Fisiologi

Sirkulasi

Menjaga homeostasis

Fungsi a.l:

Memenuhi kebutuhan sel

Mengangkut metabolit
Kekebalan
dll

Prof. Dr. Howard D. Booth

Jenis & karakteristik PD

cont...

DINDING PEMBULUH DARAH

Dari luar ke dalam:

Tunika eksterna / adventisia jar
ikat
Tunika media otot polos dan
saraf
Tunika interna / intima jar
endotel
4

JENIS & KARAKTERISTIK PD

Arteri

aliran darah dari jantung

Biasanya kaya O2

Dinding > tebal, kuat & elastik

menghantarkan darah ke kapiler

sphincter +
Katup hanya di tempat keluar dari
jantung
Ada tempat utk memeriksa palpasi
denyut jantung denyut nadi
5

JENIS & KARAKTERIST

Capillaries

PD

CON

tempat pertukaran dgn sel

Terdiri dari selapis endotel;
0,008 mm
Fungsi, a.l:
Penghub arteri & vena

Pertukaran metabolit, gas

Menyerap nutrien di usus

Menyaring darah

Membawa hasil kelenjar mis:

hormon

dll

Jenis & karakteristik PD

cont...

Vena

aliran darah mnj jantung

Biasanya miskin O2
Byk katup (valve)
Dinding > tipis

VELOCITY

10

11

12

Aliran Darah

SIRKULASI
SIRKULASI
SIRKULASI
SIRKULASI
SIRKULASI
DLL

SISTEMIK
PARU
OTAK
SPLANCNICH
KORONER

13

SIRKULASI SPLANCNICH

14

PEMBULUH LIMFE

Muara akhir saluran / pembuluh limfe

ada di pembuluh darah yaitu vena
subklavia

Fungsi a.l:
Membantu aliran darah
Membantu aliran balik pembuluh
darah dari cairan intersitial
Tempat absorpsi lemak (misal
khilomikron)

15

16

REGULASI
Hormon
a.l adrenalin
Saraf
saraf otonom
simpatis & parasimpatis

17

PENGUKURAN

Tekanan darah normal ???

Pulse pressure

Mean arterial pressure

18

The BLOOD

POKOK BAHASAN: DARAH

Fungsi darah
komposisi darah
Plasma darah
Sel darah

eritrosit
leukosit
trombosit

golongan darah
hemostasis

THE BLOOD FUNCTIONS

transports materials
oxygen and carbon dioxide
food molecules
ions
wastes (e.g., urea)
hormones
heat
defense of the body against
infections and other foreign materials

Guyton, 2006 (p. 292)

PLASMA

roles in
homeostasis
==> such as
maintaining:

normal plasma pH
osmolality

composed:

mostly of water
proteins, lipids (fats)
carbohydrates
amino acids
vitamins
minerals
hormones
wastes
cofactors
gases
electrolytes

RED BLOOD CELLS

(ERYTHROCYTES)

hemoglobin (which carries oxygen)

The other functions:

they contain a large quantity of carbonic

anhydrase, an enzyme that catalyzes
CO2 + H2O H2CO3

acid-base buffer

MORPHOLOGY

Shape & Size of RBC are biconcave

discs having a mean diameter of
about 7.8 & thickness of 1-2.5

Volume of RBC is 90 to 953

Shapes of RBC can change
remarkably as the cells squeeze
through capillaries

CONCENTRATION OF RBC

Persons living at high altitudes have

greater numbers of RBC

PLASMA (55-58%)
91% - Air
7% - Protein Plasma
2% - Nutrisi (AA, glukosa, lemak), hormon,
elektrolit
KOMPONEN SELULAR (42-45%)
Buffy Coat : sel darah putih ( 7000
9000/mm3 )
platelet ( 250.000/mm3 )
SEL DARAH MERAH ( 5.600.000/mm3 )

Figure 16-2: The blood count

PRODUCTION OF RBC

HEMATOPOIESIS

stem cell s.d reticulocyte butuh: 1 week

reticulocyte s.d erythrocyte: 24 to 48 hours

BAHAN BAKU ERITROSIT

a.l:
protein
vitamin B12
asam folat
besi

ERITROPOIETIN (EPO)

= faktor utama perangsang

produksi eritrosit
jika terjadi hipoksia (utama)
produksi eritropoietin mencapai
optimal dlm 24 jam
Dibentuk di ginjal (mesangial cell di
juxta medulary app. & di epitel
tubulus ; 90%), 10% di hepar

Life Span of Erythrocytes ==> 120

days

BESI (FE)

Jml total besi dalam tubuh 4-5 gram

65% mbtk Hb,
15-30% dlm btk feritin di sistem retikulosit &
sel parenkim hepar

4% mbtk mioglobin,
1% senyawa heme yg oksidasi intraseluler
0,1% di plasma darah/ transferin

Kehilangan besi:

1 mg/ hari, terutama dlm feses

saat menstruasi 2 mg/ hari

DISEASE

Anemia (kekurangan eritrosit/ Hb)

Perdarahan akut; kronik

Umur pendek: hemolytic anemia
Produksi terganggu;
pabrik rusak; bahan kurang

Polisitemia (eritrosit berlebih (> 6 juta/

mm3)

Relatif : dehidrasi
Absolut:
Sekunder
Vera (eritrema)

anemia
Viskositas
Tahanan vaskuler
Vasodilatasi

Aliran darah &

Venous return

Cardiac out put

(beban jtg )
Dpt tjd
Gagal jtg

Polisitemia
Viskositas

Volume darah

Aliran darah

Venous return

Venous return

Cardiac output
(tapi tdk berlebihan)

BLOOD TYPES
ABO

according to
antigens on red
blood cells
Type A: A antigens
Type B: B antigens
Type O: no antigens
(universal donor)
Type AB: A and B
antigens (universal
recipient)

Rhesus

5 main Rhesus antigens

(C, c, D, E and e)
a. Rh factor positive: D
antigen is present
b. Rh factor negative: D
antigen is not present

antibodies are developed

against the Rh factor
==> through placental
sensitization or translation

Population
Rh(D) Neg
European Basque
Caucasian
American Blacks
Native Americans
African descent
Asian

35%
16%
approx 7%
approx 1%
less 1%
less 1%
approx

Rh(D) Pos
65%
84%
93%
99%
over 99%
over 99%

WHAT ARE BLOOD TYPES?

Karl Landsteiner in the early 1900s. There are four

types of blood in the ABO system: A, B, AB, O.

BLOOD TRANSFUSIONS
whole blood

fractionated into components,

including:
RBCs
platelets
plasma

LEUKOSIT

Jumlah : 9000
sel / mm3 darah (
liter)

MACAM
1. Neutrophil 50 - 70
%
2. Eosinophil 2 - 4 %
3. Basophil 0,5 - 1 %

1-3 kelompok granulosit

4. Limfosit 20 - 40 %
5. Monosit 3 - 8 %
6. Plasma cells

4 & 5 kelompok nongranulosit

48

FUNGSI
Neutrofil :
fagositosis bakteri & benda asing
Eosinofil :
menanggulangi inf.parasit terlibat dlm proses
radang
pd kead. : alergi
Basofil :
produksi histamin, bradikinin, serotonin,
heparin
Limfosit

sistem imun adaptive

49

Marginasi
Diapedesis
Ameboid
motion

Vasa

Sel rusak
Chemotaksis

Endotel

50

MAKROFAG

Ukuran dan daya kerja : 4 5 kali

monosit
Mampu bertahan 3 bulan di jaringan
Banyak ditemukan di jaringan,misal:
mulut tonsil
kulit histiosit
usus
alveoli
otak mikroglia
hepar sel kupfer
51

Monosit

Netrofil
Langsung dewasa

Merupakan sel muda

Mampu bekerja aktif

membesar sd 5x

Masuk jaringan

memperbanyak
mitokondria & lisosom

Makrofag
(di jaringan)

Fagositosis
52

53

RESPON LEUKOSIT TERHADAP

KERADANGAN
1st line defense (satu jam pertama) :
makrofag jaringan
2nd line defense :
netrofil

produk radang dari daerah inflamasi

1. Dibawa ke pembuluh darah netrofil

marginasi,

diapedesis & kemotaksis

2. Mengirim sinyal ke sutul mobilisasi

leukosit

leukositosis/neutrofilia
54

3rd line defense :

Monosit makrofag
Butuh waktu
4th line defense :

memicu stem cell (di bone marrow)

meningkatkan

pembentukan lekosit baru

granulosit, monosit dan limfosit

55

Platelet /
Trombosit

the megakaryocytes fragment

1 to 4 micrometers; nuclei - & reproduction normal = 150,000 - 300,000 per microliter
lifespan: 15 to 45 days in the circulation
Production: in the bone marrow from
megakaryocytes

DEFINITION & MECHANISMS

Hemostasis : mencegah kehilangan
darah (saat pemb darah ruptur
Mechanisms in hemostasis:

(1) vascular constriction

(2) formation of a platelet plug
(3) formation of a blood clot as a result of
blood coagulation
(4) growth of fibrous tissue to close the hole
in the vessel permanently

fase 1-2: hemostasis primer

fase 3: hemostasis sekunder (terbentuk
fibrin)

PLATELET PLUG FORMATION

If the cut in the blood vessel ==>

sealed by a platelet plug

BLOOD
CLOT
COAGULATI
ON
CASCADE

BLOOD COAGULATION

MAJOR CAUSES OF EXCESSIVE

BLEEDING
(a) Platelet Deficiency
(i) quantitative
(thrombocytopenias)
(ii) qualitative (von Willebrands
disease)
(b) Clotting Factor Deficiency
(i) single, i.e. hemophilia
(ii) multiple, i.e. Vit. K deficiency
(c) Fibrinolytic hyperactivity

Hemophilia A and B
Hemophilia A
Coagulation factor deficiency
Inheritance

Factor VIII

Factor IX

X-linked

X-linked
recessive

Incidence
Severity

Complications

Hemophilia B

1/10,000 males

recessive
1/50,000 males

Related to factor level

<1% - Severe - spontaneous bleeding
1-5% - Moderate - bleeding with mild injury
5-25% - Mild - bleeding with surgery or trauma
Soft tissue bleeding

mAtUrnUwUn

LILIK HERAWATI, dr., MKes, AIFO