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SINHL - SINHL B
NHTI LIU SU TMTNG HPDCH
Gii thiu Information Mc lc
Bin son ebook : L nh Sng
I HC Y KHOA H NI
Trang web : www.ykhoaviet.tk
Email : [emailprotected], [emailprotected]
in thoi : 0973.910.357
THNG TIN
THNG BO VVIC XUT BN BCH KHOA Y HC 2010 :
Theo yu cu v nguyn vng ca nhiu bn c, khc vi Bch Khoa Y Hc ccphin bn
trc, bn cnh vic cp nht cc bi vit mi v cc chuyn khoa mi,cng nhthay i cchthc trnh by, Bch Khoa Y Hc 2010 c chia ra lm nhiu cun nh,mi cun bao gm mtchca Y Hc, nh thsgip bn c tit kim c thi gian tra cuthng tin khi cn.
Tc gixin chn thnh cm n tt cnhng kin ng gp ph bnh ca qu{ cgitrong thi
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gian qua. Tt ccc cun sch ca bsch Bch Khoa Y Hc 2010 bn c c thtmthy v tivttrang web www.ykhoaviet.tk c L nh Sng xy dng v phttrin.
NG H:
Tc gixin chn thnh cm n mi sng hvmt ti chnh gip cho Bch Khoa YHcc pht trin tt hn v ngy cng hu ch hn.
Mi tm lng ng hcho vic xy dng mt website dnh cho vic phbin ti liuhc tp vging dy Y Khoa ca cc c nhn v Doanh nghip xin gi v:
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trch nhim g lin quan n vic sdng thng tin trong cun sch p dng vothc tinca bn c. y l ti liu su tm tnhiu tc gikhc nhau, nhiu cun schkhc nhau,
cha c kim chng , v thmi thng tin trong cun sch ny u chmang tnhcht tngi . Cun sch ny c phn pht min ph vi mc ch sdng phi thng mi,bt chnh vi no lin quan n vic mua bn, trao i, chnh sa, inn cun schny vo bt c
thi im no u l bt hp l. Ni dung cun ebook ny c thc thay i v bsungbtclc no m khng cn thng bo trc.
GII THIU
B sch ny c L Sng su tm , bin dch v tng hp vi mc ch cung cp mtngun ti
liu tham kho hu ch cho cc bn sinh vin y khoa, v tt cnhng ai cnhu cu tm hiu,nghin cu, tra cu , tham kho thng tin y hc.
Vi tiu ch l bsch m , c xy dng da trn ngun ti liu ca cng ng ,khng mangmc ch vli, khng gn vi mc ch thng mi ha di bt kzhnh thc no, nn trc
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khi sdng bsch ny bn phi ng vi nhng iu kin sau . Nu khng ng ,bnkhng nn tip tc sdng sch :
B sch ny c cung cp n tay bn , hon ton da trn tinh thn tnguyn cabn.Khng c bt kzs thng lng, mua chuc, mi gi hay lin kt no gia bn vtc gib
sch ny.
Mc ch ca bsch phc vcng tc hc tp cho cc bn sinh vin Y khoa lchnh, ngoira nu bn l nhng i tng ang lm vic trong nghnh Y cng cthsdng bsch nhl ti liu tham kho thm .
Mi thng tin trong bsch u chc tnh chnh xc tng i, thng tin cha ckim
chng bi bt cc quan Php lut, Nh xut bn hay bt cc quan c trch nhimlin quanno . V vy, hy lun cn trng trc khi bn chp nhn mt thng tin noc cung cptrong bsch ny.
Tt ccc thng tin trong b sch ny c su tm, tuyn chn, phin dch v spxp theotrnh tnht nh . Mi bi vit d ngn hay di, d hay d dcng u l cngsc ca chnh
tc gibi vit . L nh Sngchl ngi su tm v phin dch, ni mt cch khc,ngigip chuyn ti nhng thng tin m cc tc gibi vit cung cp, n tay cc bn.
Bsch ny l ti liu su tm v dch bi mt sinh vin Y khoa chkhng phi lmt gio s
tin s hay mt chuyn gia Y hc dy dn kinh nghim,do c thc rt nhiu liv khim
khuyt khng lng trc , chquan hay khch quan, cc ti liu btr c thchahp l , nnbn cnh vic thn trng trc khi thu nhn thng tin , bn cng cn ckphn mc lc bsch v phn hng dn sdng bsch sdng bsch ny mt cch thun tinnht.
Tc gibsch in tny khng chu bt ctrch nhim no lin quan n vic sdngsaimc ch , gy hu qukhng tt vsc khe, vt cht, uy tn ca bn v bnh nhnca bn .
Khng c chuyn mn , khng phi l nhn vin y t, bn khng c php tsdngnhngthng tin c trong bsch ny chn on v iu tr. Ttrc ti ny, cc thythuc IUTRBNH NHN chkhng phi l IU TRBNH. Mi ngi bnh l mt thc thclp
hon ton khc nhau, do vic b nguyn xi tt cmi thng tin trong bschny vo thctin sl mt sai lm ln . Tc giskhng chu bt ctrch nhim g dosbt cn ny gy ra.
V l bsch cng ng, to ra v mc ch cng ng, do cng ng , bsch ny c phttrinc hay khng mt phn rt ln, khng chda vo sc lc, skin tr ca ngi tora b
sch ny , th nhng ng gp, xy dng, gp , bsung, hiu chnh ca ngi cchnh lng lc to ln b sch ny c pht trin. V mt mc tiu trthnh mt bschtham
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kho y khoa tng hp ph hp vi nhu cu v tnh hnh thc tin trong lnh vcy tni ring vtrong cuc sng ni chung . Tc gibsch mong mi bn c nhng ling gp chn
thnh mang tnh xy dng, nhng ti liu qu m bn mun san scho cng ng ,v mttng lai tt p hn. l tt cnim mong mi m khi bt u xy dng bsch ny ,ti
vn kin tr theo ui .Ni dung bsch ny, c thchng trong mt thi im nhtnh trong qu khv hin tihoc trong tng lai gn. Trong thi i cch mngkhoa hc cng nghtin nhanh nh v bonh hin nay, khng ai bit trc c liunhng kin thc m bn c c c thp dngvo tng lai hay khng . trli cu hi ny,chc chnh bn thn bn , phi lun lunkhng ngng-TMNH-cp nht thng tin minht trong mi lnh vc ca i sng, trong c lnh vc y khoa. Khng ai c th,tt nhin bsch ny khng th, lm iu thay bn.
Nghim cmsdng bsch ny di bt kzmc ch xu no, khng c php thng mi
ha sn phm ny di bt cdanh ngha no. Tc gibsch ny khng phi l tcgibi vitca bsch , nhng mt rt nhiu cng sc, thi gian, v tin bc to ran, v li chchung ca cng ng. Bn phi chu hon ton trch nhim vi bt kzvicsdng sai mc chv khng tun thni dung bsch ny nu ra.
Mi l thuyt u chl mu xm, mt cun sch hay vn cun sch cng chl lthuyt, chcthc tcuc sng mi l cun sch hon ho nht, bn khng phi l c giml dinvin chnh. V Bch Khoa Y Hc cng chl mt ht thc nh, vic sdng n xonu haynhn ging l hon ton ty thuc vo bn c. V ngi to ra ht thc nysvui mng v
c truyn thm ng lc tip tc cgng nu bit rng chnh nhbn m bit baongi
khng cn phi xp hng chcu tr.
Mi ng gp lin quan n bsch xin gi vcho tc githeo a chtrn. Rt mongnhnc phn hi tcc bn c gicc phin bn sau c tt hn.
Knh chc bn c, gia quyn v ton thngi Vit Nam lun c sng trong khemnh,cuc sng ngy cngm no hnh phc.
Lng, NghAn. Thng 8/2010
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ABOUT
ebook editor: Le Dinh Sang
Hanoi Medical University
Website: www.ykhoaviet.tk
Email: [emailprotected], [emailprotected]
Tel: 0973.910.357
NOTICE OF MEDICAL ENCYCLOPEDIA PUBLICATION 2010:
As the request and desire of many readers, in addition toupdating the new articles and new
specialties, as well as changes in presentation, MedicalEncyclopedia 2010 is divided into manysmall ebooks, each ebookincludes a subject of medicine, as this may help readers savetime
looking up informations as needed. The author would like tothank all the critical comments of
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downloaded from the site www.ykhoaviet.tk ,by Le Dinh Sangconstruction and development.
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FOREWORD
These ebooks are Le Dinh Sangs collection, compilation andsynthesis with the aim of providing
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MC LC
PHN 1. SINH L Y HC
BI 1. SINH L MU-TUN HON1. HTUN HON2. SINH L MU3. RI LON LM SNGMU4. SINH L CM MU V NG MU5. CU TO - CHC NNG CA HNG CU6. TIU CU7.BCH CU8. CHNG NG MU9. HUYT TNG10.NHM MU V AN TON TRUYN MU11.RI LONC CHCM MU
BI 2. SINH L[ CO C
12.SCO C13.SINH L C VN14.SINH L C TRN
BI 3. SINH L HTK THC VT15.GII PHU HTHN KINH THC VT16.CHC NNG CAHTHN KINH THC VT17.CC CHT DN TRUYN V RECEPTER THUC HTK THC VT18.TCNG CA THUC LN HTK THC VT19.CUNG PHN XV CC PHN XTHC VT
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BI 4. SINH L TIU HA
20.CHC NNG GAN21.SINH L TIU HA I CNG22.TIU HO MING23.TIU HODDY24.TIU HO RUT NON25.HP THU THC N RUT NON
BI 5. SINH L SINH DC
26.SINH L SINH DC N27.SINH L SINH DC NAM
BI 6. SINH L THN28.QU TRNH TO NC TIU29.SINH L THN30.IU HA CHCNNG THN31.MT SNGHIM PHP THM D CHC NNG THN
BI 7. SINH L CC DCH C TH
32.CC DCH CA C TH33.CC DCH KHC CA CTH34.THN IU HA CN BNG NIMI
PHN 2. SINH L BNH Y HC35.I CNG SINH L BNH36.
KHI NIM VBNH37.QU TRNH BNH L
38.MIN DCH BNH L39.BNH SINH HC40.BNH CN HC41.SINH L NHIMTRNG42.RI LON CN BNG AXIT BAZ43.RI LON CHUYN HA GLUCID44.RI LONCHUYN HA LIPID45.RI LON CHUYN HA NC IN GII46.RI LON CHUYN HAPROREIN47.RI LON QU TRNH PHT TRIN - U C48.RI LON IU NHIT49.SINH LBNH GAN50.SINH L BNH QU TRNH VIM51.SINH L BNH THIU XY52.SINH L BNHHTUN HON53.SINH L BNH HTIT NIU
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54.SINH L BNH HTIU HA55.SINH L BNH HTHN KINH56.SINH L BNH HNITIT57.SINH L BNH MU V TO MU58.SINH L BNH H HP59.BNH L DI TRUYNNGI
PHN NI DUNG
PHN 1. SINH L Y HC
BI 1. SINH L MU-TUN HON
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1.HTUN HONTheo Free Health Encyclopedia
Htun hon ca c thbao gm htim mch v hbch huyt.Hai hny vn chuynoxy, cht dinh dng, nhng tbo cht, hormon v nhng cht khcn v i khi cctbo trong c th.
Hng ttbo trong c thngi nhn cht dinh dng v thi ra nhng cht b hngngy,hng gi, hng pht.
Mc d strao i ny c thgia tng khi hot ng v chm li khi nghngi nhnglc no ncng hot ng lin tc.Nu n dng li, c thscht. Trong 2 h, htim mchng vai tr vn chuyn chnh, hbch huyt chhtrthm bng nhng chc nng ringbit ca n.
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NHNG THNH PHN CA HTIM MCH
Nhng thnh phn chnh ca htim mch l tim, cc mch mu v mu. C thm tmtcch
hnh tng htim mch bng hnh nh sau: mt ci bm bng c (tri tim) bm dch(mu)chy qua mt chui nhngng dn ln v nh(cc mch mu) i khp c th.Khi dichuyn qua mt hthng cc mch mu phc tp, mu ly oxy tphi, cht dinhdngtrut non v hormon tcc tuyn ni tit.Sau n phn phi li cho cc tbo cac thri ly vCO2 (c to thnh khi tbodng ng v msn xut ra nng lng) vnhng cht thi khc. Mu smang nhng
cht thi n phi v thn thi ra ngoi.
TimTim l mt cu trc rng, hnh nn lm tc nm pha sau v hi lch vbn trixngc. Np mnh vo gia 2 phi, tim c nm trong mt lng xng bo vc to bixng
c, cc xng sn v ct sng. nh tim nm pha di, c gi l mm tim, hng vphahng tri v nm trn c honh (mt mng c phn cch khoang ngc v khoang bngvinhau). Phn trn ca tim, c gi l y tim, hng vpha vai tri v nm di xngsnth2, cc mch mu quan trng ca c thc ni vo tim phn ny.
Tim c kch thc bng mt nm tay. Khi mi sinh, kch thc tim v nm tayca trl bngnhau. Khi c thpht trin, tim v nm tay cng pht trin vi cngmt tc . ngi ln,khi lng trung bnh ca tim vo khong t255 n 310 gram,ca nam ln hn ca nmtt.
Mng tim l mt ti lm tmng x, cht, bao quanh, bo vv neo gitim li vicc cu trcxung quanh. Lp mng trong bao mt ngoi ca tim v l mt thnhphn ca thnh tim. Lp
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x bn ngoi bo vtim v neo tim li vi cc cu trc xung quanh nh l xngc v chonh. Phn trong ca lp ngoi ny c gii hn bi mt lp khc, sn xut rahuyt thanh.
Cht nc bi trn gia hai lp trong v ngoi ca mng tim ny gip cho 2 lpny trt lnnhau c ddng hn v gim ma st khi tim p
Thnh tim c cu to bi 3 lp: lp ngoi (epicardium), lp c(myocardium), v lp ni tmmc (endocardium). Lp ngoi cng (epicardium)tht cht l lp trong cng ca mng ngoitim. Lp gia, myocardium, l mt lpc tim dy c thco bp c tng mu i ra khi
tim. Lp trong cng, ni tm mc, l mt mng mng gip mu c thchy trn truqua ccbung tim.Cc bung tim
Tim c chia ra lm 4 bung. Mt vch c chia tim ra lm 2 phn: phi vtri. Mi phn tiptc c chia ra lm 2 bung: bung trn v bung di. Hai bungtrn, cn c gi l tm
nh, c thnh mng. Chng m nhn chc nng nhn mu vtim. Mu chy vtm nhtccmch mu ca c th, sau c bm xung tm tht, l 2 bung nm pha di. Tm thtlbung m nhn chc nng tng mu i. Thnh ca chng dy v c nhiu c hn tm nh.N
gip tm tht co bp v bm mu ra khi tim n phi v nhng khu vc cn li cac th.Trong khi mu chy tbung ny sang bung kia, nhng ci van-mt-chiungn khng cho
mu chy ngc trli bung c. Cc van nm gia tm nh v tm tht c gi l vannh
tht. Van nh tht tri (nm gia tm nh tri v tm tht tri) cn c gi lvan hai l. Van nhtht phi (nm gia tm nh phi v tm tht phi) cn c gi lvan ba l. Cc van nm gia
2 tm tht v nhng mch mu ln c chng bm mu c gi l cc van bn nguyt.Vanbn nguyt ng mch phi nm gia tm tht phi v thn ng mch phi. Van bnnguytng mch chnm gia tm tht tri v ng mch ch.
Cc l van mv ng p ng li vi nhng thay i p lc trong tim. Cc van nhtht mra khi tim nghngi v ng li khi tm tht co bp. Cc van bn nguyt ngli khi tim nghngi v mra khi tm tht co bp. Khi cc van ng li sgy ranhng ting "bm-tc" m bcs c thnghe thy c quang nghe. Khi van nh thtng sto ra ting "bm", khi van bnnguyt ng sto ra ting "tc".
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Hdn truyn ni ti ca tim
Tim c mt hthng thn kinh ring kim sot hot ng ca n c gi l hdntruynni ti, nm bn trong m tim. Nhng tn hiu thn kinh c hny gi i slmcc phnkhc nhau ca tim co bp nhng thi im khc nhau. Mt im nt nhbao gmmt loim c c bit nm phn trn ca tm nh phi c gi l nt xoang. Do n l imkhiu ca xung ng nn nt xoang cn c gi l nt to nhp. Hthng ny cn baogmnhng nt khc nh nt nh tht, nm gn y ca tm nh phi, ngay pha trn tmtht. Bnh nht (cn c gi l b His) nm phn trn ca vch ngn gia 2 tm nh.Hai nhnh
chnh tb ny chia ra thnh nhng si nhhn phn bu cc c tim ca cc thnhtmtht. Chng c gi l nhng si Purkinje.
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Mch mu
Cc mch mu to ra mt hthng vn chuyn bao gm ccng c chiu di khong96,500km, hn gp i chiu di ca ng xch o. Ton bhthng mch mu c xem nhl
mt chui nhng con ng v ng cao tc lin kt vi nhau. Mu ri khi tim ivo cc
mch mu ln (ng cao tc) i n c th. nhiu im khc nhau, nhng mch mulnny chia ra thnh nhng mch mu nhhn (ng l). V n lt mnh, nhng mchmuny tip tc chia ra thnh nhng mch mu nhhn, nhhn na (c 1 ln xe). Khiquayngc trv, mu i qua nhng mch mu c kch thc tng dn ln (cc ng 1 lnhp lithnh ng lri thnh ng cao tc) trc khi tht strvtim.
MU C PHI L BIN BN TRONG C TH?
Chmi hn 350 nm trc, con ngi tng ngh rng mu trong c thchy ti vlui y htnh nhng cn thy triu vy. Ngi Hy Lp ci l nhng ngi u tin t ral thuyt
ny. Htin rng mu ri khi tim, sau rt trvtim mang theo nhng cht cnbng theocng mt mch mu. Githuyt ny tn ti cho n hn 1400 nm.Nm 1628,mt bc s ngi Anh, William Harvey (1578-1657), cng bmt khi nim mivtunhon mu. ng xc nhn rng mu chy khng ngng tcc ng mch sau trvtim qua cctnh mch v to nn mt vng tun hon lin tc qua c th.
Ngay lp tc sau , l{ thuyt ca Harvey bkhinh mit v n i lp li honton nhng hiubit c bn vy hc vo thi . Tuy nhin, vo khong 30 nm sau, {tng ca ng cxc minh do ngi ta pht hin ra stn ti ca cc mao mch. Do lngi tin phong nnHarvey c nhiu ngi xem nh l cha ca nn y hc hini.
ng mch, mao mch v tnh mch l nhng thnh phn chnh ca hthng vnchuyn. ngmch l nhng mch mu mang mu i ra khi tim. Cc ng mch ln ritim sau chia
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nhnh ra thnh nhng ng mch nhhn ri i n nhiu khu vc khc nhau ca cth. Sau chng tip tc chia nhhn thnh cc tiu ng mch. Trong cc m, cctiu ng mch
chia ra thnh nhng mch mu siu nhc gi l cc mao mch. Strao i chtgia muv tbo din ra xuyn qua thnh ca cc mao mch. Trc khi ri khi m,cc mao mch gp
li thnh cc tiu tnh mch. Sau nhng mch mu ny di chuyn n gn tim hnv gp lithnh nhng tnh mch ngy cng ln hn.Nhng mch mu ln c nhng cu trckhc nhau. Mc d cc thnh ca cng mch v tnh
mch u bao gm 3 lp nhng dy ca chng cng khc nhau. ng mch c lptrong vlp gia dy hn, gip chng n hi hn. Chng c th co v dn ddng khimu c bmttim trn qua. Tnh mch c thnh mng hn gip cc khung c xungquanh chng bp v y
vo thnh p mu trong trvtim. Nhng van-mt-chiu thnh cc tnh mchgipngn khng cho mu chy ngc trvv gicho dng mu chy theo 1 hng. Cc vanc
nhiu nht chn do mu phi chng li trng lc quay trvtim. Khng ging vingmch v tnh mch, thnh ca cc mao mch chdy bng 1 tbo. hu ht cc maomch,nhng tbo ny khng dnh cht vi nhau. iu ny gip cho oxy, cht dinhdng v nhng
cht thi c thdi chuyn qua li ddng gia mu v dch klp y nhng khongkhnggian gia cc tbo.VNG TUN HON PHI V VNG TUN HON HTHNG.C 2 vng tunhon chnh trong c th: vng tun hon phi v vng tun hon hthng.Nhng mchmu ca vng tun hon phi vn chuyn mu qua li gia tim v phi. Nhng
mch mu ca vng tun hon hthng vn chuyn mu n tt cnhng phn cn li cacth.ng mch chnh ca vng tun hon hthng l ng mch ch. ngi ln, ng mchch
c cng kch thc ving nc ti cy tiu chun. N tri ln khi tim v i lntrn ttmtht tri khong 1 inch ri sau bhng sang tri ngay pha trn tim(phn ny c gi lcung ng mch ch) trc khi cong thng xung chia ra ccnhnh cung cp mu chonhng phn cn li ca c th.Cc nhnh ca ng mch chbaogm ng mch cnh (cung cp mu cho u), ng mch
vnh (cung cp mu cho cc c ca tim), cc ng mch cnh tay (cung cp mucho cnh tay)v nhng ng mch i (mang mu xung cung cp cho bp i).Tnh mchchl tnh mch ln nht ca vng tun hon hthng. N c 2 nhnh: tnh mchchtrnnhn mu tu v cnh tay chy v; tnh mch chdi nhn mu tphn c th
pha di chy v. C2 nhnh ny u mu vtm nh phi.
Cc tnh mch mu vtnh mch chbao gm: tnh mch cnh (dn mu tu trv),tnhmch cnh tay v tnh mch u (dn mu vtcnh tay), tnh mch i (dn muvtbpi), v tnh mch chu (dn mu vtvng chu v hng).Nhng mch mu thuc vngtun hon phi mang mu n phi trao i kh (nhn O2 vthi CO2 ra), sau quaytrvtim. Nhng mch m chnh l ng mch phi v tnh mch
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phi. Hai ng mch phi 2 bn c ngun gc tthn ng mch phi xut pht ttmthtphi. ng mch phi phi i vo phi bn phi v ng mch phi tri i vo phi bntri. Sau
khi trao i kh phi, mu c oxy ha (c mang oxy) sc quay ngc trvtmnhtri ca tim bi 4 tnh mch phi.
MU
Mu l cht dch c tim bm vo cc mch mu i n khp cc bphn ca c th. Nl
m lin kt. Theo ng nh tn gi ca n, m lin kt l nhng loi m kt ni ccphn khcnhau ca c thli vi nhau nng , cha ng v bo v. M lin kt c tmthy khp ni trong c thv l loi m c nhiu nht trong 4 loi m ca c th(3loi m cn lil: biu m, m c v m thn kinh). Trong tt ccc m ca c thth mul loi m duy nhttn ti di dng dch.
Mu c rt nhiu chc nng trong c th. N mang tt cnhng vt cht c thvnchuync tni ny sang ni khc trong c th: oxy, cht dinh dng cho cc tbo,hormon (lnhng cht truyn tin ha hc) n cho cc m v nhng cht thi n chocc c quan mnhn nhim vthi chng ra ngoi khi c th. N gip bo vc thbng cchng mu v
bo vc thkhi nhng vi sinh vt l. N cng gip nhit c thc gi trkhng ibngcch ly nhit ra khi tbo.
Nht v nng hn nc, mu sc ca mu thay i tti sang c ty thuc vo lngoxym n ang mang (oxy cng nhiu th mu sc cng sng). Khi bn trong c th, mucnhit vo khong 38C. Mu chim khong 8% trng lng ca c th. Mt ngi namgiitrng thnh c khong 5.6l mu bn trong c th, nc khong 4.5 lt. Nam ckhuynh hngc nhiu mu hn ndo c shin din ca testosterone, l mt loihormon sinh dc nam c
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chng c thlch vo c cc mao mch nh.
CHARLES DREW v cch bo qun huyt tng
Charles Drew
Mu c 4 nhm chnh l A, B, O, v AB, y l khm ph ca cc nh nghin cu yhc vo uthk20. Khm ph ny ci thin ng khiu quca vic truyn mu. Tuynhin, vo thiim , mu ton thchc thgic trong vng 7 ngy trc khi bh. Dovn lm
sao c c ng loi nhm mu cn thit sn sng trong cp cu vn cn tn ti.Vonhng nm cui thp nin 30 ca thktrc, mt bc s ngoi khoa ngi M,Charles
Drew (1904-1950) bt u khm ph ra c khnng dng huyt tng thay thchomuton thtruyn. Do huyt tng khng c hng cu nn n c thc truyn cho btkz
bnh nhn no m khng cn quan tm n nhm mu ca h. Tnh cht ny ca huyttnglm cho n trthnh l{ tng sdng trong cp cu.Khong nm 1940, Drew phtminh ra c cch xl v bo qun huyt tng bng cchkhnc ca n do nn n c themi xa c v bo qun trong mt thi gian di. Khi
cn thit, huyt tng kh (ging nh bt) c thc ti to trli dng ban u bngcchthm nc vo.
Vic sdng huyt tng truyn mu chng tc vai tr c bit quan trng camnhtrong sut thchin thII (1939-1945), thi im mu dng iu trvt thngbthiuht trm trng. Do nghin cu trn, ng c tn thng v cu mng c v
sngi.ngi ln, hng cu c to ra bi phn ty ca xng sn, ct sng, xng cvxng chu (ty xng l mt cht tng tnh bt bin, xp c trong cc khoang bntronghu ht cc xng ca c th). Thnh phn c bn ca hng cu l mt loiprotein sc tctn l hemoglobin. Phn themoglobin chim 1/3 trng lng mitbo hng cu. phn
trung tm ca mi phn themoglobin l 1 nguyn tst to mu sc cho hngcu. Ti phi,tbo st kt hp vi oxy to ra mt hp cht c tn loxyhemoglobin. Chc nng chnh
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ca hng cu l vn chuyn oxy di dng ny n cc tbo khp c th. Sau khioxy ctrao i, hemoglobin kt hp vi CO2 thi ra ttbo v hng cu quay trliphi c
thi bt ra.Do hng cu thng xuyn bp vo nhng mao mch nhli ti nn mngca n dbh hi v
xi mn rt nhiu do mi tbo hng cu chtn ti trong khong 4 thng. Nhngtbohng cu mi c sn xut lin tc ty xng thay thnhng tbo c.
Hnh nh hng cu chy qua cc mch mu.
NHM MU.
Hng cu mang nhng protein c gi l khng nguyn, l nhng cht gip cthnhn bit
nhng vt lxm nhp, mng ca mnh. Ngi ta da trn nhng khng nguyn nyquynh nhm mu: A, B, AB, hoc O. Ngi nhm mu A c tt ccc tbo hng cutrong c
thmang khng nguyn A. Ngi nhm mu B c tt ccc tbo hng cu trong cthmangkhng nguyn B. Ngi nhm mu AB c tt ccc tbo hng cu trong cthmang khngnguyn A v B. Ngi nhm mu O c tt ccc tbo hng cu trong cthkhng mang
khng nguyn no c.
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Bit c nhm mu ca bnh nhn l iu rt quan trng nu mun thc hin truynmu.Ngi c nhm mu A khng thnhn c mu nhm B v hc mang khng thchnglikhng nguyn B. Tng t, nhm mu B mang khng thchng li khng nguyn A.Nhm mu
AB khng mang khng thchng li khng nguyn no c, nhng nhm mu O th limangkhng thchng li chai khng nguyn A v B. Nu bnh nhn bcho lm nhm muth cc t
bo mu svn cc li v lm tc nghn nhng mch mu nh. Phn ng ny, cn c gilphn ng kt dnh, c thgy tvong.Hng cu cn c 1 loi khng nguyn khc c gil khng nguyn Rh (n c ci tn ny do
loi khng nguyn ny c xc nh ln u tin khRhesus). Hu ht nhng ngi VitNammang nhm mu Rh dng (Rh), iu c ngha l hc mang khng nguyn Rh.Nhngngi mang nhm mu Rh m (Rh-) th khng mang khng nguyn Rh. Khngging vi nhm
mu ABO, cc khng thchng li khng nguyn Rh khng c tm thy mt cchtnhintrong mu. Vn duy nht chtht sxy ra khi ngi mang nhm mu Rh- ctruyn voc thmu c Rh. Khi , c thca hsphn ng li bng cch to ra khngthchng likhng nguyn Rh. ln truyn mu ktip, nu vn tip tc c truyn mu cRh+ th khngthchng li Rh c to ra tln truyn mu trc stn cng mu c truynvo.
BCH CUBch cu c rt t nu so vi hng cu, khong 4.000 n 11.000 mimillimet khi mu, chimt hn 1% tng thtch mu. Mc d chim slng t nh vynhng bch cu li ng mtvai tr quan trng trong hthng min dch ca c th. Ngip c thphng th, chng li stn cng ca vi khun, virus, k sinh trng vtbo ung th. Ging nh hng cu, bch cucng c to thnh tty xng (mt sbch cuc to ra tcc m lympho). Trong khihng cu phi i theo dng chy ca mu thbch cu khng nh vy m n c thlen qua cc
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vch ca cc mao mch i thng n nhng khu vc bnhim trng hoc btn thngcac th.
KHNG NGUYN Rh V THAI KZYu tRh ng mt vai tr quan trng trong thaikzkhi phnc Rh- ang mang thai a b
c Rh+. Trong qu trnh mang thai, nhng vt t trn mng nhau gip mcthtip xc cvi mu ca trc Rh+ (mng nhau l 1 loi mng lt tcung, cc chtdinh dng v oxy dichuyn tmi xuyn qua mng ny cung cp cho tr), khi cthca msto ra
khng thchng li khng nguyn Rh. ln mang thai ktip, nu con tip tc cnhm muRh+ th khng thchng li Rh ca msi qua mu ca con v tiu dit cctbo hng cuca b.
phng nga iu ny, bc s scho nhng thai phc Rh- RhoGAM, mt loi khngthchng li Rh trong vng 72 gica ln sinh u tin. RhoGAM stiu dit nhnghng cu Rh+i vo htun hon ca mtrc khi hmin dch c thi gian to ra khngth.C 5 loi tbo bch cu trong mu: bch cu a nhn trung tnh(neutrophil), bch cu i toan(eosinophil), bch cu i kim (basophil),mono bo v lympho bo. Mi loi gimt vai tr
khc nhau trong hthng phng thca c thv c huy ng chng li nhng loibnhkhc nhau. Chng hn nh trong nhng bnh nhim trng mn tnh (ko di) nhlao phi thmono bo gia tng slng. i vi bnh nhn bhen suyn v trong nhngt dng thbch cu i toan gia tng slng.
Hnh nh i thc bo (pha sau) v lympho bo (pha trc)
Cc tbo bch cu xc nh c mc tiu cn n nhnhng loi ha cht c bit. Khim
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bnhim trng hoc tn thng, n sphng thch nhng cht ha hc ra cc m xungquanhli ko nhng tbo bch cu thch hp n chin u chng li. Tin trnh ny cgi l
ha ng ng.TIU CU
Tiu cu khng phi l mt tbo tht sging nh hng cu v bch cu. Chng lnhngmnh vnhc dng hnh a ca nhng tbo rt ln c gi l tbo nhn khngl(megakaryocyte) nm trong ty xng. Tbo nhn khng lbvra to thnh khong50
mnh nhhoc hn v sau nhanh chng hnh thnh mng trthnh tiu cu. Ckhong300.000 tiu cu mi millimet khi mu, chng gip kim sot chy mutrong mt qu trnh rtphc tp c gi l cn bng ni mi.
Khi mch mu btn thng gy chy mu, cc tiu cu bt u tin trnh ng mu bngcchdnh vo ni tn thng ca mch mu. Trong lc , chng phng thch ra nhngcht ha hc
li ko cc tiu cu khc li. Chng my chc, cc tiu cu kt dnh li v hnhthnh mt ntchn tm thi. Sau , tiu cu phng thch ra serotonin, mt loiha cht lm cho mch muco tht v hp li lm gim lng mu chy ra bn ngoi quavt thng. Trong lc cc hin
tng ny xy ra, m btn thng phng thch ra 1 cht kt hp vi calci vnhng yu tng mu khc trong huyt tng hnh thnh cht hot ha prothrombin.Cht hot hany chuyn dng prothrombin (l mt cht c trong huyt tng dogan sn xut) thnhthrombin (l mt loi enyme). Thrombin sau kt hp vifibrinogen to ra nhng phntdi v mnh c gi l fibrin. Cc phn tfibrin kthp vi nhau hnh thnh mt ci li
bt gicc hng cu v tiu cu lm nn cho khi mu ng.HTUN HON HOT NG NHTHNO
Trong qu trnh hot ng lin tc ca mnh, tim bp trung bnh hn 100.000ln mi ngy tng mu i hng nghn dm trong cc mch mu nui sng tng tbo mttrong hng t
tbo ca c th. mi nht bp, tim tng i khong 74 milli lt mu. ngi ln,tim trungbnh p khong 72 nht mi pht, nh vy mi pht c khong 5,3 lt muc tng i, migil 318 lt, mi ngy l 7.631 lt mu c tng i. Trong lc tpthdc, con sny c th
tng ln gp 5 ln.CHU CHUYN TIM
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Chu chuyn tim l mt chui nhng skin xy ra ti tim trong mt nhp phon chnh ca
n. Mi mt chu chuyn tim chim khong 0.8 giy. Trong thi gian ngn ,mu i vo tim, dichuyn qua cc bung tim, sau c tng i ra khp cc khu vcca c th. Mi mt chuchuyn tim c chia ra lm 2 th. Hai tm nh co khi haitm tht dn v sau th 2 tm thtsdn ra khi 2 tm nh co. Pha co, c bit ltm tht, c gi l th tm thu, pha dn cgi l th tm trng. Chu chuyn timbao gm th tm thu v th tm trng ca ctm nhlntm tht.
DOPING MU
tng cng sc do dai ca mnh trc mi cuc thi u, mt svn ng vin dng nmtkthut c gi l doping mu. Ththut ny c thc hin bng cch rt bt mtlng hngcu i. Sau khi mu brt i, c thsp ng li bng cch nhanh chng sn xut
ra nhng hng cu khc thay thcho lng hng cu bly i. Sau , mt vi ngytrckhi thi u, ngi ta stim ngc li lng mu rt ra vo c th.Hiu quca vicny l to ra hng cu nhiu hn do lng oxy trong mu cng nhiu hn.
Doping mu c thlm tng khnng ca vn ng vin ln 10%.Tuy nhin, ththutny khng nhng khng hp php m cn nguy him. N c thlm suy
yu dng tun hon cng nh gy ra triu chng ging nh cm cm. Do thay vhtrthm cho khnng ca vn ng vin th n li lm hn chnhng khnng .
Qu trnh ny khi u khi mu bkhoxy (mang mt lng oxy rt nh) quaytrvtmnh phi qua tnh mch ch. Cng lc , mu c oxy ha di chuyn tphi n tmnhtri qua 4 tnh mch phi. Van nh-tht mra v khi dng mu chy vo cc tmnh n cng
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chy mt cch bng vo cc tm tht. Cc van bn nguyt ng li ngn mu khngchyttm tht ra ngoi cc ng mch. Khi cc tm tht y khong 70%, nt xoangsgi i mt
xung ng lan truyn qua tm nh n nt nh tht. Tm nh co bp v tng khong30% lngmu vo cc tm tht.
Nt nh tht lm cc xung ng chm li trong mt thi gian ngn gip tm nh cthi gian hon thnh qu trnh co li ca mnh. Xung ng ny sau i qua b nhtht, cc nhnh vmng Purkinje n mm tim. Qu trnh co li ca cc tm tht ckhi u tvtr ny,
p lc trong cc tm tht c gia tng mt cch nhanh chng v cc van nh thtng li (gyra ting "bm" nghe c bngng nghe) ngn khng cho mu chy ngctrvtm nh.Khi p lc trong cc tm tht tng cao hn p lc trong mu cc ngmch ln xut pht t
tim, cc van bn nguyt smra v mu sc tng ra khi cc tm tht. Mubkhoxytm tht phi c bm ln phi qua cc ng mch phi, mu c oxy ha sri tmthttri i n nhng phn cn li ca c thqua ng mch ch.Khi tm tht co (th tmthu), cc tm nh dn (tm trng) v c y mu trli. Khi ttcc mu c tng i khitm tht, cc van bn nguyt sng li (gy ra ting tc nghe
c quang nghe) ngn nga dng mu chy ngc trvtim. Cc tm tht trnntrngrng v ng li trong mt thi gian ngn. Khi p lc trong tm nh tng vtqu p lc trongtm tht, van nh tht smra v mu schy vo tm tht bt u mtchu chuyn timmi.Tm li, trong mt chu chuyn tim, na phn trn ca tim(cc tm nh) nhn mu v mt na
phn di (cc tm nh) bm mu. Na phn bn phi ca tim (nh phi v tht phi)nhn vbm mu bkhoxy, na phn bn tri (nh tri v tht tri) nhn v bm mu coxyha.
HUYT P
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Khi tm tht co, n tng mu ra khi tim i n cc ng mch ln v n hi lmchng dn rakhi mu chy qua. p lc ca mu chng li thnh trong ca cc mchmu c gi l huyt
p. p lc ny cn thit gip cho mu chy n khp ni trong c thv quay ngcvtim.Huyt p ln nht nhng ng mch ln v gn tim nht. Do cc thnh mch ctnh n hi
nn cc ng mch c khnng phn hi li v bo ton hu ht p lc ca mu khi nctng ra khi tim. Khi mu i n nhng mch mu t n hi hn - nhng tiu ngmch, sau n mao mch, tiu tnh mch v tnh mch - huyt p sgim xung. Khimu quay trvtm nh phi qua tnh mch ch, p lc gn nh bng 0.Khi tim co vdn trong sut chu chuyn tim th huyt p cng tng v gim trong mi nhpp.Huyt p tng cao hn trong th tm thu (tht tri co) v gim thp hn th tmtrng (tht
tri gin).
Huyt p c o bng n vmilimet thy ngn (mmHg) bng my o huyt p. Gitrhuyt
p ghi nhn c thng l c ly tng mch cnh tay. p lc tm thu c ghinhntrc, sau mi n p lc tm trng. Trung bnh, mt ngi trng thnh trtuichuyt p o c vo khong 120 mmHg i vi huyt p tm thu v 80 mmHg i vihuyt
p tm trng (c vit l 120/80 v c c l "mi-hai-trn-tm"). Ty thuc votuitc, gii tnh, cn nng, v nhng yu tkhc, huyt p bnh thng c gi trthayi t90n 135 mmHg i vi huyt p tm thu v 60 n 85 mmHg i vi huyt p tmtrng. Bnh
thng th huyt p cng gia tng theo tui.O HUYT P
Nhn vin y to huyt p ca bnh nhn bng mt thit bc bit c gi l my ohuytp (sphygmomanometer). Thit bny bao gm mt vng bng cao su, mt cibng dng bm bng tay v mt my dng c gi trhuyt p.
Vng cao su c bao va kht xung quanh cnh tay ca bnh nhn ngay phatrn khuu tay.Sau , ngi o huyt p stng nghe ln ng mch cnh tay mttrong ca cnh tay
ngay pha trn cng tay nghe nhp mch p.Vng cao su c bm cng phng lnbng cch bp bng cho n khi dng mu chy vocnh tay bngng li v khng cnnghe hay cm thy nhp mch p na. Sau p lc vng
cao su sc gii phng tt. Khi mt lng mu nhbt u chy qua c ng mchbchn p ta snghe thy c mt m nhquang nghe. p lc ca vng cao su c cvothi im nghe c ting ng u tin c ghi nhn l huyt p tm thu.Khi p lc cavng cao su c gii phng nhiu hn na, ting nhp p trnn ln hn vdu hn. Khing mch khng cn bp na v mu chy tdo th ting ng sbin mt. p
lc ca vng cao su ghi nhn c vo thi im ting nhp p cui cng nghe c cgil huyt p tm trng.Hnh ty l mt khi m thn kinh nm u ca ty sng v snca skim sot nhng cng ngoi chng hn nh thv nhp tim. trong hnh ty c 2trung tm iu khin timmch l trung tm kch thch v trung tm c ch. Nhngtrung tm ny gi nhng xung thn
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kinh n tim iu ha nhp tim.Hthn kinh tchl mt phn ca hthng thn kinhc nh hng n nhng c quan ni
tng nh tim, phi, ddy, v gan. Chc nng ca n l ngoi {, iu ny c nghal nhng cng m n iu khin xy ra m khng cn c scan thip ca thc. Hthnkinh tch
c chia ra lm 2 phn: hgiao cm v hph giao cm. Hph giao cm hot ngchyukhi c thang trng thi bnh thng v nghngi, hgiao cm hot ng chyunhnglc c thbstress hoc cn nng lng.
Trung tm kch thch hnh no gi mt xung thn kinh i theo nhng dy giaocm n timlm tng nhp tim v tng lc co bp. Trung tm c chgi xung thnkinh i theo nhngdy ph giao cm n tim lm gim nhp tim. Nhng trung tmny hot ng p ng li
vi nhng thay i ca huyt p v nng oxy trong mu thng l do tp thdc,tng thnnhit v stress vcm xc. Nhng thay i trn c nhn bit nhcc cmthquan nm trnng mch cnh v cung ng mch ch.
Cc cm thquan ng mch cnh nhn bit c sgim huyt p, nhng cmthquan
trn cung ng mch chcm nhn c sgim nng oxy trong mu. C2 loi cmthquan ny gi nhng xung thn kinh i dc theo nhng dy cm gic n trung tmkch thch,v trung tm ny sgi nhng xung thn kinh i dc cc dy thn kinh nnt xoang ca timlm tng nhp tim. Khi huyt p v nng oxy trong mu trvmcbnh thng th trungtm c chsgi nhng xung thn kinh n nt xoang n lm chmnhp tim li vmc bnh
thng.STRAO I GIA CC MAO MCH V CC M CA C THCc ng mch, tiu ng mch,tiu tnh mch v tnh mch chc mt chc nng duy nht l
vn chuyn mu i ttim ra ngoi hay tngoi trvtim. Strao i cht - oxy,CO2, chtdinh dng v cht thi - gia mu v dch kdin ra qua cc mao mch.Nhng sdi chuynny thay i khc nhau trong 3 cch: khuych tn, lc v thmthu.Khuych tn l hin tng cc phn tdi chuyn tkhu vc c nng cao hn (chanhiuphn tloi hn) n khu vc c nng thp hn (cha t phn tloi hn). Hin
tng khuyc tn xy ra v cc phn tc nng lng tdo, c ngha l chng lunlun chuynng. y l trng hp c bit ca nhng phn tkh vn chuyn ng nhanh hnnhngphn tcht lng v cht rn. Oxy v kh carbonic di chuyn qua li giamao mch v dch kbng skhuych tn. Khi mu i qua mao mch, oxy c chbihemoglobin trong hng cuc slng ln hn nn di chuyn n dch kxung quanh cslng oxy t hn c
cc tbo nhn ly. Ngc li, CO2 c nng nhiu hn trong dch knn di chuynvo ccmao mch c chuyn i. Strao i kh gia mu v dch kc gi l sh hp niti(internal respiration).
Hin tng lc l cch di chuyn ca nc v cc cht tan trong nc xuyn quamng tkhuvc c p lc cao hn n khu vc c p lc thp hn. Khi mu i vo cc maomch n c p
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lc o c l 33 mmHg trong khi p lc ca dch kchkhong 2 mmHg. Do ,thng quahin tng lc, huyt tng v cc cht dinh dng nh amino acid,glucose, v vitamin i
xuyn qua thnh cc mao mch n cc dch kxung quanh.Sthm thu l hin tngkhuych tn ca nc i qua mng bn thm (l mt loi mng ch
cho php mt vi cht qua c m thi). N di chuyn tkhu vc c nhiu hn nkhu vcc t hn. Lin quan trc tip n hin tng ny l p lc thm thu, lkhuynh hng ca mtdung dch ko nc i vo dung dch . Gi trca p lc thm thuc tnh bng lng
cht ha tan c trong dung dch. Nu lng cht ha tan c trong dung dchcng ln th lngnc c trong dung dch cng nh. Dung dch c cha mt lng lncc cht ha tan scp lc thm thu ln v nc sc khuynh hng bko vo dung dchnhiu hn.
u tn tip gip vi tiu tnh mch ca cc mao mch, ngay trc khi chng kthp li to thnh cc tiu tnh mch, p lc thm thu cc mao mch cao hn dchkdo shin
din ca albumin v mt sphn tprotein ln vn cn nm li nh mt cht hatan trongmu. Dch kc p lc thm thu thp hn v do n sbko vo cc mao mch vcmang i.
Hnh nh sthm thu: nc i tni c nhiu n ni c t nc hn
STRAO I CA MAO MCH TRONG PHISau khi mu i ht cc m ca c th, trao ioxy v cht dinh dng ly CO2 v cc cht
b th n quay trvtim. Mu bkhoxy trvtm nh phi qua tnh mch ch, sauivo tht phi. Ti y n sc bm ln thn ng mch phi, sau thn ng mchphischia ra lm 2 nhnh ng mch phi phi v ng mch phi tri mang mubkhoxy
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i vo mi bn phi.Ti phi, cc ng mch tip tc chia nhnh ra thnh nhngng mch nhhn ri sau
thnh nhng tiu ng mch nhhn na. Cui cng, nhng tiu ng mch nhnhtsphnnhnh ra thnh cc mao mch. Nhng mao mch phi ny bao xung quanh ccphnang, l
nhng ti kh ca phi. Strao i oxy v kh CO2 ti phi xy ra xuyn quathnh ca cc phnang v gn cc mao mch.Strao i kh ny xy ra da trn nguyntc khuch tn. Kh trong cc phnang c nng
oxy cao. Mu trong cc mao mch phi c nng CO2 cao. Do , theo nguyntc khuchtn, oxy ti cc phnang sdi chuyn vo cc mao mch trong khi CO2trong cc mao mchsdi chuyn ngc li vo cc phnang.
Sau khi c oxy ha, mausex chy tcc mao mch sang cc tiu tnh mch,chng kt hpvi nhau thnh nhng tnh mch ln dn. Cui cng, mu ri khi phiqua 2 tnh mch phi
ln v c mang n tm nh tri c bm ngc trli vng tun hon hthng mtln na.Sdi chuyn ca mu tphi trvtim l mt hin tng kh c bit trong c thvy l lnduy nht m cc tnh mch li c mang mu c oxy ha.
VNG TUN HON GAN - TNH MCH CAMt vng tun hon c bit khc na l vngtun hon gan - tnh mch ca, mt nhnh cavng tun hon hthng. vng tun honny, mu i tcc c quan ca bmy tiu ha vtlch chy qua gan trc khi i thngvtim.Cc mao mch dn mu n ddy, rut non, rut gi, ty v lch chy vo 2 tnhmch ln l
tnh mch mc treo trng trn v tnh mch lch. Hai tnh mch ny hp vinhau thnh tnhmch ca mang mu i vo trong gan.Khi vo gan, tnh mch cachia nhnh ra hnh thnh cc mao mch c gi l cc
xoang. Cc xoang ny ln hn nhng mao mch bnh thng khc. Thnh ca chngc tnhthm cao hn, cho php cc protein v tbo mu i vo v ra ddng. y ltnh cht rt
quan trng v mu i vo gan tcc c quan thuc htiu ha c cha mt lng lncc chtdinh dng.Khi mu chy ttqua cc xoang trong gan, mt scht dinhdng c ly ra khi mu v
cha trong gan c sdng sau hoc chuyn thnh nhng cht khc cn thit choc th.Tcc xoang, mu chy vo cc tnh mch gan tri v phi, sau i i vo tnhmch chdi vcui cng i vo tm nh phi.t khi gp hin tng mu chy hon tonthtiu ha n tim. Bnh thng th mu tcc
ng mch vcc mao mch v chy vo cc tnh mch. vng tun hon gan-tnhmch
ca khng c stham gia ca ng mch m cc mao mch kt hp li to thnh cctnhmch, sau chia nhra thnh cc mao mch ri kt hp thnh cc tnh mchtrli. Vngtun hon ny l cn thit mu c thc gan iu chnh. Cc cht dinh dngc thc bo qun hoc thay i v khi cc cht c thgy c (nh ru v thuc) cth
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chuyn thnh nhng cht t gy hi hn trc khi mu trvtim v phn cn li cavng tunhon.
2.SINH L MU1. KHI LNG.Mu l tchc lng, lu thng trong htun hon.Trong 1 kg thtrng, c 75 - 80ml mu. Trs sinh c 100ml mu /kg cn nng,sau khi lng mu gim dn. T2 -3 tui tri khilng mu li tng dn ln, ri gimdn cho n tui trng thnh th hng nh. Mt ngi
trng thnh, bnh thng mu chim 7 - 9% trng lng c th. Mt ngi nng50kg ckhong 4 lt mu. Ngi ta c thxc nh khi lng mu chnh xc bng nhiuphng phpkhc nhau: phng php tim cc cht c mu vo mu, cht ny t blc rakhi thn, phnhunhanh v khng c hi hoc dng cc cht ng vphng xnh du hngcu.
Khi lng mu tng ln sau khi n, ung, khi mang thai, khi truyndch... Khi lng mu gimkhi c thra nhiu mhi, nn ma, a chy, chn thng cchy mu bn trong hoc bnngoi c th... Nu khi lng mu tng ln trong c th,dch tmu svo khong gian boca da v cc m, sau nc c bi xut dn theo nctiu. Nu khi lng mu gimtrong c th, dch tkhong gian bo vo mu lm chokhi lng mu tng ln. Trongnhiutrng hp mt mu cp din (mt mu cc tng ln,cc xng ln, mt mu ng ngmch ...) khi lng mu bgim t ngt, c thkhng ckhnng tb tr; nu khng cp
cu kp thi, c thskhng sng c.2. THNH PHN.
Mu gm hai thnh phn: thhu hnh (huyt cu) v huyt tng. Cc thhu hnhca mul hng cu, bch cu v tiu cu, chim 43 - 45% tng smu, chsny c gilhematocrit. Hng cu l thnh phn chim chyu trong thhu hnh. Huyt tngchim 55 -57% tng smu. Huyt tng cha nc, protein, cc cht in gii, cchp cht hu c vv c, cc hocmon, cc vitamin, cc cht trung gian ho hc,cc sn phm chuyn ho ... Huyttng cha ton bcc cht cn thit cho c thvton bcc cht cn c thi ra ngoi.
Huyt tng bly mt fibrinogen th c gi l huyt thanh.3. CHC NNG SINHL[ CA MU.Mu c rt nhiu chc nng , di y l nhng chc nng c bn ca mu:
3.1. Chc nng dinh dng.Mu mang trong mnh ton bcc cht dinh dng nuic th. Cc cht dinh dng ca tngoi vo qua ng tiu ho. Ngoi ra bch cu cnvo lngng tiu ho nhn cccht dinh dng theo kiu "m bo" v "thc bo", rili vo lng mch mang thm mt phncc cht dinh dng cho mu.
3.2. Chc nng bo v.
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Mu c khnng bo vc thkhi bnhim trng nhc chthc bo,m bo v c chmindch dch th, min dch tbo. Mu cng c khnng tham gia vo c chtcm mu,
trnh mt mu cho c thkhi btn thng mch mu c chy mu.3.3. Chc nng hhp.
Mu mang 0xy tphi ti tbo v m, ng thi mu mang cacbonic ttbo v mtiphi.3.4. Chc nng o thi.
Mu mang cc cht sau chuyn ho, cht c, cht lti cc c quan o thi(thn, bmytiu ho, phi, da ) thi ra ngoi.3.5. Chc nng iu ho thnnhit.
Mu mang nhit phn "li" ca c thra ngoi thi vo mi trng hoc ginhitcho cthnhc chco mch da.
3.6. Chc nng iu ho cc chc phn c th.Bng siu ho tnh hng nh ni mi,mu tham gia vo iu ho ton bcc chc phnc thbng c chthn kinh v thn kinh- thdch.
4. C TNH CA MU.Mu c tnh hng nh. Tnh hng nh ca mu c nh gi qua ccchssinh l, sinh hoca mu. Cc chsny, trong iu kin sinh l{ bnh thng lrt t thay i hoc chthay itrong mt phm vi rt hp. V vy chng c coi nh lmt hng s. Kim tra cc chssinhl, sinh ho ca mu l mt vic lm v cng quantrng v rt cn thit nh gi nhng ri
lon chc nng ca c th.
3.RI LON LM SNG MU1. Thiu mu.Thiu mu l gim Hb trong mu di mc bnhthng. Theo W.H.O ngi bthiu mu lngi c hm lng Hb mu gim:
< 13gHb trong 100ml mu (i vi nam)
< 12g Hb trong 100ml mu (i vi n)
< 14g Hb trong 100ml mu (i vi trs sinh)Thiu mu l do mt mu, domu bhunhanh hn trong c thhoc do tuxng gim snxut.- Thiu mu do mt mucp tnh hoc mn tnh.- Thiu mu do suy nhc tuv bnhim x, nhim c (cht cho hc cng nghip, chin
tranh).
- Thiu mu do thiu acid folic, thiu vitamin B12 hoc thiu yu tni vct bddy vim
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teo ddy, vim lot ddy- t trng.-Thiu mu do thiu st, do thiudng.
- Thiu mu do thiu cc yu tkch thch tng sinh, tng trng hng cuerythropoietin (suythn, gan mn tnh).
- Thiu mu do tan mu, do i sng hng cu qu ngn. Mt sbnh ca hng cudo mnghng cu km bn dvnh bnh thiu mu c hng cu hnh li lim, bnh thiumu chng cu hnh cu (kch thc hng cu rt nh, hnh cu).2. a hng cu.- ahng cu thpht do sng vng ni cao, do suy tim, do bnh ng h hp... y lahng cu do thiu oxy cc m.
- a hng cu tht sdo tuxng tng sn xut hng cu (c km theo tng bch cuv tiucu). Hu qul qu ti chc nng tun hon, nht mu tng, ri lon tun honmao mch.
4.SINH L CM MU V NG MU1. CM MU.
Cm mu l mt qu trnh sinh l, sinh ha tng hp nhm chm dt hoc ngn cnsmt
mu ca c thkhi mch mu btn thng hoc bt. Cm mu c thc hin nhcc c
ch: co mch, shnh thnh nt tiu cu, ng mu, co cc mu, tan cc mu ng vsphttrin m x trong cc mu ng ng kn vt thng.
nh gi khi qut chc nng cm mu, cc nh lm sng th ng sdng hai xtngim: xcnh thi gian chy mu (s bnh gi cc yu tca thnh mch v tiu cu),xc inh thigian ng mu (s bnh gi cc yu tgy ng mu ca huyt tng). Thigian mu chytheo phng php ca Duke l 3 pht. Thi gian mu ng theo phngphp ca Milian l 7
pht.
1.1. Co mch.Ngay sau khi mch btn thng, mch mu bco li do tnh n hica thnh mch. Co mch
cn c thc hin nhc chthn kinh v thn kinh-thdch. Nhng kch thch gyau t
ni tn thng, nhng cht trung gian ho hc c gii phng khi au gy phnxco c trnthnh mch. ng thi lc ny ti ni tn thng, tiu cu bvra, giiphng serotonin gy comch ti ch.1.2. Shnh thnh nt tiu cu.
Ti ni tn thng, tbo ni mc hoc thnh mch tn thng lsi collagen, tiucubm vo nhng ni ny v bhot ho. Khi tiu cu bhot ho, cc protein trongn c rtmnh v gii phng ra cc yu tlm hot ho cc tiu cu bn cnh, lm chochng dnh vo
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nhau to nn nt tiu cu bt kn chtn thng (nu l cc tn thng nh). Hngngy c thta phi chu hng trm vt rch rt nhni mao mch do sang chn. Nhcchc nngny m
c thtrnh c schy mu mao mch.1.3. Shnh thnh cc mu ng.
Tiu cu gii phng ra cc yu tgy co mch v gy ng mu, to ra cc mu ngbsungcho nt tiu cu bt kn chtn thng (nu l cc tn thng ln hn). ng muphttrin nhanh trong vng 1-2 pht. Nhng cht hot ho gy ng mu c giiphng do t
chc v mch mu btn thng, nhng cht do tiu cu gii phng v nhng cht gyngmu ca huyt tng c hot ho, pht ng mt qu trnh ng mu. Nu vt thngkhngqu nng, sau 3-6 pht cc mu ng hnh thnh bt kn vt thng. Sau 20 pht n1
gi, cc mu ng co li lm cho cc mu vng chc hn.Sau khi cc mu ng hnhthnh, vi gisau cc nguyn bo si xm nhp, bin cc mu ngthnh m x trong1-2 tun l, nu l cc mu ng nhv vt thng nh. Nu l vt thngln, tn thngrng, mu mt nhiu, c thkhng tbo vc, cn phi c scan thipkp thi.
2. NG MU.Trong mu v trong cc m c cha khong 50 cht c nh hng ti qutrnh ng mu. Cc
cht kch thch qu trnh gy ng mu gi l cc cht gy ng mu. Cc cht li cchqutrnh gy ng mu gi l cc cht chng ng mu. Mu c ng hay khng ng lphthucvo scn bng gia cc cht gy ng mu v cc cht chng ng mu. Bnh thngmu
trong c thkhng ng l do cht chng ng mu chim u th. Khi mu, mch mubtnthng, khi mu ly ra ngoi c th, cc cht gy ng mu c hot ho v trnn uth,ng mu c thc hin.
2.1. nh ngha.ng mu l mt qu trnh chuyn mu thlng sang thc, m thccht l chuyn
fibrinogen dng ha tan thnh fibrin dng khng ho tan.2.2. C chng mu(cc giai on ca qu trnh ng mu).ng mu c din ra theo mt c chrt phc tp.y l mt qu trnh hot ho v hot
ng ca cc enzym vi mc ch l to ra fibrin. Thng thng ngi ta chia qutrnh ngmu ra lm ba giai on:Giai on hnh thnh phc hpprothrombinase.Giai on hnh thnh thrombin.
Giai on hnh thnh fibrin.
2.2.1. Shnh thnh phc hp prothrombinase.Khi ng cho c chng mu lshnh thnh phc hp prothrombinase. y l mt c chrt phc tp (c ll phc tpnht ) v ko di nht ca qu trnh ng mu. Qu trnh cxy ra khi c chn thngthnh mch v m, khi c chn thng mu, khi c stip xc camu vi tbo ni mc tnthng hoc vi si collagen ca mch mu, vi cc m khc ngoi
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ni mc hoc vi bt kzvt lno.Shnh thnh phc hp prothrombinase theohai c chngoi sinh v ni sinh. C chngoi
sinh xut hin nu c chn thng thnh mch hoc cc m kcn. C chni sinhxut hinnu c chn thng mu hoc mu ly ra ngoi c thtlng mch. Trong chaic chni
sinh v ngoi sinh c mt lot protein huyt tng (c bit l a2-globulin)ng vai tr rt quantrng, l cc yu tgy ng mu ca huyt tng. Hu ht cc yutny l cc enzym dng khng hot ng. Khi chuyn thnh hot ng, chng gy racc phn ng ho sinh lin
tip nhau ca qu trnh ng mu. Cc yu tny c k hiu bng chsLam phnbitvi cc yu tca tiu cu c k hiu bng chsrp.Yu tI: fibrinogen
Yu tII: prothrombinYu tIII: thromboplastin ca m
Yu tIV: ion Ca++Yu tV: proaccelerinYu tVII: proconvertin
Yu tVIII: globulin A chng a chy mu (antihemophilicglobin-AHG).Yu tIX: globulin B chng a chy mu (plasma thromboplastincomponent-PTC).Yu tX: Stuart-ProwerYu tXI: globulin C chng a chy mu(plasma thromboplastin antecedent-PTA).Yu tXII: Hageman
Yu tXIII:n nh fibrin (fibrin stabilizing factor-FSF).- Shnh thnhphc hp prothrombinase theo c chngoi sinh.M btn thng gii phng yutIII, phospholipid tmng tbo m. Yu tX c hot
ho (Xa) nhyu tIII, yu tVIIa(yu tVII c hot ho nhyu tIII), ionCa++v
phospholipid. Shnh thnh phc hp prothrombinase tyu tXac stham giaca yu t
Va(yu tV c hot ho nhthrombin), ion Ca++ v phospholipid. Yu tValmtng hot
tnh ca yu tXa. Phospholipid ng vai tr l cht nn cn ion Ca++lm cuni gia cc yu
t. Thrombin trong trng hp ny c tc dng iu ho.
- Shnh thnhphc hp prothrombinase theo c chni sinh.Mu bchn thng,mu tip xc vi collagen hoc bmt vt lth lm hot ho yu tXII vgii phngphospholipid tiu cu. Yu tXIIachuyn yu tXI thnh yu tXIa(c sthamgiaca yu tFletcher v Fitzgerald). Yu tXIachuyn yu IX thnh yu tIXa(cstham gia cayu ttiu cu). Yu tX c hot ho c stham gia ca yu tVIIIa(yutVIII c hot
nhthrombin), yu tIXa, ion Ca++v phospholipid. Shnh thnh phc hpprothrombinase t
yu tXac stham gia ca phospholipid, yu tVa(yu tV c hot honhthrombin) v
ion Ca++. Shnh thnh phc hp prothrombinase theo c chni sinh chmhn rt nhiu (1-6pht) so vi c chngoi sinh (15 giy).Prothrombinase chnh thnh tc chni sinh hoc ngoi sinh hoc ng thi chai c
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chni sinh v ngoi sinh. iu ny chng thot tnh ca prothrombinase lphthuc vo shot ho ca cc yu ttham gia vo qu trnh ny.
2.2.2.Shnh thnh thrombinProthrombin l a2-globulin, do gan snxut, c trng lng phn t68700, nng trong mu
bnh thng l 15mg/100ml mu. Khi phc hp prothrombinase hnh thnh nschuynprothrombin thnh thrombin. Giai on ny cng cn sc mt ca ionCa++. Shnh thnhthrombin tprothrombin l rt nhanh, c tnh bng vigiy.
2.2.3. Shnh thnh fibrin.Fibrinogen l mt protein do gan sn xut,trng lng phn t340000, nng trong mubnh thng l 100-700mg/100ml mu.Bnh thng fibrinogen rt kh vo dch k. Khi thnh
mch tng tnh thm (m bvim) th fibrinogen vo dch kv bng li do cc yutgyng mu cng vo dch k.Thrombin sau khi c hnh thnh chuyn fibrinogenthnh fibrin n phn. Cc fibrin nphn ttrng hp thnh fibrin dng si. Mtmng li fibrin hnh thnh v cn nhnhyu tXIII. Giai on ny cng c sthamgia ca ion Ca++. Cc tbo mu c gili
trn li fibrin v to nn cc mu ng. Chnh mng li ny dnh vo vtr tnthng cathnh mch ngn cn schy mu.Bn cht ca mu ng l hnh thnh li fibrintfibrinogen nhthrombin. Chnh v vy ccnh ngoi khoa sdng thrombin (dngtm, gc hoc bt...) cm mu khi phu thut,c bit l cm mu cc xng xp.
2.3. Sco cc mu ng.Sau khi cc mu ng hnh thnh, n bt co l i v rrahuyt thanh (huyt tng bly mtfibrinogen th c gi l huyt thanh).
Tiu cu c vai tr quan trng cho sco cc mu ng. Tiu cu c tc dng gncc si fibrinli vi nhau vn nh vng chc fibrin. Tiu cu bm trn lifibrin, khi n co rt n lm choli fibrin co theo, ng thi vi sgii phngyu t8 ca tiu cu lm cho cc mu ng cocng mnh hn. Co cc mu ng cn cstham gia ca thrombin, ion Ca++. Cc mu ng lcny rt bn vng, gicho ccmp ca thnh mch tn thng khp li gn nhau to iu kin
thun li cho lin vt thng.2.4. Stan cc mu ng.Trong huyt tng cpasminogen (profibrinolysin). Cc m tn thng, ni mc tn thng v
vi khun gii phng ra cht hot ho plasminogen. Khong mt ngy sau khicc mu ng,cht ny chuyn plasminogen thnh plasmin. Plasmin l mt enzymlm tiu fibrin v c
fibrinogen lm tan cc mu. V l do ny m c thgy ra chy mu thpht rtnguy him, cnphi c phng. Tivim, nu vi khun lm tiu fibrin i th cthslm cho vi khunlan rng v hng ro fibrin bo v bph v. Song cng nhcchny m trong c thchin tng ttiu fibrin lm khai thng nhiu mch munhbtc nghn.
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5.CU TO - CHC NNG CA HNG CUI. CU TO
1. HNH DNG V KCH THC.
Hng cu trng thnh, lu thng trong mu l tbo khng c nhn. iu kintnhin, nc hnh a lm hai mt, ng knh khong 7,2mm, bdy ngoi vi l 2,2mm,trung tm l
1mm
Thtch mt hng cu l 83mm3(83femtolit). Nhc tnh n hi tt m hng cuddngthay i hnh dng khi i qua cc mao mch. Din tch bmt hng cu ln (doc hai mt lm),
v vy khi hng cu bin dng mng hng cu khng bcng v vra. Nu tnh dintch ton b
mng hng cu trong c thcng li, c thln n 3000m2
.2. THNH PHN.Tlthnh phn ca hng cu
% Cc thnh phn
67,00 Nc
28,00 Hemoglobin
0,30 Lipid cc loi (lecitin, cholesterol)
2,00 Nhng cht khc c cha nit (enym, protein,
glutation)
0,02 Ur
1,20 Cc cht v c (K+)
Hng cu c mt cu trc c bit vi nhiu thnh phn khc nhau. N gm mt nndo proteinv lipid to nn. a slipid u kt hp vi protein to thnhlipoprotein. Trong nn cn c
glucose, clorua, phosphat... Nn v mng chim 2 -5% trng lng hngcu. Gia cc mt cann c hemoglobin. Hai thnh phn quan trng nht ca hngcu c nghin cu nhiu lmng hng cu v hemoglobin. Mng hng cu mang nhiukhng nguyn nhm mu.Hemoglobin l thnh phn quan trng trong svn chuynkh ca mu.3. SLNG.Ngi trng thnh, mu ngoi vi c 3,8 x 1012hng cu/lt (ivi n); 4,2 x1012hngcu/lt (i vi nam). Trmi sinh, ngy u slng hng curt cao (5,0 x1012hng
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cu/lt). Sau , do hin tng tan mu, slng hng cu gim dn. Trem di 15tui c slng hng cu thp hn ngi trng thnh 0,1 - 0,2 x 1012hng cu/lt.Slng hng cu
n nh tui trng thnh.Slng hng cu tng ln sau ba n, khi lao ng thlc,sng trn ni cao 700 - 1000m,
khi ra nhiu mhi, i nhiu, a chy, bng mt huyt tng, trong bnh a hngcu, bnhtim bm sinh.... Slng hng cu gim lc ng, khi ung nhiu nc, cuikzhnh kinh, sau, i lu ngy, ni c phn p oxy cao, cc loi bnh thiu mu,suy tu, nhim c, chy
mu trong, chy mu do vt thng...4. QU TRNH SINH HNG CU4.1. Ngun gcv cc giai on pht trin ca hng cu
Nhng tun u ca thai nhi hng cu c nhn c l thai gia sn xut. Tthngthhai tri gan, lch, sau l hch bch huyt cng sn xut ra hng cu c nhn.Tthng th5 ca
kzpht trin thai, tuxng bt u sn xut hng cu v t tri, tuxng l niduynht sinh ra hng cu. Sau tui 20 cc tuxng di bmho, cn tuxng xp nhxngsng, xng sn, xng c, xng chu sn xut hng cu. V vy tui gi dbthiumu
hn.Tbo tuxng l tbo gc vn nng c khnng duy tr ngun cung cp tbo gcv phttrin thnh tbo gc bit ho to ra cc dng khc nhau ca tbo mu (theothuyt mtngun gc). Tbo gc bit ho sinh ra hng cu c gi l n vto cm cadng hngcu: C.F.U.E (Colony forming unit erythrocyt). Sau cc tbo dnghng cu tri qua cc giai
on sau y.Tin nguyn hng cu (proerythoblast)
Nguyn hng cu a kim( normoblast a kim) Nguyn hng cu a sc(normoblast a
sc) Nguyn hng cu (normoblast) Hng cu li (reficulocyt) Hng cutrng thnh(erythrocyt)
Nhn ca nguyn hng cu mt i khi nng hemoglobin trong bo tng cao> 34%. Hngcu chnh thc khng c nhn xuyn mch ri btuxng vo htun honchung. Hng culi cng c khnng vo mu nh hng cu trng thnh nhng tlrt thpchchim 1%
tng slng hng cu mu ngoi vi, khong 1-2 ngy sau hng cu li trthnhhng cutrng thnh. Hng cu sng trong mu khong 120 ngy (ngi da trng),gn 120 ngy(ngi Vit).Hthng enzym ni bo hng cu lun lun tng hp ATPtglucose duy tr tnh n hica mng tbo, duy tr vn chuyn ion qua mng,gicho st lun lun c ho tr2, ng thi
ngn cn soxy ho protein trong hng cu. Trong qu trnh sng, hthngenzym gim dn,hng cu gi ci, mng hng cu km bn v dv.Mt phn hng cuthutrong mu, cn i bphn hng cu bhutrong tchc vng - nim ca lch, gan,tuxng. Hemoglobin c gii phng ra bthc bo ngay bi cc i thcbo lch,gan, tuxng. i thc bo gii phng st vo mu v n c vn chuyn di
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dng ferritin. Phn porphyrin ca hem trong i thc bo c chuyn thnhsc tbilirubingii phng vo mu, ri qua gan bi tit theo mt.
4.2.Cc nguyn liu cn thit cho qu trnh sinh hng cuto thnh hng cu,trong c thc hai qu trnh song song: sto thnh tbo hng cu
v stng hp hemoglobin. y l nhng qu trnh rt phc tp, i hi nhiunguyn liu nhprotein, cholin, thymidin, acid nicotinic, thiamin,pyridoxin, acid folic, vitamin B12, Fe++, nhiuenzym v cht xc tc choqu trnh tng hp ny.
Vitamin B12 v acid folic rt cn cho qu trnh tng hpthymidintriphosphat, mt trong nhngthnh phn quan trng ca DNA. Thiuvitamin B12 v acid folic slm gim DNA, tbo skhng phn chia v khngtrng thnh c.Lc ny cc nguyn hng cu trong tuxng c
kch thc ln hn bnh thng, c gi l nguyn bo khng l. Tbo to ra l vlng DNAkhng nhng lng RNA li tng dn ln hn bnh thng, tbo tng tnghphemoglobin hn v cc bo quan cng nhiu hn. Cc hng cu trng thnh schnh budc khng u, mng mng hn v i sng sngn hn (chbng 1/3 - 1/2 thigian ca hngcu bnh thng).
Vitamin B12 qua ng tiu ho kt hp vi yu tni (tbo vin tuyn ddy bitit).Phc hp ny gn vo receptor mng tbo nim mc hi trng v vitamin B12c hp thutheo c chm bo. Vitamin B12 vo mu, dtrgan. Nhu cu vitaminB12 l 1 - 3 mg/24h.Trong khi sdtrvitamin B12 ca gan c thgp 1000 lnnhu cu ca c thtrong mtngy.
Thnh phn thhai khng km phn quan trng l st. St c hp thu theo ngtiu hovo mu. Trong mu, st c kt hp vi mt globulin l apotransferrinto thnhtransferrin vn chuyn trong huyt tng (v st lin kt vi globulinrt lng lo). St c vn
chuyn ti cc m c bit: tchc vng - ni m v gan. Ti y, st c gii phngra vc tbo hp thu.Trong bo tng, st kt hp vi mt protein l apoferritinto thnh ferritin l dng dtrst. Mt lng nhst c dtrdng hemosiderintrong tbo. c tnh duy nht catransferrin l n gn rt mnh vi receptormng tbo nguyn hng cu. Trong tbo,
transferrin gii phng st vo ty lp th. Ti y din ra qu trnh tng hphem. Mi ngy mtngi trng thnh cn 1mg st. Phncn st nhiu gp i so vi namgii v bmt muqua mu kinh nguyt. St bthi hng ngy qua phn v mhi.St chp thu rut nhapoferritin do gan sn xut, bi tit theo mt vo ttrng.Apoferritin gn vi st tdo hoc vi st ca hemoglobin, myoglobin tothnh
transferrin.Transferrin gn vo receptor tbo nim mc rut, ri vo mu.St c hp thurt chm v rt t, mc d st c n vo theo thc n l kh nhiu. Khiapoferritin trong c
thbo ho st th transferrin khng gii phng st cho cc m v cng khngnhn st trut,hp thu st bngng li.Khi c ththa st, gan gim sn xutapoferritin lm cho apoferritin trong mu v mt gim v
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cng lm gim hp thu st. Trong trng hp n qu nhiu st, st vo mu nhiudn n lngng hemosiderin trong cc tbo vng - ni m, gy c hi cho tbony.
4.3. Siu ho qu trnh sinh hng cuSlng hng cu mu ngoi vi c iu hohng nh nhm cung cp oxy cho tbo
hot ng. Stng trng v sinh sn ca cc tbo gc c kim sot bi cc proteinkchthch tng trng, v dnh interleukin 3.Cc tbo gc bit ho n lt mnh lichu skch thch tng trng ca cc cht gy bit
ho, m cc cht ny li c rt nhiu c quan nh thn, gan... sn xut khichng bthiuoxy.
Bnh nhn bthiu mu do mt mu, bgim chc nng tuxng khi bchiu x, nhngngi
sng vng ni cao c nng oxy trong khng kh thp hn bnh thng, bnh nhnbsuytim, cc bnh vphi c gim trao i kh phi... u gy ra thiu oxy cc mlm cho qu
trnh oxy ho cc m bgim i.Khi cc m bthiu oxy chng sn xut raerythropoietin. Erythropoietin l mt glucoprotein cTLPT l 34000. Bnhthng 80-90% erythropoietin l do thn sn xut, cn li l do gan sn
xut. Mt sm khc cng sn xut erythropoietin, nhng khng ng k. V vychng ta cthgp bnh nhn thiu mu do suy thn mn tnh. Khi thn v gan thiuoxy, erythropoietinsc sn xut sau vi pht hoc sau vigi.Erythropoietin do thn sn xut dng cha hot ng gi l erythogenin.Nhkt hp vimt globulin (do gan sn xut) erythogenin chuyn thnherythropoietin hot ng.
Erythropoietin c tc dng: kch thch qu trnh chuyn C.P.U.E thnh tinnguyn hng cu vkch thch chuyn nhanh cc hng cu non thnh hng cu trngthnh.5. SC BN HNG CU
Mng hng cu l mt mng bn thm. Nc c thqua mng hng cu khi p xut thmthubn trong v bn ngoi hng cu khc nhau. Ngi ta xc nh sc bn hng cubng dung
dch mui NaCl nhc trng c nng khc nhau t0,02% mt ( phng phpHamberger).Hng cu trong dung dch mui NaCl nhc trng btrng to ln vvra do nc tdungdch mui vo trong hng cu.Khi hng cu v, hemoglobin giiphng vo dung dch v lm
cho n c mu hng. Mt shng cu bt u vtrong dung dch mui NaCl nhctrng0,44%. Nng mui NaCl 0,44% c gi l sc bn ti thiu ca hng cu. Tonbhng cuvht trong dung dch NaCl nhc trng 0,34%. Nng mui NaCl 0,34% cgi l scbn ti a ca hng cu.Sc bn ca hng cu gim trong bnh vng dahuhuyt, tng ln sau ct lch.
6. TC LNG HNG CUMu c chng ng, t trongng nghim, hng cu lng xungdi, huyt tng ni lntrn. iu xy ra l do ttrng ca hng cu (1,097) cao hnttrng ca huyt tng
(1,028). Khi c qu trnh vim din ra trong c thlm hm lng cc proteinmu thay i, cnbng in tch protein huyt tng thay i, in tch mng hng cucng bbin i theo,
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hng cu ddnh li vi nhau hn v lm cho n lng nhanh hn.Nh vy tc lngmu cng cao th qu trnh vim ang din ra trong c thcng mnh. Ch
stc lng hng cu l chiu cao ct huyt tng tnh bng mm trong 1h, 2h v24h.7. HEMOGLOBIN
7.1. Cu trc ca Hemoglobin.Hemoglobin (Hb) l 1 protein mu, phc tpthuc nhm chromoproteid mu , c nhmngoi l hem. Hb l thnh phn chyu cahng cu, chim 28% v tng ng vi 14,6g trong
100 ml mu. TLPT ca Hb l 64.458.Hb gm 2 phn: hem v globin. Mi phntHb c 4 hem v 1 globin. N c to thnh t4di n v. Mi di n vl 1 hem kthp vi globin.
Globin c cu trc l cc chui polypeptid. ngi ln, 4 chui polypeptidging nhau tng imt: 2 chui a v 2 chui b. Cc di n vlin kt vi nhau bnglin kt yu: lin kt ion, lin
kt hydro, to nn cu trc bc 4 ca phn tHb (hnh 3.2). chuipolypeptid ca mi din vc 1 hc cha hem. Trung tm ca phn tHb c 1 hcrng gi l hc trung tm (hnh3.3). Hc trung tm tip nhn phn t2,3diphosphoglycerat (2,3 DPG) v skt hp ca hc
trung tm vi 2,3 DPG c vai tr iu ho i lc ca Hb vi 0xy.Thnh phnth2 ca Hb l hem. Sc them thuc loi porphyrin l nhng cht c khnng
kt hp vi nguyn tkim loi. Hem ngi l porotophyrin IX kt hp viFe++. Hem c 4nhn pyrol lin kt vi nhau bng cu ni menten (-CH=). Vngporphyrin c gn cc gcmetyl (-CH3) vtr 1, 3, 5, 8; cc gc vinyl(-CH=CH2) vtr 2,4; cc gc propionyl (-CH2- CH2-
C00H) vtr 6,7. Fe++gn vi nh pha trong ca nhn pyrol bng hai linkt ng ho trvhai lin kt phi tr v vi globin qua gc histidin (hnh3.4).Porphyrin l phbin trong thgii sinh vt. Porphyrin kt hp viMg++to thnh cht dip
lc ca thc vt.Hem c thkt hp vi nhiu cht khc nhau. Nu hem kt hp viglobin th to thnh Hb.
Nu hem kt hp vi albumin, NH3, pyridin, nicotin... to nn cht gi lhemochromogen. Hemphn ng vi NaCl trong mi trng acid to rachloruahem (hemin). Phn ng ny c sdng trong php y.
7.2 Cc loi hemoglobin ngi.Hemogobin khc nhau phn cu to globin.Hb ca thai nhi l HbF. Globin ca HbF gm haichui a v hai chui g. Hbca ngi ln l HbA. Globin ca HbA gm hai chui a v hai chui b(vtr th3ca chui b l glutamin c thay bng threonin chui g). Hb ca bnh nhnmcbnh thiu mu c hng cu hnh li lim l HbS (HbB) vtr th6 ca chui b lvalin c
thay bng glutamin. Loi hng cu ny rt dvkhi qua mao mch nh. HbC vHbD l cc Hbbnh thng gp mt schng tc ngi Chu Phi.C nhiu phng php nhlng Hb, kccc phng php khng chy mu. Bnh thngngi Vit c Hb l 14,6g (ivi nam) v 13,3g (i vi n) trong 100ml mu. m slnghng cu v nh lng Hb lnhng xt nghim quan trng trong nh gi sthiu mu, thiu
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mu ng sc (gi trhng cu =1), thiu mu u sc (gi trhng cu >1) vthiu mu nhcsc (gi trhng cu
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Mt khc C02m sau khi khuych tn vo trong hng cu th ti y din ra qutrnh C02+H20 H2C03nhmen xc tc carboanhydrase (men ny c nhiu tronghng cu). Sau H2C03
phn ly H++ HC03- . Nhhiu ng Hamburger m HC03
- c khuych tn rt nhiu ttronghng cu chuyn sang huyt tng to ra dngvn chuyn C02quan trng nht ca mu
(C02 c vn chuyn di dng HC03-
). Nh vy hng cu ng vai tr quan trng bcnht trong svn chuyn C02dngHC03-ca huyt tng.
2. Chc nng iu ho cn bng acid - base ca mu.
Chc nng ny do hm hemoglobinat m nhim. ng thi vi hm ca Hb, hngcucn to ra HC03
-trong qa trnh vn chuyn C02, nn n to ra hmbicarbonatHC03/H2C03,hm quan trng nht ca mu.
3. Chc nng to nht ca mu.Hng cu l thnh phn chyu to nht ca mu,nhnht m tc tun hon, nht
l tun hon mao mch, hng nh. Tc tun hon hng nh l iu kin thun licho strao i vt cht gia tbo v mu. Khi nht ca mu thay i sgy ra thay itc tun hon v lm ri lon trao i vt cht ca tbo.
6.TIU CUTrong tuxng c nhng tbo nhn khng l(40-100mm). Cc tbo ny cbit ho t
tbo gc vn nng.
Tbo c nhn rt to, nhiu thuz, a dng vi nhim sc thphn bkhng u. Botngnhiu, mu nht, c nhiu ht rt nhmu xanh l. Tbo nhn khng lcho gitcdichuyn. Cc gitc ny bteo li, tch ra, t on thnh tiu cu lu thng trongmu. Nh
vy, tiu cu (thrombocyt) l mt phn bo tng ca tbo nhn khng l, l mttbokhng hon chnh, khng c nhn, rt a dng, bo tng tm nht c ht mu xanh,rt khm v dvkhi ly ra khi c th
Tiu cu c kch thc 2-4mm, thtch 7-8mm3. Bnh thng c 150-300 x109tiu cu
trong 1 lt mu ngoi vi.Tiu cu c cu trc mng glycoprotein, lp nyngn cn tiu cu dnh vo ni mc nhng liddnh vo ni thnh mch tn thng c chtcollagen lra. Mng tiu cu cng rt ddnhvo cc vt l. Khi bm vo vt l,chng li c thtbm vo nhau thnh tng m. Tiu cu
cha actomyosin, thromstbohenin nn tiu cu c khnng co rt. Tiu cuco rt mnh sbvra v gii phng serotonin gy co mch, cc phospholipid vcc yu tgy ng mu thamgia vo qu trnh gy ng mu.
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- Yu t1 l yu tc khnng chuyn prothrombin thnh thrombin. Vbn chtyu t1 gnging yu tV ca huyt tng.
- Yu t2 l yu tc tc dng y nhanh fibrinogen thnh fibrin khi c mtca thrombin.- Yu t3 l mt phospholipid c hot tnh cathromboplastin.
- Yu t4 l yu tc hot tnh ca antiheparin to iu kin thun li chogiai on u caqu trnh ng mu.- Yu t5 l serotonin c khnng gy co mch v ckhnng lm mu ng ti ch.
- Yu t6 l mt protein c tc dng lm dy thnh mch v lm gim tnh thmthnh mch.- Yu t7 l antifibrinolysin, cht c tc dng ngn cn phn ng lmtan cc mu.- Yu t8 retractozym l mt yu tc tc dng lm co cc mu ng.
- Yu t9 l mt cht lmn nh fibrin.Vi c im chc nng trn y, tiu cutham gia vo qu trnh cm mu, c xem nh
l mt hng ro bo vsmt mu. Tiu cu cng c khnng gn ln vi khun to iukinthun li cho qu trnh thc bo c ddng. Ngoi ra tiu cu cn c tc dngkhc na nhlm hhuyt p, chc nng min dch v chc nng sn xut cc enzymhuprotein.
Ssn xut tiu cu c iu ho bng slng tiu cu nhc chdo cc yu ttronghuyttng kim sot. Tiu cu btiu dit lch. i sng tiu cu cha c nghin cuy ,ngi ta cho rng n sng trong mu khong 9-11 ngy.Slng tiu cu tng ln khilao ng, khi n ung, khi bchy mu, bnh a sinh mn tnh thtubo, bnhHodgkin, bnh Vaquez. Slng tiu cu gim trong nhim c, nhim x, xut
huyt di da, nim mc, suy tu, bnh Biermer, bnh Werlhoff.
7.BCH CU1. HNH DNG V SLNG.
Bch cu l cc tbo c nhn, hnh dng v kch thc rt khc nhau tuztng loi.Bch cukhng phi chlu thng trong mu, m n cn c mt nhiu ni trong c th:bch huyt,dch no tu, hch bch huyt, cc tchc lin kt...
Thnh phn bch cu rt phc tp, gm nhiu cht hu c v v c. Bo tng ca bchcucha nhiu st, calci, lipid (cholesterol, triglycerid v acid bo).Cc lipid ny lin quan ti vai trchng nhim trng ca bch cu. Bch cu chanhiu lipid c xem nh tin lng tt chngnhim trng (Boyd,1973). trong bchcu cn c nhiu acid ascorbic, ht glycogen. Ht glycogen
nhiu ln trong qu trnh tiu ho v mc bnh i tho ng. Bch cu c mththngenzym rt phong ph (oxydase, peroxydase, catalase, lipase,amylase) v mt scht ditkhun.
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Trn mng tbo bch cu c rt nhiu ththlin quan ti chc nng ca bch cu.Da vocc ththny, nhcc kthut hin i, ta c thphn loi c bch cu v theo dicc
giai on pht trin ca bch cu.Trn bmt lympho bo c hthng khng nguynph hp tchc. Mc d mt skhng
nguyn c mt trn tbo ca nhiu m, nhng chng li bpht hin ddng trnlymphobo. Do tt ckhng nguyn ph hp tchc chyu ca ngi c k hiu lHLA(humanlymphocyt antigen). Tt cHLA hp thnh hthng khng nguyn ph hptchc cangi, cn gi l hthng HLA, chia thnh 5 nhm. Nhm HLA-A, nhmHLA-B, nhm HLA-C,nhm HLA-D v nhm HLA-DR. Di cc nhm ny c rt nhiu phnnhm c t tn. Hthng khng nguyn HLA di truyn v rt c { ngha trong p ngmin dch thi ghp.
Trong 1lt mu ngoi vi c 7,0 x 109bch cu (i vi nam) 6,2 x109bch cu(i vi n), nhnchung vo khong 5,0 x 109n 9,0 x 109 bch cu (i vi ngitrng thnh). Trs sinh c
slng bch cu rt cao: 20,0 x109bch cu/1lt mu ngoi vi. Lc mt tui cn10,0 x109bch cu/1lit mu. T12 tui tri slng bch cu trvn nh bng ngitrngthnh.
Slng bch cu tng ln khin ung, khi lao ng thlc, thng cui ca thikzmang thai,sau khi . c bit slng bch cu tng ln khi nhim khun, bnhbch cu. Mt shormon v mt stinh cht m cng lm tng slng bch cu nh:hormon tuyn gip,adrenalin, estrogen, tinh cht gan, tinh cht lch,tuxng. Slng bch cu gim khi blnh, khi bi, khi gi yu, suy nhc tu,nhim virus, nhim c, nhim trng qu nng, hoc
iu trbng cc hormon corticoid, insulin ko di...
2. PHN LOI BCH CU.
Vmt i th, vi kthut kinh in, da vo hnh dng, kch thc tbo, hnh dngnhn,sbt mu ca ht trong bo tng. Ngy nay nhkthut hin i cn pht hin ccc
ththbmt tbo bch cu v.v...; ngi ta c thphn loi bch cu thnh bch cuht(bch cu a nhn) v bch cu khng ht (bch cu n nhn). Bch cu a nhn cchialm 3 loi: trung tnh, a acid v base. Bch cu n nhn c chia lm 2loi: monocyt v
lymphocyt. ngi bnh thng, tlcc bch cu trong mu ngoi vi nh sau:Bchcu ht a acid (E): 2,3%Bch cu ht a base (B): 0,4%
Bch cu monocyt (M) : 5,3%Bch cu ht trung tnh (N): 62,0%Bch culymphocyt (L): 30,0%
Cc nh lm sng thng gi tl% cc loi bch cu mu ngoi vi l cng thc bchcu phthng. Cng thc thay i khi n ung, khi lao ng, khi c kinh nguyt,khi c thai trn 4 thng,
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khi . Trs sinh c ti 70% l bch cu a nhn, tthng th3 tri chcn 35% lcc bchcu a nhn (lc ny chyu l lympho bo). Cng thc bch cu dnn nh nsau tui dy
th mi bng ngi trng thnh.Ngy nay nhkthut cao chng ta c thphn loibch cu mt cch chi tit hn vi mc
ch tm hiu chc nng ca tng loi bch cu phc vcho nghin cu khoa hc,chn on viu tr. Tuy vy vic xc nh cng thc bch cu phthng v slng bch cuvn c coil xt nghim thng quy ca bnh vin v n vn cn gi trthc tin. ngthi vi xc nh
gi trtng i (l tl% ca tng bch cu), cc nh lm sng cn xc nh gitrtuyt i(slng tng loi bch cu c trong 1lt mu). Chsny rt cn cho stinlng bnh.Bch cu a nhn trung tnh (N) tng >70% trong cc trng hpnhim khun cp, qu trnh
lm m, vim tnh mch, nghn mch, nhi mu c tim, nhi mu phi. N cn tngtrong cogit ng kinh, a protein vo trong c th, chy mu phc mc nh. ngthi vi N tng cn
c bch cu a (stab) tng.- Bch cu a nhn trung tnh gim
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Dng monocyt: tbo gc vn nng pht trin qua nhiu giai on bit ho thnhmonocyt.Cha bit chnh xc thi gian sng ca bch cu trong mu l bao lu vbch cu c mt khp
mi ni. Bch cu vo cc c quan ri tcc c quan quay trli mu. Thi gianbch cu cmt trong mu chng qua l thi gian vn chuyn bch cu tni sn xutn ni sdng. V
vy thi gian sng ca bch cu trong mu l rt ngn.Nu ngng sn xut bchcu t ngt (bng cch chiu tia g) trong 3 n 6 ngy u mungoi vi khng cnbch cu a nhn trung tnh. Thi gian bch cu sng trong mu khang 4-5
ngy. Thi gian bch cu sng ctrong v ngoi mch khong 8-12 ngy. Thigian bch cu tnti trong tuxng khong 4-8 gi. Kh c thxc nh chnh xc thigian sng ca bch cumonocyt v n lun lun qua li gia cc m. Thi gian luthng ca monocyt trong mu
khong 10-20 gi. Thi gian sng ca monocyt trong ccvim di hn bch cua nhn trungtnh. Lympho bo vo htun hon lin tc quang ngc. Slng lymphobo trongng ngc
vo htun hon chung trong 24 githng l gp nhiu ln slng lympho bo mumtthi im. iu chng tthi gian lympho bo sng trong mu l rt ngn (24h).Bch culympho tc quan bch huyt vo mu, tmu ti m, tm li vo c quan bchhuyt, ri
li vo mu... chu kzcthdin ra lin tc.Bch cu btiu dit khp mi nitrong c thkhi bgi ci, nhng chyu l trong lngngtiu ho, phi v lch. Bchcu (c bit l cc i thc bo, bch cu ht trung tnh) btiudit ccvim, cc vngv cc din ca c thdbvi khun t nhp nh da, phi, nimmc.
4. C TNH CA BCH CU.
Bch cu c nhng c tnh chung sau y:
4.1. Xuyn mch.Bch cu M v N c khnng thay i hnh dng, xuyn qua vchgia cc tbo ti nhng
ni cn thit.4.2. Chuyn ng theo kiu a mip.Bch cu M v N c khnngchuyn ng bng chn gi(theo kiu amip) vi tc :
40mm/min.
4.3. Ho ng ng v nhit ng ngC mt scht do m vim sn xut, do vi khunto ra hoc nhng cht ho hc a tngoi
vo c ththu ht bch cu ti (ho ng ng dngtnh) hoc xua ui bch cu raxa hn(ho ng ng m tnh). Tng t, vi nhit cng nh vy, bch cu cng c nhitng ngdng tnh v m tnh. Cc c tnh ny chyu l ca bch cu M v N.4.4. Thcbo.Bch cu M v N c khnng thc bo,m bo. Nhng iu kin thun li cho thc bol:
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+ Bmt ca vt rng v x x.+ Khng c vbc. Cc cht tnhin trong c thc vbcl protein, cc cht ny y tbo
thc bo ra xa nn kh thc bo. Cc m cht, cc vt lkhng c vbc v thngtch inrt mnh nn chng dbthc bo.
+ Qu trnh opsonin ho. Cc khng th(c sn xut trong qu trnh min dch)gn vomng tbo vi khun lm cho vi khun dbthc bo.Sthc bo c thc hin nhsau:
Bch cu tip cn vt l, phng chn gibao vy vt l, to thnh mt ti kn chavt l. Tiny xm nhp vo trong tbo, tch khi mng tbo to ra mt ti thc botri tdo trongbo tng. Ti thc bo tip cn lysosom v cc ht khc trong botng v xut hin hin
tng ho mng. Cc enzym tiu ho v cc tc nhn git vi khun c trt vo tithc boxl vt l. Ti thc bo trthnh ti tiu ho. Sau khi tiu ho, cc snphm cn thit cho
tbo c gili, cc sn phm khng cn thit sc othi ra khi tbo bng qutrnhxut bo.Tnh thc bo ca bch cu khng phi l v hn. Mt bch cu ht trung tnhc ththc bo
5-25 vi khun th cht. i thc bo c khnng thc bo mnh hn nhiu. N cththc boti 100 vi khun. Khi nghin cu chc nng thc bo ca bch cu, ngita thng sdng"chsthc bo" nh gi chc nng ny.Bch cu c mt khp ni trong cthcho nn vi khun t nhp bng bt kzng nocng btiu dit. c bit bch cu trnginhng ni quan trng ca c thm vi khun d
xm nhp vo nh: da, nim mc, cc hc tnhin, phi, ng tiu ho, gan, lch.Tuy vy cmt svi khun bbch cu "nut" nhng khng "git" c nhmycobacteria, salmonella,listera ... Nhng vi khun nyn nu ri nhn lntrong i thc bo. Bch cu N v i thc
bo cn cha nhng cht git vi khun. Mt svi khun khng btiu ho bi ccenzym calysosom v chng c vbc bo v, hoc c cc yu tngn chn tc dng cacc enzym tiuho nhng li bcht bi cc cht git vi khun. Cc cht git vikhun l cc cht oxy ho mnhnh superoxid (02-), hydrogenperoxid (H202),ion hydroxyl (0H
-). Ngoi ra enzym
mieloperoxydase ca lysosom cng c khnng git vi khun v n lm tanmng lipid ca vi
khun.
5. QU TRNH VIM.
Khi vim, c tnh ca m bthay i nh sau:- Gin mch ti chlm cho lu lngmu tng ln.- Tng tnh thm mao mch gy ph n.- ng dch kv dch bch huyt dofibrinogen v cc yu tgy ng mu thot vo.- Tp trung nhiu bch cu N v ithc bo.
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- Cc tbo ca m trng phng ln.M bthng tn do bt kzmt nguyn nhn no(vi khun, chn thng, ho cht, nhit
v.v...) sgii phng histamin, bradykinin, serotonin,prostaglandin, cc yu tgy ng mu.Lympho bo T hot ho gii phng ralymphokin. Mt scht trn hot ho i thc bo v
cng vi mt ssn phm khc do tbo tn thng v vi khun to ra gy ho ngdngtnh vi bch cu N v i thc bo. Bch cu bm mch, xuyn mch v di chuyntivim.
Sng dch kv bch huyt to ra mt bc tng bo vngn cch gia vng vim vvnglnh. Stp trung ca bch cu (i thc bo ti trc: sau vi pht, bch cu Nti sau: sau vigi) l mt hng ro thhai. ng thi vi stp trung ca bch cu,tbo vim sn xut ra
cc globulin, cc sn phm phn hubch cu vo mu, theo mu ti tc ng lntuxnglm tng sn xut bch cu (sau mt, hai ngy). Do qu trnh tng sn xutbch cu cho nn
trong mu sc nhiu bch cu non hn bnh thng (bch cu a).vim hnh thnhmt ci hc cha xc vi khun, bch cu N, i thc bo, tchc hoi tgil m. Mnhiusbvthot ra ngoi hoc vo cc xoang, cc tng rng ca c th. Nu hng
ro bo vkm, vi khun slan rng vo cc c quan, c khi vo c mu. mu cngc ithc bo v bch cu N sn sng tiu dit chng. Trong nhiu trng hp cthkhng tbovc mnh cc triu chng nhim khun tng ln dn v cn phi c iutrkp thi.
6. BCH CU A NHN A ACID .
Bch cu E c khnng thc bo v ho ng ng rt yu nn khng quan trng trongnhimtrng thng thng. nhng ngi nhim k sinh trng (KST), slng bch cu Etng cao vchng ti ccnhim k sinh trng. Bch cu E gii phng ra cc chtgit KST: men thu
phn tcc ht ca bo tng, oxy nguyn t, cc peptid v.v... Bch cu E cngtp trung nhiuccc phn ng dng (tiu phqun, da v.v...). Trong qu trnhtham gia vo phn ng d
ng, dng bo v bch cu B gii phng ra cc cht gy ha ng ng dng tnh vibchcu E. Bch cu E c tc dng khc l cc cht gy vim do dng bo v bch cu Bgiiphng ra. Bch cu E cng c thc tc dng thc bo chng qu trnh lan rngca vim.
7- BCH CU A NHN A BASE.
Bch cu a nhn a base c thgii phng heparin, histamin, mt tbradykinin v serotonin.Tivim cc cht trn cng c dng bo gii phng ratrong qu trnh vim. Dng bov bch cu B ng vai tr quan trng trong phnng dng v khng thIgE gy phn ng d
ng c khnng gn vo mng dng bo v bch cu B. Khi gp khng nguyn c hiuphn
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ng vi khng thlm cho cc tbo ny bvra v gii phng heparin, histamin,bradykinin,serotonin, enzym thuphn lysosom v nhiu cht khc. Cc chttrn gy ra dng.
8. BCH CU LYMPHO.
Bch cu lympho c chia thnh hai loi: lympho bo B v lympho bo T.Chng u c chungngun gc trong bo thai l cc tbo gc vn nng. Cc tbo nysbit ho hoc c "xl{" thnh cc lympho bo trng thnh. Mt stbo lympho ditr tuyn c v c "x
l" y nn gi l lympho bo T (Thymus). Mt stbo lympho khc c "xl"gan(na u thi kzbo thai) v tuxng (na sau thi kzbo thai). Dng tbolympho nyc pht hin ln u tin loi chim v chng c "xl" bursa fabricicus(cu trc ny
khng c ng vt c v) nn c gi l lympho bo B (ly tchbursa).
Sau khi c "xl{" cc lympho bo lu thng trong mu ri dtrm bch huyt,ri livo mu v.v... chu kztip din nhiu ln. Chc nng chnh ca lympho bol: lympho bo Bchu trch nhim vmin dch dch th. Lympho bo T chu trchnhim vmin dch tbo.Hai chc nng ca hai loi tbo ny c mi lin quan chtchvi nhau.8.1. Chc nng ca lympho bo B.Trc khi tip xc vi khng nguync hiu, cc clon lympho B ngyn trong m bch huyt.
Khi khng nguyn xm nhp vo, cc i thc bo thc bo khng nguyn v giithiu (trnh)khng nguyn cho cc lympho bo B v lympho bo T. Cc lymphobo T htrc hot hocng gp phn hat ho lympho bo B. Cc lympho bo B c hiuvi khng nguyn c hot
ho, ngay lp tc trthnh cc nguyn bo lympho. Mt snguyn bo bit hotip thnhnguyn tng bo l tin thn ca tng bo plasmocyt. Trong cc tbo nyc mng ni botng c ht tng sinh. Tbo phn chia rt nhanh: 9 ln phn chiatrong khong 10 givtrong 4 ngy u mt nguyn tng bo sinh ra ti 500 tbo.Cc tng bo sinh khng thglobulin vi tc rt nhanh v mnh. Mi tng bo snxut khong 2000 khng th/1giy.
Cc khng thvo htun hon. Ssn xut khng thko di vi ngy hoc vi tuncho nkhi tng bo bcht.Trong qu trnh thc hin chc nng min dch, mtsnguyn bo lympho sinh ra mt lng
kh ln tbo lympho B mi ging nh tbo lympho B gc ca clon v c bsungthmvo stbo lympho gc ca clon. Cc tbo ny cng lu thng trong mu v cngc trtrong m bch huyt. Khi gp li cng mt khng nguyn chng sc hot ho mtln na,
l cc tbo nh. Sp ng khng thca cc tbo lympho B ny din ra nhanh vmnhhn rt nhiu so vi nhng tbo lymphpo gc ca clon c hiu. iu ny giithch ti saop ng min dch nguyn pht (tip xc khng nguyn c hiu ln u) lichm v yu hnso vi p ng min dch thpht (tip xc vi cng mt khng nguyn lnth2).8.2. Chc nng ca lympho bo T.
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Khi tip xc vi khng nguyn c hiu do i thc bo gii thiu, cc tbolympho T ca mbch hyt tng sinh v a nhiu tbo lympho T hot ho vo bchhuyt ri vo mu. Chng
i khp c thqua mao mch vo dch kri trli bch huyt vo mu mt ln na.Chu kzctip din nh vy hng thng hoc hng nm.
Tbo nhca lympho bo T cng c hnh thnh nh tbo nhca lympho bo B. pngmin dch tbo thpht l to ra lympho bo T hot ha mnh hn, nhanh hn pngmin dch tbo nguyn pht. Trn bmt ca mt lympho bo T c hng trm ngnvtr
receptor.Cc khng nguyn gn vo receptor c hiu trn bmt tbo lympho Tcng gingnh gn vi khng thc hiu do lympho bo B sn xut ra.Cc lympho boT c chia thnh lympho bo T htr, lympho bo T gy c v lympho bo T
trn p. Tbo lympho T htrchim 3/4 tng stbo lympho T v c chc nng iuhohthng min dch. Siu ho ny thng qua lymphokin m quan trng nht linterleukin.
Nu thiu lymphokin ca lympho bo T th hthng min dch sbt lit.Interleukin 2, 3, 4, 5,6 c tc dng kch thch to cm bch cu ht, bch cuM v lm tng chc nng thc bo cacc tbo ny. Interleukin 2, 4, 5 kch thchtng sinh, tng trng tbo lympho T gy c t
bo v lympho bo T trn p. Cc interleukin, c bit l interleukin 4,5, 6 kch thch rt mnhtbo lympho B v lm tng cng chc nng min dch dchth. Ngoi ra, interleukin 2 cn cvai tr iu ho ngc dng tnh i vi tbolympho T htrlm cho p ng min dchmnh ln gp bi.Lympho bo T gy c tbo ckhnng tn cng trc tip cc tbo, c khnng git cht vi
khun, i khi git cchnh bn thn c thmnh. Do c ngi gi n l tbo gittnhin(Native Kill cell, thng vit tt l NK). Cc receptor trn bmt tbogit c khnng gncht vo vi khun hoc tbo c cha cc khng nguyn c hiu. Tbogit gii phng
perforin (bn cht l mt protein) to ra nhiu ltrn mng tbo btn cng.Qua lny,cc cht gy c tbo c bm ttbo git sang tbo btn cng, lm cho tbobgit
tan ra. Tbo git c thgit lin tip nhiu tbo khc m vn c khnng tn tihngthng. Tbo git c tc dng c bit ln cc tbo c cha virus, v tnh khngnguyn cavirus trong tbo rt hp dn tbo git. Tbo git cng c vai tr quantrng trong sph
hutbo ung th, nht l tbo cc m ghp.Lympho bo T trn p c khnng trn ptbo lympho T htrv tbo lympho T gy ctbo. Chc nng ny l iu ho hot ngca tbo, duy tr sp ng min dch khngqu mc, v p ng min dch qu mc sgy tchi cho c th. V vy tbo lympho T trnp v tbo lympho T htrc gi l tbolympho iu ho. C chiu ho ca tbo
lympho T trn p i vi tbo lympho T htrl c chiu ho ngc m tnh.Lympho boT trn p cng c khnng c chtc dng ca hthng min dch tn cng votbo cc mc th(hin tng dung np min dch).
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8.CHNG NG MU1. Cc yu ttrn bmt ni mc. - Strn nhn ca ni mc ngn cnshot ho do tip xc
bmt ca hthng gy ng mu.- Lp glycocalyx (bn cht lmucopolysaccarid) hp phtrn bmt ni mc, c tc dng ytiu cu v cc yu tgyng mu cho nn ngn cn c shot ho hthng gy ng
mu.
- Thrombomodulin l mt protein ca ni mc c khnng gn vi thrombin lmbt hot
thrombin. Ngoi ra phc hp thrombomodulin-thrombin cn c tc dng hotho protein Cca huyt tng, m protein C hot ho sngn cn tc dng ca yutVav yu tVIIIa.2. Cc yu ttrong huyt tng.- Antithrombin.
Sau khi cc mu ng c hnh thnh i bphn thrombin c hp phtrn bmtsifibrin (fibrin c gi l antithrombin I). Phn cn li ca thrombin c kthp vi
antithrombin III lm cho thrombin mt hot tnh sau 12-20 pht. Tcdng trn y lm gii hncc mu ng trnh cho sng mu lan rng. Ngoi ra cn cantithrombin IV c tc dngphn huthrombin, antithrombin V hn chtc dngca thrombin trn fibrinogen.- Heparin.
Heparin (cn c gi l antithrombin II) l mt cht c hiu quchng ng rtmnh v n c
nhiu c chrt phc tp va ngn cn shnh thnh thrombin va gy bt hotthrombin.Heparin l mt polysaccarid kt hp tch in m kh mnh, bn thn nhu nh khng c tc
dng chng ng mu. Nhng khi n kt hp antithrombin III to nn phc hpheparin-antithrombin III th li c tc dng chng thrombin v cng mnh,mnh hn hng trm, hngnghn ln antithrombin III. Do chcn sc mt caheparin th thrombin bbt hot ngayv ng mu khng xy ra. Phc hpheparin-antithrombin III cn lm bt hot cc yu tIX, X,XI v XII cho nncng chng c sng mu.Heparin do rt nhiu tbo ca c thsn xut, c bit l dngbo khu tr cc m lin kt
quanh mao mch c th. Chng tp trung vi mt cao quanh mao mch gan vphi. Bnhthng dng bo bi tit mt lng nhheparin v heparin ny c khuch tnvo htunhon cng vi mt lng nhheparin ca bch cu ht a base thng xuynchng c
cc mu ng hnh thnh mao mch (c bit l mao tnh mch). V vy heparin cdnglm thuc bo vchng ng mu trong lm sng.
- a2-macroglobulin.
a2-macroglobulin c trng lng phn t360.000, n c khnng kt hp vi ccyu tgyng mu v lm bt hot chng, nhng tc dng chng ng mu ca n yu hn rtnhiu
ln so vi heparin.
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- Coumarin.
Coumarin l cht a tngoi vo c thlm gim stng hp ca cc yu tII, VII,IX v X,
do ngn cn c sng mu trong c th. Coumarin l cht cnh tranh vivitamin K, mvitamin K l cht rt cn thit cho qu trnh tng hp cc yutII, VII, IX v X. Vitamin K l loi
vitamin tan trong du dng iu trthi gian ng mu ko di do thiuvitamin K.3. Chng ng mu ngoi c th.- ng hoc bnh cha mu c trngsilicon, ngn cn shot ha do tip xc bmt ca yu
tXII v tiu cu, v vy mu khng ng.- Heparin c sdng trong v ngoi cthu cho hiu quchng ngmu rt cao.- Cc cht lm gim ion Ca++nhkalioxalat, amonioxalat, natricitrat do to ra calcioxalat,
calcicitrat nn c tc dng chng ng mu rt tt.- Mui trung tnh nhnatriclorua vi nng cao cng lm bt hot thrombin nn chng cng mu.- Boqun mu nhit thp (40C-60C) lm ngng hot ng cc enym gy ng mu nnmu cngkhng ng.
9.HUYT TNGHuyt tng l phn lng ca mu, chim 55-56% thtch mu tonphn. Huyt tng l dchtrong, hi vng, sau khi n c mu sa, vhi mn v c mic bit ca cc acid bo.
Huyt tng cha 92% l nc, cn li l cc cht hu c v cc cht v c. Huyttng blymt fibrinogen th gi l
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