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Circulatory System- recap

• https://youtu.be/NJzJKvkWWDc
Coronary Artery Bypass with Sevak Darbinian, MD

https://youtu.be/UY2xGiOwe2o

© SPL/Science Source, (inset) © Andrew Syred/Science Source


Figure 19.1 The three visible layers of blood .

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Plasma non living. Formed elements living

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Blood Composition

• Centrifuge - tube of blood yields three layers


• Plasma on top (~55%)
• Erythrocytes on bottom (~45%)
• WBCs and platelets in Buffy coat (< 1%)
• Hematocrit = RBCs
• Percent of blood volume composed of Erythrocytes
47% ± 5% for males; 42% ± 5% for females

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Physical Characteristics
and Volume
• Sticky, opaque fluid with metallic taste
• Color varies with O2 content
• High O2 - scarlet; Low O2 - dark red
• pH 7.35–7.45
• ~8% of body weight
• Average volume
• 5–6 L for males; 4–5 L for females

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BE ABLE TO

• What type of tissue is blood and what are its components?


• What is found in plasma?
• Name the three formed elements in blood and their functions.
• How does the structure of red blood cells relate to their function?
• Describe the structure and function of each white blood cell.
• What are disorders of red blood cells, white blood cells, and
platelets?
• What do you need to know before donating blood?
• What are antigens and antibodies?
• How are ABO blood types determined?
• What blood types are compatible for blood transfusions?
• What is the Rh factor and how is this important to pregnancy?
What are the functions of blood?
• Transportation: oxygen, nutrients, wastes, carbon
dioxide, and hormones

• Defense: against invasion by pathogens

• Regulatory functions: body temperature, water-


salt balance, and body pH
What is the composition of blood?

• Remember: blood is a fluid connective tissue.

• Formed elements are produced in red bone


marrow.
• Red blood cells/erythrocytes (RBCs)
• White blood cells/leukocytes (WBCs)
• Platelets/thrombocytes
What is the composition of blood?

• Plasma
• It consists of 91% water and 9% salts (ions) and
organic molecules.
• Plasma proteins are the most abundant organic
molecules.
6.1 Blood: An Overview

Three major types of plasma


proteins
• Albumins – most abundant and important for plasma’s
osmotic pressure as well as transport

• Globulins – also important in transport

• Fibrinogen – important for the formation of blood clots


Where do the formed elements
come from and what are they?

stem cells

(top): © Doug Menuez/Getty RF;

stem cells for the white blood cells

erythroblasts lymphoblasts monoblasts myeloblasts megakaryoblasts

Red Blood Cell Lymphocyte Monocyte Neutrophil Eosinophil Basophil Platelets


(erythrocyte) active in specific becomes large (contains granules) (contains granules) (contains granules) (thrombocytes)
transports O2 and immunity phagocyte phagocytizes active in allergies releases histamine aid blood clotting
helps transport CO2 pathogens and worm infections

Figure 6.1 How cells in the blood are formed.


Red Blood Cells and Transport of Oxygen

The structure of red blood cells


is important to their function

• They lack a nucleus and have few organelles.

• Their biconcave shape increases surface area.

• Each RBC contains about 280 million


hemoglobin molecules that bind 3 molecules of
O2 each.
6.2 Red Blood Cells and Transport of Oxygen

Red blood cells and the structure of


hemoglobin
heme group iron

capillary

helical shape of the


polypeptide molecule

a. Red blood cells 4,175x b. Hemoglobin molecule c. Blood capillary 400x


6.3a: © Andrew Syred/Science Source; 6.3c: © Ed Reschke/Getty Images

.
6.2 Red Blood Cells and Transport of Oxygen

How is carbon dioxide transported?


• 68% as a
bicarbonate ion in the
plasma (this
conversion takes CO + H2O H2CO3 H+ + HCO3–
2
place in RBCs) carbon water carbonic hydrogen bicarbonate
dioxide acid ion ion
• 25% bound to
hemoglobin in red
blood cells
• 7% as carbon dioxide
in the plasma
The process of red blood cell production is known as
erythropoiesis and is triggered when blood oxygen levels
are below normal

• All red blood cells originate in the red bone marrow.

• They have a lifespan of about 120 days.

• Erythropoietin (EPO) is secreted by kidney cells and


moves to red marrow when oxygen levels are low.

• Old cells are destroyed by the liver and spleen. The


spleen traps older erythrocytes so they will be
removed from circulation?
Production of red blood cells

1. Low O2
blood level
Normal O2
blood level

2. Kidney increases
production of
erythropoietin.

4. O2 blood level
returns to normal.

3. Stem cells increase


red blood cell
production.

Figure 6.4 Response of the kidneys to a decrease in blood oxygen concentration.


What is blood doping?
• Method of increasing the number of RBCs
• ….doping to increase athletic performance.

• More efficient delivery of oxygen


• and reducing fatigue.

• EPO is injected into a person months prior to an


athletic event.

• It is thought to be able to cause death due to


thickening of blood that leads to a heart attack.
6.2 Red Blood Cells and Transport of Oxygen-What disorders involve RBCs?

• Anemia – a condition resulting from too few


RBCs or too little hemoglobin that causes a
“run-down” feeling

• Sickle-cell anemia – genetic disease that


causes RBCs to become sickle-shaped and
prone to rupture

• Hemolytic disease of the newborn – a condition


with incompatible blood types that leads to
rupturing of blood cells in a baby before and
continuing after birth
White blood cells
• Derived from red bone marrow
• Large blood cells that have a nucleus
• Production regulated …
• colony-stimulating factor (CSF)
• Can be found in the tissues and blood
• Fight infection and are part of the immune
system
• Live for only days while others live months or
years
What do white blood cells look like?
White Blood Cells Function
Granular leukocytes
• Neutrophils Phagocytize pathogens
and cellular debris.

• Eosinophils Use granule contents to


digest large pathogens,
such as worms, and
reduce inflammation.

• Basophils Promote blood flow to


injured tissues and the
inflammatory response.

Agranular leukocytes
• Lymphocytes Responsible for specific
immunity; B cells produce
antibodies; T cells destroy
cancer and virus-infected
cells.
• Monocytes Become macrophages that
phagocytize pathogens
and cellular debris.

Figure 6.5 Some example of white blood cells.


• https://youtu.be/9n6olywEJ4I

• Bacteria attacking WBC


• https://youtu.be/6AP8yL1qBpw
How are white blood cells
categorized?
• Granular leukocytes – contain noticeable granules,
lobed nuclei
• Neutrophil https://youtu.be/0TvTyj5FAaQ

• Eosinophil https://youtu.be/tRgq3v1W61w

• Basophil

• Agranular leukocytes – no granules, nonlobed nuclei


• Lymphocyte
• Monocyte
Neutrophils
• About 50-70% of all WBCs

• Have a multilobed nucleus

• Upon infection, move out of circulation into


tissues to engulf pathogens by phagocytosis
Eosinophils

• Small percentage of WBCs

• Have a bilobed nucleus

• Many large granules function in parasitic


infections and play a role in allergies
Basophil
• Small percentage of WBCs

• Have a U-shaped or lobed nucleus

• Release histamine related to allergic reactions


Lymphocyte
• About 25-35% of all WBCs

• Large nucleus that takes up most of the


cytoplasm

• Develop into B and T cells that are important in


the immune system
6.3 White Blood Cells and Defense Against Disease
Monocyte

• Relatively uncommon WBCs

• Largest WBC, with horseshoe-shaped nucleus

• Take residence in tissues and develop into


macrophages

• Macrophages use phagocytosis to engulf


pathogens
6.3 White Blood Cells and Defense Against Disease

What disorders involve WBCs?

• Severe combined immunodeficiency disease (SCID) –


an inherited disease in which stem cells of WBCs lack
an enzyme that allows them to fight infection

• Leukemia – a group of cancers that affect white blood


cells in which these cells proliferate without control

• Infectious mononucleosis – also known as the “kissing


disease” and occurs when the Epstein-Barr virus (EBV)
infects lymphocytes resulting in fatigue, sore throat,
and swollen lymph nodes
6.4 Platelets and Blood Clotting
Platelets

• Fragmentation of large cells, called


megakaryocytes, in the red bone marrow.

• About 200 billion platelets are made per day.

• They function in blood clotting.

• Blood proteins named thrombin and fibrinogen


create clots by forming fibrin threads that catch
RBCs.
6.4 Platelets and Blood Clotting
How do platelets clot blood?
1. Blood vessel is punctured.

2. Platelets congregate and


form a plug.

prothrombin activator
3. Platelets and damaged tissue
cells release prothrombin Ca2+
activator, which initiates a prothrombin thrombin
cascade of enzymatic reactions.
Ca2+
fibrinogen fibrin threads

4. Fibrin threads form and trap


red blood cells.

a. Blood-clotting process

fibrin threads
red blood cell

Figure 6.7 The steps in the


b. Blood clot 4,400
formation of a blood clot.
6.7b: © Eye of Science/Science Source
Bozeman Blood Typing

• https://youtu.be/KXTF7WehgM8
What disorders involve platelets?
• Thrombocytopenia – a disorder in which the number
of platelets is too low due to not enough being made
in the bone marrow or the increased breakdown
outside the marrow

• Thromboembolism – when a clot forms and breaks


off from its site of origin and plugs another vessel

• Hemophilia – a genetic disorder that results in a


deficiency of a clotting factor so that when a person
damages a blood vessel they are unable to properly
clot their blood both internally and externally
Chapter Opener 19 Colored scanning electron micrograph (SEM) showing red and white blood cells and platelets.

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Figure 19.2 Erythrocyte structure.

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Figure 19.2a Erythrocyte structure.

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Figure 19.2b Erythrocyte structure.

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Figure 19.3a Hemoglobin structure.

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Figure 19.3b Hemoglobin structure.

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Figure 19.4-1 Erythropoiesis: formation of erythrocytes.

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Figure 19.5 Regulation of erythropoiesis.

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Figure 19.6 Erythrocyte death.

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Figure 19.7 Erythrocytes in sickle-cell disease.

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Figure 19.7a Erythrocytes in sickle-cell disease.

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Figure 19.7b Erythrocytes in sickle-cell disease.

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Figure 19.8 Classes of leukocytes.

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Figure 19.10a Structure and formation of platelets.

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ABO Blood Typing

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Unnumbered Figure 19.3_page 746

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Unnumbered Figure 19.4_page 746

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Unnumbered Figure 19.5_page 746

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Unnumbered Figure 19.6_page 746

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What do you need to know about
donating blood?
• Donating blood is a safe and sterile procedure.

• You will donate about a pint of blood.

• You will replace the plasma in a few hours and


the cells in a few weeks.

• A few people may feel dizzy afterwards so sit


down, eat a snack, and drink some water.
What do you need to know about
donating blood?
• Your blood will at least be tested for syphilis, HIV
antibodies, and hepatitis; if any of them come
back positive you will be notified.

• Your blood can help save many lives.

• You should not give blood if you


• have ever had hepatitis or malaria, or been treated
for syphilis or gonorrhea within the past 12
months.
• are at risk for having HIV or have AIDS.
What terminology can help you understand
ABO blood typing?

• Antigen – a foreign substance, often a


polysaccharide or a protein, that stimulates an
immune response

• Antibody – a protein made in response to an


antigen in the body which binds specifically to
that antigen

• Blood transfusion – the transfer of blood from


one individual into another individual
What determines
A, B, AB, or O blood type

• Presence and/or absence of 2 blood antigens,


A and B ON the surface of the erythrocyte

• Type of antibodies present in/around


erythrocyte
6.5 Blood Typing and Transfusions

If you have B ANTI-BODIES


You’re an A
type A antigen

anti-B antibodies

Type A blood has type A surface antigens.


Plasma has anti-B antibodies.
Figure 6.8 The ABO blood type system (Type A blood).
• Type O RBCs entirely lack A and B
antigens.
• Blood types only have antibodies in response to antigens
NOT present on the surface.

• i.e.Type A blood …….


• A antigens/proteins on the surfaces of
her RBCs.
• B antibodies in blood.
Blood Typing Peguin Prof

• https://youtu.be/L06TJTMVkBo
type A antigen type B antigen

anti-B antibodies anti-A antibodies

Type A blood. Red blood cells have type A surface Type B blood. Red blood cells have type B surface
antigens. Plasma has anti-B antibodies. antigens. Plasma has anti-A antibodies.

type A antigen
anti-A antibody

type B antigen anti-B antibody


Type A B blood. Red blood cells have type A and type B Type O blood. Red blood cells have neither type A nor
surface antigens. Plasma has neither anti-A nor anti-B type B surface antigens. Plasma has both anti-A and
antibodies. anti-B antibodies.
Figure 6.8 The ABO blood type system.
What about Rh blood groups?

• The Rh factor is often included when expressing


a blood type by naming it positive or negative.

• People with the Rh factor are positive and those


without it are negative.

• Rh antibodies only develop in a person when


they are exposed to the Rh factor from another’s
blood (usually a fetus).
6.5 Blood Typing and Transfusions

When is the Rh factor important?


• During pregnancy under these conditions:
• Mom: Rh-
• Dad: Rh+
• Fetus: Rh+ (possible with the parents above)
• In the case above, some Rh+ blood can leak from the
fetus to the mother during birth causing the mother to
make Rh antibodies.
• This can be a problem if the mother later has a second
fetus that is Rh+ because she now has antibodies that
can leak across the placenta and attack the fetus.
• This condition, known as hemolytic disease of the
newborn, can lead to retardation and even death.
6.5 Blood Typing and Transfusions
How can hemolytic disease of the newborn be prevented?

• Rh- women are given an injection of anti-Rh


antibodies no later than 72 hours after giving birth to
an Rh+ baby.

• These antibodies attack fetal red blood cells in the


mother before the mother’s immune system can
make antibodies.

• This will have to be repeated if an Rh- mother has


another Rh+ baby in case she has later pregnancies.
Figure 19.18 Blood type testing.

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Table 17.1 Composition of Plasma (1 of 2)

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Table 17.1 Composition of Plasma (2 of 2)

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Albumin - 60% of plasma protein

• Functions
• Substance carrier
• Blood buffer
• Major contributor of plasma osmotic pressure

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Figure 17.2 Photomicrograph of a human blood smear stained with Wright's stain.
Platelets Erythrocytes Monocyte

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Neutrophils Lymphocyte
Erythrocytes

• Biconcave discs, lack a nucleus/organelles


• Diameters larger than some capillaries
• Filled with hemoglobin (Hb) for gas transport
• Contain plasma membrane protein spectrin
(flexibility) and other proteins

• Viscosity

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Figure 17.3 Structure of erythrocytes (red blood cells).

2.5 µm

Side view (cut)

7.5 µm

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Top view
Erythrocytes

• Structural promotes gas transport


• Biconcave shape—huge surface area relative to
volume
• No mitochondria; ATP production anaerobic; do not
consume O2 they transport

• Normal values
• Males - 13–18g/100ml;
Females - 12–16 g/100ml
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Hemoglobin Structure

• Heme is pigment bonded to the globin chain


• Heme's iron atom binds one O2
• Each Hb molecule can carry four O2

• Globin composed of 4 polypeptide chains


• Two alpha and two beta chains
• Each single RBC contains 250 million Hb
molecules
• 250 million X 4 ….
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Hematopoiesis/Erythropoiesis

• Blood cell formation …. red bone marrow


• Adult: Axial skeleton, girdles, and proximal
epiphyses of humerus and femur

• How White Blood Cells Are Formed


http://youtu.be/tDTLC2swhlQ

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Regulation of Erythropoiesis

• Too few RBCs leads to tissue hypoxia


• Too many RBCs increases blood viscosity
• > 2 million RBCs made per second
• Balance between RBC production and
destruction depends on
• Hormonal controls
• Adequate supplies of iron, amino acids, and B
vitamins

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Hormone Erythropoietin (EPO)

• Stimulates erythropoiesis
• Released by kidneys (some from liver) in response
to hypoxia

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Causes of hypoxia

• Decreased RBC numbers due to hemorrhage


or increased destruction
• Insufficient hemoglobin per RBC (e.g., iron
deficiency)
• Reduced availability of O2 (e.g., high altitudes)

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Hormonal Control of Erythropoiesis

• Testosterone enhances EPO production,


resulting in higher RBC counts in males

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Figure 17.6 Erythropoietin mechanism for regulating erythropoiesis.
Slide 1

Homeostasis: Normal blood oxygen levels

1 Stimulus:
Hypoxia
5 O2-carrying (inadequate O2
ability of blood delivery) due to
rises. • Decreased
RBC count
• Decreased amount
of hemoglobin
• Decreased
availability of O2
4 Enhanced
erythropoiesis
increases RBC count. 2 Kidney (and liver to
a smaller extent)
releases
3 Erythropoietin
erythropoietin.
stimulates red
bone marrow.

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Dietary Requirements for Erythropoiesis

• Nutrients—amino acids, lipids, and


carbohydrates
• Iron
• Available from diet
• 65% in Hb; rest in liver, spleen, and bone marrow
• Free iron ions toxic
• Stored in cells as ferritin and hemosiderin
• Transported in blood bound to protein transferrin

• Vitamin B12 and folic acid necessary for DNA


synthesis for rapidly dividing cells (developing
RBCs)

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Fate and Destruction of Erythrocytes

• Life span: 100–120 days


• No protein synthesis, growth, division
• Old RBCs become fragile; Hb begins to
degenerate
• Get trapped in smaller circulatory channels
especially in spleen
• Macrophages engulf dying RBCs in spleen

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Heme and globin are
separated - Recycled

• Iron salvaged for reuse


• Heme degraded to yellow pigment bilirubin
• Liver secretes bilirubin (in bile) into intestines
• Degraded to pigment urobilinogen
• Pigment leaves body in feces
• Globin metabolized into amino acids
• Released into circulation

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Figure 17.7 Life cycle of red blood cells.
Slide 1
1 Low O2 levels in blood stimulate
kidneys to produce erythropoietin.

2 Erythropoietin levels rise in blood.

3 Erythropoietin and necessary


raw materials in blood promote
erythropoiesis in red bone marrow.

4 New erythrocytes
enter bloodstream;
function about 120
days.

5 Aged and damaged


red blood cells are engulfed
by macrophages of spleen,
liver, and bone marrow; the
hemoglobin is broken down.

Hemoglobin

Heme Globin

Bilirubin is Iron is stored Amino


picked up as ferritin or acids
by the liver. hemosiderin.

Iron is bound to transferrin


and released to blood
from liver as needed
for erythropoiesis.

Bilirubin is secreted into


intestine in bile where Circulation
it is metabolized to
stercobilin by bacteria.

6 Raw materials are


made available in blood
for erythrocyte synthesis.

Food nutrients
Stercobilin (amino acids, Fe,
is excreted B12, and folic acid)
© 2013 Pearson Education, Inc. in feces. are absorbed from
intestine and enter
blood.
Anemia

• http://youtu.be/_ZV5140OykE
• = low O2-carrying capacity
• Sign rather than disease itself
• Blood O2 levels cannot support normal metabolism
• Accompanied by fatigue, pallor, shortness of
breath, and chills

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Causes of Anemia

• Three groups
• Blood loss
• Low RBC production
• High RBC destruction

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Pernicious anemia

• Autoimmune disease - destroys stomach mucosa


• Lack of intrinsic factor needed to absorb B12
• Deficiency of vitamin B12
• RBCs cannot divide  macrocytes
• Treated with B12 injections or nasal gel
• Also caused by low dietary B12 (vegetarians)

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Aplastic anemia

• Destruction or inhibition of red marrow by drugs,


chemicals, radiation, viruses
• Usually cause unknown
• All cell lines affected
• Anemia; clotting and immunity defects
• Treated short-term with transfusions; long-term with
transplanted stem cells

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Hemolytic anemias

• Premature RBC lysis


• Caused by
• Hb abnormalities
• Incompatible transfusions
• Infections

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Sickle-cell anemia

• http://youtu.be/Qd0HrY2NlwY

• Hemoglobin S
• One amino acid wrong in a globin beta chain
• RBCs crescent shaped when unload O2 or blood O2
low
• RBCs rupture easily and block small vessels
• Poor O2 delivery; pain

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Sickle-cell Anemia

• People of African malarial belt and


descendants
• Malaria
• Kills 1 million each year
• Sickle-cell gene
• Two copies  Sickle-cell anemia
• One copy  Sickle-cell trait; milder disease; better
chance to survive malaria

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Sickle-cell Anemia: Treatments

• Acute crisis treated with transfusions; inhaled


nitric oxide
• Preventing sickling
• Hydroxyurea induces fetal hemoglobin (which does
not sickle) formation
• Blocking RBC ion channels
• Stem cell transplants
• Gene therapy

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Polycythemia

• Polycythemia vera
• Bone marrow cancer  excess RBCs
• Severely increased blood viscosity
• Secondary polycythemia
• Less O2 available (high altitude) or EPO production
increases  higher RBC count
• Blood doping

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Leukocytes

http://youtu.be/0TvTyj5FAaQ

• <1% of total blood volume


• Function in defense against disease
• Can leave capillaries via diapedesis
• Move through tissue spaces by ameboid motion and
positive chemotaxis
• Leukocytosis: WBC count over 11,000/mm3
• Normal response to infection

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Leukocytes: Two Categories

• Granulocytes – Visible cytoplasmic granules


• Basophils, eosinophils, neutrophils
• Agranulocytes – No visible cytoplasmic
granules
• Lymphocytes, monocytes
• Decreasing abundance in blood
• CBC NLMEB 60-30-8-3-0

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Neutrophils

• Most numerous WBCs


• Also called Polymorphonuclear leukocytes
(PMNs or polys)
• 3-6 lobes in nucleus; twice size of RBCs
• Very phagocytic—"bacteria slayers"

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Eosinophils

• Red-staining granules
• Bilobed nucleus
• Granules lysosome-like
• Release enzymes to digest parasitic worms
• Role in allergies and asthma
• Role in modulating immune response

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Basophils

• Rarest WBCs
• Nucleus deep purple with 1-2 constrictions
• Large, purplish-black (basophilic) granules
contain histamine
• Histamine: inflammatory chemical that acts as
vasodilator to attract WBCs to inflamed sites

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Figure 17.10a Leukocytes.
Granulocytes

Neutrophil:
Multilobed nucleus,
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pale red and blue
cytoplasmic granules
Figure 17.10b Leukocytes.
Granulocytes

Eosinophil:
Bilobed nucleus, red
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cytoplasmic granules
Figure 17.10c Leukocytes.
Granulocytes

Basophil:
Bilobed nucleus,
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purplish-black
cytoplasmic granules
Agranulocytes

• Agranulocytes
• Lack visible cytoplasmic granules
• Have spherical or kidney-shaped nuclei

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Lymphocytes

• Second most numerous WBC


• Large, dark-purple, circular nuclei with thin rim
of blue cytoplasm
• Mostly in lymphoid tissue (e.g., lymph nodes,
spleen); few circulate in blood
• Crucial to immunity

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Lymphocytes

• Two types
• T lymphocytes (T cells) act against virus-infected
cells and tumor cells
• B lymphocytes (B cells) give rise to plasma cells,
which produce antibodies

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Monocytes

• Leave circulation, enter tissues, and


differentiate into macrophages
• Actively phagocytic cells; crucial against viruses,
intracellular bacterial parasites, and chronic
infections
• Activate lymphocytes to mount an immune
response

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Figure 17.10d Leukocytes.
Agranulocytes

Lymphocyte (small):
Large spherical
nucleus, thin rim of
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pale blue cytoplasm
Figure 17.10e Leukocytes.
Agranulocytes

Monocyte:
Kidney-shaped
nucleus, abundant
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pale blue cytoplasm
Leukocyte disorders

• Leukopenia
• Abnormally low WBC count—drug induced
• Leukemias – all fatal if untreated
• Cancer  overproduction of abnormal WBCs
• Named according to abnormal WBC clone involved
• Myeloid leukemia involves myeloblast descendants
• Lymphocytic leukemia involves lymphocytes
• Acute leukemia derives from stem cells;
primarily affects children
• Chronic leukemia more prevalent in older
people
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Leukemia

• Cancerous leukocytes fill red bone marrow


• Other lines crowded out  anemia; bleeding
• Immature nonfunctional WBCs in bloodstream
• Death from internal hemorrhage; overwhelming
infections
• Treatments
• Irradiation, antileukemic drugs; stem cell
transplants

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Platelets

• Form temporary platelet plug that helps seal


breaks in blood vessels
• Age quickly; degenerate in about 10 days
• Formation regulated by thrombopoietin

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Table 17.2 Summary of Formed Elements of the Blood (1 of 2)

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Table 17.2 Summary of Formed Elements of the Blood (2 of 2)

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Hemostasis

• https://youtu.be/HFNWGCx_Eu4

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Figure 17.13 Events of hemostasis.
Slide 1

Step 1 Vascular spasm


• Smooth muscle contracts,
causing vasoconstriction.

Step 2 Platelet plug


formation
• Injury to lining of vessel
Collagen exposes collagen fibers;
fibers platelets adhere.

• Platelets release chemicals


that make nearby platelets
Platelets sticky; platelet plug forms.

Step 3 Coagulation
• Fibrin forms a mesh that traps
red blood cells and platelets,
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Fibrin forming the clot.
Figure 17.15 Scanning electron micrograph of erythrocytes trapped in a fibrin mesh.

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Disorders of Hemostasis

• Thromboembolic disorders: undesirable clot


formation
• Bleeding disorders: abnormalities that
prevent normal clot formation
• Disseminated intravascular coagulation
(DIC)
• Involves both types of disorders

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Thromboembolic Conditions

• Thrombus: clot that develops and persists in


unbroken blood vessel
• May block circulation leading to tissue death
• Embolus: thrombus freely floating in
bloodstream
• Embolism: embolus obstructing a vessel
• E.g., pulmonary and cerebral emboli
• Risk factors – atherosclerosis, inflammation,
slowly flowing blood or blood stasis from
immobility
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Anticoagulant Drugs

• Aspirin
• Heparin
• Warfarin (Coumadin)
• Prophylaxsis to atrial fibrillation
• Interferes with action of vitamin K
• Dabigatran inhibits thrombin

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Thrombocytopenia

• : deficient number of circulating platelets


• Petechiae appear due to spontaneous, widespread
hemorrhage
• Due to suppression or destruction of red bone
marrow (e.g., malignancy, radiation, drugs)
• Treated with transfusion of concentrated platelets

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Hemophilia

• – USUALLY Genetic
• Symptoms include prolonged bleeding,
especially into joint cavities
• Treated with plasma transfusions and injection
of missing factors

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Disseminated Intravascular Coagulation
(DIC)

• Clotting causes bleeding


• Widespread clotting blocks intact blood vessels
• Severe bleeding occurs because residual blood
unable to clot
• Occurs as pregnancy complication; in
septicemia, or incompatible blood transfusions

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Transfusions

• Whole-blood transfusions used when blood


loss rapid and substantial
• Packed red cells (plasma and WBCs removed)
transfused to restore oxygen-carrying capacity
• Transfusion of incompatible blood can be fatal

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Transfusions

• Type O universal donor


• No A or B antigens
• Type AB universal recipient
• No anti-A or anti-B antibodies

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Figure 17.16 Blood typing of ABO blood types.
Blood being tested Serum
Anti-A Anti-B

Type AB (contains(clumping agents)


agglutinogens A and B;
agglutinates with both
sera)

RBCs

Type A (contains
agglutinogen A;
agglutinates with anti-A)

Type B (contains
agglutinogen B;
agglutinates with anti-B)

Type O (contains no
agglutinogens; does not
agglutinate with either
© 2013 Pearson Education, Inc.
serum)
Restoring Blood Volume

• Death from shock may result from low blood


volume
• Volume must be replaced immediately with
• Normal saline or multiple-electrolyte solution
(Ringer's solution) that mimics plasma electrolyte
composition
• Plasma expanders (e.g., purified human serum
albumin, hetastarch, and dextran)
• Mimic osmotic properties of albumin
• More expensive and may cause significant complications

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Diagnostic Blood Tests

• Hematocrit – test for anemia


• Blood glucose tests – diabetes
• Microscopic examination reveals variations in
size and shape of RBCs, indications of
anemias

© 2013 Pearson Education, Inc.


Diagnostic Blood Tests

• Differential WBC count


• Prothrombin time and platelet counts assess
hemostasis
• SMAC, a blood chemistry profile – liver and
kidney disorders
• Complete blood count (CBC) – checks
formed elements, hematocrit, hemoglobin

© 2013 Pearson Education, Inc.


Crash Course

• https://youtu.be/HQWlcSp9Sls

• https://youtu.be/9-XoM2144tk

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