Transcript Blood

1
An overview of the
cardiovascular
system.
 Driven by the
pumping of the
heart, blood flows
through the
pulmonary and
systemic circuits in
sequence.
 Each circuit begins
and ends at the
heart and contains
arteries, capillaries,
and veins
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Heart
Vessel
Blood
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Cardiovascular System
Main component
 Blood : fluid circulated
 Heart : pump (pulmonary & systemic circuits)
 Vessel: Artery & vein
Heart: : Blood
Heart
Bood vessel
(artery, arteriole)
Lung
Systemic
circuit
Pulmonary
circuit
Capillary
exchange
tissue
Blood vessel
(Vein)
Heart
Excretion
(Kidney)
Aorta
(Artery)
Lymphatic vessel
(Lymphatic system)
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• Functions of the blood
• Formation of Blood Cells
• Blood component:
• Blood elements:
• Red Blood Cells
– Oxygen Transport
– Carbon Dioxide Transport
– Anemia
– Blood Groups
• White Blood Cells
– Lymphocytes
Serum protein & lipids
– Monocytes
 Blood group & Rh
– Neutrophils
factor
– Eosinophils
 Blood transfusion
– Basophils
• Platelets
• Plasma
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• If one takes a sample of
blood, treats it with an
agent to prevent clotting,
and spins it in a centrifuge,
– the red cells settle to the
bottom
– the white cells settle on
top of them forming the
"buffy coat".
– The fraction occupied by
the red cells is called the
hematocrit.
• Normally it is approximately
45%.
Blood fluid:
- Serum?
- Plasma?
– Values much lower than
this are a sign of anemia.
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Plasma
(46-63%)
Formed elements
(37-54%
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Formed elements Function & description
Source
Plasma
Function
Source
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10
11
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Blood Plasma
 Plasma protein 7%
 Other solutes 1%
 Water 92%
Blood
Plasma
(55%)
A sample of blood is
approximately 55% plasma
and 45% formed elements.
Plasma is approximately 92% water and contains
–
–
–
–
Formed
elements
(45%)
proteins to regulate the osmotic pressure of blood,
protein for the clotting process and
antibody proteins that work with the immune system to
protect your body from invading pathogens.
Electrolytes, hormones, nutrient and some blood gases
are transported in the blood plasma.
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Plasma Constituent
Water
Major functions
Solvent for carrying other substances
(organic and inorganic molecules,
formed elements, and heat)
Salts (eletrolytes):
Sodium, Potassium
Calcium, Magnesium
Chloride, Bicarbonate
Plasma proteins
- Albumin
Osmotic balance, pH buffering, and
regulation of membrane permeability
Major contribution to osmotic
pressure of plasma, transport lipids,
steroid, hormone
Essential component of blood
- Fibrinogen
clotting system, can be converted
to insoluble fibrin
- Globulins
Defense (antibodies), transport ions,
hormone, and lipid
- Regulatory proteins <1%) Enzymes, proenzymes, hormones14
Plasma Constituent
Other solutes
- Electrolytes
Major functions
Normal extracellular fluids ion
composition essential for vital cellular
activities.
Ions contribute to osmotic pressure
of body fluids. Major plasma
electrolytes are Na+, K+, Ca2+, Mg2+,
Cl-, bicarbonate, phosphate, sulfate
¯¯
- Organic nutrients
Used for ATP production, growth, and
maintenance of cells; include lipids
(fatty acids, cholesterol, glycerides),
carbohydrates (primarily glucose),
and amino acids
- Organic wastes
Carried to sites of breakdown or
excretion, include urea, uric acid,
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creatinine, billirubin, ammonium ions
The Formed Elements
• The formed elements may be organized into three
group of cells:
- the red blood cells or erythrocytes,
- the white blood cells or leukocytes, and
- the platelets.
•
When stained, each group is easy to identify with a
microscope:
- The red cells are erythrocytes,
- the stained cells are leukocytes, and
- the small cell fragments between the red and white
cells are platelets.
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Blood elements
There are seven types of cells and cell fragments :
 red blood cells (RBCs) or erythrocytes
 platelets or thrombocytes
 five kinds of white blood cells (WBCs) or leukocytes
- Three kinds of granulocytes:
neutrophils
eosinophils
basophils
- Two kinds of leukocytes without granules in their
cytoplasm (agranulocytes)
lymphocytes
monocytes
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Blood characteristic
 Blood is a composite of fluid connective tissue that flows
through the vessels of the vascular system.
 In response to injury,
blood has the intrinsic ability to change from a liquid to a gel
so as to clot and stop bleeding.
 Blood comprises cells and cell pieces that are collectively
called the formed elements. These cells are carried in an
extracellular fluid called blood plasma.
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Blood characteristic
• Blood inside the vein and artery
± 38 C (Higher than body temperature
 Viscosity: 5 x ŋ water
• pH: 7.35-7.45 (± 7.4)
• Total Volume: ± 7% body weight
• Man : 5 - 6 L
• Women: 4 - 5 L
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Functions of the blood
Blood performs two major functions:
 transport through the body of
–
–
–
–
–
–
oxygen and carbon dioxide
food molecules (glucose, lipids, amino acids)
ions (e.g., Na+, Ca2+ , HCO3−)
wastes (e.g., urea)
hormones
heat
• defense of the body against infections and other
foreign materials. All the WBCs participate in these
defenses.
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Blood Function
 Blood has many diverse functions, all relating to supplying
cells with essential materials and maintaining the
internal environment.
 Red blood cells transport respiratory gases to trillions of
cells in the body.
 The blood controls the chemical composition of all
interstitial fluid by regulating pH and electrolyte levels.
 White blood cells are part of the immune system and
protect our body from microbes by producing
antibody molecules and phagocytizing foreign cells.
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THE FORMATION OF BLOOD CELLS
(HEMATOPOIESIS)
• All the various types of blood cells are produced in the bone
marrow (some 1011 of them each day in an adult human!).
• arise from a single type of cell called a hematopoietic stem
cell — an "adult" multipotent stem cell.
• These stem cells
– are very rare (only about one in 10,000 bone marrow
cells);
– are attached (probably by adherens junctions) to
osteoblasts lining the inner surface of bone cavities;
– express a cell-surface protein designated CD34;
– produce, by mitosis,
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Which path is taken is regulated by the need for more of that type
of blood cell which is, in turn, controlled by appropriate cytokines
and/or hormones.
Examples:
• Interleukin-7 (IL-7) is the major cytokine in stimulating bone
marrow stem cells to start down the path leading to the
various lymphocytes (mostly B cells and T cells).
• Erythropoietin (EPO), produced by the kidneys, enhances the
production of red blood cells (RBCs).
• Thrombopoietin (TPO), assisted by Interleukin-11 (IL-11),
stimulates the production of megakaryocytes. Their
fragmentation produces platelets.
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• Granulocyte-macrophage colony-stimulating factor (GM-CSF), as
its name suggests, sends cells down the path leading to both
those cell types. In due course, one path or the other is taken.
– Under the influence of granulocyte colony-stimulating factor
(G-CSF), they differentiate into neutrophils.
– Further stimulated by interleukin-5 (IL-5) they develop into
eosinophils.
– Interleukin-3 (IL-3) participates in the differentiation of most
of the white blood cells but plays a particularly prominent role
in the formation of basophils (responsible for some allergies).
– Stimulated by macrophage colony-stimulating factor (M-CSF)
the granulocyte/macrophage progenitor cells differentiate into
monocytes, macrophages, and dendritic cells (DCs).
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Hemocytoblasts
Myeloid
stem cells
Lymphoid
stem cells
Progenitor
cells
blast cells
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Red Blood Cells (erythrocytes)
The most numerous type in the blood.
 Women average about 4.8 million of
these cells per cubic millimeter (mm3;
which is the same as a microliter [µl]) of blood.
 Men average about 5.4 x 106 per µl.
 These values can vary over quite a range
depending on such factors as health and
altitude.
 Peruvians living at 18,000 feet may
have as many as 8.3 x 106 RBCs per µl.)
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Red Blood Cells (erythrocytes)
• Red blood cells (abbreviated RBCs, also called
erythrocytes from erythro = red + cyte = cell) are
- continually produced in bone marrow and
- recycled in spleen.
• In mature form they lack nuclei and most
cytoplasmic structures;
• they are little more than discoid, flexible bags of
hemoglobin.
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Red Blood Cells (erythrocytes)
• RBC precursors mature in the bone marrow closely
attached to a macrophage.
• They manufacture hemoglobin until it accounts for
some 90% of the dry weight of the cell.
• The nucleus is squeezed out of the cell and is
ingested by the macrophage.
• This scanning electron micrograph
(courtesy of Dr. Marion J. Barnhart)
shows the characteristic
biconcave shape of red blood cells 
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Red Blood Cells (erythrocytes)
• Thus RBCs are terminally differentiated; that is, they
can never divide.
• They live about 120 days and then are ingested by
phagocytic cells in the liver and spleen.
• Most of the iron in their hemoglobin is reclaimed for
reuse. The remainder of the heme portion of the
molecule is degraded into bile pigments and excreted
by the liver.
• Some 3 million RBCs die and are scavenged by the
liver each second.
• Red blood cells are responsible for the transport of
oxygen and carbon dioxide.
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Oxygen Transport
• In adult humans the hemoglobin (Hb) molecule
• consists of four polypeptides:
– two alpha (α) chains of 141 amino acids and
– two beta (β) chains of 146 amino acids
• Each of these is attached the prosthetic group heme.
• There is one atom of iron at the center of each
heme.
• One molecule of oxygen can bind to each heme.
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• The reaction is reversible.
• Under the conditions of lower temperature, higher pH, and
increased oxygen pressure in the capillaries of the lungs,
the reaction proceeds to the right. The purple-red
deoxygenated hemoglobin of the venous blood becomes
the bright-red oxyhemoglobin of the arterial blood.
• Under the conditions of higher temperature, lower pH, and
lower oxygen pressure in the tissues, the reverse reaction
is promoted and oxyhemoglobin gives up its oxygen.
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Carbon Dioxide Transport
 Carbon dioxide (CO2) combines with water forming carbonic acid,
which dissociates into a hydrogen ion (H+) and a bicarbonate ions:
CO2 + H2O ↔ H2CO3 ↔ H+ + HCO3−
• 95% of the CO2 generated in the tissues is carried in the red
blood cells:
– It probably enters (and leaves) the cell by diffusing through
transmembrane channels in the plasma membrane.
(One of the proteins that forms the channel is the D antigen
that is the most important factor in the Rh system of blood
groups.)
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Carbon Dioxide Transport
 Only about 5% of the CO2 generated in the tissues
dissolves directly in the plasma.
(A good thing, too: if all the CO2 we make were carried
this way, the pH of the blood would drop from its
normal 7.4 to an instantly-fatal 4.5!)
• When the red cells reach the lungs, these reactions are
reversed and CO2 is released to the air of the alveoli.
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Carbon Dioxide Transport
 Once inside, about one-half of the CO2 is directly
bound to hemoglobin (at a site different from the
one that binds oxygen).
• The rest is converted — following the equation
above — by the enzyme carbonic anhydrase into
– bicarbonate ions that diffuse back out into the plasma and
– hydrogen ions (H+) that bind to the protein portion of the
hemoglobin (thus having no effect on pH).
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Recycling of red blood cell components
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Anemia
• Anemia is a shortage of RBCs and/or the amount of
hemoglobin in them.
• Anemia has many causes. One of the most common
is an inadequate intake of iron in the diet.
Blood Groups
• Red blood cells have surface antigens that differ
between people and that create the so-called blood
groups such as the ABO system and the Rh system.
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The ABO Blood Groups
• The ABO blood groups were the first to be discovered
(in 1900) and are the most important in assuring safe
blood transfusions.
• The table shows the four ABO phenotypes ("blood
groups") present in the human population and the
genotypes that give rise to them.
• When red blood cells carrying one or both antigens are
exposed to the corresponding antibodies, they
agglutinate; that is, clump together.
• People usually have antibodies against those red cell
antigens that they lack.
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The ABO Blood Groups
Blood
Group
Antigens
on RBCs
Antibodies Genotypes
in Serum
A
A
Anti-B
AA or AO
B
B
Anti-A
BB or BO
AB
A and B
Neither
AB
O
Neither
Anti-A and
Anti-B
OO
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Other blood groups
• Several other blood group antigens have been
identified in humans.
– Some examples: MN, Duffy, Lewis, Kell.
• They, too, may sometimes cause
– transfusion reactions and even
– hemolytic disease of the newborn
• in cases where there is no ABO or Rh incompatibility.
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• Human red blood cells before (left) and after (right) adding
serum containing anti-A antibodies. The agglutination
reaction reveals the presence of the A antigen on the surface
of the cells.
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The Rh System
• Rh antigens are transmembrane proteins with loops exposed
at the surface of red blood cells.
• They appear to be used for the transport of carbon dioxide
and/or ammonia across the plasma membrane.
• They are named for the rhesus monkey in which they were
first discovered.
• There are a number of Rh antigens.
• Red cells that are "Rh positive" express the one designated D.
• About 15% of the population have no RhD antigens and thus
are "Rh negative".
• The major importance of the Rh system for human health is to
avoid the danger of RhD incompatibility between mother and
fetus.
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The Rh System
• During birth, there is often a leakage of the baby's red blood cells
into the mother's circulation.
• If the baby is Rh positive (having inherited the trait from its
father) and the mother Rh-negative, these red cells will cause her
to develop antibodies against the RhD antigen.
• The antibodies, usually of the IgG class, do not cause any
problems for that child, but can cross the placenta and attack the
red cells of a subsequent Rh+ fetus.
• This destroys the red cells producing anemia and jaundice.
• The disease, called erythroblastosis fetalis or hemolytic disease
of the newborn, may be so severe as to kill the fetus or even the
newborn infant.
• It is an example of an antibody-mediated cytotoxicity disorder.
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White Blood Cells (leukocytes)
• White blood cells are much less
numerous than red (the ratio
between the two is around 1:700),
• have nuclei,
• participate in protecting the body from infection,
• consist of lymphocytes and monocytes with
relatively clear cytoplasm, and three types of
granulocytes, whose cytoplasm is filled with
granules.
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White Blood Cells (leukocytes)
• White blood cells (abbreviated WBCs, also called
leukocytes from leuko = white + cyte = cell)
comprise several distinct cell types, neutrophils,
eosinophils, basophils, lymphocytes and
monocytes.
– Certain developmental and morphological similarities
permit the first three these cells to be usefully grouped
together as granulocytes or polymorphonuclear
leukocytes.
– The latter two types are then categorized as mononuclear
leukocytes.
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Lymphocytes
• There are several kinds of lymphocytes (although they all look
alike under the microscope), each with different functions to
perform .
• The most common types of lymphocytes are
– B lymphocytes ("B cells"). These are responsible for making
antibodies.
– T lymphocytes ("T cells"). There are several subsets of these:
• inflammatory T cells that recruit macrophages and
neutrophils to the site of infection or other tissue damage
• cytotoxic T lymphocytes (CTLs) that kill virus-infected and,
perhaps, tumor cells
• helper T cells that enhance the production of antibodies
by B cells
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Lymphocytes
• Although bone marrow is the ultimate
source of lymphocytes, the lymphocytes that will
become T cells migrate from the bone marrow to the
thymus where they mature under the influence of
thymic hormones
• Both B cells and T cells also take up residence in lymph
nodes, the spleen and other tissues where they
– encounter antigens;
– continue to divide by mitosis;
– mature into fully functional cells.
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Lymphocytes
 Lymphocytes are small cells, 7-9 μm in diameter in
blood smears, and are the second most common white
blood cell type, comprising about 30 % of the
circulating leukoytes.
 Lymphocytes have a round heterochromatic (deeply
staining) nucleus surrounded by a relatively thin rim of
cytoplasm.
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Monocytes
• Monocytes leave the blood and become
macrophages and dendritic cells.
 Macrophages are large, phagocytic cells that engulf foreign
material (antigens) that enter the body dead and dying cells of
the body.
Mononuclear leukocytes comprise both lymphocytes
and monocytes.
Both cell types work together in immune responses.
This scanning electron micrograph (courtesy of Drs. Jan M. Orenstein
and Emma Shelton) shows a single macrophage
surrounded by several lymphocytes.
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Monocytes
• Monocytes are the largest of the leukocytes, and constitute
about 5 % of the WBC population in peripheral blood.
• In blood smears, their nuclei are typically indented, sometimes
deeply so, with a kidney-bean or bent-horseshoe shape.
• Monocytes belong to the same functional population as tissue
macrophages.
• Monocytes/macrophages engulf and digest foreign
microorganisms, dead or worn-out cells, and other tissue debris.
They interact closely with lymphocytes to recognize and destroy
foreign substances.
• Most ordinary connective tissues contain resident macrophages
which normally remain at rest in the tissue.
• But the normal number of fixed macrophages is supplemented
during inflammation by the influx of many monocytes from the
blood.
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Neutrophils
• The most abundant of the WBCs.
• Neutrophils squeeze through the capillary walls and into
infected tissue where they kill the invaders (e.g., bacteria) and
then engulf the remnants by phagocytosis.
• This is a never-ending task, even in healthy people: Our
throat, nasal passages, and colon harbor vast numbers of
bacteria. Most of these are commensals, and do us no harm.
But that is because neutrophils keep them in check.
This photomicrograph shows a single neutrophil
surrounded by red blood cells
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Neutrophils
However,
– heavy doses of radiation
– chemotherapy
– and many other forms of stress
can reduce the numbers of neutrophils so that
formerly harmless bacteria begin to proliferate. The
resulting opportunistic infection can be lifethreatening.
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Neutrophils
• Neutrophils (also called neutrophilic granulocytes,
or polymorphonuclear neutrophilic leukocytes,
PMNs, or polys) are the most numerous of the
leukocytes, about 60% of the white blood cell count.
• They are about 12 μm in diameter in blood smear
preparations (about twice the size of red blood
cells).
• Too many neutrophils is called neutrophilia;
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Neutrophils
• Neutrophils take their name from the staining properties of their
cytoplasmic lysosomal granules (vesicles containing stored
lysosomal enzymes). These granules are neutrophilic, meaning
they show no special affinity for either acidic or basic stains but
are stained mildly by both.
– This is in contrast to the specific granules of eosinophils,
which stain red with acidic stains such as eosin, and those of
basophils, which stain with basic stains.
 The nuclei of mature neutrophils are elongated and pinched
into several distinct lobes, hence the term
polymorphonuclear.
 Immature neutrophils have a band-shaped nucleus and are
hence sometimes called "bands".
 Mature neutrophils, in contrast, are called "segs", in reference
to the segmented nucleus.
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Eosinophils
• Eosinophils (eosinophilic granulocytes)
normally comprise less than two to
four percent of the peripheral leukocytes.
• Their specific granules are intense eosinophilic (stained by eosin),
hence the name.
• Eosinophils are about the same size as neutrophils.
• Their nuclei are typically band shaped (elongated) or two-lobed.
• The number of eosinophils in the blood is normally quite low (0–
450/µl).
• However, their numbers increase sharply in certain diseases,
especially infections by parasitic worms.
• Eosinophils are cytotoxic, releasing the contents of their granules
on the invader.
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Eosinophils
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Basophils
• Basophils (basophilic granulocytes)
comprise less than 1 % of
leukocytes.
normally
the peripheral
• Their specific granules are intense
hence the name.
basophilic,
• Like eosinophils, basophils are similar in size to neutrophils.
• Their nuclei may be band shaped or segmented.
• Basophils seem to be functionally similar to tissue mast cells,
involved in triggering inflammation.
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Basophils
• The number of basophils also increases during infection.
• Basophils leave the blood and accumulate at the site of infection
or other inflammation. There they discharge the contents of their
granules, releasing a variety of mediators such as:
– histamine
– serotonin
– prostaglandins and leukotrienes
which increase the blood flow to the area and in other ways add
to the inflammatory process.
The mediators released by basophils also play an important part
in some allergic responses such as
– hay fever and
– an anaphylactic response to insect stings.
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Platelets
• Platelets are cell fragments produced from
megakaryocytes.
• Blood normally contains 150,000–450,000 per
microliter (µl) or cubic millimeter (mm3). This number
is normally maintained by a homeostatic (negativefeedback) mechanism.
• If this value should drop much below 50,000/µl, there
is a danger of uncontrolled bleeding because of the
essential role that platelets have in blood clotting.
Some causes:
– certain drugs and herbal remedies;
– autoimmunity.
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Platelets
• When blood vessels are cut or damaged, the loss of
blood from the system must be stopped before shock
and possible death occur. This is accomplished by
solidification of the blood, a process called
coagulation or clotting.
• A blood clot consists of
– a plug of platelets enmeshed in a
– Network of insoluble fibrin molecules.
 Please learn by yourself Details of the clotting process!
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Plasma
• Plasma is the straw-colored liquid in which the blood
cells are suspended.
• 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
• Plasma transports materials needed by cells and materials that
must be removed from cells:
– various ions (Na+, Ca2+, HCO3−, etc.
– glucose and traces of other sugars
– amino acids
– other organic acids
– cholesterol and other lipids
– hormones
– urea and other wastes
Most of these materials are in transit from a place where they are added to the blood
(a "source")
– exchange organs like the intestine
– depots of materials like the liver
to places ("sinks") where they will be removed from the blood.
– every cell
– exchange organs like the kidney, and skin.
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Serum Proteins
• Proteins make up 6–8% of the blood. They are about
equally divided between serum albumin and a great
variety of serum globulins.
• After blood is withdrawn from a vein and allowed to
clot, the clot slowly shrinks. As it does so, a clear
fluid called serum is squeezed out. Thus:
• Serum is blood plasma without fibrinogen and other
clotting factors.
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Serum Proteins
• Serum albumin
– is made in the liver
– binds many small molecules
for transport through the blood
– helps maintain the
osmotic pressure of the blood
The other proteins are the various serum globulins (&
fibrinogen)
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Serum Proteins
Serum globulin
• They migrate in the order
– alpha globulins (e.g., the proteins that transport
thyroxine and retinol [vitamin A])
– beta globulins (e.g., the iron-transporting protein
transferrin)
– gamma globulins.
• Gamma globulins are the least negatively-charged serum proteins.
(They are so weakly charged, in fact, that some are swept in the flow of
buffer back toward the negative electrode.)
• Most antibodies are gamma globulins.
• Therefore gamma globulins become more abundant
following infections or immunizations.
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Serum Lipids
• Because of their relationship to cardiovascular disease, the
analysis of serum lipids has become an important health
measure.
• The table shows the range of typical values as well as the values above (or
below) which the subject may be at increased risk of developing
atherosclerosis.
LIPID
Typical values
(mg/dl)
Desirable
(mg/dl)
Cholesterol (total)
170–210
<200
LDL cholesterol
60–140
<100
LDL cholesterol
60–140
<100
HDL cholesterol
35–85
>40
Triglycerides
40–160
<160
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• Total cholesterol is the sum of
– HDL cholesterol
– LDL cholesterol and
– 20% of the triglyceride value
• Note that
– high LDL values are bad, but
– high HDL values are good.
• Using the various values, one can calculate a
cardiac risk ratio = total cholesterol divided by HDL cholesterol
• A cardiac risk ratio greater than 7 is considered a warning.
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Congenital
disorders:
Nutritional disorders
 Iron deficiency anemia
 Thallasemias
 Sickle cell anemia
 Hemophilia
 Iron loading
 Pernicious anemia
 Vit K deficiency
Secondary disorders
 Urinary system:
 Erythrocytosis
 Immune problems:
 Hemolytic disease
of the newborn
Trauma
 Hemorrhagic
anemia
 Aplastic anemia
Infection
Blood
disorders
Tumors
 Leukemia
 Myeloid
 Lymphoid
 Bacteremia
 Viremia
 Septicemia
 Puerperal fever
 Malaria
 Hemolytic anemia
Degenerative
disorders:
 Excessive
coagulation
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• Blood Transfusions
• "whole blood“ were transfused directly into patients
(e.g., to replace blood lost by trauma or during
surgery).
• Most were further fractionated into components,
including:
– RBCs. When refrigerated these can be used for up to 42
days.
– platelets. These must be stored at room temperature and
thus can be saved for only 5 days.
– plasma. This can be frozen and stored for up to a year.
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Ensuring the safety of donated blood
• A variety of infectious agents can be present in
blood.
–
–
–
–
viruses (e.g., HIV-1, hepatitis B and C, HTLV, West Nile virus
bacteria like the spirochete of syphilis
protozoans like the agents of malaria and babesiosis
prions (e.g., the agent of variant Crueutzfeldt-Jakob
disease)
• and could be transmitted to recipients.
• To minimize these risks,
– donors are questioned about their possible exposure to
these agents;
– each unit of blood is tested for a variety of infectious
agents.
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• Most of these tests are performed with enzyme
immunoassays (EIA) and detect antibodies against the agents.
However, it takes a period of time for the immune system to
produce antibodies following infection, and during this period
("window"), infectious virus is present in the blood. For this
reason, blood is now also checked for the presence of the
RNA of these RNA viruses:
– HIV-1
– hepatitis C
– West Nile virus
– by the so-called nucleic acid-amplification test (NAT).
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maria immaculata iwo, sf itb