anatomy fisiology hematology

8/11/2019 Anatomy Fisiology Hematology

1/57

By: Ns. YULIA

PRODI S1 ILMU KEPERAWATAN

STIKES KEPANJEN

2014


2/57

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

.


3/57

1.Blood- function

Blood is a type of liquid

connective tissue.The major function of blood

is transport.


4/57

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


5/57

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.


6/57

Blood

Blood as a system

Blood Organs for haemopoiesis Regulatory

(peripheral and destruction of apparatus

& circulating) blood (nervoushumoral)


7/57

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.


8/57

Blood composition

Blood consists of

liquid plasma

(volume-55-60%)

formed elements (cells)

(volume-40-45%)


9/57


10/57

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


11/57

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.


12/57

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.


13/57

Haemopoiesis


14/57

Blood Composition


15/57

Regulation of haemopoiesis

Humoral regulation by hormones:

Erythropoietin

Leucopoietin

Thrombopoietin

These hormones are produced by kidney

and liver.


16/57

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


17/57

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++)


18/57

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.


19/57

Tonicity effects


20/57

Blood plasma

The organic components of plasma

include :

proteins

lipids

carbohydrates


21/57

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)


22/57

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.


23/57

Blood Composition


24/57

Serum

When fibrinogen is removed from

plasma as a result of coagulation,

such plasma without fibrinogeniscalled serum.


25/57

3.Physico-chemical constants of blood

Osmotic pressure

Oncotic pressure Blood pH

Viscosity

Specific gravity

Erythrocyte sedimentation rate(ESR)


26/57

Osmosis

Osmosis

-movement of water from higher

concentration to lower concentration.(or)

-movement of dissolved substances

from lower concentration to higherconcentration.


27/57

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.


28/57

Osmotic pressure


29/57

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


30/57

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


31/57

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

)


32/57

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


33/57

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


34/57

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


35/57

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.


36/57

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.


37/57

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.


38/57

RBC Count

Normal range :

In male : 4.0-5.0 1012

/L

In female : 3.5-4.5 1012/L


39/57

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.


40/57

RBCs - FunctionsThe haemoglobin is an excellent acid-

base buffer.

Maintanence of acid-base balance.Blood group determination.


41/57

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.


42/57

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.


43/57

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)


44/57

Red Blood Cells-Pathological shapes


45/57

Red Blood Cells-Pathological forms


46/57

Erythrocytosis - Polychythemia)

If the erythrocyte count is more than normal,

such state is called erythrocytosis.

Erythrocytosis

Physiological Pathological


47/57

Erythrocytosis

Physiological Pathological

Absolute Primary- In high altitude. -Bone marrow

disorder.

Relative Secondary

-Exercises. -due to any CV or

respiratory disease.


48/57

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


49/57

Erythropenia Physiological Pathological

Absolute Primary- Deficiency of -Bone marrow

production disorder.

Relative Secondary

- Pregnancy -due to any kidney

(RBC dissolves in fluid) disease.


50/57

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


51/57

Erythrocyte Sedimentation Rate ESR)Factors influencing the ESR :

Plasma proteins mainlyfibrinogen and globulin

negative charge of the

erythrocytes(zeta potential)


52/57

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.


53/57

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).


54/57


55/57

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).


56/57

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


57/57

Have a Nice Study

anatomy fisiology hematology

Documents