Lymph () is the fluid that flows through the lymphatic system, a system composed of (channels) and intervening whose function, like the venous system, is to return fluid from the tissues to be recirculated. At the origin of the fluid-return process, interstitial fluid—the fluid between the cells in all Fluid Physiology: 2.1 Fluid Compartments—enters the lymph capillary. This lymphatic fluid is then transported via progressively larger lymphatic vessels through lymph nodes, where substances are removed by tissue and circulating lymphocytes are added to the fluid, before emptying ultimately into the right or the left subclavian vein, where it mixes with central venous blood.
Because it is derived from interstitial fluid, with which blood and surrounding cells continually exchange substances, lymph undergoes continual change in composition. It is generally similar to blood plasma, which is the fluid component of blood. Lymph returns and excess interstitial fluid to the bloodstream. Lymph also transports fats from the digestive system (beginning in the ) to the blood via .
Bacteria may enter the lymph channels and be transported to , where the bacteria are destroyed. Metastasis cancer cells can also be transported via lymph.
Interstitial fluid forms at the arteriole (coming from the heart) end of capillaries because of the higher pressure of blood compared to , and most of it returns to its venule ends and ; the rest (up to 10%) enters the lymph capillary as lymph. (Prior to entry, this fluid is referred to as the lymph obligatory load, or LOL, as the lymphatic system is effectively "obliged" to return it to the cardiovascular network.) The lymph when formed is a watery clear liquid with the same composition as the interstitial fluid. However, as it flows through the lymph nodes it comes in contact with blood, and tends to accumulate more cells (particularly, lymphocytes) and proteins.
Unlike the cardiovascular system, the lymphatic system is not closed. In some amphibian and reptile species, the lymphatic system has central pumps, called , which typically exist in pairs, but humans and other mammals do not have a central lymph pump. Lymph transport is slow and sporadic. Despite low pressure, lymph movement occurs due to peristalsis (propulsion of the lymph due to alternate contraction and relaxation of smooth muscle tissue), valves, and compression during contraction of adjacent skeletal muscle and arterial pulse.
Lymph that enters the lymph vessels from the interstitial spaces usually does not flow backwards along the vessels because of the presence of valves. If excessive hydrostatic pressure develops within the lymph vessels, though, some fluid can leak back into the interstitial spaces and contribute to formation of edema.
The flow of lymph in the thoracic duct in an average resting person usually approximates 100ml per hour. Accompanied by another ~25ml per hour in other lymph vessels, the total lymph flow in the body is about 4 to 5 litres per day. This can be elevated several fold while exercising. It is estimated that without lymphatic flow, the average resting person would die within 24 hours.
In 1913, E. Steinhardt, C. Israeli, and R. A. Lambert grew vaccinia virus in fragments of tissue culture from guinea pig cornea grown in lymph.Steinhardt, E; Israeli, C; and Lambert, R.A. (1913) "Studies on the cultivation of the virus of vaccinia" ''J. Inf Dis. 13, 294–300
Clinical significance
As a growth medium
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