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Fluids of the Body
Cells of the body are serviced by 2 fluids
composed of plasma and a variety of cells transports nutrients and wastes
± interstitial fluid
bathes the cells of the body
Nutrients and oxygen diffuse from the blood into the interstitial fluid & then into the cells Wastes move in the reverse direction Hematology is study of blood and blood disorders
Functions of Blood
± O2, CO2, metabolic wastes, nutrients, heat & hormones
± helps regulate pH through buffers ± helps regulate body temperature
coolant properties of water vasodilatation of surface vessels dump heat
± helps regulate water content of cells by interactions with dissolved ions and proteins
Protection from disease & loss of blood
Physical Characteristics of Blood Thicker (more viscous) than water and flows more slowly than water Temperature of 100.45) 8 % of total body weight Blood volume ± 5 to 6 liters in average male ± 4 to 5 liters in average female ± hormonal negative feedback systems maintain constant blood volume and osmotic pressure19-4 .35-7.4 (7.4 degrees F pH 7.
Techniques of Blood Sampling Venipuncture ± sample taken from vein with hypodermic needle & syringe ± median cubital vein (see page 717) ± why not stick an artery? less pressure closer to the surface Finger or heel stick ± common technique for diabetics to monitor daily blood sugar ± method used for infants 19-5 .
Components of Blood Hematocrit ± 55% plasma ± 45% cells 99% RBCs < 1% WBCs and platelets 19-6 .
gases. waste products 19-7 .Blood Plasma 0ver 90% water 7% plasma proteins created in liver confined to bloodstream ± albumin maintain blood osmotic pressure ± globulins (immunoglobulins) antibodies bind to foreign substances called antigens form antigen-antibody complexes ± fibrinogen for clotting 2% other substances ± electrolytes. nutrients. hormones.
B cells.Formed Elements of Blood Red blood cells ( erythrocytes ) White blood cells ( leukocytes ) ± granular leukocytes neutrophils eosinophils basophils ± agranular leukocytes lymphocytes = T cells. and natural killer cells monocytes Platelets (special cell fragments) 19-8 .
tissue hypoxia.46% (average of 42%) ± male normal range 40 .Hematocrit Percentage of blood occupied by cells ± female normal range 38 . blood doping in athletes 19-9 .54% (average of 46%) testosterone Anemia ± not enough RBCs or not enough hemoglobin Polycythemia ± too many RBCs (over 65%) ± dehydration.
Blood Doping Injecting previously stored RBC¶s before an athletic event ± more cells available to deliver oxygen to tissues Dangerous ± increases blood viscosity ± forces heart to work harder Banned by Olympic committee 19-10 .
thymus. ribs. days or weeks ± process of blood cells formation is hematopoiesis or hemopoiesis In the embryo ± occurs in yolk sac. skull & pelvis and ends of long bones 19-11 . spleen.Formation of Blood Cells Most blood cells types need to be continually replaced ± die within hours. liver. lymph nodes & red bone marrow In adult ± occurs only in red marrow of flat bones like sternum.
Hematopoiesis 19-12 .
1% of red marrow cells ± replenish themselves as they differentiate into either myeloid or lymphoid stem cells Myeloid stem cell line of development continues: ± progenitor cells(colony-forming units) no longer can divide and are specialized to form specific cell types example: CFU-E develops eventually into only red blood cells ± next generation is blast cells have recognizable histological characteristics develop within several divisions into mature cell types Lymphoid stem cell line of development ± pre-B cells & prothymocytes finish their develop into B & T lymphocytes in the lymphatic tissue after leaving the red marrow 19-13 .Stages of Blood Cell Formation Pluripotent stem cells ± .
Hemopoietic Growth Factors Regulate differentiation & proliferation Erythropoietin (EPO) ± produced by the kidneys increase RBC precursors Thrombopoietin (TPO) ± hormone from liver stimulates platelet formation Cytokines are local hormones of bone marrow ± produced by some marrow cells to stimulate proliferation in other marrow cells ± colony-stimulating factor (CSF) & interleukin stimulate WBC production 19-14 .
Medical Uses of Growth Factors Available through recombinant DNA technology ± recombinant erythropoietin (EPO) very effective in treating decreased RBC production of end-stage kidney disease ± other products given to stimulate WBC formation in cancer patients receiving chemotherapy which kills bone marrow granulocyte-macrophage colony-stimulating factor granulocyte colony stimulating factor ± thrombopoietin helps prevent platelet depletion during chemotherapy 19-15 .
8 million/drop ± new RBCs enter circulation at 2 million/second 19-16 .4 million/drop ---.female 4.Red Blood Cells or Erythrocytes Contain oxygen-carrying protein hemoglobin that gives blood its red color ± 1/3 of cell¶s weight is hemoglobin Biconcave disk 8 microns in diameter ± increased surface area/volume ratio ± flexible shape for narrow passages ± no nucleus or other organelles no cell division or mitochondrial ATP formation Normal RBC count ± male 5.
Hemoglobin Globin protein consisting of 4 polypeptide chains One heme pigment attached to each polypeptide chain ± each heme contains an iron ion (Fe+2) that can combine reversibly with one oxygen molecule 19-17 .
Transport of O2, CO2 and Nitric Oxide
Each hemoglobin molecule can carry 4 oxygen molecules from lungs to tissue cells Hemoglobin transports 23% of total CO2 waste from tissue cells to lungs for release
± combines with amino acids in globin portion of Hb
Hemoglobin transports nitric oxide & super nitric oxide helping to regulate BP
± iron ions pick up nitric oxide (NO) & super nitric oxide (SNO)& transport it to & from the lungs ± NO causing vasoconstriction is released in the lungs ± SNO causing vasodilation is picked up in the lungs 19-18
RBC Life Cycle
RBCs live only 120 days
± wear out from bending to fit through capillaries ± no repair possible due to lack of organelles
Worn out cells removed by fixed macrophages in spleen & liver Breakdown products are recycled
Recycling of Hemoglobin Components
In macrophages of liver or spleen
± globin portion broken down into amino acids & recycled ± heme portion split into iron (Fe+3) and biliverdin (green pigment)
Fate of Components of Heme Iron(Fe+3) ± transported in blood attached to transferrin protein ± stored in liver. urobilin and excreted in urine 19-21 . muscle or spleen attached to ferritin or hemosiderin protein ± in bone marrow being used for hemoglobin synthesis Biliverdin (green) converted to bilirubin (yellow) ± bilirubin secreted by liver into bile converted to urobilinogen then stercobilin (brown pigment in feces) by bacteria of large intestine if reabsorbed from intestines into blood is converted to a yellow pigment.
nucleus is ejected & a reticulocyte is formed ± orange in color with traces of visible rough ER Reticulocytes escape from bone marrow into the blood In 1-2 days. they eject the remaining organelles to become a mature RBC 19-22 .Erythropoiesis: Production of RBCs Proerythroblast starts to produce hemoglobin Many steps later.
Feedback Control of RBC Production Tissue hypoxia (cells not getting enough O2) ± high altitude since air has less O2 ± anemia RBC production falls below RBC destruction ± circulatory problems Kidney response to hypoxia ± release erythropoietin ± speeds up development of proerythroblasts into reticulocytes 19-23 .
5 to 1. nutritional deficiency or failure of red bone marrow to respond to erythropoietin stimulation High count might indicate recent blood loss or successful iron therapy 19-24 .Normal Reticulocyte Count Should be .5% of the circulating RBC¶s Low count in an anemic person might indicate bone marrow problem ± leukemia.
eosinophils or basophils ± agranulocytes are monocyes or lymphocytes 19-25 .WBC Anatomy and Types All WBCs (leukocytes) have a nucleus and no hemoglobin Granular or agranular classification based on presence of cytoplasmic granules made visible by staining ± granulocytes are neutrophils.
pale lilac practically invisible granules Diameter is 10-12 microns 60 to 70% of circulating WBCs 19-26 .Neutrophils (Granulocyte) Polymorphonuclear Leukocytes or Polys Nuclei = 2 to 5 lobes connected by thin strands ± older cells have more lobes ± young cells called band cells because of horseshoe shaped nucleus (band) Fine.
uniform-sized granules stain orangered with acidic dyes ± do not obscure the nucleus Diameter is 10 to 12 microns 2 to 4% of circulating WBCs 19-27 .Eosinophils (Granulocyte) Nucleus with 2 or 3 lobes connected by a thin strand Large.
bilobed nuclei Diameter is 8 to 10 microns Less than 1% of circulating WBCs 19-28 .Basophils (Granulocyte) Large. s-shaped. variable-sized granules stain with basic dyes ± obscure the nucleus Irregular. dark purple.
9 microns in diameter Large cells 10 .Lymphocyte (Agranulocyte) Dark.14 microns in diameter ± increase in number during viral infections 20 to 25% of circulating WBCs 19-29 . oval to round nucleus Cytoplasm sky blue in color ± amount varies from rim of blue to normal amount Small cells 6 .
20 microns Cytoplasm is a foamy blue-gray 3 to 8% o circulating WBCs 19-30 .Monocyte (Agranulocyte) Nucleus is kidney or horse-shoe shaped Largest WBC in circulating blood ± does not remain in blood long before migrating to the tissues ± differentiate into macrophages fixed group found in specific tissues ± alveolar macrophages in lungs ± kupffer cells in liver wandering group gathers at sites of infection Diameter is 12 .
shock or chemotherapy Only 2% of total WBC population is in circulating blood at any given time ± rest is in lymphatic fluid. lungs. lymph nodes & spleen 19-31 . strenuous exercise.000 cells per drop of blood ± 1 WBC for every 700 RBC Leukocytosis is a high white blood cell count ± microbes. anesthesia or surgery Leukopenia is low white blood cell count ± radiation. skin.WBC Physiology Less numerous than RBCs ± 5000 to 10.
Emigration & Phagocytosis in WBCs WBCs roll along endothelium. stick to it & squeeze between cells. ± adhesion molecules (selectins) help WBCs stick to endothelium displayed near site of injury ± molecules (integrins) found on neutrophils assist in movement through wall Neutrophils & macrophages phagocytize bacteria & debris ± chemotaxis of both kinins from injury site & toxins 19-32 .
strong chemicals ) that destroy bacteria 19-33 .Neutrophil Function Fastest response of all WBC to bacteria Direct actions against bacteria ± release lysozymes which destroy/digest bacteria ± release defensin proteins that act like antibiotics & poke holes in bacterial cell walls destroying them ± release strong oxidants (bleach-like.
Monocyte Function Take longer to get to site of infection. but arrive in larger numbers Become wandering macrophages. once they leave the capillaries Destroy microbes and clean up dead tissue following an infection 19-34 .
histamine & serotonin ± heighten the inflammatory response and account for hypersensitivity (allergic) reaction 19-35 .Basophil Function Involved in inflammatory and allergy reactions Leave capillaries & enter connective tissue as mast cells Release heparin.
Eosinophil Function Leave capillaries to enter tissue fluid Release histaminase ± slows down inflammation caused by basophils Attack parasitic worms Phagocytize antibody-antigen complexes 19-36 .
cancer cells & some bacteria Natural killer cells ± attack many different microbes & some tumor cells ± destroy foreign invaders by direct attack 19-37 . transplanted organs. fungi.Lymphocyte Functions B cells ± destroy bacteria and their toxins ± turn into plasma cells that produces antibodies T cells ± attack viruses.
poisoning. chemotherapy. leukemia.4 % (up if parasite or allergy reaction) ± basophil <1% (up if allergy reaction or hypothyroid) 19-38 .Differential WBC Count Detection of changes in numbers of circulating WBCs (percentages of each type) ± indicates infection. parasites or allergy reaction Normal WBC counts ± neutrophils 60-70% (up if bacterial infection) ± lymphocyte 20-25% (up if viral infection) ± monocytes 3 -.8 % (up if fungal/viral infection) ± eosinophil 2 -.
ovarian or testicular cancer. sickle-cell. breast.Bone Marrow Transplant Intravenous transfer of healthy bone marrow Procedure ± destroy sick bone marrow with radiation & chemotherapy ± donor matches surface antigens on WBC ± put sample of donor marrow into patient's vein for reseeding of bone marrow ± success depends on histocompatibility of donor & recipient Treatment for leukemia. lymphoma or aplastic anemia 19-39 .
4 micron cell fragment with no nucleus Normal platelet count is 150. 2 .000 white blood cells 19-40 .Platelet (Thrombocyte) Anatomy Disc-shaped.000400.000/drop of blood Other blood cell counts ± 5 million red & 5-10.
Platelets--Life History Platelets form in bone marrow by following steps: ± myeloid stem cells to megakaryocyte-colony forming cells to megakaryoblast to megakaryocytes whose cell fragments form platelets Short life span (5 to 9 days in bloodstream) ± formed in bone marrow ± few days in circulating blood ± aged ones removed by fixed macrophages in liver and spleen 19-41 .
differential WBC.5 to 18g/100mL of blood 19-42 .Complete Blood Count Screens for anemia and infection Total RBC. WBC & platelet counts. hematocrit and hemoglobin measurements Normal hemoglobin range ± infants have 14 to 20 g/100mL of blood ± adult females have 12 to 16 g/100mL of blood ± adult males have 13.
Hemostasis Stoppage of bleeding in a quick & localized fashion when blood vessels are damaged Prevents hemorrhage (loss of a large amount of blood) Methods utilized ± vascular spasm ± platelet plug formation ± blood clotting (coagulation = formation of fibrin threads) 19-43 .
Vascular Spasm Damage to blood vessel produces stimulates pain receptors Reflex contraction of smooth muscle of small blood vessels Can reduce blood loss for several hours until other mechanisms can take over Only for small blood vessel or arteriole 19-44 .
& enzymes that produce thromboxane A2 Steps in the process ± (1) platelet adhesion (2) platelet release reaction (3) platelet aggregation 19-45 . ATP. Ca+2. serotonin.Platelet Plug Formation Platelets store a lot of chemicals in granules needed for platelet plug formation ± alpha granules clotting factors platelet-derived growth factor ± cause proliferation of vascular endothelial cells. smooth muscle & fibroblasts to repair damaged vessels ± dense granules ADP. fibrin-stabilizing factor.
Platelet Adhesion Platelets stick to exposed collagen underlying damaged endothelial cells in vessel wall 19-46 .
Platelet Release Reaction Platelets activated by adhesion Extend projections to make contact with each other Release thromboxane A2 & ADP activating other platelets Serotonin & thromboxane A2 are vasoconstrictors decreasing blood flow through the injured vessel 19-47 .
Platelet Aggregation Activated platelets stick together and activate new platelets to form a mass called a platelet plug Plug reinforced by fibrin threads formed during clotting process 19-48 .
Blood Clotting Blood drawn from the body thickens into a gel ± gel separates into liquid (serum) and a clot of insoluble fibers (fibrin) in which the cells are trapped If clotting occurs in an unbroken vessel is called a thrombosis Substances required for clotting are Ca+2. enzymes synthesized by liver cells and substances released by platelets or damaged tissues Clotting is a cascade of reactions in which each clotting factor activates the next in a fixed sequence resulting in the formation of fibrin threads ± prothrombinase & Ca+2 convert prothrombin into thrombin ± thrombin converts fibrinogen into fibrin threads 19-49 .
Overview of the Clotting Cascade Prothrombinase is formed by either the intrinsic or extrinsic pathway Final common pathway produces fibrin threads 19-50 .
clotting factor X combines with V to form prothrombinase 19-51 .Extrinsic Pathway Damaged tissues leak tissue factor (thromboplastin) into bloodstream Prothrombinase forms in seconds In the presence of Ca+2.
X and V 19-52 .Intrinsic Pathway Activation occurs ± endothelium is damaged & platelets come in contact with collagen of blood vessel wall ± platelets damaged & release phospholipids Requires several minutes for reaction to occur Substances involved: Ca+2 and clotting factors XII.
Final Common Pathway Prothrombinase and Ca+2 ± catalyze the conversion of prothrombin to thrombin Thrombin ± in the presence of Ca+2 converts soluble fibrinogen to insoluble fibrin threads ± activates fibrin stabilizing factor XIII ± positive feedback effects of thrombin accelerates formation of prothrombinase activates platelets to release phospholipids 19-53 .
Clot Retraction & Blood Vessel Repair Clot plugs ruptured area of blood vessel Platelets pull on fibrin threads causing clot retraction ± trapped platelets release factor XIII stabilizing the fibrin threads Edges of damaged vessel are pulled together Fibroblasts & endothelial cells repair the blood vessel 19-54 .
Role of Vitamin K in Clotting Normal clotting requires adequate vitamin K ± fat soluble vitamin absorbed if lipids are present ± absorption slowed if bile release is insufficient Required for synthesis of 4 clotting factors by hepatocytes ± factors II (prothrombin). VII. IX and X Produced by bacteria in large intestine 19-55 .
inappropriate clots & clots at a site of a completed repair ± fibrinolysis is dissolution of a clot Inactive plasminogen is incorporated into the clot ± activation occurs because of factor XII and thrombin ± plasminogen becomes plasmin (fibrinolysin) which digests fibrin threads Clot formation remains localized ± fibrin absorbs thrombin ± blood disperses clotting factors ± endothelial cells & WBC produce prostacyclin that opposes thromboxane A2 (platelet adhesion & release) Anticoagulants present in blood & produced by mast cells ± 19-56 .Hemostatic Control Mechanisms Fibrinolytic system dissolves small.
air bubble or fat from broken bone in the blood pulmonary embolus is found in lungs Low dose aspirin blocks synthesis of thromboxane A2 & reduces inappropriate clot formation ± strokes. TIAs and myocardial infarctions 19-57 .Intravascular Clotting Thrombosis ± clot (thrombus) forming in an unbroken blood vessel forms on rough inner lining of BV if blood flows too slowly (stasis) allowing clotting factors to build up locally & cause coagulation ± may dissolve spontaneously or dislodge & travel Embolus ± clot.
Anticoagulants and Thrombolytic Agents Anticoagulants suppress or prevent blood clotting ± heparin administered during hemodialysis and surgery ± warfarin (Coumadin) antagonist to vitamin K so blocks synthesis of clotting factors slower than heparin ± stored blood in blood banks treated with citrate phosphate dextrose (CPD) that removes Ca+2 Thrombolytic agents are injected to dissolve clots ± directly or indirectly activate plasminogen ± streptokinase or tissue plasminogen activator (t-PA) 19-58 .
Rh.Blood Groups and Blood Types RBC surfaces are marked by genetically determined glycoproteins & glycolipids ± agglutinogens or isoantigens ± distinguishes at least 24 different blood groups ABO. Kell. Kidd and Duffy systems 19-59 . Lewis.
blood type O Plasma contains isoantibodies or agglutinins to the A or B antigens not found in your blood ± anti-A antibody reacts with antigen A ± anti-B antibody reacts with antigen B 19-60 .blood type A ± display only antigen B -.blood type AB ± display neither antigen -.ABO Blood Groups Based on 2 glycolipid isoantigens called A and B found on the surface of RBCs ± display only antigen A -.blood type B ± display both antigens A & B -.
RH blood groups Antigen was discovered in blood of Rhesus monkey People with Rh agglutinogens on RBC surface are Rh+.blood type & only with exposure to the antigen ± transfusion of positive blood ± during a pregnancy with a positive blood type fetus Transfusion reaction upon 2nd exposure to the antigen results in hemolysis of the RBCs in the donated blood 19-61 . Normal plasma contains no anti-Rh antibodies Antibodies develop only in Rh.
Hemolytic Disease of Newborn Rh negative mom and Rh+ fetus will have mixing of blood at birth Mom's body creates Rh antibodies unless she receives a RhoGam shot soon after first delivery. miscarriage or abortion ± RhoGam binds to loose fetal blood and removes it from body before she reacts In 2nd child. hemolytic disease of the newborn may develop causing hemolysis of the fetal RBCs 19-62 .
Transfusion and Transfusion Reactions Transfer of whole blood. cells or plasma into the bloodstream of recipient ± used to treat anemia or severe blood loss Incompatible blood transfusions ± antigen-antibody complexes form between plasma antibodies & ³foreign proteins´ on donated RBC's (agglutination) ± donated RBCs become leaky (complement proteins) & burst ± loose hemoglobin causes kidney damage Problems caused by incompatibility between donor¶s cells and recipient¶s plasma Donor plasma is too diluted to cause problems 19-63 .
Universal Donors and Recipients People with type AB blood called ³universal recipients´ since have no antibodies in plasma ± only true if cross match the blood for other antigens People with type O blood cell called ³universal donors´ since have no antigens on their cells ± theoretically can be given to anyone 19-64 .
B or Rh+ Cross-matching is to test by mixing donor cells with recipient¶s serum Screening is to test recipient¶s serum against known RBC¶s having known antigens 19-65 .Typing and Cross-Matching Blood Mixing of incompatible blood causes agglutination (visible clumping) ± formation of antigen-antibody complex that sticks cells together ± not the same as blood clotting Typing involves testing blood with known antisera that contain antibodies A.
cold intolerance & paleness lack of O2 for ATP & heat production Types of anemia ± iron-deficiency =lack of absorption or loss of iron ± pernicious = lack of intrinsic factor for B12 absorption ± hemorrhagic = loss of RBCs due to bleeding (ulcer) ± hemolytic = defects in cell membranes cause rupture ± thalassemia = hereditary deficiency of hemoglobin ± aplastic = destruction of bone marrow (radiation/toxins) 19-66 .Anemia = Not Enough RBCs Symptoms ± oxygen-carrying capacity of blood is reduced ± fatigue.
sub-Saharan Africa & Asia Person with only one sickle cell gene ± increased resistance to malaria because RBC membranes leak K+ & lowered levels of K+ kill the parasite infecting the red blood cells 19-67 .Sickle-cell Anemia (SCA) Genetic defect in hemoglobin molecule (Hb-S) that changes 2 amino acids ± at low very O2 levels. RBC is deformed by changes in hemoglobin molecule within the RBC sickle-shaped cells rupture easily = causing anemia & clots Found among populations in malaria belt ± Mediterranean Europe.
articular bleeding & pain Hemophilia A lacks factor VIII (males only) ± most common Hemophilia B lacks factor IX (males only) Hemophilia C (males & females) ± less severe because alternate clotting activator exists Treatment is transfusions of fresh plasma or concentrates of the missing clotting factor 19-68 . blood in urine.Hemophilia Inherited deficiency of clotting factors ± bleeding spontaneously or after minor trauma ± subcutaneous & intramuscular hemorrhaging ± nosebleeds.
hypoxia. hypotension & hemolysis Clots cause ischemia and necrosis leading to multisystem organ failure 19-69 . trauma. low blood flow rates.Disseminated Intravascular Clotting Life threatening paradoxical presence of blood clotting and bleeding at the same time throughout the whole body ± so many clotting factors are removed by widespread clotting that too few remain to permit normal clotting Associated with infections.
Leukemia Acute leukemia ± uncontrolled production of immature leukocytes ± crowding out of normal red bone marrow cells by production of immature WBC ± prevents production of RBC & platelets Chronic leukemia ± accumulation of mature WBC in bloodstream because they do not die ± classified by type of WBC that is predominant--monocytic. lymphocytic. 19-70 .
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