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NHTI LIU SU TMTNG HPDCH

Gii thiu Information Mc lc

Bin son ebook : L nh Sng

I HC Y KHOA H NI

Trang web : www.ykhoaviet.tk

Email : [email protected], [email protected]

in thoi : 0973.910.357

THNG TIN

THNG BO VVIC XUT BN BCH KHOA Y HC 2010 :

Theo yu cu v nguyn vng ca nhiu bn c, khc vi Bch Khoa Y Hc cc phin bn

trc, bn cnh vic cp nht cc bi vit mi v cc chuyn khoa mi,cng nh thay i cchthc trnh by, Bch Khoa Y Hc 2010 c chia ra lm nhiu cun nh, mi cun bao gm mtchca Y Hc, nh thsgip bn c tit kim c thi gian tra cu thng tin khi cn.

Tc gixin chn thnh cm n tt cnhng kin ng gp ph bnh ca qu{ c gitrong thi


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gian qua. Tt ccc cun sch ca bsch Bch Khoa Y Hc 2010 bn c c thtm thy v tivttrang web www.ykhoaviet.tk c L nh Sng xy dng v pht trin.

NG H:

Tc gixin chn thnh cm n mi sng hvmt ti chnh gip cho Bch Khoa Y Hcc pht trin tt hn v ngy cng hu ch hn.

Mi tm lng ng hcho vic xy dng mt website dnh cho vic phbin ti liu hc tp vging dy Y Khoa ca cc c nhn v Doanh nghip xin gi v:

Tn ngn hng : NGN HNG U T V PHT TRIN VIT NAM

Tn ti khon ngn hng : L nh Sng

Sti khon : 5111-00000-84877

CNH BO :

TI LIU NY CHMANG TNH CHT THAM KHO nhm mc ch nng cao hiu bit vY khoa.Tuyt i khng c t p dng cc thng tin trong ebook ny chn on v tiu trbnh, nht l vi nhng ngi khng thuc nghnh Y . Tc giebook ny khng chu bt c

trch nhim g lin quan n vic sdng thng tin trong cun sch p dng vo thc tinca bn c. y l ti liu su tm tnhiu tc gikhc nhau, nhiu cun sch khc nhau,

cha c kim chng , v thmi thng tin trong cun sch ny u chmang tnh cht tngi . Cun sch ny c phn pht min ph vi mc ch sdng phi thng mi, bt chnh vi no lin quan n vic mua bn, trao i, chnh sa, inn cun sch ny vo bt c

thi im no u l bt hp l. Ni dung cun ebook ny c thc thay i v bsung btclc no m khng cn thng bo trc.

GII THIU

B sch ny c L Sng su tm , bin dch v tng hp vi mc ch cung cp mt ngun ti

liu tham kho hu ch cho cc bn sinh vin y khoa, v tt cnhng ai c nhu cu tm hiu,nghin cu, tra cu , tham kho thng tin y hc.

Vi tiu ch l bsch m , c xy dng da trn ngun ti liu ca cng ng , khng mangmc ch vli, khng gn vi mc ch thng mi ha di bt kzhnh thc no , nn trc


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khi sdng bsch ny bn phi ng vi nhng iu kin sau . Nu khng ng , bnkhng nn tip tc sdng sch :

B sch ny c cung cp n tay bn , hon ton da trn tinh thn tnguyn ca bn.Khng c bt kzs thng lng, mua chuc, mi gi hay lin kt no gia bn v tc gib

sch ny.

Mc ch ca bsch phc vcng tc hc tp cho cc bn sinh vin Y khoa l chnh, ngoira nu bn l nhng i tng ang lm vic trong nghnh Y cng c thsdng bsch nhl ti liu tham kho thm .

Mi thng tin trong bsch u chc tnh chnh xc tng i, thng tin cha c kim

chng bi bt cc quan Php lut, Nh xut bn hay bt cc quan c trch nhim lin quanno . V vy, hy lun cn trng trc khi bn chp nhn mt thng tin no c cung cptrong bsch ny.

Tt ccc thng tin trong b sch ny c su tm, tuyn chn, phin dch v sp xp theotrnh tnht nh . Mi bi vit d ngn hay di, d hay d dcng u l cng sc ca chnh

tc gibi vit . L nh Sngchl ngi su tm v phin dch, ni mt cch khc, ngigip chuyn ti nhng thng tin m cc tc gibi vit cung cp, n tay cc bn .

Bsch ny l ti liu su tm v dch bi mt sinh vin Y khoa chkhng phi l mt gio s

tin s hay mt chuyn gia Y hc dy dn kinh nghim,do c thc rt nhiu li v khim

khuyt khng lng trc , chquan hay khch quan, cc ti liu btr c thcha hp l , nnbn cnh vic thn trng trc khi thu nhn thng tin , bn cng cn c kphn mc lc bsch v phn hng dn sdng bsch sdng bsch ny mt cch thun tin nht.

Tc gibsch in tny khng chu bt ctrch nhim no lin quan n vic sdng saimc ch , gy hu qukhng tt vsc khe, vt cht, uy tn ca bn v bnh nhn ca bn .

Khng c chuyn mn , khng phi l nhn vin y t, bn khng c php tsdng nhngthng tin c trong bsch ny chn on v iu tr. Ttrc ti ny, cc thy thuc IUTRBNH NHN chkhng phi l IU TRBNH. Mi ngi bnh l mt thc thc lp

hon ton khc nhau, do vic b nguyn xi tt cmi thng tin trong bsch ny vo thctin sl mt sai lm ln . Tc giskhng chu bt ctrch nhim g do sbt cn ny gy ra.

V l bsch cng ng, to ra v mc ch cng ng, do cng ng , bsch ny c pht trinc hay khng mt phn rt ln, khng chda vo sc lc, skin tr ca ngi to ra b

sch ny , th nhng ng gp, xy dng, gp , bsung, hiu chnh ca ngi c chnh lng lc to ln b sch ny c pht trin. V mt mc tiu trthnh mt bsch tham


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kho y khoa tng hp ph hp vi nhu cu v tnh hnh thc tin trong lnh vc y tni ring vtrong cuc sng ni chung . Tc gibsch mong mi bn c nhng li ng gp chn

thnh mang tnh xy dng, nhng ti liu qu m bn mun san scho cng ng , v mttng lai tt p hn. l tt cnim mong mi m khi bt u xy dng bsch ny , ti

vn kin tr theo ui .Ni dung bsch ny, c thchng trong mt thi im nht nh trong qu khv hin tihoc trong tng lai gn. Trong thi i cch mng khoa hc cng nghtin nhanh nh v bonh hin nay, khng ai bit trc c liu nhng kin thc m bn c c c thp dngvo tng lai hay khng . trli cu hi ny, chc chnh bn thn bn , phi lun lunkhng ngng-TMNH-cp nht thng tin mi nht trong mi lnh vc ca i sng, trong c lnh vc y khoa. Khng ai c th, tt nhin bsch ny khng th, lm iu thay bn.

Nghim cmsdng bsch ny di bt kzmc ch xu no, khng c php thng mi

ha sn phm ny di bt cdanh ngha no. Tc gibsch ny khng phi l tc gibi vitca bsch , nhng mt rt nhiu cng sc, thi gian, v tin bc to ra n, v li chchung ca cng ng. Bn phi chu hon ton trch nhim vi bt kzvic sdng sai mc chv khng tun thni dung bsch ny nu ra.

Mi l thuyt u chl mu xm, mt cun sch hay vn cun sch cng chl l thuyt, chcthc tcuc sng mi l cun sch hon ho nht, bn khng phi l c gim l dinvin chnh. V Bch Khoa Y Hc cng chl mt ht thc nh, vic sdng n xo nu haynhn ging l hon ton ty thuc vo bn c. V ngi to ra ht thc ny svui mng v

c truyn thm ng lc tip tc cgng nu bit rng chnh nhbn m bit bao ngi

khng cn phi xp hng chcu tr.

Mi ng gp lin quan n bsch xin gi vcho tc githeo a chtrn. Rt mong nhnc phn hi tcc bn c gicc phin bn sau c tt hn.

Knh chc bn c, gia quyn v ton thngi Vit Nam lun c sng trong khe mnh,cuc sng ngy cngm no hnh phc.

Lng, NghAn. Thng 8/2010


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ABOUT

ebook editor: Le Dinh Sang

Hanoi Medical University

Website: www.ykhoaviet.tk

Email: [email protected], [email protected]

Tel: 0973.910.357

NOTICE OF MEDICAL ENCYCLOPEDIA PUBLICATION 2010:

As the request and desire of many readers, in addition to updating the new articles and new

specialties, as well as changes in presentation, Medical Encyclopedia 2010 is divided into manysmall ebooks, each ebook includes a subject of medicine, as this may help readers save time

looking up informations as needed. The author would like to thank all the critical comments of

you all in the recent past. All the books of the Medical Encyclopedia 2010 can be found and

downloaded from the site www.ykhoaviet.tk ,by Le Dinh Sang construction and development.

DONATE

The author would like to thank all the financially support to help the Medical Encyclopedia are

developing better and more-and-more useful.

All broken hearted support for building a website for the dissemination of learning materialsand teaching Medicine of individuals and enterprises should be sent to:

Bank name: BANK FOR INVESTMENT AND DEVELOPMENT OF VIETNAM

Bank Account Name: Le Dinh Sang

Account Number: 5111-00000-84877

DISCLAMER :

The information provided on My ebooks is intended for your general knowledge only. It is not a

substitute for professional medical advice or treatment for specific medical conditions. You

should not use this information to diagnose or treat a health problem or disease withoutconsulting with a qualified health professional. Please contact your health care provider with

any questions or concerns you may have regarding your condition.

Medical Encyclopedia 2010and any support from L nh Sng are provided 'AS IS' and withoutwarranty, express or implied. L Sng specifically disclaims any implied warranties of

merchantability and fitness for a particular purpose. In no event will be liable for any damages,


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including but not limited to any lost or any damages, whether resulting from impaired or lost

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YOU ARE RESTRICTEDTO adapt, reproduce, modify, translate, publish, create derivative works

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FOREWORD

These ebooks are Le Dinh Sangs collection, compilation and synthesis with the aim of providing

a useful source of reference-material to medical students, and all who wish to learn, research,

investigate to medical information.

Just a set of open-knowledge, based on community resources, non-profit purposes, not

associated with commercial purposes under any kind, so before you use this books you must

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The main purpose of these books are support for studying for medical students, in addition to

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All information in the book are only relative accuracy, the information is not verified by any law

agency, publisher or any other agency concerned. So always be careful before you accept a

certain information be provided in these books.

All information in this book are collected, selected, translated and arranged in a certain order.

Each artical whether short or long, or whether or unfinished work are also the author of that

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articles, if as in this book is clearly the release of this information you must specify the author of

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This book is the material collected and translated by a medical student rather than a professor

Doctor experienced, so there may be many errors and defects unpredictable, subjective ornot offices, documents can be arranged not reasonable, so besides carefull before reading

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The author of this e-book does not bear any responsibility regarding the use of improper

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8. As is the community material, these books could be developed or not are not only based on

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9. The contents of this book, may only correct in a certain time in the past and the present or in

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12. All comments related to the books should be sent to the me at the address above. We hopeto receive feedbacks from you to make the later version better.

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MC LC

PHN 1. SINH L Y HC

BI 1. SINH L MU-TUN HON1. HTUN HON2. SINH L MU3. RI LON LM SNG MU4. SINH L CM MU V NG MU5. CU TO - CHC NNG CA HNG CU6. TIU CU7. BCH CU8. CHNG NG MU9. HUYT TNG10.NHM MU V AN TON TRUYN MU11.RI LON C CHCM MU

BI 2. SINH L[ CO C

12.SCO C13.SINH L C VN14.SINH L C TRN

BI 3. SINH L HTK THC VT15.GII PHU HTHN KINH THC VT16.CHC NNG CA HTHN KINH THC VT17.CC CHT DN TRUYN V RECEPTER THUC HTK THC VT18.TC NG CA THUC LN HTK THC VT19.CUNG PHN XV CC PHN XTHC VT


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BI 4. SINH L TIU HA

20.CHC NNG GAN21.SINH L TIU HA I CNG22.TIU HO MING23.TIU HO DDY24.TIU HO RUT NON25.HP THU THC N RUT NON

BI 5. SINH L SINH DC

26.SINH L SINH DC N27.SINH L SINH DC NAM

BI 6. SINH L THN28.QU TRNH TO NC TIU29.SINH L THN30.IU HA CHC NNG THN31.MT SNGHIM PHP THM D CHC NNG THN

BI 7. SINH L CC DCH C TH

32.CC DCH CA C TH33.CC DCH KHC CA CTH34.THN IU HA CN BNG NI MI

PHN 2. SINH L BNH Y HC35.I CNG SINH L BNH36.

KHI NIM VBNH37.QU TRNH BNH L

38.MIN DCH BNH L39.BNH SINH HC40.BNH CN HC41.SINH L NHIM TRNG42.RI LON CN BNG AXIT BAZ43.RI LON CHUYN HA GLUCID44.RI LON CHUYN HA LIPID45.RI LON CHUYN HA NC IN GII46.RI LON CHUYN HA PROREIN47.RI LON QU TRNH PHT TRIN - U C48.RI LON IU NHIT49.SINH L BNH GAN50.SINH L BNH QU TRNH VIM51.SINH L BNH THIU XY52.SINH L BNH HTUN HON53.SINH L BNH HTIT NIU


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54.SINH L BNH HTIU HA55.SINH L BNH HTHN KINH56.SINH L BNH HNI TIT57.SINH L BNH MU V TO MU58.SINH L BNH H HP59.BNH L DI TRUYN NGI

PHN NI DUNG

PHN 1. SINH L Y HC

BI 1. SINH L MU-TUN HON


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1.HTUN HONTheo Free Health Encyclopedia

Htun hon ca c thbao gm htim mch v hbch huyt.Hai hny vn chuyn oxy, cht dinh dng, nhng tbo cht, hormon v nhng cht khcn v i khi cc tbo trong c th.

Hng ttbo trong c thngi nhn cht dinh dng v thi ra nhng cht b hng ngy,hng gi, hng pht.

Mc d strao i ny c thgia tng khi hot ng v chm li khi nghngi nhng lc no ncng hot ng lin tc.Nu n dng li, c thscht. Trong 2 h, htim mch ng vai tr vn chuyn chnh, hbch huyt chhtrthm bng nhng chc nng ring bit ca n.


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NHNG THNH PHN CA HTIM MCH

Nhng thnh phn chnh ca htim mch l tim, cc mch mu v mu. C thm tmt cch

hnh tng htim mch bng hnh nh sau: mt ci bm bng c (tri tim) bm dch (mu)chy qua mt chui nhngng dn ln v nh(cc mch mu) i khp c th.Khi di chuyn qua mt hthng cc mch mu phc tp, mu ly oxy tphi, cht dinh dngtrut non v hormon tcc tuyn ni tit.Sau n phn phi li cho cc tbo ca c thri ly vCO2 (c to thnh khi tbodng ng v msn xut ra nng lng) v nhng cht thi khc. Mu smang nhng

cht thi n phi v thn thi ra ngoi.

TimTim l mt cu trc rng, hnh nn lm tc nm pha sau v hi lch vbn tri xngc. Np mnh vo gia 2 phi, tim c nm trong mt lng xng bo vc to bi xng

c, cc xng sn v ct sng. nh tim nm pha di, c gi l mm tim, hng vpha hng tri v nm trn c honh (mt mng c phn cch khoang ngc v khoang bng vinhau). Phn trn ca tim, c gi l y tim, hng vpha vai tri v nm di xng snth2, cc mch mu quan trng ca c thc ni vo tim phn ny.

Tim c kch thc bng mt nm tay. Khi mi sinh, kch thc tim v nm tay ca trl bngnhau. Khi c thpht trin, tim v nm tay cng pht trin vi cng mt tc . ngi ln,khi lng trung bnh ca tim vo khong t255 n 310 gram, ca nam ln hn ca nmtt.

Mng tim l mt ti lm tmng x, cht, bao quanh, bo vv neo gitim li vi cc cu trcxung quanh. Lp mng trong bao mt ngoi ca tim v l mt thnh phn ca thnh tim. Lp


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x bn ngoi bo vtim v neo tim li vi cc cu trc xung quanh nh l xng c v chonh. Phn trong ca lp ngoi ny c gii hn bi mt lp khc, sn xut ra huyt thanh.

Cht nc bi trn gia hai lp trong v ngoi ca mng tim ny gip cho 2 lp ny trt lnnhau c ddng hn v gim ma st khi tim p

Thnh tim c cu to bi 3 lp: lp ngoi (epicardium), lp c (myocardium), v lp ni tmmc (endocardium). Lp ngoi cng (epicardium) tht cht l lp trong cng ca mng ngoitim. Lp gia, myocardium, l mt lp c tim dy c thco bp c tng mu i ra khi

tim. Lp trong cng, ni tm mc, l mt mng mng gip mu c thchy trn tru qua ccbung tim.Cc bung tim

Tim c chia ra lm 4 bung. Mt vch c chia tim ra lm 2 phn: phi v tri. Mi phn tiptc c chia ra lm 2 bung: bung trn v bung di. Hai bung trn, cn c gi l tm

nh, c thnh mng. Chng m nhn chc nng nhn mu vtim. Mu chy vtm nh tccmch mu ca c th, sau c bm xung tm tht, l 2 bung nm pha di. Tm tht lbung m nhn chc nng tng mu i. Thnh ca chng dy v c nhiu c hn tm nh. N

gip tm tht co bp v bm mu ra khi tim n phi v nhng khu vc cn li ca c th.Trong khi mu chy tbung ny sang bung kia, nhng ci van-mt-chiu ngn khng cho

mu chy ngc trli bung c. Cc van nm gia tm nh v tm tht c gi l van nh

tht. Van nh tht tri (nm gia tm nh tri v tm tht tri) cn c gi l van hai l. Van nhtht phi (nm gia tm nh phi v tm tht phi) cn c gi l van ba l. Cc van nm gia

2 tm tht v nhng mch mu ln c chng bm mu c gi l cc van bn nguyt. Vanbn nguyt ng mch phi nm gia tm tht phi v thn ng mch phi. Van bn nguytng mch chnm gia tm tht tri v ng mch ch.

Cc l van mv ng p ng li vi nhng thay i p lc trong tim. Cc van nh tht mra khi tim nghngi v ng li khi tm tht co bp. Cc van bn nguyt ng li khi tim nghngi v mra khi tm tht co bp. Khi cc van ng li sgy ra nhng ting "bm-tc" m bcs c thnghe thy c quang nghe. Khi van nh tht ng sto ra ting "bm", khi van bnnguyt ng sto ra ting "tc".


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Hdn truyn ni ti ca tim

Tim c mt hthng thn kinh ring kim sot hot ng ca n c gi l hdn truynni ti, nm bn trong m tim. Nhng tn hiu thn kinh c hny gi i slm cc phnkhc nhau ca tim co bp nhng thi im khc nhau. Mt im nt nhbao gm mt loim c c bit nm phn trn ca tm nh phi c gi l nt xoang. Do n l im khiu ca xung ng nn nt xoang cn c gi l nt to nhp. Hthng ny cn bao gmnhng nt khc nh nt nh tht, nm gn y ca tm nh phi, ngay pha trn tm tht. Bnh nht (cn c gi l b His) nm phn trn ca vch ngn gia 2 tm nh. Hai nhnh

chnh tb ny chia ra thnh nhng si nhhn phn bu cc c tim ca cc thnh tmtht. Chng c gi l nhng si Purkinje.


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Mch mu

Cc mch mu to ra mt hthng vn chuyn bao gm ccng c chiu di khong 96,500km, hn gp i chiu di ca ng xch o. Ton bhthng mch mu c xem nh l

mt chui nhng con ng v ng cao tc lin kt vi nhau. Mu ri khi tim i vo cc

mch mu ln (ng cao tc) i n c th. nhiu im khc nhau, nhng mch mu lnny chia ra thnh nhng mch mu nhhn (ng l). V n lt mnh, nhng mch muny tip tc chia ra thnh nhng mch mu nhhn, nhhn na (c 1 ln xe). Khi quayngc trv, mu i qua nhng mch mu c kch thc tng dn ln (cc ng 1 ln hp lithnh ng lri thnh ng cao tc) trc khi tht strvtim.

MU C PHI L BIN BN TRONG C TH?

Chmi hn 350 nm trc, con ngi tng ngh rng mu trong c thchy ti v lui y htnh nhng cn thy triu vy. Ngi Hy Lp ci l nhng ngi u tin t ra l thuyt

ny. Htin rng mu ri khi tim, sau rt trvtim mang theo nhng cht cn bng theocng mt mch mu. Githuyt ny tn ti cho n hn 1400 nm.Nm 1628, mt bc s ngi Anh, William Harvey (1578-1657), cng bmt khi nim mivtun hon mu. ng xc nhn rng mu chy khng ngng tcc ng mch sau trvtim qua cc tnh mch v to nn mt vng tun hon lin tc qua c th.

Ngay lp tc sau , l{ thuyt ca Harvey bkhinh mit v n i lp li hon ton nhng hiubit c bn vy hc vo thi . Tuy nhin, vo khong 30 nm sau, { tng ca ng cxc minh do ngi ta pht hin ra stn ti ca cc mao mch. Do l ngi tin phong nnHarvey c nhiu ngi xem nh l cha ca nn y hc hin i.

ng mch, mao mch v tnh mch l nhng thnh phn chnh ca hthng vn chuyn. ngmch l nhng mch mu mang mu i ra khi tim. Cc ng mch ln ri tim sau chia


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nhnh ra thnh nhng ng mch nhhn ri i n nhiu khu vc khc nhau ca c th. Sau chng tip tc chia nhhn thnh cc tiu ng mch. Trong cc m, cc tiu ng mch

chia ra thnh nhng mch mu siu nhc gi l cc mao mch. Strao i cht gia muv tbo din ra xuyn qua thnh ca cc mao mch. Trc khi ri khi m, cc mao mch gp

li thnh cc tiu tnh mch. Sau nhng mch mu ny di chuyn n gn tim hn v gp lithnh nhng tnh mch ngy cng ln hn.Nhng mch mu ln c nhng cu trc khc nhau. Mc d cc thnh ca cng mch v tnh

mch u bao gm 3 lp nhng dy ca chng cng khc nhau. ng mch c lp trong vlp gia dy hn, gip chng n hi hn. Chng c th co v dn ddng khi mu c bmttim trn qua. Tnh mch c thnh mng hn gip cc khung c xung quanh chng bp v y

vo thnh p mu trong trvtim. Nhng van-mt-chiu thnh cc tnh mch gipngn khng cho mu chy ngc trvv gicho dng mu chy theo 1 hng. Cc van c

nhiu nht chn do mu phi chng li trng lc quay trvtim. Khng ging vi ngmch v tnh mch, thnh ca cc mao mch chdy bng 1 tbo. hu ht cc mao mch,nhng tbo ny khng dnh cht vi nhau. iu ny gip cho oxy, cht dinh dng v nhng

cht thi c thdi chuyn qua li ddng gia mu v dch klp y nhng khong khnggian gia cc tbo.VNG TUN HON PHI V VNG TUN HON HTHNG.C 2 vng tun hon chnh trong c th: vng tun hon phi v vng tun hon hthng.Nhng mch mu ca vng tun hon phi vn chuyn mu qua li gia tim v phi. Nhng

mch mu ca vng tun hon hthng vn chuyn mu n tt cnhng phn cn li ca cth.ng mch chnh ca vng tun hon hthng l ng mch ch. ngi ln, ng mch ch

c cng kch thc ving nc ti cy tiu chun. N tri ln khi tim v i ln trn ttmtht tri khong 1 inch ri sau bhng sang tri ngay pha trn tim (phn ny c gi lcung ng mch ch) trc khi cong thng xung chia ra cc nhnh cung cp mu chonhng phn cn li ca c th.Cc nhnh ca ng mch chbao gm ng mch cnh (cung cp mu cho u), ng mch

vnh (cung cp mu cho cc c ca tim), cc ng mch cnh tay (cung cp mu cho cnh tay)v nhng ng mch i (mang mu xung cung cp cho bp i).Tnh mch chl tnh mch ln nht ca vng tun hon hthng. N c 2 nhnh: tnh mchchtrn nhn mu tu v cnh tay chy v; tnh mch chdi nhn mu tphn c th

pha di chy v. C2 nhnh ny u mu vtm nh phi.

Cc tnh mch mu vtnh mch chbao gm: tnh mch cnh (dn mu tu trv), tnhmch cnh tay v tnh mch u (dn mu vtcnh tay), tnh mch i (dn mu vtbpi), v tnh mch chu (dn mu vtvng chu v hng).Nhng mch mu thuc vng tun hon phi mang mu n phi trao i kh (nhn O2 vthi CO2 ra), sau quay trvtim. Nhng mch m chnh l ng mch phi v tnh mch


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phi. Hai ng mch phi 2 bn c ngun gc tthn ng mch phi xut pht ttm thtphi. ng mch phi phi i vo phi bn phi v ng mch phi tri i vo phi bn tri. Sau

khi trao i kh phi, mu c oxy ha (c mang oxy) sc quay ngc trvtm nhtri ca tim bi 4 tnh mch phi.

MU

Mu l cht dch c tim bm vo cc mch mu i n khp cc bphn ca c th. N l

m lin kt. Theo ng nh tn gi ca n, m lin kt l nhng loi m kt ni cc phn khcnhau ca c thli vi nhau nng , cha ng v bo v. M lin kt c tm thy khp ni trong c thv l loi m c nhiu nht trong 4 loi m ca c th(3 loi m cn lil: biu m, m c v m thn kinh). Trong tt ccc m ca c thth mu l loi m duy nhttn ti di dng dch.

Mu c rt nhiu chc nng trong c th. N mang tt cnhng vt cht c thvn chuync tni ny sang ni khc trong c th: oxy, cht dinh dng cho cc tbo, hormon (lnhng cht truyn tin ha hc) n cho cc m v nhng cht thi n cho cc c quan mnhn nhim vthi chng ra ngoi khi c th. N gip bo vc thbng c chng mu v

bo vc thkhi nhng vi sinh vt l. N cng gip nhit c thc gi trkhng i bngcch ly nhit ra khi tbo.

Nht v nng hn nc, mu sc ca mu thay i tti sang c ty thuc vo lngoxy m n ang mang (oxy cng nhiu th mu sc cng sng). Khi bn trong c th, mu cnhit vo khong 38C. Mu chim khong 8% trng lng ca c th. Mt ngi nam giitrng thnh c khong 5.6l mu bn trong c th, nc khong 4.5 lt. Nam c khuynh hngc nhiu mu hn ndo c shin din ca testosterone, l mt loi hormon sinh dc nam c


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chng c thlch vo c cc mao mch nh.

CHARLES DREW v cch bo qun huyt tng

Charles Drew

Mu c 4 nhm chnh l A, B, O, v AB, y l khm ph ca cc nh nghin cu y hc vo uthk20. Khm ph ny ci thin ng khiu quca vic truyn mu. Tuy nhin, vo thiim , mu ton thchc thgic trong vng 7 ngy trc khi bh. Do vn lm

sao c c ng loi nhm mu cn thit sn sng trong cp cu vn cn tn ti.Vo nhng nm cui thp nin 30 ca thktrc, mt bc s ngoi khoa ngi M, Charles

Drew (1904-1950) bt u khm ph ra c khnng dng huyt tng thay thcho muton thtruyn. Do huyt tng khng c hng cu nn n c thc truyn cho bt kz

bnh nhn no m khng cn quan tm n nhm mu ca h. Tnh cht ny ca huyt tnglm cho n trthnh l{ tng sdng trong cp cu.Khong nm 1940, Drew pht minh ra c cch xl v bo qun huyt tng bng cchkhnc ca n do nn n c them i xa c v bo qun trong mt thi gian di. Khi

cn thit, huyt tng kh (ging nh bt) c thc ti to trli dng ban u bng cchthm nc vo.

Vic sdng huyt tng truyn mu chng tc vai tr c bit quan trng camnh trong sut thchin thII (1939-1945), thi im mu dng iu trvt thngbthiu ht trm trng. Do nghin cu trn, ng c tn thng v cu mng c v

sngi.ngi ln, hng cu c to ra bi phn ty ca xng sn, ct sng, xng c vxng chu (ty xng l mt cht tng tnh bt bin, xp c trong cc khoang bn tronghu ht cc xng ca c th). Thnh phn c bn ca hng cu l mt loi protein sc tctn l hemoglobin. Phn themoglobin chim 1/3 trng lng mi tbo hng cu. phn

trung tm ca mi phn themoglobin l 1 nguyn tst to mu sc cho hng cu. Ti phi,tbo st kt hp vi oxy to ra mt hp cht c tn l oxyhemoglobin. Chc nng chnh


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ca hng cu l vn chuyn oxy di dng ny n cc tbo khp c th. Sau khi oxy ctrao i, hemoglobin kt hp vi CO2 thi ra ttbo v hng cu quay trli phi c

thi bt ra.Do hng cu thng xuyn bp vo nhng mao mch nhli ti nn mng ca n dbh hi v

xi mn rt nhiu do mi tbo hng cu chtn ti trong khong 4 thng. Nhng tbohng cu mi c sn xut lin tc ty xng thay thnhng tbo c.

Hnh nh hng cu chy qua cc mch mu.

NHM MU.

Hng cu mang nhng protein c gi l khng nguyn, l nhng cht gip c thnhn bit

nhng vt lxm nhp, mng ca mnh. Ngi ta da trn nhng khng nguyn ny quynh nhm mu: A, B, AB, hoc O. Ngi nhm mu A c tt ccc tbo hng cu trong c

thmang khng nguyn A. Ngi nhm mu B c tt ccc tbo hng cu trong c thmangkhng nguyn B. Ngi nhm mu AB c tt ccc tbo hng cu trong c thmang khngnguyn A v B. Ngi nhm mu O c tt ccc tbo hng cu trong c thkhng mang

khng nguyn no c.


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Bit c nhm mu ca bnh nhn l iu rt quan trng nu mun thc hin truyn mu.Ngi c nhm mu A khng thnhn c mu nhm B v hc mang khng thchng likhng nguyn B. Tng t, nhm mu B mang khng thchng li khng nguyn A. Nhm mu

AB khng mang khng thchng li khng nguyn no c, nhng nhm mu O th li mangkhng thchng li chai khng nguyn A v B. Nu bnh nhn bcho lm nhm mu th cc t

bo mu svn cc li v lm tc nghn nhng mch mu nh. Phn ng ny, cn c gi lphn ng kt dnh, c thgy tvong.Hng cu cn c 1 loi khng nguyn khc c gi l khng nguyn Rh (n c ci tn ny do

loi khng nguyn ny c xc nh ln u tin khRhesus). Hu ht nhng ngi Vit Nammang nhm mu Rh dng (Rh), iu c ngha l hc mang khng nguyn Rh. Nhngngi mang nhm mu Rh m (Rh-) th khng mang khng nguyn Rh. Khng ging vi nhm

mu ABO, cc khng thchng li khng nguyn Rh khng c tm thy mt cch tnhintrong mu. Vn duy nht chtht sxy ra khi ngi mang nhm mu Rh- c truyn voc thmu c Rh. Khi , c thca hsphn ng li bng cch to ra khng thchng likhng nguyn Rh. ln truyn mu ktip, nu vn tip tc c truyn mu c Rh+ th khngthchng li Rh c to ra tln truyn mu trc stn cng mu c truyn vo.

BCH CUBch cu c rt t nu so vi hng cu, khong 4.000 n 11.000 mi millimet khi mu, chimt hn 1% tng thtch mu. Mc d chim slng t nh vy nhng bch cu li ng mtvai tr quan trng trong hthng min dch ca c th. N gip c thphng th, chng li stn cng ca vi khun, virus, k sinh trng v tbo ung th. Ging nh hng cu, bch cucng c to thnh tty xng (mt sbch cu c to ra tcc m lympho). Trong khihng cu phi i theo dng chy ca mu th bch cu khng nh vy m n c thlen qua cc


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vch ca cc mao mch i thng n nhng khu vc bnhim trng hoc btn thng cac th.

KHNG NGUYN Rh V THAI KZYu tRh ng mt vai tr quan trng trong thai kzkhi phnc Rh- ang mang thai a b

c Rh+. Trong qu trnh mang thai, nhng vt t trn mng nhau gip mc thtip xc cvi mu ca trc Rh+ (mng nhau l 1 loi mng lt tcung, cc cht dinh dng v oxy dichuyn tmi xuyn qua mng ny cung cp cho tr), khi c thca msto ra

khng thchng li khng nguyn Rh. ln mang thai ktip, nu con tip tc c nhm muRh+ th khng thchng li Rh ca msi qua mu ca con v tiu dit cc tbo hng cuca b.

phng nga iu ny, bc s scho nhng thai phc Rh- RhoGAM, mt loi khng thchng li Rh trong vng 72 gica ln sinh u tin. RhoGAM stiu dit nhng hng cu Rh+i vo htun hon ca mtrc khi hmin dch c thi gian to ra khng th.C 5 loi tbo bch cu trong mu: bch cu a nhn trung tnh (neutrophil), bch cu i toan(eosinophil), bch cu i kim (basophil), mono bo v lympho bo. Mi loi gimt vai tr

khc nhau trong hthng phng thca c thv c huy ng chng li nhng loi bnhkhc nhau. Chng hn nh trong nhng bnh nhim trng mn tnh (ko di) nh lao phi thmono bo gia tng slng. i vi bnh nhn bhen suyn v trong nhng t dng thbch cu i toan gia tng slng.

Hnh nh i thc bo (pha sau) v lympho bo (pha trc)

Cc tbo bch cu xc nh c mc tiu cn n nhnhng loi ha cht c bit. Khi m


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bnhim trng hoc tn thng, n sphng thch nhng cht ha hc ra cc m xung quanhli ko nhng tbo bch cu thch hp n chin u chng li. Tin trnh ny c gi l

ha ng ng.TIU CU

Tiu cu khng phi l mt tbo tht sging nh hng cu v bch cu. Chng l nhngmnh vnhc dng hnh a ca nhng tbo rt ln c gi l tbo nhn khng l(megakaryocyte) nm trong ty xng. Tbo nhn khng lbvra to thnh khong 50

mnh nhhoc hn v sau nhanh chng hnh thnh mng trthnh tiu cu. C khong300.000 tiu cu mi millimet khi mu, chng gip kim sot chy mu trong mt qu trnh rtphc tp c gi l cn bng ni mi.

Khi mch mu btn thng gy chy mu, cc tiu cu bt u tin trnh ng mu bng cchdnh vo ni tn thng ca mch mu. Trong lc , chng phng thch ra nhng cht ha hc

li ko cc tiu cu khc li. Chng my chc, cc tiu cu kt dnh li v hnh thnh mt ntchn tm thi. Sau , tiu cu phng thch ra serotonin, mt loi ha cht lm cho mch muco tht v hp li lm gim lng mu chy ra bn ngoi qua vt thng. Trong lc cc hin

tng ny xy ra, m btn thng phng thch ra 1 cht kt hp vi calci v nhng yu tng mu khc trong huyt tng hnh thnh cht hot ha prothrombin. Cht hot hany chuyn dng prothrombin (l mt cht c trong huyt tng do gan sn xut) thnhthrombin (l mt loi enyme). Thrombin sau kt hp vi fibrinogen to ra nhng phntdi v mnh c gi l fibrin. Cc phn tfibrin kt hp vi nhau hnh thnh mt ci li

bt gicc hng cu v tiu cu lm nn cho khi mu ng.HTUN HON HOT NG NH THNO

Trong qu trnh hot ng lin tc ca mnh, tim bp trung bnh hn 100.000 ln mi ngy tng mu i hng nghn dm trong cc mch mu nui sng tng tbo mt trong hng t

tbo ca c th. mi nht bp, tim tng i khong 74 milli lt mu. ngi ln, tim trungbnh p khong 72 nht mi pht, nh vy mi pht c khong 5,3 lt mu c tng i, migil 318 lt, mi ngy l 7.631 lt mu c tng i. Trong lc tp thdc, con sny c th

tng ln gp 5 ln.CHU CHUYN TIM


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Chu chuyn tim l mt chui nhng skin xy ra ti tim trong mt nhp p hon chnh ca

n. Mi mt chu chuyn tim chim khong 0.8 giy. Trong thi gian ngn , mu i vo tim, dichuyn qua cc bung tim, sau c tng i ra khp cc khu vc ca c th. Mi mt chuchuyn tim c chia ra lm 2 th. Hai tm nh co khi hai tm tht dn v sau th 2 tm thtsdn ra khi 2 tm nh co. Pha co, c bit l tm tht, c gi l th tm thu, pha dn cgi l th tm trng. Chu chuyn tim bao gm th tm thu v th tm trng ca ctm nhlntm tht.

DOPING MU

tng cng sc do dai ca mnh trc mi cuc thi u, mt svn ng vin dng nmt kthut c gi l doping mu. Ththut ny c thc hin bng cch rt bt mtlng hng cu i. Sau khi mu brt i, c thsp ng li bng cch nhanh chng sn xut

ra nhng hng cu khc thay thcho lng hng cu bly i. Sau , mt vi ngy trckhi thi u, ngi ta stim ngc li lng mu rt ra vo c th.Hiu quca vic ny l to ra hng cu nhiu hn do lng oxy trong mu cng nhiu hn.

Doping mu c thlm tng khnng ca vn ng vin ln 10%.Tuy nhin, ththut ny khng nhng khng hp php m cn nguy him. N c thlm suy

yu dng tun hon cng nh gy ra triu chng ging nh cm cm. Do thay v htrthm cho khnng ca vn ng vin th n li lm hn chnhng khnng .

Qu trnh ny khi u khi mu bkhoxy (mang mt lng oxy rt nh) quay trvtmnh phi qua tnh mch ch. Cng lc , mu c oxy ha di chuyn tphi n tm nhtri qua 4 tnh mch phi. Van nh-tht mra v khi dng mu chy vo cc tm nh n cng


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chy mt cch bng vo cc tm tht. Cc van bn nguyt ng li ngn mu khng chyttm tht ra ngoi cc ng mch. Khi cc tm tht y khong 70%, nt xoang sgi i mt

xung ng lan truyn qua tm nh n nt nh tht. Tm nh co bp v tng khong 30% lngmu vo cc tm tht.

Nt nh tht lm cc xung ng chm li trong mt thi gian ngn gip tm nh c thi gian hon thnh qu trnh co li ca mnh. Xung ng ny sau i qua b nh tht, cc nhnh vmng Purkinje n mm tim. Qu trnh co li ca cc tm tht c khi u tvtr ny,

p lc trong cc tm tht c gia tng mt cch nhanh chng v cc van nh tht ng li (gyra ting "bm" nghe c bngng nghe) ngn khng cho mu chy ngc trvtm nh.Khi p lc trong cc tm tht tng cao hn p lc trong mu cc ng mch ln xut pht t

tim, cc van bn nguyt smra v mu sc tng ra khi cc tm tht. Mu bkhoxytm tht phi c bm ln phi qua cc ng mch phi, mu c oxy ha sri tm thttri i n nhng phn cn li ca c thqua ng mch ch.Khi tm tht co (th tm thu), cc tm nh dn (tm trng) v c y mu trli. Khi ttcc mu c tng i khi tm tht, cc van bn nguyt sng li (gy ra ting tc nghe

c quang nghe) ngn nga dng mu chy ngc trvtim. Cc tm tht trnn trngrng v ng li trong mt thi gian ngn. Khi p lc trong tm nh tng vt qu p lc trongtm tht, van nh tht smra v mu schy vo tm tht bt u mt chu chuyn timmi.Tm li, trong mt chu chuyn tim, na phn trn ca tim (cc tm nh) nhn mu v mt na

phn di (cc tm nh) bm mu. Na phn bn phi ca tim (nh phi v tht phi) nhn vbm mu bkhoxy, na phn bn tri (nh tri v tht tri) nhn v bm mu c oxyha.

HUYT P


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Khi tm tht co, n tng mu ra khi tim i n cc ng mch ln v n hi lm chng dn rakhi mu chy qua. p lc ca mu chng li thnh trong ca cc mch mu c gi l huyt

p. p lc ny cn thit gip cho mu chy n khp ni trong c thv quay ngc vtim.Huyt p ln nht nhng ng mch ln v gn tim nht. Do cc thnh mch c tnh n hi

nn cc ng mch c khnng phn hi li v bo ton hu ht p lc ca mu khi n ctng ra khi tim. Khi mu i n nhng mch mu t n hi hn - nhng tiu ng mch, sau n mao mch, tiu tnh mch v tnh mch - huyt p sgim xung. Khi mu quay trvtm nh phi qua tnh mch ch, p lc gn nh bng 0.Khi tim co v dn trong sut chu chuyn tim th huyt p cng tng v gim trong mi nhp p.Huyt p tng cao hn trong th tm thu (tht tri co) v gim thp hn th tm trng (tht

tri gin).

Huyt p c o bng n vmilimet thy ngn (mmHg) bng my o huyt p. Gi trhuyt

p ghi nhn c thng l c ly tng mch cnh tay. p lc tm thu c ghi nhntrc, sau mi n p lc tm trng. Trung bnh, mt ngi trng thnh trtui chuyt p o c vo khong 120 mmHg i vi huyt p tm thu v 80 mmHg i vi huyt

p tm trng (c vit l 120/80 v c c l "mi-hai-trn-tm"). Ty thuc vo tuitc, gii tnh, cn nng, v nhng yu tkhc, huyt p bnh thng c gi trthay i t90n 135 mmHg i vi huyt p tm thu v 60 n 85 mmHg i vi huyt p tm trng. Bnh

thng th huyt p cng gia tng theo tui.O HUYT P

Nhn vin y to huyt p ca bnh nhn bng mt thit bc bit c gi l my o huytp (sphygmomanometer). Thit bny bao gm mt vng bng cao su, mt ci bng dng bm bng tay v mt my dng c gi trhuyt p.

Vng cao su c bao va kht xung quanh cnh tay ca bnh nhn ngay pha trn khuu tay.Sau , ngi o huyt p stng nghe ln ng mch cnh tay mt trong ca cnh tay

ngay pha trn cng tay nghe nhp mch p.Vng cao su c bm cng phng ln bng cch bp bng cho n khi dng mu chy vocnh tay bngng li v khng cn nghe hay cm thy nhp mch p na. Sau p lc vng

cao su sc gii phng tt. Khi mt lng mu nhbt u chy qua c ng mch bchn p ta snghe thy c mt m nhquang nghe. p lc ca vng cao su c c vothi im nghe c ting ng u tin c ghi nhn l huyt p tm thu.Khi p lc ca vng cao su c gii phng nhiu hn na, ting nhp p trnn ln hn vdu hn. Khi ng mch khng cn bp na v mu chy tdo th ting ng sbin mt. p

lc ca vng cao su ghi nhn c vo thi im ting nhp p cui cng nghe c c gil huyt p tm trng.Hnh ty l mt khi m thn kinh nm u ca ty sng v sn ca skim sot nhng cng ngoi chng hn nh thv nhp tim. trong hnh ty c 2 trung tm iu khin timmch l trung tm kch thch v trung tm c ch. Nhng trung tm ny gi nhng xung thn


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kinh n tim iu ha nhp tim.Hthn kinh tchl mt phn ca hthng thn kinh c nh hng n nhng c quan ni

tng nh tim, phi, ddy, v gan. Chc nng ca n l ngoi {, iu ny c ngha l nhng cng m n iu khin xy ra m khng cn c scan thip ca thc. Hthn kinh tch

c chia ra lm 2 phn: hgiao cm v hph giao cm. Hph giao cm hot ng chyukhi c thang trng thi bnh thng v nghngi, hgiao cm hot ng chyu nhnglc c thbstress hoc cn nng lng.

Trung tm kch thch hnh no gi mt xung thn kinh i theo nhng dy giao cm n timlm tng nhp tim v tng lc co bp. Trung tm c chgi xung thn kinh i theo nhngdy ph giao cm n tim lm gim nhp tim. Nhng trung tm ny hot ng p ng li

vi nhng thay i ca huyt p v nng oxy trong mu thng l do tp thdc, tng thnnhit v stress vcm xc. Nhng thay i trn c nhn bit nhcc cm thquan nm trnng mch cnh v cung ng mch ch.

Cc cm thquan ng mch cnh nhn bit c sgim huyt p, nhng cm thquan

trn cung ng mch chcm nhn c sgim nng oxy trong mu. C2 loi cm thquan ny gi nhng xung thn kinh i dc theo nhng dy cm gic n trung tm kch thch,v trung tm ny sgi nhng xung thn kinh i dc cc dy thn kinh n nt xoang ca timlm tng nhp tim. Khi huyt p v nng oxy trong mu trvmc bnh thng th trungtm c chsgi nhng xung thn kinh n nt xoang n lm chm nhp tim li vmc bnh

thng.STRAO I GIA CC MAO MCH V CC M CA C THCc ng mch, tiu ng mch, tiu tnh mch v tnh mch chc mt chc nng duy nht l

vn chuyn mu i ttim ra ngoi hay tngoi trvtim. Strao i cht - oxy, CO2, chtdinh dng v cht thi - gia mu v dch kdin ra qua cc mao mch. Nhng sdi chuynny thay i khc nhau trong 3 cch: khuych tn, lc v thm thu.Khuych tn l hin tng cc phn tdi chuyn tkhu vc c nng cao hn (cha nhiuphn tloi hn) n khu vc c nng thp hn (cha t phn tloi hn). Hin

tng khuyc tn xy ra v cc phn tc nng lng tdo, c ngha l chng lun lun chuynng. y l trng hp c bit ca nhng phn tkh vn chuyn ng nhanh hn nhngphn tcht lng v cht rn. Oxy v kh carbonic di chuyn qua li gia mao mch v dch kbng skhuych tn. Khi mu i qua mao mch, oxy c chbi hemoglobin trong hng cuc slng ln hn nn di chuyn n dch kxung quanh c slng oxy t hn c

cc tbo nhn ly. Ngc li, CO2 c nng nhiu hn trong dch knn di chuyn vo ccmao mch c chuyn i. Strao i kh gia mu v dch kc gi l sh hp ni ti(internal respiration).

Hin tng lc l cch di chuyn ca nc v cc cht tan trong nc xuyn qua mng tkhuvc c p lc cao hn n khu vc c p lc thp hn. Khi mu i vo cc mao mch n c p


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lc o c l 33 mmHg trong khi p lc ca dch kchkhong 2 mmHg. Do , thng quahin tng lc, huyt tng v cc cht dinh dng nh amino acid, glucose, v vitamin i

xuyn qua thnh cc mao mch n cc dch kxung quanh.Sthm thu l hin tng khuych tn ca nc i qua mng bn thm (l mt loi mng ch

cho php mt vi cht qua c m thi). N di chuyn tkhu vc c nhiu hn n khu vcc t hn. Lin quan trc tip n hin tng ny l p lc thm thu, l khuynh hng ca mtdung dch ko nc i vo dung dch . Gi trca p lc thm thu c tnh bng lng

cht ha tan c trong dung dch. Nu lng cht ha tan c trong dung dch cng ln th lngnc c trong dung dch cng nh. Dung dch c cha mt lng ln cc cht ha tan scp lc thm thu ln v nc sc khuynh hng bko vo dung dch nhiu hn.

u tn tip gip vi tiu tnh mch ca cc mao mch, ngay trc khi chng kt hp li to thnh cc tiu tnh mch, p lc thm thu cc mao mch cao hn dch kdo shin

din ca albumin v mt sphn tprotein ln vn cn nm li nh mt cht ha tan trongmu. Dch kc p lc thm thu thp hn v do n sbko vo cc mao mch v cmang i.

Hnh nh sthm thu: nc i tni c nhiu n ni c t nc hn

STRAO I CA MAO MCH TRONG PHISau khi mu i ht cc m ca c th, trao i oxy v cht dinh dng ly CO2 v cc cht

b th n quay trvtim. Mu bkhoxy trvtm nh phi qua tnh mch ch, sau ivo tht phi. Ti y n sc bm ln thn ng mch phi, sau thn ng mch phischia ra lm 2 nhnh ng mch phi phi v ng mch phi tri mang mu bkhoxy


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i vo mi bn phi.Ti phi, cc ng mch tip tc chia nhnh ra thnh nhng ng mch nhhn ri sau

thnh nhng tiu ng mch nhhn na. Cui cng, nhng tiu ng mch nhnht sphnnhnh ra thnh cc mao mch. Nhng mao mch phi ny bao xung quanh cc phnang, l

nhng ti kh ca phi. Strao i oxy v kh CO2 ti phi xy ra xuyn qua thnh ca cc phnang v gn cc mao mch.Strao i kh ny xy ra da trn nguyn tc khuch tn. Kh trong cc phnang c nng

oxy cao. Mu trong cc mao mch phi c nng CO2 cao. Do , theo nguyn tc khuchtn, oxy ti cc phnang sdi chuyn vo cc mao mch trong khi CO2 trong cc mao mchsdi chuyn ngc li vo cc phnang.

Sau khi c oxy ha, mausex chy tcc mao mch sang cc tiu tnh mch, chng kt hpvi nhau thnh nhng tnh mch ln dn. Cui cng, mu ri khi phi qua 2 tnh mch phi

ln v c mang n tm nh tri c bm ngc trli vng tun hon hthng mtln na. Sdi chuyn ca mu tphi trvtim l mt hin tng kh c bit trong c thvy l ln duy nht m cc tnh mch li c mang mu c oxy ha.

VNG TUN HON GAN - TNH MCH CAMt vng tun hon c bit khc na l vng tun hon gan - tnh mch ca, mt nhnh cavng tun hon hthng. vng tun hon ny, mu i tcc c quan ca bmy tiu ha vtlch chy qua gan trc khi i thng vtim.Cc mao mch dn mu n ddy, rut non, rut gi, ty v lch chy vo 2 tnh mch ln l

tnh mch mc treo trng trn v tnh mch lch. Hai tnh mch ny hp vi nhau thnh tnhmch ca mang mu i vo trong gan.Khi vo gan, tnh mch ca chia nhnh ra hnh thnh cc mao mch c gi l cc

xoang. Cc xoang ny ln hn nhng mao mch bnh thng khc. Thnh ca chng c tnhthm cao hn, cho php cc protein v tbo mu i vo v ra ddng. y l tnh cht rt

quan trng v mu i vo gan tcc c quan thuc htiu ha c cha mt lng ln cc chtdinh dng.Khi mu chy ttqua cc xoang trong gan, mt scht dinh dng c ly ra khi mu v

cha trong gan c sdng sau hoc chuyn thnh nhng cht khc cn thit cho c th.Tcc xoang, mu chy vo cc tnh mch gan tri v phi, sau i i vo tnh mch chdi vcui cng i vo tm nh phi.t khi gp hin tng mu chy hon ton thtiu ha n tim. Bnh thng th mu tcc

ng mch vcc mao mch v chy vo cc tnh mch. vng tun hon gan-tnh mch

ca khng c stham gia ca ng mch m cc mao mch kt hp li to thnh cc tnhmch, sau chia nhra thnh cc mao mch ri kt hp thnh cc tnh mch trli. Vngtun hon ny l cn thit mu c thc gan iu chnh. Cc cht dinh dng c thc bo qun hoc thay i v khi cc cht c thgy c (nh ru v thuc) c th


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chuyn thnh nhng cht t gy hi hn trc khi mu trvtim v phn cn li ca vng tunhon.

2.SINH L MU1. KHI LNG.Mu l tchc lng, lu thng trong htun hon. Trong 1 kg thtrng, c 75 - 80ml mu. Trs sinh c 100ml mu /kg cn nng, sau khi lng mu gim dn. T2 -3 tui tri khilng mu li tng dn ln, ri gim dn cho n tui trng thnh th hng nh. Mt ngi

trng thnh, bnh thng mu chim 7 - 9% trng lng c th. Mt ngi nng 50kg ckhong 4 lt mu. Ngi ta c thxc nh khi lng mu chnh xc bng nhiu phng phpkhc nhau: phng php tim cc cht c mu vo mu, cht ny t blc ra khi thn, phnhunhanh v khng c hi hoc dng cc cht ng vphng xnh du hng cu.

Khi lng mu tng ln sau khi n, ung, khi mang thai, khi truyn dch... Khi lng mu gimkhi c thra nhiu mhi, nn ma, a chy, chn thng c chy mu bn trong hoc bnngoi c th... Nu khi lng mu tng ln trong c th, dch tmu svo khong gian boca da v cc m, sau nc c bi xut dn theo nc tiu. Nu khi lng mu gimtrong c th, dch tkhong gian bo vo mu lm cho khi lng mu tng ln. Trongnhiutrng hp mt mu cp din (mt mu cc tng ln, cc xng ln, mt mu ng ngmch ...) khi lng mu bgim t ngt, c thkhng c khnng tb tr; nu khng cp

cu kp thi, c thskhng sng c.2. THNH PHN.

Mu gm hai thnh phn: thhu hnh (huyt cu) v huyt tng. Cc thhu hnh ca mul hng cu, bch cu v tiu cu, chim 43 - 45% tng smu, chsny c gi lhematocrit. Hng cu l thnh phn chim chyu trong thhu hnh. Huyt tng chim 55 -57% tng smu. Huyt tng cha nc, protein, cc cht in gii, cc hp cht hu c vv c, cc hocmon, cc vitamin, cc cht trung gian ho hc, cc sn phm chuyn ho ... Huyttng cha ton bcc cht cn thit cho c thv ton bcc cht cn c thi ra ngoi.

Huyt tng bly mt fibrinogen th c gi l huyt thanh.3. CHC NNG SINH L[ CA MU.Mu c rt nhiu chc nng , di y l nhng chc nng c bn ca mu:

3.1. Chc nng dinh dng.Mu mang trong mnh ton bcc cht dinh dng nui c th. Cc cht dinh dng ca tngoi vo qua ng tiu ho. Ngoi ra bch cu cn vo lngng tiu ho nhn cccht dinh dng theo kiu "m bo" v "thc bo", ri li vo lng mch mang thm mt phncc cht dinh dng cho mu.

3.2. Chc nng bo v.


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Mu c khnng bo vc thkhi bnhim trng nhc chthc bo,m bo v c chmin dch dch th, min dch tbo. Mu cng c khnng tham gia vo c chtcm mu,

trnh mt mu cho c thkhi btn thng mch mu c chy mu.3.3. Chc nng h hp.

Mu mang 0xy tphi ti tbo v m, ng thi mu mang cacbonic ttbo v m tiphi.3.4. Chc nng o thi.

Mu mang cc cht sau chuyn ho, cht c, cht lti cc c quan o thi (thn, bmytiu ho, phi, da ) thi ra ngoi.3.5. Chc nng iu ho thn nhit.

Mu mang nhit phn "li" ca c thra ngoi thi vo mi trng hoc ginhit cho cthnhc chco mch da.

3.6. Chc nng iu ho cc chc phn c th.Bng siu ho tnh hng nh ni mi, mu tham gia vo iu ho ton bcc chc phnc thbng c chthn kinh v thn kinh - thdch.

4. C TNH CA MU.Mu c tnh hng nh. Tnh hng nh ca mu c nh gi qua cc chssinh l, sinh hoca mu. Cc chsny, trong iu kin sinh l{ bnh thng l rt t thay i hoc chthay itrong mt phm vi rt hp. V vy chng c coi nh l mt hng s. Kim tra cc chssinhl, sinh ho ca mu l mt vic lm v cng quan trng v rt cn thit nh gi nhng ri

lon chc nng ca c th.

3.RI LON LM SNG MU1. Thiu mu.Thiu mu l gim Hb trong mu di mc bnh thng. Theo W.H.O ngi bthiu mu lngi c hm lng Hb mu gim:

< 13gHb trong 100ml mu (i vi nam)

< 12g Hb trong 100ml mu (i vi n)

< 14g Hb trong 100ml mu (i vi trs sinh)Thiu mu l do mt mu, do mu bhunhanh hn trong c thhoc do tuxng gim snxut.- Thiu mu do mt mu cp tnh hoc mn tnh.- Thiu mu do suy nhc tuv bnhim x, nhim c (cht c ho hc cng nghip, chin

tranh).

- Thiu mu do thiu acid folic, thiu vitamin B12 hoc thiu yu tni v ct bddy vim


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teo ddy, vim lot ddy- t trng.-Thiu mu do thiu st, do thiu dng.

- Thiu mu do thiu cc yu tkch thch tng sinh, tng trng hng cu erythropoietin (suythn, gan mn tnh).

- Thiu mu do tan mu, do i sng hng cu qu ngn. Mt sbnh ca hng cu do mnghng cu km bn dvnh bnh thiu mu c hng cu hnh li lim, bnh thiu mu chng cu hnh cu (kch thc hng cu rt nh, hnh cu).2. a hng cu.- a hng cu thpht do sng vng ni cao, do suy tim, do bnh ng h hp... y l ahng cu do thiu oxy cc m.

- a hng cu tht sdo tuxng tng sn xut hng cu (c km theo tng bch cu v tiucu). Hu qul qu ti chc nng tun hon, nht mu tng, ri lon tun hon mao mch.

4.SINH L CM MU V NG MU1. CM MU.

Cm mu l mt qu trnh sinh l, sinh ha tng hp nhm chm dt hoc ngn cn smt

mu ca c thkhi mch mu btn thng hoc bt. Cm mu c thc hin nhcc c

ch: co mch, shnh thnh nt tiu cu, ng mu, co cc mu, tan cc mu ng v sphttrin m x trong cc mu ng ng kn vt thng.

nh gi khi qut chc nng cm mu, cc nh lm sng th ng sdng hai xt ngim: xcnh thi gian chy mu (s bnh gi cc yu tca thnh mch v tiu cu), xc inh thigian ng mu (s bnh gi cc yu tgy ng mu ca huyt tng). Thi gian mu chytheo phng php ca Duke l 3 pht. Thi gian mu ng theo phng php ca Milian l 7

pht.

1.1. Co mch.Ngay sau khi mch btn thng, mch mu bco li do tnh n hi ca thnh mch. Co mch

cn c thc hin nhc chthn kinh v thn kinh-thdch. Nhng kch thch gy au t

ni tn thng, nhng cht trung gian ho hc c gii phng khi au gy phn xco c trnthnh mch. ng thi lc ny ti ni tn thng, tiu cu bvra, gii phng serotonin gy comch ti ch.1.2. Shnh thnh nt tiu cu.

Ti ni tn thng, tbo ni mc hoc thnh mch tn thng lsi collagen, tiu cubm vo nhng ni ny v bhot ho. Khi tiu cu bhot ho, cc protein trong n c rtmnh v gii phng ra cc yu tlm hot ho cc tiu cu bn cnh, lm cho chng dnh vo


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nhau to nn nt tiu cu bt kn chtn thng (nu l cc tn thng nh). Hng ngy c thta phi chu hng trm vt rch rt nhni mao mch do sang chn. Nhc chc nngny m

c thtrnh c schy mu mao mch.1.3. Shnh thnh cc mu ng.

Tiu cu gii phng ra cc yu tgy co mch v gy ng mu, to ra cc mu ng bsungcho nt tiu cu bt kn chtn thng (nu l cc tn thng ln hn). ng mu phttrin nhanh trong vng 1-2 pht. Nhng cht hot ho gy ng mu c gii phng do t

chc v mch mu btn thng, nhng cht do tiu cu gii phng v nhng cht gy ngmu ca huyt tng c hot ho, pht ng mt qu trnh ng mu. Nu vt thngkhng qu nng, sau 3-6 pht cc mu ng hnh thnh bt kn vt thng. Sau 20 pht n 1

gi, cc mu ng co li lm cho cc mu vng chc hn.Sau khi cc mu ng hnh thnh, vi gisau cc nguyn bo si xm nhp, bin cc mu ngthnh m x trong 1-2 tun l, nu l cc mu ng nhv vt thng nh. Nu l vt thngln, tn thng rng, mu mt nhiu, c thkhng tbo vc, cn phi c scan thipkp thi.

2. NG MU.Trong mu v trong cc m c cha khong 50 cht c nh hng ti qu trnh ng mu. Cc

cht kch thch qu trnh gy ng mu gi l cc cht gy ng mu. Cc cht li c chqutrnh gy ng mu gi l cc cht chng ng mu. Mu c ng hay khng ng l phthucvo scn bng gia cc cht gy ng mu v cc cht chng ng mu. Bnh thng mu

trong c thkhng ng l do cht chng ng mu chim u th. Khi mu, mch mu btnthng, khi mu ly ra ngoi c th, cc cht gy ng mu c hot ho v trnn u th,ng mu c thc hin.

2.1. nh ngha.ng mu l mt qu trnh chuyn mu thlng sang thc, m thc cht l chuyn

fibrinogen dng ha tan thnh fibrin dng khng ho tan.2.2. C chng mu (cc giai on ca qu trnh ng mu).ng mu c din ra theo mt c chrt phc tp. y l mt qu trnh hot ho v hot

ng ca cc enzym vi mc ch l to ra fibrin. Thng thng ngi ta chia qu trnh ngmu ra lm ba giai on:Giai on hnh thnh phc hp prothrombinase.Giai on hnh thnh thrombin.

Giai on hnh thnh fibrin.

2.2.1. Shnh thnh phc hp prothrombinase.Khi ng cho c chng mu l shnh thnh phc hp prothrombinase. y l mt c chrt phc tp (c ll phc tp nht ) v ko di nht ca qu trnh ng mu. Qu trnh cxy ra khi c chn thng thnh mch v m, khi c chn thng mu, khi c stip xc camu vi tbo ni mc tn thng hoc vi si collagen ca mch mu, vi cc m khc ngoi


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ni mc hoc vi bt kzvt lno.Shnh thnh phc hp prothrombinase theo hai c chngoi sinh v ni sinh. C chngoi

sinh xut hin nu c chn thng thnh mch hoc cc m kcn. C chni sinh xut hinnu c chn thng mu hoc mu ly ra ngoi c thtlng mch. Trong chai c chni

sinh v ngoi sinh c mt lot protein huyt tng (c bit l a2-globulin) ng vai tr rt quantrng, l cc yu tgy ng mu ca huyt tng. Hu ht cc yu tny l cc enzym dng khng hot ng. Khi chuyn thnh hot ng, chng gy ra cc phn ng ho sinh lin

tip nhau ca qu trnh ng mu. Cc yu tny c k hiu bng chsLam phn bitvi cc yu tca tiu cu c k hiu bng chsrp.Yu tI: fibrinogen

Yu tII: prothrombinYu tIII: thromboplastin ca m

Yu tIV: ion Ca++Yu tV: proaccelerinYu tVII: proconvertin

Yu tVIII: globulin A chng a chy mu (antihemophilic globin-AHG).Yu tIX: globulin B chng a chy mu (plasma thromboplastin component-PTC).Yu tX: Stuart-ProwerYu tXI: globulin C chng a chy mu (plasma thromboplastin antecedent-PTA).Yu tXII: Hageman

Yu tXIII:n nh fibrin (fibrin stabilizing factor-FSF).- Shnh thnh phc hp prothrombinase theo c chngoi sinh.M btn thng gii phng yu tIII, phospholipid tmng tbo m. Yu tX c hot

ho (Xa) nhyu tIII, yu tVIIa(yu tVII c hot ho nhyu tIII), ion Ca++v

phospholipid. Shnh thnh phc hp prothrombinase tyu tXac stham gia ca yu t

Va(yu tV c hot ho nhthrombin), ion Ca++ v phospholipid. Yu tValm tng hot

tnh ca yu tXa. Phospholipid ng vai tr l cht nn cn ion Ca++lm cu ni gia cc yu

t. Thrombin trong trng hp ny c tc dng iu ho.

- Shnh thnhphc hp prothrombinase theo c chni sinh.Mu bchn thng, mu tip xc vi collagen hoc bmt vt lth lm hot ho yu tXII vgii phng phospholipid tiu cu. Yu tXIIachuyn yu tXI thnh yu tXIa(c stham giaca yu tFletcher v Fitzgerald). Yu tXIachuyn yu IX thnh yu tIXa(c stham gia cayu ttiu cu). Yu tX c hot ho c stham gia ca yu tVIIIa(yu tVIII c hot

nhthrombin), yu tIXa, ion Ca++v phospholipid. Shnh thnh phc hp prothrombinase t

yu tXac stham gia ca phospholipid, yu tVa(yu tV c hot ho nhthrombin) v

ion Ca++. Shnh thnh phc hp prothrombinase theo c chni sinh chm hn rt nhiu (1-6pht) so vi c chngoi sinh (15 giy).Prothrombinase c hnh thnh tc chni sinh hoc ngoi sinh hoc ng thi chai c


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chni sinh v ngoi sinh. iu ny chng thot tnh ca prothrombinase l phthuc vo shot ho ca cc yu ttham gia vo qu trnh ny.

2.2.2.Shnh thnh thrombinProthrombin l a2-globulin, do gan sn xut, c trng lng phn t68700, nng trong mu

bnh thng l 15mg/100ml mu. Khi phc hp prothrombinase hnh thnh n schuynprothrombin thnh thrombin. Giai on ny cng cn sc mt ca ion Ca++. Shnh thnhthrombin tprothrombin l rt nhanh, c tnh bng vi giy.

2.2.3. Shnh thnh fibrin.Fibrinogen l mt protein do gan sn xut, trng lng phn t340000, nng trong mubnh thng l 100-700mg/100ml mu. Bnh thng fibrinogen rt kh vo dch k. Khi thnh

mch tng tnh thm (m bvim) th fibrinogen vo dch kv bng li do cc yu tgyng mu cng vo dch k.Thrombin sau khi c hnh thnh chuyn fibrinogen thnh fibrin n phn. Cc fibrin nphn ttrng hp thnh fibrin dng si. Mt mng li fibrin hnh thnh v cn nhnhyu tXIII. Giai on ny cng c stham gia ca ion Ca++. Cc tbo mu c gili

trn li fibrin v to nn cc mu ng. Chnh mng li ny dnh vo vtr tn thng cathnh mch ngn cn schy mu.Bn cht ca mu ng l hnh thnh li fibrin tfibrinogen nhthrombin. Chnh v vy ccnh ngoi khoa sdng thrombin (dng tm, gc hoc bt...) cm mu khi phu thut,c bit l cm mu cc xng xp.

2.3. Sco cc mu ng.Sau khi cc mu ng hnh thnh, n bt co l i v rra huyt thanh (huyt tng bly mtfibrinogen th c gi l huyt thanh).

Tiu cu c vai tr quan trng cho sco cc mu ng. Tiu cu c tc dng gn cc si fibrinli vi nhau vn nh vng chc fibrin. Tiu cu bm trn li fibrin, khi n co rt n lm choli fibrin co theo, ng thi vi sgii phng yu t8 ca tiu cu lm cho cc mu ng cocng mnh hn. Co cc mu ng cn c stham gia ca thrombin, ion Ca++. Cc mu ng lcny rt bn vng, gicho cc mp ca thnh mch tn thng khp li gn nhau to iu kin

thun li cho lin vt thng.2.4. Stan cc mu ng.Trong huyt tng c pasminogen (profibrinolysin). Cc m tn thng, ni mc tn thng v

vi khun gii phng ra cht hot ho plasminogen. Khong mt ngy sau khi cc mu ng,cht ny chuyn plasminogen thnh plasmin. Plasmin l mt enzym lm tiu fibrin v c

fibrinogen lm tan cc mu. V l do ny m c thgy ra chy mu thpht rt nguy him, cnphi c phng. Tivim, nu vi khun lm tiu fibrin i th c thslm cho vi khunlan rng v hng ro fibrin bo v bph v. Song cng nhc chny m trong c thchin tng ttiu fibrin lm khai thng nhiu mch mu nhbtc nghn.


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5.CU TO - CHC NNG CA HNG CUI. CU TO

1. HNH DNG V KCH THC.

Hng cu trng thnh, lu thng trong mu l tbo khng c nhn. iu kin tnhin, nc hnh a lm hai mt, ng knh khong 7,2mm, bdy ngoi vi l 2,2mm, trung tm l

1mm

Thtch mt hng cu l 83mm3(83femtolit). Nhc tnh n hi tt m hng cu ddngthay i hnh dng khi i qua cc mao mch. Din tch bmt hng cu ln (do c hai mt lm),

v vy khi hng cu bin dng mng hng cu khng bcng v vra. Nu tnh din tch ton b

mng hng cu trong c thcng li, c thln n 3000m2

.2. THNH PHN.Tlthnh phn ca hng cu

% Cc thnh phn

67,00 Nc

28,00 Hemoglobin

0,30 Lipid cc loi (lecitin, cholesterol)

2,00 Nhng cht khc c cha nit (enym, protein,

glutation)

0,02 Ur

1,20 Cc cht v c (K+)

Hng cu c mt cu trc c bit vi nhiu thnh phn khc nhau. N gm mt nn do proteinv lipid to nn. a slipid u kt hp vi protein to thnh lipoprotein. Trong nn cn c

glucose, clorua, phosphat... Nn v mng chim 2 -5% trng lng hng cu. Gia cc mt cann c hemoglobin. Hai thnh phn quan trng nht ca hng cu c nghin cu nhiu lmng hng cu v hemoglobin. Mng hng cu mang nhiu khng nguyn nhm mu.Hemoglobin l thnh phn quan trng trong svn chuyn kh ca mu.3. SLNG.Ngi trng thnh, mu ngoi vi c 3,8 x 1012hng cu/lt (i vi n); 4,2 x1012hngcu/lt (i vi nam). Trmi sinh, ngy u slng hng cu rt cao (5,0 x1012hng


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cu/lt). Sau , do hin tng tan mu, slng hng cu gim dn. Trem di 15 tui c slng hng cu thp hn ngi trng thnh 0,1 - 0,2 x 1012hng cu/lt. Slng hng cu

n nh tui trng thnh.Slng hng cu tng ln sau ba n, khi lao ng thlc, sng trn ni cao 700 - 1000m,

khi ra nhiu mhi, i nhiu, a chy, bng mt huyt tng, trong bnh a hng cu, bnhtim bm sinh.... Slng hng cu gim lc ng, khi ung nhiu nc, cui kzhnh kinh, sau, i lu ngy, ni c phn p oxy cao, cc loi bnh thiu mu, suy tu, nhim c, chy

mu trong, chy mu do vt thng...4. QU TRNH SINH HNG CU4.1. Ngun gc v cc giai on pht trin ca hng cu

Nhng tun u ca thai nhi hng cu c nhn c l thai gia sn xut. Tthng thhai tri gan, lch, sau l hch bch huyt cng sn xut ra hng cu c nhn. Tthng th5 ca

kzpht trin thai, tuxng bt u sn xut hng cu v t tri, tuxng l ni duynht sinh ra hng cu. Sau tui 20 cc tuxng di bmho, cn tuxng xp nh xngsng, xng sn, xng c, xng chu sn xut hng cu. V vy tui gi dbthiu mu

hn.Tbo tuxng l tbo gc vn nng c khnng duy tr ngun cung cp tbo gc v phttrin thnh tbo gc bit ho to ra cc dng khc nhau ca tbo mu (theo thuyt mtngun gc). Tbo gc bit ho sinh ra hng cu c gi l n vto cm ca dng hngcu: C.F.U.E (Colony forming unit erythrocyt). Sau cc tbo dng hng cu tri qua cc giai

on sau y.Tin nguyn hng cu (proerythoblast)

Nguyn hng cu a kim( normoblast a kim) Nguyn hng cu a sc (normoblast a

sc) Nguyn hng cu (normoblast) Hng cu li (reficulocyt) Hng cu trng thnh(erythrocyt)

Nhn ca nguyn hng cu mt i khi nng hemoglobin trong bo tng cao > 34%. Hngcu chnh thc khng c nhn xuyn mch ri btuxng vo htun hon chung. Hng culi cng c khnng vo mu nh hng cu trng thnh nhng tlrt thp chchim 1%

tng slng hng cu mu ngoi vi, khong 1-2 ngy sau hng cu li trthnh hng cutrng thnh. Hng cu sng trong mu khong 120 ngy (ngi da trng), gn 120 ngy(ngi Vit).Hthng enzym ni bo hng cu lun lun tng hp ATP tglucose duy tr tnh n hica mng tbo, duy tr vn chuyn ion qua mng, gicho st lun lun c ho tr2, ng thi

ngn cn soxy ho protein trong hng cu. Trong qu trnh sng, hthng enzym gim dn,hng cu gi ci, mng hng cu km bn v dv.Mt phn hng cu thutrong mu, cn i bphn hng cu bhutrong tchc vng - nim ca lch, gan, tuxng. Hemoglobin c gii phng ra bthc bo ngay bi cc i thcbo lch, gan, tuxng. i thc bo gii phng st vo mu v n c vn chuyn di


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dng ferritin. Phn porphyrin ca hem trong i thc bo c chuyn thnh sc tbilirubingii phng vo mu, ri qua gan bi tit theo mt.

4.2.Cc nguyn liu cn thit cho qu trnh sinh hng cuto thnh hng cu, trong c thc hai qu trnh song song: sto thnh tbo hng cu

v stng hp hemoglobin. y l nhng qu trnh rt phc tp, i hi nhiu nguyn liu nhprotein, cholin, thymidin, acid nicotinic, thiamin, pyridoxin, acid folic, vitamin B12, Fe++, nhiuenzym v cht xc tc cho qu trnh tng hp ny.

Vitamin B12 v acid folic rt cn cho qu trnh tng hp thymidintriphosphat, mt trong nhngthnh phn quan trng ca DNA. Thiu vitamin B12 v acid folic slm gim DNA, tbo skhng phn chia v khng trng thnh c.Lc ny cc nguyn hng cu trong tuxng c

kch thc ln hn bnh thng, c gi l nguyn bo khng l. Tbo to ra l v lng DNAkhng nhng lng RNA li tng dn ln hn bnh thng, tbo tng tng hphemoglobin hn v cc bo quan cng nhiu hn. Cc hng cu trng thnh sc hnh budc khng u, mng mng hn v i sng sngn hn (chbng 1/3 - 1/2 thi gian ca hngcu bnh thng).

Vitamin B12 qua ng tiu ho kt hp vi yu tni (tbo vin tuyn ddy bi tit).Phc hp ny gn vo receptor mng tbo nim mc hi trng v vitamin B12 c hp thutheo c chm bo. Vitamin B12 vo mu, dtrgan. Nhu cu vitamin B12 l 1 - 3 mg/24h.Trong khi sdtrvitamin B12 ca gan c thgp 1000 ln nhu cu ca c thtrong mtngy.

Thnh phn thhai khng km phn quan trng l st. St c hp thu theo ng tiu hovo mu. Trong mu, st c kt hp vi mt globulin l apotransferrin to thnhtransferrin vn chuyn trong huyt tng (v st lin kt vi globulin rt lng lo). St c vn

chuyn ti cc m c bit: tchc vng - ni m v gan. Ti y, st c gii phng ra vc tbo hp thu.Trong bo tng, st kt hp vi mt protein l apoferritin to thnh ferritin l dng dtrst. Mt lng nhst c dtrdng hemosiderin trong tbo. c tnh duy nht catransferrin l n gn rt mnh vi receptor mng tbo nguyn hng cu. Trong tbo,

transferrin gii phng st vo ty lp th. Ti y din ra qu trnh tng hp hem. Mi ngy mtngi trng thnh cn 1mg st. Phncn st nhiu gp i so vi nam gii v bmt muqua mu kinh nguyt. St bthi hng ngy qua phn v mhi.St c hp thu rut nhapoferritin do gan sn xut, bi tit theo mt vo t trng.Apoferritin gn vi st tdo hoc vi st ca hemoglobin, myoglobin to thnh

transferrin.Transferrin gn vo receptor tbo nim mc rut, ri vo mu. St c hp thurt chm v rt t, mc d st c n vo theo thc n l kh nhiu. Khi apoferritin trong c

thbo ho st th transferrin khng gii phng st cho cc m v cng khng nhn st trut,hp thu st bngng li.Khi c ththa st, gan gim sn xut apoferritin lm cho apoferritin trong mu v mt gim v


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cng lm gim hp thu st. Trong trng hp n qu nhiu st, st vo mu nhiu dn n lngng hemosiderin trong cc tbo vng - ni m, gy c hi cho tbo ny.

4.3. Siu ho qu trnh sinh hng cuSlng hng cu mu ngoi vi c iu ho hng nh nhm cung cp oxy cho tbo

hot ng. Stng trng v sinh sn ca cc tbo gc c kim sot bi cc protein kchthch tng trng, v dnh interleukin 3.Cc tbo gc bit ho n lt mnh li chu skch thch tng trng ca cc cht gy bit

ho, m cc cht ny li c rt nhiu c quan nh thn, gan... sn xut khi chng bthiuoxy.

Bnh nhn bthiu mu do mt mu, bgim chc nng tuxng khi bchiu x, nhng ngi

sng vng ni cao c nng oxy trong khng kh thp hn bnh thng, bnh nhn bsuytim, cc bnh vphi c gim trao i kh phi... u gy ra thiu oxy cc m lm cho qu

trnh oxy ho cc m bgim i.Khi cc m bthiu oxy chng sn xut ra erythropoietin. Erythropoietin l mt glucoprotein cTLPT l 34000. Bnh thng 80-90% erythropoietin l do thn sn xut, cn li l do gan sn

xut. Mt sm khc cng sn xut erythropoietin, nhng khng ng k. V vy chng ta cthgp bnh nhn thiu mu do suy thn mn tnh. Khi thn v gan thiu oxy, erythropoietinsc sn xut sau vi pht hoc sau vi gi.Erythropoietin do thn sn xut dng cha hot ng gi l erythogenin. Nhkt hp vimt globulin (do gan sn xut) erythogenin chuyn thnh erythropoietin hot ng.

Erythropoietin c tc dng: kch thch qu trnh chuyn C.P.U.E thnh tin nguyn hng cu vkch thch chuyn nhanh cc hng cu non thnh hng cu trng thnh.5. SC BN HNG CU

Mng hng cu l mt mng bn thm. Nc c thqua mng hng cu khi p xut thm thubn trong v bn ngoi hng cu khc nhau. Ngi ta xc nh sc bn hng cu bng dung

dch mui NaCl nhc trng c nng khc nhau t0,02% mt ( phng php Hamberger).Hng cu trong dung dch mui NaCl nhc trng btrng to ln v vra do nc tdungdch mui vo trong hng cu.Khi hng cu v, hemoglobin gii phng vo dung dch v lm

cho n c mu hng. Mt shng cu bt u vtrong dung dch mui NaCl nhc trng0,44%. Nng mui NaCl 0,44% c gi l sc bn ti thiu ca hng cu. Ton bhng cuvht trong dung dch NaCl nhc trng 0,34%. Nng mui NaCl 0,34% c gi l scbn ti a ca hng cu.Sc bn ca hng cu gim trong bnh vng da huhuyt, tng ln sau ct lch.

6. TC LNG HNG CUMu c chng ng, t trongng nghim, hng cu lng xung di, huyt tng ni lntrn. iu xy ra l do ttrng ca hng cu (1,097) cao hn ttrng ca huyt tng

(1,028). Khi c qu trnh vim din ra trong c thlm hm lng cc protein mu thay i, cnbng in tch protein huyt tng thay i, in tch mng hng cu cng bbin i theo,


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hng cu ddnh li vi nhau hn v lm cho n lng nhanh hn.Nh vy tc lng mu cng cao th qu trnh vim ang din ra trong c thcng mnh. Ch

stc lng hng cu l chiu cao ct huyt tng tnh bng mm trong 1h, 2h v 24h.7. HEMOGLOBIN

7.1. Cu trc ca Hemoglobin.Hemoglobin (Hb) l 1 protein mu, phc tp thuc nhm chromoproteid mu , c nhmngoi l hem. Hb l thnh phn chyu ca hng cu, chim 28% v tng ng vi 14,6g trong

100 ml mu. TLPT ca Hb l 64.458.Hb gm 2 phn: hem v globin. Mi phn tHb c 4 hem v 1 globin. N c to thnh t4di n v. Mi di n vl 1 hem kt hp vi globin.

Globin c cu trc l cc chui polypeptid. ngi ln, 4 chui polypeptid ging nhau tng imt: 2 chui a v 2 chui b. Cc di n vlin kt vi nhau bng lin kt yu: lin kt ion, lin

kt hydro, to nn cu trc bc 4 ca phn tHb (hnh 3.2). chui polypeptid ca mi din vc 1 hc cha hem. Trung tm ca phn tHb c 1 hc rng gi l hc trung tm (hnh3.3). Hc trung tm tip nhn phn t2,3 diphosphoglycerat (2,3 DPG) v skt hp ca hc

trung tm vi 2,3 DPG c vai tr iu ho i lc ca Hb vi 0xy.Thnh phn th2 ca Hb l hem. Sc them thuc loi porphyrin l nhng cht c khnng

kt hp vi nguyn tkim loi. Hem ngi l porotophyrin IX kt hp vi Fe++. Hem c 4nhn pyrol lin kt vi nhau bng cu ni menten (-CH=). Vng porphyrin c gn cc gcmetyl (-CH3) vtr 1, 3, 5, 8; cc gc vinyl (-CH=CH2) vtr 2,4; cc gc propionyl (-CH2- CH2-

C00H) vtr 6,7. Fe++gn vi nh pha trong ca nhn pyrol bng hai lin kt ng ho trvhai lin kt phi tr v vi globin qua gc histidin (hnh 3.4).Porphyrin l phbin trong thgii sinh vt. Porphyrin kt hp vi Mg++to thnh cht dip

lc ca thc vt.Hem c thkt hp vi nhiu cht khc nhau. Nu hem kt hp vi globin th to thnh Hb.

Nu hem kt hp vi albumin, NH3, pyridin, nicotin... to nn cht gi l hemochromogen. Hemphn ng vi NaCl trong mi trng acid to ra chloruahem (hemin). Phn ng ny c sdng trong php y.

7.2 Cc loi hemoglobin ngi.Hemogobin khc nhau phn cu to globin. Hb ca thai nhi l HbF. Globin ca HbF gm haichui a v hai chui g. Hb ca ngi ln l HbA. Globin ca HbA gm hai chui a v hai chui b(vtr th3 ca chui b l glutamin c thay bng threonin chui g). Hb ca bnh nhn mcbnh thiu mu c hng cu hnh li lim l HbS (HbB) vtr th6 ca chui b l valin c

thay bng glutamin. Loi hng cu ny rt dvkhi qua mao mch nh. HbC v HbD l cc Hbbnh thng gp mt schng tc ngi Chu Phi.C nhiu phng php nh lng Hb, kccc phng php khng chy mu. Bnh thngngi Vit c Hb l 14,6g (i vi nam) v 13,3g (i vi n) trong 100ml mu. m slnghng cu v nh lng Hb l nhng xt nghim quan trng trong nh gi sthiu mu, thiu


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mu ng sc (gi trhng cu =1), thiu mu u sc (gi trhng cu >1) v thiu mu nhcsc (gi trhng cu


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Mt khc C02m sau khi khuych tn vo trong hng cu th ti y din ra qu trnh C02+H20 H2C03nhmen xc tc carboanhydrase (men ny c nhiu trong hng cu). Sau H2C03

phn ly H++ HC03- . Nhhiu ng Hamburger m HC03

- c khuych tn rt nhiu ttronghng cu chuyn sang huyt tng to ra dng vn chuyn C02quan trng nht ca mu

(C02 c vn chuyn di dng HC03-

). Nh vy hng cu ng vai tr quan trng bcnht trong svn chuyn C02dng HC03-ca huyt tng.

2. Chc nng iu ho cn bng acid - base ca mu.

Chc nng ny do hm hemoglobinat m nhim. ng thi vi hm ca Hb, hng cucn to ra HC03

-trong qa trnh vn chuyn C02, nn n to ra hm bicarbonatHC03/H2C03,hm quan trng nht ca mu.

3. Chc nng to nht ca mu.Hng cu l thnh phn chyu to nht ca mu, nhnht m tc tun hon, nht

l tun hon mao mch, hng nh. Tc tun hon hng nh l iu kin thun li cho strao i vt cht gia tbo v mu. Khi nht ca mu thay i sgy ra thay i tc tun hon v lm ri lon trao i vt cht ca tbo.

6.TIU CUTrong tuxng c nhng tbo nhn khng l(40-100mm). Cc tbo ny c bit ho t

tbo gc vn nng.

Tbo c nhn rt to, nhiu thuz, a dng vi nhim sc thphn bkhng u. Bo tngnhiu, mu nht, c nhiu ht rt nhmu xanh l. Tbo nhn khng lcho gitc dichuyn. Cc gitc ny bteo li, tch ra, t on thnh tiu cu lu thng trong mu. Nh

vy, tiu cu (thrombocyt) l mt phn bo tng ca tbo nhn khng l, l mt tbokhng hon chnh, khng c nhn, rt a dng, bo tng tm nht c ht mu xanh, rt khm v dvkhi ly ra khi c th

Tiu cu c kch thc 2-4mm, thtch 7-8mm3. Bnh thng c 150-300 x 109tiu cu

trong 1 lt mu ngoi vi.Tiu cu c cu trc mng glycoprotein, lp ny ngn cn tiu cu dnh vo ni mc nhng liddnh vo ni thnh mch tn thng c cht collagen lra. Mng tiu cu cng rt ddnhvo cc vt l. Khi bm vo vt l, chng li c thtbm vo nhau thnh tng m. Tiu cu

cha actomyosin, thromstbohenin nn tiu cu c khnng co rt. Tiu cu co rt mnh sbvra v gii phng serotonin gy co mch, cc phospholipid v cc yu tgy ng mu thamgia vo qu trnh gy ng mu.


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- Yu t1 l yu tc khnng chuyn prothrombin thnh thrombin. Vbn cht yu t1 gnging yu tV ca huyt tng.

- Yu t2 l yu tc tc dng y nhanh fibrinogen thnh fibrin khi c mt ca thrombin.- Yu t3 l mt phospholipid c hot tnh ca thromboplastin.

- Yu t4 l yu tc hot tnh ca antiheparin to iu kin thun li cho giai on u caqu trnh ng mu.- Yu t5 l serotonin c khnng gy co mch v c khnng lm mu ng ti ch.

- Yu t6 l mt protein c tc dng lm dy thnh mch v lm gim tnh thm thnh mch.- Yu t7 l antifibrinolysin, cht c tc dng ngn cn phn ng lm tan cc mu.- Yu t8 retractozym l mt yu tc tc dng lm co cc mu ng.

- Yu t9 l mt cht lmn nh fibrin.Vi c im chc nng trn y, tiu cu tham gia vo qu trnh cm mu, c xem nh

l mt hng ro bo vsmt mu. Tiu cu cng c khnng gn ln vi khun to iu kinthun li cho qu trnh thc bo c ddng. Ngoi ra tiu cu cn c tc dng khc na nhlm hhuyt p, chc nng min dch v chc nng sn xut cc enzym huprotein.

Ssn xut tiu cu c iu ho bng slng tiu cu nhc chdo cc yu ttronghuyt tng kim sot. Tiu cu btiu dit lch. i sng tiu cu cha c nghin cuy , ngi ta cho rng n sng trong mu khong 9-11 ngy.Slng tiu cu tng ln khi lao ng, khi n ung, khi bchy mu, bnh a sinh mn tnh thtubo, bnh Hodgkin, bnh Vaquez. Slng tiu cu gim trong nhim c, nhim x, xut

huyt di da, nim mc, suy tu, bnh Biermer, bnh Werlhoff.

7.BCH CU1. HNH DNG V SLNG.

Bch cu l cc tbo c nhn, hnh dng v kch thc rt khc nhau tuztng loi. Bch cukhng phi chlu thng trong mu, m n cn c mt nhiu ni trong c th: bch huyt,dch no tu, hch bch huyt, cc tchc lin kt...

Thnh phn bch cu rt phc tp, gm nhiu cht hu c v v c. Bo tng ca bch cucha nhiu st, calci, lipid (cholesterol, triglycerid v acid bo). Cc lipid ny lin quan ti vai trchng nhim trng ca bch cu. Bch cu cha nhiu lipid c xem nh tin lng tt chngnhim trng (Boyd,1973). trong bch cu cn c nhiu acid ascorbic, ht glycogen. Ht glycogen

nhiu ln trong qu trnh tiu ho v mc bnh i tho ng. Bch cu c mt hthngenzym rt phong ph (oxydase, peroxydase, catalase, lipase, amylase) v mt scht ditkhun.


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Trn mng tbo bch cu c rt nhiu ththlin quan ti chc nng ca bch cu. Da vocc ththny, nhcc kthut hin i, ta c thphn loi c bch cu v theo di cc

giai on pht trin ca bch cu.Trn bmt lympho bo c hthng khng nguyn ph hp tchc. Mc d mt skhng

nguyn c mt trn tbo ca nhiu m, nhng chng li bpht hin ddng trn lymphobo. Do tt ckhng nguyn ph hp tchc chyu ca ngi c k hiu l HLA(humanlymphocyt antigen). Tt cHLA hp thnh hthng khng nguyn ph hp tchc cangi, cn gi l hthng HLA, chia thnh 5 nhm. Nhm HLA-A, nhm HLA-B, nhm HLA-C,nhm HLA-D v nhm HLA-DR. Di cc nhm ny c rt nhiu phn nhm c t tn. Hthng khng nguyn HLA di truyn v rt c { ngha trong p ng min dch thi ghp.

Trong 1lt mu ngoi vi c 7,0 x 109bch cu (i vi nam) 6,2 x109bch cu (i vi n), nhnchung vo khong 5,0 x 109n 9,0 x 109 bch cu (i vi ngi trng thnh). Trs sinh c

slng bch cu rt cao: 20,0 x109bch cu/1lt mu ngoi vi. Lc mt tui cn 10,0 x109bch cu/1lit mu. T12 tui tri slng bch cu trvn nh bng ngi trngthnh.

Slng bch cu tng ln khin ung, khi lao ng thlc, thng cui ca thi kzmang thai,sau khi . c bit slng bch cu tng ln khi nhim khun, bnh bch cu. Mt shormon v mt stinh cht m cng lm tng slng bch cu nh: hormon tuyn gip,adrenalin, estrogen, tinh cht gan, tinh cht lch, tuxng. Slng bch cu gim khi blnh, khi bi, khi gi yu, suy nhc tu, nhim virus, nhim c, nhim trng qu nng, hoc

iu trbng cc hormon corticoid, insulin ko di...

2. PHN LOI BCH CU.

Vmt i th, vi kthut kinh in, da vo hnh dng, kch thc tbo, hnh dng nhn,sbt mu ca ht trong bo tng. Ngy nay nhkthut hin i cn pht hin c cc

ththbmt tbo bch cu v.v...; ngi ta c thphn loi bch cu thnh bch cu ht(bch cu a nhn) v bch cu khng ht (bch cu n nhn). Bch cu a nhn c chialm 3 loi: trung tnh, a acid v base. Bch cu n nhn c chia lm 2 loi: monocyt v

lymphocyt. ngi bnh thng, tlcc bch cu trong mu ngoi vi nh sau:Bch cu ht a acid (E): 2,3%Bch cu ht a base (B): 0,4%

Bch cu monocyt (M) : 5,3%Bch cu ht trung tnh (N): 62,0%Bch cu lymphocyt (L): 30,0%

Cc nh lm sng thng gi tl% cc loi bch cu mu ngoi vi l cng thc bch cu phthng. Cng thc thay i khi n ung, khi lao ng, khi c kinh nguyt, khi c thai trn 4 thng,


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khi . Trs sinh c ti 70% l bch cu a nhn, tthng th3 tri chcn 35% l cc bchcu a nhn (lc ny chyu l lympho bo). Cng thc bch cu dnn nh n sau tui dy

th mi bng ngi trng thnh.Ngy nay nhkthut cao chng ta c thphn loi bch cu mt cch chi tit hn vi mc

ch tm hiu chc nng ca tng loi bch cu phc vcho nghin cu khoa hc, chn on viu tr. Tuy vy vic xc nh cng thc bch cu phthng v slng bch cu vn c coil xt nghim thng quy ca bnh vin v n vn cn gi trthc tin. ng thi vi xc nh

gi trtng i (l tl% ca tng bch cu), cc nh lm sng cn xc nh gi trtuyt i(slng tng loi bch cu c trong 1lt mu). Chsny rt cn cho stin lng bnh.Bch cu a nhn trung tnh (N) tng >70% trong cc trng hp nhim khun cp, qu trnh

lm m, vim tnh mch, nghn mch, nhi mu c tim, nhi mu phi. N cn tng trong cogit ng kinh, a protein vo trong c th, chy mu phc mc nh. ng thi vi N tng cn

c bch cu a (stab) tng.- Bch cu a nhn trung tnh gim


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Dng monocyt: tbo gc vn nng pht trin qua nhiu giai on bit ho thnh monocyt.Cha bit chnh xc thi gian sng ca bch cu trong mu l bao lu v bch cu c mt khp

mi ni. Bch cu vo cc c quan ri tcc c quan quay trli mu. Thi gian bch cu cmt trong mu chng qua l thi gian vn chuyn bch cu tni sn xut n ni sdng. V

vy thi gian sng ca bch cu trong mu l rt ngn.Nu ngng sn xut bch cu t ngt (bng cch chiu tia g) trong 3 n 6 ngy u mungoi vi khng cn bch cu a nhn trung tnh. Thi gian bch cu sng trong mu khang 4-5

ngy. Thi gian bch cu sng ctrong v ngoi mch khong 8-12 ngy. Thi gian bch cu tnti trong tuxng khong 4-8 gi. Kh c thxc nh chnh xc thi gian sng ca bch cumonocyt v n lun lun qua li gia cc m. Thi gian lu thng ca monocyt trong mu

khong 10-20 gi. Thi gian sng ca monocyt trong ccvim di hn bch cu a nhn trungtnh. Lympho bo vo htun hon lin tc quang ngc. Slng lympho bo trongng ngc

vo htun hon chung trong 24 githng l gp nhiu ln slng lympho bo mu mtthi im. iu chng tthi gian lympho bo sng trong mu l rt ngn (24h). Bch culympho tc quan bch huyt vo mu, tmu ti m, tm li vo c quan bch huyt, ri

li vo mu... chu kzcthdin ra lin tc.Bch cu btiu dit khp mi ni trong c thkhi bgi ci, nhng chyu l trong lngngtiu ho, phi v lch. Bch cu (c bit l cc i thc bo, bch cu ht trung tnh) btiudit ccvim, cc vng v cc din ca c thdbvi khun t nhp nh da, phi, nimmc.

4. C TNH CA BCH CU.

Bch cu c nhng c tnh chung sau y:

4.1. Xuyn mch.Bch cu M v N c khnng thay i hnh dng, xuyn qua vch gia cc tbo ti nhng

ni cn thit.4.2. Chuyn ng theo kiu a mip.Bch cu M v N c khnng chuyn ng bng chn gi(theo kiu amip) vi tc :

40mm/min.

4.3. Ho ng ng v nhit ng ngC mt scht do m vim sn xut, do vi khun to ra hoc nhng cht ho hc a tngoi

vo c ththu ht bch cu ti (ho ng ng dngtnh) hoc xua ui bch cu ra xa hn(ho ng ng m tnh). Tng t, vi nhit cng nh vy, bch cu cng c nhit ng ngdng tnh v m tnh. Cc c tnh ny chyu l ca bch cu M v N.4.4. Thc bo.Bch cu M v N c khnng thc bo,m bo. Nhng iu kin thun li cho thc bo l:


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+ Bmt ca vt rng v x x.+ Khng c vbc. Cc cht tnhin trong c thc vbc l protein, cc cht ny y tbo

thc bo ra xa nn kh thc bo. Cc m cht, cc vt lkhng c vbc v thng tch inrt mnh nn chng dbthc bo.

+ Qu trnh opsonin ho. Cc khng th(c sn xut trong qu trnh min dch) gn vomng tbo vi khun lm cho vi khun dbthc bo.Sthc bo c thc hin nh sau:

Bch cu tip cn vt l, phng chn gibao vy vt l, to thnh mt ti kn cha vt l. Tiny xm nhp vo trong tbo, tch khi mng tbo to ra mt ti thc bo tri tdo trongbo tng. Ti thc bo tip cn lysosom v cc ht khc trong bo tng v xut hin hin

tng ho mng. Cc enzym tiu ho v cc tc nhn git vi khun c trt vo ti thc boxl vt l. Ti thc bo trthnh ti tiu ho. Sau khi tiu ho, cc sn phm cn thit cho

tbo c gili, cc sn phm khng cn thit sc othi ra khi tbo bng qutrnh xut bo.Tnh thc bo ca bch cu khng phi l v hn. Mt bch cu ht trung tnh c ththc bo

5-25 vi khun th cht. i thc bo c khnng thc bo mnh hn nhiu. N c ththc boti 100 vi khun. Khi nghin cu chc nng thc bo ca bch cu, ngi ta thng sdng"chsthc bo" nh gi chc nng ny.Bch cu c mt khp ni trong c thcho nn vi khun t nhp bng bt kzng nocng btiu dit. c bit bch cu trn ginhng ni quan trng ca c thm vi khun d

xm nhp vo nh: da, nim mc, cc hc tnhin, phi, ng tiu ho, gan, lch. Tuy vy cmt svi khun bbch cu "nut" nhng khng "git" c nh mycobacteria, salmonella,listera ... Nhng vi khun nyn nu ri nhn ln trong i thc bo. Bch cu N v i thc

bo cn cha nhng cht git vi khun. Mt svi khun khng btiu ho bi cc enzym calysosom v chng c vbc bo v, hoc c cc yu tngn chn tc dng ca cc enzym tiuho nhng li bcht bi cc cht git vi khun. Cc cht git vi khun l cc cht oxy ho mnhnh superoxid (02-), hydrogenperoxid (H202), ion hydroxyl (0H

-). Ngoi ra enzym

mieloperoxydase ca lysosom cng c khnng git vi khun v n lm tan mng lipid ca vi

khun.

5. QU TRNH VIM.

Khi vim, c tnh ca m bthay i nh sau:- Gin mch ti chlm cho lu lng mu tng ln.- Tng tnh thm mao mch gy ph n.- ng dch kv dch bch huyt do fibrinogen v cc yu tgy ng mu thot vo.- Tp trung nhiu bch cu N v i thc bo.


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- Cc tbo ca m trng phng ln.M bthng tn do bt kzmt nguyn nhn no (vi khun, chn thng, ho cht, nhit

v.v...) sgii phng histamin, bradykinin, serotonin, prostaglandin, cc yu tgy ng mu.Lympho bo T hot ho gii phng ra lymphokin. Mt scht trn hot ho i thc bo v

cng vi mt ssn phm khc do tbo tn thng v vi khun to ra gy ho ngdng tnh vi bch cu N v i thc bo. Bch cu bm mch, xuyn mch v di chuyn tivim.

Sng dch kv bch huyt to ra mt bc tng bo vngn cch gia vng vim v vnglnh. Stp trung ca bch cu (i thc bo ti trc: sau vi pht, bch cu N ti sau: sau vigi) l mt hng ro thhai. ng thi vi stp trung ca bch cu, tbo vim sn xut ra

cc globulin, cc sn phm phn hubch cu vo mu, theo mu ti tc ng ln tuxnglm tng sn xut bch cu (sau mt, hai ngy). Do qu trnh tng sn xut bch cu cho nn

trong mu sc nhiu bch cu non hn bnh thng (bch cu a).vim hnh thnh mt ci hc cha xc vi khun, bch cu N, i thc bo, tchc hoi tgil m. Mnhiu sbvthot ra ngoi hoc vo cc xoang, cc tng rng ca c th. Nu hng

ro bo vkm, vi khun slan rng vo cc c quan, c khi vo c mu. mu cng c ithc bo v bch cu N sn sng tiu dit chng. Trong nhiu trng hp c thkhng tbovc mnh cc triu chng nhim khun tng ln dn v cn phi c iu trkp thi.

6. BCH CU A NHN A ACID .

Bch cu E c khnng thc bo v ho ng ng rt yu nn khng quan trng trong nhimtrng thng thng. nhng ngi nhim k sinh trng (KST), slng bch cu E tng cao vchng ti ccnhim k sinh trng. Bch cu E gii phng ra cc cht git KST: men thu

phn tcc ht ca bo tng, oxy nguyn t, cc peptid v.v... Bch cu E cng tp trung nhiuccc phn ng dng (tiu phqun, da v.v...). Trong qu trnh tham gia vo phn ng d

ng, dng bo v bch cu B gii phng ra cc cht gy ha ng ng dng tnh vi bchcu E. Bch cu E c tc dng khc l cc cht gy vim do dng bo v bch cu B giiphng ra. Bch cu E cng c thc tc dng thc bo chng qu trnh lan rng ca vim.

7- BCH CU A NHN A BASE.

Bch cu a nhn a base c thgii phng heparin, histamin, mt t bradykinin v serotonin.Tivim cc cht trn cng c dng bo gii phng ra trong qu trnh vim. Dng bov bch cu B ng vai tr quan trng trong phn ng dng v khng thIgE gy phn ng d

ng c khnng gn vo mng dng bo v bch cu B. Khi gp khng nguyn c hiu phn


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ng vi khng thlm cho cc tbo ny bvra v gii phng heparin, histamin, bradykinin,serotonin, enzym thuphn lysosom v nhiu cht khc. Cc cht trn gy ra dng.

8. BCH CU LYMPHO.

Bch cu lympho c chia thnh hai loi: lympho bo B v lympho bo T. Chng u c chungngun gc trong bo thai l cc tbo gc vn nng. Cc tbo ny sbit ho hoc c "xl{" thnh cc lympho bo trng thnh. Mt stbo lympho di tr tuyn c v c "x

l" y nn gi l lympho bo T (Thymus). Mt stbo lympho khc c "xl" gan(na u thi kzbo thai) v tuxng (na sau thi kzbo thai). Dng tbo lympho nyc pht hin ln u tin loi chim v chng c "xl" bursa fabricicus (cu trc ny

khng c ng vt c v) nn c gi l lympho bo B (ly tchbursa).

Sau khi c "xl{" cc lympho bo lu thng trong mu ri dtrm bch huyt, ri livo mu v.v... chu kztip din nhiu ln. Chc nng chnh ca lympho bo l: lympho bo Bchu trch nhim vmin dch dch th. Lympho bo T chu trch nhim vmin dch tbo.Hai chc nng ca hai loi tbo ny c mi lin quan cht chvi nhau.8.1. Chc nng ca lympho bo B.Trc khi tip xc vi khng nguyn c hiu, cc clon lympho B ngyn trong m bch huyt.

Khi khng nguyn xm nhp vo, cc i thc bo thc bo khng nguyn v gii thiu (trnh)khng nguyn cho cc lympho bo B v lympho bo T. Cc lympho bo T htrc hot hocng gp phn hat ho lympho bo B. Cc lympho bo B c hiu vi khng nguyn c hot

ho, ngay lp tc trthnh cc nguyn bo lympho. Mt snguyn bo bit ho tip thnhnguyn tng bo l tin thn ca tng bo plasmocyt. Trong cc tbo ny c mng ni botng c ht tng sinh. Tbo phn chia rt nhanh: 9 ln phn chia trong khong 10 givtrong 4 ngy u mt nguyn tng bo sinh ra ti 500 tbo. Cc tng bo sinh khng thglobulin vi tc rt nhanh v mnh. Mi tng bo sn xut khong 2000 khng th/1giy.

Cc khng thvo htun hon. Ssn xut khng thko di vi ngy hoc vi tun cho nkhi tng bo bcht.Trong qu trnh thc hin chc nng min dch, mt snguyn bo lympho sinh ra mt lng

kh ln tbo lympho B mi ging nh tbo lympho B gc ca clon v c bsung thmvo stbo lympho gc ca clon. Cc tbo ny cng lu thng trong mu v cng c trtrong m bch huyt. Khi gp li cng mt khng nguyn chng sc hot ho mt ln na,

l cc tbo nh. Sp ng khng thca cc tbo lympho B ny din ra nhanh v mnhhn rt nhiu so vi nhng tbo lymphpo gc ca clon c hiu. iu ny gii thch ti saop ng min dch nguyn pht (tip xc khng nguyn c hiu ln u) li chm v yu hnso vi p ng min dch thpht (tip xc vi cng mt khng nguyn ln th2).8.2. Chc nng ca lympho bo T.


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Khi tip xc vi khng nguyn c hiu do i thc bo gii thiu, cc tbo lympho T ca mbch hyt tng sinh v a nhiu tbo lympho T hot ho vo bch huyt ri vo mu. Chng

i khp c thqua mao mch vo dch kri trli bch huyt vo mu mt ln na. Chu kzctip din nh vy hng thng hoc hng nm.

Tbo nhca lympho bo T cng c hnh thnh nh tbo nhca lympho bo B. png min dch tbo thpht l to ra lympho bo T hot ha mnh hn, nhanh hn p ngmin dch tbo nguyn pht. Trn bmt ca mt lympho bo T c hng trm ngn vtr

receptor.Cc khng nguyn gn vo receptor c hiu trn bmt tbo lympho T cng gingnh gn vi khng thc hiu do lympho bo B sn xut ra.Cc lympho bo T c chia thnh lympho bo T htr, lympho bo T gy c v lympho bo T

trn p. Tbo lympho T htrchim 3/4 tng stbo lympho T v c chc nng iu hohthng min dch. Siu ho ny thng qua lymphokin m quan trng nht l interleukin.

Nu thiu lymphokin ca lympho bo T th hthng min dch sbt lit. Interleukin 2, 3, 4, 5,6 c tc dng kch thch to cm bch cu ht, bch cu M v lm tng chc nng thc bo cacc tbo ny. Interleukin 2, 4, 5 kch thch tng sinh, tng trng tbo lympho T gy c t

bo v lympho bo T trn p. Cc interleukin, c bit l interleukin 4, 5, 6 kch thch rt mnhtbo lympho B v lm tng cng chc nng min dch dch th. Ngoi ra, interleukin 2 cn cvai tr iu ho ngc dng tnh i vi tbo lympho T htrlm cho p ng min dchmnh ln gp bi.Lympho bo T gy c tbo c khnng tn cng trc tip cc tbo, c khnng git cht vi

khun, i khi git cchnh bn thn c thmnh. Do c ngi gi n l tbo git tnhin(Native Kill cell, thng vit tt l NK). Cc receptor trn bmt tbo git c khnng gncht vo vi khun hoc tbo c cha cc khng nguyn c hiu. Tbo git gii phng

perforin (bn cht l mt protein) to ra nhiu ltrn mng tbo btn cng. Qua lny,cc cht gy c tbo c bm ttbo git sang tbo btn cng, lm cho tbo bgit

tan ra. Tbo git c thgit lin tip nhiu tbo khc m vn c khnng tn ti hngthng. Tbo git c tc dng c bit ln cc tbo c cha virus, v tnh khng nguyn cavirus trong tbo rt hp dn tbo git. Tbo git cng c vai tr quan trng trong sph

hutbo ung th, nht l tbo cc m ghp.Lympho bo T trn p c khnng trn p tbo lympho T htrv tbo lympho T gy ctbo. Chc nng ny l iu ho hot ng ca tbo, duy tr sp ng min dch khngqu mc, v p ng min dch qu mc sgy tc hi cho c th. V vy tbo lympho T trnp v tbo lympho T htrc gi l tbo lympho iu ho. C chiu ho ca tbo

lympho T trn p i vi tbo lympho T htrl c chiu ho ngc m tnh. Lympho boT trn p cng c khnng c chtc dng ca hthng min dch tn cng vo tbo cc mc th(hin tng dung np min dch).


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8.CHNG NG MU1. Cc yu ttrn bmt ni mc. - Strn nhn ca ni mc ngn cn shot ho do tip xc

bmt ca hthng gy ng mu.- Lp glycocalyx (bn cht l mucopolysaccarid) hp phtrn bmt ni mc, c tc dng ytiu cu v cc yu tgy ng mu cho nn ngn cn c shot ho hthng gy ng

mu.

- Thrombomodulin l mt protein ca ni mc c khnng gn vi thrombin lm bt hot

thrombin. Ngoi ra phc hp thrombomodulin-thrombin cn c tc dng hot ho protein Cca huyt tng, m protein C hot ho sngn cn tc dng ca yu tVav yu tVIIIa.2. Cc yu ttrong huyt tng.- Antithrombin.

Sau khi cc mu ng c hnh thnh i bphn thrombin c hp phtrn bmt sifibrin (fibrin c gi l antithrombin I). Phn cn li ca thrombin c kt hp vi

antithrombin III lm cho thrombin mt hot tnh sau 12-20 pht. Tc dng trn y lm gii hncc mu ng trnh cho sng mu lan rng. Ngoi ra cn c antithrombin IV c tc dngphn huthrombin, antithrombin V hn chtc dng ca thrombin trn fibrinogen.- Heparin.

Heparin (cn c gi l antithrombin II) l mt cht c hiu quchng ng rt mnh v n c

nhiu c chrt phc tp va ngn cn shnh thnh thrombin va gy bt hot thrombin.Heparin l mt polysaccarid kt hp tch in m kh mnh, bn thn n hu nh khng c tc

dng chng ng mu. Nhng khi n kt hp antithrombin III to nn phc hp heparin-antithrombin III th li c tc dng chng thrombin v cng mnh, mnh hn hng trm, hngnghn ln antithrombin III. Do chcn sc mt ca heparin th thrombin bbt hot ngayv ng mu khng xy ra. Phc hp heparin-antithrombin III cn lm bt hot cc yu tIX, X,XI v XII cho nn cng chng c sng mu.Heparin do rt nhiu tbo ca c thsn xut, c bit l dng bo khu tr cc m lin kt

quanh mao mch c th. Chng tp trung vi mt cao quanh mao mch gan v phi. Bnhthng dng bo bi tit mt lng nhheparin v heparin ny c khuch tn vo htunhon cng vi mt lng nhheparin ca bch cu ht a base thng xuyn chng c

cc mu ng hnh thnh mao mch (c bit l mao tnh mch). V vy heparin c dnglm thuc bo vchng ng mu trong lm sng.

- a2-macroglobulin.

a2-macroglobulin c trng lng phn t360.000, n c khnng kt hp vi cc yu tgyng mu v lm bt hot chng, nhng tc dng chng ng mu ca n yu hn rt nhiu

ln so vi heparin.


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- Coumarin.

Coumarin l cht a tngoi vo c thlm gim stng hp ca cc yu tII, VII, IX v X,

do ngn cn c sng mu trong c th. Coumarin l cht cnh tranh vi vitamin K, mvitamin K l cht rt cn thit cho qu trnh tng hp cc yu tII, VII, IX v X. Vitamin K l loi

vitamin tan trong du dng iu trthi gian ng mu ko di do thiu vitamin K.3. Chng ng mu ngoi c th.- ng hoc bnh cha mu c trng silicon, ngn cn shot ha do tip xc bmt ca yu

tXII v tiu cu, v vy mu khng ng.- Heparin c sdng trong v ngoi c thu cho hiu quchng ngmu rt cao.- Cc cht lm gim ion Ca++nh kalioxalat, amonioxalat, natricitrat do to ra calcioxalat,

calcicitrat nn c tc dng chng ng mu rt tt.- Mui trung tnh nh natriclorua vi nng cao cng lm bt hot thrombin nn chng cng mu.- Bo qun mu nhit thp (40C-60C) lm ngng hot ng cc enym gy ng mu nnmu cng khng ng.

9.HUYT TNGHuyt tng l phn lng ca mu, chim 55-56% thtch mu ton phn. Huyt tng l dchtrong, hi vng, sau khi n c mu sa, vhi mn v c mi c bit ca cc acid bo.

Huyt tng cha 92% l nc, cn li l cc cht hu c v cc cht v c. Huyt tng blymt fibrinogen th gi l

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