UNIT 5 B O DY FLUIDS

DY

Str uctur
ructur e
ucture
5.0 Objectives
5.1 Introduction
5.2 Blood
5.2.1 Functions of Blood
5.2.2 Composition of Blood
5.2.3 Composition Variation in Disease Conditions
5.2.4 Biochemical Analysis of Blood
5.2.5 Blood Clotting
5.2.6 Blood Grouping

5.3 Urine
5.3.1 Functions of Urine
5.3.2 Physical Examination of Urine
5.3.3 Normal Constituents of Urine
5.3.4 Abnormal Constituents of Urine and their Diagnostic Significance

5.4 Cerebrospinal Fluid (CSF)

5.4.1 Functions of CSF
5.4.2 Composition of CSF
5.4.3 Variation of Composition in Disease Conditions
5.4.4 Biochemical Analysis of CSF

5.5 Let Us Sum Up

5.6 Key W ords
5.7 Answ ers to Check Your Progress

5.0 OBJECTIVES

After going through this unit, you should be able to:

● describe clearly the fluid distribution in cells;

● differentiate between extra cellular fluid and intracellular fluid;
● 1ist the functions of blood;
● describe the normal composition of blood and changes in it during different
conditions;
● state the importance of biochemical analysis of blood;
● explain the significance of blood clotting and blood grouping;
● state the importance of the physical examination of urine;
● compare the normal and abnormal constituents of urine and their role in diagnostic
applications;

● list the important functions of CSF;

● discuss the composition of CSF under normal healthy conditions and its alteration in
specific diseases; and

● specify the biochemical components whose altered levels point to specific

disturbances of pathological origin.
84
 CMYK

Body Fluids
5.1 INTRODUCTION
The cell represents the basic unit or building block of all living organisms. As each cell is
capable of performing almost all vital functions of the organism, the cell requires a defined
composition and also a suitable environment to exhibit its range of functions. Unicellular
organisms such as amoeba, which live in water, have to devise ways of adjusting to
changes in their external environment in order to survive. However, warm blooded,
multi-cellular organisms, like humans, have adapted to live on dry land by creating for
themselves a personal environment. This is the internal environment provided by extra
cellular fluid (ECF). Since the composition and volume of this fluid can be precisely
regulated, despite widely varying external conditions, we can ignore the changes in the
outside world. As cells are suspended in the ECF, they take up oxygen and nutrients from it
and discharge waste products into it.
Within the cells also, the various components are suspended in a fluid medium. This
constitutes the intracellular fluid (1CF). The following figure (Fig. 5.1), depicts the two
fluid compartments of the cell.

ECF

ICF

Fig. 5.1: Main fluid compartments of cell

The ECF is further sub-divided into two compartmems.

i) The larger part, contains the interstitial fluid which surround the cells closely and
intimately.

ii) The smaller part, contains plasma, which circulates throughout the body; it is thus a
bulk transporter of water and solutes in the ECF. Figure below (Fig. 5.2) shows the
subdivision of ECF.
Plasma

Interstitial Fluid

Fig. 5.2: Sub-division of ECF 85

CMYK
Biochemistry The ECF serves as a route for the even and rapid distribution of very small quantities of
substances such as drugs and hormones. It is separated from the intestinal fluid by the walls
of capillaries.

In the average young adult male, 15% of the body weight is protein and related substances;
7% is mineral and 15% is fat. Around 60% is water. The distribution of water in different
fluid compartments is as follows (Fig.5.3).

5% Body weight
Plasma

15% Body Weight Interstitial Fluid

40% Body Weight

Intracellular Fluid

Fig. 5.3: Water distribution in different compartment

The major body fluids are blood, urine and cerebrospinal fluid (CSF). These are all
extracellular fluids. Wide fluctuations can occur in the composition and volume of both
ECFs and ICF, both in normal health and various disease conditions. Analysis and
monitoring of the changes in the composition of these fluids, provides us with a suitable
tool to clinically assess the situation. However, access to the ICF is not easy, even though,
changes in it better reflect a certain aberration occurring in a specific disease. We thus
employ the various ECFs such as blood, urine or CSF, to detect changes in composition of
certain metabolites in order to diagnose a disease.
In this unit, you would be learning about the functions, composition under healthy and
disease conditions and presence of abnormal constituents, of the various body fluids such
as blood, urine and CSF. We will be knowing about the analysis of important metabolites in
these fluids and how they help us to diagnose specific pathological conditions.

5.2 BLOOD
Blood represents the life sustaining fluid of the body. It is a circulating tissue that moves
through a complicated vascular network. It is propelled mainly by the pumping action of
the heart, with assistance from the muscular sysem of the arteries; hydrostatic and osmotic
pressures generated by differences in dissolved and dispersed solid components in the
various parts of the vascular network, also help to push the blood throughout the body.
The normal total circulating blood volume is about 8% of the body weight, about 5600 ml
or 5.6 liters in a 70 kg man.
Blood serves many vital functions in the human body. We shall list the major ones now.
86
5.2.1 Functions of Blood Body Fluids

The functions of blood are numerous and varied in nature also. These include~
● Respiration: Transport of oxygen from the lungs to the tissues and of carbon dioxide
from the tissues to the lungs.
● Nutrition: Transport of absorbed food materials.
● Excretion: Transport of metabolic wastes to the kidneys, lungs, skin and intestines for
removal.
● Maintenance of normal acid-base balance in the body.
● Regulation of water balance through exchange of water between the circulating fluid
and the tissue fluid.
● Regulation of body temperature by the distribution of body heat.
● Defense against infection by the white cells and the circulating antibodies.
● Transport of hormones that regulate metabolism.
● Transport of metabolites.
Next, we shall look at the composition of blood.

5.2.2 Composition of Blood

Blood is made up of two main components namely, the cellular fraction and the fluid
medium called plasma. The different types of cells are suspended in plasma. The
composition of blood is quite complex in keeping with the variety of functions it performs.
The table below (Table 5.1) lists the composition of blood.
Table 5.1: Composition of Blood
I) Cellular fraction
Volume : 45 per cent
Constituent cells
1) Erythrocytes (Red blood cells): 5,000,000 per cubic millimeter (cmm).
2) Leukocytes (White blood cells): 6000 per cubic millimeter.
3) Plateletes: 250,000 per cmm.
II) Plasma Fraction
Volume: 55 per cent
1) Non-diffusible constituents (proteins and polypeptides)
a) Albumins
b) Globulins
c) Enzymes, Lipids, etc
2) Diffusible constituents
a) Catabolic products: urea, creatinine, uric acid, etc.
b) Anabolic constituents: glucose, amino acids, creatine, etc.
2– –
c) Electrolytes: Na+, K+, Ca++, Mg++, Cl–, HCO3– , HPO4, H2PO4, etc.
d) Hormones, vitamins, etc.
When blood is collected with a suitable anticoagulant and is centrifuged, a clear liquid
separates, leaving behind the cells. This clear liquid is called pasma. From this plasma, if
we remove fibrinogen, in the form of a clot, the clear liquid obtained is called serum.
Blood — Cells = Plasma
Plasma — Fibrinogen = Serum
The composition of blood varies, as changes occur in the concentration of many of its
components. We shall now see these features and their significance. 87
Biochemistry 5.2.3 Composition Variation in Disease Conditions
The normal composition of blood is altered whenever there is any change in either its
cellular fraction or the plasma fraction. This rnay happen due to a variety of reasons or
disease conditions. We will now briefly discuss these issues.
Variations in the Cellular Fraction
Changes in the total count of erythrocytes, as well as that of leukocytes, occur in the
cellular fraction of blood. Erythrocyte Sedimentation Rate or ESR is used clinically, as a
non-specific screening test to detect the presence of infection. For example, the test is
useful in monitoring the status of chronic inflammatory diseases such as rheumatoid
arthritis.
Erythrocytes contain the red pigment Hemoglobin, which is a protein. Hemoglobin
concentration is decreased in various anaemias.
Lenkocytes or white blood cells are of several types. They mostly have a protective or
disease fighting function. Variations in the counts of these cells occur when the body is
invaded by outside agents and it mounts a fight against them; that is, the body initiates an
immune response.
Variations in the Plasma Fraction
The composition of plasma is altered, when changes occur in the levels of either the
nondiffusible or the diffusible components. As these proteins have important functions,
alterations in their levels is a sign of a specific pathological condition, that interferes with a
designated function.
Fluctuations in the levels of the diffusible components are mostly a reflection of altered
metabolic activity, often due to the malfunctioning of a tissue or organ.
5.2.4 Biochemical Analysis of Blood
Blood is the major body fluid. As it is the medium of transporting nutrients and also the
route for excretion of waste products, analysis of blood for biochemical components is of
utmost importance in diagnosing a variety of diseases. We shall tabulate the features of
biochemical analysis of blood in the following table (Table 5.2).
Table 5.2: Features of Biochemical Analysis of Blood
Component Material Normal value Importance
analysed used

Plasma proteins Serum 5.6-8.0 g/dl Increased in severe dehydration

(total)
Albumin Serum 3.5-5.5 g/dl Decreased in liver cirrhosis, kidney
disorders, malnutrition.
Globulin Serum 1.5-3.5 g/dl Increased in infectious conditions
Fibrinogen Plasma 0.2-0.4 g/dl Decreased in acute-liver failure
(hepatic necrosis)
Enzymes Serum Elevated in diseases of liver, heart,
pancreas, etc.
Cholesterol Serum 150-250 Elevated levels lead to athero
mg/dl sclerosis and heart diseases
Urea Serum or blood 8-20 mg/dl Elevated in kidney disorders
Uric acid Serum 3.0-7.5 mg/dl High levels lead to deposition in
joints causing gout
Creatinine Blood or serum 0.6-1.8 mg/dl Increased in kidney diseases
Glucose Blood 80-120 mg/dl High in diabetes mellitus
(fasting)

Calcium (Ca2+) Serum 8.5-10.3 mg/dl Levels altered in bone diseases

Phosphate (PO43– ) Serum 2.5-5.0 mg/dl Diseases of thyroid, etc,

Ketone bodies Plasma 0.3-2.0 mg/dl Increased level leads to ketosis
(Acetone bodies)
88
A partfrom the analytical value of blood as a bodyfluid,blood also exhibits two other Body Fluids
importantfeatures. These are the clotting of blood and blood grouping or blood typing.Itis
useful for us to know these features as well.

5.2.5 Blood Clotting

The clotting of blood is a unique feature of this bodyfluid. It also happens to be life saving
process. W hen a small blood vessel is damaged,the injury initiates a series of events that
lead to the formation of a clot (hemostasis). This seals off the damagedregion and prevents
further blood loss. The initial event is constriction of the vessel and formation of a
temporary hemostatic plug of platelets that is triggered when platelets bind to collagen.
Thisisfollow ed by conversion of the plug into a definitiveclot.

The process of clotformation is a highly complex one,involving severalproteins, enzymes,

ions such as calcium (Ca2+, ) vitamin K, and so on. The entireprocess occurs in a series of
steps that is described as a cascade reaction. The effect is magnified at each step and the
process comes to an end with the formation of a largeclot, wherein,fibrinogen is converted
intofibrin.

Defects in the clotting process occur due to absence of certain clotting factors
, mostly
enzyme proteins. In such cases, theclotting time would be delayed,leading to loss of more
blood.Forexample,inliver damage,fibrinogen synthesis may be low, causing delayed
clotting. Hemophilia is a genetic disorder,affecting the clotting process. Here,one of the
clotting factors
, aprotein, is missing.

You arevery wellaware that the blood inside our body does not clot. W hy? W e havea
substance in our body,called an anticoagnant, thatprevents blood from clotting. Heparinis
the natural anticoagulant.

5.2.6 Blood Grouping

Grouping
“Donateblood,savelife”, is a common slogan that we come across frequently. It is not an
exaggeration atall! W e can saveprecious lives by donating the most precious commodity—
the blood.As nurses, you areaw are of the obligatory need for blood in any surgical
operation. It is a pity that we have not yetfound the ideal blood substitute or the completely
safe synthetic blood.So, blood donation is the only way by which blood banks can collect
donor blood and preserve them carefullyfor use in any emergency.

W e know thatblood transfusion saveslife,butitisalsotrue that sometimes it can take

awayalife too. Due to a curious twist of nature, our body cannot acceptblood from any
and every donor. Blood from some donors just does not suit us. W hy is this so? Thisis
because blood of different people is of different types. Blood of a certain type only suits a
person, while others don’t
. W e shall see the reason behind this.

T he ABO System

The outside of the membrane of human red cells contains a variety of proteins, called blood
group antigens (or agglutinogens). The most important and best known of these arethe A
and B antigens, but many othersare also present.

The antigens A and B are inherited and individuals aredivided into four major blood
groups or types on this basis.

Type A — haveA antigen

Type B — have B antigen

Type A B — have both A and B antigen

Type O — have neither A nor B antigen

Chemically,the A and B antigens are complex oligosaccharides thatdiffer,in their terminal

sugar.

Any substance foreign to the body,such as antigens, is not tolerated and the bodyfightsit,
by making neutralising molecules called antibodies, Thisistrue of the blood antigens A and
B also. The antibodies against the red cell agglutinogens are called agglutinins.
89
Biochemistry Type A individuals develop anti-B antibodies

Type B individuals develop anti-A antibodies

Type AB individuals develop no antibodies to A or B

Type O individuals develop both anti-A and anti-B antibodies

When the plasma of type A individual is mixed with type B red cell, the anti B antibodies
(in type A) cause type B red cells to clump together (a process called agglutination. Fig. 5.4
illustrates the process of agglutination):

A cells in A Plasma B cells in A Plasma

Fig. 5.4: Red cell agglutination in incompatible plasma

Similarly, agglutination reaction occurs in other mismatched plasma and red cells as
follows: (Table 5.3)
Table 5.3: Summary of the ABO System

Blood type Agglutinins in Plasma Plasma agglutinates Red cells of type

O Anti-A A, B, AB

Anti-B

A Anti-B B, AB

B Anti-A A, AB

AB None None

Type O is called the universal donor, while, Type AB is called universal acceptor.

So far, we have learnt some important features of the life saver fluid, the blood. In the next
section, we shall describe features such as composition, properties, normal and abnormal
constituents and biochemical analysis of the major excretory fluid, the urine.

Check Your Progress 1

1) How is plasma different from serum?

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2) Persons with AB blood group are said to be universal acceptors. Why?
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90 ..........................................................................................................................................................
3) An accident victim with B blood group was given blood transfusion with O group Body Fluids
blood. No difficulties were encountered in accepting it. State the reason for it.

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5.3 URINE

In the kidney, a fluid that resembles plasma is filtered through the glomerular capillaries
into the renal tubules (glomerular filtration). As this glomerular filtrate passes down the
tubules, its volume is reduced and its composition altered by the process of tubular
reabsorption (removal of water and solutes from the tubular fluid) and tubular secretion
(secretion of solutes into the tubular fluid) to form the urine that enters the same pelvis.
From here, the urine passes into the bladder and is expelled out by the process of urination
or micturition.

A comparison of the composition of plasma and an average urine specimen illustrates and
emphasizes the manner in which wastes are eliminated, while water and important
electrolytes and metabolites are conserved (Table 5.4) .

5.3.1 Functions of Urine

Urine is an excretory product of the body and the presence of certain substances in it
reflects the metabolic state of the individual. As urine can be easily collected and
examined, routine examination of urine is a preliminary step in the diagnosis of various
pathological conditions.
Table 5.4: Urinary and Plasma Concentrations of Some
Physiologically Important Substances

Substance Concentration in

Urine Plasma

Glucose (mg/dl) 0 100

Na+ (meq/l) 90 150

Urea (mg/dl) 900 15

Creatinine (mg/dl) 150 1

5.3.2 Physical Examination of Urine

Examination of the physical characteristics of urine specimen is in itself, very informative.
It can give us some idea regarding the status of the sample—whether it is a normal one or
from a patient with a certain abnormality. The following features are important in the
analysis of urine.
Colour
Normally the urine is colourless or straw coloured (due to the presence of urochrome).
A deep yellow colour is indicative of mild to severe dehydration, jaundice, vitamin B
complex therapy. A colour of red to brown suggests hematuria, hemoglobinuria,
myoglobinuria, prophyria, etc. Brown to black colour is due to Alkaptonuria,
methemoglobinuria, etc.
Appearance
Normal urine is perfectly clear and transparent, when freshly voided. It may become turbid,
if exposed for a long time, due to the urea getting converted into ammonium carbonate by
bacteria.
91
Biochemistry Turbidity

Turbidity may be due to:

● Phosphateexcretion in alkaline urine
● Pus cells

Specific Gr
Specific avity
Gra
This is measure of the capacity of kidney to concentrate the urine.
Normal value: 1.002-1.028. This depends upon the state of hydration and solute load.
Values more than 1.028 imply,
● Severe dehydration
● Diabetes mellitus
● Adrenal insufficiency
Values less than 1.002 indicates

● increased water intake

● Diabetes insipidus
● Chronic nephritis
It is important to note that
, afixed specificgravity,even on fluidrestriction, denotes loss of
concentrating pow erby the kidney and is usually seen in chronic renal failure.
Volume

Normal value: 700-2000 ml/day.Itdepends on fluid intake,solute load and loss of fluid by
skin or otherwise.
Polyuria: More than 3 litres/day.This may be due to:
● Diabetes mellitus

● Diabetes inspidus
● Recoveryfrom acute renal failure
● Diuretic therapy
Oliguria: Less than 400 ml/day.This could be due to:
● Vomiting,fever,burns
● Edema
● Acute renal failure
Anuria: Less than 50ml/12 hours.

pH

Normal range: 4.5-8.5. Averagevalue is 6.0 in 24 hours sample.

pH more than 8.5: After heavy meals, proteus infection.
pH less than 4.5: After heavy exercise,metbaolic acidosis, chronic respiratory acidosis,
W e have seen the usefulness of a physical examination or urine.A chemical examinationis
equally or even more important as a diagnostic aid.So, let us look at the normal chemical
composition of urinefi rst and then go on to list some abnormal components and their
significance in the clinical situations.

5.3.3 Normal Constituents of Urine

Normal urine varies widely in composition, being influenced by diet and other factors
.
92 Table 5.5 shows the composition of average normal urine.
 Table 5.5 : Typical Daily Excretion in Normal Urine Body Fluids

Constituent Quantity (grams)

Water 1200.0

Solids 60.0

Urea 30.0

Uric acid 0.7

Creatinine 1.2

Chloride as NaCl 12.0

Sodium 4.0

Potassium 2.0

Calcium 0.2

Phosphate as P 1.1

Ammonia 0.7

5.3.4 Abnormal Constituents of Urine and their Diagnostic Significance

In addition to the components listed in Table 5.5, urine also shows the presence of certain
abnormal constituents. Some of these are present in normal individuals also, but their levels
in urine are so small as to be hardly detectable. Only when the levels of these are raised in
pathological states, can they be detected and used in diagnosis.

There are five major abnormal constituents in urine namely, protein, glucose, ketone
bodies, blood and bile pigments. The presence of each in detectable amounts is indicative
of a specific pathology. Table 5.6 summarises the abnormal constituents and possible
pathology associated with them.

Table 5.6: Abnormal Constituents of Urine and their Associated Pathology

Constituent Amount in Amount in Specific disease

normal urine disease condition

Protein (mostly 20-750 mg/day 3.5 g/day Nephrotic syndrome

plasma proteins)

Glucose 15-130 mg/day More than normal Glycosuria, diabetes mellitus,

renal glycosuria

Ketone bodies < 50 mg/day More than normal Diabetes mellitus, starvation,
high fat diet, severe vomiting

Blood Not detectable Detectable Kidney disease, anaemia,

malignancy of kidney or
urinary tract

Bile Pigments

Bilirubin Not detectable Detectable Hemolytic anaemia, viral

hepatitis (jaundice)

Urobilinogen Detectable Increased markedly, Jaundice

decreased or absent

Specific chemical tests are available to detect the presence of each of the above
constituents. Some of these tests will be described in the practical manual.
We now move on to the analysis of another important body fluid, the cerebrospinal fluid, in
the next section. 93
Biochemistry Chec
Checkk Your Progress 2
Pro

Urine sample from a patient show ed the following pattern on analysis.

Colour: Clear, with no turbidity

Specificgravity: More than 1.002

Patient show ed polyuria

Protein: Normal

Glucose: More than normal

Ketone bodies: More than normal

Blood: Absent

Bilirubin: Absent

W hat is the probable diagnosis? Givenreason(s).

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5.4 C E R E B ROSPIN
ROSPINAL FLUID (CSF)
OSPINAL

The cerebrospinal fluid is a water-clear,alkaline,ultrafiltrate of plasma. It is contained in

the ventricular spaces of the brain and the subarachnoid spaces of the brain and spinal cord.
Itisformed mainly by a process of secretion from the epithelial cells of choroid plexuses of
the lateral, the third and the fourthventricles of the brain.

5.4.1 Functions of CSF

The cerebrospinal fluid serves some very essential functions. These are:

i
) providing mechanical support to the delicatebrain (cushion effect), protecting it
against injuries,

ii) removal of metabolic waste products.

iii) t
ransport of biologically active compounds which may function as chemical
messengers.

iv) maintenance of the chemical environment of the brain.

Like the other bodyfluids blood and urine, the composition of CSF too is an important
feature.W e shall describe the chemical composition of this fluid,

5.4.2 Composition of CSF

The total amount of CSF in a healthy, adult human is about 130 ml, and is renew ed about 6
to 8 times per day.

Table 5.7 lists the quantities of various components in a normal CSF sample.

CSF differsfrom plasma in having no bilirubin, extremelylow cholesterol, low protein, less
sugar, calcium and non-protein nitrogen, but morechloride and concentration of
94 bicarbonate.
 Table 5.7: Components and Features in Normal CSF Body Fluids

Constituent or property Quantity

Specific gravity 1.006 -1.008

pH 7.31-7.40

Colour Colourless

Transparency Clear, free of clots

Cellularity Nil or less than 5 lymphocytes or monocytes/cmm

Glucose 50-80 mg/dl

Protein 15-50 mg/dl

Bilirubin Nil

Na+ 138-150 meq/l

Cl– 116-122 meq/l

HCO3– 20-24 mmol/l

5.4.3 Variation of Composition in Disease Conditions

The physical characteristics and the chemical nature of CSF are altered under diverse
disease conditions. Such changes are worth noting as they are clinically significant. We
shall briefly describe them here.

Appearance: Normal CSF is clear and colourless and gives no coagulum or sediment on
standing.

Colour: Colour changes only in pathological condition, such as xanthochromia, where it

may be yellow. An yellow tinge indicates markedly increased protein - greater than 200
mg% (i.e., 200 mg/dl).

Markedly, yellowish CSF is due to the presence of bilirubin. Blood may be present due to
bleeding from lumbar puncture site, pathological sunbarachnoid hemorrhage, ventricular
hemorrhage, etc.

Turbidity: CSF may occasionally clot if the ratio of blood to CSF is high. Usually a fibrin
clot is seen (example, in tubercular meningitis, a cob web coagulum appears). Turbidity can
also be due to microscopic fat globules.

Cell count: Normal CSF should contain no more than 5 lymphocytes or monocytes/cmm.

Presence of red blood cells indicates hemorrhage. Presence of white blood cells indicates
bacterial meningitis.

5.4.4 Biochemical Analysis of CSF

The biochemical analysis of CSF supplies valuable diagnostic information in the study of
diseases involving the central nervous system (CNS). This is due to the semi-permeable
nature of the membranes, which cause of retention and localisation of abnormal materials
(antibodies) causing changes in chemical characteristics that indicate pathological
conditions.

The two most significant biochemical parameters in CSF analysis are, changes in the
concentration of proteins and glucose. With proteins, elevated levels are clinically
significant, whereas, with glucose, decreased levels are indicative of a specific pathology.

The actual biochemical tests for protein and glucose quantitative determination will be
mentioned in the practical manual. These are fairly simple tests and most biochemical/
chemical laboratories will be equipped to carry them out.
95
Biochemistry Table 5.8 summarises the Biochemical Analysis of CSF.

Table 5.8: Biochemical Analysis of CSF

Component Normal level Altered level Pathology involved

Protein 15-50 mg/dl Increased Hemorrhage (due to trauma,

neoplasm ruptured aneurysm),
Inflammation, meningitis,
Encephalitis, polio

Glucose 50-80 mg/dl 10-20 mg/dl Pyogenic Meningitis

30-50 mg/dl Tuberculous meningitis

Check Your Progress 3

A CSF sample, on analysis, was found to have to following features:

Appearance: Turbid (clot formation)
Protein: Normal
Glucose: 30-50 mg/dl
What pathology/disease does it indicate? What is the explanation?
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5.5 LET US SUM UP

Living organisms are made up of the building blocks called cells which are suspended in a
fluid medium. The components within the cells themselves are surrounded by a liquid
environment. The intracellular fluid exchanges nutrients with the extracellular fluid and
releases waste materials for excretion. This is a very important function for the cell as its
very survival depends on it. Blood, urine and cerebrospinal fluid are the three extra cellular
fluids whose stable composition and characteristics reflect the well being of an individual.

We have seen that blood transports essential nutrients and also carries waste products for
excretion by lungs, kidney and intestines. Its composition is thus subject to variations,
depending on changes in metabolic and other activities of the body. An analysis of the
components of blood such as proteins, enzymes and metabolites such as glucose, urea, uric
acid, cholesterol and certain ions like calcium and phosphate, is of great diagnostic value.
The process of blood clotting is a mechanism that prevents loss of blood and thus saves
life. Another life saving concept that you have learnt is that of blood transfusion. But, blood
transfusion is safe only with properly matched blood group, otherwise, serious
complications, including life threatening ones, may arise.

Urine is the major excretory fluid formed by the kidneys for elimination of a host of waste
products. A physical examination of urine itself provides much information about the
health status of an individual. Biochemically, the analysis of urine is important with respect
to certain abnormal constituents such as protein, glucose, ketone bodies, blood and bile
pigments. We now know that the presence of these components in urine points the finger at
specific metabolic or other abnormality.

The fluid surrounding the delicate organ brain and protecting it is the cerebrospinal fluid.
CSF also functions as a route to throw out waste from the body. Physical examination of
CSF also is helpful in diagnosing various aberrations concerning the brain and the central
nervous system. Elevated protein and decreased glucose levels in CSF reflect different
bacterial and other infections affecting the brain.
96
 Body Fluids
5.6 KEY W O R D S

Agglutination : Adherence together of small bodies in a fluid such as blood

corpuscles.

Albumin
Albumin : Major protein fraction of plasma.

Alkaptonuria : A genetic disease of the metabolism of the aromatic amino acid

tyrosine.

Antibody : Substance in blood thatdestroys or neutralises foreign bodies such

as bacteria

Antigen : Substance (external agent) that causes the formation of antibodies.

Bilirubin : The chief pigment (yellow coloured) of human bile thatisderived

from hemoglobin.

Cirrhosis : A disease (of liver) in which the normal tissue is replaced by

fibrous tissue

Extracellular fluid : Fluid surrounding or outside of the cell

Fibrin : Thefinal insolublecross linked protein substance formed during

clotting of blood.

Fibrinogen : The solubleprecursor protein form of fibrin

Globulins
Globu : A group of proteins thatare insoluble in waterbut solubleinsalt
solutions.

Gout : A disorder of purine metabolism affecting the joints, due to

deposition of uric acid crystals.

Hemorrhage : Escape or leakage of blood from the vessels which naturally

contain it.

Hemostasis : Arrest of bleeding by clot formation.

Interstitial fluid : Fluid in the spaces between cells

Intracellular fluid : Fluid inside the cell

Meningitis : Inflammation of the mininges, the membrane surrounding the

brain.

Plasma : Fluid portion of blood in which the particulate components are

suspended

Por ph
rph yr
phyriia : A group of disturbances characterized byexcessiveproduction and
excretion of porphyrins(from heme of hemoglobin)

Serum : The fluid which separates from blood, lymph and other body
fluids, when clotting takes place in them.

Urobilino
Uro gen
og : The colourless compound formed in the intestines by the reduction
of bilirubin.

5.7 ANSWERS T O CHECK Y OUR PROGRESS

PROGRESS
Check Your Pr
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Pro

1) Plasma is the fluid thatseparatesfrom blood (having an anticoagulant), after the

removal of the cells (RBC, WBC) by centrifugation.

Serum is the clearfluid obtained from plasma after removaloffibrinogen in the form
of a clot.
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Biochemistry
2) Persons with AB blood group, have both antigens A and B in their blood. So they do
not develop antibodies to either A or B group blood. Similarly,they do not develop
antibodies to both AB and O group blood also. Thus, they can safely accept A, B,A B
and O group bloods. Theyare universal acceptors .

3) The accident victim’sblood is B group, which has antigen B in it. It does not form
antibodies to antigen B,but it can produce antibodies to antigen A. O group blood has
neither antigen A nor antigen B.So, itissafely accepted.

Chec
Checkk Your
ourss Progress 2
ro

The probable diagnosis is that the patientisafflicted with diabetes mellitus. A diabetic
patient shows polyuria, clear urine with no turbidity,specificgravity of urine is greater than
1.002 due to increased solids being excreted (suchas glucose).

Glucose is excreted in urine (glycouria) and so areketone bodies. Proteins are not excreted
in urine,unless the kidney is also damaged. Blood and bilirubin areabsent in urine.All
these features point to the condition, diabetes mellitus.

Chec
Checkk Your Progress 3
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The diagnosis in this case is tubercular meningitis. In tubercular meningitis, CSF is turbid
due to clotformation, but there is no increase in protein content. How ever, glucose content
is markedly decreased to 30-50 mg/dl, as compared to the normal range of 50-80 mg/dl.
The bacteria consumes glucose for its survival.

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