血液

  • blood
    • plasma
    • blood cells
      • leukocytes 白细胞 WBC
        • granulocytes 粒细胞
          • neutrophils 中性粒细胞
          • eosinophils 嗜酸性粒细胞
          • basophils 嗜碱性粒细胞
        • agranulocytes 不是粒细胞
          • lymphocytes 淋巴细胞
          • monocytes 单核细胞
            • macrophages 巨噬细胞
      • erythrocytes 红细胞 RBC 99%
      • platelets 血小板
  • 一些性质
    • 组成
    • blood volume
      • 80~85ml/kg
      • female 45L, male 56L
      • about 7~8% of body weight
    • Density (compared to water)
      • Whole blood: 1.050~1.060
      • Plasma: 1.025~1.030
      • RBC: 1.090~1.092
    • Viscosity 粘度
      • the resistance of a fluid to flow, resulting from the cohesion of its particles.
      • Whole blood 45，plasma 1.62.4
  • Hemopoiesis 造血干细胞
    • 图
    • 骨头
      • The (red) bone marrow of long bones produces RBCs until a person is 5 years old.
      • The marrow of long bones becomes fatty tissue (yellow) and produces no more RBCs after age 20
      • 有些骨头产生血细胞的活性会消失
  • plasma
    • composition
      • 血浆的成分与interstitial fluid (ECF)相似，但是包含更多proteins
      • compositions of different fluid (mmol/L)
    • Osmolarity 渗透压
      • determined by the amount of solute molecule, but not related to the type or the diameter
      • 2种渗透压
        • crystal osmotic pressure 晶体渗透压
        • colloid osmotic pressure 胶体渗透压
      • The osmolarity of plasma is 280~290mmol/L
    • pH
      • plasma pH=7.35~7.45
      • HCO3-/H2CO3, HPO42-/H2PO4-, proteins
  • RBC
    • 外观
      • biconcave disc 双凹圆盘形, consumes energy to maintain
      • anucleate 无核, devoid of typical organelles 缺乏典型的细胞器
      • 图
    • 性质
      • 可塑变形性 plastic deformation
        • 面积:体积比较大，容易变形，可以穿过非常小的血管
        • viscosity inside RBC ↓，ability to deform ↑
        • membrane elasticity ↑，ability to deform ↑
      • 渗透脆性 osmotic fragility
        • 低渗溶液中会吸水破裂失去血红蛋白
      • 悬浮稳定性 suspension stability
        • 红细胞沉降率ESR male 015mm/h, female 020mm/h
        • 有一些病导致rouleaux叠连，导致沉降加快
    • hemoglobin 血红蛋白
      • consists of four polypeptide chains of globin α, β, δ and γ.
      • Different combinations of the polypeptide chains lead to different hemoglobin subtypes
      • Each chain is complexed to an Fe2+ containing heme血红素 group, which shows red when binds to O2
      • 图
      • 婴儿出生前与出生后血红蛋白组成是不同的
    • Erythropoiesis 红细胞生成
      • about 2×10^11/day
      • needs proteins, iron, folic acid and vitamin B12
      • mainly regulated by erythropoietin促红细胞生成素 (kidney) and sex hormones (promoted by androgen雄激素, inhibited by estrogen雌激素)
    • 死亡
      • The life span of RBCs is about 120 days
      • 0.8% RBCs are destroyed everyday
      • 90% are destroyed by macrophages巨噬细胞 in the spleen脾 and the bone marrow骨髓
      • 10% rupture破裂 during passage through the circulation
      • After destruction, iron and bilirubin (metabolite代谢物 of heme) were released from the digested hemoglobin
        • Iron can be reused
        • bilirubin胆红素 is removed from the body by the bile胆汁
  • leukocyte
    • 特点
      • nucleate, sphere, and contains organelles
    • 分类
      • granulocytes粒细胞
        • neutrophils中性粒细胞
          • 60%-70%
          • phagocytosis吞噬作用
          • release antimicrobal抗菌 chemicals
        • eosinophils嗜酸性粒细胞
          • 2%-4%
          • 会处理
            • allergic reactions过敏反应
            • parasitic infections寄生虫感染
            • chronic inflammation慢性炎症
        • basophils嗜碱性粒细胞
          • <0.5%
          • allergic reactions过敏反应
      • agranulocytes不是粒细胞
        • lymphocytes淋巴细胞
          • 25%-33%
          • specific immunity特异性免疫
        • monocytes单核细胞
          • 3%-8%
          • 分化为macrophages巨噬细胞
  • platelet
    • 特点
      • fragments derived from megakaryocytes巨核细胞
      • anucleate无核, contains organelles
    • Hemostasis止血
      • 三个过程
        • 图
        • Vasoconstriction血管收缩
          • ①nervous reflexes by pain and mechanical stimuli
          • ②vascular spasm血管痉挛
          • ③factors released by platelets
        • Platelet plugging形成血栓
          • platelets adhere, activate, secrete, aggregate
          • 血小板粘附、活化、分泌、聚集
        • Blood coagulation凝血
          • the loose aggregation of platelets in the temporary plug is bound together and converted into the definitive clot by fibrin纤维蛋白 (soluble→insoluble)
      • 3 essential steps of clotting
        • 图
        • ①Formation of a complex called prothrombin activator (凝血酶原酶复合物)
        • ②The prothrombin activator catalyzes conversion of prothrombin (凝血酶原) into thrombin (凝血酶)
        • ③The thrombin acts as an enzyme to convert fibrinogen (纤维蛋白原) into fibrin fibers (纤维蛋白)
      • initiating clotting
        • Extrinsic pathway
          • Clotting can occur in 15s via extrinsic pathway
          • 图
          • ①Release of tissue factor
          • ②Activation of factor X
          • ③Formation of prothrombin activator (Ⅹa+Ⅴa+Ca2++platelet phospholipids)
        • Intrinsic pathway
          • The intrinsic pathway is much slower to proceed, requiring 1~6min
          • 图
          • ①Activation of factor Ⅻ and release of platelet phospholipids
          • ②Activation of factor Ⅺ
          • ③Activation of factor Ⅸ
          • ④Activation of factor Ⅹ
          • ⑤Formation of prothrombin activator
      • Negative regulation of clotting
        • Endothelium 内皮
        • Fibrin fibers absorb 85~90% thrombin纤维蛋白吸收凝血酶，负反馈
        • Blood flow 血液流速，比如大动脉无法止血
        • Clotting factors removed by the monocyte-macrophage system单核巨噬细胞系统
        • Anticoagulants 抗凝血剂
          • antithrombin (抗凝血酶)
          • heparin (肝素)
          • protein C
          • tissue factor pathway inhibitor (TFPI, 组织因子途径抑制物)
      • fibrinolysis纤维蛋白溶解
        • Eventually, tissue repair is completed and the clot must be disposed of. The process of dissolving a clot is called fibrinolysis
        • 图
  • blood types
    • 基础
      • Blood types are determined by antigens on the surfaces of RBCs.
      • Antibodies in the serum of one blood type will react with antigens on the surface of RBCs of another blood type
      • serum
        • Serum is fluid separated out from blood clots凝块 by the contraction of platelets (containing actin and myosin) 血清是通过血小板收缩从血栓中分离出来的液体（含有肌动蛋白和肌球蛋白）
        • 血清＝血浆-凝血蛋白clotting proteins
        • Serum does not contain clotting factors or fibrin fibers, thus it can not coagulate.
      • There are at least 30 antigens having been found on the surface of RBCs. 2 types of antigens are of particular importance ←两种血型系统的由来
    • ABO system
      • 溶血
      • antigen抗原
        • 图
        • A型血有 N-acetylgalactosamine transferase
        • B型血有 galactose transferase
        • O型血俩都没有
        • AB型血俩都有
      • antibody抗体
        • A型血的血清有anti-B
        • B型血的血清有anti-A
        • O型血的血清俩都有
        • AB型血的血清俩都没有
    • Rh system
      • Rh represents rhesus恒河猴，第一次在当中发现这种血型系统
      • RBC 表面有D antigen是Rh+，没有是Rh-
      • 两种血型天生都没有抗体，但是Rh-血型在接触Rh+血型后会产生anti-D，因此Rh-母亲和Rh+父亲只能生一个孩子，第二个孩子会接触到母亲的anti-D产生溶血
      • Rh+, 99%
      • Rh-, panda blood
    • 输血前要cross-match test
      • 图