Module 4 (blood and immune) Flashcards
Blood volume and circulation
5L in humans; 14,000L through the heart every 24 hours; must be maintained to retain pressure
Blood overall function
Provides a one-way pressurised system for the transport of oxygen, proteins, lipids, glucose and essential ions required for normal cell function; bathes muscles and other organs in an oxygenated environment
Arterial pressure
Maintained by elastic vessel walls that contain lots of smooth muscle; very high pressure because walls expand to carry systolic pressure from the heart
Venous pressure
Lower pressure, veins are not elastic; one-way valves required to prevent back-flow and ensure it if always flowing in one direction
Blood loss
People can withstand up to 20% of blood loss; any more results in pressure and flow being impaired and tissue is starved of oxygen
Hypertension
High blood pressure; can be caused by a narrowing or hardening of the arteries, reducing flow and resulting in unwanted coagulation
Circulatory system components
Heart (L and R ventricles and atria); capillaries (large: high volume/low flow; small: low volume/high flow); veins and arteries
Blood pressure; changes and function
Different depending on the vessel type; normal BP is 120/80 (120mL mercury -systolic blood pressure)
High BP - arteries not expanding and contracting efficiently - something wrong and significant use to thromboses
Low BP: not enough blood pumping through veins to supply muscles and tissue with oxygen
Ensures even and efficient blood flow through the small capillaries; it is low enough to prevent capillary leakage but high enough to avoid coagulation.
Systolic pressure
Blood is at full compression (LV is squeezed at highest and arteries are expanded at greatest); 120/80 BP
Diastolic
The heart is at complete rest
Major components of blood (6)
Cells (erythroid, myeloid and lymphoid)
Proteins (major types: albumin, haemoglobin, fibrinogen, immunoglobulins)
Lipids (bound in lipoproteins; HDL, LDL and VLDL)
Electrolytes (salts and minerals; HCO3-, Na+, Cl-, Ca++, Mg++, K+, creatine, creatinine)
Vitamins, hormones
Glucose
Erythroid cells
Erythrocytes; solely for oxygen transport; don’t have a nucleus so survive radiotherapy much better (no DNA)
Myeloid cells
Neutrophils, monocytes (become macrophages), basophils, eosinophils); all white blood cells which engage in some form of innate immunity (and sometimes phagocytosis); they have a range of receptors that bind immune complexes
Composition of types of cells in the blood
Erythrocytes: 5-6 million/mL
Leukocytes: 10,000/mL
Platelets: 400,000/mL
Lymphoid cells
B-cells (come from bone marrow; provide antibodies/immunoglobulins; adaptive immunity)
T-cells (migrate to the thymus above the heart and become a part of the cellular adaptive response)
Albumin
Most abundant protein (accounts for ~50% of total blood protein); functions mainly to maintain colloidal osmotic pressure (to provide a soak for fluid within the blood - preventing leaking from capillaries) and also binds and transports many small molecules and proteins, maintains hypertonicity
Fibrinogen
Second most abundant protein - cleaved by the enzyme thrombin (in the coagulation cascade) to form cross-linked fibrin that forms the blood clot - prevents leakage; constitutes 7% of total blood protein
Immunoglobulin
(Ig) AKA antibody; found in the gamma fraction in serum electrophoresis), responsible for immunity; produced by plasma cells (a form of B lymphocyte); constitutes ~10% of total blood protein and becomes elevated in diseases such as multiple myeloma; provide us with a vast repertoire of different antigen-binding molecules which provide defence against everything
Complement proteins
A set of 9 plasma proteins that phagocyte and opsonise foreign organisms; innate immunity; most abundant protein is C3; essential for tagging/coating invading organisms so they can be digested
When they encounter bacteria with a surface different enough, it is activated
Coagulation factors
A set of 13 proteins cleaved in an ordered cascade that initiates the cleavage of fibrinogen into fibrin to form the clot; thrombin is the central enzyme that cleaves fibrinogen; Ca++ essential to coagulation
Haemoglobin
The major component of RBCs which carries oxygen from lungs to the heart to tissue; constitutes 96% of RBCs dry weight which makes up ~45% of the blood volume
Each molecule contains 4 haem molecules each containing 1 iron atom (in feris state); can carry 4 oxygen molecules each
Oxygen loaded, transported to the tissue where it dissociates (due to partial pressure of oxygen reducing), picks up a CO2 molecule and removes it
Missing coagulation component
Haemophilia’s result; factor VIII deficiency is the commonest form
Electrolytes
Salts and minerals that maintain isotonicity and buffering; free Ca++ and K+ also tightly maintained - crucial for the regulation of membrane channels, ion pumps and normal nerve and muscle function (such as the heart)
Deviation from any of the normal levels of ions will result in a significant illness
Oxygen transport conditions
Many molecules can displace O2 from Fe++
CO2 - venous blood
CO - carbon monoxide poisoning
CN - cyanide poisoning
Lipids
Taken up when a fatty meal is eaten; transported by lipoproteins; based on density (the only way to isolate them is to centrifuge them at a high speed - they have a very low density and float to the top of the centrifuged blood)
LDL - low-density lipoproteins (bad lipoprotein)
HDL and VLDL (good lipoproteins)
The ratio of LDL:HDL is tested for when doctors do a lipid screen
Vitamins and hormones
Transported to various organs by blood (insulin, glucagon, fertility hormones)
Blood homeostasis
Maintaining a stable blood acid/base balance is very important; blood pH is very tightly maintained at 7.4 with a variance of 0.2 - any more could result in severe stress (acidosis or alkalosis); effectively buffered by albumin, phosphate, bicarbonate, creatine and other compounds
Centrifugation of blood
The most simplified form of separating blood; separates into 3 components (packed red cells 40%, buffy coat containing white blood cells and platelets 10% and plasma containing soluble proteins and lipids 50%)
Blood clots are removed and serum leftover (without fibrinogen because they formed the insoluble fibrin clot, and other cells)
Medical test for health looks at packed RBCs (can have too many or too little) - too little could lead to cerebral Dema
Plasma
The viscous liquid fraction of blood without cells (uncoagulated blood); contains fibrinogen that is removed with coagulation
Doesn’t tend to electrophorese very well due to the fibrinogen causing problems with the process - needs to be removed with the clot
Serum
The less viscous yellow liquid remaining after clot removal; normally straw yellow but after a fatty meal it will be cream coloured due to the lipid ingested
Serum electrophoresis define
A common means of separating blood proteins using an electric field (electric current); separates serum into 5 major protein fractions: albumin (~50%) and globulin (alpha1, alpha2, beta and gamma add to ~40% - immunoglobulins)
Multiple myeloma
Form of leukemia where a malignant lymphocyte produces monoclonal Ig; serum electrophoresis is used to diagnose the condition; single band appears in gamma globulin fraction, which indicates there is a B-cell over-producing a monoclonal antibody
B-cell malignancy (aberrant B-cell becomes malignant), it is mature so produces an antibody in high amounts; patient develops monoclonal antibody in their blood
When it becomes advanced, the antibody is in such high concentration that it is urinated
Serum electrophoresis method
The serum is mixed with a buffer solution to regulate the pH; blood proteins are dapped on paper/carrier and an electric field is applied (+ and - electrodes); proteins are charged and with travel to either electrode - spread of blood proteins
Albumin in serum electrophoresis
It is a negatively-charged protein so will migrate toward the + electrode (the density is measured and the spikes show a scan of the stain)
Gamma fraction in serum electrophoresis
Gamma globulin fraction carries immunoglobulins or antibodies; migrate furthest to the negative electrode (due to their + charge)
The simplest technique to identify someone who has an abnormality
Hemocytoblast
All blood-circulating cells come from this single multipotent human stem cell (HSC) found in the bone marrow; extremely rare (about 1 in 10,000 WBCs are CD34+); characterised by the CD34 cell surface marker antigen to isolate these cells
CD34+ HSC give rise to myeloid or lymphoid progenitors (multipotent stem cells)
There is a high concentration in the umbilical cord blood
Autologous HSC transplants
Stem cells saved from birth can save the child
Treat leukemia using radio oblation and chemical oblation, transplant the core blood into the patient so the HSC will repopulate the bone marrow and generate a normal blood system
Can also be used in adults
Isolate the cells using monoclonal antibodies which recognise the CD34 antigen - has a fluorescent tag/magnetic bead; when added to the patient’s blood can isolate the HSCs; treat them with radiation to destroy the WBCs and their ability to make WBCs - hopefully destroying leukemic cells as well; transplant back CD34 cells
Myeloid lineage
The myeloid progenitor gives rise to erythrocytes, megakaryocytes, mast cells or myeloblasts (innate immunity)
Megakaryocytes –> thrombocytes
Myeloblasts –> neutrophils, basophils, eosinophils or monocytes (–> macrophages)
Lymphoid lineage
The lymphoid progenitor differentiates into natural killer cells or lymphocytes
B-lymphocytes (make antibodies; give rise to plasma cells)
T-lymphocytes (generated through the thymus gland; immature cells differentiate into CD4 or CD8)
Haematopoiesis and factors
Differentiation process of cells; GM-CSF, EPO and G-CSF
GM-CSF
Granulocyte macrophage colony-stimulating factor; produced by macrophages, T-cells, endothelial cells and fibroblasts; stimulates the production of neutrophils, eosinophils, monocytes and basophils
Administered to re-populate white cells in leukemia patients following radio-ablation
EPO
Erythropoietin; drives the production of erythrocytes; produced mainly by the kidney during adulthood and liver in perinatal
Favourite drug of performance athletes; more RBCs transport more O2 to tissues; also allows high-altitude training
G-CSF
Granulocyte colony-stimulating factor; produced by many different cells; stimulates the production of granulocytes but also acts as mature neutrophils
Administered to re-populate white cells in leukemia patients following radio-ablation
Oxygen transport and exchange; alveoli and arteries
Getting oxygen to tissues so oxidative phosphorylation can occur (ATP production)
Alveoli: very thin membrane for diffusion; wrapped in tiny capillaries so when blood comes through the capillary network it can pick up oxygen
Arteries reside very deep in tissue a run along bones; damage would result in rapid loss of blood (because they are under pressure)
Classical activation
Initiated by antibodies binding to the surface of a microbe; C1, C2, C4 and C3 condense on the antibody to form a bound C3 convertase on the microbe surface; mediated by IgM or IgG binding to a microbe surface which is then bound by C1
Lectin activation
Lectins are carbohydrate-binding proteins in the blood which bind to unusual carbohydrates found only on microbes; complement condenses on these bound lectin
Alternative activation
Complement C3 is activated just by being close to the surface of the microbe; this activates another type of C3 convertase
Complement and innate immunity
When complement is activated, there is a cascade pathway; includes the classical, lectin and alternative pathways, end-stage complement, anaphylatoxins and phagocytic cells
End-stage complement
The surface-bound convertases activate complement C5-9; forms a pore (MAC - membrane attack complex) that inserts into some bacterial membranes to cause lysis
Anaphylotoxins
Small polypeptides generated by cleavage of the larger complement proteins (C3, C4 and especially C5); powerful chemoattractant (C3a, C4a and C5a) that recruit and activate phagocytes (neutrophils) to the site of infection
Phagocytic cells
Neutrophils and macrophages have complement receptors that bind complement and initiate phagocytosis
Opsonisation
Deposition of complement on microbes; essential for phagocytosis
Convertases
Deposited complexes on microbes activate more complement that then deposits to coat the surface; irreversibly bound to through a covalent bond
Inhibition of the complement cascade
Many microbes produce proteins (virulence factors)
People with deficiencies in a complement component are susceptible to chronic infections
Coagulation pathway
Proteolytic activation cascade that can be initiated through the intrinsic or extrinsic pathway; tissue damage or surface contact results in the binding and activation of platelets that bind to the vessel cell wall
Calcium is essential
Intrinsic pathway
Contact;
Factors XIII, XI, IX and VIII (12, 11, 9, and 8) lead to the cleavage of factor X (10); converts prothrombin to thrombin
Extrinsic pathway
Tissue damage; Factors VII (7) and tissue factors (TF) combine to activate factor X
Factor X
Activates thrombin; common in both coagulation pathways
Thrombin; blockage
An enzyme that cleaves fibrinogen to fibrin which cross-links to form a blood clot
Anti-coagulants can block thrombin; heparin and warfarin are used in medicine and many insects and parasites that rely on blood for food produce them
Plasminogen; streptokinase and TPA
Protease that is activated by tissue plasminogen activator (TPA) or streptokinase; plasmin (active) cleaves the fibrin clot (dissolves it) resulting in thrombolysis
TPA and streptokinase are important as they are used to treat unwanted blood clots (myocardial, PE, DVT, etc.)
Innate immunity
All animals - more primordial that adaptive; recognition of traits shared by broad ranges of pathogens, using a small set of receptors; provided by myeloid cells; rapid response - immediate and first line of defence against an infection
Anatomical and physiological barriers
Intact skin, mucous membranes, secretions (ciliary clearance; lysozyme in tears and saliva); low stomach pH
Innate cellular response
Natural killer cells, neutrophils, eosinophils, macrophages, mast cells, dendritic cells
Innate humoral response
Complement, mannose-binding lectin (activate complement; recognises unique carbohydrates found on the surface of bacteria), LPS binding protein, C-reactive protein, antimicrobial peptides (bind to the surface of bacteria; in parts of the body that come into contact with the environment)