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.
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?
MARIAN DIAMOND: Connective tissue.
Blood's a connective tissue and it has a fluid matrix.
What do we call a fluid matrix?
MARIAN DIAMOND: Plasma.
It has cells, corpuscles, corpuscles, and cell fragments.
And one, two and three equal 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?
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.
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,
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?
There's the term cyte.
Sort of erroneous here, but that's what they're called.
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 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?
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?
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.
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?
MARIAN DIAMOND: Everything.
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?
No, it's a connective tissue 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.
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
Now we mentioned when we were studying bone,
that another component that's found in plasma is calcium,
So plasma has calcium.
We learned that low calcium stimulates what gland?
MARIAN DIAMOND: Parathyroid gland, sure.
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.
What hormone is released then from the parathyroid gland?
Not too complex.
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.
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
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?
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?
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
You've had it, close to it.
What do you call blood formation?
MARIAN DIAMOND: Haematopoiesis.
So now we're forming red blood cells.
What are we going to say?
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.
Do you know what to call networks in cytology?
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.
Figure it out, think of it.
Right, good for you.
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.
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?
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?
MARIAN DIAMOND: Sure, why?
What's their function?
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?
MARIAN DIAMOND: Spleen, good for you.
Somebody learned the spleen.
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
You like your blood a little better than you did before?
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.
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
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.