PERTAHANAN TUBUH DAN SISTEM IMUN

DARAHI PUTU GEDE ADIATMIKA

Bagian Ilmu Faal FAKULTAS KEDOKTERAN UNIVERSITAS UDAYANAFaal 20151PendahuluanBagian-bagian penting dalam sistem sirkulasiJANTUNGPEMBULUH DARAHPEMBULUH LIMFEDARAH2CAIRAN TUBUHINTRASELULAR, EKSTRASELULER, TRANSELULER3Cairan tubuh normal60 % tubuh terdiri dari airAir dalam tubuh harus seimbangmenentukan homeostasisdiatur oleh berbagai sistem dalam tubuh

Kekurangan dan kelebihan cairan menganggu homestasis - SAKIT4Cairan TubuhCairan yang terdapat di dalam tubuh 60 % dari berat badanTerdiri dari air dan unsur-unsur terlarut di dalamnya

KompartemenCairan intraseluler (40 %) - selCairan ekstraselulerPlasma (5 %) di dalam pembuluh darahInterstitial (transeluler) 15 % - limfe, cerebrospinal fluid, sendi, bola mata, dll5Pertukaran cairan dalam jaringanDipengaruhi oleh tekanan hidrostatik dan osmotik

Hidrostatik mendorong gerakan cairan keluar pembuluh darahOsmotik mendorong gerakan cairan ke dalam pembuluh darah DIPENGARUHI OLEH PROTEIN DALAM PLASMA

Pergerakan cairan melalui kapiler arteri dan vena LEBIH SEDIKIT KEMBALI KE VENASISANYA MELALUI PEMBULUH LIMFE6Keseimbangan air tubuhDitentukan oleh intake dan water lossDipengaruhi oleh :AktivitasBerat badandll

7Intake airDapat dengan dua cara :Air dalam bentuk cairan dan air dalam makanan (2100 ml/hari)Hasil sintesis dalam tubuh oksidasi karbohidrat (200 ml/hari)Dipengaruhi oleh :LingkunganKebiasaan Tingkat aktivitas8Kehilangan CairanInsensible water loss pernafasan dan kulit (700 ml/hari)Keringat tergantung lingkungan dan aktivitas (100 ml/hari)Feces 100 ml/hariGinjal 1400 ml/hari9Water balanceIn health the total amount of body water is kept reasonably constant

Fluid intakeLiquid 2100 mlMetoblism 200 ml

Fluid outputLungs 350 mlSweat 100 mlFeces 100 mlKidney 1400 mlSkin 350 ml10EdemaDisebabkan oleh hipoproteinemiaTekanan osmotik darah menurunPlasma keluar dari pembuluh darahPenyaluran sistem limfatik tergangguPermeabilitas kapiler menigkatPenyakit/kelainan :congestive heart failurelocalized edemaascites11KOMPOSISI CAIRAN TUBUH12Komposisi cairan tubuhCairan elektrolitKation (K, Na, Ca, Mg)Anion (Cl, HCO3, protein)Cairan non elektrolitAirGlukosaUreumKreatininZat sisa metabolisme13Cairan Tubuh60 % berat badan tubuh orang dewasa AIR42 liter BB 70 kg

14FUNGSI DAN PERANAN CAIRAN TUBUH15Fungsi cairan tubuhSebagai tempat terlarutnya zat-zat yang diperlukan oleh tubuhOksigenGlukosaElektrolit, dllMenjaga homeostasis tubuhMengatur pergerakan cairan antar kompartemenInterseluler interstitial ekstraselulerMengatur keseimbangan elektrolit dan asam basaBekerja sama dengan sistem lain (ginjal, kulit, paru, dll)16DarahDarah merupakan bagian penting dalam sistem sirkulasiSecara anatomi fisiologi darah merupakan suatu jaringan ikatFungsi :Sebagai alat angkut (O2, CO2, zat makanan, dll)Alat pertahanan tubuh (lekosit dan antibodi)Menyebarkan panas ke seluruh tubuh17Sampel Darah

18Komposisi DarahCair KUNINGPlasma (Fluid) makes up 55% of the blood volume.

Padat MERAH TUASolids (Cells) make up 45% of the blood volume.

19Blood PlasmaWater: 90 %

Solids:Plasma protein (67 %) : albumin, globulin (alfa, beta, gamma), fibrinogenRegulatory and protective proteins : hormon, antibodies, enzymeInorganic substances (0.9 %) : Na, K, Cl)Organic substances : urea, uric acid, ammonia; amino acids, glucose, fatsRespiratory gases : O2, CO2 20ERITROSIT, LEKOSIT DAN TROMBOSIT21

Human Hemopoiesis22Points to remember two lineages hierarchy of increasing commitment and differentiationRecognizable lateEmphasize that marrow stroma is not derived from the HSCHSC gives all macrophages and dendritic cells eg pulmonary macrophages, Kupffer cells etcPhoto from U. S. Federal Government courtesy of Wikipedia.Normal blood cellFrom left to right: Red blood cell (erythrocyte); Platelet (thrombocyte); White blood cell (leukocyte).

23ErythrocytesRed blood cells, called erythrocytes, are responsible for carrying oxygen from the lungs to various body tissues.Red blood cells contain hemoglobin, which gives them their characteristic red color and helps them carry the oxygen OXYHEMOGLOBINRed blood cells are biconcave discs, a shape that provides a large area for oxygen exchange.

24Erythrocytes

Erythrocytes produced in bone marrowNormal : 4.8m 5.5 million/mm3Related to Hemoglobin (Hb)Higher : PolicitemiaLower : Anemia LIFE : 120 DAYS

25

26AnemiaHemoglobin di bawah normal ( < 10 mg / dl)Menyebabkan : kemampuan menyalurkan oksigen berkurangMerupakan gejala dari berbagai penyakit27AnemiaPenyebab :iron deficiency (most common)vitamin B12, folic acid (pernicious anemia)hemolytic anemia sickle cell anemiablood lossbone marrow diseaseinfections

28Normal leukocytesWhite cell counts is normally 5000-10000/ccLeukocytosis- elevated cell countLeukopenia- count is depressedTYPE :AGRANULARlymphocytes 20-40%monocytes 5-10%GRANULARNeutrophils (PMN) 50-75%eosinophils 1-3%basophils 0-1%

29Function of leukocytesLeukocytes help fight infection

Phagocytesneutrophilsmonocytes/macrophagesphagocytes

Inflammationneutrophils infiltrate sitemonocytes/mactrophages help control immune reactionsbasophils release chemicals involved in inflammation, allergy30 Granulocytes (GRANULAR TYPE)Granulocytes are the category of leukocytes that contain granules within the cytoplasm.Granulocytes include:Neutrophils, (PMN)Eosinophils, andBasophils.

31Courtesy of Wikipedia.NeutrophilNeutrophil (purple) migrating through tissue to engulf bacteria through phagocytosis.Neutrophils produced by bone marrow, neutrophils fight disease by migrating to the point of infection, absorbing bacteria, and destroying them.Neutrophils dissolve dead tissue resulting in a semi-liquid material called pus.Abscess a concentrated area of pus.

32

Images courtesy of Wikipedia.EosinophilsEosinophils - a type of granulocyte that plays a role in combating infection by parasites, as well as, impacting allergies and asthma.They contain most of the histamine protein in the blood, which is an indication of allergic reaction when elevated.

33BasophilsImage courtesy of Wikipedia.BasophilsBasophils rare granulocytes that are responsible for the symptoms of allergies, including inflammation.

34Agranulocytes (AGRANULAR TYPE)Agranulocytes are the category of leukocytes that contain very little, if any, granules.Agranulocytes are produced by the lymph nodes, spleen, thymus, and other lymphoid tissue.Two types :Lymphocytes, andMonocytes.

35LeucemiaMajor oncological disorder of blood-forming organsmalignant cells replace health bone marrow cellsacute myelogenous leukemiaacute lymphocytic leukemia36Hodgkins DiseaseMalignant disorderPainless, progressive enlargement of lymphoid tissue first evident in cervical lymph nodes; splenomegalyAnorexia, weight loss, pruritus, anemia, leukocytosis37ThrombocyteBlood platelets, or thrombocytes, are oval-shaped discs that are formed in the bone marrow.

Related to blood thromboliticNormal : 250 500 (000) / mm3 Higher : thrombocytosisLower : thrombocytopenia 38ThrombocytesBlood platelets help prevent blood loss from injuries to blood vessels by forming clots (white thrombus).Platelets may secrete a substance that causes the clot to contract and solidify.Platelets may also secrete a substance that causes an injured vessel to constrict at the injury HEMOSTASIS.39Hemostasis cascade

40GOLONGAN DARAH DAN TRANSFUSI DARAH41Blood Groups

Four blood groups based on presence or absence of antigens (agglutinogens) on surface of RBCsAntibodies (agglutinins) within blood plasmA - A antigen - B - B antigen - AB - both AB antigens no aglutinisO - no AB antigens - 42

Blood group43

44TransfusionTransfusions are preferred between people of the same blood type

If blood is properly processed and administered :A can receive from A and OB from B and OAB from AB, A, B and OO only from type O- but can donate to everyone else

Rh-positive can receive from negative and positive Rh-negative only from negative

45Transfusion reactionsPlasma does not contain the antibody against own antigenAntigens on the donors RBCs react with the antibodies in patients plasma and cause a transfusion reaction.

46Rh FactorRh factor is antigen present on RBC of 85% of pop. of US.Rh positive and Rh negativeRh neg pregnant woman may develop antibodies to the Rh protein of her Rh-positive fetus.hemolytic disease of the newborn

47HemophyliaHereditary blood clotting disordersex-linked, usually in menlack factor VIII, essential for blood clottinghematomashemarthrosis48Bahan DiskusiDiskusikan persiapan darah untuk berbagai jenis operasiProses transfusi darah untuk pasien dengan berbagai hal khusus :Anemia gravisRhesus Reaksi alergi

TERIMA KASIH