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Doc. Nykytyuk S.O.

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Doc. Nykytyuk S.O.

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  1. LectureTHE ANATOMICAL AND PHYSIOLOGICAL PECULIARITIES OF BLOOD SYSTEM IN CHILDREN OF DIFFERENT AGE GROUPS. SEMIOTICS OF MAIN SYNDROMS (ANEMIC, HEMORAGIC, HEMOLYTIC) AND BLOOD SYSTEM DISORDERS (ACUTE AND CHRONIC LEUCEMIAS, HEMOPHILIA, HEMORAGIC VASCULITIS). NURSING CARE FOR CHILDREN WITH HAEMATOLOGICAL PROBLEMS. Doc. Nykytyuk S.O.

  2. Conception of blood system Blood system is blood, which consists of 1) blood, which is moving through the vessels, 2) blood forming organs, 3) blood destroying organs, 4) storage of blood, 5) apparatus for regulation

  3. Blood functions • 1) respiratory • 2) transport of nutritive elements, products of metabolism, hormones and waste materials • 3) thermoregulation • 4) maintaining the acid-base balance of the tissues • 5) supporting of oncotic and osmotic pressure • 6) help to form a clot • 7) protective

  4. Blood volume, notion of blood reserve 6-8 % The blood depo (storage) are in liver – 30 %; subcutaneus tissue – 20 %; spleen – 1,5-2,5 %

  5. Composition of blood • Plasma and cells (red blood cells, white blood cells, and blood platelets) • Plasma: • water - 92 %, • solids - 8 %; • inorganic chemicals: sodium, calcium, potassium, magnesium, chloride, bicarbonate, phosphate, sulfate; • organic chemicals: proteins: serum albumin, serum globulin, fibrinogen; nonprotein nitrogenous substances: urea, uric acid, creatine, creatinine, ammonium salts, amino acids; nonnitrogenous substances: glucose, fats, cholesterol, hormones, gases: oxygen, carbon dioxide, nitrogen.

  6. Functional meaning of plasma protein • The blood plasma include serum albumin, • serum globulin, • and fibrinogen.

  7. Buffer´s system of blood pH of arterial blood is between 7,35 and 7,45. There are 4buffer systems: bicarbonate hemoglobin phosphate protein

  8. Quantity of erythrocytes In men – 4,0-5,1•1012/L; in women – 3,7-4,7•1012/L. The quantity of erythrocytes may be increase – in pregnancy, in physical training, mental work, in newborn or decrease; and decrease – only in pathology.Functions of erythrocytesThe primary function of the erythrocytes is to carry oxygen to the tissue.Regulation of erythropoiesisCoused by erythropoietins, which produced in kidneys and macrophagal system. Thyroid, epinephrine and male sex hormons increase quantity of erythrocytes and female sex hormones decrease its.

  9. Erythrocytes • Neonatal period • -5.4x10 12/l-7.2x10 12/l (at the beginning of the period) • -4.7x10 12 (by the end of the period) • Breast feeding period-14 years 4.2x1012/l • Older than 14 years -in boys-5.2x10 12/l • -in girls-4.8x1012/l

  10. Critical number of erythrocytes is 1.0x1012/l

  11. Hemoglobin • Newborn period- 220-180 g/l -150g/l(till the end of the period) • 1 month-5 months -120-150 g/l • 1 months-5 years -on average 120-140g/l (but not less than 110 g/l) • Older than 5 years -on average 130-150 g/l (but not less than 120 g/l) • Critical number-20 g/l

  12. Pathological changes • Eythropenia (=erythrocytopenia)-reduction in quantity of erythrocytes in children of 1 month of age below 3.5x10 12/l • Reduction in the quantity of hemoglobin (below the special level) • -Anemia of different genesis • -Malignant diseases of blood (leucosis) • -Hyperhydratation, when pseudo-anemia is observed

  13. Osmotic fragility of erythrocytes • MIN.OFE-0.48-0.44% • Max.OFE-0.36-0.28% • Exponents of newborn are • Min.OFE-0.52-0.48% • Max.OFE-0.30-0.24%

  14. Pathological changes • The decrease in OFE is a sign of congenital and acquired genesis

  15. Erythrocyte sedimentation rate (ESR) in norm is equal to • Newborn period- 0-2 mm/hour • Breast-feeding age-2-4 mm/hour • Further on -4-10 mm/hour • The increase in ESR • -inflammatory process of any system • -Allergic reaction • -malignancy

  16. The reduction in ESR is observed rather • seldom • -exsiccosis • -Anaphylactic shock • -hypotrophy,exhaustion • -peptic ulcer • -decompensated heart diseases • -can be in acute viral hepatitis

  17. Color index of blood • 3xHbg/l • --------------------------------------------------------- • First three digits in the number of erythrocytes per one million • (without the point)

  18. Thrombocytes 150-300x109/l • Critical number is 100 G/l • Thrombocytosis higher than 400G/l • It is observed that thrombocytosis occurs in the postoperative period of splenectomy, • Bad prognosis of chronic myeloid leucosis • Thrombocytopenia lower than 100x109/l

  19. Normochromia- • the figure is within the limits of the specified norm that indicates normal satiation of erythrocytes with hemoglobin

  20. Hypochromia • -the figure is below normal which indicates incomplete satiation of erythrocytes with hemoglobin or microcytosis,or both impairments together

  21. Hyperchromia • - the figure is higher than normal-it is only a sign of increased volume of erythrocytes, macrocytic hyperchromia

  22. Reticulocytes • absolutely non mature forms of erythrocytes with the substance,their predecessors • Newborn period- 10-30% • Breast-feeding age- 5-10% • After 1 year - 2.5-5%

  23. Reticulocytes- • It is a positive index of the efficiency of treatment in bleeding and anemia • Indicates the hemolytic character of disease • Sometimes is a diagnostic criterion of latent bleeding

  24. Erythremia • .simultaneous decrease in number of leucopoiesis and aplasia of hemopoiesis condition in the whole.

  25. Anemias • Anemia is defined as reduction of red cell volume or he­moglobin concentration to levels below normal

  26. Stages of aenemiasDecreasing • 1 stageDecreasing Hb level (before 90gr per liter • 2 stage Decreasing Hb level (lower 90gr per liter • 3 stage Decreasing Hb level (lower 70gr per liter

  27. HemoglobinErythrocytes derive their colour from a complex protein called hemoglobin. This substance is composed of a pigment, heme, containing iron, and the protein globin. Hemoglobin has the power to attract oxygen molecules and to hold them in a loose chemical combination known as oxyhemoglobin. It is said, therefore, to have a chemical affinity for oxygen.MyoglobinHem is also part of the structure of myoglobin, an oxygen-binding pigment found in red (slow) muscles and in the respiratory enzyme cytochrome c. Porphyrins other than that found in hem play a role in the pathogenesis of a number of metabolic diseases (congenital and acquired porphyria, etc.) It may be the reserve pigments, which give the tissue oxygen in a smalloxygen condition.

  28. Quantity and chemical structure of hemoglobin • In man – 130-160 g/L; in woman – 120-140 g/L. • The iron atoms are bivalent or in the ferrous state. There are 2 pairs of polypeptides in each hemoglobin molecule, 2 of the subunits containing one type of polypeptide and 2 containing another. In normal adult human hemoglobin (HbA), the 2 types of polypeptide are called the a, and the chains.

  29. Methods of definitition • gasometric – definition of gases, such as O2, • colorimetric – definition of colour substances, • iron metric – definition of iron concentration.

  30. Combination of hemoglobin, their peculiarities • hemoglobin (oxyhemoglobin) • reduced hemoglobin • Carboxyhemoglobin (with CO) • carbhemoglobin • methemoglobin

  31. Physiological valuation of white blood • There are two major groups of white cells: • granular, • or poly-morphonuclear, leukocytes (neutrophils, eosinophils, basophils) • and nongranular white cells (lymphocytes and monocytes).

  32. Quantity of leukocytes and their changesWhite cells numbering is 4-9•109 per liter. The number of lymphocytes are – 18-37 %,monocytes – 3-11 %, eosinophils –0,5-5 %, basophils – 0-1 %, juvenile neutrophile – 0-1 %, relating to stab (rod-shaped) neutrophil – 1-6 %, segmented neutrophil – 47-72 %.

  33. The number of leukocytes and different kind of leukocytes may increase. This condition called – leukocytosis, lymphocytosis, monocytosis, neutrophilosis, eosinophilia, basophilia. The number of leukocytes and different kind of leukocytes may decrease. This condition named – leukopenia, lymphocytopenia, monocytopenia, neutropenia, eosinopenia.

  34. Lymphocytes • Physiological role of T-lymphocytes (There are receptors to antigens on the membrane of T-lymphocytes, which helps to distinguish genetic heterologous substances.) • Functional significance of B-lymphocytes (B-lymphocytes syntheses the immunoglobulins such as IgM, IgN, IgA, IgG, IgB, IgE.)

  35. Neutrophils • The neutrophils seek out, ingest, and kill bacteria and have been called the body‘s first line of defense against bacterial infections. The average half-life of a neutrophil in the circulation is 6 hours. Many of the neutrophils enter the tissues; they first adhere to the endothelium and then insinuate themselves through the walls of the capillaries between endothelial cells by a process called diapedesis. Many of those that leave the circulation enter the gastrointestinal tract and are lost from the body. When bacteria invade the body, the bone marrow is stimulated to produce and release large numbers of neutrophils. Phagocytosis refers to the ability of neutrophils to ingest bacteria or other foreign bodies. They contain protein-digesting enzymes.

  36. Eosinophils • These cells make up only 0,5 to 5 percent of the total number of white cells in the blood, but in the tissues they can congregate in considerable numbers. There is a rise in the number of eosinophils in some cases of allergy, possibly in response to toxic substances released by the allergic reaction.The eosinophils attack some parasites, and they inactivate mediators released from mast cells during allergic reactions.

  37. Basophils • Basophils constitute only 0,5 percent of the white cells of the blood. Basophils in the blood are said to contain histamine and a heparinlike substance. Histamine dilates capillaries and often permits fluid to move through the capillary wall into the tissues: heparin is an anticoaguiant of the blood. Apparently tissue basophils become the mast cells of the tissues. The large granules of mast cells are thought to store enzymes. The basophils contain histamine and heparin, but their role in the maintenance of normal balance between the clotting and anticlotting systems is uncertain.

  38. System of mononuclear phagocytes • These is the system, which connect the cells with one nucleus, it has common origin from red bone marrow, common function of high specific phagocytosis. • It origines from promonocytes of red bone marrow. Tissue monocytes named macrophage.There are many macrophages in different organs. The macrophage of lungs named alveolar macrophages of lungs, the macrophage of spleen named free or fixed macrophages of spleen, the macrophage of liver named Kupffer cells, the macrophage of skin named Langergans cells, the macrophage of brain named microglia etc. • It has the function of high specific phagocytosis. • The monocytes are actively phagocytic and contain peroxidase and lysosomal enzymes. The macrophages migrate in response to chemotactic stimuli and engulf and kill bacteria by processes that are generally similar to those occurring in neutrophils. They also play a key role in cellular immunity because proliferation of T-lymphocytes requires that they come in physical contact with macrophages that have taken up and processed antigen.

  39. Definition of “leukocytes formula‘s” notion and its quantitative expressionThe number of different kinds of leukocytes in the volume of blood called “leukocytes formula”. It quantitative determination in 109/L. We has determination the number of leukocytes in 100 leukocytes of the smear, that‘s way the quantity of leukocytes may be occur in percent.

  40. The number of lymphocytes are – 0,18-0,37 (18-37 %), monocytes – 0,03-0,11 (3-11 %), eosinophils –0,005-0,05 (0,5-5 %), basophils – 0-0,01 (0-1 %), juvenile neutrophile – 0-0,01 (0-1 %), relating to stab (rod-shaped) neutrophil – 0,01-0,06 (1-6 %), segmented neutrophil – 0,47-0,72 (47-72 %).

  41. Hemostasis system • Hemostasis isthe physiologic system, which support the blood in the fluid condition and prevent bloodless. • The components of hemostasis are wall of the vessels, blood cells – platelets, erythrocytes, leucocytes, enzymes and nonenzymes components of plasma – clotting and anticlotting substances, fibrinolysis components of hemostasis. • There are 2 kinds of hemostasis: vessel-platelets (primary) and coagulative (secondary) hemostasis. Primary hemostasis activity begin the first after the destroyed of vessels. Secondary hemostasis starts after that in case the primary hemostasis do not stopped the bloodless.

  42. Vessel-platelets hemostasis (or primary hemostasis) • Quantity of platelets is 180-320 G/L. Diameter of platelets is 1-4 micrometers, thickness – 0,5-0,75 micrometers. Platelets circulated in blood from 5 to 11 days and than destroyed in liver, lungs, spleen by the cells of macrophages system. • Function of platelets are: • 1. Hemostatic function • 2. Angiotrophic function (provide trophic of endotheliocytes of vessel wall, support structure and functions of microvessels). For one day near 35 G/L platelets do this function. • 3. Transport function – transfer the enzymes, ADP, serotonin and other. • 4. Phagocytosis function. • 5. Regeneratory function – platelets have the growth factor, which help to grow the endothelial and muscles cells which are present in the vessel wall.

  43. Stages of vessel-platelets hemostasis • 1. Shorting spasm of the vessels – vascular spasm duration to 1 minute is caused by catecholamins and other enzymes. • 2. Adgesion of platelets – activation of platelets and stick it to the place of defect in vessel wall. • 3. Reverse aggregation of platelets – the thromb which are formed may make way for plasma. • 4. Unreverse aggregation of platelets – the thromb which are formed can not may make way for plasma. • 5. Retraction of platelets plug – decrease the size of plug, pack down the plug.

  44. Hemophylia

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