CHAPTER IV

ANATOMY AND PHYSIOLOGY

The Blood
The blood consists of cells and cell fragments, called formed elements, and water with
dissolved
molecules, called blood plasma.
Eyrthrocytes
Erythrocytes, or red blood cells (RBCs), transport oxygen (O 2) and carbon dioxide (CO2)
in the blood. Erythrocytes contain the protein hemoglobin to which both O 2 and CO2
attach.
Mature erythrocytes lack a nucleus and most cellular organelles, thereby maximizing
the cell's volume and thus its ability to carry hemoglobin and to transport O 2.
Erythrocytes are shaped like flattened donuts with a depressed center (rather than a
donut hole). Their flattened shape maximizes surface area for the exchange of O 2and
CO2 and allows flexibility that permits their passage through narrow capillaries.
Hemoglobin contains both a protein portion, called globin, and nonprotein heme groups.
Globin consists of four polypeptide chains, each of which contains a heme group. The
heme group is a red pigment that contains a single iron atom surrounded by a ring of
nitrogen-containing carbon rings. One oxygen atom attaches to the iron of each heme
group, allowing a single hemoglobin molecule to carry four oxygen atoms. Each
erythrocyte contains about 250 million hemoglobin molecules.
Oxyhemoglobin (HbO2) forms in the lungs when erythrocytes are exposed to oxygen as
they pass through the lungs. Deoxyhemoglobin (Hb) forms when oxygen detaches form
the iron and diffuses into surrounding tissues.
Carbaminohemoglobin (HbCO2) forms when CO2 attaches to amino acids of the globin
part of the hemoglobin molecule. About 25 percent of the CO 2 transported from tissues
to lungs is in this form.
Carbonic anhydrase, an enzyme in erythrocytes, converts CO 2 and H2O in the blood
plasma to H+ and HCO3 About 65% of the CO2 collected from tissues travels in the
blood plasma as HCO3.
Because they lack cellular organelles and thus physiology to maintain themselves,
erythrocytes survive for only about 120 days. Degenerated erythrocytes are broken
down in the spleen and liver by macrophages (phagocytic white blood cells)
Leukocytes
Leukocytes, or white blood cells (WBCs), are cells that protect the body from foreign
microbes and toxins. Although all leukocytes can be found in the bloodstream, some

permanently leave the bloodstream to enter tissues where they encounter microbes or
toxins, while other kinds of leukocytes readily move in and out of the bloodstream.
Leukocytes are classified into two groups, granulocytes and agranulocytes, based upon
the presence or absence of granules in the cytoplasm and the shape of the nucleus.
Platelets
Platelets (thrombocytes) are fragments of huge cells called megakaryocytes. Platelets
lack a nucleus and consists of cytoplasm (with few organelles) surrounded by a plasma
membrane. Platelets adhere to damaged blood vessel walls and release enzymes that
activate hemostasis, the stoppage of bleeding.
Plasma
Plasma is the straw-colored, liquid portion of the blood.

The liver, weighing roughly 1.2-1.6 kg, performs many of the functions necessary
for staying healthy. It is located in the right side of the body under the lower ribs and is
divided into four lobes of unequal size. Two large vessels carry blood to the liver. The
hepatic artery comes from the heart and carries blood rich in oxygen. The portal vein
brings the liver blood rich in nutrients absorbed from the small intestine. These vessels
divide into smaller and smaller vessels, ending in capillaries. These capillaries end in
the thousands of lobules of the liver. Each lobule is composed of hepatocytes, and as
blood passes through, they are able to monitor, add, and remove substances from it.
The blood then leaves the liver via the hepatic vein, returns to the heart, and is ready to
be pumped to the rest of the body.

Among the most important liver functions are:

Removing and excreting body wastes and hormones as well as drugs and other
foreign substances. These substances have entered the blood supply either through
production by metabolism within the body or from the outside in the form of drugs or
other foreign compounds
Synthesizing plasma proteins, including those necessary for blood clotting. Most of the
12 clotting factors are plasma proteins produced by the liver. If the liver is damaged or
diseased, it can take longer for the body to form clots.

 Producing immune factors and removing bacteria, helping the body fight infection The
phagocytes in the liver produce
acute-phase proteins in response to microbes. These proteins are associated with the
inflammation process, tissue repair, and immune cell activities.
Other important but less immediate functions include:
Producing bile to aid in digestion. Bile salts aid in fat digestion and absorption. Bile is
continuously secreted by the liver and stored in the gallbladder until a meal, when bile
enters the beginning of the small intestine. Bile production ranges from 250 mL to 1 L
per day depending of amount of food eaten.
Excretion of bilirubin. Bilirubin is one of the few waste products excreted in bile..
Bilirubin then results from the breakdown of the hemoglobin in the red blood cells and is
excreted into bile by hepatocytes. Jaundice results when bilirubin cannot be removed
from the blood quickly enough due to gallstones, liver disease, or the excessive
breakdown of red blood cells.
Storing certain vitamins, minerals, and sugars .The liver stores enough glucose in the
form of glycogen to provide about a day's worth of energy. The liver also stores fats,
iron, copper, and many vitamins including vitamins A, D, K, and B12.
Processing nutrients absorbed from digestive tract. The liver converts glucose into
glycogen, its storage form. This glycogen can then be transformed back into glucose if
the body needs energy. The fatty acids produced by the digestion of lipids are used to
synthesize cholesterol and other substances. The liver also has the ability to convert
certain amino acids into others.
One of the liver's most interesting abilities is self-repair and the regeneration of
damaged tissues. In clearing the body of toxins, the liver is damaged by exposure to
harmful substances, demonstrating why this capability is important. It also gives hope
that if a failing liver can be supported for a certain period of time, it might regenerate
and allows the patient to survive and regain a normal life.