blood and blood circulation

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1 5 Blood and blood circulation disorders 1. 2. 3. 4. - 5. 1. 2. 3-4 3. pH 7.35-7.454. 70- 75 cc./kg body weight 4-5 2 1. (Plasma) 55% 22. 45% 90-92 % 8-10 % 7 % waste product (urea, creatinine, uric acid, bilirubin) 500 (albumins) 3.5-5.2 /. 60% (globulin) 5 IgG,IgM, IgA, IgD, IgE (Erythrocytes or red blood cell) (Hemoglobin, Hb) 48 42 (Heme) (Globin) ( Leucocytes or white blood cells) 5,000 10,000 / 5 Neutrophil (PMN) 60-70 3Lymphocyte 20 - 30 Monocyte 1-5 Eosinophil 1-5 Basophil 0-1 (Thrombocytes or platelets) (Megakareocytes) 140,000 340,000 / 1/3 10 (macrophage) stem cell (Homeostasis) 1. (Vasoconstriction)2. (Platelet plug)3. (clotting factors)4. 5. 1. local reflex 2. 15-20 43. (Clotting factors) ( Intrinsic pathway) (Extrinsicpathway) Factor X Coagulation factors or Clotting fators Coagulation factors procoagulant,anticoagulant fibrinolysis 1. Procoagulant 14 factor I XIII factor VI (activeform) factor V 2 high molecular weight kininogen (HMWK) prekallekrein (Flethcher factor) intrinsic pathway extrinsic pathway 2 ( 1) 1 PK = prekallekrein; HMWK = high molecular weight kininogen51.1 Extrinsic pathway tissue factor factor VII active form(factor VIIa) factor VIIa/TF factor X active form (factor Xa)factor Xa factor Va thrombin platelet factor 3 prothrombin thrombin fibrinogen fibrin extrinsic pathway extrinsic pathway lipoprotein-associatedcoagulation inhibitor (LACI) extrinsic pathway inhibitor (EPI)5 factor Xa EPI/factor Xa factor VIIa/TF1.2 Intrinsic pathway factor XII active form(factor XIIa) factor XIIan prekallekrein kallekrein factor XII factor XIIa factor XIIa factor XI factor XIa, factor Xla factor IX active form (factor IXa), factor IXa factor VIIIa thrombin platelet factor 3 factor X active form (factor Xa), factor Xa factor Va thrombin platelet prothrombin thrombin Thrombin fibrinogen peptide alpha beta fibrinogen fibrinopeptide A fibrinopeptide B fibrin monomer polymerization fibrin polymer non-cross-linked form thrombin factor XIII active form (factor XIIIa) fibrin polymer covalent bond cross-linked fibrin stabilized fibrin platelet plug Fibrin thrombosthenin (clot retraction) platelet plug (coagulation cascade) fibroblast tissue factor (TF) activated factorVII (VIIa) 1 VII TF:factor VIIa complex factor X factor Xa factor Xa factor Va prothrombin thrombin thrombin factor VIII activated form (VIIIa) factor V activated form (Va) platelet activated platelet thrombin fibrinogen fibrin clot factor VIIa 6 2. Anticoagulant 2.1 Antithrombin III (AT III) heparin cofactor I thrombin,factor XIIa, Xia, Xa, Ixa plasmin 1:1 2,000-10,000 AT III anticoagulant AT III 2.2 Heparin cofactor II thrombin thrombin 1:1 dermatan sulfate subendothelium 1,300 heparin cofactor II anticoagulant heparin cofactor II AT III heparin cofactor II 2.3 Protein C factor VIIa Va . protein C 2.4 Protein S cofactor protein C protein S 4 Heffman M et al. Blood Coagulfibrinolysis 1998:9 (suppl 1):S61-S65. 2.5 C1 esterase inhibitor complement, factor XIIa, kallekrein plasmin hereditary angioneurotic edema 2.6 1-antitrypsin factor Xia elastase 2.7 2 macroglobulin plasmin, kallekrein macroglobulin 3. Fibrinolysis recanalisation 48-72 plasminogen plasminogen activator active form plasmin, plasmin fibrinogen, fibrinpolymer cross-linked fibrinogen-fibrin degradation product (FDP)7 factor XII , prekallekrein HMWK plasminogen activator (Anemia) ..(RBCcount), (Hematocrit, Hct.), (Hemoglobin, Hb) ( , 2547 : 54) Hb (g/dl) Hct (%) 6 6 11 33 6 14 12 36 14 13 39 14 12 36 11 331. 1.1 1.1.1 1.1.2 pure red cell aplasia 1.1.3 1.2 erythropoietin Hypothyroidism2. 12 3. 3.1 3.1.1 3.1.2 Hereditary spherocytosis3.1.3 metabolism G6PD3.2 Antibody AIHA 83.3 Injury , Burn, 4. 4.1 4.2 (dyspnea) (palpitation) Hb < 7.5 g/dL Cardiac output stroke volume myocardial function (dizziness) (pallor) Hb< 10 g/dLTachycardia, wild pulse pressure (Jaundice) 38.3 91. - - G6PD deficiency- - - - - - 2. - - - - - 3. - (Peripheral blood smear) inclusion - (mean corpuscular volume, MCV) 80 . 12 6 - 1 (mean corpuscularhemoglobin, MCH) 27-31 picogram- 1 (mean corpuscularhemoglobin concentration, MCHC) 32- 36 ./.- (Basophilic stippling) (Target cell) 10- (Reticulocyte count) 1-2 (Hemolysis) Acute blood loss - 1-2 1 Heinz body G6PD deficiency- Serum ferritin, transferring saturation 1. 2. 3. 4. 5. Counseling (Bleeding disorders) 3 1. 2. 3. (Vascular defect) 1. 2. 3. 4. 11 (Serotonin) (Plug) (Psuedopodia) 24-48 1. 2. 2 1. 2. 1. (thrombocytopenia) 100,000 /.. 150,000 400,000 /.. co-factor 2 1.1 1.1.1 megakareocyte 1.1.2 ASA, isoniazid , penicillin1.1.3 1.1.4 1.1.5 121.1.6 1.1.7 1.2 1.2.1 (Autoimmune idiopathic thrombocytopenia) 1.2.2 24 antiplatelet antibody1.2.3 1.2.4 Spleenic hypertrophy 1.2.5 DIC (petechiae) (ecchymosis) (/..) > 100,000 50,000 100,000 < 50,000 1 / >8 / >24 / 1.4 isometric aerobic 30-60 3-5 /1.5 2. 2.1 Lasix, aldactone2.2 Apresoline2.3 calcium channel block nifidipine, diltiazem2.4 Beta blockers Cardiac output Aldomet,minipress2.5 angiotensin converting enzyme (ACE) inhibitor angiotensin Captopil 1. 2. 2.1 2.2 2.3 233. 2 4. 5. 6. (Heart Failure) 1. 1.1 1.2 1.3 1.4 2. 2.1 2.2 (increase preload) 2.3 2.4 (Volume overload) 2 1. (Left heart failure: LHF)2. (Right heart failure: RHF) 2 2 2 24-(Forward effect) (Low outputsyndrome)- (backward effect) LHF RHF (backward effect) - ( Dyspnea)- (Orthopnea)- (Paroxysmal Noctural dyspnea)- (cough)- (cyanosis)- (Pulmonary edema)(Forward effect) Reninangiotensin aldosterone system - - - - 25 Cor pulmonale (backward effect) (Systemic venous congestion) - (Hepatospleenomegary)- (ascities)- (jugular vein distention)- (Subcutaneous edema)(Forward effect) 1. 1.1 1.2 1.3 1.4 1.4.1 Preload 1.4.2 1.4.3 afterload ACE inhibitors1.4.4 2. 3. 4. 26