1. The Cardiovascular System: Blood11
The Cardiovascular System: Blood

2. Chapter 11 Learning Outcomes
11-1: Describe the components and major functions of blood, and list the physical characteristics of blood.
11-2:Describe the composition and functions of plasma.
11-3:List the characteristics and functions of red blood cells, describe the structure and function of hemoglobin, indicate how red blood cell components are recycled, and explain erythropoiesis.
11-4:Discuss the factors that determine a person's blood type, and explain why blood typing is important.
11-5:Categorize the various white blood cells on the basis of their structures and functions, and discuss the factors that regulate their production.
11-6:Describe the structure, function, and production of platelets.
11-7:Describe the mechanisms that control blood loss after an injury.
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3. 3 Parts of Life of a Platelet
Once upon a time... Life - The blood (1 of 3)
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4. Introduction to the Cardiovascular System (Introduction)
Includes heart, blood vessels, and blood
Major transportation system for:
Substances we need from the external environment
Substances we need to eliminate through wastes
Substances we synthesize that need delivery to other organs
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5. Functions of Blood (11-1)
Transports dissolved gases, nutrients, hormones, and metabolic wastes
Regulates pH and ion makeup of interstitial fluids
Restricts fluid loss at injury sites
Defends against toxins and pathogens
Stabilizes body temperature
What is blood ?
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6. Composition of Blood (11-1)
A liquid connective tissue made of plasma and formed elements (blood cells and cell fragments)
Temperature is 38oC, a little above body temperature
Blood is five times more viscous than water
Viscosity refers to thickness, stickiness
Caused by plasma proteins, formed elements
pH is slightly alkaline in a range of 7.35–7.45
Composition of Blood -
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7. Blood Collection and Analysis (11-1)
Venipuncture when Whole blood is usually collected from veins, Common site is median cubital vein, anterior side of elbow, easy to find, walls thinner, bp low, heals quickly
Can also be collected from peripheral capillary, A drop from fingertip or earlobe, blood smear
Occasionally collected from arterial puncture or arterial stick, to evaluate gas exchange efficiency in lung function, radial artery at wrist of brachial artery at elbow
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8. Checkpoint (11-1) List five major functions of blood.
What two components make up whole blood?
Why is venipuncture a common technique for obtaining a blood sample?
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9. Checkpoint (11-1) List five major functions of blood.
Transportation of dissolved gases, nutrients, hormones, and metabolic wastes
Regulation of pH and ion composistion of interstitial fluids
Restriction of fluid losses at injury sites
Defense against toxins and pathogens
Stabilization of body temperature
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10. Checkpoint (11-1) 2. What two components make up whole blood?
plasma and formed elements
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11. Checkpoint (11-1)
3.Why is venipuncture a common technique for obtaining a blood sample?
Superficial veins are easy to locate walls
thinner than arteries
heals quickly
pb low
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12. Plasma (11-2) Along with interstitial fluid, makes up most of ECF
Contains:
Plasma proteins
Hormones
Nutrients
Gases
Water
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13. Three Major Types of Plasma Proteins (11-2)
Albumins (al-BU-minz)
Most abundant
Maintains osmotic pressure of plasma
Globulins (GLOB-u-linz)
Act as antibodies (immunoglobulins) and transport proteins (bind to hormones so they do not get lost in kidney, thyroid hormones, or lipoproteins transport lipids to peripheral tissues)
Fibrinogen (fi-BRIN-o-jen) (soluble protein)
Functions in blood clotting, converting to fibrin (insoluble strands), conversion removes the clotting proteins leaving fluid called serum
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14. Plasma Proteins continued (11-2)
Plasma, minus the clotting proteins like fibrinogen, is called serum
90 percent of plasma proteins are synthesized by liver
Liver disorders can result in altered blood composition and function
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15. Figure 11-1 The Composition of Whole Blood
SPOTLIGHT
FIGURE 11-1
The Composition of Whole Blood
Fibrinogen
(fī-BRIN-ō-jen) functions
in clotting, and normally
accounts for roughly 4% of
plasma proteins. Under certain
conditions, fibrinogen molecules
interact, forming large, insoluble
strands of fibrin (FĪ-brin) that
form the basic framework
for a blood clot.
A Fluid Connective Tissue
Plasma Proteins
Albumins
(al-BŪ-minz) constitute
roughly 60% of the plasma
proteins. As the most
abundant plasma proteins,
they are major contributors
to the osmotic pressure
of plasma.
PLASMA
Blood is a fluid connective tissue with a unique composition.
Plasma proteins are in solution rather than forming
insoluble fibers like those in
other connective tissues,
such as loose connective
tissue or cartilage.
Globulins
(GLOB-ū-linz) account for
approximately 35% of the
proteins in plasma. Important
plasma globulins include antibodies
and transport globulins. Antibodies,
also called immunoglobulins
(i-mū-nō-GLOB-ū-linz), attack foreign
proteins and pathogens. Transport
globulins bind small ions,
hormones, and other
compounds.
Plasma, the matrix of blood, makes up about 55% of the volume of
whole blood.
Plasma also contains
enzymes and hormones
whose concentrations
vary widely. 7%
Organic
Nutrients: Organic
nutrients are used for ATP
production, growth, and
maintenance of cells. This
category includes lipids (fatty
acids, cholesterol, glycerides),
carbohydrates (primarily
glucose), amino acids,
and vitamins.
Other Solutes
Organic
Wastes: Waste
products are carried to sites
of breakdown or excretion.
Examples of organic wastes
include urea, uric acid,
creatinine, bilirubin,
and ammonium
ions.
Other solutes are generally present in concentrations similar to those in the interstitial fluids.
However, because blood is a transport medium there may be differences in nutrient and waste
product concentrations between
arterial blood and venous blood.
Electrolytes:
Normal extracellular ion
composition is essential for
vital cellular activities. The
major plasma electrolytes are
Na+, K+, Ca2+, Mg2+, Cl–,
HCO3–, HPO4–, and
SO42–.
Plasma
Plasma Proteins 1%
55%
(Range: 46–63%)
Other Solutes
Water
92%
consists of
Formed
Elements
Platelets
Platelets
< .1%
bound cell fragments that contain enzymes and other substances important to clotting.
Platelets are small, membrane-
45%
(Range: 37–54%)
White Blood Cells
Red Blood Cells
< .1%
White Blood Cells
White blood cells (WBCs), or leukocytes (LOO-k -sīts; leukos, white + -cyte, cell),
participate in the body’s
defense mechanisms. There
are five classes of leukocytes.
Formed elements are blood cells and cell fragments that are
suspended in plasma.
The hematocrit
(he-MAT- -krit) is the
percentage of whole
blood volume contributed
by formed elements.
Neutrophils
Basophils
99.9%
Eosinophils
Lymphocytes
Monocytes
Red Blood Cells
Red blood cells (RBCs), or
erythrocytes (e-RITH-rō-sits;
erythros, red + -cyte, cell), are the most abundant blood cells.
FORMED
ELEMENTS
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16. Figure 11-1a The Composition of Whole Blood
SPOTLIGHT
FIGURE 11-1
The Composition of Whole Blood
A Fluid Connective Tissue
PLASMA
Blood is a fluid connective tissue with a
unique composition. It consists of a matrix
called plasma (PLAZ-muh) and formed
elements (cells and cell fragments). The term
whole blood refers to the combination of
plasma and the formed elements together.
The cardiovascular system of an adult male
contains 5–6 liters (5.3–6.4 quarts) of whole
blood; that of an adult female contains 4–5
liters (4.2–5.3 quarts). The sex differences in
blood volume primarily
reflect differences in
average body size.
Plasma, the matrix of blood, makes up about 55% of the
volume of whole blood. In many respects, the
composition of plasma resembles that of interstitial
fluid. This similarity exists because water, ions, and
small solutes are continuously exchanged between
plasma and interstitial fluids across the walls of
capillaries. The primary differences between plasma and
interstitial fluid involve (1) the levels of respiratory gases
(oxygen and carbon dioxide, due to the respiratory
activities of tissue cells), and (2) the concentrations and
types of dissolved proteins (because plasma proteins
cannot cross capillary walls). 7%
Plasma
Plasma Proteins 1%
55%
(Range: 46–63%)
Other Solutes
Water
92%
consists of
Formed Elements
Platelets
< .1%
45%
(Range: 37–54%)
White Blood Cells
Red Blood Cells
< .1%
Formed elements are blood cells and cell
fragments that are suspended in plasma. These
elements account for about 45% of the volume of
whole blood. Three types of formed elements exist:
platelets, white blood cells, and red blood cells.
Formed elements are produced through the
process of hemopoiesis (hēm-ō-poy-Ē-sis). Two
populations of stem cells—myeloid stem cells and
lymphoid stem cells—are responsible for the
production of formed elements.
The hematocrit
(he-MAT-ō-krit) is the
percentage of whole
blood volume contributed
by formed elements. The
normal hematocrit, or packed cell
volume (PCV), in adult males is 46 and in
adult females is 42. The sex difference in
hematocrit primarily reflects the fact that
androgens (male hormones) stimulate red
blood cell production, whereas estrogens
(female hormones) do not.
99.9%
FORMED
ELEMENTS
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17. Figure 11-1-1 The Composition of Whole Blood
A Fluid Connective Tissue
PLASMA
Blood is a fluid connective tissue with a
unique composition. It consists of a matrix
called plasma (PLAZ-muh) and formed
elements (cells and cell fragments). The term
whole blood refers to the combination of
plasma and the formed elements together.
The cardiovascular system of an adult male
contains 5–6 liters (5.3–6.4 quarts) of whole
blood; that of an adult female contains 4–5
liters (4.2–5.3 quarts). The sex differences in
blood volume primarily
reflect differences in
average body size.
Plasma, the matrix of blood, makes up about 55% of the
volume of whole blood. In many respects, the
composition of plasma resembles that of interstitial
fluid. This similarity exists because water, ions, and
small solutes are continuously exchanged between
plasma and interstitial fluids across the walls of
capillaries. The primary differences between plasma and
interstitial fluid involve (1) the levels of respiratory gases
(oxygen and carbon dioxide, due to the respiratory
activities of tissue cells), and (2) the concentrations and
types of dissolved proteins (because plasma proteins
cannot cross capillary walls). 7%
Plasma
Plasma Proteins 1%
Other Solutes
55%
(Range: 46–63%)
Water
92%
consists of
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18. Figure 11-1-2 The Composition of Whole Blood
consists of
Formed
Elements
Platelets
< .1%
45%
(Range: 37–54%)
White Blood Cells
Red Blood Cells
< .1%
Formed elements are blood cells and cell
fragments that are suspended in plasma. These
elements account for about 45% of the volume of
whole blood. Three types of formed elements exist:
platelets, white blood cells, and red blood cells.
Formed elements are produced through the
process of hemopoiesis (hēm-ō-poy-Ē-sis). Two
populations of stem cells—myeloid stem cells and
lymphoid stem cells—are responsible for the
production of formed elements.
The hematocrit
(he-MAT-ō-krit) is the
percentage of whole
blood volume contributed
by formed elements. The
normal hematocrit, or packed cell
volume (PCV), in adult males is 46 and in
adult females is 42. The sex difference in
hematocrit primarily reflects the fact that
androgens (male hormones) stimulate red
blood cell production, whereas estrogens
(female hormones) do not.
99.9%
FORMED
ELEMENTS
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19. Figure 11-1 The Composition of Whole Blood (3–4)
Fibrinogen
(fī-BRIN-ō-jen) functions
in clotting, and normally
accounts for roughly 4% of
plasma proteins. Under certain
conditions, fibrinogen molecules
interact, forming large, insoluble
strands of fibrin (FĪ-brin) that
form the basic framework
for a blood clot.
Plasma Proteins
Albumins
(al-BŪ-minz) consti
tute roughly 60% of the
plasma proteins. As the
most abundant plasma
proteins, they are major
contributors to the
osmotic pressure
of plasma.
Plasma proteins are in solution rather
than forming insoluble fibers like those
in other connective tissues, such as
loose connective tissue or cartilage.
On average, each 100 mL of plasma
contains 7.6 g of protein, almost five
times the concentration in interstitial
fluid.The large size and globular
shapes of most blood proteins prevent
them from crossing capillary walls, so
they remain trapped within the
bloodstream. The liver synthesizes and
releases more than 90% of the plasma
proteins, including all albumins and
fibrinogen, most globulins, and various
prohormones.
Globulins
(GLOB-ū-linz) account for
approximately 35% of the
proteins in plasma. Important
plasma globulins include antibodies
and transport globulins. Antibodies,
also called immunoglobulins
(i-mū-nō-GLOB-ū-linz), attack foreign
proteins and pathogens. Trans-
port globulins bind small ions,
hormones, and other
compounds.
Plasma also contains
enzymes and hormones
whose concentrations
vary widely.
Organic
Nutrients: Organic
nutrients are used for ATP
production, growth, and
maintenance of cells. This
category includes lipids (fatty
acids, cholesterol, glycerides),
carbohydrates (primarily
glucose), amino acids,
and vitamins.
Organic
Wastes: Waste prod-
ucts are carried to sites of
breakdown or excretion.
Examples of organic wastes
include urea, uric acid,
creatinine, bilirubin,
and ammonium
ions.
Other Solutes
Electrolytes:
Normal extracellular ion
composition is essential for
vital cellular activities. The
major plasma electrolytes are
Na+, K+, Ca2+, Mg2+, Cl–,
HCO3–, HPO4–, and
SO42–.
Other solutes are generally present in
concentrations similar to those in the
interstitial fluids. However, because blood
is a transport medium there may be
differences in nutrient and waste product
concentrations between arterial blood and
venous blood.
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20. Figure 11-1 The Composition of Whole Blood (5–7)
Platelets
Platelets are small, membrane-bound cell
fragments that contain enzymes and other
substances important to clotting.
White Blood Cells
White blood cells (WBCs), or leuko-
cytes (LOO-kō-sīts; leukos, white + -cyte,
cell), participate in the body’s defense
mechanisms. There are five classes of
leukocytes, each with slightly different
functions that will be explored later in the
chapter.
Neutrophils
Basophils
Lymphocytes
Eosinophils
Monocytes
Red Blood Cells
Red blood cells (RBCs), or erythrocytes
(e-RITH-rō-sits; erythros, red + -cyte, cell),
are the most abundant blood cells. These
specialized cells are essential for the
transport of oxygen in the blood.
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21. Checkpoint (11-2) List the three major types of plasma proteins.
What would be the effects of a decrease in the amount of plasma proteins?
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22. Checkpoint (11-2) List the three major types of plasma proteins.
Albumins
Globulins
Fibrinogen
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23. Checkpoint (11-2)
5. What would be the effects of a decrease in the amount of plasma proteins?
Cause a reduction in:
a. plasma osmotic pressure
b. Ability to fight infections
c. transport and binding of some ion, hormones and other molecules
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24. Big Picture of RBC
RBC are the most numerous cells in the body. They remain in circulation for approximately 4 months before being recycled; several million are produced each second. The hemoglobin inside RBCs transport oxygen from the lungs to peripheral tissues; it also carries carbon dioxide from those tissues to the lungs.
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25. Erythrocytes or Red Blood Cells (11-3)
RBCs
Make up 99.9 percent of formed elements
Contain pigment molecule hemoglobin, Transports oxygen and carbon dioxide
Measured in red blood cell count, cells/µL
Men have 5.4 million/µL, Women have 4.8 million/µL
Hematocrit- Measured as a percentage of whole blood (VPRC or PCV) (1000 RBC/1 WBC)
men 46 % (40-54), women, 42 % (37-47)
Can fluctuate- dehydration, EPO stimulation, internal bleeding, RBC formation
Not a clear test but indication more tests needed
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26. Structure of RBCs (11-3)
Main function is to transport oxygen and carbon dioxide within the bloodstream
Unique biconcave disc (thin in middle, thick margins) provides advantages:
Increased surface area increases rate of diffusion
Increased flexibility to squeeze through narrow capillaries
During RBC formation organelles are lost (nucleus, mitochondria, ribosomes)
Cannot go through cell division, cant make new proteins/enzymes
Can only rely on glucose from plasma for energy (anaerobic metabolism)
Oxygen will be carried to peripheral tissues and not stolen by mitochondria
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27. Figure 11-2 The Anatomy of Red Blood Cells.
Blood smear
LM x 477
RBCs
Colorized SEM x 2100
When viewed in a standard
blood smear, RBCs appear
as two-dimensional objects,
because they are flattened
against the surface of the
slide.
The three-dimensional shape
of RBCs.
A sectional view of a mature RBC,
showing the normal ranges for its
dimensions.
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28. Hemoglobin Structure (11-3) (HE-mo-glo-bin)
Hb structure
95 percent of all RBC intracellular proteins
Transports oxygen and carbon dioxide
Composed of two pairs of globular proteins, called subunits
Each subunit containsorganic pigment heme, with an iron atom
Oxygen binds to heme, carbon dioxide binds to the globular subunits (cause it to look bright red)
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29. Hemoglobin Function (11-3)
O2–heme bond is fairly weak, easily broken
High plasma O2
Causes hemoglobin to gain O2 until saturated
Occurs as blood circulates through lung capillaries
Low plasma O2 and high CO2
Causes hemoglobin to release O2
Occurs as blood circulates through systemic capillaries
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30. Anemia (11-3) A reduction in oxygen-carrying capacity
Caused by:
Low hematocrit
Low hemoglobin content in RBCs
Symptoms include:
Muscle fatigue and weakness
Lack of energy in general
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31. RBC Life Span and Circulation (11-3)
Round trip take about 1 min
RBCs are exposed to stresses of friction and wear and tear, Move through small capillaries, Bounce against walls of blood vessels
Life span is about 120 days
About 1 percent of all RBCs are replaced each day
About 3 million new RBCs enter circulation per second
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32. Hemoglobin Recycling (11-3)
Most RBCs are phagocytized in liver, spleen, and bone marrow, Hb components are recycled
If RBCs hemolyze (rupture) in bloodstream, Hb breaks down in blood
Kidneys filter out Hb, If a lot of RBCs rupture at once it causes hemoglobinuria, indicated by reddish-brown urine
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33. Three Steps of Hemoglobin Recycling (11-3)
Globular proteins are broken into amino acids, metabolized or released for other cell use
Heme is stripped of iron, converted to biliverdin (green color/ bruises), Biliverdin is converted to bilirubin(orange-yellow), Liver absorbs bilirubin, it becomes part of bile If not put into bile, tissues become yellow, jaundiced, or reach the large intestine converted to urobilins and stercobilins, some excreted into urine (yellow urine or brown feces)
Iron can be stored in macrophage or released into blood to bind with transferrin, a plasma protein, utilized in to make new hemoglobin molecules in bone marrow
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34. Figure 11-4 Recycling of Hemoglobin.
Events Occurring in
Macrophages
Events Occurring in the
Red Bone Marrow
Macrophages in liver,
spleen, and bone marrow
RBC
formation
Fe2+ transported in the bloodstream
by transferrin
Amino acids
Heme
Average life span of
RBC is 120 days
90%
Biliverdin
Old and
damaged
RBCs
New RBCs
released into
circulation
Bilirubin
10%
In the bloodstream,
the rupture of RBCs
is called hemolysis.
Bilirubin bound
to albumin in
bloodstream
Hemoglobin that is not
phagocytized breaks down,
and the polypeptide subunits
are eliminated in urine.
Liver
Kidney
Bilirubin
Absorbed into the bloodstream
Urobilins
Excreted
in bile
Eliminated
in urine
Urobilins,
stercobilins
Bilirubin
Events Occurring in
the Kidney
Events Occurring
in the Liver
Events Occurring in
the Large Intestine
Eliminated
in feces
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35. Abnormal Hemoglobin- 2 inherited disorders
Thalassemia- (thal-ah-SE-me-uh),
Result from an inability to produce adequate amount of the globular protein components of hemoglobin
Rate of RBC production is slowed, mature RBCs are fragile and short lived
Reduces the oxygen-carrying capacity of blood and lead to problems in growth and development
Frequent transfusions
Sickle Cell Anemia (SCA)
Mutation affecting the amino acid sequence of one pair of the globular proteins of the hemoglobin molecule
Decrease in O2 levels, causes cell to change shape, stiff and curved “sickling”, does not alter ability to carry O2
More fragile and easily damaged  hemolytic anemia
Block blood flow, stuck in capillary, tissue O2 starved
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36. Gender and Iron Reserves (11-3)
Men have about 3.5 g of ionic Fe2+, 2.5 g of that is in Hb, providing a reserve of 1 g
Women have 2.4 g of Fe2+ and 1.9 g in Hb, providing a reserve of only 0.5 g
Women often require dietary supplements
If low, iron deficiency anemia may appear
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37. Stages of Erythropoiesis or RBC formation (11-3)
Appear in blood stream during the 3rd week of development and move to organs as they develop
Embryonic cells differentiate into multipotent stem cells, called hemocytoblasts
Erythropoiesis occurs in red bone marrow, or myeloid tissue, located in the skeletal system
If under extreme blood loss areas of yellow marrow can convert to red marrow increasing the rate of RBC formation
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38. Stages in Maturation Hematologist- specialists in blood formation
RBC results from the division of hemocytoblasts (multipoten stem cells) in bone marrow,
Hemocytoblalsts  myeloid stem cells  mature erythrocytes
Hemocytoblasts produce myeloid stem cells
Erythroblasts are immature and are synthesizing Hb
When nucleus is shed they becomes reticulocytes
Reticulocytes enter bloodstream to mature into RBCs
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39. White Blood Cells (WBCs)
Figure The Origins and Differentiation of RBCs, Platelets, and WBCs.
Red bone
marrow
Hemocytoblasts
Multi-CSF
Myeloid Stem Cells
Lymphoid Stem
Cells
Progenitor Cells
EPO
GM-CSF
Blast Cells
EPO
G-CSF
M-CSF
Proerythroblast
Myeloblast
Monoblast
Lymphoblast
Myelocytes
Erythroblast stages
Band Cells
Ejection of
nucleus
Megakaryocyte
Promonocyte
Prolymphocyte
Reticulocyte
Erythrocyte
Platelets
Basophil
Eosinophil
Neutrophil
Monocyte
Lymphocyte
Red Blood Cells
(RBCs)
Granulocytes
Agranulocytes
White Blood Cells (WBCs)
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40. Regulation of Erythropoiesis (11-3)
Requires amino acids, iron, and B vitamins
Stimulated by hormone erythropoietin and indirectly by thyroxin, androgens and GH
Stimulated by low tissue oxygen, called hypoxia
Kidney hypoxia triggers release of erythropoietin or EPO
When anemia occurs
When blood flow to kidney decreases
When oxygen content of air declines
When damage to respiratory membrane occurs
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41. Erythropoietin / EPO(11-3) (hormone)
Target tissue is myeloid stem cell tissue
2 major effects:
Stimulates increase in cell division
Speeds up rate of maturation of RBCs
Essential for patients recovering from blood loss
EPO infusions can help cancer patients recover from RBC loss due to chemotherapy
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42. Figure 11-6 The Role of EPO in the Control of Erythropoiesis.
Red bone marrow
Increased
mitotic rate
Stem
cells
Release of
erythropoietin
(EPO)
HOMEOSTASIS
DISTURBED
Erythroblasts
Accelerated
maturation
Tissue oxygen
levels decline
Reticulocytes
HOMEOSTASIS
RESTORED
Tissue oxygen
levels rise
Improved
oxygen
content
of blood
Increased
numbers of
circulating RBCs
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43. Checkpoint (11-3) Describe hemoglobin.
What effect does dehydration have on an individual's hematocrit?
In what way would a disease that causes liver damage affect the level of bilirubin in the blood?
What effect does a reduction in oxygen supply to the kidneys have on levels of erythropoietin in the blood?
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44. Checkpoint (11-3) Describe hemoglobin.
It is a protein composed of 4 globular protein subunits, each bound to a heme molecule, which gives RBCs the ability to transport oxygen in the blood
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45. Checkpoint (11-3)
7. What effect does dehydration have on an individual's hematocrit?
By lowering total blood volume, dehydration increases the hematocrit- the percentage of total blood volume occupied by the formed elements (mostly red blood cells)
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46. Checkpoint (11-3)
8. In what way would a disease that causes liver damage affect the level of bilirubin in the blood?
Bilirubin would accumulate in the blood, producing jaundice, because diseases that damage the liver, such as hepatitis or cirrhosis, would impair the liver’s ability to excrete bilirubin in the bile
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47. Checkpoint (11-3)
9. What effect does a reduction in oxygen supply to the kidneys have on levels of erythropoietin in the blood?
A decreased oxygen supply to the kidneys triggers increased erythropoietin levels in the blood, which stimulates increased erythropoiesis (RBC production)
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48. ABO Blood Types and Rh System (11-4)
Based on antigen–antibody responses
Antigens, or agglutinogens, are substances that can trigger an immune response
Your surface antigens are considered normal, not foreign, and will not trigger an immune response (50 types)
Presence or absence of antigens on membrane of RBC determines blood type
Three major antigens are A, B, and Rh (or D)
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49. 4 Blood Types (11-4) Type A blood has antigen A only
Type B blood has antigen B only
Type AB blood had both A and B
Type O blood has neither A nor B
Rh positive notation indicates the presence of the Rh antigen; Rh negative, the absence of it
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50. © 2013 Pearson Education, Inc.

51. Table 11-1 The Distribution of Blood Types in Selected Populations
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52. Antibodies Also called agglutinins (11-4)
Found in plasma, will not attack your own antigens on your RBCs
Will attack foreign antigens of different blood type
Type A blood contains anti-B antibodies
Type B blood contains anti-A antibodies
Type AB blood contains neither antibodies
Type O blood contains both antibodies
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53. Cross-Reactions in Transfusions (11-4)
Occur when antibodies in recipient react with their specific antigen on donor's RBCs
Cause agglutination or clumping of RBCs
Referred to as cross-reactions or transfusion reactions
Checking blood types before transfusions ensures compatibility
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54. The Difference between ABO and Rh (11-4)
Anti-A or anti-B antibodies
Spontaneously develop during first six months of life
No exposure to foreign antigens needed
Anti-Rh antibodies in Rh negative person
Do not develop unless individual is exposed to Rh positive blood
Exposure can occur accidentally, during a transfusion or during childbirth
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55. Figure 11-7a Blood Types and Cross-Reactions.
Type A
Type B
Type AB
Type O
Type A blood has RBCs with
surface antigen A only.
Type B blood has RBCs with surface antigen B only.
Type AB blood has RBCs with both A and B surface antigens.
Type O blood has RBCs lacking both A and B surface antigens.
Surface
antigen A
Surface
antigen B
If you have Type A blood, your
plasma contains anti-B
antibodies, which will attack
Type B surface antigens.
If you have Type B blood, your plasma contains anti-A antibodies, which will attack Type A surface antigens.
If you have Type AB blood, your plasma has neither
anti-A nor anti-B antibodies.
If you have Type O blood,
your plasma contains both
anti-A and anti-B antibodies.
Blood type depends on the presence of surface antigens (agglutinogens) on RBC surfaces. The plasma contains antibodies (agglutinins) that will react with foreign surface antigens.
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56. Figure 11-7b Blood Types and Cross-Reactions.
RBC
Surface antigens
Opposing antibodies
Agglutination (clumping)
Hemolysis
In a cross-reaction, antibodies react with their target antigens causing agglutination and hemolysis of the affected RBCs.
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57. Figure 11-8 Blood Type Testing.
Anti-A
Anti-B
Anti-Rh A+ B+
AB+ O-
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58. Checkpoint (11-4)
Which blood type(s) can be safely transfused into a person with Type AB blood?
Why can't a person with Type A blood safely receive blood from a person with Type B blood?
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59. Checkpoint (11-4)
Which blood type(s) can be safely transfused into a person with Type AB blood?
Type AB- lack both anti A and B  A, B, AB or O
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60. Checkpoint (11-4)
11. Why can't a person with Type A blood safely receive blood from a person with Type B blood?
Due to the anti B antibodies in the plasma causing agglutinate, could block blood flow to varous organs and tissues
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61. Hemolytic disease of the Newborn (HDN)
Genes controlling the presence or absence of any surface antigen in the membrane of an RBC are provided by both parents.
The child's blood type can differ from parents
During pregnancy the circulatory systems are closely intertwined come antibodies can cross the placenta attacking the fetal RBCs  HDN
Usually occurs during delivery, when bleeding at the placenta and uterus exposes an Rh neg mother to an Rh positive fetus
Typically first child not affected, second child typically affected
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62. Big Picture – White Blood Cells
WBCs are usually outnumbered by RBCs by ratio of 1000:1. WBCs are responsible for defending the body against infection, foreign cells, or toxins, and for assisting in the cleanup and repair of damaged tissues. The most numerous are neutrophils, which engulf bacteria, and lymphocytes, which are responsible for specific defenses of the immune system.
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63. Leukocytes or White Blood Cells (11-5)
WBCs
Larger than RBCs, involved in immune responses
Contain nucleus and other organelles and lack hemoglobin
Divided into 2 groups based on appearance after staining
Granulocytes – granules (secretory vesicles/ lysomes)
Neutrophils, eosinophils, basophils
Agranulocytes- no or few granules (or too small to see)
Lymphocytes and monocytes
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64. WBC Circulation and Movement (11-5)
Circulate for short period of time
Migrate through loose dense connective tissue
Move to site of injury
Four characteristics of WBCs:
All are capable of amoeboid movement
All can migrate outside of bloodstream through diapedesis (di-a-pe-De-sis)
All are attracted to specific chemical stimuli, referred to as positive chemotaxis, guiding them to pathogens
Neutrophils, eosinophils, and monocytes are phagocytes (micro or macrophage)
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65. Types of WBCs (11-5)
Nonspecific defense- Neutrophils, eosinophils, basophils, and monocytes
Respond to any threat
Are part of the nonspecific immune response
Specific defense- Lymphocytes
Respond to specific, individual pathogens
Are responsible for specific immune response
** more in chapter 14 immune system
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66. 1. Neutrophils (11-5) (Noo-Tro-filz)
Make up 50–70 percent of circulating WBCs
Have a dense, contorted multilobular nucleus (looks like beads on a string; 2-5 lobes)
Usually first WBC to arrive at injury
Phagocytic, attacking and digesting bacteria
Numbers increase during acute bacterial infections
Short life span (10hrs)
Pus- broken down wbc and cellular debris
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67. 2. Eosinophils (11-5) (e-o-SIN-o-filz)
Granules stain darkly red with eosin
Make up 2–4 percent of circulating WBCs
Similar in size to neutrophils
Have deep red granules and a two-lobed nucleus
Are phagocytic, but also attack through exocytosis of toxic compounds (nitric oxide and cytotoxic enzymes)
Numbers increase during parasitic infection or allergic reactions
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68. 3. Basophils (11-5) (BA-so-filz)
Somewhat smaller than neutrophils and eosinophils
Rare, less than 1 percent of circulating WBCs
Numerous granules stain darkly, deep purple or blue
Travel to site of injury and release granules
Granules contain:
An anticoagulant, heparin
Inflammatory compound, histamine
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69. 4. Monocytes (11-5) (MON-o-sits)
About twice the size of a RBC with a large, kidney bean–shaped nucleus
Usually 2–8 percent of circulating WBCs
Circulate for 24 hours  tissues macrophages
Migrate into tissues and become macrophages
Aggressive phagocytes
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70. 5. Lymphocytes (11-5) (LIM-fo-sits)
Slightly larger than typical RBC with nucleus taking up most of cell
About 20–40 percent of circulating WBCs
Large numbers are migrating in and out of tissues and lymphatic
Some attack foreign cells, others secrete antibodies into circulation
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71. The Differential WBC Count (11-5)
Counting the numbers of the five unique WBCs of a stained blood smear, called a differential count
Change in numbers or percentages is diagnostic:
Leukopenia – (poverty) is a reduction in total WBCs
Leukocytosis - Is excessive numbers of WBCs
Leukemia - Is an extremely high WBC count and is a cancer of blood-forming tissues
** Unless treated ALL are fatal
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72. WBC Formation (11-5) Produce lymphoid stem cells (lymphocytes)
Derived from hemocytoblasts
Regulated by colony-stimulating factors,(CSF), thymosins
Produce lymphoid stem cells (lymphocytes)
Differentiate into lymphocytes, called lymphopoiesis
Migrate from bone marrow to lymphatic tissues, thymus, spleen, lymph nodes
Produce myeloid stem cells (Other)
Differentiate into all other formed elements
New technology- cancer patients undergoing chemo, GE CSF, stimulate production of neutrophils
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73. Checkpoint (11-5) Identify the five types of white blood cells.
Which type of white blood cell would you expect to find in the greatest numbers in an infected cut?
Which type of cell would you find in elevated numbers in a person producing large amounts of circulating antibodies to combat a virus?
How do basophils respond during inflammation?
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74. Checkpoint (11-5)
Which type of white blood cell would you expect to find in the greatest numbers in an infected cut?
Neutrophils, phagocytic
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75. Checkpoint (11-5) Identify the five types of white blood cells.
Neutrophils
Eosinophil
Basophils
Monocytes
lymphocytes
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76. Checkpoint (11-5)
Which type of cell would you find in elevated numbers in a person producing large amounts of circulating antibodies to combat a virus?
Lymphocytes
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77. Checkpoint (11-5) 15. How do basophils respond during inflammation?
Release a variety of chemicals such as histamine and heparin, that enhance inflammation and attract other types of wbc
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78. Table 11-2 A Review of the Formed Elements of the Blood (1 of 2)
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79. Table 11-2 A Review of the Formed Elements of the Blood (2 of 2)
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80. Big Picture- Platelets and Clotting
Platelets are involved in the coordination of hemostasis (blood clotting). When platelets are activated by abnormal changes in their local environment, they release clotting factors and other chemicals. Hemostasis is a complex cascade of events that establishes a fibrous patch that can subsequently be remodeled and then removed as the damaged area is repaired.
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81. Platelets (11-6) (PLAT-lets) (formed elements)
Platelets or fragments (not whole cells) formed elements found in mammals, thrombocytes found in nonmamals
Cell fragments involved in prevention of blood loss
Hemocytoblasts differentiate into megakaryocytes (big nucleus)
Contain granules of chemicals
Initiate clotting process and aid in closing tears in blood vessels
Normal count is 150,000–500,000/µL
Low count is called thrombocytopenia, internal bleeding
High count is called thrombocytosis, response to infection or cancer
Circulates 9-12 days before removed by phagocytes
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82. Checkpoint (11-6)
Explain the difference between platelets and thrombocytes.
List the primary functions of platelets.
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83. Checkpoint (11-6)
Explain the difference between platelets and thrombocytes.
Platelets are nonnucleated cellular fragments found in the blood of mammalian vertebrates
Thrombocytes are nucleated cells found in the blood of vertebrates other than mammals
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84. Checkpoint (11-6) 17. List the primary functions of platelets.
Initiating the clotting process and helping to close damaged blood vessels
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85. Hemostasis
Blood, halt
Process that halts bleeding and prevents the loss of blood through the walls of damaged vessels. All while setting up the framework for tissue repair
Drawing-
(10mins)
(3mins)
3 major phases (overlaping)
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86. Three Phases of Hemostasis (11-7)
Halts bleeding and prevents blood loss
Vascular phase
Platelet phase
Coagulation phase
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87. 1. The Vascular Phase (11-7) (30mins)
Blood vessels contain smooth muscle lined with endothelium (simple squamous)
A vascular spasm of smooth muscle occurs
Damage causes muscle fibers to contract, vascular spasm causing a decrease in vessel diameter, if small can stop bleeding
Endothelial cells become sticky, may stick together and block opening
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88. 2. The Platelet Phase (11-7) (plug of Platelets)
Platelets attach to sticky endothelium and exposed collagen, 15 seconds after injury
More platelets arrive and stick to each other forming a platelet plug
May be enough to close a small break
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89. 3. The Coagulation Phase (11-7)
Also called blood clotting
Starts about 30 sec after injury
(complex) A chemical cascade of reactions that leads to fibrinogen being converted to fibrin
Fibrin mesh grows, trapping cells and more platelets forming a blood clot
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90. The Clotting Process (11-7) (Normal)
Requires clotting factors:
Calcium ions, vitamin K and 11 different plasma proteins
Proteins are converted from inactive proenzymes to active enzymes involved in reactions (synthesized by liver)
Cascade event or chain reaction
Step-by-step
Product of first reaction is enzyme that activates second reaction, etc.
Two pathways intrinsic (inside)and extrinsic (outside)
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91. The Extrinsic (fast and short ) Pathway of Blood Clotting (11-7) (outside)
Starts after 15 seconds
Begins with damaged tissue releasing tissue factor (lipoprotein)
Greater the damage more protein release  faster clotting
Combines with calcium and other clotting proteins
Leads to formation of enzyme that can activate Factor X
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92. The Intrinsic Pathway of Blood Clotting (long and slow)(11-7) (inside)
Begins with activation of proenzymes exposed to collagen fibers at injury site
Proceeds with help from platelet factor released from aggregated platelets, other factors are also released to speed up the process
Several reactions occur, forming an enzyme that can activate Factor X
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93. The Common Pathway of Blood Clotting (11-7)
Begins when enzymes from either extrinsic or intrinsic pathways activate Factor X
Forms enzyme prothrombinase
Which converts prothrombin into thrombin
Which converts fibrinogen into fibrin
And stimulates tissue factor and platelet factors
Positive feedback loop rapidly prevents blood loss
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94. Blood Clotting- Calcium ions and Vitamin K
All 3 pathways require the presence of calcium ions, any disorders that lower will impair clotting
Vitamin K must be present for the liver to synthesis 4 of the clotting factors  deficiency lead to the breakdown of the common pathway, inactivating the clotting system. (half is absorbed by diet and ½ is created by bacteria in the intestine)
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95. © 2013 Pearson Education, Inc.

96. © 2013 Pearson Education, Inc.

97. Figure 11-10 The Structure of a Blood Clot.
Trapped
RBC
Fibrin network
Platelets
Blood clot containing trapped RBCs
SEM x 2060
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98. Figure 11-11 Events in the Coagulation Phase of Hemostasis.
Extrinsic
Pathway
Common Pathway
Intrinsic Pathway
Factor X
Factor X
activator
Factor X
activator
Prothrombinase
Prothrombin
Thrombin
Multiple
clotting
factors
Clotting
Factor VII
Fibrin
Fibrinogen
Platelet
factor
Tissue
factors
Activated
proenzymes
Tissue
damage
Contracted smooth muscle cells
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99. Clot Retraction and Removal (11-7)
Fibrin network traps platelets and RBCs, Platelets contract, pulling tissue close together in clot retraction
During repair of tissue, clot dissolves through fibrinolysis
Plasminogen is activated by thrombin and tissue plasminogen activator (t-PA) (released by damaged tissue)
Plasminogen produces plasmin, which digests clot
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100. Abnormal Hemostasis Excessive Coagulation
Clots from in circulation not at injury site
Embolus- blood clot floating in blood stream
Can be stuck in small blood vessel- kills tissue, stroke, pulmonary embolism
Thrombus- clot attached to vessel wall, near plaques, (lipids), will enlarge decreasing the diameter of the vessel, can block or break off becoming an embolus
Can be removed, given anticoagulants
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101. Abnormal Hemostasis Inadequate Coagulation
Hemophilia- inherited disorder, recessive on X
Not enough clotting factors
1 in 10,000, Males 80-90%
Transfusions of clotting factors
New technologies for synthetic
Haemophilia and Porphyria - Royal diseases from Tainted Blood
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102. Checkpoint (11-7)
If a sample of red bone marrow has fewer than normal numbers of megakaryocytes, what body process would you expect to be impaired as a result?
Two alternate pathways of interacting clotting proteins lead to coagulation, or blood clotting. How is each pathway initiated?
What are the effects of a vitamin K deficiency on blood clotting (coagulation)?
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103. Checkpoint (11-7)
If a sample of red bone marrow has fewer than normal numbers of megakaryocytes, what body process would you expect to be impaired as a result?
A decreased number of megakaryocytes, which produce platelets, would impair the clotting process
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104. Checkpoint (11-7)
19. Two alternate pathways of interacting clotting proteins lead to coagulation, or blood clotting. How is each pathway initiated?
The faster extrinsic pathway is initiated by the release of lipoprotein called tissue factor by damaged endothelial cells or peripheral tissue. The slower intrinsic pathway begins in the bloodstream with the activation of clotting protein proenzymes exposed to damaged collagen fibers and the release of platelet factor by aggregating platelets
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105. Checkpoint (11-7)
20. What are the effects of a vitamin K deficiency on blood clotting (coagulation)?
Vitamin K deficiency would reduce the production of clotting factors necessary for normal blood coagulating
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