadia, on the other hand, remains unconscious and is experiencing irregular
heart patterns. Among other things, it is recommended that she receive a blood
transfusion to prevent complications with a possible sickle-cell anemia diagnosis and to
receive an echocardiogram to inspect if there is any damage to her heart.

Make IV fluid:

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IV fluid is an artificially made solution that is meant to mimic the “plasma” portion of
blood. All IV fluid administered to patients is made by trained laboratory technicians and
tested judiciously to prevent contamination. There are many different IV fluid “cocktails”
available depending on the needs of the patient.

6. Imagine that the following protocol was done for you. A common IV fluid, D5NS, was
made that contains normal saline solution (0.9%) and dextrose/glucose (5%):

a. The following ingredients are added to a clean 100 mL beaker and stirred until all
components were dissolved:

Reagent Amount Instructions

Deionized water 100 mL Measured with graduated cylinder
NaCl 0.9 g Measured using balance
Dextrose/glucos 5g Measured using balance
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b. A TDS meter (“total dissolved solids”) was used to ensure that
the IV fluid was made properly. The expected range for D5NS
is 650 to 850 ppm. See the image for the reading obtained by
the TDS meter.

c. A label was added to the IV fluid that included the following:

i. The name of the solution
ii. The date it was made
iii. The TDS reading with correct units
Source
iv. Your name

7. Use the information in Question 6 to answer the following:

a. (1 mark) According to the TDS meter, was the D5NS made properly? – Yes/No

b. (3 marks) Compare the ingredients in D5NS to plasma in real blood. List 3

ingredients that are present in real blood plasma that are not present in D5NS.
- Albumin
-Globulin
-Fibrinogen

c. (2 marks) Write a complete label for the IV bag on the line below:
_D5N5: December 2nd, 2020: 789 ppm: Tiffany Mooy

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Investigate blood transfusion compatibility:
Due to an increasingly busy night, the hospital is running short on banked blood for Nadia’s
blood transfusion. Unfortunately, only Type ARh+ and Type ORh- blood are available.
8. Determine if Nadia’s blood would be compatible with these blood types by completing
the tables below. Be as specific as possible.

a. (7 marks) Transfusion Option 1: Type ARh+ is given to Nadia

DONOR
(Type ARh+)
What antigens are What antibodies are
present on the RBC? present in the plasma?
A antigen and Rh Anti-B antibodies
antigen
RECIPIENT
(Nadia = Type A- negative____ )
What antigens are Which antibodies are
present on the RBC? present in the plasma?
A antigen Anti-B antibodies

Highlight your answer:

Yes/No - Will antibodies in the recipient’s blood bind to antigens on the donor’s RBCs?
Yes/No - Will agglutination occur?
Yes/No - Will this blood transfusion be safe?

b. (7 marks) Transfusion Option 2: Type ORh- is given to Nadia

DONOR
(Type ORh-)
What antigens are What antibodies are
present on the RBC? present in the plasma?
No antigens Anti- A and anti-B
antibodies
RECIPIENT
(Nadia = Type _A negative_____ )
What antigens are Which antibodies are
present on the RBC? present in the plasma?
A antigens Anti-B antibodies

Highlight your answer:

Yes/No - Will antibodies in the recipient’s blood bind to antigens on the donor’s RBCs?
Yes/No - Will agglutination occur?
Yes/No - Will this blood transfusion be safe?

Learn heart anatomy via an “echocardiogram:”

Echocardiograms are used to inspect blood flow through the heart. This specialized
procedure allows for the diagnosis of potential cardiac abnormalities. As severe
amphetamine overdose is commonly linked to heart conditions such as myocardial infarction,
this echocardiogram may prove to be crucial in determining if Nadia has suffered any heart
damage. This is especially important given that Nadia may also suffer from sickle-cell
anemia, another risk factor for heart disease.

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 9. Watch the video to show the flow of blood through the heart:
https://www.youtube.com/watch?v=JA0Wb3gc4mE

10. Use the heart model below to simulate blood flow through the heart:

a. (4.5 marks) Begin by reviewing basic heart anatomy by matching the labels on the
model to the list below. Some have been completed for you.

M aorta
__G___ atrium – left
__E___ atrium – right
__L___ lungs – left/right
H pulmonary artery – L/R
D pulmonary vein – L/R
__K___ valve – aortic SL
_J____ valve – bicuspid AV
__A___ valve – pulmonary SL
_I____ valve – tricuspid AV
C vena cava
_F____ ventricle – left
__B___ ventricle – right

b. (4.5 marks) Track the pathway

of blood through the heart. Start
with the vena cava and finish with the aorta. Remember to be as specific as
possible.
BODY > Vena cava
>_Right Atrium_
>_Tricuspid AV valve______
>__Right Ventricle_______
>___Pulmonary SL valve_____
> pulmonary artery
> LUNGS-left/right
>_Pulmonary Vein__
>__Left atrium_____
>_Bicuspid AV valve__
>___Left Ventricle__
>__Aortic SL valve___
> Aorta > BODY
References
1. Sickle Cell images Sickle Cell Image Reference Retrieved online March 20, 2020

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2. Nadia’s blood Image for Nadia's blood Retrieved online March 20, 2020
3. Normal blood smear Biology 1700 Lab Manual
4. Heart pumping video https://www.youtube.com/watch?v=JA0Wb3gc4mE Retrieved online March 20, 2020
5. TDS Meter image TDS Meter Image Retrieved online March 23, 2020

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