Blood Physiology PDF

WHAT IS PLASMA AND SERUM? Components of Blood Introduction Blood cell types and diseases 2 BLOOD PHYSIOLOGY BLOOD, WHICH IS A PART OF THE EXTRACELLULAR FLUID , IS A TISSUE IN WHICH BLOOD CELLS (ERYTHROCYTE, LEUKOCYTE, THROMBOCYTE)...

WHAT IS PLASMA AND SERUM? Components of Blood Introduction Blood cell types and diseases 2 BLOOD PHYSIOLOGY BLOOD, WHICH IS A PART OF THE EXTRACELLULAR FLUID , IS A TISSUE IN WHICH BLOOD CELLS (ERYTHROCYTE, LEUKOCYTE, THROMBOCYTE) ARE DISPERSED IN SUSPENSION IN A LIQUID MEDIUM CALLED PLASMA, FILLING THE INSIDE OF THE VASCULAR SYSTEM AND CIRCULATING THE WHOLE BODY WITHIN THIS SYSTEM  COMPONENTS OF BLOOD Plasma (%55) Buffy coat (leukocyte and platlelt) Formed elements (45%) Erytrhrocytes  BLOOD FORMATION The formation of blood cells is called hemopoiesis, and the areas where this event occurs are called hemopoietic organs. In mammals, blood cells are formed in different tissues before and after birth. For prenatal blood formation Mesenchyme, Liver, 7 Spleen and Bone marrow work. Postpartum blood production only takes place in the bone marrow. Production of lymph cells occurs in lymphatic tissues (spleen, lymph node and thymus).  FORMED ELEMENTS OF BLOOD (BLOOD CELLS) There are red blood cells (erythrocytes), white blood cells (leukocytes) and thrombocytes in the circulating blood. The formation of red blood cells is called erythropoiesis. The red blood cells formed during the fetal period are nucleated. 8 Whether white blood cells or leukocytes carry granules in their cytoplasm or not 1. Granulated leukocytes (Granulocytes) and 2.Non-granular leukocytes (Agranulocytes) It is divided into two parts. 1. Granulated cells function in body defense and protection. These; Neutrophil leukocytes, Eosinophil leukocytes, Basophil are leukocytes The formation of granulocytes is called granulopoiesis. 2. Cells that do not carry granules in their cytoplasm also function in body defense and protection. These; Lymphocytes, Monocytes The formation of monocytes is called monopoiesis, and the formation of lymphocytes is called lymphopoiesis. Platelets play an important role in blood coagulation. Their formation is called thrombopoiesis. Kanın Şekilli Elemanları 11  TRANSPORTATION OF RESPURATUARY GASES CO2 transport O2 transport 70% of HCO3 97% hemoglobin 23% in the form of 3% dissolved in plasma carboamino compounds 7% is carried in free solution.  VISCOSITY OF BLOOD Viscosity: It is the resistance shown against flow. If the viscosity of the water is perceived as 1, the viscosity of the blood of healthy adults is 3.5-4.5, and the viscosity of the plasma is 1.8-2.2. Blood viscosity; The plasma water content, protein content and erythrocyte count affect. When the number of erythrocytes increases, the amount of protein increases and the water ratio in the plasma decreases, the viscosity of the blood increases. Otherwise, it decreases.  91-92% of the plasma is water and 8-9% is organic and inorganic substances in dissolved form.  Plasma proteins constitute the majority of organic substances in plasma. Plasma proteins are globulins (alpha, beta, gamma globulins), fibrinogen and albumin. Plasma Proteins Albumin, prothrombin and fibrinogen are produced in the liver, Globulins are produced in the monocyte-macrophage system, including the liver, and in the rest of the immune system.  Albumin ⚫It makes up about 60% of plasma proteins. (3.5-4.5 mg / dl) ⚫Plasma colloid is responsible for 80% of oncotic pressure. ⚫It is responsible for carrying many substances in the blood by binding to them. Albumin production decreases in liver diseases such as cirrhosis. 1G of albumin holds 18 ml of water. Edema occurs when plasma albumin level decreases by 3 mg / dl.  Globulin ⚫It constitutes 38% of total plasma proteins. ⚫Plasma contains 2.3 mg / dl. ⚫It exists as lipoprotein, glycoproteins and globulins. ⚫ (glycoproteins): Most of glucose is transported in the form of glycoproteins. ⚫Globulins: It is a very important carrier for lipids and polysaccharides. ⚫75% of all lipids in plasma are transported by binding to plasma proteins as lipoproteins. ⚫Transferrin, a protein carrying Fe ++, is a protein from this group. ⚫Globulins: Important in immune response. ⚫Ig G ⚫Ig A ⚫Ig M ⚫Ig E ⚫Ig D Fibrinogen ⚫It constitutes 7% of plasma proteins. ⚫It coagulates blood. Plasma proteins have very important functions, and these can be listed as follows: a) The osmotic force created by plasma proteins is called colloid osmotic pressure = oncotic pressure. This osmotic power is the most important force holding water in the plasma and prevents the water in the plasma from escaping out of the vein. The protein responsible for 70% of this osmotic power is albumin. Inadequate production of albumin or albumin losses for any reason cause water to escape outside the vessel and accumulate between tissues, in other words, EDEMA. b)Since proteins combine with acids and bases to form salts, it is an important buffer system that functions in the regulation of blood pH. c)Many substances such as hormones, drugs and metals are carried in the blood by binding to proteins. d)During the circulation of blood in the vascular system, they regulate the sedimentation of erythrocytes (accumulation of erythrocytes on each other by forming a roll form). e)They affect blood viscosity.  In addition to proteins, plasma contains many organic substances such as monosaccharides, fatty acids and hormones. Examples of inorganic substances found in plasma are Na +, K +, Ca2+, HC03-, P3-, Fe2 +, Mg2+, I. Inorganic substances are responsible for the adjustment of the osmotic power and pH of the blood.  ERYTHROCYTES (RED BLOOD CELLS) It is the group of cells with the highest number in the organism. Their number is 4.8 million in women and 5.4 million in men in 1 mm3 of blood. Their appearance is in the form of a biconcave disc (the middle parts are flattened from the top and bottom) and they can easily change shape. Thanks to their ability to easily change shape, they can easily pass through the narrowest diameter capillaries. The erythrocytes in the blood circulation do not contain nuclei and their lifespan in circulation is approximately 120 days. Towards the end of their life, they lose these elastic properties and during their passage through capillaries, red blood cells are torn, hemoglobin is released and they are phagocytosed by macrophages. The main functions of erythrocytes are to carry hemoglobin. Hemoglobin is a large protein molecule containing Fe+2 atom in its structure and its main task is to carry oxygen to tissues. Oxygen is transported by binding to the Fe2+ atom in the hemoglobin molecule. Normal erythrocytes carrying normal hemoglobin are flexible and can easily pass through small capillaries with blood flow. Sickle cells with abnormal hemoglobin, on the other hand, have little flexibility, usually causing capillary occlusion and cessation of blood flow. The second difference is in the longevity of these cells. Normal erythrocytes live up to 120 days, while the much more fragile sickle cells live for 60 days or less. The body cannot make erythrocytes so quickly to regenerate these lost cells. As a result, patients with sickle cell anemia have less erythrocytes and less hemoglobin in their blood than normal blood cells. Low hemoglobin is called anemia and less oxygen goes to body cells. View of a smear of blood with sickle cell anemia under light microscope (left) and scanning electron microscope (right). Normal and sickle cells can be seen together in the patient. (EM Unit, Royal Free Hospital School of Medicine/Wellcome Photo Library)  Hemolysis It is when the Hb molecule leaves the cell as a result of rupture of the erythrocyte membranes. Two types of hemolysis are defined depending ontheir cause: Osmotic hemolysis and hemocytolysis Regardless of the cause of hemolysis, it eventually causes an increase in bilirubin (a yellow pigment, bilirubin that gives the yellow color of saffron) in the blood and yellowness. Bilirubin is a product formed as a result of the breakdown and metabolization of hemoglobin that comes out of cells. Thus, it should not be forgotten that if there is an erythrocyte damage above normal in the organism, hepatitis may develop with the increase of bilirubin.  Anemia It means the low number of erythrocytes. In addition to the decrease in the number of erythrocytes, the amount of Hb has also decreased. Anemia is caused by the decrease or loss ofthe erythrocyte structure. Increased extracellular bilirubin concentration as a result of increased erythrocyte destruction gives the skin a characteristic yellow color. There are different types of anemia.  Hemorrhagic anemia It occurs due to blood loss as a result of bleeding. If an injury or trauma occurs, the erythrocyte concentration returns to normal in a few weeks. If the loss is not too much, the blood will be replaced in a few days. However, in cases where the loss is high, time is needed (3-6 weeks) to cover the loss. Iron deficiency anemia Anemia develops if the production of erythrocytes is reduced due to low iron intake or impaired iron absorption or interaction. In addition, the erythrocytes formed are small (microcytic). It can be corrected by supplementation of high- iron foods and / or by intake of synthetic iron preparations. The erythrocyte diameter is less than 8 microns. The pale area in the middle of the erythrocytes is increased. Hypochromic and microcytic erythrocytes in peripheral smear Iron deficiency anemia  APLASTIC ANEMIA It is anemia caused by the loss of function of the bone marrow. Poisons such as lead, benzene, or arsenic can be caused by gamma ray exposure, X-ray exposure, some industrial poisons, and even some drugs. As a result of these effects, the number of erythrocytes and leukocytes drops too low, and death may occur within a few weeks. In the bone marrow, hematopoietic cells decreased, and fat accumulation increased. HEMOLYTIC ANEMIA Various erythrocyte abnormalities, many of which are hereditary, make the cells fragile. Such erythrocytes break down easily and cause hemolysis, especially when passing through capillaries. HEMOLYTIC ANEMIA Another example of hemolytic anemias is thalassemias. Hb mutants that occur in thalesemia have abnormalities resulting from the construction of the polypeptide chain that makes up hemoglobin. It is also called Mediterranean anemia because it is usually seen in Mediterranean countries. Megaloblastic and pernicious anemia As a result of the reduction of B9 (folic acid) and B12 (cyanocobolamine) and any of the intrinsic factors released from the gastric mucosa, erythroblasts are slowed down in the bone marrow, resulting in oddly shaped, large megaloblasts. Both B9 and B12 vitamins are required for DNA construction. Because erythroblasts cannot divide quickly enough to form a normal number of erythrocytes, large oddly shaped and fragile membrane cells emerge. Megaloblastic anemia arises from folic acid deficiency Pernicious anemia develops in the deficiency of a glycolipid, one of the intrinsic factors that enable vitamin B12 absorption from the gastric mucosa.  PHYSIOLOGICAL POLYCYTHEMIA 1). Newborn LEUKOCYTES (WHITE BLOOD CELLS, WHITE BLOOD CELLS, WBC) They are cells that have protective properties against microorganisms entering the body. Diapedesis is the passage of white blood cells from the vein to the tissue. Their number in normal adult blood varies between 4-11 thousand in 1mm3 blood. Increased leukocyte count is also observed in cases of infection. The increase in the number of leukocytes is called leukocytosis and its decrease is called leukopenia.  There are various types with functional differences in circulation. They are divided into two groups in terms of cell structures. 1.Those with granules in their cytoplasm (Granulocytes), 2.Those that do not contain granules in their cytoplasm (Agronulocytes). The production of leukocytes is called leukopoiesis. Leukocytes are made in the bone marrow in adulthood, stored here and released into the circulation when necessary. While erythrocytes mainly work in circulation, leukocytes work in tissues. The relative proportions of the various types of leukocytes in human blood are constant. Neutrophils 55-65%, Eosinophils 1-3%, Basophils less than 1%, Lymphocytes 20-35%, Monocytes 3-8% GRANULOCYTES (Polymorphs, Polymorphonuclear Leukocytes) They are leukocytes with granules in their cytoplasm as well as multi-lobed nuclei. Most of the leukocytes are in this group. 1. Neutrophil: Approximately 50-70% of leukocytes are of this type. Neutrophils are characterized in that they are the first cells in acute inflammation to leave the blood and attack microorganisms. Another distinctive feature is their multi-lobed nucleus (polymorphonuclear leukocytes). These cells are phagocytic, meaning they surround the microbes and ingest them before they can digest the microorganisms with their enzymes.  SPECIFIC CHEMICALS RELEASED FROM THE SITE OF INFECTION OR INJURY ATTRACT LEUKOCYTES SUCH AS NEUTROPHILS, MONOCYTES, AND MACROPHAGES. The action of these cells to such areas is called chemotaxis. In reaching these areas, neutrophils and other leukocytes exit the vein pores by changing their shape and lengthening. This movement is called diapedesis. The half-life of circulating neutrophils is about six hours. This period is related to the activity of the neutrophil. In order to maintain the normal number in the circulation, more than 100 million neutrophils must be produced every day. 2. Eosinophils: They make phagocytosis with amoeboid movements like neutrophils. Its granules contain lysosomal enzymes as well as peroxidase and plasminogen, which helps the blood clot to dissolve. They are found in about 2-4% of leukocytes. Their numbers increase in some parasitic or autoimmune diseases and especially in allergic conditions. 3.Basophil: It is the least amount of leukocytes. It is even less than about 1%. They secrete histamine, heparin, bradykinin, serotonin. The vasodilating property of basophil histamine is faster than mast cells. It has an important role in providing immunity against parasites.  AGRANULOCYTES (Mononuclear Leukocytes) There are only a few lysosome granules in their cytoplasm. Since these are not visible in the light microscope, they are considered granule free. 1. MONOCYTES It is the largest blood cell. It is almost two or three times the size of a normal erythrocyte with a size of approximately 15-20 µm. It is 2-8% compared to all leukocytes. They are leukocytes that do not show distinctive granules in their cytoplasm under light microscope, and whose nuclei are kidney-shaped and single-piece. After the bone marrow, monocytes remain in the circulation for a short time (25-72 hours) and then pass into tissues and turn into tissue macrophages.  2.Lymphocytes Its availability rate is approximately 20-30% compared to all leukocytes with round, single- piece nuclei that constantly circulate between blood, lymphatic circulation and tissues. Most lymphocytes are found in body tissues, especially lymph nodes, spleen, thymus, tonsils and lymphoid tissues of the gastrointestinal tract. Some lymphocytes can survive for years by circulating between blood and tissues. They are cells of the immune system and work to make the organism resistant to bacteria, viruses, fungi, foreign tissues and tumors. It has two different types, T and B cells.  B lymphocytes are formed in the bone marrow and are collected in lymphoid tissues. B lymphocytes synthesize special protein molecules called antibodies or immunoglobulins against antigens.  T lymphocytes are activated in the thymus. These are cells that both regulate the antibody production of B lymphocytes and can fight antigens directly. For this reason, the immunity created by T lymphocytes is called cellular immunity, and that of B lymphocytes is called humoral immunity. Leukopenia: ⚫Leukocyte scarcity. The body remains vulnerable due to the decreased number of leukocytes in this rarely developed condition. ⚫In fact, infections develop in the mouth, respiratory tract, digestive tract, eye, urethra and vagina, which are bacteria that are normally present in the body, but do not cause any pathogenicity. If left untreated, death may occur in a short time. ⚫Irritation of the body with gamma rays due to nuclear explosion, the use of chemicals or drugs containing benzene or anthracene core causes bone marrow aplasia. Leukemia (Blood Cancer): It is a malignant increase in the leukocyte count. Leukemic cells have little or no ability to function. The most characteristic feature of leukemia is metastasis (spread). Cells in the bone marrow multiply and spread rapidly. Regardless of its type, leukemias spread to lymph nodes, liver and especially to vascular regions. PLATELETS  Theyare the cells that have a very important role in blood coagulation.  Since these cells, which are nucleated in non- mammalian vertebrates, are in the form of a cell fragment (fragment) rather than a cell in humans, the word platelet is also used to mean flat discs instead of the term platelets.  They consist of giant megakaryocyte cells in the bone marrow and are not real cells. They do not have nuclei, but they do have metabolism. They have a short life span of about 5-12 days. Aging and expiring platelets are destroyed by macrophages in the spleen and liver. Their number is around 300,000 in 1mm3 blood.  Hemostasis : means prevention of blood loss. When a vessel is damaged or ruptured, the vessel wall and various mechanisms in the blood act to preventing the blood from leaving the vessel and hemostasis is achieved. Platelets play a role in clot formation by binding to each other and to collagen, a connective tissue thread. They have a direct important role in preventing people from dying from blood loss. When a blood vessel is injured, the thrombocytes immediately turn in that direction and begin to join the damaged area.  The serotonin granules released by the platelets enable the delay of bleeding by narrowing the cut or injured vessels and more platelets are collected in this area. If the shrinkage or damage is small, the thrombocyte plug that occurs in this way is sufficient for the release of hemostasis. If the vessel is large, the platelet plug is insufficient, and the blood coagulation mechanism is activated. STOP OF BLEEDING AND THE MECHANISM OF BLOOD COLLECTION Blood loss must be prevented to prevent the deterioration of homeostasis. Prevention of blood loss takes place in 3 stages. Vasoconstrictive phase: If the vein is cut in any way, the smooth muscle strands on the wall Vasoconstruction of the veins contract and thus blood flow begins to slow down. This phase takes about 20-30 minutes after the vein is cut. Endothelial cells contract and the underlying basement membrane is exposed to blood Platelet adhesion flow. Endothelial cells begin to secrete local hormones and chemical factors. Endothelin, a peptide hormone, stimulates smooth muscle contraction and vascular spasm.  Plateletsare activated when they reach this area. The most obvious sign of activation is that their shape gives a more spherical appearance. Thromboxane A2, secreted by platelets, provides aggregation of platelets and contraction of smooth muscle in the vessels. Serotonin released from the surrounding connective tissue helps TX A2 in local vasoconstriction. In addition, platelets secrete growth factor derived from platelets. These factors stimulate endothelial cells, smooth muscle cells and fibroblasts. In addition, activated platelets release calcium, which is necessary for platelet aggregation and other coagulation steps. COAGULATION PHASE: THIS PHASE FOLLOWS THE REALIZATION OF THE OTHERS AND STARTS APPROXIMATELY 30 SECONDS AFTER THE VESSEL DAMAGE. THE BASIS OF BLOOD COAGULATION IS THE CONVERSION OF THE DISSOLVED FIBRINOGEN CIRCULATING IN THE BLOOD INTO FIBRIN THREADS. THESE FIBRIN THREADS COVER THE PLATELET PLUG. There are three basic mechanisms that work one after another in coagulation. a.Formation of prothrombin activator b.Prothrombin activator creates thrombin from the protombin (a protein molecule in the plasma) together with Ca2 + ions. c.The effect of thrombin on fibrinogen to form fibrin threads. Fibrin threads take in blood cells and plasma and form a mass, this is called a clot. Hemophilia:  It is a genetically prone bleeding disease that occurs almost exclusively in males as females are carriers.  It is largely caused by the lack of factor VIII. This type is called hemophilia A or classical hemophilia. Less common hemophilia is caused by factor IX deficiency. It creates serious problems in preventing blood loss in any trauma or injury. In this case, sometimes the bleeding does not stop for weeks after tooth extraction. Thrombocytopenia: It is the decrease in the number of platelets. There is a tendency to bleed when platelets are deficient due to their role in bleeding. Unlike hemophilia, bleeding occurs through small venules and small capillaries. This disease is also called thrombocytopenic purpura because these bleedings form punctiform, purplish spots all over the body. Bleeding begins when the platelet count falls below 50,000 in 1 mm3 of blood, and death occurs when the number falls below 10,000. The cause of thrombocytopenia is usually unclear. It usually shows an autoimmune feature. In such patients, a fresh blood transfusion stops the bleeding within a few days.