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Composition of Blood (Viva) Except Proteins i.e. Albumin, globulin & fibrinogen all the substances in % will be in mg. Proteins7 to 8gm% Fat cholesterol150 to 250mg% Carbohydrate glucose80 to 100mg% Calcium9 to 10mg% Phosphorus5mg% NaCl500 to 600 mg% Urea30mg% Uric acid2mg% N.P.N30mg% Creatine & creatinine1.5mg%each Functions of Blood 1. Carriage of O2 &CO2 2. Carriage of nutrients to different cells 3. Carriage of waste products 4. Maintenance of water balance 5. Maintenance of ph of blood 6. Maintenance of ionic concentration i.e. Na, K, Ca, P etc of blood 7. Maintenance of temperature regulation 8. Defense mechanism of body 9. Coagulation

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PLASMA PROTEINS
What are plasma proteins? Describe there functions with physiological importance? What is plasmaphoresis? Normally total proteins is about 7 to 8gm% Albumin about 4.5gm% Globulin about 2.5gm% Fibrinogen about 0.4 to 0.8gm% Prothrombin in traces All albumin and fibrinogen are formed in the liver. The globulins is formed in the liver (50 80 %) and remaining in the lymphoid tissues. The rate of formation of plasma proteins is about 30 gram per day. Ratio of albumin: globulin is 2:1, and this is reversed in Liver diseases. Molecular wt of albumin is 68, 000, globulin is 1 to 1.5 lakhs & fibrinogen is 3 lakhs. Smaller the molecular wt more will be the osmotic pressure. Globulin is divided into 3 factors , and , out of which globulin is most important & required for defense mechanism of the body i.e. formation of antibodies. Functions as follows Albumin: Being the smallest particle of protein they will exert the maximum osmotic pressure, though the osmotic pressure will be by all the three types of proteins. The osmotic pressure is very important for maintaining the water balance of the body, specially the exchange of water between the blood and the tissue fluid, therefore in malnutrition the total protein becomes less therefore attracting forces for water by protein molecules will be less (osmotic pressure) so accumulation of fluid in the tissue spaces producing oedema as shown in the diagram.

ILLUSTRATED PHYSIOLOGY Globulin: Globulins can be separated into water soluble pseudoglobulins and insoluble euglobulins. Most antibodies are found to be euglobulins. Out of the , and globulins the gamma globulin is important for defense mechanism by formation of antibodies in certain disease to fight against that disease e.g. typhoid and small pox. Fibrinogen: This is important for the mechanism of coagulation of blood by forming fibrin network. It is also required for normal E.S.R. Prothrombin: This is manufactured only in the liver in traces and is responsible for coagulation of blood. Other minor functions: 1. The plasma proteins functions as a labile protein storage medium and represent a rapidly available source of amino acid wherever in the body a particular tissue requires them. 2. Carriage of CO2 only 2 to 3 cc out of 50 cc as carbamino protein compound. 3. Similarly many other products are carried with the help of proteins, mainly attaching with albumin e.g. hormone Thyroxin, iron, enzymes and bile pigment. 4. It forms tryphone with combination of leucocytes which is important for the nutrition. Plasma Phoresis: Whipple was the person who studied this. Here the experiment is done on a dog as follows. Blood is drawn. It is centrifuged. Plasma is thrown out and RBC is replaced in the dog. This is done several times till the percentage of blood proteins comes down to 4%. This is an ideal animal for studying the regeneration of different blood proteins when the following things are noticed. When regeneration occurs it is in this order. First fibrinogen then globulin and then albumin, after feeding the dog with protein diet. Regeneration with different type of diet is as follows. Plasma 3: 1 which means given 3 gram of plasma 1 gram of protein regenerated Liver and kidney 5: 1 Spleen and heart 3: 1 Importance: This experiment has given the idea for the treatment of patients with extreme low protein contents of blood.

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HAEMOGLOBIN
Give the composition synthesis function and fate of haemoglobin? Chemistry: It is a chromo protein containing globulin and haem. Haem is a porphyrin compound having 4 porphyrin rings together with iron as follows This has molecular weight of 1700 but molecular wt. of haemoglobin is 68000 so it is supposed to be formed with 4 such porphyrin compounds i.e. 1700 X 4. Property: 1. It easily combines with oxygen to form oxyhaemoglobin (HbO2) which is loose compound and can easily be broken to give O2. 2. Haemoglobin directly combines with CO2 to form a compound carbamino Hb to carry only 3 cc of CO2 . 3. Similarly it also combines with other gases like CO, NO2, H2S of which combination with Carbon monoxide is important as poisoning and death with the gas is common. 4. It forms typical haem crystals with NaCl and glacial acetic acid which is useful in diagnosis of blood sample (man or animal). In the spectroscope it can be diagnosed as human sample by presence of dark band between D and E. Synthesis: following are essential 1. First class proteins milk, fish, egg, soyabean etc. 2. Metals iron and sulphur. 3. Vitamin B12 (Folic acid). 4. Porphyrin compound Types of Haemoglobin: 1. Foetal Hb called as HbF where Hb combines easily with O2 of mothers blood. 2. Adult Hb called as HbA after birth when O2 combining power is less. 3. Pathological Hb e.g. HbS i.e. in sickle cell anemia Hb does not combine O2 easily.

ILLUSTRATED PHYSIOLOGY Functions: 1. Major function is carriage of Oxygen ( HbO2 ) 2. Carriage of CO2 as (HbCO2) Minor Functions: 1. PH regulation of blood because Hb will be acting as buffer 2. It will be source of iron and bile pigment Fate of Haemoglobin:

RBCs when becoming old and useless after 2 to 3 months is destroyed by reticuloendothelial cells there by releasing Hb with the above fate.

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R.B.C
Describe different stages of development of R.B.Cs (erythropoises) and what is the role of maturation factor? In foetal life R.B.Cs are developed for first six months in the liver after that throughout the life they are developed in red bone marrow. This bone marrow is present in the center of all types of bones. There are two theories regarding erythropoises. 1. Extra vascular 2. Intra vascular It is the intra vascular theory which is more accepted. Here all the stages of development are inside the vessel and when the R.B.C. becomes matured, only then they are thrown out in general circulation. The different stages of development are as shown in the diagram on next page.

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BLOOD Proerythroblast is recognized by the presence of nucleoli, while normoblast A, B, C series are recognized by the nature of there chromatin network. Reticulocyte by the presence of reticular structure. By maturation of R.B.C. we mean as follows 1. Size of cell becomes smaller and smaller 2. Appearance of more and more Hb 3. Giving out of nucleus from cell This is done by 3 maturation factor at different level as shown below

Give the life history of R.B.C.? Stages of development as described above Function and fate will be same as described in Hb. Normal count about 5 million / Cubic mm. in adult male The shape of R.B.C. is biconcave disc Diameter is 7 Thickness is 2.2 Area is 120 square Volume is 87 The biconcave shape will help the R.B.C. to accumulate more fluid therefore it will not be destroyed or ruptured quickly Physiological variation in newly born infant count is high i.e. 7 million. Sex in female count is less i.e. about 4 million 8

ILLUSTRATED PHYSIOLOGY In pregnancy count is more because blood volume is more At high altitude count is more i.e. about 7 million because hypoxia stimulates the bone marrow. Diurnal variation evening count is more than morning count Note for Hb also same variation as above

PLATELETS (THROMBOCYTES) Short Note

They are small biconcave disc about 2.5 without any nucleus. Normal count is 2 to 3 lacks per cubic mm. there main important function being coagulation. The structure and composition is as shown in diagram. It is a protein which combines with phospholipids (lecithin). It has got a peculiar property of clumping together either to a cut surface or abnormal surface there by releasing a substance by there breakdown called as thromboplastin required for coagulation. Functions: 1. The main function being, it initiates the process of coagulation by forming thromboplastin as mentioned above. This will convert prothrombin into thrombin. 2. It helps in the repair of the damaged capillaries by plugging the areas with platelets. 3. It helps contraction of capillaries to stop bleeding with the release of serotonin. 4. It helps for the retraction of clots. 5. If the thrombocytes count is less than normal i.e. below 50,000 it produces a disease called as thrombocytic purpura.

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BLOOD GROUP
Rh factor: This is another blood group over and above the person possessing A, B, O group. The name Rh factor is given because of the type of monkey known as Rhesus. This antigen which is called Rh antigen is present in this type of monkeys, is also present in 90% of the human population and they are called Rh positive. Those not having this antigen are called Rh negative i.e. 10%. More detail of Rh antigen Following are the two type pair of antigen containing 3 in each as bellow 1st CDE nd 2 cd e of all these 6 Rh antigen, D is the dominant antigen (i.e. strong antigen) while all the other 5 are recessive antigen (weak), a person will inherit 1 antigen from the above 2 group therefore some possibilities are Cd, De, Ed, Dd, of this the one containing D will be called as Rh positive and those not containing D called as Rh negative. Clinical Importance: Rh Ve mother giving birth to a dead child. This can be explained as follows if the foetus growing is Rh +Ve, R.B.C.of the foetus will cross over to the mothers blood and will form Rh antibodies, which will again return back to the foetus so that Rh+Ve R.B.C. of the foetus will be constantly destroyed with the Rh antibodies, therefore the foetus though full term is born extremely anaemic or will die within few days. This child is called as erythroblastosis foetus (immature R.B.C.). The above mother giving birth to such a child is fully charged with Rh antibodies. She should be warned while taking any blood transfusion because if she is given Rh +Ve blood, this Rh +Ve blood will react with Rh antibodies of mother producing clumping together and causing even death by heart failure or kidney failure, therefore before blood transfusion there should be cross matching as safe guard.

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ILLUSTRATED PHYSIOLOGY M & N Factor: This group is important from medico legal point of view to know the parentage. Group M means M + M contributed from parent similarly N=N+N MN = M + N Therefore if child group is M then mother can not be N. Similarly if child group is N then mother can not be M. If the child group is MN then mother can be M or N.

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COAGULATION OF BLOOD
Describe recent concept of mechanism of coagulation of blood? Coagulation of blood is very essential for stopping the bleeding whenever there is some injury. Normal coagulation time is 3 to 7 minutes. Mechanism of Coagulation Morawikg theory of coagulation still stands which is as follows 1. Fibrinogen + Ca + prothrombin in blood no coagulation 2. Thromboplastin by tissue damage + prothrombin thrombin 3. Thrombin + fibrinogen forms insoluble fibrin network 4. Fibrin + R.B.C. + W.B.C. and platelets forms clot. But recent concept is as follows Gradually this problem of understanding coagulation becomes more and more complicated. In the beginning as shown there were only 4 coagulation factors responsible but now there are 13 coagulation factors recently found which are some how responsible for the quick formation of sufficient amount of thromboplastin, therefore if any one of them is absent thromboplastin formation will be hampered and coagulation time is increased. Following are the 13 factors 1. Fibrinogen 2. Prothrombin 3. Thromboplastin 4. Calcium 5. Labile factor 6. Accelerin now it is rejected 7. Stable factor 8. Antihaemophilic factor (ahf) 9. Christmas factor 10. Stuart factor 11. Plasma thromboplastin antecedent factor (pta) 12. Hageman factor 13. Laki and lorand factor

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ILLUSTRATED PHYSIOLOGY Role of coagulation factors for formation of thromboplastin. There are two pathways 1. Intrinsic pathway where damage to the internal part of vessel starts the process of thromboplastin formation. 2. Extrinsic pathway starts the process of thromboplastin formation when ever there is cut to external surface. In short pathways are as follows. Damaged protein will activate factor XII which will go on activating lower down other factors till factor V is activated, finally active factor 10 and factor V will form thromboplastin. INTRINSIC PATHWAY Factor 12 + damaged protein Active factor 12 Active factor 11 Active factor 9 Active factor 8 Active factor 10 + factor 5 Thromboplastin EXTRINSIC PATHWAY damaged protein + factor 7 active factor 7 active factor 10 active factor 5 + 10 thromboplastin

Clinical conditions with different coagulation factors. 1. Fibrinogen lack of this protein which may be from birth is called fibrinogenaemia, it will produce prolonged coagulation time. 2. Calcium lack of Ca in blood will prolong coagulation time. 3. Prothrombin lack of prothrombin appears in vitamin k deficiency and also in newly born infants leading to prolong coagulation time. 4. Lack of factor VIII called (ahf) antihaemophilic factor produces a disease called hemophilia, where coagulation time is much prolonged

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BLOOD and bleeding time is normal. It is hereditary disease, but only males will suffer while females are carrier. 5. Lack of other factors such as vii, xi, and x will produce pseudohaemophilia where coagulation time is prolonged but not very much.

ANTICOAGULATION (Viva)
It means the substance by which coagulation of blood will be prevented. Anticoagulants will be useful for following purposes 1. For sending the blood sample for pathological investigation. 2. In blood transfusion 3. For research purpose 4. As treatment Following are the methods 1. Keeping the blood sample at zero degree temperature. Here cold will prevent coagulation for some time. 2. Using a test tube coated with paraffin prevents the clotting because the platelets will not adhere to the test tube and so will not break down to give thromboplastin. Above two methods are generally not used. 3. Most common method is by addition of a pinch of potassium oxalate. Here Ca is precipitated as calcium oxalate. And as Ca is not available, coagulation will not take place. 4. Addition of potassium chlorate is also very common method, here also Ca will form calcium citrate, and though this is soluble Ca will be bound with citrate and therefore not available. 5. Heparin this is formed only in the liver by the mast cells lining the wall of the blood vessels, which contain the heparin granules, they go on continuously secreting heparin in general circulation therefore will be acting as intravascular anticoagulant so that any chance of coagulation will be prevented. The probable mechanism is that it

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ILLUSTRATED PHYSIOLOGY combines with prothrombin so that prothrombin is not converted into thrombin and hence no coagulation. As heparin is very costly it is generally not used as anticoagulant except for research purposes. 6. Certain dyes such as congo red and Chicago blue also act as anti coagulant. 7. Dicaumaral this drug is very useful as anticoagulant for treatment.

HAEMOLYSIS (Viva)
It means destruction of R.B.C. there by releasing Hb. Following are the methods which will produce haemolysis. 1. Mechanical vigorous shaking of blood will destroy R.B.C. 2. Physical extreme heat or cold will destroy the cell wall. 3. Chemical a drop of ether or alcohol will produce haemolysis. This is because cell wall which is made up of fat will be dissolve in this chemical. 4. Osmotic pressure difference if blood is put in distilled water, water will move inside the R.B.C. and finally burst it. 5. By surface tension - example putting a pinch of bile salt suddenly changes the surface tension of the cell wall thereby rupturing it. 6. Intravascular haemolysis occurs in following conditions a. malaria b. snake bite c. improper blood transfusion d. certain bacterial infection

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W.B.C
Give the development, fate and function of W.B.C.? Normal count is 5 to 10 thousand/Cu mm. Physiological variations 1. Age in newly born infants count is high. 2. Sex no variation. 3. Diurnal variation evening count is more than morning count. 4. High altitude count is more. 5. Exercise and after meals count is more W.B.C. is divided into granulocytes and agranulocytes.

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Development: granulocytes are developed solely from red bone marrow while agranulocytes are developed mainly from lymphoid tissues and to some extent from red bone marrow. Development of granulocytes: The different stages of development in bone marrow is as follows (next page).

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Starting from myeloblast three things are important 1. Division of cells quick. 2. Appearance of more and more granules. 3. Amoeboid movement begins. Development of Lymphocytes: They are mainly developed from lymphoid tissue i.e. spleen, tonsils, lymph glands, and payers patches of intestine.

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BLOOD Functions: 1. The main function been the defense mechanism of the body which is done by the polymorph by letting directly bacterias inside and killing them, in the process they themselves are destroyed therefore they together with the tissues form pus. 2. By lymphocytes they are also responsible for defense of the body as they form antibodies. They are also responsible for repair of damaged tissues. 3. By eosinophil as this count is very much increased in all allergic conditions when histamine is formed therefore there role is antihistaminic. 4. Basophil basophils are increased in chronic doubtful cases.

IMMUNITY (Short Note)

The bodys ability to resist or protect itself from the harmful effects of disease producing substances (organisms) is called immunity. Any substance that causes this type of response in the body is known as antigen. Antigens may be bacteria, viruses, or allergens (pollen grains). Antigens enable the body to protect itself through the antibodies produced by gamma globulin (humoral) and by lymphocytes (cellular). Immunity is of two types 1. Natural i.e. present by birth. 2. Acquired immunity develops during life time due to exposure to a disease or by vaccination. Acquired immunity of two types a. Active immunity: develops by exposure to a disease causing germ. The body produces antibodies that remain in the blood to prevent further infection by that particular pathogen. Vaccines containing weakened germs also provide active immunity e.g. DPT & BCG vaccines. b. Passive immunity: this form of immunity is short lived and here antibodies are made available to the organism without the trigger of an antigen e.g. a newly born infant, for the first few months of life is provided with antibodies from the mother to

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ILLUSTRATED PHYSIOLOGY fight against infections because the immune system in child is not well developed. Passive immunity is also provided by injecting readymade antibodies (collected from other animals) e.g. anti-tetanus serum (ATS vaccine). Cells of immune system: There are two major types of cells, T-cells & B-cells, both develop in bone marrow. T-CELLS Mature in Thymus glands T-Cells identify antigens and destroy them by making a number of copies. Attack directly Life span is up to 3-4 years B-CELLS Mature in lymphoid tissues like tonsils and appendix. Recognize antigen with the help of surface receptors. Produces a large number of antibodies for attack. Antibodies are short lived

A person may lack T-Cells or B-Cells, or both. Such persons are highly prone to infections.

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