CARDIOVASCULAR SYSTEM

BLOOD-FORMED-ELEMENT-RBC

ESR ERYTHROCYTE SEDIMENTATION RATE

ESR 1- SIMPLE 2- NON-SPECIFIC 3- SCREENING TEST 4- INDIRECTLY MEASURES THE PRESENCE OF INFLAMMATION IN THE BODY .

ESR IT REFLECTS THE TENDENCY OF RBCS TO SETTLE MORE RAPIDLY IN THE FACE OF SOME DISEASE STATES, USUALLY BECAUSE OF INCREASES IN: 1-PLASMA FIBRINOGEN. 2-IMMUNOGLOBULINS, 3-ACUTE-PHASE REACTION PROTEINS. 4-CHANGES IN RED CELL SHAPE OR NUMBERS MAY ALSO AFFECT THE ESR.

THEORETICAL CONSIDERATIONS THE RBCS SEDIMENT BECAUSE THEIR DENSITY IS GREATER THAN THAT OF PLASMA; THIS IS PARTICULARLY SO, WHEN THERE IS AN ALTERATION IN THE DISTRIBUTION OF CHARGES ON THE SURFACE OF THE RBC (NORMALLY KEEPS THEM SEPARATE FROM EACH OTHER) RESULTING IN THEIR COMING TOGETHER TO FORM LARGE AGGREGATES KNOWN AS ROULEAUX.

ROULEAUX FORMATION IS DETERMINED LARGELY BY INCREASED LEVELS OF PLASMA FIBRINOGEN AND GLOBULINS, AND SO THE ESR REFLECTS MAINLY CHANGES IN THE PLASMA PROTEINS THAT ACCOMPANY 1-ACUTE 2-CHRONIC INFECTIONS 3-SOME TUMORS 4-DEGENERATIVE DISEASES. IN SUCH SITUATIONS, THE ESR VALUES ARE MUCH GREATER THAN 20MM/HR .

ESR DENOTES MERELY THE PRESENCE OF TISSUE DAMAGE OR DISEASE, BUT NOT ITS SEVERITY. IT MAY BE USED TO: A-FOLLOW THE PROGRESS OF THE DISEASED STATE. OR B-MONITOR THE EFFECTIVENESS OF TREATMENT

SOME INTERFERENCES WHICH INCREASE ESR:

1-INCREASED LEVEL OF FIBRINOGEN, GAMMA GLOBULINS. 2-TECHNICAL FACTORS: TILTED ESR TUBE, HIGH ROOM TEMPERATURE.

SOME INTERFERENCES WHICH DECREASE ESR:

A-ABNORMALLY SHAPED RBC (SICKLE CELLS, SPHEROCYTOSIS). B-TECHNICAL FACTORS: 1-SHORT ESR TUBES. 2-LOW ROOM TEMPERATURE. 3-DELAY IN TEST PERFORMANCE (>2 HOURS). 4-CLOTTED BLOOD SAMPLE 5-EXCESS ANTICOAGULANT. 6-BUBBLES IN TUBE.

HEMOGLOBIN

Hb

HEMOGLOBIN LARGE MOLECULES WITH:

1-GLOBIN 2-HEME GLOBIN COMPLEX PROTEIN WITH 4 POLYPEPTIDES (2 Α AND 2 Β POLYPEPTIDES)

HEME GROUP IRON CONTAINING PIGMENT PART OF HEMOGLOBIN (TO WHICH OXYGEN BINDS)

EACH POLYPEPTIDE HAS ONE HEME GROUP. EACH HEME CARRIES ONE O2

O2 CARRIED DOES NOT BECOME IONIC BUT

MOLECULE SO LOOSELY BOUND. NORMAL HEMOGLOBIN LEVELS (GRAMS/L00 ML BLOOD) I INFANTS 14-20 GRAMS/100 ML II ADULT FEMALE 12-16 GRAMS/100 ML III ADULT MALE 13-18 GRAMS/100 ML

HB FORMATION STARTED IN ERYTHROBLASTS & CONTINUES TILL RETICULOCYTES.

STATES OF HEMOGLOBIN

1-OXYHEMOGLOBIN - WHEN OXYGEN IS BOUND TO FE2+

2-DEOXYHEMOGLOBIN - NO OXYGEN BOUND TO FE2+

3-CARBAMINOHEMOGLOBIN - WHEN CARBON DIOXIDE BOUND (TO POLYPEPTIDE CHAIN)4-CARBON MONOXYHEMOGLOBIN – WHEN CARBON MONOXIDE BOUND TO POLYPEPTIDE CHAIN (HIGHER AFFINITY FOR CO THAN O2).

5-METHEMOGLOBIN WHEN IRON FOUND IS IN FERRIC STATE FE3+. IT IS DARK-COLORED, AND CAUSES A DUSKY DISCOLORATION OF THE SKIN RESEMBLING CYANOSIS IF FOUND IN LARGE AMOUNT.

GLYCO Hb GLYCATED HEMOGLOBIN GLYCOSYLATED Hb HEMOGLOBIN A1C, HBA1C

Hb1c SERVES AS A MARKER FOR AVERAGE BLOOD GLUCOSE LEVELS OVER THE PREVIOUS MONTHS PRIOR TO THE MEASUREMENT

THE A1C ≥ 48 MMOL/MOL (≥6.5%) AS ANOTHER CRITERION FOR THE DIAGNOSIS OF DIABETES. IN DIABETES mellitus, HIGHER AMOUNTS OF GLYCATED HEMOGLOBIN, INDICATING POORER CONTROL OF BLOOD GLUCOSE LEVELS

IN ANEMIA, THE BLOOD DOES NOT CARRY ENOUGH OXYGEN TO THE REST OF THE BODY. THE MOST COMMON CAUSE OF ANEMIA IS

NOT HAVING ENOUGH IRON. THE BODY NEEDS Fe TO MAKE Hb. WHICH IS AN IRON-RICH PROTEIN THAT GIVES THE RED COLOR TO BLOOD. IT CARRIES OXYGEN FROM THE LUNGS TO THE REST OF THE BODY.

CAUSES OF IRON DEFICIENCY

1-HEAVY PERIODS 2-PREGNANCY 3-ULCERS 4-COLON POLYPS OR COLON CANCER 5-INHERITED DISORDERS 6-A DIET LOW IN IRON,FOLIC ACID OR VITAMIN B 12 7-BLOOD DISORDERS/SICKLE CELL ANEMIA AND 8-THALASSEMIA, OR CANCER 9-APLASTIC ANEMIA/ INHERITED OR ACQUIRED

BONE MARROW (BM)

BONE MARROW (BM): IS THE FLEXIBLE TISSUE FOUND IN THE INTERIOR OF BONES. RBCs ARE PRODUCED IN THE HEADS OF LONG BONES, IN A PROCESS KNOWN AS

HEMATOPOESIS. BM CONSTITUTES 4% OF THE TOTAL BODY MASS (TBM).IN AN ADULT WEIGHING

65 KG. BM ACCOUNTS FOR APPROX. 2.6 KG.. THE HEMATOPOIETIC COMPARTMENT OF BM PRODUCES

APPROX. 500 BILLION BLOOD CELLS PER DAY.BM IS

ALSO A KEY COMPONENT OF THE LYMPHATIC SYSTEM, PRODUCING THE LYMPHOCYTE THAT SUPPORT THE BODY'S IMMUNE SYSTEM

BM TYPES THE TWO TYPES OF BONE MARROW ARE:

1-MEDULLA OSSIUM RUBRA (RED BM) WHICH CONSISTS MAINLY OF HEMATOPOIETIC TISSUE

2-MEDULLA OSSIUM FLAVA (YELLOW BM)

AT BIRTH, ALL BM IS RED. WITH AGE, MOST OF IT

IS CONVERTED TO THE YELLOW TYPE; ONLY

AROUND HALF OF ADULT BM IS RED. RED MARROW IS IN THE FLAT BONES: 1-PELVIS. 2-STERNUM. 3-CRANIUM. 4-RIBS. 5-VERTEBRAE. 6-SCAPULAE. 7-CANCELLOUS ("SPONGY") BONES AT THE EPIPHYSEAL ENDS OF LONG BONES SUCH AS THE FEMUR AND HUMERUS.

YELLOW MB:

IS FOUND IN THE MEDULLARY CAVITY THE OF THE MIDDLE PORTION OF LONG BONES. IN CASES OF SEVERE BLOOD LOSS, THE BODY CAN CONVERT YELLOW BM BACK TO RED MARROW TO INCREASE BLOOD CELL PRODUCTION.

WBCs

WBCs (LEUKOCYTES) ARE CLASSIFIED INTO:

1-GRANULOCYTES 2-AGRANULOCYTES

AS THE GRANULOCYTES, WHICH INCLUDE NEUTROPHILS, EOSINOPHILS, AND BASOPHILS, HAVE GRANULES IN THEIR CELL CYTOPLASM. NEUTROPHILS, EOSINOPHILS, AND BASOPHILS ALSO HAVE A MULTILOBED NUCLEUS. AS A RESULT THEY ARE ALSO CALLED POLYMORPHONUCLEAR LEUKOCYTES OR "POLYS." THE NUCLEI OF NEUTROPHILS ALSO APPEAR TO BE SEGMENTED, SO THEY MAY ALSO BE CALLED SEGMENTED NEUTROPHILS OR "SEGS." THE AGRANULOCYTES, LYMPHOCYTES AND MONOCYTES, D HAVE GRANULES AND HAVE NON-LOBULAR NUCLEI. THEY ARE ALSO CALLED MONONUCLEAR LEUKOCYTES .

LEUKOCYTES /WBCs

THE LIFESPAN OF WBCs RANGES FROM (13-20) DAYS,THEY ARE DESTROYED IN THE LYMPHATIC SYSTEM. WHEN IMMATURE WBCS ARE FIRST RELEASED FROM THE BONE MARROW INTO THE PERIPHERAL BLOOD, THEY ARE CALLED "BANDS“ OR "STABS." WBCs FIGHT INFECTION THRU A PROCESS KNOWN AS PHAGOCYTOSIS. WHERE LEUKOCYTES SURROUND AND DESTROY FOREIGN ORGANISMS. WBS ALSO PRODUCE, TRANSPORT, AND DISTRIBUTE ANTIBODIES AS PART OF THE BODY'S IMMUNE RESPONSE .

TOTAL WBC: 4,500 -10,000 BANDS (STABS): 3-5 %

A-GRANULOCYTES (POLYMORPHONUCLEAR) NEUTROPHILS (SEGS): 50 - 70% EOSINOPHILS: 1 - 3% BASOPHILS: 0.4% - 1%

B-AGRANULOCYTES (MONONUCLEARS) LYMPHOCYTES:------------------25 - 35%

MONOCYTES: ------------------------4 - 6%

LEUKOCYTOSISA WBC ABOVE 10,000, IS USUALLY DUE TO AN INCREASE IN ONE OF THE FIVE TYPES OF WHITE BLOOD CELLS AND IS GIVEN THE NAME OF THE CELL THAT SHOWS THE PRIMARY INCREASE. NEUTROPHILIC LEUKOCYTOSIS =NEUTROPHILIALYMPHOCYTIC LEUKOCYTOSIS = LYMPHOCYTOSIS EOSINOPHILIC LEUKOCYTOSIS = EOSINOPHILIA MONOCYTIC LEUKOCYTOSIS = MONOCYTOSIS BASOPHILIC LEUKOCYTOSIS = BASOPHILIA

IN RESPONSE TO AN ACUTE INFECTION, TRAUMA, OR INFLAMMATION, WBCS RELEASE A SUBSTANCE CALLED COLONY-STIMULATING FACTOR (CSF).

CSFSTIMULATES THE BONE MARROW TO INCREASE WBCS PRODUCTION. THE NUMBERS OF WBCS CAN DOUBLE WITHIN HOURS IF NEEDED. AN INCREASE IN THE NUMBER OF CIRCULATING LEUKOCYTES IS RARELY DUE TO AN INCREASE IN ALL FIVE TYPES OF LEUKOCYTES. WHEN THIS OCCURS, IT IS MOST OFTEN DUE TO DEHYDRATION AND HEMOCONCENTRATION. IN SOME DISEASES, SUCH AS MEASLES, PERTUSSIS AND SEPSIS, THE INCREASE IN WHITE BLOOD CELLS IS SO DRAMATIC THAT THE PICTURE RESEMBLES LEUKEMIA (LEUKEMOID REACTION) LEUKOCYTOSIS OF A TEMPORARY NATURE, MUST BE DIFFERENTIATED FROM LEUKEMIA, WHERE THE LEUKOCYTOSIS IS BOTH PERMANENT AND PROGRESSIVE .