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FUNCTIONS OF BLOOD
TRANSPORTATION
Blood brings oxygen from the lungs to cells
throughout the body, while taking carbon dioxide to the lungs. It also sends nutrients broken down in the gastrointestinal tract and hormones throughout the body. Blood sends heat and waste products to the lungs, kidneys and skin.
fluids. helps to maintain body temperature, given the heat absorbing and cooling properties of water.
loss due to injury. White blood cells, antibodies and other blood proteins protect against disease.
viscous than water 38o C (100.4oF) pH : 7.35 7.45 4-6 liters in an adult Varies with electrolyte concentration and amount of adipose tissue
Blood Volume
Blood volume is about 8% of
body weight. 1 kg of blood 1 L of blood 70 kg X 0.08 = 5.6 Kg = 5.6 L 45 % is formed elements 55% plasma
Plasma
92 % Water 8% Solutes organic and inorganic
Plasma proteins largest proportion of
maintain osmotic (oncotic) pressure hold water in the blood Globulins 38 % - antibodies synthesized by plasma cells Clotting factors fibrinogen 4 %
Waste products
Dissolved gases
Formed elements
Three types:
Erythrocytes red blood cells- RBCs Leukocytes white blood cells WBCs Thrombocytes platelets cell fragments
Hemopoiesis (Hematopoiesis)
All blood cells common from a common stem cell Hemocytoblast These are in the bone marrow (red) and develop into blood cells as
needed by the body Mitosis is signaled by biochemicals released from the body Stem cell is signaled to differentiate into the needed type of blood cell Hematopoiesis / cell breakdown continue through life.
Erythrocytes (RBCs)
Most abundant blood cell type Transport gases
Shape is important
Large surface to volume ratio Reversible deformability can change shape
to low blood oxygen levels; signals bone marrow to increase RBC production
Cytoplasm is mostly hemoglobin (lacks organelles) Made up of 4 peptide chains that form the globin
portion and four molecules of the pigment heme which contains an atom of iron Oxygen binds to iron in heme (also CO) 23 % of CO2 is bound to globin portion If there is a problem with any part of the molecule it may not be functional.
RBC breakdown
Healthy RBCs live about 120 days; we break down
about 174 million per minute RBCs are removed from circulation by the liver and spleen Broken down into heme and globin portions Globin is broken down into amino acids Iron is removed from heme and stored or recycled Heme is broken down into biliverdin and then into bilirubin
sufficient iron and amino acids as well as the vitamins folate (folic acid) and vitamin B12
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Abnormalities Anemias
Anemia is the inability of the blood to carry
Cinical Manifestations
Pallor Fatigue
Pallor
Weakness; exercise intolerance Dyspnea Syncope (fainting) and dizziness Angina Tachycardia (increased heart rate) Organ dysfunctions
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Classification of Anemias
Identified by their causes or by the changes that
affect the size, shape or substance of the erythrocyte Terms that end with cytic refer to cell size, and those that end in chromic refer to hemoglobin content. Additional terms: Anisocytosis various sizes Poikilocytosis various shapes
(megaloblasts) in the marrow that mature into erythrocytes that are unusually large in size, thickness and volume. The hemoglobin content is normal, so these are normochromic anemias.
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(cobalamin) deficiencies malabsorption or malnutrition These cells die prematurely, decreasing the numbers of RBCs in circulation
DNA synthesis is blocked or delayed, but
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Pernicious Anemia
Common megaloblastic anemia Caused by a Vitamin B12 deficiency Pernicious means highly injurious or destructive
protein , intrinsic factor, necessary to absorb B12 from the stomach Adult onset one example is an autoimmune dysfunction - type A chronic atrophic gastritis where there is destruction of the gastric mucosa Most commonly affects people over 30 Females are more prone to PA , and black females have an earlier onset.
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Pernicious Anemia is also associated with: Heavy alcohol consumption Hot tea Cigarette smoking Other autoimmune conditions Complete or partial removal of the stomach can cause intrinsic factor deficiency
Develops slowly over 20 - 30 years Usually severe by the time individual seeks
treatment Early symptoms ignored because they are nonspecific and vague- infections, mood swings, and gastrointestinal, cardiac or kidney ailments. Usually a degree of neuropathy occurs Untreated, it is fatal, us. due to heart failure
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females Absorbed from small intestine and does not require any other elements for absorption. Folate deficiency is more common than B12 deficiency
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deficiency , esp. in alcoholics and those who are malnourished because of fad diets or diets low in vegetables. Specific manifestations include cheilosis, (scales and fissures of the mouth), inflammation of the mouth, and ulceration of the buccal mucosa and tongue, magenta tongue.
contain reduced amounts of hemoglobin. Possible causes: Disorders of iron metabolism Disorders of porphyrin and heme synthesis Disorders of globin synthesis
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Clinical manifestations:
Early symptoms are nonspecific Later - changes in epithelial tissue: Fingernails become brittle and concave
(koilonychia) Tongue papillae atrophy and cause soreness, redness and burning Corners of mouth become dry and sore Difficulty in swallowing due to web of mucus and inflammatory cells at opening of esophagus
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Treatment
Stop blood loss
Iron replacement therapy
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Sideroblastic Anemia
Due to inefficient iron uptake, resulting in abnormal
hemoglobin synthesis Characterized by the presence of ringed sideroblasts in the bone marrow red cells containing iron granules that have not been synthesized into hemoglobin, but instead are arranged in a circle around the nucleus.
http://sickle.bwh.harvard.edu/sideroblast.jpg
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disorders Reversible - secondary to alcoholism, drug reactions, copper deficiency and hypothermia Hereditary SA rare, almost always in males probably X-linked recessive gene.
Clinical manifestations
Along with cardiovascular and respiratory
manifestations of anemia, may also show signs of iron overload (hemosiderosis) Enlargement of spleen and liver Bronze tint to skin Heart rhythm disturbances Impaired growth and development in young children
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Treatment
Drug therapy pyridoxine Iron overload requires repeated blood removal
content, but are too few in number. Less common than the macrocytic and microcytic anemias
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Aplastic anemia
Fortunately, this condition is rare; it means the RBCs are
not being produced. Bone marrow stem cells are not functioning. Can result from disorders of the bone marrow, such as cancer; autoimmune diseases; renal failure due to lack of erythropoietin; B12 or folate deficiency; congenital problems; or it may be induced by radiation, toxins or the use of some drugs, such as chloramphenicol. Treatment treat the underlying disorder, blood transfusions, and possibly bone marrow transplant
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Posthemorrhagic
Caused by sudden loss of blood. Can be fatal if loss exceeds 40- 50 % of plasma
volume. Treatment is to restore blood volume by intravenous administration of saline, dextran, albumin, plasma or whole blood.
Hemolytic Anemia
Red blood cells are formed, but are broken down. May be acquired or hereditary. Acquired hemolytic anemia is extrinsic, due to
factors outside the red blood cell, such as an abnormal autoimmune response that targets red cells, or by improper matches during transfusions; or due to infection, systemic diseases, or drugs or toxins.
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acid in each of the beta-chains in the globin, under conditions of low oxygen the hemoglobin forms insoluble threads that change the shape of the erythrocyte into a crescent. This shape is not as flexible and tend to be trapped in the capillaries, where they obstruct blood flow and cause ischemic injury.
rather than 120, and is removed from circulation by the spleen. Either mechanism causes a chronic anemia. Sickle crisis: episodes of acute sickling that block blood flow, posing the threat of widespread and possibly life-threatening ischemic organ damage.
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http://www.sunyniagara.cc.ny.us/val/sicklecellhigh.html
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called sickle cell trait, and the person is essentially normal. This condition tends to persist because it protects against malaria. When a cell becomes infected by the parasite, the cell sickles and is removed from circulation, preventing reproduction of the parasite. Only when a person inherits two defective genes does sickle cell anemia occur.
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alpha or beta chains of the globin are defective, or the beta chain is not produced. When the beta protein is lacking, the alpha protein accumulates and causes destructive membrane effects, causing these cells to be rapidly removed from the circulation. Highest incidence in populations around the Mediterranean and Southeast Asia. Problem occurs when two defective genes are inherited; heterozygotes are essentially normal.
Thalassemia major is an inherited form of hemolytic anemia, characterized by red blood cell (hemoglobin) production abnormalities. This is the most severe form of anemia, and the oxygen depletion in the body becomes apparent within the first 6 months of life. If left untreated, death usually results within a few years. Note the small, pale (hypochromic), abnormally-shaped red blood cells associated with thalassemia major. http://www.nlm.nih.gov/medlineplus/ency/imagepages/1498.htm
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Myeloproliferative Disorders
The opposite of anemias here we have too many RBCs. Polycythemia excessive production of RBCs
effect, a benign tumor of the marrow, leading to increased numbers of stem cells and therefore RBCs, and splenomegally. Polycythemia vera rare, mostly Northern European Jewish males between 60 80 yrs.
Secondary Polycythemia
Due to the overproduction of erythropoietin caused
by hypoxia. This is more common. Seen in: Persons living at high altitudes Smokers COPD patients Congestive heart failure patients
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Polcythemia leads to : Increased blood volume and viscosity Congestion of liver and spleen Clotting
Thrombus formation
(last two may be due increased numbers of
platelets along with the increase in RBCs due to bone marrow dysfunction.)
Itching / sweating
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Treatment of polycythemia
Reduce blood volume by phlebotomy 300-500 ml. Treat underlying condition - Stop smoking Radioactive phosphorus injections Prevent thrombosis
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