Total body fluid-dr aaser m abdelazim

2,415 views

Published on

Dr.ehab

Published in: Education
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,415
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
298
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Total body fluid-dr aaser m abdelazim

  1. 1. Chemistry of blood and body fluids Aaser M. Abdelazim, PhD Abdelazim, Lecturer of medical Biochemistry and Molecular Biology Zagazig Vet. Medicine PhD studies in Niigata college of Medicine, Niigata University, Niigata, JAPAN asr@zu.edu.eg Chemistry of blood and body fluids17-11-2011 1 Dr Aaser Abdelazim
  2. 2. What do you want to know about body fluids? Chemistry of blood and body fluids17-11-2011 2 Dr Aaser Abdelazim
  3. 3. Different body fluids Vetrous humor CSF Milk Pleural fluids Pericardial Blood Bile Gastric fluids Lymph Amniotic fluids Intestinal fluids Urine Female discharge Semen Chemistry of blood and body fluids17-11-2011 3 Dr Aaser Abdelazim
  4. 4. BLOODPointes of the lecture:1. Definition2. Functions of blood3. Blood composition4. Plasma proteins17-11-2011 Chemistry of blood and body fluids Dr Aaser Abdelazim Lecture 1 4
  5. 5. BloodBlood is a tissue which circulating insideclosed vessels, It is a liquid which containsplasma in which red blood cells, white cells andplatelets are suspended. Chemistry of blood and body fluids 17-11-2011 5 Dr Aaser Abdelazim
  6. 6. Functions of blood Chemistry of blood and body fluids 17-11-2011 6 Dr Aaser Abdelazim
  7. 7. Chemistry of blood and body fluids17-11-2011 7 Dr Aaser Abdelazim
  8. 8. Chemistry of blood and body fluids17-11-2011 8 Dr Aaser Abdelazim
  9. 9. BLOOD COMPOSITION Blood plasma (55%) Cellular elements (45%) Water (90%) Solids (10%) Organic components Inorganic components •Sugars •Cl •Lipids •Na •Proteins •K •NPN •Ca •hormones •CO2 Chemistry of blood and body fluids17-11-2011 9 Dr Aaser Abdelazim
  10. 10. e Chemistry of blood and body fluids17-11-2011 10 Dr Aaser Abdelazim
  11. 11. Blood composition Chemistry of blood and body fluids17-11-2011 11 Dr Aaser Abdelazim
  12. 12. Cellular elements Chemistry of blood and body fluids17-11-2011 12 Dr Aaser Abdelazim
  13. 13. Erythrocytes 4.7-6.1 million/mm3 Chemistry of blood and body fluids17-11-2011 13 Dr Aaser Abdelazim
  14. 14. Leukocytes 7,000 mm3 (5-7,000/mm3) Chemistry of blood and body fluids 17-11-2011 14 Dr Aaser Abdelazim
  15. 15. Thrombocytes 250,000/mm3 Chemistry of blood and body fluids17-11-2011 15 Dr Aaser Abdelazim
  16. 16. Plasma proteins Chemistry of blood and body fluids17-11-2011 16 Dr Aaser Abdelazim
  17. 17. Plasma proteins Globulins Albumin Chemistry of blood and body fluids17-11-2011 17 Dr Aaser Abdelazim
  18. 18. Plasma proteins Chemistry of blood and body fluids17-11-2011 18 Dr Aaser Abdelazim
  19. 19. Functions of plasma proteinsAlbumin Chemistry of blood and body fluids17-11-2011 19 Dr Aaser Abdelazim
  20. 20. Chemistry of blood and body fluids17-11-2011 20 Dr Aaser Abdelazim
  21. 21. ɣ-globulins functions Chemistry of blood and body fluids17-11-2011 21 Dr Aaser Abdelazim
  22. 22. Synthesis of plasma proteins Non immune proteinsImmunoglobulins Liver endocrine glands lymphoid tissues Protein hormones Chemistry of blood and body fluids 17-11-2011 22 Dr Aaser Abdelazim
  23. 23. All plasma proteins are glycoproteins except albumin Chemistry of blood and body fluids17-11-2011 23 Dr Aaser Abdelazim
  24. 24. Protein degradation glycoprotein asialoglycoproteins Sialic acid Neuraminidase Protein Protein Recognized by hepatocytes Galactose Taken by endocytosis Chemistry of blood and body fluids Degraded protein 17-11-2011 24 Dr Aaser Abdelazim
  25. 25. Normal serum levels= 6-8.2 g/dl DysproteinemiasHypoproteinemia Hyper proteimemia1. Loss (blood, Urine, GIT) 1. Dehydration (diarrhea,2. Dec. synthesis (liver vomiting) diseases, immun. Diff) 2. Increase antibody3. Dec. intake(mal-nutrition, production mal-absorption) Acute hepatitis, typhus, malaria4. Incr. catabolism(trauma, burns) 17-11-2011 Chemistry of blood and body fluids 25 Dr Aaser Abdelazim
  26. 26. Albumin/ globulins ratio (A/G ratio) It is about 1.6/1 this ratio is inverted inLiver disease Decrease protein biosynthesisKidney diseases Loss of more albumins due to its low molecular weight. Chemistry of blood and body fluids 17-11-2011 26 Dr Aaser Abdelazim
  27. 27. Methods used for determination of plasma proteins Chemical Separation Protein method techniques activity Physical determination Chemistry of blood and body fluids 17-11-2011 27 Dr Aaser Abdelazim
  28. 28. Protein electrophoresis Chemistry of blood and body fluids17-11-2011 28 Dr Aaser Abdelazim
  29. 29. Protein electrophoresis graph Chemistry of blood and body fluids 17-11-2011 29 Dr Aaser Abdelazim
  30. 30. Plasma enzymes and their rolein clinical diagnosis 17-11-2011 Chemistry of blood and body fluids 30 Dr Aaser Abdelazim
  31. 31. Plasma enzymesFunctional enzymes Nonfunctional enzymes 1. Lipoprotein lipase Plasma not their usual site 2. Clotting enzymes Only inside the tissues 3. Cholinesterase 1. Lipases 2. Transaminases 3. Amylases 4. Alkaline phospahtases 5. Acid phosphatases 17-11-2011 6. Chemistry of blood and body fluids 31 Dr Aaser Abdelazim
  32. 32. How enzymes used in diagnosis Infection Diseases Cell Tissue destructionMarker of organ disease Enzyme escape Blood Elevated level Enzyme Chemistry of blood and body fluids 17-11-2011 32 Dr Aaser Abdelazim
  33. 33. Enzymes of clinical importance1 Transaminases (ALT, AST)ALT/GPT TransaminationSite: Pyruvate Glutamate oxaloacetate ALTNormal level : 3-15 IU/L AST Alanine α- keto Aspartate1- Acute infectious hepatitis glutarate2- Chronic hepatitis3- hepatotoxicity4- Obstructive jaundice Chemistry of blood and body fluids 17-11-2011 33 Dr Aaser Abdelazim
  34. 34. AST/GOTSite:Normal level : 17-40 IU/LDiagnose:1- Hepatocellular damage.2- Myocardial infarction,it gives its maximum level after 2 days of attack.3- Neoborn normally4- Viral hepatitis5- Circulatory failure Chemistry of blood and body fluids 17-11-2011 34 Dr Aaser Abdelazim
  35. 35. 2 Alkaline phospahtase (ALP):Site:Normal level : 3-13 U/dLDiagnose:1- Physiologically, in children and in pregnant women.2- Rickets, osteomalcia, bone carcinoma and healing phaseof fractures.3- Hyperparathyroidism4- Hepatitis, Obstructive jaundice, tumors and hepaticinfiltration. Chemistry of blood and body fluids 17-11-2011 35 Dr Aaser Abdelazim
  36. 36. 3 Acid PhophataseSite: RBCs Prostate PlateletsDiagnose:1. Prostatic cancer2. Following rectal examination, passage of catheter3. Constipation4. Acute urine retention5. After prostatectomy Chemistry of blood and body fluids 17-11-2011 36 Dr Aaser Abdelazim
  37. 37. 4 Creatine kinase (CK)/ Creatine phosphokinase (CPK):Site:Normal level : 4-60 IU/LDiagnose: 1. Physiologically, in neoborn. 2. Myocardial infraction 3. Muscle dystrophy 4. Hemolysed samples 5. Muscle injuries 6. After surgery 7. Alcoholism 8. Hypothyroidism Chemistry of blood and body fluids 17-11-2011 37 Dr Aaser Abdelazim
  38. 38. 5 Lactate dehydrogenase (LDH):Site: TumorNormal level : 60-250 IU/LDiagnose:1. Marked increase in myocardial infarction.2. Leukemia3. Pernicious anemia4. Circulatory shock5. Viral hepatitis6. Skeletal muscle diseases7. Pulmonary embolism Chemistry of blood and body fluids 17-11-2011 38 Dr Aaser Abdelazim
  39. 39. 6 Gamma glutamyl transferase (GGT):Site:Diagnose: 1. Liver diseases 2. Chronic alcoholism 3. In patient treated with anticonvulsant therapy. Chemistry of blood and body fluids 17-11-2011 39 Dr Aaser Abdelazim
  40. 40. 7 AmylaseSite: Pancreatic juice Fallopian tube SalivaDiagnose: 1. Acute pancreatitis 2. Severe diabetic ketoacidosis 3. Severe uremia 4. Perforated peptic ulcer 5. Acute Cholestasis 6. Salivary calculi 7. Ruptured ectopic pregnancy Chemistry of blood and body fluids 17-11-2011 40 Dr Aaser Abdelazim
  41. 41. 8 Aldolase (ALS):Site:Diagnose: 1. Myocardial infraction 2. Muscle trauma 3. Hemolysis 4. Generalized malignancy Chemistry of blood and body fluids 17-11-2011 41 Dr Aaser Abdelazim
  42. 42. 9 Lipase:• It produced by pancreas• Its activity increased in acute pancreatitis and pancreatic carcinoma 10 Cholinesterase (ChE):There are two types:1. Plasma cholinesterase known as pseudocholinesterase.2. Tissue cholinesterase known as true cholinesteraseSuccinyl choline apnea: some patients develop prolongedapnea after anesthesia continued for hours due to theirplasma is deficient in pseudocholinesterase essential forhydrolysis of succinyl dicholine used as muscle realantduring anesthesia. Chemistry of blood and body fluids 17-11-2011 42 Dr Aaser Abdelazim
  43. 43. Lipoproteins Aaser Abdelazim, PhD Lecturer of medical biochemistry and molecular biology Zagazig university asr@zu.edu.eg Chemistry of blood and body fluids17-11-2011 43 Dr Aaser Abdelazim
  44. 44. Structure of lipoproteins: spherical or discoid aggregates of lipids Core (Polar lipids) Shell 2nm thick (Amphipathic lipids) Chemistry of blood and body fluids17-11-2011 44 Dr Aaser Abdelazim
  45. 45. Proteins to lipid contents of lipoproteins: Protein Fat HDL LDL VLDL Chylomicrons (good) (bad) High protein, low fat Low protein, high fat Chemistry of blood and body fluids 17-11-2011 45 Dr Aaser Abdelazim
  46. 46. Lipoproteins classes: their density, diameter, protein, phospholipids and triacylglycerol contents.Lipoprotein Density Diameter Protein (%) Phospholipi Triacylglycerol class (g/ml) (nm) of dry weight ds (%) (%) of dry weightChylomicr < 0.95 100-500 1-2 7 84 ons VLDL 0.95-1.006 30-80 10 18 50 IDL 1.006-1.019 25-50 18 22 31 LDL 1.019-1.063 18-28 25 21 4 HDL 1.063-1.21 5-15 33-50 29 8 Chemistry of blood and body fluids 17-11-2011 46 Dr Aaser Abdelazim
  47. 47. Metabolism of lipoproteins Chemistry of blood and body fluids 17-11-2011 47 Dr Aaser Abdelazim
  48. 48. LDL metabolism Chemistry of blood and body fluids17-11-2011 48 Dr Aaser Abdelazim
  49. 49. Four main lipoproteins and their functions:Lipoprotein Main Properties and Functions apolipoprotein Chylomicrons B48, A-I, C-II •Largest lipoprotein (CM) and E •Synthesized in gut after meals •Not present in normal fasting plasma •The main carrier of dietary TAGsVery low density B100, C-II and •Synthesized in liver lipoproteins E •Main carrier of endogenous TAGs (VLDL) Low density B100 •Generated from VLDL in circulation lipoproteins •Main carrier of cholesterol (LDL) High density A-I and A-II •Smallest but most abundant in plasma lipoprotiens •It has a protective function (HDL) •It takes cholesterol from extra hepatic tissues to liver for excretion. Chemistry of blood and body fluids 17-11-2011 49 Dr Aaser Abdelazim
  50. 50. Prosperities of some human Apolipoproteins:Apolipoprotein Molecular Site of synthesis Functions weight A-I 28,000 Intestine and Activates LCAT liver A-II 17,000 Intestine and Unknown liver B100 549,000 Liver 1. Transports TAGs and Cholesterol 2. Binds to LDL receptors B48 264,000 Intestine Transports TAGs C-I 6600 Liver Activates LCAT C-II 8850 Liver Activates LPL C-III 8800 Liver Inhibits LPL E 34,000 Liver, intestine 1. Binds to LDL receptors and 2. Binds to another liver 17-11-2011 macrophage Chemistry of blood and body fluids receptors 50 Dr Aaser Abdelazim
  51. 51. Clinical disorders of plasma lipoproteins (dyslipidemias/ dyslipoproteinemias)Hyperlipoproteinemias HypolipoproteinemiasPrimary hyperlipoproteinemia Secondary hyperlipoproteinemia (Genetic) Look to the table (next) Chemistry of blood and body fluids 17-11-2011 51 Dr Aaser Abdelazim
  52. 52. Some genetic causes of dyslipidemias: Disease Genetic defect/effect Fredrickson RiskFamilial Lipoprotein lipase 1. Reduced functional LPL I Pancreatitis deficiency 2. CM and VLDL high elevatedApo C-II deficiency Inability to synthesize apo I Pancreatitis C-II which is the cofactor for LPLFamilial hypercholesterolemia 1. Reduced number of II (a) or II (b) CHD and atherosclerosis functional LDL receptors 2. High plasma LDL and CHyperlipoproteinemia 1. Low CM, VLDL clearance III CHD 2. High plasma CM and VLDLFamilial hypertriglyceridemia 1. Single gene defect IV CHD, diabetes and obesity 2. Over production of VLDLFamilial combined 1. Single gene defect V CHD hyperlipidemia 2. Over production of VLDL and CMA betalipoproteinemia Inability to synthesize Apo Normal Fat soluble vitamin deficiency B (low level of LDL) and neurological disorders Low plasma VLDL and CMAnalphalipoproteinemia 1. Inability to synthesize Normal Neurological disorders and (Tangier disease). Apo A Cholestrolyester storage in 2. Deficiency ofof blood and body fluids Chemistry LCAT abnormal sites 17-11-2011 52 Dr Aaser Abdelazim
  53. 53. Secondary causes of hyperlipidemia: Disease Unusual dominant lipid abnormality 1. Diabetes mellitus Increase triacylglycerol 2. Alcoholism Increase triacylglycerol 3. Chronic renal failure Increase triacylglycerol 4. Hypothyroidism Increased cholesterol 5. Nephrotic syndrome Increased cholesterol 6. Drugs e.g., thiazide Increase triacylglycerol diuretics, nonselective beta blockers Chemistry of blood and body fluids 17-11-2011 53 Dr Aaser Abdelazim
  54. 54. Fredrickson (WHO) classification of dyslipidemias: Type N I II (a) II (b) III IV V SampleLipoprotein N CM (+) VLDL /LDL LDL (+) IDL (+) VLDL (+) (+) /CM (+) Total N N or (+) (+) (+) (+) N or (+) N or (+)cholesterol TAGs N (++) N (+) (+) (+) (++) LDL-C N N or (-) (+) (+) N or (-) N N HDL-C N N or (-) N or (-) N or (-) N or (-) N or (-) N or (-)It based on appearance of fasting plasma and analysis of TAGs and Cholesterol after standing for 12 Chemistry of blood and body fluidshs 17-11-2011 at 4ºC ( N = normal (+) Dr high Abdelazim ) = Aaser (-) = low 54
  55. 55. PLASMA CARBOHYDRATES:It includes:1. Glucose: its normal fasting level is 70 – 110 mg / dl.2. Traces of galactose, fructose and pentoses.3. Lactose in lactation.HYPOGLYCEMIA/HYPERGLYCEMIA and DIABETES MELLITUS Hypoglycemia Hyperglycemia Diabetes mellitus(1): Reactive hypoglycemia: 1. Diabetes mellitus•Sensitive epinephrine release 2. Gestational diabetes 1. IDDM (juvenile /non 3. Acromegaly•Deficiency of glucagon 4. Acute stress (heart attack) genetic)•Gastric surgery 5. Chronic renal failure(2): Fasting hypoglycemia: 6. Cushing syndrome (excess 2. NIDDM (adult/genetic)•Alcoholism glucocorticoids)•Critical illness (liver/heart diseases) 7. Hyperthyroidism•Hormonal deficiency(cortisol, 8. Pancreatitis 9. Pancreatic tumorsepinephrine) 10. Excess food intake•Tumors (B- cells tumore) 11. Drugs (corticosteroids,•Drugs (salicylates, pentamidines, diuretics, epinephrine,quinines) estrogen, salicylates large dose). Chemistry of blood and body fluids 17-11-2011 55 Dr Aaser Abdelazim
  56. 56. Chemistry of blood and body fluids17-11-2011 56 Dr Aaser Abdelazim
  57. 57. PLASMANON PROTEIN NITROGENOUSCOMPOUNDS(NPNs) Aaser Abdelazim, PhD Lecturer of medical biochemistry and molecular biology Zagazig university asr@zu.edu.eg Chemistry of blood and body fluids17-11-2011 57 Dr Aaser Abdelazim
  58. 58. Properties of NPNs:1. Determined to monitor renal functions.2. Nitrogen containing compounds that are not proteins or polypeptides.3. The NPN fraction comprises about 15 compounds.4. Mostly arise from catabolism of proteins and nucleic acids Chemistry of blood and body fluids17-11-2011 58 Dr Aaser Abdelazim
  59. 59. Clinically significant non proteinnitrogenous compounds: Compound Approximate plasma concentration (% of total NPNs) Urea 45 Amino acids 20 Uric acid 20 Creatinine 5 Creatine 1-2 Ammonia 0.2 Chemistry of blood and body fluids 17-11-2011 59 Dr Aaser Abdelazim
  60. 60. Blood Urea Nitrogen (BUN): Protein catabolismSources and fates: Ammonia + CO2 Liver 40% UREA 10% Kidney GIT Skin Chemistry of blood and body fluids17-11-2011 60 Dr Aaser Abdelazim
  61. 61. BUN CONCENTRATION IS AFFEXTED BY:1. Renal function2. Dietary intake3. Protein catabolism rateMEASUREMENT OF UREA IS USED TO: 1. Evaluate renal function 2. Assess hydration status 3. Determine nitrogen balance 4. Aid in the diagnosis of renal disease 5. Verify adequacy of dialysis Chemistry of blood and body fluids17-11-2011 61 Dr Aaser Abdelazim
  62. 62. Azotemia: high plasma urea Pre-renal Renal Post-renal1. Reduced renal blood flow: 1. Acute & Chronic Obstruction of •Congestive heart failure. renal failure urine flow due to: •Shock. 2. Glomerular nephritis 1. Renal calculi •Hemorrhage. 3. Tubular necrosis 2. Tumors of •Dehydration. 4. Other Intrinsic renal bladder or2. High protein diet disease prostate3. Increased protein catabolism 3. Severe infections Chemistry of blood and body fluids 17-11-2011 62 Dr Aaser Abdelazim
  63. 63. Decreased Urea Nitrogen:1. Low protein dietary intake2. Liver disease (lack of synthesis)3. Severe vomiting and/or diarrhea (loss)4. Increase protein synthesis Chemistry of blood and body fluids 17-11-2011 63 Dr Aaser Abdelazim
  64. 64. Creatinine Arginine + glycine + methionineMetabolism: Liver/ kidneys CPK Creatine-P CREATINE Muscles PO4 H2O CREATININE Kidneys Urine Chemistry of blood and body fluids17-11-2011 64 Dr Aaser Abdelazim
  65. 65. Plasma creatinine concentration is a function of: 1. Relative muscle mass 2. Renal function 3. Rate of creatine turnoverMeasurement of creatinine concentration is used to determine: 1. Sufficiency of kidney function 2. Severity of kidney damage 3. Monitor the progression of kidney diseaseCreatine:Elevated in plasma inMuscular dystrophy, hyperthyroidism, trauma. Chemistry of blood and body fluids17-11-2011 65 Dr Aaser Abdelazim
  66. 66. Uric acid Purines Adenine/Gauanine Metabolism: Urate crystals in tissues Hypoxanthine High plasma uric acid Xanthine oxidase Allantion Uric acid Xanthine Monosodium urate Kidney Return to plasma Chemistry of blood and body fluids17-11-2011 66 Dr Aaser Abdelazim
  67. 67. Uric acid is measured to: 1. Assess inherited disorders of purine metabolism 2. Confirm diagnosis and monitor treatment of gout. 3. Assist in the diagnosis of renal calculi. 4. Prevent uric acid nephropathy during chemotherapeutic treatment. 5. Detect kidney dysfunction. Chemistry of blood and body fluids17-11-2011 67 Dr Aaser Abdelazim
  68. 68. Hyperuricemia Increased uric acid Chronic renal Gout catabolism diseaseIt is a metabolic disease Occurs in patients causes elevatedcharacterized by: on chemotherapy levels of uric acid1. Pain & inflammation of for diseases such because filtration joints as leukemia & and secretion are2. Increased risk of renal multiple myeloma hindered. calculi3. Hyperuricemia Chemistry of blood and body fluids 17-11-2011 68 Dr Aaser Abdelazim
  69. 69. Hypouricemia:It is a condition characterized by low plasma level of uric acid.Causes:1. Secondary to severe liver disease2. Defective renal tubular reabsorption3. Fanconi’s Syndrome Chemistry of blood and body fluids 17-11-2011 69 Dr Aaser Abdelazim
  70. 70. Activities Group A: Hemoglobin Group B: Blood indices and their significance Group C: Anemias and their diagnosis Group D: Blood sugar: control and disorders Group E: Semen analysis Group F: Stem cells Group G: Nanotechnology Group H: Tumor markers Group I: Endocrine disorders and their diagnosis Group J: Prenatal diagnosis Chemistry of blood and body fluids17-11-2011 70 Dr Aaser Abdelazim
  71. 71. AmmoniaSources and fates: Urea Dietary proteins Bacterial urease Purines and pyrimidines Amino acids CO2 Amines Ammonia α-keto acids Glutamate +ATP NH3 ADP+Pi Glutamate Urine Glutamine H2O Chemistry of blood and body fluids 17-11-2011 71 Dr Aaser Abdelazim
  72. 72. Hyperammonemia (ammonia intoxication) Acquired hyperammonemia Inherited hyperammonemia 1. Liver diseases: Genetic deficiency of one or • Liver cirrhosis due to more of urea cycle enzymes Bilharziasis leads to failure of urea Alcoholism synthesis. Hepatitis Biliary obstruction. • Liver cell failure: inability of liver cells to convert ammonia to urea 2. Shunt operation between portal and systemic circulation. 3. Renal failure. Chemistry of blood and body fluids 17-11-2011 72 Dr Aaser Abdelazim
  73. 73. Chemistry of blood and body fluids17-11-2011 73 Dr Aaser Abdelazim
  74. 74. ACID–BASE BALANCE/ BLOOD BUFFERS: Aaser Abdelazim, PhD Lecturer of medical biochemistry and molecular biology Zagazig university asr@zu.edu.eg Chemistry of blood and body fluids01-12-2011 74 Dr Aaser Abdelazim
  75. 75. ACID–BASE BALANCE/ BLOOD BUFFERS: Chemistry of blood and body fluids01-12-2011 75 Dr Aaser Abdelazim
  76. 76. (1): Sources of protons in blood: Carbohydrates oxidationPhospholipids/phosphoproteins Carbonic acid Phosphoric acid Sulfuric acid H + CO2sulfur containing amino acids. Organic acids lactic, citric, acetoacetic acids (2): Sources of alkalis in blood: 1. Sodium bicarbonate (Na2CO3). 2. Ammonia. Chemistry of blood and body fluids 01-12-2011 76 Dr Aaser Abdelazim
  77. 77. Buffer systems in the plasma: Carbonic anhydrase Chemistry of blood and body fluids 01-12-2011 77 Dr Aaser Abdelazim
  78. 78. Disturbances in acid base balance:(1) Respiratory: (1) Respiratory:Pneumonia , emphysema, asphyxia, bronchial asthma, Hyperventilation resulted from; fever, salicylatesand morphine poisoning. poisoning, encephalitis, climbing of high altitudes,(2) Metabolic: hystericalresulted from decrease in acid production or decrease (2) Metabolic: increase of blood HCO3 and lossin acid excretion due to: of acids due to:1. Increase acid production 1. Prolonged vomiting as in pyloric stenosis• Severe muscular exercise produce more lactate 2. Prolonged suction in high surgical operations• Increase ketone bodies production they are acids 3. High dose of alkalis during treatment of• Increase protein diets contains acids as acidosis phosphoric, sulfuric and uric acids 4. Hypokalemia2. Decrease the excretion of acids in renal failure 5. Excess mineralocorticoids3. Increase the loss of bases as in severe diarrhea Chemistry of blood and body fluids 01-12-2011 78 Dr Aaser Abdelazim
  79. 79. Hemoglobin Aaser Abdelazim, PhD Lecturer of medical biochemistry and molecular biology Zagazig university asr@zu.edu.eg Chemistry of blood and body fluids01-12-2011 79 Dr Aaser Abdelazim
  80. 80. Hemoglobin structure: Globin(146 amino acids) (141 amino acids) Hemoglobin α2,ᵦ2 Chemistry of blood and body fluids 01-12-2011 80 Dr Aaser Abdelazim
  81. 81. Hemoglobin helices:Are identified from A-------H as in the diagram: Chemistry of blood and body fluids01-12-2011 81 Dr Aaser Abdelazim
  82. 82. States of hemoglobin (allosteric effect): T form R form (for tense) (for relaxed) Deoxyhempglobin Oxyhemoglobin Oxygen BPG Chemistry of blood and body fluids 01-12-2011 82 Dr Aaser Abdelazim
  83. 83. Low affinity to O2 Chemistry of blood and body fluids 01-12-2011 83 Dr Aaser AbdelazimBPG: 2,3-bisphosphoglycerate
  84. 84. Bohr effects:Low pH and high CO2 pressure at the level of tissues lead to lower the O2binding to Hb and enhance O2 release this binding known as Bohr Effect. Shift to left: (High affinity to O2) 1. Decrease of temperature 2. Dec. BPG 3. Dec. H 4. Dec.CO2 Shift to right: (low affinity to O2 at level of tissues) 1. Increase of temperature 2. Inc. BPG 3. Inc. H 4. Inc. CO2 Chemistry of blood and body fluids 01-12-2011 84 Dr Aaser Abdelazim
  85. 85. Hemoglobin metabolism(1) Heme biosynthesis:Site of synthesis: Both mitochondria and cytoplasm are involved in hemesynthesis.Organs: 85% in bone marrow Low % in liver Chemistry of blood and body fluids 01-12-2011 85 Dr Aaser Abdelazim
  86. 86. 2. Formation of prophobilinogen: Prophobilinogen synthase + 2H2O Prophobilinogen (PBG) 2 molecules of δ-amniolevulinic acid Uroporphyrinogen I, III synthase 4 prophoblinogens are condensed Chemistry of blood and body fluids 01-12-2011 86 Dr Aaser Abdelazim
  87. 87. Steps of heme synthesis:1. Synthesis of ALA (5-aminolevulinic acid/δ-amniolevulinic acid):Occurs in mitochondria + Succinyl-CoA Glycine H ALA synthase CoASH PLP CO2 δ-amniolevulinic acid Chemistry of blood and body fluids 01-12-2011 87 Dr Aaser Abdelazim
  88. 88. 3. Formation of heme: A; acetic acid A P A P P; propionic acid M; methyle group V; vinyle CH2=CH2 A A P A A P P P Cytosol P A P A Light LightUroporphyrin I Uroprophyrinogen I Uroprophyrinogen III Uroporphyrin III Uroprophyrinogen decarboxylase 6H 4CO2 4CO2 6H M P M P P M M M Cytosol M P P P Light P M P MCoproporphyrin I Coproprophyrinogen I Coproprophyrinogen III Light Coproporphyrin III 6H Chemistry of blood and body fluids 6H 01-12-2011 88 Dr Aaser Abdelazim
  89. 89. M P I M M IV II P P III P M Coproprophyrinogen III Mitochondria Coproprophyrinogen oxidase M V M M P V P M Protoporphyrin III (IX) Chemistry of blood and body fluids01-12-2011 89 Dr Aaser Abdelazim
  90. 90. Incorporation of iron in prophyrin to form heme: M V M V Fe+2 M M M M Fe+2 P V Ferrochelatase P V P M P M Protoporphyrin III (IX) Heme Prosthetic group of hemoglobin Chemistry of blood and body fluids 01-12-2011 90 Dr Aaser Abdelazim
  91. 91. Types and major findings of prophyrias: Porphyria Enzyme Deficient Primary Symptom Erythropoietic Class(1) Congenital erythropoietic Uroprophyrinogen III synthase Photosensitivityporphyria (CEP).(2) Erythropoietic Ferrochelatase Photosensitivityprotoporphyria (EPP). Hepatic Class(3) ALA dehydratase deficiency ALA dehydratase Neurovisceralporphyria, ADP(4) Acute intermittent porphyria, PBG deaminase NeurovisceralAIP(5) Hereditary coproporphyria, Neurovisceral, some Coproporphyrinogen oxidaseHCP photosensitivity Neurovisceral, some(6) Variegate porphyria, VP Protoporphyrinogen oxidase photosensitivity(7) Porphyria cutanea tarda, Uroporphyrinogen PhotosensitivityPCT decarboxylase(8) Hepatoerythropoietic Uroprophyrinogen Photosensitivity, someporphyria, HEP decarboxylase neurovisceral Chemistry of blood and body fluids 01-12-2011 91 Dr Aaser Abdelazim
  92. 92. Types of hemoglobin: α α α α Glucose units ᵦ ᵦ ᵦ ᵦHb A (α2β2): 95-97% Hb A1c (glycosylated Hb): 5-8% (Major adult hemoglobin) Gives ideas about Glc. level for last 3months α α α α δ δ ɣ ɣ Hb F (α2 γ2): 1% Hb A2 (α2δ2): 2% Has high affinity to O2, only in fetuses (Minor adult hemoglobin) 01-12-2011 Chemistry of blood and body fluids 92 Dr Aaser Abdelazim
  93. 93. Hemoglobinopathies: Sickle cell anemia Thalassemia HbS ᵦ- thalassemia α- thalassemia(2 normal α chains and 2 mutant β-chains) ᵦ ᵦ α α α α ᵦ ᵦ Deleted ᵦ-chains gene Deleted α-chains gene Normal cells Sickle cells Chemistry of blood and body fluids 01-12-2011 93 Dr Aaser Abdelazim
  94. 94. Abnormal derivatives of hemoglobin:(1) Met-hemoglobin (Met-Hb): 1. Free radicals as H2O2 2. Drugs 3. Endogenous oxidants NADH+H+ cytochrome B5 reductase. Ferric heme Ferrous heme Met-Hb (Induce hypoxia and cyanosis. ) Chemistry of blood and body fluids 01-12-2011 94 Dr Aaser Abdelazim
  95. 95. (2) Carboxy –hemoglobin (COHb): Oxyhemoglobin Carboxyhemoglobin Conc. Over 40% lead to death CO has 200 times affinity to Hb more than O2 itself Chemistry of blood and body fluids 01-12-2011 95 Dr Aaser Abdelazim
  96. 96. (3) Sulf – hemoglobin (S-Hb): Sulfonamides Sulf – hemoglobin Induce anoxia and cyanosis Chemistry of blood and body fluids01-12-2011 96 Dr Aaser Abdelazim
  97. 97. (4) Hematin: Hematin: Hemoglobin without iron Produced during intravascular hemolysis Chemistry of blood and body fluids01-12-2011 97 Dr Aaser Abdelazim
  98. 98. Hemoglobin catabolism:Reticuloendothelial cells (REC) •Non water soluble (not secreted Hemoglobin catabolism from kidneys) •It is neurotoxic •Can cause permanent brain damage in neonates Unconjugated bilirubin Albumin bound Liver Bile duct Unconjugated bilirubin Conjugated bilirubin Conjugated bilirubin Bacteria Portal vein Stercobilinogenkidneys Stercobilinogen Stercobilinogen Large intestine •Brown coloration of feces •If not present lead to pale 01-12-2011 Orange color of urine on body fluids Chemistry of blood and colored feces 98 Urobilinogen long standing Dr Aaser Abdelazim
  99. 99. HYPERBILIRUBINEMIA AND JAUNDICE:Jaundice: is pathological term while Hyperbilirubinemia is lab term1. 2 mg/dl bilirubin is hyperbilirubinemia; While 3 mg/dl is jaundice2. The normal plasma bilirubin level up to 1.2 mg/dl (1 mg = 17.1 mol/L). Hyperbilirubinemia Neonatal Pathological Congenital1. Deficiency of UDP- glucuronyltransferase Hemolytic Obstructive Hepatocellular Dubin-johnson2. Accelerated hemolysis syndrome of RBCs. Crigler-Najjar syndrome ‫متالزمة كريغلر نجار‬ Chemistry of blood and body fluids 01-12-2011 Dr Aaser Abdelazim Gilbert disease 99
  100. 100. Different types of pathological jaundice: Feature Hemolytic Cholestasis (obstructive) Hepatocellular (toxic) Cause Destruction of RBCs Closure of bile ducts by Death of hepatic cells due to due to toxins or stones or tumors viral infections or toxins infections Mechanism Produced bilirubin over There is a regurgitation of Inability of hepatocytes to the capacity of liver conjugated bilirubin to the performs conjugation very power for conjugation circulation due to closure well its way to intestine Serum Bilirubin >75 mol/l Over 3 times than in >75 mol/l but appears later hemolytic Type of bilirubin Unconjugated Conjugated Unconjugated/conjugated Bilirubin in urine Not present Present Present (Unconjugated is not (high level of conjugated water soluble and bilirubin) bound to albumin and not filtered ) Urine Increased Decreased /absent Decreased/absent Urobilinogen Stool Normal Clay/pale in color Normal (no bilirubin reaches the Chemistry intestine) body fluids of blood and 01-12-2011 100 Dr Aaser Abdelazim
  101. 101. HEMOSTASIS AND BLOOD COAGULATION Aaser Abdelazim, PhD Lecturer of medical biochemistry and molecular biology Zagazig university asr@zu.edu.eg Chemistry of blood and body fluids01-12-2011 101 Dr Aaser Abdelazim
  102. 102. Hemostasis: is the stop of bleeding When blood vessel is injured, bleeding can be stopped by:Constriction of blood vessel Formation of temporary platelets plug (white thrombus): Formation of fibrin mesh or clot (coagulation): Chemistry of blood and body fluids 01-12-2011 102 Dr Aaser Abdelazim
  103. 103. Mechanism of blood coagulation: Intrinsic pathway Extrinsic pathway It occurs mainly in the areas It occurs mainly in the areas with without tissue injury to: tissue injury to: Response to Release of tissueRestrict the abnormal blood factor that acts as ablood flow vessel wall cofactor for active factor VIIa Chemistry of blood and body fluids 01-12-2011 103 Dr Aaser Abdelazim
  104. 104. Intrinsic pathway:Stage I: generation of active factor X (Xa): Injured blood vessel Active factor XII (XIIa) CollagenPrekallikrein Kallikrein + Factor XII High molecular kininogen HMK HMK PL VIIIa BradykininFactor Xa Factor X Ca2+ Factor XIa Factor XI Ca2+ Factor IXa Factor IX 01-12-2011 104
  105. 105. Stage II: conversion of prothrombin into thrombin: Factor Xa Factor II Factor IIa (Prothrombin) (Thrombin) Ca2+ PL Factor VaStage III: conversion of fibrinogen to fibrin: Fibrinogen Fibrin Fibrin gel Act as trap for more platelets and red blood cells to form white or red thrombi. Factor XIIIa Ca2+ Fibrin clot Chemistry of blood and body fluids 01-12-2011 105 Dr Aaser Abdelazim
  106. 106. Extrinsic pathway: Thrombin Minute amounts Factor VII Factor VIIa Tissue factor Factor Xa Factor X Proceeds in the final common pathway as in intrinsic pathway. Chemistry of blood and body fluids 01-12-2011 106 Dr Aaser Abdelazim
  107. 107. Inhibitors of coagulation: The concentration of active thrombin should be controlled to preventunneeded clotting So there are natural inhibitors to limit the clotting only at the level of tissueinjury. The major inhibitors of coagulation include: Inhibitor Action on StimulatorsAntithrombin III Thrombin, factors IXa, Xa, XIa, XIIIa HeparinHeparin co-factor II thrombin Heparinα2- macroglobulins Thrombin and kallikrein -----Protein C Factors Va and VIIIa Vitamin K dependant/ protein CProtein S Acts as cofactor for activation of ------- protein C. Chemistry of blood and body fluids 01-12-2011 107 Dr Aaser Abdelazim
  108. 108. Fibrinolysis: Definition: It is the dissolution of clotted blood after their formation by enzyme called plasmin. PlasminogenKidneys activators like Tissue/ Plasma activatorsurokinase / sterptokinase Plasmin Fibrin thrombus Soluble proteins In active plasmin α2-antiplasmin Chemistry of blood and body fluids 01-12-2011 108 Dr Aaser Abdelazim
  109. 109. Hemophilia: Definition: These are a group of inherited diseases at which clotting factors are deficient Hemophilia: Hemophilia A Hemophilia B Hemophilia CDeficiency of factor VIII. Deficiency of factor IX. Von Willbrand disease Chemistry of blood and body fluids 01-12-2011 109 Dr Aaser Abdelazim
  110. 110. BLOOD GROUPS: Antibodies Antigens Donor Recipient Proteins with oligosaccharides Chemistry of blood and body fluids01-12-2011 110 Dr Aaser Abdelazim
  111. 111. ABO system for blood grouping:Glycoproteins or glycolipids (Antigens) RBC 4 types of blood groups according to Antigens A B AB H Lacks the terminal residue Terminal residue Chemistry of blood and body fluids 01-12-2011 111 Dr Aaser Abdelazim
  112. 112. ABO system:Blood group A B AB O Genotypes AA and AO BB and BO AB OO Antigens A B A and B H Antibodies Anti-A Anti-B ------ Anti-A and Anti-B Frequency in 40% 16% 4% 40%central EuropeCompatibility : Blood group Compatible Take Give A From A A B From B B AB From A or B or AB (all) Only AB O Only from O Chemistry of blood and body fluids All 01-12-2011 112 Dr Aaser Abdelazim
  113. 113. Rh system for blood grouping: rhesus factors (Antigen D) RBC Occurs in 84% of RBC white populations Rh-positive Chemistry of blood and body fluids01-12-2011 113 Dr Aaser Abdelazim
  114. 114. Fetal erythroblastosis: Rh-negative Fetal erythrocytes Rh-positive 1st child Mother circulation IgG For this child or mother Against antigen D there is no problem Rh-positive IgG (anti-D) Against antigen D Cross placenta 2nd child fetal erythroblastosis Destructs fetal RBCs Chemistry of blood and body fluids 01-12-2011 Dr Aaser Abdelazim 114
  115. 115. Urine Aaser Abdelazim, PhD Lecturer of medical biochemistry and molecular biology Zagazig university asr@zu.edu.eg Chemistry of blood and body fluids08-12-2011 116 Dr Aaser Abdelazim
  116. 116. Human urinary system: Chemistry of blood and body fluids 08-12-2011 117 Dr Aaser Abdelazim
  117. 117. Structure of nephron: Glomerulus Afferent arteriole Efferent arteriole Bowman’s capsule Distal convolutedProximal convoluted tubulestubules Collecting tubules Loop of henle Collecting duct Chemistry of blood and body fluids 08-12-2011 118 Dr Aaser Abdelazim
  118. 118. URINE FORMATION: In DCT: (1) Ultra filtration: (2) Resorption: Resorption of Na+ and Cl– And water By action of hormone Aldosterone and ADH In PCT: •Organic metabolites As glucose, lactate, ketone bodies and amino acids •Amino acids have special transporters 1. Glomerular Pore size: 2.9 nm 2. Allow passage of all plasma contents of less than 15 Kda 3. All large proteins are unfilterable with RBCs and other cells (3)Secertion: 4. All passed molecules form primary urine 5. Primary urine pass to tubules H+ and K+ ions, urea, and creatinine, as well as drugs such as penicillin. Chemistry of blood and body fluids 08-12-2011 119 Dr Aaser Abdelazim
  119. 119. PHASES OF URINE FORMATION: Chemistry of blood and body fluids08-12-2011 120 Dr Aaser Abdelazim
  120. 120. PHYSICAL PROPERTIES OF URINE:(1): Volume:Normal collected urine per day is about 1-2 liters; this volume is dependingon many factors included:1. Fluid intake per day2. Body temperature3. Environmental temperature4. Respiratory rates5. Relative humidity6. Emotional states Chemistry of blood and body fluids 08-12-2011 121 Dr Aaser Abdelazim
  121. 121. Abnormal urine volumes: Abnormal Physiological causes Pathological causes volumesPolyurea 1. Much fluids and water 1. Diabetes mellitus intake 2. Diabetes insipidus 2. High protein diets 3. Hypertention 3. Drugs: as calomel, 4. Chronic renal failure salicylates, acetates and digitalisOligurea 1. Severe muscular exercise 1. Acute nephritis 2. Hot weather (more 2. Acute renal failure sweating) 3. Shock 4. Hemorrhage 5. Conditions lead to loss of water (diarrhea, vomiting and fever).Anurea Pure pathological case 1. Bilateral renal calculi 2. Urinary tract tumors 3. Severe stages of acute nephritis Chemistry of blood and body fluids 08-12-2011 122 Dr Aaser Abdelazim
  122. 122. (2) Color:1. Normal observed color of urine is amber yellow or straw yellow, this color is resulted from urochrome pigment which is a component of urobilin.2. Urine also contains traces of urobilinogens and ribofalvins.Abnormal urine colors: Abnormal colors Conditions Dark yellow sever exercise due to void of concentrated urine. color Light yellow to All cases that elevate the urine volume, proteinuria, whitish and presence of phosphates with high concentration in urine. Red to red Hematuria, Hemoglobinuria, and high doses of brown antibiotics. Greenish in jaundice when high level of bile salts and pigments present in urine. Black Alkaptonuria Chemistry of blood and body fluids 08-12-2011 123 Dr Aaser Abdelazim
  123. 123. (3) Odor:The normal odor of urine called urinefrous odor or aromatic odor and itmainly due to presence of some volatile fatty acids in urine.Abnormal urine odors: Abnormal colors ConditionsAmmonical odor UTIRotten apple/ advanced cases of diabetes mellitus due to highacetone odor concentration of ketone bodies in urine.Putrid odor UTI and all conditions associated by pyouria.Special odor Spices and drugs (4) Aspect: 1. Normal appearance of the urine is clear showing no turbidity. 2. Turbidity originates from presence of phosphates, urates, albumin, lipids, and pus in urine. Chemistry of blood and body fluids 08-12-2011 124 Dr Aaser Abdelazim
  124. 124. (5) Sediment: In normal conditions, urine shows no deposits. Up on centrifugation one or more of the following deposits could beappeared: Urine deposits ConditionsPus cells UTI due to high levels of dead leukocytesRed cells HematuriaEpithelial cells From kidney, uerters, urethra due to UTI.Parasites and Ova As bilharisasisCasts Mucoproteins formed in DCT and detached in many conditionsCrystals Urate, Oxalate and Phosphate crystals Chemistry of blood and body fluids 08-12-2011 125 Dr Aaser Abdelazim
  125. 125. (6) Urine reaction (pH):1. The normal pH of urine is around (5.5-6) means it is slightly acidic.2. Urine acidity originates from presence of sulfuric and phosphoric acids in urine.3. In urine basic phosphates (Na2HPO4) changed to acid phosphates (NaH2PO4) in distal tubules which confirm the urine acidity.Alkaline tide: is the excretion of alkaline urine after meals due to absorption ofhigh amount of bicarbonates and excreted in urine associated with HCl formationfrom gastric juice. pH Conditions High urine acidity 1. Metabolic and respiratory acidosis 2. High protein diets 3. Drugs e.g., salicylates, acetates 4. Ingestion of citrus fruits e.g., lemon and orange. Low urine acidity 1. Alkalosis 2. Urinary tract infections 3. Treatment with NaHCO3 4. Ingestion of vegetables Chemistry of blood and body fluids 08-12-2011 126 Dr Aaser Abdelazim
  126. 126. (7) Urine specific gravity: 1. It is known as the ratio between concentrations of total urine solids to its concentration of water. 2. It means when the solids elevated in urine the specific gravity also increased and vice versa. 3. Normal urine specific gravity is around 1015-1025. Specific gravity Conditions High urine specific gravity 1. Nephritis 2. Diabetes mellitus 3. Severe muscle exercise. Low urine specific gravity 1. Diabetes insipidus 2. All conditions that elevate urine volume Chemistry of blood and body fluids 08-12-2011 127 Dr Aaser Abdelazim
  127. 127. URINE CONSTITUENTS: (1): Organic components: Chemistry of blood and body fluids 08-12-2011 128 Dr Aaser Abdelazim
  128. 128. (2): inorganic components: Chemistry of blood and body fluids 08-12-2011 129 Dr Aaser Abdelazim
  129. 129. Chemistry of blood and body fluids08-12-2011 130 Dr Aaser Abdelazim
  130. 130. Abnormal components of urine:(1) Sugars: Glucose: normally its level is less than 0.1 g/day in urine. Fructose: causing fructosuria, galactose in galactosuria, pentoses inpentosuria and lactose in infants and lactating mothers during lactation period. Glucosuria Physiological causes Pathological causes1. Much intake of carbohydrates 1. Diabetes mellitus2. Late stage of pregnancy 2. Renal glucosuria3. Alimentary glucosuria 3. Experimental diabetes4. Lactosuria in lactating females due to:5. Adrenaline glucosuria Pancreatomy. Alloxan, Streptozotocin, phlorozin injection. Chemistry of blood and body fluids 08-12-2011 131 Dr Aaser Abdelazim
  131. 131. (3) Ketone bodies: Normally its level in urine is less than 18 mg /day Ketonuria: its causes are: 1. Uncontrolled diabetes mellitus 2. Renal glucosuria (diabetes innocence). 3. Much fat intake 4. Starvation for long time 5. Low dietary carbohydrates(4) Bilirubin: It present mainly in urine of patients with obstructive jaundice with less prevalence in ones of toxic jaundice. It gives urine characteristic dark greenish color.(5) Blood: Blood present in urine in the form of intact RBCs in a condition called Hematuria. It is mainly due to urinary bilharziasis, glomerulonephritis and malignant diseases. Chemistry of blood and body fluids 08-12-2011 132 Dr Aaser Abdelazim
  132. 132. (2) Proteins: Normal amount of proteins in urine is less than 30mg/L these proteins are: 1. Albumin: Microalbuminemia: is the excretion of proteins (30-200 mg/L). It indicates: early affection of the kidneys as in diabetes mellitus. 2. Mucoproteins: 3. Other proteins: e.g., Bence Jones proteins, hemoglobin and myoglobin. Proteinuria Physiological causes Pathological causes1. High protein diet2. Severe muscular exercise Pre-renal Renal Post-renal3. In late stages of gestation and lactation 1. Liver diseases 1. Nephrosis 1. Urothliasis4. Standing for long time 2. Hemolysis 2. Nephritis 2. Cystitis (Postural proteinuria) 3. Cardiac diseases 3. Renal failure 3. Prostitis 4. Hypertension Chemistry of blood and body fluids 08-12-2011 133 Dr Aaser Abdelazim
  133. 133. URINARY STONES:Composition of urinary stones: Less common substances Most common substances Uric acid (4-10%) Calcium oxalates Cystine stones (less 1%). Calcium phosphates Xanthine stones (very rare). Calcium carbonates Triple phosphates (Magnesium ammonium phosphates). Classes of urinary stone: 1. Simple stone: consisted of one constituent. 2. Mixed stones: formed from one or more constituents Chemistry of blood and body fluids 08-12-2011 134 Dr Aaser Abdelazim
  134. 134. Calcium oxalates stones: Calcium oxalates stones Calcium oxalates crystals Chemistry of blood and body fluids 08-12-2011 135 Dr Aaser Abdelazim
  135. 135. Calcium phosphates stones:Calcium phosphates stones Calcium phosphates crystals Chemistry of blood and body fluids 08-12-2011 136 Dr Aaser Abdelazim
  136. 136. Triple phosphates stones: Triple phosphates crystals Chemistry of blood and body fluids 08-12-2011 137 Dr Aaser Abdelazim
  137. 137. Calcium carbonates stones: Calcium carbonates crystals Chemistry of blood and body fluids 08-12-2011 138 Dr Aaser Abdelazim
  138. 138. Uric acid stones: Uric acid stones Chemistry of blood and body fluids Uric acid crystals 08-12-2011 139 Dr Aaser Abdelazim
  139. 139. Cystine stones: Cystine stone Chemistry of blood and body fluids 08-12-2011 140 Dr Aaser Abdelazim
  140. 140. Xanthine stones: Chemistry of blood and body fluids 08-12-2011 141 Dr Aaser Abdelazim
  141. 141. Causes of urinary stones:1. Change in urine pH: alkalinity of urine due to bacterial infections lead to precipitation of crystals and so stone formation.2. Disturbances in vitamins: Excess vitamin D: lead to absorption of more calcium and formation of calcium stones. Excess vitamin C: converted to oxalates and so increase oxalates stones. Vitamin A deficiency: lead to roughness of urinary epithelium and make it a suitable media for crystals precipitation.3. Disturbances in hormones: as in hyperparathyroidism; leads to high urinary excretion of calcium and predispose for calcium stones.4. High uric acid excretion: leads to uric acid stones.5. High cystine in urine: as in a metabolic disorder known as cystinuria.6. High amount of mucoproteins in urine: mucoproteins act as cement materials for stone formation. Chemistry of blood and body fluids 08-12-2011 142 Dr Aaser Abdelazim
  142. 142. Aaser Abdelazim, PhD Lecturer of medical biochemistry and molecular biology Zagazig university asr@zu.edu.eg Chemistry of blood and body fluids29-12-2011 144 Dr Aaser Abdelazim
  143. 143. DEFINITION:It is the secretion of mammary glands in human and animals which is essential fornewborn feeding up to the age of weaning. PHYSICAL PROPERTIES: Properties Human milk Cow milkColor White due to Creamy yellow as it presence of fat contains excess globules and amount of carotenes. calcium phosphates.pH 6 - 7.7 6 - 7.7Specific 1032 1082gravity Chemistry of blood and body fluids 29-12-2011 145 Dr Aaser Abdelazim
  144. 144. COMPOSITION OF MILK(1) Milk proteins: 1.2 g/dl:Milk proteins are less in human milk than in animal milk Protein Properties and Functions Albumin and Soluble proteins globulins (75%) Easily digested Globulins give immunity to babies. Casein (25%) It is very important to babies as it shares in the formation of milk clot. Ca paracasinate (milk clot) Enzymes Proteinase Amylase Peroxidase Catalase Alkaline phosphatase Aldehyde oxidase Chemistry of blood and body fluids 29-12-2011 146 Dr Aaser Abdelazim
  145. 145. (2) Milk carbohydrates (lactose) 7 g/dl: More in human milk than animal’s milkLactose Responsible for the sweetness of milk it less than the sweetness of cane sugar sucrose, this enable babies to take large quantities of milk without developing nausea After its hydrolysis it gives glucose; which is a potent source of energy and galactose; which is used to synthesize glycolipids. Chemistry of blood and body fluids 29-12-2011 147 Dr Aaser Abdelazim
  146. 146. (3) Milk fats 3.7 g/dl: Fatty acids: (48% saturated) (52% unsaturated) human contains more unsaturated fatty acids than animals Little amounts of phospholipids and cholesterol(4) Milk minerals: Minerals Contents Iron It does not supply the babies need It is more in human milk than in animal milk. Calcium and phosphorus Milk is one of the richest sources of Calcium and Phosphorus They present in milk with optimal ratio needed for absorption 2/1. Sodium and potassium They more in animal milk than human milk(5) Milk vitamins: Milk contains most of vitamins; it is very rich in vitaminsA and B2 Milk is poor in vitamins C, D, K. Chemistry of blood and body fluids 29-12-2011 148 Dr Aaser Abdelazim

×