MARIAN DIAMOND: A new system.
Your blood vascular system.
So we'll start with the
oh, oh, important things.
I'm sorry, I'm
sorry, yes, you can
see we had so many announcements
I was busy just getting that.
So much for the blood
vascular system.
Jennifer Cha.
All right, is Jennifer Cha here?
There's Jennifer, good.
And how about James Stoddard?
Great, all right, so will you
see me right after lecture?
Thank you for reminding me and
I apologize for forgetting,
but we've got a little
different procedure here today.
So back to the science of blood.
And the blood vascular system.
So the science of blood then is
called hematology, hematology.
So what is blood?
You've got four kind of tissues.
What tissue is blood?
STUDENT: Connective.
MARIAN DIAMOND:
Connective tissue.
Blood's a connective tissue
and it has a fluid matrix.
What do we call a fluid matrix?
STUDENT: Plasma.
MARIAN DIAMOND: Plasma.
It has cells, corpuscles,
corpuscles, and cell fragments.
And one, two and three
equal formed elements,
formed elements.
These are considered formed
elements in the blood.
So when anybody asks
you what blood is,
it's plasma with
formed elements,
and then you can go from there.
So where is blood formed?
Where is it developed?
It depends on whether you're
a fetus or you're an adult.
In the fetus, the blood
is formed in the liver
and in bone marrow.
In the adult, blood
is formed where?
STUDENT: Bone marrow.
MARIAN DIAMOND: Bone marrow and?
Where are your
white cells formed?
STUDENT: [INAUDIBLE]
MARIAN DIAMOND: Some of them.
Adult bone marrow
and lymphatic tissue.
Not all white cells, but
we'll see which ones.
So we have formation.
We have the components.
And now, how much blood?
It's going to differ
whether you're a child
or whether you're an adult.
So they say that the child
has three quarts of blood.
Depends on the child today.
You see some child,
pretty big, but this is
what the literature tells us.
And how much blood you have?
Took us a while to get some
from our students this morning,
but we succeeded.
One, two, three, four, five.
You ever thought of your blood
in that perspective before?
Five quarts in an adult.
Now, why do you have blood?
What's the function?
Well, it does a lot of
transporting obviously,
because it's a liquid.
So it's going to transport
our formed elements.
It's going to transport
nutrients and gases.
Which gases?
Oxygen, carbon dioxide.
You learned that
in second grade.
It's going to transport waste.
Those who are having their
endocrinology exam in a day
or so know that blood
is transferring what?
Hormones, enzymes, buffers.
Buffer to maintain a constant
hydrogen ion concentration,
for example.
And will help to maintain
your body temperature.
Help maintain body temperature.
So we can see what a
crucial liquid this is.
As you expect,
it's a little warm.
All right, let's now then
look at the general view
of our formed elements.
We'll look at them
generally and then
come back to them specifically.
Well, first we have
our white blood cells.
These are called leukocytes.
White leukocyte cell.
And these are true cells,
because they have a nucleus.
And then you have the
red blood corpuscles,
red blood corpuscles.
What do we call them?
Erythrocytes.
There's the term cyte.
Sort of erroneous here, but
that's what they're called.
Erythrocyte.
Why'd I say that was erroneous?
Because they're not
cells, they're corpuscles.
There is no nucleus, no nucleus.
And then we have cell
fragments, cell fragments.
Or they're called
platelets, platelets.
They're fragmenting
from a big cell
that we'll learn about later.
This is general.
So platelets come from
a big cell, cytoplasm.
But this is a platelet.
And again, since they're
from the cytoplasm,
they have no nucleus.
So as I said before,
these three groups
make up our formed elements.
So now it's possible to
find out the proportion
of formed elements to plasma.
What do you think they are?
Percentage formed elements
to plasma in blood.
It's about 45% formed elements
to then just 55% plasma.
How do they know this?
They use a tube called
hematocrit, hematocrit,
and centrifuge.
And you separate
formed elements.
We'll just abbreviate
them here, from plasma.
Since most of your
formed elements
are red blood corpuscles,
most of your formed element
will turn out here in this ratio
to be red blood corpuscles.
So they could see if there's
a decrease in the amount
of red blood corpuscles.
It's hard to say red blood
corpuscle instead of red blood
cell, because we're all so
sloppy, we call them cells,
and we shouldn't.
They are not.
And it's hard to
change, but that's
what we're here for, to learn.
So in our hematocrit,
when we have reduced RBC,
what do we call this
condition in the individual?
STUDENT: Anemia.
MARIAN DIAMOND: Anemia, sure.
You look anemic.
So we could have,
for example, what's
called a microcytic
anemia, micro cytic anemia.
So what are you going to see?
What's the name tell you?
What's micro?
Little.
What's citic?
Cell.
So you have small RBCs.
And in this case,
you've a few RBCs.
Small and few RBCs.
There are many kinds of anemias.
We didn't have a
hypochromic anemia.
Hypochromic.
So what's going to
be reduced here?
This is reduced hemoglobin.
Hypo reduced, chromic goes
for color, hemo globin.
Hemoglobin is an oxygen
carrying pigment.
Carrying pigment rich in iron.
So what are you told to
eat to get your iron?
STUDENT: [INAUDIBLE]
MARIAN DIAMOND: Everything.
Why not?
That includes hot
fudge sundaes, too.
All right, but the
point is, you can
get different kinds of
anemia for different reasons.
And whether you've got few
cells or reduced hemoglobin,
it's important to know these.
So now what have we got?
We've got our plasma.
Let's look, what is plasma?
As you might expect,
it's 90% water.
And about 7% to 9%
plasma proteins.
And what are some
of those proteins?
You'll have albumin.
You'll have
fibrinogen, fibrinogen.
And globulin, globulin.
Albumin and fibrinogen
are formed where?
They're formed in the liver.
Slowly we'll be putting
in lots of functions
for this massive liver of ours.
Globulins are formed
in mast cells.
Ever heard of mast cells?
Possibly not.
No, it's a connective
tissue cell.
Masts cell.
Could have mast cell tumors.
Get to know your cells, because
when you get to pathology,
you're going to learn
these all over again
and know what happens
when they go astray.
So it's a CT cell.
So these are your
plasma proteins.
And why do you need them?
You need the albumin to regulate
osmosis, regulate osmosis.
To maintain a balance of water.
You've got so much water,
how do you maintain that?
You need albumin to
maintain water balance.
You need fibrinogen. It's,
you're going to see later,
a process of clotting.
This is to clot blood.
And globulin plays a
role with the antibodies.
Lots of detail in any
one of these, but this
is just introducing you to
why you need plasma proteins.
Now I saw an
interesting experiment,
it was back, please.
STUDENT: [INAUDIBLE]
MARIAN DIAMOND: 90% water.
I asked how much water
and then I said 90%.
But I didn't, I said it,
but I didn't write it.
OK, good question, always ask.
All right, I was
going to tell you
about an experiment that was
done in 2002 for a patient who
had multiple sclerosis.
How many have ever known
anybody with multiple sclerosis?
Quite a few, right.
It's a degenerating disease
of the nervous system.
We won't go into what part and
what it's doing or anything,
but just generally, it's
affecting the nervous system.
Well, for some reason,
these investigators
decide to remove the plasma.
And only put back
in the albumin.
Returned the albumin.
That's pretty drastic, isn't it?
But we don't know the condition
that they had to do this
and they found
marked improvement
in the condition of the patient.
Something to think about as
you sit there and say you
want to be doctors
and do things.
Who knows where the
status is today.
This was back 2002.
I don't know, but
I read this and I
thought it puts the dynamics
of knowing your plasma together
for you.
Now we mentioned when
we were studying bone,
that another component that's
found in plasma is calcium,
right?
So plasma has calcium.
We learned that low calcium
stimulates what gland?
STUDENT: Parathyroid
MARIAN DIAMOND:
Parathyroid gland, sure.
Parathyroid.
It's called parathyroid.
Para means next to.
It's behind the thyroid.
We'll talk about it when we
get to the endocrine part.
This is low calcium.
Parathyroid gland.
What hormone is released then
from the parathyroid gland?
Not too complex.
Parathormone.
And what does parathormone
act on in the bones?
It's trying to get calcium.
What would it act on?
Let's think, think it out.
STUDENT: Osteoclast.
MARIAN DIAMOND:
Osteoclast, certainly.
You want to destroy the
bone, get rid of the calcium,
get it back in the blood.
So I want you to start to think.
This, we've had, but I want
you to see it in this context.
So parathormone then will act
on osteoclasts, which destroy
bone and release calcium.
See, we're going to start
putting things together now so,
we had to handle each
system separately and little
by little, we'll put
them all together
as we bring in new systems.
But here's our calcium
within our plasma.
Again, to give the
dynamics of calcium.
So now then, let's
look at our specific
formed elements and
start with our RBCs.
These red blood corpuscles
are small, flexible, biconcave
discs.
Small, flexible,
biconcave discs.
Why do they get
this description?
Because we said
they had no nucleus,
if we look at them
sideways, they
look like a biconcave disc.
That's our biconcave, this
is where the nucleus was.
If we look down on them,
they'll be circular
and they'll be lighter in the
middle, for obvious reasons.
It's thinner there.
So they'll be dark
on the outside.
So you have to learn the
normal characteristics,
so when you see abnormal
blood, you might see that
and say oh, that's abnormal.
But that's normal.
So the size of an RBC,
you see different things
in the literature today.
There are so many books
that are just saying
sort of what they want to say.
But it's roughly 7.5 to 8.0
micra, the diameter of the RBC.
What did we say
about this before?
Universal measuring stick.
Because every tissue you
look at will have our RBCs.
You'll say, oh, 7.5 to 8.0.
What's the size of
that cell over there?
You can approximate.
So it's called a
universal measuring stick.
It's in every field.
So that's one you
don't want to forget
because you use it when you're
looking at the growth of cells.
Are these abnormal?
Normal?
Well, look for an RBC,
see what its size is
and get an approximation.
How many are RBCs do you
have per cubic millimeter?
You have about 5 million
per cubic millimeter.
You'll see different
figures, but that's
sort of common average one.
You have more in
males than females.
Slightly more in males,
supposedly due to testosterone.
Slightly more in males
and slightly less
in females than 5 million.
You'll see 4.5 million
and 5.5 million for males,
so it's slightly.
But this increase supposedly
is due to testosterone.
If you want to increase
your RBC level,
what are you going to do?
STUDENT: Exercise.
MARIAN DIAMOND: Exercise, sure.
Why do you think I stay up here
and work on the blackboards?
All right, increase
RBCs with exercise.
What's another enjoyable
way of doing it?
Going up into the Sierras.
Increasing the altitude.
Now you'll see a common
number given here again.
I'm sure it gives
rough estimate,
but it says with these, you
can increase to 8 million
per cubic millimeter with
exercise and altitude.
And I'm sure, I don't
know, does anybody
have a figure for Everest?
Know any mountain
climbers, wonder when you
get that high what you can do?
But we're trying to make
the blood dynamic for you,
because it is so important
and it is dynamic.
So now what do we call the
formation of these red blood
corpuscles?
You've had it, close to it.
What do you call
blood formation?
STUDENT: Haematopoiesis.
MARIAN DIAMOND: Haematopoiesis.
So now we're forming
red blood cells.
What are we going to say?
STUDENT: [INAUDIBLE]
MARIAN DIAMOND: Sure,
erythropoiesis, erythro.
I want you to start
thinking anatomy.
Erythropoiesis is RBC formation.
We'll put a few steps
in, because I'll
tell you about a cell you
perhaps never heard about.
And it's terribly
important in the diagnosis
of cancer of the blood.
So let's say that we have
here, bone marrow on this side.
And we have the blood
stream on this side.
And we're not
going to start back
with the original stem cell.
You need the original stem cell.
It's the same for whether
you're doing red cells,
white cells, any blood cell.
They all come from
this original one,
but we're not going
to go back that far.
We're going to go back to
the precursor of the RBC.
This is a step before the RBC.
And we'll have a cell, a true
cell called a normoblast.
Looks like a nucleated RBC.
This is a normoblast.
So you know it's
a developing cell.
Now before it leaves the bone
marrow, it loses the nucleus.
So it'll go from this
stage to this stage.
And now we're going to go
out into the bloodstream.
And if we look at it
in the bloodstream,
I shouldn't have
changed the size.
So I did, only
because of my line.
So I'll try to
get it back again.
Let's get them
all the same size.
Move my line.
Sorry, just do it this way.
Should be the same size roughly.
And then it's going to
go out and it will have
a network in the cytoplasm.
A network.
Do you know what to call
networks in cytology?
A reticulum.
It has a reticulum, right.
And this reticulum
consists of ribosomes.
These are ribosomes.
And ribosomes assist
with protein formation.
And you can keep going
and going and going.
I just want to put a little
information about them.
Now, what are you going
to call these cells
if they've got a reticulum?
You know you can
use the term cyte,
so what are you going
to put before cyte.
Reticulocyte.
Reticulocyte, sure.
Figure it out, think of it.
Right, good for you.
Reticulocyte.
So you have reticulocytes.
And they will make up
about 1% to 2% of your RBCs
in the pathway.
1% to 2% of an RBC count.
And they will circulate
for only about 24 hours,
very short period.
Circulate for 24 hours.
Circulate 24 hours.
So what's the value here?
Have any of you ever been
a technician in a hospital
and counted cells?
No, it's routinely to do a
reticulocyte counts there
when you get blood samples.
Find out what the percentage is.
What if you see
that it's up to 10%?
What have you got?
Cancer of the red blood cells.
Polycythemia.
So they're a very
important cell.
So if elevated count
of reticulocytes,
everything in the
body is important.
You just have to know
something about it
and why you have cancer of RBCs.
And it's called polycythemia.
Many, many blood
cell increase, right?
Poly means many.
Cy for cell.
Themia for red blood corpuscle.
So that's the
name, polycythemia.
Anybody know anybody who has
polycythemia or ever had it?
Don't you feel
fortunate how well
your body functions
and you never
thought about a reticulocyte
before in your life?
Isn't it amazing what's going
on inside beneath that skin?
Yes.
STUDENT: [INAUDIBLE] cell has
lost its [INAUDIBLE] nucleus
or is [INAUDIBLE].
MARIAN DIAMOND:
Only, all I know is
that it's got a reticulum
that's left there.
Then it won't have anything,
just like a corpuscle.
It's lost it.
Lost it with the nucleus.
Unless somebody has some
other idea, I don't know.
All right, so that gets
us down to polycythemia.
Let's then look
at our leukocytes.
Let's begin with those.
How many of you
have donated blood?
That's very encouraging.
But did you ever think of
what you were really donating?
As you give this to somebody
else, how precious it is?
So we're going to go to white
blood cells, our leukocytes.
Why do we need them?
They're our defense
mechanism to allow
you to survive in this world.
They're, on the whole, larger
than red blood corpuscles.
And they're much fewer.
How many did we say we had
of red blood corpuscles
per cubic millimeter?
STUDENT: 5 million.
MARIAN DIAMOND: 5 million.
We're down to 4,000 to
10,000 white blood cells.
You see the big difference here.
4,000 to 10,000 white blood
cells per cubic millimeter.
This reminds me
that, do you think
you have more white
blood cells at birth
than when you're an adult?
STUDENT: [INAUDIBLE].
MARIAN DIAMOND: Sure, why?
What's their function?
Defense.
You're coming from that
uterus, that pure little uterus
out into this environment.
So newborns can get up from
18,000 to 20,000 white blood
cells per cubic millimeter.
So you have to really
know your blood.
Wouldn't take it and say look
it, this child has leukemia,
has cancer of the
white blood cells.
No, it's just that
adjusting to the environment
and will come down soon.
So all these dynamic things
are going on every second.
And one I should mention
to you, how many RBCs
you're producing each second.
As you're sitting
there, there's a second.
How many new RBCs do you have?
About 2 million.
Isn't that amazing?
I'm just jumping back again
because I wanted to bring that
in, so we put a 2 million
RBCs through the process
of reticulocytes and
everything per second.
Well, if you're
producing so many,
how can your blood flow at all?
You've got to be killing
them off, don't you?
Do you know how long they live?
They live about 120 days.
About four months.
So 120-day lifespan.
And what tissue do you
need to destroy them?
Where are they destroyed?
STUDENT: Spleen.
MARIAN DIAMOND:
Spleen, good for you.
Somebody learned the spleen.
That's great.
So destroyed by spleen.
I love that when you call out.
Really lets me know
you're listening.
Otherwise, I look
out there and I can't
tell what you're thinking.
Maybe that's good too.
All right, destroyed by spleen
and what other structure?
STUDENT: The liver.
MARIAN DIAMOND:
The liver, right.
So you've got another
function for your liver,
to destroy RBCs.
So when we get to the liver,
you'll know something about it.
Well, he did click on the light,
so let's show just a few slides
here.
You like your blood a little
better than you did before?
STUDENT: [INAUDIBLE].
MARIAN DIAMOND: You think so.
Now you want a memory pill.
But see, I don't want to
give you a memory pill,
because then you'll remember
everything in this room.
And a pill won't
be able to discern
what is important to
know versus everything.
So you have to trust this
brain to do it for you.
All right, here we go.
You see, these are our
so-called erythrocytes.
And you could see that
they're these biconcave discs.
They're light in the middle,
because they're thinner here.
And this will be a lymphocyte.
We'll start with that next time.
Large nucleus, but
roughly the same size.
We see entirely different
type of white blood cell
than a red blood corpuscle.
Next one.
This is another preparation.
But you could see you could
get another preparation
and you don't get as
clearly defined RBCs.
This will be a neutrophil.
Many lobes to its nucleus.
Another white blood cell
essential to fight and protect
you.
Next one.
This is a monocyte.
This is another neutrophil.
The stain shows how light
these are in the center,
so they're normal.
Here's some platelets.
Just little cell fragments.
And the next one.
And this one is what's
called eosinophil.
But again, look at all the
numerous red blood corpuscles
in contrast to the few
thousand of white blood cells.
And the next one.
And this is called a basophil.
It's pretty hard
to define anything.
They're less than 1% of
your white blood cells.
Very few of them, hard to find.
But those will be the ones
we'll talk about next time.
So enjoy your lunch.
