Blood Chapter 17 PDF

Visual Anatomy & Physiology Third Edition Chapter 17 Blood Copyright © 2018 Pearson Education, Inc. All Rights Reserved Section 1: Plasma and Formed Elements Learning Outcomes 17.1 List the compo...

Visual Anatomy & Physiology Third Edition Chapter 17 Blood Copyright © 2018 Pearson Education, Inc. All Rights Reserved Section 1: Plasma and Formed Elements Learning Outcomes 17.1 List the components of the cardiovascular system, and describe several important functions of blood. 17.2 Describe the important components and major properties of blood. 17.3 Explain the origins and differentiation of the formed elements. Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.1: Blood is the Fluid Portion of the Cardiovascular System Cardiovascular system consists of heart, blood vessels, blood 1. H​ eart—pumps blood; maintains blood pressure 2. ​Blood vessels ▪ Arteries carry blood away from heart ▪ Capillaries permit exchange between blood and interstitial fluids ▪ Veins return blood to heart Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.1: Blood Functions (1 of 3) Functions of blood – Transport dissolved gases, nutrients, hormones, and metabolic wastes ▪ Oxygen—lungs to peripheral tissues ▪ Carbon dioxide—tissues to lungs ▪ Nutrients—from digestive tract or storage in adipose or liver ▪ Hormones—gland to target ▪ Wastes—to kidneys (excretion) Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.1: Blood Functions (2 of 3) Functions of blood (continued) – Regulate pH and ion composition of interstitial fluids (I F) ▪ Absorbs/neutralizes acids ▪ Diffusion between blood and IF balances ion concentrations – Restrict fluid loss at injury sites ▪ Enzymes/other substances initiate clotting when vessel wall is broken; clot = temporary patch – Defend against toxins and pathogens ▪ Transports white blood cells and antibodies to fight infection Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.1: Blood Functions (3 of 3) Functions of blood (continued) – Stabilize body temperature ▪ Absorbs heat generated in one area; distributes to other tissues ▪ High body temperature—blood directed closer to skin ▪ Low body temperature—blood directed to brain, internal organs Copyright © 2018 Pearson Education, Inc. All Rights Reserved Functions of Blood Transport dissolved gases, nutrients, hormones, and metabolic wastes Regulate the pH and ion composition of interstitial fluids Restrict fluid losses at injury sites Defend against toxins and pathogens Stabilize body temperature Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.1: Review A. Identify the components of the cardiovascular system. B. What are the functions of blood? Learning Outcome: List the components of the cardiovascular system, and describe several important functions of blood. Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.2: Blood is a Fluid Connective Tissue Containing Plasma and Formed Elements – Blood = fluid connective tissue – Whole blood = blood with all components ▪ Plasma = liquid matrix ▪ Formed elements = cells and cell fragments ▪ 5–6 liters (5.3–6.4 quarts) blood in males ▪ 4–5 liters (4.2–5.3 quarts) blood in females Copyright © 2018 Pearson Education, Inc. All Rights Reserved Properties of Whole Blood Blood temperature is about slightly above normal body temperature. Blood is five times as viscous as water—that is, five times as resistant to flow. Blood’s high viscosity results from interactions among dissolved proteins, formed elements, and water molecules in the plasma. Blood is slightly alkaline, with a pH between 7.35 and 7.45 (average: 7.4). Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.2: Blood composition (1 of 9) Plasma = 55 percent of the volume of whole blood – Similar to interstitial fluid (IF) constant exchange of water, ions, small solutes across capillary walls ▪ Primary differences – Respiratory gases (oxygen, carbon dioxide) – Dissolved proteins (plasma proteins cannot cross capillary walls) Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.2: Blood composition (2 of 9) Formed elements = blood cells/fragments; percent of whole blood – 99 percent of formed elements are red blood cells – Hematocrit (packed cell volume, P CV) ▪ Percentage of whole blood from formed elements ▪ Overall average 45 percent (range 37–54 percent) ▪ Males average 47 percent; females average 42 percent (androgens stimulate RBC production) Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.2: Blood composition (3 of 9) Plasma proteins – In solution – Each 100 m L has illi iter of protein – Large, globular shapes prevent leaving bloodstream – Liver synthesizes >90 percent of plasma proteins Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.2: Blood composition (4 of 9) Albumins percent of plasma proteins; for osmotic pressure Globulins percent of plasma proteins – Antibodies (immunoglobulins) attack foreign proteins, pathogens – Transport globulins bind ions, hormones, lipids, other compounds Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.2: Blood composition (5 of 9) Fibrinogen percent of plasma proteins – Blood clotting—form large insoluble fibrin strands – Plasma also contains active and inactive enzymes and hormones Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.2: Blood composition (6 of 9) Plasma solutes (water = 92 percent of plasma) – Electrolytes—essential for vital cellular activities ▪ Major ions: – Organic nutrients include lipids, carbohydrates, and amino acids ▪ Used for cell ATP production, growth, and maintenance Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.2: Blood composition (7 of 9) Plasma solutes (continued) – Organic wastes carried to sites of breakdown or excretion ▪ Examples: urea, uric acid, creatinine, bilirubin, Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.2: Blood composition (8 of 9) Formed elements – Platelets < 0.1 percent of formed elements ▪ Small membrane-bound cell fragments involved in clotting – White blood cells (WBCs, leukocytes) < 0.1 percent of formed elements ▪ Body defense; five classes, each with different functions Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.2: Blood composition (9 of 9) Formed elements (continued) – Red blood cells (RBCs, erythrocytes) = 99.9 percent of formed elements ▪ Oxygen transport Copyright © 2018 Pearson Education, Inc. All Rights Reserved Summary of the Composition of Whole Blood Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.2: Review A. Identify the two components making up whole blood, and list the composition of each. B. Define hematocrit. C. Which specific plasma proteins would you expect to be elevated during an infection? Learning Outcome: Describe the important components and major properties of blood. Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.3: Formed Elements are Produced by Stem Cells in Red Bone Marrow Development of formed elements = hemopoiesis/hematopoiesis – Occurs in red bone marrow Hemocytoblasts from hematopoietic stem cells (HSCs) – Produce two types of stem cells 1. Lymphoid stem cells produce lymphocytes (type of WBC) 2. ​Myeloid stem cells produce R BCs, other WBCs Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.3: Hemopoiesis (1 of 9) Two types of stem cells produced by hemocytoblasts ​ ymphoid stem cells produce 1. L lymphocytes (immune response) ▪ Originate in red bone marrow; some stay ▪ Others migrate to lymphoid tissues (thymus, spleen, lymph nodes) ​ yeloid stem cells give rise to 2. M all other formed elements Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.3: Hemopoiesis (2 of 9) Lymphoid stem cells to lymphocytes Colony-stimulating factors = hormones released by activated lymphocytes and other cells during immune response to stimulate blood cell formation Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.3: Hemopoiesis (3 of 9) Myeloid stem cells to immature blast cells – Myeloid stem cells differentiate into three types of progenitor cells that, in turn, differentiate into: 1. Monoblasts and myeloblasts 2. ​Megakaryocytes 3. Proerythroblasts Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.3: Hemopoiesis (4 of 9) Myeloid stem cells to monoblasts to monocytes – Monoblasts differentiate into promonocytes – Promonocytes differentiate into monocytes Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.3: Hemopoiesis (5 of 9) Myeloid stem cells to myeloblasts to W BCs – Myeloblasts differentiate into three types of myelocytes – Myelocytes differentiate into band cells – Band cells differentiate into neutrophils, eosinophils, basophils Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.3: Hemopoiesis (6 of 9) Myeloid stem cells to megakaryocytes to platelets – Myeloid stem cells differentiate into megakaryocytes ▪ Megakaryocytes are enormous cells with large nuclei ▪ Eventually shed cytoplasm in small, membrane-enclosed packets = platelets Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.3: Hemopoiesis (7 of 9) Myeloid stem cells to proerythroblasts to R BCs – Myeloid stem cells differentiate into proerythroblasts – Proerythroblasts differentiate to erythroblasts, which shed their nuclei, and then on to anucleate reticulocytes – Reticulocytes differentiate to erythrocytes (red blood cells/RBCs) Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.3: Hemopoiesis (8 of 9) Erythropoietin (EPO) – Released into plasma in response to low tissue oxygen levels = hypoxia (hypo, below + oxy, presence of oxygen) Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.3: Hemopoiesis (9 of 9) Erythropoietin (EPO) (continued) – Stimulus for EPO release: ▪ Anemia ▪ Reduced blood flow to kidneys ▪ content in lungs decreased from disease or high altitude ▪ Lung damage – Stimulates stem cells and developing RBCs in red bone marrow Copyright © 2018 Pearson Education, Inc. All Rights Reserved The Process of Hemopoiesis Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.3: Review A. Define hemocytoblasts. B. Describe platelets and their origin. C. Compare the types of cells that lymphoid stem cells and myeloid stem cells produce. Learning Outcome: Explain the origins and differentiation of the formed elements. Copyright © 2018 Pearson Education, Inc. All Rights Reserved Section 2: Structure and Function of Formed Elements (1 of 3) Learning Outcomes 17.4 Define hematology, describe the elements of a complete blood count (CBC), and give examples of red blood cell lab tests. 17.5 List the characteristics and functions of red blood cells, and describe the structure and functions of hemoglobin. 17.6 Describe how the components of aged or damaged red blood cells are recycled. Copyright © 2018 Pearson Education, Inc. All Rights Reserved Section 2: Structure and Function of Formed Elements (2 of 3) Learning Outcomes (continued) 17.7 Explain the importance of blood typing and the basis for ABO and Rh incompatibilities. 17.8 Clinical Module: Describe hemolytic disease of the newborn, explain the clinical significance of the cross- reaction between fetal and maternal blood types, and cite preventive measures. Copyright © 2018 Pearson Education, Inc. All Rights Reserved Section 2: Structure and Function of Formed Elements (3 of 3) Learning Outcomes (continued) 17.9 Categorize the various types of white blood cells on the basis of their structures and functions. 17.10 Discuss the mechanisms that control blood loss after an injury, and describe the reaction sequences responsible for blood clotting. 17.11 Clinical Module: Explain how blood disorders are detected, and describe examples of the various categories of blood disorders. Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.4: Hematology is the Study of Blood and Blood-forming Tissues Hematology – Important information about a person’s health – Can detect disorders (anemia, infection, clotting disorders) – Dyscrasias = blood disorders; can have systemic effects Reasons for performing blood tests – Determine blood type – Evaluate types/numbers of RBCs, WBCs, and platelets – Abnormal values may indicate underlying medical conditions Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.4: Hematology (1 of 3) Complete blood count (CBC) – Determines following in 1 cubic millimeter (1 microliter or ) of blood: ▪ RBC count ▪ WBC count ▪ Erythrocyte indices (hemoglobin) ▪ Hematocrit ▪ Others WBC differential count – Identifies numbers of each type of white blood cell Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.4: Hematology (2 of 3) Red blood cell tests – Several common tests – Assess number, size, shape, maturity of circulating R BCs – Can detect problems that lack obvious signs (internal bleeding) RBC Tests and Related Terminology Terms Associated with Terms Associated with Test Determines Abnormal Values Elevated Abnormal Values Depressed Hematocrit (Hct) Percentage of formed elements in Polycythemia Anemia whole blood Normal = 37–54% Hemoglobin Concentration of hemoglobin in Polycythemia Anemia Concentration (Hb, blood Normal = 12–18 g /d L rams eci iter Hgb) Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.4: Hematology (3 of 3) RBC Tests and Related Terminology [continued] Terms Associated with Terms Associated with Test Determines Abnormal Values Elevated Abnormal Values Depressed Mean Corpuscular Average weight of Hb in one R BC Hyperchromic Hypochromic Hemoglobin Normal = 27 to 34 micrograms per R B C Concentration (M CH) (normochromic) Mean Corpuscular Average volume of one RBC Macrocytic Microcytic Volume (MCV) Normal = 82 to 101 ­cubic meters per cell (normocytic) RBC Count Number of RBCs per per Liter of Erythrocytosis/polycythemia Anemia whole blood Normal = 4.2 to 6.3 million cells/ per Liter Reticulocyte Count Percentage of circulating Reticulocytosis Diminished erythropoiesis (Retic.) reticulocytes Normal = 0.8% Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.4: Review A. What is hematology? B. Describe a complete blood count (CBC). C. Which condition would a patient have if she had a depressed hematocrit level? Learning Outcome: Define hematology, describe the elements of a complete blood count (CBC), and give examples of red blood cell lab tests. Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.5: Red Blood Cells, the most Common Formed Elements, Contain Hemoglobin that Transports Respiratory Gases Red blood cells (RBCs) – Roughly one-third of all cells in the body – Single drop of whole blood contains million RBCs ▪ Average adult trillion RBCs = one-third of all cells in body Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.5: Red Blood Cells (1 of 6) – Red blood cell count (standard test) ▪ Number of RBCs per microliter or cubic millimeter of whole blood ▪ Adult males: 4.5–6.3 million ▪ Adult females: 4.2–5.5 million Copyright © 2018 Pearson Education, Inc. All Rights Reserved RBCs are Biconcave Discs—Thinner Centers, Thicker Edges Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.5: Red Blood Cells (2 of 6) Functional aspects of red blood cells – Large surface area–to–volume ratio ▪ Packed with hemoglobin (= protein that carries oxygen) ▪ Allows more oxygen exchange ▪ Total RBC surface area (adult) equals total surface area of body – Form stacks (rouleaux)—facilitate transport in small vessels – Flexible—RBCs can move through narrowest capillaries with diameters smaller than RBC Copyright © 2018 Pearson Education, Inc. All Rights Reserved Functional Aspects of Red Blood Cells Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.5: Red Blood Cells (3 of 6) Red blood cell characteristics – Lose most organelles during development – Mature RBCs lack nuclei (anucleate) and ribosomes ▪ Cannot divide/repair – Life span 1 billion oxygen molecules – percent of oxygen in blood is bound to Hb; rest is dissolved in plasma Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.5: Review A. Describe the functional aspects of RBCs. B. Describe hemoglobin. C. Compare oxyhemoglobin with deoxyhemoglobin. Learning Outcome: List the characteristics and functions of red blood cells, and describe the structure and functions of hemoglobin. Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.6: Red Blood Cells are Continually Produced … (1 of 2) – percent of circulating RBCs are replaced each day (short lifespan) – million new RBCs enter circulation each second – End of RBC life ▪ Plasma membrane ruptures (hemolysis) or ▪ RBC is engulfed by macrophages in spleen, liver, or bone marrow Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.6: Red Blood Cells are Continually Produced … (2 of 2) Erythropoiesis = red blood cell formation – Occurs only in red bone marrow, or myeloid tissue, in vertebrae, ribs, sternum, skull, scapulae, pelvis, and ends of limb bones – Fatty yellow bone marrow can convert to red bone marrow in cases of severe, sustained blood loss and make RBCs Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.6: RBC Production and Breakdown (1 of 6) – Erythroblasts begin producing Hb – Normoblasts lose their nuclei and become reticulocytes – Reticulotyes contain percent of the Hb of mature RBCs; enter bloodstream after 2 days Copyright © 2018 Pearson Education, Inc. All Rights Reserved Events Occurring in Macrophages Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.6: RBC Production and Breakdown (2 of 6) Events occurring in macrophages (continued) – Macrophages monitor condition of circulating RBCs ▪ Engulf old RBCs before rupture (hemolyze) ▪ Remove Hb molecules/cell fragments – Heme units stripped of iron ▪ Iron is stored in phagocyte or enters blood and binds to transferrin (plasma protein) ▪ – Globular proteins disassembled and amino acids recycled Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.6: RBC Production and Breakdown (3 of 6) Events occurring in macrophages (continued) – Hemoglobin that is not phagocytized breaks down into its protein chains and is excreted in urine – Breakdown of an abnormally large number of RBCs results in red or brown urine; condition is hemoglobinuria Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.6: RBC Production and Breakdown (4 of 6) Events occurring in the liver – Bilirubin is excreted in bile – Blocked bile ducts or inability to process bilirubin causes bilirubin levels to increase ▪ Bilirubin diffuses into peripheral tissues ▪ Causes yellow color in skin and eyes = jaundice Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.6: RBC Production and Breakdown (5 of 6) Events occurring in large intestine – Bacteria convert bilirubin to urobilins and stercobilins; they enter feces, giving it yellow- brown or brown color Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.6: RBC Production and Breakdown (6 of 6) Events occurring in kidneys – Excrete hemoglobin and urobilins—gives urine yellow color – Hematuria = presence of intact RBCs; occurs only after urinary tract damage Copyright © 2018 Pearson Education, Inc. All Rights Reserved Summary of the Production and Clearance of RBCs Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.6: Review A. In what way would a liver disease affect the level of bilirubin in the blood? Learning Outcome: Describe how the components of aged or damaged red blood cells are recycled. Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.7: Blood Type is Determined by the Presence or Absence of Specific Surface Antigens on RBCs Blood types – Antigens = substances that can elicit immune response – Our cells have surface antigens embedded in their plasma membranes; recognized as normal, or self, by immune system Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.7: Blood Type (1 of 7) Blood types (continued) – Blood type determined genetically by which surface antigens are present in RBC plasma membranes ▪ >50 blood cell surface antigens ▪ Three most important: –A –B – Rh (or D) Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.7: Blood Type (2 of 7) ABO blood group – Based on the presence or absence of A and B surface antigens (or agglutinogens) – Plasma has antibodies that will attack “foreign” surface antigen(s) – Four ABO blood types Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.7: Blood Type (3 of 7) Agglutination = clumping together of RBCs – Occurs when surface antigens (agglutinogens) are exposed to corresponding antibodies (agglutinins) from another blood type ▪ Example: Giving type A blood to someone who is type B Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.7: Blood Type (4 of 7) Agglutination (continued) – Called a cross-reaction ▪ Forms dangerous clumps/fragments of R BCs; can block small blood vessels—cuts blood supply, damages/destroys tissues – Cells may undergo hemolysis Copyright © 2018 Pearson Education, Inc. All Rights Reserved Module 17.7: Blood Type (5 of 7) Rh blood group – Based on presence or absence of Rh surface antigen on R BCs – “Rh” comes from original discovery in Rhesus monkeys – Rh positive has Rh surface antigen ▪ Indicates presence of Rh surface antigen – Rh negative lacks Rh surface antigen – Included in full blood type as ▪ Examples: O negative AB positive Copyright © 2018 Pearson Education, Inc. All Rights Reserved Differences in Blood Type Distribution Percentage Percentage Percentage Percentage Percentage with with Each with Each with Each with Each Each Blood Population Blood Type O Blood Type A Blood Type B Blood Type AB Type R h plus United States Blank Blank Blank Blank Blank Black American 49 27 20 4 95 Caucasian 45 40 11 4 85 Chinese American 42 27 25 6 100 Filipino American 44 22 29 6 100 Hispanic 57 31 10 2 92 Japanese American 31 39 21 10 100 Korean American 32 28 30 10 100 Native North 79 16 4