BLOOD

 Define Blood give its Composition and general functions of blood

 Name Plasma proteins where they are produced? Give their function
 Erythropoiesis and red blood cell function
 Define hemoglobin . What are its type. Give their function. What ill be sign and symptoms of anemia?
 Iron absorption storage and metabolism
 What are blood indices. Give their importance
 Function, production and type of white blood cells
 Function and production of platelets
 Clotting mechanism of blood
 Define blood groups. Give its different types and significance of knowing the blood group.name different
transfusion reaction occurring due to ABO and Rh incompatibility.
 Complications of blood transfusion
 Components of reticuloendothelial systems, gross and microscopic structure including tonsil, lymph node
and spleen
 Development and function of reticuloendothelial system
BLOOD
 BLOOD

SPECIALIZED CONNECTIVE TISSUE

Connective tissue Blood

Connects two tissue Connects many tissue
Mesodermal origin Mesodermal
Fluid and cells Fluid and cells
Fluid is matrix Fluid is plasma
Cells specific Three types
Highly viscose Low viscosity
Confined area Moves in vessels
Solid fibers Dissolved fibers
COMPOSITION OF BLOOD
COMPOSITION OF BLOOD
Anticoagulated blood – plasma

When clot is removed from clotted blood fluid found is called serum
It is plasma excluding fibrinogen and clotting factors II, V. VIII
Has higher serotonin from platelets
COMPOSITION OF BLOOD
5 – 8 % of total body weight of 70 kg adult male 25 years age
450 ml at birth – 3.5 – 6 liters adult
Opaque and red

 viscosity 5 times to that of water

 Specific gravity – 1.050 – 1.060

pH – 7.38 – 7.45

45 – 50 % cellular components – formed elements / hematocrit/ PCV (Packed cell

volume)
 FUNCTIONS OF BLOOD

Regulation of pH
Help regulation of ECF volume
Blood pressure
Temperature
Transportation Nutrients ;Waste products ; Hormones ;Respiratory gases
Defense Blood loss – hemostasis
Foreign invaders/ harmful substances
Synthesis of Plasma Proteins
 In Embryo By Mesenchymal Cells
 In Adults Albumin And Fibrinogen By Liver
 Alpha And Beta Globulins By Liver, Spleen And Bone Marrow
 Gama Globulins By B-lymphocytes
 PLASMA PROTEINS

Functions of plasma proteins

Osmotic pressures – 25 – 32 mm Hg

pH buffering – 15% of the buffering capacity of the blood (COOH and NH2 groups)

Hemostasis – Clotting factors

Defense – Complement system ; antibodies

Carriage – “Hormones” “Metals” “Ions” “Amino Acids” “Fatty Acids” Bilirubin”

Tool for genetic information

CELLULAR COMPONENT

HEMATOPOEISIS
 HEMATOPOIESIS

BUFFY COAT
THROMBOCYTE – PLATELETS
150,000 – 450,000 CELLS/ 100 ml
LEUKOCYTES – WHITE BLOOD CELLS
4000 – 11000 CELLS / 100 ml

ERYTHROCYTES – RED BLOOD CELLS

4 Millon TO 6 Million CELLS/ 100 ml

Formation of cellular components is called

HEMATOPOIEOSIS
 HEMATOPOIESIS
Sites of Development

First two month: Yolk sac – nucleated RBC

From third month: mainly liver some spleen; lymph nodes and thymus

In last month and after birth: bone marrow

Extramedullary Hematopoiesis – in adult -- In case of destruction of marrow

liver, spleen ; lymph node ; thymus

Red bone marrow – active
White bone marrow – infiltrated with fat
 HEMATOPOIESIS
EMBRYONIC
UNCOMMITTED
FROM BLASTOCYTES TOTIPOTENT STEM
SELF
CELLS
ADULT RENEWAL
UNCOMMITTED
PLURIPOTENT STEM
CELLS

COMMITTED STEM
CELLS COMMITTED STEM
(PROGENITOR) CELLS
DIFFERENTIATI
MGAKARYOCYTES (PROGENITOR)
ON
ERYTHROCYTES NEUTROPHILS
LYMPHOCYTES MONOCYTES
EOSINOPHILS
BASOPHILS
OSTEOCLAST ; KUPFFER CELLS; MAST CELLS ; DENTRITIC
CELLS; LANGERHAN CELLS
DERIVED FROM MONOCYTES
 HEMATOPOIESIS
Growth inducers
Interleukins
Differentiation inducers
Erythropoeitin
Thrombopoeitin
HEMATOPOIESIS
 ERYTHROCYTES

Red in appearance
Due to hemoglobin
Biconcave discs – round
Loss of nucleus – increase surface area to volume inside
Diameter (normal)Microcytic <7 – 8 μm (av. 7.8 μm)> macrocytic
Surface area 120 – 140 μm2
Thickness
periphery 2.5 μm
Center 1 μm
Volume 90 – 95 μm3
 ERYTHROCYTES
Pleuripotent stem cell

Proerythroblast

Early Normoblast
2 -4
Basophillic Erythroblast
(5)DAYS
Intermediate Normoblast
Polychromatic Erythroblast

Late Normoblast
Orthochromatic Erythroblast
Extrusion of
nucleus
Reticulocytes
2
days
Erythrocytes
 ERYTHROCYTES

ERYTHROCYTE (RED BLOOD CELL; RBC)

NORMAL COUNTS

AGE COUNT (RBC MILLIONS /μl)

New Born 4 – 4.9
1 month 3 – 4.3
Adult 4-6

LIFE
120 days
 ERYTHROCYTES
FUNCTIONS OF ERYTHROCYTES
 MAINTAIN VISCOSITY OF BLOOD
INCREASE AND DECREASE COUNT
 TRANSPORT OF RESPIRATORY GASES
Hb – OXYGEN CARBON DIOXIDE
 ACID BASE BALANCE
Hb & CARBONIC ANHYDRASE
 IDENTIFICATION OF BLOOD GROUPS
 ERYTHROCYTES

PHYSIOLOGICAL VARIATION

AGE
GENDER – male will have higher count
HIGH ALTITUDE – have higher count
EXERCISE – have higher count
EMOTIONAL CONDITIONS – have higher count FROM POOL
 ERYTHROCYTES
ERYTHROPOIESIS
FACTORS REQUIRED FOR ERYTHROPOIESIS

EXOGENOUS ENDOGENOUS

INTERLEUKINS
DIETARY
HORMONES
IRON
AMINO ACIDS ERYTHROPOIETIN

VITAMINS GROWTH HORMONE

C THYROID ; CORTISOL
B -12 ACTH (androgen)
FOLIC ACID
FACTORS – INTRINSIC ; HCl
 ERYTHROCYTES
ERYTHROPOIESIS

Factors Required For Erythropoiesis

Iron – The total iron in the body averages 4 to 5 gm

65 per cent in the form of hemoglobin
4 per cent is in the form of myoglobin,
1 per cent is in the form of various hemes
15 to 30 per cent is stored in the reticuloendothelial system, liver parenchymal cells – in
the form of ferritin.
 ERYTHROCYTES
ERYTHROPOIESIS
Absorption, Transport & Storage of Iron
Hepasti
n

Diavalent metal ferroprote

transporter in

Intake – 15 -20 mg/day Ferric Apotransferrin Transferrin

Mensturation1.3 mg/day
(β Globulin)
ABSORBED (0.5 -1 mg; 1-1.5 mg 3 – 6% Dietary)
Ferrous
By pinocytosis – According to need
HEMOGLOBIN
 HEMOGLOBIN

Red pigment
Metalloprotein
Conjugated protein
Respiratory pigment
 HEMOGLOBIN

 Begins in the proerythroblasts

Continues the reticulocyte stage in circulation for another day or so

 Hb Conc:

In adult males 14-18 gm/dl

In adult females 12-16 gm/dl
 Mol. Wt: 68,000
 HEMOGLOBIN
 TYPES OF Hb:
 Adult Hb

HbA1(α2 β2) HbA2(α2δ2) HbA1c

 Fetal Hb HbF (α2 γ2)

 Embryonic Gower -1 Hb (ζ2ε2) Gower -2 Hb (α2ε2 )

 Haemoglobinopathies:

HbS; HbC; Thalassemia

 HEMOGLOBIN
CATABOLISM
 HEMOGLOBIN
FUNCTIONS OF Hb

 Transports o2 from lung to tissues

 1 gm Hb CARRIES 1.34 ml of O2

 Transports Co2 from tissues to lungs

 Control pH of blood

 2,3-DPG and H+ compete with O2 for binding to deoxygenated

hemoglobin, decreasing the affinity of hemoglobin for O2

 ERYTHROCYTES

Polycythemia
Increased in mature RBC count
Classification
Primary – Tumor of bone marrow
7-8 Millions
Polycythemia Vera
Secondary – Chronic Hypoxia
6-7 Million
Physiological – high altitude
Pathological – lung diseases
Relative – secondary to dehydration
 ANEMIA

Decrease RBC Count or decreased Hb levels below normal

RBC count below 4 Million /mm3
Hb below 10 gm/ dl
Symptoms
Dyspnea
Fatigue
Sign
Pallor skin
 HEMOGLOBIN
Classification of Anemia
Etiology
 Decreased production
RBC – Microcytic
Hb – Dietary – Hypochromic
Genetic
Aplastic anemia – x – ray; drugs
 Increased destruction
Enzyme deficiency
Autoimmunity
Incompatibility of blood
Groups
Hemoglobinopathies
 Increased loss – Acute &
 ANEMIA

Morphological Classification of anemia

Color – hypochromic
Size – microcytic / macrocytic/ megaloblastic
Normocytic normochromic
On the basis of Color Indices Microcytic hypochromic
Macrocytic hypochromic

Mean Corpuscular volume 80 – 100μm3 : 80 – 100 fl

25 – 36 ρg/Cell :
0.39 – 0.54 fmol/ Cell
Mean Corpuscular Hb .
31 – 36 %:
Mean Corpuscular Hb Conc.
4.81 – 5.58 mmol Hb/ L
 LEUCOCYTES

TOTAL – 4000 – 11000 cell/ mm3 IN ADULTS

At birth – 9000 – 30000 cells/ mm3
10 % in circulation (50 % in margination)
90 % in bone marrow (store 6 – day)
The percentage of neutrophils – high for the first few weeks of life then
Lymphocyte predominance until about 8 years of age
Lymphocytes predominant In the elderly with slight decreased TLC
 LEUCOCYTES

Differential leukocyte count (DLC)

Classification of WBC on the basis of staining characteristics and appearance of nucleus

– Leishman stain

Two groups

Granulocytes

Agranulocytes
 LEUCOCYTES
WHITE BLOOD CELLS OR LEUKOCYTES

GRANULOCYTES
Eosinophils – picking acidic dye
Basophils – picking basic dye
Neutrophils – picking both dyes equally
AGRANULOCYTES
Lymphocytes
Monocytes
 LEUCOCYTES
DEVELOPMENT OF LEUKOCYTES

Lymphogenic
Thymus
Lymph nodes
Spleen
Bone marrow Tonsils
Peyer’s patch
 LEUCOCYTES
Myeloid series – 12 days

1: Myeloblast
2: Promyelocyte
4: Myelocyte – Neutrophil myelocyte
– Eosinophil myelocyte
– Basophil myelocyte
5: Metamyelocyte – Neutrophil metamyelocyte
– Eosinophil metamyelocyte
– Basophil metamyelocyte

6: Band – Neutrophil
– Eosinophil
– Basophil
7: Polymorphonuclear – Neutrophil
– Eosinophil
LEUCOCYTES
 LEUCOCYTES

DIFFERENTIAL LEUCOCYTES
Basophils a – < 1 %
Eosinophils – 1 – 5 %
Neutrophils – 40 – 75 %
Monocytes – 3 – 9 %
Lymphocytes – 20 – 40
 LEUCOCYTES
INCREASED COUNT - LEUKOCYTOSIS
PHYSIOLOGICAL
Age
Exercise
Pregnancy – predominant neutrophil
Tension
PATHOLOGICAL
Infections
Burn
Leukemia
Leukomoid reaction – measles, pertussis and sepsis
 LEUCOCYTES

LEUCOPENIA – Decreased count – less than 4000

DECREASE PRODUCTION
Radiations
Chemotherapy
INFECTIONS – Overwhelming infection
Typhoid
VIRAL INFECTION
BONE MARROW DISORDERS – Myelofibrosis
Metastasis
Drugs
Functions of leukocytes (WBC)

Defense against harmful substances by phagocytosis , inflammation , production of

antibodies, neutralization of chemicals, killing of bacteria
Secretion of different cytokines for growth and development of other cells
 PLATELETS

Bone marrow
Thrombopoietin – secreted by liver &kidney
5000 – 10000 / megakaryocyte
Destroyed in spleen & liver
 PLATELETS
Varying in shape
150,000-450,000/mm3
Half life: 8-12 days in blood

Functions of platelets
Prevent haemostasias
Promote clot formation
Promote clot retraction
Promote repair of injured vessel – secretion of growth factor
Promote transport and release of 5-HT
 Hemostasis
Hemostasis – prevention of blood loss from blood vessel or maintenance of blood within
 Vasoconstriction
blood vessel
 Platelet Aggregation
 Clot formation
 Retraction of clot
 Repair of vessel
 Hemostasis

Loss of Fluidity Is Called Coagulation – results in clot formation

Begins 15 – 20 Seconds Sever Trauma
1 – 2 Minutes Minor Trauma
Result of Balance Between More Than 50 Factors
Procoagulants – Inactive Serine Proteases
Anticoagulants – Physical factors
Chemical factors
In Normal Conditions Anticoagulants Dominate
 Hemostasis

Three Steps of Coagulation

Formation of prothrombin activator
Requires Activation of Procoagulants – prothrombin activator convert
prothrombin to Prothrombin
Formation of clot
Conversion of Soluble Fibrinogen into Insoluble Fibrin by Thrombin
Two mechanisms/ Pathway
Extrinsic Pathway
Intrinsic Pathway
Consolidation of clot
Requires Fibrin Stabilizing Factor and Calcium Ion
 Hemostasis
CLOTTING FACTORS
I Fibrogen
II Prothrombin
III Thromboplastin
IV Calcium
V Proaccelerin, labile factor, accelerator globulin
VII Proconvertin, SPCA, stable factor
VIII Antihemophilic factor (AHF), antihemophilic factor A,
antihemophilic globulin (AHG)
IX Plasma thromboplastic component (PTC), Christmas
factor, antihemophilic factor B
X Stuart-Prower factor
XI Plasma thromboplastin antecedent (PTA), antihemophilic
factor C
XII Hageman factor, glass factor
XIII Fibrin-stabilizing factor, Laki-Lorand factor
HMW-K High-molecular-weight kininogen, Fitzgerald factor
Pre-Ka Prekallikrein, Fletcher factor
Ka Kallikrein
PL Platelet phospholipid
Hemostasis
 Hemostasis

Abnormalities of hemostasis

Purpura – bleeding under skin with or without minor trauma due to decrease or non
functional platelets result in increase bleeding time
Hemophilia – inability of blood to form clot due to decrease concentration of
clotting factor VIII, IX and X resulting in increase in clotting time
 Blood groups

Blood groups
Genetically determined antigenic characteristic on RBC and other cells

Landsteiner law
Genotype Phenotype Agglutinogen Agglutinin
OO (47%) O – Anti A & Anti B
OA/AA (41%) A A Anti B
OB/BB(09%) B B Anti A
AB(03%) AB AB –
 Blood groups

SIGNIFICANCE OF BLOOD GROUPS

PREVENTION

Blood Transfusion Reactions

Erythroblastosis Fetalis

Transplant Rejection

IDENTIFICATION

Paternity
 Blood groups

MORE THAN 30 BLOOD GROUP SYSTEMS

 ABO System Rh System

 MNS Kidd

 Duffy Bombay

 Lewi’s Lutheran

 Kell Deigo

 Xg

Each Expressed By their Specific Genes

 Blood groups

BLOOD GROUP – 500 billion phenotypes

UNIVERSAL – ABO & Rh System ;

PRIVATE – Bombay ; Kidd ; Duffy

Formed By Addition of A Specific Carbohydrate or Change In Amino Acids to ‘H’ Antigen

 Blood groups

TRANSFUSION REACTIONS

Reaction due to
Faulty technique
Contamination
Mismatch of blood groups
 Blood groups

Signs of hemolysis due to mismatched blood groups

Pain & Heat Along the Vein,
Facial Flushing,
Rigor,
Pain In Loins,
Hypotension,
Oliguria,
Acute Renal Failure
Death
 Reticuloendothelial system
(Monocyte – Macrophage system)

Reticuloendothelial system (monocyte – macrophage system)

It is the combination of
Monocytes
Mobile macrophages
Fixed tissue macrophages
Specialized endothelial cells in the bone marrow
spleen,
lymph nodes
 Reticuloendothelial system
(Monocyte – Macrophage system)
 Reticuloendothelial system
(Monocyte – Macrophage system)

Monocytes/ Macrophage
Monocytes are immature cell when activated by harmful substance get matured and
called Macrophage.
Monocytes – 10 – 20 μm in dia with half life of 10 to 20 Hrs In the blood
Macrophages are of two types
Wandering
Fixed – months to years or until perform its function
Alveolar macrophage : Kupffer cell of liver
Histocyte of skin : Dendritic cells of spleen
Monocytes/ Macrophage
Functions
Killing of bacteria
Antigen recognition
Antigen presentation to immune cells
Secretion of cytokines
Removed dead cell
Digest foreign material and regression material of body