[Music] welcome to the hematologic system overview human illogic system is not a simple system but it is so imperative that you understand kind of how it works that you understand what's behind the scenes because really this is what binds all our systems together this is what makes our system one big Orchestra so without each of these aspects of the system doing its thing you are not going to have a system that's functioning or that has homeostasis so let's take a look at specifically see the functions of the human to logic system that we're going to take a look at even further and that also provides the basis the foundation for all the subsequent units that we're going to discuss clot formation and dissolution we're going to talk about the formation of a platelet plug they would be one of the formed elements of the whole blood which we're going to talk about in a second and also your responsibility in administrating those antiplatelet drugs those anticoagulant drug serious implications for care as you know those are high risk medication that's on your little list of high risk rub so you know it's important oxygenation that's what it's all about right ladies and gentlemen without oxygenation you're not going to have normal cellular metabolism and you're going to have cell death so that's pretty important transport again the transport mechanism of the blood is with ties in all our systems it makes us whole and connected okay so let's look at the components of whole blood so there's 5% of whole blood the weight of whole blood is comprised of plasma so playa blob is 92 percent water so it's mostly water 6% of that plasma our plasma proteins 2% of solutes what's the rest of whole blood are called the formed elements so the formed elements are the solids of the blood and I'm going to take a really close look at the platelets or these ROM besides the white blood cell or the leukocytes and the erythrocyte or the red blood cells so what's fascinating to me about this is that okay you have 6% of all of this weight is proteins only 6% and yet if you have the deviation in what we know to be normal levels of any of this you're not going to have homeostasis so I'll movement for example what's the role of albumin in the blood on Kotik pressure that pulling power for water without albumin you're not going to have transport because you're not having to have anything that stays in the intravascular space there's nothing to pull it and keep it in there so I'll view many normal level 3 point 5 to 5 so you know your application is hypoalbuminemia you're going to have some issues with extravascular weight and volume lower extremity edema and problems with perfusion blood pressure transport so albumin is so essential for this orchestra to all communicate with one another okay so let's look now at solvents of the blood so there's all these different types of songs and yet it's only 2% of that whole blood to regret all of it so when you take a look at just one in our list the ions well what's an ion positively charged ion potassium sodium calcium hopefully you know all those normal values to memory there are some things you do have to memorize for the licensing exam and the normal values of your metabolic panel and your complete blood count is definitely on the list of things to memorize so the tax head being three point five to five if that normal level of that positively charged ion deviates from three point five to five you can have some serious issues with cardiac conduction which leads to problems with perfusion which could lead to death so my point is and I need to be so heavy is that you need to understand how each aspect of this blood plays such an imperative role and so the identification of whatever is deviating is one of our essential functions at the bedside nutrients waste product when you're in nitrogen uric acid isn't like the stuff we need to rid because it balances organs and it disrupts homeostasis last tape for example we're going to talk about an anaerobic metabolism takes place and the byproduct of that is lactic acid well now not only do we have hypoxemia now and which is disruption is in oxygenation now we're going to have a disruption and acid-base balance a metabolic acidosis on top of your severe hypoxemia so my point is that every one of these components again is so essential from neo stasis the gas is oxygen co2 the delivery of oxygen to the cells for cellular metabolism and then the Cardinal Way of the waste products of that cellular the a form of carbon dioxide or co2 regulatory substances oh my gosh the hormones in the system again that system the endocrine system which releases those substances that act either on a cell or an organ in order for some effect to take place that's the endocrine system without the precise amount of these hormones at the precise time that they should be released you're not going to have homeostasis and you're going to have disease so again this is the basis for every subsequent system we're going to talk about okay so let's take a look now at the four endowment with your platelet or the thrombocytes a platelet is one of the formed elements that is essential for normal clotting processes without the platelet to release that sticky substance you're not going to have the platelet plug form which is the first step in fibrin clot formation so that's just your overview and we're going to talk a little bit more about it in a few minutes but leukocyte is the white blood cell now again you're going to have to know normals of these formed element those platelets as we just spoke about not to backtrack a little bit but make sure you are very familiar with normal platelet values being 150,000 to 350,000 not sometimes you'll see 150 but that's just an abbreviated way to say 150,000 because it's assumed we know there's the platelets are in a thousand okay so back to the lupus site so the loop of site is the white blood cell rule being five to ten thousand so without being able to recognize the normal values you're not going to be able to identify when there is this absence of normal physiology pathophysiology again this section is behind the scenes it's the most complex because it's not something that jumps out at you like this is what's wrong in the immune system this is what's wrong with my clotting you're going to have to dig deeper and look at these things unlike other diseases I love the example of liver failure patient because whatever is going wrong pathophysiological II that patients that are present with those clinical manifestations so it's so much easier to illustrate it literally and figuratively okay so when I come to the white blood cells there's all these different types of white blood cells can you need to be a little more familiar with some of them than others the neutrophil is they called the immature white blood cell why because it's not going to begin to multiply unless an acute infection is present so we know when the neutrophil is elevated then an acute infection is possibly pending let's skip over on the side for one second that monocytes and the eosinophils basophils you know we just check in with them every once in a while we don't pay a lot of attention to up close and personal at the bedside but we need to know they're there we need to know they're doing their job of phagocytosis the lymphocyte okay we're going to talk about lymphocyte because it does have real political relevance for us as we look at the needs and hypersensitivity disorders in particular and Allergy and acyl axis which is an extreme form of allergy Alton okay so just to backtrack one second again to these regulatory substances one of them in particular being erythropoietin where is erythropoietin secreted from from the kidney from the renal system you see how it is all very much involved with each other all the organ systems talk to each other through hormone so just take a look at the bone marrow for a second because the bone marrow is where all of the foreign elements are manufactured so when you have bone marrows depression and what types of disorders or diseases or circumstances will suppress your bone marrow to therapy bone marrow cancers so when you have a suppressed bone marrow you have what's called can cytokine Ian and I know you saw a pan for my students you know here in Japan and you're cooking up some whatever it is the egg and you've got your eggs and you've got your ham and you've got your cheese and it's all in there but in this context you got your platelets and you've got your red blood cells and you've got your white blood cells they're all being cooked up this they're all down they're all going away so that's pan site-- ischemia the red blood cell for a minute or the erythrocyte now they represent areas the hemoglobin in fact one erythrocyte carries 300 hemoglobin molecules and you need to be very familiar with the clinical significance of hemoglobin the oxygen carrying capacity of the blood clinical relevance for you is that when you're administering to your patient packed red blood cells that's why you need to restore their oxygen carrying capacity of their blood let's look at these other players just for a minute of a hematologic system the spleen the spleen is very important for immunity because it does provide a filter for blood and it is also what stores the old components of red blood cells and platelets a liver oh my god I just love talking about the liver because again when you have a patient in liver failure there it is it's all out there for you you can see everything that's going wrong with their liver by looking at them but we'll get to that Pro from and that's the plasma protein guess where it's made the liver love that organ albumin guess where albumin is manufactured in the liver so if you have liver there you're going to have a diminished amount of all these plasma proteins in the liver all also manufactures bile why does that be been significant now in this series because without bile you are not able to absorb that okay a suggestion or fat soluble vitamins fat soluble vitamins let's think about which ones are they AED for an important port and K very important without the absorption of vitamin K when you get bleeding so this all ties in