Body Fluids
>> This is the last lecture for Dr Saleem in this semester ,I promise it is easy and it
won't take you a lot of time to study it.
>> The slides are included . for a better view of pictures ,please check the softcopy.
In this lecture we will talk about three concepts :
1- Blood transfusion
2-The body fluids regulation
3-Edema
> Lets start with the first concept .
1-Blood transfusion :
-Transfusion is : the transfer of whole blood OR blood compartments into
the blood stream.
-In the previous lecture the Dr explains the tybes of blood groups :
a-ABO blood groups
b-RH blood groups
-These blood groups are important of blood transfusion.
- From the definition of transfusion , we can transfer just only any
compartments of blood(RBCs and plasma for example) , So we have a
machines for separate RBCs , WBCs , Platelets and Coagulations factor.
-Usually blood transfusion for the RBCs.(or blood volume)
Some important notes :
-Before transfusion blood to the patient ,we must do blood grouping and
crossmatching test, then we put it in the bank under temperature 4 C' not
below(rupture) and not above(rots).
-Then we use anticoagulant such as( heparin ,warfine and EDTA) but we use
ACD(acid citrate dextrose) (why?) >> The best more survival for RBCs
because it has dextrose.(we also can use CBD"citrate phosphate dextrose")
- If the patient come to the hospital and he needs a blood , we donate the
same blood group , if we did not have ; we donate RH-; if we did not have
also ; we donate RH+ either survive or dead.
**Important note : we need fresh blood to donate RBCs and platelets
(WHY?) >>Because it has a low half life.
-When we want to donate blood , the blood must be no more two weeks in
the bank .(Why?) >>Because the cells in the blood become hemolytic and
the concentration of potassium in the plasma increases .
Now let's talk about the indication of blood transfusion Or ( why we do the
blood transfusion ? )
a- To restore the blood volume , e.g in hemorrhage (like in accident )
b- To provides RBCs e.g anomies (just needs RBCs,so we tranfuse RBCs)
c- To increase blood coagulability in hemorrhagic diseases (just need
coagulation factor)
d- To replace infant's blood with Rh -ve blood in Erthryoblastosis foetalis.
-Also known as hemolytic disease of newborn(HDN)
-In this case if the mother has Rh- and the baby has Rh+ , maybe small
amount of RH+ leaks from the fetus to the blood stream of an mother. the
mother will start to make antibodies . the first born usually not affected ,
but if the mother becomes pregnant again , her antibodies cross the
placenta and enter the blood stream of the fetus . If the fetus has RH+
hemolysis occur in blood fetal.
-Treatment: replace the hemolysis RBCs by transfuse RH- blood to the baby
but not from his mother.
e- To supply antibodies to raise the general resistance of the body
f- To provide the WBCs e.g in leucopenia (decreased in WBCs )
h- To supply plasma proteins
- We end the indication of blood transfusion , Now let's move to the
complication of blood transfusion .
- The complication of blood transfusion classified into two portions :
a- Early :
1- Hemolytic reactions (immediate or delayed)
2 Reactions due to infected blood
3- Allergic reactions to WBCs , platelets or proteins
4- Circulatory overload (When we transfuse an excessive blood volume to
the patient. occurs when nurse inattention to her job )
5- Air embolism (Rarely occurs )
- We use machines to transfuse the blood to patients , this machines
present mostly in the cities , but in villages these machines are not found .
- So the possibility of air embolism occurs in the villages more than in the
cities .
6- Citrate toxicity
7- Hyperkalemia ( increase concentration of K+ in the blood)
_ the most problems of blood transfusion are hemolysis and
hyperkalemia
_ Increase the K+ in the blood lead to tachycardia of left ventricle and this
lead to death , So most dead people in the wars due to hyperkalemia
8- Clotting abnormalities (after massive transfusion)
B- Late :
1- Transmission of disease like hepatitis , malaria , syphilis and AIDS .(Rarely
because we do test before transfusion)
2- Transfusion iron overload results from hemolysis.
3- Immune sensitisation e.g to Rh D antigens.
-We finished the first concept , now we will move to second concept
2-Regulation of body fluids :
- We know the total body fluids distrebuted mainly between two
coompartments :
a- The intracellular fluids ( inside the cell)
b- The extracelluler fluids(outside the cell) : divided into the interstitial fluid
(between the cells) and blood plasma.
- In the below figure we see the extracellular fluids occupied 14L(either
inerstitial or plasma) and the intracellular fluids occupied 28L.
Age
10-18
18-40
40-60
Over 60
Male
59%
61%
55%
52%
Female
57%
51%
47%
46%
We have a
significant
different
here
Table 1-3 TBW in relation to age and sex
- From the table , there is significant different of total body fluids weight
(TBW) between male and female at age from 18 to 40 (why?)
- Because in this age females have a prime time of puberty , that mean
the estrogen is the highest . ( Estrogen distributed and increases the
adipose tissue )
-At age 10-18 the different between male and female almost same
because it is no more estrogen in the females ; because still ovals not
function properly; there function after puberty.
-Gradually decreases the TBW but not has a significant different
Table 16-2 Distribution of water in various tissues and organs
Tissue/organ
Skin
Muscle
Skeleton
Brain
Liver
Heart
Lungs
Kidneys
Spleen
Blood
Intestine
Adipose
Total body
Water%
Body weight%
72.0
75.7
31.0
74.8
68.3
79.2
79.0
82.7
75.8
83.0
74.5
10.0
62.0
18.0
41.7
15.9
2.0
2.3
0.5
0.7
0.4
0.2
7.7
1.8
9.0
100.0
L. in 70 kg man
9.07
22.10
3.45
1.05
1.10
0.28
0.39
0.23
0.11
4.47
0.94
0.63
43.4
-These are tissues or organs and these are the percent of water in these
tissues
-From the table :
>the least tissue contains water is adipose tissue (10%)
>Females have more adipose tissue , so they have less water compared
with males (as a percentage not as overweight )
Constituents
And properties
Na
K
Ca
Mg
Cl
Sulfate
Bicarbonate
Phosphate
Organic acids
Protiens
Glucose
Lipids
PH
Extracellular fluids
Plasma
142
4
5
2
101
1
27
2
6
16
90mg%
0.5g%
7.4
Interstitial fluids
145
4
5
2
114
1
31
2
7
1
90mg%
__
7.4
Intracellular
fluids
10
160
2
26
3
20
10
100
__
65
0-20mg%
__
6.7
Composotion of extracellular and intracellular compartments
-There is no difference between interstitial fluids and plasma except
proteins .
-From the table the main difference fluid between Interstitial fluid and
Plasma are proteins (Why?) , due to colloidal osmotic pressure (exchange
between capillaries and interstitial spaces)
-colloidal osmotic has synonym name oncotic.
-Note that : PH differ between ICF and ECF but it is same between plasma
and interstitial fluid.
-we see the difference between ECF and ICF like :
>potassium concentrate in ICF and sodium concentrate in ECF , so the Na
tries to get in and the K tries to get out
>the cell from outside +ve and from inside is -ve
>-ve because of the proteins and some of ions such as phosphate
>in the bank old blood , the k-Na pump is weaken , Na enters and K leaves ,
the result is hyperkalemia, the cells become swelling.
This slide talk about water balance in our bodies:
-The input must equal the output
-input involves liquids(1L) , other liquids in the food(1.2) , and from the metabolism
400ml.
-output involves urine 1.5L , through the lungs 500 ml , through the skin 460ml, and
in the feces 150 ml
-which of these mostly changeable ?>>the urine
-The body has mechanisms operating the output and the
input.
-We have two cases :
1-Hypervolemia:
- body produces ANP(Atrial natriuretic peptide) that increases
secretion of Na , and secretion of ADH.
2-Hypovolemia:
-First renin is produced because renal pressure decreases .
-Renin cleaves angiotensiongen to angiotensin I
-angiotensin I converted to angiotensin II (have many
functions) :
a-constriction blood vessels
b-Stimulate thirst
c-stimulate the ADH
d-stimulate the aldosterone
-All of these functions restore the blood volume
**Note : People who have a hypertension use a class of medication known
as angiotensin converting enzymes inhibitor , these class is most safe.
Hypertension
Renal failure
Atherosclerosis
Heart attack
Dehydration:
-means loss of water , and happens mostly in babies and old ages .
-Dehydration classified according to the relative loss of fluid and
electrolytes to :
a-Isotonic dehydration: equal loss of fluid and electrolyte.
b-Hypertonic dehydration : excessive fluid loss then electrolyte.
c-Hypotonic dehydration : excessive electrolyte loss than fluid.
Hydration :(Water intoxication) :
- result from excessive water intake (such as people addicted to drink
alcohol) , decreased loss of water , or increased reabsorption of water from
the kidney because ADH administration.
-Symptoms of hydration :
a-Disorientation
b-Convulsions
c-Comamay
d- Gastrointestinal dysfunction
e-Invascular weakness
f-Abnormal cardiac rhythmus
3-Edema :
-The final concept the Dr talk about is edema
-Edema means : condition caused by accumulation of fluid primarily in the
interstitial compartments
-Fluid movement between the vascular and interstitial spaces is governed
mainly by 2 opposing forces :hydrostatic and colloid osmotic pressure.
>Now we will mention the causes of edema:
a-High capillary pressure
b-Low blood proteins (colloid pressure decrease)
c-Lymphatic obstruction
d-Increase hydrostatic pressure
-All of these causes lead to extravascular fluid accumulation.
The End ~
If you find any mistake please post it in the group
A special thanks for partner Ahmad Khleifat
Best of luck !
Done by : Malek Hijjawi