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Chapter 10: Blood

 Blood

 The only fluid tissue in the body

 Classified as a connective tissue
 Notable: collagen & elastin absent from blood
 Dissolved fibrin proteins become evident during clotting

 Components of blood
 Living cells
 Formed elements – RBC & WBC
 Non-living matrix
 Plasma
 When Blood is centrifuged

 Plasma rises to the top (55%)

 Erythrocytes sink to the bottom (45%)5
 This is known as the hematocrit
Normal hematocrit:
47% +/- 5%: males
42% +/-5%: females

 Buffy coat contains leukocytes & platelets (<1%)

 Thin, whitish layer that is between erythrocytes &
plasma
 Physical Characteristics of Blood

 Sticky, opaque fluid – metallic taste

 More dense than water, 5x more viscous

 Colors:
 Oxygen rich blood – scarlet red (bright)
 Oxygen poor blood – dull red

 pH is between 7.35 – 7.45

 Blood temperature is always slightly higher than body temperature – around

100.4F
 In a healthy man, blood volume is about 5-6 liters or about 6 quarts
 Women have less blood, about 3.5 – 5 liters

 Blood makes up about 8% of body weight

 Functions of Blood

 All concerned with:

 substance distribution
 regulating blood levels of particularly substances
 bodily protection

 Distribution:
 Oxygen to lungs
 Nutrients to digestive system
 Transporting metabolic wastes from elimination sites
(lungs, kidneys, liver)
 Hormones from glands to target organs
 Functions of Blood

 Regulation:
 Maintain appropriate body temperature by absorbing and
distributing heat through body, encouraging skin for heat
loss
 Maintain normal pH, blood holds an “alkaline” reserve to
raise pH when necessary
 Maintain adequate fluid volume in circulation
 Salts & blood protein – prevent excess fluid loss

 Protection
 Prevents blood loss
 Prevents infection
 Blood Plasma

 Straw colored, sticky liquid

 Composed of approximately 90% water

 Includes over 100 dissolved substances:

 Nutrients
 Salts (electrolytes)
 Respiratory gases (CO2 & O2)
 Hormones
 Plasma proteins
 Waste products
 Uric acid, creatinine, lactic acid, ammonium salts
 Blood Plasma: Plasma Proteins

 Most abundant solutes in plasma

 Made mostly by the liver

 Proteins include:
 Albumin: regulates osmotic pressure
 The pressure that keeps water in the blood
 Essentially carries all proteins around the blood
 High albumin almost always caused by dehydration
 Low albumin can come from liver disease, kidney disease, & malnutrition
 Globulins:
 Alpha, beta: transport proteins that bind to lipids, metal ions, fat-soluble vitamins
 Gamma: antibodies released during an immune response
 Clotting proteins: help to stop blood loss when a blood vessel is injured
 Antibodies: help protect the body from pathogens (disease)
 Blood Plasma

 Acidosis: blood becomes too acidic

 Liver failure, kidney failure

 Alkalosis: blood becomes too basic

 Main cause: hyperventilation –
resulting in a loss of CO2
 Other causes: prolonged
vomiting, Cushing’s syndrome,
severe dehydration
 In each scenario, the respiratory
system & kidneys help restore blood
pH to normal
 Formed Elements

 Erythrocytes
 Red blood cells (RBCs)

 Leukocytes

 Lymphocytes
 Both are white
blood cells (WBCs)
 Platelets

 Cell fragments
 Formed Elements
 Erythrocytes
 AKA Red blood cells (RBCs)
 4-6 million (per mm3)
 Developed in the bone marrow
 Salmon – colored biconcave discs
 Anucleate – CAN’T reproduce–produced in the bone marrow
 Literally, sacs of hemoglobin
 most organelles have been rejected
 Structural protein called spectrin: spectrin net is deformable – allows
erthyrocytes to change shape as necessary to move through blood vessels
 Each erythrocyte has 250 million hemoglobin sacs
 Normal blood contains 12-18g per 100ml of blood
 Functions:
 Transport oxygen to lung capillary beds
 Also transports small amounts of CO (about 20%)
 Formed Elements
 Erythrocytes
 Women have lower RBC count (4.32 -5, versus 5.1 – 5.8
mm3)
 As RBCs increase, blood viscosity increases, blood flow slows

 Function:
 Respiratory gas transport
 Hemoglobin in RBC binds to oxygen
 14-20 (g/100ml) – infants
 13-18 – adult males
 12 – 16 – adult females
 Hemoglobin is inside RBCs to prevents the protein molecule
from breaking apart and leaking through the bloodstream
 Formed Elements
 Diseases of RBCs
 Anemia
 Decrease in oxygen carrying ability

 Sickle cell anemia (SCA)

 abnormally shaped hemoglobin
 Genetically caused
 Painful condition

 Polycythemia
 excessive or abnormal increase in
the number of RBCs
Formed Elements
 Formed Elements: Leukocytes
 Essential for body’s defense against pathogens

 Complete cells with a nucleus & organelles

 Can move in/out of blood vessels on their own

(diapedesis)
 Move with ameboid motion

 Respond to chemicals released by damaged

tissues
 4,000 – 11,000 per mm3 of blood
 Hemocytoblast
Formed Elements: Types of Leukocytes
stem cells

 Granulocytes Lymphoid Myeloid

stem cells stem cells
 Possess lobed nuclei
 Will show granules in cytoplasm when stained
Secondary stem cells
 Include: neutrophils, eosinophils, & basophils

 Agranulocytes
 Lack of visible granules Basophils
Erythrocytes
 Nuclei are spherical, oval or kidney – shaped
 Include: lymphocytes & monocytes
Platelets
 List of the WBCs from most to least abundant
Eosinophils
 Neutrophils Never
 Lymphocytes Let
 Monocytes Monkeys
 Eosinophils Eat
 Basophils Bananas
Lymphocytes Monocytes Neutrophils
 Formed Elements: Types of Leukocytes
 Neutrophils
 Multilobed nuclei with small granules
 Acts as phagocyte at active site of
infection
 “first responder” to inflammatory site
(trauma) – tell tale sign of acute
inflammation

 Eosinophils
 Large brick red granules
 Shown in response to allergies, asthmatic
reactions or parasitic worms
 May play a role in defense against viruses
 Formed Elements: Types of Leukocytes
 Basophils
 Least common granulocytes
 Contain histamine granules
 Initiate inflammation
 Contain heparin
 Prevent blood from clotting too quickly
 May regulate the behavior of T cells
 Formed Elements: Types of Agranulocytes
 Lymphocytes
 Nucleus fills most of the cell
 Plays an important role in the immune
system
 Types of Lymphocytes:
 Killer Cells (Killer T Cells)
 Defend against tumors and virally infected
cells
 T Cells (Thymus Cells)
 Many subsets of t cells
 All cell mediated immunity – pathogen
detection
 B Cells (Bone cells)
 Secretion of antibodies
 Neutralize foreign objects like bacteria &
viruses
 Formed Elements: Types of Agranulocytes
 Monocytes
 Largest WBC in size
 ~50% found in the spleen
 Function as macrophages
 Specific & non-specific defense
 Act in response to inflammatory situations
to get rid of pathogen/allergic causing
antigen
 Important in fighting chronic infection
 WBC Abnormalities
 Leukocytosis
 WBC count above 11,000 leukocytes/mm3
 Generally indicates an infection
 But not indicative of any specific infection
 It’s diagnostically similar to a fever

 Leukopenia
 Abnormally low leukocyte level
 Commonly caused by certain drugs such as corticosteroids and anticancer agents
 An important indicator of infection risk

 Leukemia
 Bone marrow becomes cancerous, turns out excess WBC
 4 types: ALL (acute lymphoblastic), CLL, AML (acute myelogenous), & CML
 Can be acute or chronic
 Acute is more common in children, chronic in the elderly
 Can be lymphoid or myeloid
 Lymphoid is more common in children, myeloid is rare in children

 http://www.youtube.com/watch?v=tDTLC2swhlQ
 Formed Elements: Platelets
 Aka thrombocytes

 Small regular shaped cell fragments, derived from megakaryocytes (bone marrow
cell)
 Average lifespan of a platelet is 5 to 9 days

 Needed for the clotting process

 If platelets are too low, excessive bleeding can occur; if too high, wanted/unwanted
clotting can occur.
 Hematopoiesis
 Blood cell formation in red bone marrow

 All blood cells (red & white) derive from a common

stem cell (hemocytoblast)
 Differentation:
 Lymphoid stem cells produce lymphocytes
 Myeloid stem cell produces all other formed elements
 These stem cells are self-renewing
 I.e. – some never develop into RBCs or WBCs – they stay
stem cells so they can mitotically divide into more stem
cells.
 Erthyrocyte formation
mb I
 Erthyrocytes are unablealato divide, grow & synthesize proteins
nce
Stimulus: Decreased
 Wear out in 100 – 120 days
Normal blood oxygen levels RBC count, decreased
availability of O2 to
blood, or increased
Imb
al a tissue demands for O2
 When they are no longer usable, they will be removed by n ce
Increased
phagocytosis by the liver or spleen
O2- carrying
ability of blood
Reduced O2
 Lost cells are replaced by hemocytoblasts levels in blood

 Rate
Moreof RBC production is controlled by the hormone erthyropoietin
RBCs

 Kidneys produce most erythropoietin as a response to Kidney

reducedreleases
erythropoietin
Enhanced
oxygen levels in the blood
erythropoiesis Erythropoietin
stimulates
Red bone
 Homeostasis is maintained by negative feedback from blood oxygen
marrow

levels
 Formation of WBCs and platelets

 Controlled by hormones
 Colony stimulating factors (CSFs) and interleukins prompt bone
marrow to generate leukocytes
 Thrombopoietin stimulates production of platelets
 Hemostasis

 Stoppage of bleeding resulting from a break in a

blood vessel
 Hemostasis involves three phases
 Vascular spasms
 Vasoconstriction causes the blood vessel to spasm
 Spasms narrow the blood vessel and decreases
overall blood loss
 Hemostasis
Platelets release chemicals
 Platelet
thatplug formation
attract more platelets to
the site and make nearby
 Collagen fibers that make up the blood vessel become exposed by the
platelets sticky

break
PF from
 Platelets
3
platelets become sticky & cling to the collagen fibers
Calcium
and other
 Those platelets
+ clotting
release chemicals (PF3) to attract more platelets
factors
 The in blood
platelets pile up to form a platelet plug
Tissue factor
plasma
in damaged
tissue
 Coagulation (blood clotting)
 Injured tissues
Phases of
coagulation Formationrelease
of TF (tissue factor)
(clotting prothrombin
 PF interacts with TF, clotting factors & calcium ions to initiate the
cascade) 3 activator

clotting cascade
Prothrombin Thrombin
 Prothrombin gets converted to thrombin by prothrombin activator.
 Thrombin
Fibrinogen joins fibrinogen proteins into hair-like molecules of insoluble
Fibrin
(soluble) (insoluble)
fibrin
 Fibrin forms a meshwork (the basis for a clot)
 Hemostasis

 Blood usually clots within 3 to 6 minutes

 The clot remains as endothelium regenerates
 The clot is broken down after tissue repair
 Undesirable Clotting
 Thrombus
 A clot in an unbroken blood vessel – normal during injury but should
be disposed of once the risk of excessive bleeding has past.
 Can be deadly in areas like the heart
 More likely to occur when there are problems in the heart (arrhythmia,
heart valve replacement and/or recent heart attack

 Embolus
 A thrombus that breaks away and floats freely in the bloodstream
 In general, an embolus is ANY detached, itinerant intravascular mass –
they can be solid, liquid or gas
 Can later clog vessels in critical areas such as the brain
 Bleeding Disorders
 Thrombocytopenia
 Platelet deficiency = below 50,000 per
microliter
 Normal platelet counts are between
150,000 – 450,000 per microliter of
blood (that’s a lot)
 Even normal movements can cause
bleeding from small blood vessels
that require platelets for clotting
 Symptoms include frequent bruising,
purpura, & petechiae
 Bleeding Disorders
 Haemophilia
 Hereditary bleeding disorder
 Normal clotting factors are missing
 When bleeding occurs, a scab does
form, but it is temporary
 The clotting factor prevents the fibrin
from reattaching and healing the blood
vessel
 Blood Typing & Transfusions
 Large losses of blood have serious consequences
 Loss of 15–30% causes weakness
 Loss of over 30% causes shock, which can be fatal

 Transfusions are the only way to replace blood quickly

 Transfused blood must be of the same blood group

 Blood is tested for a large number of diseases before giving to the patient who needs blood
 Tested for:
 All forms of HIV, All forms of hepatitis, syphillis, CMV, and West Nile virus – just to name a few 
 Complications:
 Hemolytic reactions: you have antibodies again the donor’s RBCs –
 symptoms include fever, chills, increased heart rate, shortness of breath, rapid drop in blood pressure.
 Transfusion must be stopped immediately before kidney damage occurs
 Allergic reactions: while blood banks look at the complete chemical make up of donor blood, if a
patient is unaware of allergies and these chemicals are in blood – an allergic reaction can occur
 If severe, Usually easily fixed by dosing epinephrine to stop anaphylaxis
 Human Blood Groups

 Blood contains genetically determined proteins

 Antigens (a substance the body recognizes as foreign) may be

attacked by the immune system
 Antibodies are the “recognizers”

 Blood is “typed” by using antibodies that will cause blood with

certain proteins to clump (agglutination)
 There are over 30 common red blood cell antigens

 The most vigorous transfusion reactions are caused by ABO and Rh

blood group antigens
 ABO Blood Groups
 Based on the presence or
absence of two antigens
 Type A: The presence of
antigen A, has anti-B
antibodies
 Type B: The presence of
antigen B, has anti-A
antibodies
 Type O: lacks the presence of
any antigens, has anti-A &
anti-B antibodies
 Type AB: the presence of
antigen A & antigen B, has no
antibodies
 ABO Blood Groups

 Blood type AB can

receive A, B, AB, and
O blood
 Universal recipient

 Blood type B can

receive B and O blood
 Blood type A can
receive A and O blood
 Blood type O can
receive O blood
 Universal donor
 Rh Blood Groups

 Named because of the presence or absence of one

of eight Rh antigens (agglutinogen D) that was
originally defined in Rhesus monkeys
 Most Americans are Rh+ (Rh positive)

 Problems can occur in mixing Rh+ blood into a body

with Rh– (Rh negative) blood
 Dangers of an Rh mismatch
 Danger occurs only when the mother is Rh– and the father is Rh+,
and the child inherits the Rh+ factor
 RhoGAM shot can prevent buildup of
anti-Rh+ antibodies in mother’s blood
 The mismatch of an Rh– mother carrying an Rh+ baby can cause
problems for the unborn child
 The first pregnancy usually proceeds without problems
 The immune system is sensitized after the first pregnancy
 In a second pregnancy, the mother’s immune system produces
antibodies to attack the Rh+ blood (hemolytic disease of the newborn)
 Blood typing
 Blood samples are mixed with
anti-A and anti-B serum
 Agglutination or no
agglutination leads to
determining blood type
 Typing for ABO and Rh factors
is done in the same manner
 Cross matching—testing for
agglutination of donor RBCs by
the recipient’s serum, and vice
versa
 Developmental Aspects of Blood

 Sites of blood cell formation

 The fetal liver and spleen are early sites of blood cell formation
 Bone marrow takes over hematopoiesis by the seventh month

 Fetal hemoglobin differs from hemoglobin produced after birth

 It can carry much more oxygen than adult hemoglobin
 By 12 weeks of life, fetal hemoglobin is replaced by adult hemoglobin

 Physiologic jaundice results in infants in which the liver cannot rid

the body of hemoglobin breakdown products fast enough