Topic 1 - Blood

Question 1

What is blood?

Answer 1

• Organ
• Made of RBC, WBC, plasma, & platelets
• Want to avoid giving blood in perfusion (goal directed perfusion)

Question 2

What does blood do?

Answer 2

• Transport services
• Protection services
• Temperature regulation (heating from the inside-out is more uniform)

Question 3

Plasma

Answer 3

• 54% of TBV
• 4% of body weight (1L water = 1kg water)
• 90% water / 10% solute (proteins/electrolytes/organic material)

Question 4

Electrolytes

Answer 4

• makes up most of solute in NUMBER inside the plasma
• Ca, K, Na, Cl, Mg, HCO3
• Impulse conduction, coagulation, cardiac rhythm, fluid balance, muscle function, and acid base balance

Question 5

Plasma proteins function

Answer 5

• Maintain osmotic pressure
• Maintain fluid balance
• Transport and carry
• Immune functions
• Enzymes
• Blood buffers

Question 6

Plasma protein types

Answer 6

• Albumin : 62%
• Globulins (all protein except albumin and fibrinogen) : 34%
• Fibrinogen : 4%

Question 7

Albumin

Answer 7

• Responsible for colloid osmotic pressure
• Transport free fatty acids and bilirubin
• Binds competitively with variety of drugs

Question 8

Globulins

Answer 8

• Gamma/Immunoglobulins are of interest

- Involved with Immune system

Question 9

Plasma Proteolytic Protein Systems

Answer 9

-Globulin functional group
-Complement system (inflammation)
-Kinin system (vasoactive effects)
-Blood Coag system
(extrinsic/intrinsic factors -> thrombin -> fibrinogen -> clotting)
-Fibrinolytic system (makes plasmin which breaks down fibrin)

Question 10

Plasma Protease Inhibitors

Answer 10

• Globulin functional group
• Macroglobulin (inhibits plasmin/thrombin/kallikrien)
• Antithrombin III (thrombin)
• C1 inhibitor (Activiated C1/kallikrien)
• Plasmin inhibitor (plasmin)

Question 11

Carrier proteins

Answer 11

• Globulin functional group
• Albumin
• Haptoglobin
• Hemopexin

Question 12

Acute Phase Proteins

Answer 12

• Globulin functional group
• Involved with inflammatory response
• Interleukins recruit WBCs
• Initiates fever

Question 13

Hypoproteinemia

Answer 13

• Protein deficiency
• Caused by : malnutrition / protein production (liver problems) / poor absorption / protein excretion / hemodilution
• Hemodilution caused by CCP….can prime ECC with albumin to help

Question 14

Hypoproteinemia affects

Answer 14

• Acid-base balance
• Clotting mechanisms
• Enzyme dependent reactions
• Fluid Balance
• Transport problems

Question 15

Hyperprotienemia

Answer 15

• Increased plasma proteins
• More rare than hypo
• Can cause clots in blood in microvascular

Question 16

RBC Function

Answer 16

Carry O2 and CO2

Question 17

RBC dimensions

Answer 17

• Biconcave discoid
• 8.1 microns in diameter
• 1.0 - 2.7 microns (thin part and thick part)
• 138 microns^2 in area
• 95 microns^3 in volume

Question 18

RBC Lifecycle

Answer 18

• 120 days

- Stimulated by pO2

Question 19

Normal pO2 that gives us 50% hemoglobin bound to O2

Answer 19

25 mmHg

Question 20

Factors that shift Oxy-Hemo curve to right (less affinity)

Answer 20

• Increased PCO2
• Decreased pH
• Increase in Temp
• Increase in 2,3 DPG

Question 21

Bohr affect

Answer 21

• How change in [CO2] affects affinity of O2/Hb

Question 22

Haldene affect

Answer 22

• How [O2] affects CO2/Hb curve

- Opposite affect of Bohr

Question 23

O2 transport

Answer 23

• 2% of total O2 is dissolved in plasma (forms partial pressure)
• 98% of total O2 bound to Hb inside RBC (reversible bound)

Question 24

CO2 transport

Answer 24

Insert picture

Question 25

Methemoglobin

Answer 25

- Formed when normal Fe2+ is oxidized to Fe3+ - Bad for body...can no longer bind to O2 - Methemoglobin reductase prevents this in RBC

Question 26

Fetal Hb

Answer 26

- Hb F | - Higher affinity for O2 than Hb A

Question 27

RBC Hemolysis

Answer 27

- Lysis of RBC (can activate clotting cascade) | - Caused by: immune response after transfusion / sepsis / medications / toxins / enzyme deficiency / CPB

Question 28

Types of WBC

Answer 28

- Granulocytes (neutrophils/eosinophils/basophils) ~neutrophils big prob for perfusionist - Monocytes (become macrophages) - Lymphocytes (B and T cells)

Question 29

Neutrophils

Answer 29

- Little version of macrophage - very sensitive to stimulation - respond to bacteria - forms pus - removed by macrophages - short lived

Question 30

Eosinophils

Answer 30

- Toxic to all antigens - function in allergic reactions - release chemical called MBP (bad if on CPB)

Question 31

Basophil

Answer 31

- exhibit chemotaxis....not phagocytosis - may release histamine and heparin - histamine = very potent vasodilator - Basophils (in blood) --> Mast cells (in tissues)

Question 32

Monocytes

Answer 32

- mature into macrophages | - very big relatively (12-20 microns)

Question 33

Lymphocytes

Answer 33

- Most complex WBC - Directs the immune system - T cells are 75% and B cells 25%