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Dr.

Rusdiana MKes
Blood is a connective tissue
Its volume is 5-6 L in males and 4-5 L in
females
It is slightly alkaline, with a pH of ~ 7.4
Its color varies from bright to dark red
Transport of:
Gases, nutrients, waste products
Processed molecules
Regulatory molecules
Regulation of pH and osmosis
Maintenance of body temperature
Protection against foreign substances
Clot formation

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Respiratory
Red blood cells or erythrocytes transport
Oxygen from lungs to cells and Carbon
dioxide from cells to lungs
Nutritive
Blood absorb nutrients from digested foods in
gastrointestinal tract and transport to all the
cells in body
Excretory
Metabolic wastes, excess water and ions , and
other molecules not needed by the body are
carried by the blood to the kidneys and
excreted in the urine
Hormonal
Blood carries hormones from their site of
origin to distant target tissues , where they
perform the regulatory functions
Temperature
Blood is responsible to carry body heat to the
surface in high temperature environment as
well as to keep body heat in within low
temperature environment
Blood cell (erythrocytes, leucocyte,trombocyte)

Plasma
Albumin, 4.7-5.7 mg % osmosis
Globulins, 1.3-2.5 mg % immunity
Fibrinogen, 0.2-0.4 mg % clotting
substrate
Enzymes released
from cells
Alkaline Phosphatase AP, 39-117 U/liter
Lactate Dehydrogenase LDH, 100-250 U/liter
Creatine Phosphokinase CPK,
Alanine aminotransferase ALT ;
Aspartate aminotransferase AST 7-37 U/liter
Serum glutamate oxaloacetate transaminase SGOT
Thrombin clotting
(coagulation) 7
Blood glucose, ions, lipoproteins
Glucose 70-110 mg/dL energy
Bilirubin 0.2-1.0 mg/dL (yellow)
Calcium 8.3-10.0 mg/dL various
functions
Uric acid 2.5-7.0 mg/dL from
purines
BUN (blood urea nitrogen) 10-20 mg/dL kidney function
Cholesterol, 120-240 mg/dL cell fluidity
HDL-Cholesterol, 35-55 mg/dL removal of
chol
VLDL and LDL cholesterol delivery of chol
LDL = TC - HDL - 0.2 TG about 70-100
Triglycerides, 20-190 mg/dL
Many other compounds, salts, amino acids, etc.

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Red blood cells (erythrocytes)
White blood cells (leukocytes)
Granulocytes
Neutrophils
Eosinophils
Basophils
Agranulocytes
Lymphocytes
Monocytes
Platelets (thrombocytes)

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Liquid part of blood
Pale yellow made up of 91% water, 9% other
Colloid: Liquid containing suspended
substances that dont settle out
Albumin: Important in regulation of water
movement between tissues and blood
Globulins: Immune system or transport
molecules
Fibrinogen: Responsible for formation of blood
clots

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* The term haemostasis means prevention
of
blood loss.

* Haemostasis is the process of forming


clots in the walls of damaged blood
vessels and
preventing blood loss, while maintaining
blood in a fluid state within the vascular
system.
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2nd Year Physiotherapy-
November 2008
Haemostasis involves 4 main steps:

1. Vascular spasm
2. Platelets reaction
3. Formation of platelet plug
4. Blood coagulation

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Reduces flow of blood from injured
vessel.

Cause:
1- Sympathetic reflex
2- Release of vasoconstrictors
(TXA2 and serotonin) from
platelets that adhere to the
walls of damaged vessels.

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Mechanism:

Platelet adherence
Platelet activation
Platelet aggregation

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Functional characteristics of
platelets
The cell membrane of platelets contains:

A coat of glycoprotein (receptors) that cause


adherence to injured endothelial cells and
exposed collagen.
Phospholipids, that play an important role in
blood clotting.

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Their cytoplasm :
Contains:
contractile proteins (actin & myosin).
Dense granules, which contain substances that
are secreted in response to platelet activation
including serotonin & ADP.
-granules, which contain secreted proteins e.g.
platelet-derived growth factor (PDGF) which
stimulates wound healing, fibrin stabilizing
factor (factor XIII) and other clotting factors.
Can store large quantities of Ca++.

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* Platelet adhesion: When a blood vessel
wall is injured, platelets adhere to the
exposed collagen and von Willebrand
factor in the wall via platelet receptors
Platelet activation.

*Activated platelets release the contents of their


granules including ADP and secrete TXA2
activates nearby platelets to
produce further accumulation of more
platelets (platelet aggregation) and forming
a platelet plug.

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The clotting mechanism involves a cascade of
reactions in which clotting factors are activated.
Most of them are plasma proteins synthesized by
the liver (vitamin K is needed for the synthesis of
factor II, VII, IX and X).
They are always present in the plasma in an
inactive form.
When activated they act as proteolytic enzymes
which activate other inactive enzymes.
Several of these steps require Ca++ and platelet
phospholipid.

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2nd Year Physiotherapy-
November 2008
The ultimate step in clot formation is the
conversion of fibrinogen fibrin.

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An Intrinsic system.
An Extrinsic system

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The initial reaction is the conversion of
inactive factor XII to active factor XIIa.
Factor XII is activated in vitro by exposing
blood to foreign surface (glass test tube).
Activation in vivo occurs when blood is
exposed to collagen fibers underlying the
endothelium in the blood vessels.

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Requires contact with tissue factors
external to blood.
This occurs when there is trauma to the
vascular wall and surrounding tissues.
The extrinsic system is triggered by the
release of tissue factor (thromboplastin
from damaged tissue), that activates
factor VII.
The tissue thromboplastin and factor VII
activate factor X.

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Protein plasma total kira-kira 7-7,5
gr/dl. Protein plasma merupakan bagian
utama zat padat plasma. Proten plasma
sebenarnya merupakan campuran yang
sangat kompleks yang tidak hanya terdiri dari
protein sederhana tetapi juga protein
campuran atau conjugated protein seperti
glikoprotein dan berbagai jenis lipoprotein.
Komposisi dari protein plasma tersebut
adalah
Albumin
1. Merupakan komposisi utama dari protein
dalam plasma
2. Mempunyai BM yang paling rendah
3. Menentukan intra vaskuler collid osmotic
pressure
4. Disintesis di hepar terdiri dari 610 AA
yang tersusun dalam satu rantai peptida
5. Berfungsi sebagai molekul carrier dari
bilirubin, asam lemak, trase elements,
Globulin
1. Merupakan protein yang tidak larut dalam
air murni tetapi larut dalam air garam.
2. Sering disebut sebagai globulin , atau
didasarkan pada mobilitas elektroforesis
3. Berperan penting didalam mekanisme
pertahanan tubuh
Glikoprotein
1. Mempunyai gugusan polisakarida
2. Dijumpai sebagai fraksi 1 dan 2 globulin
3. Berfungsi sebagai transport vitamin, lemak,
mineral
4. Merupakan molekul dari komplemen,
interferon, hormon (chorionik gonadotropin,
thyrotropin) dan enzim (faktor-faktor
pembekuan darah)
Lipoprotein
1. Protein yang mengandung lipid biasanya
dengan ikatan noncovalent.
2. Dikenal dalam beberapa jenis seperti
Khylomikron,VLDL, HDL, LDL, IDL (spesifik
graviti menurun kandungan proteinnya)
3. Disintesa di hepar dan usus halus
4. Fungsi:
Sebagai carrier dari molekul-molekul
lipid
Melarutkan lipid yang hydrophobic
Mengandung signal yang berfungsi
untuk mengatur transport lipid
tertentu ke sel yang spesifik dari
jaringan
Fibrinogen
1. Merupakan precursor dari fibrin
2. Berperan penting dalam proses
pembekuan darah