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8/11/2019 Anatomy Fisiology Hematology
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By: Ns. YULIA
PRODI S1 ILMU KEPERAWATAN
STIKES KEPANJEN
2014
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PREFACE Hematology is defined as the study of blood (its blood
forming tissues) and its components.
blood has been referred to by some asthe river of life
.Additionally, because routine examination of the blood
by means of the complete blood count (CBC) is the most
widely performed test in the clinical laboratory and has
also been referred to asa window on the body
.
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1.Blood- function
Blood is a type of liquid
connective tissue.The major function of blood
is transport.
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Subfunctions
Respiration :
-if oxygen and carbon dioxide are transported
Trophic :
-when the nutrient materials are delivered to
the tissues
Excretive :
-when the metabolites are delivered from
tissues to excretory organs
Regulative :
-if the hormones and BAS are transported
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Subfunctions
Homeostatic :
- maintenance of water content and acid-
base balance
Protective :
- immunity and non-specific resistance;
- blood coagulation
Maintenance of body temperature :
-as a result of a redistribution of blood
volume between skin and the internal organs at high
and low temperature of external environment.
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Blood
Blood as a system
Blood Organs for haemopoiesis Regulatory
(peripheral and destruction of apparatus
& circulating) blood (nervoushumoral)
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Blood
The total blood volume makes upabout 6-8 percent of the bodysweight.
Accordingly, a 70-kilogram personwill have 5 to 6 litres of blood.
Circulating blood volume will be lesser
than total blood volume, because someamount of blood will be deposited inorgans like liver.
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Blood composition
Blood consists of
liquid plasma
(volume-55-60%)
formed elements (cells)
(volume-40-45%)
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Hematocrit
The hematocrit , alsoknown as packed cell
volume (PCV)
or erythrocyte volume
fraction (EVF), is the
volume percentage (%)
of red blood cells in the
blood. It is normallyabout
40-48% for men and
36-42%for women
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Hematocrit
If a portion of blood is centrifuged or
allowed to stand for a sufficient long
time, it will be found that the bloodcells will settle towards the bottom of
the test tube while the plasma remains
on top.By this means the percentage of blood
cells in whole blood can be determined.
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Haemopoiesis
Haemopoiesis is the formation
of blood cellular components. All cellular
blood components are derivedfrom pluripotent haemopoietic stem cells
which is present in the bone marrow.
In a healthy adult person, approximately
10111012new blood cells are produced daily inorder to maintain steady state levels in the
peripheral circulation.
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Haemopoiesis
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Blood Composition
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Regulation of haemopoiesis
Humoral regulation by hormones:
Erythropoietin
Leucopoietin
Thrombopoietin
These hormones are produced by kidney
and liver.
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2. Blood plasma
Composition :
90-92% of water
8-10% of dry substancemainly consisting from proteins (6-
8%)
Dry substance includes :inorganic (mineral)
organic components
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Blood plasma
The main (inorganic) mineral components :
(0.9-1.5 %):
Cations : Anions :
Sodium (Na+), Chlorides(Cl
)
Potassium (K+), Phosphates (PO4
)
Calcium (Ca++),
Bicarbonates(HCO3
)
Magnesium (Mg++)
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Blood plasma
A solution with the same salt
concentration 0.9% is named isotonic
solution. If salt concentration more than 0.9%
such solution is called hypertonic.
If salt concentration is less than 0.9% hypotonic solution.
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Tonicity effects
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Blood plasma
The organic components of plasma
include :
proteins
lipids
carbohydrates
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Plasma proteins and their role
Plasma proteins include :
Albumin - Transportation
(65-85 g/l) Regulation of oncotic pressureRegulation of pH
Globulin -
(28 g/l) - Transportation
- Defense
Fibrinogen - Blood clotting (haemostasis)
(3 g/l)
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Lipids and carbohydrates in plasma
The major plasma carbohydrate is glucose
(3.3-5.5 mmol/L) .
Plasma normally contains varying amountsof hormones, enzymes, pigments, and
vitamins.
The composition of plasma varies with the
bodys activity and different physiologicalstates.
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Blood Composition
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Serum
When fibrinogen is removed from
plasma as a result of coagulation,
such plasma without fibrinogeniscalled serum.
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3.Physico-chemical constants of blood
Osmotic pressure
Oncotic pressure Blood pH
Viscosity
Specific gravity
Erythrocyte sedimentation rate(ESR)
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Osmosis
Osmosis
-movement of water from higher
concentration to lower concentration.(or)
-movement of dissolved substances
from lower concentration to higherconcentration.
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Osmotic pressure 7.6 atm)
Osmotic pressure :
-is defined as the minimum amount of
pressure needed to prevent osmosis.
Dissolved particles maintain the osmotic pressure.
Among them, the most active is
-NaCl (0.9 % isotonic)
- and also glucose (5 % isotonic).
In hypotonic solution
- swelling and bursting occurs.
In hypertonic solution
- shrinkage occurs.
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Osmotic pressure
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Oncotic pressure
Oncotic pressure, or colloid osmotic pressure,is a form of osmotic pressure exerted by bloodplasma proteins. It usually tends topull water (fluid) into the circulatorysystem(capillaries).
It is the opposing force to hydrostatic pressure
Its normal value is :
0.03-0.04 atm(or)
20-25 mm Hg
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pH of blood
pH is a measure of the acidity or basicity of
an aqueous solution.
It is the negative decimal logarithm of hydrogenconcentration
Normal pH of blood is :
(arterial blood) 7.45 7.35 (venous blood)
If pH is less than 7.3 , it is acidosis
If pH is more than 7.5, it is alkalosis
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pH of bloodpH is maintained by :
The excretion of carbon dioxide by the lungs
The excretion of H+or OH- by the kidneys.
By the action of buffer system
Carbonate Phosphate ProteinHaemoglobin
( HA H
+ A
)
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Viscosity
Blood viscosity can be described as the thicknessand stickiness of blood.
It is a measure of the resistance of blood to flow.
The viscocity of blood is 5 times more than that ofwater
(based on time taken for the flow of both in atube)
It depends on :
RBCs
Plasma proteins
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Specific gravity
Specific gravity is the ratio of
the density of a substance to the density
of a reference substance. Specific gravity is also called relative
density.
Blood normally has a specific gravity of:
1.05 - 1.06 g/L
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Specific gravity Specific gravity depends on :
RBCs Plasma proteins
The higher the concentration of RBCs and plasma
proteins, higher will be the specific gravity.
1.03 1.04 1.05 1.06
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4. Erythrocytes
Red blood cells, or erythrocytes, are the
most abundant type of blood cell.
Approximately 2.4 million newerythrocytes are produced per second.
Approximately a quarter of the cells in
the human body are red blood cells.
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Erythrocytes -Structure
In humans, mature red blood cells are
oval biconcave disks and they are
flexible.
A typical human erythrocyte has a disk
diameter of approximately 6.28.2 m
They lack a cell nucleus and
most organelles, in order toaccommodate maximum space for
haemoglobin.
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Erythrocytes
Since RBCs have a elastic membrane, theyare able to change their shape when theypass through the capillaries.
The cells develop in the bone marrow andcirculate for about 100120 days in the bodybefore their components are recycledby macrophages.
Human red blood cells take on average20 secondsto complete one cycle ofcirculation.
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RBC Count
Normal range :
In male : 4.0-5.0 1012
/L
In female : 3.5-4.5 1012/L
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RBCs - Functions
The major function of these cells is a transport
of haemoglobin, which in turn carries oxygen
from lungs to the issues
Red blood cells contain carbonic anhydrase,
which catalyzes the reaction between carbon
dioxide and water, that has a significance in
transporting carbon dioxide (CO2) fromtissues to lungs.
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RBCs - FunctionsThe haemoglobin is an excellent acid-
base buffer.
Maintanence of acid-base balance.Blood group determination.
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Erythropoiesis
Erythropoiesis is the process by which red
blood cells (erythrocytes) are produced.
It is stimulated by decreased O2 in
circulation, which is detected by the kidneys,which then secrete the
hormone erythropoietin.
The whole process lasts about 7 days. Throughthis process erythrocytes are continuously
produced in the red bone marrow of large
bones, at a rate of about 2 million per second
in a healthy adult.
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Erythropoiesis
Mature red blood cells live in blood circulation for about 100 to 120days. At the end of their lifespan, they become senescent, and are
removed from circulation by the macrophages. This process is termed
eryptosis, erythrocyte programmed cell death.
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Red Blood Cells
According to size:
Normocytes - Normal sized RBCs
Microcytes - Small sized RBCs
Macrocytes - Large sized RBCs
According to colour:Normochromia - Normal coloured RBCs
Hyperchromia - Darker,due to increased hemoglobin
Hypochromia - Paler, due to decreased hemoglobin
They are determined by measuring the :
Mean corpuscular haemoglobin (MCH)Mean corpuscular haemoglobin concentration
(MCHC)
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Red Blood Cells-Pathological shapes
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Red Blood Cells-Pathological forms
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Erythrocytosis - Polychythemia)
If the erythrocyte count is more than normal,
such state is called erythrocytosis.
Erythrocytosis
Physiological Pathological
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Erythrocytosis
Physiological Pathological
Absolute Primary- In high altitude. -Bone marrow
disorder.
Relative Secondary
-Exercises. -due to any CV or
respiratory disease.
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Erythropenia
If the erythrocyte count is less than normal,
such state is called erythropenia.
A deficiency in number of RBCs or reduced
haemoglobin levels in RBCs is known asanaemia.
Erythropenia may be because of :
Problems in production
Excessive destruction (haemolysis)
Blood loss
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Erythropenia Physiological Pathological
Absolute Primary- Deficiency of -Bone marrow
production disorder.
Relative Secondary
- Pregnancy -due to any kidney
(RBC dissolves in fluid) disease.
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5.Erythrocyte Sedimentation Rate ESR)
The erythrocyte sedimentation rate (ESR), is
the rate at which red blood cells sediment in a
period of one hour.
RBC and plasma will be separated.
It is a common hematology test.
Normal values :
Men - 2-10 mm/hr
Women - 2-15 mm/hr
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Erythrocyte Sedimentation Rate ESR)Factors influencing the ESR :
Plasma proteins mainlyfibrinogen and globulin
negative charge of the
erythrocytes(zeta potential)
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Erythrocyte Sedimentation Rate ESR)
Increased ESR may be due to :
Pregnancy
Inflammation
Cancer.
Decreased ESR may be due to :
Polycythemia
Sickle cell anemia
Hereditary spherocytosis
Congestive heart failure.
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6.Haemolysis of RBCs, its types
Haemolysis is the rupturing of
erythrocytes and the release of their
contents (cytoplasm) into surroundingfluid (blood plasma).
Hemolysis may occur in vivo or in
vitro (inside or outside the body).
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Types of haemolysis
Types of haemolysis :
Intrinsic - Due to problems within the RBC
Physical - Radiation injury
Osmotic - In hypotonic solution
Mechanical - Due to pressure
Thermal - Due to heat
Biological - Blood transfusion, poisonChemical - Due to drugs
Extrinsic - Antibodies against
RBC(Immunological).
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Osmotic resistance of RBCs
Concentration at which complete
hemolysis of erythrocytes occurs
Normal value 0.35 - 0.45%
Due to elasticity of erythrocyte's
membrane
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