Download Overview of Anatomy and Physiology

Chapter 47
Care of the Patient with a Blood
or Lymphatic Disorder
-Overview of
Anatomy and Physiology
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 1
Overview of Anatomy and Physiology:
-Characteristics of blood
• Ancient times

Referred to as “river of life” or “fluid of life”
• Contains

RBC, WBC, platelets which are suspended in a light
yellow fluid called plasma
• Consistency


45% blood cells
55% blood plasma
• pH

7.35 to 7.45
• Volume

5 to 6 liters or 10 to 12 pints
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 2
Overview of Anatomy and Physiology:
-Characteristics of blood
• 3 Functions



1. transports oxygen and nutrition to cells and waste
products away from cells and transports hormones
from endocrine glands to tissue cells
2. regulates acid-base balance (pH) with buffers, aids
with body temperature because of its water content
and controls the water content of its cells as a result of
dissolved sodium ions
3. protects body against infection with special cells
and prevents blood loss with special clotting
mechanisms
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 3
Figure 47-1
(From Thibodeau, G.A., Patton, K.T. [2003]. Anatomy and physiology. [5th ed.]. St. Louis: Mosby.)
Human blood cells.
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 4
Overview of Anatomy and Physiology:
-Characteristics of blood
• Red blood cells (RBC)

Erythrocytes
• Men = 5.5 million per cubic millimeter
• Women = 4.8 million per cubic millimeter

Contains cytoplasm and Hgb
• Transport oxygen and carbon dioxide
• Men = 14 to 18 gm/dL
• Women = 12 to 16 gm/dL


Life span of 120 days
Produced in
• Red bone marrow in vertebrae, ribs, sternum, proximal
ends of humerus and femur
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 5
Overview of Anatomy and Physiology:
-Characteristics of blood
• Erythropoiesis: RBC production


depends on: health condition of BM; dietary
substances like rion and copper, plus essential AA;
and vitamins like B12, folic acid, riboflavin (B2),
pyridoxine (B6)
Feedback mechanism:
• Decreased oxygen triggers release of erythropoietin
from the kidneys
• Erythropoietin increases maturation of RBC
• Increased RBC allows more O2 delivered to cells and
signals RBC production to shut off

Hematocrit
• Measure of packed cell volume of RBC
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 6
Overview of Anatomy and Physiology:
-Characteristics of blood
• Erythropoiesis: RBC production (cont’d)

Hematocrit
• Measure of packed cell volume of RBC
• Men 42% to 52%
• Women 37% to 47%

Hemoglobin falls below normal (anemia):
• Less hemoglobin, less oxygen transported to cells,
slower breakdown and use of nutrients by cells, less
energy produced by cells, decreased cellular function
• Anemic complains of feeling “tired all the time”
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 7
Overview of Anatomy and Physiology:
-Characteristics of blood
• White blood cells (WBC) – leukocytes



Nucleated, colorless, live from few days to years
Body defenses: destruction of bacteria and viruses
Two broad categories:
• Granulocytes and agranulocytes

Granulocytes:
• Neutrophils, eosinophils, basophils

Agranulocytes
• Lymphocytes and monocytes
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 8
Overview of Anatomy and Physiology:
-Characteristics of blood
• White blood cells (WBC) – leukocytes (cont’d)

Neutrophils
•
•
•
•
•
•
Granular circulating leukocytes for phagocytosis
Ingest bacteria and dispose of dead tissue
Primary phagocytic cells in acute inflammatory response
Mature are called segmental neutrophil or “seg”
Release lysozyme
Immature neutrophils

Immature polymorphonuclear leukocytes (polys) called
bands in their final stages of development
• Presence of excess bands in the periphery is called shift
to the left and indicates a severe infection
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 9
Overview of Anatomy and Physiology:
-Characteristics of blood
• White blood cells (WBC) – leukocytes (cont’d)

Eosinophils
• Plays in allergic reaction and effective against parasitic
worms
• Normal value is 1% to 4%

Basophils
• Nonspecific immune response to inflammation because
of role in releasing histamine (vasodilator)
• Cytoplasmic granules that contain heparin, serotonin,
and histamine
• Normal values 0.5% to 1%
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 10
Overview of Anatomy and Physiology:
-Characteristics of blood
• Monocytes




Function similar to neutrophils; circulate in blood
stream and move into tissue where they engulf
antigens and cell debris
Second to arrive at scene of injury
Useful in removing dead bacteria and cells in recovery
stage of acute bacterial infections
Normal value is 2% to 6%
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 11
Overview of Anatomy and Physiology:
-Characteristics of blood
• Lymphocytes


For antibody formation
Two groups:
• B cells and T cells
• B cells: function to search out, identify and bind with
specific antigens
• T cells: when exposed to antigen, divide rapidly and
produce new T cells that are sensitized to that antigen

Normal values are 20% to 40%
• See Table 47-1, pg 1531-1532
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 12
Overview of Anatomy and Physiology:
-Characteristics of blood
• Thrombocytes (platelets)

Smallest cell in the blood
 Circular cell fragments, do not have nuclei
 Life span of 5 to 9 days
 Normal value of 150,000 to 400,000 per cubic mm
 Initiate blood clotting and produced in the BM
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 13
Overview of Anatomy and Physiology
• Hemostasis:

A body process that arrests the flow of blood and
prevents hemorrhage
 1. vessel spasm
 2. platelet plug formation
 3. clot formation
 Vessel tear, smooth muscle in the walls of vessel
causes it to contract
 Platelet rush to area and seals it
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 14
Overview of Anatomy and Physiology:
-Characteristics of blood
• Hemostasis

Clot formation
•
•
•
•
•
•
•
•
•
Injury
Hemorrhage
Grouping platelets
Thromboplastin released (reacts along with calcium
ions)
Converts prothrombin to thrombin
Links with fibrinogen
Formation of fibrin
Trap RBCs and platelets
Forms clot
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 15
Figure 47-2
(From Thibodeau, G.A., Patton, K.T. [2005]. The human body in health and disease. [4th ed.]. St. Louis: Mosby.)
Blood clotting.
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 16
Overview of Anatomy and Physiology
• Blood types (groups)

Determined by the presence or absence of specific
antigens on the outer surface of the RBC
• Type A
• Type B
• Type AB

Universal recipient
• Type O


Universal donor
In certain types of blood, the Ag on RBCs are
accompanied by Ab found in blood plasma
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 17
Overview of Anatomy and Physiology
• Blood types (groups)

Type A blood:
• RBCs contain type A antigen and the plasma contains
anti-B antibodies

Type B:
• RBCs contain type B antigen and the plasma contains
anti-A antibodies

Type AB:
• RBCs contain bothe type A and type B antigens, and
the plasma contains neither anti-A nor anti-B antibodies

Type O:
• RBCs contain neither type A nor type B antigens and
plasma contains both anti-A and anti-B
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 18
Overview of Anatomy and Physiology
• Harmful effects or death result from a blood
transfusion if donor’s RBCs become agglutinated by
antibodies in recipient’s plasma (fig. 47-3, pg 1534)
• Two types of reaction:


Agglutination and hemolyzation
Agglutination
• Donor cells clump together because of the antibodies
• Occludes arteries resulting to death

Hemolyzation
• Antibodies cause RBCs of recipient to rupture,
releasing their contents
• Can lead to death
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 19
Overview of Anatomy and Physiology
• Rh factor

Rh antibodies may be located on the surface of the
RBC
• Rh positive: antibodies are present
• Rh negative: antibodies are not present



85% are Rh +; 15% are Rh –
Rh incompatibility seen commonly in pregnancy
If Rh antibody is present in mother then given IM dose
of RhoGAM, a desensitization drug
• Enables her to carry next infant without complications
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 20
Overview of Anatomy and Physiology
• Rh factor

Normally, plasma does not contain Rh antibodies;
develop in response to individual’s receiving wrong
type of blood
• Develop Rh antibodies develop in 2 weeks and remain
in the blood
• Rh – person receives more Rh + blood , reaction occurs
because Rh + antibodies react with donor blood,
hemolysis occurs
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 21
Overview of Anatomy and Physiology:
-Lymphatic System
• Consist of lymphatic vessels, lymph fluid and lymph
tissue
• Functions

Maintenance of fluid balance
 Production of lymphocytes
 Absorption and transportation of lipids from the
intestine to the bloodstream
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 22
Overview of Anatomy and Physiology:
-Lymphatic System
• Lymph and lymph vessels
• Lymph is a specialized fluid formed in the tissue
•
spaces transported by way of the lymphatic vessels
and reenters the circulatory system
Substances that cannot enter or return through
capillary walls, including excess fluid and protein
molecules, are returned to blood as lymph
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 23
Overview of Anatomy and Physiology:
-Lymphatic System
• Lymphatic tissue
• Lymph nodes
 Two functions: 1) filter impurities from lymph; 2)




produce lymphocytes (WBCs)
Act as filters, keeping particulate matter such as
bacteria from entering bloodstream
Small bean shaped structures appearing in groups
Body contains 500 to 600 nodes
Most numerous in axilla, groin, abdomen, thorax,
cervical regions
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 24
Overview of Anatomy and Physiology
-Lymphatic System
• Lymphatic tissue (continued)

Tonsils
• Masses of lymphoid tissue embedded in mucous
membrane of oral cavity and pharynx
• Produce lymphocytes and antibodies
• Trap bacteria and become enlarged
• Larger in children and begin to atrophy at age 7
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 25
Overview of Anatomy and Physiology
-Lymphatic System
• Lymphatic tissue (continued)

Spleen
• Reservoir for blood (1 pint of blood) which can be
released during emergencies like hemorrhage in less
than 60 seconds
• Main functions:





1) reservoir for blood
2) forms lymphocytes, monocytes, and plasma cells
3) destroys worn-out RBCs
4) removes bacteria by phagocytosis
5) produce RBCs before birth
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 26
Overview of Anatomy and Physiology
-Lymphatic System
• Lymphatic tissue (continued)

Thymus
• Functions in utero (before birth) and a few months after
birth to develop immune system
• Responsible for development of T lymphocytes of cellmediated immune response before they migrate to
lymph nodes and spleen
• Atrophies at puberty and replaced by fat and connective
tissue
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 27
Figure 47-4
(From Thibodeau, G.A., Patton, K.T. [2003]. Anatomy and physiology. [5th ed.]. St. Louis: Mosby.)
Principal organs of the lymphatic system.
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 28