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Chapter 3 - Blood
The ninth edition of Physiology and Human Health summarizes the overview of blood physiology, blood cell physiology, physiological hemostasis, blood types and blood transfusion principles. Friends in need hurry up and collect it!
Edited at 2024-02-08 16:19:51
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Chapter 3 - Blood
- Avatar Character Relationship Chart
Avatar 3 centers on the Sully family, showcasing the internal rift caused by the sacrifice of their eldest son, and their alliance with other tribes on Pandora against the external conflict of the Ashbringers, who adhere to the philosophy of fire and are allied with humans. It explores the grand themes of family, faith, and survival.
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- Zootopia 2 Character Relationship Chart
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- Outline
blood
Overview of blood physiology
1. Composition of blood
Blood is composed of plasma and blood cells suspended in it, accounting for 6% to 8% of human body weight.
(1) Plasma
Plasma is a crystalline substance solution, including water and a variety of electrolytes, small molecule organic compounds and some gases dissolved in it.
plasma proteins
albumin
globulin
ɑ-globulin
beta-globulin
γ-globulin
Fibrinogen (biologically inactive)
(2) Blood cells
Classification
red blood cells
leukocyte
platelets
Hematocrit
The percentage of the volume occupied by blood cells in the blood is called hematocrit. Normal adult males are 40% to 50% and females are 37% to 48%.
Hematocrit is approximately equal to hematocrit
Patients with anemia have reduced hematocrit, and the blood hematocrit in large vessels is slightly higher than that in microvessels
2. Physical and chemical properties of blood
(1) Plasma osmotic pressure
The osmotic pressure of a solution depends on the number of solute particles (molecules or ions) per unit volume of the solution, and has nothing to do with the type of solute and the size of the particles.
Osmotic pressure classification
The osmotic pressure formed by crystal substances is called crystal osmotic pressure, 80% of which comes from Na and Cl ions
The osmotic pressure formed by proteins is called colloid osmotic pressure (low osmotic pressure), mainly coming from albumin
Solution classification
Isotonic solution: a variety of solutions used in clinical and physiological experiments whose osmotic pressure is equal to the plasma osmotic pressure Such as 0.9% sodium chloride solution, 5% glucose solution and 1.9% urea solution
Isotonic solution: A solution that maintains the normal shape and size of red blood cells suspended in it Such as 0.9% sodium chloride solution and 5% glucose solution
(2) Plasma pH
The plasma pH of normal people is 7.35~7.45. The buffer substances in the plasma mainly include sodium bicarbonate/carbonic acid (the most important), sodium protein salt/protein and disodium hydrogen phosphate/sodium dihydrogen phosphate.
When the plasma pH is lower than 7.35, it is called acidosis; when it is higher than 7.45, it is called alkalosis.
Organ regulation of acid-base balance
The lungs excrete carbon dioxide (volatile acid) and act only on carbon dioxide
Kidney regulation has a great effect on fixing acid (reabsorbing sodium carbonate and excreting hydrogen ions) but takes effect slowly
blood cell physiology
1. Physiology of red blood cells
(1) Number and shape of red blood cells
The number of red blood cells and hemoglobin concentration are lower in children than in adults
Normal mature red blood cells have no nuclei, are biconcave disc-shaped, and have no mitochondria.
(2) Physiological characteristics and functions of red blood cells
Physiological characteristics
(1) Plastic deformability
The deformability of red blood cells depends on the geometry of the red blood cell (most important), the viscosity within the red blood cell (inversely related) and the elasticity of the red blood cell membrane
The normal biconcave disk shape gives red blood cells a large surface area to volume ratio, which makes red blood cells prone to deformation when subjected to external forces.
(2) Suspension stability
The characteristic that red blood cells can be relatively stably suspended in plasma
Erythrocyte sedimentation rate: The sedimentation speed of red blood cells is usually expressed as the distance that red blood cells sink at the end of the first hour, which is called the erythrocyte sedimentation rate.
The speed of erythrocyte sedimentation rate depends on changes in plasma components and has nothing to do with red blood cells
Usually when the levels of fibrinogen, globulin and cholesterol in plasma increase, they can accelerate cell stacking and sedimentation rate. When the content of albumin and lecithin in plasma increases, it can inhibit the occurrence of stacking and slow down the sedimentation rate.
(3) Penetration brittleness
The characteristic of red blood cells swelling and rupturing in hypotonic saline solution is called erythrocyte osmotic fragility.
Function
①Transport oxygen and carbon dioxide
②Participate in the buffering of acid-base substances in the blood and the clearance of immune complexes
(3) Regulation of red blood cell production
Bone marrow is the only place where red blood cells are produced in adults
1. The production process of red blood cells
Hematopoietic stem cells in red bone marrow first differentiate into erythroid-committed progenitor cells, then pass through the stages of proerythroblasts, proerythroblasts, intermediate erythrocytes, late erythrocytes and reticulocytes, and finally become mature erythrocytes.
Late immature red blood cells no longer divide, the hemoglobin in the cells has reached normal levels, and they have shed their nuclei and become reticulocytes. After reticulocytes enter the blood circulation, they remove residual mitochondria, ribosomes and other organelles through autophagy and develop into mature red blood cells.
2. Substances required for the production of red blood cells
(1) Iron
It is an essential raw material for the synthesis of hemoglobin
Iron deficiency can cause iron deficiency anemia
(2) Folic acid and vitamin B12
Is an important coenzyme required for the synthesis of DNA
Intrinsic factor promotes the absorption of vitamin B12, which can also be converted into tetrahydrofolate to participate in DNA synthesis.
3. Regulation of erythropoiesis
(1) Erythropoietin (EPO)
The kidney is the main site for producing EPO, followed by the liver.
Renal anemia often occurs due to lack of EPO
(2) Sex hormones
Androgens can increase the concentration of EPO in plasma and promote the production of red blood cells
Estrogen can reduce the response of erythroid progenitor cells to EPO and inhibit the production of red blood cells.
2. White blood cell physiology
(1) Classification and number of white blood cells
White blood cells are colorless, nucleated cells that are generally spherical in blood.
Physiological variation
① Newborns have a higher number of white blood cells
②The number of white blood cells is high in women at the end of pregnancy
(2) Physiological characteristics and functions of white blood cells
The characteristics of leukocytes such as deformation, migration, chemotaxis, phagocytosis and secretion are the physiological basis for performing defense functions.
1. Neutrophils
Neutrophils are the major phagocytes in the blood
When infection occurs, neutrophils are the first effector cells to arrive at the inflammatory site. When they begin to phagocytose, they can release substances that attract neutrophils, causing more neutrophils to move toward the inflammatory area.
When neutrophils phagocytose 3 to 20 bacteria, they disintegrate themselves and release various lysosomal enzymes that can dissolve surrounding tissues and form pus.
Neutrophils can also phagocytose and eliminate aging red blood cells and antigen-antibody complexes, etc.
2. Monocytes
Monocytes that enter the bloodstream from the bone marrow are immature cells where they continue to develop into macrophages. Monocytes and macrophages in organs and tissues together constitute the mononuclear phagocyte system
The phagocytosis method of macrophages is self-preserving phagocytosis, which has a stronger phagocytic ability than neutrophils.
3. Eosinophils
When the concentration of glucocorticoids in the blood increases, the number of eosinophils decreases
effect
①The limitation is the role of alkaline granulocytes and mast cells in type I hypersensitivity reactions
②Participate in the immune response to worms
related to the occurrence of asthma
4. Basophils
effect
①The released heparin has anti-coagulant function, which is beneficial to keeping blood vessels open and allowing phagocytes to reach the antigen invasion site and destroy it.
②The released histamine and leukotrienes are involved in allergic reactions
5. Lymphocytes
Examine all the differences externally and examine yourself internally
T cells, produced in the thymus, are mainly related to cellular immunity; B cells, produced in the bone marrow, are mainly related to humoral immunity; NK cells are the executors of the body's innate immunity and can directly kill self-cells or tumor cells infected by viruses.
3. Platelet Physiology
(1) Number and function of platelets
Platelets are small in size, have no nuclei, and are disc-shaped with slightly convex sides.
The number of platelets increases after strenuous exercise and in the second and third trimesters of pregnancy; the number of platelets in venous blood is higher than that in capillary blood
Platelets help maintain the integrity of blood vessel walls
(2) Physiological characteristics of platelets
1.Adhesion
Platelets cannot adhere to normal endothelial cells. When vascular endothelial cells are damaged, platelets can adhere to subendothelial tissue.
2. Release
Substances released by platelets after stimulation (such as ADP, ATP, etc.) can promote further activation and aggregation of platelets and accelerate hemostasis.
3. Gather
The first aggregation phase occurs rapidly and can also be rapidly depolymerized, which is reversible aggregation. The second aggregation phase: occurs slowly but cannot deaggregate, indicating irreversible aggregation.
Low-dose, exogenous ADP induces first aggregation phase High-dose, endogenous ADP induces second aggregation phase
4. Shrink
Platelets have the ability to contract. When the platelets in the blood clot shrink, they can retract the blood clot and form a solid hemostatic thrombus.
5. Adsorption
The surface of platelets can adsorb a variety of coagulation factors in plasma, increasing the concentration of coagulation factors in damaged parts of the vascular endothelium, which is beneficial to blood coagulation and physiological hemostasis.
(3) Production and regulation of platelets
Platelets are small pieces of biologically active cytoplasm that are shed from the cytoplasm of mature megakaryocytes in bone marrow.
Thrombopoietin (TPO) is mainly produced by liver cells and may also be produced in small amounts by the kidneys.
Physiological hemostasis
Under normal circumstances, bleeding caused by damage to small blood vessels will stop on its own within a few minutes. This phenomenon is called physiological hemostasis. Physiological hemostasis is one of the important protective mechanisms of the body.
1. Basic process of physiological hemostasis
1. Vasoconstriction
Cause of shrinkage
① Injurious stimulation reflexively causes vasoconstriction
② Injury to the blood vessel wall causes local vascular myogenic contraction
Vasoconstriction caused by the release of vasoconstrictor substances from platelets adhering to the injured site
2. Formation of platelet hemostatic thrombus
Primary hemostasis mainly relies on vasoconstriction and formation of platelet hemostatic thrombus
3. Blood coagulation
Damage to blood vessels can also activate the coagulation system, causing rapid local blood coagulation, converting soluble fibrinogen in the plasma into insoluble fibrin, and interweaving it into a network to strengthen the hemostatic thrombus, which is called secondary hemostasis. Finally, local fibrous tissue proliferates and grows into the blood clot, achieving permanent hemostasis.
2. Blood coagulation system
Blood coagulation refers to the process in which blood changes from a flowing liquid state to an immobile gel state. Its essence is the process of converting soluble fibrinogen in plasma into insoluble fibrin.
(1) Coagulation factors
Substances in plasma and tissues that directly participate in blood coagulation are collectively called coagulation factors.
Except for FIV, which is Ca2, the other coagulation factors are proteins.
Except for FIII, other coagulation factors exist in fresh plasma, and most of them are synthesized in the liver. The synthesis of FII, FVII, FIX, and FX requires the participation of vitamin K, so they are also called vitamin K-dependent coagulation factors.
(2) Coagulation process (positive feedback)
1. Formation of prothrombinase complex (FⅩa-FⅤa-Ca2-PL)
intrinsic coagulation pathway
It means that all the factors involved in coagulation come from the blood and are usually initiated by contact between the blood and the surface of a negatively charged foreign body.
Initiation factor FⅫ has a large number of enzymes involved and slows blood coagulation.
Mainly plays the role of maintaining and consolidating blood coagulation
extrinsic coagulation pathway
The coagulation process initiated by exposure of tissue factors from outside the blood to the blood
Initiation factor FIII has a small number of participating enzymes and a fast coagulation speed.
Mainly plays a role in initiating coagulation
2. Activation of prothrombin
3. Production of fibrin
3. Anticoagulation system
(1) Cellular anticoagulation system
vascular endothelium
Prevent coagulation factors, platelets from coming into contact with subendothelial components, thereby avoiding activation of the coagulation system and activation of platelets
mononuclear phagocyte
Activated coagulation factors entering the circulation can be phagocytosed by mononuclear phagocytes
(2) Body fluid anticoagulation system
serine protease inhibitor
Mainly antithrombin
heparin
It enhances the affinity between antithrombin and coagulation factors, rapidly inactivates activated coagulation factors, and has a strong anticoagulant effect in vitro.
tissue factor pathway inhibitor
Protein C system
4. Fibrinolytic system (prefeedback)
The process of fibrin being broken down and liquefied is called fibrinolysis, or fibrinolysis for short.
(1) Activation of plasminogen
(2) Degradation of fibrin and plasminogen
(3) Fibrinolysis inhibitors
Blood types and blood transfusion principles
1. Blood type and red blood cell agglutination
Blood type: usually refers to the type of specific antigen on the red blood cell membrane. This antigen is a polymorphic antigen controlled by germline genes, called blood group antigen.
Generalized blood group: specific antigen type on the blood cell membrane, roughly divided into red blood cell blood group, white blood cell blood group and platelet blood group
The essence of red blood cell agglutination is antigen-antibody reaction
2. Red blood cell blood type
(1) ABO blood type
1.ABO blood group typing
Blood can be divided into four ABO blood types based on the presence of A and B antigens on the red blood cell membrane.
Type A blood: contains only A antigen
A1 blood type: has both A and A1 antigens
A2 blood type: has A antigen but no A1 antigen
Blood type B: only contains B antigen
AB blood type: has both A and B antigens
A1B blood type: has A, A1, and B antigens
Pay attention to the presence of A2 and A2B subtypes during blood transfusions
A2B blood type: has A and B antigens but no AI antigen
Type O blood: has neither A nor B antigens
2. Antigens of the ABO blood group system
A and B antigens are formed on the basis of H antigen
3. Antibodies of the ABO blood group system
Blood type antibodies include natural antibodies and immune antibodies. Natural antibodies exist in the ABO blood group system. Natural antibodies are mostly IgM, which have large molecular weight and cannot pass through the placenta.
Antibodies of the ABO blood group system begin to be produced 2 to 8 months after birth and peak at 8 to 10 years old.
4.Heredity of ABO blood type
A and B genes are dominant genes, and O gene is recessive gene.
In forensic medicine, when judging parent-child relationship based on blood type, only a negative judgment can be made but not a positive judgment can be made.
5. Identification of ABO blood type
Forward typing: Use anti-A and anti-B antibody tests to check for the presence of A or B antigens on the red blood cell membrane
Reverse typing: using red blood cells of known blood types to detect the presence of anti-A or anti-B antibodies in the serum
The purpose of performing forward and reverse typing at the same time is to confirm each other. Since the serum in the newborn's blood comes from the mother, only forward typing is performed during newborn blood group identification.
(2) Rh blood type
1. Antigens and typing of Rh blood group system
In medicine, people who contain D antigen on red blood cells are usually called Rh positive; while people who lack D antigen on red blood cells are called Rh negative.
Rh antigen only exists on red blood cells and is already mature at birth
2.Characteristics and clinical significance of Rh blood type
There are no natural Rh antibodies in human serum. Only when Rh-negative people receive Rh-positive blood will they produce Rh immune antibodies through humoral immunity.
Therefore, Rh-negative blood recipients generally do not have an obvious transfusion reaction when they receive Rh-positive blood for the first time, but when Rh-positive blood is transfused for the second or multiple times, an antigen-antibody reaction can occur. The red blood cells of Rh-positive blood will be destroyed and hemolysis will occur.
Anti-Rh antibodies are IgG antibodies that can enter the fetal blood through the placenta, causing hemolysis of the fetal red blood cells, causing neonatal hemolytic anemia, and in severe cases can lead to fetal death.
When an Rh-negative mother carries her first Rh-positive fetus, neonatal hemolysis rarely occurs. However, in the second pregnancy, the anti-Rh antibodies in the mother can enter the fetus and cause neonatal hemolysis.
If an Rh-negative mother promptly infuses specific anti-D immune globulin after giving birth to her first child, it can neutralize the D antigen entered by the mother to avoid sensitization of the Rh-negative mother and prevent neonatal hemolysis in the second pregnancy.
3. Blood volume and blood transfusion principles
(1) Blood volume
Store blood volume
circulating blood volume
(2) Principles of blood transfusion
① Before blood transfusion, blood type must be identified and cross-matched
Cross-match blood test: the blood donor's red blood cells and the recipient's serum are combined in the experiment
Secondary cross-matching: Matching the recipient’s red blood cells with the donor’s serum
② Same-sex blood transfusion, heterotype blood transfusion with caution
If agglutination does not occur on both the primary and secondary sides, blood transfusion can be performed; if agglutination occurs on the primary side, blood transfusion cannot be performed; if there is no agglutination on the primary side but agglutination on the secondary side, blood transfusion is restricted.
① A small amount; ② The antibody titer in the serum should not be too high; ③ The blood transfusion speed should not be too fast; ④ Pay attention to the reaction of the blood recipient. If a blood transfusion reaction occurs, stop the blood transfusion immediately.
③Promote component blood transfusion and autologous blood transfusion
clinical knowledge
In liver disease, albumin decreases and γ-globulin increases, often causing a decrease in the plasma albumin/globulin ratio.