Module 15 Flashcards
The Blood
Blood is a Connective Tissue:
- Cells and Formed Elements (WBCs, RBCs, platelets)
- Extracellular Fluid Matrix (Plasma)
Functions:
- Transportation for oxygen, carbon dioxide, hormones, and nutrients
- Regulation of body temperature and pH
- Protection
Blood is a very important part of maintaining homeostasis
Characteristics of the Blood
Blood has a number of physical characteristics that give it its functional properties:
- Viscosity: Thicker than water due to the amount of solutes, colloids, & suspended formed elements.
- Temperature: 38 degrees C (100.4 degrees F)
- pH: 7.35-7.45 (slightly alkaline)
- Color: Variable shades of red depending on oxygen content
- Volume: 4-6 liters depending on gender and body mass
What are the 2 main components of blood?
1. Cells
Cells
Blood Component:
Cells make up 45% of Blood
- More specifically formed-elements
- White Blood Cells, Red Blood Cells, and Platelets (thrombocytes)
Plasma
Blood Component:
Plasma makes up 55% of Blood
- Typically a clear, yellow liquid
- 92% Water
- 8% solutes: 7 of the 8% are the plasma proteins Albumin, globulins, and fibrinogen
- 1% miscellaneous solutes
Hematopoiesis
Hematopoiesis is the development of the formed elements of the blood:
- Red Bone Marrow
- Blood Cells are formed in red bone marrow from pluripotent stem cells and mature in the bone marrow or lymphoid tissue (spleen, tonsils, lymph nodes, thymus, etc.) under the influence of vaious cytokines
Cytokines
Proliferation and maturation of blood cells depends of specific cytokines: chemical signals from one group of cells to stimulate another. Under the influence of these cytokines (growth factors, colony-stimulating factors, and interleukins) cells differentiate into the various cell types. The stem cells differentiate into either:
- the myeloid group or
- the lymphoid group
The Myeloid Group
The immature myeloid (bone marrow) cells differentiate and become red blood cells, platelets, and many types of white blood cells.
The Lymphoid Group
The lymphoid cells mature in the lymphatic system and give rise to a specific group of white blood cells called lymphocytes.
What are the 3 types of Cytokines?
The three types of cytokines, chemical signals, are:
- Erythropoietin (EPO): Increases number of early red blood cells in the bone marrow
- Thrombopoietin (TPO): Increases the formation of platelets
- Colony-stimulating factors (CSFs) and interleukins: Increases the production and differentiation of white blood cells.
Red Blood Cells (RBCs)
- Red cells are bi-concave discs: give high surface-to-volume rations.
- Red cells demonstrate reversible-deformity: able to squeeze through small spacese
- Mature red cells do not have a nucleus: provides maximum cytoplasmic space. Before the nucleus is lost, it provides instructions to produce hemoglobin, the oxygen carrying molecule of the red cell.
- RBCs live about 120 days
- Because they lack mitochondria, they don’t use any of the oxygen they carry
Hemoglobin
Each red cell contains approximately 280 million hemoglobin molecules.
- Hemoglobin is the oxygen and CO2 carrying molecule in the body. Hgb transports O2 to the cells and CO2 from the cells.
- A Hgb molecule consists of: 4 heme molecules (ringed molecue with Iron atom at the center; each heme carries one oxygen molecule) and 4 globin chains (polypeptides: 2 alpha and 2 beta)
- Each Fe2 can pick up one oxygen molecule at the lungs, because the Iron atom is the binding site for oxygen.
Erythropoiesis
Is part of hematopoiesis, specifically relating to the production and maturation of red blood cells.
- Red cells are produced continuously (approximately 2 million per second) to keep up with red cell production.
- The average person has 4.00-6.00 x 10^6 RBCs/mm^3
Hypoxemia
If the number of red cells lost exceeds the number made, hypoxemia (too little oxygen in the blood) will result.
- Stimulates the kidneys to release the hormone erythropoietin
Erythropoietin (EPO)
Hypoxemia (decreased amount of oxygen) detected in the kidneys stimulates the release of Erythropoietin, a hormone which increases the rate of Erythropoiesis.
- Measured by a reticulocyte (retic) count
- A reticulocyte is a new, not yet fully mature red cell
Red Blood Cell Maturation
#1. Large cell with nucleus & very little cytoplasm - lack hemoglobin #2. Nucleus is lost, gains its bioconcave shape. Not mature yet, still contains some mitochondria, ribosomes, & endoplasmic reticulum. This almost-mature cell is called a reticulocyte. #3. Hemoglobin increases #4. Decreased cellular size
Hematocrit (Hct)
Percentage of the whole blood that is occupied by red blood cells. Average is 45%, but women tend to be a little lower.
What are the 2 types of Erythropoiesis Imbalances?
#1. Polycythemia #2. Anemia
Polycythemia
Excess number of red blood cells. Increases the blood viscosity.
- Primary polycythemia (polycythemia vera): may cause an increase in all formed elements
- Secondary polycythemia: is an increase in red blood cells due to another condition.
#1. Hypoxia, smoking,sleep apnea, or any other
because of hypoxemia
#2. Dehydration
Anemia
Is a decrease in the normal number of red blood cells. Insufficient RBCs or hemoglobin. Classified based on:
- Size: macrocytic, normocytic, and microcytic
- Hemoglobin Content: hypochromic & normochromic
- Etiology: Iron deficiency, red cell destruction, autoimmune disease, hemorrhage, lack of production in the bone marrow.
What are 5 examples of Anemia?
- Hemorrhagic anemia: Normocytic, Normochromic, and caused by bleedin
- Iron deficiency anemia: Microcytic, Hypochromic, and caused by lack of iron
- Pernicious anemia: Macrocytic, Normochromic, and caused by Vitamin B12 deficiency
- Hemolytic anemia: Normocytic, Normochromic, and caused by destruction of RBCs
- Aplastic anemia: Normocytic, Normochromic, and caused by bone marrow failure
Leukocytes
Are white blood cells. They are larger than RBCs, they have nuclei, they don’t have hemoglobin, and there are fewer white than red. There are 2 groups of WBCs:
- Granulocytes (granular leukocytes)
- Agranulocytes (agranular leukocytes)
Granulocytes
The granulocytic group includes three specific WBCs, named from staining characteristics:
- Neutrophils: Stain somewhere in between red and purple
- Eosinophils: Stain red
- Basophils: Stain purple
Agranular Leukocytes
Contain some cytoplasmic granules but they are much less prominent and they don’t stain as well as their granulocytic counterparts.
- Monocytes: macrophages in tissues
- Lymphocytes: T lymphocytes, B lymphocytes, Natural Killer (NK) cells.
What are the terms for white blood cell increases and decreases?
- Leukocytosis
- Leukopenia
Leukocytosis
Is an increase in the number of white blood cells. It is a normal physiological response, up to a certain point. WBCs increase as a response to disease or conditions, and any disruption of homeostasis. Common causes would be bacterial infections, viruses, parasites, stress, temperature extremes, etc.
Leukemia
WBC numbers above 40,000 would indicate an abnormal proliferation. Frequently this is one of the various types of leukemia.
Leukemia is a cancer of the blood-forming cells, most often white cells.
Leukopenia
Is a decrease in white cell numbers, and is never a normal response. There isn’t a normal physiological reason for a person’s white count to go down. Causes can include AIDS, chemotherapy, or bone marrow failure (aplastic anemia).
White Blood Cell Functions
Physician’s use the percentage of white blood cells in the blood to aid in the diagnosis of specific diseases. White blood cells work together to provide a powerful immune response, but each type has a unique role:
- Increased granulocytes in bacterial infections
- Increased lymphocytes in viral infections
Doctors will order a WBC differential analysis when a patient has an increased WBC count.
Neutrophils
60-70% of total WBCs in blood stream. Powerful phagocytes, increased in bacterial infections and inflammation. Granular cytoplasm
Lymphocytes
20-25% of total WBCs in blood sream. Increased and major role in viral infections and cancer prevention. Specific cellular immunity.
Monocytes
3-8% of total WBCs in blood stream. Differentiate into macrophages (phagocytes), present in chronic inflammation and infections.
Eosinophil
2-4% of total WBCs in blood stream. Allergic reactions, parasitic infections. Large red granules.
Basophil
0.5-1% of total WBCs in blood stream. Function poorly understood, chronic inflammation. Large dark blue granules.
Thrombocytes (Platelets)
Are cytoplasmic fragments of large cells in bone marrow called megakaryocytes. Platelets have a very short life span, approximately 5-9 days.
- Megakaryocytes are too large to leave the bone marrow
- 2000-5000 platelets develop from one megakaryocyte
- They assist with clot formation limiting blood loss by forming a platelet plug.
- Release chemicals to encourage vasoconstriction and activate coagulation.
Thrombocytes (Platelets)
Are cytoplasmic fragments of large cells in bone marrow called megakaryocytes. Platelets have a very short life span, approximately 5-9 days.
- Megakaryocytes are too large to leave the bone marrow
- 2000-5000 platelets develop from one megakaryocyte
- They assist with clot formation limiting blood loss by forming a platelet plug.
- Release chemicals to encourage vasoconstriction and activate coagulation.
Hemostasis
Is the overall process by which bleeding has stopped. There are 3 mechanisms involved in the process of bleeding cessation:
- Vascular Spasm
- Platelet plug formation
- Coagulation (clotting)
Vascular Spasm
Is the constriction of damaged blood vessels. Smooth muscle contraction reduces blood loss. The vascular constriction is due to chemicals released from platelets, damage to the smooth muscle of the vessels, and pain receptor reflexes.
Coagulation
A series of complex enzymatic reactions designed to activate specific coagulation proteins; most are plasma proteins.
- Activated in a stepwise/cascading fashion - similar to knocking over dominos. Most of these factors are synthesized by the liver and are enumerated with Roman numerals.
Coagulation
A series of complex enzymatic reactions designed to activate specific coagulation proteins; most are plasma proteins.
What are the 2 pathways to activate coagulation?
There are 2 separate pathways to activate coagulation, and they merge to form a common pathway. The presence of 2 attempts to guarantee that bleeding stops. Each is activated in a slightly different fashion. #1. Extrinsic Pathway #2. Intrinsic Pathway
Extrinsic Pathway
Is activated by damage outside of the vessel, specifically tissue. The extrinsic pathway has fewer steps and occurs rapidly.
- Fast activation and fewer steps
- A tissue protein called tissue factor (TF) or tissue thromboplastin is released from damaged tissue into the blood vessels.
Intrinsic Pathway
Is activated by substances within or associated with the vessel. Exposed vascular collagen, damaged endothelium, or activated platelets are all potent coagulation activators.
Stages of Coagulation
Regardless of the pathway, the goal is to merge at a common pathway by activating an enzyme called prothrombinase.
- Merge at common pathway - Formation of prothrombinase
- Formation of thrombin from prothrombin
- Formation of fibrin from fibrinogen
- Fibrin forms the clot and strengthens the platelet plug
- Ca++ plays a role throughout almost every step of the clotting process
Cofactors in the clotting process
There are a number of cofactors that must be present for clotting factor synthesis and for coagulation to occur:
- Vitamin K for clotting factors II, VII, IX, and X
- Ca++ required for almost every step of the coagulation process.
Plasma vs. Serum
Plasma and serum are almost the same liquid - side by side, one can’t tell the difference:
- The liquid portion of clotted blood is serum. If the blood forms a clot by activating the soluble clotting factors, the liquid is called serum.
- The liquid portion of unclotted is plasma. If the clotting process is inhibited an the clotting factors remain inactive and soluble, the liquid is called plasma.
What are the 3 kinds of clots?
- Thrombus: Stationary Blood Clot
- Embolus: A circulating particle, often a clot that may obstruct a blood vessel. Can be fat, air, cholesterol plaque, blood, clump of platelets, etc.
- Thromboembolus: A stationary clot that dislodged from its primary site and traveled to another location.
Fibrinolytic System
Coagulation is not infrequent. The body has a mechanism to dissolve clots so they are not allowed to persist and accumulate called the Fibrinolytic System.
- As coagulation occurs, substances from tissue and blood activate the enzyme plaminogen to become plasmin.
- Plasmin is a potent proteolytic enzyme. It dissolves the clot by digesting fibrin and interferes with new clot formation by inactivating fibrinogen, prothrombin, and other clotting factors.
Anticoagulants
No, they are not blood thinners. Anticoagulants interfere with the coagulation process. Some examples of anticoagulants include:
- Heparin
- Coumadin (warfarin)
- EDTA
- Sodium Citrate
- Aspirin
Heparin
An Anticoagulant
Administered intravenously to a stroke or heart attach victim, also used in surgery and dialysis