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Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Pathophysiology The Cardiovascular System
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2 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Heart Disease Heart disease (which includes Heart Disease, Stroke and other Cardiovascular Diseases) is the No. 1 cause of death in the United States, killing nearly 787,000 people alone in 2011. Heart disease is the leading cause of death for people of most racial/ethnic groups in the United States, including African Americans, Hispanics and Whites. For Asian Americans or Pacific Islanders and American Indians or Alaska Natives, heart disease is second only to cancer More people die of heart disease than all forms of cancer combined.
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3 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Symptoms of a Heart Attack Dyspnea – difficulty in breathing. Chest Pain – Pressure / pain Left Arm/ shoulder pain – Dizziness / Sweating Tired / fatigue /insomnia
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4 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Medical Treatment for Heart Attacks First Aid: Maintain life with CPR / Defibrillation Defibrillation Medical interventions: Clot busting medications. Video Video Stints inserted into the coronary arteries. Video Video Coronary Artery by pass Surgery. Video Video
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5 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Chambers of Normal Heart
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6 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Peripheral Vascular System
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7 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Overview of Major Diseases Congenital heart diseases- Birth defects linklink Ischemic vascular disease - Ischemia means a "reduced blood supply". Ischemic Vascular Disease (IVD) is where a waxy substance called plaque (plak) builds up inside blood vessels, and restricts the normal flow of blood linklink Hypertension-related disease. linklink Infectious diseases linklink Autoimmune disorders linklink Metabolic diseases linklink
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8 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Incidence of Fatal Cardiovascular Diseases
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9 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Causes of Cardiac Diseases
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10 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Congenital Heart Disease Approximately 25,000 babies per year born with heart defects Defect may be: Minor: asymptomatic or related to only minor clinical symptoms Major: associated with major clinical problems or may be lethal
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11 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Causes of Congenital Heart Disease Cause unknown (most often) Viruses Alcohol Chromosomal abnormalities
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12 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Most Common Congenital Heart Diseases Ventricular septal defect Atrial septal defect Tetralogy of Fallot link videolinkvideo ____________________________________ Note: Isolated septal defects are initially acyanotic, but later may become cyanotic when direction of blood flow through a shunt is reversed. Tetralogy of Fallot presents with early cyanosis.
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13 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Ventricular Septal Defect
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14 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Tetralogy of Fallot Tetralogy of Fallot (TOF) is a congenital heart defect which is classically understood to involve four anatomical abnormalities of the heart (although only three of them are always present). It is the most common cyanotic heart defect, and the most common cause of blue baby syndrome. [1] TOF is usually a right-to-left shunt, in which higher resistance to right ventricular outflow results in more severe cyanosis symptoms. [2] congenital heart defectcyanoticblue baby syndrome [1]right-to-left shuntcyanosis [2]
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15 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Atherosclerosis Generalized videovideo Localized Coronary heart disease Cerebrovascular disease videovideo Atherosclerosis of aorta Peripheral vascular disease
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16 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Forms of Atherosclerosis
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17 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Pathogenesis of Atherosclerosis
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18 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Pathogenesis of Atherosclerosis (Cont’d)
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19 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Complications of Atheroma
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20 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Risk Factors of Atherosclerosis Risk Factors That Cannot Be Changed Risk Factors That Can Be Changed Protective Factors AgeLipid metabolism- related factors: diet, obesity, hyperlipidemia, diabetes mellitus Exercise GenderHypertensionEstrogen HeredityClotting factors Cigarette smoking Behavior
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21 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Endothelial Cell Injury Leading to Atherosclerosis
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Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Atherosclerosis: Gross Appearance of Aorta 22 T = thrombi
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23 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Aneurysms videovideo
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24 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Peripheral Vascular Disease Atherosclerosis of renal arteries Atherosclerosis of intestinal arteries Atherosclerosis of extremities Dry gangrene Wet gangrene
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25 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Clinical Presentations of Coronary Heart Disease Asymptomatic – No symptoms observed Angina pectoris- heart pain videovideo Congestive heart disease – heart failure. video video Myocardial infarction- heart attack… blood flow blockage… heart muscle death. videovideo
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26 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Coronary Artery Disease
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27 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Distribution of Myocardial Infarcts
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28 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Coronary Occlusion by Thrombus
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29 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Complications of Myocardial Infarct
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30 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Hematopericardium Due to heart attack or aneurysm the heart bleeds into the pericardial sack and squeezes the heart.
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31 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Coronary Heart Disease: Clinical Features
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32 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Chronic Congestive Heart Disease
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33 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Outcome of Myocardial Infarct (MI)
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34 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Diagnosis of Myocardial Infarction
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35 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Arterial Hypertension Primary hypertension (>90%); cause unknown videovideo Secondary hypertension Renal; kidney blockage Endocrine – hormonal changes - adrenaline Neurogenic- psychological stress. Drugs- legal and illegal drugs can increase BP
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36 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Blood Pressure Systolic pressure – the internal arterial pressure when the heart is compressing. Diastolic pressure – the internal pressure of the arteries between heart beats. Normal: 120/80 mm/Hg Measurement video Measurement videoMeasurement video Measured by soundings: technique video video Heartbeat rate: How many beats / minute. Normal: 60-100 bpm Tachycardia: rate > 100 bpm Bradycardia: rate < 60 bpm
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37 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Regulation of Arterial Pressure
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38 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Pathogenesis of Hypertension
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39 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Complications of Hypertension Cardiac hypertrophy- swelling of heart muscle due to chronic high pressure. Congestive heart disease- decreased efficiency of heart pumping. Renal insufficiency – kidney failure. VideoVideo Hypertensive encephalopathy- brain swelling and pain due to high blood pressure. videovideo Hypertensive retinopathy- eye damage due to high blood pressure. VideoVideo
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40 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Rheumatic Heart Disease: Pathogenesis RHD is a chronic heart condition caused by rheumatic fever that can be prevented and controlled. Rheumatic fever is caused by a preceding group A streptococcal (strep) infection. Treating strep throat with antibiotics can prevent rheumatic fever. Moreover, regular antibiotics (usually monthly injections) can prevent patients with rheumatic fever from contracting further strep infections and causing progression of valve damage. Consequences of rheumatic heart disease Acute rheumatic fever primarily affects the heart, joints and central nervous system. The major importance of acute rheumatic fever is its ability to cause fibrosis of heart valves, leading to crippling valvular heart disease, heart failure and death
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41 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Chronic Rheumatic Endocarditis
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42 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Infectious Diseases of the Heart Endocarditis- an infection of the innermost layer of the heart due to bacteria or viruses. Myocarditis- the infection of the heart muscle in between the inside and outside membranes. Pericarditis- an infection of the outer layer membrane of the heart.
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43 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Bacterial Endocarditis
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44 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Bacterial Endocarditis (Cont’d)
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45 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Complications of Endocarditis
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46 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Causes of Infectious Myocarditis Viruses (most common) Bacteria (immunosuppressed persons or in sepsis) Parasites & protozoa (e.g., Trypanosoma cruzi)
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47 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Causes of Pericarditis Viruses (most common) Bacteria Fungi (rare) Rheumatic heart disease Uremia Open heart surgery
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48 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Pericarditis
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49 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Cardiomyopathy video video Heart Muscle Disease: Dilated: viral infection, alcohol, cardiotoxic drug Hypertrophic: genetic Restrictive: amyloidosis, endomyocardial fibrosis
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50 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Cardiomyopathy (Cont’d)
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51 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Cardiac Tumors Rare Most common primary tumor: atrial myxoma, which is benign; can be removed surgically Metastases: most often from lung cancer; involve pericardium
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52 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Artificial Valve Video
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53 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Arterial Diseases Atherosclerosis Arteritis Polyarteritis nodosa is a vasculitis of medium and small- sized arteries, which become swollen and damaged from attack by rogue immune cells. Small aneurysms are strung like the beads of a rosaryvasculitisarteriesimmune cellsrosary Giant cell arteritis is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head, predominantly the branches of the external carotid artery.inflammatoryblood vessels arteries external carotid artery Raynaud’s Disease -is excessively reduced blood flow in response to cold or emotional stress, causing discolouration of the fingers, toes, and occasionally other areas
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54 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Polyarteritis Nodosa
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55 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Diseases of Veins Varicose veins - are veins that have become enlarged and twisted. The term commonly refers to the veins on the leg. Veins have pairs of leaflet valves to prevent blood from flowing backwards.veins Thrombi – blood clots. Thrombophlebitis- inflammation of veins that causes blood clots.
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56 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Varicose Veins
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57 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Electrocardiogram Measurement The quickest and easiest test to check for MI’s is the EKG or ECG. Video Video It measures the wave of electrical energy through the heart nervous system and muscle. Career link Career linkCareer link
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58 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Typical Heartbeat on EKG P-wave - atrial contraction/ depolarization QRS wave – ventricular contraction T wave – repolarization of the ventricles EKG Course Link
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59 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Systematic Approach Rate - How fast is the heart beating? Rhythm- is the sequence sequential? Axis- which way is the electrical impulse moving through the heart? Wave Morphology P, T, and U waves and QRS complex Intervals PR, QRS, QT ST-T wave/Search for Infarction
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60 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Determine the Rate
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61 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Determine the Rhythm Is the rhythm regular or irregular? What is the atrial rate? What is the ventricular rate? Is AV conduction normal? Are there any unusual complexes? Is the rhythm dangerous?
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62 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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63 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Axis Find the quadrant Isolate the isoelectric lead Smallest QRS voltage Isolate the closest lead Isolate the vector Double check your findings
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64 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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65 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Morphology – What do the waves look like and how long do they last? P waves - small beginning of beat QRS Complexes – ventricle depolarization ST segments- ventricle contraction; key signature of a MI T waves- ventricle repolarization
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66 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. EKG Changes Positive EKG is single most important lab test in the diagnosis of AMI: Location Stage Extent ST elevation – transmural injury Q waves – transmural necrosis T wave changes – hyperacute=peaked
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67 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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68 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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69 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Composition of Blood Plasma - a liquid suspending other blood components Red blood cells - (erythrocytes) carries oxygen to the body’s cells and carbon dioxide away. White blood cells - (leukocytes) fights disease and foreign invaders and, alone, contain cell nuclei. Platelets – (thrombocytes) aids in blood clotting and the repair of damaged blood vessels. 69
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70 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Composition of Blood 70
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71 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Composition of Blood A bag containing one unit of fresh frozen plasma
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72 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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73 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Forensic Serology Serology Serology – involves the study of body fluids and stains at a crime scene, particularly blood. If blood contains DNA matching: It could link a suspect to a scene It can prove a link between suspect, victim and crime 2009©Forensic Science Today73
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74 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Cellular Components of Blood 2009©Forensic Science Today74
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75 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Forensic Science: Blood Basics Fill out worksheet 2009©Forensic Science Today75
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76 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 2009©Forensic Science Today76
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77 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 2009©Forensic Science Today77
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78 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 2009©Forensic Science Today78
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79 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 2009©Forensic Science Today79
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80 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 2009©Forensic Science Today80
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81 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 2009©Forensic Science Today81
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82 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 2009©Forensic Science Today82
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83 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Discovery of Blood Types Discovered in 1900 by Karl Landsteiner. Identifies the presence or absence of particular proteins embedded in the cell. In 1901, Landsteiner described the A and B proteins found on red blood cells. The Rh factor (protein) were also identified. An antibody reaction test is used to identify each blood type. 83
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84 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. A and B Proteins 84 42% 12% 3% 43% of the population in the United States
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85 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Rh Factor 85 85% of the human population has a protein called RH factor on their red blood cells.
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86 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 86 Rhesus monkeys have an important history with humans and have aided a great deal of medical and scientific research. Rhesus antigens found in their blood enabled doctors to identify the different human blood groups. These primates also preceded humans into space.
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87 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Naming of Blood Types A person’s blood type is based on the presence or absence of the AB and Rh proteins. The presence of different blood types was not discovered until 1901. Wrong blood = cause clumping = death 2009©Forensic Science Today87
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88 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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89 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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90 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Blood Groups Type Antigen Antibody Can Give Blood To Can Get Blood From A B AB O A B A and B Neither A nor B B A Neither A nor B A and B A, ABO, A B, ABO, B AB A, B, O, AB O 90
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91 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Blood Donation 91 Video of Type and cross lab Blood donation process video
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92 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Antibodies 2009©Forensic Science Today92 Antibodies are Y- shaped proteins secreted by white blood cells that attach to antigens to destroy them. Antigens are foreign molecules or cells that react to antibodies.
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93 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Antigen-Antibody Response Foreign invader is recognized by the immune system and an attack is launched against the invader. Viruses, bacteria, or red blood cells proteins from a different blood type. 2009©Forensic Science Today93
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94 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Agglutination There are more than 300 known blood group proteins and more than 1 million different protein binding sites on each RBC. Agglutination animation Agglutination animation Agglutination animation An antibody reaction to surface proteins on RBC causes agglutination, or clumping, of the cells. 2009©Forensic Science Today94
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95 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Blood Typing Tests Blood typing is a way to identify and match blood samples. Structure and Function of Blood -Video Structure and Function of Blood -Video Structure and Function of Blood -Video 2009©Forensic Science Today95
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96 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. In addition to A, B, and Rh protein, people can have M and N proteins. ABO System MN System ABO System MN System Additional Blood Proteins and Probability TypePercentFraction A42%42/100 B12%12/100 AB3%3/100 O43%43/100 TypePercentFraction MM30%30/100 MN48%48/100 NN22%22/100 TypePercentFraction Rh +85%85/100 Rh -15%15/100 Rh System New Game
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