PCB3703C Exam 3

Blood Volume -- M vs F?

M = 5-6L

F = 4-5 L

Plasma is __%

55

Hematocrit M vs F?

M = 42-52%

F = 37-47%

3 main plasma proteins

albumins, globulins, fibrinogen

Formed elements: blood cells =

erythrocytes, leukocytes, platelets

Production of RBCs: fetus -> placenta formation -> new born

Fetus
- embryo during 4th week of pregnancy, embryo is connected to yolk sac which produces RBCs - gives nutrients to embryo (at this time there is no placenta)

Complete form of placenta
- placenta takes over nutrition
- after yolk sac is liver
- liver takes care of formation of RBCs

New born
- bone marrow within long bones which produces blood cells, including RBCs

Life span of the RBC

120 days

Leukocytes

WBC

contains nuclei and mitochondria and can move in an amoeboid fashion

they can squeeze through pores in capillary walls and move to a site of infection

Subgroups of WBCs (leukocytes) the types within them

Agranular = lymphocute and monocyte

Granular = eosinophil, basophil, neutrophil

Neutrophil function

phagocytize bacteria

Eosinophil function

turn off allergic responses and kill parasites

Basophil function

release histamine and other mediators of inflammation

Lymphocyte function

Mount immune response by direct cell attack (T cells) or via antibodies (B cells)

Monocyte function

phagocytosis; develop into macrophages in tissues

3 functions of circulatory system

transportation, regulation, protection

Blood plasma is approx. ____% water

90

Albumin

60-80%

produced by liver

role in osmotic P - draw water from the surrounding tissue fluid into the capillaries

albumin cannot cross blood cell wall, stays in BVs. instead of crossing wall, it should absorb extra fluid from interstitial space.

Adjusts osmolarity by absorbing extra fluid from cell. Inhibits edema.

Controls cellular fluid **

Globulins

alpha, beta, gamma

alpha & beta produced in liver and function in transporting lipids and fat-soluble vitamins and function in immunity

gamma can be used for hepatitis (viral infection of liver) - controls the immune cells

Fibrinogen

important clotting factor produced by the liver

the fluid from clotted blood, called serum

Erythrocytes (general)

RBC

mainly controlled by a hormonal mechanism

contains 280 million hemoglobin molecules (gives blood its red colour)

each hemoglobin molecule consists of 4 protein chain called globins, each of which is bound to one heme, the iron group of heme is able to combine with O2 in the lungs and release O2 in the tissues

Lymphocyte (general)

compose 20-45% of WBCs

most important cells of the immune system, their nucleus stains dark purple

effective in fighting infectious organisms, act against a specific foreign molecule (antigen)

T cell lymphocytes

attack foreign cells directly

changes shape and surrounds bacteria

B cell lymphocytes

multiply to become plasma cells, secrete antibodies

antibody does not kill antigen, it just detects it. Lysosomes can attach to antigen and kill it

Monocyte (general)

compose 4-8% WBCs

largest leukocyte

phagocytic cells

nucleus is kidney shaped

transform into macrophages in tissue

Platelets are also called

thrombocytes

Platelet role

blood clotting by releasing serotonin which stimulates constriction of the BVs, reducing the flow of blood to the injured area

platelets also secrete growth factors, autocrine regulators.

Hematopoiesis

1. Embryo
2. Before birth
3. After birth

1. Yolk sac of embryo during week 4 of pregnancy

2. Liver

3. Bone marrow - main place for production of blood cells

All blood cells originate in ____ from one cell type called _____

bone marrow

blood stem cell

Lymphoid stem cells give rise to

lymphocytes

Conversion of reticulocyte into erythrocyte requires 3 factors:

B12, iron, folic acid

Myeloid stem cells give rise to

all other blood cells

iron deficiency anemia

anemia caused by inadequate iron intake

pernicious anemia

Vitamin B12 deficiency

aplastic anemia

failure of blood cell production in the bone marrow

due to chemical radiation which destroys bone marrow and changes RBC shape

Granulocytes form from

myeloblasts

Monoblasts enlarge and form

monocytes

Platelet-forming cells from

megakaryoblasts

Polycythemia

excess of red blood cells

abnormality to bone marrow structure = over production of RBCs, WBCs, platelets

s/s headache, hypertension, coagulation, enlarged liver and spleen

aka polyvera

Normocytic anemia

such as blood loss

Microcytic anemia

iron deficiency

Macrocytic anemia

Vit B12 or folate deficiency

Sickle cell disease

Genetic disorder in which red blood cells have abnormal hemoglobin molecules and take on an abnormal shape

RBCs cannot cross BV wall because of its abnormal shape

deficiency in O2

s/s headache, bone pain, fever, respiratory issues, increase in bilirubin (result of dead RBCs -> patients skin becomes yellow - jaundice)

treatment: replace folic acid, iron, b12, antibiotics etc.

Leukemia

cancer of white blood cells

bone marrow starts to make a lot of abnormal WBCs - do not work like normal WBCs - they grow faster and don't stop growing when they should

s/s = fever and night sweats, headache, bleeding easily, bone or joint pain, swollen lymph nodes in the armpit and neck, lot of infections, weakness, losing weight

Leukemia treatment (4)

1. Chemotherapy to kill leukemia cells using strong anti-cancer drugs;
2. Interferon-alpha (growth factor that controls immune cells) (INFa) therapy to slow the reproduction of leukemia cells and promote the immune system's anti-leukemia activity;
3. Radiation therapy to kill cancer cells by exposure to high-energy radiation.
4. Stem cell transplantation (SCT) to enable treatment with high doses of chemotherapy and radiation therapy - last resort.

lymphocytic leukemia

produces large number of mature WBCs

not functional

myelogenous leukemia

produces large numbers of immature and mature WBCs

Thrombocytopenia

low platelet count

hemoglobin

An iron-containing protein in red blood cells that reversibly binds oxygen.

Abnormal types of hemoglobin

Hemoglobin S and hemoglobin C

s/s of sickle cell anemia + treatment

anemia
jaundice
formation of pigment gallstones
abd pain
bone pain
breathlessness
delayed growth and puberty
fatigue
paleness
rapid HR
ulcers on lower leg

treatment: folic acid supplements, antibiotics and vaccines to prevent bacterial infections

BV layers (out to in)

tunica externa (composed of CT)

tunica media (sheets of smooth muscle)

tunica intima (composed of simple squamous epi.)

Contraction of BV =

vasoconstriction

Relaxation of BV =

vasodilation

BV order from artery to vein

artery (like aorta)

arteriole

capillaries

venule

large veins (like SVC and IVC)

Wall of ____ is thicker than _____

artery is thicker than vein

arterial pressure __ venous pressure

>

Wall of artery and vein both have ____ muscle which helps with ...

smooth muscles which is good for contraction

Capillaries do not contain, but do contain

they do not have smooth muscle

they contain pores for gas exchange, waste, nutrients, etc.

low permeability capillaries are found in

blood brain barrier

highly selective, only vital substances pass through.

not a barrier against O2, CO2 and some anesthetics

Bilirubin is stored in the

gall bladder

Blood order through HEART

SVC, IVC, coronary sinus -> RA -> TV -> RV -> PSV -> PA -> lung -> 4 PVs -> LA -> BV -> LV -> ASV -> aorta -> body

Pericardium

Membrane surrounding the heart

# of papillary muscles in LV and RV

LV: 2

RV: 3

Systemic circulation

SVC and IVC takes blood to heart

aorta takes blood from heart to body

Pulmonary circulation

PA takes blood from heart to lungs

4 PVs carry fresh blood from lungs to heart

Smallest branches of arteries

arterioles

Stressed volume

Blood volume contained in arteries

Do veins have stressed volume?

No

Cardiac output equation

mean arterial P - right atrial P / total peripheral resistance

Cardiac output

The volume of blood ejected into aorta by LV per minute

about 5L per minute

Stroke volume

The amount of blood ejected from the heart in one contraction

about 70mL

Systolic pressure

Blood pressure in the arteries during contraction of the ventricles.

measured after the heart contracts (systole) and blood is ejected into the arterial system

Diastolic pressure

Blood pressure that remains between heart contractions - in relaxation phase

measured when the heart relaxed (diastole) and blood is returning to the heart via the veins

Pre-load (aka EDV)

Volume of blood in the ventricles at the end of diastole, immediately before ventricular contraction.

End Systolic Volume (ESV)

volume of blood remaining in each ventricle after systole (contraction)

70mL

After-load

P that comes to aorta and pulmonary artery by contraction of each ventricle

Resistance depends on ___ of blood, depends on ____ of BV

viscosity of blood

diameter of BVs

Capacitance depends on ____ of BV wall

thickness

Amount of blood which exists in artery is a little bit _____ than venous system

Amount of blood which exists in artery is a little bit less than venous system

Mean pressure in aorta

100 mmHg

Mean pressure of Arterioles

50 mmHg

Mean pressure of Capillaries

20 mmHg

Mean pressure in the vena cava

4 mmHg

Pulse Pressure (PP)

difference between systolic and diastolic pressure

Atrial pressure is ___ than venous pressure

lower

BP equation

BP = CO x TPR

Hypertension

any factor which leads to closure of BV, destruction of BV, or vasoconstriction of BV leads to hypertension

Hypertension primary/essential

reason unknown

possible could be due stress, diet (high Na+) -> can lead to high TPR by vasoconstriction or increased CO or both

Hypertension secondary

reason known

based on endocrine system

can be due to
1. adrenal gland
2. cushings syndrome
3. hyperaldosteronism
4. pheochromocytoma
5. kidney disease
6. drugs (like birth control)
8. coarctation of aorta (aorta is narrowed)
9. preeclampsia - condition related to pregnancy
10. thyroid and parathyroid problems

s/s nose blood, headache, anxiety, vertigo, sleep disorder, fatigue

Two systems involved in pathophysiology of hypertension

sympathetic nervous system

renin-angiotensin-aldosterone system

Vasodilator substances (2)

prostaglandin

bradykinin

deficiency is either one leads to hypertension

Cortisol increases

TPR and increases systolic and diastolic P

Aldosterone increases

BP and blood sodium

Conn's disease

Hyperaldosteronism

Thyroid has direct effect on ...

alpha 1 adrenergic receptor of sympathetic system

beta 1 adrenergic receptor of sympathetic system

Oversecretion of thyroid hormones

hyperthyroidism

Oversecretion of parathyroid hormones

Hypercalcemia

normal is 10mg/dL

Drugs to treat high BP: ACE inhibitors (2)

captopril

ramipril

Drugs to treat high BP: ARBs (1)

valsartan

Drugs to treat high BP: diuretics (1)

thiazide diuretics such as hydrochlorothiazide