Blood makes up about 7%7 \% of the weight of a human body, with a volume of about 5 liters in an average adult. 血液大約 7%7 \% 占人體的重量，普通成年人的體積約為 5 升。
It is made of fluid (plasma) and cellular elements (RBC, WBC, and platelets) 它由液體（血漿）和細胞成分（RBC、WBC 和血小板）組成
It is slightly alkaline, with a pH of 7.4 呈微鹼性，pH 值為 7.4
Its color varies from bright to dark red 它的顏色從亮紅色到深紅色不等
It has a salty metallic taste 它有鹹的金屬味
Blood 血
Blood along with the heart and the blood vessels （e．g．veins and arteries）comprises the circulatory system of the body． 血液與心臟和血管（例如靜脈和動脈）一起構成了身體的循環系統。
The circulatory system helps in maintaining balanced conditions within the body（i．e． homeostasis體內動觬平衡）． 循環系統有助於維持體內的平衡狀態（即體內平衡）。
Blood：Functions 血液：功能
－Transports oxygen and nutrients - 輸送氧氣和營養物質
－Removes CO_(2)\mathrm{CO}_{2} and other by－products of cell activity - 去除 CO_(2)\mathrm{CO}_{2} 細胞活性的其他副產品
－Maintains homeostasis體内動態平衡，growth and tissue repair -維持體內平衡、生長和組織修復
－Participates in the defense against infection - 參與防禦感染
－Participates in hemostasis止血機制 -參與止血制
－Participates in body heat distribution and regulation - 參與體熱分配和調節
Blood - Plasma 血液 - 血漿
Straw colored fluid made of water ( ∼90%\sim 90 \% ), other contents include: 稻草色水製成的液體 （ ∼90%\sim 90 \% ），其他內容物包括：
Proteins make the bulk of the solutes: 蛋白質構成了大部分溶質：
Albumins (60%), manufactured in the liver are the most abundant, for oncotic(osmotic) pressure 肝臟中製造的白蛋白 （60%） 最豐富，用於滲透（滲透）壓
Globulins (36%) are immune bodies Fibrinogen (4%) for blood clotting Clotting factors 球蛋白 （36%） 是凝血因數的免疫體纖維蛋白原 （4%）
Nutrients: glucose, amino acids, lipoproteins, cholesterol 營養物質：葡萄糖、氨基酸、脂蛋白、膽固醇
Electrolytes: Na^(+),K^(+),Ca^(++),Mg^(++),H^(+),Cl^(-),HCO_(3)^(-),PO_(4)^(--),SO_(4)^(--)\mathrm{Na}^{+}, \mathrm{K}^{+}, \mathrm{Ca}^{++}, \mathrm{Mg}^{++}, \mathrm{H}^{+}, \mathrm{Cl}^{-}, \mathrm{HCO}_{3}^{-}, \mathrm{PO}_{4}^{--}, \mathrm{SO}_{4}^{--} Waste: urea, creatinine, uric acid, 電解質： Na^(+),K^(+),Ca^(++),Mg^(++),H^(+),Cl^(-),HCO_(3)^(-),PO_(4)^(--),SO_(4)^(--)\mathrm{Na}^{+}, \mathrm{K}^{+}, \mathrm{Ca}^{++}, \mathrm{Mg}^{++}, \mathrm{H}^{+}, \mathrm{Cl}^{-}, \mathrm{HCO}_{3}^{-}, \mathrm{PO}_{4}^{--}, \mathrm{SO}_{4}^{--} 廢物：尿素、肌酐、尿酸、
bilirubin Gases: O_(2),CO_(2),N_(2)\mathrm{O}_{2}, \mathrm{CO}_{2}, \mathrm{~N}_{2} 膽紅素氣體： O_(2),CO_(2),N_(2)\mathrm{O}_{2}, \mathrm{CO}_{2}, \mathrm{~N}_{2}
Protein bound hormones 蛋白結合激素
Plasma without clotting factors is called “serum” 不含凝血因數的血漿稱為“血清”
Plasma= Blood fluid with no cells 血漿 = 無細胞的血液
(Serum= Blood fluid with no cells and no clotting factors) （血清 = 無細胞且無凝血因數的血液）
Plasma: 55% of blood volume 血漿：血容量的55%
Blood Cells: 45% of blood volume, with RBC as the greatest contributor 血細胞：佔血容量的45%，其中紅細胞是最大的貢獻者
ESR (Erythrocyte Sedimentation Rate) rate at which red blood cells in anticoagulated whole blood descend in a standardized tube over a period of one hour. ESR（紅細胞沉降率）：抗凝全血中的紅細胞在標準化管中一小時內下降的速率。
Hematocrit vol% of RBCs in blood 血細胞比容體積 血液中紅細胞的百分比
Female: 36.1-44.3% 女性：36.1-44.3%
Non specific, Increased in pregnancy, inflammation, multiple myeloma 非特異性、妊娠期升高、炎症、多發性骨髓瘤
Blood - Cell Types & Function 血液 - 細胞類型和功能
Red blood cells (RBC) carry oxygen 紅細胞 （RBC） 攜帶氧氣
White blood cells (WBC) fight infection 白細胞 （WBC） 抵抗感染
Platelets 血小板 clotting 凝血
Cells in the blood 血液中的細胞
RBC (size: 6-8 microns) life span: ~100-120 days. (can be stored in the Blood Bank for 42 days.) 紅細胞（大小：6-8 微米）壽命：~100-120 天。（可在血庫中儲存 42 天。
WBC (size: 10 to 17 microns) life span: 1-9 days. (must be used within 24 hours) WBC（尺寸：10 至 17 微米）壽命：1-9 天。（必須在 24 小時內使用）
Platelets (2-4 microns) life span: 8-10 days. (can be stored in the Blood Bank for 5 days.) 血小板（2-4 微米）壽命：8-10 天。（可在血庫中保存 5 天。
Formation of Blood cells Hemopoiesis 血細胞的形成 造血
Hormones:
RBC: 激素：
紅細胞：
Erythropoietin Platelets: 促紅細胞生成素血小板：
Thrombopoietin WBC’s: 血小板生成素 WBC：
Colony- 殖民地-
Stimulating 刺激
Factors 因素
WBC Anatomy and Function Neutrophil WBC 解剖和功能 中性粒細胞
Make up 60 to 70% of WBC’s 占 WBC 的 60% 至 70%
lobulated nucleus, 2-5 lobes (increase with cell age) 分葉狀核，2-5 個裂片（隨著細胞年齡的增加而增加）
WBC Anatomy and Function Lymphocytes WBC 解剖和功能淋巴細胞
Make up 20 to 25% WBC’s 佔 20% 至 25% 的白細胞
Nucleus is round or slightly indented 細胞核呈圓形或略微凹陷
adaptive/aquired Immunity 適應性/獲得性免疫
B cells produce antibodies B 細胞產生抗體
T cells attack viruses, cancer cells, and transplanted tissues T 細胞攻擊病毒、癌細胞和移植組織
Natural killer cells attack infectious microbes and tumor cells 自然殺傷細胞攻擊感染性微生物和腫瘤細胞
Red blood cells 紅細胞
biconcave shape 雙凹形
2) no nucleus 2） 無核
rarr\rightarrow extra space inside rarr\rightarrow 內部空間
3) contain hemoglobin 3） 含有血紅蛋白 rarr\rightarrow the oxygen carrying molecule rarr\rightarrow 攜氧分子 rarr250\rightarrow 250 million molecules rarr250\rightarrow 250 萬分子
increases the 增加
surface area so more / cell oxygen can be carried 表面積因此可以攜帶更多/細胞氧氣
In adults: bone marrow (medulla) vertebrae, pelvis, sternum, ribs, clavicles, skull, long bones of arms and legs 成人：骨髓（延髓）椎骨、骨盆、胸骨、肋骨、鎖骨、顱骨、手臂和腿部的長骨
What is extramedullary hematopoiesis? 什麼是髓外造血術？
production of blood cells outside the bone marrow, when there is inadequate blood cell production in bone marrow. Mainly liver and spleen. Others like lungs, kidneys, peritoneal cavity. 當骨髓中血細胞生成不足時，骨髓外產生血細胞。主要是肝臟和脾臟。其他如肺、腎、腹膜腔。
marrow www.fotosearch.com 骨髓 www.fotosearch.com
Bone Marrow Produces 骨髓產生
Figure 4-7. Human blood cells form a smear after Wright’s stain. A and D, Neutrophilic leukocytes. B and E, Eosinophilic leukocytes. C. Basophilic leukocyte. F. Plasma cell; this is not a normal constituent of the peripheral blood but is included here for comparison with the nongranular leukocytes. G and HH, Small lymphocytes. tt, Medium lymphocytes. JJ, KK, and L, Monocytes. 圖 4-7.人類血細胞在 Wright 染色后形成彌散片。A 和 D，中性粒細胞白細胞。B 和 E，嗜酸性粒細胞白細胞。C. 嗜鹼性白細胞。F. 漿細胞;這不是外周血的正常成分，但此處包括用於與非顆粒白細胞進行比較。G 和 HH ，小淋巴細胞。 tt ，中等淋巴細胞。 JJ 、 KK 和 L，單核細胞。
Reticuloyte Count 1% of RBCs 網狀細胞計數 1% 的紅細胞
Hemostasis 止血
Hemostasis 止血
capability of activation of clot formation and clot lysis in order to prevent hemorrhage without causing thrombosis 啟動凝塊形成和凝塊溶解的能力，以防止出血而不引起血栓形成
Primary hemostasis: platelet aggregation rarr\rightarrow for plug 原發性止血：血小板聚集 rarr\rightarrow 導致栓塞
Secondary hemostasis: involve clotting cascade to form fibrin. Fibrin then form mesh with trap blood cells to form clot, which dried to form a scab. 繼發性止血：涉及凝血級聯反應形成纖維蛋白。然後纖維蛋白與捕獲血細胞形成網狀物形成凝塊，凝塊乾燥形成結痂。
Fibrinolysis: enzymatic breakdown of fibrin in blood clot 纖維蛋白溶解：血凝塊中纖維蛋白的酶促分解
Steps in blood clotting 血液凝固的步驟
Vascular spasm 血管痙攣
Collagen fibers 膠原纖維
Fibrin 纖維素
Platelet plug formation 血小板栓形成
HEMOSTASI 止血
DEPENDENT UPON: 依賴：
Vessel Wall Integrity 容器壁完整性
Adequate Numbers and 足夠的人數和
Proper Functioning of Platelets 血小板的正常功能
Adequate Levels of Clotting Factors 足夠的凝血因數水準
and Proper Function of Fibrinolytic 和纖溶劑的正常功能
Pathway 路
Vessel Injury 血管損傷
Endothelial Damage 內皮損傷 rarr\rightarrow disrupts the smooth lining of the endothelial cells. rarr\rightarrow 破壞內皮細胞的光滑襯裡。 rarr\rightarrow Exposure of Collagen: rarr\rightarrow 膠原蛋白的暴露： rarr\rightarrow triggers platelets adhesion, initiates subsequent clotting steps. rarr\rightarrow 觸發血小板粘附，啟動後續的凝血步驟。 rarr\rightarrow Damaged endothelial cells release various factors that promote clotting. rarr\rightarrow 受損的內皮細胞會釋放各種促進凝血的因數。
Coagulation Cascade: 凝血級聯反應：
Intrinsic Pathway: 內在途徑：
Activation of Factor XII by contacts with collagen or damaged cells 通過與膠原蛋白或受損細胞接觸啟動因數 XII rarr\rightarrow triggers a series of enzymatic reactions, resulted in activation of factor X . rarr\rightarrow 觸發一系列酶促反應，導致因數 X 的啟動。 rarr\rightarrow enters the common pathway. rarr\rightarrow 進入 Common Pathway。
Extrinsic Pathway: 外源性途徑：
Activation of factor VII by Tissue Factors 組織因數啟動因數 VII rarr\rightarrow triggers a series of enzymatic reactions, resulted in activation of factor XX rarr\rightarrow 觸發一系列酶促反應，導致因數 XX 啟動 rarr\rightarrow enter the common pathway rarr\rightarrow 進入 Common Pathway
Common Pathway: 常見途徑：
Prothrombin is converted to thrombin by activated factor XX, in collaboration with activated factor V . Thrombin enzyme converts fibrinogen to fibrin. 凝血酶原通過活化因數 XX 轉化為凝血酶 ，與活化因數 V 合作。凝血酶將纖維蛋白原轉化為纖維蛋白。
Fibrin Clot Formation: 纖維蛋白凝塊形成：
Positive Feedback Loop: Thrombin positively feedback on the clotting cascade and amplify the cascade. A robust clot formation resulted. 正反饋迴路：凝血酶對凝血級聯反應產生正反饋並放大級聯反應。導致形成強大的凝塊。
Fibrin form a fibrous mesh that traps platelets and red blood cells, solidifying the clot. 纖維蛋白形成纖維網，捕獲血小板和紅細胞，使凝塊凝固。
Platelet Activation and Aggregation: Thrombin also activates platelets, causing them to release clotting factors, change shape, and clump together, further strengthening the clot. 血小板活化和聚集：凝血酶還激活血小板，使它們釋放凝血因數、改變形狀並聚集在一起，進一步加強凝塊。
Anticoagulation, Fibrinolysis: 抗凝、纖維蛋白溶解：
Antithrombin Regulation: Antithrombin, a glycoprotein, inactivates thrombin and other clotting factors to prevent excessive clot formation and unwanted spread. 抗凝血酶調節：抗凝血酶是一種糖蛋白，可滅活凝血酶和其他凝血因數，以防止過度凝塊形成和不必要的擴散。
Protein CC and SS Activation: Thrombin activates protein C, which, in collaboration with protein S, degrades activated clotting factors, further limiting clot growth. 蛋白質 CC 和 SS 活化：凝血酶啟動蛋白 C，蛋白 C 與蛋白 S 協同降解活化的凝血因數，進一步限制凝塊生長。
Plasminogen Conversion: As the wound heals, the inactive plasminogen is 纖溶酶原轉化：隨著傷口癒合，無活性纖溶酶原
converted into the active enzyme plasmin. Plasmin degrades fibrin clots. 轉化為活性酶纖溶酶。纖溶酶降解纖維蛋白凝塊。
clotting 凝血
