Pre-auditory self-work materials.
HIGHER STATE EDUCATIONAL INSTITUTION OF UKRAINE
“UKRAINIAN MEDICAL STOMATOLOGICAL ACADEMY”
PHYSIOLOGY DEPARTMENT
ZAPOROZHETS T.N., TKACHENKO E.V.
PHYSIOLOGY
METHODICAL INSTRUCTIONS TO PRACTICAL CLASSES FOR STUDENTS OF MEDICAL AND DENTAL PROPHILES
PART 2. VISCERAL SYSTEMS: “BLOOD PHYSIOLOGY”
МІНІСТЕРСТВО ОХОРОНИ ЗДОРОВ'Я УКРАЇНИ
ВИЩИЙ ДЕРЖАВНИЙ НАВЧАЛЬНИЙ ЗАКЛАД УКРАЇНИ
“УКРАЇНСЬКА МЕДИЧНА СТОМАТОЛОГІЧНА АКАДЕМІЯ”
КАФЕДРА ФІЗІОЛОГІЇ
ЗАПОРОЖЕЦЬ Т.М., ТКАЧЕНКО О.В.
ФІЗІОЛОГІЯ
НАВЧАЛЬНИЙ ПОСІБНИК ДЛЯ СТУДЕНТІВ МЕДИЧНОГО ТА СТОМАТОЛОГІЧНОГО ФАКУЛЬТЕТІВ
ЧАСТИНА 2. ФІЗІОЛОГІЯ ВІСЦЕРАЛЬНИХ СИСТЕМ:
«ФІЗІОЛОГІЯ КРОВІ»
ПОЛТАВА 2009
Approved by
the Central methodical commission
the protocol N.4 from 19.02.2009
It has been composed by Zaporozhets T.N., d.med.sci., prof., Tkachenko E.V., cand.med.sci., assistant
Reviewers:
The doctor of medical sciences, professor Kostenko V.A., the head of pathological physiology department of higher state educational institution of Ukraine “Ukrainian Medical Stomatological Academy”, Poltava.
Cand.Phil.Sci Znamenskaya I.V., the higher lecturer of foreign languages department of higher state educational institution of Ukraine “Ukrainian Medical Stomatological Academy”, Poltava.
The manual contains theoretical material and material for practical classes, questions for students' self-preparing as well as tests and tasks (with answers) for training to Krok-1. It is illustrated by figures and tables.
Затверджено Центральною
методичною комісією
Протокол № 4 від 19.02.2009 р.
Склали: Запорожець Т.М., д.мед.н., професор. Ткаченко О.В., к.мед.н., асистент
Рецензенти:
Доктор медичних наук, професор Костенко В.О., завідувач кафедри патологічної фізіології Вищого державного навчального закладу України “Українська медична стоматологічна академія”, м.Полтава
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Кандидат філологічних наук Знаменська І.В., старший викладач кафедри іноземних мов Вищого державного навчального закладу України “Українська медична стоматологічна академія”, м.Полтава
Посібник містить теоретичний матеріал та практичні завдання, питання до самопідготовки студентів, а також навчальні тести та задачі (із відповідями) для підготовки до ліцензійного іспиту з “Крок-1”. Посібник вдало ілюстрований тематичними малюнками і таблицями.
CONTENT
СONTENT MODULE 11: BLOOD SYSTEM PHYSIOLOGY.. 5
LESSON 31. 5
BLOOD PHYSICAL-CHEMICAL FEATURES INVESTIGATION.. 5
LESSON 32. 18
ERYTHROCYTES NUMBER AND HEMOGLOBIN CONCENTRATION INVESTIGATION.. 18
LESSON 33. 39
BLOOD GROUPS BELONGING INVESTIGATION.. 39
LESSON 34. 48
LEUCOCYTES NUMBER, LEUCOCYTIC FORMULE INVESTIGATION.. 48
LESSON 35. 81
PLATELETS AND VASCULAR-PLATELET HEMOSTASIS INVESTIGATION 81
LESSON 36. 92
BLOOD COAGULATION INVESTIGATION.. 92
LESSON 37. 102
DIFFERENTIATED COAGULOGRAM. DISSEMINATED INTRAVASCULAR COAGULATION (DIC) SYNDROME. 102
LESSON 38. 113
FIBRINOLYSIS AND ANTICOAGULANTS. BLOOD COAGULATION AND FIBRINOLYSIS REGULATION.. 113
LESSON 39. 123
TOTAL BLOOD.. 123
LESSON 40. 134
PRACTICAL SKILLS ON BLOOD SYSTEM PHYSIOLOGY.. 134
GLOSSARY.. 134
BLOOD SYSTEM PHYSIOLOGY.. 134
TESTS ON BLOOD PHYSIOLOGY.. 141
СONTENT MODULE 11: BLOOD SYSTEM PHYSIOLOGY
“Blood reflects like in mirror
all processes taking place
in alive organism”.
LESSON 31
BLOOD PHYSICAL-CHEMICAL FEATURES INVESTIGATION
1. The topic studied actuality. Blood is characterized by lots of constants that can be either very stable or hard (so, their change even a bit can lead to serious, irreversible changes or even to death – pH, plasma ionic content, osmotic and oncotic pressures, plasma proteinic content, oxygen partial pressure, glucose content et al.) or unstable (they can vary in wide ranges and these variations do not lead to any serious results in organism functioning – circulating blood volume, formed elements content, hemoglobin level, blood viscosity, velocity sedimentation rate et al.). Blood system belongs to one of the most sensitive indicators testifying about organism state both under norm and pathology. Oral cavity also can suffer at blood pathological conditions.
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2. Study aims:
To know: blood content and its functions in organism, blood constants and their significance in clinics, in part, in stomatological one; blood main components, hematocrit, blood buffer systems, acidosis, alkalosis, erythrocytes osmotic resistance, velocity sedimentation rate and affecting factors.
To be able to: estimate erythrocytes osmotic resistance, velocity sedimentation rate and assess the results received.
Pre-auditory self-work materials.
3.1.Basic knowledge, skills, experiences, necessary for study the topic:
| Subject | To know | To be able to |
| Bioinorganic, bioorganic, physical-colloid chemistry | Data about buffer systems, blood proteins, osmotically-active substances | |
| Medical biological chemistry | Data about buffer systems, blood proteins | Assess given indexes of acid-alkaline equilibrium and make a conclusion about possible reasons and developmental mechanisms |
| Biophysics | Data about oncotic and osmotic pressure, hematocrit, velocity sedimentation rate, blood viscosity, erythrocytes osmotic resistance | Count hematocrit, velocity sedimentation rate and blood viscosity, erythrocytes osmotic resistance |
| Medical Biology | Data about osmosis, osmotic pressure | |
| Pathophysiology | About metabolic and respiratory alkalosis and acidosis reasons and developmental mechanisms | Assess given indexes of acid-alkaline equilibrium and make a conclusion about possible reasons and developmental mechanisms |
Topic content
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INTRODUCTION
Body is formed by solids and fluids. The fluid part is more than 2/3 of the whole body.
Water forms most of the fluid part of the body.
In human beings, the total body water varies from 45 to 75% of body weight. In a normal young adult male, body contains 60-65% of water and 35-40% of solids. In a normal young adult female, the water is 50 to 55% and solids are 45-50%. In females, water is less because of more amount of subcutaneous adipose tissue. In thin persons, water content is more than in obese persons. In old age, water content is decreased due to increase in adipose tissue. The total quantity of body water in an average human being weighing about 70 kg is about 40 l iters.
1.. Isotonic Solutions
The solutions having the same effective osmolality (tonicity) as body fluids are called isotonic solution. The examples are 0.9% sodium chloride solution (normal saline) and 5% glucose solution.
The red blood cells placed in isotonic solution (normal saline) neither gain nor lose water by osmosis (Fig. 1). This is because of the osmotic equilibrium between inside and outside the cell across the cell membrane.
2.. Hypertonic Solutions
Solutions like 2% sodium chloride solution, having greater effective osmolality than the body fluids are called hypertonic solutions. When red blood cells are placed in hypertonic solution, water moves out of the cells (exosmosis) resulting in shrinkage of the cells (crenation).
FIGURE 1: Effect of hypertonic and hypotonic solutions on red blood cells
3. Hypotonic Solutions
The solutions, which have less effective osmolality than the body fluids are called hypotonic solutions. The example is 0.3% sodium chloride solution. When the red blood cells are taken in hypotonic solution, water moves into the cells (endosmosis) resulting in swelling and rupture (hemolysis) of the cells.
APPLIED PHYSIOLOGY—DEHYDRATION
DEFINITION
Significant decrease in water content of the body is known as dehydration. This is observed more commonly in children than adults.
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CONDITIONS WHEN DEHYDRATION OCCURS
Dehydration is common in the following conditions:
1. Severe diarrhea and vomiting leading to decrease in body water, sodium and other electrolytes.
2. Increased urinary output because of renal diseases or adrenal insufficiency leading to lack of aldosterone. In the absence of aldosterone, the reabsorption of sodium and chloride by the renal tubules reduces and urine output increases.
3. Insufficient intake of water.
4. Excessive sweating leading to heat frostration, i.e. extreme loss of water, heat and energy.
COMPLICATIONS OF DEHYDRATION
Dehydration reduces blood volume and cardiac output resulting hypovolemic cardiac shock. In severe conditions of dehydration, renal failure and coma occur.
Blood is a connective tissue in fluid form. It is considered as the fluid of life because it carries oxygen from lungs to all parts of the body and carbon dioxide from all parts of the body to the lungs. It is known as fluid of growth because it carries nutritive substances from the digestive system and hormones from endocrine gland to all the tissues. The blood can also be called the fluid of health. Because it protects the body against the diseases and gets rid of the waste products and unwanted substances by transporting them to the excretory organs like kidneys.
PROPERTIES OF BLOOD
Following are the properties of the blood.
1. Color:
2. Volume: The volume of blood in a normal adult is 5 liters.
3. Reaction and pH: Blood is slightly alkaline and its pH in normal conditions is 7.4.
4. Specific gravity:
The specific gravity of total blood: 1.052 to 1.061
The specific gravity blood cells: 1.092 to 1.101
The specific gravity of plasma: 1.022 to 1.026
5. Viscosity: Blood is five times more viscous than water.
It is mainly due to red blood cells and plasma proteins.
6. Blood temperature
7. Blood densit:1,056-1,060.
Blood color - depends on hemoglobin. Blood is red in color. Arterial blood is brightly red because of oxyhemoglobin (hemoglobin connected with oxygen) big amount. Venous blood is dark red with blue shade or purple red. Such blood color is linked with presence not only of oxydated hemoglobin but also reducted hemoglobin.
Blood temperature depends greatly on organ metabolism level from which it outflows. The more intensive metabolism level is, the higher is the temperature of blood that outflows from it. Thus, venous blood temperature is bigger always in one and the same organ than the one of the arterial blood. Though, this rule does not correspond to skin superficial veins because they are in touch with atmospheric air and participate indirectly in heat-exchange. Blood temperature is fluctuated from 37 to 40°C under resting conditions in different vessels in homoiothermal animals and human being. So, blood outflowing from lover through veins can have the temperature equal to 39,7°C. Blood temperature is increased significantly at intensive muscular activity.
Blood density is increased at blood condensation; is decreased – at its liquerfaction. Density level depends on formed elements (mainly erythrocytes) amount and proteins concentration.
Acid-alkaline equilibrium – correlation between acid and alkaline equivalent in blood. This is reaction caused by H+-ions concentration. Ph or hydrogen index is used for its evaluation. If pH is equal to 7,0 the environment is called neutral; less than 7,0 – acid; more than 7,0 – alkaline. Norma: in venous blood – 7,34, arterial blood – 7,4; blood in a whole – 7,35-7,47. At muscular tension increasing acid products come into blood (lactic acid, carbonic acid) and movement to acid side (acidosis) is observed. At increased carbonic acid releasing (with lungs at hyperventillation) movement to alkaline side (alkalosis) occurs.
COMPOSITION OF BLOOD
Blood contains the blood cells which are called formed elements and the liquid portion known as plasma.
BLOOD CELLS
Three types of cells are present in the blood.
1. Red blood cells or Erythrocytes
2. White blood cells or Leukocytes
3.Platelets or Thrombocytes
Hematocrit Value
If blood is collected in a hematocrit tube along with suitable anticoagulant and centrifuged for 30 minutes with a speed of 3000 RPM (revolutions per minute), there are blood cells settle down at the bottom having a clear plasma at the top. The plasma forms 55% and the red blood cells form 45% of the total blood. The volume of red blood cells expressed in percentage is called the hematocit value or packed cell volume (PCV).
In between the plasma and the red blood cells there is a thin layer of white buffy coat. This white buffy coat is formed by the aggregation of white blood cells and platelets.
PLASMA
Plasma is a straw coloured clear liquid. It contains 91 to 92% of water and 8 to 9% of solids. The solids are the organic and the inorganic substances.
Organic Substances of the Plasma
The following are the organic substances of the plasma.
1. Proteins: The proteins present in the plasma are albumins, globulins and fibrinogen. These are specifically known as plasma proteins.
2. Carbohydrates: The carbohydrate is present in plasma mainly in the form of glucose.
3. Fats: The lipid substances present in plasma are the neutral fats, phospholipids and cholesterol.
4. Amino acids: Plasma contains both essential and nonessential amino acids.
5. Nonprotein nitrogenous substances: The plasma also contains some nonprotein nitrogenous substances like ammonia, creatine, creatinine, xanthine, hypoxanthine, urea and uric acid.
6. Internal secrets: The plasma contains many hormones.
7. Enzymes: The enzymes like amylase, carbonic anhydrase, alkaline phosphatase, acid phosphatase, lipase, esterase, protease and transaminase are present in plasma.
8. Antibodies: The plasma contains many antibodies, which are called immunoglobulins.
Inorganic Substances of the Plasma
Following are the inorganic substances present in plasma.
1. Sodium
2. Calcium
3. Potassium
4. Magnesium
5. Chloride
6. Iodide
7. Iron
8. Phosphates
9. Copper.
Gases Present in Plasma
Oxygen and carbon dioxide are also present in plasma.
The Table 1 gives the normal values of some important substances in blood.
TABLE 1: Blood level of some important substances
| Glucose | 3,5-5,5 mmol/l |
| Cholesterol | 3,9-6,5 mmol/l |
| Plasma proteins (globulins, albumins, fibrinogen) | 23-35 g/l, 35-50 g/l, 2-4 g/l |
| Iron | 11-31 mcmol/l |
| Calcium | 2,25-2,74 mmol/l |
| Bilirubin (total, unconjugated, conjugated) | 8,55-20,52, 1,7-17,1, 2,2-5,1 mcmol/l |
FUNCTIONS OF BLOOD
1. NUTRIENT FUNCTION
Nutritive substances like glucose, amino acids, lipids and vitamins derived from digested food are absorbed from gastrointestinal tract and carried by blood to different parts of the body for growth and for production of energy.
2. RESPIRATORY FUNCTION
Transport of respiratory gases is done by the blood. It carries oxygen from alveoli of lungs to different tissues and carbon dioxide from tissues to alveoli.
3. EXCRETORY FUNCTION
Waste products formed during various metabolic activities the tissues are removed by blood and carried to the excretory organs like kidney, skin, liver, etc.
4. TRANSPORT OF HORMONES AND ENZYMES
The hormones and some of the enzymes are carried by blood to different parts of the body from the source of secretion.
5. EGULATION OF WATER BALANCE
Water content of the blood is freely interchangeable with interstitial fluid. This helps in the regulation of water content of the body.
6. REGULATION OF ACID-BASE BALANCE
The plasma proteins and hemoglobin act as buffers and help in regulation of acid base balance.
7. REGULATION OF BODY TEMPERATURE
Because of the high specific heat of blood, it is responsible for maintaining the ther-moregulatory mechanism in the body, i.e. the balance between heat loss and heat gain in the body. Not only temperature making equal but also creating conditions for heat-production or heat-releasing in organism occurs at blood movement. Bigger blood amount passage through skin vessels in hot weather encourages to heat-emission. Cutaneous vessels are constricted in cold weather, blood is pushed in abdominal cavity that leads to heat-saving.
8. STORAGE FUNCTION
Water and some important substances like proteins, glucose, sodium and potassium are оnstantly required by the tissues. Blood serves as a readymade source for these substances. And, these substances are taken from blood during the conditions like starvation, fluid loss, electrolyte loss, etc.
9. DEFENSIVE FUNCTION
Blood plays important role in the defense of the body. The white blood cells are responsible for this function. Neutrophils and monocytes engulf the bacteria by phagocytosis. Lymphocytes are involved in immunity (both humoral and cell-mediated). Eosinophils are responsible for detoxification, disintegration am removal of foreign proteins. In general, blood coagulation and fibrinolysis (clot destruction), antioxidants belong to this wide function.
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