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  • 1. Physical Characteristics of Blood
    • Thicker (more viscous) than water and flows more slowly than water
    • Temperature of 100.4 degrees F
    • pH 7.4 (7.35-7.45)
    • 8 % of total body weight
    • Blood volume
      • 5 to 6 liters in average male
      • 4 to 5 liters in average female
      • hormonal negative feedback systems maintain constant blood volume and osmotic pressure
  • 2. Blood components
    • 55% plasma: 7 to 8% dissolved substances (sugars, amino acids, lipids & vitamins), ions, dissolved gases, hormones
      • most of the proteins are plasma proteins: provide a role in balancing osmotic pressure and water flow between the blood and extracellular fluid/tissues
      • loss of plasma proteins from blood – decreases osmotic pressure in blood and results in water flow out of blood into tissues – swelling
      • most common plasma proteins: albumin, globulins, clotting proteins (fibrin)
  • 3. Blood: Cellular elements
    • 45% of blood is the cellular elements or formed elements
    • 99% of this (44.55% of total blood) is erythrocytes or RBCs
      • formed by differentiation of hematopoietic stem cells (HSCs) in the red bone marrow of long bones and pelvis – makes about 2 million per second!
      • most numerous cell type in the body – 4 to 6 million per ul blood
      • as they mature in the marrow they lose most organelles and its nucleus
      • lack mitochondria and cannot use the oxygen they transport for ATP synthesis
      • lives only about 120 days – destroyed by the liver and spleen
      • liver degrades the hemoglobin to its globin component and the heme is degraded to a pigment called bilirubin - bile
      • Iron(Fe+3)
        • transported in blood attached to transferrin protein
        • stored in liver, muscle or spleen
        • attached to ferritin or hemosiderin protein
        • in bone marrow being used for hemoglobin synthesis
  • 4.
    • -1% found in the Buffy coat :
      • - leukocytes (WBCs) and platelets (thromobocytes)
      • -neutrophils: phagocytic properties
      • -release lysozymes which destroy/digest bacteria
      • -release defensin proteins that act like antibiotics & poke holes in bacterial cell walls destroying them
      • -release strong oxidants (bleach-like, strong chemicals ) that destroy bacteria
      • - releases cytokines that attract other neutrophils
      • -eosinophils: parasitic defense cells
      • -also involved in the allergic response
      • -r elease histaminase
      • slows down inflammation caused by
      • basophils
      • -basophils: heparin, histamine & serotonin
      • -heighten the inflammatory response and account for hypersensitivity (allergic) reaction
      • -monocytes: enter various tissues and
      • differentiate into phagocytic macrophages
      • -lymphocytes: T and B cells
  • 5. Hematopoiesis
  • 6. Hematocrit
    • Percentage of blood occupied by cells
      • female normal range
        • 38 - 46% (average of 42%)
      • male normal range
        • 40 - 54% (average of 46%)
        • testosterone
    • Anemia
      • not enough RBCs or not enough hemoglobin
    • Polycythemia
      • too many RBCs (over 65%)
      • dehydration, tissue hypoxia, blood doping in athletes
  • 7. Blood Groups and Blood Types
    • RBC surfaces are marked by genetically determined glycoproteins & glycolipids
      • agglutinogens or isoantigens
      • distinguishes at least 24 different blood groups
        • ABO, Rh, Lewis, Kell, Kidd and Duffy systems
  • 8. RH blood groups
    • Antigen was discovered in blood of Rhesus monkey
    • People with Rh agglutinogens on RBC surface are Rh+. Normal plasma contains no anti-Rh antibodies
    • Antibodies develop only in Rh- blood type & only with exposure to the antigen
      • transfusion of positive blood
      • during a pregnancy with a positive blood type fetus
    • Transfusion reaction upon 2nd exposure to the antigen results in hemolysis of the RBCs in the donated blood
  • 9. Hemolytic Disease of Newborn
    • Rh negative mom and Rh+ fetus will have mixing of blood at birth
    • Mom's body creates Rh antibodies unless she receives a RhoGam shot soon after first delivery
      • can lead to miscarriage or spontaneous abortion of future Rh+ children
      • RhoGam binds to loose fetal blood and removes it from body before she reacts
    • In 2nd child, hemolytic disease of the newborn may develop causing hemolysis of the fetal RBCs
  • 10. Anemia
    • Symptoms
      • oxygen-carrying capacity of blood is reduced
      • fatigue, cold intolerance & paleness
        • lack of O2 for ATP & heat production
    • Types of anemia
      • iron-deficiency = lack of absorption or loss of iron
        • type of nutritional anemia
        • failure to take in essential raw ingredients not made by the body
      • pernicious = lack of intrinsic factor for vitamin B12 absorption from the digestive tract
        • B12 is essential for normal RBC formation and maturation
        • binding of B12 to intrinsic factor allows its absorption
        • intrinsic factor – synthesized by the small intestine
      • hemorrhagic = loss of RBCs due to bleeding (ulcer)
      • hemolytic = defects in cell membranes cause rupture
        • rupture of too many RBCs by external factors such as malaria (normal RBCs) or genetic disorders like sickle cell anemia (defective RBCs)
      • thalassemia = hereditary deficiency of hemoglobin
      • aplastic = destruction of bone marrow (radiation/toxins)
        • failure of the bone marrow to produce enough RBCs
        • may selectively destroy the ability to produce RBCs only
        • but may also destroy the myeloid stem cells – affect WBCs and platelets
  • 11. Sickle-cell Anemia (SCA)
    • Genetic defect in hemoglobin molecule (Hb-S) that changes 2 amino acids in the globin protein
      • at low very O2 levels, RBC becomes deformed by changes in hemoglobin molecule within the RBC
        • sickle-shaped cells do not pass through capillaries well and get stuck = causing occlusions and decreased blood flow to organs
        • also rupture easily = causing anemia & clots
    • Found among populations in malaria belt
      • Mediterranean Europe, sub-Saharan Africa & Asia
    • Person with only one sickle cell gene
      • increased resistance to malaria because RBC membranes leak K+ & lowered levels of K+ kill the parasite (Plasmodium) infecting the red blood cells
  • 12. Blood Clotting
      • in a test tube blood separates into liquid (serum) and a clot of insoluble fibers (fibrin) in which the cells are trapped
      • in the body the clot “plugs” damaged blood vessels and initiates healing
      • ultimate step is conversion of fibrinogen (soluble plasma protein) into insoluble fibrin
    • Substances required for clotting are Ca+2, enzymes synthesized by liver cells ( clotting factors and plasma proteins ) and substances released by platelets or damaged tissues
      • thrombin – released by damaged cells, catalyzes the conversion of fibrinogen to fibrin
      • 12 clotting factors involved
    • Clotting is a cascade of reactions in which each clotting factor activates the next in a fixed sequence resulting in the formation of fibrin threads
      • prothrombinase & Ca+2 convert prothrombin into thrombin
      • thrombin converts fibrinogen into fibrin threads
  • 13. Overview of the Clotting Cascade -may be triggered through two possible paths 1. extrinsic pathway 2. intrinsic pathway -either path leads to activation of the final common pathway in which thrombin cleaves fibrinogen to form fibrin
  • 14. Lymphatic & Immune System Lymphatic system: system of lymphatic vessels and organs -larger lymphatic vessels are similar to blood vessels - presence of valves -lymphatic vessels - for the transport of lymph -lymph : filtrate produced in tissues and NOT reabsorbed by the CV system -enters lymphatic capillaries from the tissues -low pressure system - moves by muscular contraction and breathing -capillaries join to form lymphatic vessels -vessels join to form: 1) thoracic duct 2) lymphatic duct - Right side head, arm & chest empty into right lymphatic duct and rest of body empties into thoracic duct -then dumped directly into left & right subclavian veins -lymphatic system is ONE WAY (from tissues to heart)
  • 15. Lymphatic organs: 1) lymph nodes: found at certain points along the lymphatic system -capsule surrounding an outer cortex and inner medulla -cortex contains immune cells = lymphocytes (fight pathogens) -medulla contains immune cells = macrophages (clean lymph) 2) tonsils: lymphatic tissue located in the pharynx ( adenoids ) or oral cavity ( palatine tonsils ) -defense against pathogens 3) spleen: upper left region of the abdomen -cleanses the blood -capsule, white and red pulp -white pulp contains lymphocytes -red pulp contains red blood cells & macrophages
  • 16. 4) bone marrow (red): adult - within the spongy bone of the epiphyses, pelvis, skull, clavicle, sternum -site of origin for all blood cells (RBCs, WBCs) -derived from hematopoietic stem cells (hematopoiesis) -also the site of origin for all mesodermal cells (bone, muscle, cartilage, fat…..) -derived from mesenchymal stem cells 5 ) thymus gland : located below the trachea, on top of the heart -divided into lobules -larger in children -production of T lymphocytes -production of hormones - thymosin - stimulates the lymphocytes located in other tissues
  • 17. 1) Non-specific defenses A)Mechanical barriers: first line of defense - Skin and mucus membranes lining the respiratory tract, digestive & reproductive systems e.g. ciliated epithelium of respiratory system - coated with mucus, coughed out B) Chemical barriers: first line of defense -acidic pH of the stomach interior -E.coli within the small intestine -gastric enzymes in gastric juice -high salt in perspiration kills some bacteria C) Fever: second line of defense -secretion of pyrogen by lymphocytes - raises body temp -rise in body temp enhances the phagocytic activity of immune cells D) Inflammation: second line of defense E) Phagocytosis
  • 18. Inflammation: 1) injury to tissue 2) synthesis of histamine, prostaglandins, pyrogens (heat) and kinins (pain) by damaged cells 3) histamine released - dilation of capillaries & increased blood flow 4) delivery of proteins (e.g. clotting response), increase of fluid in damaged area, reddening of skin - swelling 5) increased migration of neutrophils and monocytes/macrophages via dilated capillaries - phagocytosis of foreign particles 6) clotting response by blood - cascade/positive feedback - to minimize blood loss 7) macrophages release Colony stimulating factors - differentiation of more WBCs by the bone marrow 8) production and release of lymphocytes from lymph nodes - travel to infection site
  • 19. Prostaglandins
    • made by every cell in the body
      • stimulates smooth muscle contraction (PGE2)
      • stimulates synthesis of gastric juice
    • also made by damaged cells
      • stimulates blood clotting – thromboxane synthesis by platelets
      • stimulates the inflammatory pathway – pain and fever
    • work within the cell that makes them
    • derived from arachadonic acid – phospholipid in the plasma membrane
    • damaged cells release histamine – increases blood flow to damaged area – brings WBCs to the area – stimulates damaged cells to make prostaglandins – stimulates secretion of kinins (pain ) and pyrogens (fever) also by damaged cells
    • related cousin = leukotrienes
    • AA is converted either into leukotrienes or into prostaglandins
    • first PG made is called PGG2 – converted into PGH2
    • this conversion is done by a enzyme complex called
    • cyclooxygenase – contains an enzyme called COX
    • most cells express COX1 – normal production of PG
    • damaged cells express COX2 – abnormal production of PGs
    • (inflammation) and thromboxane (clotting)
    http://cti.itc.virginia.edu/~cmg/Demo/pdb/cycox/cycox.html http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/I/Inflammation.html
  • 20. Blood clotting
    • step 1 (extrinsic): injured cells in vessel walls release tissue factor or thromboplastin
    • or platelets contact the collagen of the damaged vessel wall and release factor VII (intrinsic)
    • step 2 (extrinsic or intrinsic): these factors convert an inactive clotting factor X to its active form (requires calcium)
      • active factor X converts an inactive protein into an activator – prothrombin activator/prothrombinase
    • step 3 (common): PA converts prothrombin to thrombin (liver)
    • step 4 (common): thrombin converts fibrinogen to fibrin
    • step 5: fibrin forms a network which traps RBCs and platelets to form a clot
      • trapped platelets release factor XIII stabilizing the fibrin threads
    • Normal clotting requires adequate vitamin K
      • fat soluble vitamin absorbed if lipids are present
      • absorption slowed if bile release is insufficient
    • Required for synthesis of 4 clotting factors by hepatocytes
      • factors II (prothrombin), VII, IX and X
    • Produced by bacteria in large intestine
  • 21. 2) Specific Defenses (Immunity) Immunity: ability of the body to defend itself from infectious agents, foreign cells, cancer cells Antigens: -before birth, the body takes an “inventory” of all self proteins = antigens -lymphocytes develop receptors that allow them to distinguish between self and foreign -non-self antigens combine with T and B cell receptors and stimulate an immune reaction T Cell-mediated immunity:/Cell-mediated immunity -T = thymus derived -respond to antigens by cell-cell contact - attach to foreign cells directly -antigens are processed before interacting with T cells -antigen-presenting cells (B cells, macrophages)
  • 22.
    • Foreign antigen in body fluid is phagocytized by the APC
      • macrophage, B cell, dendritic cell (Langerhans cell in skin)
    • Antigen is digested and fragments are bound to MHC-II molecules stuck into antigen presenting cell membrane
    • APC migrates to lymphatic tissue to find T cells
    • most of the antigens presented to T cells are self-antigens – so the T cell learns what is self and what is foreign
    Antigen Presenting Cell (APC)
  • 23.
    • APC displays the foreign antigen to the T cell
    • this requires cell-cell contact between the APC and T cell in order to activate the T cell
    • both T helper and cytotoxic T cells can be activated by an APC
    • interaction between the MHC complex with the Ag and a complex of proteins on the T cell called the T cell receptor
    • TCR = multiple proteins associated with a co-receptor (CD4 for a T helper or CD8 for a cytotoxic T cells)
    • activation of the T cell now causes it to synthesize specific soluble chemicals called cytokines – interleukins and interferons
    APC
  • 24. T cell types
    • 1. Cytotoxic T cells (Tc cells) destroy virally infected cells and tumor cells
      • also implicated in transplant rejection.
      • are also known as CD8+ T cells , since they express the CD8 glycoprotein at their surface.
      • secrete perforin which punches holes in the foreign membrane
    • 2. Helper T cells , (Th cells) participate in bacterial infections
      • need to be activated by an APC
      • once activated - divide rapidly ( clonal expansion ) and secrete small proteins called cytokines that regulate or "help" the immune response.
      • also called CD4+ T cells
      • are a target of HIV infection - virus infects the cell by using the CD4 protein to gain entry. The loss of Th cells .
    • 3. Memory T cells - T cells that persist long-term after an infection has resolved.
      • quickly expand to large numbers of effector T cells upon re-exposure to their cognate antigen,
      • provide the immune system with "memory" against past infections.
      • comprise two subtypes: central memory T cells (TCM cells) and effector memory T cells (TEM cells).
      • may be either CD4+ or CD8+.
  • 25. B Cell-mediated immunity/Antibody mediated immunity -antibody producing cells -activated by interacting with an antigen that fits with an antibody displayed on the surface of the B cell -activation is helped by T helper cells - releases cytokines that induce the B cell to proliferate - clonal expansion -activated B cell differentiates into a plasma cell - secretes antibodies specific to the bound antigen and therefore similar in structure to the antigen receptor on the B cell surface Antibodies = Immunoglobulins -B cells produce a polyclonal response - several types of antibodies against one type of foreign particle -comprised of 4 chains of amino acids linked by pairs of sulfur atoms (disulfide bonds) -two light chains, two heavy chains -each light and heavy chain has a variable region that recognizes a specific antigen -also called an antigen-binding site
  • 26. Antibody types: 5 major types 1) IgG = immunoglobulin G -plasma and tissue fluids -effective against bacteria, viruses and toxins -activates the complement system 2) IgA - exocrine gland secretions e.g. breast milk, tears, nasal discharge, gastric juices 3) IgM - blood plasma -develops in response to contact with certain antigens in foods and bacteria -also activates complement 4) IgE - exocrine secretions with IgA -associated with the allergic response 5) IgD - surfaces of most B cells -activation of B cells
  • 27. B cell types
    • 1) Plasma B cells (also known as plasma cells )
      • large B cells that have been exposed to antigen
      • produce and secrete large amounts of antibodies
    • 2) Memory B cells - formed from activated B cell
      • activation requires interaction with between the B cell and an antigen encountered during the primary immune response.
      • are able to live for a long time
      • respond quickly following a second exposure to the same antigen.
    • 3) B-2 cells are the conventional B cells most texts refer to.
  • 28. B cell activation
    • requires binding of a foreign antigen to the antibody displayed on the surface of the B cell
      • antigen is internalized and processed into fragments which are displayed in association with the MHC-II complex = APC
    • the membrane bound antibody is called a B cell receptor (BCR)
      • the BCR recognizes the unprocessed form of an antigen
      • the TCR recognizes a processed form of the antigen
    • interaction of the B cell displaying the antigen activates the T helper cell
    • interaction leads to the differentiation of the B cells into a plasma cell and production of soluble antibodies
      • activated T cells secrete lymphokines which stimulates the differentiation of the B cell
  • 29. Antibody actions 1) direct attack on antigens - combine with antigens and cause them to agglutinate or clump -easier to phagocytose -or neutralizes the toxic portions of an antigen by binding -or causes antigens to precipitate and become insoluble 2) activation of complement -group of proteins in plasma and body fluids -activation of complement proteins by IgM and IgG results in several effects including: coating Ag-Ab complexes (susceptible to phagocytosis), attraction of macrophages and neutrophils ( Chemotoxis ), rupturing of foreign membranes, altering structure of viruses 3) stimulates changes in local environment making spread of antigens difficult
  • 30. Immune Responses Primary response : when B or T cells become activated after an intial exposure -release of IgM then IgG by plasma cells into the lymph -several weeks -several B and T cells become dormant but persist in the lymph = memory cells -if an identical antigen is encountered - clonal expansion and an immediate response called a Secondary response -lasts years Immunity Types 1) Passive - when an individual is given prepared antibodies to combat a disease -temporary because the Ig’s are not produced by the individual -passed from mother to child in breast milk -usually given as a gamma globulin injection (blood serum) from a person who have recovered from an infection 2) Active - develops after exposure to an antigen -also can be induced through exposure to small amounts of the pathogen
  • 31. Immunization = administration of a vaccine - vaccine = contains small amounts of an antigen to which the immune system responds -antigens are treated so that they are no longer virulent (i.e. no longer replicates or no longer viable) -today - bacteria can be engineered to mass produce specific proteins from a pathogen e.g. Hepatitis B vaccines -active immunity depends on the presence of memory T and B cells -long lasting - although booster shots may be required e.g. Diptheria, tetanus, pertussis - age 4 to 6 years, tetanus boosters at 11 and 14 years and older e.g. Polio - age 2, 4 and 6 months, 4 to 6 years, no booster e.g. measles, mumps, rubella - 12 to 15 months, 4 to 6 years, booster at 11-12 years
  • 32. Allergies -hypersensitivities to substances such as pollen, dander, or other substances that normally do no damage to others -these antigens = allergens -four types of allergic responses 1. Immediate response: -within seconds of contact -cold-like symptoms -caused by release of IgE antibodies by allergen activated B cells -IgE are also found on cell surface of mast cells in tissues and basophils in the blood -allergen-IgE interaction causes release of histamine from these cells -severe reaction = anaphylatic shock e.g. bee sting - first exposure results in high sensitivity -second exposure can be fatal due to massive histamine release, resulting in increased vessel permeability and a drastic drop in blood pressure -allergy shots - build up of IgG which will react with the allergen before the allergens can interact with IgE
  • 33. Allergic reactions
    • allergen stimulates the B cell to secrete IgE antibodies
    • these IgE antibodies bind to mast cells and basophils
    • these release histamine immediately – immediate reaction
    • but they also wait and release prostaglandins and leukotrienes – longer term cold like symptoms - inflammation
  • 34. 2. Delayed response: -intiated by memory T cells -regulated by cytokines secreted by T cells e.g. tuberculosis skin test - positive = red and hardened at injection site e.g. contact dermatitis - poison ivy, jewelry, cosmetics