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Department of Physiology, Medical School, Soochow University, Suzhou 215123, China
E-mail:email@example.com Tel:0512-62096158; 13506212030
I. II. Physical and chemical characteristics of blood III. Blood Cells 1. Hemopoietic process and hemopoietic stem cells 2. Hemopoietic microenvironment 3. Erythrocyte Physiology 4. Leukocyte Physiology 5. Platelet or Thrombocyte Physiology IV. Physiological Hemostasis 1. Endocrine functions of vessel endothelial cells 2. Physiological Characteristics of Platelet 3. Blood Coagulation 4. Fibrinolysis V. Blood Group 1. RBC Agglutination 2. ABO blood group system 3. Rh blood group system 4. Relation between blood volume and clinic 5. Principle of Transfusion and Cross-match test
What will we discuss in this chapter? (Outline) Blood composing
Blood and Internal Environmental Homeostasis
Blood is that part of extracellular fluid within the cardiovascular system Blood forming During animals’ evolution, extracellular fluid was gradually shaped from the age-old time with ocean which was mainly salty solution. At last, extracellular fluid was differentiated into plasma and interstitial fluid and blood came from plasma and cells. The role of blood in internal environmental homeostasis Blood, the most active component in extracellular fluid, display functions as follows:
(1) (2) (3) (4)
transportation; pH value buffer; temperature or thermal maintenance; immunity and defence
I. Blood composing
Blood composing: plasma + blood cells Hematocrit: blood cells occupies the percentage of total blood volume. normal value male: 40-50% female: 37-48% newborn: 55%
Blood component (summing-up) .
Terminology and normal value .
β-. (2) nutrition. Function of plasma protein: (1) transportation. hormone. it is electrolytes. globulin (20-30 g/L. Most of albumin and globulin made from liver. (4) coagulation and anticoagulation. (5) pH value buffer. (6) immunity (globulin) .Chemical component of plasma Water: > 90% Small molecule: 2%. metabolic products. enzyme. (3) forming colloid osmotic pressure. γ.α1-. Protein: 60-80 g/L.etc. A/G and clinic. nutriment. plasma protein include albumin (40-50 g/L).) and fibrinogen. α2.
5 4.3 2 14 145 117 2.Chemical component of plasma H 2O 90 .3 0.4 4.91% Plasma 血浆 Interstitial 组织液 fluid Intracellular 细胞内液 fluid Na+ ClCa++ K+ PO4Protein 蛋白质 142 104 2.4 12 4 <0.4 2.001 139 29 54 (Unit：mmol/L) .
Plasma relative viscosity (1. plasma (1.6~2. Viscosity: Blood relative viscosity (4~5) mainly depends on the numbers of red blood cells.4) is mainly involved in plasma protein Plasma osmotic pressure is 300 mmol/L or 770kPa (1) Crystal osmotic pressure results from NaCl and modulates water distribution between inside and outside of cells. and usually buffer systems are NaHCO3/H2CO3 (20:1). Physical and chemical characteristics of blood Specific gravity: total blood (1. etc [lungs and kidney mainly regulate Plasma pH value ]. protein salt/protein. RBC (1. Plasma pH value is about 7.030) more influenced by plasma protein. KHCO3/H2CO3. K2HPO4/ KH2PO4.092) more influenced by Hb.060) more influenced by red blood cells.35~7.050-1. Na2HPO4/ NaH2PO4.45. Hb salt/Hb. . (2) Colloid osmotic pressure results from albumin and regulates water distribution between inside and outside of capillary.025-1.II. HbO salt/ HbO2.090-1.
Osmosis and Osmotic Pressure Osmosis is the movement of water down its concentration gradient. Osmosis is determined by the number of impermeable molecules. . Osmotic pressure is the force drawing water down its concentration gradient.
two compartments (A and B) are separated by a semipermeable membrane (broken vertical line). . The water concentration in compartment A is greater than the concentration in compartment B because of the presence of salt (X) in B. The force needed to prevent this water movement is called osmotic pressure.Osmosis and Osmotic Pressure A B Water [Water] > [Water] [Salt] < [Salt] Osmotic Pressure < Osmotic Pressure Osmosis is the movement of water from a high concentration to a low concentration. In this illustration. Therefore. water will move down its concentration gradient from A to B.
A hypotonic solution is one in which the water concentration is greater outside than inside the cell. no water movement.Tonicity The tonicity of a solution refers to the effect of the solution on cell volume. . A hypertonic extracellular solution is one in which the water concentration is less outside the cell than inside. An isotonic extracellular solution is one in which the water concentration is the same inside and outside the cell. cell volume decreases. water leaves the cell. water enters the cell. An isosmotic solution may not be an isotonic solution if the particles are permeable to the cell membrane. cell volume increases. cell volume does not change.
. RBC). WBC) and thrombocyte (platelet.Blood Cells Blood cells are erythrocyte (red blood cell. leukocyte (white blood cell. P).III.
. skull and long bone ending) rather than yellow marrow has hematopoietic functions. e. red marrow (flat bones. leukocyte (white blood cell. spleen↓ (after fourth embryo month) → marrow (fetus birth time) and liver. RBC). vertebra. WBC) and thrombocyte (platelet.g. Transfer of blood cells forming place: yolk sac hemopoiesis (early embryo period) → liver and spleen (second embryo month) → marrow↑and liver. P) originating from hematopoietic stem cells are hemopoiesis. sternum. spleen as complementary role.Blood Cells The forming processes of erythrocyte (red blood cell. During adulthood (after 18). rib.ilium.
. [CFU: colony.1. steady numbers. CFU-MK. CFU-TB). Hemopoietic process and hemopoietic stem cells Hemopoietic process Stage one: Hemopoietic stem cells self renewal. Stage two: committed progenitors directional differentiation (CFU-GEMM. CFU-E. active differentiation. CFU- GM.forming unit Stage three: precursors morphologic occurrence of various original blood cells.
Lin: systemic specific antigen on the hemopoietic cells. using fluorescence-activated cell sorting (FACS). its main surface sign is CD34+CD38-Lin-and CD34-CD38-Lin-. Multi. . constant from young to old age. Surface sign According to CFU (colony forming unit).directional differentiation Large potential proliferation. Note CD: cluster of differentiation of antigen on the white blood cells. Hemopoietic stem cells produce about 1×1011 blood cells releasing to blood for use.Hemopoietic stem cells Basic characteristics Self renewal in high degree.
Stromal cells in the marrow come from fibrocyte. monocyte.Hemopoietic microenvironment Hemopoietic microenvironment: It includes stromal cell secreting extracellular matrix (ECM). III. etc). IV).2. II. . osteoblast and osteoclast. sulfate heparin. hyaluronic acid and sulfate dermatin. reticulocyte. engulfing cell. glycoprotein (fibronectin. laminin. another is membrane-combined adhesive molecule. Hemopoietic cells must adhere to stromal cell and is in the hemopoietic microenvironment for survival. such as collagen (typeI. hemopoieticnectin ) and protein amylose (sulfate cartilagetin. Stromal cells supply two material: one is soluble hemopoietic growth factor. hemopoietic nerves and blood vessels. Extracellular stroma synthesized and secreted by marrow stromal cell filling cellular interstice contains big molecules. multihemopoietic regulating factor. endothelial cell. ectoblast cell.
Hemopoietic process .
Hemopoietic process .
Hemopoietic process .
peripheral thickness about 2.Erythrocyte Physiology Shape and number of red blood cells (RBC) Shape of RBC: like biconcave disc Its diameter is about 7~8 µm.3. central thickness about 1 µm and cubage about 90 µm3. .5 µm.
Reason for shape of RBC biconcave disc like .
numbers of RBC and Hb are relatively less (because of more plasma). Hb in female adult. numbers of RBC and Hb are relatively more (because of compensation for anoxia). 110~150 g/L.5×1012/L.0×1012/L Female adult. 3.6× 1012/L.Erythrocyte Physiology Number of RBC: It is most numbers in the blood. ≥ 200 g/L Pregnant female. average. . Hb in newborn (within 5 days). 120~160 g/L.2×1012/L Newborn. Dweller lived in plateau. 4. average. Normal value about RBC Male adult. Hb in male adult.5~5. 4.8~4. 5. ≥ 6.0×1012/L Protein within RBC is hemoglobin (Hb).
Physiological Characteristics and Functions of RBC
① Characteristics of RBC Permeability: semipermeable membrane, gas and urea freely passing through, negative ions easily in or out of RBC, and positive ions not. There are NaK ATPase as pump on the membrane of RBC and low-temperature-stored plasma easily has high kalium. Why? Plasticity and metamorphose:
Plasticity and metamorphose depend on: 1) surface area-cubage ratio, 2) viscosity of Hb, 3) membrane elasticity and viscosity.
Physiological Characteristics and Functions of RBC
Characteristics of RBC ③ Suspension stability: it cab be described by erythrocyte sedimentation rate (ESR) which is RBC descending distance per hour and suspension stability is inverse proportion to ESR. Normal value of ESR: male, 0~15 mm/h; female, 0~20 mm/h. ESR and clinic: some diseases bring about rouleaux formation (mainly involved in plasma component, e.g. globulin, fibrinogen, cholesterol) and speed up ESR.
Physiological Characteristics and Functions of RBC
④ Characteristics of RBC Osmotic fragility: Changes in RBC put into lower osmotic salty solution. Osmotic fragility of aged RBC is large and easily results in rupture (hemolysis and ghost cell). Isosmotic solution, e.g. 0.85% NaCl, 1.4%NaHCO3, 5% glucose, etc. Isotonic solution, e.g. 0.85% NaCl Isosmotic solution does not equal to isotonic solution. Isosmotic solution, isotonic solution and clinic
Physiological Characteristics and Functions of RBC
Functions of RBC
RBC can be used for transportation of O2 and CO2 in the blood. RBC can be served as pH buffer.
[mitosis several times] [apoptosis] . This process requires 6~7 days. [reason for anemia] Influencing factors of RBC maturity: Vitamin B12 and folic acid (DNA metabolism).Erythropoiesis Hemopoietic material for erythropoiesis: iron (Fe++) and protein. [clinic relation] Process of erythropoiesis: Hemopoietic stem cells→multi systemic hemopoietic progenitor cells→RBC-committed progenitor cells (BFU-E→CFUE)→original RBC→ earlier infantile RBC→medium-term infantile RBC→terminal infantile RBC→reticular RBC→mature RBC→blood for circulation.
.Place for Erythropoiesis Main place for Erythropoiesis is bone marrow. Aother place is liver.
molecular weight. important to earlier erythropoiesis. BPA outside body. that is to say. plasma concentration 10 pmol/L. BUF-E. important to terminal erythropoiesis. EPO which is also a glycoprotein. 160×106 RBC production every minute. Burst forming unit-erythroid. BPA made by leucocyte is a glycoprotein whose molecular weight is about 25000~40000 Colony forming unit-erythroid. depends on stimulation of burst promoting activity.Regulation of Erythropoiesis 0. depends on erythropoietin. increasing release when anoxia. half life 5 hours. 34000.8% of total RBCs has self renewal. CFU-E. .
Regulation of Erythropoiesis .
. each RBC circulates 27 km averagely in vessels. and after breakage. normally. short life-span for aged RBC Breakage: places are liver. very toxic if it get into blood. it can be metabolized into bile pigment in liver. Hb.Life and breakage of RBC Life-span: 120 days. spleen and lymphatic node. Hb released from RBC immediately combine with plasma α2-globulin (Hb touched protein) which is taken in by liver for iron reuse. Clinic relation. about 4 months.
WBC): (4. basophil). eosinophil.Leukocyte Physiology Classification and numbers of Leukocyte Number of Leukocyte (white blood cells. .4. monocyte and lymphocyte.0~10)×109/L Classification: It is granulocyte (neutrophil.
0 .8~4.5 Neutrophil (foliiform nucleus) Eosinophil Basophil Monocyte Lymphocyte 2.Classification and numbers of Leukocyte TABLE. Classification and normal value of Leukocyte Absolute Value (×109/L) Total numbers of leukocytes 4.0 0.04~0.8 0.5 0.12~0.0~0.0~10.0~7.02~0.5~5 0~1 3~8 20~40 For Clinic Use Percentage (%) Neutrophil (bacilliform nucleus) 0.1 0.0 1~5 50~70 0.
lymphocyte. . 34×109/L. ache and mood excitation: Number of WBC is remarkably higher. return to original level after action stop. 70%. and during parturition. being about 10×109/L. Circadian changes: Number of WBC is more in the afternoon than in the morning. 15×109/L. Terminal pregnancy of female: Numbers changes in 12~17×109/L. secondarily. about 35×109/L. Food taking. number return to original level. Heavy exercise and laboring: Increasing numbers. neutrophil. mainly. after birth 3 or 4 days to 3 months.Physiological Changes in Numbers of Leukocyte Newborn: Number is higher. and after parturition 2~5 days.
toxin. Phagocytosis: It is a process that WBCs enclose and engulf exotic or extraneous material. etc).Physiological Characteristics and Functions of WBC Terminology Diapedisis: Metamorphosed WBCs pass through vessel wall getting into interstitial fluid. Chemotaxis: It is a process that WBCs shift to some chemical material (metabolic production. bacteria. antigen-antibody complex. and use intracellular enzyme digesting them. WBC Diapedisis Blood Vessel Metamorphose .
diapedisis. such as bacteria. polymorphonuclear.Physiological Characteristics and Functions of WBC ① Neutrophil Another name. PMN. . parasite. Clinic relation: Number of neutrophil greatly increase occurring in acute inflammation and earlier time of chronic inflammation. number decrease of neutrophil will result in poor resistibility and easily suffering from infection. etc. chemotaxis and phagocytosis (using its hydrolyzed enzyme) Function: It plays a very important role in nonspecific cellular immunity system which is against pathogenic microorganism. 6~8 h in the vessels. virus.
Function: 1. Clinic relation: Its number increase when person suffers from parasite infection or allergic reaction. It limits and modulates the effects of basophil on fast allergic reaction. It is involved in immune reaction against worm with opsonization.Physiological Characteristics and Functions of WBC ② Eosinophil Circadian changes: Its number is lower in the morning and higher at night. . 2.
Histamine and chronic reactive material increase permeability of capillary and contract bronchia smooth muscle. 3. 1. Heparin serves as lipase cobase and speeds up fatty decomposition. histamine. Eosinophil chemotactic factor A released by basophil can attract eosinophil collection and modify eosinophil function.Physiological Characteristics and Functions of WBC ③ Basophil Circulatory time: 12 hours Basogranules contain heparin. asthma. chemotactic factors and chronic reactive material for allergic reaction. and result in allergic reaction such as measles. . 2. Function: It is also involved in allergic reaction.
2. 4. such as colony stimulating factor (CSF). 3. it change name called macrophage activating monocyte. It contains many nonspecific lipase and displays the powerful phagocytosis. .Physiological Characteristics and Functions of WBC ④ Monocyte Its body is large. IL-3.macrophage system to release many cytokins. diameter about 15~30 µm without granule Function: 1. As soon as monocytes get into tissue from blood . Monocyte.β .etc. Cytokins induced by monocyte may modulate other cells growth. IL-6.macrophage system plays a very important role in specific immune responsive induction and regulation. INF-α. TNFα. IL-1.
Lymphocyte and B.Lymphocytes involved in cellular immunity. Clinic relation: Numbers increase of lymphocytes occur in .Lymphocyte. Lymphocytes serve as a nuclear role in immune responsive reaction. Function: 1. 2. 3. B. T.Physiological Characteristics and Functions of WBC ⑤ Lymphocyte Classification: It can be separated into T.Lymphocytes involved in humoral immunity.
differentiation and growth are influenced by hemopoietic growth factor. spleen and lymphatic node. Regulation and Breakage Birth place: bone marrow. Leukocyte breakage: site are liver. Colony stimulating factor. monocytemacrophage. Pus or purulence forming . fibrous cell and endothelial cell. Life span: several hours to 3 or 4 days. CSF. originating from hemopoietic stem cells.Leukopoiesis. Multi-CSF (IL-3) also influence Leukopoiesis. and leukopoiesis process is similar to RBC. G-CSF. such as GM-CSF. M-CSF. Leukopoiesis. HGF which are glycoprotein secreted by lymphocyte.
opening tubular system.etc. dense tubular system. . Ca2+.Platelet or Thrombocyte Physiology Shape: Biconvex disk like. Source: Platelet comes from megakaryocyte fractionlet release in the marrow.etc. diameter about 2~4 µm. canaliculus. 5-HT.5. Dense body: It contains ADP. dense body. ATP. there are α-granule. average cubage 8 µm3. Complicated structure: under the electronic microscope. lysin peroxide enzyme. epinephrine.
2. more in the venous blood than capillary. Platelet and clinic relation: decrease of platelet. It maintains capillary endothelial cells smooth and integrated (repairing endothelium and providing nutrition). purpuric symptom. after sport↑. . It is involved in physiological hemostasis.Normal Value and Function of Platelet Normal value: 100×109 ~ 300×109. range from 6%~10% Normal changes: more number in the afternoon than in the morning. pregnacy↑. more in winter than in spring. *Functions: 1. will results in hemorrhage or bleeding. abnormal immune reaction.
originating from hemopoietic stem cells. found by Methin in 1993. then continuously into CFU-MK. BFU-MK. and into megakaryocyte. expressed by c-mpl (oncogene) exists in CD34+ located at hemopoietic stem cells/ committed progenitors. and differentiating into burst forming unitmegakaryocyte. demarcation membrane system. Regulation: Protein. (one megakaryocyte can produce 200~7700 platelet). TPO was discovered in 1994 which promoted hemopoietic stem cells differentiating into megakaryocyte as hemopoietic stem cells positive regulating factor.Platelet Forming and Regulation Platelet forming: Birth place is bone marrow. DMS. . megakaryocyte and platelet. into fractionlet release to the blood requiring 8~10 days. and its ligand named thrombopoietin. Mpl.
spleen and lymphatic node. 7~14 days in the blood. Breakage: Aged platelet can be processed by phagocytosis in liver. .Life. It can be consumed when it displays physiological functions.Span and Breakage of Platelet Life-span: Averagely.
clot forming and maintenance (made by blood coagulation activation) . Blood vessel contraction or convulsion (induced by neuroreflex. 5-hydroxytryptamine. Process of hemostasis: 1. Platelet thrombosis forming (made by platelet adhesion. *Bleeding time: The time from vessel bleeding to automatic hemostasia. fibrin. thromboxane A2.IV. ET ) 2. endothelin. aggregation. Normal time is 1~3 min and it is longer when platelet decrease.5-HT. release and contraction) 3. Physiological Hemostasis *Definition: The process from vessel bleeding to automatic hemostasia. TXA2.
Physiological Hemostasis .
protein enzyme inhibitor. Promoting coagulative material: Tissue factor. heparin sulfate. PAI-2. interleukin-1 (IL-1). uPA. Vessel constricting and relaxing modulators: endothelin1 (ET-1). microfibril. Anticoagulative material: They are prostacyclin (PGI2). plasminogen activator (PA). NO). ② ③ ④ . etc. PGI2.Endocrine functions of vessel endothelial cells ① Material related to hemostasis are basal membrane. ATIII). protein enzyme. elastin. vWF. fibronectin. thrombomomodulin (TM). endothelium-derived relaxing factor (EDRF or nitric oxide. adhesive amylose. collagen (III. etc. EDRF (NO). ectonectin. IV). von Willebrand factor (vWF). tissue-type plasminogen activator (tPA). ATIII. TNFα. laminin.1. protein C. plasminogen activator inhibitor (PAI-1. ADPase. blood clotting factor V.
ET-1. cells also release anticoagulative factors and fibrinolysis material to modify blood coagulation. At the same time. hemostasis of platelet is immediately activated to form thrombus blocking wounded vessels. lasting about 60 sec. speed up blood coagulation. As soon as collagen expose to blood. ② ③ . Platelet activation can releases constrictive factors (TXA2. collagen) and blood. etc) making vessel convulsion.Roles of Vessel Endothelial Cells in Physiological Hemostasis Roles are close related to its endocrine functions ① Vessel endothelium serves as barrier between underendothelial structure (namely. Stimulated vessel endothelial cells release coagulative factors and Promoting coagulative material to realize. 5-HT.
Inactive Platelet Under the electronic microscope .
Activated Platelet for Hemostasis Under the electronic microscope .
Thrombocyte aggregation: induced by physiological factors such as ADP. and β-platelet globin. Two phases require Ca2+. The process can be separated into two phases: phase one is reversible aggregation and phase two irreversible aggregation. and acid protein hydrolyzed enzyme. cGMP↑→ platelet aggregation. thrombin. 5-HT. etc. immune complex. PDGF. thromboxane A2 (TXA2). PF4. collagen. ATP. tissue hydrolyzed enzyme from lysosome.2. fibrinogen and energy consumption. . Thrombocyte contraction: Loose platelet thrombus could turn into compact platelet thrombus by Ca2+ release and cytoskeleton movement (filament/canaliculus) within platelet. GPIb/IX and GPIIa/IIIb). histamine.etc and by pathological factors like bacteria. fibrinogen. 5-HT. PFV. Mechanism : Various factors+corresponding receptors on the platelet →changes in the second messenger within platelet →cAMP↓. Ip3↑. prostacyclin. vWF. virus. Thrombocyte release: ADP. drugs. epinephrine. vWF (plasma component). Ca2+↑.Physiological Characteristics of Platelet Thrombocyte adhesion: its membrane glycoprotein (GP. Mechanism: Exposed collagen+vWF →vWF changes →platelet membrane glycoprotein+changed vWF → Thrombocyte adhesion. Ca2+ released from dense body. collagen (underendothelial structure). thrombin sensitive protein from α-granule. fibrinogen are involved in adhesion.
Activated platelets release α-granule which contains fibrinogen to intensify fibrin forming and blood coagulation. 2. such as fibrinogen. FXI. 3. Blood coagulation activation by platelet: Fibrin net forming. FXIII to speed up coagulation. Activated platelets contract clot with its contractive protein to solidify blood coagulation. . Surface of platelet membrane combine with many blood clotting factor. Activated platelets supply lecithoid (phospholipid) surface for blood clotting factor and involve in activating factor X and prothrombin. *Roles of platelet in hemostasis: 1. 4. FV. aggregation. Loose platelet thrombus forming: First phase of hemostasis. release and contraction. second phase of hemostasis.Roles of Platelet in Hemostasis Activation of platelet: Stimulus brings about thrombocyte adhesion.
Two Phases of Physiological Hemostasis First Phase Second Phase .
Mechanism1 of Platelet in Hemostasis .
Mechanism2 of Platelet in Hemostasis .
FXI. Blood clotting factor: Material which are directly involved in blood coagulation. . FVII. and except FIII (TF). FXII. Difference between serum and plasma mainly consists in no fibrinogen in serum. FIX. Serum: Light yellow fluid after blood coagulation. Fx. others are in fresh plasma synthesized by liver with VitK . except Ca2+. FXIII].Blood Coagulation Blood Clotting Factor Definition: The process of blood flow from flowing liquid to gel or gelatin.3. phospholipid，other factors being protein. There are 12 factors named Roman numerals. Blood clotting enzymes have two type: inactive and activated type [FII. Blood coagulation is a series of complicated biochemical reactions with various enzymes.
High-molecular weight 80 kininogen. platelet Liver Liver 2d 2~3 d 24 h 8d - 13 4 5 6.PTA Ⅻ Contact factor or Hageman factor 40 XIII Fibrin-stabilizing factor 10 .HMW-K .Blood Clotting Factor Factor Name Plasma Concentration I Fibrinogen 3000 II Prothrombin 100 III Tissue factor IV Ca2+ 100 V Proaccelerin 10 Ⅶ Proconvertin 0.1 3 4 .Prekallikrein. platelet Liver (with Vit K) Liver Liver (with Vit K) 4~5 d 3d 12~15 h 4~7 h 8~10 h 24 h Half life Chromsome site 4 11 1 13 Ⅹ Ⅹ Liver (with Vit K) Liver Liver Liver.PTC(Christmas factor) Ⅹ Stuart-Prower Factor 10 Ⅺ Plasma thromoboplastin 5 antecedent.Pre-K or Fletcher factor 35 Synthesizing site Liver Liver (with Vit K) Endothelial cell Endothelial cell.AHF 0.5 Ⅷ Antihemophilic factor.1 Ⅸ Plasma thromboplastic 5 component.
Extrinsic pathway of blood coagulation: Stimulus activates tissue factor (FIII) as beginning of coagulation. C in the clinic results from deficiency of FVIII. FIX. Extrinsic pathway of blood coagulation is faster than intrinsic pathway of blood coagulation because its steps are more simple. Eyewinker surface with negative charges (collagenin) on the endothelium of blood vessel activates blood FXII as beginning of coagulation named surface activation. . respectively.Blood Coagulation Intrinsic pathway of blood coagulation: All blood clotting factors involved in blood coagulation come from blood. FXI in the blood. *Basic steps of blood coagulation [typical positive feedback]: Prothrombin activator forming [FXa-Va-Ca2+-phospholipid] Step 1 Prothrombin thrombin Step 2 Fibrinogen fibrin (clot) Step 3 Hemophilia A. B.
Process of Blood Coagulation Extrinsic pathway （Tissue Factor，TF） TF+Ⅶ Ca2+ Ⅶ-TF Ⅹa Ⅶa-TF Ca2+ PL Ⅹ PL: phospholipid Intrinsic pathway （ Eyewinker surface ） Ⅻ Ⅺ Ⅸ Ca2+ HK Ⅻa Ⅺa S K PK Ca2+ ，PL Ⅸa Ca2+ Ⅷa PL Ⅹa Ca2+ Ⅴa PL ⅩⅢ CL: cross linking fibrin HK: high molecular weight kininogen S: Subendothelium PK: prekallikrein K: kallikrein Ⅱ Ⅱa ⅩⅢa Ca2+ Ⅰ Ⅰa CLⅠa .
Mechanism of Blood Coagulation .
FXIIa and thrombin and then inactivate them for anticoagulation. Heparin used in the clinic widely is due to ①It combines with antithrombin III to increase functions of antithrombin III. 4. FXIa. 2. ②It blocks FXa combining with platelet phospholipid membrane to reduce prothrombin activation. FXa. ③It intensifies PC activation and stimulates vessel endothelial cell releasing plasminogen activators to increase fibrinolysis. 3. protease nexin-1 (PN-1) to combine with FIXa. [lower molecular weight heparin is less hemorrhage] Anticoagulative system in blood . Tissue factor pathway inhibitor (TFPI) mainly coming from vessel endothelial cells inhibits FXa and inactivates FVIIa-TF complex to block extrinsic pathway of coagulation with negative feed back. Humoral anticoagulative system: 1. Protein C system are protein C (PC). ②It stimulates vessel endothelial cell greatlu releasing TFPI and other anticoagulative material. protein S and Protein C inhibitors. Heparin can intensify functions of antithrombin III. α1 antitrypsin. heparin coenzyme II. FVIIIa with phospholipid and Ca2+. prothrombin complex and soluble fibrin monomer. Main functions of PC consist in ①It inactivates FVa. α2 huge globin. Cellular anticoagulative system: Liver cell and reticular endothelial cell could engulf blood clotting factor. thrombomodulin (TM). α2 antiplasmin. ④ Protein S is a coenzyme of PC and greatly intensify functions of PC. tissue factor. Clinhibitor. Amino acid protease inhibitors in blood include antithrombin III. ③It stimulates plasminogen activators release to trigger fibrinolysis.
mesothelial cell and platelet to engulf and digest fibrin. Basic steps: Endothelial cells (Extrinsic pathway ) (Urokinase. plasminogen. macrophage. endothelial cell. The former is leucocyte.Fibrinolysis Fibrinolytic system is involved in fibrinolysis. uPA) Kallikrein (Intrinsic pathway) Cl-inhibitors uPAG tPA Plasminogen uPA PAI-1 α2-antiplasmin α2-huge globin Plasmin Fibrin dissolution Fibrin or fibrinogen . Two fibrinolytic systems: cellular one and plasma one. plasmin.4. The latter is plasminogen activators (PA) and its inhibitors (PAI). tissue repair and vessel rebirth.
Blood Coagulation and Fibrinolysis .
alexin C1 inhibitor. α1-antitrypsin. etc stimulate its release from platelet. smooth muscular cell. IL-1. Some factors such as thrombin. megakaryocyte is stored in platelet with inactive form. . PAI-1 synthesis and release: PAI-1 made by endothelial cell. (3) Combine with fibrin αchain and block fibrinolysis Clinic relation: Innate deficiency of α2-antiplasmin often brings about serious hemorrhage. α2antiplasmin (in liver). TNFα.Antifibrinolysis: Fibrinolytic Inhibitors and Its Functions Main fibrinolytic inhibitors: They are plasminogen activator inhibitor type-1 (PAI-1. (2) Inhibit plasminogen adhering to fibrin. mesothelial cell. α2-antiplasmin characteristics: (1) Quick effect. antithrombin III. PAI-1 function: It inhibits tPA (tissue-type plasminogen activator) limiting local fibrinolysis of thrombus. in platelet). α2-huge globin.
r-globin in serum) results in harmful immune reactions showing hemolysis. Agglutination: Combination of the same antigen (or named agglutinogen. glycoprotein/glycolipid on the membrane of blood cell) and antibody (or named agglutinin. Blood Group History: ABO blood group system was firstly found by Landsteiner in 1901. Zw. Human leukocyte antigen. Platelet antigens such as PI. Definition for blood group*: Types of specific antigens on the blood cell. etc may bring about fever heat when transfusion occur.V. HLA have widespread distribution in the body and involves in immune repulsive reaction of organ transplant. Ko. .
1. RBC Agglutination Antigen-Antibody Harmful immune Reaction Blood Coagulation RBC Agglutination .
namely.Antigen of Blood Group Antigen: Its genes are located at allele on euchromosome. Genes in the blood system decide differential specific antigen on the membrane with control of enzymatic activity. Genotpye is genetic gene in blood group system and phenotype is antigen produced by corresponding genetic gene and amorph is noneffective allele. expressed gene. .
Duffy. which belong to IgG (small molecule) and IgM (big molecule).g. Immune antibody: Various extraordinary RBC antigens (transfusion or parturition) sensitize lymphatic cells producing antibody such as Rh. IgM in ABO blood group system which can not pass through placenta for the sake of big molecule. ..Antibody of Blood Group Crude antibody: It is the unexposed antibody to correlative RBC. e. kidd. Kell.
193 antigens. ABO blood group system: Antigen on the RBC A B Antibody in the serum Anti-B Anti-A Anti-A+Anti-B Blood group A B AB O A+B . Rh. kidd.Blood Group of RBC Number: 23 types. Lutheran. MNSs. duff. more important blood groups are ABO. etc and all of them could result in hemolysis during transfusion. kell. Lewis.
ABO blood group system Antigen (agglutinogen) and antibody (agglutinin) in ABO blood subgroup system Blood group A B AB A1B A2B O A1 A2 Antigen on the RBC A+ A1 A B A+ A1 +B A+B Antibody in the serum Anti-B Anti-B+ Anti-A1 Anti-A Anti-A1 Anti-A+Anti-B .2.
Antigen of blood group Ushering material ABH Antigen chemical structure in ABO blood group system O(H)-antigen A-antigen B-Antigen Galactose Sugar N-acetamide Glucose Glucose N-acetamide galactose .
BO AB phenotype O A B AB . H agglutinogen in ABO blood group system controlled by gene which is located at allele on No.9 chromosome (9q34. B. Genotype and Phenotype: Genotype and Phenotype in ABO blood group system Genotype OO AA.2).Inheritance of ABO blood group Inheritance: The A. AO BB.1-q34.
B. AB B. AB A. B. AB A .B A . AB ____ O. A O. AB A×O B×B B×O B×A AB×O AB×A AB×B O. AB O . AB O O AB×AB A . A A. AB A. B O. B O. A. B. B. AB B. AB A. B.Inheritance of ABO blood group Genetic relationship of ABO blood group Parents’ blood group Offspring possible blood group Offspring impossible blood group O×O A×A O O.
Type O 30. Other chinese minority is different.31%. China Han nationality: Type A 31. Type O 40%. America aborigines: Type O 90%.Distribution of ABO blood group Mid Europe: Type A 40%.77%. Bloog group can be used in research on anthropology . Type B 28. Type AB 6%. Type B 10%.86%. Type AB 9.06%.
Mensuration of ABO blood group Anti-B Serum Anti-A Serum Anti-A. B Serum .
IgM. Rh blood group system and clinic work Transfusion and pregnacy [Clinic meaning] . Rh blood group system Rh antigen (Rh factor) is about 40 kinds and Rh factors related to clinic are D. otherwise. while ABO blood group. IgG. Most of people (99％) are Rh Positive and less than 1% persons are Rh negative. e and most important is D antigen. E. crude antibody and complete antibody. Membrane of RBC has D antigen meaning Rh Positive. C. Rh blood group characteristics: Immune antobody and incomplete antibody. Rh negative.3. c.
.Quantification of Blood Volume Blood volume is an important determinant of systemic arterial pressure. Circulatory system is essentially a closed container including a volume of blood equal to approximately 5 liters or 70-80mL/Kg of the body weight (in kilograms).
results in shock and the measures in the hospital should be immediately taken for life survival [Transfusion]. force-lacked.4. dazzled. artery contraction increases peripheral resistance but artery blood pressure can not maintain the normal levels which occur in symptoms such as light-headed. Volume loss up to 30-40 % of total blood volume can be tolerated if the loss is corrected within 30 min (e. etc) Blood loss more than 40 % of total blood volume will threaten the life. .g. and the volume is replaced through the normal ingestion of fluids. Relation between blood volume and clinic When you donate 10 % of total blood volume. your body compensates so that blood pressure does not change.
. 4. 3. The different tpyes of blood group for transfusion should be very careful.5. Principle of Transfusion Transfusion is widely used in clinic treatment. changes in the same tpyes of blood group for transfusion. Cross-match test must be done before transfusion. Identification of blood group must be taken before transfusion. small amount and slow import and if condition is better. Principle of transfusion*: 1. The same tpyes of blood group for transfusion should be firstly considered. 2.
+ Perfect match.Cross-match test for transfusion RBC 红细胞 Donator RBC 红细胞 供 血 者 Receiver 受 血 者 Serum Main side of 主侧凝集反应 agglutination 血清 Serum 血清 Subordinary side 次侧凝集反应 of agglutination Decision + - +. transfusion 不合，不能输血 Transfusion under emergency 应急情况下输血 × +: Agglutination. -: No agglutination . transfusion 相合，可以输血 No match.
allogenetic transfusion (more use). whole blood transfusion.Types of Transfusion According to source of transfusion. ③ It stimulates bone marrow hemopoiesis towards RBC. . ① ② Transfusion of blood components is good. transfusion of blood components Autologous transfusion has some advantages: It decreases infection. autologous transfusion. hemolysis) induced by allogenetic transfusion. It blocks syndrome (fever. According to component of transfusion.
Summarization PLEASE TAKE DOWN .
. Please describe the principle of classification and blood transfusion of ABO blood group system.Consideration after class 【本章节问题思考】 1. 2. What is the elementary process of blood coagulation and main factors which have participated in blood coagulation? 3. Please describe classification and main effects of leucocyte.
Stanton BA. St Louis: Mosby Electronic Production. Blood. Levine JD. Blakeley AGH. 生理学. 2000. Bardin F. Saunders Co. Edinburgh: Churchill Livingston. Berardi AC. Kaushansky K. 造血调控. 北京: 科学出版社. Bone marrow stromal cells as a vehicle for gene transfer. 2005. Gene Ther. 李俊成. Functional isolation and characterization of human hematopoietic stem cells. Levy MN. 1999. 5. 人类红细胞血型学实用理论与实验技术. 生理学. Hall JE. 11. 1995. New York: McGraw-Hill Co Inc.B. 汤浩. Kidd C. 贺福初. 范少光. 87(3): 949-955. 267(5194): 104-108. 7. . 4. 1996. Wang A. CD34+/Thy1+ cells. 北京: 人民卫生出版社. Human physiology. TEXTBOOK OF MEDICAL PHYSIOLOGY. Lu S. et al. 2. Philadelphia: W. 临床生理学. 秦晓群主编. 人体生理学（二版）. Maroc C. Physiology. 2001. 2000. 裴雪涛主编. 10th ed. Phenotypic. 杨贵贞主编. 吴祖泽. 6(9): 1611-1616.Davies A. 5th ed. 上海: 上海医科大学出版社. 8. 996: 39-43. 北京: 北京医科大学出版社. 北京: 高等教育出版社. and functional characterization of human peripheral blood. Batchu R. 2000. Thrombopoietin: accumulating evidence for an important biological effect on the hematopoietic stem cell. Human physiology. 2003. 李勇. 全国高等学校医学规划教材. Guyton AC. 9. Ann N Y Acad Sci. Koeppen BMI. 14. Berne RM. 1. 7th ed. 贺石林. 第五版. 王庭槐主编. 2002. Science. Humeau L. 潘伟丰主编. 2004.Guide of Reference 【本章节学习参考书单】 姚泰主编. 6. 1999. 北京: 中国科学技术出版社. Ding L. 13. 12. molecular. 2000. 3. 10. et al. et al. 2001. Fox SI.
kr/PHYSIOLOGY%2 0BLUE.http://www.188.htm 5.com/HEM38.http://www.co.http://www.fpnotebook.Navigation for Web Address 【本章节课后学习导航网站】 1.http://bioresearch.edu/cliniweb/G9/G9.mednote.ac.ohsu.html 2.edu/EdRes/Colleges /HONR/HONR269U/Jenn/ 3.uk/browse/mesh/detai l/c0005811L0005811.h tml 4.http://www.htm .inform.umd.
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