BODY FLUIDS

Total body watermakes up about 60% of body weight in

men and about 50% in women. Approximately 2/3 of total
body is located in the intracellular compartment and
constitutes the intracellular fluid volume (ICFV), about
1/3 of total body water is located in the extracellular
compartment and comprises the extracellular fluid
volume (ECFV). The interstitial fluid volume comprises
about ¾ of the ECFV, and the blood plasma volume is
about ¼ of the ECFV (or about 5% of the body weight..

BLOOD.
The specific gravity of blood is 1.055 to 1.060, and its
viscosity is approximately 4.5 times that of water. If blood
is drawn from a vein and measures are taken to prevent
clotting, the suspended cellular element can be separated
by centrifugation. The normally clear, slightly yellow an
fluid is termed blood plasma. If the blood is drawn and
allowed to clot, there separates from the clot a clear
yellowish fluid, the blood serum. The yellow color is due to
the presence of small quantities of bilirubin, a bile
pigment and of carotenoids. The clot is composed largely
of cellular elements, enmeshed in a network of fibrous
strand of fibrin. Thus blood plasmarepresent blood minus
its cellular elements, whereas blood serum lacks in
addition, fibrinogen, the precursor of fibrin.

The function of the blood:

1. Respiration. Transport of O2 from the lung to the tissues
and of CO2 from the tissues to the lungs.
2. Nutrition. Transport of absorbed foof materials.
3. Excretion. Transport of metabolic waste to the kidney,
lungs, skin, and intestines for removal.
4. Maintenance of normal acid-base balance in the body.
5. Regulation of water balance through the effects of blood
on the exchange of water between the circulating fluid and
the tissue fluid.
6. Regulation of body temeratur by the distribution of
blood heat.
7. Defense against infection in the white cells and the
circulating antibodies.
8. Transport of hormones , regulation of metabolism.
9. Transport of metabolites.
10. Coagulation.

The functions of blood – except for specific cellular ones

such as oxygen transport and cell mediated immunologic
defense – are carried out by plasma and its constituent.
Plasma consists of water, electrolytes, metabolites,
nutrients, protein and hormones. The water and
electrolyte composition of plasma is practically the same
as that of all extracellular fluids.
Plasma contains a complex mixture of proteins. The
concentration of total protein in human plasma is
approximately 7.0 – 7.5 g/dL and coprises the major part
of the solids of the plasma. The proteins of the plasma are
actually a complex mixture that includes not only simple
proteins but also conyugated proteins such as glycoprotein
and variant types of lipoproteins. The proteins fractions in
the clinical laboratory is usually as albumin-globulin ratio.
Albumin is the major protein in plasma.
Most plasma proteins are synthesized in the liver except
gamma globulin (immunoglobulin).

Packed cell volume.

When blood which has been prevented fron clotting (using
anticoagulant) is centrifuged, the cells settle to the bottom
of the tube while the plasma will rise to the top. Normally
the cells compriseabout 45% of the total volume, that is
the hematocrit or packed cellvolume.
The viscosity of blood varies in accordance with the
number of cell present and with the temperature and
degree of hydration of the body.
Blood osmotic pressure.
The osmotic pressure of the blood is kept relatively
constant mainly by the kidney. The osmotic pressure of the
blood is 7 – 8 atmospheres at body temperature; it is the
same with a solution of sodium chloride on concentration
of 0.9 g/100 ml. Such a saline solution is termed ‘isotonic’
or ‘physiologic’ saline.

Vascular hemostasis.
Vascular hemostasis is cessation of bleeding from a cut of
blood vessel. In hemostasis vascular, there is initial
vasoconstriction of the injured vessel, platelets
aggregation, blood coagulation/clotting and fibrinolysis .
Fig.
Blood coagulation.
Blood coagulation pathway leading to the formation of fibrin from fibrinogen.
Two pathway lead fibrin clot formation: the intrinsic and extrinsic pathways. Both pathways lead to
activation of protrombin to thrombin and the thrombin catalyzed cleavage of fibrinogen to form the
fibrin clot.
The pathways are complex and involve many different protein (blood clotting factors).
These blood clotting factors can be classified into five types:
- 1. Zymogen proteases which become activated during the process of coagulation.
- 2. Cofactors.
- 3. Fibrinogen.
- 4. Transglutaminase (zymogen) which stabilizes the fibrin clot.
- 5. Regulatory and other proteins.

Conversion of fibrinogen to fibrin is catalyzed by thrombin.

Fibrinogen is a soluble plasma glycoprotein that consist of three nonidentical pairs of polypeptide
chains (alpha, beta, gamma).

Fibrinogen catalyzed by thrombin  fibrin monomer (soluble fibrin), catalyzed by transglutaminase

(F XIIIa) insoluble fibrin.

Fibrinolysis.
Fibrin clots are dissolved by plasmin.
Plasminogen binds to fibrin plasmin, activated by t-PA (tissue plasminogen activator ) and
urokinase. Plasmin digests the fibrin to form soluble degradation products (D dimer is one of the
product).

Regulatory protein (anticoagulants, antiplasmin)

Anticoagulants: antithrombin (AT-III), thrombomodulin, protein C, protein S, macroglobulin.
The activity of AT-III is greatly potentiated by heparin.
Thrombomodulin binds thrombin and this complex activates protein C and protein S.

The synthesis of F II, F VII, F IX, F X, protein C and protein S require vitamine K which function as
coenzyme ( for enzyme carboxylase) toproduce GLA in these proteins.
The synthesis of most of the clotting factors occur in the liver.

LYMPH
The protein content of lymph is variable, depending upon the source. Cervical lymph contains about
3% protein, subcutaneous lymph, 0.25% and liver lymph as much as 6%.
The albumin: globulin ratio is greater than that of plasma (1.2:1), generally of the order 3:1 to 5:1.
There are also present in lymph sufficient fibrinogen and prothrombin to permit slow clotting.

Cerebrospinal Fluid.
The cerebrospinal fluid, contained within subarachnoid space of the brain and spinal cord and the
ventricles of the brain, originates in the choroid plexus and returns to the blood in the vessels of the
lumbar region.
The total volume of this fluid is about 125 ml in a healthy adult, is renewed every 3 or 4 hr.
The composition of spinal fluid suggests that it is primarily a simple transudate or ultrafiltrate from
plasma. The fluid contains between 15 and 40 mg of protein per 100 ml., with albumin:globulin ratio
of 4. Plasma lipid is absent.