Blood is a highly specialised circulating tissue consisting of several types of cell suspended in a fluid medium known as plasma. The cellular constituents are: red blood cells, which carry respiratory gases and give it its red color, white blood cells (leucocytes), which fight disease, and platelets, cell fragments which play an important part in the clotting of the blood. Medical terms related to blood often begin with hemo- or hemato- (BE: haemo- and haemato-) from the Greek word "haima" for "blood." Anatomically, blood is considered a connective tissue from both its origin in the bones and its function.
Functions of blood are:
* supply of oxygen to tissues (bound to hemoglobin which is carried in red cells)
* supply of nutrients such as glucose, amino acids and fatty acids (dissolved in the blood or bound to plasma proteins)
* removal of waste such as carbon dioxide, urea and lactic acid
* immunological functions, including circulation of white cells, and detection of foreign material by antibodies
* coagulation, which is one part of the body's self-repair mechanism
* messenger functions, including the transport of hormones and the signalling of tissue damage
* regulation of body pH
* regulation of core body temperature
* hydraulic functions, including erection (see also jumping spider)
Problems with blood composition or circulation can lead to downstream tissue dysfunction. The term ischaemia refers to tissue which is inadequately perfused with blood.
The blood is circulated around the lungs and body by the pumping action of the heart. Additional return pressure may be generated by gravity and the actions of skeletal muscles. In mammals, blood is in equilibrium with lymph, which is continuously formed from blood (by capillary ultrafiltration) and returned to the blood (via the thoracic duct). The lymphatic circulation has been called the "second circulation".
Physiology of blood
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Production and degradation
Blood cells are produced in the bone marrow; the process is termed hematopoiesis. The proteinaceous component (including clotting proteins) is produced overwhelmingly in the liver, while hormones are produced by the endocrine glands and the watery fraction regulated by the hypothalamus and maintained by the kidney and indirectly by the gut.
Blood cells are degraded by the spleen and the Kupffer cells in the liver. The liver also clears some proteins, lipids and amino acids. The kidney actively secretes waste products into the urine. Erythrocytes usually live up to 120 days before they are systematically replaced by new erythrocytes created by the process of hematopoiesis.
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Transport of oxygen
Blood oxygenation is measured in several ways, but the most important measure is the hemoglobin (Hb) saturation percentage. This is a non-linear (sigmoidal) function of the partial pressure of oxygen. About 98.5% of the oxygen in a sample of arterial blood in a healthy human breathing air at normal pressure is chemically combined with the Hb. Only 1.5% is physically dissolved in the other blood liquids and not connected to Hb. The hemoglobin molecule is the primary transporter of oxygen in mammals and many other species (for exceptions, see below).
With the exception of pulmonary and umbilical arteries and their corresponding veins, arteries carry oxygenated blood away from the heart and deliver it to the body via arterioles and capillaries, where the oxygen is consumed; afterwards, venules and veins carry deoxygenated blood back to the heart.
Differences in infrared absorption between oxygenated and deoxygenated blood form the basis for realtime oxygen saturation measurement in hospitals and ambulances.
Under normal conditions in humans, haemoglobin in blood leaving the lungs is about 98-99% saturated with oxygen; deoxygenated blood returning to the lungs is still approximately 75% saturated.[3][4] A fetus, receiving oxygen via the placenta, is exposed to much lower oxygen pressures (about 20% of the level found in an adult's lungs) and so fetuses produce another form of hemoglobin with a much higher affinity for oxygen (hemoglobin F) in order to extract as much oxygen as possible from this sparse supply.[5]
Besides oxygen other substances can bind to the haemoglobin which can cause irreversible damage to the body. Carbon monoxide for example is extremely dangerous when absorbed into the blood. When combined with the haemoglobin, it irreversibly makes carboxyhaemoglobin which reduces the volume of oxygen that can be carried in the blood. This can very quickly cause suffocation as oxygen is vital to many organisms (including humans). This damage can occur when smoking a cigarette (or similar item) or in event of a fire. Thus carbon monoxide is considered far more dangerous than the actual fire itself because it reduces the oxygen carrying content of the blood.
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Insects
In insects, the blood (more properly called hemolymph) is not involved in the transport of oxygen. (Openings called tracheae allow oxygen from the air to diffuse directly to the tissues). Insect blood moves nutrients to the tissues and removes waste products in an open system.
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Small invertebrates
In some small invertebrates like insects, oxygen is simply dissolved in the plasma. Larger animals use respiratory proteins to increase the oxygen carrying capacity. Haemoglobin is the most common respiratory protein found in nature. Hemocyanin (blue) contains copper and is found in crustaceans and mollusks. It is thought that tunicates (sea squirts) might use vanabins (proteins containing vanadium) for respiratory pigment (bright green, blue, or orange).
In many invertebrates, these oxygen-carrying proteins are freely soluble in the blood; in vertebrates they are contained in specialized red blood cells, allowing for a higher concentration of respiratory pigments without increasing viscosity or damaging blood filtering organs like the kidneys.
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Deep sea invertebrates
Giant tube worms have extraordinary hemoglobins that allow them to live in extraordinary environments. These hemoglobins also carry sulfides normally fatal in other animals.
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Transport of carbon dioxide
When systemic arterial blood flows through capillaries, carbon dioxide diffuses from the tissues into the blood. Some carbon dioxide is dissolved in the blood. Some carbon dioxide reacts with hemoglobin and other proteins to form carbamino compounds. The remaining carbon dioxide is converted to bicarbonate and hydrogen ions. Most carbon dioxide is transported through the blood in the form of bicarbonate ions.
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Transport of hydrogen ions
Some oxyhemoglobin loses oxygen and becomes deoxyhemoglobin. Deoxyhemoglobin has a much greater affinity for H+ than does oxyhemoglobin so it binds most of the hydrogen ions.
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Colour
In humans and other hemoglobin-using creatures, oxygenated blood is bright red. This is due to oxygenated iron in the red blood cells. Deoxygenated blood is a darker shade of red, which can be seen during blood donation and when venous blood samples are taken. However, due to an optical effect caused by the way in which light penetrates through the skin, veins typically appear blue in color. This has led to a common misconception that venous blood is blue before it is exposed to air. Another reason for this misconception is that medical charts always show venous blood as blue in order to distinguish it from arterial blood which is depicted as red on the same chart.
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Health and disease
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Ancient medicine
Hippocratic medicine considered blood one of the four humors (together with phlegm, yellow bile and black bile). As many diseases were thought to be due to an excess of blood, bloodletting and leeching were a common intervention until the 19th century (it is still used for some rare blood disorders).
In classical Greek medicine, blood was associated with air, springtime, and with a merry and gluttonous (sanguine) personality. It was also believed to be produced exclusively by the liver.
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Diagnosis
Blood pressure and blood tests are amongst the most commonly performed diagnostic investigations that directly concern the blood.
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Pathology
See also blood diseases
Problems with blood circulation and composition play a role in many diseases.
* Wounds can cause major blood loss (see bleeding). The thrombocytes cause the blood to coagulate, blocking relatively minor wounds, but larger ones must be repaired at speed to prevent exsanguination. Damage to the internal organs can cause severe internal bleeding, or hemorrhage.
* Circulation blockage can also create many medical conditions from ischemia in the short term to tissue necrosis and gangrene in the long term.
* Hemophilia is a genetic illness that causes dysfunction in one of the blood's clotting mechanisms. This can allow otherwise inconsequential wounds to be life-threatening, but more commonly results in hemarthrosis, or bleeding into joint spaces, which can be crippling.
* Leukemia is a group of cancers of the blood-forming tissues.
* Major blood loss, whether traumatic or not (e.g. during surgery), as well as certain blood diseases like anemia and thalassemia, can require blood transfusion. Several countries have blood banks to fill the demand for transfusable blood. A person receiving a blood transfusion must have a blood type compatible with that of the donor.
* Blood is an important vector of infection. HIV, the virus which causes AIDS, is transmitted through contact between blood, semen, or the bodily secretions of an infected person. Hepatitis B and C are transmitted primarily through blood contact. Owing to blood-borne infections, bloodstained objects are treated as a biohazard.
* Infection of the blood is bacteremia or sepsis. Malaria and trypanosomiasis are blood-borne parasitic infections.
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Treatment
Blood transfusion is the most direct therapeutic use of blood. It is obtained from human donors by blood donation. As there are different blood types, and transfusion of the incorrect blood may cause severe complications, crossmatching is done to ascertain the correct type is transfused.
Other blood products administered intravenously are platelets, blood plasma, cryoprecipitate and specific coagulation factor concentrates.
Many forms of medication (from antibiotics to chemotherapy) are administered intravenously, as they are not readily or adequately absorbed by the digestive tract.
As stated above, some diseases are still treated by removing blood from the circulation.
It is the fluid part of the blood that saves lives where severe blood loss occurs, other preparations can be given such as ringers atopical plasma volume expander as a non-blood alternative, and these alternatives where used are rivalling blood use where used.
2006-10-04 23:42:13
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answer #7
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answered by Anonymous
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