Chapter V ANATOMY AND PHYSIOLOGY

I. Hematologic System The structures of the hematologic or hematopoietic system include the blood, blood vessels, and blood-forming organs (bone marrow, spleen, liver, lymph nodes, and thymus gland). The hematologic system also pays an important role in hormone transport, the inflammatory and immune responses, temperature regulation, fluid-electrolyte balance, and acidbase balance. A. Bone Marrow

a.

Contained inside all bones, occupies interior of spongy

bones and center of long bones; (4%-5% of total bodyweight).

b.

Primary function is hematopoiesis (the formation of blood

cells). c. Two kinds of Bone Marrow: Red and Yellow

Red Marrow the red vascular substance consisting of connective tissue and blood vessels containing primitive blood cells,

macrophages, megakaryocytes, and fat cells. It is found in the cavities of many bones, including flat and short bones, bodies of the vertebrae, sternum, ribs, and articulating ends of long bones. Red marrow manufactures and releases leukocytes, erythrocytes, and thrombocytes into the bloodstream.

Yellow Marrow bone marrow in which the fat cells predominate in the meshes of the reticular network. Its a red marrow that has changed to fats and is found in long bones. It doesnt contribute to hematopoiesis.

B. Blood

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a.

a specialized bodily fluid that delivers necessary substances

to the body's cells such as nutrients and oxygen and transports waste products away from those same cells. b. important functions within the body include:

Supply of oxygen to tissues (bound to hemoglobin, which is carried in

red cells)
Supply of nutrients such as glucose, amino acids, and fatty acids

(dissolved in the blood or bound to plasma proteins (e.g., blood lipids))

Removal of waste such as carbon dioxide, urea, and lactic acid Immunological functions, including circulation of white blood cells, and

detection of foreign material by antibodies

Coagulation, which is one part of the body's self-repair mechanism (the

act of blood clotting when one gets cut to stop the bleeding)
Messenger functions, including the transport of hormones and the

signaling of tissue damage

Regulation of body pH Regulation of core body temperature Hydraulic functions

c.

Composed of 55% plasma and 45% cellular components Plasma It's a straw-colored, clear liquid that is 90 percent water, and it is an essential ingredient for human survival. Besides water, plasma also contains dissolved salts and
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minerals like calcium, sodium, magnesium, and potassium. It transports dissolved substances around the body and defends it against disease. Consists of serum (liquid portion of plasma) and fibrinogen
Contains plasma proteins such as albumin, serum

globulins, fibrinogen, prothrombin, and plasminogen Albumin - largest of plasma proteins, involved in regulation of intravascular plasma volume and maintenance of osmotic pressure Serum globulins - A protein fraction of serum composed chiefly of antibodies. Fibrinogen - Fibrinogen (factor I) is a soluble plasma glycoprotein, synthesized by the liver, that is converted by thrombin into fibrin during blood coagulation. Prothrombin - (activated Factor II [IIa]) is a coagulation protein in the blood stream that has many effects in the coagulation cascade. It is a serine protease that converts soluble fibrinogen into insoluble strands of fibrin, as well as

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catalyzing reactions.

many

other

coagulation-related

Plasminogen - Plasmin is an important enzyme present in blood that degrades many blood plasma proteins, most notably, fibrin clots. Cellular Components Cellular components or formed elements of blood are erythrocytes (red blood cells), which are responsible for oxygen transport; thrombocytes (platelets), which function in

homeostasis; and leukocytes (white blood cells), which play a major role in defense against microorganisms; Erythrocytes They are biconcave discs approximately 7.2 m in diameter.. The color of red blood cells is due to the eosinophilia of hemoglobin. Mature erythrocytes are anucleated and lack organelles. Thrombocytes Platelets (25 m) in diameter are fragments of cytoplasm surrounded by a plasma membrane. The cytoplasm stains blue and contains azurophilic granules. The platelets can occur in single or in clumps.

Leukocytes Granulocytes (polymorphonuclear leukocytes)

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Neutrophils can be recognized by their segmented nuclei and the presence of abundant, small, pale staining granules in their cytoplasm. Often the individual granules are barely distinguishable. Examine a number of neutrophils under oil immersion until you can quickly identify them. In good preparations, you may be able to see that there are two types of granules present, the more abundant, smaller specific granules which stain light pink and the larger, non-specific azurophilic granules which stain red-purple. Under normal conditions, neutrophils constitute 6070% of the total leukocyte count. The specific granules of the eosinophil are large and distinctive. These may be located even under low power by their large bright redstaining, refractile granules. The nucleus of the eosinophil is also segmented, but it is usually bi-lobed and paler staining than the neutrophil nucleus. The granules may be seen very clearly in cells which have had their cell membranes ruptured during preparation. The granules will then be spread apart and are easily seen to be large and oval. Eosinophils constitute up to 3% of the leukocytes. Basophils make up less than 0.5% of the leukocytes and are difficult to find. The granules are very large, purple staining and not of uniform size. The nucleus, which is often difficult to see clearly because of the granules, maybe segmented.

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Nongranular leukocytes (mononuclear leukocytes) Azurophilic (non-specific) granules can also be found in lymphocytes and monocytes. However, these cells do not contain specific granules. The lymphocytes vary in size from 6 m (slightly smaller than an RBC) to large cells up to 15 m in size. The small lymphocytes have only a thin rim of sky-blue cytoplasm. Their nuclei of densely-stained chromatin are generally round or slightly indented on one side. Medium and larger lymphocytes have larger, round nuclei centrally located in a sky-blue cytoplasm. A few azurophilic granules may be present in the cytoplasm. Lymphocytes normally constitute 2030% of the total leukocyte count, with small lymphocytes predominating. The monocyte is usually the largest leukocyte present (1520m). The nucleus of the monocyte, which is usually bean or U-shaped and is eccentric, may have a "lumpy" appearance which is seen by focusing up and down. The chromatin appears as a fine lacy network. The cytoplasm is gray in color and opaque and usually contains fine granules. The monocyte can sometimes be confused with a medium or large lymphocyte or with an immature neutrophil. A medium lymphocyte usually contains denser chromatin and sky-blue

cytoplasm. A young neutrophil (called a band), contains a U-shaped nucleus with condensed chromatin and a cytoplasm filled with small granules. C. Spleen

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The spleen is located in the upper left abdominal cavity, just beneath the diaphragm, and posterior to the stomach. It is similar to a lymph node in shape and structure but it is much larger. The spleen is the largest lymphatic organ in the body. Surrounded by a connective tissue capsule, which extends inward to divide the organ into lobules, the spleen consists of two types of tissue called white pulp and red pulp. The white pulp is lymphatic tissue consisting mainly of lymphocytes around arteries. The red pulp consists of venous sinuses filled with blood and cords of lymphatic cells, such as lymphocytes and macrophages. Blood enters the spleen through the splenic artery, moves through the sinuses where it is filtered, then leaves through the splenic vein. The spleen filters blood in much the way that the lymph nodes filter lymph. Lymphocytes in the spleen react to pathogens in the blood and attempt to destroy them. Macrophages then engulf the resulting debris, the damaged cells, and the other large particles. The spleen, along with the liver, removes old and damaged erythrocytes from the circulating
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blood. Like other lymphatic tissue, it produces lymphocytes, especially in response to invading pathogens. The sinuses in the spleen are a reservoir for blood. In emergencies such as hemorrhage, smooth muscle in the vessel walls and in the capsule of the spleen contracts. This squeezes the blood out of the spleen into the general circulation. D. Liver

The liver is a large, meaty organ that sits on the right side of the belly. Weighing about 3 pounds, the liver is reddish-brown in color and feels rubbery to the touch. Normally you can't feel the liver, because it's protected by the rib cage. The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food. The liver's main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that
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ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions. II. Normal Findings of a Neonate VITAL SIGNS OF THE NEWBORN INFANT The infant's body temperature drops immediately after birth in response to the extrauterine environment. His internal organs are poorly insulated and his skin is very thin and does not contain much subcutaneous fat. The infant's heat regulating mechanism has not fully developed. His temperature rapidly reflects that of his environment. The flexed position that the infant assumes is a safeguard against heat loss because it substantially diminishes the amount of body surface exposed. The infant's axillary temperature is maintained at 36.4 to 37.2o C. The normal pulse range for an infant is 120 to 140 beats per minute (bpm). The rate may rise to 160 bpm when the infant is crying or drop to 100 bpm when the infant is sleeping. The apical pulse is considered the most accurate. The average blood pressure (BP) of an infant at birth is 72/42. A drop in systolic BP of about 15 mm Hg the first hour after birth is common. The newborn's BP may be taken with a Doppler blood pressure device. This greatly improves accuracy.

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The respirations of a newborn infant are irregular in depth, rate, and rhythm and vary from 30 to 60 beats per minute. Respirations are affected by the infant's activity (that is, crying). Normally, respirations are gentle, quiet, rapid, and shallow. They are most easily observed by watching abdominal movement because the infant's respirations are accomplished mainly by the diaphragm and abdominal muscles. No sound should be audible on inspiration or expiration. III. Neonates Hematologic System In the neonatal hematologic system, the blood volume accounts for 80-85 mL/kg of body weight. Immediately after birth, the neonatal blood volume averages 300 mL; however, it can drop to as low as 100 mL depending on how long the neonate remains attached to the placenta via umbilical cord. Thus, the amount of blood bound to hemoglobin is lesser as well as the partial pressure of the oxygen in the blood. Neonates are born with high erythrocyte counts secondary to the effects of fetal circulation and the need to ensure adequate oxygenation. In addition, neonatal blood has a prolonged coagulation time because of decreased levels of vitamin K.

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