THE PHYSIOLOGY OF BLOOD

AN INTRODUCTION AND OVERVIEW By Dr.M.ANTHONY DAVID, MD.
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WHAT IS BLOOD?

IT IS A LIQUID CONNECTIVE TISSUE IN AN AVERAGE 70 Kg MAN:
 

 

100 Trillion cells. Of which 25 trillions are Red Blood Cells! The average blood volume is 5 – 6 lts. It is roughly 7% of the total body weight.
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HEMATOL OGY: TH E S TU DY OF B LOOD MAD E POSSIBLE BY MIC ROSCOPY

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THE COMPOSITION OF BLOOD PLASMA

The Liquid: Plasma:
 

Water, the solvent The solute:

Proteins:
  

BLOOD PLASMA

Albumin Globulins:# Fibrinogen Na+ K+ Ca++ Urea Glucose Lipids
WATER SOLUTES

Electrolytes:
  

PROTEINS ELECTRO -LYTES ORGANIC MOLECULES 4

Organic molecules
  

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THE FORMED ELEMENT: CELLS
BLOOD CELLS

ERYTHROCYTES

LEUCOCYTES

THROMBOCYTES

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BLOOD: COMPOSITION

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FUNCTIONS OF BLOOD
    

NUTRITIVE RESPIRATORY EXCRETORY BODY DEFENCE: IMMUNITY TRANSPORT:
  

HORMONES VITAMINS DRUGS
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BLOOD:TRANSPORTING HORMONE MOLECULES

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OXYGEN & CO2 TRANSPORT

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FUNCTIONS OF BLOOD

HOMEOSTATIC FUNCTION:
   

ACID BASE BALANCE. ELECTROLYTE BALANCE. HEMOSTASIS. THERMOREGULATION.

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WHAT IS BLOOD VOLUME?
The total amount of blood in circulation plus the amount of blood in the reservoirs constitutes the “Blood Volume”  The average adult 70 kg man has a blood volume of 5 to 6 litres.

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EXPRESSION OF BLOOD VOLUME
 

Usually Blood Volume is expressed in liters. It can also be expressed in relation to body weight.

It is 7% Body Weight

Another way to express it is in terms of Body Surface Area.
 

Whole Blood : 2.8 Lts/M2 Plasma : 1.5 Lts/M2
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METHODS OF MEASURING BLOOD VOLUME
  

IN HUMANS: ONLY INDIRECT METHODS DYE DILUTION TECHNIUE: PRINCIPLE:
 

Injection of a known volume of non toxic substance into the circulation. Measuring the dilution of this injected dye after some time. This gives us the Plasma volume.
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DYE DILUTION TECHNIQUE

V1 = VOLUME C1 = CONCENTRATION OF DYE

V2 = VOLUME C2 = CONC. OF DYE

V1 X C 1 = V 2 X C 2 OR V2 = V1 X C 1 = Amount of Dye injected C2 Conc. Of the dye in the Plasma
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HEMATOCRIT (PCV)
The volume of erythrocytes in the whole blood expressed in percentage is the Hematocrit.  This is also called as Packed Cell Volume or PCV.  This is determined by the Wintrobe’s tube, using a Centrifuge.

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HEMATOCRIT
 

A mixture of blood and double oxalate (K – NH4) is taken upto 100 mark in the Wintrobe’s tube. The tube is placed in the centrifuge. It is rotated at 3,000 rpm for 30 minutes. The Hematocrit is then read off the tube. Blood Volume = Plasma Volume X 100 NOMAD:2005: BP: INTROVERVIEW 16 100 - PCV

HEMATOCRIT

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BLOOD VOLUME: PHYSIOLOGICAL VARIATIONS AGE  SEX  TEMPERATUR E  BODY WEIGHT  BODY SURFACE

PREGNANCY  EXERCISE  POSTURE  HYPOXIA  EMOTIONS

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BLOOD VOLUME & AGE
AGE AT BIRTH 6 Months 1 year 2yrs 6 months 4 years 7 years 10 years ADULTS BLOOD VOLUME in Liters 0.3 0.5 0.7 1.0 1.3 1.7 2.5(Girls); 3.2 (Boys) 5 (Men) 4.5 (Women)

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BLOOD VOLUME: PHYSIOLOGICAL VARIATIONS
1. SEX:

Males have more blood volume than females. Acute exposure to cold causes reduction in blood volume due to Plasma water loss to tissues.
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2. TEMPERATURE:

BLOOD VOLUME: PHYSIOLOGICAL VARIATIONS
3. BODY WEIGHT:  It is usually 7% of the Body Weight. 4. BODY SURFACE AREA:  2.8 Lts/Square Meters of BSA

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BLOOD VOLUME: PHYSIOLOGICAL VARIATIONS
5. PREGNANCY:

Increases by 20 – 30% due to mass of fetus. Vigorous exercise causes an increase. Changing from lying down to erect.
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6. EXERCISE:

7. POSTURE:

BLOOD VOLUME: PHYSIOLOGICAL VARIATIONS
8. HYPOXIA:

 

Seen in High altitudes.  Erythrocytes So  Blood volume. Excitement causes an increase in the Blood volume.
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9. EMOTIONS:

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BLOOD VOLUME: PATHOLOGICAL VARIATIONS
DECREASE IN BLOOD VOLUME IS HYPOVOLEMIA. CAUSES: 1. BLOOD LOSS: 2. SHOCK:  Crushing Injury  Cardiogenic  Neurogenic  Psychogenic.

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HYPOVOLEMIA: CAUSES (contd)
3. HEMOLYSIS:

 

Mismatched transfusion Snake bite Black water fever Hemorrhagic Plagues/Dengue Measles
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HYPOVOLEMIA: CAUSES (contd)
4. DEHYDRATION:
    

Diarrhoea Cholera Gastroenteritis Burns Hyperemesis.

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HYPOVOLEMIA: CAUSES (contd)
5. ANEMIA:
 

Decreased RBC volume Plasma may increase. Blood volume per body weight decreases though Blood volume per BSA may be normal. Decrease in Blood volume.

6. OBESITY:

7. HYPOTHYROIDISM (MYXEDEMA):

8. ACUTE COLD: Decreases blood volume. NOMAD:2005: BP: INTROVERVIEW

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TREATMENT FOR BLOOD LOSS
TRANSFUSION OF WHOLE BLOOD OF THE SAME BLOOD GROUP & TYPE.  INFUSION OF PLASMA  INFUSION OF DEXTRAN OR NORMAL SALINE.

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HEMOPOIESIS & ERYTHROPOIESIS
By Dr. M.Anthony David.MD.

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HEMOPOIESIS: INTRO
  

Hemo: Referring to blood cells Poiesis: “The development or production of” The word Hemopoiesis refers to the production & development of all the blood cells:
  

Begins in the 20th week of life in the fetus & continues in the red bone marrow till death.
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Erythrocytes: Erythropoiesis Leucocytes: Leucopoiesis Thrombocytes: Thrombopoiesis.

STEM CELL THEORY

 

All blood cells are produced by the bone marrow. They come from a single class of primitive mother cells called as: PLURIPOTENT STEM CELLS. These cells give rise to blood cells of:

Myeloid series: Cells arising mainly from the bone marrow. Lymphoid series: cells arising from lymphoid tissues.
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PROGENITOR CELLS

  

Committed stem cells lose their capacity for self-renewal. They become irreversibly committed. These cells are termed as “Progenitor cells” They are regulated by certain hormones or substances so that they can:
 

Proliferate Undergo Maturation.

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BLOOD CELLS: DEVELOPMENT
PROG ENI TOR CE LL S

LY MPHO ID PRO MEGA MYELO BLA ST MONOBL AST CE LLS NORMOBL AST KA RYO BL AST

LYMP HO CY TESERYTHROCYTESTH ROMB OCY TES GRANUL OCYTE S MONOCYTE S

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ERYTHROPOIESIS: SITES/PHASES

INTRA UT ER INE LIF E:

INTRAVASC UL AR PH ASE : Up to 3 rd mo nth of Intr a U te ri ne Life.

End ot helial cell s = = = RBCs

HEPATI C P HAS E : 3 rd t o 5 th mo nth IU L
Li ver & Sp lee n  nR BCs from M ese nchymal cell s.

MYEL OI D PH ASE : Fr om 5 th m onth of IUL onwar ds.
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ERYTHROPOIESIS: SITES/PHASES contd.

POST NATAL LIFE:

CHILDREN:

 

Predominantly Red Bone Marrow of skeleton:
Axial & Appendicular.

ADULTS:

Red Bone Marrow of Axial Skeleton.

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ERYTHROPOIESIS
PROERYTHROBLAST BASOPHILIC ERYTHROBLAST POLYCHROMAT OPHILIC ERYTHROBL AST ORTHOCHROMATIC ERYTHROBLAST

RETICULOCYTE

MATURE ERYTHROCYTES
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FACTORS REGULATING ERYTHROPOIESIS
    

SINGLE MOST IMPORTANT REGULATOR: “TISSUE OXYGENATION” BURST PROMOTING ACTIVITY ERYTHROPOIETIN IRON VITAMINS:
 

Vitamin B12 Folic Acid

MISCELLANEOUS
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ERYTHROPOIETIN
 

A hormone p ro duced by the Ki dn ey. Now adays a vailabl e a s Syn thet ic Epo ie ti Incre as es the n umbe r of :
 

Nucl eate d p recur so rs i n t he m ar ro w. Ret icul ocyte s & Matur e Er yth rocyte s i n the blood .

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VITAMINS

B 12 : Cya noco ba la mi ne & Fol ic Ac id:
 

 

Is also cal led Ex tr insi c Facto r of Ca stle . Needs th e Intr insi c Facto r from th e Gastri c j ui ce for ab so rpti on f rom S mal l Inte sti ne. De ficiency cause s Per nicious (Wh en I F is mi ssi ng) o r Me gal ob lasti c An emi a. Sti mulat es Er yt hrop oiesis Is foun d in meat & diar y prod ucts.
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IRON

Esse ntia l f or the synthe si s o f Hem og lo bin . Def icie ncy ca use s Microc yti c, Hypoc hro mic A nemi a. Def icie ncy ca use s the c ommone st typ e o f Anem ia .

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