1. Dr.n.n.kumari 7-10-20111 MBBS-Year I term1 MCBM 1 Element 2 Lec-16

2. Dr.n.n.kumari 7-10-20112 Plasma Proteins Composition of plasma Packed cell volume (haematocrit) Relationship between plasma volume and blood volume Physiologic functions of plasma proteins

3. Dr.n.n.kumari 7-10-20113 Give the composition of plasma Write a detailed account of the functions of plasma proteins. Explain the role of starlings forces in tissue fluid formation Define edema ? Explain the factor that cause edema. How do you obtain a sample of plasma & serum

4. Dr.n.n.kumari 7-10-20114 Hematocrit or packed cell volume The Percentage of the RBC in the blood is called hematocrit Hematocrit is determined by centrifuging blood mixed with an anticoagulant in the hematocrit tube at 3000 rpm for 30 min

5. Dr.n.n.kumari 7-10-20115 COMPOSITION OF BLOOD 1.Plasma :- Plasma proteins, Inorganic & organic substances 2.Formed elements RBC, WBC & platelets

6. Dr.n.n.kumari 7-10-20116 Blood Composition Formed elements 45% Plasma 55% Erythrocytes (RBC) Leucocytes (WBC) Thrombocytes (Platelets ) 90% water 10 % solids

7. Dr.n.n.kumari 7-10-20117 Plasma Proteins 7% Albumin Globulin Fibrinogen Prothrombin Non-protein nitrogenous substances Urea Uric acid Creatine Creatinine Xanthine Hypoxanthine Organic Glucose Aminoacids fatty acids phospholipids cholesterol hormones enzymes antibodies Inorganic substances Na + K + Ca 2+ Mg 2+ Fe 2+ Cu I & Cl -

8. Dr.n.n.kumari 7-10-20118 Plasma proteins Concentration 6 - 8.5 g/dl Classification of plasma proteins Serum Albumin 3.5 – 5.0 g% Serum Globulin 2.0 – 3.5 g% Fibrinogen 0.2 --0.3 g%

9. Dr.n.n.kumari 7-10-20119 Plasma protein Concentration G% Molecular weight Albumin3.5 -5.0 (4.5)69000 Globulin2.0 – 3.5 (2.7)90000 to 150000 Fibrinogen0.2 – 0.3 (0.25)340000 to 400000 Concentration of Plasma proteins

10. Dr.n.n.kumari 7-10-201110 Variations in the amount of plasma proteins Protein fraction IncreaseDecrease FibrinogenPregnancy Menstruation Tissue injuries, Acute diseases Hepatectomy Liver diseases haemorhage Globulin ( α 1 α 2,β & γ ) Liver diseases Multiple myeloma Acute nephrites Leukemia Tuberculosis

11. Dr.n.n.kumari 7-10-201111 Albumin --------Cirrhosis, other liver diseases, kidney diseases nephritis, nephrosis Normal A:G ratio in the blood is 3:2.In all the above mentioned cases there is no absolute increase in globulin, but there is relative increase in globulin due to decrease in albumin synthesis. The A:G ratio is reversed-2:3.

12. Dr.n.n.kumari 7-10-201112 Colloidal Osmotic Pressure (COP) or Oncotic pressure The COP of blood & plasma is about 25 mm Hg. COP is due to plasma proteins. 80% of it (20 mm Hg) is exerted by serum albumin. 20% i.e. 5 mm Hg is exerted by globulin & fibrinogen

13. Dr.n.n.kumari 7-10-201113 Functions of plasma proteins 1.Colloidal osmotic pressure 2.Coagulation of blood 3.Defence Mechanism 4.Buffering action 5.Transport of substances 6.Protein reserve 7.Viscosity of blood 8.Erythrocyte sedimentation rate

14. Dr.n.n.kumari 7-10-201114 Functions of albumin 1. Maintains colloidal osmotic pressure. Albumin is responsible for 80% of total COP ( 20 mmHg ) 2.Transports unconjugated bilirubin, drugs & CO 2 3. Buffering action 4. Viscosity

15. Dr.n.n.kumari 7-10-201115 Functions of Globulins 1.Enzymatic functions in plasma 2.Natural & acquired immunity 3.Viscosity 4.Acid – Base balance 5.Clotting of blood 6.Transportation of CO 2 thyroxine & cortisol

16. Dr.n.n.kumari 7-10-201116 Starling’s forces

17. Dr.n.n.kumari 7-10-201117

18. Dr.n.n.kumari 7-10-201118 Arterial end HSP = 37-1=36 mmHg COP = 25 mmHg Net filtration pressure = 36-25 = 11mm Starling’s hypothesis of tissue fluid formation Venous end HSP = 17 mmHg COP = 25 mmHg Net Pressure = 17-25 = 8 mmHg

19. Dr.n.n.kumari 7-10-201119 Functions of Fibrinogen 1. Clotting of blood 2. Viscosity 3. Acid - base balance 4. Colloidal osmotic pressure

20. Dr.n.n.kumari 7-10-201120 FunctionProteins responsible Maintain colloidal osmotic pressure A>G>F Clotting of blood F & G ViscosityF > A > G Acid-Base balance Protein store All proteins. Rouleaux formationF&G

21. Dr.n.n.kumari 7-10-201121 Mechanism of Clotting 1.Formation of intrinsic & extrinsic prothrombin activator 2. Prothrombin Thrombin 3.Fibrinogen Fibrin monomer Fibrin polymer Cross-linked fibrin polymer (clot)

22. Dr.n.n.kumari 7-10-201122 Source of plasma proteins 1. Amino acids from food 2. From tissue proteins in conditions of protein starvation

23. Dr.n.n.kumari 7-10-201123 Origin of plasma proteins Albumin, most globulins & Clotting factors of blood (Fibrinogen & Prothrombin are formed in the Liver The γ– globulins (antibodies) are formed by plasma cells & B- lymphocytes

24. Dr.n.n.kumari 7-10-201124 Causes of albumin deficiency ( Hypoalbuminemia ) Decreased synthesis — Cirrhosis of liver Decreased production - Malnutrition (as in starvation) Excess excretion by the Kidneys (as in nephrotic syndrome) Excess loss in bowel (protein losing enteropathy)

25. Dr.n.n.kumari 7-10-201125 Edema W hat is edema? Edema is excessive accumulation of fluid in the tissue spaces. There is much swelling & when the pressure applied with the thumb over the region is released, there is a depression due to movement of fluid away from the region and is called ‘pitting on pressure’.

26. Dr.n.n.kumari 7-10-201126 Features of Kwashiorkor:  Retarded growth  Pot belly  Thin swollen legs  Lethargy  Depressed mentation  Edema 1.Protein deficiency syndrome

27. Dr.n.n.kumari 7-10-201127 Factors involved in Edema 1.Increased capillary Hydrostatic pressure 2.Reduced Plasma colloidal osmotic pressure 3.Increased capillary permeability & surface area 4.Obstruction to lymphatic drainage

28. Dr.n.n.kumari 7-10-201128 Edema continued 2.In Liver diseases (cirrhosis of liver, portal obstruction) Diminished synthesis  Decrease in Plasma proteins concentration  decreased colloidal osmotic pressure  retention of fluid (Edema ) 3.Renal diseases: Due to loss of Proteins in urine

29. Dr.n.n.kumari 7-10-201129 Pitting edema Accumulation of fluid caused due to disturbance s in the fluid exchange mechanisms across the capillary pitting