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BLOOD

BLOOD. “Sometimes the questions are complicated and the answers are simple.” ― Dr. Seuss. Functions of the blood. Transportation Gases Nutrients Waste Hormones Regulation – pH, heat, fluid balance Protection – disease, blood loss. COMPONENTS. FORMED ELEMENTS (LIVING)

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BLOOD

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  1. BLOOD “Sometimes the questions are complicated and the answers are simple.” ― Dr. Seuss

  2. Functions of the blood • Transportation • Gases • Nutrients • Waste • Hormones • Regulation – pH, heat, fluid balance • Protection – disease, blood loss

  3. COMPONENTS • FORMED ELEMENTS (LIVING) • RED BLOOD CELLS (erythrocytes) • BUFFY COAT • LEUKOCYTES • PLATELETS • MATRIX (NOT LIVING) • PLASMA

  4. PLASMA • 90% Water • Nutrients, Salts (Electrolytes) • Respiratory Gases • Waste products • Plasma Proteins (Most Abundant at 8%) • HORMONES • ALBUMIN • CLOTTING FACTORS • COMPLEMENT

  5. HOMEOSTASIS OF BLOOD • LOW ALBUMIN= LIVER IS STIMULATED TO MAKE MORE PROTEIN • CHANGE IN ACIDITY = LUNGS AND KIDNEYS WORK TO BALANCE IT • PLASMA HELPS WITH HEAT DISTRIBUTION • PLATELETS PREVENT BLOOD LOSS

  6. RED BLOOD CELLS • ANUCLEATE, NO MITOCHONDRIA • FEW ORGANELLES • FULL OF HEMOGLOBIN • BICONCAVE DISK – INCREASES SURAFCE AREA FOR GAS EXCHANGE • TRANSPORT OXYGEN/ CO2 • 4-6 MILLION CELLS /MM3

  7. HEMOGLOBIN/ HEMATOCRIT • HGB – MEASUREOF HEMOGLOBIN IN RBC • MEN – 14 -17 G/ 100 ML • WOMEN – 12 – 15 G/ 100 ML • HCT – VOLUME % OF RBC IN WHOLE BLOOD • MEN – 42 – 54% • WOMEN – 36 -46% • HINT: HCT IS 3 TIMES GREATER THAN HGB

  8. LEUKOCYTES (WBC) • 5,000 – 10,000/ MM3 • COMPLETE CELL WITH NUCLEUS, ETC • DIAPEDESIS – ABLE TO MOVE INTO AND OUT OF BLOOD VESSELS • POSITIVE CHEMOTAXIS – ABILITY TO FIND AREAS OF TISSUE DAMAGE • USE DIFFUSION GRADIENT

  9. WBC GROUPS • GRANULOCYTES • NEUTROPHILS • EOSINOPHILS • BASOPHILS • HISTAMINE • HEPARIN • AGRANULOCYTES • LYMPHOCYTES • MONOCYTES

  10. PLATELETS • FRAGMENTS OF MEGAKARYOCYTES • 150,000 – 450,000/ MM3 • NEEDED IN THE CLOTTING CASCADE • ACT LIKE SANDBAGS AT A BREAK IN THE LEVEE

  11. HEMATOPOIESIS • OCCURS IN RED BONE MARROW • SKULL, PELVIS, RIBS, STERNUM AND PROXIMAL EPIPHYSIS OF LONG BONE • HEMOCYTOBLAST (STEM CELL) STARTS OFF FROM THE MARROW • BECOMES EITHER LYMPHOID OR MYELOID STEM CELL. • CANNOT GROW, DIVIDE OR SYNTHESIZE PROTEINS = 120 DAY LIFE SPAN

  12. CONTINUED • RBC DIVIDES MANY TIME, ACCUMULATES HGB; WHEN GETS ENOUGH HGB, CELL EJECTS NUCLEUS & ORGANELLES, COLLAPSES ON SELF = BI-CONCAVE • IMMATURE RBC IS A RETICULOCYTE • TAKES 3-5 DAYS UNTIL A MATURE RBC • PRODUCTION RATE CONTROLLED BY ERYTHROPOIETIN (KIDNEY) IN RESPONSE TO O2 LEVELS IN BLOOD. • E-POIETIN STIMULATES BONE MARROW

  13. CONTINUED • AS THEY AGE, RBC BECOMES RIGID AND BREAKS APART • ELIMINATED BY MACROPHAGES IN THE SPLEEN , LIVER AND OTHER TISSUES • GLOBIN &IRON IS RECYCLED • HEME IS BROKEN DOWN AND EXCRETED BY LIVER

  14. LEUKOCYTE AND PLATELET FORMATION • COLONY STIMULATING FACTORS AND INTERLEUKIN INCREASE LEUKOCYTE PRODUCTION IN THE MARROW • THROMBOPOIETIN INCREASES RATE OF PLATELET FORMATION • BONE MARROW BIOPSY ASPIRATES MARROW FROM STERNUM OR ILIUM FOR EXAMINATION REGARDING DISEASES

  15. HEMOSTASIS - CLOTTING • PLATELET PLUG FORMATION • VASCULAR SPASMS • COAGULATION/ CLOTTING • FIBROUS TISSUE FORMATION GROWS INTO THE CLOT AND PERMANENTLY CLOSE THE DAMAGE IN THE VESSEL

  16. #1-PLATELET PLUG FORMATION • PLATELETS DO NOT STICK TO SMOOTH SURFACES • COLLAGEN FIBER EXPOSURE CAUSES PLATELETS TO BECOME STICKY AND ADHERE TO DAMAGED AREA • SECRETE CHEMICALS THAT ATTRACT MORE AND MORE PLATELETS UNTIL A PLUG IS FORMED

  17. #2 VASCULAR SPASM • ANCHORED PLATELETS SECRETE SEROTONIN CAUSING VASCULAR SPASM • SPASM CONSTRICTS THE VESSEL WHICH DECREASES BLOOD LOSS

  18. #3 COAGULATION • INJURED TISSUE RELEASES (TF) TISSUE FACTOR • PF3 (ON PLATELET), TF, VITAMIN K, CALCIUM, & CLOTTING FACTORS MAKE PROTHROMBINASE • PROTHROMBINASE CONVERTS PROTHROMBIN INTO THROMBIN • THROMBIN ALTERS FIBRINOGEN TO FIBRIN WHICH FORMS THE MESH TO TRAP RBCS

  19. CLOTTING • USUALLY TAKES 3-6 MINUTES • ONCE CLOTTING HAS STARTED, THE TRIGGERING FACTORS ARE INACTIVATED TO PREVENT WIDESPREAD CLOTTING IN BODY • PRESSURE SPEEDS UP CLOTTING BY RELEASING LOCAL TISSUE FACTORS • ENDOTHELIUM GROWS AND CLOT IS MACROPHAGED, SCAR REMAINS.

  20. UNDESIRABLE CLOTTING • THROMBUS – STABLE CLOT IN A VESSEL • EMBOLUS – MOVING CLOT IN A VESSEL • FACTORS THAT ENCOURAGE CLOTTING: • SEVERE BURNS • PHYSICAL BLOWS • ACCUMULATION OF FATTY MATERIAL • SLOW FLOWING BLOOD • BLOOD POOLING

  21. BLEEDING DISORDERS • THROMBOCYTOPENIA – LOWERED LEVEL OF PLATELETS • HEMOPHILIA – LACK OF A CLOTTING FACTOR • LIVER FAILURE – LEADS TO INABILITY TO SYNTHESIZE ENOUGH CLOTTING FACTORS

  22. HUMAN BLOOD GROUPS • ANTIGEN – SOMETHING OUR BODY RECOGNIZES AS FOREIGN “NOT ME” • WE RECOGNIZE OUR OWN AS “ME” • GIVING “NOT ME” TO “ME” CAUSES OUR BODY TO BUILD ANTIBODIES TO “NOT ME”; WHEN SEE “NOT ME”, THE ANTIBODIES BIND WITH THEM AND CLUMP (AGGLUTINATE) • 30 COMMON RBC ANTIGENS

  23. ABO BLOOD GROUPS • TYPE A HAS “A” ANTIGEN • TYPE B HAS “B’ ANTIGEN • TYPE O HAS NEITHER ANTIGEN • TYPE AB HAS BOTH A AND B ANTIGEN • THE ANTIGEN CAUSES RECOGNITION OF “SELF” • ANTIBODIES ARE BUILT TO “NOT SELF”

  24. CONTINUED • “A” ANTIGEN HAS “NOT B” ANTIBODIES • “B” ANTIGEN HAS “NOT A” ANTIBODIES • “O” HAS NO ANTIGEN; HAS BOTH “NOT A & NOT B” ANTIBODIES SO IS THE UNIVERSAL DONOR BUT CAN ONLY RECEIVE ‘O’ • “AB” HAS BOTH ANTIGEN THEREFORE HAS NO ANTIBODIES; IS THE UNIVERSAL RECIPIENT, CAN ONLY GIVE TO AB

  25. RH GROUPS • RH ANTIGENS ARE DETERMINED AT BIRTH • POSITIVE MEANS YOU HAVE THE ANTIGEN, NEGATIVE MEANS YOU DON’T • TRANSFUSE RH- WITH RH+ BLOOD CAUSES ANTIBODIES TO BE BUILT • ANTIBODIES WILL LYSE RBC ON SECOND CONTACT • HEMOLYTIC DISEASE OF THE NEWBORN- GIVE RHOGAM TO PREVENT ANTIBODIES

  26. BLOOD TYPING • TEST BLOOD BY MIXING IT WITH ANTI A OR ANTI B SERUM AND WATCH FOR AGGLUTINATION • SAME IS DONE FOR RH FACTOR • CROSS MATCHING USES THE PATIENTS BLOOD AND THE DONOR BLOOD TO ASSESS FOR AGGLUTINATION

  27. WHOLE BLOOD TRANSFUSIONS • TREAT MASSIVE HEMORRHAGE • REPLACES LOSS • EXCHANGE BLOOD FOR HEMOLYTIC DISEASE OF THE NEWBORN

  28. USING BLOOD COMPONENTS • HEMAPHARESIS- REMOVE BLOOD, SPIN OUT NEEDED ELEMENTS, & RETURN REMAINDER OF CELLS ANS PLASMA TO PERSON • PLASMAPHARESIS – REMOVE BLOOD, SPIN IT AND RETURN THE FORMED ELEMENTS

  29. USE OF PLASMA • REPLACES BLOOD VOLUME TO PREVENT SHOCK – NO RED CELLSSO DO NOT NEED TO TYPE IT • ALBUMIN 5% OR 25% • FFP = FRESH FROZEN PLASMA • CRYOPRECIPITATE – FACTOR 8 & FIBRINOGEN • GAMMA GLOBULIN

  30. IMBALANCE OF RBC • ANEMIA • HEMOLYTIC –SICKLE CELL • HEMORRHAGIC • PERNICIOUS – VITAMIN B12 • THALESSEMIA • APLASTIC – BONE MARROW SUPPRESSION • IRON DEFICIENCY • POLYCYTHEMIA

  31. IMBALANCE WITH WBC • LEUKOPENIA- LOWERED WBC COUNT IN BLOOD • NEUTROPENIA – LOWERED NEUTROPHIL COUNT • LEUKOCYTOSIS – MORE THAN 11,000/ MM3 • LEUKEMIA – LARGE NUMBER OF IMMATURE WBC SENT FROM MARROW

  32. CLOTTING DISORDERS • HEMOPHILIA • VON WILLEBRANDS DISEASE • THROMBOCYTOPENIA • DISSEMINATED INTRAVASCULAR COAGULATION

  33. DEVELOPMENTAL • FETAL HEMOGLOBIN CARRIES MORE OXYGEN THAN AFTER BORN • IF RBC ARE BROKEN DOWN FASTER THAN INFANTS IMMATURE LIVER CAN HANDLE, JAUNDICE OCCURS • AS WE AGE, CLOTS, LEUKEMIAS AND ANEMIAS INCREASE IN FREQUENCY

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