Human Physiology: Body Water and Blood Volume
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Questions and Answers

What is the first step in the intrinsic pathway of blood coagulation?

  • Activation of factor XI
  • Formation of the IXa-VIIIa complex
  • Conversion of fibrinogen to fibrin monomers
  • Activation of factor XII to factor XIIa (correct)

Which factor is directly activated by tissue phospholipid (TPL) in the extrinsic pathway?

  • Factor X
  • Factor IX
  • Factor VII (correct)
  • Factor XI

What role does thrombin play in the common pathway of blood coagulation?

  • Releases thromboplastin
  • Converts fibrinogen to fibrin (correct)
  • Activates factor VII
  • Activates factor X

In the intrinsic pathway, which factor complex is essential for the activation of factor X?

<p>The IXa-VIIIa complex (D)</p> Signup and view all the answers

What initiates blood clotting in response to vascular injury?

<p>Release of thromboplastin (A)</p> Signup and view all the answers

Which condition is characterized by a decrease in RBC mass and normal MCH and MCV values?

<p>Normocytic normochromic anemia (B)</p> Signup and view all the answers

Which of the following is NOT a manifestation of aplastic anemia?

<p>Jaundice (A)</p> Signup and view all the answers

What is a common cause for the extrinsic form of hemolytic anemia?

<p>Incompatible blood transfusion (A)</p> Signup and view all the answers

Which type of anemia is associated with severe pain due to the occlusion of blood vessels?

<p>Sickle cell anemia (C)</p> Signup and view all the answers

What management strategy is effective in treating aplastic anemia?

<p>Bone marrow transplantation (A)</p> Signup and view all the answers

Which of the following conditions is characterized by premature destruction of red blood cells?

<p>Hemolytic anemia (C)</p> Signup and view all the answers

Which of the following conditions leads to a decreased production of blood cells due to bone marrow failure?

<p>Aplastic anemia (C)</p> Signup and view all the answers

In G6PD deficiency, which factor primarily triggers acute hemolysis?

<p>Oxidizing agents (C)</p> Signup and view all the answers

What is the primary function of ADP in platelet activation?

<p>Promoting the aggregation and fusion of platelets (A)</p> Signup and view all the answers

Which group of coagulation factors is activated by thrombin?

<p>Fibrinogen group (C)</p> Signup and view all the answers

What role does platelet factor 3 play during platelet pro-coagulant activity?

<p>It provides a surface for coagulation factor activation (B)</p> Signup and view all the answers

What triggers the intrinsic pathway of coagulation?

<p>Exposure to subendothelial collagen (D)</p> Signup and view all the answers

Which substance is released from dense granules to enhance platelet activation?

<p>Calcium (C)</p> Signup and view all the answers

What initiates the platelet release reaction?

<p>High concentration of thrombin (A)</p> Signup and view all the answers

Which statement about the fusion of aggregated platelets is correct?

<p>Irreversible fusion is triggered by ADP and thrombin (D)</p> Signup and view all the answers

What is the main mechanism by which fibrin threads stabilize a blood clot?

<p>By entrapping red blood cells and platelets (C)</p> Signup and view all the answers

What is the primary role of albumin among plasma proteins?

<p>Regulation of osmotic pressure (D)</p> Signup and view all the answers

Which of the following constituents accounts for the majority of plasma volume?

<p>Water (C)</p> Signup and view all the answers

What could cause a decrease in the Albumin-Globulin Ratio (A/G Ratio)?

<p>Liver cirrhosis (D)</p> Signup and view all the answers

What is the composition of serum after blood is allowed to clot?

<p>Plasma minus clotting factors (B)</p> Signup and view all the answers

Which plasma component supports the transport of lipids in the bloodstream?

<p>Plasma proteins (C)</p> Signup and view all the answers

What is the combined contribution of red blood cells (RBCs) and platelets to total blood volume?

<p>44% (D)</p> Signup and view all the answers

Which substance is primarily responsible for maintaining the blood's osmotic pressure?

<p>Albumin (C)</p> Signup and view all the answers

What is the normal plasma volume range in milliliters?

<p>3000-3500 ml (A)</p> Signup and view all the answers

What is the average lifespan of erythrocytes?

<p>120 days (B)</p> Signup and view all the answers

Which form of hemoglobin has a higher affinity for oxygen?

<p>HbF (C)</p> Signup and view all the answers

What is the primary cause of hereditary methemoglobinemia?

<p>Deficiency of NADH-met-Hb reductase (C)</p> Signup and view all the answers

Which statement about the function of the hemoglobin is correct?

<p>It has a buffering function 12 times that of plasma proteins. (D)</p> Signup and view all the answers

What happens to the heme component of hemoglobin after erythrocytes rupture?

<p>It is converted to iron and bilirubin. (D)</p> Signup and view all the answers

What is the effect of hemoglobin being present in the plasma?

<p>It leads to renal tubule blockage. (B)</p> Signup and view all the answers

What are the normal hematocrit values for adult males and females, respectively?

<p>46% and 42% (C)</p> Signup and view all the answers

Where does erythropoiesis primarily occur in the fetus?

<p>Liver and spleen (B)</p> Signup and view all the answers

What is the primary function of folic acid in the body?

<p>It is crucial for DNA synthesis. (D)</p> Signup and view all the answers

What is the relationship between vitamin B12 and cobalt?

<p>Cobalt acts as a stimulator of erythropoietin secretion and is part of vitamin B12. (A)</p> Signup and view all the answers

How does a deficiency in folic acid directly affect red blood cells?

<p>It results in macrocytic anemia due to impaired DNA synthesis. (D)</p> Signup and view all the answers

Which of the following best defines anemia?

<p>A decrease in the oxygen-carrying capacity of the blood. (B)</p> Signup and view all the answers

What is the formula for calculating Mean Corpuscular Hemoglobin (MCH)?

<p>MCH = Hb content / RBC count x 10 (D)</p> Signup and view all the answers

Which condition indicates a hypochromic status in red blood cells?

<p>MCH less than 25 picograms. (B)</p> Signup and view all the answers

What are common symptoms associated with anemia?

<p>Shortness of breath and fatigue. (A)</p> Signup and view all the answers

Which demographic is most affected by anemia globally?

<p>Preschool-age children. (C)</p> Signup and view all the answers

Flashcards

Blood Plasma Composition

Blood plasma comprises 55% of total blood volume, consisting of water, electrolytes, proteins, nutrients, wastes, and gases.

Plasma vs. Serum

Serum is plasma without clotting factors removed during clot formation.

Plasma Protein Function

Plasma proteins are crucial for osmotic balance and various blood functions via maintaining colloidal osmotic pressure and participating in metabolic processes.

Albumin-Globulin Ratio (A/G)

The ratio of albumin to globulin concentrations in plasma, a crucial diagnostic marker for various health conditions.

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Liver's Role in Plasma Proteins

The liver primarily synthesizes albumin, fibrinogen, and about 50% of globulins.

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Plasma Water Content

About 90% of plasma's volume is water, crucial for its transport and regulatory functions.

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Plasma Main Constituents

Plasma consists of water, electrolytes (like sodium and chloride), proteins (including albumin and globulins), nutrients, wastes and gases.

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Plasma Osmotic Pressure

Plasma proteins mainly contribute to ~25-28 mmHg (colloidal osmotic pressure), with most osmotic pressure being from other constituents.

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Fetal Hemoglobin (HbF)

A type of hemoglobin with a higher affinity for oxygen than adult hemoglobin (HbA).

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Hemoglobin Levels (Adults)

Adult males typically have 15-16 gm/dL hemoglobin, while females have 13-14 gm/dL. Newborns have higher levels.

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Hematocrit

Percentage of red blood cells (RBCs) in total blood volume.

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Hemoglobin Functions

Hemoglobin transports oxygen and carbon dioxide, and acts as a buffer in the blood.

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Methemoglobinemia

A condition where iron in hemoglobin is oxidized to a form that cannot carry oxygen.

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Erythrocyte Life Span

Average lifespan of a red blood cell is 120 days.

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Spleen's role in RBCs

The spleen filters and removes old or damaged red blood cells, and stores blood.

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Erythropoiesis

Process of red blood cell production.

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C- Normocytic Normochromic Anemia

Anemia where the number of red blood cells and hemoglobin content decrease, but mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) remain within normal range.

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Anemia of Chronic Disease

Anemia resulting from ongoing inflammatory conditions, kidney disease, autoimmune disorders, or cancer.

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Hemolytic Anemia

A condition characterized by the premature destruction of red blood cells due to intrinsic or extrinsic disorders.

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G6PD Deficiency

An inherited X-linked recessive disorder causing reduced glucose-6-phosphate dehydrogenase (G6PD) enzyme, leading to red blood cell breakdown.

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Sickle Cell Anemia

A hereditary disease where hemoglobin is abnormal, causing red blood cells to become rigid and sickle-shaped, leading to blockages and pain.

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Aplastic Anemia

A bone marrow failure disorder where the bone marrow stops producing enough of all blood cell types.

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Manifestations of Anemia

Symptoms due to reduced oxygen-carrying capacity of the blood.

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Venesection (blood removal)

A medical procedure to remove a specific volume of blood from a patient.

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Vitamin B12 Absorption

Vitamin B12 absorption requires intrinsic factor for cellular entry through pinocytosis, then released and transported in the blood by transcobalamine II.

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Folic Acid Sources

Folic acid is found in green vegetables, some fruits, liver, and meat, but it's easily destroyed by cooking.

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Folic Acid Importance

Essential for DNA synthesis, crucial for red blood cell division and development.

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Folic Acid Deficiency Cause

Can result from dietary deficiencies, gastrointestinal issues affecting absorption, or antifolate drug use (e.g., methotrexate).

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MCH (Mean Corpuscular Hemoglobin)

Amount of hemoglobin in a single red blood cell (RBC).

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MCV (Mean Corpuscular Volume)

Volume of a single red blood cell (RBC).

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MCHC (Mean Corpuscular Hemoglobin Concentration)

Measure of hemoglobin in 100 ml of packed red blood cells (RBCs).

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Anemia Definition

Reduced oxygen-carrying capacity of blood, either from fewer red blood cells or less hemoglobin per cell.

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In Vitro Factor XII Activation

In a laboratory setting, the inactive form of factor XII (factor XII) is transformed into its active form, factor XIIa.

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Platelet activation

Platelets change shape, swell, and release granule contents in response to intracellular signals, enhanced by ADP and thrombin.

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Platelet Release Reaction

A calcium-dependent process where platelets release ADP, serotonin, and calcium to further activate and aggregate more platelets.

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Extrinsic Pathway Trigger

Tissue injury (vascular or extravascular) initiates the extrinsic clotting pathway by releasing thromboplastin.

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Platelet Aggregation

Platelets bind together at an injury site, forming a plug, through the release of ADP and thromboxane A2, a self-propagating process.

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Intrinsic Pathway Initiation

The intrinsic pathway involves a cascade of activation steps within the blood, starting with damaged blood vessels.

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Platelet Pro-coagulant Activity

Platelets expose membrane phospholipids, creating a surface for coagulation factor activation.

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Common Pathway: Fibrin Formation

Thrombin converts fibrinogen into fibrin, forming a loose mesh that later hardens to create a clot.

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Coagulation factors

Plasma proteins (mainly beta-globulins) synthesized by the liver, inactive enzymes that activate each other in a cascade.

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Factor XIII Role in Clotting

Factor XIII, activated by thrombin, stabilizes the fibrin mesh, converting it from a loose to a strong clot.

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Intrinsic pathway (coagulation)

Clotting pathway initiated by contact with subendothelial collagen or in vitro conditions, involving a cascade of reactions.

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Fibrinogen group (coagulation factors)

Coagulation factors that are activated by thrombin, including fibrinogen itself, along with factors V, VIII, and XIII.

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Prothrombin group (coagulation factors)

Coagulation factors that need vitamin K for synthesis in the liver, including prothrombin (factor II), factor VII, IX, and X.

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Study Notes

Blood

  • Total body water (TBW) is 60% of body weight in adult males, 75% in infants, and less than 60% in adult females and obese individuals.

  • Total blood volume is about 8% of body weight.

Distribution of Body Water

  • Intracellular fluid (ICF) is water inside cells (2/3 TBW, 40% body weight).

  • Extracellular fluid (ECF) is water outside cells (1/3 TBW, 20% body weight).

    • Intravascular fluid (IVF) is 5% in blood vessels (plasma).

    • Interstitial fluid (ISF) is 15% outside the vessels, between cells.

  • Main cations in ICF include potassium (K).

  • Main cations in ECF include sodium (Na), calcium (Ca), and chloride (Cl).

  • Main anions in ECF include protein, phosphate (PO4), and bicarbonate (HCO3).

Measurement of Water Volumes

  • Fick's principle is used to determine compartment volumes by measuring the amount of indicator injected and its concentration in plasma.

  • Indicators used include heavy water (Dâ‚‚O), inulin, and Evan's blue.

    • TBW volume uses heavy water (Dâ‚‚O).

    • ECF volume uses inulin.

    • Plasma volume uses Evan's blue.

    • ICF volume cannot be directly determined (calculated by TBW - ECF).

    • ISF volume cannot be directly determined (calculated by ECF - plasma).

Homeostasis

  • Homeostasis is maintaining a stable internal environment despite external or internal changes.

  • The internal environment is the interstitial fluid.

  • Most body functions work to maintain homeostasis.

Blood Functions

  • Transport function carries oxygen, nutrients, hormones, waste products etc throughout the body.

  • Defensive function protects the body from infection and disease through immune responses.

  • Hemostatic function involves stopping bleeding through clot formation.

  • Homeostatic function maintains fluid balance and pH levels.

Blood Composition

  • Plasma accounts for about 55% of total blood volume.

  • Cellular elements account for about 45%, including red blood cells (RBCs), white blood cells (WBCs), and platelets.

Plasma Constituents

  • Water accounts for 90% of plasma volume. The main cation is sodium (Na).
  • Main anions include chloride (Cl) and bicarbonate (HCO3).
  • Plasma proteins have a role in osmotic balance and other functions.

Differences in Plasma and Serum

  • Serum is plasma minus clotting factors.

Plasma Protein Ratio

  • Albumin-globulin ratio (A/G Ratio) is between 1.2-1.6. This ratio changes based on the specific health condition.

    • Liver diseases result in a decreased ratio (decreased albumin synthesis).
    • Renal diseases result in an increased ratio (increased albumin loss in urine).
    • Infections result in an increased ratio (increased globulin production).

Plasma Protein Functions

  • Osmotic function, maintains osmotic pressure.

  • Buffering function, acts as buffer in blood.

  • Defensive function via immunoglobulins (gamma globulins).

  • Blood clotting involving fibrinogen and prothrombin.

  • Blood viscosity mediated by RBCs and plasma proteins. Viscosity is important for maintaining normal arterial blood pressure.

  • Capillary function by limiting their permeability.

  • Transport of hormones, vitamins, etc; and prevents their rapid loss in urine

Red Blood Corpuscles (RBCs)

  • RBC shape is circular and biconcave.

  • RBCs are non-nucleated.

  • RBC contains hemoglobin, the oxygen-carrying protein.

  • Hemoglobin constitutes about 34% of RBCs weight and has two main forms, HbA (adult) and HbF (fetal).

  • Normal Hemoglobin values vary based on gender and age.

  • Functions of RBCs include oxygen and carbon dioxide transport. Buffering capacity and maintaining blood viscosity.

Hemoglobin Reactions

  • Hemoglobin combines with oxygen, carbon dioxide, and carbon monoxide to accomplish gas transport.

Life Span of RBC

  • The average lifespan of a RBC is 120 days.

Role of the Spleen

  • Spleen filters blood (removing aged and abnormal cells).
  • Blood storage function

Erythropoiesis

  • Erythropoiesis is the formation of new red blood cells. The process occurs in bone marrow.
  • Factors affecting erythropoiesis include oxygen supply to tissue and erythropoietin hormone.

Hypoxia and Erythropoietin

  • Hypoxic conditions stimulate erythropoietin production.

  • Erythropoietin is produced mainly by the kidneys, and in lesser amounts by the liver.

  • Erythropoietin activates the processes involved in creating new RBC production, mitosis and inhibits apoptosis,

Iron Requirements and Balance

  • About 30 mg of iron needed daily for hemoglobin synthesis.
  • Iron is mostly recycled from aged RBCs (macrophages) in liver and spleen.
  • Dietary iron absorption occurs in the duodenum
  • Heme iron from animal sources is readily absorbed while non heme iron from plant sources is not as easily absorbed.
  • Dietary factors influence iron absorption

Iron Absorption

  • Absorbed iron is transported by transferrin to bone marrow/liver/muscle cells.

  • Iron is absorbed in duodenum.

  • Dietary factors that regulate iron absorption:

    • High levels of dietary iron reduce the amount of iron absorbed.
    • Hepcidin, a liver-produced hormone, promotes iron storage and reduces iron absorption in the intestines.

Blood Coagulation

  • Coagulation factors(plasma proteins) are involved in forming a blood clot.

  • Coagulation factors are grouped into different contact/fibrinogen/and prothrombin groups.

  • Active factors in coagulation form a cascading chain/cascade reaction; this involves clotting factors that activate each other in sequential activation until a stable fibrin clot forms.

  • Intrinsic pathway will be activated when blood is exposed to a wettable surface (in vitro), or if a subendothelial collagen becomes exposed (in vivo).

  • Extrinsic pathway will occur in a situation when tissues are exposed to blood.

  • Clotting factors are activated to form a fibrin clot at the site of injury, thereby entrapping RBCs, platelets, and plasma in the clot.

  • The extrinsic system reacts faster than the intrinsic system.

  • Platelets work to initiate vasoconstriction to slow down blood flow, which is critical for effective clot formation.

  • Thromboxane A2, ADP, serotonin, and other factors facilitate platelet aggregation to form the temporary hemostatic plug that stops bleeding.

  • Blood loss and damage to blood vessels initiate a cascade of reactions to form a clot to stop the bleeding, and to prevent blood loss.

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This quiz explores the concepts of total body water distribution, blood volume, and the measurement of water volumes in the human body. Understand the differences between intracellular and extracellular fluids, and how various indicators are used in these measurements. Perfect for students of human physiology and related fields.

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