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blood
The mind map of blood includes an overview of blood physiology, blood cell physiology, physiological hemostasis, blood types and blood transfusion principles. It can be downloaded directly to help memorize knowledge points.
Edited at 2023-04-01 17:45:11
- cáncer de pulmón
El cáncer de pulmón es un tumor maligno que se origina en la mucosa bronquial o las glándulas de los pulmones. Es uno de los tumores malignos con mayor morbilidad y mortalidad y mayor amenaza para la salud y la vida humana.
- diabetes
La diabetes es una enfermedad crónica con hiperglucemia como signo principal. Es causada principalmente por una disminución en la secreción de insulina causada por una disfunción de las células de los islotes pancreáticos, o porque el cuerpo es insensible a la acción de la insulina (es decir, resistencia a la insulina), o ambas cosas. la glucosa en la sangre es ineficaz para ser utilizada y almacenada.
- sistema digestivo
El sistema digestivo es uno de los nueve sistemas principales del cuerpo humano y es el principal responsable de la ingesta, digestión, absorción y excreción de los alimentos. Consta de dos partes principales: el tracto digestivo y las glándulas digestivas.
blood
- cáncer de pulmón
El cáncer de pulmón es un tumor maligno que se origina en la mucosa bronquial o las glándulas de los pulmones. Es uno de los tumores malignos con mayor morbilidad y mortalidad y mayor amenaza para la salud y la vida humana.
- diabetes
La diabetes es una enfermedad crónica con hiperglucemia como signo principal. Es causada principalmente por una disminución en la secreción de insulina causada por una disfunción de las células de los islotes pancreáticos, o porque el cuerpo es insensible a la acción de la insulina (es decir, resistencia a la insulina), o ambas cosas. la glucosa en la sangre es ineficaz para ser utilizada y almacenada.
- sistema digestivo
El sistema digestivo es uno de los nueve sistemas principales del cuerpo humano y es el principal responsable de la ingesta, digestión, absorción y excreción de los alimentos. Consta de dos partes principales: el tracto digestivo y las glándulas digestivas.
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- Outline
blood
Overview of blood physiology
blood composition
Blood consists of plasma and blood cells suspended in it
Plasma: composed of water, small organic molecules, inorganic salts, and plasma proteins. It is different from tissue fluid, which contains very little protein. Blood cells: red blood cells, white blood cells, platelets Hematocrit: The percentage of blood cells occupied by the volume of blood
Physical and chemical properties of blood
relative density of blood
Whole blood: 1.950~1.060, depending on the number of red blood cells Plasma: 1.025~1.030, depending on plasma protein content Red blood cells: 1.090~1.092, depending on the hemoglobin content in red blood cells
blood viscosity
Blood viscosity is one of the important factors in forming blood flow resistance
Whole blood: determined by the level of hematocrit Plasma: Determined by the content of plasma proteins
plasma osmolarity
Plasma osmotic pressure: close to 300mmol/L (280~290mmol/L) equivalent to 770kPa or 5790mmHg Plasma crystal osmotic pressure (99.5%): mainly formed by albumin, maintaining the balance of water inside and outside blood vessels Plasma colloid osmotic pressure (0.5%): mainly formed by sodium ions and chloride ions, maintaining the balance of water inside and outside cells
pH of plasma
Normal human plasma pH is 7.35~7.45
The buffer substances in plasma include three main buffer pairs: sodium bicarbonate and sodium carbonate, protein sodium salt and protein, sodium monohydrogen phosphate and sodium dihydrogen phosphate.
Immunological properties of blood
innate immunity
A defense function gradually established by organisms during the long-term germline development and evolution process. It can be inherited and has no specificity against a certain antigen. It is also called non-specific immunity.
Innate immune cells include phagocytes (neutrophils, monocytes-macrophages), dendritic cells, natural killer cells, natural killer T cells, and B1 cells
acquired immunity
The individual develops or receives an immune effect after contact with antigenic substances after birth, and thus acquires a specific defense function that reacts to a certain antigenic substance. It is also called specific immunity, including humoral immunity and cellular immunity.
Various white blood cells in the blood, such as neutrophils, eosinophils, basophils, lymphocytes, monocytes, and various antibodies and complements in the plasma, are important components of the body's immune cells and immune molecules.
blood cell physiology
Parts and general processes of blood cell production
Hematopoietic organs in different stages of human body
All adult blood cells originate from bone marrow
Early embryonic development: yolk sac hematopoiesis Starting from the second month of embryonic life: hematopoiesis in the liver and spleen After the fourth month of embryonic development: hematopoiesis in the liver and spleen decreases, and hematopoiesis in the bone marrow begins and gradually increases. When the baby is born: almost entirely dependent on bone marrow for hematopoiesis, but when the need for hematopoiesis increases, the liver and spleen can participate in hematopoiesis to supplement the lack of bone marrow function. After four years of age: the growth rate of the bone marrow cavity exceeds the increase rate of hematopoietic cells, and fat cells enter the bone marrow and gradually fill the excess bone marrow cavity. Around 18 years old: Hematopoietic bone marrow is only present in the spine, ilium, ribs, sternum, skull and proximal bone of long bones, but it is sufficient for normal hematopoiesis.
hematopoietic microenvironment
The place where hematopoietic stem cells colonize, survive, proliferate, differentiate and mature (T lymphocytes mature in the thymus), including stromal cells in hematopoietic organs, extracellular matrix secreted by stromal cells and various hematopoietic regulatory factors, as well as cells that enter hematopoietic organs. Nerves and blood vessels play a role in regulating, inducing and supporting the entire process of blood cell production.
General process of human hematopoiesis
Hematopoietic stem cell stage
committed progenitor stage
Morphologically identifiable precursor cell stages
Red blood cell physiology
Number and shape of red blood cells
Shape: Double concave disc
Features: Plastic deformation ability There is no nucleus and high hemoglobin content. Mature red blood cells have no mitochondria and glycolysis is their only way to obtain energy.
Quantity: Male (4.0～5.5)×10^12/L Female (3.5～5.0)×10^12/L
Hemoglobin concentration: Male: 120~160g/L Female: 110~150g/L Newborn: 200g/L
Anemia: The number of red blood cells and hemoglobin concentration in the blood are lower than normal
Physiological characteristics of red blood cells
Plastic deformability
The greater the ratio of surface area to volume, the greater the ability to deform. The elasticity of the red blood cell membrane is reduced or the viscosity is increased, and its deformation ability is reduced. The greater the viscosity in red blood cells, that is, when the hemoglobin is deformed or the concentration is too high, the deformation ability is smaller.
suspension stability
Erythrocyte sedimentation rate (erythrocyte sedimentation rate): The distance that red blood cells sink at the end of the first hour. The erythrocyte sedimentation rate is 0 to 15 mm/h for adult men and 0 to 20 mm/h for adult women. The faster the sedimentation rate, the less stable the suspension of red blood cells is.
Red blood cell stacking: In certain diseases, such as active tuberculosis and rheumatic fever, the red blood cells can attach to each other more quickly with concave surfaces. The factor that determines the speed of red blood cell stacking formation is not the red blood cells themselves, but the changes in plasma components. Usually, when the content of fibrinogen, globulin and cholesterol in the plasma increases, it can accelerate the red blood cell stacking and sedimentation. In the plasma, albumin, Increased content of lecithin can inhibit the occurrence of stacking and slow down the sedimentation rate.
Osmotic fragility
Red blood cells have the characteristic of swelling and rupture in hypotonic saline solution and have certain resistance to hypotonic solution. The smaller the resistance, the greater the osmotic fragility.
function of red blood cells
Highly efficient ability to transport oxygen and carbon dioxide
Red blood cells contain a variety of buffer pairs, which have a certain buffering effect on acid and alkali substances in the blood and participate in maintaining the body's acid-base balance.
Regulation of erythropoiesis
Substances required for the production of red blood cells
Ingredients: Protein and Iron Cofactors: folic acid and vitamin B12 are necessary for DNA synthesis Others: amino acids, vitamin B6, vitamin B2, vitamin C, vitamin E and trace elements copper, manganese, cobalt, zinc, etc.
Iron deficiency anemia: hypochromic microcytic anemia, in which the volume of red blood cells in the circulating blood volume becomes smaller, the number and the concentration of hemoglobin decrease, but the decrease in hemoglobin is the most obvious Megaloblastic anemia: lack of folic acid or vitamin B12. The absorption of vitamin B12 requires the participation of intrinsic factor (produced by parietal cells of the gastric mucosa)
Regulation of red blood cell production: mainly erythropoietin (produced by the kidneys), in addition to androgens, thyroid hormones, growth hormone, white blood cells and platelets, etc.
destruction of red blood cells
A small number of senescent red blood cells directly undergo hemolysis, and most of the red blood cells are engulfed by macrophages. The spleen is the main place where red blood cells are destroyed.
Extravascular disruption of macrophage phagocytosis Intravascular damage Damage to blood vessels caused by mechanical impact
White blood cell physiology
Classification and number of white blood cells
Shape: colorless, nucleated cells, generally spherical in blood
Quantity: (4.0～10.0)×10^9/L
Classification: granulocytes (eosinophils 0.5 to 5%, basophils 0 to 1%, neutrophils 50 to 70%) agranulocytes (monocytes 3 to 5%, lymphocytes. 25 to 40%)
Physiological properties and functions of white blood cells
Overview
Leukocyte extravasation: the process of extending pseudopods through deformation movements and passing through capillary walls (except lymphocytes) Chemotaxis: the characteristic that exuded leukocytes can migrate to inflammatory areas to exert their physiological effects when attracted by certain chemicals. Chemokines: chemicals that attract white blood cells to move in a directed manner Phagocytosis: the process by which white blood cells surround foreign objects and swallow them into the cytoplasm
Physiological characteristics of white blood cells: The characteristics of white blood cells such as deformation, migration, chemotaxis, and phagocytosis are the physiological basis for performing defense functions.
Physiological functions of white blood cells
Phagocytosis of microorganisms, foreign bodies, own necrotic tissue and aging red blood cells that invade the body. White blood cells are selective in their phagocytosis.
Participate in the body’s immune defense function
Certain white blood cells can produce some chemicals and participate in other physiological functions of the body
Physiological characteristics and functions of white blood cells
neutrophils
Physiological characteristics: The nucleus is lobulated, so it is also called polymorphonuclear leukocyte. It is the main phagocyte in the blood. It has strong deformation and migration ability and phagocytic activity. Neutrophils contain a large number of lysosomal enzymes.
Main functions: phagocytose cells that invade the body and prevent the spread of pathogenic microorganisms in the body; phagocytose and remove aging red blood cells and antigen-antibody complexes; neutrophils have active deformability, keen chemotaxis and strong Phagocytosis is the main response cell when the body undergoes an acute inflammatory response and is the first line of defense against the invasion of purulent bacteria.
monocytes
Physiological characteristics: The monocytes that enter the blood from the bones are still immature cells. After staying in the blood for 2 to 3 days, the monocytes first move into the tissues and continue to develop into large sizes. They also have a large number of media particles and mitochondria. Macrophages with greater phagocytic ability than neutrophils
Function: phagocytose and kill invading pathogens, identify and kill tumor cells; remove necrotic tissue and aging red blood cells, platelets, etc.; participate in immune responses; macrophages can produce colony-stimulating factors, interleukins, tumor necrosis factor, Interferons, etc., participate in the regulation of other cell growth
basophils
Produce and release a variety of biologically active substances Participate in the body’s allergic reaction
eosinophils
Physiological characteristics: The number of eosinophils in the blood has obvious diurnal fluctuations. The number of cells decreases in the early morning and increases at midnight. It is related to the diurnal fluctuation of adrenocortical hormone content in the blood. It has weak phagocytic ability but basically no bactericidal effect.
Function: Limit the role of basophils and mast cells in immediate allergic reactions. Eosinophils increase in bronchial asthma, urticaria, and food allergies. Involved in the immune response to worms
Lymphocytes
Lymphocytes play a central role in the immune response process and can be divided into two categories based on their growth and development processes, cell surface markers, and functions. Lymphoid stem cells generated from bones mature into T lymphocytes under the action of thymus hormones, which are mainly related to cellular immunity. B lymphocytes mature in the bone marrow or intestinal lymphoid tissue and perform humoral immunity mainly in lymph nodes, spleen and intestinal lymphoid tissue.
Production and regulation of white blood cells
The production of granulocytes is regulated by colony-stimulating factor CSF.
CSF includes granulocyte-macrophage colony-stimulating factor GM-CSF, granulocyte colony-stimulating factor G-CSF, macrophage colony-stimulating factor M-CSF, etc.
destruction of white blood cells
Since white blood cells mainly play a role in tissues, and lymphocytes can travel between plasma, interstitial fluid and lymph, and can proliferate and differentiate, it is difficult to judge the life span of white blood cells.
Platelet Physiology
Platelet number and function
Platelets do not have a nucleus, but they have cell membranes and organelles. They are living cells capable of metabolism and are closely related to the physiological hemostasis process. The platelets in normal adult blood are 100~300×10^9/L
Physiological function: Platelets help maintain the integrity of blood vessel walls Can participate in the blood coagulation process Participate in the process of hemostasis Affects fibrinolysis
Physiological properties of platelets
Adhesion: the adhesion of platelets to non-platelet surfaces
Release: The phenomenon of platelets expelling substances stored in dense bodies, α-granules or lysosomes after being stimulated.
Aggregation: The adhesion of platelets to each other. Platelet aggregation usually occurs in two phases. That is, the first gathering phase and the second gathering phase. The first aggregation phase occurs rapidly and is caused by adenosine diphosphate ADP released from damaged tissue. It also depolymerizes rapidly, indicating reversible aggregation. The second aggregation phase occurs slowly and involves the release of endogenous α from platelets. Caused by ADP, cannot depolymerize, and is irreversible aggregation
Contraction: Platelets have the ability to contract. The contraction of platelets is related to the contractile protein of platelets. When the platelets in the blood clot shrink, the blood clot can shrink.
Adsorption: The surface of platelets can adsorb a variety of coagulation factors in plasma. If the vascular endothelium is damaged, the concentration of local coagulation factors will increase as platelets adhere and aggregate in the damaged area, which is beneficial to blood coagulation and physiological hemostasis.
Platelet production and regulation
Production: Platelets are biologically active small pieces of cytoplasm shed from the cytoplasm of mature megakaryocytes in bone marrow.
Regulation: The production of platelets is regulated by thrombopoietin TPO
destruction of platelets
After platelets enter the blood, their average lifespan is 7 to 14 days, but they only have physiological functions during the first two days. Aged platelets are engulfed and destroyed in the spleen, liver and lung tissues. In addition, during physiological hemostasis, after platelets aggregate, they themselves will disintegrate and release all active substances, which will be consumed when performing their physiological functions.
Physiological hemostasis
Basic process of physiological hemostasis
The physiological hemostasis process mainly includes three processes: vasoconstriction, platelet thrombosis and blood coagulation.
vasoconstriction
Injurious stimulation reflexively causes vasoconstriction
Damage to the vascular wall causes local vascular myogenic contraction
Platelets adhered to the injured area release vasoconstrictor substances such as 5-hydroxytryptamine (5-HT) and thromboxane A (TXA), causing vasoconstriction.
Formation of platelet hemostatic thrombus
Vascular damage - exposure of subendothelial collagen fibers - platelet adhesion to subendothelial collagen (the first step in the formation of hemostatic thrombus) - activation of endogenous and exogenous ADP and TXA2 and promote platelet aggregation - formation of soft hemostatic thrombus - blockage Wound
blood clotting
Damage to blood vessels - activate coagulation system - soluble fibrinogen - insoluble fibrin in plasma - intertwined into a network - trap blood cells - reinforce hemostatic thrombus (secondary hemostasis) - local fibrous tissue proliferation - ingrowth Clots - permanently stop bleeding
blood clotting
Blood coagulation refers to the process in which blood changes from a flowing liquid state to an immobile gel state. Its essence is the process of converting soluble fibrinogen in plasma into insoluble fibrin.
clotting factor
Substances in plasma and tissues that are directly involved in blood coagulation
coagulation process
Blood coagulation consists of three basic steps, the formation of prothrombinase complex, activation of thrombin, and fibrin production.
Formation of prothrombinase complex
It can be generated through the intrinsic coagulation pathway and the extrinsic coagulation pathway. The difference between the two pathways lies in the way they are initiated and the coagulation factors involved. The intrinsic coagulation pathway activates factor XII first. The extrinsic coagulation pathway activates factor III first.
intrinsic coagulation pathway
Refers to a pathway that gradually coagulates blood entirely by relying on coagulation factors in the blood. The initiating factor of the intrinsic coagulation pathway is F XII
Inherited deficiency of F VIII will cause hemophilia A, in which the coagulation process is very slow, and even minor trauma may cause bleeding. Lack of F IX and F XI are called invisible hemophilia and hemophilia C respectively.
extrinsic coagulation pathway
A coagulation process initiated solely by exposure of F III present outside the blood to the blood
Activation of prothrombin and fibrin production
activation of prothrombin
The prothrombinase complex formed by F Xa, F Va, calcium ions and phospholipids activates prothrombin into thrombin
F Va can make F Xa activate prothrombin 10,000 times faster
fibrin formation
Thrombin can activate F
1 to 2 hours after blood coagulation, the platelets in the blood clot are activated, causing the blood clot to retract, releasing a light yellow liquid called serum.
Since some coagulation factors are consumed during the coagulation process, the difference between serum and plasma is that the former lacks fibrinogen and coagulation factors such as F II, F V, F VIII, and FXII, but also adds a small amount of substances released by platelets during the coagulation process.
Physiological coagulation mechanism in vivo
The coagulation process in vivo can be divided into three stages: initiation, amplification and spread.
Negative regulation of blood coagulation
Anticoagulant effect of vascular endothelium
Normal vascular endothelium serves as a barrier to prevent coagulation factors and platelets from contacting subendothelial components, thus preventing activation of the coagulation system and platelet activation.
Has antiplatelet and coagulation properties
Fibrin adsorption, blood flow dilution, and monocyte-macrophage phagocytosis
Physiological anticoagulant substances
serine protease inhibitor
Protein C system
tissue factor pathway inhibitor
heparin
Procoagulation and anticoagulation
Dissolution of fibrin
Overview
Fibrinolysis refers to the process in which fibrin is decomposed and liquefied, which is referred to as fibrinolysis. The fibrinolytic system mainly includes fibrinolytic enzymes, plasmin, plasminogen activator and plasminogen activator.
activation of plasminogen
Plasminogen activators include tissue plasminogen activator, urokinase plasminogen activator and kallikrein, etc. The former two are the most important.
Tissue plasminogen activator and urokinase plasminogen activator are mainly produced by vascular endothelial cells and renal tubule and collecting duct epithelial cells respectively.
Degradation of fibrin and fibrinogen
Plasmin is a serine protease, and its most sensitive substrates are fibrin and fibrinogen
Plasmin is the most active protease in plasma with low specificity. In addition to mainly degrading fibrin and fibrinogen, it also has a certain degradation effect on coagulation factors such as F II, F V, F VIII, F X, and F XII.
fibrinolysis inhibitor
There are many substances in the body that can inhibit the activity of the fibrinolytic system
Plasminogen activator inhibitor-1: Mainly produced by vascular endothelial cells and inactivated by binding to tissue plasminogen activator and urokinase
∝2-antiplasmin is mainly produced by the liver, and a small amount of ∝2-antiplasmin is also stored in platelet r-granules. ∝2-antiplasmin inhibits the activity of the latter by combining with plasmin to form a complex.
Physiological hemostasis: After a small blood vessel is injured and ruptured, blood will flow out of the blood vessel and the bleeding will stop automatically after a few minutes. Bleeding time: In clinical practice, a small needle is commonly used to prick the earlobe or fingertip to allow the blood to flow out naturally, and then measure the bleeding duration, which does not exceed nine minutes for normal people and reflects the physiological hemostasis function.
Blood type and blood transfusion principles
Blood type and red blood cell agglutination
Blood type: refers to the type of specific antigen on the red blood cell membrane
If the blood of two people with incompatible blood types is dropped on a glass slide and mixed, the red blood cells can agglutinate into clusters. This phenomenon is called red blood cell agglutination. The essence of red blood cell agglutination is the antigen-antibody reaction. Blood type identification is the key to safe blood transfusion. premise
The specificity of agglutinogens depends on some specific proteins or glycolipids embedded in the red blood cell membrane. They act as antigens in the coagulation reaction and are called agglutinogens.
Specific antibodies that react with agglutinogens on the red blood cell membrane are called agglutinins. The agglutinins are r-globulins and are present in plasma.
In addition to the same blood group antigens as red blood cells, white blood cells and platelets also have their own unique blood group antigens.
The strongest alloantigen on white blood cells is human leukocyte antigen (HLA)
red blood cell blood type
ABO blood group system
Distribution of ABO blood types
ABO blood type divides blood into four types based on the presence of A and B antigens on the red blood cell membrane.
Those with only A antigen on their red blood cell membranes are type A
Those who only contain B antigen are type B
Those who contain both A and B antigens are type AB
Those who have neither A nor B antigens are type O
ABO blood group classification
Antigens of the ABO blood group system
The specificity of the antigen is determined by the composition and connection sequence of the sugar chains contained in the glycoproteins or glycolipids on the red blood cell membrane.
ABO blood group system antibodies
There are two types of blood type antibodies: natural antibodies and immune antibodies. Natural antibodies, mostly IgM, have a large molecular weight and cannot pass through the placenta. Immune antibodies are produced when the body is stimulated by red blood cell antigens that do not exist on its own. Immune antibodies are IgG antibodies with small molecular weight and can enter the fetus through the placenta.
The plasma of the same individual does not contain blood group antibodies that oppose the native red blood cells.
If the mother has produced immune antibodies due to exogenous A or B antigens entering the body in the past, pregnant women with incompatible fetal ABO blood types may cause the destruction of fetal red blood cells due to maternal immune blood type antibodies entering the fetus, resulting in hemolytic disease of the newborn.
ABO blood type inheritance
People with the same blood type do not necessarily have the same genetic genotype
Identification of ABO blood type
Identification is based on the presence or absence of agglutination. Type A blood (containing anti-B antibodies) and type B serum (containing anti-A antibodies) are used as standard serum to observe whether agglutination occurs when mixed with the red blood cells of the subject.
Rh blood group system
Discovery and distribution of Rh blood types
Definition: The blood group system established based on the Rh factor on the red blood cell membrane is called the Rh blood group.
Rh factor: The same antigens present on the red blood cell membranes of most people as those on the red blood cell membranes of rhesus monkeys are called Rh factors.
About 85% of Rh positive Caucasians and about 15% of Rh negative people
Antigens and typing of the Rh blood group system
Rh positive: those who have D antigen on their red blood cells
Rh negative: A person who lacks the D antigen on red blood cells
Characteristics of Rh blood type
The antibodies of the Rh system are mainly IgG, which can pass through the placenta because of their small molecules. The plasma of Rh-negative people does not contain natural antibodies to Rh. The first transfusion of Rh-positive blood to Rh-negative people generally does not produce an obvious reaction, but it can stimulate Rh-negative people to produce anti-Rh antibodies.
Blood volume and blood transfusion principles
HP
It refers to the total volume of blood in the whole body. The blood volume of a normal adult accounts for about 7% to 8% of its volume.
Blood volume = total red blood cell volume/hematocrit
Blood volume = plasma volume / (1 - reduced hematocrit)
Blood transfusion principle
crossmatch test
component transfusion
autologous blood transfusion