Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Dr. Vince Scialli BSC 1086 BLOOD Rev. 12-25-06 Blood ~ Fluid component of the cardiovascular system 5 - 8% of total body weight Male ~ 5-6 Liters ~ 1.3 Gallons Female ~ 4-5 Liters Primary Functions 1. Distribution ~ oxygen/carbon dioxide nutrients metabolic waste hormones 2. Regulation ~ body temperature maintains pH of tissue fluid volume ~ blood pressure 3. Protection ~ clotting ~ blood loss infection ~ WBC’s, antibodies WHOLE BLOOD: Cellular Component 45% (PCV) Blood and Clotting ~ Chapter 19 ~ 4/29/2017 1 + Liquid Component 55% Dr. Vince Scialli BSC 1086 WHOLE BLOOD: Cellular Component + Liquid Component 45% (PCV) 55% Cellular Component ~ “Formed Elements” 1. Red Blood Cells ~ Erythrocytes ~ RBC’s MOST abundant cells in blood 2. 3. White Blood Cells ~ Leukocytes ~ WBC’s Granulocytes: Neutrophils Basophils Eosinophils Agranulocytes: Lymphocytes Monocytes Platelets ~ Thrombocytes Packed Cell Volume ~ 45% of total blood volume Centrifuged Formed Elements RBC’s ~ 45% WBC’s + Platelets ~ buffey coat < 1% Hematocrit ~ packed RBC’s Male Female Blood and Clotting ~ Chapter 19 ~ 4/29/2017 = = 2 47% + 5% 42% + 5% Dr. Vince Scialli BSC 1086 BLOOD: Cellular Component + Liquid Component 45% 55% Liquid Component ~ Plasma Connective tissue MATRIX component Straw colored ~ thick & sticky 5x more viscous than water pH 7.4 (Range 7.35 to 7.45) Temperature ~ 38 oC ~ 100.4 oF 1. Water ~ 90% 2. Solutes ~ 10% Proteins = 80 % of Solutes Albumin ~ 60% ~ carrier proteins Globulins ~ 35% ~ antibodies Fibrinogen ~ 4% ~ clotting Prothrombin ~ clotting Enzymes ~ metabolism Hormones ~ several Cholesterol ~ good & bad Nitrogen Wastes ~ urea, uric acid, creatinine Nutrients ~ glucose, CHO, AA, Fats Electrolytes ~ ions, phosphate, bicarbonate Blood Gases ~ O2 & CO2 Blood and Clotting ~ Chapter 19 ~ 4/29/2017 3 Dr. Vince Scialli BSC 1086 FORMED ELEMENTS Hematopoiesis ~ formed element production Erythrocytes ~ Red Blood Cells ~ RBC’s Flat, biconcave disc, flexible shaped ~ 7.5 um Can “stack” & “flex” ~ get into tiny spaces NO nuclei or mitochondria ~ NOT a true cell Come from “hemocytoblasts” in red bone marrow DO NOT divide ~ replenished in bone marrow Contain large amounts of HEMOGLOBIN ~ Hb Each RBC has ~ 280,000,000 hemoglobin molecules Hemoglobin ~ a “globular” protein ~ 97 % of RBC Contains HEME ~ a red pigment O2 binds to iron (Fe) on hemoglobin molecule RBC Role: carry O2 ~ to cells . . . carry CO2 ~ to lungs Life Span ~ 120 days Old or damaged RBC’s removed from blood by macrophages of liver and spleen ~ “RBC graveyard” Hemoglobin & Fe are recycled Heme degraded to bilirubin ~ bile Blood and Clotting ~ Chapter 19 ~ 4/29/2017 4 Dr. Vince Scialli BSC 1086 Normal RBC & Hemoglobin Values Hematocrit ~ packed RBC’s “PCV” Hemoglobin ~ Hb RBC Count Male 47% + 5% Female 42% + 5% Infant 14-20 gm % Male 13-18 gm % Female 12-16 gm % Male 5.5 million/cu ml Female 4.7 million/cu ml Blood Cell Production ~ Hematopoiesis Body produces 100 billion new RBC’s & WBC’s /day MOST in red bone marrow ~ myeloid tissue SOME in lymphoid tissue: lymph nodes, spleen, thymus Constant BALANCE between production & destruction LOW RBC’s causes HYPOXIA ~ O2 deprivation to tissue Anemia ~ blood loss ~ high altitude ~ lung damage RBC’s produced @ 2.5 million per second NEED: Iron (Fe) . . . Amino acids . . . Vitamin B Hormones ~ erythropoietin & testosterone Blood and Clotting ~ Chapter 19 ~ 4/29/2017 5 Dr. Vince Scialli BSC 1086 Erythropoietin ~ EPO Stimulates RBC production from stem cells Testosterone ~ stimulates kidneys to produce EPO RBC Production ~ erythropoiesis Occurs ONLY in red bone marrow Hematoblasts ~ stem cells ----> Myeloid Stem Cells ----> Proerythroblast ----> Erythroblast (in marrow) ----> Reticulocyte ~ immature blood cell (in blood) Represent 1-2% of circulating RBC’s Indicator of “NEEDED” RBC formation RBC Production Stimuli 1. Hemorrhage ~ reduced circulating RBC’s 2. Anemia reduced RBC production increased RBC destruction 3. Reduced O2 availability ~ high altitude 4. Lung Damage or Disease ~ low O2 exchange Pneumonia ~ Cancer ~ Emphysema 5. Increased O2 tissue demands ~ Exercise Blood and Clotting ~ Chapter 19 ~ 4/29/2017 6 Dr. Vince Scialli BSC 1086 Diseases & Abnormal RBC Production Anemia ~ “lack of blood” ~ Lack of O2 carrying capacity Symptoms: Low blood O2 levels Fatigue Shortness of breath Pale & Chilly Causes: 1. Insufficient number of RBC’s Hemorrhage ~ blood loss Destruction of RBC’s ~ “Hemolytic” Bone marrow failure ~ “Aplastic” 2. Decreased hemoglobin content Iron deficiency anemia ~ low Fe Pernicious anemia ~ low B12 3. Abnormal Hemoglobin Sickle cell anemia ~ hereditary 4. Kidney Disease ~ Renal Failure NO erythropoietin Polycythemia ~ Excessive RBC’s ~ Hematocrit > 80% Abnormal viscosity ~ sludge Polycythemia vera ~ bone marrow cancer High Altitude Blood and Clotting ~ Chapter 19 ~ 4/29/2017 7 Dr. Vince Scialli BSC 1086 FORMED ELEMENTS Leukocytes – White Blood Cells - WBC’s True cells ~ Have nuclei & mitochondria Account for < 1% of total blood volume Normal Count: 4,000-11,000 WBC’s/ cc Make up buffey coat ~ centrifuged blood Body defense against disease Inflammation & immune function Migrate into tissue via capillary beds & venules Gather large numbers at site of tissue damage/infection Increased production ~ “leukocytosis” > 11000 per cc Types of White Blood Cells Granulocytes: Agranulocytes: Neutrophils Basophils 0-1% Eosinophils 1-4% Lymphocytes Monocytes Blood and Clotting ~ Chapter 19 ~ 4/29/2017 40-70% 8 20-45% 4-8% Dr. Vince Scialli BSC 1086 Leukocytes ~ White Blood Cells ~ WBC’s GRANULOCYTES ~ granules in cytoplasm Spherical shaped ~ Larger than RBC’s . . . All have nuclei Shorter lived than RBC’s ~ 12 hrs – to 3 days Function: phagocytosis ~ to attack & destroy “Non-specific” body defenses ~ attack anything 1. Neutrophils MOST numerous type ~ up to 70% of WBC’s Cytoplasm Granules ~ blue & red stain Polymorphs ~ many shapes ~ 2 to 5 nuclear lobes Function: Phagocytosis ~ of bacteria & fungi Neutrophilia ~ INCREASE during infection ~ Pus 2. Eosinophils Account for up to 4% of WBC’s Same size as neutrophils ~ Red stained granules Function: attack & destroy parasites ~ worms Destroy antibody-antigen complex Allergic response ~ Fire Ant Bites Blood and Clotting ~ Chapter 19 ~ 4/29/2017 9 Dr. Vince Scialli BSC 1086 GRANULOCYTES ~ LEUKOCYTES 2. Basophils RARE WBC ~ up to 1% of WBC’s Smaller than neutrophils Cytoplasm stains blue Cytoplasm Granules contain HISTAMINE Histamine ~ inflammatory chemical Potent vasodilation Attracts neutrophils to infection site AGRANULOCYTES NO GRANULES in cytoplasm Monocytes & Lymphocytes Blood life span ~ 100-300 days Important in immunity ~ antibody formation 1. Monocytes Account for up to 8% of WBC’s Very large ~ LARGEST WBC Become Macrophages ~ phagocytosis in tissue Blood and Clotting ~ Chapter 19 ~ 4/29/2017 10 Dr. Vince Scialli BSC 1086 2. Lymphocytes Second most numerous WBC ~ up to 45% Small Lymphocytes ~ found in blood only Medium & Large Lymphocytes ~ MOST numerous Found in lymphatic tissue Spleen . . . Lymph Nodes . . . Tonsils T-Lymphocytes ~ T-cells Immune Response ~ “cell mediated immunity” Act against virus infected cells Act against tumor cells B-Lymphocytes ~ B-cells Immune Response ~ “humoral immunity” B-cells become “plasma cells” Produce antibodies ~ immunoglobulins NK Cells ~ Natural Killer Cells Immune Surveillance ~ “on patrol” Detect & destroy abnormal tissue Involved in cancer prevention Blood and Clotting ~ Chapter 19 ~ 4/29/2017 11 Dr. Vince Scialli BSC 1086 LEUKOCYTE PRODUCTION & LIFE SPAN Leukopoiesis ~ WBC Leukocyte Production Stimulated by CYTOKINES Cytokines produced by: Macrophages T-Lymphocytes Leukocyte Differentiation Pathway Hemocytoblast (red bone marrow) Myeloid Stem Cell ↓ Myeloblast ↓ Monoblast ↓ Promyelocyte ↓ Promonocyte Lymphoid Stem ↓ Lymphoblast ↓ Prolymphocyte ↓ Band Cells ↓ ↓ Monocytes Lymphocytes T-Lymphocytes B-Lymphocytes ↓ ↓ (immature) ↓ Eosinophils Neutrophils Basophils Macrophages (tissues) Blood and Clotting ~ Chapter 19 ~ 4/29/2017 12 Plasma Cells (antibodies) Dr. Vince Scialli BSC 1086 LEUKOCYTE DISORDERS & ABNORMALATIES Leukopenia ↓ ↓ ↓ ABNORMAL LOW white cell count < 4000/cc Cause: Virus Infection ~ lymphopenia ~ ↓ Lymphocytes Drugs: Anti-cancer agents & Glucocorticoids Leukocytosis ↑ ↑ ↑ Increased WBC count ~ usually neutrophils Causes: Bacterial Infections ~ moderate increase Leukemia ~ a specific disease with MANY forms Over-production of “ABNORMAL” leukocytes Bone marrow becomes infiltrated with immature & abnormal WBC’s Destroys Body defenses & RBC production Symptoms: Vary with MANY forms of leukemia Infectious Mononucleosis ~ a specific disease Highly contagious viral infection ~ “kissing disease” Excessive production of monocytes & lymphocytes Disease runs course in 3-4 weeks Blood and Clotting ~ Chapter 19 ~ 4/29/2017 13 Dr. Vince Scialli BSC 1086 FORMED ELEMENTS Platlets ~ thrombocytes Fragments of large Megakaryocytes ~ NOT true cells Megakaryocytes derived from stem Hemocytoblasts Purple stained cytoplasmic granules Platelets contain: Ca+, serotonin, enzymes, & ADP Seratonin causes vascular spasm Degenerate in ~ 10 days . . . Continuously Produced Normal Platelet Count ~ 250,000 - 500,000 per cc of blood Function: Clotting mechanism Stick to damaged sites ~ tenaciously adhere to collagen Form plug to prevent blood loss when blood vessel is damaged Response is fast & localized Hemostasis ~ stop bleeding Thrombocytosis ~ very HIGH platelet count Thrombocytopenia ~ very LOW platelet count Blood and Clotting ~ Chapter 19 ~ 4/29/2017 14 Dr. Vince Scialli BSC 1086 HEMOSTASIS Blood Clotting Phases ~ Stop Bleeding in SMALL vessels VERY RAPID sequence ~ 5 seconds to 30 minutes Vascular Spasm Immediate vasoconstriction ~ causes blood flow Enhanced by seratonin Allows time for platelet formation (20-30 minutes) Platelet Plug Formation ~ Platelet Aggregation Platelets DO NOT adhere to endothelial lining Platlet Plug ~ temporarily seals break in vessel wall Platlets adhere tenaciously to exposed collagen MORE platelets attracted & stick to area Coagulation Steps ~ actual blood clotting Blood transformed from liquid to gel Prothrombin Activator formed in10-15 sec in Liver Prothrombin converted to Thrombin ~ enzyme Thrombin > Fibrinogen in plasma to form a Fibrin Mesh > Blood Clot Fibrin mesh traps RBC’s & seals vessel ----> Clot Blood and Clotting ~ Chapter 19 ~ 4/29/2017 15 Dr. Vince Scialli BSC 1086 CLOT RETRACTION & REPAIR Occurs 30 – 60 minutes after clot is stabilized Platelets induce process Platelets pull serum from clot ----> compacted clot Pulls vessel hole or damage together Vessel wall endothelial cells multiply & restore lining Fibroblasts form connective tissue patch ----> Scar Granulation Tissue FIBRINOLYSIS Enzyme reactions causing clot to dissolve Clot digestion follows healing of damaged vessel Takes several days Prevents vessels from becoming blocked Plasmin ----> TPA ----> Plasminogen = Clot Buster TPA = Tissue Plasminogen Activator Plasminogen ~ is a clot dissolver Blood and Clotting ~ Chapter 19 ~ 4/29/2017 16 Dr. Vince Scialli BSC 1086 OTHER COAGULATION FACTORS . . . REQUIRED Pro-coagulants ~ “Coagulants” ~ SEVERAL & COMPLEX Plasma Proteins ~ have direct clotting effects Prothrombinase ~ Prothrombin ~ Thrombin Fibrinogen ~ Fibrin Factors I-XIII ~ several factors involved in clotting Vitamin K ~ required for factor synthesis Prostaglandins ~ cause platelet adherence Aspirin ~ prostaglandin inhibitor ~ anti-coagulant FACTORS LIMITING CLOT GROWTH ~ Anti-coagulation PREVENT excessive or unnecessary clot formation Plasma Anti-coagulants ~ normally circulating Antithrombin III ~ inhibits Thrombin Heparin ~ found in basophils & mast cells Blood Thinner ~ Inhibits Thrombin Protein C ~ plasma protein inhibits other Pro-coagulants Breaks down fibrin strands Tissue Plasminogen Activator ~ Fibrinolysis clot buster Blood and Clotting ~ Chapter 19 ~ 4/29/2017 17 Dr. Vince Scialli BSC 1086 HEMOSTASIS DISORDERS Thrombo-embolytic Conditions Thrombus ~ NORMAL clot fragments in circulation Could cause “occlusion” ~ blockage in small vessel Coronary Thrombosis ~ Heart Attack Cerebral Thrombosis ~ stroke Embolism ~ floating clot or air bubble in small vessel Artherosclerosis ~ rough vessel walls ~ attract platelet Treatment of Thromboembolic Conditions Aspirin ~ anti-prostaglandin ~ anti-coagulant Heparin ~ anti-coagulant ~ blood thinner Warfarin ~ Coumadin ~ Dicoumarol ~ rat poisons Vitamin K inhibitor ~ anti-coagulant Tissue Plasminogen Activator TPA ~ # 1 Plavex ~ prevents platelet adherence to walls Cardiac Catherization . . . Angioplasty . . . Stent By-pass surgery as last resort Cost considerations & vessel condition in options Blood and Clotting ~ Chapter 19 ~ 4/29/2017 18 Dr. Vince Scialli BSC 1086 HEMOSTASIS DISORDERS Bleeding Disorders Anything that interferes with the clotting mechanism Thrombocytopenia ~ deficient platelets Cause: bone marrow suppression Malignancy Radiation Certain drugs Symptoms ~ spontaneous Petichae Hemorrhage Impaired Liver Function ~ many conditions Liver CANNOT produce pro-coagulants No Prothrombin or Fibrinogen CANNOT utilize Vitamin K ~ no factor synthesis Hemophilia Due to lack of necessary clotting Factors Sex linked condition ~ X chromosome in males A ~ Hereditary deficiency ~ Factor VIII – 83% Von Willebrand Disease Most common inherited Factor VIII clotting disorder Blood and Clotting ~ Chapter 19 ~ 4/29/2017 19 Dr. Vince Scialli BSC 1086 WHOLE BLOOD TRANSFUSION ~ Blood Replacement A Normal System minimizes effects of blood loss Reduced volume of blood in affected vessels - - - -> Lower Pressure - - - -> vasoconstriction Increased production of RBC’s occurs immediately System can be overwhelmed . . . if blood loss to great “Transfusion” ~ given to replace lost blood Severe blood loss ~ requires whole blood transfusion Anemia ~ requires packed red cell replacement Thrombocytopenia ~ requires platelets only Transfusion requires knowing specific blood types HUMAN BLOOD GROUPS ~ Typing or Cross Matching People have different blood types . . . ABO & Rh Transfusion of incompatible blood can be fatal Antigens ~ agglutinogens ~ found on surface of RBC’s Surface proteins that stimulate antibodies that attach to RBC ----> agglutination or clumping in recipient, if the recipient does not have the same surface antigens on their own RBC’s Blood and Clotting ~ Chapter 19 ~ 4/29/2017 20 Dr. Vince Scialli BSC 1086 HUMAN BLOOD GROUPS ~ BLOOD TYPING Several types of RBC surface antigens can exist A or B are MOST COMMON & most allergenic antigens Rh Factor is either present (Rh+) or absent (Rh-) ABO SYSTEM A- = A surface antigen. No Rh antigen (Rh-) Will make antibodies against B antigen and Rh+ antigen A+ = A surface antigen and Rh antigen ~ Rh+ B- B surface antigen. No Rh antigen ~ Rh- = B+ = B surface antigen and Rh antigen ~ Rh+ AB- = A and B surface antigens. No Rh antigen ~ Rh- AB+ = A and B surface antigens & Rh antigen ~ Rh+ O- None of the surface antigens are present ~ Rh- = O+ = Only Rh+ antigen present If a person receives blood from a type different from their own (other than type O = no surface A or B antigens), the immune system will recognize the blood as foreign, and antibodies are produced. This will cause clumping ~ agglutination Blood and Clotting ~ Chapter 19 ~ 4/29/2017 21 Dr. Vince Scialli BSC 1086 ABO BLOOD SYSTEM Type O = Universal Donor ~ no A or B antigens Will not be recognized as foreign if injected into Type A, Type B or Type AB recipients Types A, B, AB, and O can all receive blood from Type O If no A or B antigens, then no antibodies produced Type O recipient can only receive blood from Type O donor Type AB = Universal Recipient ~ both A and B antigens Type AB recipient will not make antibodies against Type A or Type B donor blood since both A and B antigens are already present Type AB recipient can receive donor blood from Type O since Type O blood has no surface antigens Type AB can also receive blood from Type A or Type B since neither is recognized as foreign Blood and Clotting ~ Chapter 19 ~ 4/29/2017 22 Dr. Vince Scialli BSC 1086 ABO BLOOD SYSTEM Rh Factor 85% of population is Rh+ Problem occurs when Rh- person receives blood from Rh+ donor “Sensitizes” Rh- recipient to produce antibodies against Rh+ blood First transfusion is not a problem Causes Hemolysis ~ rupture of RBC’s Becomes a problem in future transfusions Must check for “Compatability” Rh+ fetuses inside Rh- pregnant mothers Hemolytic Disease of the Newborn ~erythroblastosis fetailis Fetus Rh+ blood crosses placenta into Rh- pregnant mother Pregnant mother produces antibodies against Rh+ Anti Rh+ Antibodies cross placenta into fetus causing hemolysis of fetus blood Blood and Clotting ~ Chapter 19 ~ 4/29/2017 23 Dr. Vince Scialli BSC 1086 TRANSFUSION REACTIONS Agglutination & Hemolysis Donor’s blood is attacked once injected into recipients blood by recipients antibodies Reaction Steps: 1. Agglutination ~ occurs within 1-2 hrs Clumping of foreign RBC’s due to ABO Clogging of small vessels 2. Hemolysis ~ busting of RBC’s due to Rh Reduces O2 to tissues RBC’s Destroyed by phagocytosis Hemoglobin released ~ clogs kidneys Kidney failure Symptoms: Fever & Chills Nausea and Vomiting Signs of Kidney Failure ~ if severe Treatment: Reverse Kidney Shutdown Prevent Renal Damage Diuretics ~ flush out Hb Prevent: Blood Typing ~ Compatability Check Cross Matching ~ agglutination test Blood and Clotting ~ Chapter 19 ~ 4/29/2017 24 Dr. Vince Scialli BSC 1086 PLASMA & BLOOD VOLUME EXPANDERS Given when replacement fluid volume is necessary Low Blood Volume ----> circulatory shock Emergency Situations ~ NO time to type or match MUST restore adequate circulation fast No concern for allergic reaction No RBC’s involved ~ no antigens involved Synthetic Plasma Expanders Normal Saline ~ isotonic Multiple Electrolyte Solution ~ Lactated Ringers ~ iso Dextran ~ concentrated sugar solutions ~ hypertonic Plasminate ~ synthetic plasma ~ hypertonic Serum albumin ~ hypertonic Blood and Clotting ~ Chapter 19 ~ 4/29/2017 25 Dr. Vince Scialli BSC 1086 DIAGNOSTIC BLOOD TESTS Provide information about the blood & body conditions Evaluates current state of health . . . NOT ABSOLUTE Types of Tests: Complete Blood Count ~ CBC RBC Count WBC Count ~ with differential Hemoglobin Hematocrit ~ PCV Platelet Count Differential White Cell Count Relationship % and absolute numbers of neutrophils, eosinophils, basophils lymphocytes and monocytes Serum Modular Analysis ~ SMA Serum ~ plasma minus clotting proteins Blood chemistry profile: Protein ~ albumin, globulin Glucose BUN ~ kidney function + many others Enzymes (many) Ions ~ Ca+, Na+, K+ Blood Gases Blood and Clotting ~ Chapter 19 ~ 4/29/2017 26 Dr. Vince Scialli BSC 1086 AGE RELATED CHANGES AFFECTING BLOOD Decreased Hematocrit Constriction or blockage of peripheral arteries ~ thrombus Causes Pulmonary Embolism Pooling of blood in veins of legs ~ varicose veins Valves not working properly Blood and Clotting ~ Chapter 19 ~ 4/29/2017 27