Blood and lymph

Blood is a body fluid in humans and other animals that delivers necessary
substances such as nutrients and oxygen to the cells and transports metabolic
waste products away from those same cells.

In vertebrates, it is composed of blood cells suspended in blood plasma.

Plasma, which constitutes 55% of blood fluid, is mostly water (92% by volume), and
contains proteins, glucose, mineral ions, hormones, carbon dioxide (plasma being
the main medium for excretory product transportation), and blood cells
themselves. Albumin is the main protein in plasma, and it functions to regulate the
colloidal osmotic pressure of blood. The blood cells are mainly red blood cells (also
called RBCs or erythrocytes), white blood cells (also called WBCs or leukocytes)
and platelets (also called thrombocytes). The most abundant cells in vertebrate blood
are red blood cells. These contain hemoglobin, an iron-containing protein, which
facilitates oxygen transport by reversibly binding to this respiratory gas and greatly
increasing its solubility in blood. In contrast, carbon dioxide is mostly transported
extracellularly as bicarbonate ion transported in plasma.

Blood is circulated around the body through blood vessels by the pumping
action of the heart. In animals with lungs, arterial blood carries oxygen from inhaled
air to the tissues of the body, and venous blood carries carbon dioxide, a waste
product of metabolism produced by cells, from the tissues to the lungs to be exhaled.

Functions
Blood performs many important functions within the body, including:

 Supply of oxygen to tissues (bound to hemoglobin, which is carried in red cells)

 Supply of nutrients such as glucose, amino acids, and fatty acids (dissolved in the
blood or bound to plasma proteins (e.g., blood lipids))
 Removal of waste such as carbon dioxide, urea, and lactic acid
 Immunological functions, including circulation of white blood cells, and detection
of foreign material by antibodies
 Coagulation, the response to a broken blood vessel, the conversion of blood from
a liquid to a semisolid gel to stop bleeding
 Messenger functions, including the transport of hormones and the signaling
of tissue damage
 Regulation of core body temperature
 Hydraulic functions

Blood accounts for 7% of the human body weight, with an average density
around 1060 kg/m3, very close to pure water's density of 1000 kg/m3. The average
adult has a blood volume of roughly 5 litres (11 US pt),which is composed of plasma
and several kinds of cells. These blood cells (which are also called corpuscles or
"formed elements") consist of erythrocytes (red blood cells, RBCs), leukocytes
(white blood cells), and thrombocytes (platelets). By volume, the red blood cells
constitute about 45% of whole blood, the plasma about 54.3%, and white cells
about 0.7%.
 Cells
One microliter of blood contains:

 4.7 to 6.1 million (male), 4.2 to 5.4 million (female) erythrocytes:[6] Red blood
cells contain the blood's hemoglobin and distribute oxygen. Mature red blood
cells lack a nucleus and organelles in mammals. The red blood cells (together
with endothelial vessel cells and other cells) are also marked by glycoproteins that
define the different blood types. The proportion of blood occupied by red blood
cells is referred to as the hematocrit, and is normally about 45%. The combined
surface area of all red blood cells of the human body would be roughly 2,000
times as great as the body's exterior surface.[7]
 4,000–11,000 leukocytes:[8] White blood cells are part of the body's immune
system; they destroy and remove old or aberrant cells and cellular debris, as well
as attack infectious agents (pathogens) and foreign substances. The cancer of
leukocytes is called leukemia.
 200,000–500,000 thrombocytes:[8] Also called platelets, they take part in blood
clotting (coagulation). Fibrin from the coagulation cascade creates a mesh over
the platelet plug.

Plasma
About 55% of blood is blood plasma, a fluid that is the blood's liquid medium,
which by itself is straw-yellow in color. The blood plasma volume totals of 2.7–3.0
liters (2.8–3.2 quarts) in an average human. It is essentially an aqueoussolution
containing 92% water, 8% blood plasma proteins, and trace amounts of other
materials. Plasma circulates dissolved nutrients, such as glucose, amino acids,
and fatty acids (dissolved in the blood or bound to plasma proteins), and removes
waste products, such as carbon dioxide, urea, and lactic acid.
Other important components include:

 Serum albumin
 Blood-clotting factors (to facilitate coagulation)
 Immunoglobulins (antibodies)
 lipoprotein particles
 Various other proteins
 Various electrolytes (mainly sodium and chloride)
The term serum refers to plasma from which the clotting proteins have been
removed. Most of the proteins remaining are albumin and immunoglobulins.

pH values
Blood pH is regulated to stay within the narrow range of 7.35 to 7.45, making it
slightly basic.[9][10] Blood that has a pH below 7.35 is too acidic, whereas blood pH
above 7.45 is too basic. Blood pH, partial pressure of oxygen (pO2), partial pressure
of carbon dioxide (pCO2), and bicarbonate (HCO3−) are carefully regulated by a
number of homeostatic mechanisms, which exert their influence principally through
the respiratory system and the urinary system to control the acid-base balance and
respiration. An arterial blood gas test measures these. Plasma also
circulates hormones transmitting their messages to various tissues. The list of
normal reference ranges for various blood electrolytes is extensive.

Oxygen transport
About 98.5% of the oxygen in a sample of arterial blood in a healthy human breathing
air at sea-level pressure is chemically combined with the hemoglobin. About 1.5% is
physically dissolved in the other blood liquids and not connected to hemoglobin. The
hemoglobin molecule is the primary transporter of oxygen in mammals and many
other species (for exceptions, see below). Hemoglobin has an oxygen binding
capacity between 1.36 and 1.40 ml O2 per gram hemoglobin, which increases the
total blood oxygen capacity seventyfold, compared to if oxygen solely were carried
by its solubility of 0.03 ml O2 per liter blood per mm Hg partial pressure of oxygen
(about 100 mm Hg in arteries).

Carbon dioxide transport

CO2 is carried in blood in three different ways. (The exact percentages vary
depending whether it is arterial or venous blood). Most of it (about 70%) is converted
to bicarbonate ions HCO− ; about 7% is dissolved in the plasma; and about 23% is
bound to hemoglobin as carbamino compounds. Hemoglobin, the main oxygen-
carrying molecule in red blood cells, carries both oxygen and carbon dioxide.
However, the CO2 bound to hemoglobin does not bind to the same site as oxygen.
Instead, it combines with the N-terminal groups on the four globin chains.

Thermoregulation
Blood circulation transports heat throughout the body, and adjustments to this flow
are an important part of thermoregulation. Increasing blood flow to the surface (e.g.,
during warm weather or strenuous exercise) causes warmer skin, resulting in faster
heat loss. In contrast, when the external temperature is low, blood flow to the
extremities and surface of the skin is reduced and to prevent heat loss and is circulated
to the important organs of the body, preferentially.

Rate of blood flow

Rate of blood flow varies greatly between different organs. Liver has the most
abundant blood supply with an approximate flow of 1350 ml/min. Kidney and brain
are the second and the third most supplied organs, with 1100 ml/min and ~700
ml/min, respectively.[25]
Relative rates of blood flow per 100 g of tissue are different, with kidney, adrenal
gland and thyroid being the first, second and third most supplied tissues,
respectively.[2
The Lymphatic System
The lymphatic system is part of the vascular system and an important part of the
immune system, comprising a large network of lymphatic vessels that carry a clear
fluid called lymph (from Latin, lympha meaning "water directionally towards the
heart.
Unlike the circulatory system, the lymphatic system is not a closed system. The
human circulatory system processes an average of 20 litres of blood per day through
capillary filtration, which removes plasma while leaving the blood cells. Roughly 17
litres of the filtered plasma is reabsorbed directly into the blood vessels, while the
remaining three litres remain in the interstitial fluid.
One of the main functions of the lymph system is to provide an accessory return
route to the blood for the surplus three litre

The other main function is that of defense in the immune system.

Lymph is very similar to blood plasma: it contains lymphocytes. It also contains

waste products and cellular debris together with bacteria and proteins.
Lymphocytes are concentrated in the lymph nodes.
The spleen and the thymus are also lymphoid organs of the immune system. The
tonsils are lymphoid organs that are also associated with the digestive system.
Lymphoid tissues contain lymphocytes, and also contain other types of cells for
support. The system also includes all the structures dedicated to the circulation and
production of lymphocytes (the primary cellular component of lymph), which also
includes the bone marrow, and the lymphoid tissue associated with the digestive
system.
Lymph is the fluid that is formed when interstitial fluid enters the initial lymphatic
vessels of the lymphatic system. The lymph is then moved along the lymphatic vessel
network by either intrinsic contractions of the lymphatic passages or by extrinsic
compression of the lymphatic vessels via external tissue forces (e.g., the contractions
of skeletal muscles), or by lymph hearts in some animals. The organization of lymph
nodes and drainage follows the organization of the body into external and internal
regions; therefore, the lymphatic drainage of the head, limbs, and body cavity walls
follows an external route, and the lymphatic drainage of the thorax, abdomen, and
pelvic cavities follows an internal route. Eventually, the lymph vessels empty into the
lymphatic ducts, which drain into one of the two subclavian veins, near their junction
with the internal jugular veins.
A lymph node or lymph gland is an ovoid or kidney-shaped organ of the
lymphatic system, and of the adaptive immune system, that is widely present
throughout the body. They are linked by the lymphatic vessels as a part of the
circulatory system. Lymph nodes are major sites of B and T lymphocytes, and other
white blood cells. Lymph nodes are important for the proper functioning of the
immune system, acting as filters for foreign particles and cancer cells. Lymph nodes
do not have a detoxification function, which is primarily dealt with by the liver and
kidneys.
Lymph nodes also have clinical significance. They become inflamed or enlarged
in various diseases which may range from trivial throat infections, to life-threatening
cancers.
Lymph nodes are present throughout the body, are more concentrated near and
within the trunk, and are divided in the study of anatomy into groups. Some lymph
nodes can be felt when enlarged (and occasionally when not), such as the axillary
lymph nodes under the arm, the cervical lymph nodes of the head and neck and the
inguinal lymph nodes near the groin crease. Some lymph nodes can be seen, such as
the tonsils. Most lymph nodes however lie within the trunk adjacent to other major
structures in the body - such as the paraaortic lymph nodes and the tracheobronchial
lymph nodes.

There are no lymph nodes in the central nervous system, which is separated from
the body by the blood-brain barrier.

Blood disorders can affect any of the three main components of blood:

 Red blood cells, which carry oxygen to the body's tissues

 White blood cells, which fight infections
 Platelets, which help blood to clot

Blood disorders can also affect the liquid portion of blood, called plasma.
Treatments and prognosis for blood diseases vary, depending on the blood condition and
its severity.

Blood Disorders Affecting Red Blood Cells

Anemia : People with anemia have a low number of red blood cells. Mild anemia often
causes no symptoms. More severe anemia can cause fatigue, pale skin, and shortness of
breath with exertion.
Iron-deficiency anemia: Iron is necessary for the body to make red blood cells. Low
iron intake and loss of blood due to menstruation are the most common causes of iron-
deficiency anemia. Treatment includes iron pills, or rarely, blood transfusion.
Anemia of chronic disease: People with chronic kidney disease or other chronic diseases
tend to develop anemia. Anemia of chronic disease does not usually require treatment.
Injections of a synthetic hormone, epoetin alfa(Epogen or Procrit), to stimulate the
production of blood cells or blood transfusions may be necessary in some people with this
form of anemia.
Pernicious anemia (B12 deficiency)
Aplastic anemia: In people with aplastic anemia, the bone marrow does not produce
enough blood cells, including red blood cells. This can be caused by a host of conditions,
including hepatitis, Epstein-Barr, or HIV -- to the side effect of a drug, to chemotherapy
medications, to pregnancy. Medications, blood transfusions, and even a bone marrow
transplant may be required to treat aplastic anemia.
Autoimmune hemolytic anemia: In people with this condition, an overactive immune
system destroys the body's own red blood cells, causing anemia. Medicines that suppress
the immune system, such as prednisone, may be required to stop the process.
Thalassemia: This is a genetic form of anemia that mostly affects people of
Mediterranean heritage. Most people have no symptoms and require no treatment.
Others may need regular blood transfusions to relieve anemia symptoms.
Sickle cell anemia : A genetic condition that affects mostly people whose families
have come from Africa, South or Central America, the Caribbean islands, India, Saudi
Arabia, and Mediterranean countries that include Turkey, Greece, and Italy. In sickle
cell anemia, the red blood cells are sticky and stiff. They can block blood flow.
Severe pain and organ damage can occur.
Polycythemia vera: The body produces too many blood cells, from an unknown
cause. The excess red blood cells usually create no problems but may cause blood
clots in some people.
Malaria: A mosquito's bite transmits a parasite into a person's blood, where it infects
red blood cells. Periodically, the red blood cells rupture, causing fever, chills, and
organ damage. This blood infection is most common in parts of Africa but can also be
found in other tropical and subtropical areas around the world; those traveling to
affected areas should take preventive measures.

Blood disorders that affect white blood cells include:

Lymphoma : A form of blood cancer that develops in the lymph system. In
lymphoma, a white blood cell becomes malignant, multiplying and spreading
abnormally. Hodgkin's lymphoma and non-Hodgkin's lymphoma are the two major
groups of lymphoma. Treatment with chemotherapy and/or radiationcan often extend
life with lymphoma, and sometimes cure it.
Leukemia
Multiple myeloma
Myelodysplastic syndrome

Blood Disorders Affecting Platelets

Thrombocytopenia : A low number of platelets in the blood; numerous conditions
cause thrombocytopenia, but most do not result in abnormal bleeding.
Idiopathic thrombocytopenic purpura: A condition causing a persistently low
number of platelets in the blood, due to an unknown cause; usually, there are no
symptoms, yet abnormal bruising, small red spots on the skin (petechiae), or abnormal
bleeding can result.
Heparin -induced thrombocytopenia: A low platelet count caused by a reaction
against heparin, a blood thinner given to many hospitalized people to prevent blood
clots
Thrombotic thrombocytopenic purpura: A rare blood disorder causing small blood
clots to form in blood vessels throughout the body; platelets are used up in the
process, causing a low platelet count.
Essential thrombocytosis (primary thrombocythemia): The body produces too
many platelets, due to an unknown cause; the platelets do not work properly, resulting
in excessive clotting, bleeding, or both.
 Blood Disorders Affecting Blood Plasma
Blood disorders that affect blood plasma include:
Hemophilia : A genetic deficiency of certain proteins that help blood to clot; there are
multiple forms of hemophilia, ranging in severity from mild to life-threatening.
von Willebrand disease: von Willebrand factor is a protein in blood that helps blood
to clot. In von Willebrand disease, the body either produces too little of the protein, or
produces a protein that doesn't work well. The condition is inherited, but most people
with von Willebrand disease have no symptoms and don't know they have it. Some
people with von Willebrand disease will have excessive bleeding after an injury or
during surgery.
Hypercoaguable state (hypercoagulable state): A tendency for the blood to clot too
easily; most affected people have only a mild excess tendency to clot, and may never
be diagnosed. Some people develop repeated episodes of blood clotting throughout
life, requiring them to take a daily blood thinning medicine.
Deep venous thrombosis: A blood clot in a deep vein, usually in the leg; a deep
venous thrombosis can dislodge and travel through the heart to the lungs, causing
a pulmonary embolism.
Disseminated intravascular coagulation (DIC): A condition that causes tiny blood
clots and areas of bleeding throughout the body simultaneously; severe infections,
surgery, or complications of pregnancy are conditions that can lead to DIC.

A poorly working lymphatic system causes tissues to become swollen with fluid. This
is called lymphedema. It commonly results in swelling in your arms or legs. Other
parts of the body can be affected, too.
The skin may feel tight and hard, and skin problems may occur. In some cases, fluid
may leak through the skin.

Obstruction can result from surgery, radiation therapy, injury, a condition known as
lymphatic filariasis, or—rarely—a congenital disorder

Most people who have swollen glands with a cold or flu do not need to see a doctor.

However, medical advice should be sought if:

 lymph nodes stay swollen for longer than 1 to 2 weeks

 a swollen lymph node feels hard or fixed in place

 swelling is accompanied by fever, night sweats, or unexplained weight los

 Decongestive lymphatic therapy (DLT):
 compression bandages – to complement exercise by moving fluid out of the affected
limb and minimise further build-up
 skin care – to keep the skin in good condition and reduce the chances of infection
 exercises – to use muscles in the affected limb to improve lymph drainage
 specialised massage techniques – known as manual lymphatic drainage (MLD); this
stimulates the flow of fluid in the lymphatic system and reduces swelling
prevention: healthy lifestyle, balanced diet, skincare.