1. Blood, Lymphatic System and Immune System
dr. Sri Lestari Sulistyo Rini, MSc

2. I. Function
A. Transport
nutrients
oxygen/carbon dioxide
waste
B. Maintaining Homeostasis
hormones
C. Protection
immune system
II. Composition of blood
A. Plasma

4. 91% water
9% suspended material
Proteins:
Albumin – most abundant ->water regulation
Globulins – transport steroid hormones
Fibrinogen – formation of clots
B. Formed elements
Derived from hemocytoblast stem cells
1. Erythrocytes (RBC)
transports gases
1/3 volume hemoglobin

7. Production:
Erythropoietin from Kidney (liver)
Red bone marrow
Iron required
RBC cycle
120 days
Damaged RBC – liver and spleen
Macrophages
Hemoglobin breakdown
Heme (iron) globin (protein)

9. Heme
Iron
Biliverdin
Bone marrow
Bilirubin – bile pigment
liver
2. Leukocytes (WBC)
no hemoglobin/has nucleus
immune response
hormones: interleukins and colony-stimulating (CSF)

10. a. Neutrophils
granulocyte
most numerous
phagocytic cells (lysosomes)
b. Eosinophils
granulocyte
1-3%
control inflammatory & allergic response
c. Basophils
granulocyte
least common
histamine (inflammatory) / heparin (prevents clots)

11. DARAH Eritrosit Leukosit Trombosit (platelet) Granulosit Agranulosit
Neutrofil
Eosinofil
Basofil
Agranulosit
Limfosit
Monosit
Trombosit (platelet)

12. d. Monocytes
agranulocyte
largest WBC
after 3 days -> macrophages
phagocytes with lysosomes
ingests larger objects than Neutrophils
e. Lymphocytes
agranulocyte
cells of the immune system
B cells (antibodies) / T cells immune response

13. 3. Platelets (Thrombocytes)
fragments of megakaryocytes
hormone: thrombopioetin
blood clotting/ mend blood vessels
C. Hemostasis
1. Platelet plug
platelets bind to damaged vessel wall
release chemical for more platelets
platelets release serotonin (constriction)
2. Blood clot
damaged vessel releases Thromboplastin

14. trombosit –- terpapar kolagen  Adhenosin diphospat (ADP) dan tromboxan  trombosit agregrasi di daerah luka

15. Proses pembentukan protombin : jalur instrinsik
Proses pembentukan protombin : jalur instrinsik dan ekstrinsik  protombin menjadi trombin  trombin mengubah fibrinogen fibrin

16. Retraksi bekuan –- luka menutup Plasminogen  plasmin ---fibrinolisis

19. Thromboplastin w/ platelets & calcium
Prothrombin Thrombin
Thrombin acts on fibrinogen (in plasma)
fibrin threads
fibrin threads create mesh
III Human blood groups
A. ABO blood type
1. Antigens (proteins) on RBC
2. Antibodies against other antigens

22. B. Rh blood type
1. Antigens on RBC
Rh positive – has antigens
Rh negative – no antigens
2. Antibodies against Rh
Rh negative individual – antibodies after Rh+ encounter
3. Pregnancy
Rh neg w/Rh+ fetus
blood from fetus -> into mother’s blood
2nd pregnancy w/Rh+ fetus -> antibodies attack

24. Functions of the Immune System
The function of the immune system
Protect the entire body from a variety of harmful substances.
Combining form:
IMMUN/o immune, protected and safe

25. Functions of the Lymphatic System
Three primary functions:
Return excess lymph (interstitial) fluid to the blood.
Absorb fats and fat soluble vitamins from the digestive system and transport them to the cells.
Functions as part of the immune system to defend the body against foreign organisms.

26. Structures of the Immune System
Immune system is not contained with in a single organ or vessel
Immune system depends on structures from
Lymphatic system
Cardiovascular system
Integumentary system

27. Structures of the Lymphatic System
Major structures of the lymphatic system:
Lymph vessels Lymph nodes
Lymph fluid Tonsils
Adenoids Spleen
Thymus Lymphocytes

28. Lymphatic System Lymph Fluid intercellular Lymph Vessels
Lymph Capillaries > Lymph vessels
Right lymphatic duct & Thoracic Duct
Lacteals

29. Lymph Capillaries and Lymph Vessels
Lymph Capillaries: thin walled tubes that carry lymph from the tissue spaces to the larger lymphatic vessels.
Lymphatic Vessels:
Have valves to prevent the backward flow of fluid
Lymph always flows toward the thoracic cavity.

30. Lymph Fluid
Clear, colorless tissue fluid that leaves the capillaries and flows in the tissue spaces between cells.
Lymph fluid brings nutrients and hormones to the cells.
Carries waste products from these tissues
pH 7,00

31. limfe mengalir dari cairan interstitial melalui pembuluh limfe thoracic duct
 right lymph duct
Berakhir di vena subclavia  limfe masuk dalam darah ductus limphaticus kanan bagian kanan dari thoraks, leher dan kepala, sisanya Ductus thoracicus.
Limfe membawa lemak dan vitamin yang larut dalam lemak absorbsi dari traktus gastrointestinal

33. Lymph Nodes 3 functions of the lymph nodes
Produce lymph cells (lymphocytes)
Filter lymph and trap substances from inflammatory and cancerous lesions.
Macrophages: located in lymph nodes can engulf and destroy foreign substances.

34. Lymphatic System
Cervical
Axillary
Inguinal

35. Major Lymph Node Sites
Cervical lymph nodes: located in the neck (CERVIC/o neck)
Axillary lymph nodes: located under the arms. (AXILL/o armpit)
Inguinal lymph nodes: located in the groin area of the lower abdomen. (INGUIN/o groin)
Appendix & Peyer’s patches: specialized lymph nodes located in the intestines.

36. *** *** *** Mucosal NALT BALT GALT RALT#
*** #
***
The secondary lymphoid organs can be sub-divided into the Systemic (***) and Mucosal immune systems

37. Tonsils and Adenoids
Tonsils and Adenoids: masses of lymphatic tissue that form a protective ring around the nose and upper throat.

38. Pharyngeal tonsil

39. Spleen Saclike mass of lymphatic tissue
Produces lymphocytes and monocytes
Filters microorganisms and other foreign material from the blood.
Stores red blood cells
Maintains appropriate balance between cells and plasma in the body

40. Immune System Defense First Line of Defense
Skin (Intact) free of cuts, scrapes, or open sores.
Skin is a physical barrier to prevent entry of invading organisms

41. Immune System Defense
Respiratory system is also a primary line of defense
foreign matter that is breathed in is trapped by cilia (nose hairs)
mucus secreted continually flushes away foreign matter.
Coughing and sneezing removes matter also.

42. Immune System Defense Digestive system has a protective function also.
Destroys bacteria and other invaders that are accidentally allowed or consumed with food.

43. Figure 8-42

44. 123. NORMAL MUCOSAL DEFENSES
Normally an intact mucus layer and epithelial tight junctions combine to prevent uptake of luminal antigen and translocation of viable bacteria. Goblet cells secrete mucus which covers the epithelial cell as well as intestinal trefoil factor, which increases the viscosity of mucus as well as stimulates epithelial restitution, which is the ability of epithelial cells to rapidly migrate to cover a denuded surface, thereby restoring epithelial integrity. Secreted growth factors (keratinocyte growth factor [KGF] and transforming growth factor  [TGF]) from fibroblasts and lamina propria mononuclear cells also enhance epithelial restitution. In addition, secreted products, including defensins made by epithelial cells and Paneth cells and secretory IgA (sIgA) from plasma cells, provide protection against bacteria. Defensins lyse bacteria while secretory IgA complexes bacterial and dietary antigens to prevent uptake. Finally, protective prostaglandins, including PGE2, from mesenchymal cells (fibroblasts, smooth muscle cells and myofibroblasts) as well as activated immune cells enhance epithelial barrier function, stimulate secretion of chloride which washes away luminal pathogens and increase mucosal blood flow.

45. Surface barrier / mucosal immunity
- Sekret dari lapisan kulit yang asam pH <7,0
- Saliva, air mata, sekret hidung yang mengandung lisozim
- Cairan lambung yang asam 0,9< pH > 3,0 dan enzim pencerna protein.

47. Antigen-Antibody Reactions
Antigen: any substance such as a virus, bacterium, or toxin that the body regards as foreign. Antigens stimulate the production to antibodies.
Antibodies: is a disease fighting protein developed by the body in response to the presence of a specific antigen.

48. Antigen – Antibody Reaction
The antigen – antibody reaction is also known as the Immune Reaction.
Binding antigens to antibodies to form antigen antibody complexes that render the toxic antigen harmless.

49. Lymphocytes Monocytes: Macrophage Histocytes
Major class of white blood cells that specialize so they can attack specific microorganisms.
3 types of lymphocytes
Monocytes:
Macrophage
Histocytes

50. Monocytes Lymphocyte formed in the bone marrow
Transported to other parts of the body
Become macrophages

51. Macrophages Type of lymphocyte
Protects the body by ingesting the invading cells.

52. Histocytes Large macrophages Found in loose connective tissue
Two major types
T-Cells
B-Cells

53. B Cells / Plasma Cells Produced in bone marrow.
Designed to make a specific antibody against a specific antigen
(antibody specifically coded to match one antigen)
- Effective against most free floating agents

54. B Cells or B lymphocytes
>Plasma Cells> secrete antibodi
Immunoglobulin
Immunoglobulin M
Immunoglobulin G
Immunoglobulin A
Immunoglobulin E
Immunoglobulin D

56. Complement Series of complex proteins occurring in normal serum.
In an antigen - antibody reaction complement aids phagocytes in the destruction of antigens.
LYSIS: destruction of a cells by penetrating the cell wall, allowing fluid in, causing the cell ruptures.

57. T Cells T cells are small, circulating lymphocytes
Produced in bone marrow
T-cells live for years
Primary function is to coordinate immune defense and kill.
Responsible for graft rejections.

58. Types of T Cells
Helper T cell: secrete substances that stimulate the production of antibodies by B cells.
Suppressor T cell: stops B-cell activity when this activity is no longer needed.
Memory T cell: remembers specific antigen and stimulate a faster and more intense response if the antigen returns.

59. T Cells or T lymphocytes
Interferon
Lymphokines
Macrophage
Phagocyte

60. Interferon Produced by T-cells
Family of proteins released by cells when invaded by a virus.
Interferon induces non-infected cells to form an antiviral protein that slow or stops the viral multiplication.

61. Lymphokines Chemicals produced by the T cells
Direct the immune response between cells.
Attract macrophages to the site

63. T lymphocytes become CD4+ or helper T cells, or they can become CD8+ cells, which in turn can become killer T cells, also called cytotoxic T cells.

64. Immune System in Action
Stage One
viruses invade body to invade cells and replicate.
Macrophages eat invading viruses
helper T cells activated.

65. Immune System in Action
Stage Two
Helper T cells multiple
Helper T cells attract complement to the areas
Helper T stimulate multiplication B cells
B cells start producing antibodies

66. Immune System in Action
Step Three
Complement proteins break open cells invaded by the virus and spill the viral content
Antibodies produced by the B cells inactivate the viruses.

67. Immune System in Action
Stage Four
Suppressor T cells halt the immune response
B-cells remain ready in case the same virus invades again

73. Immunity
Natural Immunity
Acquired Immunity / Artificial Immunity

74. Natural Immunity
Natural Passive Immunity: passed from mother to child before birth or immediately after birth through breast milk
Natural Active Immunity: Obtain by the development of antibodies during an attach of an infectious disease. (Example: chicken pox.)

75. Acquired Immunity
Artificial Active Immunity: process of artificially acquiring immunity through vaccination. (Immunization)
Artificial Passive Immunity: Acquired by receiving antiserum containing antibodies from another host. (Example: Snake bite)

77. Terima kasih