hematology - mt. sac
TRANSCRIPT
HEMATOLOGY
PhysiologyUnit3
RegulationofErythrocyteProduction
• Erythropoietin– Secretedbykidney,liver– Actsonbonemarrowtostimulateproductionoferythrocytes
– IncreasedsecretionwhenlessO2 deliveredtokidneys
– Testosteronealsostimulatesreleaseoferythropoietin
Leukocytes
• Producedbybonemarrow• Monocytesandmanylymphocytesundergofurtherdevelopmentoutsidethebonemarrow
Platelets
• Fragmentsoflargecellscalledmegakaryocytes
• Involvedinbloodclotting
• Clotformationcannotoccurwithoutplatelets
BloodCellProduction
Hemostasis
• Preventionofbloodloss(stoppageofbleeding)• Injuriestosmallvessels(arterioles,capillaries,venules)• Immediateresponsetoinjuryisvasoconstriction– Reducesflowtothearea– Pressestogetherthesidesoftheendothelium
• Inducesstickiness• “glues” theendotheliumtogether
• Requires2processes1. Plateletplugformation2. Bloodcoagulation(clotting)
FormationofaPlateletPlug1. Plateletadhesion
– Exposedcollageninconnectivetissue
– vonWillebrandfactor• Secretedbyendothelialcellsandplatelets
2. Triggersplateletactivation– Releasecontentsofsecretory
vesiclesthatactlocally
3. Triggersplateletaggregation– Formationofplateletplug
PlateletPlugLocalization
• Adjacent,undamagedendothelialcellsreleaseprostacyclin(PGI2)– Stronginhibitorofplateletaggregation
• Adjacent,undamagedendothelialcellsalsoreleaseNO– Vasodilator– Inhibitsplateletadhesion,activationandaggregation
BloodCoagulationClotFormation
• Thetransformationofbloodintoasolidgelcalledaclot orthrombus– Consistsmainlyoffibrin
• Clottingoccurslocallyaroundtheplateletplug• Functionistosupportandreinforcetheplateletplugandtosolidifybloodthatremainsinthewoundchannel
ClottingPathwayRoleofThrombin
• Cascadeofeventsleadstotheconversionofprothrombin (plasmaprotein)tothrombin
• Thrombincatalyzesthesplitoffibrinogen toloosefibrin– Fibrinnetworkthenbecomesstabilized
• Thrombinalsostimulatesplateletactivation
ClottingPathway
ClottingPathwayRoleofPlatelets
• Clottingcannotoccurintheabsenceofplatelets
• Activatedplateletsareessentialbecauseseveralofthecascadereactionstakeplaceonthesurfaceofactivatedplatelets
• Activatedplateletsdisplayspecificmembranereceptorsthatbindseveraloftheclottingfactorswhichpermitsthereactionstooccur
ClottingPathway
• Intrinsicpathway– Everythingnecessaryforthispathwayisintheblood
• Extrinsicpathway– Acellularelementoutsidethebloodisneeded
– Tissuefactor• Notaplasmaprotein• Locatedontheouterplasmamembraneoffibroblasts
Thrombin Burst
DissolvingtheClotFibrinolyticSystem
• Afibrinclotisatemporaryfixuntilthebloodvesselisrepaired
• Plasminogen isactivatedtoplasmin
• Plasmin digestsfibrinwhichdissolvestheclot