(1) oxygen pressure in tissue is 40, while blood has 100, so there is a favorable gradient to transfer to tissues- still need more oxygen in tissue(a) acid/CO2 has to be present in the system in order to be added to hemoglobin and bump off oxygen off the hemoglobin(i) Hyperventilation (alkalosis) is not enough CO2 in the system, we do not have enough acid to take the oxygen off the red blood cells in the blood—huge effect on brain(b) Hemoglobin has affinity for oxygen – saturation curve shows us this (hemoglogin on the y axis and oxygen on the x axis- At 40 mmHG oxygen, hemoglobin is at 70 percent because we are in the tissue and oxygen is realeased, and then it is 99% hemoglobin in the lungs at 100mmHg oxygen, this is oxygen loading)6. Eurythropoeisisa) amount of reticulocytes tells us how many red blood cells we have to replaceb) reticulocytes are truly moral- no mitosis, they will immerge into the blood stream and mature and live for 120 days, and will travel up to 300 miles before it is destroyed, this is about 200,000 trips through the heartc) for eurythropoesis, need: iron (for heme group), then there are 2 globulin chain groups, alpha and beta that must be made in balance, for this, we also need vitamin folic acid and B12(1) If we do not have the needs, and they are underproduced, or there is an abnormal hemoglobin level, we reach Anemia – normal RBC count is 40% and Anemic RBC count is 30%d) Spleen – where old redblood cells are destroyed, RBCs will be trapped in the spleen if spherical(old and damaged red blood cells get stuck), and if they are biconcave, they will keep going through (the young, working RBCs will continue to circulate)(1) macrophages in the spleen will take apart the iron(heme) and globin (globin are turned into amino acids)(2) Heme is broken down into unconjugated bilirubin that is insoluable- this will then bind to albumen and be sent to the liver where it will react with glucouronic acid to produce a conjugated bilirubin, which is soluable(a) too much bilirubin too fast makes you hydrophobic and it deposits in the tissue, and we will get jaundice --- big problem when it deposits in the brain(b) we can only handle 2-4mg until we get jaundice, therefore we can only live with 5-20mg of thise) infant has different type of blood cells, they have gamma cells rather than beta(1) most babies become jaundice after 3-4 days, but if it becomes kernicturous which means it has deposited in the brain(2) phototherapy will reduce the insoluable bilirubin to soluable isoforms that the body can handle phototherapy at 460-490wavelengthf) bilirubin is an important part of bile and fat absorption(1) important component to liver and spleen functionB. Exchange1. Bulk flow exchangea) Exchange of glucose, water, ions, amino acids and lipidsb) Hydrostatic exchange2. Diffusiona) Must be a pressure gradientb) If arterial pCO2 in the arteries is greater than or equal to the pCO2 in the tissue then:(1) CO2 is absorbed in the water: CO2 + H2O H2CO3(2) there is a decrease in oxygen unloading  anaerobic respiration and lactic acid is produced --- Acidity in tissue3. Diffusion of nitrogena) change to urea and waste4. Transcytosis- active transport –NOT using ATP and rather a coupled systema) transcellular coupled transport across the cellular membrane so that the major waste (organic acid) is releasedb) also will use this to get amino acids to the tissue5. Pressurea) oncotic (colloidal) pressure- osmotic pressure that favors movement of water from the tissue and into the blood -made by plasma proteins(1) plasma proteins (albumin, globulin, and coagulation) originate in the liver(a) pressure is built up because large proteins can not easily cross through the capillary walls, and will then pull water into the capillaries to satisfy osmosis(2) we may lose protein in the urine, and if we do, we will pee brown foam – meaning that the kidneys are failing, losing this oncotic pressureb) hydrostatic pressure – capillary pressure (opposing force to oncotic pressure)(1) balances with oncotic pressure to balance the releasing and reabsorbing water(a) obstructing vein with deep vein thrombosis (can be caused by crossing your legs) will slow venous movement and increase capillary pressure above oncotic pressure and you will create edema for this and eventually cause hypertension.c) Homeostasis- blood clotting work(1) Requires: 200,000 mL platelets, coagulation plasma proteins and calcium(2) Virchows Triad(a) platelet # is low =hemorrhagic, High= thrombotic (platelet begins to adhere to the wall = thrombi)(b) coagulation/ anticoagulation protein balance(c) vessel wall injury- activates vanWillebrand factor (VWF) to aggregate and adhere to the wall of the brain6. thrombopoetin- platelet developmenta) megakaryocytes made to produce platelets in the liverb) Leukemia – white blood cell cancer of bone marrow(1) lyphocytic – no other blood is affected (early) – Meilocytic anemia at hypothrombopoenia hemmerogging- check for leukemia7. Fibrin clot – intrinsic and extrinsic pathway converge on a common pathwaya) common pathway critical step is when the bandaid starts to form: prothrombin converted to thrombinb) calcium dependent pathwayc) either clot too fast or too slowd) PT time – Prothrombin and thrombin time – this time here indicates the full activation, the point of no returne) PTT time – Tissue thromboplastin time – this is the time of the start of the cascade, which is under 3 secondsf) fibrin platelet clot needs to be controlled or it can reach the brain or heartg) checks and balances(1) thrombin makes plasminogen and converted to plasmin that will eat at the clot(2) the most common one would be TPA, activating plasminogen and plasmin will take care of the clotLecture 23 Outline of Last Lecture Q. Plasma Transport Outline of Current Lecture Q. Plasma transport continuedR. ExchangeCurrent Lecture (1) oxygen pressure in tissue is 40, while blood has 100, so there is a favorable gradient to transfer to tissues- still need more oxygen in tissue (a) acid/CO2 has to be present in the system in order to be added to hemoglobin and bump off oxygen off the hemoglobin(i) Hyperventilation (alkalosis) is not enough CO2 in the system, we do not have enough acid to take the oxygen off the red blood cells in the blood—huge effect on brain (b) Hemoglobin has affinity for oxygen – saturation curve shows us this (hemoglogin on the y axis and oxygen on the x axis- At 40 mmHG