Chapter 18 The Circulatory System: Blood

1
Chapter 18The Circulatory System Blood

• Blood Functions and properties
• Blood cell production
• Erythrocytes (RBC)
• Leukocytes (WBC)
• Hemostasis
• Blood types

2
Functions and Properties of Blood

• Function Helps cells get nutrition, gets rid of
  waste
• Two types of fluid Blood and Interstitial
• Blood is the transported
• Interstitial fluid is the diffuser

3
Hematology

• The study of blood
• (Hemo blood, -ology study)
• Blood is as unique as your fingerprints
• Most cells cannot move around to get oxygen and
  nutrients and get rid of waste, the blood system
  does this for them.
• INTO the BLOOD- Oxygen from the lungs, nutrients
  from the small intestines
• OUT OF the BLOOD- Waste goes out the kidneys,
  skin and large intestine

4
Two Functions of Blood

• 1. Transport- oxygen, nutrients, waste
• 2. Protection- clotting, immunity white blood
  cells (WBC), interferon, complement

5
Physical Characteristic of Blood

• Alkaline 7.4 pH avg.
• 8 of body weight (if you were a 100 bill,
  about 8 of you would be blood)
• Blood volume 1.2 gallon female, 1.5 gallon male
• Temperature of the blood is a little higher then
  body temperature, WHY? ______________

6
Components of Blood

• If Blood is spun down (centrifuged), we see two
  parts
• 1. Plasma- liquid
• If this is allowed to clot what remains is called
  serum
• 2. Cells- bottom of tube
• Cells of the blood are mostly red blood cells
  (RBCs). The rest, only 1, is basically
  platelets and white blood cells (WBCs)

7
Centrifuging Blood

• Centrifuging blood forces cells to separate from
  plasma
• Hematocrit is the of total volume of cells
• Normal crit females 42 avg., males 47 avg.

8
Hematocrit Tells Us

• Hematocrit of 40 means that 40 of the blood is
  __ __ __s
• Does a doctor do a hematocrit to determine the
  amount of WBCs or platelets? YES NO
• Then what is in the buffy coat? ________
• Abnormal
• Low crit Anemia, decreased ________
• High crit Polycythemia

9
Polycythemia

• Polycythemia is an excess of RBC
• primary polycythemia is due to cancer of
  erythropoietic cell line in the red bone marrow
• Hematocrit of 80
• secondary polycythemia from dehydration,
  emphysema, high altitude, or physical
  conditioning
• Dangers of polycythemia
• increased blood volume, pressure and viscosity
  can lead to embolism, stroke or heart failure

10
Plasma Proteins

• 3 major categories of plasma proteins
• Albumins are most abundant plasma protein
• Globulins (antibodies) provide immune system
  defenses
• alpha, beta and gamma globulins
• Fibrinogen creates fibrin threads that causes
  blood to clot

11
Formation of Blood Cells

• Hemopoiesis- Blood making
• Lymphoid hemopoiesis occurs in widely distributed
  lymphoid tissues (thymus, tonsils, lymph nodes,
  spleen peyers patches in intestines)
• red bone marrow produces RBCs, WBCs and platelets
• SEQUENCE
• 1.) Stem cells
• 2.) Committed cells
• 3.) Precursor Cells
• 4.) Final blood cells

12
Hemopoiesis
13
Hypoxia An important concept

• Cellular oxygen deficiency is hypoxia (hypo
  under, ox oxygen)
• Ischemia is a from of hypoxia due to obstruction
  of blood flow (as by the narrowing of arteries by
  spasm or disease)
• This can cause cell death (necrosis)
• Occurs in many situations
• High altitude
• Anemia
• Iron or B12 deficiency resulting in anemia
• Circulatory problems

14
Erythrocyte Homeostasis

• Classic negative feedback control
• drop in RBC count causes hypoxemia to kidneys
• stimulation of bone marrow
• RBC count ? in 3-4 days
• Stimulus for erythropoiesis
• Hypoxia is a stimulus for blood production such
  as
• low levels of atmospheric O2 (high altitude)
• increase in exercise
• Circulatory problems
• Anemia from Iron or B12 deficiency

15
Erythropoiesis Making RBCs
16
Lab Test for RBC creation

• Reticulocyte count (Tic) measures the rate of
  erythropoiesis and so can give an indication of
  RBC creation.
• Normal avg. 1 --- because about 1 of RBCs are
  replaced in a day therefore about 1 of the blood
  is reticulocytes
• Low tic count red bone marrow not working.
  Cause nutritional deficiency or leukemia
• High tic count usually good sign, response to
  iron therapy

17
Red Blood Cells (RBCs)

• RBCs are called erythrocytes (red, cells)
• Oxygen-carrying cells
• Contains oxygen-carrying protein called
  hemoglobin
• Anatomy- 7.5 microns, biconcave disc- can get
  into small places
• large surface area helps diffusion of gases
• No nucleus or organelles so ample space for
  oxygen
• Gets energy anaerobically
• So it doesnt need the oxygen that its carrying

18
Erythrocytes on a Needle
19
Leukocyte Production (Leukopoiesis)

• Some lymphocytes leave bone marrow unfinished
• go to thymus to complete their development (T
  cells)
• Circulating WBCs do not stay in bloodstream
• granulocytes leave in 8 hours
• monocytes leave and transform into macrophages
• WBCs provide long-term immunity lasting decades

20
Platelet Production

• Cells called megakaryocyte create platelets
• Cytoplasm of the cell splits off creating cell
  fragments that enter the bloodstream as platelets
  (live for 10 days)
• some stored in spleen released as needed
• Platelets are important for _________

21
Erythrocytes and Hemoglobin Tests

• RBC count hemoglobin concentration indicate the
  amount of oxygen the blood can carry
• hemoglobin concentration of whole blood
• men avg. 15 women avg. 14
• RBC count
• men 5.5 million avg. women 5 million avg.

22
Erythrocyte Death Disposal

• RBCs live for 120 days
• membrane fragility -- lysis in narrow channels in
  the spleen through a process called ____________
• Macrophages in spleen
• remove iron from heme
• convert heme to bilirubin (yellow pigment)
• Why cant RBCs repair themselves?
• Bilirubin is converted to urobilogen in the
  intestine by bacteria giving fecal matter its
  brown color

23
Anemia

• Causes of anemia
• Decreased RBCs or hemoglobin
• inadequate dietary vitamin B12
• Or lack of intrinsic factor in the stomach
  (pernicious anemia)
• iron-deficiency anemia
• If in males and post-menopausal females check for
  hemorrhage
• aplastic anemia can be drug induced marrow
  destruction
• Anemia (normocytic) causes ABCDAcute blood
  lossBone marrow failureChronic dietary
  deficiencyDestruction (hemolysis)

24
Anemia

• Effects of anemia
• FATigue
• Heart races
• Edema
• Low blood pressure
• Pallor
• Shortness of breath
• (Fat HELPS)

25
Sickle-Cell Disease

• Sickle-Cell is hereditary Hemoglobin defect of
  African Americans
• sickle-cell disease individual has shortened life
• cell stickiness causes agglutination and blocked
  vessels
• intense pain, kidney and heart failure,
  paralysis, and stroke
• Sickle cell Disease-codominant genetic disorder,
  resistant to malaria. Why?
• Because sickle cells hemoglobin is indigestible
  to malaria parasites

26
Sickle-Cell Diseased Erythrocyte
27
Blood Types

• The surface of RBCs contain genetically
  determined antigens (antibody generator) these
  determine the blood types
• Major blood types are ABO and Rh
• ABO blood group are based on people that have
  blood antigens A or B
• If you have A antigen on your RBCs you are type
  A, if you have B antigens you are type B, and
  type AB has both antigens but if you dont have
  any A or B antigens you are type O.
• Remember This applies to incoming blood

28
Blood Type Diet Theory

• Type O is said to be the Original blood type, no
  antigens. These were the hunters. Diet is meat
  based. Native Americans are 79 type Os.
• Type A is the Agrarian blood type. These are the
  farmers. Diet is vegetarian.
• Blood type demo http//www.svgs.k12.va.us/Outreac
  h/Activities/aborh/Flash/ABORhbloodtyping.swf

29
ABO Blood Typing

• Agglutination is the term for blood clumping
• For example type A has agglutination on the left
  which tells us this blood reacted with anti-A
• Type AB has agglutination to both ____ and ______

30
Blood Swapping

• Type AB- universal ABceptor, person can be
  infused with any type of blood
• Type O- universal dOnor, can give their blood to
  anyone
• Caveat Remember that blood contains other
  antigens and antibodies than ABO, so specific
  typing should always be done to avoid
  Agglutination (clumping)
• Agglutination is massive clumping which is
  distinct from normal clotting (like from a cut)

31
The Rh Group

• Rh or D agglutinogens discovered in Rhesus monkey
  
• If you have the Rh antigen you are Rh
• If you dont have the Rh antigen you are Rh-
• Anti-D agglutinins are not normally present in
  blood
• formed only in individuals exposed to Rh blood
• Rh- pregnant woman carrying an Rh fetus
• no problems result with the first pregnancy
• hemolytic disease of the newborn
  (erythroblastosis fetalis) occurs if mother has
  formed antibodies is pregnant with 2nd Rh
  child
• RhoGAM is given to pregnant woman to prevent
  antibody formation and prevent any future
  problems
• Relate disease Peanut butter should be avoided
  in ____ peanut butter cup syndrome

32
Hemolytic Disease of Newborn

• Mothers antibodies attack fetal blood causing
  toxic brain syndrome from excessive bilirubin in
  blood from hemolysis
• treatment is phototherapy to degrade bilirubin or
  complete exchange transfusion to replace all the
  infants blood

33
White Blood Cells (WBCs)WBC are also called
Leukocytes (leuko white, cyte old cell)-Have
nucleus but no hemoglobin________________________
_____________

• AGRANULAR
• Lymphocytes
• Monocytes

• GRANULAR
• Neutrophils
• Eosinophils
• Basophiles

34
Granular Leukocyte (WBCs)

• Granulocytes- when stained these show granules
  under the microscope
• basophils non-abundant, dark violet granules
  (lt1)
• large U- to S-shaped nucleus hidden by granules
• eosinophils - pink-orange granules bilobed
  nucleus (2-4)
• neutrophils - multilobed nucleus (60-70)
• fine reddish to violet granules in cytoplasm
• Older neutrophils are called polymorphonuclear
  (PMN) leukocytes or POLYS
• BEN

35
Granulocyte Functions

• Neutrophils (? in bacterial infections)
• phagocytosis of bacteria
• releases antimicrobial chemicals
• Eosinophils (? in parasitic infections or
  allergies)
• phagocytosis of antigen-antibody complexes,
  allergens inflammatory chemicals
• release enzymes destroy parasites such as worms
• Basophils (? in chicken pox, sinusitis, diabetes)
• secrete histamine (vasodilator)
• secrete heparin (anticoagulant)

36
Agranular Leukocyte (WBCs)

• These cells do contain granules but do not stain
  and are small
• Monocytes- the cops of the body
• The blood is a transport system (cop car) for
  monocytes as they fight infection in tissues
• They go into tissue and become macrophages
  (macro big, phage eater)
• Lymphocytes- cytoplasm stains and forms a blue
  rim around the cell
• B cells, T cells and Killer cells

37
Agranulocyte Functions

• Lymphocytes (? in diverse infections immune
  responses)
• destroy cancer foreign cells virally infected
  cells
• coordinate actions of other immune cells
• secrete antibodies provide immune memory
• Monocytes (? in viral infections inflammation)
• differentiate into macrophages
• phagocytize pathogens and debris

38
LYMPHOCYTES

• Major types are B cells, T cells, and natural
  killer cells which are major warriors in the
  immune response
• B cells- from Bone marrow
• Good at destroying Bacteria
• T cells- Formed in bone marrow but matures in the
  Thymus gland
• Good at attacking virus, fungi, cancer cells and
  Transplanted organs
• Killer cells- kill microbes and tumor cells

39
Increased and Decreased WBCs

• INCREASED
• Neutrophils- bacteria
• Lymphocytes- virus
• Monocytes-virus, fungus
• Eosinophils-allergy, parasites
• Basophils- allergy, cancer

• DECREASED
• Neutrophils- radiation, drugs, nutrition
  deficiency
• Lymphocytes- chronic illness
• Monocytes-bone marrow depression
• Eosinophils-drugs, stress
• Basophils- pregnancy, stress

40
WBC Pathology

• Leukocytosis- increased WBCs
• usually normal
• Due to stresses such as microbes and strenuous
  exercise
• Leukopenia- decreased WBCs
• Abnormal
• due to shock or drug reactions or disease

41
WBC pathology- Leukemia

• Leukemia cancer of hemopoietic tissue
• Uncontrolled WBC production
• Subject to opportunistic infection, anemia
• Acute Leukemia- immature WBC
• Chronic Leukemia- too many WBCs
• Remission (disappearing) and exacerbation
  (occurrence) common

42
Normal and Leukemia Blood Smears

• Normal blood ratio 700 RBCs to 1 WBC

43
The Action of WBCs

• WBCs leave the bloodstream by emigration
• Phagocytosis- the process of the WBC eating an
  invader, a bacteria
• Chemotaxis- the process of attracting phagocytes,
  caused by toxins that are produced by microbes
  destroying tissue
• Lysozymes- enzymes that the phagocytes use to
  destroy bacteria
• A Differential WBC count (Diff) is counting of
  the different WBC, determining the percentage of
  each type of WBC helps in the diagnosis

44
Of Thrombosis and Embolism

• Unwanted coagulation
• Thrombosis the formation of a clot of blood
  within a blood vessel
• Thrombosis can create a thrombus
• Thrombus a clot of blood formed within a blood
  vessel and remaining attached to its place of
  origin
• most likely to occur in leg veins of inactive
  people
• the thrombus may break off causing an embolus
• An embolus is an abnormal particle circulating in
  the blood
• An embolus could travel from veins to lungs
  producing pulmonary embolism
• death from hypoxia may occur

45
Necrosis

• Necrosis Tissue death
• Infarct an area of necrosis in a tissue or
  organ resulting from obstruction of the local
  circulation
• Infarction is the process of forming an infarct
• may occur if an embolus or thrombus blocks blood
  supply to an organ (MI or stroke)
• 650,000 Americans die annually of thromboembolism

46
COAGULATION (BLOOD COTTING) Blood has the
ability to clot together.
This is good and bad, depending.

• BAD
• Thrombosis- blood clotting in vessels forming
  BLOOD CLOTS
• Embolism- a blood clot, or air bubble or fat,
  that blocks a vessel causing Ischemia
• Hemorrhage- blood loss. Can be from drugs like
  Celebrex, anticoagulants, or vessel tear

• GOOD
• Hemostatis- the process of stopping the bleeding
  process

47
Anticoagulant Drugs

• Warfarin or Coumadin (rat poison) may be given to
  people who have a tendency to produce blood
  clots, like in atrial fibrillation
• Their blood must be monitored for possible
  hemorrhage
• These drugs are antagonists to vitamin K
• Streptokinase- produced from streptococcal
  bacteria is a thrombolytic agent, it dissolves
  blood clots both good and bad. Used in stroke
  patients.

48
Hemophilia

• Genetic lack of any clotting factor affecting the
  patients blood coagulation
• Sex-linked recessive in males (inherit from
  mother)
• Physical exertion causes bleeding excruciating
  pain

49
Hemostasis - The Control of Bleeding

• Platelet plug is formed by pseudopods that adhere
  to the vessels and contract drawing the vessel
  together
• Fibrin, a sticky protein, comes from the plasma
  to trap blood cells

50
Formed Elements of Blood

• Never Let Monkeys Eat Bananas- quantities of WBCs

51
Nutritional Needs for Erythropoiesis

• B12 folic acid (for rapid cell division) and
  vitamin C copper synthesizing RBCs
• Iron is key nutritional requirement for
  erythropoiesis
• lost daily through urine, feces, and bleeding
• low absorption rate requires consumption of 5-20
  mg/day
• Maintain supplement for six months to replace
  liver storage
• dietary iron in 2 forms ferric (Fe3) ferrous
  (Fe2)
• ferrous is the form of iron used by the body (For
  US two)
• stomach acid converts Fe3 to absorbable Fe2

52
Iron Blood Tests

• Transferrin blood test determines how much iron
  is bound to the protein that carries iron in the
  blood (Trans-port)
• Serum ferritin test shows the level of iron in
  the liver (FerritIN the liver)

53
CBC Blood Test

• Complete Blood Count (CBC) is a composite of
  blood tests that measures certain components of
  the blood.
• RBCs, WBCs and platelets are counted
• ______ the total blood volume of RBCs is
  measured
• A diff (differential of WBCs) is included
• Hemoglobin content is included- which measures
  the amount of the oxygen carrying protein found
  in the RBCs