Sunday, March 18, 2012

Anatomy & Physiology: BLOOD

    

      INTRODUCTION
•          Blood inside blood vessels
•          To obtain nutrients and remove wastes, cells must be serviced by blood and interstitial fluid.
•          Blood, a connective tissue, is composed of plasma and formed elements.
•          The branch of science concerned with the study of blood, blood-forming tissues, and the disorders associated with them is called hematology.
          FUNCTION OF BLOOD
•          Transportation
–         O2, CO2, metabolic wastes, nutrients, heat & hormones
•          Regulation
–        helps regulate pH through buffers
–        helps regulate body temperature
–        helps regulate water content of cells by interactions with dissolved ions and proteins
•          Protection from disease & loss of blood
      COMPONENT OF BLOOD
•          Hematocrit
–         plasma
–         cells
•          Blood plasma consists of water and solutes.

   BLOOD PLASMA
•          0ver 90% water
•          7% plasma proteins
•          created in liver
•          confined to bloodstream
–        albumin
•          maintain blood osmotic pressure
–        globulins (immunoglobulins)
•          antibodies bind to foreign
substances called antigens
•          form antigen-antibody complexes
–        fibrinogen
•          for clotting
•          2% other substances
–        electrolytes, nutrients, hormones, gases, waste products

      RED BLOOD CELLS OR ERYTHROCYTES
•          Contain oxygen-carrying protein hemoglobin that gives blood its red color
•          Biconcave
–        increased surface area/volume ratio
–        flexible shape for narrow passages
–        no nucleus or other organelles
•          Worn out cells removed by fixed macrophages in  spleen & liver
         WHITE BLOOD CELLS
•          All WBCs (leukocytes) have a nucleus and no hemoglobin
•          Granular or agranular classification based on presence of  cytoplasmic granules made visible by staining
–        granulocytes are neutrophils, eosinophils or basophils
–        agranulocytes are monocyes or lymphocytes
       NEUTROPHILS(GRANULOCYTE)
•          Nuclei = 2 to 5 lobes connected by thin strands
•          Neutrophils and wandering or fixed macrophages (which develop from monocytes) do so through phagocytosis.
•          Fastest response of all WBC to bacteria
  EOSINOPHILS(GRANULOCYTE)
•          Nucleus with 2 or 3 lobes connected by a thin strand
•          Large, uniform-sized granules stain orange-red with acidic dyes
•          Leave capillaries to enter tissue fluid
•          Release histaminase
–        slows down inflammation caused by basophils
•          Attack  parasitic worms
•          Phagocytize antibody-antigen complexes
        BASOPHILS (GRANULOCYTE)
•          Large, dark purple, variable-sized granules stain with basic dyes
•          Irregular, s-shaped, bilobed nuclei
•          Involved in inflammatory and allergy reactions
•          Leave capillaries & enter connective tissue as mast cells
•          Release heparin, histamine & serotonin
     LYMPHOCYTE(AGRANULOCYTE)
•          Dark, oval to round nucleus
•          Cytoplasm sky blue in color
–        amount varies from  rim of blue to normal amount
•          B cells
–        destroy bacteria and their toxins
–        turn into plasma cells that produces antibodies
•          T cells
–        attack viruses, fungi, transplanted organs, cancer cells & some bacteria
•          Natural killer cells
–        attack many different microbes & some tumor cells
–        destroy foreign invaders by direct attack
  MONOCYTE(AGRANULOCYTE)
•          Nucleus is kidney or horse-shoe shaped
•          Largest WBC in circulating blood
–        does not remain in blood long before migrating to the tissues
–        differentiate into macrophages
•          macrophages, are active in phagocytosis.
•          Destroy microbes and clean up dead tissue following an infection
•          Take longer to get to site of infection, but arrive in larger numbers
  PLATELET(THROMBOCYTE)
•          Platelets help stop blood loss from damaged vessels by forming a platelet plug.
•          Their granules also contain chemicals that promote blood clotting.
•          Disc-shaped, 2 - 4 micron cell fragment with no nucleus
 HEMOSTASIS
•          A clot is a gel consisting of a network of insoluble protein fibers (fibrin) in which formed elements of blood are trapped
•          The chemicals involved in clotting are known as coagulation (clotting) factors; most are in blood plasma, some are released by platelets, and one is released from damaged tissue cells
•          Blood clotting involves a cascade of reactions that may be divided into three stages:
–         formation of prothrombinase (prothrombin activator), conversion of prothrombin into thrombin
–         conversion of soluble fibrinogen into insoluble fibrin
HEMOSTASIS
•          The clotting cascade can be initiated by either the extrinsic pathway or the intrinsic pathway.
•          Normal coagulation requires vitamin K and also involves clot retraction (tightening of the clot) and fibrinolysis (dissolution of the clot).
•          The fibrinolytic system dissolves small, inappropriate clots and clots at a site of damage once the damage is repaired.
•          Plasmin (fibrinolysin) can dissolve a clot by digesting fibrin threads and inactivating substances such as fibrinogen, prothrombin, and factors V, VIII, and XII.

  HEMOSTASIS
•          Stoppage of bleeding in a quick & localized fashion when blood vessels are damaged
•          Prevents hemorrhage (loss of a large amount of blood)
•          Methods utilized
–        vascular spasm
–        platelet plug formation
–        blood clotting (coagulation = formation of fibrin threads)
  VASCULAR SPASM
•          Damage to blood vessel produces stimulates pain receptors
•          Reflex contraction of smooth muscle of small blood vessels
•          Can reduce blood loss for several hours until other mechanisms can take over
•          Only for small blood vessel or arteriole
 PLATELET PLUG FORMATION
•          Steps in the process
–        (1) platelet adhesion  (2) platelet release reaction (3) platelet aggregation
•          Platelets stick to exposed collagen underlying damaged endothelial cells in vessel wall
•          Extend projections to make contact with each other
•          Release thromboxane A2 & ADP are vasoconstrictors decreasing blood flow through the injured vessel
•          Activated platelets stick together and activate new platelets to form a mass called a platelet plug

 BLOOD CLOTTING
•          Blood drawn from the body thickens into a gel
–        gel separates into liquid (serum) and a clot of insoluble fibers (fibrin) in which the cells are trapped
•          If clotting occurs in an unbroken vessel is called a thrombosis
•          Substances required for clotting are Ca+2, enzymes synthesized by liver cells and substances released by platelets or damaged tissues
•          Clotting is a cascade of reactions in which each clotting factor activates the next in a fixed sequence resulting in the formation of fibrin threads
–        prothrombinase & Ca+2 convert prothrombin into thrombin
–        thrombin converts fibrinogen into fibrin threads
•          Clot Retraction & Blood Vessel Repair
•          Clot plugs ruptured area of blood vessel
•          Platelets pull on fibrin threads causing clot retraction
•          Edges of damaged vessel are pulled together
•          Fibroblasts & endothelial cells repair the blood vessel

   HEMOSTATIC CONTROL MECHANISMS
•          Fibrinolytic system dissolves small, inappropriate clots & clots at a site of a completed repair
–        fibrinolysis is dissolution of a clot             
•          Inactive plasminogen is incorporated into the clot
–        plasminogen becomes plasmin (fibrinolysin) which digests fibrin threads
•          Clot formation remains localized
–        fibrin absorbs thrombin
–        blood disperses clotting factor
•          Anticoagulants present in blood & produced by mast cells
–        Hemostatic Control Mechanisms
•          Clots are generally localized due to fibrin absorbing thrombin into the clot, clotting factors diffusing through blood, and the production of prostacyclin, a powerful inhibitor of platelet adhesion and release.
•          Substances that inhibit coagulation, called anticoagulants, are also present in blood. An example is heparin.
•          Despite the anticoagulating and fibrinolytic mechanisms, blood clots sometimes form within the cardiovascular system.
•          Clotting in an unbroken blood vessel is called thrombosis.
•          A thrombus (clot), bubble of air, fat from broken bones, or piece of debris transported by the bloodstream that moves from its site of origin is called an embolus.