BLOOD

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BLOODFLUIDS
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Blood and FluidsObjectives

• Upon completion the student will be able to
• Describe the components of the cardiovascular
  system
• Describe the three major functions of blood
• Describe the important components of blood
• Discuss the composition and functions of plasma
• Discuss the characteristics and functions of red
  blood cells
• Describe the various kinds of white blood cells
  and their functions

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Blood FluidsObjectives

• Describe the formation of the formed elements in
  blood.
• Describe the mechanisms that control blood loss
  after an injury
• Explain what determines blood type and why blood
  types are important

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FLUIDS

• TOTAL BODY WATER
• 57 of an average adult male
• Approximately 40 Liters

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TOTAL BODY WATER

• INTRACELLULAR
• 62 of TBW
• Total fluid inside a cell/25 Liters

• EXTRACELLULAR
• All fluids outside the cell/15 Liters
• Includes
• Interstitial
• Intraocular
• Plasma
• GI Tract
• Cerebrospinal
• Potential Space Fluids

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TOTAL BODY WATER

• Another component is interstitial fluid.
• Fluid which lies between the cells.
• Not freely moving, bound by proteins and other
  substances.

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BLOOD VOLUME

• INTRAVASCULAR FLUID
• Extracellular Intracellular
• (plasma) (red blood cells)
• Average adult male 5 to 6 Liters

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DISSOLVED COMPONENTS

• ELECTROLYTES molecules which disassociate to
  form ions.
• IONS molecules/elements that have a positive or
  negative charge.
• ANIONS negative charge
• CATIONS positive charge
• Charges in the body tend to equalize between
  positive and negative charges.

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ELECTROLOYTES

• FUNCTIONS OF ELECTROLYTES
• Control water distribution
• Establishes osmotic pressure
• Muscular irritability
• Water distribution controlled by sodium levels
• Water follows salt !!!!!!!!!!!!!

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ACID-BASE BALANCE

• Mechanism of homeostasis
• Primary measurement is pH
• pH is a direct relationship between the hydrogen
  ion (H) water

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ACID-BASE BALANCE

• Normal arterial pH 7.35 - 7.45
• 7.4 is the absolute norm.

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ACID-BASE BALANCE

• Values less than 7.35 Acidosis
• In other words, H increases, pH decreases

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ACID-BASE BALANCE

• Values greater than 7.45 Alkalosis
• In other words, H decreases, pH increases

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ACID-BASE BALANCE

• Two states of acidosis and alkalosis
• Respiratory
• Metabolic

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ACID-BASE BALANCE

• Type of acidosis/alkalosis based on Arterial
• Blood Gases (ABGs)
• pH (Acid/Base measurement)
• pCO2 (Partial Pressure Carbon Dioxide)
• pO2 (Partial Pressure Oxygen)
• HCO3 (Bicarbonate Level)

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ACID-BASE BALANCE

• EXAMPLES
• Hypoventilation Respiratory Acidosis
• Hyperventilation Respiratory Alkalosis
• Shock Metabolic Acidosis
• Increased bicarbonate Metabolic Alkalosis

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ACID-BASE BALANCE

• BUFFERS
• Bicarbonate System
• Respiratory System
• Renal System

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BLOOD

• FUNCTIONS OF BLOOD
• Transportation
• Regulation of pH
• Restriction of fluid losses
• Defense
• Stabilize body temperature

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COMPOSITION OF BLOOD

• Plasma ground substance of blood.
• Liquid part of the blood that does not contain
  cells.

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COMPOSITION OF BLOOD

• Formed elements blood cells that are suspended
  in the plasma
• Red Blood Cells (RBCs) - transport oxygen and
  carbon dioxide.
• White Blood Cells (WBCs) - components of the
  immune system.
• Platelets (Thrombocytes) - clot formation.

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PLASMA

• Plasma Proteins
• Albumin
• Globulins
• Fibrinogen
• Because of their large size they are not able to
  cross the cell membrane and so are part of the
  extracellular fluid.

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ALBUMINS

• 60 of plasma proteins.
• Play a major role in osmotic pressure of the
  plasma.
• Osmotic pressure is the hydrostatic pressure
  produced by a solution that is separated from a
  solvent by a semipermeable membrane, due to a
  differential in the concentrations of solute.
  Osmoregulation is the homeostasis mechanism of an
  organism to reach balance in osmotic pressure.

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GLOBULINS

• 35 of plasma proteins.
• Include
• Immunoglobulins - antibodies
• Transport proteins - binds and transports
  elements that would be filtered out of the blood
  at the kidneys.

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FIBRINOGEN

• Clotting reaction.
• Fibrinogen binds and forms insoluble strands of
  fibrin.
• Fibrin (also called Factor Ia) is a protein
  involved in the clotting of blood. It is a
  fibrillar protein that is polymerised to form a
  "mesh" that forms a hemostatic plug or clot (in
  conjunction with platelets) over a wound site.

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FORMED ELEMENTS - RBCs and WBCs

• Production of Formed Elements
• Process known as hemopoiesis.
• Primarily in the spleen, thymus and bone marrow.
• In adults the bone marrow is the only site of RBC
  production and most WBC production.

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RED BLOOD CELLS

• Also known as erythrocytes.
• Contain the pigment hemoglobin, which binds and
  transports oxygen and carbon dioxide.
• 5.4 million RBCs in 1 cubic millimeter of blood.
• Hematocrit of RBCs in the blood.

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STRUCTURE OF RBCs

• Lack several organelles
• Mitochondria
• Ribosomes
• Nucleus
• Cannot undergo cell division or synthesize
  proteins.
• Without a mitochondria do not use up oxygen.

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HEMOGLOBIN

• Give the RBC its color.
• Responsible for the cells ability to transport
  oxygen and carbon dioxide.
• Iron is the key component of hemoglobin.

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RBC LIFE SPAN

• Approximately 120 days.
• Travels the circulatory in about 30 seconds. And
  travels approximately 60,000 miles a day.

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CONSERVATION AND RECYCLING

• With age RBCs rupture (hemolyze) or are
  destroyed by phagocytic cells.
• If enough breakdown it will turn the urine
  reddish or brown hemoglobinuria.
• Phagocytic cells of the liver, spleen and bone
  marrow monitor and engulf RBCs before they
  hemolyze.

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CONSERVATION AND RECYCLING

• Once engulfed the hemoglobin molecule begins to
  recycle
• Globular proteins disassembled and are either
  metabolized or released for use by other cells.
• Iron is removed and converted to biliverdin
  (green substance). Biliverdin is then converted
  to bilirubin.

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CONSERVATION AND RECYCLING

• Bilirubun absorbed by the liver and excreted in
  the bile.
• If bile ducts are blocked the bilirubin diffuses
  into the peripheral tissues causing a yellow
  discoloration in the skin and eyes (jaundice).

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CONSERVATION AND RECYCLING

1. Extracted iron may be stored in the phagocytic
   cell or released into the bloodstream, where it
   binds to transferrin. Then absorbed by bone
   marrow for the production of new hemoglobin.

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RBC FORMATION ERYTHROPOIESIS

• Occurs in the bone marrow, or myeloid tissue.
• Usually occurs in red bone marrow but in rare
  occasions yellow marrow (fatty tissue) can
  convert to red marrow.

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RBC MATURATION

• Erythroblasts - immature RBC
• Reticulocyte - develop into the mature RBC

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REGULATION OF ERYTHROPOIESIS

• Stimulated directly by erythropoietin (EPO).
• Erythropoietin has two major effects
• Stimulates increased production rates of
  erythroblasts.
• Speeds up the maturation of RBCs.
• RBC can be produced at 30 million/second.

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BLOOD TYPE

• Blood type is determined by the presence or
  absence of specific surface antigens, or
  agglutinogens in the RBC.
• TYPES
• Type A - antigen A only
• Type B - antigen B only
• Type AB - both antigens
• Type O - neither antigen

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BLOOD TYPE

• Rh-Factor
• Rh positive (Rh) - antigen present
• Rh negative (Rh-)- antigen absent
• Erythroblastosis Fetalis
• Mother Rh-
• Father Rh

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ANTIBODIES AND CROSS REACTIONS

• Person with Type A contains anti-B antibodies,
  which will attack Type B surface antigens. The
  opposite holds true for the Type B individual.
• Type AB lack antibodies. (Universal recipient).
• Type O has not surface antigens and is known as
  the Universal Donor.

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WHITE BLOOD CELLS

• Also known as Leukocytes.
• Each has a nucleus and lacks hemoglobin.
• Divided into two groups
• Granulocytes
• Agranulocytes (non granulated)

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GRANULOCYTES

• THREE TYPES
• Neutrophils
• Eosinophils
• Basophils

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AGRANULOCYTES

• TWO TYPES
• Monocytes
• Lymphocytes
• Unlike RBCs there is only about 6000-9000 WBCs
  in a cubic millimeter of blood

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WBC CIRCULATION

• Do not hold to just the bloodstream, can move
  anywhere an invasion or injury takes place.
• Four characteristics
• Amoeboid movement - move along the walls of blood
  vessels as well as surrounding tissue.
• Can move out of the bloodstream by diapedesis
  (the passage of blood cells, esp. leukocytes,
  through the unruptured walls of the capillaries
  into the tissues.)

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WBC CIRCULATION

1. Positive chemotaxis - chemical stimuli that leads
   them to invading pathogens, and damaged tissue.
2. Capable of phagocytosis (neutrophils,
   eosinophils, and monocytes).

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GENERAL FUNCTIONS

• Nonspecific defenses - neutrophils, eosinophils,
  basophils and monocytes.
• Specific immunity - lymphocytes

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NEUTROPHILS

• 70 of WBC
• Usually the first to arrive at an injury site.
• Short life span.

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EOSINOPHILS

• Named because their granules stain darkly with
  the red dye eosin.
• 2-4
• Numbers increase during allergic reactions or a
  parasitic infection.

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BASOPHILS

• lt 1
• Migrate to the injury site and discharge their
  granules into the interstitial fluids.
• Granules contain heparin and histamine.
  Initiating the inflammation process.

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MONOCYTES

• 2-8
• In the peripheral tissues they are called free
  macrophages.
• Secrete chemicals that attract and stimulate
  neutrophils, additional monocytes and other
  phagocytes. Also lure fibroblasts to the region.

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LYMPHOCYTES

• 20-30 of leukocyte population.
• Primary cells of the lymphatic system.
• Three classes
• T cells
• B cells
• NK cells

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DIFFERENTIAL COUNT

• Obtained by examining a stained blood smear, and
  indicates the number of each type of WBC.
• Leukopenia indicates inadequate numbers of WBCs.
• Leukocytosis refers to excessive numbers of WBCs

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DIFFERENTIAL COUNT

• White cell counts of over 100,000 usually
  indicate leukemia.

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WBC FORMATION

• Stem cells for WBC originate in bone marrow.
• Neutrophils, eosinophils, and basophils complete
  their development in myeloid tissue.
• Monocytes begin maturation in the bone marrow and
  it is complete when they become free macrophages
  in peripheral tissue.

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PLATELETS

• Bone marrow contains enormous cells called
  megakaryocytes.
• Shed small membrane-enclosed packets of cytoplasm
  that enter the circulation that form platelets.
• Part of the clotting system.
• 350,000 platelets is normal.

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PLATELETS

• Thrombocytopenia - excessive platelet destruction
  or inadequate platelet production.
• Thrombocytosis - (1,000,000) usually a result of
  infection, inflammation, or cancer.

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HEMOSTASIS

• Prevents the loss of blood through the walls of
  damaged vessels.
• PHASES
• Vascular Phase vasoconstriction, lasts about 30
  minutes.
• Platelet Phase attach themselves to exposed
  endothelial surfaces to form a mass that may plug
  the break in the vessel.

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HEMOSTASIS

• Coagulation Phase formation of blood clot that
  effectively seals off the damaged portion of the
  vessel.

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CLOTTING FACTOR

• Made up of calcium ions and 11 different plasma
  proteins.
• 3 Chain Reactions/Cascades
• Extrinsic Pathway begins with the release of
  lipoprotein called tissue factor. Combines with
  calcium to form an enzyme called tissue
  thromboplastin (factor and thromboplastin one in
  the same).
• Tissue factor - Wikipedia, the free encyclopedia

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CLOTTING FACTOR

• Intrinsic Pathway begins with the activation of
  a clotting protein and finally forms an enzyme
  platelet thromboplastin.
• Common Pathway converts prothrombin into
  thrombin. Thrombin completes the coagulation
  process by converting fibrinogen to fibrin.

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RETRACTION REMOVAL

• Clot Retraction When the platelets contract and
  pull the torn edges of the wound closer together.
• Fibrinolysis Dissolving of the clot as the
  repairs proceed.
• This process begins with the release of the
  plasma protein plasminogen (t-PA).
• Releases plasmin which digests the fibrin of the
  clot.

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Conclusion

• Understanding blood AP is vital.
• The bodys response to medications, injuries,
  shock, etc., is directly correlated to structure
  and function of blood.
• ANY QUESTIONS?