1/7/2020 Blood Anatomy and Physiology: Study Guide for Nurses

Blood Anatomy and Physiology

By Marianne Belleza, R.N. - August 16, 2017

Blood is the “river of life” that surges within us. It transports everything that must be carried
from one place to another within the body- nutrients, wastes (headed for elimination from
the body) and body heat through blood vessels. Long before modern medicine, blood was
viewed as magical, because when it drained from the body, life departed as well.

1. Functions of the Blood

2. Components of Blood
2.1. Physical Characteristics and Volume
2.2. Plasma
3. Formed Elements
3.1. Erythrocytes
3.2. Leukocytes
3.3. Hematopoiesis
3.4. Formation of Red Blood Cells
3.5. Formation of White Blood Cells and Platelets
4. Hemostasis
5. Blood Groups and Transfusions
5.1. Human Blood Groups
5.2. Blood Typing

Functions of the Blood

Blood is unique; it is the only uid tissue in the body.

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1. Carrier of gases, nutrients, and waste products. Oxygen enters blood in the lungs
and is transported to cells. Carbon dioxide, produced by cells, is transported in the
blood to the lungs, from which it is expelled. Ingested nutrients, ions, and water are
carried by the blood from the digestive tract to cells, and the waste products of the cells
are moved to the kidneys for elimination.
2. Clot formation. Clotting proteins help stem blood loss when a blood vessel is injured.
3. Transport of processed molecules. Most substances are produced in one part of the
body and transported in the blood to another part.
4. Protection against foreign substances. Antibodies help protect the body from
pathogens.
5. Transport of regulatory molecules. Various hormones and enzymes that regulate
body processes are carried from one part of the body to another within the blood.
6. Maintenance of body temperature. Warm blood is transported from the inside to
the surface of the body, where heat is released from the blood.
7. pH and osmosis regulation. Albumin is also an important blood bu er and
contributes to the osmotic pressure of blood, which acts to keep water in the blood
stream.

Components of Blood
Essentially, blood is a complex connective tissue in which living blood cells, the formed
elements, are suspended.

Physical Characteristics and Volume

Blood is a sticky, opaque uid with a characteristic metallic taste.

Color. Depending on the amount of oxygen it is carrying, the color of blood varies
from scarlet (oxygen-rich) to a dull red (oxygen-poor).

Weight. Blood is heavier than water and about ve times thicker, or more viscous,
largely because of its formed elements.

pH. Blood is slightly alkaline, with a pH between 7.35 and 7.45.

Temperature. Its temperature (38 degrees Celsius, or 100.4 degrees Fahrenheit) is

always slightly higher than body temperature.

Plasma

Plasma, which is approximately 90 percent water, is the liquid part of the blood.

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Fresh Frozen Plasma

Dissolved substances. Examples of dissolved substances include nutrients, salts

(electrolytes), respiratory gases, hormones, plasma proteins, and various wastes and
products of cell metabolism.

Plasma proteins. Plasma proteins are the most abundant solutes in plasma; except
for antibodies and protein-based hormones, most plasma proteins are made by the
liver.

Composition. The composition of plasma varies continuously as cells remove or add

substances to the blood; assuming a healthy diet, however, the composition of
plasma is kept relatively constant by various homeostatic mechanisms of the body.

Formed Elements
If you observe a stained smear of human blood under a light microscope, you will see
disc-shaped red blood cells, a variety of gaudily stained spherical white blood cells, and
some scattered platelets that look like debris.

Erythrocytes

Erythrocytes, or red blood cells, function primarily to ferry oxygen in blood to all cells of
the body.

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Anucleate. RBCs di er from other blood cells because they are anucleate, that is,
they lack a nucleus; they also contain a very few organelles.

Hemoglobin. Hemoglobin, an iron bearing protein, transports the bulk of oxygen

that is carried in the blood.

Microscopic appearance. Erythrocytes are small, exible cells shaped like biconcave
discs- attened discs with depressed centers on both sides; they look like miniature
doughnuts when viewed with a microscope.

Number of RBCs. There are normally about 5 million cells per cubic millimeter of
blood; RBCs outnumber WBCs by about 1000 to 1 and are the major factor
contributing to blood viscosity.

Normal blood. Clinically, normal blood contains 12-18 grams of hemoglobin per 100
milliliters (ml); the hemoglobin content is slightly higher in men (13-18 g/dl) than in
women (12-16 g/dl).

Leukocytes

Although leukocytes, or white blood cells, are far less numerous than red blood cells,
they are crucial to body defense against disease.

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Number of WBCs. On average, there are 4,000 to 11,000 WBC/mm3 , and they
account for less than 1 percent of total body volume.

Body defense. Leukocytes form a protective, movable army that helps defend the
body against damage by bacteria, viruses, parasites, and tumor cells.

Diapedesis. White blood cells are able to slip into and out of the blood vessels- a
process called diapedesis.

Positive chemotaxis. In addition, WBCs can locate areas of tissue damage and
infection in the body by responding to certain chemicals that di use from the
damaged cells; this capability is called positive chemotaxis.

Ameboid motion. Once they have “caught the scent”, the WBCs move through the
tissue spaces by ameboid motion (they form owing cytoplasmic extensions that help
move them along).

Leukocytosis. A total WBC count above 11, 000 cells/mm3 is referred to as

leukocytosis.

Leukopenia. The opposite condition, leukopenia, is an abnormally low WBC count.

Granulocytes. Granulocytes are granule-containing WBCs; they have lobed nuclei,

which typically consist of several rounded nuclear areas connected by thin strands of
nuclear material, and includes neutrophils, eosinophils, and basophils.

Neutrophils. Neutrophil are the most numerous of the WBCs; they have a multilobed
granules and very ne granules that respond to acidic and basic stains; neutrophils
are avid phagocytes at sites of acute infection, and are particularly partial to bacteria
and fungi.

Eosinophils. Eosinophils have blue red nucleus that resembles an old-fashioned

telephone receiver and sport coarse, lysosome-like, brick-red cytoplasmic granules;
their number increases rapidly during allergies and infections by parasitic worms or
entering via the skin.

Basophils. Basophils, the rarest of the WBCs, contain large, histamine-containing

granules that stain dark blue; histamine is an in ammatory chemical that makes
blood vessels leaky and attracts other WBCs to the in ammatory site.

Agranulocytes. The second group of WBCs, the agranulocytes, lack visible

cytoplasmic granules; their nuclei are closer to the norm- that is, they are spherical;
they are spherical, oval, or kidney-shaped; and they include lymphocytes and
monocytes.

Lymphocytes. Lymphocytes have a large, dark purple nucleus that occupies most of
the cell volume; they tend to take up residence in lymphatic tissues, where they play
an important role in the immune response.

Monocytes. Monocytes are the largest of the WBCs; when they migrate into the
tissues, they transform into macrophages with huge appetites; macrophages are very
important in ghting chronic infections.

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Platelets. Platelets are not cells in the strict sense; they are fragments of bizarre
multinucleate cells called megakaryocytes, which pinch o thousands of anucleate
platelet “pieces” that quickly seal themselves o from surrounding uids; platelets are
needed for the clotting process that occurs in plasma when blood vessels are
ruptured or broken.

Hematopoiesis

Blood cell formation, or hematopoiesis, occurs in red bone marrow, or myeloid tissue.

Hemocystoblast. All the formed elements arise from a common type of stem cell,
the hematocystoblast.

Descendants of hemocystoblasts. The hemocystoblast forms two types of

descendants- the lymphoid stem cell, which produces lymphocytes, and the
myeloid stem cell, which can produce all other classes of formed elements.

Formation of Red Blood Cells

Because they are anucleate, RBCs are unable to synthesize proteins, grow, or divide.

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Life span. As they age, RBCs become more rigid and begin to fragment, or fall apart,
in 100 to 120 days.

Lost RBCs. Lost cells are replaced more or less continuously by the division of
hemocystoblasts in the red bone marrow.

Immature RBCs. Developing RBCs divide many times and then begin synthesizing
huge amounts of hemoglobin.

Reticulocyte. Suddenly, when enough hemoglobin has been accumulated, the

nucleus and most organelles are ejected and the cell collapses inward; the result is
the young RBC, called a reticulocyte because it still contains some rough endoplasmic
reticulum (ER).

Mature erythrocytes. Within 2 days of release, they have rejected the remaining ER
and have become fully functioning erythrocytes; the entire developmental process
from hemocystoblast to mature RBC takes 3 to 5 days.

Erythropoietin. The rate of erythrocyte production is controlled by a hormone called

erythropoetin; normally a small amount of erythropoeitin circulates in the blood at all
times, and red blood cells are formed at a fairly constant rate.

Control of RBC production. An important point to remember is that it is not the

relative number of RBCS in the blood that controls RBC production; control is based
on their ability to transport enough oxygen to meet the body’s demands.

Formation of White Blood Cells and Platelets

Like erythrocyte production, the formation of leukocytes and platelets is stimulated by

hormones.

Colony stimulating factors and interleukins. These colony stimulating factors and
interleukins not only prompt red bone marrow to turn out leukocytes, but also
marshal up an army of WBCs to ward o attacks by enhancing the ability of mature
leukocytes to protect the body.

Thrombopoeitin. The hormone thrombopoeitin accelerates the production of

platelets, but little is known about how that process is regulated.

Hemostasis

The multistep process of hemostasis begins when a blood vessel is damaged and
connective tissue in the vessel wall is exposed to blood.

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Vascular spasms occur. The immediate response to blood vessel injury is

vasoconstriction, which causes that blood vessel to go into spasms; the spasms
narrow the blood vessel, decreasing blood loss until clotting can occur.

Platelet plug forms. Injury to the lining of vessels exposes collage bers; platelets
adhere to the damaged site and platelet plug forms.

Coagulation events occur. At the same time, the injured tissues are releasing tissue
factor (TF), a substance that plays an important role in clotting; PF3, a phospholipid
that coats the surfaces of the platelets, interacts with TF, vitamin K, and other blood
clotting factors; this prothrombin activator converts prothrombin, present in the
plasma, to thrombin, an enzyme; thrombin then joins soluble brinogen proteins
into long, hairlike molecules of insoluble brin, which forms the meshwork that traps
RBCs and forms the basis of the clot; within the hour, the clot begins to retract,
squeezing serum from the mass and pulling the ruptured edges of the blood vessel
closer together.

Blood Groups and Transfusions

As we have seen, blood is vital for transporting substances through the body; when
blood is lost, the blood vessels constrict and the bone marrow steps up blood cell
formation in an attempt to keep the circulation going.

Human Blood Groups

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Although whole blood transfusions can save lives, people have di erent blood groups,
and transfusing incompatible or mismatched blood can be fatal.

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Antigen. An antigen is a substance that the body recognizes as foreign; it stimulates

the immune system to release antibodies or use other means to mount a defense
against it.

Antibodies. One person’s RBC proteins will be recognized as foreign if transfused

into another person with di erent RBC antigens; the “recognizers” are antibodies
present in the plasma that attach to RBCs bearing surface antigens di erent from
those on the patient’s (blood recipient’s) RBCs.

Agglutination. Binding of the antibodies causes the foreign RBCs to clump, a

phenomenon called agglutination, which leads to the clogging of small blood vessels
throughout the body.

ABO blood groups. The ABO blood groups are based on which of two antigens, type
A or type B, a person inherits; absence of both antigens results in type O blood,
presence of both antigens leads to type AB, and the presence of either A or B antigen
yields type A or B blood.

Rh blood groups. The Rh blood groups are so named because one of the eight Rh
antigens (agglutinogen D) was originally identi ed in Rhesus monkeys; later the
same antigen was discovered in human beings; most Americans are Rh+ (Rh positive),
meaning that their RBCs carry the Rh antigen.

Anti-Rh antibodies. Unlike the antibodies of the ABO system, anti-Rh antibodies are
not automatically formed and present in the blood of Rh- (Rh-negative) individuals.

Hemolysis. Hemolysis (rupture of RBCs) does not occur with the rst transfusion
because it takes time for the body to react and start making antibodies.

Blood Typing

The importance of determining the blood group of both the donor and the recipient
before blood is transfused is glaringly obvious.

Blood typing of ABO blood groups. When serum containing anti-A or anti-B
antibodies is added to a blood sample diluted with saline, agglutination will occur
between the antibody and the corresponding antigen.

Cross matching. Cross matching involves testing for agglutination of donor RBCs by
the recipient’s serum and of the recipient’s RBCs by the donor serum;

Blood typing for Rh factors. Typing for the Rh factors is done in the same manner as
ABO blood typing.

Practice Quiz: Blood Anatomy and Physiology

Here’s a 10-item quiz about the study guide:

EXAM MODE
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In Exam Mode: All questions are shown but the results, answers, and rationales (if
any) will only be given after you’ve nished the quiz.

Practice Quiz: Blood Anatomy and Physiology

Start

PRACTICE MODE

Practice Mode: This is an interactive version of the Text Mode. All questions are
given in a single page and correct answers, rationales or explanations (if any) are
immediately shown after you have selected an answer. No time limit for this exam.

Practice Quiz: Blood Anatomy and Physiology

Start

TEXT MODE

Text Mode: All questions and answers are given on a single page for reading and
answering at your own pace. Be sure to grab a pen and paper to write down your
answers.

1. What is the normal pH of the blood?

A. 7.30–7.40
B. 7.35–7.45
C. 7.20–7.30
D. 7.45–7.55

1. Answer: B. 7.35–7.45

Option B: The normal blood pH is tightly regulated between 7.35 and 7.45.

2. The major component of plasma is:

A. Gases
B. Ions
C. Nutrients

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D. Proteins
E. Water

2. Answer: E. Water

Option E: Plasma is a pale yellow uid that consists of about 91% water; 7%
proteins; and 2% other substances, such as ions, nutrients, gases, and waste
products.

3. The most common formed elements in the blood are:

A. Albumins
B. Globulins
C. Leukocytes (white blood cells)
D. Erythrocytes (red blood cells)
E. Thrombocytes (platelets)

3. Answer: D. Erythrocytes (red blood cells)

Option D: About 95% of the volume of the formed elements consists of red
blood cells (RBCs), or erythrocytes. The remaining 5% of the volume of the
formed elements consists of white blood cells (WBCs), or leukocytes, and cell
fragments called platelets, or thrombocytes.

4. Hematopoiesis is:

A. a serious medical condition that most commonly results from maternal-fetal

blood type (Rh factor) incompatibility
B. an abnormally high absorption of iron by the intestinal tract, resulting in
excessive storage of iron, particularly in the liver, skin, pancreas, heart, joints, and
testes
C. the process of blood cell production or the formation of blood cellular
components
D. the presence of megakaryocytes in the blood or of excessive numbers in the
bone marrow
E. a disorder in which the body produces too many platelets (thrombocytes), which
play an important role in blood clotting

4. Answer: C. the process of blood cell production or the formation of blood

cellular components

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Option C: Hematopoiesis is the process of blood cell production or the

formation of blood cellular components.

Option A: Erythroblastosis fetalis is a serious medical condition that most

commonly results from maternal-fetal blood type (Rh factor) incompatibility.

Option B: Hemochromatosis is an inherited disorder characterized by

abnormally high absorption of iron by the intestinal tract, resulting in excessive
storage of iron, particularly in the liver, skin, pancreas, heart, joints, and testes.

Option D: Megakaryocytosis is the presence of megakaryocytes in the blood or

of excessive numbers in the bone marrow.

Option E: Thrombocytosis is a disorder in which the body produces too many

platelets (thrombocytes), which play an important role in blood clotting.

5. Each hemoglobin molecule:

A. contains 1 iron atom.

B. contains red-pigmented globin molecules.
C. consists of 4 protein chains and 4 heme groups.
D. can carry 1 oxygen molecule.
E. is bluish in color when bound to oxygen

5. Answer: C. consists of 4 protein chains and 4 heme groups.

Option C: Hemoglobin is the protein that makes blood red. It is composed of

four protein chains, two alpha chains and two beta chains, each with a ring-like
heme group containing an iron atom.

6. Erythrocytes:

A. are biconvex disks.

B. have several nuclei in each cell.
C. divide frequently.
D. contain large quantities of hemoglobin.
E. have all these properties.

6. Answer: D. contain large quantities of hemoglobin.

Option D: Red blood cells (RBCs) or erythrocytes are biconcave disks; no

nucleus; contain hemoglobin, which color the cells red; 6.5–8.5 μm in diameter.

7. Which of these leukocytes is NOT correctly matched with its function or

description?

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A. Monocytes — become macrophages

B. Lymphocytes — vital in immune response
C. Basophils — synthesize or produce antibodies
D. Eosinophils — reduce in ammation
E. Neutrophils — phagocytize microorganisms and other foreign substances

7. Answer: C. Basophils — synthesize or produce antibodies

Option C: Basophil releases histamine, which promotes in ammation, and

heparin, which prevents clot formation.

Option A: Monocyte is a phagocytic cell in blood; leaves the blood and

becomes a macrophage, which phagocytizes bacteria, dead cells, cell fragments,
and other debris within tissues.

Option B: Lymphocyte produces antibodies and other chemicals responsible

for destroying microorganisms; contributes to allergic reactions, graft rejection,
tumor control, and regulation of the immune system.

Option D: Eosinophil releases chemicals that reduce in ammation; attacks

certain worm parasites.

Option E: Neutrophil phagocytize microorganisms and other foreign

substances.

8. Granulocytes are so called because these cells have granules of enzymes

which help to digest the invading microbes. Granulocytes account for about
60% of our white blood cells. The white blood cells called granulocytes are:

A. erythrocytes, thrombocytes, and megakaryocytes.

B. monocytes, macrophages, and neutrophils.
C. neutrophils, basophils, and eosinophils.
D. lymphocytes and monocytes.
E. thrombocytes, monocytes, and macrophages.

8. Answer: C. neutrophils, basophils, and eosinophils.

Option C. Granulocytes are a category of white blood cells characterized by the

presence of granules in their cytoplasm. Neutrophils, basophils, and
eosinophils are categorized as granulocytes.

Option D: Agranulocytes, also known as mononuclear leukocytes, are white

blood cells with a one-lobed nucleus. Lymphocytes and monocytes are
considered agranulocytes.

9. Which of the following does not help to prevent blood loss?

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A. Formation of a network of brin

B. Formation of a platelet plug
C. Synthesis of thromboxanes
D. Release of heparin
E. Blood vessel constriction

9. Answer: D. Release of heparin

Option D: Heparin acts as an anticoagulant, preventing the formation of clots

and extension of existing clots within the blood. It is contraindicated in those
with risk of bleeding (especially in people with uncontrolled blood pressure, liver
disease, and stroke), severe liver disease, or severe hypertension.

10. The healing process after clot formation involves:

A. Clot retraction
B. Repair of the damaged vessel by broblasts
C. Repair of the wound by division of epithelial cells
D. Clot dissolution
E. All of these

10. Answer: E. All of these

Option E: After a clot has formed, it begins to condense into a more compact
structure by a process known as clot retraction. Retraction of the clot pulls the
edges of the damaged blood vessel together, helping to stop the ow of blood,
reducing the probability of infection, and enhancing healing. The damaged
vessel is repaired by the movement of broblasts into the damaged area and
the formation of new connective tissue. In addition, epithelial cells around the
wound divide and ll in the torn area. Clots are dissolved by a process called
brinolysis.

See Also

Other anatomy and physiology study guides:

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Anatomy and Physiology: Nurse Study Guides

Blood Anatomy and Physiology

Cardiovascular System Anatomy and Physiology

Digestive System Anatomy and Physiology

Endocrine System Anatomy and Physiology

Integumentary System Anatomy and Physiology

Lymphatic System Anatomy and Physiology

Muscular System Anatomy and Physiology

Nervous System Anatomy and Physiology

Respiratory System Anatomy and Physiology

Skeletal System Anatomy and Physiology

Special Senses Anatomy and Physiology

Urinary System Anatomy and Physiology

Female Reproductive System Anatomy and Physiology

Male Reproductive System Anatomy and Physiology

Further Reading

1. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care

2. Medical-Surgical Nursing: Assessment and Management of Clinical Problems

3. Medical-Surgical Nursing: Patient-Centered Collaborative Care

4. Saunders Comprehensive Review for the NCLEX-RN Examination

5. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing

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Last updated on September 24, 2017

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Marianne Belleza, R.N.

Marianne is a sta nurse during the day and a Nurseslabs writer at night. She is a registered nurse since 2015 and is
currently working in a regional tertiary hospital and is nishing her Master's in Nursing this June. As an outpatient
department nurse, she is a seasoned nurse in providing health teachings to her patients making her also an excellent
study guide writer for student nurses. Marianne is also a mom of a toddler going through the terrible twos and her
free time is spent on reading books!

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