Nilesh Blood Components.ppt [recovered]2

Whole blood

solid Organic 1) Protein - albumin, globulin, fibrinogen, prothrombin 2) Internal secretion, antibodies, enzymes 3) Non proteins like urea, uric acid, creatinine 4) Neutral fat, cholesterol, glucose Inorganic

sodium chloride, sodium bicarbonate, calcium, iron Gases Oxygen, carbon diaoxide, nitrogen

RBC Major function – carries oxygen through

hemoglobin Contains carbonic anhydrase which catalyses reaction between water and carbon diaoxide and transport it from tissue to lung in the form of bicarbonate ion Responsible for buffering of the blood

Shape and size Shape – biconcave disc

shape changes while passing through capillaries It is like a bag which can change into any shape because of excess of cell membrane Size- Diameter -7.8 micrometer thickness- 2.5 micrometer at thickest 1 micrometer at the center

Production Early weeks of embryonic life- yolk sac Middle trimester – liver also spleen and lymph

node Last month and after birth- bone marrow Till 5 years – all the bone marrow After around 20 years – membranous bones like vertebra, sternum ribs

Concentration 5.2 million in male 4.2 million in female per cubic mililter  Quantity of hemoglobin Whole blood contains 16 gm per deciliter in

males 

in females

14 gm per deciliter

Factors controlling growth and reproduction

Growth inducers- IL1, IL6, IL3 IL3- promotes growth for all types of cells. Others only specific type of committed cells Growth factors promote growth but not

differentiation This function done by protein called as differentiation inducers Formation of growth and differentiation inducers in turn controlled by factors outside the marrow like low oxygen tension in case of RBC and infections in case of WBC

Regulation of RBC production  Reduced tissue oxygenation - high altitudes,

destruction of marrow, circulation disorders • Erythropoietin Principle factor formed in kidney 90 % (renal tubular epithelial cells) and also in liver10% • Effect – hypoxia induces production of erythropoietin within minutes and RBC

Maturation – Vitamin B & Folic acid 12

Bone marrow cells are most rapidly

reproducing and growing cells. Maturation and rate of production are affected by nutritional status. For maturation Vit B12 and folic acid are needed Both are needed for synthesis of DNA as they are required in formation of thymidine phosphate which a building block of DNA Lack of Vit B12 and folic acid leads to failure of nuclear maturation and division

Forms larger than normal cells with normal

oxygen carrying capacity but fragile cell walls leading reduced life. This is called as maturation failure

Hemoglobin • Formation begins at proerythroblats and

continues into reticulocyte stage. • Steps - 2succinyl CoA + 2glycine -> pyrrole • 4 pyrrole-> protoporphyrine IX • protoporphyrine IX +Fe -> heme • heme + polypeptide -> hemoglobin chain Types of hemoglobin chains – alpha, beta, gamma chains and delta chains

Most common form of hemoglobin is hemoglobin a made up of 2 alpha and 2 beta chains Fetal hemoglobin ( hemoglobin F) is made up of a alpha and 2 gamma. This type facilitates movement of oxygen from maternal to fetal circulation and is replaced by adult circulation soon after the birth. There are 4 iron atoms attached in each Hb

molecule Each iron atom can bind to 1 molecule oxygen making it total of 4 molecules of oxygen.

Iron metabolism. Iron is absorbed from small intestine Transported in plasma by formation of

transferrin and can be released to any tissue cell. Excess amount of iron is stored mainly in hepatocytes in the form of ferritine

Destruction of RBC Life span of RBC is 120 days Metabolic system of RBC become

progressively less active with time and cell become more fragile. These fragile cell rupture while passing through tight spot in circulation mostly in spleen as the spaces between trabeculae is a very small. Destruction of hemoglobin – hemoglobin released during destruction of RBC is phagocytized by macrophages, mainly by

The iron is released back in circulation by

macrophages Which is carried by tranferrin to bone marrow for reuse or liver and other tissues for storage. The porphyrine portion is converted to bilirubin

Anemia Anemia means deficiency red blood cells with reduced oxygen carrying capacity. Causes Blood loss – acute and chronic Nutritional deficiency – Iron deficiency megaloblastic anemia hemolytic anemia – Spherocytosis sickle cell anemia Aplastic anemia - radiation, drugs like chloramphenicol

Leukocytes Granulocytes - neutrophil, eosinophil,

basophill Agranulocytes – lymphocyte and monocyte Granulocyte and monocyte are formed in bone marrow Lymphocyte are mainly produced in lymphogenous organ like thymus, lymph glands and spleen. Neutrophil 62% Eosinophil 2.3% Basophill 0.4%

Granulocytes Neutrophil, eosinophil, basophil The granules contain biologically active

substances Multilobed nucleus no of lobes increases with time Neutrophil Forms 1st line of defense takes part in inflammatory responses Average half life is 6 hours Neutrophil enter tissue spaces by diapedesis One in tissue spaces it moves around in

Chemotaxis – bacterial toxin, degenerated

products, complement complex

Phagocytosis Cellular ingestion of offending agent Slective process Opsonisation –C3 molecule of complement

system Neutrophil attaches itself with to the particles and then project pseudopodia which meet at opposite side and fuse The enclosed chamber is then filled with neutrophillic granule and digested. The granules contain defensin which are

In addition to this NADPH oxidase is activated

which produces large amount of toxic oxygen metabolites Also myelopeoxidase is discharged which produces potent oxidants Neutrophil kills bacteria with hydrogen peroxide and hydroxyl ion

Eosinophil Like neutrophil it releases proteins, cytokines

and chemokines which kills bacteria and also causes inflammation Active against parasite because of larvacidal polypeptide called major basic protein Numbers increase in allergic reaction like

Basophill Releases protein and cytokines Resembles mast cells and contains heparin

and histamine Takes part in in immediate type of

hypersensitive reaction

Monocytes  after leaving bone marrow it gets fixed in

tissue and acts a macrophages Skin- histiocyte Liver – kupffer cell

Combination of monocyte, tissue

macrophage, mobile macrophage and specialized cells endothelial cell in marrow, spleen and lymph node is called as reticuloendothelial system

Lymphocyte Key element in production of immunity 2 types – B lymphocyte and T lymphocyte Originates from bone marrow and are

processed in thymus or brusal equivalent Located more extensively in lymph nodes also in spleen, GIT, bone marrow

T lymphocyte Processed in thymus Provides cell mediated immunity Divide extensively in thymus and develops

specificity against antigens This continues till there are different lymphocyte with specificity against millions of different antigens Now it leaves thymus and gets lodge in different lymph node in body Once T lymphocyte comes in contact with specific antigens the same type of lymphocytes are produced in large no called as clone of lymphocytes

T cell marker – these are surface receptor

proteins present on the T lymphocyte. It is highly specific against the antigens

B lymphocyte Destined to form antibodies it is processed in liver during fetal life and in

bone marrow after birth This population of cell was first seen in birds where it is processed in bursa of fabricus and that’s why it is called as B lymphocyte.

Disorders of leucocyte Nonneoplastic - Leucopoenia – reduced

number Leucocytosis – increased in number Neoplastic - Malignant lymphoma (hodgkins and non hodgkins lymphoma) Lymphomas are malignant neoplasm of cell native to lymphoid tissue Leukemia's – malignant neoplasm of stem cells characterized by diffuse replacement of bone marrow by malignant cells Acute – acute lymphoblastic and acute myeloblastic leukemia

Platelets 3oo,ooo/ùL Half life about 4 days 60 – 75% of platelet are in circulation and

remainder are in spleen There membrane contain receptor for collagen , von Willibrand factor and fibrinogen Cytoplasm has granules containing non

proteins like serotonin, ADP And proteins like clotting factor and PDGF.

Platelet production controlled by colony

stimulating factor acting on megakaryocye And by thrombopoietin a circulating protein factor When platelet count is low – thrombocytopinic purpura When circulating platelets are abnormal – thrombasthenic pupura

Blood groups  There At least 30 group systems most of

them are weak Two particular types are most likely than others – OAB and Rh system

OAB system There two antigens A & B occur on the

surface of RBC These are also called as agglutinogen

Major types Type A when agglutinogen A is present Type B when agglutinogen B is present Type AB when agglutinogen A & B both are present Type O when both are absent Agglutinins - antibodies when particular type of antigens are missing, antibodies against it develops Antibodies are IgM and IgG types

Blood type

Agglutinoge n

Agglutinin

O

-

Anti-A and Anti B

A

A

Anti B

B

B

AB

A and B

Anti A -

Rh blood types Difference - Agglutinin are formed instantly in

OAB system but in Rh system it is not In Rh system there must be massive blood transfusion for formation of antibodies. Rh positive and Rh negative Six common type of antigens C, D, E, c, d, and e The person having C antigen does not have c antigen and vice a versa. Same is true for other antigens Type D is widely present and more antigenic than other Rh factors

Therefore person having D antigen is called

as Rh positive and person not having D antigen is called as Rh negative About 85% of population is Rh positive and 15% Rh negative. If Rh negative person receives Rh positive blood for first time then immediate reaction will not occur. Mild reaction develops after 2 to 4 weeks. But on subsequent transfusion reaction will be greatly enhanced

Erythroblastosis Fetalis Rh negative mother having Rh positive child First child no does not develop complication Second Rh positive child develop

erythroblastosis fetalis due to presence of antibodies in mothers blood which act against child's RBC Antibody diffuse through placental membrane and causes agglutination Jaundice, anemia, kernicterus Treatment – replacement with Rh negative blood.

Blood transfusion  Indications 2) Acute haemorrhage 3) Major surgeries 4) Deep burns – destruction of rbc and

hemolysis 5) Preoperatively for anaemic patient 6) Anaemic patient with Hb below 10gm/100ml 7) Coagulation disorders and also during chemotherapy for malignant diseases there is bone marrow depression

Collection of blood Screen the donor for diseases which can be

transferred through blood like HIV and hepatitis Donor lies down sphygmomanometer is applied and inflated to 80mm h\Hg 15 gauge needle is inserted in  medial cuboidal vein Blood is collected n plastic bag containing 70 ml of anticoagulant. About 410 ml of blood is collected Anticoagulants – 2 types 1) CPD containing trisodium citrate, citic acid and sodium dihydrogen phosphate

 Stored at 4 degree Celsius in refrigerator  Shelf life is 3 to 5 weeks  RBC loose ability to release oxygen in 7 days  Platelets useful up to 24 hours  Types of blood transfusion 6) CPD stored blood 7) Warm blood – cardiopulmonary operations to

reduce risk of cardiac arrest 8) Filtered blood to filter off platelet and leukocyte aggregate 9) Auto transfusion 10)Exchange transfusion – erythroblastosis fetalis

Packed red cells – chronic anemia, low cardiac

reeve. Old patient Amount of blood transfusion – 500ml of blood raises Hb by 10% Complications 1)incompatibility - after expiry date, already hemolysed blood 2) Pyerexial reactions 3) allergic reaction to plasma products 4) sensitisation to leucocytes and platelets 5) transmission of diseases

 Reaction caused by massive

transfusions  Acid base imbalance  Hyperkalaemia- shift of potassium out of rbc  Citrate toxicity  Hypothermia  Failure of coagulation due to dilution  Blood substitutes 8) Fresh frozen plasma – factor V and VIII 9) Platelet rich plasma - - thrombocytopinic

purpura 10)Fibrinogen – stored in powdered form and mixed with distilled water. Used in DIC

4) Cryoprecipitate – if frozen plasma is allowed to bring at a temperature of 4 degree Celsius it divides into precipitate and plasma this precipitate is called cryoprecipitate it is a rich source of factor VIII Synthetically prepared solutions Dextran - increases plasma volume, used in restoring plasma volume for longer time Gelatin- less effective than dexran Hydroxyethylstarch- plasma volume expander Fluorocarbons- colorless, odorless, dens liquid inert and soluble It binds and release oxygen. Also considered as red cell substitute

Capillary circulation It is also called a microcirculation Transport of nutrients Extremely thin structure with highly

permeable endothelial cells.

Structure Artery ( Divides 6 – 8 times ) Arteriole ( Divides 2- 5 times) Meta arteriole Capillary Preferential arteriole capillaries

True

 Structure of capillary wall  Wall – unicellular layer of endothelial cells.  Pores – intercellular cleft- thin slit between

 5) 6)

7)

endothelial cells .the size is slightly smaller than albumin protein molecule. Special types of pores. Brain – tight junction of cells – Blood- brain barrier Liver- wide open junction – so all dissolved substances including plasma protein can pass In kidney special arrangement for filtering the blood

Vasomotion Flow is not continuous instead it is

intermittent It is because of contraction of metarterioles and precapillary sphincters Regulation – Depends on oxygen demand

Lymphatic system Accessory rout by which fluid can flow from

interstitial spaces into the blood. Carries protein and large particulate matter away from blood which can not be removed by capillaries This is essential function without which person can die in 24 hours.

Lymph channels of body All lymph from lower part flows up thoracic

duct and empties into venous system at the junction of left internal jugular vein and subclavian vein

Lymph from right side of head , neck right

arm and parts of chest enters right lymph duct which empties in to junction between right subclavian and internal jugular vein.

• Terminal lymphatic capillaries

and its permeability 1/10th of fluid from capillary system enters lymphatic system Total quantity is about 3 liters per day. This minute quantity is very important as high molecular weight substances can pass through easily which can not be reabsorbed in any other way

Rate of lymph flow 100 ml/hour flows through thoracic duct More the interstitial fluid pressure more is the

flow elevated capillary pressure increased capillary permeability increased fluid protein Lymphatic pump increases lymph flow – valves Intrinsic pumping by lymph vessels Extrinsic compression by surrounding muscle of body movement of body, arterial pulsation,

Role of lymphatic

protein leaks into the interstitium increased osmotic pressure

and

fluid is pulled in to interstitium this causes raised fluid volume pressure this leads to increased rate of

lymph flow and excess fluid and protein is

Lymphatic disorders Lymphengitis – infection spreading into

lymphatics mainly caused by beta hemolytic streptococci  Lymphedema Primary secondary Congenital Obstruction removal fibrosis filariasis