1. Introduction of Blood Tel: 88208252 Email: xiaqiang@zju.edu.cn Qiang XIA (夏强), PhD Department of Physiology Room C518, Block C, Research Building, School of Medicine

2. Objectives • To know the components of blood • To understand blood coagulation and fibrinolysis • To be able to recognize the process of hemostasis

3. Body Fluid = 60% of Body Weight (BW) Plasma 5% of BW Extracellular Fluid 1/3, 20% of BW Interstitial Fluid 15% of BW Internal Environment 70 kg Male, 42 L Intracellular Fluid 2/3, 40% of BW Internal environment （内环境）

4. Homeostasis（稳态） Homeostasis (from the Greek words for “same” and “steady”): maintenance of static or constant conditions in the internal environment Walter B. Cannon http://en.wikipedia.org/wiki/Walter_Bradford_Cannon

5. Components of Homeostasis • Concentration of O2 and CO2 • pH of the internal environment • Concentration of nutrients and waste products • Concentration of salt and other electrolytes • Volume and pressure of extracellular fluid

6. Components of blood • Plasma（血浆） • Blood Cells • Red Blood Cells (RBC) or Erythrocytes（红细胞） • White Blood Cells (WBC) or Leucocytes（白细胞） • Platelets (PLT) or Thrombocytes（血小板）

10. The hematocrit is a rapid assessment of blood composition.It is the percent of the blood volume that is composed of RBCs (red blood cells). Plasma includes water, ions, proteins, nutrients, hormones, wastes, etc. Hematocrit（packed cell volume, 血细胞比容）

11. Red blood cells (Erythrocytes)（红细胞） • RBC count M: 4.0~5.5×1012/L F: 3.5~5.0×1012/L • Hemoglobin（血红蛋白） M: 120~160 g/L F: 110~150 g/L

12. d Erythrocyte Sedimentation Rate (ESR)（红细胞沉降率） • The distance that red blood cells settle in a tube of blood in one hour • Normal value [Westergren method（魏氏法，国际血液学标准化委员会推荐魏氏法为标准法）]: M: 0~15 mm/h，F: 0~20 mm/h • An indication of inflammation which increases in many diseases, such as tuberculosis & rheumatoid arthritis… International Council for Standardization in Haematology (ICSH)

13. Anemia（贫血） • Anemia is defined as a qualitative or quantitative deficiency of hemoglobin, a protein found inside red blood cells (RBCs) • The three main classes of anemia： • excessive blood loss (acutely such as a hemorrhage or chronically through low-volume loss) • excessive blood cell destruction (hemolysis) • deficient red blood cell production (ineffective hematopoiesis)

14. Iron deficiency anemia （缺铁性贫血）

15. 巨幼红细胞性贫血（megaloblastic anemia）

17. Hemolysis（溶血） Red blood cells without (left and middle) and with (right) hemolysis. Note that the hemolyzed sample is transparent, because there are no cells to scatter light.

18. White blood cells (Leucocytes)（白细胞）

19. WBC Count (109/L) % Granulocytes Neutrophils 2.0~7.0 50~70 Eosinophils 0.02~0.5 0.5~5 Basophils 0~0.1 0~1 Monocytes 0.12~0.8 3~8 Lymphocytes 0.8~4.0 20~40 • WBC count Total 4~10

20. Platelets (Thrombocytes)（血小板） • Normal value: (100~300) x 109/L • An important role in hemostasis

21. Physiological properties of platelets • Adhesion（粘附）：Platelets adhere to the vessel wall at the site of injury

22. Aggregation（聚集）：Platelets adhere to one another

24. Phospholipid Phospholipase A2 Arachidonic Acid Cyclo-oxygenase PGG2 & PGH2 Thromboxane synthase (Platelets) Prostacyclin synthase (Vascular endothelium) TXA2 PGI2 Aggregation Anti-aggregation Contraction Relaxation

25. Release or secretion（释放或分泌）： • Platelets contain alpha and dense granules • Dense granules: containing ADP or ATP, calcium, and serotonin • α-granules: containing platelet factor 4, PDGF, fibronectin, B-thromboglobulin, vWF, fibrinogen, and coagulation factors V and XIII

26. Contraction（收缩）: Clot retraction (血块回缩) • Adsorption （吸附）

27. Hemostasis（止血） • The arrest of bleeding following injury and the result of 3 interacting, overlapping mechanisms: • Vascular spasm（血管收缩） • Formation of a platelet plug（血小板血栓形成） • Blood coagulation (clotting)（血液凝固） Bleeding time (出血时间)：<9 min

30. Blood coagulation（血液凝固） Clotting factor Synonyms I fibrinogen纤维蛋白原 II prothrombin凝血酶原 III tissue thromboplastin组织因子 IV Ca2+ V proaccelerin前加速素易变因子 VII proconvertin前转变素稳定因子 VIII antihemophilic factor抗血友病因子 IX plasma thromboplastin component血浆凝血活酶 X Stuart-Prower factor XI plasma thromboplastin antecedent血浆凝血活酶前质 XII contact factor接触因子 XIII fibrin-stabilizing factor纤维蛋白稳定因子 Clotting factors

31. Coagulation cascade 3 processes 2 pathways

33. A deficiency of a clotting factor can lead to uncontrolled bleeding • Vitamin K is a cofactor needed for the synthesis of factors II, VII, IX, & X in the liver. So a deficiency of Vitamin K predisposes to bleeding

34. Anticoagulants（抗凝物质） • Antithrombin III（抗凝血酶III） • Protein C system（蛋白C系统） • Heparin（肝素） RNA适体

35. Fibrinolysis（纤维蛋白溶解）

36. Summary • Componentsof blood: • Plasma • Blood cells • Homeostasis: 3 steps • Blood coagulation • Anticoagulants • Fibrinolysis

37. Thank you for your attention!