Body fluids and

Circulation
Introduction

- All living cells have to be provided with nutrients, O2 and other essential substances. Also, the waste or harmful
substances produced, have to be removed continuously for healthy functioning of tissues
- Hence it is essential to have efficient mechanisms for the movement of these substances to the cells and from the
cells
- Simple organisms like sponges and coelenterates circulate water from their surroundings through their body
cavities to facilitate the cells to exchange these substances
- More complex organisms use special fluids within their bodies to transport such materials

- Blood is the most commonly used body fluid by most of the higher organisms including humans for this purpose

- Another body fluid, lymph, also helps in the transport of certain substances
Blood
- Blood is a special connective tissue consisting of a fluid matrix, plasma, and formed elements

Plasma
- Plasma is a straw colour, viscous fluid constituting nearly 55% of the blood
- 90-92% of plasma is water and proteins (Fibrinogen, globulins and albumins) contribute 6-8% of it

- Fibrinogens are needed for clotting or coagulation of blood

- Globulins primarily are involved in defense mechanisms of the body and
- Albumins help in osmotic balance
- Plasma also contains small amounts of minerals like Na+, Ca++, Mg++, HCO3–, Cl–, etc
- Factors for coagulation or clotting of blood are also present in the plasma in an inactive form

- Plasma without the clotting factors or with fibrinogen removed is called serum
Formed elements
- Erythrocytes, leucocytes and platelets are collectively called formed elements

Erythrocytes
- Erythrocytes or red blood cells (RBC) are the most abundant of all the cells in blood

- A healthy adult man has, on an average, 5 millions to 5.5 millions of RBCs mm–3 or (per μL) of blood
- RBCs are formed in the red bone marrow in the adults. Mature RBCs are devoid of nucleus in most of
the mammals and are biconcave in shape. Erythrocytes also lack mitochondria and generate their ATP by
anaerobic metabolism
- Erythrocytes have red coloured iron containing Haemoglobin (loss of nuclei gives more space for
haemoglobin)
- A healthy individual has 12-16 gms of haemoglobin in every 100 ml of blood

- RBCs have an average life span of 120 days after which they are destroyed in the spleen (graveyard of
RBCs)
Leukocytes
- Leucocytes are also known as white blood cells (WBC) as they are colourless due to the lack of
haemoglobin

- Nucleated and are relatively lesser in number which averages 6000-8000 mm–3 of blood
- Leucocytes are generally short lived and larger in size than RBCs. We have two main categories of
WBCs – granulocytes and agranulocytes

- Neutrophils, eosinophils and basophils are different types of granulocytes, while lymphocytes and
monocytes are the agranulocytes or non-granular leukocytes
- In humans, neutrophils are the most numerous of the leukocytes (60-65%), followed in order by
lymphocytes, monocytes, eosinophils, and basophils (0.5-1%)

- Neutrophils and monocytes (6-8 per cent) are phagocytic cells which destroy foreign organisms
entering the body
- Basophils secrete histamine, serotonin, heparin, etc., and are involved in inflammatory reactions
 - Eosinophils (2-3 per cent) resist infections and are also associated with allergic reactions
- Lymphocytes (20-25 per cent) are of two major types – ‘B’ and ‘T’ forms
- Both B and T lymphocytes are responsible for immune responses of the body

Platelets
- Platelets also called thrombocytes, are cell fragments produced from megakaryocytes (pinched off
cytoplasmic fragments of special cells in the bone marrow, hence they contain NO nuclei)
- Blood normally contains 1,500,00-3,500,00 platelets mm–3
- Platelets can release a variety of substances most of which are involved in the coagulation or clotting
of blood
- A reduction in their number can lead to clotting disorders which will lead to excessive loss of blood
from the body
Blood group
- Various types of grouping of blood has been done, two such groupings – the ABO and Rh – are widely
used all over the world
- ABO grouping is based on the presence or absence of two surface antigens on the RBC namely A and
B

- Similarly, the plasma of different individuals contain two natural antibodies anti-A and anti-B
Rh grouping
- Another antigen called Rh antigen similar to one present in Rhesus monkeys (hence Rh), is also
observed on the surface of RBCs of majority (nearly 80%) of humans, such individuals are Rh+ and
individuals without this antigen are called Rh negative
- An Rh-ve person, if exposed to Rh+ve blood, will form specific antibodies against the Rh antigens.
Hence, Rh group should also be matched before transfusions
- Rh antigens of the foetus do not get exposed to the Rh-ve blood of the mother in the first pregnancy
as the two bloods are well separated by the placenta
- During the delivery of the first child, there is a possibility of exposure of the maternal blood to small
amounts of the Rh+ve blood from the foetus
- In such cases, the mother starts preparing antibodies against Rh antigen in her blood
- In case of her subsequent pregnancies, the Rh antibodies from the mother (Rh-ve) can leak into the
blood of the foetus (Rh+ve) and destroy the foetal RBCs

- This could be fatal to the foetus or could cause severe anaemia and jaundice to the baby. This
condition is called Erythroblastosis foetalis (Hemolytic Disease of Newborn) and can be avoided by
administering anti-Rho (D) immunoglobulin (RhoGAM) within 72 hours of delivery
Coagulation of Blood
- Blood exhibits coagulation or clotting in response to an injury or trauma
- One would have observed a dark reddish brown scum formed at the site of a cut or an injury over a
period of time
- This reddish brown scum is a clot or coagulam formed mainly of a network of threads called fibrins in
which dead and damaged formed elements of blood are trapped
- Fibrins are formed by the conversion of inactive fibrinogens in the plasma by the enzyme thrombin
- Thrombins, in turn are formed from another inactive substance present in the plasma called
prothrombin

- An enzyme complex, thrombokinase, is required for the above reaction

- An injury or a trauma stimulates the platelets in the blood to release certain factors which activate the
mechanism of coagulation
- Certain factors released by the tissues at the site of injury also can initiate coagulation
- Calcium ions play a very important role in clotting
Lymph
- As the blood passes through the capillaries in tissues, some water along with many small water
soluble substances move out into the spaces between the cells of tissues leaving the larger proteins and
most of the formed elements in the blood vessels, this fluid is called lymph or tissue fluid or interstitial fluid
- It has the same mineral distribution as that in plasma. Exchange of nutrients, gases, etc., between the
blood and the cells always occur through this fluid
- Lymphatic system collects this fluid and drains it back to the major veins. The fluid present in the
lymphatic system is called the lymph

- Lymph is a colourless fluid containing specialised lymphocytes which are responsible for the immune
responses of the body

- Lymph is also an important carrier for nutrients, hormones, etc. Fats are absorbed through lymph in the
lacteals present in the intestinal villi
Circulatory Pathways
- The circulatory patterns are of two types – open or closed
- Open circulatory system is present in arthropods and molluscs in which blood pumped by the heart
passes through large vessels into open spaces or body cavities called sinuses
- Annelids and chordates have a closed circulatory system in which the blood pumped by the heart is
always circulated through a closed network of blood vessels

- Closed circulatory system is considered to be more advantageous as the flow of fluid can be more
precisely regulated
- Fishes have a 2-chambered heart with an atrium and a ventricle
- In fishes the heart pumps out deoxygenated blood which is oxygenated by the gills and supplied to the
body parts from where deoxygenated blood is returned to the heart (single circulation)

- Amphibians and the reptiles (except crocodiles) have a 3-chambered heart with two atria and a
single ventricle, whereas crocodiles, birds and mammals possess a 4-chambered heart with two atria
and two ventricles
 - In amphibians and reptiles, the left atrium receives oxygenated blood from the gills/lungs/skin and
the right atrium gets the deoxygenated blood from other body parts
- However, they get mixed up in the single ventricle which pumps out mixed blood (incomplete
double circulation)
- In birds and mammals, oxygenated and deoxygenated blood received by the left and right atria
respectively passes on to the ventricles of the same sides

- The ventricles pump it out without any mixing up, i.e., two separate circulatory pathways are
present in these organisms, hence, these animals have double circulation

- LET US STUDY THIS IN DETAIL

Human Circulatory System
- Human circulatory system consisted of a muscular chambered heart, a network of closed branching
blood vessels and blood

- Heart, the mesodermally derived organ, is situated in the thoracic cavity, in between the two lungs,
slightly tilted to the left

- It has the size of a clenched fist and it is protected by a double walled membranous bag,
pericardium, enclosing the pericardial fluid
- Human heart has four chambers, two relatively small upper chambers called atria and two larger
lower chambers called ventricles

- A thin, muscular wall called the inter atrial septum separates the right and the left atria, whereas a
thick-walled, the inter-ventricular septum, separates the left and the right ventricles
- The atrium and the ventricle of the same side are also separated by a thick fibrous tissue called the
atrio-ventricular septum
 - Opening between the right atrium and the right ventricle is guarded by a valve formed of
three muscular flaps or cusps, the tricuspid valve
- Whereas a bicuspid or mitral valve guards the opening between the left atrium and the left
ventricle

- The openings of the right ventricle is provided with pulmonary semilunar valves and the left
ventricle is provided with the aortic semilunar valves

- These valves prevent any backward flow

- Entire heart is made up of cardiac muscles and the walls of ventricles are much thicker than that of the
atria

- A specialised cardiac musculature called the nodal tissue is also distributed in the heart
- A patch of this tissue is present in the right upper corner of the right atrium called the sino-atrial
node (SAN)
- Another mass of this tissue is seen in the lower left corner of the right atrium close to the atrio-
ventricular septum called the atrio-ventricular node (AVN)
 - A bundle of nodal fibres, atrioventricular bundle (AV bundle) continues from the AVN which passes
through the atrio-ventricular septa to emerge on the top of the interventricular septum and
immediately divides into a right and left bundle

- These left and right bundle give rise to minute fibres called purkinje fibres

- This Nodal musculature has the ability to generate action potentials without any external stimuli, i.e.,
it is auto-excitable

- Number of action potentials that could be generated in a minute vary at different parts of the nodal
system
- SAN can generate the maximum number of action potentials, i.e., 70-75 min–1, and is responsible for
initiating and maintaining the rhythmic contractile activity of the heart
- SAN is called as the pacemaker. Our heart normally beats 70-75 times in a minute (average 72
beats min–1)
Cardiac cycle
How does the heart function?

- All the four chambers of heart are in a relaxed state, i.e., they are in joint diastole
- As the tricuspid and bicuspid valves are open, blood from the pulmonary veins and vena cava
flows into the left and the right ventricle respectively through the left and right atria

- Semilunar valves are closed at this stage. SAN now generates an action potential which
stimulates both the atria to undergo a simultaneous contraction – the atrial systole

- Atrial systole increases the flow of blood into the ventricles by about 30 per cent
- Action potential is conducted to the ventricular side by the AVN and AV bundle from where the
bundle of His transmits it through the entire ventricular musculature

- This causes the ventricular muscles to contract, (ventricular systole), the atria undergoes
relaxation (diastole), coinciding with the ventricular systole

- Ventricular systole increases the ventricular pressure causing the closure of tricuspid bicuspid
valves due to attempted backflow of blood into the atria
 - As the ventricular pressure increases further, the semilunar valves guarding the pulmonary artery
and the aorta are forced open, allowing the blood in the ventricles to flow through these vessels into the
circulatory pathways

- Ventricles now relax (ventricular diastole) and the ventricular pressure falls causing the closure of
semilunar valves which prevents the backflow of blood into the ventricles
- As the ventricular pressure declines further, the tricuspid and bicuspid valves are pushed open by the
pressure in the atria exerted by the blood which was being emptied into them by the veins
- The ventricles and atria are now again in a relaxed (joint diastole) state, as earlier
- Soon the SAN generates a new action potential and the events described above are repeated in that
sequence and the process continues

- sequential event in the heart which is cyclically repeated is called the cardiac cycle and it consists of
systole and diastole of both the atria and ventricles

- Heart beats 72 times per minute, and the duration of a cardiac cycle is 0.8 seconds
 - During a cardiac cycle, each ventricle pumps out approximately 70 mL of blood which is called the
stroke volume

- Stroke volume multiplied by the heart rate (no. of beats per min.) gives the cardiac output

- Cardiac output can be defined as the volume of blood pumped out by each ventricle per minute and
averages 5000 mL or 5 litres in a healthy individual

- Our body has the ability to alter the stroke volume as well as the heart rate and thereby the cardiac
output

- For example, the cardiac output of an athlete will be much higher than that of an ordinary man

- First heart sound (lub) is associated with the closure of the tricuspid and bicuspid valves whereas
the second heart sound (dub) is associated with the closure of the semilunar valves
Electrocardiograph
- ECG or EKG is a graphical representation of the electrical activity of the heart during a cardiac cycle
- To obtain a standard ECG a patient is connected to the machine with three electrical leads (one to each wrist
and to the left ankle) that continuously monitor the heart activity

- For a detailed investigation of heart function multiple leads are attached to the chest

- P-wave represents the electrical excitation (or depolarisation) of the atria, which leads to the contraction of both
the atria

- The QRS complex represents the depolarisation of the ventricles, which initiates the ventricular contraction

- Contraction starts shortly after Q and marks the beginning of the systole

- The T-wave represents the return of the ventricles from excited to normal state (repolarisation)
- Obviously, by counting the number of QRS complexes that occur in a given time period, one can
determine the heart beat rate of an individual
 - Since the ECGs obtained from different individuals have roughly the same shape for a given lead
configuration, any deviation from this shape indicates a possible abnormality or disease
Double Circulation
- Blood flows strictly through blood vessels which consists of Arteries and Veins

- Basically, each artery and vein consists of three layers, they are
1) tunica intima, inner lining of squamous endothelium
2) tunica media, a middle layer of smooth muscle and elastic fibres
3) tunica externa, external layer of fibrous connective tissue with collagen fibres
- tunica media is comparatively thin in the veins
- Deoxygenated blood pumped by the right ventricle enters the pulmonary artery, is passed
on to the lungs from where it gets oxygenated and the oxygenated blood is carried by the
pulmonary veins into the left atrium

- This pathway constitutes the pulmonary circulation

 - Oxygenated blood entering the aorta is carried by a network of arteries, arterioles and capillaries to
the tissues from where the deoxygenated blood is collected by a system of venules, veins and vena cava
and emptied into the right atrium
- This is the systemic circulation, which provides, nutrients, O2 and other essential substances to the
tissues and takes CO2 and other harmful substances away for elimination
- A unique vascular connection exists between the digestive tract and liver called hepatic portal
system
- Hepatic portal vein carries blood from intestine to the liver before it is delivered to the systemic
circulation

- A special coronary system of blood vessels is present in our body exclusively for the circulation of
blood to and from the cardiac musculature
Regulation of Cardiac activity
- Normal activities of the heart are regulated intrinsically, i.e., auto regulated by specialised muscles
(nodal tissue), hence the heart is called myogenic

- Medulla oblongata can moderate the cardiac output through Autonomic nervous system (ANS)
- ANS through sympathetic nerves can increase the rate of heart beat, the strength of ventricular
contraction and thereby the cardiac output
- On the other hand, parasympathetic neural signals (another component of ANS) decrease the rate of
heart beat, speed of conduction of action potential and thereby the cardiac output

- Adrenal medullary hormones can also increase the cardiac output (ex. Epinephrine)
Disorders of Circulatory system
1) Hypertension
- Hypertension is the term for blood pressure that is higher than normal (120/80)

- In this measurement 120 mm Hg is the systolic, or pumping, pressure and 80 mm Hg is the diastolic, or resting, pressure

- If repeated checks of blood pressure of an individual is 140/90 (140 over 90) or higher, it shows hypertension
- High blood pressure leads to heart diseases and also affects vital organs like brain and kidney

2) Coronary Artery disease

-Coronary Artery Disease, often referred to as atherosclerosis or hardening of the arteries, affects the
vessels that supply blood to the heart muscle

- It is caused by deposits of calcium, fat, cholesterol and fibrous tissues, which makes the lumen of arteries
narrower
3) Angina
- It is also called ‘angina pectoris’ (Chest pain). A symptom of acute chest pain appears when no
enough oxygen is reaching the heart muscle
- It occurs due to conditions that affect the blood flow

4) Heart failure

- Heart failure means the state of heart when it is not pumping blood effectively enough to meet the
needs of the body
- It is sometimes called congestive heart failure because congestion of the lungs is one of the main
symptoms of this disease
- Heart failure is not the same as cardiac arrest (when the heart stops beating) or a heart attack (when the
heart muscle is suddenly damaged by an inadequate blood supply).