Chapter 27 Reproductive Endocrinology



Chapter 17 Blood

functions of blood

* transportation

* nutrients glucose, AA, etc

* waste products urea, lactic acid , creatinine

* gases O2 , CO2

* hormones

* electrolytes Na+ K+ Cl- Ca++

* regulation

* ph buffers

* temperature

* protection

* infection WBC , antibodies

* blood loss platelets, clotting factors

components of blood

* 4 – 6 liters

* whole blood = cells + matrix

* formed elements = cells 38 – 48 % volume

* RBC erythrocytes

* WBC leukocytes

* Platelets thrombocytes

* plasma = liquid 52 – 62 % volume

* proteins

* other chemicals

characteristics of blood

* color

* oxygenated - bright red

* de-oxygenated - dark red / purple

* pH

* 7.35 – 7.45

* venous < arterial

* osmolality 285 – 295 mOsm

* viscosity thicker than water

Plasma

* 52 – 62 % of blood, by volume

* 90% water

* solvent molecules must dissolve in plasma for transport

* nutrients

* hormones

* wastes

* electrolytes

* gases

* plasma proteins

plasma proteins

* albumin ~ 60 % of plasma proteins

* osmotic pressure

* edema

* pH buffer

* globulins ~ 38 %

* γ globulins = immunoglobulins = antibodies

* α, β globulins = carrier proteins

* tranferrin transports iron

* clotting proteins:

* fibrinogen clotting factor

* prothrombin clotting factor

serum

* plasma = liquid + all contents

* serum = plasma w/o clotting factors

RBC = erythrocytes

* blood count 4.5 - 6.0 mill/mm3

* carry Oxygen in blood

* aid transport of Carbon Dioxide

* mostly hemoglobin

* no nucleus

* no mitochondria

* life span ~ 120 days

Hemoglobin

* Hemoglobin (Hb) 12 – 18 grams / 100 ml

* heme + globulin

* heme = Iron (Fe) + bilirubin

* made in red bone marrow

* oxyhemoglobin with O2

* deoxyhemoglobin without O2

* carbaminohemoglobin with CO2

Hematocrit

* Hematocrit (Hct) 38 – 48 %

* = % packed RBC

* 38 – 48 %

* increase polycythemia

* decrease anemia

blood cell formation

* hemopoietic tissues where blood cells are made

* hemopoiesis making blood cells

* erythropoiesis making RBC

* leukopoiesis making WBC

erythropoiesis

* erythroblast ( normoblast ( reticulocyte ( RBC

* Reticulocyte immature RBC < 1.5% reticulocytes > 1.5% when increased erythropoiesis

* normal ~ 2 million RBC / second

regulation of RBC production

* regulator - Oxygen levels

* stimulus is low O2 = hypoxia

* reduced RBC blood loss (hemorrhage) low RBC’s (anemia)

* reduced availability high altitude respiratory condition

* increased demand exercise

* where would you put the receptors for low O2 ?

* erythropoietin = hormone stimulates RBC production

RBC nutrition

* erythropoiesis requires:

* mitosis

* DNA synthesis

* vitamin B12 = extrinsic factor

* folic acid

* intrinsic factor increases B12 absorption

* hemoglobin requires:

* iron

* liver proteins globulin ; transferrin

* copper cofactor

what could go wrong?

* anemia

* polycythemia

* hemolysis

* jaundice

* blood loss

anemia

* anemia = decreased O2 carrying capacity

* due to :

* low # RBC

* increased RBC loss

* decreased RBC production

* low hemoglobin

* abnormal hemoglobin

low # RBC

* increase RBC loss

* hemorrhagic anemia blood loss

* hemolytic anemia RBC destruction

* infections , toxins

* transfusions

* decrease RBC production

* aplastic anemia destroyed red bone marrow

* leukemia , radiation , drugs

* pernicious anemia

* Vit B12 deficiency

* intrinsic factor deficiency

low hemoglobin

* iron deficiency anemia

* hemorrhage

* dietary deficiency

abnormal hemoglobin

* sickle cell anemia low O2 content of RBC clogs capillaries

* Thalassemia smaller Hb molecule

other RBC problems

* polycythemia hi # RBC

* high altitude

* respiratory conditions

* polycythemia vera w/o cause

* jaundice high bilirubin

* hemorrhage blood loss

RBC destruction

* spleen, liver

* iron, globulin re-used to make new Hemoglobin

* heme ( bilirubin

* bilirubin ( bile in the liver

* bile released into digestive tract aids digestion of fats

* stercobilinogen

* urobilinogen

jaundice

* hyperbilirubinemia = increased bilirubin in blood

* jaundice yellow tinge of skin caused by hyperbilirubinemia

* excess RBC destruction

* decreased liver function

* obstructed biliary tree

blood types

* antigens (Ag) on cell membrane

* 2 main groups: ABO Rh

* antibodies (Ab) for foreign blood cells

* agglutination clumping Ab - Ag

* hemolysis rupture of RBC by Ab

ABO blood types

* 2 antigens A B

* 2 antibodies anti- A anti-B

* antigen antibody

* type A

* type B

* type O

* type AB

* universal donor ?

* universal recipient ?

Rh factor

* Rhesus factor

* D antigen on RBC

* Rh+ D antigen present

* Rh- D antigen not present

* antibodies made only when exposed to antigen

* cross placental exchange Rh- mother / Rh+ child

* 1st exposure mother produces antibodies

* 2nd exposure mother’s antibodies destroy fetal RBC’s

* erythroblastosis fetalis

* hemolysis of infant RBC’s by mother’s antibodies

* RhoGAM

WBC

* = leukocytes

* 5,000 – 10,000 / mm3

* many more in tissues bone marrow lymph nodes

* diapedesis migration from blood to tissues

* chemotaxis move toward chemical

* function: defense vs foreign bodies / proteins

* phagocytosis

* chemical destruction - antibodies

WBC

* granulocytes granules in cytoplasm lobed nucleus

* neutrophils

* eosinophils

* basophils

* agranulocytes no granules large single nucleus

* lymphocytes

* monocytes

neutrophils

* polymorphonuclear leukocytes = PMN’s = polys = segs

* 55 – 70 % of WBC

* phagocytosis - esp vs bacteria

* defensins - proteins that destroy bacteria

eosinophils

* stain red / rosy (eosin stain)

* 2 – 4 % of WBC

* attack parasites, worms

* allergic reactions limit inflammation

basophils

* stain blue

* 0.5 – 1.0 % of WBC

* inflammatory response

* histamine increase tissue fluid attract other WBC

* heparin anticoagulant

lymphocytes

* immune respone

* 20 – 40 % of WBC

* most in lymphatic tissue lymph nodes spleen

* T lymphocytes = T cells

* develop in Thymus

* attack foreign cells directly

* B lymphocytes = B cells

* develop in Bone marrow

* attack via antibodies

monocytes

* 2 – 8 % of WBC

* macrophages outside of blood phagocytosis aid lymphocytes

* connective tissues

* spleen, liver (RBC destruction)

WBC - cells

* count 5,000 – 10,000 / mm3

* Differential

* neutrophils 55 – 70 %

* eosinophils 2 - 4 %

* basophils 0.5 – 1 %

* lymphocytes 20 - 40 %

* monocytes 2 - 8 %

WBC formation

* hemopoiesis making blood cells

* leukopoiesis making WBC

* interleukins

* colony stimulating factors (CSF)

* lymphoid stem cell forms lymphocytes

* bone marrow , lymph tissues

* myeloid stem cell forms all other blood cells

* bone marrow

WBC diseases

* leukocytosis ( WBC 20,000

* infection

* leukopenia ( WBC

* drugs , HIV

* leukemia ( ( WBC 100,000

* infectious mononucleosis ( abnormal monocytes Ebstein-Barr virus

Leukemia

* extremely high WBC count 100,000 / mm3

* acute or chronic

* myelogenous (granular) or lymphocytic

* problems :

* aplastic anemia ( RBC

* infection ( WBC

* hemorrhage ( platelets

platelets

* = thrombocytes

* 150,000 - 500,000 / mm3

* thrombopoietin stim production in bone marrow

* function - blood clotting = hemostasis

platelets and endothelium

* normal:

* platelets don’t contact collagen of blood vessels

* endothelial vasodilators prostacyclin nitric oxide

* damage:

* collagen exposed

* platelets attach to collagen von Willebrand’s factor

* platelets release reaction :

* serotonin vasoconstrictor

* thromboxane attract more platelets

* ADP attract more platelets

hemostasis

* stimulation for clotting rough edge of blood vessel (collagen, smooth muscle)

* 1st event = platelets attach to rough edge

* 3 phases :

* vascular spasm

* platelet plug

* coagulation (chemical clotting )

vascular spasm

* vasoconstriction of vessel

* decrease area of repair

* decrease blood flow through damaged area

* stim by:

* smooth muscle reflex

* serotonin

platelet plug

* platelets stick to collagen

* platelet release reaction

* thromboxane

* ADP

* new platelets stick to old

* these platelets attract other platelets (positive feedback)

coagulation = chemical clotting

* clot = fibrin + platelets + RBC

* chemicals used :

* inactive plasma proteins

* prothrombin

* fibrinogen

* other clotting factors

* PF3 (platelet factor 3)

* TF = tissue thromboplastin made locally

* factors V – XII made in liver

* some require Vitamin K

* calcium

chemical cascade

* instrinsic pathway

* uses factors present in blood

* slower

* extrinsic pathway

* uses factor made in damaged connective tissues

* TF tissue thromboplastin

* shortcut - faster

* common pathway

finishing touches

* clot retraction

* actin, myosin contract platelets

* repair

* platelet-derived growth factor (PDGF)

* stimulates rebuilding of blood vessel

* fibroblasts , smooth muscle cells

* fibrinolysis

* tissue plasminogen activator endothelial cells (

* plasminogen ( plasmin dissolves fibrin

limiting clotting

* blood flow removes and dilutes clotting factors

* fibrin absorbs thrombin

* antithrombin III inactivates thrombin

* heparin inhibits thrombin

anticoagulants

* heparin inhibits thrombin

* EDTA bind to calcium

* coumadin inhibit Vitamin K

* aspirin reduces platelet aggregation stim antithrombin III (COX enzymes)

abnormal clotting

* thrombus normal clot

* embolus moving clot

* increased stimulus rough rdge

* arteriosclerosis

* chronic inflammations

* decreased clotting:

* liver disease decreased clotting factors

* thrombocytopenia decreased platelets

* hemophilia factor VIII deficiency

* Vitamin K deficiency

CBC’s

* RBC 4.5 – 6.0 mill/mm3

* Hemoglobin 12 – 18 g/ Dl

* Hematocrit 38 – 48 %

* Reticulocytes < 1.5%

* WBC 5,000 – 10,000/mm3

* Neutrophils 55 – 70 %

* Eosinophils 2 - 4 %

* Basophils 0.5 – 1 %

* Lymphocytes 20 - 40 %

* Monocytes 2 - 8 %

* Platelets 150,000 – 300,000/mm3

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