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THE PHYSIOLOGY OF     BLOOD            By  Dr.M.ANTHONY DAVID, MD.        NOMAD:2005: BP:     1        INTROVERVIEW
WHAT IS BLOOD?• IT IS A LIQUID CONNECTIVE TISSUE• IN AN AVERAGE 70 Kg MAN:   • 100 Trillion cells.   • Of which 25 trillio...
HEMATOLOGY: THE STUDY OF BLOOD MADE POSSIBLE BY MICROSCOPY            NOMAD:2005: BP:      3            INTROVERVIEW
THE COMPOSITION OF PLASMA       • The Liquid: Plasma:          • Water, the solvent          • The solute:              • ...
THE FORMED ELEMENT: CELLS               BLOOD CELLSERYTHROCYTES   LEUCOCYTES         THROMBOCYTES                NOMAD:200...
BLOOD : COMPOSITION     NOMAD:2005: BP:   6     INTROVERVIEW
FUNCTIONS OF BLOOD• NUTRITIVE• RESPIRATORY• EXCRETORY• BODY DEFENCE: IMMUNITY• TRANSPORT:  • HORMONES  • VITAMINS  • DRUGS...
BLOOD : TRANSPORTINGHORMONE MOLECULES           NOMAD:2005: BP:   8           INTROVERVIEW
OXYGEN & CO2 TRANSPORT         NOMAD:2005: BP:   9         INTROVERVIEW
FUNCTIONS OF BLOOD• HOMEOSTATIC FUNCTION:  •ACID BASE BALANCE.  •ELECTROLYTE BALANCE.  •HEMOSTASIS.  •THERMOREGULATION.   ...
BLOOD VOLUME    NOMAD:2005: BP:   11    INTROVERVIEW
WHAT IS BLOOD VOLUME?• The total amount of blood in  circulation plus the amount of  blood in the reservoirs  constitutes ...
EXPRESSION OF BLOOD VOLUME• Usually Blood Volume is expressed  in liters.• It can also be expressed in relation  to body w...
METHODS OF MEASURING BLOOD         VOLUME• IN HUMANS: ONLY INDIRECT METHODS• DYE DILUTION TECHNIQUE:• PRINCIPLE:   • Injec...
DYE DILUTION TECHNIQUEV1 = VOLUMEC1 = CONCENTRATION     OF DYE                              V2 = VOLUME                   ...
HEMATOCRIT (PCV)• The volume of erythrocytes in  the whole blood expressed in  percentage is the Hematocrit.• This is also...
HEMATOCRIT• A mixture of blood and double oxalate  (K – NH4) is taken upto 100 mark in the  Wintrobe’s tube.• The tube is ...
HEMATOCRIT   NOMAD:2005: BP:   18   INTROVERVIEW
BLOOD VOLUME: PHYSIOLOGICAL         VARIATIONS• AGE                • PREGNANCY• SEX                • EXERCISE• TEMPERATURE...
BLOOD VOLUME & AGE    AGE         BLOOD VOLUME in Liters  AT BIRTH                        0.3  6 Months                   ...
BLOOD VOLUME: PHYSIOLOGICAL         VARIATIONS1. SEX:  • Males have more    blood volume than    females.2. TEMPERATURE:  ...
BLOOD VOLUME: PHYSIOLOGICALVARIATIONS3. BODY WEIGHT:   • It is usually 7% of the Body Weight.4. BODY SURFACE AREA:   • 2.8...
BLOOD VOLUME: PHYSIOLOGICAL          VARIATIONS5. PREGNANCY:   • Increases by 20 – 30%     due to mass of fetus.6. EXERCIS...
BLOOD VOLUME: PHYSIOLOGICAL        VARIATIONS           8. HYPOXIA:                • Seen in High                  altitud...
BLOOD VOLUME: PATHOLOGICAL    VARIATIONS : hypovolemia1. BLOOD LOSS:2. SHOCK:  • Crushing Injury  • Cardiogenic  • Neuroge...
HYPOVOLEMIA: CAUSES3. HEMOLYSIS:   • Mismatched     transfusion   • Snake bite   • Black water fever   • Hemorrhagic     P...
HYPOVOLEMIA: CAUSES4. DEHYDRATION:   • Diarrhoea   • Cholera   • Gastroenteritis   • Burns   • Hyperemesis.               ...
HYPOVOLEMIA: CAUSES (contd)5. ANEMIA:  • Decreased RBC volume  • Plasma may increase.6. OBESITY:  • Blood volume per body ...
TREATMENT FOR BLOOD LOSS• TRANSFUSION OF WHOLE  BLOOD OF THE SAME BLOOD  GROUP & TYPE.• INFUSION OF PLASMA• INFUSION OF DE...
NOMAD:2005: BP:   30INTROVERVIEW
HEMOPOIESIS &ERYTHROPOIESIS    NOMAD:2005: BP:   31    INTROVERVIEW
HEMOPOIESIS: INTRO• Hemo: Referring to blood cells• Poiesis: “The development or production  of”• The word Hemopoiesis ref...
STEM CELL THEORY• All blood cells are produced by the  bone marrow.• They come from a single class of  primitive mother ce...
PROGENITOR CELLS• Committed stem cells lose their capacity for  self-renewal.• They become irreversibly committed.• These ...
BLOOD CELLS: DEVELOPMENT                         PROGENITOR                            CELLSLYMPHOID       PRO        MEGA...
ERYTHROPOIESIS: SITES• INTRAUTERINE LIFE:   • INTRAVASCULAR PHASE: Upto 3rd month of Intra     Uterine Life.      •Endothe...
ERYTHROPOIESIS: SITES contd.      • POST NATAL LIFE:         • CHILDREN:            •Predominantly Red Bone Marrow of     ...
ERYTHROPOIESISPROERYTHROBLAST   BASOPHILIC  ERYTHROBLASTPOLYCHROMATOPHILIC   ERYTHROBLAST             ORTHOCHROMATIC      ...
FACTORS REGULATING  ERYTHROPOIESIS • SINGLE MOST IMPORTANT   REGULATOR: “TISSUE   OXYGENATION” • BURST PROMOTING ACTIVITY ...
ERYTHROPOIETIN•A hormone produced by the Kidney.•Nowadays available as Synthetic Epoietin•Increases the number of:  •Nucle...
VITAMINS• B12: Cyanocobalamine & Folic Acid:  •Is also called Extrinsic Factor of Castle.  •Needs the Intrinsic Factor fro...
IRON•Essential for the synthesis of Hemoglobin.•Deficiency causes Microcytic, Hypochromic Anemia.•Deficiency causes the co...
NOMAD:2005: BP:   43INTROVERVIEW
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Blood intro,vol& poiesis by Dr.M.Anthony David MD

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An introduction to the physiology of human blood. Useful forHealth professional students

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Transcript of "Blood intro,vol& poiesis by Dr.M.Anthony David MD"

  1. 1. THE PHYSIOLOGY OF BLOOD By Dr.M.ANTHONY DAVID, MD. NOMAD:2005: BP: 1 INTROVERVIEW
  2. 2. WHAT IS BLOOD?• IT IS A LIQUID CONNECTIVE TISSUE• IN AN AVERAGE 70 Kg MAN: • 100 Trillion cells. • Of which 25 trillions are Red Blood Cells! • The average blood volume is 5 – 6 lts. • It is roughly 7% of the total body weight. NOMAD:2005: BP: 2 INTROVERVIEW
  3. 3. HEMATOLOGY: THE STUDY OF BLOOD MADE POSSIBLE BY MICROSCOPY NOMAD:2005: BP: 3 INTROVERVIEW
  4. 4. THE COMPOSITION OF PLASMA • The Liquid: Plasma: • Water, the solvent • The solute: • Proteins: • Albumin • Globulins • Fibrinogen • Electrolytes: • Na+ • K+ • Ca++ • Organic molecules • Urea • Glucose • Lipids NOMAD:2005: BP: 4 INTROVERVIEW
  5. 5. THE FORMED ELEMENT: CELLS BLOOD CELLSERYTHROCYTES LEUCOCYTES THROMBOCYTES NOMAD:2005: BP: 5 INTROVERVIEW
  6. 6. BLOOD : COMPOSITION NOMAD:2005: BP: 6 INTROVERVIEW
  7. 7. FUNCTIONS OF BLOOD• NUTRITIVE• RESPIRATORY• EXCRETORY• BODY DEFENCE: IMMUNITY• TRANSPORT: • HORMONES • VITAMINS • DRUGS NOMAD:2005: BP: 7 INTROVERVIEW
  8. 8. BLOOD : TRANSPORTINGHORMONE MOLECULES NOMAD:2005: BP: 8 INTROVERVIEW
  9. 9. OXYGEN & CO2 TRANSPORT NOMAD:2005: BP: 9 INTROVERVIEW
  10. 10. FUNCTIONS OF BLOOD• HOMEOSTATIC FUNCTION: •ACID BASE BALANCE. •ELECTROLYTE BALANCE. •HEMOSTASIS. •THERMOREGULATION. NOMAD:2005: BP: 10 INTROVERVIEW
  11. 11. BLOOD VOLUME NOMAD:2005: BP: 11 INTROVERVIEW
  12. 12. WHAT IS BLOOD VOLUME?• The total amount of blood in circulation plus the amount of blood in the reservoirs constitutes the “Blood Volume”• The average adult 70 kg man has a blood volume of 5 to 6 litres. NOMAD:2005: BP: 12 INTROVERVIEW
  13. 13. EXPRESSION OF BLOOD VOLUME• Usually Blood Volume is expressed in liters.• It can also be expressed in relation to body weight. • It is 7% Body Weight• Another way to express it is in terms of Body Surface Area. • Whole Blood : 2.8 Lts/M2 • Plasma : 1.5 Lts/M2 NOMAD:2005: BP: 13 INTROVERVIEW
  14. 14. METHODS OF MEASURING BLOOD VOLUME• IN HUMANS: ONLY INDIRECT METHODS• DYE DILUTION TECHNIQUE:• PRINCIPLE: • Injection of a known volume of non toxic substance into the circulation. • Measuring the dilution of this injected dye after some time. • This gives us the Plasma volume. NOMAD:2005: BP: 14 INTROVERVIEW
  15. 15. DYE DILUTION TECHNIQUEV1 = VOLUMEC1 = CONCENTRATION OF DYE V2 = VOLUME C2 = CONC. OF DYEV1 X C1 = V 2 X C2ORV2 = V1 X C1 = Amount of Dye injected C2 Conc. Of NOMAD:2005: BP: the Plasma the dye in 15 INTROVERVIEW
  16. 16. HEMATOCRIT (PCV)• The volume of erythrocytes in the whole blood expressed in percentage is the Hematocrit.• This is also called as Packed Cell Volume or PCV.• This is determined by the Wintrobe’s tube, using a Centrifuge. NOMAD:2005: BP: 16 INTROVERVIEW
  17. 17. HEMATOCRIT• A mixture of blood and double oxalate (K – NH4) is taken upto 100 mark in the Wintrobe’s tube.• The tube is placed in the centrifuge.• It is rotated at 3,000 rpm for 30 minutes.• The Hematocrit is then read off the tube.• Blood Volume = Plasma Volume X 100 100 - PCV NOMAD:2005: BP: 17 INTROVERVIEW
  18. 18. HEMATOCRIT NOMAD:2005: BP: 18 INTROVERVIEW
  19. 19. BLOOD VOLUME: PHYSIOLOGICAL VARIATIONS• AGE • PREGNANCY• SEX • EXERCISE• TEMPERATURE • POSTURE• BODY WEIGHT • HYPOXIA• BODY SURFACE AREA • EMOTIONS NOMAD:2005: BP: 19 INTROVERVIEW
  20. 20. BLOOD VOLUME & AGE AGE BLOOD VOLUME in Liters AT BIRTH 0.3 6 Months 0.5 1 year 0.72yrs 6 months 1.0 4 years 1.3 7 years 1.7 10 years 2.5(Girls); 3.2 (Boys) ADULTS 5 (Men) 4.5 (Women) NOMAD:2005: BP: 20 INTROVERVIEW
  21. 21. BLOOD VOLUME: PHYSIOLOGICAL VARIATIONS1. SEX: • Males have more blood volume than females.2. TEMPERATURE: • Acute exposure to cold causes reduction in blood volume due to Plasma water loss to tissues. NOMAD:2005: BP: 21 INTROVERVIEW
  22. 22. BLOOD VOLUME: PHYSIOLOGICALVARIATIONS3. BODY WEIGHT: • It is usually 7% of the Body Weight.4. BODY SURFACE AREA: • 2.8 Lts/Square Meters of BSA NOMAD:2005: BP: 22 INTROVERVIEW
  23. 23. BLOOD VOLUME: PHYSIOLOGICAL VARIATIONS5. PREGNANCY: • Increases by 20 – 30% due to mass of fetus.6. EXERCISE: • Vigorous exercise causes an increase.7. POSTURE: • Changing from lying down to erect. NOMAD:2005: BP: 23 INTROVERVIEW
  24. 24. BLOOD VOLUME: PHYSIOLOGICAL VARIATIONS 8. HYPOXIA: • Seen in High altitudes. •  Erythrocytes • So  Blood volume. 9. EMOTIONS: • Excitement causes an increase in the Blood volume. 24 NOMAD:2005: BP: INTROVERVIEW
  25. 25. BLOOD VOLUME: PATHOLOGICAL VARIATIONS : hypovolemia1. BLOOD LOSS:2. SHOCK: • Crushing Injury • Cardiogenic • Neurogenic • Psychogenic. NOMAD:2005: BP: 25 INTROVERVIEW
  26. 26. HYPOVOLEMIA: CAUSES3. HEMOLYSIS: • Mismatched transfusion • Snake bite • Black water fever • Hemorrhagic Plagues/Dengue • Measles NOMAD:2005: BP: 26 INTROVERVIEW
  27. 27. HYPOVOLEMIA: CAUSES4. DEHYDRATION: • Diarrhoea • Cholera • Gastroenteritis • Burns • Hyperemesis. NOMAD:2005: BP: 27 INTROVERVIEW
  28. 28. HYPOVOLEMIA: CAUSES (contd)5. ANEMIA: • Decreased RBC volume • Plasma may increase.6. OBESITY: • Blood volume per body weight decreases though Blood volume per BSA may be normal.7. HYPOTHYROIDISM (MYXEDEMA): • Decrease in Blood volume.8. ACUTE COLD: Decreases blood volume. NOMAD:2005: BP: 28 INTROVERVIEW
  29. 29. TREATMENT FOR BLOOD LOSS• TRANSFUSION OF WHOLE BLOOD OF THE SAME BLOOD GROUP & TYPE.• INFUSION OF PLASMA• INFUSION OF DEXTRAN OR NORMAL SALINE. NOMAD:2005: BP: 29 INTROVERVIEW
  30. 30. NOMAD:2005: BP: 30INTROVERVIEW
  31. 31. HEMOPOIESIS &ERYTHROPOIESIS NOMAD:2005: BP: 31 INTROVERVIEW
  32. 32. HEMOPOIESIS: INTRO• Hemo: Referring to blood cells• Poiesis: “The development or production of”• The word Hemopoiesis refers to the production & development of all the blood cells: • Erythrocytes: Erythropoiesis • Leucocytes: Leucopoiesis • Thrombocytes: Thrombopoiesis.• Begins in the 20th week of life in the fetus & continues in the red bone marrow till death. BP: NOMAD:2005: INTROVERVIEW 32
  33. 33. STEM CELL THEORY• All blood cells are produced by the bone marrow.• They come from a single class of primitive mother cells called as:• PLURIPOTENT STEM CELLS.• These cells give rise to blood cells of: • Myeloid series: Cells arising mainly from the bone marrow. • Lymphoid series: cells arising from lymphoid tissues. NOMAD:2005: BP: 33 INTROVERVIEW
  34. 34. PROGENITOR CELLS• Committed stem cells lose their capacity for self-renewal.• They become irreversibly committed.• These cells are termed as “Progenitor cells”• They are regulated by certain hormones or substances so that they can: • Proliferate • Undergo Maturation. NOMAD:2005: BP: 34 INTROVERVIEW
  35. 35. BLOOD CELLS: DEVELOPMENT PROGENITOR CELLSLYMPHOID PRO MEGA MYELOBLAST MONOBLAST CELLS NORMOBLAST KARYOBLASTLYMPHOCYTES ERYTHROCYTES THROMBOCYTES GRANULOCYTES MONOCYTES NOMAD:2005: BP: 35 INTROVERVIEW
  36. 36. ERYTHROPOIESIS: SITES• INTRAUTERINE LIFE: • INTRAVASCULAR PHASE: Upto 3rd month of Intra Uterine Life. •Endothelial cells = = = RBCs • HEPATIC PHASE: 3rd to 5th month IUL •Liver & Spleen •nRBCs from Mesenchymal cells. • MYELOID PHASE: From 5th month of IUL onwards. NOMAD:2005: BP: 36 INTROVERVIEW
  37. 37. ERYTHROPOIESIS: SITES contd. • POST NATAL LIFE: • CHILDREN: •Predominantly Red Bone Marrow of skeleton: •Axial & •Appendicular. • ADULTS: •Red Bone Marrow of Axial Skeleton. NOMAD:2005: BP: 37 INTROVERVIEW
  38. 38. ERYTHROPOIESISPROERYTHROBLAST BASOPHILIC ERYTHROBLASTPOLYCHROMATOPHILIC ERYTHROBLAST ORTHOCHROMATIC ERYTHROBLAST RETICULOCYTE NOMAD:2005: BP: 38 INTROVERVIEW MATURE ERYTHROCYTES
  39. 39. FACTORS REGULATING ERYTHROPOIESIS • SINGLE MOST IMPORTANT REGULATOR: “TISSUE OXYGENATION” • BURST PROMOTING ACTIVITY • ERYTHROPOIETIN • IRON • VITAMINS: • Vitamin B12 • Folic Acid • MISCELLANEOUS NOMAD:2005: BP: 39 INTROVERVIEW
  40. 40. ERYTHROPOIETIN•A hormone produced by the Kidney.•Nowadays available as Synthetic Epoietin•Increases the number of: •Nucleated precursors in the marrow. •Reticulocytes & Mature Erythrocytes in the blood. NOMAD:2005: BP: 40 INTROVERVIEW
  41. 41. VITAMINS• B12: Cyanocobalamine & Folic Acid: •Is also called Extrinsic Factor of Castle. •Needs the Intrinsic Factor from the Gastric juice for absorption from Small Intestine. •Deficiency causes Pernicious (When IF is missing) or Megaloblastic Anemia. •Stimulates Erythropoiesis •Is found in meat & diary products. NOMAD:2005: BP: 41 INTROVERVIEW
  42. 42. IRON•Essential for the synthesis of Hemoglobin.•Deficiency causes Microcytic, Hypochromic Anemia.•Deficiency causes the commonest type of Anemia. NOMAD:2005: BP: 42 INTROVERVIEW
  43. 43. NOMAD:2005: BP: 43INTROVERVIEW
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