BLOOD

From Big Medical Encyclopedia

BLOOD [sanguis (PNA, JNA, BNA)] — the liquid fabric which is carrying out transport of chemicals in an organism (including oxygen), thanks to Krom occurs integration of the biochemical processes proceeding in various cells and intercellular spaces into uniform system. It is implemented thanks to reductions of heart, maintenance of a tone of vessels and a big total surface of walls of the capillaries having selective permeability. Besides, To. carries out protective, regulatory, thermoregulatory and other functions.

To. consists of a liquid part — plasma and the cellular (uniform) elements weighed in it. The insoluble fatty particles of a cellular origin which are present at plasma are called blood dusts (blood dust).

Volume To. normal averages 5200 ml at men, women have 3900 ml. Its increase is called the general hypervolemia, an umenteniye — the general hypovolemia; hyper - or a hypovolemia of body is understood as increase or reduction of volume To. in this body.

Distinguish red and white blood cells (cells); is normal of red (erythrocytes) at men of 4 — 5 million, women have 3,9 — 4,7 million in 1 mkl To., white (leukocytes) of 4 — 9 thousand in 1 mkl To. Besides, in 1 mkl To. 180 — 320 thousand platelets — thrombocytes (tab. 1) contain.

Normal the volume of cells makes 35 — 45% of volume To. Increase in cellular weight To. reduction by an oligocytemia is called a polycythemia, and.

Contents

Physical and chemical properties

Density integral To. the hl depends. obr. from the maintenance in it of erythrocytes, proteins and lipids. Normal density integral To. — 1,050 — 1,064 g/ml, plasmas of 1,024 — 1,03 g/ml, cells of 1,089 — 1,097 g/ml.

Color K. changes from scarlet to dark red depending on a ratio of oxygenic (scarlet) and neoksitenirovanny forms hemoglobin (see), and also presence of derivatives of hemoglobin — a methemoglobin, carboxyhaemoglobin etc. Coloring of plasma depends on presence at it of red and yellow pigments — hl. obr. carotinoids and bilirubin, a large number to-rogo at pathology gives to plasma yellow color.

To. represents colloid and polymeric solution, in Krom water is solvent, salts and low-molecular organic matters of plasma — solutes, and proteins and their complexes — colloidal component. On a surface of cells To. there is a double layer of electric charges consisting of the negative charges and the diffusion layer of positive charges counterbalancing them which are strongly connected with a membrane. At the expense of a double electric layer there is an electrokinetic potential (zeta-potential) which plays an important role in stabilization of cells, preventing them aggregation (see). At increase in ionic strength of plasma in connection with hit in it multiply charged positive ions the diffusion layer contracts also the barrier interfering aggregation of cells decreases.

One of manifestations of microheterogeneity To. the phenomenon of sedimentation of erythrocytes is. It is that in To. out of a circulatory bed (if its coagulation is prevented) cells settle (sedimentate), leaving from above a plasma layer. The Blood Sedimentation Rate (BSR) increases at various diseases, generally inflammatory character, in connection with change of proteinaceous composition of plasma. Sedimentation of erythrocytes is preceded by their aggregation with formation of certain structures like monetary columns (see. Aggregation of erythrocytes ). How there takes place their formation, and SOE depends. It is influenced also by conditions of carrying out an experiment; in particular, SOE is more in inclined tubes, than in vertical.

Pasting (agglutination) of erythrocytes and the related sedimentation in many respects depend on structure of the environment, in a cut they are weighed; it is promoted by the agglutinins of various nature which in particular are formed at immunochemical reactions of a fitogemagglkhotinina (plant origin) and also simple substances, napr, solution of sucrose.

The surface-bound ionic charge of membranes of cells is directly connected with physical. - the chemical transformations happening on cellular membranes. It is possible to define a cellular charge of membranes by an electrophoresis. Electrophoretic mobility is directly proportional to the size of a charge of a cell. The greatest electrophoretic mobility erythrocytes, the smallest — lymphocytes possess.

Conductivity of blood, i.e. its ability to carry electric current, depends on the content of electrolytes in plasma and sizes of a hematocrit (see. Conductivity of biological systems ). Conductivity integral To. is defined on 70% by the salts which are present at plasma (hl. obr. sodium chloride), for 25% proteins of plasma and only for 5% blood cells. Conductivity in the return ohms is expressed (ohm - 1 ). With temperature increase conductivity of plasma and serum increases approximately by 2,1% for each degree. Measurement of conductivity To. (see. Conductometry ) use in a wedge, practice, in particular during the definition of SOE.

Ionic strength of solution — the size characterizing interaction of the ions dissolved in it that affects coefficients of activity, conductivity and other properties of solutions electrolytes (see); for plasma K. the person this size is equal to 0,145.

Concentration of hydrogen ions of plasma is expressed in sizes hydrogen ion exponent (see), i.e. a negative logarithm of activity of hydrogen ions (rn = - log aH+). Average pH of blood (7,4) corresponds to activity of hydrogen ions 0,000 000 04. At the coefficient of activity of H+ equal 1, concentration of hydrogen ions makes 4•10 - 8 mol/l — the 40th nmol/l. Maintenance of constancy of this size has big fiziol, value as it determines speeds of very many chemical and physical. - chemical processes in an organism. It is normal of pH arterial To. 7,35 — 7,47, is 0,02 lower than a venous blood, contents of erythrocytes usually have on 0,1 — 0,2 more acid reaction, than plasma.

Maintenance of constancy of concentration of hydrogen ions in To. it is provided numerous physical. - chemical, biochemical, and fiziol, mechanisms among which an important role is played by buffer systems of blood which existence is caused by presence of pseudosalts to - t, hl. obr. coal, and also hemoglobin (it dissociates as weak to - that), low-molecular organic to - t and phosphoric to - you (see. Buffer systems ). The shift of concentration of hydrogen ions in the acid party is called acidosis (see), in alkaline — alkalosis (see). Both that, and another can be noncompensated if the size pH went beyond norm, or compensated at corresponding changes of buffer systems. Distinguish also metabolic, or gas, acidosis and an alkalosis depending on that, they are caused by change of quantity organic to - t or coal to - you.

For maintenance of constancy of pH of plasma the bicarbonate buffer system has the greatest value (see. Acid-base equilibrium ). Coal to - that in plasma K. at fiziol. pH values can exist in the form of four connections: physically dissolved carbonic acid, its hydrated form — coal to - you (H 2 CO 3 ), ions of bicarbonate (HCO) and carbonate (CO 3 2- ). Real quantities coal to - you and ions of a carbonate at fiziol, conditions it is insignificant are small; the overwhelming quantity is the share of ions of bicarbonate; at significant amounts there is also physically dissolved carbonic acid, partial pressure a cut (pCO 2 ) in arterial To. it is usually equal to its partial pressure in an alveolar air as a pulmonary membrane well a pronitsayema for carbonic acid. On the other hand, the dissolved carbonic acid is in balance with its hydrated form — coal to - that; in plasma process of its hydration and dehydration goes quickly enough as usual chemical reaction, in erythrocytes it even more accelerates the enzyme which is present there karboangidrazy (see). Thanks to it concentration coal to - you in plasma K., as a rule, is in balance with the partial pressure of carbon dioxide gas in an alveolar air.

Proceeding from this pattern and the mass action law, Genderson's equation — Gasselbalkh is removed:

ph = 6,11 + lg ([HCO 3- ] / [CO 2 ]),

where [HCO 3- ] — concentration of bicarbonate in plasma K., expressed as a percentage (the relation of volume of carbon dioxide gas to the volume of plasma), and [CO 2 ] — the partial pressure of carbon dioxide gas expressed in millimeters of mercury in the gas which is in balance with the studied sample of plasma, napr in an alveolar air. This formula can be used as for determination of the size pH if the sizes pCO2 and contents of bicarbonate, and for the solution of the return task — determination of amount of bicarbonate are known if the size pH of a sample of plasma is measured or To., which is counterbalanced with the gas supporting the known number of CO 2 . This formula is widely used in a technique of a research of a condition of acid-base equilibrium (see).

Since buffer properties of plasma almost entirely depend on the content in it of bicarbonate, and in erythrocytes the large role is played also by hemoglobin, buffer properties integral To. to a large extent depend on content of hemoglobin in it. Hemoglobin, as well as vast majority of proteins K., at fiziol, pH values dissociates as weak to - that, upon transition to oxyhemoglobin it turns into much stronger to - that that promotes replacement coal to - you from To. and to its transition to an alveolar air.

Osmotic pressure of plasma K. is defined by its osmotic concentration, i.e. the sum of all particles — molecules, ions, colloid particles which are in unit volume. This size is supported fiziol, mechanisms with very big constancy, making at body temperature 37 ° 7,8 mn/m 2 (~ 7,6 atm). Almost completely this size is caused contained in To. sodium chloride and other low-molecular substances, very small part, ~ 0,02 atm — proteins, hl. obr. the albumine incapable it is easy to get through an endothelium of capillaries. This part of osmotic pressure call kolloidnoosmotichesky or oncotic (see. Osmotic pressure ). It plays an important role in fluid movement between blood and a lymph, and also in formation of a glomerular filtrate.

In medical researches the size of osmotic pressure is used very seldom, use an equivalent concept of osmotic concentration much more often, to-ruyu determined by the size of a depression (decrease) of temperature of freezing of the studied liquid in comparison with water. Normal this size makes 0,55 — 0,56 ° that corresponds to 0,27 — 0,31 mol/l, or 270 — 310 milliosmoly. At reduction of osmotic concentration of plasma of a cell bulk up, at its increase they shrivel.

Constancy of osmotic pressure To. it is provided with the thin neurohumoral mechanism inherent only this way naz. gomoyosmotichesky animal. Sea invertebrates, selakhiya, and also sturgeon have no such ability, they have an osmotic pressure To. changes together with change of osmotic pressure of surrounding sea water (poykilosmotichesky animals).

The size of surface intention of blood is various depending on that, measurement is performed at once, i.e. in conditions when again formed surface layer did not reach an equilibrium state (dynamic surface intention) yet, or later a nek-swarm time (static surface intention). Time, during to-rogo a surface layer reaches an equilibrium state, makes for To. not less than 30 min. Dynamic surface intention of plasma 67 — 77 mn/m is close in size to a water surface tension and in very big degree depends on conditions of receiving a sample of plasma or serum. Static surface intention more constantly and strongly increases at fall of temperature: at t ° 38 ° it makes 46 — 47 mn/m, and at t ° 18 ° 57 — 58 mn/m.

One of the major properties K. — flowability — makes a subject of studying of a biorheology. In a circulatory bed To. normal behaves as the non-Newtonian liquid changing the viscosity (see) depending on conditions of a current. In this regard viscosity To. in large vessels and capillaries significantly differs, and the data on viscosity provided in literature have conditional character. Patterns of a current To. (hemorheology) are studied insufficiently. Non-Newtonian behavior To. is explained by big volume concentration of cells To., their asymmetry, presence at plasma of proteins and other factors.

Measured on capillary viscosimeters (with a diameter of a capillary several tenth millimeter) viscosity To. by 4 — 5 times of high viscosity of water. It is usually characterized by relative size: η otn = η kr in , (η kr and η in - viscosity of blood and water respectively). Relative viscosity of plasma under the same conditions of measurement and in the same units apprx. 1,8.

If to use Einstein's formula for suspension from firm spherical particles — ηs/ηp = ηотн = 1 + 2,5 φ (where ηs — viscosity of suspension, ηp — viscosity of solvent, φ — volume ratio of a solid phase), then a contribution of cells to viscosity To. will make 2,0 — 2,2 instead of 2,2 — 2,8, received at measurement, a contribution of proteins of plasma — 1,2 instead of 1,8. These distinctions are not really big and demonstrate that cells have the form which is not too differing from spherical. For proteins this difference is more considerable.

With a free-flowing state To. also the phenomena masso-and heattransfer which in view of their variety and complexity are studied still insufficiently are closely connected. It is known that the most important contribution in masso-and heattransfer To. water brings. Thanks to quite high heat capacity To. (i.e. to the amount of heat energy necessary for heating of 1 kg of blood on 1 ° Calvin), to great values of thermal conductivity coefficients, edges are characterized by the speed of transfer of heat energy, and the possibility of effective molecular interaction of the components dissolved in it is provided to diffusion (as, e.g., oxygen with membranes of erythrocytes, and then hemoglobin; various humoral regulatory proteins with membranes of lymphocytes and other cells, etc.) and as a result a metabolism and regulation between all systems of an organism.

At pathology and injuries flowability To. significantly changes owing to action of certain factors coagulant system of blood (see).

Generally work of this system consists in enzymatic synthesis of linear polymer — the fibrin forming a net and giving To. properties of jelly. This «jelly» has the viscosity in hundreds and thousands of times exceeding viscosity To. in liquid state, shows strength properties and high adhesive ability that allows a clot to keep on a wound and to protect it from bruises.

Formation of clots on walls of blood vessels at disturbance of balance in coagulant system is one of the reasons of thromboses. Formation of a clot of fibrin is interfered by anticoagulative system K.; destruction of the formed clots happens under the influence of fibrinolitic system. The formed clot of fibrin has a loose structure in the beginning, then becomes more dense, there is retraction of a clot.

Morphology and function of uniform elements of blood

To uniform elements K. the erythrocytes, leukocytes presented by granulocytes (polymorphonuclear neutrophylic, eosinophilic and basphilic granulocytes) and agranulocytes (lymphocytes and monocytes) and also thrombocytes — platelets belong. V K. also the insignificant number of plasmatic and so-called DNA-synthesizing of cells is defined.

A membrane of cells To. is the place where there are major enzymatic processes and immune responses are carried out. Membranes of cells To. bear information on groups K. and fabric antigens.

Erythrocytes

Fig. 1. Microphotos of erythrocytes: and — at a submicroscopy (1 — the gentle granulation identified with hemoglobin; 2 — the outer membrane of an erythrocyte having an appearance of a strip on the periphery of a cell, x 13 800); — at scanning electron microscopy (two diskotsit, x 4000 are visible); in — at light microscopy; X 900.

Erythrocytes depending on the size call micro and macrocytes, their ground mass is presented by normocytes. Erythrocytes represent normal a nuclear-free biconcave cell to dia. 7 — 8 microns (fig. 1). The volume of a cell is 90 microns 3 , the area is 142 microns 2 , the greatest thickness of 2,4 microns, minimum — 1 micron, average diameter on the dried-up drugs of 7,55 microns. Nonvolatile solid of an erythrocyte contains apprx. 95% of hemoglobin, 5% fall to the share of other substances (negemoglobinovy proteins and lipids). The ultrastructure of an erythrocyte is uniform. Its contents are filled with gentle granulation (diameter of granules of 4 — 5 nanometers), edges are identified with hemoglobin. The outer membrane of an erythrocyte is presented in the form of a dense strip on the periphery of a cell, thickness a cut apprx. 20 nanometers. At earlier stages of development of an erythrocyte (reticulocyte) in cytoplasm it is possible to find the remains of structures of progenitors (a mitochondrion, etc.).

Fig. 2. Various forms of erythrocytes of peripheral blood revealed at scanning electron microscopy: 1,2 — diskotsit; 3 — diskotsit with a crest; 4 — diskotsit with multiple outgrowths; 5 — an erythrocyte in the form of mulberry berry; 6 — a dome-shaped erythrocyte; 7 — a spherical erythrocyte (smooth); 8 — a spherical erythrocyte with outgrowths; 9 — an erythrocyte in the form of the lowered ball; 10 — dystrophic the changed erythrocytes; X 3600

The research of erythrocytes in the scanning supermicroscope (a raster submicroscopy) allowed to define existence of forms, various depending on their superficial very tectonics, in peripheral To. (fig. 2 and tab. 2). Apprx. 85% of all erythrocytes make diskotsita. Transformation of a diskotsit to other forms, up to dystrophic, can be caused by various reasons.

Reduction of elasticity of a membrane leads to emergence of outgrowths on a surface of an erythrocyte. At reduction in cells of content of ATP deformation amplifies. Formation of outgrowths in itself does not influence life expectancy of an erythrocyte of in vivo.

The membrane of an erythrocyte throughout is identical. Hollows and cambers can arise at change of pressure outside or from within, equal ±15% of average pressure, without causing at the same time wrinkling of a cell. If the cellular membrane of an erythrocyte is broken, then the cell takes spherical shape and can be hemolyzed. The structure of a membrane of an erythrocyte can be presented as follows: on an outer surface lipoproteids, sialine to - that, antigenic oligosaccharides, the adsorbed proteins, on an inner surface — glycolytic enzymes, sodium, potassium and ATP-ases, a glycoprotein, hemoglobin are located.

Mature erythrocytes are incapable of synthesis nucleinic to - t and hemoglobin. Rather low level of exchange is characteristic of them that provides them the long period of life (about 120 days). Since 60th day after an exit of an erythrocyte in a blood channel activity of enzymes, and first of all a hexokinase, glyukozo-6-fosfatdegidrogenazy, fruktozo-6-fosfatkinazy and glitserinaldegid-3-fosfatdegidrogenazy gradually decreases. It leads to disturbance of glycolysis and, therefore, reduction of potential of power processes in an erythrocyte. Changes of intracellular exchange are connected with aging of a cell and as a result lead to its destruction. The large number of erythrocytes (apprx. 200 billion) daily is exposed to destructive changes and perishes.

Thrombocytes

Thrombocytes (platelets) represent the polymorphic nuclear-free educations surrounded with a membrane. In a blood channel thrombocytes have the rounded or oval shape (fig. 3, c). Normal distinguish 4 main types of thrombocytes. 1. Normal (mature) thrombocytes — a round or oval form with dia. 3 — 4 microns; make 88,2±0,19% of all thrombocytes. In them distinguish an outside pale blue zone (hyalomere) and central with azurophilic granularity (granulomer). At contact with an alien surface of a fibril of a hyalomere, intertwining among themselves, form on the periphery of a thrombocyte shoots of various size — from small jags to long antennas. 2. Young (unripe) thrombocytes — a little big in comparison with mature the sizes with basphilic to contents; make 4,2±0,13%. 3. Old thrombocytes — various form with a narrow rim and plentiful granulation, contain many vacuoles; make 4,1 ± 0,21%. 4. Other forms; make 2,5 ± 0,1%.

Fig. 3. Microphotos of thrombocytes: and — at a submicroscopy (1 — a granulomer of a thrombocyte with granules of various form; 2 — a hyalomere of a thrombocyte, X 8000); — at scanning electron microscopy (a thrombocyte with various shoots, x 8000); e — at light microscopy (thrombocytes of the different sizes, x 900).

The ultrastructure of a thrombocyte is diverse (fig. 3, a). The hyalomere is limited by a three-layered membrane, thickness of layers a cut fluctuates from 4 to 10 nanometers. General thickness of a membrane of a thrombocyte of 16 — 25 nanometers. In a hyaloplasma mesh smooth structures of a cytoplasmic reticulum are found; it is a lot of ribosomes. Granulomer contains granules of various form, size and structure, an alpha granule — dense educations with homogeneous substance of an oval or round form with dia. 120 — 300 nanometers surrounded with a single-layer membrane. Ultracentrifuging showed heterogeneity of these granules. In less dense granules hydrolases, p-glucuronidase, cathepsine and acid phosphatase are defined. These granules are specific to thrombocytes and are the main component of a granulomer. Beta Granules are identical to mitochondrions of other cells. They in thrombocytes are not enough (2 — 3 in everyone), to dia. 160 — 220 nanometers. Delta Granules are educations in the form of bubbles, vacuoles, small tubules. σ-granules represent the educations filled with granularity (the size of grains apprx. 5 nanometers). It is supposed that this granularity is a component of ferritin since the size of granules is in limits of sizes of micelles of molecular ferritin. Thrombocytes are characterized by polymorphism. In the scanning supermicroscope numerous shoots and antennas well differ (fig. 3, b). The main depot of thrombocytes is the spleen. Duration of their life on average 8 — 11 days. The speed of disappearance of thrombocytes from a blood channel determined by a tag 51 Cr, is directly proportional to their accumulation in a spleen. In thrombocytes find also electronic and dense granules of serotonin which size apprx. 170 nanometers.

The chemical structure of thrombocytes is complex. Their solid residue contains 0,24% of sodium, 0,3% of potassium, 0,096% of calcium, 0,02% of magnesium, 0,0012% of copper, 0,0065% of iron and 0,00016% of manganese. Due to the existence in thrombocytes of iron and copper it is possible to think of their participation in breath. The most part of calcium of thrombocytes is connected with lipids in the form of a lipidic and calcium complex. An important role is played by potassium; in the course of formation of a blood clot it passes into serum that is necessary for its implementation retractions (see). To 60% of dry weight of thrombocytes make proteins. The maintenance of lipids reaches 16 — 19% of dry weight.

In thrombocytes are found also sincaline - and etanolplazmalogen, playing a part in retraction of a clot.

Besides, in thrombocytes significant amounts of beta glucuronidase and acid phosphatase, and also cytochrome oxydase, a dehydrogenase, polysaccharides, a histidine are defined. A role of proteids in the course of coagulation To. up to the end it is not studied. The connection close to glycoproteins capable to accelerate process of formation of a blood clot is found in thrombocytes, the small content of RNA and DNA which are localized in mitochondrions is revealed.

Leukocytes

Granulocytes — neutrophylic (fig. 4, c), acidophilic (eosinophilic), basphilic polymorphonuclear leukocytes — large cells from 9 to 15 microns, circulate in peripheral To. several hours, and then move to fabrics. In the course of differentiation granulocytes pass stages of metamyelocytes and band forms. In metamyelocytes the kernel of a gentle structure, has the fabiform form. In band granulocytes chromatin of a kernel is more densely packed, the kernel is extended, sometimes in it formation of segments (segments) is already planned. In mature granulocytes the kernel usually has from 2 to 5 segments. All granulocytes are characterized by existence in cytoplasm of granularity, to-ruyu subdivide on azurophilic and special. The last is divided, in turn, into mature and unripe granularity.

Fig. 4. Microphotos of neutrocytes: and — at a submicroscopy (1 — a kernel; 2 — neutrophylic granules, x 13 000); — at scanning electron microscopy (on a surface of a neutrophil — multiple wavy outgrowths; x 5000); in — at light microscopy (neutrocytes are specified by shooters, x 900).

In neutrophylic mature granulocytes. the new growth of granules does not occur. It is accurately shown in experiences with artificially caused degranulation. Inability of mature granulocytes to a producing granules correlates with a reduction in these cells of a rough cytoplasmic reticulum and a lamellar complex (see. Golgi complex ), and also with reduction in them of number and the sizes of mitochondrions. Granularity of neutrocytes is painted from brownish till reddish-violet color. Cytoplasm is painted in pink color. The ratio of azurophilic and special granules is changeable. The relative number of azurophilic granules reaches 10 — 20%. An important role in life activity of granulocytes is played by their superficial membrane. Its complex structure is visible during the studying of cells in a supermicroscope (fig. 4, and and b). On a set of hydrolases granulocytes can be identified as a lysosome with nek-ry specific features (existence of a fagotsitin and lysozyme). At an ultracytochemical research it is shown that activity of acid phosphatase is generally connected with azurophilic granules, and activity of an alkaline phosphatase — with special granules. By means of cytochemical changes in neutrocytes lipids, polysaccharides, Peroxidase, etc. are found. The main function of neutrocytes is defense reaction in relation to microbes (microphages). They are active phagocytes (see. Phagocytosis ). The highest percent of the englobing neutrophils (99,3±0,69%) is noted at persons of young age. With increase in age statistically reliable decrease in phagocytal activity of granulocytes is established.

Eosinophilic granulocytes differ in less various forms of a kernel. Their kernel is more often has 2 segments, 3 is more rare. Cytoplasm of these cells poorly a bazofilna that it is difficult to find because of abundance of granularity. Eosinophilic granularity is painted by acid aniline dyes, especially well eosine. Shades of coloring — from pink till color of copper. In eosinophils Peroxidase, cytochrome oxydase, a succinatedehydrogenase, acid phosphatase, etc. are revealed. Attribute to eosinophilic granulocytes disintoxication function. The quantity them increases at introduction to an organism of a foreign protein. The eosinophilia is a characteristic symptom at allergic states. Eosinophils take part in disintegration of protein and removal of proteinaceous products, along with other granulocytes are capable to phagocytosis.

Basphilic granulocytes have property to be painted metakhromatichesk, i.e. in the shades other than color of paint. Fine structure of basophiles is studied less in comparison with other cells of K. Yadro of these cells has no structural features, in cytoplasm of an organella are developed poorly. Sometimes in it thin fibrillar educations are defined. Special granules of a polygonal form, to their dia. 0,15 — 1,2 microns, they consist of electronic and dense particles. Existence in basphilic granules of a histamine gives the grounds to assume that basophiles along with eosinophils participate in allergic reactions of an organism. Participation of basophiles and in exchange of heparin is undoubted.

High lability of a cellular surface is characteristic of all granulocytes, edges it is caused by a low surface-bound negative charge and it is shown in adhesive properties, ability to aggregation (see), to formation of pseudopodiums, movement, to phagocytosis (see). Movement of granulocytes unevenly. The chemotaxis does not make direct impact on the speed of their movement. In granulocytes are found chalones (see) — substances which have specific effect, suppressing synthesis of DNA in cells of a granulotsitarny row. Apparently, chalones do not affect the committed (progenitors) parent cells (see. Hemopoiesis ), and regulate processes of proliferation of direct predecessors of leukocytes.

Fig. 5. Microphotos of lymphocytes: and — a big lymphocyte at a submicroscopy (1 — a kernel, 2 — mitochondrions, 3 — a lamellar complex, 4 — osmiofilny granules, x 10 00); — at the scanning microscopy (1 — a smooth T-cell, 2 — a fleecy B-lymphocyte, X 3000); in — at light microscopy; X 900.

Lymphocytes (fig. 5, c) hold a specific place in system K. They are considered as the central link in specific immunol, reactions, as predecessors of antiteloobrazuyushchy cells and as carriers immunol, memories (see. Immunocompetent cells ). Lymphocytes are responsible for development and delivery of antibodies at reactions of rejection and local allergic reactions. It is conditionally accepted to divide lymphocytes on small (diameter from 5 to 9 microns), average and big (from 10 to 13 microns); in a leykokontsentrata in a small amount it is possible to reveal limfoplazmotsita. This classification of lymphocytes cannot be considered rather objective since cells can be in various phases of a cellular cycle. Besides, in such approach properties of these cells are not reflected funkts. Due to the distinction immunol, properties lymphocytes can be divided into two types (fig. 5, b): the timuszavisimy T-cells responsible for the mediated immune response, and V-lymphocytes, being predecessors of plasmocytes and responsible for efficiency of humoral immunity.

Fig. 6. Diffraction pattern of ultrathin section of a small lymphocyte: 1 — a kernel with conglomerates of chromatin; 2 — mitochondrions; X 15 000.
Fig. 7. Diffraction pattern of ultrathin section of a limfoplazmotsit: 1 — a kernel of irregular shape; 2 — the expressed development of structures of a granular cytoplasmic reticulum; x 15 000.

Big lymphocytes (fig. 5, a) — cells with a diameter more than 10 microns. The kernel usually round or oval, chromatin is condensed on edge of a nuclear membrane. In cytoplasm — single ribosomes. The cytoplasmic reticulum is developed poorly. 3 — 5 mitochondrions are noted, is more rare than them more. The lamellar complex is presented by small bubbles. The small electronic and dense osmiofilny granules surrounded with a single-layer membrane are defined. Small lymphocytes (fig. 6) — a cell to 9 microns with the high nucleocytoplasmic relation, characteristic of it. Densely packed chromatin forms large conglomerates on the periphery and in the center of a kernel, a cut happens an oval or fabiform form. Cytoplasmatic organellas are localized on one pole of a cell. Limfoplazmotsita (fig. 7) meet seldom. Development of a granular cytoplasmic reticulum is characteristic of them.

Life expectancy of a lymphocyte fluctuates from 15 — 27 days to several months and, perhaps, years. Lymphocytes — mobile cells, they quickly move and have property to penetrate in other cells. A small amount of lymphocytes takes part in phagocytal reaction. In chemical structure of a lymphocyte the most expressed components are nucleoproteids. In a kernel the diploid amount of DNA is defined. Lymphocytes contain cathepsine, a nuclease, amylase, a lipase, acid phosphatase, a suktsindegidrogenaza, cytochrome oxydase, arginine, a histidine, a glycogen. In certain conditions for lymphocytes the high level of RNA and proteins is characteristic that is established by means of marked amino acids.

On a submicroscopic structure and funkts, to properties lymphocytes from all cells To. are closest to young hemopoietic cells (existence of kernels and ability to proliferation). Researches showed that lymphocytes peripheral To. are in deep interphase, is able peculiar fiziol, anabiosis. This condition of cells allows them to circulate a long time in To., keeping immunol, information. In turn the big range of antigens and their impact on lymphocytes, probably, are the major factor causing them funkts, a raznokachestvennost. Such assumption is according to existence of timuszavisimy T-cells (apprx. 80%) and the antiteloobrazuyushchy B-cells which are not depending on a thymus gland (apprx. 20%).

Monocytes

Fig. 8. Diffraction pattern of a monocyte: 1 — a kernel of irregular shape; 2 — a cytoplasmic reticulum; 3 — mitochondrions; 4th phagosoma; X 12 000
Fig. 9. The diffraction pattern of a monocyte with multiple branchy outgrowths (1) and fleecy V-lymphocytes (2); x 4000.

Monocytes — the largest (12 — 20 microns) blood cells (fig. 8 and 9). The form of a kernel various, from round to wrong with numerous ledges and deepenings of a surface, is painted in violet-red color. The chromatinic network in a kernel has a shirokonitchaty, friable structure. Cytoplasm has slabobazofilny properties, is painted in blue-pink color, having various shades in different cells. In cytoplasm the small gentle azurophilic granularity diffuzno distributed on all cell is defined; it is painted in red color. In a monocyte considerable number of mitochondrions with well developed system of crypts (inner membranes). The quantity of ribosomes is small. Structures of a cytoplasmic reticulum gain the expressed development in the form of vacuoles, tubules, bubbles, etc. Some granules with heterogeneous contents, perhaps, represent phagosomas.

Monocytes have sharply expressed ability to coloring, the amoeboid movement and phagocytosis, especially the remains of cells, alien small bodies, etc.

Fig. 10. Diffraction pattern of ultrathin section of a plasmocyte: 1 — a kernel; 2 — structures of a granular cytoplasmic reticulum; 3 — mitochondrions; x 12 000.

Plasmocytes meet in normal To. in single quantity. Considerable development of structures of an ergastoplazma in the form of tubules, sacks, etc. is characteristic of them. On membranes of an ergastoplazma there are a lot of ribosomes that does cytoplasm intensively basphilic. About a kernel the light zone is localized, in a cut the cellular center and a lamellar complex is found. The kernel is located excentricly (fig. 10).

In a leykokontsentrata of healthy people the DNA-synthesizing cells in the form of insignificant quantity of unripe cells, and also not identified blast cells are found. For most of them the following is peculiar: the size 13 — 15 microns, irregular shape, a kernel with a glybchaty structure of chromatin, basphilic cytoplasm and intensive inclusion of the marked predecessor of DNA (thymidine 3H).

See also Leukocytes , Lymphocytes , Plasmocytes , Thrombocytes , Erythrocytes .

Biochemistry

At the metaphytes standing on low steps of evolution, structure To. it is rather simple as all necessary substances can be transferred in the dissolved look by a hemolymph. In the course of evolution began to carry out transfer of oxygen to fabrics To., what demanded improvement of its respiratory function, in particular accumulation in large amounts of special proteins — oxygen carriers. These are the lame proteids containing iron or copper which received the name of blood pigments. If a carrier low-molecular, it increases colloid osmotic pressure if high-molecular — increases viscosity, complicating the movement of blood. Concentration of transport of oxygen in vocational educations — erythrocytes was the most perfect. At birds and reptiles it is cells with structure inherent in them and functions — a kernel, synthesis of protein etc. At mammals the kernel is lost to an exit in a vascular bed and cells turn into «sacks» for transport of hemoglobin. Thanks to it viscosity integral To. is much lower, than the same To., but when erythrocytes are destroyed (gemolizirovana).

Solid residue of plasma K. the person apprx. 9%, 7% make proteins of them, including apprx. 4% it is the share of the albumine supporting colloid and osmotic, or oncotic, pressure. In erythrocytes of dense substances much more (35 — 40%), from them 9/10 it is the share of hemoglobin. As the hematocrit makes usually 36 — 48%, a solid residue To. is defined by the hemoglobin which is contained in erythrocytes, to-rogo counting on integral To. there are 12 — 16%, i.e. is almost twice more, than all other substances combined.

A research of chemical structure integral To. it is widely used for diagnosis of diseases and control of treatment. For simplification of interpretation of results of a research of substance, being a part To., divide into several groups. 1. The substances having constant concentration (hydrogen ions, sodium, potassium, glucose etc.), necessary for the correct functioning of cells; increase or reduction of their quantity means development patol. states. The concept of constancy of internal environment (homeostasis) is applicable to them. 2. Substances which are produced by special types of cells (hormones, plazmospetsifichesky enzymes etc.); change of their concentration — a sign of damage of appropriate authorities. 3. Substances (some of them are toxic), which are removed from an organism only special systems (urea, creatinine, bilirubin, etc.); their accumulation in blood — a symptom of damage of these systems. 4. Substances, to-rymi are rich only some fabrics (organospetsifichesky enzymes); emergence them in plasma — a sign of destruction or damage of cells of these fabrics. 5. Substances which are normal produced in small amounts or are not produced at all; in plasma they appear at patol, processes — an inflammation, a new growth, disbolism, e.g. Paraproteina. 6. Toxicants of an exogenous origin.

Proceeding from interests practical a lab. diagnoses, the concept of norm, or normal structure is developed, To. — range of the concentration not testimonial of a disease. However practical development of the standard normal amounts is very difficult, it managed to be carried out only for some substances. Complexity is connected with the fact that in most cases individual distinctions considerably exceed fluctuations of concentration at the same person at different times so the average norm only approximately allows to judge individual norm (tab. 3). Individual distinctions are connected with age, a floor, an ethnic origin (prevalence of genetically caused options of a normal metabolism), klimatogeografichesky and the prof. by features, eating habits and traditions. Fluctuations of concentration of substances in To. happen periodic — daily, seasonal, and also depend on meal, age and function of hemadens.

At senile age the hemoglobin content decreases, the number of reticulocytes is lowered, diameter of erythrocytes increases. By 75 years sexual distinctions in concentration of hemoglobin disappear. Also the content of transferrin goes down and transport of iron worsens. The composition of proteins of plasma also undergoes certain changes — the amount of albumine decreases and globulins increase, ROE increases.

Chemical structure To. most often expressed in gram-percent (of %), and also in their shares, napr, mg of %, mkg of % etc., and g-ekv/l. Due to the transition of all divisions of science and the equipment to system of units of CPI results of researches in a wedge, began to express to biochemistry in terms of molar concentration, i.e. in moths (or their shares) on 1 l, and for enzymes — in moths of the substrate destroyed for 1 sec. by the enzyme which is contained in 1 l. It is possible for those connections which relative molecular masses are known, in other cases units of percentage by weight are applied (hl, mg/l, mkg/l etc.).

Proteins of a blood plasma. In plasma K. more than 100 various proteins from which apprx. 60 it is allocated in pure form contain. The vast majority of them glycoproteins, i.e. contain carbohydrates in the structure, there are also glycolipoproteids. Only albumine, prealbumin, retinolsvyazyvayushchy protein and a lysozyme, and also some polypeptide hormones consist only of amino acids. Pier. the mass (weight) of the majority of plasmatic proteins is small — from 40 000 to 150 000, the largest — the macroglobulin (relative a pier. weight 650 000) following by the sizes — fibrinogen (relative a pier. weight 340 000), the smallest molecule at beta microglobulin (relative a pier. weight 11 800). The vast majority of serum proteins is formed in a liver, edges at the adult produces them to 15 — 20 g a day; squirrels from a blood-groove after filtering in extracellular liquid, in t leave. h in a glomerular filtrate. Duration of existence of various proteins in a blood-groove strongly varies, being measured by for days or weeks, albumine (a half-cycle of 17 — 27 days), and also gamma-globulins is most quicker updated.

Fiziol, functions of plasmatic proteins are very various: they serve for maintenance of colloid osmotic pressure and by that for deduction of water and electrolytes, perform transport, regulatory and protective functions, provide a blood coagulation (hemostasis) and can serve as a reserve of amino acids. Their mobility at an electrophoresis in the free environment is the cornerstone of classification of plasmatic proteins, either on paper, or on cellulose acetate. On other environments when endoosmosis (agarose) or pore size (polyacrylamide gel) matters, resolving power is much higher, but distribution on fractions is excellent from used at classification. Distinguish 5 main fractions of proteins K.: albumine (see), α1-, α2-, β-, γ-globulins ((((((((((see. Immunoglobulins ). Albumine makes rather homogeneous group consisting of albumine and prealbumin. In embryonic development the albuminous fraction is formed before others, probably, of cells of a mesenchyma. Most of all in blood of albumine (apprx. 60% of all proteins), its relative a pier. the weight 67 500, the main function — maintenance of colloid osmotic pressure and transportation of some, adsorbed on its surface substances. At the content of albumine lower than 3% develop hypostases. Defined a wedge, value is related the sums of albumine (more soluble proteins) to the sum of globulins (less soluble) — so-called. albuminglobulinovy coefficient (see), reduction to-rogo serves as an indicator of inflammatory process.

Globulins are very heterogeneous both on chemical structure, and on fiziol. to functions. The group of alfa1-globulins includes the following proteins: orozomukoid (α1-гликопротеид), α1-антитрипсин, α1-липопротеид, etc. α2-глобулинов are among α2-макроглобулин, gaptoglobin (see), ceruloplasmin (the cupriferous protein having properties of enzyme of an oxidase), a group-specific component, α2-липопротеид, tiroksinsvyazyvayushchy globulin, etc. β-globulins are very rich with lipids, they include also transferrin (the protein transferring iron), hemopexin, steroidsvyazyvayushchy β-globulin, fibrinogen (see), etc. Gamma-globulins are the proteins responsible for humoral factors of immunity, in their structure distinguish 5 various groups of immunoglobulins: IgA, IgD, IgE, IgM, IgG (see. Immunoglobulins ). Unlike other proteins, they are synthesized not in a liver, and in lymphocytes. Emit also seromucoids — serumal mukoproteida (see) which include the proteins belonging to various fractions.

Many of the listed proteins exist in several genetically caused options. Their presence in To. in one cases is followed by a disease, and in others is option of norm. There is also an intermediate case when presence of atypical abnormal protein brings to very insignificant, almost proceeding completely, to disturbances of health. Acquired diseases can be followed by accumulation of special proteins — para-proteins — patol, options of immunoglobulins which healthy people do not have. Here belong Bens-Jones's protein (see. Bens-Jones of squirrels ), amyloid, Valdenstrem's IgM (see. Valdenstrema disease ) and cryoglobulin.

Lipoproteids of plasma shelter and. Lipids not of a rastvorima in water therefore are transferred To. only in structure lipoproteids (see). Unlike proteins, it is not individual chemical substances therefore at their classification establish only top and bottom borders of some signs, most often density, about a cut judge by ability to emerge (flotations) during the ultracentrifuging in salt solution. Use also such sign as mobility at an electrophoresis. The relation can vary a protein/lipid as a part of a lipoproteid from 1: 99 to 99: 1; the more in a particle of fat, the, as a rule, it is larger, has the smaller density and mobility at an electrophoresis. The easiest lipoproteids contain triglycerides (see), in process of increase in density they are replaced by cholesterol and its ethers, and then phospholipids (see. Phosphatides ). The special group of lipoproteids of plasma is made by chylomicrons — the particles up to 0,5 microns in size containing triglycerides and only 1% of protein. Most often allocate the following three groups of lipoproteids: very low, low and high density. At an electrophoresis the most part of lipoproteids of very low density gets into group pre - beta lipoproteids, low density — into group of beta lipoproteids, and high density — into group of alpha lipoproteids. Not esterified fat to - you, adsorbed on albumine, sometimes carry in group of lipoproteids of very high density. There are also more detailed classifications which are marking out bigger quantity of classes, and also separate lipoproteids, napr, designated by a letter X which appears at disturbance of passability of bilious channels.

After meal in To. content of chylomicrons increases and keeps to 4 — 6 hours; they transport the triglycerides which arrived with food (see. Lipometabolism ). Lipoproteids of low density also transport triglycerides, but endogenous; lipoproteids of very low density (pre-beta), probably, represent a complex of lipoproteids of high and low density which breaks up to components under the influence of the lipoproteidlipaza (KF 3.1.1.34) activated by heparin.

Enzymes of a blood plasma usually divide into two groups: organospetsifichesky and plazmospetsifichesky. Carry those to the first group of them which contain in bodies, and in significant amounts get to plasma only at damage of the corresponding cells. Carry enzymes to the second group, the main fiziol which function is implemented directly in a blood-groove; their concentration in plasma is always higher, than in any body. The special group is made by enzymes exocrine glands, getting to blood at obstruction of their channels. During the definition of activity of enzymes (tab. 4) synthetic substances — such that reaction products were convenient to be investigated often use not their natural substrates which are not even always known and. Results of definition of activity of enzyme depend not only on temperature, pH and other conditions of carrying out the analysis, but also on the used substrate and on as far as it is subject to action of this isoform of enzyme. Selecting these conditions, applying a thermal denaturation if it is necessary, allocating fractions on ion-exchange resins or by an electrophoresis, it is possible to define what and in what quantities of an isoform of enzymes are present at plasma.

The fermental structure of cells of different fabrics, and also organellas of the same cell is very various; even if different bodies contain the same enzyme, it is very probable that there are its different forms (isoenzymes). Therefore, knowing a range of organospetsifichesky enzymes in plasma, one may say, from what body there was this combination of enzymes and even, its damage since at an inflammation through the damaged cellular membrane there are only cytoplasmatic enzymes is how deep, and at a necrosis appear mitochondrial and lizosomalny. Speed of removal of enzymes from plasma, as well as other proteins, is very variable, the half-cycle of their existence makes from several hours to several days. From it as well as from the speed of an exit of enzyme from the damaged body, dynamics of a fermentemiya at a disease depends. So, e.g., at a creatine kinase a half-cycle of removal of 15 hours, therefore on 3 — the 4th day after a myocardial infarction its activity in plasma K. it is normalized while at the first isoenzyme of a lactate dehydrogenase (LDG1) a half-cycle of removal of 113 hours therefore activity of this isoenzyme in serum K. remains the raised more than a week.

Functions of plazmospetsifichesky enzymes are very various. Treat them a letsitinatsiltransferaz (KF 2.3.1.43), moving the remains fat to - t from lecithin on cholesterol; the diglitserollipaza (a lipoproteidlipaza, KF 3.1.1.34) destroying pre - beta lipoproteids; cholinesterase (KF 3.1.1.8); lysozyme (KF 3.2.1.17); the bactericidal factor hydrolyzing polysaccharides of microbic covers. The same group includes tripsinopodobny enzymes: thrombin (KF 3.4.21.5), plasmin (KF 3.4.21.7) and kininogenin (kallikrein, KF 3.4.21.8), the plasmas K playing the main role in coagulant, anticoagulative and kinin systems. As the activator of all these substances, though in different degree, serves the factor of the XII coagulation To. — so-called factor of Hageman, ai-antitrip-sin inhibitors, alfa2-macroglobulin and inactivator of complementary system CI. Plazmospetsifichesky enzyme rhenium (KF 3.4.99.19) which is produced in kidneys is of great importance for regulation of a hemodynamics.

Low-molecular nitrogenous substances. Most part of nitrogenous low-molecular substances K. make slags which shall be removed from an organism. It occurs because the human body always consumes more proteins with food, than synthesizes new fabric proteins. About a half of residual nitrogen makes an urea nitrogen — an end product of exchange of amino groups at the person and some animals (the main way of binding of ammonia at the same time consists in synthesis of urea in a liver — so-called ureotelic type of removal of nitrogen). Urea is synthesized in a liver and removed together with other nitrogenous slags (uric to - that and creatinine, etc.) by filtering in renal balls. Unlike them, decomposition product of hemoglobin — bilirubin — is removed with bile. In cells of reticuloendothelial system bilirubin which circulates in plasma in the form of a complex with albumine is formed of the ectoglobular hemoglobin connected with plasmatic protein gaptoglobiny. It is called in a lab. to practice indirect (free) as directly does not react with a diazoreactant. In hepatic cells bilirubin contacts two molecules glucuronic to - you, the water soluble product giving forward reaction with a diazoreactant is as a result formed. Bilirubindiglyukuronid is brought with bile in intestines where it is recovered in uro-and stercobilin, a part to-rogo is again soaked up in To. also it is removed already through kidneys, ground mass is excreted with a stake.

In plasma K. all amino acids which are a part of proteins, and also some related to them amino compounds — taurine, citrulline and others circulate; a part of amino acids, napr, tryptophane, is adsorbed on albumine. There is a circadian rhythm of content of amino acids in blood — a minimum apprx. 4 o'clock in the morning, at most (15 — 35% higher) in afternoon time (see. Biological rhythms ). The nitrogen which is a part of amino groups quickly exchanges as by interamination from one amino acid on another, and being included proteins. The general content of nitrogen of amino acids of plasma (5 — 6 mmol, k) is approximately twice lower, than the nitrogen which is a part of slags. Dagnostichesky value has generally increase in content of some amino acids, especially at children's age, a cut testifies to insufficiency of the enzymes which are carrying out their metabolism. V K. also quite significant amount of di - and polypeptides (generally in erythrocytes), including ergotionin, fiziol which role is not completely clear contains. Unlike amino acids which, like urea and creatinine, are distributed almost evenly between plasma and erythrocytes nucleotides are concentrated in blood cells.

Nitrogen-free organic matters. Three classes of substances — lipids, carbohydrates and organic to - you concern to them.

Lipids of plasma are a part of lipoproteids. It is the second-large group of substances, concedes edges only to proteins. Among them there are most of all triglycerides (neutral fats), then there are phospholipids — hl. obr. lecithin, and also kephalin, sphingomyelin and lysolecithin; the phospholipidic composition of plasma in comparison with other fabrics is rather simple. The research of content in plasma is of great importance for identification and typing of disturbances of a lipometabolism (lipidemias) cholesterol (see) and triglycerides; the research of phospholipids is considered low-informative.

About 2/3 cholesterol of plasma are connected in the form of ethers fat to - t (esterifiedly), 1,3 makes free alcohol — cholesterol, at small amounts there are also alpha sitosterol, beta sitosterol, stigmasterol and galactoside of cholesterol. Content of cholesterol increases with age; at men it is higher, than at women. Cholesterol is synthesized by very many fabrics from where gets to plasma. The liver of the adult can produce 1,5 g, adrenal glands of 0,5 g a day, noticeable quantities are formed also in intestines and an internal cover of an aorta. Intake of cholesterol with food depends on character of food. Cholesterol is removed from an organism of hl. obr. with bile in the form of bile acids.

Lipids of plasma continuously exchange with lipids of erythrocytes and other cells, there is also a transfer of separate groups from one lipid on another, in particular etherification of the cholesterol which is generally a part of lipoproteids of high density. An essential role in a lipometabolism is played not esterified fat to - you plasmas; they are formed in fat depos as a result of a lipolysis, utilized by various fabrics for power needs, in plasma are connected with albumine. The fat and acid structure of lipids of plasma depends on structure of food, it differs from structure fat to - t of erythrocytes and other cells.

Glucose K. (sometimes it is not absolutely correctly identified with sugar of blood) is the main source to energy for many fabrics and the only thing for a brain, cells to-rogo are very sensitive to reduction of its contents. It is considered that the minimum size of contents in To. glucose (see), at a cut it is not observed patol, manifestations, apprx. 2,7 mmol/l (50 mg of %) yet. In an organism there are numerous well duplicated mechanisms of maintenance of its concentration in fiziol, limits. Therefore in spite of the fact that reserves of carbohydrates in an organism are limited — only 300 — 400 g which can provide energy demands only for 12 — 18 hours, concentration of glucose is maintained on fiziol, level even at multi-day starvation or performance physical. works. Adrenaline, a glucagon, glucocorticoids increase the content of glucose in To., insulin lowers. If concentration of glucose exceeds 9 mmol/l (150 mg of %), it appears in urine. After meal, especially carbohydrate-rich, the content of glucose in To. increases, but as a result of the coming endocrine reaction, in particular emission of insulin, for 1 — 2 hour is returned to norm. At a diabetes mellitus when insulin insufficiency, increase in content of glucose in takes place To. more considerable, and return to normal amounts slower. For identification of initial forms of this disease widely use loadings glucose after which its contents in To. it is investigated in dynamics and it is represented graphically in the form of glycemic curves.

In addition to glucose, in To. there are at small amounts other monosaccharides: fructose, a galactose, and also phosphoric ethers of sugars — intermediate products of glycolysis. The noticeable quantity them happens after reception of carbohydrate food; it is possible to establish it on a decrease of inorganic phosphorus. From high-molecular carbohydrates of plasma heparin, all glycogen deserves mentioning To. it is concentrated in leukocytes.

Organic acids of plasma K. (free of nitrogen) are presented by products of glycolysis (the most part of their fosforilirovan), and also intermediate substances of a cycle Tricarboxylic to - t. Among them holds a specific place lactic acid (see), edges in large numbers collects when the organism makes the bigger volume of work, than receives for this oxygen (an oxygen debt). Accumulation organic to - t happens also at different types of a hypoxia. Treat them also beta and hydroxy-butyric and acetoacetic to - you which together with the acetone which is formed of them combine a concept ketone bodies (see). Normal they are formed in rather small amounts as products of exchange of the hydrocarbon remains of some amino acids. However if carbohydrate metabolism is broken, napr, at starvation and diabetes, then owing to a shortcoming oxalacetic to - you are broken normal utilization of the remains acetic to - you in a cycle of Tricarboxylic acids therefore ketone bodies can collect in To. in large numbers.

The liver of the person produces cholic, urodezoksikholevy and chenodesoxycholic to - you which are allocated with bile in a duodenum where, emulsifying fats and activating enzymes, promote digestion. In intestines under the influence of microbic flora are formed of them deoxycholic and lithocholic to - you. From intestines bile acids (see) are partially soaked up in To., where their most part is in a type of pair connections with taurine or glycine (conjugated bilious to - you).

Hormones of blood. All produced by endocrine educations hormones (see) circulate in K. Eto very big group of substances, the edge cannot be accurately delimited from the mediators of a nervous system, fabric hormones (extending the action only to those fabrics in which they are formed), and also factors of coagulation To. Cells, related from the point of view of a histogenesis, also relatives by the chemical nature usually produce biologically active agents which in the course of evolution, however, got various fiziol, functions. Therefore chemical classification of hormones does not match with physiological or based on anatomy of the bodies making them.

Unlike the majority of other components of plasma which concentration is rather constant and even at pathology changes no more than by two-three times, content of hormones in To. at the same person depending on fiziol, situations can change many times over. Also monthly cycles are characteristic of them also daily, seasonal, and at women. Much circulating in To. hormones are partially connected with proteins carriers as which both specific, and nonspecific proteins can act. It is considered though it strictly is not proved that fiziol. free forms have activity. In the conditions of pathology, at replaceable hormonal therapy (e.g., treatment of diabetes insulin) the organism develops antibodies against the entered hormone therefore the quantity of free, physiologically active form falls.

V K. always there are products of incomplete synthesis, and also disintegration (catabolism) of hormones which often possess biol, action, therefore in a wedge, to practice a wide spread occurance has definition of the whole group of the related substances having the general chemical group, e.g. 11 oxycorticosteroids, iodinated organic matters at once.

Circulating in To. hormones are quickly removed from an organism; the period of their semi-removal is usually measured for minutes, is more rare for hours. At the same time there is a change of their chemical structure: proteins and polypeptides are split by proteolytic enzymes, low-molecular substances are exposed to oxidation-reduction transformations, hydroxylic groups are etherified glucuronic and sulfuric to-tami, and also methylated.

Basic changes in definition of hormones K. happened to development of a method of competitive linkng with specific proteins (the saturation analysis) which is that the studied substance competes with the known number of the added marked connection to be connected with specific protein. As such specific protein antibodies, and also transport proteins of plasma K most often act. and proteins of target organs.

Single-step definition of hormones in To. usually maloinformativno, as their concentration fluctuates in considerable limits depending on fiziol, situations: provisions of a body, character of food, time of day etc. To reveal true opportunities of glands, apply funkts, load tests which cornerstone reaction of endocrine system to reception of various substances is most often. For this purpose use glucose, amino acids (a leucine, arginine, dioxyphenylalanine). Apply also loadings insulin (in this case as an irritant serves the hypoglycemia caused by it), ethylene diamine tetraacetic to - that, triple hormones, inhibitors of their synthesis.

By the chemical nature hormones divide into three classes: proteins and polypeptides derivative of amino acids and steroids. The central place in endocrine system is taken by a hypophysis, the front share to-rogo produces triple hormones. From them corticotropin (adrenocorticotropic hormone, AKTG), lipotropin, Somatotropinum (a growth hormone, STG), Prolaktin (mammotropny hormone, lactotropin) of the proteinaceous nature; others — thyrotropin (TTG), follitropin (follicle-stimulating hormone, FSG) and lyutropin (luteinizing hormone, LG) — glycoproteins. Education and braking of some of these hormones is regulated by hypothalamic factors — liberina and statines which also circulate in blood. In a back share of a hypophysis cyclic octapeptides — vasopressin (antidiuretic hormone, ADG) and oxytocin are formed. The placenta of pregnant women produces two proteinaceous hormones: one of them a glycoprotein — a chorionic gonadotrophin, its emergence in an organism — a precursory symptom of pregnancy, other polypeptide horiomammotropin (chorionic somatomammotrophin, placental lactogen). The big group of hormones is produced by glands of a digestive tract. In a pancreas insulin and a glucagon are produced; the last is chemically close to gastrin which together with secretin and cholecystokinin-pankreaziminom, etc. makes group of digestipeptid — fabric hormones went. - kish. path. Proteinaceous hormones are defined in To. generally by method of the saturation analysis, the greatest lab. definition of insulin (so-called immunoreactive insulin) matters, however at the same time not only biologically active products, but also and the pro-insulin and fragments of a molecule of hormone connected with antibodies come to light.

The vascular tone is influenced by two systems of fabric hormones K. — the polypeptides which are formed directly in a vascular bed: angiotenzina increase blood pressure, kinina lower it. Under the influence of the enzyme of a renin produced by kidneys from alfa2-globulin of angiotensinogen decapeptide angiotensin I which then turns into nonapeptide angiotensin II is chipped off. In an alpha globulinovoy of fraction there are also at least three kininogen — one high-molecular and two with a smaller molecular weight. Under the influence of tripsinopodobny enzyme of a kininogenin (a kininogenaz, kallikrein) from them kinina — nonapeptide bradikinin, decapeptide lysyl-bradykinin (collidine) and methyl-lysylbradykinin are chipped off.

Hormones of a thyroid gland thyroxine (T4) and triiodothyronine (T3) represent iodinated derivatives of amino acids. In plasma K. they are connected with tiroksinsvyazyvayushchy protein therefore about their quantity it is possible to judge by amount of the iodine connected with protein (see. Proteinaceous and connected iodine ), and also on to butanolekstragiruyemy iodine (see). Besides, the more in plasma of tiroksinsvyazyvayushchy protein, untied with hormone, the it is less hormone there. Catecholamines (pyrocatechins) enter into other group of derivatives of amino acids: adrenaline, noradrenaline, dopamine; they are adjoined by fabric hormones and mediators of a nervous system: serotonin, its metabolite 5-oxyindolyacetic to - that, a histamine, acetylcholine, piperidic to - that. Serotonin is almost completely concentrated in thrombocytes, and the histamine in basphilic and eosinophilic granulocytes which quantity determines the content of these amines in integral K. K to the same group of substances adjoins a mediator of hormonal activity — cyclic adenosinemonophosphoric to - that, also found in To.

Hormones of the steroid nature are presented by 5 groups of substances — glucocorticoids, mineralokortikoida, androgens, estrogen and progesterone which combine several tens of hormones and their next metabolites which are also possessing biol, activity. Existence of OH group at the 11th carbon atom is characteristic of glucocorticoids, more extensive group is made by 17 oxycorticosteroids combining also their derivatives and mineralokortikoida. Androgens and decomposition products of all steroid hormones, except for estrogen enter into group 17 of ketosteroids. On physical. - to chemical properties steroids are adjoined by prostaglandins — derivatives unsaturated fat to - you, containing 20 carbon atoms. Among their numerous effects there is an influence on blood pressure and prevention of a thrombogenesis due to reduction of adhesive ability of thrombocytes.

Mineral substances of blood and microelements. Sodium makes 9/10 all cations of plasma, contents it is supported with very big constancy — fluctuations at the same person do not exceed 2% of absolute value. Activity of sodium and potassium in free water of plasma and erythrocytes corresponds to their activity in solutions of inorganic salts, however it must be kept in mind that in plasma free water makes 96%, and in erythrocytes of 80% of volume. Activity of bivalent cations of calcium and magnesium is influenced more by their linkng with proteins and lemon to - that. At pH 7,35 and t ° 37 ° only 50 — 58% of all calcium are ionized, magnesium is ionized almost for 70%.

As a part of anions chlorine and bicarbonate dominate; their concentration are less constant, than cations as allocation coal to - you through lungs lead to the fact that a venous blood is richer with bicarbonate, than arterial. In the course of a respiratory cycle chlorine moves from erythrocytes to plasma and back. While all cations of plasma — mineral substances, about 1/6 part of all anions which are contained in it it is the share of protein and organic to - you. Emergence of acid products of metabolism originally affects anion composition of plasma and for the second time cationic. At fiziol, pH values contained in To. multiply charged to - you are dissociated not completely — phosphoric to - that exists in the form of ions of HPO 4 2- and H 2 PO 4 - , coal to - that generally in the form of bicarbonate (HCO 3 - ), and also in the form of dissolved coal to - you (H 2 CO 3 ) and ions of a carbonate (CO 3 2- ). The quantitative relations between these forms are connected with the size pH of blood Genderson's equation — Gasselbalkh; they play an important role in functioning of buffer systems K. and its respiratory function. Mineral composition To. it is closely connected also with balance of acids and the bases.

At the person and almost at all highest animals the electrolytic structure of erythrocytes differs from composition of plasma markedly — instead of sodium potassium prevails, the content of chlorine is also much less. The exception is made by dogs who have in red blood cells a lot of sodium.

Iron of plasma is completely connected with protein transferrin, normal sating it for 30 — 40%. As one molecule of this protein connects two Fe3+ atoms, the bivalent iron formed at disintegration of hemoglobin is oxidized previously to trivalent, probably, by means of protein of ceruloplasmin which contains copper and has properties of an oxidase (see. Oxidases ). In erythrocytes copper is a part of other protein — an eritrokuprein who catalyzes superoksiddismutazny reaction therefore hydrogen peroxide is formed. In plasma K. the cobalt which is a part of polyneuramin contains 12  ; zinc contains preferential in erythrocytes where is a part of a karboangidraza. Biol, a role of attendees in To. such microelements as manganese, chrome, molybdenum, selenium, vanadium and nickel, completely it is not clear; their contents in a human body in many respects depends on contents in vegetable food where they get from the soil or with the industrial wastes polluting the environment.

Emergence in To. mercury, cadmium and lead has purely toksikol, value. Mercury and cadmium in plasma K. are connected with sulphhydryl groups of proteins, generally albumine. Content of lead in To. serves as an indicator of impurity of the atmosphere; according to WHO recommendations, it shall not exceed 40 mkg of %, i.e. 0,5 µmol/l.

Chemical composition of blood cells and exchange processes in them. The structure of erythrocytes differs from composition of plasma not only the fact that they contain hemoglobin and potassium, but also and taking place in the reduced form, in comparison with other cells, exchange processes necessary for maintenance of mechanical integrity of an erythrocyte, chemical full value of the hemoglobin and chemical structure of the intracellular environment necessary in order that hemoglobin could be a full-fledged oxygen carrier. As in red blood cells there is neither kernel, nor mitochondrions, in them synthesis of protein is limited and there is no oxidizing phosphorylation.

Concentration of hemoglobin in To. depends on total quantity of erythrocytes and contents in each of them of hemoglobin. Say about hypo - normo-or hyperchromic anemia depending on whether falling of hemoglobin K is interfaced. with reduction or increase in its contents in one erythrocyte. Tolerance levels of concentration hemoglobin (see) at which decrease it is possible to speak about development of anemia, states depend on a yole, age and fiziol.

The most part of hemoglobin of the adult is made by HbA, at small amounts there are also HbA2 and fetalis HbF, to-rogo many in To. at newborns, and also at a number of diseases

of K. U of some people existence in is genetically caused To. abnormal haemo globins (see. Gemoglobin, haemo globins unstable ); all them more than one hundred are described. Often (but not always) it is accompanied by development of a disease.

A small part of hemoglobin exists in the form of its derivatives of the carboxyhaemoglobin (connected with WITH) and a methemoglobin (in it iron is oxidized to trivalent); at pathology appear tsianmetgemoglobin, sulfhemoglobin etc. In erythrocytes are present at small amounts the prosthetic group of hemoglobin deprived of iron — protoporphyrin IX and intermediate products of biosynthesis — coproporphyrin, aminolevulinic to - that, etc.

Exchange processes in erythrocytes are presented generally by exchange of carbohydrates — glycolysis and a pentozofosfatny cycle (see. Carbohydrate metabolism ). Thanks to glycolysis there is a formation of ATP (certainly, at the level of substrate phosphorylation), 2,3-diphosphoglyceric to - you, edges are necessary for ensuring S-figurativeness of curve dissociation of hemoglobin, and also NAD-N2 which recovers a methemoglobin in hemoglobin. At a pentozofosfatny pathway of carbohydrates enzyme glyukozo - 6 recovers NADF in NADF-N2 which is spent for maintenance in got into condition sulphhydryl groups of proteins and glutathione that provides funkts, full value of systems of transport of ions, and thereby and mechanical integrity of erythrocytes recovers. Normal in red blood cells hydrogen does not pass with NADF-N2 on OVER, but if there are intermediate carriers of electrons as which methylene blue and some drugs can act, NADF-N2 is spent for recovery OVER, and through it and a methemoglobin. If it is accompanied by insufficiency of enzyme of a glyukozo-6-phosphate-dehydrogenase, the number of the recovered sulphhydryl groups falls, integrity of erythrocytes is broken and there can come hemolitic crisis (see. Crises ). More than 50 are described hereditarily the caused abnormal types of a glyukozo-6-phosphate-dehydrogenase, the majority of which has hypoactivity. Activity of proteolytic enzymes in erythrocytes is much higher, than in plasma. Cells are also a little richer with nucleotides which are continuously synthesized from the nucleinic bases and sugars and break up before these connections.

Unlike erythrocytes, leukocytes in funkts, the relation — full-fledged cells with a big kernel and mitochondrions, high content nucleinic to - t and oxidizing phosphorylation. In them all glycogen is concentrated To., which is an energy source at a lack of oxygen, napr, in the centers of an inflammation. The main function of segmentoyaderny leukocytes — phagocytosis (see), the power to-rogo is provided with strengthening glycolysis (see). After the foreign particle is taken, oxygen consumption and apotomichesky oxidation of glucose amplifies; the formed NADF-N2 is a source of formation of hydrogen peroxide, edges by means of enzyme of verdoperoxidase is spent for destruction of the taken particle. It is promoted by also big set of the acid hydrolases synthesized by the segmented leukocytes. Their antimicrobic and anti-virus activity is provided also with development lysozyme (see) and interferon (see). The main function of lymphocytes — production of immunoglobulins — carriers of function of antibodies.

Though thrombocytes (platelets) cannot be considered as full-fledged cells as do not contain a kernel, in them all proceed the main biochemical, processes: protein is synthesized, carbohydrates and fats exchange, breath is accompanied by phosphorylation. The main fiziol. function of platelets — to promote a stop of bleeding; they have ability to be spread, aggregate (to stick together) and contract, providing thereby the beginning of formation of a blood clot, and after its formation retraction. Aggregation occurs in the presence of ADF and calcium, can be caused also by nek-ry other agents. Thrombocytes contain the fibrinogen a little other than fibrinogen of plasma, and also sokratitelny protein trombastein, the actomyosin in many respects reminding muscular sokratitelny protein. Plates are rich with adenilnukleotida, a glycogen, serotonin, a histamine. Granules contain the III factor of coagulation To., on a surface V, VII, VIII, IX, X, XI and XIII factors are adsorbed (see. Coagulant system of blood ). To. vertebrate animals at damage of a vessel is curtailed — forms a clot as a result threads of fibrin are formed of the dissolved plasmatic protein of fibrinogen. The chain of consecutive reactions is the cornerstone of coagulation, each link a cut represents the enzymatic transformation of an inactive factor (substance) into an active form accelerating the following link of reaction. Also autocatalytic processes when the subsequent links accelerate previous take place. Distinguish external coagulant system where the substances and systems relating to cells, hl enter. obr, to thrombocytes, and internal where plasma factors belong. Plasma factors are designated by the Roman figures from I to XIII, in an active form the letter «and» is added to figure (e.g., XII and XIIa). Except for the IV factor — calcium ions, plasma factors — proteins; they are synthesized in a liver, synthesis of some of them depends on phthiocol. The order of numbering of factors is explained by the historical reasons and is not connected with the sequence of their action.

Filamentation of fibrin is preceded by consecutive activation of plasma factors with participation fabric therefore thromboplastin (thrombokinase) which provides transition of a prothrombin (a factor of II) to thrombin (a factor of Pa) is formed; this process takes 2 — 5 min. Thrombin — proteolytic enzyme with tripsinopodobny activity — very selectively chips off from alpha and beta chains of fibrinogen peptides A and B; the remained fragments of a molecule will be polymerized. Its polymerization is reversible until primary clot of fibrin is not stabilized by means of XIIIa of a factor which has properties of a transglyutaminaza.

Normal the coagulant system of blood is counterbalanced anticoagulative, edges are included by two groups of substances: the antithrombins interfering effect of thrombin and the fibrinolysins dissolving already formed fibrinous clot. Antithrombic activity first of all fibrinogen and fibrin which adsorb thrombin, and also plasmatic proteins alfa1-antitrypsin and alfa2-macroglobulin and polysaccharide heparin have. The fibrinolysis is carried out tripsinopodobnsh by enzyme plasmin (fibrinolysin), the inactive form to-rogo — plasminogen — is present at plasma. Its activation happens at presence lizokinaz, contained in various cells, including and in erythrocytes.

Physiology

Main function K. — transfer of various substances, including by means of what the organism is protected from influences of the environment or regulates functions of separate bodies. Depending on character of transferable substances distinguish the following functions K.

1. Respiratory function — transport of oxygen from air cells to fabrics and carbonic acids from fabrics to lungs.

2. Nutritious function — transfer of nutrients (glucose, amino acids, fat to - t, triglycerides etc.) from bodies of a digestive tract, bodies depots or bodies where these substances are formed, to fabrics where they are exposed to further transformations; this function is closely connected with transport of intermediate products of a metabolism.

3. Excretory function — transfer of end products of a metabolism (urea, creatinine, uric to - you etc.) in kidneys and other bodies (e.g., skin, a stomach) and participation in process of formation of urine (see. Secretory processes ).

4. Homeostatic function — achievement of constancy of internal environment of an organism thanks to movement To., to washing of all fabrics by it with which intercellular liquid its structure is counterbalanced (see. Homeostasis ).

5. Regulatory function — transfer of the hormones produced by hemadens and other biologically active agents by means of which regulation of functions of separate cells of fabrics is carried out and also removal of these substances and their metabolites after them fiziol, the role is executed (see. Humoral regulation ).

6. Thermoregulatory function: movement To. thanks to its high thermal conductivity and heat capacity increases heat waste by an organism when there is a threat of overheating, or, on the contrary, provides preservation of heat at fall of temperature of the environment; this function is implemented by change of size of a blood-groove in skin, a hypodermic fatty tissue, muscles and internals under the influence of change of ambient temperature (see. Thermal control ).

7. Protective function is carried out by substances (a lysozyme, etc.)» providing humoral protection of an organism against an infection and getting in To. toxins, and also the lymphocytes participating in antibody formation. Cellular protection is carried out by leukocytes (neutrophils, monocytes) which are transferred by current To. in the center of an infection, to the place of its penetration and together with fabric macrophages provide formation of a protective barrier (see. Immunity ). Current To. the products of their destruction which are formed at damage of fabrics are removed and neutralized (see. Barrier functions ). To protective function K. its ability to coagulation, formation of blood clot and the termination of bleeding belongs. Factors of coagulation take part in this process and thrombocytes (see). At considerable decrease in quantity of thrombocytes (thrombocytopenia) the slowed-down coagulation is observed To. (see. Coagulant system of blood ).

Quantity To. in an organism — size quite constant and carefully adjustable. The hemoglobin which is contained in erythrocytes is synthesized and updated slowly (life expectancy of an erythrocyte apprx. 120 days); lump of hemoglobin in an organism and the related bulk volume of erythrocytes — sizes relatively constants which, except for bleedings or acute hemolysis, can change considerably only for weeks. Nek-roye change of volume of erythrocytes can happen owing to their swelling at change of acid-base equilibrium. The mass of hemoglobin at the healthy person makes 350 — 450 g per 1 m 2 body surfaces, or 9 — 11 g per 1 kg of body weight, the mass of erythrocytes are 27 — 33 ml per 1 kg of body weight, the mass of plasma is about 45 — 46 ml per 1 kg of body weight.

During the definition of total quantity To. in an organism separately define one of its components — erythrocytes or plasma, using a dilution method of a tag. During the determination of mass of erythrocytes usually enter intravenously known quantity of erythrocytes, marked radioactive materials ( 51 Cr, 32 P), then define concentration of a tag in To., and on it the mass of erythrocytes. The best results are yielded by use of a karbonmonoksidny method, at Krom inspected inhales the dosed amount of carbon monoxide, and then the content of carboxyhaemoglobin in is defined To. During the scoping of plasma use cultivation of albumine, marked a radioiodine, Evans-blue is more rare chrome, or dye. Bulk volume To. calculate on one of components and size of a hematocrit (see. Gematokritny number ).

Transport of substances from To. to fabrics it is substantially carried out thanks to constant filtering of a part of plasma in an arterial part of a capillary bed. As the capillary wall is not enough pronitsayem for plasmatic proteins, in an arterial part of capillaries under the influence of hydrostatic pressure To. there is filtering of its liquid part containing only low-molecular well soluble substances; concentration of proteins in To. raises, also oncotic pressure respectively increases. Filtrational pressure, under action to-rogo happens this fluid movement to the substances dissolved in it, makes 7 — 8 mm of mercury. (0,93 — 1,06 kPa). In a venous part of capillaries the filtered liquid is returned to their gleam under the influence of forces of oncotic pressure. This mechanism provides intake to tissues of all of readily soluble substances in water; substances, slightly soluble in water as, e.g., oxygen or lipids, are transferred To. only being connected with special substances carriers. Hormones of adrenal glands take part in regulation of volume of plasma: during the falling of hydrostatic pressure in capillaries secretion of Aldosteronum and a reabsorption of water in tubules of kidneys increases. Providing fabrics with oxygen as it is consumed in rather large numbers is the most difficult — oxidation of 1 molecule of glucose requires 6 molecules of oxygen. Concentration of oxygen in plasma cannot be higher, than in an alveolar air, concentration it in plasma makes 0,25 mmol/l, and concentration of glucose of 4 — 5 mmol/l. In the course of evolution the difficult and thin mechanisms providing the partial pressure of oxygen, necessary for life activity of fabrics, in circulatory capillaries were developed.

Respiratory function

During the passing through capillaries arterial To. loses oxygen and, being enriched with carbonic acid, becomes venous. Passing through capillaries of lungs, To. gives * carbonic acid and buys oxygen, i.e. becomes arterial again. Process of transfer of oxygen of a respiratory organs to fabrics and carbonic acids in the opposite direction also makes respiratory function K. (respiratory cycle). Exchange of gases between an alveolar air and To. in lungs, and also between fabrics and To. it is carried out by the diffusion caused by a difference of partial pressures of gases (see. Gas exchange ).

Transport of necessary amount of oxygen is provided with existence in To. hemoglobin (see) which easily enters with oxygen fragile connection also so easily gives this oxygen. With a partial pressure of oxygen in lungs of the person apprx. 100 mm of mercury. hemoglobin almost completely (for 96 — 97%) turns into oxyhemoglobin. In fabrics with much more low partial pressures of oxygen oxyhemoglobin gives oxygen, turning into the recovered hemoglobin. Ability of hemoglobin to connect and give oxygen express it oxygen dissotsiatsionnoy curve (ODC), characterizing percent of saturation of hemoglobin by oxygen depending on the partial pressure of oxygen. The CDC reflects properties of hemoglobin as oxygen carrier and has more or less expressed S-shaped bend arising owing to interaction of four humic groups of a molecule of hemoglobin, each of which reversibly attaches on a molecule of oxygen. It turns out that accession of the first molecule of oxygen to hemoglobin facilitates joining of other three.

The form of CDC is of great importance: the more it is bent, the more difference between the oxygen content in arterial and venous To., i.e. more oxygen is given by that to fabrics. The maximum degree of curvature is possible only in the narrow range fiziol, pH values, temperature etc.; specific value has existence in blood 2,3-diphosphoglyceric to - you, in absence a cut the curve of dissociation of oxyhemoglobin loses S-shaped character. In laboratory and clinical practice for assessment of nature of curve dissociation of oxyhemoglobin determination of size of that partial pressure of oxygen is used, at Krom hemoglobin for 50% is oxygenated (pO 2 50). Than this size is higher, that hemoglobin gives more oxygen to fabrics.

Efficiency To. as oxygen carrier it is characterized also by the size of its oxygen capacity, i.e. that maximum quantity of oxygen, a cut can connect To. Oxygen capacity To. depends on contents in it respiratory pigments (see). To. supports the person apprx. 15 g of hemoglobin in 100 ml. Since 1 g of hemoglobin can connect 1,39 ml of oxygen, oxygen capacity To. makes apprx. 20 ml of oxygen on 100 ml of K. Uglekislot lowers ability of hemoglobin to connect oxygen, owing to what receipt in To. carbonic acids promotes return of oxygen to fabrics.

Carbonic acid is present at a blood plasma of hl. obr. in the form of bicarbonates. An important role in transport of carbonic acid is played by presence in To. hemoglobin. Oxyhemoglobin is much stronger to - that, the hemoglobin by what recovered. In capillaries of fabrics oxyhemoglobin gives oxygen, its acid properties weaken, and coal to - that can take away from hemoglobin the related bases, forming bicarbonate. In lungs hemoglobin turns into oxyhemoglobin again and forces out carbonic acid from bicarbonate. The forcing-out effect of oxygen in relation to coal to - those was for the first time described by B. F. Verigo (see. Verigo effect ).

Nek-raya a part of carbon dioxide communicates and transferred directly by hemoglobin in the form of carbohaemoglobin and other carbamic connections.

Unlike oxygen, bicarbonate — the main form, in a cut carbonic acid is present at blood — we will well dissolve in water, and carbonic acid possesses a big diffusion coefficient that very much facilitates its transport as from fabrics in To., and from blood in an alveolar air. Therefore at diseases of lungs or vessels transport of carbonic acid is broken much later, than transport of oxygen. Coal to - that is not just slag, an end product of metabolism; it performs many important functions in an organism, participating in synthesis of fats and a neoglycogenesis, it is necessary also for maintenance of acid-base balance. Content of carbonic acid in To. is much higher, than oxygen, respectively relative differences of its concentration between an arterial and venous blood it is less, than oxygen.

As it was already noted, hemoglobin possesses the leading role in implementation of respiratory function K., and in particular in transport of carbonic acid, edge in venous To. diffuses in erythrocytes, and in arterial leaves them; at the same time also properties of hemoglobin as acids change. Since the membrane of an erythrocyte is impenetrable for cations, transition of an ion of bicarbonate to a red blood cell and is back compensated by back motion of other negative ion — chlorine, and also a nek-eye change osmotic concentration therefore in the course of a respiratory cycle the content of chlorides in erythrocytes and their volume changes.

Nutritious function

to Hit of nutrients in To. their absorption in intestines precedes. Products of digestion of carbohydrates (glucose, fructose, galactose, etc.) and proteins (low-molecular peptides, amino acids), and also salts, vitamins and water are soaked up directly in To., proceeding on capillaries of fibers of intestines. Neutral fat and products of its splitting (glycerin and fat to - you) are soaked up in To. and in a lymph (see. Absorption ). The substances which are soaked up in To., treat her on a portal vein in a liver and only then are carried on all organism. The fats which are partially soaked up in a lymph get from a chest channel, passing a liver, in a blood channel where circulate in the form of chylomicrons. Further they are processed in a liver into lipoproteids of low density and again get to K.

Glyukoz is transferred with To. in a liver where its surplus is late and turns into a glycogen. Other glucose is transported To. to all fabrics and bodies, including to muscles where a part it turns into the glycogen consumed during the muscular work. At insufficient intake of carbohydrates with food in To. the glucose which is formed of a glycogen of a liver, stocks to-rogo at the same time, naturally, passes decrease. Thus, despite receipt with food of various amounts of carbohydrates, the content of glucose in To. it is characterized by relative constancy. Maintenance of datum level of glucose in To. and adjournment of a glycogen in a liver are regulated by a nervous system and hormones. If physical is carried out. work at a lack of oxygen, a glycogen of fabrics breaks up to milk to - you are (glycolysis), edges current To. it is transferred to a liver where it is again used for synthesis of a glycogen or glucose. Consumption of a significant amount of carbohydrates causes increase in a sugar content in To., i.e. causes so-called alimentary hyperglycemia (see). Disturbance of constancy of content of glucose in To. it is observed at a diabetes mellitus.

Amino acids are carried To. on all organism; they are used as plastic material for creation of proteins of fabrics, and also for power needs and synthesis of carbohydrates (neoglucogenesis). Triglycerides and formed at their splitting not esterified fat to - you are transported To. to all fabrics where they are used by hl. obr. for power needs. Excess of fat is postponed in so-called fat depos (a hypodermic fatty tissue, an epiploon, etc.). From business fats can arrive again in To. and to be transferred to places of consumption. Content of fat in To. not constantly, during digestion of fats in intestines it raises (see. Lipemia ).

Excretory function

From all bodies and fabrics in To. metabolic products arrive. Ammonia (see) — one of products of a nitrogen metabolism — is formed by hl. obr. at deamination of amino acids. Ammonia is toxic for an organism; in To. it contains — a little since its most part is neutralized, turning into urea or amino groups of amino acids. A part of ammonia is allocated with kidneys in the form of ammonium salts. Mochevina (see) — an end product of a nitrogen metabolism at the majority of vertebrate animals and the person. Ground mass contained in To. urea is emitted through kidneys; a nek-swarm the quantity is distinguished with sweat glands. Uric acid (see) at the person and primacies it is formed in fabrics as an end product of exchange of the purine bases which are a part nucleinic to - t, transferred To. to kidneys it is also allocated with urine. Creatinine K. it is formed in fabrics at disintegration creatine phosphoric to - you (see. Creatine ); it is allocated with kidneys.

Bilious pigments, hl. obr. bilirubin (see), are formed as a result of disintegration of hemoglobin, are allocated with a liver and bile. A part of bilirubin in intestines gives other pigment — urobilinigen which gets in To. also it is allocated with urine. V K. there are also substances, poisonous for an organism, which are formed as a result of life activity of putrefactive microbes in intestines — some amines, phenolic compounds, an indole, etc. The majority of these substances is neutralized in a liver and removed with urine.

Blood groups

are understood As blood groups of people various combinations of group factors — antigens (see), various persons inherent in erythrocytes (see. Blood groups ). For the first time the term «blood groups» was applied to the group AB0 system, opening a cut by K. Landshteyner (1900) laid the foundation for knowledge of a group differentiation To. person. Further other group systems K were open. person, and also group properties K. various animals.

In the AB0 system two antigens of erythrocytes — And yes are known Century. Depending on existence or lack of one or both from them allocate four groups K. In other systems K. the person — MNSs, Rh, Kell, Duffy, Kidd, Lewis, Lutheran and so forth — amount of the known antigens variously and respectively variously quantity of possible group combinations (groups) in each of these systems. Group antigens of each system are normal inborn signs To. the individual, they do not change during his life and are descended. Group antigens of all systems are in a varying degree capable to cause formation of specific isoimmune antibodies (see). Such isoimmunization (most often to antigen a Rhesus factor) can occur at transfusion of raznogruppny blood and at different groups K. at mother and a fruit.

Also existence of the normal group antibodies which are regularly present in To is characteristic of the group AB0 system. antigens do not have people and directed to that antigen (or), to-rogo at this person. Normal group antibodies meet in relation to antigens of some other systems, but not regularly and at the same time have low activity. Normal isoimmune antibodies differ among themselves with a number of features. -

Accessory To. people to this or that group and existence at them normal or isoimmune antibodies predetermines biologically favorable or, on the contrary, an adverse combination To. various persons. It can take place at receipt of erythrocytes of a fruit in an organism of mother during pregnancy or at transfusion To.

At different groups K. at mother and a fruit and in the presence at mother of antibodies to antigens K. a fruit at a fruit or the newborn the hemolitic disease develops (see. Hemolitic disease of newborns ).

Transfusion raznogruppny To. in connection with existence at the recipient in To. antibodies to the entered antigens leads to the phenomenon of incompatibility and damage of the poured erythrocytes with serious consequences for the recipient (see. Hemotransfusion ). Thereof a basis of transfusion To. the accounting of group accessory and compatibility is To. donor and recipient. The accounting of group accessory To. is of great importance and at organ and tissue transplantation (see. Transplantation ).

Genetic markers of blood

Genetic markers To. — inherent to uniform elements and plasma K. the signs used in genetic researches for typing of individuals. To genetic markers To. carry group factors of erythrocytes, antigens of leukocytes, fermental and other proteins with rather wide variability in human populations. The possibility of their use appeared in genetic researches after opening of Groups K. and antigens of leukocytes, and also after development of a technique of an electrophoresis of proteins in starched gel. Believe that uniqueness of each individual on enzymatic and proteinaceous structure can be reflected on its physical., fiziol, and other features.

Distinguish genetic markers of cells To. — erythrocytes (antigens of blood groups, acid phosphatase, glyukozo-6-fosfatdegidrogenaza, etc.), leukocytes (HLA, NA antigens) and plasmas (immunoglobulins, gaptoglobin, transferrin, etc.).

Studying of genetic markers To. it was very perspective during the development of such important problems of medical genetics, molecular biology and immunology as clarification of mechanisms of mutations (see. Mutation ) and genetic code (see), molecular organization, confirmation of a hypothesis of an inactivation of X-chromosome, definition of a mosaic of antigens, couplings of genes, genetic identity, polymorphism of proteins and role of the selection factors.

Genetic markers To. were valuable in a research of a cellular mosaic on groups K. and generalized mosaicity of fabrics at hermaphrodites. Value of genetic markers increased To. in connection with rapid development of organ and tissue transplantation in view of need of tracing of destiny of a transplanted organ or fabric. The genealogical analysis of genetic markers is the cornerstone of studying of coupling of genes To. Thanks to progress of this section not only many markers are localized To., but also other signs.

In respect of studying of genetic identity of individuals Giblitt (E. R. Giblett, 1969), combining a technique of an electrophoresis for identification of options of protein with method of typing on various antigens, submitted the report on various genetic systems K. for assessment of genetic identity of two people (tab. 5) who are accidentally chosen from the Western European population. In all specified systems there are two or more alleles with a gene frequency more than 0,01. According to the submitted data, less than 1 on 350 000 people have an identical combination of phenotypes on the specified systems. However calculations for polymorphic systems, a beta lipoproteid, antigens of leukocytes, etc. are not included here. Opening of new polymorphic systems can increase this ratio considerably.

For drawing up tables on various ethnic groups, obviously, other sets of markers are necessary. Testing on a large number of genetic systems gains importance at organ transplantation and fabrics, for determination of probability of a monozigotnost from twins and in court. - medical researches at paternity proof.

Opening by means of genetic markers To. genetic polymorphism at people at molecular level raised a question of its reasons. On the basis of calculations of gene frequencies of groups K. and enzymes Lyyuontin (R. Page of Lewontin, 1967) estimated that about 1/3 loci of structural genes can be polymorphic. The fact that genes on these molecular to options are supported in different frequencies at various racial groups, indicates existence in the environment of powerful selection factors.

The nature of the selection factors influencing the majority of other polymorphic systems is unknown.

Features of blood at children

Fiziol, the features inherent to children's age define features To. at children (a row from them is presented in tab. 6, 7 and 8). Quantity To. at children is not a constant and it is subject to broad fluctuations depending on age and the weight of the child. At the newborn on 1 pg body weight it is necessary apprx. 140 ml To., children of the first year have lives — apprx. 100 ml.

Specific weight To. children, especially early children's age, have enough (1,06 — 1,08), than at adults (1,053 — 1,058). Viscosity To. at children it is a little raised.

On researches of most of authors, duration of coagulation To. at children does not differ from that at adults, on observations of others — it is considerably slowed down.

Healthy children have a chemical structure To. (tab. 7) differs in a certain constancy and changes a little with age. Between features morfol, structure To. and close connection exists a condition of intracellular exchange. Such enzymes K., as amylase, a catalase and a lipase, at children in the period of a neonatality are lowered, at healthy children of the first year of life their increase is noted.

Crude protein of serum K. gradually decreases after the birth till 3rd month of life and after the 6th month reaches the level of teenage age. The expressed lability of globulinovy and albuminous fractions and stabilization of protein fractions after the 3rd month of life is characteristic. Fibrinogen in plasma K. usually makes apprx. 5% of crude protein.

Antigens of erythrocytes (And yes In) reach activity only by 10 — 20 years, and the agglyutinabelnost of erythrocytes of newborns makes 1/5 part of an agglyutinabelnost of erythrocytes of adults. Isoantibodies (an alpha and a beta) begin to be developed at the child on 2 — the 3rd month after the birth, and their credits remain low about one year. Isohemagglutinins are found in the child with 3 — reach 6-month age and datum level only by 5 — 10 years.

Rapid growth and an increase of weight of the child, in particular chest age, demand the increased synthesis of hemoglobin, a hypermetabolism of iron. Reserves of iron, amount of hemoglobin are proportional to the body weight of the child.

A hemopoiesis at the child of early age proceeds in marrow of all bones. The Bystry erythrogenesis is caused by the fact that marrow completely consists of a red brain. The first signs of transformation of marrow in fatty are noted at children on the 4th year of life, and only by the time of puberty a hemopoiesis proceeds, as well as at adults, in marrow of flat bones, edges and bodies of vertebrae. At infectious and other diseases a hemopoiesis in a liver, a spleen and limf, nodes ekstramedullyarno develops.

Limf, nodes at early children's age are rather big and contain many averages and big lymphocytes. Are noted lability of all hemopoietic device and emergence of a lymphoid and myeloid metaplasia is frequent. Unlike small lymphocytes, averages are 1,5 times more than an erythrocyte, cytoplasm is wider than them, it contains azurophilic grains more often, the kernel is less intensively painted. Big lymphocytes there are almost twice more small lymphocytes (12 — 15 microns), their kernel is painted in gentle tone, is located a little excentricly and has often pochkovidny form because of impression sideways. Cytoplasm of blue color can contain azurophilic granularity and sometimes vacuoles. According to most of authors, small lymphocytes can be considered mature, average and big younger.

In the period of a neonatality peripheral To. (tab. 6) is characterized by the raised hemoglobin content and erythrocytes. So, by data A. F. Tura (1967 — 1970), number of erythrocytes makes 3,58 — 7,20 million in 1 mkl, the level of hemoglobin of 17 g of %. Four fifth parts of hemoglobin of newborns are made by fetalis hemoglobin (HbF) which in the first months of life is replaced with hemoglobin of adult (HbA).

By the time of the birth the child has two types of hemoglobin - HbF (80%) and HbA (20%), the quantity of reticulocytes (8 — 13%) is increased and normoblasts can appear in a small amount. The macrocytosis of erythrocytes, an anisocytosis and Polikhromatofiliya are characteristic. The blood sedimentation rate at newborns is slowed a little down. There are erythrocytes with raised and with the lowered osmotic firmness.

According to literary data, the number of leukocytes at newborns is increased and reaches on average 10 250 in 1 mkl, in a leukocytic formula of serum K. in the first days of life neutrophils prevail (to 60 — 65%), it is frequent with shift to myelocytes and metamyelocytes to the left, the quantity of monocytes fluctuates from 8 to 14%, eosinophils from 0,5 to 8%; often there are no basphilic leukocytes.

The number of thrombocytes, according to A. F. to a tour, fluctuates ranging from 143 000 to 413 000 in 1 mkl, averaging 278 000 in 1 mkl. The anisocytosis them with existence of huge forms of plates is noted.

Changes peripheral To. at newborns and children of the first months of life are caused by features of a blood formation, existence of red marrow without the centers of fatty marrow, big regenerator ability of red marrow and if necessary mobilization of the extramedullary centers of a hemopoiesis in a liver and in a spleen.

Decrease at newborns of level of a prothrombin, pro-accelerin, proconvertin, fibrinogen, and also thromboplastic activity To. promotes changes in coagulant system and tendency to hemorrhagic manifestations.

Excessive lability of indicators To. at children it is caused by imperfection of the regulating action of a cerebral cortex and endocrine system. Changes in structure To. at babies are less expressed, than at newborns. By 6th month the quantity of erythrocytes decreases on average to 4,55 million in 1 mkl, hemoglobin to 13,2 g the % and diameter of erythrocytes becomes equal 7,2 — 7,5 microns. The maintenance of reticulocytes is on average equal 5,0 °/00. The quantity of leukocytes makes apprx. 11 000 in 1 mkl. In a leukocytic formula lymphocytes prevail, the moderate monocytosis is expressed and often plasmocytes meet. The quantity of thrombocytes at babies is equal 200 000 — 300 000 in 1 mkl.

Morfol, composition of peripheral blood of the child from 2nd year of life until puberty gradually gains the lines characteristic of adults. The number of leukocytes decreases. In a leukocytic formula the quantity of neutrophils increases and the quantity of lymphocytes decreases. The number of monocytes decreases, plasmocytes disappear. Quantity of thrombocytes same, as at adults.

Cytochemical indicators in cells peripheral To. at children illustrate immaturity of final forms of all ranks of a hemogenesis and some features of chemism of cells.

Noticeable cytochemical shifts in lymphocytes peripheral To. occur to 3-month age of the child. So, activity of acid phosphatase is increased at children of early age. Considerable fluctuations are found also by alpha naphthylacetateesterase — its increase in the period of a neonatality and decrease by 3 — 4 months of the child is noted. Contents CHIC-positive of material of lymphocytes finds insignificant age fluctuations. High activity of acid phosphatase and a succinatedehydrogenase in lymphocytes at children of the first months of life is the testimony of hyperreactivity limf, tissues of the child of early age. At children in cells peripheral To. activity of nonspecific esterase is revealed in monocytes, thrombocytes and lymphocytes. The greatest activity of acid phosphatase is revealed in monocytes, in plasmocytes, in eosinophils, slight activity of acid phosphatase — in lymphocytes and in segmentoyaderny neutrophils.

Diseases of system of blood

Frequency of diseases of the system K. it is rather small. However changes in To. arise at many patol, processes.

Among diseases there are systems K. allocate several basic groups. From them the group of the diseases connected with defeat of an erythrogenesis most often meets (see. Hemopoiesis ). The etiology and a pathogeny of these disturbances are various. They have the acquired or hereditary character. Patol, process usually concerns the qualitative and (or) quantitative characteristic of elements of an erythropoietic row that is often expressed by the increased their destruction, reduction of products of erythrocytes or contents of hemoglobin in them. In certain cases as the main display of a disease serves increase in quantity of erythrocytes.

Anemias

Anemias (see) — the most numerous group of diseases of the hemopoietic system. Sovr, their classification is constructed taking into account a fundamental unit in a pathogeny of a disease. Distinguish big group iron deficiency anemias (see), resulting from deficit of iron and usually followed by reduction of a hemoglobin content in erythrocytes at their normal quantity in unit volume To.; hemolitic anemias — hereditary and acquired (see. Hemolitic anemia ), the numbers of erythrocytes proceeding almost always with decrease. Hemolitic anemias can be caused by the immune conflict concerning erythrocytes or their predecessors (e.g., at autoimmune hemolitic anemia the immune conflict takes place on a surface of own erythrocytes); disturbances in a gemoglobinoobrazovaniye, in particular as a result of changes of synthesis or structure of chains of a globin, e.g. thalassemia (see), sickemia (see), etc. The last are included in group of the diseases which received the name hemoglobinopathies (see). Hemolitic anemias arise also owing to decrease of the activity of the enzymes which are in an erythrocyte. The anemia at deficit of activity glyukozo-6-fosfatdegidrogenazy, in particular, concerns to them, a hexokinase, a glutationreduktaza. Some forms of hemolitic anemias develop as a result of change in structure of a membrane of erythrocytes, e.g. a paroxysmal night Haemoglobinuria, a hereditary microspherocytosis, etc.

Certain forms of anemia arise owing to a vitamin deficiency. So, manifestation of deficit of vitamin B 6 there can be sideroakhrestichesky anemias (see. Zhelezorefrakternaya anemia ), polyneuramin 12 , folic K-you — Pernicious anemia (see), anemia at to a spr (see). At a part of patients anemia can develop as a result of a complex of the reasons, napr, anemia of pregnant women, agastralny anemias, etc. Hypoplastic anemias (see) result from dysfunctions of a stem cell and (or) its microenvironment; main sign dizeritropoetichesky anemias (see) the inefficient erythrogenesis with death in marrow of qualitatively defective cells is.

Emergence is connected with disturbance of a gemoglobinoobrazovaniye methemoglobinemias (see), sulfhemoglobinemias, carboxyhaemoglobinaemia. It is known that iron, proteins and porphyrines are necessary for synthesis of hemoglobin. The last are formed eritro-by both normoblasts of marrow and hepatocytes. Deviations in porphyrinic exchange can lead to the diseases which received the name of a porphyria (see. Porphyrinic disease ). In most cases it genetically caused dysfunctions of various fermental systems. Distinguish erythropoietic and hepatic porphyrias. Genetic defects of an erythrogenesis are the cornerstone of the hereditary hyperglobulias proceeding with the increased maintenance of erythrocytes and hemoglobin (see. Eritrotsitov hereditary and family ).

Hemoblastoses

the Important place among diseases of system K. borrow hemoblastoses (see) — diseases of the tumoral nature from which myeloproliferative and limfoproliferativny processes are distinguished.

In group of hemoblastoses allocate leukoses (see) — the diseases caused by dysfunction of stem cells and which are characterized from the very beginning of the development by damage of marrow. Distinguish acute and hron, forms of leukoses. Their allocation is based on belonging of the cells characteristic of this disease, to this or that class. Morfol, substrate of acute leukoses are blast cells. At the same time distinguish acute miyeloblastny, miyelomonoblastny, lymphoblastoid, undifferentiated and other forms of leukoses. Morfol, substrate hron, leukoses is made by generally mature cells. Among hron, leukoses a myeloleukemia, a lymphoid leukosis most often meet. Many authors carry to hron, to leukoses also idiopathic myelofibrosis (see. Osteomyelofibrosis ).

Paraproteinemic hemoblastoses are considered as limfoproliferativny diseases in group hron. leukoses. Among them distinguish Valdenstrem's disease (see. Valdenstrema disease ), a disease of heavy chains (see. Heavy chains disease ), a multiple myeloma and a pulmonary disease of chains (see. Multiple myeloma ). Distinctiveness of these diseases is ability of tumor cells to synthesize patol, immunoglobulins.

Carry also malignant lymphoma, or the gematosarkoma which are characterized by primary local malignant tumoral growth, coming from limf, fabrics to hemoblastoses (see. Lymphoma ). Unlike leukoses at which already at early stages of formation of process specific damage of marrow and in the most part of cases a leukemic picture peripheral is found To., at malignant lymphoma in an initial stage, and sometimes and for a long time the tumor keeps the localized character (preferential in limf, nodes) with various degree of an invasion in surrounding fabrics, at the same time marrow long time remains intact.

In group of malignant lymphoma allocate lymphogranulomatosis (see), characterized by granulematozny growths with existence of cells of Berezovsky — Shternberg, and nekhodzhkinsky (negranulematozny) lymphoma, the Crimea diffusion or nodular (nodulyarny) proliferation, as a rule, of monomorphic cellular elements is inherent. Nekhodzhkinsky lymphoma at a certain stage of their development can be characterized by leukemic damage of marrow with a possible leukemic picture peripheral To., what pulls together them with leukoses.

Diseases of monocytic and macrophagic system

To diseases of system K. diseases of monocytic and macrophagic system belong: diseases of accumulation and histiocytoses of X. Diseases of accumulation develop owing to inborn euzymatic defect. The main manifestations often are result of accumulation by incompleteness of the catabolized fabric products in cells of monocytic and macrophagic system. These diseases quite often should be differentiated with hemoblastoses as at some of them, napr, at a disease to Gosha (see. to Gosha disease ), Nimann's diseases — Peak (see. Nimanna-Pika disease ), anemia, leykotsitopeniya, thrombocytopenia, gepato-and a splenomegaly develop.

Idiopathic histiocytoses combine the term «histiocytoses of X». Clinically these diseases are characterized by defects in bone system, some of them — an exophthalmos, increase in a liver and spleen, a limfoadenopatiya is often observed. Distinguish from histiocytoses of X Henda — Schueller — Krischena a disease (see), Letterera — Siwa a disease (see), solitary and multiple eosinophilic granuloma of bones (see).

Hemorrhagic diathesis

Quite big group of diseases of system K. make hemorrhagic diathesis (see). Distinguish separate forms which development is caused by disturbance in certain links of coagulant system of blood (see) from them. In particular, distinguish the hemorrhagic diathesis caused by insufficiency of thrombocytes. So, quantitative insufficiency is the cornerstone Werlhof's disease (see), etc., and qualitative — at the heart of Glantsmann's disease (see. Trombotsitopatiya ), etc.; are caused by insufficiency of plasma factors of coagulation hemophilia (see), angiohemophilia, or angiogemophilia (see), etc. Besides, bleeding can be result accelerated fibrinolysis (see), the disseminated intravascular coagulation, etc.

Quite often pathology in system K. it is shown in a look agranulocytosis (see). The immune conflict or influence of myelotoxic factors allowing to distinguish an immune and myelotoxic agranulocytosis can be the reason of its development. In certain cases the neutropenia is a consequence of genetically caused defects in a granulocytopoiesis (a hereditary neutropenia).

Methods of a laboratory research

One of the most widespread lab. methods of a research studying of quantitative and qualitative structure is To. These researches are applied for diagnosis, studying of dynamics patol, process, efficiency of therapy and forecasting of a disease. Implementation in practice of the unified methods a lab. researches, means and methods of quality control of the carried-out analyses, and also use gematol, and biochemical, autoanalyzers (see) provide sovr, the level of carrying out a lab. researches, succession and comparability of data of various laboratories.

Definition of indicators gemogramma (see) it is carried out, as a rule, on capillary To. Use for these purposes venous To. demands use of anticoagulants of a certain concentration (increase in this concentration causes partial disintegration of uniform elements K.). Earlier applied to capture capillary To. Franke's needle is practically not used because the use of sterile, needles scarificators disposable provides reliable prevention of serumal hepatitis. With the same purpose individual sterile pipettes are applied. The main indicators of a gemogramma should be defined during the first hours after capture To. For biochemical, analyses it is used preferential venous To., edges undertakes individual sterile needles with rather large diameter not to injure a cell To. Gemolizirovanny serum (plasma) should not be applied to the analysis since in it concentration of a number of substances owing to destruction of erythrocytes is usually overestimated, napr, free hemoglobin, plasma, potassium, iron, etc. to Take To. it is necessary for a research in the morning, on an empty stomach, since on structure To. time of day, position of a body, physical, mental, medicamentous, physiotherapeutic and other impacts influences. Storage of test for biochemical, researches in the form of integral is not recommended To., since at the same time concentration of the making substances in serum (plasma) changes. Serum (plasma) before carrying out the analysis should be stored at a temperature from 0 to +4 °. In necessary cases To. it is transported in thermal containers.

For a research of a gemogramma in a lab. to practice the probirochny method of capture is used To. Providing an exact dosage To. and the parting liquids are reached by means of use of the calibrated pipettes and dosers. There is a number of methods of definition of concentration of hemoglobin (see Gemoglobinometriya). In laboratories colorimetric methods among which the gemoglobintsianidny method using acetone cyanohydrin is recommended as unified are used. Concentration of hemoglobin is measured by photoelectrocalorimeters, devices of Federal Energy Regulatory Commission, GF-2, GF-3, gemoglobinometrama at autoanalyzers. For determination of quantity erythrocytes (see) as the parting solution isotonic solution of sodium chloride or Gayem's solution is used (mercurous chloride of 0,5 g, sodium of sulfate 5 g, sodium chloride 1 g, the water distilled — to 200 ml); Gayem's solution keeps erythrocytes better and, tinting kernels of leukocytes, allows to exclude them from calculation. For determination of quantity leukocytes (see) as the parting liquid 3 — 5% solution acetic to - you are applied. Calculation of erythrocytes, leukocytes and thrombocytes is carried out In a cytometer of Goryaev (see. cytometers ) and automatic counters — gemotsitometra (IKM-1, IKM-2, TsMK, etc.).

In gemotsitometra, except calculation of quantity of leukocytes, erythrocytes and thrombocytes, determine their average volume and the nature of distribution of cells by volume (gemotsitometriya). Use gematol, autoanalyzers K. Ryad of the indicators characterizing erythrocytes gives the chance to define to 7 parameters of a gemogramma from one test is defined by calculations. The color indicator gives an idea only of abundance of hemoglobin in one erythrocyte. For more objective assessment calculation of average content and average concentration of hemoglobin in one erythrocyte is for this purpose recommended (see. Gemogramma ). Gematokritny number (see) is defined by method of centrifuging To. in the graduated tubes, capillaries or by calculation in autoanalyzers. For coloring of smears To. for calculation leukocytic formula (see) several methods among which methods of coloring across Romanovsky — to Gimza (are the most widespread in practice see are offered. Romanovsky-Gimza method ), to Nokht, Leyshman, Mai — Gryunvaldu. Use of the main gematol is their cornerstone. dyes — methylene blue and its derivative — azur-I and II and water-soluble eosines. Coloring of a smear can be carried out also in automatic devices like «Gema-Tek», etc. The leukocytic formula is defined at light microscopy of the painted smears To. by calculation of 100 — 200 leukocytes. During the viewing of a smear To. are estimated morfol, features of cells, their extent, a form, coloring, the nature of granularity, feature of chromatinic structure of a kernel etc. The most perspective for large laboratories is the differentiated calculation of leukocytes in autoanalyzers. Quantity thrombocytes (see) is defined by method of direct calculation in automatic counters, cytometers, and also by an indirect method in the painted K. Kolichestvo's smears of reticulocytes it is counted after supravital coloring of drugs K. brilliantkrezilovy blue or azury. ROE is investigated by Panchenkov's micromethod (see. Sedimentation of erythrocytes ).

Definition of protein content and its division has important diagnostic value for identification hyper - and hypoproteinemias, dis-and paraproteinemias (see. Proteinemia ). For a research of content of crude protein in serum K. the following methods are applied: azotometrichesky — the amount of protein is established by amount of the nitrogen which is contained in it (nitrogen makes apprx. 16% of weight of protein); weight (gravimetric) — proteins besiege, dry up to constant weight and weigh on analytical scales; refraktometrichesky — amount of protein determine by the size of a corner of a refraction, or refraction (see. Refractometry ); nefelometrichesky — amount of protein determine by degree of a turbidity of the solution supporting squirrels at addition to it of certain reactants (see. Nefelometriya ); spektrofotometrichesky — are based on determination of size of absorption of an ultraviolet light with the wave band of 200 — 220 or 280 nanometers (see. Spektrofotometriya ). In a wedge, practice apply colorimetric methods (see. Colorimetry ), which are based on staining reactions of proteins (or their components — amino acids) with the corresponding reactants. As unified the biuretic method of determination of content of crude protein is recommended (see. Biuret reaction ). For a wedge, the purposes definition of protein fractions — albumine (see), α1-, α2-, β-, γ-globulins matters ((((((((((see. Globulins ) and fibrinogen (see). Several methods of definition of fractions of protein are offered: salting-out by neutral salts — ammonium sulfate, sodium and sodium phosphate; sedimentation — division of proteins into fractions ultracentrifuging; fractionation by sedimentation by various concentration of alcohol at a low temperature; The Immunoelectrophoresis (see) — is based on immunological (antigenic) properties of protein. The greatest distribution to a wedge, practice electrophoretic methods — zone paper electrophoresis, in agar, starched, polyacrylamide gel and to a lesser extent — «a free electrophoresis» received. The most perspective method is the electrophoresis on cellulose acetate, allowing to reduce considerably time of carrying out the analysis (see the Electrophoresis).

Determination of content of nonprotein nitrogenous compounds has clinical value mainly at diseases of kidneys. Nonprotein nitrogen K. (see. residual nitrogen ) includes an urea nitrogen, amino acids, creatine and creatinine, uric to - you, ammonia, bilirubin, etc. Diagnostic value has a research of each of the specified substances and total determination of content of nitrogen. The main methods of determination of content of nonprotein nitrogen are the azotometrichesky method of Kyeldal and his modification (see. Kyeldalya method ) and gipobromidny methods. In a lab. to practice apply the unified methods of determination of amount of residual nitrogen K.: after a mineralization forward reaction with Nessler's reagent (see. Nesslera reactant ) and a gipobromidny method of Rappaport — Eykhgorna (see. Rappaporta-Eykhgorna method ). For determination of content urea (see) the following methods are offered: gas-metric, gipobromidny, ksantgidrolovy, hypochlorite, enzymatic ureazny, etc. As the unified methods of determination of level of urea in To. are accepted an ureazny method on reaction about phenol-hypochlorite and an express method using indicator paper of «Ureatest». Concentration of creatinine (see. Creatine ) define by colorimetric and enzymatic methods. The method of determination of content of creatinine (Popper's method) on staining reaction of Jaffe (see Jaffe reaction) is approved as unified. Division and quantification of amino acids carry out hl. obr. by method of a chromatography of a pas to paper, on columns with ion-exchange resins (see. Chromatography ) and by means of autoanalyzers. By the main methods of definition of concentration bilirubin (see) the methods based on distribution of fractions of bilirubin in solvents are a colorimetric diazomethod, spektrofotometrichesky, hromatografichesky, and also. In a lab. to practice use the colorimetric methods of determination of level of bilirubin based on reaction Wang - den - Berg (see Wang - den - Berg reaction) among which the method of definition of bilirubin on a diazo test in the presence of an accelerator (is unified see. Endrashika — Klegkhorna — Grofa a method ), allowing to investigate the general content of bilirubin, free and related its fractions.

Determination of content of nitrogen-free organic matters. Among this group of substances the main place is taken by components of lipidic and carbohydrate metabolism. The research of indicators of lipidic exchange is especially important for diagnosis of primary and secondary dislipoproteinemiya. Assessment of this type of exchange is based on studying of the general lipids combining lipidic components of serum: triglycerides (see), cholesterol (see), phospholipids (see. Phosphatides ), lipoproteids (see), etc. Apply methods to determination of quantity of the general lipids: gravimetric, oxidizing, nefelometrichesky, the methods based on property of lipids to be painted by Sudan black, etc. Colorimetric methods among which the method of determination of content of the general lipids on reaction with a sulfofosfanilinovy reactant is unified have practical value. For definition of concentration of triglycerides there are indirect (computing), and also chemical and hromatografichesky methods. As unified the chemical method of determination of content of triglycerides on staining reaction with chromotropic to - that is accepted. The euzymatic method allowing to define directly triglycerides is considered perspective.

For a research amounts of the general cholesterol there are several methods. In a lab. to practice apply colorimetric methods among which are unified the direct method based on Libermann's reaction — Burkharda more often — a method of the Fisher (see. Fishers method ), and the method based on Zlatkis's reaction — Zac (see. Zlatkisa-Zac method ). Definition of concentration of phospholipids is carried out generally on the content of phosphorus. For a research of maintenance of lipoproteids use methods of centrifuging, fractionation, immunochemical, chemical, electrophoretic. As the unified method of determination of content of beta lipoproteids the turbidimetrichesky method is approved (see. Nefelometriya ).

Research of indicators of carbohydrate metabolism it is applied to identification hypo - and hyper glycemic conditions of various origin. The most important component of carbohydrate metabolism is glucose, for a research of contents the cut exists considerable number of methods. The main are reduktometrichesky, enzymatic also the methods based on condensation of glucose with these or those connections. The unified methods of definition of concentration of glucose are: colorimetric — on staining reaction with orthotoluidine; reduktometricheskiya — a titrimetric (ferritsianidny) method of Hagedorn — Janszen (see. Carbohydrates, methods of definition ) and the most perspective euzymatic glyukozooksidazny method (see. Gorodetsky methods ).

Determination of content of hormones. Content of hormones in To. is defined for assessment funkts, conditions of closed glands. Chemical methods of a research of hormones and their metabolites were earlier widely used. Belong to number of perspective the radio immunological method differing in high sensitivity and specificity (see. Hormones ). It is applied during the studying of proteinaceous and peptide hormones, a part of steroid hormones. A research in To. corticosteroids (see) it is widely applied in a wedge, diagnosis. Determination of content in is important To. a hydrocortisone (see) and corticosterone (see). For definition of concentration of the general corticosteroids in plasma use various methods: colorimetric, flyuorimetrichesky, polyarografichesky, radio isotope, euzymatic, hromatografichesky, etc. Assessment of glucocorticoid function of bark of adrenal glands can be carried out by means of the recommended unified methods of definition in plasma of level 17 oxycorticosteroids (see) in plasma on reaction with phenylhydrazine and 11 oxycorticosteroids on their fluorescence in a sulfur-alcohol reactant.

Definition of activity of enzymes in serum K. has diagnostic value, especially at diseases of a liver, cardiovascular system, hemolitic anemias etc. About quantity enzymes (see) judge by their activity, i.e. by the action made by them. Activity of enzyme is considered or on the speed of accumulation of products of this enzymatic reaction, or on the speed of disappearance (decrease) of substrate. It is recommended to determine activity of enzymes by initial velocity of reaction since at this time there is an excess of substrate, reaction products forms a little, and enzyme does not manage to collapse partially yet. Enzymatic reaction can be carried out at t ° 25 — 40 °. For definition of activity of enzymes a number of methods is offered. In a lab. to practice use colorimetric and spectrophotometric methods more often. Measurement by means of the photoelectrocolorimeter of the painted substance which is formed at interaction of substrate or a product of effect of enzyme with the specific reactants added to test, as a rule, after a stop of enzymatic reaction is the cornerstone of colorimetric methods. Spectrophotometric methods are based on determination of size of absorption in visible or UF-parts of the light spectrum passing through solutions of substrates or reaction products of various enzymes. Most in practice the unified methods of definition in serum of activity of enzymes were widely used: aspartate - and alaninaminotranspherases (see. Aminotransferases ) by a dinitrofenilgidrazinovy method (see. Raytmana-Frenkel method ); lactate dehydrogenases (see) on reaction with 2-4 dinitrophenylhydrazine (Svell's reaction — Tovareka); cholinesterases (see) a colorimetric method on hydrolysis of an atsetilkholinkhlorid and express method using indicator paper; alpha amylases (see Amylases) an amiloklastichesky method with resistant starched substrate (Karavey's method), etc. Methods of kinetic measurement of the general activity of enzymes, and also methods of definition of activity of fractions of a number of enzymes are perspective — isoenzymes (see).

Determination of content of vitamins. In a wedge, practice studying of indicators of exchange of vitamins, especially in cases of a vitamin deficiency is important, edges can be the cause of development of disturbance of exchange processes in an organism. For these purposes definition of concentration of the corresponding vitamins is carried out (see. Vitamin deficiency , Vitamins and articles devoted to separate vitamins, e.g. Ascorbic acid , Cyanocobalamine etc.).

Determination of content of mineral substances. In the diagnostic purposes the research of electrolytes in is especially important To. (serum, plasma, erythrocytes). The main methods of definition of electrolytes are chemical, the flame photometry and a spektrofotometriya, X-ray spectroscopy, electrometric definition, etc. By the unified method of definition in serum (plasma) of contents potassium (see) and sodium (see) the method flame is accepted photometry (see). As the unified methods of definition in serum (plasma) of quantity magnesium (see) the method based on staining reaction with titanic yellow or with magony is offered. For the purpose of definition in serum K. concentration of the general calcium (see) methods of flame photometry, the atomic and adsorptive electrophotometry, titirimetric, flyuorimetrichesky and other methods are used. Colorimetric methods among which methods with use of a krezolftaleinkomplekson are most widespread are often applied. Also the method of determination of content of the general calcium on staining reaction about glyoxal - an encore - 2-oksianilom is known. For quantitative determination of content in To. inorganic phosphorus (see) several methods from which colorimetric are most often applied are offered. A method of definition of concentration of inorganic phosphorus in serum for recovery phosphatomolybdic to - you are approved as unified. Research of content in serum K. gland (see) is important especially at anemias of various origin. Determination of level of serumal iron is based on release it from a proteinaceous complex, sedimentation of protein and the subsequent staining reaction of iron with one of the reactants giving staining reaction. Among many methods offered for determination of amount of iron in serum as the most exact are considered ortofenantrolinovy, pyridsilt, batofenantrolinovy, etc. The method of determination of content of iron in serum on staining reaction with batofenantroliny is unified. In some cases the wedge, matters definition in To. contents mercury (see), copper (see) and other elements.

Definition of a functional condition of coagulant system. Assessment funkts, conditions of coagulant system K. it is carried out by definition of activity of factors of coagulation (plasma and platelet), the factors which are slowing down fibrillation (anticoagulants, inhibitors) and also factors of a fibrinolysis (plasma and fabric). For definition of activity of the specified factors numerous methods of researches are offered. In a wedge, practice the unified methods of a research of coagulant system of blood (see) and a fibrinolysis are widely used (see): definition of time of coagulation To., recalcifications of plasma, tolerance of plasma to heparin, thrombin (tromboplastinovy) time, content of fibrinogen and fibrinogen B in plasma, factors of VIII, IX, XIII, fibrinolitic activities. For a general characteristic of a condition of coagulant and anticoagulative systems K. it is applied tromboelastografiya (see) and other methods (see. Koagulogramma ). Graphic registration of dynamics of coagulation To. (tromboelastogramma) is carried out by a trom-boelastograf, the principle of action to-rogo is based on measurement of viscosity To., changing in the course of coagulation.

Receiving uniform elements of blood for biochemical researches

Cells can be separated from plasma by free sedimentation, centrifuging or ultrafiltration. For allocation of separate types of cells their selective deposition, differential centrifuging, centrifuging in solutions of a certain density, adsorption on krupnoporisty carriers (cotton wool, fiber glass etc.) and svobodnoprotochny is used electrophoresis (see). Subcellular structures (membranes, kernels, mitochondrions, etc.) can be allocated during the use of the called methods after preliminary destruction of cells with hemolysis, by means of ultrasound, temperature influence.

Morphological methods of a research of blood cells (light, luminescent, phase-contrast microscopy). Light microscopy (see. Microscopic methods of a research ) in a combination to special coloring allows to investigate morfofunktsionalny properties of cells To. At luminescent microscopy (see) observation of the shining object against a dark background is possible. Primary luminescence of an object, as well as a luminescence of flyuorokhromirovanny drug (a secondary luminescence), occurs under the influence of UV rays or a blue-violet part of a visible range: an object begins to shine, lets out light with a bigger length of waves. Own UF-fluorescence of the majority of cells is limited to a soft luminescence of cytoplasm at rather weak luminescence of a kernel. Myeloid cells fluoresce most brightly, but in process of a differentiation their luminescence decreases. Poorly elements of a red row fluoresce, mature erythrocytes do not shine. Secondary fluorescence of cells To. it is studied by means of a vital flyuorokhromirovaniye by acridine orange, a supravital flyuorokhromirovaniye and a flyuorokhromirovaniye of the fixed drugs. In flyuorokhromirovanny drugs the differentiation of uniform elements K is possible., calculation of leukocytes and thrombocytes, definition of osmotic firmness of leukocytes and viability of leukocytes. Some special types of coloring allow to define such inclusions as basphilic stippling of erythrocytes, to make calculation of number of thrombocytes, reticulocytes, siderocytes (if they appear). With the help fazovokontrastny microscopy (see) investigate live low-contrast objects in an uncolored look. The principle consists in the artificial shift of phases of fluctuations of light waves with formation of new fluctuations with a bigger amplitude for increase in contrast of the image. At phase-contrast microscopy of cells differentiation of cells and calculation in fresh drugs of number of reticulocytes, thrombocytes are possible.

The electronic and scanning microscopy. Transmission electron microscopy (see) allows to study fine structure of cells. For a submicroscopy of cells To. apply a method of double fixing. Primary material place in 2,5% solution of a glutaraldegid in the phosphatic pH 7,2 buffer within one hour, wash out in solution of the phosphatic pH 7,2 buffer twice. In addition fixing is carried out to 1% solution of osmium tetroxide on the main buffer. Scanning electron microscopy allows to study superficial very tectonics of cells To. and their percentage ratio. For scanning electron microscopy as well as for transmission, material is fixed glutaraldegidy and osmium. Then after dehydration twice in 95 — 96% alcohol material is applied with a thin coat on copper or brass plates, dried up on air, napylyat gold and looked through in the scanning microscope.

Cytochemical blood analyses are based generally on a visual estimate of specific staining reactions. Contents and activity of the chemical connections revealed in cells To., decides, as a rule, by calculation of percent of cells on positive reaction. For the research of activity of cytochemical compounds in a cell demanding high precision quantitative definition of these substances by means of cytospectrophotometers is carried out (see. Cytophotometry ).

Tsitospektrofotometriya consists in identification of quantity and localization of chemical components in cells on change of size of light absorption with a certain wavelength. Content nucleinic to - t in leukocytes can be determined by a fotometrirovaniye of instained preparations of an ultra-violet spectral range at the wavelength of 260 nanometers after extraction of DNA or RNA. At photometry of RNA or DNA can be defined in the visible range of a range: DNA — during the coloring of smears on Feylgena, RNA — during the coloring by the main dyes and a reactant gallocyanine - chrome alum. Apply coloring to definition of histones green strong at pH 8,2. For definition of negistonovy proteins, globulins and lipoproteids the photometry in an ultra-violet spectral range at the wavelength of 280 nanometers is carried out, and also in the visible range during the coloring green strong at pH 1,2 and naftolovy yellow S. For identification of carbohydrates use CHIC reaction, defining the formed painted product by means of photometry of the visible range of a range. Apply specific extraction of the studied substances to control. The hemoglobin content in erythrocytes can be defined by cytophotometry of instained preparations in the range of lengths of waves of 404 — 415 nanometers corresponding to a maximum of absorption for gem. Advantage of microcytospectrophotometric methods before biochemical is that it is possible not only to receive total result for cells of a certain type, but also to estimate localization and content of substances in each cell separately.

Cellular electrophoresis. On a superficial cell membrane there is a mosaic of charges at the expense of cationic and anion groups which ratio defines the general electric charge. Electric charge and electrophoretic mobility are in directly proportional dependence. Therefore, using an analytical cellular electrophoresis, it is possible to receive quantitative assessment of size of surface-bound charge on electrophoretic mobility of a cell. Definition of electrophoretic mobility gives the chance to obtain indirect information about some physical. - chemical features of a superficial cell membrane and more fully to characterize it funkts, full value. It is established that electric surface-bound charge of cells To. it is negative and does not depend neither from group, nor from a Rhesus factor accessory, nor on a floor. Electrophoretic mobility of cells To. is a constant and it is characterized by small dispersion of mobility at measurement of the same cells. Among cells peripheral To. the greatest electrophoretic mobility erythrocytes have, the smallest — neutrophils. Lymphocytes are intermediate.

Tracer techniques of a research are used for assessment of life expectancy (time of circulation) of cells peripheral To., and also for identification of some parties of intracellular exchange. For a total tag of all cells To. or separately each cellular fraction with its preliminary allocation apply 51 Cr, FP diisopropyl-flyurofosfat D, 32 P, 3 H, 14 C. Besides, for a tag of thrombocytes use 35 S, Se-methionine, a 59 Nadstrochny text Fe for a tag of erythrocytes of in vivo through its inclusion in synthesis of hemoglobin of erythroidal predecessors. Various antigenic serums, marked 125 I, apply to definition of antigens on a surface of erythrocytes. Registration of a tag depending on a type of radiation (a beta, scale) can be carried out by means of the radiometric equipment (see. Radio isotope diagnosis ) and method autoradiography (see).

Wide recognition was gained also by a method of a preparative electrophoresis in a free stream which is based on combined action of homogeneous electric field and gravity. The preparative electrophoresis allows to divide depending on the size of a charge suspension of cells into various fractions.

The holography is used for size discrimination and a form of cells To. (see. Holography , Eritrotsitometriya ).

Immunological methods of a research give the chance to reveal existence of antibodies to these or those cells To., to define a ratio of T and V of populations of lymphocytes (see. Immunoglobulins , Immunocompetent cells , Lymphocytes ).

Blood preparations

How to lay down. means To. it is applied in an integral look, in the form of components (see. Leykokontsentrat , Trombotsitnaya weight , Eritrotsitnaya weight ) and drugs. Liquid part K. — plasma (see. Blood plasma ) it can independently be applied how to lay down. drug; at division (fractionation) of the proteins which are contained in it receive separate drugs (tab. 9). Drugs of plasma and its proteins render generally complex, immunological active and haemo static action.

Plasma and various solutions of albumine belong to drugs of complex action. These drugs at the same time have a hemodynamic, antishock and all-promoting effect; they are applied also to parenteral proteinaceous food.

Plasma K. it is used in native liquid, frozen, the lyophilic dried-up and concentrated look. Transfusions of plasma are followed by increase in the weight circulating To., speeds of a blood-groove and normalization of hemodynamic indicators. As the indication to its use serve also gipoproteinemichesky states. The Svezhezagotovlenny native and frozen plasma is effective for a stop of bleeding; dry plasma, especially long terms of storage, considerably loses haemo static properties. The concentrate of native plasma received after department of cryoprecipitate possesses more expressed to lay down. action due to increase in specific protein content.

Solutions of albumine release in various countries in 5, 10, 20 and 25% of concentration, enter intravenously. Along with the purified albumine widely use the drugs containing also 15 — 20% alpha and beta globulins. Such drug is the protein known abroad under the name «the stable pasteurized solution of proteins of plasma». Thanks to introduction of stabilizers solutions of albumine maintain the pasteurization inactivating a virus of hepatitis.

Use of albumine is shown at different types of shock — traumatic, operational, burn, at hypostases and disturbances of proteinaceous structure To. The concentrated solutions of albumine are recommended at the injuries of a skull which are followed by wet brain at cardiovascular pathology when the volume of the liquid entered into an organism shall be limited. It is reasonable to apply the drugs of albumine consisting of protein of 5% of concentration at extensive blood loss to bystry normalization of the ABP. At massive bleedings administration of albumine should be combined with transfusions To. (see. Albumine, albumine as blood preparation ).

New drug of complex action — the February representing a complex of albumine with iron is developed. The drug is administered intravenously, it is effective at treatment of the iron deficiency anemia which is especially followed by a hypoproteinemia.

Group of the immunological drugs having specific activity against inf. diseases, make immunoglobulins (see), the plasmas emitted at fractionation. In practice gamma-globulin is most widely applied. High to lay down. effect immune drugs of the specific directed action against whooping cough, smallpox, tetanus, staphylococcus, immunoglobulin an anti-Rhesus factor, etc. have. Methods of receiving immunoglobulins against other infections, and also the combined drugs are developed.

The drugs of immunoglobulins are administered intramusculary. A part of protein at the same time is split by fabric proteases, the rassasyvaniye in the place of an injection occurs slowly that reduces efficiency of action. In this regard particularly important researches on creation of immunoglobulin for intravenous use become. The possibility of intravenous administration of 25 — 50 ml of 5% of solution of immunoglobulin considerably will increase efficiency it at prevention and therapy of a number of diseases.

The plasma separated from To belongs to haemo static drugs. during the first hours after its capture from the donor. Such plasma contains a complex of coagulant factors, including a factor of VIII — anti-hemophilic globulin (AGG), and can be applied to prevention and a stop of bleedings at hemophilia. In the AGG native plasma it is unstable and in 24 hours practically loses activity. Freezing and lyophilic drying of the plasma containing AGG prolongs its safety.

Broad application was found by cryoprecipitate which is emitted in the form of a deposit during the thawing and centrifuging of freshly frozen plasma. Depending on initial activity of plasma cryoprecipitate contains up to 200 activity units of AGG, at drug there are also a fibrinogen, a fibrinstabiliziruyushchy factor of XIII, dashes of other factors of coagulation. Cryoprecipitate is produced in plastikatny bags or in bottles in the frozen or dried up look. Also concentrates of the cleared AGG with activity to 900 units are made. To lay down. efficiency of such drugs considerably increases, side effect of impurity of other proteins decreases.

For treatment of a Cristmas disease, or Kristmas's disease (deficit of a factor of coagulation of IX), the drug of a complex of factors II, VII, IX and X called by a prothrombin complex is developed. Its use is shown at the bleedings caused by anticoagulating therapy at the diseases of a liver which are followed by disturbance of synthesis of factors of this complex. In these cases introduction of a concentrate of native plasma is also effective (see. Hemophilia , methods of preparation of anti-hemophilic drugs).

Fibrinogen (see), allocated at initial stages of fractionation of plasma, it is shown as specific therapy at the bleedings caused by deficit of fibrinogen. Hypo - and an afibrinogenemiya in most cases are followed by insufficiency of other factors of coagulation To., therefore use of fibrinogen is reasonable in combination with other haemo static drugs or in the form of one of components of such drugs.

In addition to the listed drugs administered intravenously there are hemostatics applied locally to a stop of the outside bleedings or hemorrhages arising at operative measures. Treat them thrombin (see), a fibrinny film (see. Medicinal films ) and an absorbable gelatin sponge (see. Fibrinnaya sponge ), biological antiseptic tampon, etc.

The main effective agent of these means is the thrombin causing formation of a clot as a result of transformation of fibrinogen K. in fibrin which closes a gleam of vessels in the place of bleeding. Use of drugs for a hemostasis on a blemished surface of parenchymatous bodies is especially effective.

Fibrinny films and sponges owing to the mechanical characteristics are effective not only for a stop of bleeding, but also as plastic material. These properties of drugs provide positive effect at treatment of a burn disease, a covering of deserozirovanny surfaces of loops of intestines. In neurosurgical practice fibrinny films with success apply to substitution of defect of a firm meninx. At the same time fibrinny films from isogenic material have advantages before the films made of plasma K. cattle. Isogenic films can be left during operation in an organism of the patient that is impossible at use of heterogeneous drug because of threat of a sensitization of an organism of a foreign protein.

Except described, there is a number of the drugs possessing an antianemic and promoting effect. It is possible to carry to this group erigy and nonspecific biostimulators — the sterilized serum F and Polybiolinum.

Medicolegal research

Research K. is of great importance at investigation of crimes. In research problems To. establishment of existence enters To., its specific, group, sexual and age accessory, a regional origin To., prescription and the mechanism of formation of its traces, changes To. at some poisonings, the solution of questions of a doubtful paternity, motherhood and replacement of children.

Fig. 1. Ranges of blood: 1 — oxyhemoglobin, 2 — the recovered hemoglobin, 3 — carboxyhaemoglobin, 4 — a methemoglobin, 5 — hematin in caustic solution, 6 — hemochromogen, 7 — haematoporphyrin in acid solution; dark strips with a clear boundary in a range — strips of light absorption by hemoglobin and its derivatives.

For detection To. some approximate preliminary methods — test with hydrogen peroxide, with benzidine can be applied (see. the Benzidine test ), a research in ultraviolet rays, etc. Existence is proved To. by detection of uniform elements (in liquid To.), hemoglobin (see) or its derivatives. Hemoglobin can be found by method of a spectral analysis (see. Microspectral analysis ) and microcrystallic reactions (see. Mikrokristalloskopiya ). The spectral research is based on ability of solutions of hemoglobin K. and its connections to absorb waves of light of a certain length and to give characteristic strips of absorption in a range (tsvetn. fig. 1).

Spectral research K. it is made by means of a spectroscope of direct vision, a microspectroscope and spektrofotometrichesky, method. For a spectral research from a spot the extract, in a cut hemoglobin prepares under. influence of the corresponding reactants usually turns in hemochromogen (see) or haematoporphyrin (see. Gematoporfirinovaya test ), the giving absorption spectrums, characteristic of them. Thanks to strict specificity and high sensitivity the spectral method allows to prove existence To. in a spot.

Fig. 2. Crystals of muriatic hemin (1), crystals of hemochromogen (2).

Method of receiving microcrystals — muriatic hemin and hemochromogen (tsvetn. fig. 2, 1 and 2) — considerably concedes spectral on the sensitivity. Loss of crystals is interfered by strong drying and rotting To., various impurity. Therefore the negative take of reactions is not the proof of absence To. Loss of characteristic crystals allows to claim authentically about existence To.

For establishment of specific accessory To. reaction is applied: Chistovich's precipitations (see. Precipitation ). It is made in test tubes with the thin ends in which place extracts from the studied spots To., and then a pipette on a bottom of test tubes enter specific on protein of the person and certain animals of serum. If in an extract from a spot is available To. the person, on border of contact of serum, specific on protein of the person, and an extract the ring of precipitation is formed. As control serve researches with serums on protein of certain animals which do not give precipitation with To. person. It is possible to establish by a similar method To. certain animals. If the extract from a spot muddy, then is better to carry out a precipitation test in an agar, in Krom several «openings» become. In the central opening the extract from a spot, and in peripheral — specific precipitant serums is located. Due to diffusion in an agar there is a meeting of an extract and serums. If they are homologous, then precipitated calcium superphosphate in the form of a strip of a whitish look is formed. Such reaction in an agar proceeds within 2 — 3 days. It can be accelerated up to 15 — 20 min. by carrying out in electric field (a method of electroprecipitation). Definition of specific accessory To. it can be made also by methods immunofluorescence (see) and emission spectral analysis.

For difference To. individuals features of erythrocytes, plasma proteins and enzymes are used immunol. First of all the research of groups K is made. (AB0 system). If it is impossible to differentiate To. individuals on troupes (them To. treats one troupe), resort to a research of other erythrocyte systems. Antigens of erythrocyte systems in spots To. usually are defined by methods of absorption in quantitative modification, absorption elution and method of the mixed agglutination (see Blood groups).

For differentiation To. people not only erythrocyte, but also serumal systems are used (see. Serumal systems of blood ). Proteins — gaptoglobin, the gamma-globulin and lipoproteids having descendible features (groups) concern them. Besides, To. people differs on enzymes which contain in erythrocytes and serum. From enzymes for differentiation To. in spots acid phosphatase, phosphoglucomutase of erythrocytes, serumal cholinesterase, etc. have the greatest value. Group properties of each system are not connected with features of other system that allows to use them for an exception of accessory To. to a certain person.

A sexual differentiation To. it is made by detection of distinctions in a structure of kernels of segmentoyaderny leukocytes (see. Sex chromatin ). Existence in a large number in kernels of leukocytes of the outgrowths reminding a drum stick, a racket in a form is peculiar To. women. V K. there are no men of such educations or they are available in a small amount. Accessory To. the man can establish by method of luminescent microscopy, having found a Y-chromosome in kernels of leukocytes.

Accessory of a spot To. the pregnant woman can establish by injection to infantile white rats of an extract from a spot. Positive reaction (a spout at rats) can be if To. the woman possesses with duration of gestation not less than 6 weeks provided that the spot was prescription not of St. 3 months.

Difference To. newborns from To. adults in spots it is based on bigger alkalis resistance of hemoglobin of newborns in comparison with hemoglobin of adults. About it it is possible to judge by discoloration To. after addition to it of alkali or on change of absorption spectrums.

Definition of a regional origin To. it is made by detection in it additional inclusions. E.g., in spots To. a menstrual origin there can be cells of an epithelium of a mucous membrane of a uterus, a hemorrhoidal origin — a particle a calla etc.

Prescription of traces To. establish by detection of silver chlorides in it at immersion of a spot To. in 1% solution of caustic silver. However this method is not absolutely reliable as treatment of a spot chlorides depends not only on the term which passed from the moment of formation of a spot but also on various external influences.

Fig. 3. Preliminary assays on carboxyhaemoglobin: 1 — to Goppa — Zeylera, 2 — Liebman, 3 — Zalessky; And — the drops of blood containing carboxyhaemoglobin, B — drops of normal blood; an upper row — prior to a research, the lower row — after addition of a reactant: coloring of the drops of blood containing carboxyhaemoglobin does not change, decolourization of drops of normal blood is expressed.
Fig. 4. Test with a tannin: at the left — blood with carboxyhaemoglobin; on the right — control (normal blood at reaction with a tannin).

Identification in To. carboxyhaemoglobin and a methemoglobin it is made in cases of suspicion of poisoning with carbon monoxide, potassium chloride, nitrites, etc. Carboxyhaemoglobin is defined spectral and chemical researches. The range of carboxyhaemoglobin is similar to a range of oxyhemoglobin (two strips of absorption in a flavovirent part of a range). For differentiation the reducer (hydrosodium sulfate, ammonium polysulphide) increases. In the presence of carboxyhaemoglobin addition of a reducer does not cause change of a range while in control there is a formation of a range of the recovered hemoglobin (one wide strip in a flavovirent part of a range). Chemical definition of carboxyhaemoglobin is based on preservation in the presence of poisoning of bright red coloring To. after addition of alkali to it (Goppe-Zeyler's test), formaldehyde (Liebman's test), solution of cuprous sulfate (Zalessky's test), a tannin, from which normal To. changes the coloring (tsvetn. fig. 3 and 4).

The methemoglobin is defined at a spectral research or is translated in tsianmetgemoglobin or ftormetgemoglobin which ranges are better distinguishable (see. Methemoglobinemia ).

In size and a form of traces To. it is possible to judge the mechanism of their education and certain circumstances of incident. Traces To. it is possible to divide into the following types:

1) spots from falling of drops To. on the horizontal plane; on degree of a crenation of edges of drops establish height of falling;

2) spots from splashes or from falling of drops To. to the inclined plane, the getting forms of an exclamation mark, the narrow end to-rogo it is directed towards falling of a drop;

3) begin to flow, formed at hit and plaint To. on a vertical surface; 4) the blots and smears arising at a wipe of traces To. rag, towel etc.;

5) traces To. in the form of fingerprints, soles and other objects;

6) the spots impregnating various objects;

7) pools To., testimonial of big bleeding shortly before survey;

8) «zamyvny waters», i.e. traces To. in water and other liquids, to-rymi To. it was washed away.

Determination of quantity streamed To. on the traces formed by it on material evidences (see) it is made on a solid residue To. with its subsequent recalculation on liquid To. A solid residue To. define by comparison of weight of the site of a subject with traces To. with the site of a subject, identical on the area, without traces To. or by extraction dry To. from a spot caustic solutions.

The origin of the child from certain parents in cases of a doubtful paternity, disputable motherhood and replacement of children is established by a research K. on the basis of laws of genetics (see. Motherhood disputable , doubtful paternity ). Group signs of erythrocyte, serumal, leukocytic systems and enzymes are descended by certain rules, and on the basis of their research establish a possibility of an origin of the child from certain parents. Examination To. allows to exclude only paternity (motherhood, replacement of children), but does not establish them.

See also Hemopoiesis .

Tables

Table 1. SOME INDICATORS of GEMOGRAMMA VZROSLY (according to V. V. Sokolov and I. A. Gribov)

Table 2. MORPHOLOGICAL CHARACTERISTIC of SOME FORMS of ERYTHROCYTES

Table 3. The MAIN BIOCHEMICAL INDICATORS of BLOOD AT ADULTS (indicative data on materials of a number of authors)

Notes:

  • Content of diphosphoglyceric acid in erythrocytes

is expected also in micromoths 1 g of Hb; normal it makes 12 — &15nbsp; &mkmolnbsp; on 1 g of Hb.

  • The maintenance of a histamine in basphilic leukocytes is expected

in nanograms 1000 cells; normal it makes 1 — 3 &ng/1000nbsp; cells.

    • Content of serotonin in thrombocytes is calculated in

nanograms on &109nbsp; thrombocytes; normal it makes 3 0 0 — 700 mg / &109nbsp; thrombocytes.


Table 4. ACTIVITY of SOME ENZYMES of PLASMA AT ADULTS

Table 5. ASSESSMENT ON GENETIC MARKERS of BLOOD of GENETIC IDENTITY of TWO ACCIDENTALLY CHOSEN PERSONS FROM the WESTERN EUROPEAN POPULATION [E. R. Giblett, 1969]

Table 6. GEMOGRAMMA REBENKA (according to A. F. to a tour)


Table 7. The MAIN BIOCHEMICAL INDICATORS of BLOOD AT CHILDREN (indicative data on materials of a number of authors)

  • 1 Pascal (Pa) = 7,5 • 10 - 3   &mmnbsp; hg; 1 kPa =

&7,5nbsp; &mmnbsp; hg; &1nbsp; &mmnbsp; hg = 0,133 kPa.

  • Calculation of hemoglobin &vnbsp; &mmolyakhnbsp; gland on &1nbsp; &lnbsp; (coefficient

of recalculation 0,622). *,


Table 8. ACTIVITY of SOME ENZYMES of BLOOD AT CHILDREN (indicative data on materials of a number of authors)

Table 9. KLINIKO-FARMAKOLOGIChESKAYa CHARACTERISTIC of the MAIN BLOOD PREPARATIONS

Bibliography:

Physical and chemical properties, biochemistry and physiology — Bergelson L. D. Ultrastructure of biological membranes, Zhurn. Vsesoyuz, chemical about-va, t. 20, No. 3, page 322, 1975, bibliogr.; And yes to L. I. Haemo globins and their properties, M., 1975, bibliogr.; G. I. knee sprung, Borzov L. V. and R. A Drawing table. Surface-bound charge of blood cells and some aspects of its biological role, Laborat, business, No. 5, page 284, 1975; Kudryashov B. A. Biological problems of regulation of liquid state of blood and its coagulation, M., 1975, bibliogr.; L and-kink. M imakarovv. A. Influence of prostaglandins on system of blood, in book: Prostaglandins, under the editorship of. I. S. Azhgikhi-na, page 84, M., 1978, bibliogr.; M and r about A. I. sh-nicknames, etc. Division of cellular suspensions, M., 1977, bibliogr.; With e r-geevp. Century, to the Safe of l of la of R. D. imay-with to and y A. I. Physical and chemical mechanisms and hormonal regulation of a blood coagulation, M., 1974, bibliogr.; H and - e in with to and y A. L. Electric and magnetic properties of erythrocytes, Kiev, 1973; Advances in clinical chemistry, v. 1—17, N. Y. — L., 1958 — 1975; Blood and its disorders, ed. by R. M. Hardi-sty a. D. J. Weatherall, Oxford, 1974; Bunn H. F., Forget B. G. a. R a n-n e at H. M. Human hemoglobins, Philadelphia, 1977, bibliogr.; Dintenfass L. Rheology of blood in diagnostic and preventive medicine, L., 1976; H i t z i g W. H. Plasmaproteine, Pathophysiologie und Klinik, B. — N. Y., 1977; Structure and function of plasma proteins, ed. by A. Page of Allison, v. 1—2, L. — N. Y., 1974 — 1976, bibliogr.; V i lcu A. Eritrocitul, morfologie, fiziologie, fiziopatologie, Bucure§ti, 1977, bibliogr.

Morphology and functions of uniform elements — Butenko 3. And., etc. Cytochemistry and submicroscopy of blood cells and hemopoietic bodies, Kiev, 1974, bibliogr.; M about with I and N of an E. N, etc. Kinetics of uniform elements of blood, M., 1976, bibliogr.; A normal hemopoiesis and its regulation, under the editorship of N. A. Fedorov, M., 1976; Terentyeva E. I. ishishkanovaz. G. Atlas of ultrastructure of cells of the hemopoietic fabric, M., 1972, bibliogr.; Fedorov N. A. Regulation of proliferation of the hemopoietic cells, M., 1977, bibliogr.; Bessi s M. Living blood cells and their ultrastructure, V. a. o., 1973; S t o b b e H. Hamatologischer Atlas, B., 1970; T a n a-k a Y. ampere-second of o o d m a n J. R. Electron microscopy of human blood cells, N. Y., 1972.

Genetic markers — Bochkov H. P. Genetika of the person, M., 1978; T about-karev Yu. N. idr. Value of some genetic markers in identification of heterozygous carriers of a gene of hemophilia And, Probl, gematol, and a modulation, blood, t. 22, No. 4, page 8, 1977, bibliogr.; Harris G. Fundamentals of biochemical genetics of the person, the lane with English, M., 1973, bibliogr.; Stern K. Fundamentals of genetics of the person, the lane with English, M., 1965; With i b 1 e t t E. R. Genetic markers in human blood, Oxford — Edinburgh, 1969; Harris H. Enzyme polymorphisms in man, Proc. roy. Soc. B, v. 164, p. 298, 1966; Lewontin R. C. An estimate of average heterozygosity in man, Amer. J. hum. Genet., v. 19, p.681, 1967; Mourant A. E., K o p e of 6 A. S. Domaniewska-Sobezak K. The distribution of the human blood groups and other polymorphisms, L., 1976.

Features of blood at children — Hematology of children's age with the atlas of miyelo-grams, under the editorship of B. Ya. Reznik, Kiev, 1974; Kislyak N. S. and Lensk R. V. Blood cells at children are normal also of pathology, M., 1978; T at r A. F. and Sh and and l about in N. P. Krov of healthy children of different age, M., 1970, bibliogr.; Bessis M. Cellules du sang, normal et pathologique, P., 1972; Hematology of infancy and childhood, ed. by D. G. Nathan a. F. A. Oski, Philadelphia, 1974.

Diseases of system of blood — In about r about-e in A. I. and B r and l of l and and N of t M. D. Patogenez and therapy of leukoses, M., 1976, bibliogr.; And d e of l with about L. I. N, D and d to about Sunday to and y N. A. and Ermilchenkog. B. Hemolitic anemias, M., 1975, bibliogr.; Kassirsky I. A. and Alekseev G. A. Clinical hematology, M., 1970; New in hematology, under the editorship of A. I. Vorobyova and Yu. I. Loriye, M., 1974; Feinstein F. E. Aplastic and hypoplastic anemias, M., 1965, bibliogr.; Feinstein F. E. idr. Chronic lymphoid leukosis, Tbilisi, 1976; With h and-narin I. and. the lake of Blood and its diseases, Edinburgh — N. Y., 1976, bibliogr.; W i n-t r o b e M. M. Clinical hematology, Philadelphia, 1974.

Methods of a laboratory research — Balakhovsky S. D. and B and l and x about Sunday to and y I. S. Methods of chemical analysis of blood, M., 1953; Biochemical methods of a research in clinic, under the editorship of A. A. Pokrovsky, M., 1969; Mosquitoes F. I., Korovkin B. F. and Menshikov B. B. Biochemical researches in clinic, L., 1976, bibliogr.; The guide to clinical laboratory trials, under the editorship of E. A. Kost and L. G. Smirnova, M., 1964; The Reference book on clinical laboratory methods of a research, under the editorship of E. A. Kost, page 5, M., 1975; The Reference book on functional diagnosis, under the editorship of I. A. Kassirsky, page 304, M., 1970; Todorov Y. Clinical laboratory trials in pediatrics, the lane with bolg., Sofia, 1968; Fundamentals of clinical chemistry, ed. by N. W. Tietz, Philadelphia, 1977; Harper H. A. Review of physiological chemistry, Los Altos, 1975; Lynch M. J. a. Raphael S. S. Lynch’s medical laboratory technology, v.2, Philadelphia, 1976.

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I. S. Balakhovsky (biochemical), B. of H. Borisov, B. of E. Movshev, H. A. Fedorov, H. A. Fedorov (biophysical.), A. P. Gromov (court.), N. V. Demidov, G. I. Kozinets (mt. issl.), G. I. Kozinets, E. I. Terentyeva (morphology), E. To M. Krepa (physical.), L. A. Makhonova (ped.), V. M. Rusanov (blood preparations), Yu. N. Tokarev (gen.), M. A. Umnova (of), F. E. Feinstein (gems.). Authors of the tab.: A. A. Ananenko, Yu. E. Veltishchev, Yu. A. Knyazev, G. I. Lesina (tab. 7 and 8), A. V. Mazurin (tab. 6).

Яндекс.Метрика