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1 Physiology Chapter 3 The Blood 陈丽 (O) 四川大学华西基础医学与法医学院生理教研室

2 I. Review of The Blood 7~8 % of BW Hematocrit ( 血细胞比容 ) The volume percentage of blood cells in the whole blood. The male: 40%-50% The female: 37%-48%

3 Blood Constituents and Their Functions RBC transportation of O 2, CO 2 Blood Cell WBC immune defense Platelet hemostasis Plasma protein water nutrition albumin transportation colloid osmotic pressure globulin immune fibrinogen blood coagulation crystal substances electrolytes small organic chemicals crystal osmotic pressure O 2 CO 2

4 II. Red Blood Cells (Erythrocytes) 1. Erythrocyte Structure The biconcave shape The thinness of the cell (2 m 1 m ) A single RBC has 250 million hemoglobin molecules

5 2. Physiological Features of RBC Plastic deformation( 可塑变形性 ) volume 90 m 3 superficial area 140 m 2 140/90 (ball) 100 m 3 Volume/Area Suspension Stability ( 悬浮稳定性 ) Erythrocyte Sedimentation Rate, ESR male 0~15mm/h female 0~20mm/h Osmotic Fragility ( 渗透脆性 )

6 iso-osmotic solution hypo-osmotic solution hyperosmotic solution 0.85%NaCl 1.9% carbamide isotonic solution = iso-osmotic solution

7 3. Regulation of Genesis of RBCs Hemopoiesis 1 Pluripotential stem cell committed progenitor precursor 8-32

8 Raw Ingredients of RBC--- Iron Iron:To form the heme molecule mg/day (1mg from every day s diet and 95% from recycle) Combine and transport by transferrin in blood stream Iron deficiency anemia occurs when not enough iron is available for synthesizing hemoglobin

9 Raw ingredients--- Vitamin B12 and Folic Acid Both of these are essential for the synthesis of DNA Maturation of RBCs-requirement for Vitamin B 12 and Folic Acid Megaloblastic anemia( 巨幼红细胞性贫血 ) is caused by an inability to absorb enough ingested vitamin B 12 from the digestive tract.

10 Regulation of genesis---erythropoietin (EPO) Erythropoiesis is controlled by erythropoietin from the kidneys Target cells:bfu-e ( 晚期红系祖细胞 ) Stimulating proliferation Promoting differentiation and maturation

12 III. Blood Groups and Transfusion Hemorrhage In clinic, blood transfusion may be used to save life or treat diseases. Blood transfusion history

13 Discovery of the first blood group system The ABO blood group system was discovered by the Austrian scientist Karl Landsteiner in Be awarded the Nobel Prize in Karl Landsteiner June 14, 1868 June 26, 1943

14 Blood Groups Blood Groups (Types): Types of the specific antigens on the surface of red blood cells. Antigen Agglutinogen Antibody Agglutinin Agglutination reaction of Ag and Ab

15 1. ABO Blood Group System Antigen: agglutinogen A, B Antibody (agglutinin): Anti-A, Anti-B Ig M, natural Ab, cannot cross the placenta Antibodies are produced in postnatal 2-8 months; Peak level appears at 8-10 years Ig G, immune Ab, cross the placenta

16 ABO System

17 Subgroup of ABO System agglutinogen A 1, anti-a 1 agglutinin Group Agglutinogen Agglutinin A AB A 1 A 2 A 1 B A 2 B A+A 1 Anti-B A (1%) Anti-B +Anti-A 1 A+A 1 +B none A+B (1%) Anti-A 1

18 Inheritance of ABO System The genotype and phenotype of ABO system genotype OO AA,AO BB,BO AB phenotype O A B AB 9

19 Agglutinogen A + Anti A Agglutination Hemolysis

20 Blood Group Examination Anti-A Anti-B Anti-A Anti-A Anti-B A type B type Anti-A Anti-B Anti-A Anti-B AB type O type

21 2. Rh System (Landsteiner & Weiner, 1940) inject (Rhesus monkey) Serum of rabbit 85% 15%

22 Antigen Rhesus factor 40+ (located on RBC) D, E, C, c, e Grouping: Rh positive + (Rhesus factor D) Rh negative Antibodies No natural antibodies Ig G (cross the placenta) Incidence: Rh positive 99% in China 0.2% Rh negative in Chengdu

23 Clinic significance (1) RH - group recipients First transfusion RH + blood Second transfusion RH + Safety Agglutination

24 (2) RH - group pregnant woman Hemolytic Disease of the Newborn Therapy: anti D globulin

25 2008 年 1 月出生在青岛的 AB 型,Rh + 男婴, 因母亲是 Rh - 而发生新生儿溶血, 急需换血, 需 800ml 换什么血型的血??

26 央视东方时空 : 血型之谜 1997 年 5 月, 正读初三的谢 XX( 女性 ) 遇车祸导致多发性骨折, 被送至天津某医院救治经过检验, 确认谢 XX 的血型为 AB 型, 紧急输血 800ml 后为她进行了第一次手术 1997 年 6 月 4 日, 医院为谢 XX 做第二次手术, 术前进行了血型检测, 为 AB 型 Rh 阳性手术中, 谢 XX 又被输入了 2000 毫升 Rh 阳性血 1998 年 11 月 3 日, 谢 XX 因左膝髋关节僵直再次住进医院接受手术治疗然而, 这次血型检测却为 AB 型 Rh 阴性医院用自体血回收的办法为谢 XX 完成了手术 2001 年 3 月, 谢 XX 的母亲认为该医院在其输血问题上有过错, 将该医院告上法庭问题 : 输血对谢 XX 造成了什么伤害? 医院的医疗行为是否有过错?

27 3. Principles of Blood Transfusion 1) Blood transfusion is allowed among people with same type of blood (ABO, Rh). 2) Cross-matching test must be carried out

28 Cross-matching test RBC RBC Donor Recipient Serum Serum Primary side: the donor s blood cells with the recipient s serum Secondary side: the recipient s blood cells with the donor s serum

29 Primary Side Secondary Side Blood Transfusion (a little amount, slowly, observed) RBC from Donor can not be clumped by Ab of recipient Transfusion of blood components

30 References 1. Lauralee Sberwood Human Physiology From Cells to Systems, 4 th edition, 中国协和医科大学出版社, Guyton & Hall Textbook of Medical Physiology 10 th edition, 北京医科大学出版社, Robert M. Berne Physiology 5 th edition, 北京医科大学出版社 Lingappa, V.R. 医学生理学科学出版社 2005

绪言

绪论生理学 (physiology) 是生物学的一个分支, 它以生物机体的功能 (function) 为研究对象, 是研究生物体的正常生命活动规律的科学动物生理学 (animal physiology) 是生理学的一个分支, 研究动物体的整体及其各个系统的器官