BLOOD

Plasma

 

Composition

of Blood

Formed elements

BLOOD FUNCTIONS

• TRASPORTATION OF OXYGEN, CARBON DIOXIDE, NUTRIENTS, HORMONES, HEAT AND WASTE.

• REGULATION OF pH, BODY TEMPERATURE & WATER CONTENT

• PROTECTION AGAINST DISEASE BY WHITE BLOOD CELLS & ANTIBODIES

BOOD VOLUMES

• RANGE OF BLOOD VOLUME IS 5 TO 6 LITERS

• MEDICAL TERMS:– NORMOVOLEMIC: NORMAL BLOOD VOLUME

– HYPOVOLEMIC: LOW BLOOD VOLUME

– HYPERVOLEMIC: HIGH BLOOD VOLUME

PHYSICAL CHARACTERISTICS

• MEAN TEMPERATURE: 38C (100.4F)

• VISCOSITY: PLASMA = 1.5 WHOLE BLOOD =

3

• MEAN pH: 7.35 to 7.45

PLASMA COLOR IS YELLOWISHCOMPOSITION91.5% WATER• 7% PROTEINS1.5% OTHER SOLUTES

PLASMA PROTEINS

• ALBUMIN – 54%

• GLOBULIN – 38%

• FIBRINOGEN – 7%

OTHER SOLUTES

• ELECTROLYTES

• NUTRIENTS

• ENZYMES

• HORMONES

• GASES

• WASTE PRODUCTS

FORMATION OF FORMED ELEMENTS

HEMOPOIESIS• IN RED BONE MARROW & LYMPH TISSUE• ALL BLOOD CELLS COME FROM

PLURIPOTENT STEM CELLS THAT BECOME MYELOID OR LYMPHOID STEM CELLS.

• LYMPHOID STEM CELLS PRODUCE THE WBC’s CALLED LYMPHOCYTES.

• MYELOID STEM CELLS PRODUCE ALL THE REST (RBC’s, PLATELTES & THE OTHER FOUR WBC’s)

RED BLOOD CELLS (RBC’s) (ERYTHOCYTES)

• NUMBER: MALE = 5.4 MILLIONS/ uL FEMALE = 4.8 MILLIONS/

Ul

• BICONCAVE DISCS, 7-8 um DIAMETER

• NO NUCLEUS

• EACH CONTAIN ONE HEMOGLOBIN MOLECULE, 4 HEME GROUPS AND 4 IRON IONS.

RBC’s FUNCTIONS

• HEMOGLOBIN TRANSPORT 97% OF OXYGEN.

• HEMOGLOBIN TRANSPORT 23% OF CARBON DIOXIDE

• HEMOGLOBIN PARTICIPATE IN THE REGULATION OF BLOOD FLOW BY RELEASING NITRIC OXIDE.

HEMOGLOBIN

• COMPOSED OF A PROTEIN PART CALLED GLOBIN AND FOUR IRON CONTAINING PARTS CALLED HEME.

• EACH HEME BIND ONE OXYGEN MOLECULE.

• HEMOGLOBIN BIND OXYGEN IN THE LUNGS AND RELEASE IT IN TISSUES.

HEMOGLOBIN MOLECULE

RBC’s FORMATION

• CALLED ERYTHROPOIESIS

• OCCUR IN RED BONE MARROW

• HEMOGLOBIN SYNTHESIS OCCUR DURING DEVELOPMENT.

• PROCEED THROUGH VARIOUS CELL STAGES AND TAKES ABOUT A WEEK.

RBC’s DEVELOPMENT

• MYELOID STEM CELLS

• PROERYTHROBLASTS

• RETICULOCYTES

• ERYTHROCYES

Requirements for RBC Formation

*IRON *AMINO ACIDS *VITAMIN B12– Supplied by diet and recycled from storage in

liver and spleen– Free iron is toxic, so must combine with

proteins to be stored or transported• Storage molecule is FERRITIN

• Transport molecule is TRANSFERRIN

STIMULATION OF RBC FORMATION• DECREASED RBCs NUMBER• ↓• TISSUE HYPOXIA• ↓• ERYTHROPOIETIN HORMONE • SECRETION BY THE KIDNEYS• ↓• BONE MARROW STIMULATION• ↓• PROERYTHROBLASTS → ERYTHROCYTES

Recycling of RBC’s

• RBC’s live for about 80 - 120 days• Death

– Hemolysis in blood– Liver and spleen phagocytes consume them

• Hemoglobin degraded to globin and heme– Amino acids of globin recycled– Heme split open releasing iron which is recycled– Heme → Biliverdin → Bilirubin in bile → urobilin in

urine or stercobilin in feces

RBCs RECYCLING

White Blood Cells or Leukocytes

• General functions: Protection by immune response or phagocytosis.

• Whole count: 5000 – 10,000 / uL

• Differential: Determining the percentage of each type of white blood cells.

WBC’s TYPES & FUNCTIONS

• GRANULAR: NEUTROPHILS, EOSINOPHILS AND BASOPHILS.

• FUNCTION FOR PHAGOCYTOSIS AND INFLAMMATORY RESPONSE.

• AGRANULAR: LYMPHOCYTES AND MONOCYTES.

• FUNCTION IN ANTIGEN-ANTIBODY REACTIONS & AS MACROPHAGES.

FORMATION OF WBC’s

• LOCATION – RED BONE MARROW FOR MONOCYTES,

NEUTROPHILS, BASOPHILS AND EOSINOPHILS.

– LYMPH TISSUE FOR LYMPHOCYTES.

DEVELOPMENTAL PATHWAYS

• Leukocytes– Myeloid stem cells myeloblasts and monoblasts

• Myeloblasts Neutrophils, Eosinophils and Basophils.

• Monoblasts Monocytes

– Lymphoid stem cells lymphoblasts• Lymphoblast lymphocytes

WBC Function Differential

NEUTROPHILS (POLYMORPHONUCLEOCYTE) (PMN)

PRIMARY PHAGOCYTES.

SEGMENTED NUCLEUS AND LAVENDER GRANULATER CYTOPLASM

LYMPHOCYTES B-CELLS & T-CELLS

IMMUNITY SPHERICAL NUCLEUS & BLUE CYTOPLASM

MONOCYTES TISSUE MACROPHAGES

KIDNEY-SHAPED OR OVAL NUCLEUS

EOSINOPHILS PHAGOCYTOSIS OF PARASITES AND ANTINFLAMMATORY

BILOBED NUCLEUS & RED GRANULES

BASOPHILS HISTAMINE & INFLAMMATION

BILOBED NUCLEUS & DARK GRANULES

Table of WBC’s Ranked by Differential

PLATELETS

• THROMBOPOIETIN: FROM THE LIVER• FUNCTIONS: BLOOD CLOTTING AND

PLATELTES PLUG FORMATION.• DEVELOPMENT: MYELOID STEM

CELL > MEGAKARYOPLAST > MEGAKARYOCYTE > FRAGMENT INTO PLATELETS.

• NUMBER: 150,000 – 400,000 / uL

HEMOSTASIS

RESPONSES THAT STOP BLEEDING

(1) VASCULAR SPASM: CONTRACTION OF THE INJURED BLOOD VESSEL SMOOTH MUSCLES TO REDUCE THE BLOOD VESSEL DIAMETER AND DECREASE LOSS OF BLOOD.

HEMOSTASIS

(2) Platelet plug formation• Platelet adhesion

______________________________________________

• Platelet release reaction ______________________________________________

• Platelet aggregation ______________________________________________

HEMOSTASIS

(3) CLOT FORMATION:

• Clot closes the broken blood vessel.

• Clot consists of a gel of fibrin and trapped formed blood elements.

• When gel separates from liquid, remaining fluid is called serum.

• Clotting process is called coagulation.

• Blood clotting occurs in three stages– Stage 1.

– Stage 2.

– Stage 3.

Formation of Prothrombinase

Formation of Thrombin

Formation of Fibrin plug (clot)

• Formation of prothrombinase involves two pathways– Intrinsic pathway results from blood trauma

• Damaged vessel• Damaged platelets• Slowest

– Extrinsic pathway results from tissue trauma• Damage of cells outside blood• Fastest

– Both pathways occur during normal clotting and produce Prothrombinase.

Basic Steps in Blood Clotting

Extrinsic Pathway Involves Tissue Trauma and Clotting Factors

Intrinsic Pathway Involves Blood Trauma and Clotting Factors

Prothrombinase

Ca2+Ca2+

Prothrombin Thrombin

Fibrinogen Fibrin (clot)Thrombin

Ca2+

CLOT DISSOLVING• As repair of a cut or damaged vessel proceeds, a

series of enzyme catalyzed reactions called ___________ slowly dissolves the clot

• An enzyme called _______________________ catalyzes the conversion of inactive enzyme ___________ to active_________

• Active enzyme catalyzes the dissolving of clot

fibrinolysistissue plasminogen activator

plasminogen plasmin

CLOT DISSOLVING

Plaminogen PlasminTissue plasminogen activator

INTRAVASCULAR CLOT

• Intravascular clot – clot within closed vessel• Damaged vessel lining or slowing of blood flow• Platelets aggregate and release clotting factors• Resulting clot called a _________• Moving piece of the clot is an ________• Clot moves downstream and blocks smaller vessel

_________• May cut off blood supply to organ

thrombus

embolus

embolism

ANTICOAGULANTS

• Chemicals that decrease or prevent blood clotting are called ____________

• Heparin is administered medically and it occurs naturally in our bodies. It works by decreasing thrombin production

• Coumadin (warfarin) is effective as a long-term anticoagulant. It is an antagonist of vitamin K.

• EDTA and CPD are used in blood banks to keep the donated blood from clotting. They both work by tying-up and removing calcium.

anticoagulants

BLOOD TYPES

• ABO and Rh

• Antigens (glycoproteins and glycolipids) called ____________ on surface of RBC’S determine blood types.

• Blood types are inherited

• The greatest concern with blood types involves ___________

agglutinogens

transfusions

• During a transfusion, the person giving the blood is a ______, the person getting the blood is a ________

• The immune system may develop antibodies called __________ against certain agglutinogens. These agglutinins float in the plasma.

donorrecipient

agglutinins

• If RBC’s of a donor are incompatible with the

blood of a recipient, agglutinins in the plasma of the recipient will bind to the agglutinogens of the

donated RBC’s. This reaction will ______ (_________) and destroy (cause hemolysis of) the donated RBC’s, causing a serious and possibly fatal reaction.

clumpagglutinate

ABO BLOOD TYPES

ABO Type Antigen on RBC’s

Antibodiesin Plasma

Acceptable

Transfusion

Donate to

Receive from

Donate to

Receive from

Donate to

Receive from

Donate to

Receive from

A

B

AB

Neither

A

B

A&B

Anti-B

Anti-A

Neither

BothO

A & AB

A&O

B&AB

B&O

O

A,B,AB&O

only O

only AB

Rh blood type and hemolytic disease of

the newborn • Rh blood type is determined by presence of

absence of Rh _____________ (________) on the surface of RBC’s

• If Rh agglutinogens are present, the type is Rh . If no agglutinogens are present, the type is Rh .

agglutinogens antigens

+

-

• People with Rh- type lack anti-Rh agglutinins (antibodies), but if they receive Rh+ blood, their immune systems will be stimulated to produce them, and they are then _________. Future exposure to Rh+ blood will cause a dangerous blood reaction.

sensitized

Hemolytic Disease of the Newborn

(HDN) • Results from Rh incompatibility between

___ mother and her ____child

• If Rh+ RBC’s of first born child enter mother’s circulation, mother will be __________, and her plasma will carry anti-Rh agglutinins (antibodies)

Rh- Rh+

sensitized

• The first child is not harmed, but the mother’s ____________, acquired by exposure to the first child’s blood, easily pass across the placenta where they ___________and destroy the second child’s RBC’s.

agglutinins

agglutinate

Hemolytic Disease of the Newborn

CLINICAL TERMS

• Polycythemia: High RBC’s number.

• Anemia: Low RBC’s number.

• Leukemias: High WBC’s number diseases.

• Leukopenia: Low WBC’s number.

Clinical Terms Continued• Leukocytosis: High WBC’s number.

• Hemophilia: Lack of blood coagulation.

• Thrombocytopenia: Low platelets number.

• Sickle cell disease: Abnormal RBC’s form

• Jaundice: bilirubin leak in the blood.