Physiology of the blood Patophysiology, hematology Blood: main represenetive of the ECF Functions: result from physical and chemical properties, morphological properties, universal medium, contact with all tissues/ Transport of O2, CO2 Transport of nutriens Transport of final products of metabolism transport of hormones, vitamines transport of heat Defence function against blood lost, infections Maintanance of homeostasis isovolemia, isoionia, isoosmia, isohydria Mainainance of the blood pressure Source of informations for interoreceptors: baro, presso, volumo, chemo, osmoreceptors. Source of informations for phisicians about homeostasis Blood composition Blood : plasma 91% water 8% organic substances proteins: albumins 45 g/l, globulins 25 g/l, fibrinogen 3 g/l. Lipids 10 g/l. Carbonhydrates 5 mmol/l. Inorganic substances 1% blood cells: erythrocytes, leukocytes, platelets General properties of the blood 1. Isovolemia 2. Hematocrit value 3. Viscosity 4. Specific gravity 5. Isoionia 6. Osmotic pressure 7. Acid Base balance 8. Erythrocytes sedimentation rate Blood: red, nontransparent, viscous, suspension 1. Blood volume: 5l, 7% of the body weight, 5% from TBF 2.8 l/m2, 83ml /kg normovolemia hypovolemia (blood lost) : simple : bleeding hyperythorcytotic: sweeting, burning hypervolemia: after work, exersice, high altitude, pregnancy, transfusion, infusion, excess drinking Regenaration of blood: daily 50 ml, 3X / Year Regulation: nervous, hormonal, local Meassurement: direct (1790), indirect Measurement of body fluid: distribution principle Volume = injected amount of substance i.v / concentration of substance in plasma

Test material must be: nontoxic, mix throughout the compartment, movable only into the definite compartment, unchanged in the body, easy measured. Using materials: TBW: deuterium oxide ECF: inulin, sucrose Blood: plasma: Evans blue, radioactive, albumin redcells: radioactive red cells interstitial fluid = ECF plasma volume, ICF = TBW ECF 2. Hematocrit value (PCV) Volume of the RBC in the total blood volume in 1% Male: 44 +- 5% (0.44) Female: 39 +- 4% (0.41) Dependent on: number of RBC, size of RBC, water content in plasma, place of sampling (arteria, vena, spleen, kidneys). Importance: RBCplasma relation, caculation of blood volume, volume of the RBC. MCHC (mean compulsolar hemoglobin concentration). 3. Viscosity: whole blood: 4-5 X > water Plasma 2.2 x > water depend on: number of RBC, size of RBC, water content, proteins content, temprature, blood flow speed 4. Specific gravity: whole blood: 1.062 g/cm3 Er: 1.090 plasma: 1.027 dependent on: number of Er, size of Er, water content, proteins content 5. Ionic composition isoionia cations+ : H+, NH4, Na, K anions-: OH, HCO3, Cl funcions of ions 1. Physico-chemical: osmotic pressure, pH, solubility 2. biological: K+: heart conductivity Ca2+: excitability, contractillity, blood clotting, Mg+2: Nervous system, Fe+2: erythrocyte, I:thyroxine Regulation: hormonal 6. Blood osmolarity osmotic pressure isoosmia Osmolarity = concentration of osmotically active particles in soulution Plasma contains: water, ions (NaCl, Ca, Cl), proteins, low mollecular organic substance (glucose, amino acids, urea) Osmotic pressure = 700 kPa - 0.57 C 290 mosmol/l 96% by electrolytes, 4% by nonelectrolytes, proteins oncotic pressure (3.3 kPa) Tonicity = osmolarity of solution relative to the plasma isotonic solution = 0.9 NaCl physiological solution 5% glucose hypotonic, hypertonic solution Osmotic resistance osmotic fragility of Er. Hemolysis releasing of hemoglobin from Er. physical mechanical, thermal, chemical, osmotic, toxical, imunobiological

osmotic fragility: 0.48 0.32 % NaCl 7. Acid Base balance isohydria is the maintainance od the H+ concentration in the ECF pH os the negative logarithm of the hydrogen ion concentration, or hydrogen ion activity (nmol/l) arterial plasma: pH7.4 +- 0.05 (40 nmol/l) compatible with life: pH 7.0-7.7 ICF: pH 6.8-7 Constancy of the pH is maintained by: Blood, lungs, kidney, liver buffer systems 1. biocarbons (53%) 2. hemoglobin (35%) 3. proteins (7%) 4. phosphates (5%) acidosis (acidemia) pH < 7.36 (metabolic, respiratory) alkalosis (alkemia) pH > 7.43 interstitial fluid: bicarbonates, phosphates intracellular fluid: proteins, phosphates, bicarbonate 8. Erythrocyte sedimentation rate (FW) nonspecific method, Fahraeus Westergreen (1921), used in clinical practice. Suspension stabillity sedmentation rate Male: 3 8 mm/ hour, Female: 7 2 mm / hour, 2-3 mm/ h at newborn FW = 3/6 (first hour/ second hour) dependent on: 1. number of Er: higher number lower FW 2. size of Er: bigger size higher FW 3. composition of plasma proteins: albumins decreases FW globulin increases FW fibronogen increases FW lipids: cholesterol (increases), lecithine (decreases) 4. pH: alkalosis, acidosis 5. funcional state (pregnancy, menstrution) - increase 6. extencive tissue damage (cancer, infract) increase 7. external temprature increase Methods: classic (vertical), quick (45 deg) Importance: diagnosis, effectivity of therapy, prognosis Plasma proteins 75 g/l: albumins: 45 globulins: 25 fibrinogen: 3-5 Functions Maintainence of the blood volume (oncotic pressure 3.3 4 kPa)

Transport of vary substances (hormone, vitamins, billrubin, fatty acids, ions medicaments) Buffering function (pH) Maintainence of blood suspension stabillity preventing of the blood loss (clotting) Immune functions (immune globulins) Nutritional funcion? Anorganic substances: Na+ - 142 mmol/l, K+ - 5 mmol/l Ca+2 2.5 mmol/l, Cl- mmol/l Red Blood Cells erythrocytes biconcave, nonuclear cells, diameter 7.4 um, thickness 1.8-2.1 um mean corpuscular volume: 86 fl (10 ^-15 l) surface: 130 um^2 Functions of erythrocytes transport of o2, co2 transport of substances Maintainence of pH metabolism antibiotic effect (erythrin) ? Metabolic pecularities of Er anaerobic glycolysis 2,3 DPG (diphosphoglycerate) production high amount of glutathione methemohlobin reductase carbonanhydrase Number of RBC: Depend on: Age Sex pO2 Physical activity Functional state of organism