Chapt. Object.

Figures & Tables

Trnspcy. Acetates

Masters

1

I. Functions

A. Transportation

1. Gases & Nutrients to Cells

2. Gases & Metabolic Waste Products Away from Cells

3. Movement of Other Substances - Intermediates and Regulatory Compounds

B. Maintenance (of Homeostasis)

1. Electrolytes, Fluid Balance, pH

2. Body Temperature

C. Protection

1. Against Foreign Substances - Immune System

2. Against Blood/Fluid Loss - Clotting Cascade

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II. Plasma

Fig. 19.1, p.578

TA-235

A. Colloidal Solution

B. Components of Plasma

Table 19.1, p.579

1. Water (91%)

2. Suspended Proteins

a. Albumin (58%)

b. Globulins (38%)

c. Fibrinogen (4%)

3. Dissolved Components

a. Ions

b. Nutrients

c. Waste Products

d. Gases

e. Regulatory Substances

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III. Formed Elements

Fig. 19.1, p.578; Table 19.2, p.580

TA-235

4

A. Production of Formed Elements = Hematopoiesis

1. Embryonic - Yolk Sac, Liver, Thymus, Spleen, Lymph Nodes and Red Bone Marrow

2. Adults - Confined to Red Bone Marrow, Some Lymphoid Contribution

3. Single Population of Stem Cells = Hemocytoblasts

Fig. 19.2, p.581; Clinical Note, p.579

TA-236

B. Erythrocytes (Red Blood Cells, RBC's)

Fig. 19.3, p.582; Clinical Focus, pp.584-585

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1. General

a. 700 times More Numerous than Leukocytes, 17 Times More Numerous than Platelets

b. % Have 4.2 - 5.8 Million RBC's per mm³; & Have 3.6 - 5.2 Million RBC's per mm³

c. Erythrocytes are Moved Passively as the Blood Circulates

2. Structure

a. Biconcave Disks - 7.5 m m Diameter

b. Mature Erythrocytes Lack a Nucleus

c. Usually Flexible

d. Contents - Hemoglobin (1/3 Vol.), Lipids, ATP, Carbonic Anhydrase

3. Function

a. Transport of O₂ from Lungs to Tissues - Hemoglobin Important

b. Transport of CO₂ from Tissues to Lungs - Carbonic Anhydrase Important

4. Hemoglobin

Fig. 19.4, p.583; Predict Quest. 1; Clinical Note, p.582; Clinical Note, p.583

TA-237

a. Four Protein Chains - Globins

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b. Four Heme Groups

1). Contain Iron

2). Reversibly Bind O₂

c. Oxyhemoglobin, Deoxyhemo-globin , & Carbaminohemoglobin

5. Life History of Erythrocytes

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a. Erythrocyte Production

Fig. 19.5, p.585

TA-238

1). Erythropoiesis

2). 4 Days to Make; 2.5 Million Destroyed / Sec

3). Red Bone Marrow

b. Released into Blood as Reticulocytes

1). 1-3% of Circulating RBC's are Nromally Reticulocytes

Predict Quest. 2

2). No Nucleus Remains

c. Control of Erythropoiesis by Hormone Erythropoietin

Predict Quest. 3

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d. Old Cells Removed by Macrophages of Liver, Spleen & Lymphatic Tissue

Fig. 19.6, p.586

TA-239

1). Iron and Amino Acids Recycled

2). Heme Converted to Bilirubin & Excreted in Bile and Urine

3). Build up of Bilirubin = Jaundice

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C. Leukocytes (White Blood Cells or WBC's)

Fig. 19.7, p.587; Table 19.2, p.580

1. General Characteristics

a. Primarily Protective Functions, such as Phagocytosis and Antibody Production

b. Enter Tissue via Diapedesis

c. Move along Chemical Gradients = Chemotaxis

2. Neutrophils - Polymorphonuclear Neutrophils (PMN's)

Fig. 19.7, p.587; Table 19.2, p.580

a. Most Common WBC

b. 10 -12 hrs in Circulation then Migrate to Tissues for 1-2 Days

c. Phagocytosis and Lysozymes

3. Eosinphils

Table 19.2, p.580

a. Associated with Inflammatory Reactions

b. Contain Enzymes that Limit the Inflammatory Response and Phagocytize Antigen-Antibody Complexes

4. Basophils

Table 19.2, p.580

a. Least Common of WBCs - Participate in Inflammation and Allergy

b. Also Migrate to Tissues

c. Contain Mediators of Inflammation (Histamine) and Heparin (Anti-coagulant)

5. Lymphocytes

Fig. 19.7, p.587; Table 19.2, p.580

a. Smallest of the WBCs (6-8 m m Diameter)

b. Little Cytoplasm

c. Proliferate in Lymphatic Tissue

d. B Cells Produce Antibodies

e. T Cells Destroy Virally Infected and Tumor Cells

6. Monocytes

Table 19.2, p.580

a. Largest WBCs (12-20 m m Diameter)

b. In Circulation 3 Days

c. Primary Function is Phagocytosis with Presentation of Breakdown Products to Lymphocytes

d. Become Macrophages in Tissues

Predict Quest 4. (See Fig. 19.8, p.588)

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D. Platelets

Fig. 19.7, p.587; Table 19.2, p.580

1. Circulate as Cell Fragments of Megakaryocytes

2. Very Small (3 m m Diameter) and Very Common

3. Exist 5-9 Days

4 Resist Blood Loss

a. Platelet Plug Formation - Small Holes

b. Initiate Blood Clot Formation - Larger Wounds

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IV. Hemostasis (Arrest of Bleeding)

A. Vascular Spasm

1. Immediate & Temporary Constriction of Smooth Muscle Cells

2. Nervous Reflex and Chemical Mediators

a. Thromboxanes (Prostaglandin Derivative) - Platelet Plugs

b. Endothelin (Peptide) - Endothelial Cells

B. Platelet Plug Formation

Fig. 19.9, p.589; Clinical Note, p.589

TA-240

1. Exposure of Vessel Connective Tissue

2. Platelets Adhere, Release ADP, Thromboxane & Coagulation Factors

3. Mediators Help Stick Platelets Together to Form Aggregate, Further Release of Mediators

4. Mass of Platelets Physically Plugs Tear in Endothelium

C. Coagulation

1. Network of Fibrin, Cells, Platelets and Fluid

2. Initiated and Sustained by Coagulation Factors in Plasma

Table 19.3, p.590; Predict Quest 5; Clinical Note, pp.591-592

3. Stages

Fig. 19.10, p.591

a. Stage 1 - Formation of Prothrombinase

b. Stage 2 - Conversion of Prothrombin to Thrombin

c. Stage 3 - Conversion of Fibrinogen to Insoluble Fibrin

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4. Clotting Pathways

a. Extrinsic Pathway

Fig. 19.10, p.591

1). Initiated by Chemicals from Outside of the Blood

2). Tissue Factor (Thromboplastin) from Damaged Tissues

3). With Ca²⁺ and Factor VII, Activates Factor X

b. Intrinsic Pathway

1). Initiated by Exposed Collagen

2). Contact with Collagen Activates Factor XII

3). with Platelet Phospholipids, Ca²⁺, Factors IX and VIII, Activates Factor X

4). Thrombin Positive Feedback Loop on Clotting and Platelet Aggregation<

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D. Control of Clot Formation

Clinical Note, p.592

1. Normal Blood Anticoagulants

a. Antithrombin from Liver- Slowly Inactivates Thrombin

b. Heparin from Basophils and Endothelial Cells- Rapidly Inactivates Thrombin

c. Prostacyclin from Endothelial Cells- Vasodilation and Inhibits Release of Platelet Factors

2. Exogenous Anticoagulants

a. Heparin

b. Ethylenediaminetetraacetic Acid (EDTA) and Sodium Citrate - Ca²⁺ Chelating Agents

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E. Clot Retraction and Dissolution

1. Contraction of Platelets - Pull Edges of Clot Together, Squeezing out Serum

2. Activation of Plasmin and Process of Fibrinolysis

Fig. 19.11, p.593

TM-62

V. Blood Grouping

1. Transfusions and Blood Compatibility - Based on Antigen/Antibody Reaction

2. Antigens on RBC's, Antibodies in Plasma

3. Agglutination or Hemolysis Reaction

A. ABO Blood Groups

Fig. 19.12, p.594

TA-241

1. Type A - A Antigens, B Antibodies

2. Type B - B Antigens, A Antibodies

3. Type O - No Antigens, A and B Antibodies

4. Type AB - A & B Antigens, No Antibodies

5. Frequency of Blood Type Varies with Race

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6. Mismatches Result in Transfusion Reactions ñ Donor/Recipient Matching

Fig. 19.13, p.594; Predict Quest. 6

TA-242

B. Rh Blood Group

1. Rh Positive - D Antigen Present (Most Common)

2. Rh Negative - D Antigen Absent, D Antibodies Produced Only through Prior Exposure to Rh Pos. Blood

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3. Rh Incompatability Between Mother and Fetus Involved in Hemolytic Disease of the Newborn

Fig. 19.14, p.596

TA-243

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VI. Diagnostic Blood Tests

A. Type and Crossmatch

1. Both Donor and Recipient

2. Prior to Transplantation or Transfusion

B. Complete Blood Count (CBC)

1. Red Blood Cell Count

a. % Normal Ref. Value = 4.2-5.8 Million Cells/ mm³ Whole Blood

b. & Normal Ref. Value = 3.6-5.2 Million Cells/ mm³ Whole Blood

c. Polycythemia and Consequences

2. Hemoglobin Measurement

a. % Normal Ref. Value = 14-18 gm/dL Whole Blood

b. & Normal Ref. Value = 12-16 gm/dL Whole Blood

c. Together with RBC Count and Hematocrit Anemia Diagnosed

3. Hematocrit

Fig. 19.15, p.597

a. Percent of Volume of Whole Blood Occupied by Cells

b. % Normal Ref. Value = 44-54%

c. & Normal Ref. Value = 38-48%

d. Value Related to both Number and Ave. Size of RBC's

4. White Blood Cell Count

a. Normal = 5-10 Thousand Cells Per mm³ Whole Blood

b. Leukopenia and Consequences

c. Leukocytosis and Consequences

1). Infection

2). Leukemia

C. White Blood Cell Differential Count

1. Percentages of WBC's of Each Type

2. Profiles Help Diagnosis

a. Neutrophils 60-70%

b. Lymphocytes 20-30%

c. Monocytes 2-8%

d. Eosinophils 1-4%

e. Basophils 0.5-1%

D. Clotting

1. Platelet Count

a. Normal = 250-400 Thousand Per mm³ Whole Blood

b. Thrombocytopenia & Consequences

2. Prothrombin Time Measurement

a. Normal = 9-12 Seconds

b. Vitamin K Deficiency, Liver diseases & Drug Therapies

E. Blood Chemistry

1. Material Dissolved and Suspended in Plasma

2. Acidosis & Alkalosis

3. Clues to Source(s) of Abnormal Function

Predict Quest. 7