Blood & Body Fluid Jotting PDF

BLOOD & BODY FLUID JOTTING Body fluid is divided into ECF and ICF which have 18L and 22L respectively. ECF is divided into plasma (2.75),interstitial fluid (12L) and trans cellular fluid (3.75). PH of ECF is about 7.4 while ICF is 7.0 4 CEREBROSPINAL FLUID 3 This is the fluid...

BLOOD & BODY FLUID JOTTING Body fluid is divided into ECF and ICF which have 18L and 22L respectively. ECF is divided into plasma (2.75),interstitial fluid (12L) and trans cellular fluid (3.75). PH of ECF is about 7.4 while ICF is 7.0 4 CEREBROSPINAL FLUID 3 This is the fluid contained in the central canal of spinal cord, subarachnoid space and cerebral 2 ventricles. It’s part of the ECF 1 Normal amount: 150ml Site Of Formation CSF is formed by choroid plexus in the ventricles. Large amount of CSF is formed in the lateral ventricle. Choroid plexuses is a bed of capillary projections present inside the ventricles and are covered by pia mater and ependymal covering. Mechanism Of Formation CSF is mainly formed by secretion and active transport is used for this secretion thus requires energy. It DOES NOT require ultrafiltration and dialysis. Factors Affecting Formation Of CSF. Pilocarpine: stimulates secretion by stimulating choroid plexus.. Isotonic saline injection: stimulates secretion. Hypotonic saline injection: stimulates secretion. Hypertonic saline injection: decreases secretion CSF contains more sodium than potassium. It also contains lymphocytes which are added when it flows in the spinal cord. The CSF Secreted by the ventricle does not contain any cell. CIRCULATION OF CSF Large quantity of CSF is formed in the lateral ventricles and passes through the foramen of Monro into the 3rd ventricle. From here, it passes into the 4th ventricle Via aqueduct of Sylvius. From 4th Ventricle, it inters into the Cisterna magna and Cisterna lateralis through the foramen of Magendie (central opening) and foramen of Luschika (lateral opening). The greater portion of the fluid passes upwards, over the brainstem to the surface of the cerebral hemispheres while a portion of the cisternal fluid circulates through the spinal subarachnoid space Note: Certain events like coughing, and crying increase the pressure by decreasing the absorption. Also, compression of Internal Jugular Vein increases the CSF pressure. 500ml of CSF is produced per day and an equal amount is absorbed. FUNCTIONS OF CSF. Protective function: from shock, brain floats in CSF cause they have almost equal specific gravity. Thus protect brain from the counter coup injury.. Medium of Exchange: Serves as medium through which many substances, especially the nutritive substances and waste materials are exchanged between blood and brain tissues.. Regulation of cranial content volume. COLLECTION OF CSF This is done in two ways; Lumbar Puncture: Lumbar Puncture needle is inserted into the subarachnoid space in the lumbar region between 3 and 4 lumbar spaces Reasons for selecting site of lumber puncture: - The spinal cord will not be injured, because it terminates below the lower border of the 1st lumbar vertebra. The cauda equina may be damaged but it is regenerated. - The subarachroid space is wider in this site because the pia mater is reduced very much. Cisternal Puncture: This is done by passing a needle between the occipital and atlas bone into the cisterna magna Purpose of lumber puncture:. For diagnostic purposes. For introducing spinal anaesthesia. Measuring pressure exerted by CSF HYDROCEPHALUS This is the abnormal collection of CSF in the skull associated with enlargement of head. It is of two types;. Non communicating (internal): this is when there is a block in any foramen preventing proper circulation. Communicating (external): this has to do with block of arachnoid villi preventing CSF from being absorbed. Symptoms- Headache, vomiting. In severe conditions, leads to atrophy of brain, mental weakness and convulsions. CSF composition may vary in different diseases conditions such as; SEMINAL FLUID This is an organic fluid that usually contains spermatozoa and it is secreted by gonads and other sexual organs of the male. Some Functions Of Seminal Fluid Constituent:. Mucus: sperm mobility. Fructose: energy source for sperm. Prostaglandins: suppression of immune response of the female against foreign sperm. Zinc: stabilize DNA containing chromatin in sperm. Basic anime: neutralizes acidity of vagina SYNOVIAL FLUID This is a yolk like fluid found in the cavities of synovial joints and serve to reduce friction between articular cartilages of synovial joints during movement. The synovial mb. Secrete this fluid and it is made up of Type A and B cells. It’s the type B that secretes the fluid Normal Constituents Of Synovial Fluid. Hyaluronic acid: increases viscosity. Lubricin: boundary layer lubrication and cell growth. Phagocytic cells: removes microbes and cellular debris Note: SF exhibits a non Newtonian flow characteristic, I.e the fluid viscosity is not constant ALSO SF has thixotropic properties meaning fluid thins over a period of stress. Functions Of Synovial Fluid. shock absorption,. transport O2 and nutrients and. removes CO2 and waste metabolites from the condrocytes within the articular cartilage.. Reduces friction between synovial joints AMNIOTIC FLUID This play a major role in Fetal growth and development and as regard its production, some amniotic fluid is initially secreted by amniotic cell but most is derived from maternal tissue and interstitial fluid by diffusion across the Amniochoric membrane from decidual basalis. Amniotic fluid contains approximately equal portions of organic and inorganic constituents. For the organic constituents, about half is made up of protein and the other by constituents such as carbohydrates, fats, enzymes, hormones, pigments etc. Note: steroid administration during pregnancy is for lung development (surfactant production) CLINICAL SIGNIFICANCE /APPLICATION OF AMNIOTIC FLUID Amnioncentesis: is the process by which amniotic fluid is collected for analysis. This analysis is important for prenatal diagnosis like;. Assessment Of Lung Maturity: Lecithin/sphingomylein ratio is used to assess lung maturity. A value greater than 2.0 indicates a matured lung. Assessment Of Haemolytic Disease: Here what is measured is bilirubin contents in amniotic fluid. Remember bilirubin is a product of RBC degradation.. Use of Alpha- Fetoprotein: in detection of Neural tube defects, Down syndrome (T21) and Edward syndrome (T18). Alpha- cholinesterase: this is also used for NTD assessment INTRA-OCULAR FLUID This is the fluid inside the eye. It is responsible for keeping the eye distended and maintaining the eye in its spherical form. The fluid can be divided into two parts: A. The aqueous humour: Is a thick watery substance filling the space between the lens and the cornea. It is transparent so as to allow light to pass through. Functions of Aqueous humour I. Maintains the Intraocular pressure and inflates the globe of the eye. II. Provides nutrition for the avascular ocular tissues III. Presence of immunoglobulin indicate a role in immune response to defend against pathogens. IV. increased protection against dust, wind and some pathogen. V. For refractive index Note: Glaucoma is a condition characterized by increased Intraocular pressure either through increased production or decreased outflow of aqueous humour. Uncontrolled glaucoma typically leads to visual field loss and ultimately blindness. B. Vitreous humour: This is the clear gel that fills the space between the lens and the retina of the eyeball of humans and other vertebrates. Note: Vitreous humor has no blood vessels Clinical significance: The flow of nutrients and waste products between the bloodstream and the vitreous humor is very slow. Because of this, vitreous humor is often used for testing glucose levels and other substances in postmortem analysis, as these substances break down or leave the body more slowly in the eye fluid compared to the bloodstream. SWEAT Sweat contains the chemicals or odorants 2 - methylphenol and 4 -methylphenol as well as a small amount of urea. Sweating allows the body to regulate its temperature. URINE urine is formed by kidney and voided out by micturition. Urine is produced by filtration, reabsorption and secretion. Urine is sterile till it reaches urethra. Few things to remember here;. Color: range from colorless- amber. PH: limiting PH is 4.5. Volume: 1-2L per day. Specific gravity: 1.004- 1.035gcm3 HUMAN MILK This a fluid secreted by mammary tissues (breast) which is mainly meant for the nourishing of infants. First secretion from Breast is called COLOSTRUM which contains same protein and lactose as normal milk but almost no fats. It contains IgG Antibodies Note: The concentration of lactose in human milk is about 50% greater than in cow's milk but the concentration of protein in cow milk is about about two times that in human milk. Also, ash, which contains the minerals, is only one-third of that of cow's milk in human milk. SALIVA This is the aqueous solution found in the oral cavity produced by salivary glands which are;. Parotid. Submandibular. Sublingual Most important factor that affects the composition of saliva is the flow rate. The concentration of Na+,Cl-, and Hco-3 in saliva increase with increasing flow rate while concentration of potassium is fairly constant over a wide range of flow rate. During sleep, the flow rate of saliva is nearly zero. This is of high clinical significance. The highly reduced or absent salivary flow during sleep allows the rapid proliferation of oral micro-organism and demineralization of the enamel caused by the acid end products of bacterial metabolism. This is associated with high incidence of dental cavities Note: Dietary intake of electrolytes does not affect their concentration in plasma or saliva because their blood levels are carefully regulated. Age and sex affect salivary composition. The flow rate of saliva increases progressively from childhood to adolescence. In old age, salivary flow rate decreases. Functions of Saliva. General cleansing and protection of oral cavity.. Starts the digestion of carbohydrate. Provides mucous which acts as a lubricant and has some other functions. Role in speech. Contributes to digestion of fats. BLOOD Packed Cell Volume (PCV) is the volume of blood expressed is percentage. {skipped a few things already in physiology} PLASMA PROTEINS. Albumin. Globulin. Fibrinogen Remember: Serum has no fibrinogen Albumin/ Globulin ratio The ratio between both A/G ratio is used to assess liver and kidney function. Normal ratio is 2:1 PROPERTIES OF PLASMA PROTEINS. Molecular Weight – Albumin - 69,000 – Globulin - 156, 000 – Fibrinogen- 400, 000. Oncotic Pressure: plasma proteins are responsible for the oncotic pressure with albumin playing the major role.. Specific gravity. Buffer action SEPARATION OF PLASMA PROTEINS. Precipitation by “salting out”: various salt are used to precipitate the various fractions of proteins which are then separated. Salt solutions are; – Ammonium sulphate solution – Sodium sulphate + Sodium sulphite sol. By using this method, all 3 plasma proteins can be precipitated and thus separated. Albumins precipitate at full saturation Globulins precipitate at half saturation Fibrinogen precipitate at 1/5 saturation All with Ammonium Sulphate solution. This means fibrinogen will precipitate first and albumin last with this solution.. Cohn’s Fractionation ( ethanol used): Here varying concentration of ethanol was used at a low temperature to separate fractions of proteins which are called; – Fraction I = Fibrinogen – Fraction II = Y globulin – Fraction III = alpha and beta globulin & prothrombin  – Fraction IV = alpha and beta globulin – Fraction V = Albumin Clinical Use: This method is useful for obtaining purified proteins on a large scale for therapeutic purposes.. Electrophoresis: here they’re separated based on their differences in electric charge. – Albumin= 55% – Alpha Globulin = 13% – Beta Globulin = 14% – Y globulin = 11% – Fibrinogen = 7%. Ultracentrifugation: completely based on difference in density. Used to determine MW. Characteristics Of Individual Plasma Proteins. Albumin: most abundant, migrates fastest in electrophoresis and precipitates the slowest in salting out or alcohol method. It is synthesized in the liver. Decrease in albumin conc. Is seen in severe PEM, liver disease and nephrotic syndrome. Functions Of Albumin – Exerts low viscosity – Contributes 70-80% oncotic pressure – Helps in transport of several substances like FFA, unconjugated bilirubin, Ca – Certain drugs like aspirin and penicillin bind to albumin and transported to target organs. – Nutritive function. GLOBULIN: This can be separated into alpha 1, alpha 2 , beta and Y globulins. Both alpha and beta are synthesized in the liver then Y by plasma cells and beta cells of lymphoid tissues. Alpha 1 Globulin: it’s a glycoprotein with 41% carbohydrate content. It is also called oroso mucoid. Clinical Importance – It’s a reliable indicator for inflammation – It rises in acute and chronic inflammatory disease like liver cirrhosis – It decreases in conditions like hepatic disease, cachexia, malnutrition and nephrotic syndrome. Alpha 1 Feto Protein: it is very reliable tumor marker. It is in high concentration in foetal blood during mid pregnancy. Alpha 2 Globulin: comprises ceruloplasmin and haptoglobin. It is synthesized in the liver. Females have more of this than males. Note that increase is seen in pregnancy, inflammatory response, oral estrogen therapy and contraceptive. It is decreased in Wilson’s and Menke’s disease. Alpha 1 antitrypsin Role in Cirrhosis: Juvenile hepatic cirrhosis has also been correlated with α1-AT deficiency. In this condition molecules of Piz (ZZ phenotype) accumulate and aggregate in the cells of the cisternae of the endoplasmic reticulum of hepatocytes. The hepatocytes cannot secrete this particular type of α1-AT. Thus, Piz protein of α1-AT is synthesized but not released from the hepatocytes. Thus, there is aggregation due to formation of polymers of mutant α1-antitrypsin (the polymers forming as a result of strong interaction between a specific loop in one melecule and a prominent B-pleated sheet in another, called Loop-sheet polymerization). The aggregates lead to damage of liver cells leading to hepatitis and Cirrhosis. Role as a tumour maker: α1-AT has been used as a tumour maker. It is increased in germ cell tumours of testes and ovary. As an inhibitor of fibrinolysis: α1-AT is one of the most important inhibitors to fibrinolysis along with α1-antiplasmin and α2-macroglobulin. All these inhibitors block the action of plasmin on fibrinogen. Haptoglobulin This is responsible for binding Hb by its alpha chain to minimize urinary loss of Hb. Beta Globulin: consists of beta lipoprotein and transferrin (siderophilin). Transferrin is a non heme iron containing protein and its synthesized in the liver. Increase of transferrin is seen in iron deficiency anemia and last month of pregnancy while decrease is seen in liver cirrhosis, nephrotic syndrome. C- REACTIVE PROTEINS It precipitates with group c polysaccharide of pneumococci in presence of calcium hence the name. It can bind both heme and T lymphocytes and activate complement system Haemopexin It’s a beta globulin its function is to bind and remove circulating haem formed from Hb and myglobin breakdown. Clinical significance. Decrease seen in haemolytic disorders, at birth in new borns. Increase seen in pregnancy, diabetes mellitus Complement C1q Refer to blood physiology. It’s same as complement system. ACUTE PHASE PROTEINS. C reactive proteins. Haptoglobulin. Alpha 1 antitrypsin. Oroso mucoid. Fibrinogen. Y globulin. FIBRINOGEN: things to know about this is in the slide above. Other Proteins Of Clinical Significance. Bence Jones Protein: is an abnormal protein found in the blood and urine of people suffering from a disease called multiple myeloma Identification The protein is identified easily in urine by a simple Heat test. On heating the urine to 50oC to 60oC, Bence- jones proteins are precipitated ;but when heated further, it dissolves again. Reverse occurs on cooling. Best detected by zone electrophoresis and immunoelectrophoresis of concentrated urine.. Cryoglobulins: Increase - In rheumatoid arthritis, lymphocytic leukemia, multiple myeloma, lumphosarcomas and SLE. These proteins are coagulated when serum or plasma is cooled to a very low temperature (2-4°c) HAEMOGLOBIN Haemoglobin is tetrameric while myoglobin is monomeric. That is myoglobin binds only 1 oxygen Varieties of Normal HB. HbA (major adult Hb). HbA2 (minor adult Hb). Foetal-Hb. Embryonic Hb (in first 3months of IU life). Hb-A3 (altered form of HbA). Hb-A1c (glycosylated Hb) ABNORMAL HAEMOGLOBIN. Hbs : Is due to the replacement of the polar Glutamic acid by Valine at position 6 of the β chain subunit.. HbC: Is due to Glutamic acid replacement by Lysine at position 6 of the β - subunit. HbD: Is due to replacement of glutamic acid () by glutamine (Gln) on position 121 of the β- chain.. HbE: Is due to replacement of Glutamic acid (Glu) by Lysine (Lys) on position 26 on the β - chain.. HbM: Is due to substitutions by Tyrosine which can involve the α or β - chains at the proximal or Distal Histidine As stated, some of these Hb Variants do not produce clinical conditions but some do. Those associated with clinical conditions include: 1. Hbs and HbC - These produce sickle syndrome in the homozygous state with consequent haemolytic anaemia. Hbcc produce mild to moderate haemolytic anaemia while HbAc and HbAs (sickle trait) do not have clinical manifestations. 2. HbM and Hb Kansas - This Hb has low affinity for O2 and thus produces cyanosis and the degree varies depending on whether the defect is on the alpha (α) or Beta (β) Histidine (His) residue.No haemolytic anaemia is associated with HbM and Hb Kansas unlike Hbs and HbC. 3. Hb Chesapeake: This variant Hb has increased affinity for O2 and thus has decreased ability to deliver or release O2 to the tissues. This leads to Hypoxia and consequent Polycythaemia. 4. HbE: Heterozygous are asymptomatic but Homozygous have slight decrease in Hb - level due to slight increase in RBC fragility