Human Physiology - 혈액생리 (Blood) - 생리학교실이광이메일 : glee@ajou.ac.kr. 내선 : 4554 실험실 : 송재관 607 호
I. 혈액의기능과조성 A. 혈액의기능 1. 운반작용 : CO 2, O 2, urea, nutrients, antibody, hormones 2. 조절작용 : 혈당량, 체온, 삼투압, ph 유지 ( 생체의항상성유지 ) 3. 방어작용 : 식균작용, 혈액응고 * Self-preserve activity B. 혈액의조성 1. 세포성분 (cellular component; 45%) 1) 적혈구 (4.2-6.2 X 10 6 / mm 3 ) 2) 백혈구 ( 과립구 (granulocytes), 무과립구 (agranulocyte); 5,000-10,000/mm 3 ) 염기성구 (basophils) 0-7.5 % 산성구 (eosinophils) 1-3 % 중성구 (neutrophils ) 57-67 % 림프구 (lymphocytes) 25-33 % 단핵구 (monocytes ) 3-7 % 3) 혈소판 (platelet, thrombocytes; 140,000-340,000/mm 3 ) 2. 혈장성분 (plasma component, 55%) 3. 물리적특성 Hematocrit (Hct) : 전체혈액에대한적혈구의용적비율 Specific gravity (SG) : 1.00-1.06 Viscosity : ca. 5.00 (cf. pure water : 1.00) Erythrocyte Sedimentation Rate (ESR) : 2-10 mm/h
혈액의구성성분 Blood is a circulating tissue consisting of three types of cells. - Red Blood Cells (Erythrocytes) - White Blood Cells (Leukocytes) - Platelets (Thrombocytes)
혈액의구성성분
혈액세포들과혈소판
Blood is red because it contains hemoglobin and iron rich pigment Plasma Plasma is the relatively clear liquid water, sugar, fat, protein and salt solution Normally, 55% of our blood's volume is made up of plasma About 95% of it consists of water Helps to regulate body temperature Plasma transports blood cells, products of digestion and hormones throughout the body
Hematocrit: 적혈구용적률 polycythemia, 赤血球增加症
Rouleaux : 連錢狀 Red cell rouleaux are formed as shear rates are reduced and RBCs aggregate. They become jammed at the capillary entrance slowly break apart with time 진단 : 골수종, 마이크로글로부린혈증등
II. 혈구의생성과기능 A. 혈구의생성 1. 혈구세포의생성 1) 태아시혈액생성 (intrauterine blood formation) - 거적아세포기 {megaloblastic phase (yolk sac)}: 수정후 2개월까지난황에서거대적혈구를형성 - 간기 ( hepatic phase): 그다음 4개월까지간, 비장, 흉선, 임파절등에서혈액세포생성 - 골수기 ( myeloid phase): 출생때가지골수에서혈액세포생성 2) 출생후혈액생성 (extrauterine blood formation) - 골수성조직 (myeloid tissue) : bone marrow - 골수외혈구생성 (extramedullary hematopoiesis) : 간, 비장, 림프조직 3) 혈구의분화및증식 - Hematopoiesis; erythropoiesis, leucopoiesis, thrombocytopoiesis - Proliferation and differentiation from pluripotent, uncommitted stem cell - committed stem cell (hemocytoblast, 혈구모 ( 아 ) 세포 ) proerythroblast ( 前赤母球 ) normoblast ( 正赤母球 ) reticulocyte ( 網狀赤血球 ) erythrocyte
megaloblastic phase, hepatic phase, myeloid phase
Hematopoiesis
Consisting mainly hematopoietic tissue Consisting mainly of fat cells The fatty degeneration of red bone marrow (RBM) (25%) into yellow bone marrow (YBM) (75%) is completed around age 21 years.
B. 적혈구 1. 적혈구의특성 1) 형태적특성 - biconcave disc: 직경 Ca. 8μm, 두께 1-2 μm - 표면적 / 체적비율이높다 : 세포내외로의물질확산이용이 - 세포의유연성이크다 : 변형능 (deformability) - 세포막의긴장도가낮다 : 세포용적의변화에손쉽게대응 2) 구조적특성 - 진정한의미의세포가아님 - cytoskeleton : homogenous matrix and loosely arranged meshwork of fibrous and globular proteins 3) 유전적결함 : hereditary spherocytosis ( 구상적혈구증 ), hereditary elliptocytosis ( 타원적혈구증 ) * Price-Jones curve : normal distribution of RBC size
Erythrocyte Deformability
pernicious anemia, 惡性貧血
2. 혈색소 (hemoglobin) - hemoglobin : 200-300 million molecules/rbc (34% of RBC), 분자식, C 3032 H 4816 O 872 N 780 S 8 Fe 4 1) 기능 (1) 산소운반 (2) ph 변화에대한화학적인완충제 2) 구조 - 두쌍의 polypeptide 사슬 (α,β,γ,δ) 로구성된 tetramer : 각각 heme group 과공유결합 3) 산소운반능력 ; 약 20 ml of oxygen/dl - 혈중에서운반되는산소의약 98 % 는 oxyhemoglobin 의형태 - 1 gram 의 hemoglobin 은 1.34 ml 의산소와결합 4) 함량 ; 15 grams of hemoglobin/100 ml whole blood - 정상치 : 성인여성 : 14.0 20.0 g/dl; 성인남성 : 16.0 20.0 g/dl
5) hemoglobin 의종류 (1) 정상 hemoglobin; 2 types; globin 구조에차이 - Type A - Type A 1 (96%), Type A 2 (2%) - Type F (2%) (2) peptide 사슬의조성 - type A 1 : 2 α-chains, 2 β-chains - type A 2 : 2 α-chains, 2 δ-chains - type F : 2 α-chains, 2 γ-chains (3) Hemoglobin F; 태아혈액중의주성분 - O 2 에대한친화력이크다. - 출생직후 hemoglobin A 로대체 (6 개월후완전히대체 )
Respiratory Function of Hemoglobin (lungs) - Deoxyhemoglobin + O2 Oxyhemoglobin (tissues) - Hemoglobin: transport O 2 and CO 2 cooperativity in the binding of oxygen sigmoid shape of oxygen dissociation curve 산화헤모글로빈해리곡선 산소의하역량 (unloading) - ph - 온도 - 2,3-BPG (2,3-biphosphoglyceric acid) 혈액이조직을통과하여동맥에서정맥으로이동 - 산화헤모글로빈의백분율이 22% 감소하여 100 ml 의혈액당 5mL 미만의산소가조직으로하역됨
ph 가산화헤모글로빈해리곡선에미치는영향 보어효과 (Bohr effect): 낮은 ph 에서헤모글로빈의산소친화도가떨어지는현상
2,3-BPG 에의해산소의하역증가 1,3-Biphosphoglycerite(BPG) 를 2,3-BPG 로변환 산소에대한 hemoglobin 의친화력감소
이산화탄소의수송과염소이동 carbaminohemoglobin
6) Hemoglobinopathies (1) 비정상적인 hemoglobin 의합성겸형 ( 鎌形 ) 적혈구 : β-chain 아미노산이상 (glutamine 6 valine) sickle cell hemoglobin (type S): deoxygenation of hemoglobin S sickle shape(reversible) sickle cell anemia Malaria Disease that attacks the RBC, if you have sickle cell shaped RBC can not get the disease.
(2) α- or β-globin chain 합성부전 (Thalassaemia) α-thalassaemia : fatal, 동남아시아 β-thalassaemia : 지중해성빈혈 (mediterranean anemia)
Carbon Monoxide 일산화탄소 (Carbon monoxide, CO) - colorless - odorless - tasteless gas that is slightly less dense than air - Hemoglobin binds with CO 200 250 times more readily than with oxygen
7) 혈색소의대사 - Hemoglobin : Heme + globin; Heme biliverdin bilirubin conjugated bilirubin mesobilirubinogen ( 장내세균에의함 ) urobilinogen, stercobilinogen 으로배설되거나재흡수 - Hyperbilirubinemia : 혈중 bilirubin 농도 2 mg/100 ml 이상 황달 (jaundice, icterus)
3. 적혈구의생성 (Erythropoiesis) - 약 230 billion RBC/ 일생성 ( 약 3 10 9 RBC s/kg/day) - 120 days 생존, 비장, 간, 골수의 macrophages에의해제거 1) 분화 (differentiation) Uncommitted stem cell (pluripotent stem cell) Committed stem cell Reticulocytes ( 망상적혈구 ): 혈행중 1.5일이내에 RBC로성숙 (maturation), 통상, RBC 의 1% 에해당 index of erythropoietic activity stains (new methylene blue) 2) Erythropoiesis 조절물질 ribosomal RNA (1) 철 - 영양요구량 성인남성및비월경여성 (nonmenstruating female) : < 1 mg / 일 menstruating female : 1.5 mg/ 일 정상식이 : 10-20 mg/ 일 성장기, 임신등에의해요구량증대 - 철의흡수 : 십이지장, proximal jejunum ( 空腸 ) by phagocytosis by interaction of specific surface receptors with transferrin - 저장형 : ferritin, hemosiderin; 간및골수에각각 1/3, 나머지는비장, 근육등에저장
Erythropoiesis Stem cell Committed cell Developmental pathway Phase 1 Ribosome synthesis Phase 2 Hemoglobin accumulation Phase 3 Ejection of nucleus Hemocytoblast Proerythroblast Early erythroblast Late erythroblast Normoblast Reticulocyte Erythrocyte Day 1 Day2 Day4 Day 5-7
(2) Vitamin B 12 - 유기금속화합물 (complex organometallic compound): corrin ring에 cobalt원자함유 - 최소영양요구량 : 2.5 μg/ 일, 정상적으로간에 2 mg, 기타조직에 2 mg 저장 - 흡수과정 : 위에서 R factor (haptocorrin) 와결합 십이지장에서 R factor와분리, 내인성인자 (intrinsic factor) 와결합 vitamin B 12 -IF 복합체가 ileal receptor에결합, 흡수 혈중에서 Vitamin B 12 - Transcobalamin II 복합체형성 간, 골수등의조직에서흡수
(3) 엽산 (folic acid, pteroylmonoglutamic acid) - 최소영양요구량 : 50 μg/ 일, 임신중요구량증대, 체내에정상적으로 5 20 mg 저장 (1/2은간 ) - 혈중엽산 : 주로 N 5 -methyltetrahydrofolate의형태로존재, 특이적수송체에의해세포내로이동 세포내에서 vitamin B 12 가관여하는 N 5 -methyl group 제거반응후, polyglutamate형태로변환 DNA 생성에관여 - Metabolic function : one-carbon moieties (methyl and formyl group) 전달반응 DNA 생합성에필수적 (4) 기타 - Vitamin B 6 (pyridoxine), Vitamin B 2 (riboflavin), niacin, Vitamin C (ascorbic acid), Vitamin E (tocopherol), Cobalt, Copper, Thyroxine, Amino acids Pteroic acid
3) 적혈구생성조절 - 신장내의산소분압 : erythropoiesis 의주요조절인자 Oxygen tension renal erythropoietic factor (released by the kidney) + plasma protein from the liver erythropoietin - Erythropoietin 분자량 34KD, 신장 (80 90%) 및간 (10 20%) 에서생성 산소분압이낮은환경에서생성, hemopoietic stem cell proerythroblast 과정촉진 - 만성신장질환 erythropoietin 결핍에의한빈혈
4. 적혈구내대사 에너지대사 - 혐기적해당과정 (anaerobic glycolysis)
5. 비정상적혈구 (abnormal red cells) - Anisocytosis ( 赤血球大小不同症 ): 크기변화 ; macrocytes, microcytes - Poikilocytosis ( 奇形赤血球症 ) : 형태변화 ; spherocytes, sickle cell * Red cell indicies ( 적혈구수치 ) : 적혈구이상을판정하는지표 ( 크기, 형태, 색깔 ) 1) 평균적혈구용적 (MCV, mean corpuscular volume index) : 정상성인 87±5 m 3 2) 평균적혈구혈색소 (MCH, mean corpuscular hemoglobin) : 정상성인 29±2 pg 3) 평균적혈구혈색소농도 (MCHC, mean corpuscular hemoglobin concentration) : 정상성인 34±2% 6. 적혈구의취약성 - tonicity 와 osmolarity - 고장액 (hypertonic solution) : 적혈구의 crenation - 저장액 (hypotonic solution) : 삼투성용혈 (osmotic hemolysis) - 삼투성취약성 (osmotic fragility) : 적혈구의용혈곡선 (fragility curve), 빈혈을유발하는각종질병상태에서곡선의좌우이동관찰
In hypertonic solution In hypotonic solution
7. 빈혈 (Anemia) - 빈혈은질환의증상 (sign of disease) 이며혈액의산소운반능력저하에기인 - Hemoglobin < 12 g/dl ( 정상치 : male 16.02, female 14.02); Hematocrit < 37% ( 정상치 : male 47.05, female 42.05) - 증상 일반증상 : 호흡곤란 (shortness of breath), 빈맥 (tachycardia), 두통 (headache), 피로, 정신작업곤란, pallor of the conjunctival mucosa ( 격막성점막의창백 ), 설사, 변비 특이증상 spoon nail (koilonychia) : iron deficiency 황달 : 용혈성, 거대적혈구성 (megalobalstic) 빈혈 leg ulcer: sickle cell anemia bone deformity: thalassaemia major, 기타선천적용혈성빈혈
8. 적혈구과다증 (polycythemia) - 적혈구수 > 6 million/mm 3 ( 정상치 : 5x10 6 RBC/ mm 3 : 남 : 4.5 6.5 x10 6 /mm 3 ; 여 : 3.9 5.6 x10 6 /mm 3 ) 1) 생리적적혈구과다증 (physiologic polycythemia) (1) 상대적적혈구과다증 (relative-, stress- or pseudopolycythemia) - 혈중적혈구수의상대적증가 : 탈수, hemoconcentration ( 혈액농축 ) - 심혈관계질환 (e.g. myocardial ischemia), 이뇨제치료 (diuretic therapy), heavy smoking (2) secondary polycythemia (erythrocytosis); - 저산소증에의한 2차적인적혈구생성증가 : 만성적인저산소환경 ( 고산지대 ), 기타질환 (emphysema, pulmonary fibrosis, carbon monoxide poisoning) 2) Polycythemia vera ( 적혈구증가증 ) - a chronic, slowly progressive disease - 골수에서의혈구세포생성증가 (hyperplasia) - 원인 : 대개의경우잘모름 (idiopathic); 혈중산소부족과는관계없음, 골수, 신장, 뇌의종양? - 혈액점도증가, 심장및혈관에부담 (increased load), 혈전생성용이
C. 백혈구 - 7,000-10,000 leucocytes/ mm 3 1. 분류 1) 과립백혈구 (granulocytes ) - 다형핵백혈구 (polymorphonuclear leucocytes) : 호중구 (neutrophil), 호산구 (eosinophil), 호염기구 (basophil) 2) 무과립백혈구 (agranulocytes) - 단순한형태의핵 (simple, unlobulated nucleus, monomorphonuclear leucocyte) : 림프구 (lymphocyte), 단핵세포 (monocyte) 2. 기능 - 생체방어기능 : 해독작용 (detoxify poisons), 항체생성, 각종화학물질, 효소생성및분비 1) 식균작용 (phagocytosis) 2) 면역기능 (immunity)
백혈구의기능적성질 - 누출성 : 위족통과 (diapedisis) 에의해혈관통과 - 아메바성운동 (ameboid movement): 30~40 m/sec - 화학주성 (chemotaxis): 감염받은조직내에서생성된화학물질 (leucotaxin, necrosin, etc) 이백혈구를감염받은조직으로끌어당김 Diapedesis
3. 백혈구의특징 1) 호중구 (Neutrophil, 10-14μm) - 총백혈구의 40-75 % - 급성염증반응에관여 (act as phagocytes), myeloperoxidase 다량함유 2) 호산구 (Eosinophils, 10-12μm) - allergic disorder나기생충감염시증가 eosinophilia - 기능 : histamine 불활성화 항원-항체복합체탐식작용 fibrinolysin 분비 fibrin clot 용해 3) 호염기구 (Basophils, 8-12μm) - histamine 및 heparin 함유과립 allergy 반응및혈액응고방지계에중요한역할 4) 림프구 (Lymphocytes) - 체액성면역 (humoral immunity) 및세포성면역 (cell mediated immunity) 에중요한역할 - T-세포, B-세포 5) 단핵세포 (Monocytes, 16-20μm) - tissue macrophages: 급성염증반응, 면역반응에관여 * 망상내피조직계 (Reticuloendothelial system) : red bone marrow, 간, 비장, 림프절, loose connective tissue 등의일반명칭 : dying blood cell, platelets 파괴
4. 백혈구형성 (Leucopoiesis) - 과립구, 단구 (monocyte) : 골수에서발생, 성숙 - 림프구 : potential T-lymphocytes: 흉선, 비장에서성숙 ; potential B-lymphocytes; 소장의림프조직, 비장, 골수에서성숙 - Leucocytes-inducing factor (LIF) : granulopoiesis 촉진 - 백혈구의수명 : 호중구 : 수일 ; B-림프구, 몇몇 T-림프구 : 수년 5. 백혈구감소증 (Leucopenia) - 골수의결함 ( 세포발생, 성숙지체 ), 백혈구파괴등에기인 - 무과립세포증 (agranulocytosis) 호중구의뚜렷한감소가특징 골수억제에기인 (irradiation, cytotoxic drugs) 세균감염에대한저항성약화
6. 백혈구증가증 (Leucocytosis) - 비정상적인백혈구수의증가 : >500,000 cells/mm 3 -- leucocytosis 1) 생리적백혈구증가증 (physiological leucocytosis, 10,000-20,000/mm 3 ) - 신생아, 임신, 정서불안, 월경, 격심한운동 2) 병리적백혈구증가증 (pathological leucocytosis) - 세균, 바이러스감염, 대사및호르몬이상, allergies, 종양 3) 백혈병 (Leukemia) - 기능적으로결함이있는미성숙조혈세포의과도한증식 : malignant disease ( 악성질환 ) - 환경인자 : radiation, benzene, 유전적소인, RNA virus - 분류 : 세포또는조직의형태, 질환의이행과정및경과기간등에따라분류 (1) 급성백혈병 (acute leukemia, 87%) rapid onset, massive numbers of immature leucocytes, severe anemia 급성림프성백혈병 (acute lymphocytic leukemia, 30%) 급성골수성백혈병 (acute myelogenous leukemia, 70%) (2) 만성백혈병 (chronic leukemia, 13%) gradual onset and increased numbers of mature leucocytes, may lead to acute leukemia 빈혈, excessive bleeding(impairment of platelets), 국소또는전신감염
D. 혈소판 - 진정한세포가아님, 거대핵세포 (megakaryocyte) 유래 : 140,000-340,000/mm 3 6,000 thrombocytes/one megakaryocyte 1. 혈소판형성 (Thrombocytopoiesis) 1) 대부분의 megakaryocytes 는골수에위치 2) 일부 megakaryocyte 가타조직 ( 특히폐 ) 으로이동 혈소판형성 2. 형태적특성 1) 핵이없다 (small, membrane-bound bodies without nuclei) 2) granules, vesicles, microfilaments, microtubules, occasionally mitochondria 포함 3. 기능 1) 혈관손상시 : chemicals 유리 혈관수축 2) adhesive properties 3) 혈액응고인자생성 4. 기타 - 수명 : 약 1-2 주, 간, 비장의대식세포에의해파괴 - 비장 : 혈소판의주요저장장소, stress (hemorrhage, burns) 시 sympathetic stimulation of spleen 다량의혈소판을혈중으로방출 - Thrombocytopenia ( 혈소판감소증 ) : 혈중혈소판부족 ; 골수활성부전또는백혈병에기인 ; 과도한출혈 ( 예 ; skin, gastrointestinal tract)
Platelets form by budding off from megakaryocytes in the bone marrow Platelets: reddish or purple granules
Mesenchymal stem cells, or MSCs, are multipotent stromal cells that can differentiate into a variety of cell types, including: osteoblasts (bone cells), chondrocytes (cartilage cells),and adipocytes (fat cells)
III. 혈장 (Plasma) A. 혈장의성분 (composition of plasma) 성분분포 Water 90 % Protein 7 % Na +, K +, Cl -, HCO 3-, Ca ++ 1 % non-protein organic substances, fatty acids, glycerol 1 %
B. 단백성분 1. Albumin (MW 69,000) - 가장많은혈장단백 ( 약 40 g/l plasma), 간에서합성 - 교질삼투압형성 (colloid osmotic pressure) - 각종물질의운반체 : hormone (e.g. corticosteroids), bilirubin, fatty acids, 중금속, 약물 - ph 완충작용 (H2A HA - + H + ) 2. Globulin - 분자량이다양 - 지단백 (lipoprotein) : High-density lipoprotein, Low-density lipoprotein - 물질수송에관여 : thyroxine-binding globulin for thyroxine, transcortin for corticosteroid, transcobalamin for vitamin B 12, transferrin for iron, ceruloplasmin for copper, lipoproteins for lipid (LDL, HDL, VLDL) - 면역글로불린 (immunoglobulin); IgA, IgD, IgE, IgG, IgM - A/G 비율 (A/G ratio) : 정상치 1.0 1.5 ( 간장애 A/G 비율감소 ) 3. Fibrinogen - 간에서합성 - 혈액응고과정중불용성의 fibrin 으로변환 * 혈청 (serum) 과혈장 (plasma)
IV. 지혈 (Hemostasis) A. 지혈과정 혈관수축 (Vasoconstriction) 혈소판응집 (Platelet aggregation) 혈전형성 (Formation of blood clot) 혈전수축및용해 (Clot retraction and dissolution) 1. Vascular phase - Vascular spasm: 자율신경계 (autonomic nervous system) 및혈관수축물질 (serotonin등) 작용 2. Platelet phase : 혈소판응집에의한일시적혈소판마개형성 (platelet plug) 1) Step 1: 혈소판의혈관내부착 2) Step 2: 혈소판마개 (platelet plug) 형성 primary aggregation, secondary aggregation, release reaction 3. Coagulation phase : fibrin에의한 plug의안정화 1) Stage I: prothrombin converting factor (plasma thromboplastin) 의형성 내인성경로 (intrinsic pathway) : 모든인자가혈액내존재 외인성경로 (extrinsic pathway) : tissue thromboplastin (factor III) 가손상된조직및세포에서분비 2) Stage II: prothrombin의 thrombin으로의변환 3) Stage III: fibrinogen의 fibrin으로의변환 4. Clot retraction and dissolution (fibrinolysis, 纖維素溶解 ) Clot retraction: thrombosthenin (platelet factor) 섬유소용해 (fibrinolysis): plasmin
혈소판응축 (aggregation) 은혈전 (blood clot) 을형성 혈소판마개 (Platelet plug) ADP: Adenosine diphosphate TxA 2 : Thromboxane A 2
주요혈액응고관련인자
혈전 (Blood clot) RBC Platelet Fibrin thread XIII (Fibrin stablizing factor)
응고반응 손상된조직에서시작 콜라겐단백질에부착되어있는응고인자들의활성화로시작 X: Stuart-Power factor (serine protease) Cross-linked fibrin
Vitamin K (Factors II, VII, IX, X)
Vitamin K 2-methyl-1,4-naphtoquinone skeleton Phylloquinone Menaquinone Menadione Vit K Antagonists
B. 혈액응고이상 (Clotting disorder) 1) 혈관이상 (vascular defects) 2) 혈소판부족 (thrombocytopenia) 3) 혈소판기능부전 4) 응고인자부전 5) Inherited clotting disorder : Hemophilia ( 혈우병 ) Hemophilia A ( 응고인자 VIII 결함 ) Hemophilia B ( 응고인자 IX 결함 ) Czar Nicholas II of Russia and his family, photographed c. 1916, showing his wife Alexandra (who was a carrier of hemophilia), his four daughters, and (in the foreground) his son Alexis, perhaps the most famous European royal with hemophilia.
V. 혈액형 (Blood Type) A. ABO 식혈액형 Landsteiner (1868-1943) 응집원 (agglutinogen), 응집소 (agglutinin) Blood Types AA or AO = Type A BB or BO = Type B OO = Type O AB = Type AB GalNAc: N-acetylgalactosamine ABO 혈액형의빈도수 Phenotype Genotype Antigens Agglutinin Frequency (%) Korean American O OO O Anti-A, Anti-B 29.1 45 A AA or AO A Anti-B 32.6 41 B BB or BO B Anti-A 27.3 10 AB AB AB None 10.9 4
ABO 식혈액형 Universal Donor Universal Recipient
ABO 혈액형항체 (agglutinin) 의기원 : - 출생직후혈중에는 A 와 B 항체가존재하지않음 6 개월이내에생성 유전적으로결정?
B. Rh 혈액형 - 수혈시가장중요 (Landsteiner 1941) - 붉은털원숭이 (rhesus monkey) 적혈구의항체에대한반응성 1. Rh 인자 (Rh factor) - anti-rhesus antibodies에의해인식여부 : Rh-positive, Rh-negative - 주요 6 항원 (C,D,E,c,d,e) 한쌍으로유전 : 예 ) CDE/cDE D-antigen에따라구분 : Rh-positive (genotype DD or Dd) Blood type European Asian Black-American African Rh + 85% Rh - 15% 95% <1% 95% 5% 100% 2. 항체의생성 - 수혈및임신 ( 임신시 : 항체에의한태아적혈구파괴 erythroblastosis fetalis) 3. Erythroblastosis fetalis ( 태아적모구증, 胎兒赤母球症 ) first child; generally no harm second child : 3% sign of erythroblastosis fetalis third child : 10% sign of erythroblastosis fetalis * 핵황달 ( 核黃疸, Kernicterus) * erythrobalstosis fetalis의예방과치료 : 출산직후산모에 anti-d antibody [anti-d prophylaxis (RhoGAM)] 처리
Rh - mother w/rh - baby- no problem Rh + mother w/rh - baby no problem Rh - mother w/rh + baby problem
C. 교차시험 (cross matching) - 주교차시험 (major cross matching) : 공혈자의적혈구 + 수혈자의혈청 - 부교차시험 (minor cross matching) : 수혈자의적혈구 + 공혈자의혈청 D. 혈액형의생물학적의의 1) 면역반응 (Immunoreactions) 2) 불임및유산 (Infertility and early fetal loss) 3) 기타질환과의관련성 - Type O "nonsecretors" : type A 또는 B secretors에비해십이지장궤양발현율이 2배 - Type A : type O에비해 salivary glands, stomach, pancreas 발암율이높다 - Rh null type (Rh antigen이결핍 ): 용혈정도가높다.