FAAL

Cair Tubuh,
Darah & Imun Dasar
LILIK HERAWATI

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 Komposisi Tubuh

Padat (40%)

Tubuh Intraselular
(45%)

Cair (60%) Interstitial (10%)

Ekstraselular
(15%)
Intravaskular (5%)

transeluler
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 Kebutuhan air pada anak
 4-6 gelas (1-1,5 lt) • Soft drink  jgn
• jgn menunggu tiap hari
anak haus baru – mperlama lapar
dberi minum k/ rasa manis
• lihat warna urin : • teh, kopi, cola 
bersih& pucat blm cocok u/
(tdk kuning anak
pekat) – ada kafein yg
mhambat
• air, buah  baik, absorpsi Fe
dan
• susu  byk 4
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 Dehidrasi Edema
• = Hilangnya air • Peningkatan cairan
dan elektrolit di (intersitial)
yang diperlukan • Nama lain tgtg
tubuh u/ dpt tempat
bfungsi normal = hydrothorax;
hydropericardium;
hydroperitoneum
• cairan masuk < (ascites)
cairan keluar
• Anasarca
– mis:muntah,
diare Edema luas,
didapatkan
pembengkakan 5
subkutan misal
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 • Pada kapiler
normal
– Di akhir arteri
cairan keluar
tp hampir
diimbangi oleh
masuknya
cairan di akhir
vena
– Cairan yang
merembes 
ke sirkulasi
limfe

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 LILIK HERAWATI

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 The blood functions
• transports materials
– oxygen and carbon dioxide
– food molecules
– ions
– wastes (e.g., urea)
– hormones

heat

defense of the body against
infections and other foreign materials

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Blood contains:
• extracellular fluid (the fluid in plasma)
• intracellular fluid (the fluid in the blood cells)

~8% - 9% of body weight for children

~7% of body weight for adults

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 Plasma
• roles in • composed:
homeostasis ==> – mostly of water
such as – proteins, lipids (fats)
maintaining: – carbohydrates
– normal plasma pH – amino acids
– osmolality – vitamins
– minerals
– hormones
– wastes
– cofactors
– gases
– electrolytes
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 Composition of blood plasma
Component Percent

Water ~92
Proteins 6–8
Salts 0.8
Lipids 0.6
Glucose (blood sugar) 0.1

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 Plasma & Serum
• serum: blood plasma without
fibrinogen and other clotting factors
• serum= plasma – fibrinogen

• to get serum ==> let the blood clotted (after

centrifuge). The upper supernatant is the
serum
• to get plasma ==> add anticoagulant like
heparin in the blood to avoid clotting and
then centrifuge.
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
alpha globulins

e.g., the proteins that transport thyroxine and
retinol [vitamin A])

beta globulins

(e.g., the iron-transporting protein transferrin)

gamma globulins
• Most antibodies are gamma globulins
• albumin

made in the liver

Function:
• protein binding
• helps maintain the osmotic
pressure 13
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 Red Blood Cells (Erythrocytes)
• Mengandung hemoglobin yang membawa
oxygen

• The other functions:

– they contain a large quantity of carbonic
anhydrase, an enzyme that catalyzes CO2 +
H2O  H2CO3
• acid-base buffer

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 Morphology
• Shape & Size of RBC are biconcave discs
having a mean diameter of about 7.8ц &
thickness of 1-2.5ц

• Volume of RBC is 90 to 95ц3

• Shapes of RBC can change remarkably as
the cells squeeze through capillaries

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 PLASMA (55-58%)
91% - Air
7% - Protein Plasma
2% - Nutrisi (AA, glukosa, lemak), hormon,

elektrolit

KOMPONEN SELULAR (42-45%)

Buffy Coat : sel darah putih ( 7000 –
9000/mm3 )
platelet ( 250.000/mm3 )

SEL DARAH MERAH (  5.600.000/mm3 )

16
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 17
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 Hematopoiesis

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• stem cell s.d reticulocyte butuh: 1 week
• reticulocyte s.d erythrocyte: 24 to 48 hours

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 Materials
• ie:
–protein
–vitamin B12
–asam folat
–Fe
–Copper
–Zinc
–etc 20
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 COBALAMIN & FOLIC ACID

21
Despopoulos, Color Atlas of Physiology © 2003 Thieme
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 Eritropoietin (EPO)
• = faktor utama perangsang produksi
eritrosit
– jika terjadi hipoksia (utama)
• produksi eritropoietin mencapai optimal dlm
24 jam

• Dibentuk di ginjal (mesangial cell di juxta

medulary app. & di epitel tubulus ; 90%),
10% di hepar
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23
 Struktur Hb
Molekul Hb
– 4 rantai (tiap rantai dg 1 Fe  jadi ada 4 Fe) &
tiap rantai menentukan afinitas ikatannya thdp
O2
– 1 Fe berikatan dg 1 molekul oksigen (2 atom
Oksigen), jadi 4 molekul oksigen (8 atom
oksigen)

• Jika kekurangan Fe  Hb sedikit 

anemia hipokromik
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 Life Span of Erythrocytes ==> 120 days

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 Disease
• Anemia (kekurangan eritrosit/ Hb)
– Perdarahan akut; kronik
– Umur pendek: hemolytic anemia
– Produksi terganggu;
pabrik rusak; bahan kurang

• Polisitemia
– Relatif : dehidrasi
– Absolut (eritrosit berlebih (> 6 juta/ mm3):
• Sekunder
• Vera (eritrema)
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 anemia

Viskositas 

Tahanan vaskuler  Aliran darah &

Vasodilatasi Venous return 

Cardiac out put 

(beban jtg )

Dpt tjd
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Gagal jtg
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 Polisitemia

Viskositas  Volume darah 

Aliran darah  Venous return 

Venous return 

Cardiac output 
(tapi tdk berlebihan)
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 29
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 Blood Types
ABO Rhesus
according to antigens on • 5 main Rhesus antigens
red blood cells
(C, c, D, E and e)
• Type A: A antigens • a. Rh factor positive: D
• Type B: B antigens antigen is present
• Type O: no antigens • b. Rh factor negative: D
(universal donor) antigen is not present
• Type AB: A and B
antigens (universal • antibodies are
recipient) developed against the
Rh factor ==> through
placental sensitization
or translation
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 Population
Rh(D) Neg Rh(D) Pos

European Basque approx 35% 65%

Caucasian 16% 84%
American Blacks approx 7% 93%
Native Americans approx 1% 99%
African descent less 1% over 99%
Asian less 1% over 99%

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 What are Blood Types?
• Karl Landsteiner in the early 1900s. There are four types of
blood in the ABO system: A, B, AB, O.

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 34
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• the megakaryocytes fragment
• Ø 1 to 4 micrometers; nuclei - & reproduction -
• normal = 150,000 - 300,000 per microliter
• lifespan: 15 to 45 days in the circulation
• Production: in the bone marrow from megakaryocytes

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 DEFINITION & MECHANISMS
• Hemostasis : mencegah kehilangan darah
(saat pemb darah robek)

Mechanisms in hemostasis:
(1) vascular constriction
(2) formation of a platelet plug
(3) formation of a blood clot as a result of blood
coagulation
(4) growth of fibrous tissue to close the hole in the
vessel permanently
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 Platelet Plug Formation

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 Blood clot
coagulation cascade

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 Major Causes of Excessive
Bleeding

(a) Platelet Deficiency

(i) quantitative (thrombocytopenias)
(ii) qualitative (von Willebrandís
disease~AD)
• von Willebrand factor (Carrier of factor VIII, Anchors platelets to
subendothelium, Bridge between platelets)
(b) Clotting Factor Deficiency
(i) single, i.e. hemophilia (FVIII)
(ii) multiple, i.e. Vit. K deficiency (II, VII, IX ,X)
(c) Fibrinolytic hyperactivity 39
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 LEUKOSIT
• Jumlah : ± 9000
sel / mm3 darah (μ
liter)

MACAM • 4. Limfosit 20 - 40 %
• 1. Neutrophil 50 - 70 % • 5. Monosit 3 - 8 %
• 2. Eosinophil 2 - 4 % • (6. Plasma cells)
• 3. Basophil 0,5 - 1 %
4 & 5 kelompok non-
granulosit
1-3 kelompok granulosit
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 Fungsi
Neutrofil :
• fagositosis bakteri & benda asing

Eosinofil :
• menanggulangi inf.parasit terlibat dlm
proses radang
• Σ ↑↑ pd kead. : alergi

Basofil :
• produksi → histamin, bradikinin, serotonin,
heparin 41
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 Marginasi

Diapedesis

Vasa Ameboid
motion

Sel rusak
Chemotaksis

Endotel

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 Makrofag
• Ukuran dan daya kerja : 4 – 5 kali
monosit
Mampu bertahan ± 3 bulan di jaringan
Banyak ditemukan di jaringan,misal:
 mulut → tonsil
 kulit → histiosit
otak → mikroglia
 hepar → sel kupfer

43
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 44
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 Respon leukosit terhadap
Keradangan
1st line defense (satu jam pertama) :
makrofag jaringan

2nd line defense :

netrofil
produk radang dari daerah inflamasi
1. Dibawa ke pembuluh darah → netrofil marginasi,
diapedesis & kemotaksis
2. Mengirim sinyal ke sutul → mobilisasi leukosit →
leukositosis/neutrofilia

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 3rd line defense :
Monosit  makrofag
Butuh waktu

4th line defense :

memicu stem cell (di bone marrow)
meningkatkan pembentukan lekosit baru
→ granulosit, monosit dan limfosit

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 Disorders of WBCs
Non-neoplastik
• Leukopenia
– Agranulositosis (~ neutropenia)
• Leukositosis
– granulositosis (~neutrofilia); eosinofilia

Neoplastik
• Leukemia
• Limfoma
• Diskrasia sel plasma
• Histiositosis
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 The Role of Helper T Cells in Defense & Immunity 49
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 Humoral
immunity Cell-mediated
immunity

Microbe
Intracellular
Extracellular Phagocytosed Microbes
microbes Microbes in (e.g., viruses)
macrophage Replicating within
Infected cell

Responding
lymphocytes
Helper Cytolytic
B lymphocyte T lymphocyte T lymphocyte

Secreted
antibody

Effector
mechanism

Guyton
12ed
Block Activate
infections and Kill infected
macrophages cells and
eliminate to kill
Functions extracellular eliminate
phagocytosed reservoirs of
microbes microbes infection
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Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
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 52
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 Imunity disorder

• Allergic / Hypersensitivity Disorders

• Autoimmune diseases/ disorder
• Immunodeficiency Disorders
• Transplantation Immunopathology

Overlap

53
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 • Berapa % cair tubuh kita?
• Bagaimana pembagian cair tubuh?
• Bagian manakah cair tubuh yang terbanyak?
• Berapa kebutuhan cair tubuh kita? Apa parameter
sederhana cair tubuh telah cukup?
• Sebutkan fungsi darah secara umum!
• Sebutkan komposisi darah!
• Sebutkan komposisi plasma!
• Sebutkan jenis sel darah!
• Apa peran masing-masing protein plasma?
• Apakah fungsi utama eritrosit?
• Berapa jumlah eritrosit & Hb normal?
• Produksi eritrosit membutuhkan bahan apa saja?
• Apa perangsang produksi eritrosit di sumsum tulang yang
berupa hormon? Hormon tsb dihasilkan oleh organ apa?
• Berapa lama umur eritrosit normal?
• Hemolisis adalah….. 54
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 • Apakah anemia dan polisitemia?
• Apa efek anemia dan polisitemia dalam tubuh?
• Fungsi leukosit?
• Macam leukosit & fungsi masing-masing?
• Jika ada serangan partikel asing, bagaimana
mekanisme leukosit dapat keluar dari pembuluh
darah?
• Bagaimana urutan respon leukosit terhadap
keradangan?
• Bagiamana pembagian sistem imun?
• Fungsi trombosit?
• Apa yang dimaksud hemostasis?
• Sebutkan fase dalam hemostasis?
• Apa guna mengetahui golongan darah?
• Golongan darah sistem ABO diklasifikasikan
berdasarkan apa?
55
• Gol darah Rhesus diklasifikasikan berdasarkan apa?
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 Kindly do not share it. Only for 2nd
semester Unair Nutritionist students,
academic year 2018/2019, as study guide.

Dr. Lilik Herawati, dr, M.Kes 56