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Blood mind map
This is a mind map about blood, mainly including blood, red blood cells, white blood cells, physiological hemostasis, blood types and blood transfusion, etc.
Edited at 2024-03-02 20:28:05
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Blood mind map
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- Outline
Physiological hemostasis
blood
composition
blood cells
RBC 99%
Male: 120~160g/L
Female: 110~150g/L
Pregnant women: >100g/L
Transport O2, CO2, acid-base buffering, immunity (complement C3b)
WBC 0.1%: 4~10
PLT: 100~300
Hematocrit: The volume percentage of blood cells in the blood
plasma
composition
Water (mainly), electrolytes (same as tissue fluid), protein
pro: intracellular fluid 63%, extracellular fluid 16% (plasma 16%, interstitial fluid 0)
Plasma protein 65～85g/L
White/albumin 40～48g/L
Liver synthesis, liver disease→Albumin↑
Globulin 15～30g/L
α1, α2
β
Gamma-globulin (gammaglobulin)
plasma cell synthesis
MM disease→ ↑
A/G=1.5~2.5, the ratio decreases in liver disease
Function
Form plasma colloid osmotic pressure (albumin) to maintain water balance inside and outside blood vessels;
Maintain plasma pH
transport function
nutritional effect
Anticoagulant, fibrinolytic effect
catalysis
Immune Function
Function
transportation
adjust
buffer
defense
HP
Circulating blood volume: cardiovascular system, fast
Blood storage volume: liver and lungs, abdominal cavity V, subcutaneous V plexus, chronic
The total blood volume of a normal person accounts for 7% to 8% of the body weight.
Physical and chemical properties
blood specific gravity
whole blood specific gravity
There are many red blood cells and the specific gravity of blood↑
plasma specific gravity
There are many plasma proteins and the specific gravity of plasma↑
red blood cell specific gravity
More hemoglobin, specific gravity ↑
Relative density
Whole blood relative density depends on red blood cells Plasma relative density depends on plasma proteins Relative density of red blood cells depends on hemoglobin
viscosity
Whole blood viscosity (4~5)-hematocrit
Plasma viscosity (1.6~2.4)--plasma protein concentration
plasma osmolarity
Osmotic pressure depends on the number of solute particles and has nothing to do with the type and size of the solute particles.
composition
Plasma crystalloid osmotic pressure (98.5%): 80% NaCl - intracellular and intracellular water balance
Plasma colloid osmotic pressure (1.5%): 75~80% albumin - water balance inside and outside blood vessels
size
Colloidal osmotic pressure: intracellular fluid > plasma > tissue fluid
Crystal osmotic pressure: tissue fluid = plasma > intracellular fluid
Blood pH (7.35~7.45)
buffer pair
In plasma (external fluid--high sodium)
NaHCO3/H2CO3--most important
protein sodium salt/protein
Na2HPO4/NaH2PO4
Within red blood cells (high potassium)
Hbk/Hb
growth of blood cells
Hematopoietic stem cells (bone marrow)
Myeloid system (granule system)
granule - single core
Primitive grain→early grain→medium grain→late grain
acidophilic
Basophilic system
Red series
Early young red→medium young red→late young red→reticuline red→mature red blood cells
Megakaryon
Protomegalonucleus→young megakaryon→mature megakaryon (late megakaryon)→platelets
lymphatic system
B lymphocytes-humoral immunity
T lymphocytes - cellular immunity
NK cells (natural killer cells)
acute leukemia classification
M0--Undifferentiated type: primitive cells >30%
M1--minimally differentiated type: blasts >90%
M2--partially differentiated type: blasts (30%~90%)
M3--early grain＞30%
M4--Granulocyte-Mononuclear: granulocytes ≥20%, monocytes ≥20%
M5--monocytes ≥30%
M6--red blood cells ≥30%
M7--megakaryocytic leukemia
red blood cells
Double concave disc shape, diameter 7~8 μm
ATP is required to maintain shape, glycolysis is the only energy source; no nucleus or mitochondria
red blood cell count
Male: (4.5~5.5) x1012/L average 5
Women: (3.8~4.6) x1012/L average 4.2
hemoglobin concentration
Male: 120 ~ 160g/L
Women: 110~ 150g/L
Women's plasma increases in late pregnancy, and RBCs per unit volume decrease relatively.
Physiological properties
Plastic deformability
Allows red blood cells to pass through capillaries/splenic sinusoids with smaller diameters than others
Hereditary spherocytosis → Surface-to-body ratio ↓ → Plastic deformability ↓ → Destructive hemolysis (extravascular) when passing through the splenic sinus → Jaundice
Factors affecting deformability
Surface area/volume: The larger the value, the stronger the deformation ability.
The higher the viscosity, the smaller the deformation ability
cell membrane elasticity
Suspension stability/erythrocyte sedimentation rate (ESR)--inverse ratio
RBC sedimentation rate/erythrocyte sedimentation rate ESR: the distance RBC sinks in the plasma at 1h (erythrocyte sedimentation rate)
Red blood cell stacking → surface-to-body ratio ↓ → friction force ↓ → ESR ↑ (suspension stability ↓)
Factors affecting erythrocyte sedimentation rate depend on plasma composition
Cholesterol, globulin, fibrinogen--ESR↑
Albumin (negatively charged), lecithin--ESR↓
Active tuberculosis, rheumatic fever--ESR↑
Osmotic fragility
The ability of red blood cells to absorb water and rupture in hypotonic solutions
The lower the resistance, the higher the brittleness
0.42% NaCl: RBC begins to rupture and hemolysis → Hb overflows, leaving empty shells (ghost cells)
Leftover ball → surface-to-body ratio ↓ → osmotic fragility ↑ → prone to rupture and hemolysis
Production of red blood cells--Hb (hemoglobin/hemoglobin)
basic raw materials
protein
Fe2
Absorption: duodenum
Promote maturation
folic acid
VitB12
Ileal absorption
One carbon unit→Nucleotide→DNA/RNA→Hb
Subtotal gastrectomy-parietal cells
Hydrochloric acid promotes the absorption of iron--iron deficiency (old core and young pulp)
Intrinsic factor promotes the absorption of VitB12 (ileum)--megalophilia (nuclear and cytoplasmic aging)
regulator
Promote
EPO
Promote the proliferation of early and late erythroid progenitor cells and differentiate into morphologically identifiable precursor cells, accelerate the proliferation and differentiation of precursor cells, promote the release of reticulocytes, and maintain a stable number of RBCs in the blood
Synthesis: Renal cortex, peritubular interstitial cells, hepatocytes, macrophages (synthesized in small amounts)
Renal insufficiency→renal anemia
androgens
thyroid hormone
growth hormone
Explosive Boost Activator BPA
glycoprotein A major regulator of proliferation of early erythroid hematopoietic progenitor cells
inhibition
Estrogen
destruction of red blood cells
Lifespan: 120d
destroy
Extravascular (90%)-phagocytosis by macrophages
Splenic sinus (main)
marrow
Intravascular (10%)--mechanical impact
Acute hemolysis caused by mismatched blood transfusion→Hb ↑
leukocyte
Classification and functions of white blood cells
(4.0~10.0)x109/L, no significant difference between men and women
N：50% ~ 70%
Phagocytosis kills pathogenic microorganisms and regulates inflammatory responses
The first line against purulent bacterial infection
Contains lysosome that dissolves surrounding tissue to form an abscess
Phagocytosis and removal of senescent RBC, Ag-Ab, and necrotic cells
E：0.5% ~ 5%
eosinophilic granules
Contains peroxidase, alkaline protein, no lysozyme
No bactericidal effect
Limiting the role of basophils and mast cells in immediate allergic reactions
Involved in immune response to worms, parasitic infections, allergic reactions
Less in the morning and more at midnight: GC increases and E decreases
B：0%~1%
Alkaline dye particles
Releases various biologically active substances such as heparin, histamine, eotaxin A and leukotriene
Histamine and Leukotrienes Linked to the Development of Allergic Reaction Symptoms
Anticoagulant, immediate allergic reaction
M: 3%~8%
Monocytes have weak phagocytic ability, and after differentiation into macrophages, the phagocytic ability is even stronger than that of N
1. Clear and phagocytose senescent RBCs, PLTs, and pathogenic microorganisms (lysosomal enzymes)
2. Participate in the specific immune function of activated lymphocytes
L：20% ~ 40%
T cells: myelopoiesis, thymus maturation
B cells: humoral immunity
Natural killer cells: related to innate immunity
Physiological properties
deformability
ooze
Except for lymphocytes, all white blood cells can extend pseudopods and make deformation movements through capillary walls.
migratory
Chemotaxis
The movement of white blood cells toward certain chemicals
Chemokines
Chemical substances that attract white blood cells to cause directional movement
Devour
PLT
Number of forms
A small piece of biologically active cytoplasm shed by mature megakaryocytes in the bone marrow.
No nucleus, double-sided disc shape, diameter 2 ~ 4μm
(100~ 300) x109/L
<50: Massive purpura/ecchymosis
Physiological properties
stick
vWF is the bridge between platelets adhering to collagen fibers
gather
activator
Physiological: ADP, AD, 5-HT, histamine, collagen, thrombin, TXA2, etc.
TXA2: Reduce cAMP concentration and promote PLT aggregation
Aspirin: inhibits TXA2 and inhibits PLT aggregation
Pathological: bacteria, viruses, immune complexes, drugs
Inhibitors: PG, NO
two phases
First phase/reversible phase aggregation: low concentration ADP
Second phase/irreversible phase aggregation: high concentration ADP
freed
Platelets are stimulated to excrete substances stored in dense bodies, α-granules or lysosomes
α-granule: vWF, coagulation factor, platelet-derived growth factor, transforming growth factor β, thrombospondin, etc. Dense body: ADP, ATP, 5-hydroxytryptamine (5-HT), Ca2
shrink
contractile protein
Increased Ca concentration causes PLT contraction
Adsorption
Adsorb coagulation factors in plasma → stop bleeding
Function
Maintain the integrity of blood vessel walls
PLT can fill the gaps where endothelial cells have fallen off in blood vessel walls
Physiological hemostasis
Participate in blood coagulation
Participate in the activation of II and X
Adsorb coagulation factors and accelerate coagulation
Contains contractile proteins that can shrink blood clots
Inhibits (PF6) and promotes (5-HT) fibrinolysis
platelet regulation
Thrombopoietin (TPO) is the most important physiological regulator of platelet production.
Megakaryocyte colony-stimulating factor Meg-CSF
destruction of platelets
Lifespan: 7~14d
Physiological hemostasis
basic process
vasoconstriction
damage stimulus
Platelets release vasoconstrictor substances: TXA2, 5-HT
myogenic contraction
Platelet thrombosis (initial hemostasis)
stick
Bridge -- vWF: Deficiency → Von Willebrand Disease
gather
Aggregation between GPIIb/IIIa on platelet surface
Deficiency → Thrombocytthenia
Bridge--fibrinogen
Blood coagulation (reinforcement of hemostasis)
Blood changes from a flowing liquid state to an immobile gel state
Essence: soluble fibrinogen → insoluble fibrin
Coagulation factors: directly involved in blood coagulation
FⅠ-fibrinogen
FⅡ--prothrombin
FIII--tissue factor (phospholipid protein)
FIV--Calcium ion (promotes coagulation)
1. Except III, all are in plasma and synthesized by liver 2. Most F exists in the form of inactive zymogens
coagulation process
Formation of prothrombin activator → formation of prothrombin → fibrin production
Prothrombinase complex (Xa)
intrinsic pathway
12 and 11 go into 9 and 8, just ten and five (2, 1)
e.g. Damage to the intima of blood vessels or situations where blood is drawn out and placed in a glass tube
Surface activation stage 12→11
12a can activate PK to become kallikrein and positive feedback promotes the formation of 12a
12a activate 11
Phospholipid surface stage 11→2
8a: Cofactor, which accelerates the activation of factor X
8, 9, 11 defects → hemophilia A, B, C
Fibrin formation stage 2→1
extrinsic pathway
Tissue factor pathway of coagulation, 3, 7, 10, 5 only (2, 1)
Tissue factor is the initiator of physiological coagulation reaction;
Coagulation in the body is mainly through the exogenous pathway
Plasma & Serum
Serum increases substances released by platelets during coagulation
Serum lack of coagulation factors 2, 5, 8, 13 and other factors
anticoagulation system
endothelial anticoagulation
Barrier effect to prevent contact between coagulation factors, platelets and subendothelial components
Vascular endothelial cells release PGI2 and NO--inhibit PLT aggregation
Heparan proteoglycan, antithrombin III: fire extinguishing coagulation factors
Tissue factor pathway inhibitor, antithrombin III: anticoagulation
Tissue plasminogen activator activates plasmin and breaks down fibrin
Fibrin adsorption, blood dilution, monocyte phagocytosis
Thrombin has a high affinity for fibrin
Accelerate local coagulation reaction
Prevent thrombin from spreading to the surroundings
Physiological anticoagulant substances
serine protease inhibitor
Antithrombin III
Produced by liver/vascular endothelial cells
Inhibit 9, 10, 11, 12
Heparin can promote coagulation and antithrombin effect
Heparin cofactor II
α1-antitrypsin
C1 inhibitor
Protein C system
Protein C (PC)
Inactivate 5, 8
Thrombin and thrombomodulin (TM) activate PC
PS acceleration
TFPI (tissue pathway inhibitor)
Glycoprotein synthesized by vascular endothelium
Feedback inhibition of the extrinsic coagulation pathway
heparin
Mast cells, basophils
mechanism
Promote the inactivation of coagulation factors by antithrombin III (main role) - both in vivo and in vitro
Promote the release of TFPI from vascular endothelial cells (secondary effect) - anticoagulation in the body
Clinically anticoagulant/procoagulant
Promoting coagulation: warm saline, gauze, injection of VitK, Yunnan Baiyao, Panax notoginseng
Anticoagulation: cooling, increasing the smoothness of foreign body surfaces, sodium citrate, potassium oxalate (Ca precipitation), heparin
Fibrinolytic-Antifibrinolytic
fibrinolysis
The fibrinolytic system includes: plasminogen, plasmin, plasminogen activator, fibrinolysis inhibitor
activation of plasminogen
plasma activator
XII-dependent activator
vasoactivator
Tissue plasminogen activator (t-PA)
tissue activator
The uterus, thyroid, prostate, lymph nodes, and adrenal glands are the most common
Urokinase plasminogen activator (u-PA)
plasmin
Antifibrinolytic
fibrinolysis inhibitor
Plasminogen Activator Inhibitor-1 (PAI-1)
α2-antiplasmin (α-AP)
Blood type and blood transfusion
red blood cell agglutination
Essence: Ag-Ab
Agglutinogen: Antigen in agglutination reaction
Essence: Specific proteins, glycoproteins, and glycolipids on the RBC membrane
Specificity: glycoprotein/glycolipid/oligosaccharide chain
Lectin: a specific antibody that reacts with agglutinogens on the red blood cell membrane
Essence: Gamma globulin in plasma
ABO
A1 red blood cells cannot be combined with A2 serum A2 and A2B red blood cells do not react with antibody A
H antigen
A enzyme: acetylgalactosamine linked to H substance → A antigen
B enzyme: galactosyl attached to H substance → B antigen
Type O contains H substance
All four blood types have H substances, so there are no H antibodies in the serum.
ABO is a natural antibody: IgM, which has a large molecular weight and cannot pass through the placenta (it will not cause hemolysis in newborns). It is produced 2 to 8 months after birth (no antibodies in the fetus) and reaches its peak at 8 to 10 years old.
complete antibody
identification
Forward typing: Use anti-A and anti-B antibody tests to check whether red blood cells have A or B antigens
Reverse typing: using red blood cells of known blood type to detect the presence of anti-A or anti-B antibodies in the serum
Rh blood group system
Immune antibodies: IgG antibodies with small molecular weight and able to pass through the placenta
Types
Rh positive: D antigen positive (most)
Rh negative: D antigen negative
Antigens: There are mainly five types: D, E, C, c, and e (D is the most antigenic)
Features
There are no natural antibodies against Rh in human serum
Rh(-) accepts Rh( ): produces anti-Rh antibodies
First time: no obvious reaction
Second time: hemolysis
Rh-The mother gives birth to Rh. For the first time: a small amount of D antigen from the fetus enters the mother's body, and the mother's body produces anti-D
After the first child is born, anti-D immune globulin should be injected promptly to neutralize the D antigen entering the mother’s body and prevent hemolysis in the second child.
Blood volume and transfusion principles
Blood transfusion principle
Adhere to homotypic blood transfusion
Cross-matching is required
Cross-matching primary side: Match the donor's red blood cells with the recipient's serum for a matching test
Secondary cross-matching: The recipient’s red blood cells are then matched with the donor’s serum for a matching test
Homotype blood transfusion--best
The main side is consistent, but the secondary test is not consistent - in an emergency, a small amount of blood can be transfused slowly (once, a small amount, slowly)
O loses to others/Others lose to AB
Primary side does not comply - blood transfusion is prohibited
Promote component blood transfusion
Be careful with heterotypic blood transfusions