Tables 19-20

• Composition of Plasma


  • Water
  • Plasma Proteins
  • Ions
  • Nutrients
  • Vitamins
  • Waste Products
  • Bilirubin
  • Lactate
  • Gases
  • Regulatory Substances
• Albumins


  Make up 58% of the plasma proteins and are important in regulating the movement of water between the tissues and the blood. They do not pass easily from the blood into tissues and play an important role in maintaining blood colloid osmotic pressure. They also bind and transport other molecules in the blood, such as fatty acids, bilirubin, and thyroid hormones.
• Globulins


  Account for 38% of the plasma proteins. They are subdivided into α, β, and γ globulins and function in transporting many substances in the blood. Antibodies are globulins that protect against microorganisms.
• Fibrinogen


  Constitutes 4% of the plasma proteins and is responsible for the formation of blood clots.
• Plasma composition remains relatively constant, even though material is constantly moving between the blood and the cells. Various homeostatic control mechanisms function to maintain plasma composition.
• The levels of water, proteins, and other substances in the blood, such as ions, nutrients, waste products, gases, and regulatory substances, are maintained within narrow limits.
• Normally, the amount of water taken in through the digestive tract closely matches the amount of water lost through the kidneys, lungs, digestive tract, and skin. Therefore, plasma volume also remains relatively constant.
• Oxygen enters the blood in the lungs and leaves the blood as it flows through tissues. Carbon dioxide enters the blood from the tissues and leaves the blood as it flows through the lungs.
• Types of White Blood Cells

  • Granulocytes (Neutrophils, Eosinophils, Basophils)
  • Agranulocytes (Lymphocytes, Monocytes)
• Neutrophils


  • Nucleus with two to five lobes connected by thin filaments; cytoplasmic granules stain a light pink or reddish-purple; 10–12 μm in diameter
  • Phagocytizes microorganisms and other substances

  
• Eosinophils


  • Nucleus often bilobed; cytoplasmic granules stain orange-red or bright red; 11–14 μm in diameter
  • Attacks certain worm parasites; releases chemicals that modulate inflammation; negatively impacts airways during asthma attacks
• Basophils


  • Nucleus with two indistinct lobes; cytoplasmic granules stain blue-purple; 10–12 μm in diameter
  • Releases histamine, which promotes inflammation, and heparin, which prevents clot formation
• Lymphocytes


  • Round nucleus; cytoplasm forms a thin ring around the nucleus; 6–14 μm in diameter
  • Produces antibodies and other chemicals responsible for destroying microorganisms; contributes to allergic reactions, graft rejection, tumor control, and regulation of the immune system
• Monocytes


  • Nucleus round, kidney-shaped, or horseshoe-shaped; contains more cytoplasm than lymphocyte does; 12–20 μm in diameter
  • Phagocytic cell in the blood; leaves the blood and becomes a macrophage, which phagocytizes bacteria, dead cells, cell fragments, and other debris within tissues
• Platelets


  • Cell fragment surrounded by plasma membrane and containing granules; 2–4 μm in diameter
  • Forms platelet plugs; releases chemicals necessary for blood clotting
• Clotting Factors


  • Fibrinogen
  • Prothrombin
  • Thromboplastin (tissue factor)
  • Calcium ion
  • Proaccelerin (labile factor)
  • Serum prothrombin conversion accelerator (stable factor, proconvertin)
  • Antihemophilic factor (antihemophilic globulin)
  • Plasma thromboplastin component (Christmas factor)
  • Stuart factor (Stuart-Prower factor)
  • Plasma thromboplastin antecedent
  • Hageman factor
  • Fibrin-stabilizing factor
  • Platelet accelerator
  • Thrombin accelerator
  • Phospholipids
• Representative Diseases and Disorders of Blood

  • Erythrocytosis (Relative, Primary, Secondary)
  • Anemia (Iron-deficiency, Folate-deficiency, Pernicious, Hemorrhagic, Hemolytic, Aplastic)
  • Thalassemia
  • Leukemia
  • Thrombocytopenia
  • Disseminated intravascular coagulation (DIC)
• Aplastic anemia


  Caused by an inability of the red bone marrow to produce red blood cells, usually as a result of damage to stem cells after exposure to certain drugs, chemicals, or radiation
• Thalassemia


  Autosomal recessive disease that results in insufficient production of globin part of hemoglobin
• Thrombocytopenia


  Reduction in the number of platelets that leads to chronic bleeding through small vessels and capillaries; causes include genetics, autoimmune disease, infections, and decreased platelet production resulting from pernicious anemia, drug therapy, radiation therapy, or leukemias
• Disseminated intravascular coagulation (DIC)


  Clotting throughout the vascular system, followed by bleeding; may develop when normal regulation of clotting by anticoagulants is overwhelmed, as occurs due to massive tissue damage; also caused by alteration of the lining of the blood vessels resulting from infections or snakebites
• Von Willebrand disease


  Most common inherited bleeding disorder; platelet plug formation and the contribution of activated platelets to blood clotting are impaired; treatments are injection of von Willebrand factor or administration of drugs that increase von Willebrand factor levels in blood, which helps platelets adhere to collagen and become activated
• Hemophilia


  Genetic disorder in which clotting is abnormal or absent; each of the several types results from deficiency or dysfunction of a clotting factor; most often a sex-linked trait that occurs almost exclusively in males
• Malaria


  Caused by a protozoan introduced into blood by Anopheles mosquito; symptoms include chills and fever produced by toxins released when the protozoan causes red blood cells to rupture
• Infectious mononucleosis


  Caused by Epstein-Barr virus, which infects salivary glands and lymphocytes; symptoms include fever, sore throat, and swollen lymph nodes, all probably produced by the immune system response to infected lymphocytes
• Acquired immunodeficiency syndrome (AIDS)


  Caused by human immunodeficiency virus (HIV), which infects lymphocytes and suppresses immune system
• Hemoglobin measurement


  Determines the amount of hemoglobin in a given volume of blood, usually expressed as grams of hemoglobin per 100 mL of blood. The normal hemoglobin count for a male is 14–17 g/100 mL of blood, and for a female it is 12–15 g/100 mL of blood. Abnormally low hemoglobin is an indication of anemia
• Major Cardiac Arrhythmias


  • Tachycardia
  • Paroxysmal atrial tachycardia
  • Ventricular tachycardia
  • Atrial flutter
  • Atrial fibrillation
  • Ventricular fibrillation
  • Bradycardia
  • Sinus Arrhythmia
  • SA Node Block
  • AV Node Block
  • Premature Atrial Contractions
  • Premature Ventricular Contractions (PVCs)
• Stenosed valves have an abnormally narrow opening and produce abnormal heart sounds. Blood flows through stenosed valves very turbulently and produces a rushing sound before the valve closes.
• Inflammation of the heart valves, resulting from a condition such as rheumatic fever, can cause valves to become either incompetent or stenosed.
• Myocardial infarctions that make papillary muscles nonfunctional can cause bicuspid or tricuspid valves to be incompetent.
• Heart murmurs also result from congenital abnormalities in the hearts of infants, such as septal defects in the heart and patent ductus arteriosus.
• Either incompetent or stenosed valves increase the amount of work the cardiac muscle must perform. Consequently, these conditions can lead to heart failure.