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Body fluids & the blood


Note: this lecture will be divided into two parts, the first will be a
complement to the previous lecture which was about the body
fluids, while the other part will be about blood components.

In the previous lecture we discussed the body fluids and


how the body should keep the volume of them constant, and that
can be achieved by :

1-c Hydrostatic pressure (it is the pressure that pushes the plasma-
the liquid part of the blood- out of the capillary, and it has a
value in the Arterial end that differs from the Venus end ).
2-c Osmotic pressure.

In the arterial end of the capillary the net filtration


pressure is 13 mmHg that pushes the plasma out of it, however
in the Venus end the net filtration pressure is -7 mmHg whish
cause the re-absorption of water there.

So the plasma leaves the capillary from the arterial end


carrying the nutrients ,vitamins ,and other important
substances to the tissues, then it washes out the interstitium
from metabolic waste(toxic materials,co2...etc) and finally the
plasma goes back to the capillary from the Venus end but in
different amount. (the amount of plasma leaves the capillary not
exactly equal to that which will return to it) so here the
lymphatic system which is goes around the capillaries play a
crucial role in:
1-c Gathering the extra amount of plasma that remains in the
interstitiumin and get them back to the capillaries.
2-c Washing out the plasma protein particles which have left the
capillaries and then get them back to the vascular system .

So, by that the body maintains the volume of its fluids constant.
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cNow, how the body keeps the osmolarity of the


fluids constant???
The normal osmolarity of the internal body fluids is isotonic
(normotonic) which equals to 280-300 milli-osmoles/liters.

*The osmolarity can be calculated by the equation:

The osmolarity = the molarity *dissociation factor

As we know there are 3 types of solutions:

1-’ 
  (increased number of particles, decreased
amount of water)

2-’ 
  (decreas ed number of particles, increased
amount of water)

3-

  (e.g: normal saline, glucose dextrose which is
used in the hospital)

*the osmolarity of the isotonic solutions is (280-300 milli-


osmoles/liters)

90% of the osmolarity in the plasma or in the Extracellular


body fluids related to the NaCl concentration, while the osmolarity
inside the cell is mainly related to the Ka concentration, and
because the extracellular fluids concern us more , the NaCl
particles are the major issue.

When we are talking about osmotic equilibrium in the body


fluids you have to remember these 2 important principles:

1- Osmolarity of ECF and ICF must remain almost


equal :that doesn't mean it has to be normotonic all the time,
it means that if there is a change in the ECF toward
hypertonic, for example,the ICF should follow that change
and become hypertonic too, cause you can't see that the
extracellular is normotonic and the intracellular is
hypertonic/hypotonic or vice versa; that¶s because the barrier

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between the extracellular and the intracellular compartments


is the cytoplasmic membrane which is in turn highly
permeable to water molecules, so any change of water
concentration in either sides of the cell it will be followed by
water movement either in or out until it reaches the
equilibrium.

2-The cytoplasmic membrane neither permeable to Na


nor Ka however it's highly permeable to water molecules ,so
that¶s explain why there is about 150 milli-molar Ka particles
inside the cell and outside it just about 5 milli-molar ,and
why there is 140 milli-molar Na outside the cell and only 8
milli-molar inside it, and this situation should remain like
that all the time .So the cytoplasmic membrane is
impermeable to the particles which are responsible for the
osmolarity (NaCl),however there are other particles that can
go throw it without affecting the osmolarity.

***Keep in mind that whenever you heard osmolarity or


body fluid concept you should immediately remember NaCl
particles

o  
ÈcA 70 Kg patient is dehydrated (losing of water),when measuring the
NaCl molarity we calculated the osmolarity of blood plasma molecules
which is equal to 320 mOsm/liter.

How much water is needed to restore plasma osmolarity to 280 c-


mOsm/L.??

The osmolarity was found to be 320 mOsm/liter which is higher


than the normal osmolarity (300 milli-osmole), so we have a
hypertonic solution which is abnormal, that's because the patient
has lost high amount of water, and that causes the reduction of
water particles while the number of solutes particles increased, so
in order to get the normal osmolarity back we have to dilute the
NaCl particles by increasing water concentration until we get the
tonicity equal to 300 0r 280.

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In order to calculate how much water we need to achieve that, we


should do several steps:

Ë
: assume that;

The ECF is 20% of body weight (normal) =20%*70=14 liter

The ICF is 40% of body weight = 40%*70=28 liters

The summation of these which is the volume of the body


fluid in the patient: 14+28=42 liters

Number of osmoles = the volume*osmolarity

Number of osmoles =42*320(from the question)


=13440 milli- osmoles
In the whole body of the patient

The number of osmoles in the extracellular = the volume


of the extracellular fluid*osmolarity

The number of osmoles in the intracellular = the volume


of the intracellular fluid*osmolarity

-------------------

: we have to know the volume of water that we


should add in order to return the normal osmolarity back.

The volume of water = number of osmoles/osmolarity

In order to calculate the volume of water that we


should give to the patient, we first have to find the total
volume of water that should be present in his body after
treating him to get the normal osmolarity back, which can
be achieved by dividing the number of osmoles from the
previous step by the normal osmolarity:

13440 milli-osmoles/280(milli-osmoles/liter) =48 liters

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The patient has 42 liters before treatment, with a


hypertonic extracellular compartment, so in order to get
back to the normotonic there should be 48 liters inside his
body.

The difference = 48-42 = 6 liters


In the result I need to give that patient 6 extra litres in
order to dilute the particles in his body and get back to the
normotonic solution, which is the answer of our question.

 
 you have a normal person with a normotonic
solution, if he drinks 3 liters of pure water ,what will
happen??
the water will go throw the GI track the vascular
system in the plasma capillaries interstitial
compartment ,so after drinking 3 litres of water the
extracellular fluid will be hypotonic, meanwhile the
intracellular fluid will still isotonic .

This is not acceptable because the osmolarity should be


equal in and outside the cell ,and homeostasis will not
accept this situation, so the water will start to move from
the outside to the inside where the cytoplasmic membrane
is highly permeable to water molecules and accepts that
movement until it reaches the equilibrium ,and that's will
happen when the osmolarity is equal in and out which is-
in this case - hypotonic in both sides, WHY??

(Because some of the extra water will go from the outside


to the inside, and when it reaches the equilibrium there
will be more water inside and more water outside
compared to the normotonic situation which is hypotonic).

In summery when you drink high amount of pure


water you will have hypotonic intracellularly and
hypotonic extracellularly.

If another person drinks a hypertonic solution, after a


while extracellular fluid (interstitial and plasma) will be
hypertonic which is not acceptable, ( inside the cell
normotonic ,outside the cell hypertonic), so the water
moves in the opposite direction from inside the cell to the
outside until it reaches the equilibrium.

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When the intracellular fluid loses water it will


transfer from normotonic to hypertonic, the extracellular
will still hypertonic although it got some extra water, so by
the end of the equilibrium inside and outside the cell will
be hypertonic.

If a third person doesn¶t drink hypertonic or


hypotonic solutions, instead he drinks normal saline (a
normotonic solution)??
There will be no change in the osmolarity of both
intracellular and extracellular, because he drank a
normotonic solution, so if you add 3 liter,7 liter,100 liters
of normotonic solution to a normotonic solution it won't
change the osmolarity, instead the volume of the plasma
will increase because the starling capillary circulation will
not allow the plasma to remain in the interstitial
compartment.

’ o

We mentioned that under normal condition the body


should have 42 litres of fluid that always should be
constant (no decrease no increase),and that we have what
is called hydrostatic pressure that pushes the plasma out
of the capillaries which equals to 30 mmHg ,but, if we have
a situation where the hydrostatic pressure instead of 30 it
is 40 mmHg or 45 mmHg,that indicates that the amount of
plasma which will leave from the capillary will be
increased(the plasma filtration increase) which will cause a
pathological phenomenon called ( Edema ).

The edema: [is an abnormal accumulation of fluid


beneath the skin or in one or more cavities of the body]c
(Wikipedia)

The edema has two major groups:

‘ c Intracellular edema : (very rare)


Depression in the metabolism inside the cell - mainly when we
have defect in Na/Ka pump- will lead to cell swelling which is the
intracellular edema.

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*Na/Ka pump is very crucial to our life, and the inhibition of


that pump will lead to cell death.

There is a special type of fish which found to be toxic to the


human being and causes death, that 's because this type of fish
contains an inhibitor to the Na/Ka pump, which will block the
Na/Ka pump, the respiration will stop ,the action potential will
stop and everything will stop, so the human being dies.

Ê c The extracellular edema: (the major edema in medicine)


It is the accumulation of plasma in the interstitial
compartment or in the vascular system.

The major cause of extracellular edema is an increase in


the capillary pressures (hydrostatic pressure, osmotic
pressure) which will cause extra filtration of plasma that
results from many diseases and abnormalities:

A.cExcessive kidney retention of salt and water:


Any extra amount of water or salt in the body will be
taken out by the kidneys, so that retention will increase the
volume of plasma in the vascular system and in turn will
increase the hydrostatic pressure which will lead to the
edema.

B.c High venous pressure :


In Varicose Veins disease (ϲϟ΍ϭΪϟ΍ νήϣ) which means that the
veins especially in the lower limps can't pump the volume
of blood inside them to the heart, so the blood will remain
in the veins and due to that an increase in the hydrostatic
pressure will happen and causes the extracellular edema.

C. Decreased arteriolar resistance:


The structure of the vascular system:
Aorta ----artery ----arterioles-----capillaries---ca  c---
veins.
The arterioles are structure of the vascular system
which has smooth muscle in it, not as the capillaries which
have endothelial structure.
Because they have smooth muscles; if the arteriolar
resistance decreased, the blood volume in that section will
be increased , and the blood flow will also increase in the

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arteriole which will increase the hydrostatic pressure in


the capillaries and cause the increase of filtration of
plasma and finally cause the extracellular edema.

{In the exam if a question contains a disease in it, the


doctor should explain that this disease will increase the
hydrostatic pressure}

The second cause of the extracellular edema is ®



 
 
:
Which will lead to decrease in the inward forces (oncotic
colloid pressure) ,that means the back suction of the plasma
into the capillary will be less and the accumulation of the
plasma outside will cause the edema-- that if the plasma
protein increases it will suck the water from the interstatuim,
and if it decreased it will reduce the suction--.

The causes of that reduction are:


A.c Nephrotic syndrome: where the kidneys start to lose plasma
protein with the urine, so the plasma protein concentration
will be lower than before.
B.c Wounds, burns will cause the lost of protein with plasma .
C.cFailure to produce proteins by
1-Liver disease 2. Malnutrition (ΔϳάϐΗ ˯Ϯγ)

When the protein is less the oncotic pressure is less


the suction power is less water accumulation outside the
capillary is more and that will cause an edema.

In other words (the decrease in the inward forces will cause


edema, and the increase in the outward forces will cause
edema, too)

The third cause of the extracellular edema is 



    :

As we mentioned before, the permeability of the capillary


from the Venus part is higher than arterial part, but if the
permeability of the whole capillary increases, the amount of
water that will leave the capillary will be more.

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The diseases or the abnormalities in which will cause that are:

1- Allergic reactions: where some swellings appear on the


person with allergy; that because the permeability of the
capillary increases and the plasma leaves to the extracellular
compartment.

2-toxins

c Lrolong ischemia:
Ischemia is a local lack of oxygen; anemia is a general lack of
oxygen.
Bed patients; those who don¶t move for long period of time
will have swellings in their legs which are an extracellular
edema due to the prolonged ischemia. After a while this
edema will be transfer to an alcer.

The forth cause of the extracellular edema is Ë  


’ ’

 or a blockage in it where it is the
responsible part in taking the extra amount of water,so the
failure or the blockage of it will lead to return fluids from the
interstitium back into the blood, and cause the accumulation
of water to cause the swelling(edema). The reasons of that
are:

A.cCancer which will block the lymph

B.c Infections of parasites (filari) which causes the elephantiasis


disease(Ϟϴϔϟ΍ ˯΍Ω) mainly in Africa ,where the patient will have
huge swelled legs because there will be small
worms(parasites) which only live in the lymphatic vessels so
they will block the lymphatic vessels and cause the huge
swelling.

C.cSurgery; after the surgery when the Surgeon cut random


tissues he always cuts the lymphatic vessels in the area of the
wound, so there will always be small/medium/large swellings
there and that because the lymphatic vessel is not there .

D.cCongenital abnormality of the lymphatic vessels.

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If you sleep at night, when you wake up you should have


large amount of edema in your body because when you push
your cells on the bed you increase the hydrostatic pressure in
them; but thanks God we have safety factors that will prevent
edema in our bodies.

In soft tissues just the weight of that tissue with the gravity
should create some levels of edema; however fatty people are
walking around without edema because of the safety factors.

So if the hydrostatic pressure is 30 mmHg (normal ), 33


mmHg, 35 mmHgm, 36 mmHg that will not lead to the Edema.
And if the colloid oncotic pressure is 28mmHg (normal) , 25
mmHg, 20 mmHg there won't be any Edema, too. The reason
behind that, that's the body, has in the interstitial compartment
a power which will prevent edema unless the changes exceed 17
mmHg.

Úc The safety factors are:


1. Low tissue compliance of the interstitium (you don¶t have to
go in details)

2. Ability of the lymphatic flow to increase its efficiency 10-50


times more; which means if a small leak in water happened the
lymphatic vessel will suck it more because it has the ability to be
50 times more efficient

3. Lroteins from interstitium compartment (which create 8


mmHg pressure); if there is increase in them the lymph vessel
will be able to take them back to the blood vessels

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What is the normal number of red blood cells in the


human body??

5 million cells /micro liter


1 mill 1000 ȝL
So in one ml we have 5 billion RBCs

1 liter 1000 ml
and we have 5 liters of blood in the body
So It is about   
RBCs in the whole body.

The liquid part of the blood (plasma) represents about


55% of the blood volume.
90% of plasma is water and 10% mainly is the plasma c V
protein, electrolytes and other substances.

Functions of Llasma proteins:c V


1- Establish an osmotic gradient (oncotic pressure( colloid))

2- LH buffering (if you drink an acidic juice the plasma protein


will interfere within seconds to do the buffering)

3- Bind cholesterol, iron, and thyroid hormone (as a transporter)

4- Carry Blood clotting factors (about 13 factors)

5- Inactivate precursor molecules; (angiotensenogen for example)


6- Į-globulins, immunoglobulin, antibodies.

_______________________________________________________

"Erythrocytes"

1- Red in color.

2-They don¶t have nucleus so they don¶t live for a long time (the life
span of the RBC is 120 days-4 months only-),so in each second our
body should produce about 2-3 million cells in order to keep their
number constant.

3-The shape of red blood cells is biconcave (thinner in the middle) ,


and the diameter of it is about 8 ȝm.

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The hemoglobin also can bind to:

1- CO2

2- Acidic hydrogen ion portion of carbonic acid

3- CO

4- nitric-oxide (NO)

Each cell of the red blood contains 250 millions of hemoglobin


molecules which is a huge number that correlates in transporting
the huge numbers of oxygen molecules that the body needs to serve
it properly.

*250 millions HB molecules /cell

How can you calculate the number of HB molecules in your body?

The # of HB molecules=250 million /cell *5 millions/ ȝL*1000 ȝL


/ml*1000 ml/liter *5 liters = 625 *10 ^19 molecules.

We don¶t use that¶s much amount of oxygen, we only use 25% of it


(only one fourth of the blood oxygen is used in tissues), while the
remaining is used in specific situations where you have to duple,
triple, or use ten times more oxygen, so you don¶t need to wait for
the blood to go back to the lungs in order to supply you with more
oxygen.

How the body builds the RBCs??

There is a specific structure in the body that is called bone marrow


(red bone marrow),which is the factory of all blood cells. The stem
cell in the bone marrow is differentiated either to red blood cells or
to white blood cells or platelets. The red bone marrow after the age
of 20-25 starts to be a yellow bone marrow rather than red, that's
mean that the bone marrow will not produce blood cells. However;
Even after 25 years you will still have red bone marrow specially in

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the sternum(the bone in front of your chest),and in the upper and


the lower ends of the long bones(legs and hands).

There is a special chemical called erythropoietin , that will be


secreted by kidneys only if the body suffers from lacking of oxygen
(ischemia) in which the decreased O2 concentration È kidney
stimulationÈ erythropoietin secretion È bone marrow stimulation È
increased RBCs È increased O2 concentration È erythropoietin
secretion is turned off.

The decreased amount of oxygen is considered as a signal to


stimulate the stem cells production of RBCs .

The End

c Done by:Enas Salameh


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