Nilesh Blood Components.ppt [Recovered]2

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    Whole blood

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    solidOrganic

    1) Protein - albumin, globulin, fibrinogen,prothrombin

    2) Internal secretion, antibodies, enzymes3) Non proteins like urea, uric acid, creatinine

    4) Neutral fat, cholesterol, glucose

    Inorganic

    sodium chloride, sodium bicarbonate,calcium, ironGases

    Oxygen, carbon diaoxide, nitrogen

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    RBCMajor function carries oxygen through

    hemoglobin

    Contains carbonic anhydrase which catalysesreaction between water and carbon diaoxideand transport it from tissue to lung in the formof bicarbonate ion

    Responsible for buffering of the blood

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    Shape and sizeShape biconcave disc

    shape changes while passing through

    capillariesIt is like a bag which can change into

    any

    shape because of excess of cell

    membraneSize- Diameter -7.8 micrometer

    thickness- 2.5 micrometer at thickest

    1 micrometer at the center

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    ProductionEarly weeks of embryonic life- yolk sac

    Middle trimester liver also spleen and lymph

    nodeLast month and after birth- bone marrow

    Till 5 years all the bone marrow

    After around 20 years membranous bones

    like vertebra, sternum ribs

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    Concentration5.2 million in male

    4.2 million in female per cubic mililter

    Quantity of hemoglobin

    Whole blood contains 16 gm per deciliter inmales

    14 gm per deciliter

    in females

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    Factors controlling growth and reproduction

    Growth inducers- IL1, IL6, IL3

    IL3- promotes growth for all types of cells.

    Others only specific type of committed cellsGrowth factors promote growth but not

    differentiation

    This function done by protein called as

    differentiation inducersFormation of growth and differentiation

    inducers in turn controlled by factors outsidethe marrow like low oxygen tension in case ofRBC and infections in case of WBC

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    Regulation of RBC production Reduced tissue oxygenation - high altitudes,

    destruction of

    marrow,circulation

    disorders

    Erythropoietin

    Principle factorformed in kidney 90 % (renal tubular

    epithelial cells) and also in liver10%

    Effect hypoxia induces production of

    erythropoietin within minutes and RBC

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    Maturation Vitamin B12&

    Folic acidBone marrow cells are most rapidly

    reproducing and growing cells.

    Maturation and rate of production areaffected by nutritional status.

    For maturation Vit B12 and folic acid areneeded

    Both are needed for synthesis of DNA as theyare required in formation of thymidinephosphate which a building block of DNA

    Lack of Vit B12 and folic acid leads to failure of

    nuclear maturation and division

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    Hemoglobin

    Formation begins at proerythroblats andcontinues into reticulocyte stage.

    Steps - 2succinyl CoA + 2glycine -> pyrrole

    4 pyrrole-> protoporphyrine IX

    protoporphyrine IX +Fe -> heme

    heme + polypeptide -> hemoglobin

    chainTypes of hemoglobin chains alpha,beta, gamma chains and delta chains

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    Most common form of hemoglobin is hemoglobina made up of 2 alpha and 2 beta chains

    Fetal hemoglobin ( hemoglobin F) is made up of aalpha and 2 gamma. This type facilitatesmovement of oxygen from maternal to fetalcirculation and is replaced by adult circulation

    soon after the birth.

    There are 4 iron atoms attached in each Hbmolecule

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

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    Iron metabolism.Iron is absorbed from small intestine

    Transported in plasma by formation of

    transferrin and can be released to any tissuecell.

    Excess amount of iron is stored mainly inhepatocytes in the form of ferritine

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    Destruction of RBCLife span of RBC is 120 days

    Metabolic system of RBC become

    progressively less active with time and cellbecome more fragile.

    These fragile cell rupture while passingthrough tight spot in circulation mostly in

    spleen as the spaces between trabeculae is avery small.

    Destruction of hemoglobin hemoglobinreleased during destruction of RBC is

    phagocytized by macrophages, mainly by

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    The iron is released back in circulation bymacrophages

    Which is carried by tranferrin to bone marrowfor reuse or liver and other tissues forstorage.

    The porphyrine portion is converted to

    bilirubin

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    AnemiaAnemia means deficiency red blood cells withreduced oxygen carrying capacity.

    CausesBlood loss acute and chronic

    Nutritional deficiency Iron deficiency

    megaloblastic

    anemiahemolytic anemia Spherocytosis

    sickle cell anemia

    Aplastic anemia - radiation, drugs likechloram henicol

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    LeukocytesGranulocytes - neutrophil, eosinophil,

    basophill

    Agranulocytes lymphocyte and monocyteGranulocyte and monocyte are formed in

    bone marrow

    Lymphocyte are mainly produced in

    lymphogenous organ like thymus, lymphglands and spleen.

    Neutrophil 62%

    Eosinophil 2.3%

    Basophill 0.4%

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    GranulocytesNeutrophil, eosinophil, basophil

    The granules contain biologically active

    substancesMultilobed nucleus no of lobes increases with

    time

    Neutrophil

    Forms 1st line of defense takes part ininflammatory responses

    Average half life is 6 hours

    Neutrophil enter tissue spaces by diapedesis

    One in tissue s aces it moves around in

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    Chemotaxis bacterial toxin, degeneratedproducts, complement complex

    PhagocytosisCellular ingestion of offending agent

    Slective process

    Opsonisation C3 molecule of complementsystem

    Neutrophil attaches itself with to the particlesand then project pseudopodia which meet atopposite side and fuse

    The enclosed chamber is then filled withneutrophillic granule and digested.

    The granules contain defensin which are

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    In addition to this NADPH oxidase is activatedwhich produces large amount of toxic oxygen

    metabolitesAlso myelopeoxidase is discharged which

    produces potent oxidants

    Neutrophil kills bacteria with hydrogenperoxide and hydroxyl ion

    EosinophilLike neutrophil it releases proteins, cytokines

    and chemokines which kills bacteria and alsocauses inflammation

    Active against parasite because of larvacidalpolypeptide called major basic protein

    Numbers increase in aller ic reaction like

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    Basophill

    Releases protein and cytokines

    Resembles mast cells and contains heparinand histamine

    Takes part in in immediate type ofhypersensitive reaction

    Monocytes

    after leaving bone marrow it gets fixed intissue and acts a macrophages

    Skin- histiocyte

    Liver ku ffer cell

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    Combination of monocyte, tissuemacrophage, mobile macrophage and

    specialized cells endothelial cell in marrow,spleen and lymph node is called asreticuloendothelial system

    LymphocyteKey element in production of immunity

    2 types B lymphocyte and T lymphocyte

    Originates from bone marrow and areprocessed in thymus or brusal equivalent

    Located more extensively in lymph nodes alsoin spleen, GIT, bone marrow

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    T lymphocyte

    Processed in thymusProvides cell mediated immunity

    Divide extensively in thymus and developsspecificity against antigens

    This continues till there are differentlymphocyte with specificity against millions ofdifferent antigens

    Now it leaves thymus and gets lodge indifferent lymph node in body

    Once T lymphocyte comes in contact withspecific antigens the same type of

    lymphocytes are produced in large no calledas clone of l m hoc tes

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    T cell marker these are surface receptorproteins present on the T lymphocyte. It is

    highly specific against the antigens

    B lymphocyteDestined to form antibodies

    it is processed in liver during fetal life and inbone marrow after birth

    This population of cell was first seen in birdswhere it is processed in bursa of fabricus and

    thats why it is called as B lymphocyte.

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    Disorders of leucocyte

    Nonneoplastic - Leucopoenia reducednumber

    Leucocytosis increased innumber

    Neoplastic - Malignant lymphoma (hodgkinsand non hodgkins lymphoma)

    Lymphomas are malignant neoplasm of cellnative to lymphoid tissue

    Leukemia's malignant neoplasm of stem cellscharacterized by diffuse replacement of bonemarrow by malignant cells

    Acute acute lymphoblastic and acutemyeloblastic leukemia

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    Platelets

    3oo,ooo/LHalf life about 4 days

    60 75% of platelet are in circulation andremainder are in spleen

    There membrane contain receptor forcollagen , von Willibrand factor and fibrinogen

    Cytoplasm has granules containing nonproteins like serotonin, ADP

    And proteins like clotting factor and PDGF.

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    Platelet production controlled by colonystimulating factor acting on megakaryocye

    And by thrombopoietin a circulating proteinfactor

    When platelet count is low thrombocytopinic

    purpuraWhen circulating platelets are abnormal

    thrombasthenic pupura

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    Blood groups There At least 30 group systems most ofthem are weak

    Two particular types are most likely thanothers OAB and Rh system

    OAB systemThere two antigens A & B occur on the

    surface of RBCThese are also called as agglutinogen

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    Major types

    Type A when agglutinogen A is presentType B when agglutinogen B is present

    Type AB when agglutinogen A & B both arepresent

    Type O when both are absentAgglutinins - antibodies

    when particular type of antigens are missing,antibodies against it develops

    Antibodies are IgM and IgG types

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    Blood type Agglutinogen

    Agglutinin

    O - Anti-A andAnti B

    A A Anti B

    B B Anti A

    AB A and B -

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    Rh blood types

    Difference - Agglutinin are formed instantly inOAB system but in Rh system it is not

    In Rh system there must be massive bloodtransfusion for formation of antibodies.

    Rh positive and Rh negativeSix common type of antigens

    C, D, E, c, d, and e

    The person having C antigen does not have cantigen and vice a versa. Same is true forother antigens

    Type D is widely present and more antigenicthan other Rh factors

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    Therefore person having D antigen is calledas Rh positive and person not having D

    antigen is called as Rh negativeAbout 85% of population is Rh positive and

    15% Rh negative.

    If Rh negative person receives Rh positiveblood for first time then immediate reactionwill not occur.

    Mild reaction develops after 2 to 4 weeks.

    But on subsequent transfusion reaction will begreatly enhanced

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    Erythroblastosis Fetalis

    Rh negative mother having Rh positive child

    First child no does not develop complication

    Second Rh positive child developerythroblastosis fetalis due to presence of

    antibodies in mothers blood which act againstchild's RBC

    Antibody diffuse through placental membraneand causes agglutination

    Jaundice, anemia, kernicterusTreatment replacement with Rh negative

    blood.

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    Blood transfusion Indications2) Acute haemorrhage

    3) Major surgeries4) 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 duringchemotherapy for malignant diseases thereis bone marrow depression

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    Collection of blood

    Screen the donor for diseases which can betransferred through blood like HIV andhepatitis

    Donor lies down sphygmomanometer is

    applied and inflated to 80mm h\Hg 15 gaugeneedle 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 containingtrisodium citrate, citic acid and sodium

    dihydrogen phosphate

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    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 blood7) Warm blood cardiopulmonary operations to

    reduce risk of cardiac arrest

    8)Filtered blood to filter off platelet andleukocyte aggregate

    9) Auto transfusion

    10)Exchange transfusion erythroblastosis

    fetalis

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    Packed red cells chronic anemia, low cardiacreeve. Old patient

    Amount of blood transfusion 500ml of bloodraises 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 platelets5) transmission of diseases

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    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 VIII9) Platelet rich plasma - - thrombocytopinic

    purpura

    10)Fibrinogen stored in powdered form andmixed with distilled water. Used in DIC

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    4) Cryoprecipitate if frozen plasma is allowedto bring at a temperature of 4 degree Celsius

    it divides into precipitate and plasma thisprecipitate is called cryoprecipitate it is a richsource of factor VIII

    Synthetically prepared solutions

    Dextran - increases plasma volume, used inrestoring plasma volume for longer time

    Gelatin- less effective than dexran

    Hydroxyethylstarch- plasma volume expanderFluorocarbons- colorless, odorless, dens liquid

    inert and soluble

    It binds and release oxygen. Also considered as

    red cell substitute

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    Capillary circulationIt is also called a microcirculationTransport of nutrients

    Extremely thin structure with highlypermeable endothelial cells.

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    Structure

    Artery ( Divides 6 8times )

    Arteriole ( Divides 2- 5

    times)

    Meta arteriole

    Capillary

    Preferential arteriole True

    capillaries

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    Structure of capillary wall

    Wall unicellular layer of endothelial cells. Pores intercellular cleft- thin slit between

    endothelial cells .the size is slightly smallerthan albumin protein molecule.

    Special types of pores.5) Brain tight junction of cells Blood- brain

    barrier

    6) Liver- wide open junction so all dissolvedsubstances including plasma protein canpass

    7) In kidney special arrangement for filtering

    the blood

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    Vasomotion

    Flow is not continuous instead it isintermittent

    It is because of contraction of metarteriolesand precapillary sphincters

    Regulation Depends on oxygen demand

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    Lymphatic system

    Accessory rout by which fluid can flow frominterstitial spaces into the blood.

    Carries protein and large particulate matteraway from blood which can not be removed

    by capillariesThis is essential function without which

    person can die in 24 hours.

    Lymph channels of bodyAll lymph from lower part flows up thoracic

    duct and empties into venous system at thejunction of left internal jugular vein and

    subclavian vein

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    Lymph from right side of head , neck rightarm and parts of chest enters right lymph

    duct which empties in to junction betweenright subclavian and internal jugular vein.

    Terminal lymphatic capillaries

    and its permeability1/10th of fluid from capillary system enters

    lymphatic system

    Total quantity is about 3 liters per day.

    This minute quantity is very important as highmolecular weight substances can passthrough easily which can not be reabsorbed inany other way

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    Rate of lymph flow

    100 ml/hour flows through thoracic ductMore the interstitial fluid pressure more is the

    flow

    elevated capillary pressure

    increased capillary permeabilityincreased fluid protein

    Lymphatic pump increases lymph flow valves

    Intrinsic pumping by lymph vessels

    Extrinsic compression by surrounding muscleof body

    movement of body, arterial pulsation,

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    Role of lymphatic

    protein leaks into theinterstitium

    increased osmotic pressure

    fluid is pulled in to interstitium

    this causes raised fluid volumeand pressure

    this leads to increased rate oflymph flow

    and excess fluid and protein is

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    Lymphatic disorders

    Lymphengitis infection spreading intolymphatics mainly caused by beta hemolyticstreptococci

    Lymphedema

    Primary secondaryCongenital Obstruction

    removal

    fibrosis

    filariasis

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