Blood Chap 10

8/3/2019 Blood Chap 10

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Chapter 10


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Bone marrowBlood cells

Plasma


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Whole blood consists of formed elementssuspended in a liquid component.

5-6 liters total blood volume in an adult

8% of total body weight

Slightly alkaline: pH 7.35-7.45

Temp.: 38 celsius


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Bone marrow

4% - 5% of total body weight

Contained within the spongy bones and centralcavity of long bones


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Red marrow Site of active cell formation

Major blood producing organ (hematopoiesis)

Yellow marrow Constitutes inactive areas composed mainly of fat

Stem cells Free, primitive cells present in bone marrow

Differentiates into mature blood cells


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Blood cells

Hematocrit refers to the percentage of total bloodvolume composed of cells.

Normal value approximately 45%

Whole blood contains 3 types of mature blood cells

Erythrocytes Leukocytes

Thrombocytes


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ERYTHROCYTES (RBCs)

Average total RBC count: 5million cells/mm3of blood

Erythrocyte major cellular element of circulating blood

Bi-concave disks that normally are about 7mm indiameter and containing hemoglobin confinedwithin a plasma membrane


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Reticulocytes Immature erythrocytes

Released prematurely from marrow to circulation

under conditions necessitating rapid blood cellproduction (compensatory mechanism)


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Hemoglobin Consist of an iron-containing pigment and a simple

protein

95% of the erythrocyte mass

Has the ability to bind oxygen loosely andreversibly

Called oxyhemoglobin if combined with oxygen

15g. Of hemoglobin per 100ml of blood


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LEUKOCYTES (WBCs)

5,000-10,000 cells/cubic mm of blood -Average total WBC count

2 Major Types:

1. Granular Leukocytes

Produced in bone marrow Granulocytes comprise 70% of all WBCs


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3 Types of Granulocytes Neutrophils

Pink stain

Multi-lobed nucleus

Eosinophils

Blue red nucleus

Basophils Dark blue stain


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2. Mononuclear leukocytes2 groups

Lymphocytes Produced in bone marow

Undergo differentiation in lymph tissue Comprise 30% of leukocytes Large purple nucleus

Monocytes Produced in bone marrow Transform into mature forms called macrophages on

release into tissues Comprise 5% of total leukocytes Largest WBCs


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THROMBOCYTES Normal platelet count is:

150,000 to 450,000/mm3 of blood

Thrombocytes are formed from fragments ofmembrane and cytoplasm from very largecells in bone marrow, lung, and spleen calledmegakaryocytes

Normal lifespan of thrombocytes:

7-14 days


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Liquid portion of whole blood remaining afterblood cells are removed

55% of blood volume

Contains large quantities of organic andinorganic substances

Serum Fluid remaining when plasma is allowed to clot


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PLASMA PROTEINS Albumin

Largest of plasma proteins, produced in the liver

Globulins Gamma globulins

Consists of antibodies known as immunoglobulins

Alpha and beta fractions

Clotting factors, produced in the liver and transport proteins

Fibrinogen High-molecular wt. protein important in blood clotting


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FACTOR SYNONYMS NORMAL PLASMACONCENTRATIONS(mg/dl)I Fibrinogen 200 400

II Prothrombin 10III Tissue thromboplastin,

tissue factor0

IV Calcium ion 4 5

V Pro accelerin, labile factor 1


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FACTOR SYNONYMS NORMAL PLASMACONCENTRATIONS(mg/dl)VII Serum prothrombin

conversion

accelerator(SPCA),stable factor

0.05

VIII Antihemophilic factor 1 - 2

IX Christmas factor 0.3

X Stuart-Power factor 1

XI Plasmathromboplastinantecedent (PTA)

0.5


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FACTOR SYNONYMS NORMAL PLASMACONCENTRATIONS(mg/dl)XII Hageman factor 3

XIII Fibrin stabilizingfactor (FSF)

1 2

Prekallikrein Fletcher factor 5

High

molecularweightkininogen

Fitzgerald,

Flaujeac, Williamsfactor, contactactivation cofactor

6


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Transport oxygen absorbed from lungs andnutrients absorbed from the GIT to body cellsfor cellular metabolism

Transport waste products from tissues toexcretory organs

Aid in chemical, acid-base, and thermalregulation of the body

Transport hormones and other substancesinternally secreted to their tissue sites ofaction


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Aid in defense against infection through theactons of antibodies and phagocytes

Aid in regulation of extracellular fluid volume

Promoting hemostasis through the arrest ofbleeding blood clot formation, followed by

clot dissolution


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Produces all blood cells During hematopoiesis:

Stem cells in the bone marrow divide into themyelocyte stem cell line and lymphiod stem cell line

transform into committed precursors,

and eventually differentiate into mature blood cells


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ERYTHROCYTES Normal production is stimulated by

erythropoietin and requires several nutrients: Iron

Folic acid Pyridoxine (vit. b complex) Ascorbic acid

Transport O2 from lungs to tissues

Ave. lifespan is 120 days


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LEUKOCYTESDefend the body against invasion by infectious and

parasitic organisms through phagocytosis andantibody production

Neutrophils Arrive early at the site of inflammatory reaction

Increase in number with the onset of infection


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Eosinophils and basophils Alter blood supply to tissues and help mobilize body

defenses Eosinophils increases in allergies and infections of

parasitic worms Basophils - Contain and release potent biologic

materials: Histamine, serotonin, heparin Makes blood vessels leaky and attracts other WBCs to

inflammation site

Monocytes Largest non-granular leukocytes

Phagocytizes large foreign particles, cell fragments,necrotic tissue


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LymphocytesProduce substances that aid in attacking foreign cells

and substances

B lymphocytes

Produce antibodies

T lymphocytes Kill foreign cells directly or release lymphokines

Natural killer cells (NK) Defend against microorganisms and some types of

malignant cells


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THROMBOCYTESHelp control bleeding by:

Aggregating and adhering to sites of vascularinjury, forming a plug that temporarily stopsbleeding

Releasing biochemical substances thatactivate coagulation factors in plasma to forma stable fibrin clot


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Part of the ECF of the body and provides amedium for circulation of blood cells

Plasma proteins

1. Albumin Causes osmotic pressure at the capillary

membrane

Prevents fluid from leaking out of the capillariesinto the interstitial spaces

Process called colloid osmotic pressure


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2. Globulins Alpha and beta globulins

Transport of other substances by combining withthem

Acting as substrates for formation of othersubstances Transporting proteins from part of the body to

another

Gamma globulins Protect body against infections Antibodies that resist infection and toxicity


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3. Fibrinogen

High molecular weight protein

One of the essential factors in thecoagulation process

Thrombin acts on fibrinogen to form thereticulum of the clot


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Constituent substances in plasma provide for: Blood coagulation

Vascular phase vessel constriction Platelet phase aggregation at bleeding site

Coagulation phase - clot formation

Maintenance of acid-base balance Clot lysis

Fibrinolytic system Plasminogen

Fibrinolysis Transportation of nutritional and hormonal

substances


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Platelet plug

forms

Vascular

spasm occur

Coagulation

events occur


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Antigen Substance recognized by body as foreign Stimulates immune system to release antibodies E.g. foreign substances, part of bacteria

Antibodies Recognizers Present in the plasma that attach to RBCs

Agglutination Binding of antibodies causing RBCs to clump


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Based on which of 2 antigens A or B a prsoninherits

Type O Absence of both antigens

Type AB Presence of both antigens

Type A or Type B Presence of either A or B antigen


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Bloodgroup RBCantigens Plasmaantibodies Blood thatcan bereceivedAB A

BNone A, B, AB, O

Universalrecipient

B B Anti-A B, O

A A Anti-B A, OO None Anti-A

Anti-BOUniversal

donor


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One of the 8 antigens identified with Rhesusmonkeys, but later discovered in humans

Rh+

Rh-

Hemolysis


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Before birth:

liver, spleen

7 months:

Red marrow

Throughout

life:

Red marrow


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Whole Blood Replacement of RBCs and plasma volume to raise Hgb and

Hct levels Not commonly used due to fluid overload

PRBCs Preferred replacement of RBCs and plasma volume to raise

Hgb and Hct levels RBCs without plasma volume For severe symptomatic anemia or acute blood loss

Fresh frozen plasma Replacement of plasma without RBCs or platelets Contains most coagulation factors except platelets Used to control bleeding caused by deficiency in clotting

factors


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Platelets Replacement of platelets

Used to treat severe or symptomaticthrombocytopenia

Albumin A hyperosmolar solution prepared from plasma that

expands vascular volume

Used to treat hypovolemic shock orhypoalbumenemia


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One of the most common blood diseasesworldwide is anemia, which is characterizedby an abnormally low number of red bloodcells or low levels of hemoglobin.

One of the major symptoms of anemia isfatigue, due to the failure of the blood tocarry enough oxygen to all of the tissues.


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The most common type of anemia occurs because the marrow fails to produce

sufficient red blood cells.

When insufficient iron is available to the bonemarrow, it slows down its production ofhemoglobin and red blood cells.

The most common causes of iron-deficiencyanemia are certain infections that result ingastrointestinal blood loss and the consequent

chronic loss of iron. Adding supplemental iron to the diet is often

sufficient to cure iron-deficiency anemia.


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Some anemias are the result of increaseddestruction of red blood cells, as in the caseof sickle-cell anemia

a genetic disease most common in persons of

African ancestry. The red blood cells of sickle-cell patients

assume an unusual crescent shape, causingthem to become trapped in some bloodvessels, blocking the flow of other blood cellsto tissues and depriving them of oxygen.


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Direct cause: Decrease in RBC Number

Results from: Sudden hemorrhage

Lysis of RBCs as a result of bacterial infections


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Results from: Lack of vitamin B12

Due to lack of intrinsic factor required forabsorption of the vitamin; intrinsic factor is formedby stomach mucosa cells


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Results from: Depression/destruction of bone marrow by cancer,

radiation, or certain medications


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Some white blood cell diseases arecharacterized by an insufficient number ofwhite blood cells.

This can be caused by the failure of the bone

marrow to produce adequate numbers ofnormal white blood cells, or by diseases thatlead to the destruction of crucial white bloodcells.

These conditions result in severe immunedeficiencies characterized by recurrentinfections.


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Any disease in which excess white blood cells areproduced, particularly immature white bloodcells, is called leukemia, or blood cancer.

Many cases of leukemia are linked to gene

abnormalities, resulting in unchecked growth ofimmature white blood cells.

If this growth is not halted, it often results in thedeath of the patient.

These genetic abnormalities are not inherited inthe vast majority of cases, but rather occur afterbirth.


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Treatment for leukemia typically involves theuse of chemotherapy, in which strong drugsare used to target and kill leukemic cells,permitting normal cells to regenerate.

In some cases, bone marrow transplants areeffective. Much progress has been made overthe last 30 years in the treatment of thisdisease.

In one type of childhood leukemia, more than80 percent of patients can now be cured oftheir disease.


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One disease of the coagulation system ishemophilia, a genetic bleeding disorder in whichone of the plasma clotting factors, usually factorVIII, is produced in abnormally low quantities,resulting in uncontrolled bleeding from minor

injuries.

Although individuals with hemophilia are able toform a good initial platelet plug when blood

vessels are damaged, they are not easily able toform the meshwork that holds the clot firmlyintact.


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Thrombus Clot that develops and persists in an unbroken

vessel

May prevent blood flow to the cells beyond the

blockage

Embolus Clot (thrombus) that breaks away from the vessel

wall and floats freely in the blood stream


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RBC 120 days

WBC 18 to 36 hrs

Platelets - 7 to 14 days


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Fluosol Main ingredient: perfluorocarbons (PFCs) Depresses the immune system

Chemically Altered Hemoglobin Harvested hemoglobin from erythrocytes and

altered

Artificial RBCs (Neohemocytes) Natural hemoglobin packaged in bubbles made

from phospholipids and cholesterol

Hemopure Natural but non human blood substitute Purified hemoglobin extracted from cattle blood


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Bone marrow aspiration and biopsy Complete Blood Cell count

CBC with Differential WBC count

Bleeding time

Clotting time

Platelet aggregation

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Blood Chap 10