Chapter 21, sp 10


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Chapter 21, sp 10

  1. 1. Human Anatomy, Second Edition McKinley & O'Loughlin Chapter 21 Lecture Outline: Blood
  2. 2. Cardiovascular System <ul><li>Blood, heart and blood vessels </li></ul><ul><li>Lymphatic system is closely related </li></ul><ul><li>Circulatory system = cardiovascular system and lymphatic system </li></ul>21-
  3. 3. General Composition and Functions of Blood <ul><li>A connective tissue: cells and a liquid ground substance and dissolved protein fibers (plasma). </li></ul><ul><li>About four times more viscous (thicker) than water. </li></ul><ul><li>Temperature is about 1°C higher than measured body temperature (38 degrees). </li></ul><ul><li>8% of body weight = 5 liters </li></ul><ul><li>Can be broken down into its liquid and cellular components by a machine called a centrifuge. </li></ul>21-
  4. 4. Components of Blood <ul><li>Plasma </li></ul><ul><ul><li>straw-colored liquid that rises to the top </li></ul></ul><ul><ul><li>about 55% of blood </li></ul></ul><ul><li>Buffy coat </li></ul><ul><ul><li>middle layer </li></ul></ul><ul><ul><li>thin, slightly gray-white layer composed of leukocytes and platelets </li></ul></ul><ul><ul><li>less than 1% of a blood sample </li></ul></ul><ul><li>Erythrocytes (or red blood cells) </li></ul><ul><ul><li>lowest layer </li></ul></ul><ul><ul><li>about 44% of a blood sample </li></ul></ul>21-
  5. 5.
  6. 6. Components of Blood <ul><li>Erythrocytes and the components of the buffy coat are called the formed elements . </li></ul><ul><ul><li>WBCs are cells </li></ul></ul><ul><ul><li>RBCs, no nuclei or other organelles, can’t divide </li></ul></ul><ul><ul><li>Platelets, merely fragments broken off from a larger cell, can’t divide </li></ul></ul><ul><li>Formed elements plus liquid plasma compose whole blood. </li></ul>21-
  7. 7.
  8. 8. Functions of Blood –Transportation <ul><li>Transports numerous elements and compounds throughout the body: gases, nutrients, heat, wastes, hormones </li></ul><ul><ul><li>erythrocytes carry most of the oxygen and some of the carbon dioxide </li></ul></ul><ul><ul><li>blood plasma </li></ul></ul><ul><ul><ul><li>nutrients absorbed from the GI tract </li></ul></ul></ul><ul><ul><ul><li>hormones </li></ul></ul></ul><ul><ul><ul><li>waste products from the cells to organs such as the kidneys, where these waste products are removed </li></ul></ul></ul>21-
  9. 9. Functions of Blood – Regulation: Body Temperature <ul><li>Plasma absorbs and distributes heat throughout the body </li></ul><ul><li>For cooling, the blood vessels in the dermis dilate and dissipate the excess heat through the integument </li></ul><ul><li>To conserve heat, the dermal blood vessels constrict, and the warm blood is shunted to deeper blood vessels in the body </li></ul>21-
  10. 10. Functions of Blood – Regulation: pH Levels <ul><li>pH is a measure of how alkaline or acidic a fluid is. </li></ul><ul><li>Neutral pH is exactly 7 (0-14). </li></ul><ul><li>Blood plasma contains compounds and ions that may be distributed to the fluid among tissues (interstitial fluid) to help maintain normal tissue pH. </li></ul><ul><li>Blood plasma pH is continuously regulated at a value of 7.4 (7.35-7.45) for normal cellular functioning. </li></ul><ul><li>If pH falls to 7.0, then acidosis, and CNS depression, coma, and death possibly </li></ul><ul><li>If pH rises to 7.8, then alkalosis, and hyperexcited nervous system and convulsions </li></ul>21-
  11. 11. Functions of Blood – Regulation: Fluid Levels <ul><li>Blood contains compounds (such as salts and some proteins) to prevent excess fluid loss in the plasma. </li></ul><ul><li>Constant exchange of fluid between the blood plasma and the interstitial fluid. </li></ul><ul><li>Water content of cells regulated through blood osmotic pressure , esp. dissolved ions and proteins </li></ul><ul><li>If too much fluid is absorbed in the blood, high blood pressure results. </li></ul><ul><li>If too much fluid escapes the bloodstream and enters the tissues, blood pressure drops to unhealthy low levels, and the tissues swell with excess fluid (edema). </li></ul>21-
  12. 12. Functions of Blood – Protection <ul><li>Leukocytes (white blood cells) help guard against infection by mounting an immune response if a pathogen or an antigen is found. </li></ul><ul><li>Plasma transports antibodies, which are molecules that can immobilize antigens until a leukocyte can completely kill or remove the antigen. </li></ul><ul><li>Platelets and blood proteins protect the body against blood loss by forming blood clots on damaged vessels. </li></ul>21-
  13. 13. Blood Plasma <ul><li>Complex mixture of water, proteins, and other solutes. </li></ul><ul><li>Serum = plasma - clotting proteins </li></ul><ul><li>Water makes up about 92% of plasma’s total volume. </li></ul><ul><ul><li>water facilitates the transport of materials in the plasma </li></ul></ul>21-
  14. 14. Plasma Proteins <ul><li>The next most abundant materials in plasma are the plasma proteins. </li></ul><ul><li>Make up about 7% of the plasma . </li></ul><ul><li>The plasma proteins include: </li></ul><ul><ul><li>albumins </li></ul></ul><ul><ul><li>globulins </li></ul></ul><ul><ul><li>fibrinogen </li></ul></ul><ul><ul><li>regulatory proteins </li></ul></ul>21-
  15. 15. Plasma Proteins – Albumins <ul><li>Smallest and most abundant of the plasma proteins. </li></ul><ul><ul><li>make up approximately 58% of total plasma proteins </li></ul></ul><ul><li>Regulate water movement between the blood and interstitial fluid. </li></ul><ul><li>Albumins act as transport proteins that carry ions, hormones, and some lipids in the blood. </li></ul>21-
  16. 16. Plasma Proteins – Globulins <ul><li>Second largest group, about 37% of all plasma proteins. </li></ul><ul><li>Smaller alpha-globulins and the larger beta-globulins primarily bind, support, and protect certain water-insoluble or hydrophobic molecules, hormones, and ions. </li></ul><ul><li>Gamma-globulins or immunoglobulins or antibodies. </li></ul><ul><ul><li>Produced by some of our defense cells to protect the body against pathogens that may cause disease. </li></ul></ul>21-
  17. 17. Plasma Proteins – Fibrinogen <ul><li>About 4% of all plasma proteins . </li></ul><ul><li>Responsible for blood clot formation. </li></ul><ul><li>Following trauma to the walls of blood vessels, the soluble fibrinogen is converted into long, insoluble strands of fibrin, the essence of a blood clot. </li></ul>21-
  18. 18. Plasma Proteins – Regulatory Proteins <ul><li><1% </li></ul><ul><li>Include enzymes to accelerate chemical reactions in the blood and hormones being transported throughout the body to target cells. </li></ul>21-
  19. 19. Differences Between Plasma and Interstitial Fluid <ul><li>Plasma is an extracellular fluid (ECF), a body fluid outside cells </li></ul><ul><li>Plasma is similar to interstitial fluid (fluid between cells) </li></ul><ul><ul><li>both have similar concentrations of nutrients, waste products, and electrolytes </li></ul></ul><ul><li>The concentrations of oxygen and carbon dioxide are different to ensure the movement of the gases in the right directions </li></ul>21-
  20. 20. Formed Elements in the Blood <ul><li>Erythrocytes </li></ul><ul><ul><li>make up more than 99% of formed elements </li></ul></ul><ul><ul><li>primary function is to transport respiratory gases in the blood </li></ul></ul><ul><li>Leukocytes </li></ul><ul><ul><li>make up less than .01% of formed elements </li></ul></ul><ul><ul><li>contribute to defending the body against pathogens </li></ul></ul><ul><li>Platelets </li></ul><ul><ul><li>make up less than 1% of formed elements and </li></ul></ul><ul><ul><li>help with blood clotting </li></ul></ul>21-
  21. 21. Hematocrit <ul><li>Percentage of the volume of formed elements (or erythrocytes, clinically) in the blood. </li></ul><ul><li>Values vary slightly and are dependent on age and sex. </li></ul><ul><li>Adult males: 42% - 56% ; Adult females: 38% - 46%. </li></ul><ul><li>Childrens’ hematocrit ranges also vary and differ from adult values. </li></ul><ul><li>Uses: </li></ul><ul><ul><li>Diagnosis of anemia, polycythemia (greater than 65), and abnormal hydration </li></ul></ul><ul><li>Normally higher in athletes </li></ul><ul><li>Altitude can affect the hematocrit. </li></ul><ul><ul><li>body compensates by making more erythrocytes </li></ul></ul><ul><ul><li>more erythrocytes in the blood can carry more oxygen to the tissues </li></ul></ul>21-
  22. 22. Blood Doping <ul><li>RBC donation to yourself </li></ul><ul><li>Increases oxygen carrying capacity of blood for competition </li></ul><ul><li>Results in increased performance in endurance events </li></ul><ul><li>Danger: increased viscosity of blood increases the workload for the heart and may lead to heart failure </li></ul><ul><li>Banned by athletic governing bodies </li></ul>21-
  23. 23.
  24. 24. Erythrocytes <ul><li>Transport O 2 and CO 2 to and from the tissues and the lungs. About 5 million/cubic mm of blood (1/3 or all cells!) and 99.9% of formed elements. </li></ul><ul><li>Mature erythrocytes lack nuclei which enables them to carry respiratory gases more efficiently. </li></ul><ul><li>7.5 microns in diameter - about the width of the smallest capillaries. Rouleau formation in capillaries. </li></ul><ul><li>Biconcave shape </li></ul><ul><ul><li>Increases surface area for gas exchange </li></ul></ul><ul><ul><li>Increases flexibility which helps them squeeze through small capillaries </li></ul></ul><ul><li>No nucleus, mitochondria, or ribosomes (more room to carry oxygen and without mitochondria, they do not use up the oxygen) </li></ul>21-
  25. 25.
  26. 26. Hemoglobin in Erythrocytes <ul><li>About 280 million molecules of a red-pigmented protein called hemoglobin/RBC . </li></ul><ul><li>Transports almost all of the oxygen and some carbon dioxide, and is responsible for the characteristic bright red color of arterial blood. </li></ul><ul><li>Hemoglobin that contains no oxygen has a deep red color that is perceived as blue because the blood within these veins is observed through the layers of the skin (with collagen) and the subcutaneous tissue. </li></ul>21-
  27. 27. Hemoglobin (Hb) in Erythrocytes <ul><li>Each Hb molecule has four protein building blocks, called globins: 2 alpha and 2 beta chains. </li></ul><ul><li>All globin chains contain a nonprotein (or heme) group with an iron ion (Fe ++) in its center. </li></ul><ul><li>Each Hb molecule has four iron ions and each is capable of binding a molecule of oxygen, i.e., 4 O 2 /Hb </li></ul><ul><li>Over 99% of the oxygen is carried by the heme. </li></ul><ul><li>Oxygen binding is fairly weak to ensure rapid attachment in the lungs and detachment in the tissues. </li></ul><ul><li>The globin carries 23% of the carbon dioxide. Most of the carbon dioxide is carried in the bicarbonate ion. </li></ul>21-
  28. 28.
  29. 29. Erythrocyte Life Cycle <ul><li>About 120 days - plasma membrane wears away </li></ul><ul><li>Fixed macrophages in spleen and liver remove. Also hemolysis. Components recycled. </li></ul><ul><li>Need about 2-3 million new mature RBC/sec to balance destruction </li></ul>21-
  30. 30.
  31. 31. <ul><li>Anemia: low Hct or low Hb </li></ul><ul><ul><li>Aplastic anemia: bone marrow </li></ul></ul><ul><ul><li>Congenital hemolytic anemia: genetic </li></ul></ul><ul><ul><li>Erthroblastic anemia: immature RBCs </li></ul></ul><ul><ul><li>Familial microcytic anemia: genetic defect of iron </li></ul></ul><ul><ul><li>Hemorrhagic anemia: blood loss </li></ul></ul><ul><ul><li>Macrocytic anemia: lack of B 12 and folic acid </li></ul></ul><ul><ul><ul><li>Pernicious anemia: lack of intrinsic factor leads to lack of B 12 absorption </li></ul></ul></ul><ul><ul><li>Sickle-cell disease: recessive genetic disease, cells sickle when oxygen low. Malaria protection from one copy of gene. </li></ul></ul>Erythrocyte Volume Disorders 21-
  32. 32. <ul><li>Polycythemia - Hematocrit >65 </li></ul><ul><ul><li>Compensatory polycythemia: chronic hypoxia (smoker’s) </li></ul></ul><ul><ul><li>Relative polycythemia: decrease in blood plasma (dehydration-temporary) </li></ul></ul><ul><ul><li>Erythrocytosis: increase in EPO </li></ul></ul><ul><ul><li>Polycythemia vera: increase in blood volume and RBCs due to loss of RBC growth regulation in red bone marrow </li></ul></ul>Erythrocyte Volume Disorders 21-
  33. 33. Blood Types <ul><li>Surface antigens on RBCs are genetically determined </li></ul><ul><li>At least 14 blood group systems and more than 100 antigens </li></ul><ul><li>Uses </li></ul><ul><ul><li>Transfusions </li></ul></ul><ul><ul><li>Paternity tests </li></ul></ul><ul><ul><li>Crime detection </li></ul></ul><ul><li>2 major blood group classifications </li></ul><ul><ul><li>ABO blood grouping </li></ul></ul><ul><ul><li>Rh blood grouping </li></ul></ul>21-
  34. 34.
  35. 35. Antibodies <ul><li>An antibody interacts with a specific antigen. </li></ul><ul><li>The ABO blood group has both anti-A and anti-B antibodies that react with the surface antigen A and the surface antigen B, respectively. </li></ul><ul><li>The antibodies in your blood plasma do not recognize the surface antigens on your erythrocytes. </li></ul>21-
  36. 36.
  37. 37.
  38. 38. Transfusions <ul><li>Type O is the universal donor </li></ul><ul><li>Type AB is universal recipient </li></ul><ul><li>Whole blood seldom used. Usually divided into three components. </li></ul><ul><ul><li>Erythrocytes </li></ul></ul><ul><ul><li>Clotting proteins </li></ul></ul><ul><ul><li>Platelets </li></ul></ul>21-
  39. 39. <ul><li>Anti-Rh (D) antibodies only made if Rh - person is sensitized by previous exposure to Rh + RBCs: transfusions and pregnancy </li></ul><ul><li>Rh - mother who is sensitized carrying Rh + baby could hemolyze the baby’s blood </li></ul><ul><li>Rho-Gam is an anti-Rh gamma globulin given to mother that inactivates Rh + fetal blood cells in mother’s blood before she becomes sensitized and produced antibodies </li></ul>Hemolytic Disease of the Newborn (Erthroblastosis fetalis) 21-
  40. 40. <ul><li>Red bone marrow - need to match </li></ul><ul><li>Hipbones used: heparin added, passed through screens, T-cells removed, injected, reseed bone marrow </li></ul><ul><li>Uses: </li></ul><ul><ul><li>Aplastic anemia </li></ul></ul><ul><ul><li>Some leukemias </li></ul></ul><ul><ul><li>Severe combined immunodeficiency disease </li></ul></ul>Bone Marrow Transplant 21-
  41. 41. Leukocytes <ul><li>Help initiate an immune response and defend the body against invading pathogens. </li></ul><ul><li>“ Cells.” </li></ul><ul><li>About 1.5 to 3 times larger than RBCs and no hemoglobin. </li></ul><ul><li>Fight infections in the loose connective tissues outside the capillaries </li></ul><ul><li>Blood: 5000-10,000/mm 3 but most are outside the blood! </li></ul><ul><li>Leukopenia = lack possibly from viral or bacterial infection, some leukemias, or bone marrow toxins </li></ul><ul><li>Leukocytosis = increased number may indicate dehydration, allergy, or infection </li></ul>21-
  42. 42. Leukocyte Characteristics <ul><li>Do not circulate for long. They move into abnormal tissue areas. </li></ul><ul><li>Amoeboid movement </li></ul><ul><li>Diapedesis = squeeze through blood vessel walls to go into tissues </li></ul><ul><li>Positive chemotaxis </li></ul><ul><li>Some phagocytic </li></ul><ul><ul><li>Neutrophils </li></ul></ul><ul><ul><li>Eosinophils </li></ul></ul><ul><ul><li>Monocytes -> macrophages </li></ul></ul>21-
  43. 43. Leukocytes <ul><li>The five types are granulocytes or agranulocytes — based upon the presence or absence of visible organelles termed specific granules. </li></ul><ul><ul><li>Granules are actually lysosomes </li></ul></ul>21-
  44. 44. Wright’s Stain <ul><li>Helps distinguish WBCs </li></ul><ul><ul><li>Eosin is an acid stain </li></ul></ul><ul><ul><li>Methylene blue is a basic stain </li></ul></ul>21-
  45. 45. Granulocytes <ul><li>Neutrophils (polymorphonuclear leukocytes) </li></ul><ul><ul><li>60–70% of the total number of leukocytes </li></ul></ul><ul><ul><li>2-6 lobes </li></ul></ul><ul><ul><li>Light colored granules with lilac cytoplasm </li></ul></ul><ul><ul><li>d = 10-12 microns </li></ul></ul><ul><ul><li>Increase during bacterial infections - lysozyme helps destroy cell walls </li></ul></ul><ul><li>Eosinophils have reddish, or pink-orange granules in their cytoplasm. </li></ul><ul><ul><li>about 2–4% of the total number of leukocytes </li></ul></ul><ul><ul><li>d = 10-12 microns </li></ul></ul><ul><ul><li>nucleus usually has two lobes, which are connected by a thin strand </li></ul></ul><ul><ul><li>Increase to phagocytize antigen-antibody complexes and during parasitic worm infections </li></ul></ul>21-
  46. 46. Granulocytes <ul><li>Basophils are </li></ul><ul><ul><li>1.5 times larger than erythrocytes </li></ul></ul><ul><ul><li>about 0.5–1% of the total number of leukocytes </li></ul></ul><ul><ul><li>d = 8-10 microns </li></ul></ul><ul><ul><li>have a bilobed nucleus (obscured by the granules) and abundant blue-violet granules in the cytoplasm </li></ul></ul><ul><ul><li>Contain histamine which increases the diameter of blood vessels and other allergic symptoms. </li></ul></ul><ul><ul><li>Contains heparin, a natural anticoagulant, that inhibits blood clotting. </li></ul></ul>21-
  47. 47. Agranulocytes <ul><li>Agranulocytes have such small granules in their cytoplasm that they are frequently overlooked. </li></ul><ul><li>Agranulocytes include both lymphocytes and monocytes. </li></ul>21-
  48. 48. Lymphocytes <ul><li>Most are in the lymphatic tissues </li></ul><ul><li>Small ones only have only a thin rim of blue-gray cytoplasm around the nucleus </li></ul><ul><li>When activated, they grow larger and have proportionally more cytoplasm </li></ul>21-
  49. 49. Types of Lymphocytes <ul><li>T-lymphocytes (T-cells) </li></ul><ul><ul><li>manage and direct an immune response </li></ul></ul><ul><ul><li>some directly attack foreign cells and virus-infected cells </li></ul></ul><ul><li>B-lymphocytes (B-cells) </li></ul><ul><ul><li>stimulated to become plasma cells and produce antibodies </li></ul></ul><ul><li>Natural killer cells (NK cells) </li></ul><ul><ul><li>attack abnormal and infected tissue cells </li></ul></ul><ul><ul><li>“ immunological surveillance” </li></ul></ul><ul><ul><li>nonspecific </li></ul></ul>21-
  50. 50. Monocytes <ul><li>Up to three times the diameter of an RBC. </li></ul><ul><li>About 3–8% of all leukocytes. </li></ul><ul><li>Nucleus is kidney-shaped or U-shaped. </li></ul><ul><li>After about 3 days in the circulation, monocytes move into tissues and become macrophages that phagocytize bacteria, cell fragments, dead cells, and debris. </li></ul><ul><li>Nonspecific </li></ul>21-
  51. 51. Mnemonic Disease <ul><li>Never let monkeys eat bananas </li></ul>21-
  52. 52. Lifespan <ul><li>Varies : 12 hrs. for neutrophils to years for lymphocytes </li></ul><ul><li>During an infection, some may live for only a few hours </li></ul>21-
  53. 53. <ul><li>Characterized by abnormal development and proliferation of WBCs in the bone marrow and circulating blood </li></ul><ul><li>Acute leukemia : rapid progression and death in a few months following onset of symptoms </li></ul><ul><ul><li>Severe anemia, hemorrhages, and recurrent infection </li></ul></ul><ul><ul><li>Occurs usually in children and young adults </li></ul></ul><ul><li>Chronic leukemia : progresses more slowly with survival exceeding one year following onset of symptoms </li></ul><ul><ul><li>Anemia and tendency to bleed </li></ul></ul><ul><ul><li>Occurs usually in middle-aged and older individuals </li></ul></ul><ul><li>Good chance of cure now in childhood leukemias </li></ul>Leukemia 21-
  54. 54. Platelets (Thrombocytes) <ul><li>Fragments (2 microns) continually shed by megakaryocytes in the red bone marrow which then enter circulation. </li></ul><ul><li>120,000-about 300,000/mm 3 of blood </li></ul><ul><li>Severe trauma to a blood vessel causes the blood to coagulate, or clot. </li></ul><ul><li>Components in the plasma produce a web of fibrin that traps erythrocytes and platelets in the web (platelet plug) to halt blood flow. </li></ul><ul><li>Lifespan: about 8-10 days </li></ul>21-
  55. 55. Hemopoiesis: Production of Formed Elements <ul><li>Hemocytoblast (blood stem cell) </li></ul><ul><li>Myeloid stem cells </li></ul><ul><ul><li>Erythropoiesis </li></ul></ul><ul><ul><li>Thrombopoiesis </li></ul></ul><ul><ul><li>Leukopoiesis </li></ul></ul><ul><ul><ul><li>Granulocytes </li></ul></ul></ul><ul><ul><ul><li>Monocytes </li></ul></ul></ul><ul><li>Lymphoid stem cells </li></ul><ul><ul><li>lymphocytes </li></ul></ul>21-
  56. 56. Hemopoiesis: Production of Formed Elements <ul><li>Hormones and growth factors influence the maturation and division of the blood stem cells </li></ul><ul><li>Called colony-stimulating factors (CSFs) </li></ul>21-
  57. 57. Erythropoiesis <ul><li>Erythrocyte production is about three million per second. </li></ul><ul><li>Testosterone stimulates, but estrogen inhibits </li></ul><ul><li>Erythropoietin released by the kidney in response to hypoxia (low tissue oxygen levels) increases mitotic rate and accelerates maturation. </li></ul><ul><li>Reticulocyte count is a measure of the rate of erythropoiesis (about 1% is normal) </li></ul><ul><ul><li>Low “retic” count in anemia indicates an inability for red bone marrow response </li></ul></ul><ul><ul><li>High “retic” count in anemia indicates a good red bone marrow response </li></ul></ul><ul><li>Hemopoietic growth factors: recombinant available </li></ul><ul><ul><li>Increases RBC in end-stage kidney disease </li></ul></ul>21-
  58. 58. Thrombopoiesis <ul><li>A committed cell, the megakaryoblast, produces a megakaryocyte. </li></ul><ul><li>The megakaryocyte produces thousands of platelets . </li></ul>21-
  59. 59. Leukopoiesis <ul><li>Three different maturation processes: </li></ul><ul><ul><li>Granulocyte maturation </li></ul></ul><ul><ul><li>Monocyte maturation </li></ul></ul><ul><ul><li>Lymphocyte maturation </li></ul></ul>21-