ANATOMI FISIOLOGI MANUSIA

HEMATOLOGI
Oleh:
Dr. dina

BLOOD

Blood separates into two main parts: plasma and

formed elements.

Plasma accounts for 55% and formed elements 45% of

blood volume.

Plasma contains mostly water (9092%) and plasma

proteins (78%), but it also contains nutrients and
wastes.

BLOOD

8% total body weight

5 L pada wanita dan 5,5 L pada pria

3 Tipe elemen sel : eritrosit, leukosit, platelet

Albumin is a large plasma protein that

transports bilirubin; globulins are plasma
proteins that transport lipoproteins.

Composition of blood

 When

blood is transferred to a test tube

and prevented from clotting, it forms tw
layers. The transparent, yellow top layer
is plasma, the liquid portion of the
blood. The formed elements are the
bottom layer.

Blood constituents
and its functions

Blood constituents and

its functions

HEMOPOESIS

Hemopoesis atau hematopoesis ialah proses pembentukan

darah.

Pranatal di hati dan limpa

Pascanatal terbatas di sumsum tulang

Untuk kelangsungan hemopoesis diperlukan sel induk

hemopoetik (hematopoetic stem cell).

A stem cell is capable of dividing into new cells that differentiate

into particular cell types.

HEMOPOESIS

Sel induk yang paling primitif disebut sebagai pluripotent stem

cell.

Sel induk pluripotent mempunyai sifat (Bakta IM, 2006):

self renewal: kemampuan memperbarui diri sendiri sehingga
tidak akan pernah habis meskipun terus membelah;
proliferatif: kemampuan membelah atau memperbanyak diri;
diferensiatif: kemampuan untuk mematangkan diri menjadi
sel-sel dengan fungsi tertentu.

The use of adult stem cells does not require that an

embryo be sacrificed.

HEMOPOESIS
Sel induk sel progenitor yang semakin
terspesialisasi sel matur perifer :
- sel darah merah,
- granulosit,
- monosit,
- trombosit dan limfosit
(Mehta AB dan Hoffbrand V, 2006)

Blood cell formation in red bone marrow

 Multipotent

stem cells give rise to two

specialized stem cells. The myeloid
stem cell gives rise to still other cells,
which become red blood cells, platelets,
and all the white blood cells except
lymphocytes. The lymphoid stem cell
gives rise to lymphoblasts, which
become lymphocytes.

Hemopoesis

The Red Blood Cells

Normally there are 4 to 6 million RBCs per mm3 of

whole blood.

Red blood cells contain the pigment hemoglobin for

oxygen transport;

hemogobin contains heme, a complex ironcontaining group that transports oxygen in the blood.

Physiology of red blood

cells

Red blood cells move in single file through

the capillaries. Each red blood cell is a
biconcave disk containing many molecules of
hemoglobin, the respiratory pigment.
Hemoglobin contains four polypeptide chains
(in blue). There is an iron-containing heme
group in the center of each chain. Oxygen
loosely combines with hemoglobin when
oxygenated. Oxyhemoglobin is bright red,
and deoxyhemoglobin is a dark maroon color.

The Red Blood Cells

Red blood cells (erythrocytes or RBCs) are

made in the red bone marrow of the skull,
ribs, vertebrae, and the ends of long
bones.

The kidneys produce the hormone

erythropoietin to increase blood cell
production when oxygen levels are low.

The Red Blood Cells

The air pollutant carbon monoxide combines

more readily with hemoglobin than does
oxygen, resulting in oxygen deprivation and
possible death.

Red blood cells lack a nucleus and have a 120

day life span.

The Red Blood Cells

When worn out, the red blood cells are dismantled in

the liver and spleen.

Iron is reused by the red bone marrow where stem cells

continually produce more red blood cells;

the remainder of the heme portion undergoes chemical

degradation and is excreted as bile pigments into the
bile.

Lack of enough hemoglobin results in anemia.

In iron-deficiency anemia, the most common type

of anemia, the hemoglobin levels are low, probably
due to a diet that does not contain enough iron.

The White Blood Cells

White blood cells (leukocytes) have nuclei and defend against

disease.

Leukocytes are divided into granular and agranular based on

appearance.

Granular leukocytes (neutrophils, eosinophils, and basophils)

contain enzymes and proteins that defend the body against
microbes.

The agranular leukocytes (monocytes and lymphocytes) have a

spherical or kidney-shaped nucleus.

White Blood Cellular Elements

The White Blood Cells

Monocytes can differentiate into macrophages that phagocytize

microbes and stimulate other cells to defend the body.

Lymphocytes are involved in immunity.

An excessive number of white blood cells may indicate an

infection or leukemia;

HIV infection drastically reduces the number of lymphocytes.

Leukemia is a form of cancer characterized by uncontrolled
production of abnormal white blood cells.
There are two types of lymphocytes, B lymphocytes and T
lymphocytes, have different roles in immunity. Their specific roles
are covered in Chapter 14.

RES (Reticulo Endothelial

Systems)

Sel yang berasal dari monosit yang tersebar di seluruh

tubuh dalam banyak organ dan jaringan.

Fungsi:
Memfagositosis dan menghancurkan patogen dan debris
selular

Memproses dan menyajikan antigen ke sel limfoid (antigen

presenting cell) yang bereaksi dengan sel T dalam kelenjar
limfe, limpa, timus, sumsum tulang dan jaringan.

Menghasilkan sitokin (misal IL-1) yang mengatur dan

berperan dalam jaringan kerja dan gf hemopoesis,
peradangan dan respon selular.

Macrophage engulfing bacteria

Monocyte-derived macrophages are the bodys scavengers. They engulf

microbes and debris in the bodys fluids and tissues, as illustrated in this
colorized scanning electron micrograph. The macrophage is in red, and the
bacteria are in green.

The Platelets and Blood

Clotting
Red

bone marrow produces large cells called

megakaryocytes that fragment into platelets at a
rate of 200 billion per day.

Vitamin K, found in green vegetables and also formed by intestinal bacteria,

is necessary for the production of prothrombin. Hemorrhagic disorders might
develop if this vitamin is missing.

Trombosit

HEMOSTASIS
Tujuan:
Mempertahankan darah tetap cair
Berada di dalam pembuluh darah
Membeku darah saat keluar pembuluh darah
Koordinasi :
Pembuluh darah
Trombosit
Faktor-faktor pembekuan
Natural inhibitor (penghambat alamiah)
Protein fibrinolitik

Hemostasis
Hemostasis normal membutuhkan 3 tanggapan:
Tanggapan normal pembuluh darah
Pembentukan sumbat trombosit
Pembentukan sumbat fibrin yang insoluble
Selanjutnya, sistem fibrinolisis berperan :
Mengontrol trombosis
Mengontrol fibrinolisis & inflamasi
Menghancurkan dan menyingkirkan kelebihan
fibrin

Pembuluh darah

Peran utama mencegah perdaraha

Vasokostriksi
Endotel utuh trombosit & eritrosit terpisah
sekresi zat yg mencegah pembekuan
Trauma trombosit menggumpal
proses pembekuan dimulai
Disebut mekanisme hemostatik primer
Mekanisme hemostatik sekunder mengontrol
pembentukan bekuan fibrin.
Mekanisme hemostatik primer dan sekunder
berjalan simultan.

Trombosit

Segera setelah jejas, trombosit menggumpal

dan mencegah perdarahan lebih lanjut.
Adesi
Agregasi
Membentuk fibrin
Sekresi prokoagulan

Blood clotting
Trapped red blood cells make a clot appear red.
Platelets and damaged tissue cells release
prothrombim activator, which acts on
prothrombin in the presence of calcium ions
(Ca2+) to produce thrombin. Thrombin acts on
fibrinogen in the presence of Ca2+ to form fibrin
threads. The scanning electron micrograph of a
blood clot shows red blood cells caught in the
fibrin threads.

FIBRINOLISIS
Setelah fibrin terbentuk FIBRINOLISIS.
Fungsi : menyingkirkan bekuan dan menjamin
darah mengalir kembali.

Plasmin Plasminogen

t-PA

Fibrin akan diubah menjadi FDPs

TERIMA KASIH