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SINH L MU
Mu l mt loi m lin kt c bit gm hai thnh phn l huyt tng
v huyt cu. Huyt tng l thnh phn ca dch ngoi bo nm trong lng
mch (xem chng 2). Huyt cu l cc t bo mu c sn sinh t t bo
m trong ty xng. Qu trnh ny bt u t t bo gc vn nng, bit ha
thnh cc cc dng hng cu, bch cu v tiu cu. Mu c cc chc nng
chnh l h hp, dinh dng, o thi, bo v v iu ha hot ng c th.
nhiu tc nhn oxy ho khc nhau, ion Fe++ tr thnh Fe+++, khi Hb s
chuyn thnh metHb khng c kh nng vn chuyn O2 na. MetHb c mu
sm v cht ny c nhiu trong tun hon s gy ra triu chng xanh tm
(cyanosis).
+ Kh CO (oxide carbon), mt sn phm ca s chy khng hon ton
carbon, c trong khi ca nhng v chy n, cc ng c n, than t... c i
lc rt mnh vi hemoglobin (gp 250-350 ln so vi oxy), rt d kt hp vi
hemoglobin trong mu thnh HbCO (carboxyhemoglobin) gy nn hi
chng thiu oxy mu, mu c mu o anh o. Tuy theo nng kh CO
trong khng kh m nng HbCO c hnh thnh trong mu s tng cao v
cc triu chng nhim c s nng dn ln.
3.1.2. Hemoglobin vn chuyn CO2 t m v phi
Mt phn nho, khong 20% CO2 trong mu c kt hp Hb to
carbaminhemoglobin. CO2 kt hp vo Hb qua cc nhm amin (NH 2) ca
globin. y l phn ng thun nghch cn goi l phn ng carbamin.
Hb + CO2 HbCO2
(R NH2 + CO2 R NH COOH)
Phn ng thun nghch ny xy ra theo chiu no tuy thuc vo phn
p CO2. cc m, phn p CO2 cao, phn ng xy ra theo chiu thun.
Ngc li, phi phn p CO 2 thp, HbCO2 s phn ly v CO2 c thi ra
khoi c th qua cc ng tc h hp.
3.2. Chc nng min dch hng cu
Hng cu c vai tr min dch do:
- Gi ly cc phc hp khng nguyn - khng th - b th to thun li
cho qu trnh thc bo.
- Cc khng nguyn mng hng cu l c trng ca cc nhm mu.
3.3. Chc nng iu ha thng bng toan kim
Hb trong hng cu l mt h thng m quan trong. Ngoi ra, hng cu
cn to ra HCO3- trong qu trnh v n chuyn CO2, do v y gp phn to ra
h m bicarbonat.
3.4. Chc nng to p sut keo
Nhng thnh phn cu to ca hng cu ch yu l protein nn gp
phn to p sut keo ca mu.
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4. NHM MU
4.1. nh ngha
Nm 1900, Landsteiner nhn thy c s ngng kt hng cu khi trn
mu ca cc c th trong cung mt loi vi nhau. T ng pht hin ra
c khng nguyn trn mng hng cu v khng th trong huyt thanh v ng
phn loi nhm hng cu trn ngi. Trong y hoc, ngi thng goi nhm
hng cu l nhm mu.
Nh vy, nhm mu l khng nguyn nm trn mng hng cu. Cc
loi mu c phn nhm da theo s hin din ca cc khng nguyn .
Cc khng nguyn thng c bn cht l glycoprotein.
Cc khng th nhm mu c th l khng th t nhin (IgM) nhng
cng c th l khng th min dch (IgG). Cc khng th min dch khc vi
khng th t nhin ch chi hnh thnh khi c tip xc vi khng nguyn; c
kh nng khuch tn mnh, qua c mng nhau thai nn c th t m sang
thai nhi; c hot tnh mnh 37oC vi cng , hiu gi v nhy cao hn
khng th t nhin, nu b kch thch lp li (tip xc khng nguyn) th hot
tnh s cng cao, nhng nu khng lp li th s gim dn n mt hn.
4.2. Phn loi nhm mu
Sau ny, ngoi nhng khng nguyn m Landsteiner tm ra, ngi ta
cn tm thy nhiu khng nguyn khc c trn mng hng cu v t phn
ra nhiu h thng nhm mu: ABO, Rh, MNSs, Kell, Kidd, Duffy, Lewis
Trong , hai h thng nhm mu c nhiu ng dng trn lm sng l ABO
v Rh.
4.2.1. Cc nhm mu h ABO
* Cc khng nguyn ca nhm mu h ABO:
Cc khng nguyn nhm hng cu h ABO l cc cht
mucopolysaccharid gm khng nguyn A v B. Cc khng nguyn ny l s
th hin ca cc gen A v B trn b mt hng cu. Khng nguyn A v B c
th pht hin c t lc bo thai 5-6 tun. Trong sut thi k bo thai lng
khng nguyn tng khng ng k. Sau khi sinh, lng khng nguyn tng
dn v t n mc n nh sau 2-4 nm v tn ti hng nh sut i.
Da vo s c mt hay khng c mt ca cc khng nguyn A v B trn
mng hng cu, Landsteiner phn loi thnh 4 nhm mu: A, B, AB v O
(bng 4.1). ngi Vi t Nam, khong 48% l nhm mu O, 28% nhm mu
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ABo
B
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- Dng lympho: cc t bo tin thn dng lympho pht trin thnh hai
dng l bch cu lympho T v bch cu lympho B. Hu ht bch cu lympho
ri khoi ty xng trc khi chn. Bch cu lympho T trng thnh trong
tuyn c, trong khi bch cu lympho B pht trin v trng thnh trong cc
m bch huyt rut, lch v ty xng.
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cu tng trong cc bnh nhim khun cp tnh v c bit tng cao trong bnh
bch cu cp hoc mn tnh. S lng bch cu gim trong nhim c, nhim
x, trong bnh suy ty.
i sng bch cu thay i theo tng loi. i vi bch cu ht, sau
khi c phng thch t ty xng s lu hnh trong mu trong 4-8 gi, sau
di chuyn vo trong m v tn ti thm khong 4-5 ngy. Nu m b nhim
khun, bch cu ht s c huy ng n thc hin chc nng v t tiu hy
sau th i sng c th ngn hn, thm ch chi cn vi gi. Bch cu mono
cng c thi gian lu hnh trong mu ngoi vi ngn khong 10-20 gi, trc
khi i xuyn mao mch vo m. Sau khi vo m, bch cu mono pht trin
thnh i thc bo trong m, c th sng nhiu thng, nhiu nm cho n khi
t tiu hy trong qu trnh thc bo. T bo lympho t cc hch bch huyt v
cc m lymphoid xm nhp vo h tun hon, sau vi gi chng vo m, ti
xm nhp bch huyt ri tr vo mu, v c nh th t bo lympho lin tc
tun hon i khp c th. i sng ca bch cu lympho thay i t nhiu
tun n nhiu thng tuy thuc vo nhu cu ca c th i vi t bo ny.
2.2. Hnh dng bch cu
Cn c vo hnh dng, kch thc trung bnh, s bt mu khc nhau ca
nhn v cc loi ht trong bo tng khi nhu m giemsa nhn dng cc loi
bch cu.
- Ba loi bch cu c ht khi nhum: kch thc khong 10-15m
+ Bch cu ht trung tnh (Neutrophil): nhn cha chia mi hoc chia
nhiu mi mu tm en. Bch cu cng gi, nhn cng nhiu mi. Bo tng
c nhiu ht rt nho, mn u nhau, bt mu hng tm. Hu ht cc ht ny l
cc tiu th cha enzym thu phn. Ngoi ra cn cc ht cha cc cht oxy
ho mnh c tc dng tiu dit vi khun.
+ Bch cu ht a acid (Eosinophil): nhn thng chia hai mi nh
hnh mt knh mu tm. Bo tng c nhng ht to, trn u nhau bt mu o
cam. Cc ht ny c cha nhiu enzym peroxidase v phosphatase acid.
+ Bch cu ht a kim (Basophil): nhn thng c gii hn khng r,
i khi cho ta hnh nh nh t bo b v nt hay hnh hoa th mu tm en.
Bo tng c nhng ht to nho khng u nhau nm c ln nhn, bt mu
xanh en. Cc ht ny c cha nhiu heparin, histamin v m t lng nho
bradykinin, serotonin.
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SINH L TIU CU V CM MU
Mc tiu:
1. M t c qu trnh sn sinh, phn b, hnh dng v cu trc ca tiu cu.
2. Xc nh c s lng tiu cu ngi Vit Nam bnh thng.
3. Trnh by c cc c tnh v chc nng ca tiu cu.
4. Phn tch c c ch cm mu.
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- Hin tng hot ha tiu cu: hin tng kt dnh lm cho tiu cu
c hot ha v phng xut cc cht trong tiu cu nh ADP, thromboxan A2
v serotonin. Cc phn t ny s khuch i s hot ha.
- Hin tng ngng tp tiu cu: khi c hot ha tiu cu s bc l
phc h GPIIb/IIIa, phc h ny s gn kt vi fibrinogen. Nh c cu trc
nh mt phn t kp nn fibrinogen tr thnh cu ni gia hai tiu cu.
- Hin tng co cc mu: cc tiu cu lc u mong manh, d b dng
mu chy cun tri, sau s tr nn chc chn nh hin tng co cc mu
thng qua hot ng ca h thng vi ng vung sol-gel ca tiu cu.
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Yu t II: prothrombin
Yu t III: thromboplastin hay yu t t chc (TF)
Yu t IV: Ca++
Yu t V: proaccelerin
Yu t VII: proconvertin
Yu t VIII: yu t chng hemophilia A
Yu t IX: yu t chng hemophilia B
Yu t X: yu t Stuart
Yu t XI: yu t Rosenthal
Yu t XII: yu t Hageman
Yu t XIII: yu t n nh fibrin
Yu t Fletcher: prekallikrein
Yu t Fitzgerald: kininogen trong lng phn t cao (HMWK)
Cc yu t ng mu c th c chia thnh cc nhm sau:
+ Nhm cc yu t tip xc hay ng chm: gm cc yu t XI, XII,
prekallikrein, kininogen tham gia vo giai on u ng mu n i sinh (giai
on tip xc). Chng c c tnh khng ph thuc vo vitamin K khi tng
hp, khng ph thuc vo Ca++ trong qu trnh hot ha, n nh tt trong
huyt tng lu tr v l nhng yu t bn vng.
+ Nhm prothrombin: gm cc yu t II, VII, IX, X. Chng c c tnh
ph thuc vo vitamin K khi tng hp, cn c Ca ++ trong qu trnh hot ha,
n nh trong huyt tng lu tr v khng b tiu th trong qu trnh ng
mu tr yu t II (c mt trong huyt thanh).
+ Nhm fibrinogen: gm cc yu t I, V, VIII, XIII. Chng c c tnh
tc dng qua li vi thrombin, b tiu th trong qu trnh ng mu (khng c
mt trong huyt thanh), yu t V v VIII mt hot tnh trong huyt tng lu
tr.
+ Yu t t chc (III): y l yu t duy nht khng phi ca huyt
tng m nm trong m (lp di nim mc mch mu) v cng khng c
hot tnh men m tc ng nh mt ng yu t trong hot ha yu t VII, X.
+ Ca++ (IV): y l yu t ion, to thun li cho cc protein ph thuc
vitamin K kt hp vi phospholipid mng ng thi cng can thip vo cc
phn ng khng lin quan n cc protein ph thuc vitamin K. Ca ++ cng
cn thit cho s th hin hot tnh men ca yu t XIIIa, cho s n nh yu
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mu:
- Thnh lp fibrin: thrombin co vai tr chuyn fibrinogen thnh fibrin,
ng thi hot ha yu t XIII n nh si huyt.
- Lm tng tc hnh thnh ca bn thn (t khuch i): thrombin
gy hot ha yu t VIII dn n gia tng s hnh thnh yu t Xa bng c hai
con ng ni sinh v ngoi sinh. N cng hot ha yu t V.
* Giai on 3: thanh lp fibrin
Thrombin thy phn phn t fibrinogen to thnh cc monomer ca
fibrin v cc fibrinopeptid (A v B). Cc monomer ca fibrin t trung hp to
thnh phn t fibrin S (fibrin ha tan). Cui cung, yu t XIII hot ho s
polymer ha cc fibrin S thnh fibrin I n nh (fibrin khng ha tan) hay cn
goi l si huyt. Cc si huyt giam gi hng cu bn trong to thnh cc
mu ng.
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a. Neutrophil
b. Basophil.
c. Eosinophil.
d. Monocyte.
12. Cc t bo sau y c lin
quan n tnh trng d ng:
a. Neutrophil v eosinophil.
b. Neutrophil v basophil.
c. Eosinophil v basophil.
d. Basophil v monocyte.
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