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8/14/2019 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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