BLOOD

BLOOD
• It is the only fluid tissue in the body.
• A homogenous liquid that has both solid and
liquid components.
• Taste, Odor, 5x thicker than water
• Classified as a connective tissue
Living cells = formed elements
Non-living matrix = plasma (90% water)
COMPONENTS
• Formed elements (blood cells) are suspended in plasma
• The collagen and elastin fibers typical of other connective tissues
are absent from blood; instead, dissolved proteins become
visible as fibrin strands during blood clotting
• If a sample of blood is separated, the plasma rises to the top,
and the formed elements, being heavier, fall to the bottom.
• Most of the erythrocytes (RBCs) settle at the bottom of the tube
• There is a thin, whitish layer called the buffy coat at the junction
between the erythrocytes and the plasma containing leukocytes
(WBCs) and platelets.
 PHYSICAL CHARACTERISTICS
AND VOLUME
• Color range
Oxygen-rich blood is scarlet red
Oxygen-poor blood is dull red

• pH must remain between 7.35–7.45

• Slightly alkaline
• Blood temperature is slightly higher than body
temperature
• 5-6 Liters or about 6 quarts /body
 FUNCTIONS AND
COMPOSITION OF BLOOD
1. Transport of gases, nutrients and waste products
2. Transport of processed molecules
3. Transport of regulatory molecules
4. Regulation of pH and osmosis
5. Maintenance of body temp
6. Protection against foreign substances
7. Clot formation
PLASMA
• The liquid part of the blood; 90 percent water
• Over 100 different substances are dissolved in this
straw-colored fluid (nutrients, electrolytes, respiratory
gases, hormones, plasma proteins, and various wastes
and products of cell metabolism)
• Plasma proteins are the most abundant solutes in
plasma (albumin and clotting proteins)
• Plasma helps to distribute body heat, a by-product of
cellular metabolism, evenly throughout the body.
• Plasma is a pale yellow fluid that consists of about 91%
water, 7% proteins, and 2% other components, such as ions,
nutrients, gases, waste products, and regulatory substances.
• Plasma proteins include albumin, globulins, and
fibrinogen.
• Albumin makes up 58% of the plasma proteins. Although
the osmotic pressure of blood results primarily from Na+ and
Cl−, albumin also makes an important contribution. The
water balance between the blood and the tissues is
determined by the movement of water into and out of the
blood by osmosis.
• Globulins account for 38% of the plasma proteins. Some
globulins, such as antibodies and complement, are part of
the immune system. Other globulins and albumin function as
transport molecules because they bind to molecules, such as
hormones, and carry them in the blood throughout the body.
Some globulins are clotting factors, which are necessary for
the formation of blood clots.
• Fibrinogen is a clotting factor that constitutes 4% of
plasma proteins. Activation of clotting factors results in the
conversion of fibrinogen to fibrin, a threadlike protein that
forms blood clots. Serum is plasma without the clotting
factors.
FORMED ELEMENTS
Erythrocytes (RBCs)
• Function primarily to ferry oxygen to all cells of the body.
• RBCs differ from other blood cells because they are anucleate
(no nucleus)
• Contain very few organelles (RBCs circulating in the blood are
literally “bags” of hemoglobin molecules
• Very efficient oxygen transporters (they lack mitochondria and
make ATP by anaerobic mechanisms)
• Their small size and peculiar shape provide a large surface area
relative to their volume, making them suited for gas exchange.
FORMED ELEMENTS
• RBCs outnumber WBCs by about 1,000 to 1 and are the major factor
contributing to blood viscosity.
• There are normally about 5 million cells per cubic millimeter of
blood.
• The more hemoglobin molecules the RBCs contain, the more
oxygen they will be able to carry.
• A single RBC contains about 250 million hemoglobin molecules,
each capable of binding 4 molecules of oxygen.
• Normal hemoglobin count is 12-18 grams of hemoglobin per 100 ml
of blood
• Men: 13-18g/ml Women: 12-16 g/ml
HOMEOSTATIC IMBALANCE
Anemia
• a decrease in the oxygen-carrying ability of the blood,
whatever the reason is.
• May be the result of (1) a lower-than-normal number of RBCs
or (2) abnormal or deficient hemoglobin content in the RBCs.
Polycythemia Vera
• An excessive or abnormal increase in the number of
erythrocytes; may result from bone marrow cancer or a normal
physiologic response to living at high altitudes, where the air is
thinner and less oxygen is available (secondary polycythemia)
FORMED ELEMENTS
Leukocytes (WBCs)
• Are far less numerous than RBCs
• They are crucial to body defense
• On average, there are 4,800 to 10,800 WBCs/mm3 of blood
• WBCs contain nuclei and the usual organelles, which makes them
the only complete cells in the blood.
• WBCs are able to slip into and out of the blood vessels – a process
called diapedesis
• WBCs can locate areas of tissue damage and infection in the body
by responding to certain chemicals that diffuse from the damaged
cells (positive chemostaxis)
FORMED ELEMENTS
• Whenever WBCs mobilize for action, the body speeds up their
production, and as many as twice the normal number of WBCs
may appear in the blood within a few hours.
• A total WBC count above 11,000 cells/mm3 is referred to as
leukocytosis.
• The opposite condition, leukopenia, is an abnormally low WBC
count (commonly caused by certain drugs, such as
corticosteroids and anti-cancer agents)
• WBCs are classified into two major groups – granulocytes and
agranulocytes – depending on whether or not they contain
visible granules in their cytoplasm.
GRANULOCYTES
Neutrophils (Pink)
Are the most numerous WBCs.
Neutrophils are avid phagocytes at sites of acute infection.

Eosinophils (Brick red)

Their number increases rapidly during infections by parasitic worms ingested in
food such as raw fish or entering through the skin.

Basophils (Dark blue)

The rarest of the WBCs, have large histamine-containing granules.
Histamine is an inflammatory chemical that makes blood vessels leaky and
attracts other WBCs to the inflamed site
AGRANULOCYTES
Lymphocytes
• Have a large, dark purple nucleus that occupies most of the cell volume.
• Lymphocytes tend to take up residence in lymphatic tissues, such as the
tonsils, where they play an important role in the immune response.
• They are the second most numerous leukocytes in the blood

Monocytes
• Are the largest of the WBCs.
• When they migrate into the tissues, they change into macrophages.
• Macrophages are important in fighting chronic infections, such as
tuberculosis, and in activating lymphocytes.
PLATELETS
• They are fragments of bizarre multinucleate cells
called megakaryocytes, which pinch off thousands of
anucleate platelet “pieces” that quickly seal
themselves off from the surrounding fluids.
• Normal adult has 150,000 to 450,000 per cubic
millimeter of blood
• Platelets are needed for the clotting process that stops
blood loss from broken blood vessels.
• Average lifespan is 9 to 12 days
HEMATOPOIESIS
• Occurs in red bone marrow, or myeloid tissue.
• In adults, this tissue is found chiefly in the axial skeleton, pectoral and
pelvic girdles, and proximal epiphyses of the humerus and femur.
• On average, the red marrow turns out an ounce of new blood
containing 100 billion new cells every day.
• All the formed elements arise from a common stem cell, the
hemocytoblast, which resides in red bone marrow.
• Once a cell is committed to a specific blood pathway, it cannot change.
• The hemocytoblast forms two types of descendants – the lymphoid
stem cell, which produces lymphocytes, and the myeloid stem cell,
which can produce other classes of formed elements.
FORMATION OF RBCS
• Because they are anucleate, RBCs are unable to synthesize proteins,
grow, or divide.
• As they age, RBCs become rigid and begin to fall apart in 100 to 120
days.
• Their remains are eliminated by phagocytes in the spleen, liver, and
other body tissues.
• RBC components are salvaged. Iron is bound to protein as ferritin, and
the balance of the heme group is degraded to bilirubin, which is then
secreted into the intestine by liver cells where it becomes a brown
pigment called stercobilin that leaves the body in feces.
• Globin is broken down to amino acids which are released into the
circulation.
FORMATION OF RBCS
• The rate of erythrocyte production is controlled by a hormone
called erythropoietin (from the kidneys)
• Erythropoietin targets the bone marrow prodding it into “high
gear” to turn out more RBCs.
• An overabundance of erythrocytes, or an excessive amount of
oxygen in the bloodstream, depresses erythropoietin release
and RBC production.
• However, RBC production is controlled not by the relative
number of RBCs in the blood, but by the ability of the available
RBCs to transport enough oxygen to meet the body’s demands.
 FORMATION OF WBCS AND PLATELETS
• The formation of leukocytes and platelets is stimulated by
hormones
• These colony stimulating factors (CSFs) and interleukins
not only prompt red bone marrow to turn out leukocytes, but
also enhance the ability of mature leukocytes to protect the
body.
• The hormone thrombopoietin accelerates the production of
platelets from megakaryocytes, but little is know about how
process is regulated.
• When bone marrow problems or disease condition is suspected,
bone marrow biopsy is done.
HEMOSTASIS
If a blood vessel wall breaks, a series of reactions
starts the process of hemostasis (stopping the
bleeding).

Phases of Hemostasis
[Link] spasms occur.
[Link] plug forms.
[Link] events occur.
HUMAN BLOOD GROUPS

• An antigen is a substance that the body

recognizes as foreign; it stimulates the
immune system to mount a defense
against it.
• The “recognizers” are antibodies present
in plasma that attach to RBCs bearing
surface antigens different from those on
the patient’s RBCs.
 ABO AND RH BLOOD TYPES
The blood group system recognizes four blood types:
• Type A, B, AB, and O

• They are distinguished from each

other in part by their antigens and
antibodies.

• Specific antibodies are found in

the serum based on the type of
antigen on the surface of the RBC.
 ABO AND RH BLOOD TYPES
Can Accept Can Donate To
BLOOD TYPE From
A A, O A, AB

B B, O B, AB

AB A, B, AB, O AB

O O O, A, B, AB
Rh Blood Group
• Another important blood group is the Rh blood group, so
named because it was first studied in the rhesus monkey.
• People are Rh-positive if they have certain Rh antigens on
the surface of their red blood cells, and they are Rh-
negative if they do not have these Rh antigens.
• About 85% of Caucasians and 95% of African-Americans
are Rh-positive.
• The ABO blood type and the Rh blood type are usually
expressed together. For example, a person designated as
type A in the ABO blood group and Rh-positive is said to
be A-positive. The rarest combination in the United States
is AB-negative, which occurs in less than 1% of the
population.
• As stated earlier, the antibodies for the A and B
antigen are found in the plasma of blood, this is not
the case with the Rh antigens. Antibodies against the
Rh antigens do not develop unless an Rh-negative
person is exposed to Rh-positive red blood cells.
• This can occur through a transfusion or by the
transfer of blood across the placenta to a mother
from her fetus. When an Rh-negative person receives
a transfusion of Rh-positive blood, the recipient
becomes sensitized to the Rh antigens and produces
anti-Rh antibodies. If the Rh-negative person is
unfortunate enough to receive a second transfusion
of Rh-positive blood after becoming sensitized, a
transfusion reaction results.
• Rh incompatibility can pose a major problem in
a pregnancy when the mother is Rh-negative
and the fetus is Rh-positive.
• If fetal blood leaks through the placenta and
mixes with the mother’s blood, the mother
becomes sensitized to the Rh antigen.
• The mother produces anti-Rh antibodies that
cross the placenta and cause agglutination and
hemolysis of fetal red blood cells. This disorder
is called hemolytic disease of the newborn
(HDN), or erythroblastosis fetalis.
• In the mother’s first pregnancy, there is often no
problem. The leakage of fetal blood is usually the
result of a tear in the placenta that takes place
either late in the pregnancy or during delivery.
• Thus, there is not sufficient time for the mother to
produce enough anti-Rh antibodies to harm the
fetus. In later pregnancies, however, a problem can
arise because the mother has been sensitized to the
Rh antigen.
• Consequently, if the fetus is Rh-positive and if any
fetal blood leaks into the mother’s blood, she rapidly
produces large amounts of anti-Rh antibodies, which
can cross the placenta to the fetus, resulting in HDN.
• Because HDN can be fatal to the fetus, the
levels of anti-Rh antibodies in the
mother’s blood should be monitored.
• If they increase to unacceptable levels,
the fetus should be tested to determine
the severity of the HDN.
• In severe cases, a transfusion to replace
lost red blood cells can be performed
through the umbilical cord, or the baby
can be delivered if mature enough.
• Prevention of HDN is often possible if the Rh-
negative mother is injected with a specific
preparation called Rho(D) immune globulin
(RhoGAM), which contains antibodies against Rh
antigens.
• The injection can be given during the pregnancy,
before delivery, or immediately after each
delivery, miscarriage, or abortion.
• The injected antibodies bind to the Rh antigens of
any fetal red blood cells that may have entered
the mother’s blood. This treatment inactivates the
fetal Rh antigens and prevents sensitization of the
mother.
DIAGNOSTIC BLOOD TESTS
Type and Crossmatch
• In today’s medical settings, blood transfusions are common
procedures that often are life-saving.
• To prevent transfusion reactions, the blood must be typed.
Blood typing determines the ABO and Rh blood groups of a
blood sample.
• Typically, the cells are separated from the serum and then
tested with known antibodies to determine the type of
antigen on the cell surface.
• Agglutination during the typing procedure identifies the
antigens on the red blood cells. For example, if a patient’s
blood cells agglutinate when mixed with anti-A antibodies but
do not agglutinate when mixed with anti-B antibodies, the
cells have type A antigen.
• Normally, donor blood must match the
ABO and Rh type of the recipient.
• However, because other blood groups can
cause a transfusion reaction, a crossmatch
is performed. In a crossmatch, the donor’s
blood cells are mixed with the recipient’s
serum, and the donor’s serum is mixed
with the recipient’s cells.
• The donor’s blood is considered safe for
transfusion only if no agglutination occurs
in either match.
Complete Blood Count
Red Blood Count
• Blood cell counts are usually performed electronically
with a machine, but they can also be done manually
with a microscope.
• A normal red blood count (RBC) for a male is 4.6–6.2
million red blood cells per mm3 of blood; for a
female, a normal RBC count is 4.2–5.4 million per
mm3 of blood or 10−6 L.
• The condition called erythrocytosis is an
overabundance of red blood cells leading to
increased blood viscosity, reduced flow rates and, if
severe, plugged capillaries.
Hemoglobin Measurement
• The amount of hemoglobin in a given volume
of blood is usually expressed in terms of grams
of hemoglobin per 100 mL of blood.
• The normal hemoglobin measurement for a
male is 14–18 grams (g) per 100 mL of blood,
and for a female 12–16 g per 100 mL of blood.
• An abnormally low hemoglobin measurement is
an indication of anemia, which is either a
reduced number of red blood cells or a reduced
amount of hemoglobin in each red blood cell.
Hematocrit Measurement
• The percentage of the total blood volume
that is composed of red blood cells is the
hematocrit.
• The red blood cells account for 40–52% of the
total blood volume in males and 38–48% in
females.
• The hematocrit measurement is affected by
the number and size of red blood cells because
it is based on volume
White Blood Count
• A white blood count (WBC) measures the total
number of white blood cells in the blood.
• There are normally 4,500–11,000 white blood
cells per microliter of blood.
• Leukopenia is a lower than normal WBC resulting
from decreased production or destruction of the
red marrow. Radiation, drugs, tumors, viral
infections, or a deficiency of the vitamins folate
or B12 can cause leukopenia.
• Leukocytosis is an abnormally high WBC.
• Bacterial infections often cause leukocytosis by
stimulating neutrophils to increase in number.
• Leukemia, cancer of the red marrow characterized by
abnormal production of one or more of the white
blood cell types, can cause leukocytosis. However,
the white blood cells do not function normally.
Because these cells are usually immature or
abnormal and lack normal immunological functions,
people with leukemia are very susceptible to
infections.
• The excess production of white blood cells in the red
marrow can also interfere with the formation of red
blood cells and platelets and thus lead to anemia and
bleeding.
Differential White Blood Count
• A differential white blood count determines the
percentage of each of the five kinds of white blood
cells.
• Normally, neutrophils account for 60–70%,
lymphocytes 20–25%, monocytes 3–8%, eosinophils
2–4%, and basophils 0.5–1% of all white blood cells.
• Much insight into a patient’s condition can be
obtained from a differential white blood count. For
example, if a bacterial infection is present, the
neutrophil count is often greatly increased, whereas
in allergic reactions, the eosinophil and basophil
counts are elevated.
Clotting
Platelet Count
• A normal platelet count is 150,000–450,000
platelets per microliter of blood.
• In the condition called thrombocytopenia,
the platelet count is greatly reduced, resulting
in chronic bleeding through small vessels and
capillaries.
• It can be caused by decreased platelet
production as a result of hereditary disorders,
lack of vitamin B12 (pernicious anemia), drug
therapy, or radiation therapy.
Prothrombin Time Measurement
• Prothrombin time measurement calculates how long it takes
for the blood to start clotting, which is normally 9–12 seconds.
• Prothrombin time is determined by adding thromboplastin to
whole plasma. Thromboplastin is a chemical released from
injured tissues that starts the process of clotting.
• Prothrombin time is officially reported as the International
Normalized Ratio (INR), which standardizes the time it takes to
clot on the basis of the slightly different thromboplastins used
by different labs.
• Because many clotting factors have to be activated to form
fibrin, a deficiency of any one of them can cause the
prothrombin time to be abnormal.
• Vitamin K deficiency, certain liver diseases, and drug therapy
can increase prothrombin time.
SUMMARY
• Blood is responsible for transporting oxygen, fluids,
hormones, and antibodies and for eliminating waste
materials.
• The major components of blood include the formed
elements and plasma.
• RBCs transport oxygen and carbon dioxide; WBCs destroy
foreign invaders.
• WBCs include granulocytes and agranulocytes.
• Plasma is the liquid portion of unclotted blood. Serum is
the liquid portion of clotted blood.
• Hemostasis includes four stages: blood vessel
spasm, platelet plug formation, blood clotting,
and fibrinolysis.
• ABO and Rh types are determined by the
antigen found on the RBCs.