Blood and its protective functions. Value of mouth

cavity in blood productions

Conception of blood system

Blood system is blood, which consists of 1) blood, which is moving through the vessels, 2) blood forming organs, 3) blood destroying organs, 4) storage of blood, 5) apparatus for regulation

Blood functions

1) respiratory (carries oxygen, carbon dioxide), 2) transport of nutririve elements, products of

metabolism, hormones and waste materials, 3) thermoregulation, 4) maintaining the acid-base balance of the tissues, 5) supporting of oncotic and osmotic pressure, 6) help to form a clot, 7) plays an important part in protecting the body from

bacteria and other organism that can cause disease or other abnormal conditions.

Blood volume, notion of blood reserve

The amount of blood in the body has been measured in various ways. Naturally the volume of blood can be expected to vary with the size of the body. It has been estimated at 1/20 to 1/13 of the body weight or 6-8 %. The blood depo (storage) are liver – 30 %; subcutaneus tissue – 20 %; spleen – 1,5-2,5 %

plasma

erythrocytes

Leucocytes and platelets

Composition of blood The liquid portion of circulating blood is called the plasma.

The red cells, white cells, and blood platelets float in this liquid medium.

Plasma: water - 92 %, solids - 8 %; inorganic chemicals: sodium, calcium, potassium, magnesium, chloride, bicarbonate, phosphate, sulfate; organic chemicals: proteins: serum albumin, serum globulin, fibrinogen; nonprotein nitrogenous substances: urea, uric acid, creatine, creatinine, ammonium salts, amino acids; nonnitrogenous substances: glucose, fats, cholesterol, hormones, gases: oxygen, carbon dioxide, nitrogen.

Functional meaning of plasma protein The blood plasma include serum albumin, serum globulin, and fibrinogen. Food proteins are absorbed as amino acids and transported to the tissues as such. Fibrinogen is formed in the liver, and most other plasma proteins are thought to be formed there also. Serum globulin is concerned with antibody formation – the reaction of the blood to toxins formed by bacteria or to foreign proteins introduced into the blood. Fibrinogen is essential to the clotting mechanism.

Quantity of erythrocytes In men – 4,0-5,1•1012/L; in women – 3,7-4,7•1012/L. The quantity

of erythrocytes may be increase – in pregnancy, in physical training, mental work, in newborn or decrease; and decrease –

only in pathology.Functions of erythrocytes

The primary function of the erythrocytes is to carry oxygen to the tissue.

Development of erythrocytes Common progenitor cell – uncommited stem cell – commited stem cell – erythroblast – pronormoblast – early (basophilic)

normoblast – intermidiate (polychromatorhylic) normoblast – late (eosinophilic) normoblast – reticulocyte – erythrocyte.

Regulation of erythropoiesis Coused by erythropoietins, which produced in kidneys and macrophagal system. Thyroid, epinephrine and male sex hormons increase quantity of erythrocytes and female sex

hormones decrease its..

Hemoglobin Erythrocytes derive their colour from a complex protein

called hemoglobin. This substance is composed of a pigment, heme, containing iron, and the protein glohin. Hemoglobin has the power to attract oxygen molecules and to hold them in a loose chemical combination known as oxyhemoglobin. It

is said, therefore, to have a chemical affinity for oxygen.

MyoglobinHem is also part of the structure of myoglobin, an oxygen-

binding pigment found in red (slow) muscles and in the respiratory enzyme cytochrome c. Porphyrins other than that found in hem play a role in the pathogenesis of a number of metabolic diseases (congenital and acquired porphyria, etc.) It may be the reserve pigments, which give the tissue oxygen

in a small oxygen condition.

Quantity and chemical structure of hemoglobin In man – 130-160 g/L; in woman – 120-140 g/L. It

consists of four folded polypeptide chains of amino acid units. The four chains form the globin, or protein, part of the molecule. In addition there are four atoms of iron, each associated with a pigment, or heme, group of atoms. The heme group provides the red colour of the blood and also its oxygen-combining ability. The iron atoms are bivalent or in the ferrous state. There are 2 pairs of polypeptides in each hemoglobin molecule, 2 of the subunits containing one type of polypeptide and 2 containing another. In normal adult human hemoglobin (HbA), the 2 types of polypeptide are called the a, and the chains.

Methods of definitition

gasometric – definition of gases, such as O2, colorimetric – definition of colour substances, ironmetric – definition of iron concentration.

Function of leukocytesFunction of leukocytes

1. Protective1. Protective 2. Transport2. Transport 3. Metabolic3. Metabolic 4. Regenerator4. Regenerator

LymphocytesLymphocytes

Physiological role of T-lymphocytes (There are receptors to antigens on the membrane of T-lymphocytes, which helps to distinguish genetic heterologous substances.)

Functional significance of B-lymphocytes (B-lymphocytes syntheses the immunoglobulins such as IgM, IgN, IgA, IgG, IgB, IgE.)

NeutrophilsNeutrophils The neutrophils seek out, ingest, and kill bacteria and have

been called the body‘s first line of defense against bacterial infections. The average half-life of a neutrophil in the circulation is 6 hours. Many of the neutrophils enter the tissues; they first adhere to the endothelium and then insinuate themselves through the walls of the capillaries between endothelial cells by a process called diapedesis. Many of those that leave the circulation enter the gastrointestinal tract and are lost from the body. When bacteria invade the body, the bone marrow is stimulated to produce and release large numbers of neutrophils. Phagocytosis refers to the ability of neutrophils to ingest bacteria or other foreign bodies. They contain protein-digesting enzymes.

EosinophilsEosinophils These cells make up only 0,5 to 5 percent of the total number These cells make up only 0,5 to 5 percent of the total number

of white cells in the blood, but in the tissues they can of white cells in the blood, but in the tissues they can congregate in considerable numbers. There is a rise in the congregate in considerable numbers. There is a rise in the number of eosinophils in some cases of allergy, possibly in number of eosinophils in some cases of allergy, possibly in response to toxic substances released by the allergic reaction.response to toxic substances released by the allergic reaction. The eosinophils attack some parasites, and they inactivate The eosinophils attack some parasites, and they inactivate mediators released from mast cells during allergic reactions. mediators released from mast cells during allergic reactions.

BasophilsBasophils Basophils constitute only 0,5 percent of the white

cells of the blood. Basophils in the blood are said to contain histamine and a heparinlike substance. Histamine dilates capillaries and often permits fluid to move through the capillary wall into the tissues: heparin is an anticoaguiant of the blood. Apparently tissue basophils become the mast cells of the tissues. The large granules of mast cells are thought to store enzymes. The basophils contain histamine and heparin, but their role in the maintenance of normal balance between the clotting and anticlotting systems is uncertain.

System of mononucleares phagocytes These is the system, which connect the cells with one nucleus, it has

common origin from red bone marrow, common function of high specific phagocytosis.

It origines from promonocytes of red bone marrow. Tissue monocytes named macrophage. There are many macrophages in different organs. The macrophage of lungs named alveolar macrophages of lungs, the macrophage of spleen named free or fixed macrophages of spleen, the macrophage of liver named Kupffer cells, the macrophage of skin named Langergans cells, the macrophage of brain named microglia etc.

It has the function of high specific phagocytosis. The monocytes are actively phagocytic and contain peroxidase and

lysosomal enzymes. The macrophages migrate in response to chemotactic stimuli and engulf and kill bacteria by processes that are generally similar to those occurring in neutrophils. They also play a key role in cellular immunity because proliferation of T-lymphocytes requires that they come in physical contact with macrophages that have taken up and processed

antigen.

Quantity of leukocytes and their Quantity of leukocytes and their changes changes

WWhite cells are nucleated and somewhat variable in hite cells are nucleated and somewhat variable in size and shape. Their numbering is 4-9•size and shape. Their numbering is 4-9•GigaGiga per per liter. The number of liter. The number of lymphocytes are – 18-37 %, lymphocytes are – 18-37 %,

monocytes – 3-11 %, monocytes – 3-11 %, eosinophils –0,5-5 %, eosinophils –0,5-5 %, basophils – 0-1 %, basophils – 0-1 %, juvenile neutrophile – 0-1 %, juvenile neutrophile – 0-1 %, relating to stab (rod-shaped) neutrophil – 1-6 %, relating to stab (rod-shaped) neutrophil – 1-6 %, segmented neutrophil – 47-72 %. segmented neutrophil – 47-72 %. The number of leukocytes may increase or The number of leukocytes may increase or

decrease. decrease.

Physiological role of T-lymphocytes Physiological role of T-lymphocytes

1. 1. Immune memoryImmune memory.. 2. 2. Anti viruses immunityAnti viruses immunity.. 3. 3. Anti tissue immunity.Anti tissue immunity. 4. 4. Regulate phagocytosisRegulate phagocytosis..

Function of Function of В-В-lymphocyteslymphocytes 1. 1. Immune memoryImmune memory.. 2. 2. SpecificSpecific immunityimmunity. B-lymphocytes syntheses the . B-lymphocytes syntheses the

immunoglobulins such as IgM, IgN, IgA, IgG, IgB, immunoglobulins such as IgM, IgN, IgA, IgG, IgB, IgE. IgE.

System of mononucleares System of mononucleares phagocytesphagocytes

These is the system, which common the cells These is the system, which common the cells with one nucleus, with one nucleus,

common origin from red bone marrow, common origin from red bone marrow, common function of high specific common function of high specific phagocytosisphagocytosis

EOSINOPHILSEOSINOPHILS

TThe index of nuclear’s changing of he index of nuclear’s changing of neutrophyls, it interpretation neutrophyls, it interpretation

NCN=(M+J+S1)/S2, whereNCN=(M+J+S1)/S2, where M – myelocytes, M – myelocytes, J– juvenile, J– juvenile, S1 – stab neutrophils, S1 – stab neutrophils, S2 – segmented neutrophilsS2 – segmented neutrophils

Norm Norm is is 0,06-0,090,06-0,09

Hemostasis systemHemostasis system Hemostasis isHemostasis is the physiologic system, which the physiologic system, which

support the blood in the fluid condition and support the blood in the fluid condition and prevent bloodless. prevent bloodless.

Hemostasis system vital necessary and Hemostasis system vital necessary and functionally connect with the cardiovascular, functionally connect with the cardiovascular, digestive, digestive, breathing, endocrine and other breathing, endocrine and other systems. systems.

The components of hemostasisThe components of hemostasis systemsystem

The components of hemostasis are The components of hemostasis are - - wall of the vessels, wall of the vessels, - - blood cells – platelets, erythrocytes, blood cells – platelets, erythrocytes, leukocytesleukocytes,, - - enzymes and nonenzymes components of plasma – enzymes and nonenzymes components of plasma –

clotting and anticlotting substances, clotting and anticlotting substances, fibrinolyticfibrinolytic components. components.

There are 2 kinds of hemostasisThere are 2 kinds of hemostasis:: vessel-platelets vessel-platelets (primary) and coagulative (secondary)(primary) and coagulative (secondary)..

PlateletsPlatelets

Properties and function of plateletsProperties and function of platelets Quantity of platelets is 180-320 G/L. Quantity of platelets is 180-320 G/L. Diameter of platelets is 1-4 micrometers, thickness – 0,5-0,75 Diameter of platelets is 1-4 micrometers, thickness – 0,5-0,75

micrometers. micrometers. They are the little peace of megakaryocytes cytoplasm (from They are the little peace of megakaryocytes cytoplasm (from

one megacariocytes may develop few hundred of platelets). one megacariocytes may develop few hundred of platelets). Platelets circulates in blood from 5 to 11 days and than Platelets circulates in blood from 5 to 11 days and than destroyed in destroyed in liver, lungs, spleenliver, lungs, spleen by the cells of macrophages by the cells of macrophages system. system. Formation is regulated by thrombopoietin.Formation is regulated by thrombopoietin.

Their granules contain serotonin, Ca2+, enzymes, ADP, and platelet-derived growth factor (PDGF)

Platelets function in the clotting mechanism by forming a temporary plug that helps seal breaks in blood vessels

Platelets not involved in clotting are kept inactive by Nitric Platelets not involved in clotting are kept inactive by Nitric Oxide (NO) and prostaglandins.Oxide (NO) and prostaglandins.

Function of platelets are:Function of platelets are: 1. haemostatic function – platelets produce substances, which 1. haemostatic function – platelets produce substances, which

are secure the hemostasis. are secure the hemostasis. 2. Angiotrophic function – provide trophy of endotheliocytes 2. Angiotrophic function – provide trophy of endotheliocytes

of vessel wall, support structure and functions of micro of vessel wall, support structure and functions of micro vessels. These function is realize by adhesion of platelets to vessels. These function is realize by adhesion of platelets to endotheliocytes and injection the enzymes into the endotheliocytes and injection the enzymes into the endotheliocytes. For one day near 35 G/l of platelets do this endotheliocytes. For one day near 35 G/l of platelets do this function. function.

3. Transport function – transfer the enzymes, ADP, serotonin 3. Transport function – transfer the enzymes, ADP, serotonin and other. and other.

4. Phagocytes function – the contain of platelets help to kill 4. Phagocytes function – the contain of platelets help to kill viruses and antigens bodies. viruses and antigens bodies.

5. Regeneratory function – platelets have the growth factor, 5. Regeneratory function – platelets have the growth factor, which help to grow the endothelial and muscles cells which which help to grow the endothelial and muscles cells which are present in the vessel wall.are present in the vessel wall.

Stages of vessel-platelets hemostasisStages of vessel-platelets hemostasis 1. Shorting spasm of the vessels – vascular spasm duration to 1. Shorting spasm of the vessels – vascular spasm duration to

1 minute is caused by catecholamines and other enzymes. 1 minute is caused by catecholamines and other enzymes. Diameter of vessels decrease on ½-⅓. Mechanism of it Diameter of vessels decrease on ½-⅓. Mechanism of it development determine by secretion of serotonin and development determine by secretion of serotonin and thromboxan Athromboxan A22 from platelets and epinephrine from ending of from platelets and epinephrine from ending of sympathetic nerves. sympathetic nerves.

2. Adhesion of platelets – activation of platelets and stick it to 2. Adhesion of platelets – activation of platelets and stick it to the place of defect in vessel wall. the place of defect in vessel wall.

3. Reverse aggregation of platelets – the thrombus which are 3. Reverse aggregation of platelets – the thrombus which are formed may make way for plasma. formed may make way for plasma.

4. Unreverse aggregation of platelets – the thrombus which are 4. Unreverse aggregation of platelets – the thrombus which are formed can not may make way for plasma. formed can not may make way for plasma.

5. Retraction of platelets plug – decrease the size of plug, pack 5. Retraction of platelets plug – decrease the size of plug, pack down the plug.down the plug.

Primary haemostasisPrimary haemostasis

Investigation of vessel-platelets hemostasisInvestigation of vessel-platelets hemostasis

1. Calculation of the platelets quantity 180-320 1. Calculation of the platelets quantity 180-320 G/l. G/l.

2. Determination of duration of capillary 2. Determination of duration of capillary bleeding after Duke’s method – to 3 minute in bleeding after Duke’s method – to 3 minute in norm. norm.

3. Sample of fragility of capillary – to 10 3. Sample of fragility of capillary – to 10 petechias in norm in a round with diameter 5 petechias in norm in a round with diameter 5 centimeters.centimeters.

Coagulative (secondary) hemostasis.Coagulative (secondary) hemostasis. Characteristics of clotting factors Characteristics of clotting factors There are 12 clotting factors: There are 12 clotting factors: I – fibrinogen; I – fibrinogen; II – prothrombine; II – prothrombine; III – thromboplastin of tissue; III – thromboplastin of tissue; IV – ions of calcium; IV – ions of calcium; V – proaccelerin; V – proaccelerin; VII – proconvertin; VII – proconvertin; VIII – antihemophylic factor A; VIII – antihemophylic factor A; IX – Christmas factor or antihemofilic factor B; IX – Christmas factor or antihemofilic factor B; X – Stuart-Prower factor or prothrombinase; X – Stuart-Prower factor or prothrombinase; XI – plasma thromboplastin antecedent; XI – plasma thromboplastin antecedent; XII – Hageman factor; XII – Hageman factor; XIII – fibrin stabilizing factor. XIII – fibrin stabilizing factor.

Some of them are enzymes – II, VII, IX, X, Some of them are enzymes – II, VII, IX, X, XI, XII,XIII; otherXI, XII,XIII; other are not – I, III, IV, V, VIII. are not – I, III, IV, V, VIII. The vitamin K is necessary for the functional The vitamin K is necessary for the functional activity of II, VII, IX, X factors. activity of II, VII, IX, X factors.

VVitamin K (produced by bacteria in the colon) itamin K (produced by bacteria in the colon) stimulates the production of prothrombin by stimulates the production of prothrombin by the liver.the liver.

Blood clotBlood clot

Regulation of the clotting mechanismsRegulation of the clotting mechanisms Increase of clotting names hypercoagulation, decrease Increase of clotting names hypercoagulation, decrease

– hypocoagulation. Hypercoagulation may be in a – hypocoagulation. Hypercoagulation may be in a stress cases. It depends on epinephrine, which stress cases. It depends on epinephrine, which concentration increased in the cases of stress. concentration increased in the cases of stress. Epinephrine increase from the vessels walls factors Epinephrine increase from the vessels walls factors from which produced prothrombinase. In cases of big from which produced prothrombinase. In cases of big concentration epinephrine should activate XII factor concentration epinephrine should activate XII factor in a bloodstream. It divides fats and fat acids, which in a bloodstream. It divides fats and fat acids, which have prothrombinase activity. After the have prothrombinase activity. After the hypercoagulation stage may be secondary hypercoagulation stage may be secondary hypocoagulation.hypocoagulation.

CoagulogramCoagulogram -Time of clotting by Ly-Wait – 5-10 minutes; -Time of clotting by Ly-Wait – 5-10 minutes;

- Time of plasma recalcification – 60-120 seconds; - Time of plasma recalcification – 60-120 seconds;

- Thrombotest – IV, V, VI degree; - Thrombotest – IV, V, VI degree; - Thromboplastin time – 12-15 seconds;Thromboplastin time – 12-15 seconds;- Thromboplastin index – 80-105 %;Thromboplastin index – 80-105 %;- Concentration of fibrinogen – 2-4 g/L;Concentration of fibrinogen – 2-4 g/L;- Tolerance of plasma to heparin – 6-11 minutes; Tolerance of plasma to heparin – 6-11 minutes; - Heparin time – 50-60 seconds;Heparin time – 50-60 seconds;- Fibrinolysis – 15-20 %.Fibrinolysis – 15-20 %.

Anticoagulative mechanisms. Fibrinolysis.Anticoagulative mechanisms. Fibrinolysis. The primary anticoagulants are The primary anticoagulants are antithrombin III (the most important anticoagulant in antithrombin III (the most important anticoagulant in

the blood); the blood); heparin (heparin (originally found inoriginally found in the liverthe liver, , by large by large

basophilic cells in tissues of various organs. Heparin basophilic cells in tissues of various organs. Heparin reduces the ability of the blood to clot by blocking the reduces the ability of the blood to clot by blocking the changechange of prothrombin to thrombin. It can also be of prothrombin to thrombin. It can also be used to aid in reducing clots in cases in which internal used to aid in reducing clots in cases in which internal

clotting has already occurred. clotting has already occurred. HeparinHeparin form complex form complex with antithrombin-III. Activate nonenzyme with antithrombin-III. Activate nonenzyme fibrinolysis.); fibrinolysis.);

alpha-2-macroglobulin (Alpha-2-macroglobulin is a alpha-2-macroglobulin (Alpha-2-macroglobulin is a similar to antithrombin-heparin cofactor in that it similar to antithrombin-heparin cofactor in that it combines with the proteolytic coagulation factors. Its combines with the proteolytic coagulation factors. Its activity is not accelerated by heparin. Its function is activity is not accelerated by heparin. Its function is mainly to act as a binding agent for the coagulation mainly to act as a binding agent for the coagulation factors and prevent their proteolytic action until they factors and prevent their proteolytic action until they can be destroyed in various ways. It a faint inhibitor can be destroyed in various ways. It a faint inhibitor of thrombin, connect with plasmin), of thrombin, connect with plasmin),

alpha-1-antitripsin (Alpha-1-antitripsin inhibits alpha-1-antitripsin (Alpha-1-antitripsin inhibits thrombin activity, IXa, XIa, XIIa factors, plasmin and thrombin activity, IXa, XIa, XIIa factors, plasmin and kallilrein), kallilrein),

protein C (Protein C inhibits VIIIa, Va factors. It protein C (Protein C inhibits VIIIa, Va factors. It activity depend of thrombin and vitamin K activity depend of thrombin and vitamin K concentration).concentration).

Functionation of secondary anticlotting Functionation of secondary anticlotting substancessubstances

Primary anticoagulants are produce and Primary anticoagulants are produce and present all time in plasma and secondary present all time in plasma and secondary anticoagulants form in a case of blood clotting. anticoagulants form in a case of blood clotting. They are antithrombin-I or fibrin and products They are antithrombin-I or fibrin and products of fibrinolysis or products of fibrinogen of fibrinolysis or products of fibrinogen degradation. Fibrin is sorbs and inactivates degradation. Fibrin is sorbs and inactivates thrombin and Xa factor. Products of thrombin and Xa factor. Products of fibrinolysis inactivate ending stage of clotting, fibrinolysis inactivate ending stage of clotting, IXa factor, platelets' aggregation.IXa factor, platelets' aggregation.

FibrinolysisFibrinolysis Clot dissolved by activity of plasmin, an enzyme Clot dissolved by activity of plasmin, an enzyme

which hydrolyzes fibrinwhich hydrolyzes fibrin

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