Sistem Sirkulasi

(Pertemuan II)

Sistem
Sirkulasi
Secara Umum

02/15/15

Sistem Sirkulasi Tertutup pada Vertebrata

Sistem Sirkulasi pada Ikan

2 ruang jantung
Sirkulasi Tunggal

Jantung Ikan

Sistem Sikrkulasi Katak

3 ruang jantung
2 atria dan satu
ventrikel

Aliran darah dalam jantung katak

Saat bernapas:
Resistensi ke
pulmokutanea rendah

Tubuh

Atrium
kanan

Ventrikel

Paru-paru dan
kulit

Ventrikel

Atrium kiri
Saat tidak bernapas:
Resistensi ke pulmokutanea tinggi

Lengkung
pulmokutanea

Vena pulmonalis

Sistem Sirkulasi Katak

Katak memiliki atria yang terpisah dan
ventrikel tunggal.
Sirkulasi ganda
Darah kaya oksigen dan miskin oksigen
hanya sedikit tercampur saat melewati
ventrikel.
Darah kaya oksigen dari vena pulmonalis
kemungkinan masuk dalam dinding
ventrikel berspon, sehingga tidak bercampur
dengan darah miskin oksigen.
Paru-paru kecil, sehingga darah ada yang

Sistem sirkulasi kura-kura

Aliran darah dalam jantung kura-kura

1. Saat bernapas di darat
Tubuh

Atrium
kanan

(resistensi aliran darah ke paru-paru rendah)

Sebelum
atrium kiri
kontraksi

Ventrikel
kiri

Ventrikel kanan

Arteri pulmonalis

Aorta

Paru-paru

Ventrikel kiri

Atrium kiri

Pola kiri-kanan

Vena pulmonalis

Aliran darah dalam jantung kura-kura

1. Saat berada di dalam air
Tubuh

Atrium
kanan

(resistensi aliran darah ke paru-paru tinggi,

resistensi aliran sistemik rendah)
Ventrikel
kiri

Ventrikel kanan
Resistensi
tinggi

X
Arteri pulmonalis
X
X
Paru-paru
X

Aorta

X
X

Ventrikel kiri

X
X

Atrium kiri

Pola kanan-kiri

Vena pulmonalis

Aliran darah dalam jantung buaya

1. Saat bernapas di darat
Tubuh

Arteri kiri

(resistensi aliran darah ke paru-paru rendah)

Atrium
kanan

Ventrikel kanan

Tekanan pangkal arteri kiri>

Arteri pulmonalis

ventrikel kanan

Foramen panizae

Paru-paru

Arteri kanan

Ventrikel kiri

Atrium kiri

Vena pulmonalis

Aliran darah dalam jantung buaya

(resistensi aliran darah ke paru-paru

tinggi/tidak bernapas)

2. Saat berada di air

Tubuh

Atrium
kanan

Ventrikel kanan

Arteri kiri

X
X

Tekanan ventrikel kanani>

pangkal arteri kiri

Arteri pulmonalis

X
Foramen
X panizae
X

Paru-paru

Arteri kanan

X
X

Ventrikel kiri

Atrium kiri

Vena pulmonalis

Sistem Sikulasi Mamalia dan Burung

Generalisasi
sistem
sirkulasi

02/15/15

25

Mamalia dan Burung

Mamalia dan burung memiliki dua ventrikel yang

terpisah sempurna, sehingga tidak ada
percampuran darah kaya oksigen dan miskin
oksigen.
Memiliki pola sirkulasi ganda, sirkulasi sistemik
dan sirkulasi pulmonalis.

Sirkulasi pada Jantung Manusia

Katup jantung menahan aliran balik darah

Siklus jantung
cycle

Animation

Sistem Elektrik Jantung

Sistem Konduksi Jantung

Siklus Jantung
Pacemaker (nodus sinoatrialis) menentukan tempo
detak jantung.

Siklus Jantung
Sinyal menyebar ke atria, tetapi ditunda di nodus
atrioventrikularis

Siklus Jantung
Sinyal, kemudian dihantarkan ke serabut Purkinje ke
ujung jantung

Siklus Jantung
Kontraksi terjadi pada ventrikel.

Siklus Jantung
Selama
diastol atria
dan diastol
ventrikel,
seluruh
jantung
relaksasi

Fig. 42.7

Siklus Jantung
Sistol
atrium,
atrium
kontraksi

Fig. 42.7

Sikuls Jantung
Sistol
ventrikel,
ventrikel
kontraksi.

Fig. 42.7

Aliran Darah dalam Jantung

Atrium kanan menerima darah ter-deoksigenasi (miskin oksigen).

Darah kemudian mesuk ke ventrikel kanan melalui valvula trikuspidalis

Kontraksi ventrikel kanan mendorong darah melalui valvula

semilunaris ke dalam arteri pulmonalis menuju paru-paru.
Ke paru-paru

Setelah melalui kapiler paru-paru, darah yang teroksigenasi

(kaya oksigen) kembali ke jantung melalui vena pulmonalis.

From lungs

Atrium kiri menerima darah dari vena pulmonalis.

Darah melalui katup mitral (valvula bikuspidalis) masuk ke

ventrikel kiri.

Kontraksi ventrikel kiri mendorong darah melewati katup

semilunaris menuju aorta. Darah menalir ke semua bagian tubuh di
mana darah memasok oksigen dari paru-paru dan nutrien dari sistem
pencernaan.
Ke seluruh tubuh

Darah kembali dari tubuh melalui vena kava superior dan

vena kava inverior.

Kecepatan denyut jantung

(denyut nadi)
Kecepatan denyut jantung saat
istirahat sekitar 70 kali per menit
Aktivitas yang tinggi atau stress
dapat meningkatkan kecepatan
denyut jantung sampai 170 kali
per menit atau lebih.
Sistem syaraf dan hormon
mengontrol ritme pacemakers

Cardiac output, Stroke Volume &

kecepatan denyut jantung

Arteri dan Vena Jantung

(Koronaria)

Pembuluh Darah

Are pembuluh /
kecepatan darah/
Tekanan darah

1. Amati diagram di
samping!

2. Deskripsikan hubungan
antara luas area, kecepatan
darah dan tekanan darah
untuk masing-masing

 Saat

arteri bercabang,
penampang melintang
bertambah menyebabkan
tekanan dan kecepatan alir
darah s turun.
Pada mamalia, terdapat 800
kali lipat peningkatan area
penampang melintang dari
aorta ke kapiler.
Kecepatan alir semula
sekitar 40-50 cm/s,
sebaliknya di dalam kapiler
turun menjadi to < 0.1 cm/s.

Arteri
Kontraksi jantung memacu darah mengalir melalui pembuluh arteri, kapiler, dan
vena.
Velositas aliran darah tertinggi terjadi pada total area penampang melintang
paling kecil, dan velositas paling rendah terjadi di area penampang melintang
paling besar.
Arteri mempunyai total area penampang melintang terkecil, sedangkan kapiler
mempunyai total penampang melintang paling besar.
Velositas tertinggi terjadi pada aorta dan arteri pulmonalis, kemudian turun
dengan tajam saat aliran darah melalui kapiler, dan naik lagi saat darah mengalir
melalui vena.

Arteri

Arteri

Secara umum arteri memiliki dinding yang tebal dan lebih berotot
dibanding vena dengan diameter luar yang sama.
Arteri mempunyai 4 fungsi utama:
.Penyalur darah di antara jantung dan kapiler
Reservoir tekanan untuk mendorong darah ke dalam arteriol yang berdiameter
kecil
Mempertahankan tekanan dan aliran yang dipacu oleh jantung dan
menghasilkan aliran darah ke kapiler.
Mengontrol distribusi darah ke jaringan kapiler tertentu melalui kosntriksi
yang selektif dari cabang-cabang akhir pohon arteri.

Arteri
Tekanan darah arteri ditentukan oleh volume darah sistem arteri
yang terlibat dan sifat-sifat dindingnya.
Volume darah dalam arteri adalah resultan dari pengisian oleh
kontraksi jantung dan pengosongan melalui arteriol dan dalam
kapiler .
Jika cardiac output naik, tekanan darah arteri akan naik.
Sebaliknya, jika aliran kapiler naik, tekanan darah akan turun.
Sifat elastis dinding bervariasi. Secara umum elastisitas turun seiring
turunnya tebal lapisan otot dan bertambahnya jarak dari jantung.
Dekat jantung, arteri elastik mempertahankan tekanan aliran yang
dipacu oleh kontraksi jantung.

Arteri
Perubahan kecil pada tekanan dapat mengasilkan perubahan
volume yang besar.
Sistem arteri yang elastisitasnya lebih rendah berfungsi
sebagai reservoir tekanan untuk mempertahankan aliran darah
kapiler.

Kontrol Sirkulasi Kapiler

Arteri, arteriol, dan metarteriol yang
memasok darah ke kapiler ,
dindingnya mengandung lapisan
sirkuler otot polos.
Kontraksi otot-otot polos ini
(vasokonstriksi) penting dalam
mengontrol aliran darah melalui
kepiler.
Relaksasi otot polos menghasilkan
vasodilatasi, yaitu suatu pelebaran
diameter pembuluh yang
meningkatkan aliran darah.

Vena
Arteri

Vena

Vena
Sistem vena berfungsi sebagai penyalur pengembalian darah
dari kapiler ke jantung.

Sistem vena memiliki volume darah yang besar, sistem tekanan

rendah dengan pembuluh-pembuluh berdiameter besar. Pada
mamalia, sistem vena menyimpan 50% total volume darah.
Sistem vena berfungsi sebagai reservoir penyimpanan darah
atau reservoir volume, karena perubahan besar volume
berpengaruh kecil pada tekanan vena.

Vena

Aliran darah vena dipengaruhi oleh berbagai faktor:

1. Aktivitas otot-otot kaki dan tekanan diafragma pada perut
menghasilkan penekanan vena dalam bagian-bagian tubuh.

2. Aliran darah
satu arah (ke
arah jantung)
ditentukan oleh
keberadaan
3. katup.
Pernapasan pada mamalia berperan dalam pengembalian darah vena
ke jantung. Jantung dan vena besar berada pada rongga dada.
Pelebaran rongga dada menurunkan tekanan dalam dada, sehingga
darah tersedot dari vena kepala dan rongga perut.

Vena
3. Aktivitas peristaltik menyebabkan aliran darah vena.
4.

Pendarahan menurunkan reservoir darah vena.

Kehilangan ini dikompensasi oleh otot polos yang diinervasi

oleh serabut-serabut adrenergic sympatetic.

Stimulasi saraf-saraf ini menyebabkan vasokonstriksi dan

pengurangan besar reservoir vena.

Refleks ini menyebabkan beberapa pendarahan terjadi tanpa

penurunan tekanan vena.

5. Otot polos vena membantu pengaturan distribusi darah

dalam sistem vena. Ketika seseorang berpindah dari posisi
duduk ke posisi berdiri, perubahan posisi jantung dan otak
terhadap gravitasi mengaktivasi serabut adrenergic
sympatetic yang menginervasi vena-vena kaki, menyebabkan
kontraksi otot polos vena dan memacu aliran darah yang
terkumpul.

Kapiler

Kapiler sangat kecil, kurang lebih

berdiameter sama dengan satu sel darah
merah (8m atau kurang).
Dinding kapiler merupakan satu lapis selsel endotel, yang menempel pada ujungujungnya dan dikelilingi oleh membran
basal (matriks ekstrasel).

Sel-sel endotel

Kapiler
1. Aliran darah yang lambat digunakan untuk bertukar substansi
di antara darah dan jaringan.
2. Pertukaran gas dan zat lain terjadi menembus kapiler yang
memiliki dinding setebal satu sel.
3. Di dalam sebagian besar jaringan, kapiler yang menyebar dalam
jaringan, jauhnya tidak lebih dari tiga atau empat sel, bahkan
hanya dua sel yang penting untuk transfer gas, nutrien, dan zat
sampah. Kondisi ini juga berhubungan dengan lambatnya difusi.

4. Penetrasi kapiler di dalam jaringan sangat

luas. Masing-masing kapiler melayani
jaringan 10 kali beratnya.
Tubuh manusia memiliki kapiler

Kapiler
Modifikasi volume/jalur saluran
Aliran darah
melalui kapiler
dapat dikurangi
dengan tajam .
Sfinkter
prekapiler

shunt

Vasokonstriksi = penutupan atau penyempitan pembuluh darah

Vasodilatasi = pembukaan atau pelebaran pembuluh darah

Kapiler

Sfinkter prekapiler
merupakan cincin-cincin
otot polos yang
mengelilingi batas kapiler
dengan arteriol atau
metarteriol.
Kontraksi sfinkter
prekapiler dapat
menghentikan aliran darah
ke jaring-jaring kapiler.

Contoh fungsi sfinkter prekapiler:

Pengontrolan panas dengan mengurangi aliran darah ke permukaan.
Aliran panas

COLD

Aliran arterial-venal
TERTUTUP

Aliran arterial-venal
MEMBUKA

arteri

Area kapiler

Vasoconstriction

vena

Area kapilet

Vasodilation
77

DINGIN

vena

arteri

KULIT

HANGAT

Kapiler

5% darah yang disirkuasi berada dalam kapiler

Pertukaran Cairan antara Kapiler dan Jaringan

Tekanan hidrostatik darah menambah potensial osmotik
negatif yang berkebalikan dari plasma darah.

Air, yang mengandung molekul-molekul yang larut, didorong

keluar kapiler melalui pori-pori kecil pada dinding kapiler
oleh kelebihan tekanan hidrostatik.

Pertukaran cairan
antara kapiler dan jaringan
Gradien antara cairan Interstitial dan darah
Kapiler merupakan tempat pertukaran materi antara darah dan cairan
interstitial dan membasahi jaringan.
Pertukaran cairan antara darah dan cairan interstitial ditentukan oleh
keseimbangan antara tekanan darah positif (tekanan hidrostatik)
dan potensial osmotik negatif bersih pada plasma darah.
Potensial osmotik plasma darah pada kaliper lebih negatif daripada
potensial osmotik sekitar cairan insterstitial.
Protein pada plasma darah yang tidak dapat dengan mudah
meninggalkan kapiler merupakan sumber perbedaan potensial
osmotik. Namun, cairan interstitial dan plasma darah memiliki
konsentrasi ion dan molekul kecil lain yang mirip.

Pertukaran Cairan antara Kapiler dan Jaringan

Tekanan hidrostatik darah menambah potensial osmotik
negatif yang berkebalikan dari plasma darah.

Air, yang mengandung molekul-molekul yang larut, didorong

keluar kapiler melalui pori-pori kecil pada dinding kapiler
oleh kelebihan tekanan hidrostatik.

Pertukaran Cairan antara Kapiler dan Jaringan

Blood pressure
(hydrostatic)
32 mm Hg

Plasma colloidal osmotic potential

-22 mm Hg

Net pressure
10 mm Hg

Pertukaran Cairan antara Kapiler dan Jaringan

Dorongan bersih kurang dari pada ujung arah vena (7 mm Hg ke

arah dalam vs 10 mm Hg ke arah luar pada ujung arah arteri).
Lebih sedikit air yang masuk kembali ke kapiler daripada yang
aslinya tertinggal di ujung arah arteri.
Kelebihan cairan diambil oleh sistem limfatik.

Vesicles; large,
lipid-insoluble
(proteins)
Blood cells,
most
proteins.

Filtration; fluid and

small, lipid-insoluble
molecules (water,
amino acids,
NaCl, glucose,
urea)

Diffusion;
lipid-soluble
molecules
(O2, CO2, lipids)

Tekanan Darah
Tekanan darah merupakan ukuran kekuatan yang
muncul oleh darah pada dinding arteri.
Contoh: 120/80 (tekanan sistol/tekanan diastol).
Tekanan sisteol adalah hasil kontraksi ventrikel (normal
=110-140)
Tekanan diastol didapat selama relaksasi ventrikel (normal=
70-90)

Measuring blood pressure

Blood pressure is measured by two values:
Systolic pressure during ventricular contractions
Diastolic pressure between ventricular contractions

Measuring blood pressure

The cuff is inflated to stop blood flow in the arm

Measuring blood pressure

Pressure is released from the cuff until blood flow is
just audible below the cuff; blood passes through the
cuff only at highest pressure (systolic pressure)
Fig. 42.12

Measuring blood pressure

Further pressure is released from the cuff until blood
flow is continuous and no longer audible (diastolic
pressure)

Circuitry and pressure

Animal
Teleost fish
Lungfish
Amphibian
Reptile
Mammal
Bird

Max. Systemic
pressure (kPa)
3.9

Max. Pulmonary
pressure (kPa)

3.5

4.4
5.5
21.0

2.8
3.2
3.5

High
15.5
pressure
2.7
circuit
in birds
and mammals!

Pulmonary pressures
2.5
are low and constant

Separate pulmonary and systemic circuits allow terrestrial anima

to have high-pressure circulatory systems and still breathe air

Hydrostatic pressure
Gravity also affects blood pressure (esp. in big vessels)
Works against blood returning from legs to heart

Solution?

Oneway valves in veins

Action of leg muscles pushes blood back up
94

Gravity effects blood pressure

Pressure is
lower up here
6 meters

Giraffes wear support hose: very thick, tough blood vessels in legs!

Blood
pressure is
very high
at heart to
send blood
up to brain
(~260 Torr)

Valves in neck blood vessels prevent backflow

Systolic pressure decreases when giraffes drink

Blood flow in humans at rest

Pulmonary
Circuit
Systemic
Circuit

Tissue

% blood flow

Lungs

100

Brain
Heart
Liver and gut
Kidneys
Skeletal muscle
Skin
Bone

14
4
27

Circuits are
in parallel
20
21

5
9

Thought question:
How might exercise change this distribution?
97

Circuits
are in
series

Sistem Limfatik

Sistem Limfatik
Water and plasma are forced from the capillaries
into intracellular spaces.
This interstitial fluid transports materials between
cells.
Most of this fluid is collected in the capillaries of a
secondary circulatory system, the lymphatic system.
Fluid in this system is known as lymph.

 Lymph flows from small lymph capillaries into

lymph vessels that are similar to veins in having
valves that prevent backflow.
Lymph vessels connect to lymph nodes, lymph
organs, or to the cardiovascular system at the
thoracic duct and right lymphatic duct.

 Lymph nodes are small irregularly shaped masses

through which lymph vessels flow.
Clusters of nodes occur in the armpits, groin, and
neck.
Cells of the immune system line channels through
the nodes and attack bacteria and viruses traveling
in the lymph.

The Lymphatic System

A separate system of
vessels, the lymphatic
system, returns excess
tissue fluid to the blood.
Lymphatic ducts drain
into the venous system
Fig. 43.5
near the heart.

Main Channels of Lymphatics

Major Lymphatic Vessels of the Trunk

Lymph contains
fat and proteins
being returned to the
venous system
Lacteals- lymphatic
vessels draining the
digestive tract
Afferent Vessels
Efferent Vessels

Tonsils

Spleen

Thymus Gland

Cortex
Medulla

Function of the Lymphatic System

Defense against harmful organisms and chemicals
2 types of defense
Nonspecific
Specific

Specific defense = immunity

Humoral immunity involves B cells that become plasma cells which
produce antibodies that bind with specific antigens.
Cell-mediated immunity involves T cells that directly destroy foreign
cells

Derivation and Distribution of

Lymphocytes

Darah

Functions
Adult
Store RBCs
Produce lymphocytes
Store iron
Destroy worn out RBCs
Fetus
Produce RBCs

What is plasma?
Plasma is a straw-colored liquid that contains
dissolved proteins, salts, minerals, and hormones

Hemopoiesis

Hemopoiesis outline

Plasma
Plasma is the liquid component of the blood.
Plasma is about 60 % of a volume of blood; cells and
fragments are 40%.
Plasma has 90% water and 10% dissolved materials
including: proteins, glucose, ions, hormones, and gases.
It acts as a buffer, maintaining pH near 7.4.
Plasma contains nutrients, wastes, salts, proteins, etc.
Proteins in the blood aid in transport of large molecules
such as cholesterol.

Red Blood Cells

Red blood cells, also known as erythrocytes, are flattened,
doubly concave cells about 7 m in diameter that carry
oxygen associated in the cell's hemoglobin.
Mature human erythrocytes lack a nucleus.
They are small, 4 to 6 million cells per cubic millimeter of
blood, and have 200 million hemoglobin molecules per cell.
Humans have a total of 25 trillion (about 1/3 of all the cells
in the body).
Red blood cells are continuously manufactured in red
marrow of long bones, ribs, skull, and vertebrae.

 Life-span of an erythrocyte is only 120 days,

after which they are destroyed in the liver and
spleen.
Iron from hemoglobin is recovered and reused
by red marrow.
The liver degrades the heme units and secretes
them as pigment in the bile, responsible for the
color of feces.
Each second 2 million red blood cells are
produced to replace those taken out of
circulation.

What is blood?
Red blood cells = erythrocytes
These are the most numerous cells in the blood
Their dimpled shape gives them extra surface area
They are packed full of the
pigment hemoglobin

What is blood?
Hemoglobin
Four subunit polypeptide chains
Each subunit
polypeptide chain has
an iron-rich heme
group
Each heme group can
reversibly bind one O2
molecule

What is blood?
Hemoglobin
Carries ~ 70 times
more O2 than
dissolves in the
plasma
Also carries CO2, but
with much less affinity
than for O2

What is blood?
Red blood cells = erythrocytes
Produced in the bone marrow
Live ~ 120 days
Dead and damaged cells are
removed from circulation by
the liver and spleen

White Blood Cells

White blood cells, also known as leukocytes, are larger than
erythrocytes, have a nucleus, and lack hemoglobin.
They function in the cellular immune response.
White blood cells (leukocytes) are less than 1% of the
blood's volume.
They are made from stem cells in bone marrow.
There are five types of leukocytes, important components of
the immune system
White blood cells can squeeze through pores in the
capillaries and fight infectious diseases in interstitial areas

Five types of WBCs

Neutrophils
Macrophages
Lymphocytes
Eosinophils
Basophils

What is blood?
White blood cells 5 types of leukocytes
Produced by the bone marrow
Collective function is to fight infection

Fig. 42.16

Neutrophils
The most abundant of the WBCs.
Neutrophils squeeze through the capillary walls and into
infected tissue where they kill the invaders (e.g.,
bacteria) and then engulf the remnants by phagocytosis.
This is a never-ending task, even in healthy people: Our
throat, nasal passages, and colon harbor vast numbers of
bacteria. Most of these are commensals, and do us no
harm. But that is because neutrophils keep them in check

Macrophages

Macrophages are large, phagocytic cells that

engulf
1. foreign material (antigens) that enter the body
dead and
2. dying cells of the body.

They release white blood cell growth factors,

causing a population increase for white blood
cells.

Lymphocytes
There are several kinds of lymphocytes (although they all look
alike under the microscope), each with different functions to
perform . The most common types of lymphocytes are
B lymphocytes ("B cells"). These are responsible for making
antibodies.
T lymphocytes ("T cells"). There are several subsets of these:
inflammatory T cells that recruit macrophages and neutrophils to the site of
infection or other tissue damage
cytotoxic T lymphocytes (CTLs) that kill virus-infected and, perhaps, tumor
cells
helper T cells that enhance the production of antibodies by B cells

Eosinophils
The number of eosinophils in the blood is normally
quite low (0450/l).
However, their numbers increase sharply in certain
diseases, especially infections by parasitic worms.
Eosinophils are cytotoxic, releasing the contents of
their granules on the invader.

Basophils
The number of basophils also increases during infection.
Basophils leave the blood and accumulate at the site of
infection or other inflammation.
There they discharge the contents of their granules, releasing a
variety of mediators such as:
1. histamine
2. serotonin
3. prostaglandins and leukotrienes

which increase the blood flow to the area and in other ways
add to the inflammatory process. The mediators released by
basophils also play an important part in some allergic
responses such as
hay fever and
an anaphylactic response to insect stings.

Platelets
Platelets result from cell fragmentation and are
involved with clotting.
Platelets are cell fragments that bud off
megakaryocytes in bone marrow.
They carry chemicals essential to blood clotting.
Platelets survive for 10 days before being removed
by the liver and spleen.
There are 150,000 to 300,000 platelets in each
milliliter of blood.

 Platelets stick and adhere to tears in blood

vessels; they also release clotting factors.
A hemophiliac's blood cannot clot. Providing
correct proteins (clotting factors) has been a
common method of treating hemophiliacs. It
has also led to HIV transmission due to the use
of transfusions and use of contaminated blood
products.
A blood clot is a plug of platelets enmeshed in
a network of insoluble fibrin molecules.

Human ABO Blood Groups

RBC membranes have glycoprotein antigens on their external surfaces.
These antigens are:
. Unique to the individual
. Recognized as foreign if transfused into another individual
. Promoters of agglutination and are referred to as agglutinogens
Presence or absence of these antigens is used to classify blood groups

Rh-Based Hemolytic Disease of the Newborn

Hemolytic disease of the newborn Rh+ antibodies of a sensitized Rh
mother cross the placenta and attack and destroy the RBCs of an Rh+
Baby
Rh mother becomes sensitized when Rh+ blood (from a previous
pregnancy of an Rh+ baby or a Rh+ transfusion) causes her body to
synthesis Rh+ antibodies.
The drug RhoGAM can prevent the Rh mother from becoming
Sensitized.
Treatment of hemolytic disease of the newborn involves pre-birth
transfusions and exchange transfusions after birth

The Process of Clotting

Platelets
Platelets are fragments of
megakaryocytes with a bluestaining outer region and a
purple granular center
They do not contain a
nucleus.
Their granules contain
serotonin, Ca2+, enzymes,
ADP, and platelet-derived
growth factor (PDGF)

Platelets
Platelets function in the
clotting mechanism by
forming a temporary plug
that helps seal breaks in
blood vessels.
They also play a key role in
blood formation of fibrin
from fibrinogen.
Platelets not involved in
clotting are kept inactive by
NO and prostaglandin I2.

Clot Formation - Micrograph

Dynamics of Blood Circulation

Interrelationships between

Pressure
Flow
Resistance
Control mechanisms that regulate blood
pressure
Blood flow through vessels

21-162

Laminar and Turbulent Flow

Laminar flow
Streamlined
Outermost layer
moving slowest and
center moving fastest

Turbulent flow
Interrupted
Rate of flow exceeds
critical velocity
Fluid passes a
constriction, sharp
turn, rough surface
21-163

Blood Pressure
Measure of force exerted by blood against
the wall
Blood moves through vessels because of
blood pressure
Measured by listening for Korotkoff sounds
produced by turbulent flow in arteries as
pressure released from blood pressure cuff
21-164

Blood Pressure Measurement

21-165

Blood Flow, Poiseuilles Law

and Viscosity
Blood flow
Amount of blood
moving through a
vessel in a given time
period
Directly proportional
to pressure differences,
inversely proportional
to resistance

Poiseuilles Law
Flow decreases when
resistance increases
Flow resistance
decreases when vessel
diameter increases

Viscosity
Measure of resistance
of liquid to flow
As viscosity increases,
pressure required to
flow increases
21-166

Critical Closing Pressure,

Laplaces Law and Compliance
Critical closing pressure
Pressure at which a blood
vessel collapses and blood
flow stops

Laplaces Law
Force acting on blood
vessel wall is proportional
to diameter of the vessel
times blood pressure

Vascular compliance
Tendency for blood
vessel volume to
increase as blood
pressure increases
More easily the vessel
wall stretches, the
greater its compliance
Venous system has a
large compliance and
acts as a blood
reservoir
21-167

Physiology of Systemic
Circulation
Determined by
Anatomy of circulatory system
Dynamics of blood flow
Regulatory mechanisms that control heart and
blood vessels

Blood volume
Most in the veins
Smaller volumes in arteries and capillaries
21-168

Pulse Pressure
Difference between systolic and diastolic pressures
Increases when stroke volume increases or vascular
compliance decreases
Pulse pressure can be used to take a pulse to determine
heart rate and rhythmicity

21-169

Capillary Exchange and

Interstitial Fluid Volume Regulation
Blood pressure, capillary permeability, and
osmosis affect movement of fluid from
capillaries
A net movement of fluid occurs from blood
into tissues. Fluid gained by tissues is
removed by lymphatic system.

21-170

Vein Characteristics and

Effect of Gravity on Blood
Pressure
Vein Characteristics
Venous return to heart
increases due to
increase in blood
volume, venous tone,
and arteriole dilation

Effect of Gravity
In a standing position,
hydrostatic pressure
caused by gravity
increases blood
pressure below the
heart and decreases
pressure above the
heart
21-171

Control of Blood Flow by Tissues

Local control
In most tissues, blood flow is proportional to
metabolic needs of tissues

Nervous System
Responsible for routing blood flow and
maintaining blood pressure

Hormonal Control
Sympathetic action potentials stimulate
epinephrine and norepinephrine
21-172

Local Control of Blood Flow

by Tissues

Blood flow can increase 7-8 times as a result of vasodilation of

metarterioles and precapillary sphincters in response to
increased rate of metabolism
Vasodilator substances produced as metabolism increases
Vasomotion is periodic contraction and relaxation of precapillary
sphincters

21-173

Nervous Regulation of
Blood Vessels

21-174

Short-Term Regulation of
Blood Pressure
Baroreceptor reflexes
Change peripheral resistance, heart rate, and stroke
volume in response to changes in blood pressure

Chemoreceptor reflexes
Sensory receptors sensitive to oxygen, carbon dioxide,
and pH levels of blood

Central nervous system ischemic response

Results from high carbon dioxide or low pH levels in
medulla and increases peripheral resistance
21-175

Baroreceptor Reflex Control

21-176

Baroreceptor Effects

21-177

Chemoreceptor Reflex Control

21-178

Effects of pH and Gases

21-179

Cardiovascular diseases
Disorders of the heart and blood vessels
Leading causes of death in the USA (~ 1 million
people each yr)
Hypertension (high blood pressure), often caused by
constriction of the arteries and arterioles, can strain
the heart
Hypertension often results from plaque buildup

Cardiovascular diseases
Plaques are thickened
artery and arteriole
walls; smooth muscle
infiltrated by lipids
(especially low-density
lipoproteins, LDLs, the
bad cholesterols)

Cardiovascular diseases
Atherosclerosis is the
condition in which
plaques impair
circulation
Arteriosclerosis is a
more advanced
condition in which
plaques become
hardened by calcium
deposits

Cardiovascular diseases
Plaques are often sites
of clotting within
vessels; thrombus (clot
formed & found at the
site of blockage) or
embolus (clot
transported within the
blood to its site of
blockage)

Cardiovascular diseases
Restricted blood flow within the coronary arteries (which
deliver blood to heart tissues) may cause chest pains
(angina)

Cardiovascular diseases
Blockage from a thrombus or embolus of coronary arteries
is one cause of heart attack
A similar blockage in the brain is a cause of stroke

Cardiovascular diseases
Exercise, low-fat diet, and abstinence from smoking and
alcohol abuse all promote a healthy heart

Aliran darah
Sistem sirkulasi merupakan sistem
berelanjutan yang tertutup dengan
bagian-bagian yang memiliki tekanan
darah tinggi dan rendah