Blood and Body fluids

Dr.Kishan.K
MBBS,MD

Assistant professor

TOPICS TO BE COVERED
1. 2. 3. 4. 5. 6. 7. Body fluid compartments Principle of estimation Introduction to blood Functions of blood Components of blood Blood as a part of body fluids Functions of individual components in brief

Evolution of blood
With evolution, multicellular organisms developed and tubules developed to carry sea water to each cell. Open system with evolution became a closed one and sea water entrapped within the body

Evolution of blood
This entrapped fluid underwent many modifications & transformed BLOOD

With Further evolution each cell was furnished with a small private sea of its ownThis is interstitial fluid or extra cellular fluid; called milieu interior coined by Claude Bernard.

Body Fluids
ECF should be constantly replenished by having a set of tubules and capillaries. Fluid in the capillaries is in constant motion because of pumping of the heart. Capillaries exchange their materials with external environment at few points for fresh supply of nutrients and disposal of waste--- lungs, kidneys, GIT.

Body Fluids
Aim of the different systems is to achieve constancy in characteristics of ECF Homeostasis.(Maintenance of a relatively stable internal environment)

Essential for survival and function of all cells Each cell contributes to its maintenance Disease, by and large, is a failure of homeostasis

 Digestive, respiratory, excretory, blood and cardiovascular systems contribute directly to homeostasis; Endocrine, nervous system co-ordinate the activity of all other systems.

Systems contribute directly to homeostasis

Systems

Body Systems

Body Fluids
Total body water - 45-75% of body weight. In young men - 55-60% of the body weight. In young women - 45-50% of body weight. In children -70-75% of body weight.

1. 2. 3. 4. 5.

Significance of body fluid:

To maintain homeostasis In transport mechanism In metabolic reactions In texture of tissue In temperature regulation

11

FLUID COMPARTMENTS

EXTRA CELLUAR FLUID

INTRA CELLULAR FLUID

PLASMA

INTERSTITIAL FLUID CSF Intra ocular Pleural Peritoneal Synovial Digestive Secretions

TRANSCELLULAR FLUID

12

TBW

15

VOLUME OF BODY FLUIDS IN 70 kg MAN

TOTAL VOLUME 42 L

INTRA CELLUAR FLUID 28 L(ROUGHLY 2/3 OF TBW) EXTRA CELLULAR FLUID 14 L(ROUGHLY 1/3 OF TBW) PLASMA 4 L (ROUGHLY OF ECF)
16

Composition of ECF & ICF

Measurement of volume of body fluids: By indicator dilution or dye dilution method. Dilution principle: Ficks principle says

The final concentration of the substance in a solution depends upon the volume of the solvent in which it dissolves

Example: if 25 mg of glucose are added to an unknown volume of distilled water and the final concentration of glucose after mixing is 0.05 mg/ml, then the volume of solvent is ???

Quantity of fluid in the compartment is measured by the following formula:

M
V- Volume of the fluid in the compartment M- Total quantity of marker substance injected C- con. of the marker substance in the sample fluid

V=-----C

Correction factor
Amt of sub injected --Amt of sub excreted Volume = -----------------------------------Concentration of substance in sample of fluid

This method is used to measure the ECF volume, plasma volume and the volume of total body water.

Characteristics of the marker substances:

1. It must be non toxic 2. It must mix with the fluid compartment within reasonable time 3. It should not be excreted rapidly

4. It should be excreted from the body completely within reasonable time 5. It should not change the color of the body fluid 6. It should not alter the volume of body fluid

Marker substances used

To measure T B W: Deuterium oxide, Tritium oxide, Antipyrine To measure E C F: Radioactive sodium, chloride, bromide, sulfate

Non-metabolizable saccharides like inuline,mannitol. To measure plasma volume Radioactive iodine(131I) Evans blue (T-1824)

Osmosis
Osmosis: Is movement of water molecules from a
region of its higher concentration to the region of its lower concentration through a semipermiable membrane.

Osmotic pressure: Is the amount of pressure required to stop osmosis completely. Its determined by the number of particles per unit volume of fluid Osmolality: Its expressed as number of particles per kilogram of solution.

Osmolarity: expressed as number of particles per liter of solution.

Blood
Described as a specialized tissue with Physical properties of blood Colour- Red opaque liquid Volume- 5-6 liters pH-7.4 Specific gravity- 1.052-1.062 Viscosity- 4-5 times of water

liquid intercellular substance (Plasma) and formed elements (RBC,WBC &platelets)

Functions of blood
1. Respiratory function 2. Nutritive function 3. Excretory function 4. Transport of Hormones and enzymes 5. Regulation of water balance 6. Regulation of acid base balance 7. Regulation of body temperature 8. Storage function 9. Defensive function 10.Regulation of blood pressure 11.Coagulation

Composition of Blood

Serum
Serum is the fluid part of the blood after clotting. Serum = plasma -- clotting factors & fibrinogen

Composition of Blood

TOPICS COVERED TILL NOW

1. 2. 3. 4. 5. 6. Body fluid compartments Principle of estimation Introduction to blood Functions of blood Components of blood Functions of individual components in brief

Contents of plasma
91% water 9% solids1% inorganic moleculesNa+,Ca2+,K+,Cl-,I-,etc

8% organic substances 1% other substances- NPN substances,

sugar, fats, enzymes, hormones

7% plasma proteins-

6.4-8.4gm%

Plasma proteins

Plasma proteins
Types & Normal values :
Total proteins: 7.3gm%
(6.4 to 8.3gm%)

Serum albumin: 3-5gm%(55%) Prothrombin: 40mg%

Serum globulin: 2-3gm% (38%) Fibrinogen: 0.3gm% (7%)

Characteristics of plasma proteins

Serum albumin Mol wt- 69000, Made up of single polypeptide chain; Each molecule is ellipsoid in shape. It is synthesized in liver Pre-albumin helps in the transport of Thyroid hormones

Serum globulin(38%)
Mol wt-90,000to1,50,000. It is also mixture of several globulin

13% -globulin,14% - globulins,11% - globulins

Glycoproteins Lipoproteins Transferrin Ceruloplasmins Haptoglobins.(Hb)

Globulins continued--Prothrombin - globulins in nature

MW-68,000-Helps in blood clotting

FibrinogenIs globulin in nature,

MW-4,00,000-helps in bloodclotting

origin of plasma proteins:

In Embryo: The Mesenchymal cells In Adults-All the fractions are produced mainly in liver, sources of globulin are disintegrated blood cell reticulo-endothelial system General tissue cells and Lymphoid nodules

Albumin: Globulin R atio

Serum albumin: globulin ratio is 1.7:1.0 The ratio may be reversed in liver disease where albumin formation is decreased and kidney diseases where albumin is excreted

Synthesis of proteins
After depletion of plasma proteins, it comes back to normal level in about 14 days. The plasma proteins get completely used up and replaced every fourteen days. Fibrinogen is regenerated first, followed by globulin and last is albumin.

Separation of plasma proteins

The most commonly used method is electrophoresis.

 Because the plasma proteins form charged molecules in solution, if an electric field is applied, from the line of application, the proteins move either towards negative or positive pole of an electrical field and at different velocity.

Electrophoresis

44

Methods of Separation of plasma proteins

1. Electrophoresis

2.Precipitation -22% sodium sulphate solution-Globulin is precipitated 3.salting out method-sodium chloride 4.ultra centrifugation-depending on their density 5.Immunoelectrophoretic method

Plasmapheresis
Is an experiment done to demonstrate the relation of diet to plasma proteins-- Whipples Standard plasma depleted dog Whole blood is withdrawn & cells suspended in same volume of ringer locke solution is re-injected

Plasmapheresis
If repeated daily, leads to progressive reduction in the plasma proteins This process is continued till plasma protein falls after the exhaust of protein reserves to below 4gm%

Standard diet is given to the dog-rate of protein formation is constant

47

Plasmapheresis
Protein in the cells are of 3 types 1. Fixed or indispensable cell proteins.

2. Dispensable reserve proteins(skeletal muscle & glands)

3. Labile reserve proteins(in liver, tissue macrophage)
48

Variations in plasma protein concentration

Decrease- Hemorrhage, Severe protein

malnutrition, Liver diseases

Increase- dehydration, Diabetes

insipidus

49

Functions of plasma proteins:

1. 2. 3. 4. Maintains colloidal osmotic pressure Role in acid base regulation Maintains viscosity and blood pressure Role in erythrocyte sedimentation rate (ESR) 5. Essential for blood clotting---Fibrinogen 6. Acts as a protein reserve

7. Role in defense mechanism of body 8. Help transport of certain substances 9. Synthesis of trephones

50

Maintains colloidal osmotic pressure of blood Normal colloidal osmotic pressure-28 mm Hg. Oncotic pressure

80% is contributed by albumin

higher concentration low molecular weight

20% is due to other plasma proteins.

51

 Colloidal osmotic pressure (COP) is essential for maintenance of fluid volume in intra vascular compartment and interstitial spaces (tissue spaces) Helps in the exchange of fluid at tissue level

Maintainence colloidal osmotic pressure of blood

52

Structural details of capillary

53

Starlings Forces
Rate of filtration at any point along the capillary depends on the balance of different forces called as Starling Forces

1.Hydrostatic pressure

The pressure exerted on the walls of capillaries . At the arterial end of capillary - 30 mm Hg. At the venous end of capillary - 10 mm Hg Hydrostatic pressure of the capillary out-driving force

54

2.Interstitial fluid pressure -3mmHg Negative- outward force 3.Interstitial colloidal osmotic pressureoutward force--- 8mm Hg

Starlings Forces

4.Colloidal osmotic pressure- inward force- 28 mm Hg COP remains 28 mm Hg throughout the length of capillary ( impermeable to plasma proteins).
55

Starling Forces
Arterial end
mmHg

Venous end
mmHg

Capillary Pressure 30 Negative interstitial fluid pressure -3 Interstitial colloidal osmotic pressure 8 Total outward force 41 Plasma Colloidal pressure (inward ) 28 Outward Inward 41 28

Capillary Pressure 10 Negative interstitial fluid pressure -3 Interstitial colloidal osmotic pressure 8 Total outward force 21 Plasma Colloidal pressure (inward ) 28 Inward Outward 28 21

Net outward force

13

Net inward force

7
56

arterial end -- out-driving force (41mm0f Hg ) is stronger than the in-driving force (colloidal osmotic pressure-28mmHg ).
Net difference of pressure - 13 mm Hg and is directed outwards fluid goes out from the intra vascular compartment to interstitial spaces.

57

Venous end the hydrostatic pressure - 10 mm Hg 0utward driving force is 21mmHg & inward driving force is 28mmHg 7 mm Hg and is directed inward
Fluid that has gone out at the arterial end returns to capillaries from tissue spaces.

58

 At arterial end net outward force of 13 mm HgFiltration pressure

At venous end net inward force of 7 mm Hg- Reabsorption pressure The Reabsorption pressure is considerably less than the Filtration pressure

59

Venous end of the capillaries more permeable than the arterial end Less pressure is required to cause the inward movement Nine tenths of fluid is returned -- venous ends. One tenth of fluid remains in the interstitial spaces-----tissue fluid or interstitial fluid
60

The remaining one part of fluid in tissue spaces with the leaked proteins will enter the lymphatic vessels and is now known as lymph. Drain into the circulatory system. Effectively no extra fluid is allowed to get accumulated in tissue spaces and thereby edema is prevented

61

If the tissue fluid is allowed to accumulate, it decreases blood volume & it also results in swelling of that part of the body (edema).

62

Edema.
By definition, fluid accumulation in interstitial spaces is known as edema. Decreased concentration of plasma proteins especially that of albumin fraction. Some of the common conditions in which edema occurs are: a.Protein malnutrition. b.Liver diseases. c.Kidney diseases. d.Cardiac diseases
63

2.Role in acid base regulation

Plasma proteins act as buffers. Their buffering capacity is 1/6th (about 15%-16%) of total buffering capacity of blood. They are amphoteric in nature i.e. behave as acids or bases depending on the conditions and thereby maintain theblood pH at 7.4, by accepting or rejecting H+.

64

3.Role in viscosity and blood pressure Blood is 4- 5 times more viscous than water Viscosity of blood-both cells and plasma proteins contribute Viscosity is dependent on shape, size & number proteins.

65

3.Role in viscosity and blood pressure o The resistance to the flow of fluid through a capillary depends on the viscosity of fluid

o Pressure=Flow X Resistance It determines the peripheral resistance of the blood flow

66

Concerned with erythrocyte sedimentation rate (ESR):

Rouleaux----- Piling up of RBCs one above the other Globulin & Fibrinogen of the plasma accelerates rouleaux formation

67

Functions of plasma proteins:

1. 2. 3. 4. Maintains colloidal osmotic pressure of blood Role in acid base regulation Maintains viscosity and blood pressure Essential for blood clotting---Fibrinogen

5. Role in erythrocyte sedimentation rate (ESR)

6. Acts as a protein reserve

7. Role in defense mechanism of body 8. Help transport of certain substances in blood 9. Synthesis of trephones

68

9.Synthesis of trephones
9.Leucocytes can manufacture few substances called Trephones or Carrel from plasma proteins, which help in the nutrition of tissues.

69

NEXT CLASS RED BLOOD CELLS

70