Blood
• Blood is composed of cells.
• The cells normally constitute 45% of the blood volume and include erythrocytes,
leukocytes, and platelets or thrombocytes.
• The remaining 55% of blood is plasma, a solution of water, proteins, sugar, hormones,
lipids, and vitamin.
Plasma – clear, straw-colored liquid
Hematopoietic Stem Cell –
• an immature cell that can develop into all types of blood cells, including WBC’s, RBC’s,
and platelets.
Erythrocytes (Red Blood Cells):
• RBC’s matures from erythroblast to erythrocyte.
• RBC’s contain hemoglobin (enables to carry oxygen) – heme (iron-containing pigment)
and globin (protein)
• Hemoglobin + oxygen = oxyhemoglobin – produces bright red color of blood.
• There are about 4 to 6 million per microliter of blood.
• Lifespan of RBC’s – 120 days.
Erythropoietin (secreted by kidneys) –
• stimulates the red blood cell formation.
Hemolysis:
• destruction or breakdown of blood (red blood cells).
Leukocytes (White Blood Cells)
• 7000 to 9000 cells per microliter of blood
• 3 polymorphonuclear granulocytic leukocytes (neutrophil, eosinophil, and basophil)
• 2 mononuclear agranulocytic leukocytes (lymphocyte and monocyte)
Basophil:
• it contains granules that stain dark blue with a basic dye.
• These granules contain heparin (anticlotting substance) and histamine (chemical
released in allergic responses).
• Percentage of basophils in blood is 0-1%.
• It responds to allergens.
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Eosinophil:
• it contains granules that stain with eosin, a red acidic dye.
• These granules increase in allergic responses and engulf substances that trigger the
allergies.
• Percentage of eosinophils in blood is 1-4%.
• It responds to parasitic infections and is a phagocyte in allergic reactions.
Neutrophil:
• It contains granules that are neutral.
• They do not stain intensely and show only a pale color.
• These are phagocytes that accumulate at sites of infection, where they ingest and
destroy bacteria.
• Percentage of neutrophils in blood is 50-70%.
• It plays major role in fighting bacterial infection.
Lymphocytes:
• Play an important role in immune response that protects the body against infection.
• They can directly attack foreign matter and in addition, make antibodies that neutralize
and can lead to the destruction of foreign antigens.
• Percentage of Lymphocytes in blood is 20-30%.
Monocytes:
• these are phagocytic cells that also fight disease.
• As macrophages, thy move from the bloodstream into tissues and dispose of dead and
dying cells and other tissue debris by phagocytosis.
• Percentage of monocyte in blood is 3-8%.
Platelets (thrombocytes):
• Main function of platelets is to help blood to clot.
Plasma:
• liquid part of blood.
• 4 major plasma proteins – Albumin, Globulins, Fibrinogen, and Prothrombin.
Albumin:
• It maintains the proper proportion of water in the blood.
Globulins:
• there are alpha, beta, and gamma globulins.
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• The gamma globulins are immunoglobulins.
• IgG (found in high concentration in plasma) and IgA (found in breast milk, tears, saliva,
and respiratory mucus)
• IgM, IgD, and IgE – other immunoglobulins.
Electrophoresis:
• method of separating serum proteins by electrical charges.
Plasmapheresis:
• Separating plasma from cells and then removing the plasma from the patient.
Blood Types and Blood Clotting
Blood Types:
• 4 main blood types: A, AB, B, O
Whole blood (cells and plasma)
• These types are based on antigen on red blood cells and antibodies found in each
person’s serum.
Serum –
• formed from plasma, but does not contain protein-coagulating factors.
• Plasma minus clotting proteins and cells.
Type Red cell antigen Serum Antibodies
A A Anti-B
B B Anti-A
AB A&B -
O - Anti-A & Anti-B
Universal donor – Type O blood
Universal recipient – Type AB blood.
DIC (Disseminated Intravascular Coagulation)
• Excessive clotting in blood vessels –
Rh factor –
• antigen – located on the surface of red blood cells.
• Rhesus monkey
• Rh+ ----- Rh antigen
• Rh- ------ No antigen
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Example:
A+ (positive) ----- A and Rh antigens
A-(negative) ------- A antigen No Rh Antigen
Blood Clotting or Coagulation
Fibrinogen
• Gen – giving rise to
Platelets, in combination with tissue and clotting factors, plus calcium, prothrombin,
thrombin, fibrinogen is converted to fibrin to form a clot.
Clotting factor VIII – antihemophilic factor
Heparin – anticoagulant – produced by tissue cells especially in liver.
Terminology
Coagulo – clotting Thrombo – clot
Cyto – cell Penia – deficiency
Erythro – red Apheresis – removal, carrying away
Blast – immature Cytosis – abnormal condition of cells
Hemo – blood Emia – blood condition
Iso – equal, same Gen – giving rise to or producing
Leuko – white Osis – abnormal condition
Morpho – shape Philia – attraction for (an increase in cell
numbers)
Myelo – bone marrow
Phoresis – carrying, transmission
Phago – eat, swallow
Poiesis – formation
Sidero – iron
Stasis – stop, control
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Pathology of Blood System
Dyscrasia – any abnormal or pathologic condition of the blood.
Diseases of Red Blood Cells:
Anemia –
• Deficiency in erythrocytes or hemoglobin.
• Most common type of anemia – iron deficiency anemia – lack of iron.
Abnormalities of red blood cell morphology:
• Anisocytosis – cells are unequal in size
• Hypochromia – cells have reduced color (less hemoglobin)
• Macrocytosis – cells are large
• Microcytosis – cells are small
• Poikilocytosis – cells are irregularly shaped
• Spherocytosis – cells are rounded
Type of Anaemia
1. Aplastic anemia – Failure of blood cell production in the bone marrow.
2. Hemolytic anemia – Reduction in red cells due to excessive destruction
Eg: congenital spherocytic anemia (hereditary spherocytosis)
3. Perinicious anemia – lack of mature erythrocytes caused by inability to absorb vitamin
B12 into the bloodstream.
Intrinsic factor – normally found in gastric juice.
4. Sickle cell anemia – hereditary disorder of abnormal hemoglobin producing sickle-
shaped erythrocytes and hemolysis.
• It leads to thrombosis and infarction (local tissue death from ischemia)
• Signs and symptoms – arthralgia (joint stiffness), acute attacks of abdominal
pain, and ulcerations of extremities.
5. Thalassemia – inherited defect in ability to produce hemoglobin leading to
hypochromia.
Hemochromatosis – Excess iron deposits throughout the body.
Polycythemia vera – general increase in red blood cells (erythremia).
Disorders of Blood Clotting:
Hemophilia –
▪ Excessive bleeding caused by hereditary lack of blood clotting factors (factor
VIII or IX) necessary for blood clotting.
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Purpura –
▪ Multiple pinpoint hemorrhages and accumulation of blood under the skin. Red-
purple discoloration of the skin.
Petechiae –
▪ tiny purple or red flat spots.
Ecchymoses –
▪ large blue or purplish patches on the skin.
Autoimmune thrombocytopenic purpura –
▪ this is a condition in which a patient makes an antibody that destroys platelets.
Diseases of White Blood Cells:
a. Leukemia – increase in cancerous white blood cells.
1. Acute myelogenous (myelocytic) leukemia (AML):
▪ is a type of cancer in which bone marrow makes a large number of abnormal
blood cells.
▪ Immature granulocytes (myeloblasts) predominate.
2. Acute lymphocytic leukemia (ALL):
▪ is a caner of blood and bone marrow.
▪ It affects white blood cells which your body needs to fight infection.
▪ Immature lymphocytes (lymphoblasts) predominate.
3. Chronic myelogenous (myelocytic) leukemia (CML):
▪ slowly progressing blood and bone marrow disease that usually occurs
during or after middle age and rarely occurs in children.
▪ Both mature and immature granulocytes are present in large numbers in
marrow and blood.
4. Chronic lymphocytic leukemia (CLL):
▪ most common type of leukemia in adults.
▪ Abnormal numbers of relatively mature lymphocytes predominate in bone
marrow, lymph nodes, and spleen.
Remission – disappearance of signs and symptoms.
Relapse – when disease symptoms reappear.
b. Granulocytosis:
• abnormal increase in granulocytes in the blood.
c. Mononucleosis:
• infectious disease marked by increased number of mononuclear leukocytes
and enlarged cervical lymph nodes.
• EBV – Epstein-Barr virus
• Asthenia – weakness
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Diseases of Bone Marrow Cells
Multiple myeloma –
• malignant neoplasm of bone marrow.
• Bence Jones protein – immunoglobulin fragment found in the urine
• Thalidomide and velcade
Autologous bone marrow transplantation (ABMT) –
• in which the patient serves as his or her own donor for stem cells, may lead to
prolonged remission.
Laboratory Tests and Clinical Procedures
Laboratory tests
Antiglobulin test (Coombs test): Test for the presence of antibodies that coat and damage
erythrocytes.
Bleeding time: Time required for blood to stop flowing from a tiny puncture wound.
Coagulation test: Time required for venous blood to clot in a test tube.
Complete blood count (CBC): Determination of numbers of blood cells, hemoglobin
concentration, hematocrit, and red cell values – MCH, MCV, MCHC
MCV – mean corpuscular volume
MCH – mean corpuscular hemoglobin
MCHC – mean corpuscular hemoglobin concentration
Erythrocyte sedimentation rate (ESR): Speed at which erythrocytes settle out of plasma.
Hematocrit (Hct): Percentage of erythrocytes in a volume of blood.
Hemoglobin test: Total amount of hemoglobin in a sample of peripheral blood.
Platelet count: Number of platelets per cubic millimeter (mm3) or microliter of blood.
Prothrombin time (PT): Test of the ability of blood to clot. PTT (Partial thromboplastin time)
Red blood cell count (RBC): number of erythrocytes per mm3 or microliter of blood.
Red blood cell morphology: microscopic examination of a stained blood smear to determine
the shape of individual red cells.
White blood cell count (WBC): Number of leukocytes per cubic millimeter or microliter of
blood.
White blood cell differential: Percentage of different types of leukocytes in the blood.
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Clinical Procedures:
1. Apheresis: separation of blood into component parts and removal of a select portion
from the blood.
Eg: Leukapheresis, plateletpheresis, and plasmapheresis.
Plasma exchange: If plasma is removed from the patient and fresh plasma is given, the
procedure is known as plasma exchange.
2. Blood transfusion: Whole blood or cells are taken from a donor and infused into a
patient.
3. Bone marrow biopsy: Microscopic examination of a core of bone marrow removed
with a needle.
4. Hematopoietic stem cell transplantation: Peripheral stem cells from a compatible
donor are administered to a recipient.
Abbreviations
H and H – hemoglobin and hematocrit
HLA – human leukocyte antigen
WNL – within normal limits
MDS – myelodysplastic syndrome
Diff – differential count
ASCT – autologous stem cell transplantation
Ab – antibody
PT, pro time – prothrombin time
Sed rate – erythrocyte sedimentation rate
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