physiology of the blood i. fluid compartments and the plasma · 1 physiology of the blood i. fluid...
TRANSCRIPT
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Physiology of the Blood I.
Fluid compartments and the plasma
Prof. Szabolcs Kéri
University of Szeged, Faculty of Medicine, Department of Physiology
2019
Ferenc Domoki
Introductory case vignette
• Young male patient
• Pale skin
• Fatigue, dizziness, shortness of breath
• Poor attention and concentration
• Recurrent infections, fever
• Sensitive gingiva (bleeding)
• Small suffusions under the skin
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Blood sample
Increased number of undifferentiated white blood cells
(accelerated division, poor differentiation – lymphoblasts)
Lymphoblasts destroy the bone marrow:
- Red blood cell ↓ → pale skin, fatigue
- Mature white blood cells ↓ → infections
- Platelets ↓ → bleeding
Diagnosis: acute leukaemia
Petechia and purpura due to low platelet number
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Severe or chronic inflammation in the oral cavity (e.g., ginigva):A potential sign of disturbed leukocyte function or number
• Blood and the fluid compartments of the body
• Functions of the blood in general
• Components of the blood: plasma and cells
• Anorganic and organic components of the
plasma
• Special emphasis: proteins of the plasma
Topics to be discussed:
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Intracellular Extracellular
Cell membrane Capillary
wall
Interstitial fulid P
las
ma
Principles of:
- Isotonicty- Isovolemia
EDEMA: fluid movement and accumulation through the cell membrane
and/or capillary wall
Inside the cell
Organization of the fluid spaces: the three compartment model
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Blood and the fluid compartments of the body
Total water: 0.6 x body weight (kg)
1. INTRACELLULAR COMPARTMENT: 0.4 x body weight
2. EXTRACELLULAR COMPARTMENT: 0.2 x body weight
2.1. Interstitial (0.75 x extracellular)
2.2. Intravasal = BLOOD PLASMA (0.25 x extracellular)
2.3. Transcellular (liquor, eye, inner ear, pleura)
Volume = amount of indicator / concentration after equilibrium
- Intravasal (plasma): Evans-blue or 131I bound to albumin
- Extracellular: inulin
- Total: tritiated water, antipyrine
- Intracellular = Total – extracellular
- Blood volume = Intravasal / 1- Hematocrit
When the continuity of fluid compartments is disrupted:thrombosis
Thrombus in the blood vessel
Ahead the thrombus: insufficient/ceased flowBeyond the thrombus: congestion andedema
Ultrasound diagnosis of deep vein thrombosis
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Excessive fluid in the chest: hydrothorax
Chest X-ray:pleural effusion (accumulation of fluid around the lungs)
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Blood components after centrifugation
PLASMA (55%)
WHITE BLOOD CELLS AND PLATELETS (<1%) (buffy coat)
RED BLOOD CELLS (45%)
HEMATOCRIT: the proportion of cells in
the blood
(~ 0.44-0.46 male, 0.41-0.43 female)
Serum = plasma without fibrinogen and
clotting
factors (after blood coagulation)~ 5 liters
Components of the plasma1. ANORGANIC
ELECTROLITES: sodium,
potassium, calcium, magnesium,
chloride, bicarbonate,
phosphate
2. ORGANIC SUBSTANCES:
- proteins
- glucose
- amino acids
- urea (blood urea nitrogen
[BUN]), creatinine, uric acid
- lipids (triglyceride, cholesterol)
- organic acid (lactate, pyruvate,
citrate, bilirubin)
NORMAL VALUES !!!
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Proteins of the plasma
- synthesis: liver, gut, white blood cells, endothelium (60-80 g/l)
- function: oncotic pressure, transport, acid-base buffer, inhibition of
renal filter and receptor effect
1. Albumin (35-45 g/l): oncotic pressure, bilirubin transport, binding of drugs
2. α1-globulin: thyroxine, cortisol, vitamin D transport
3. α2-globulin: ceruloplasmin (copper), haptoglobin
4. β-globulin: transferrin (iron)
5. γ-globulin: antibodies
6. Fibrinogen: blood coagulation
Normal Liver cirrhosis
Nephrosis Multiple myeloma
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Lipoproteins of the plasma
Hydrophobic core: triglycerides (T), cholesterol (C)
Hydrophilic periphery: phospholipids, apolipoproteins (Apo)
Chylomicron, VLDL (Very Low Density Lipoprotein), IDL (intermediary),
LDL (low), HDL (high): increased density and protein content in this
order
Chylo: absorbed from gut
HDL („good” cholesterol): synthesis in liver, taking up cholesterol in
vessels
Peroxisome proliferator- activated receptors(PPARs): nuclear receptors, Apo-expression
Ligand: e.g. fatty acids