Circulatory System

Blood

Physiology for nursing

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 HEART & CIRCULATION
Homeostatic Functions
1. Transportation: Transports substances to and from capillaries
for exchange with tissue fluid

a. Respiratory Gases. RBC (erythrocytes) transport O2 to the cells and

CO2 away to capillaries
b. Nutritive materials. Food digested mechanically & chemically by
the GIT.
c. Excretory Wastes. Urea, excess water and ions, and other unneeded
molecules are carried by blood to kidneys and excreted in the
urine.

2. Regulation of hormones & temperature. Buffers body pH,

Maintain osmotic pressure

3. Protection. Clotting: Clots prevent blood/fluid loss

& Immunity (leukocytes protect against pathogens invasion).
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 Characteristics of blood
• Amount – 4 to 6 liters (8% of body weight).
• Color –
arterial blood: bright red
venous blood: dull red
• Viscosity – means thickness or resistance to flow; Viscosity
is increased by presence of cells and proteins.
• pH – slightly alkaline.

Question: What is the normal pH range of blood?

• Arterial blood: is blood leaving heart (It is
bright red except of that going to lungs).

• Venous blood: is blood returning to the heart

(looks dark except for venous blood returning
from lungs).

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 BLOOD COMPOSITION
• The blood has two components: plasma and formed
elements
1-Formed elements
A. Erythrocytes ( transport O2 & CO2);
B. Leukocytes: immune defense
C. Thrombocytes/platelets: blood clotting
• 2-Plasma made of water; plasma proteins; and
electrolytes.

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 PLASMA
• Straw-colored liquid consisting of:
• (1) Water (91%)
• (2) Plasma proteins (7-8%) and
• (3) Ions mainly Na & other materials like nutrients, wastes,
salts (< 1%).
• In addition, plasma contains other organic molecules such as
metabolites, hormones, waste products, Antibodies, & other
proteins.
• Salts and proteins buffer the blood:
a. They effectively keep the blood pH near 7.4
b. They maintain the blood osmotic pressure which pulls tissue
fluid into capillaries.

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• Plasma Proteins (7-8g/dL of plasma).
There are three main types that are produced by liver:
1. Albumins the smallest in size (MW= 70 kd); they function
in:
A-transports bilirubin, a breakdown product of hemoglobin.
B- maintains the blood osmotic pressure so water enters
capillaries.

2. Globulins 3 subtypes: α- and β-globulins; they are lipoproteins

that transport cholesterol lipids & fat-soluble molecules.
γ-globulins: are antibodies produced by lymphocytes. They
function in immunity.

3. Fibrinogens 4% of plasma proteins. They are important

clotting factors that are converted to fibrin threads.
Serum: is plasma that lacks fibrinogen.

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• Plasma Volume. If the body loses water:
• Dehydration plasma becomes concentrated
osmolarity.
• This is detected by osmoreceptors in the hypothalamus
thirst
ADH release (from posterior
pituitary)
ADH release water retention by kidneys
thirst increase water intake

• Both effects blood Pressure and blood volume.

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 Formed Elements

3 kinds:
1. red blood cells (RBCs),
2. white blood cells (WBCs),
3. platelets.
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 HEMATOPOIESIS
ُ (‫تَ َكو‬
‫ن الد"م‬
• Blood cells are constantly formed by a process called
hematopoiesis/hemopoiesis.
• Hematopoietic stem cells migrate to fetus liver. They then
migrate to bone marrow, and shortly after birth the liver ceases
to be a source of blood cell production.
• 500 billion cell per day.
• The process takes place in:
• 1-Myeloid tissue (red bone marrow ) in long bones, ribs,
sternum, pelvis, vertebrae, and skull produces all blood cells.
• 2-Lymphoid tissue in lymph nodes, tonsils, spleen, &thymus
produces lymphocytes.
• As stem cells differentiate they develop receptors which
determine to which line they are going to commit.
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• HEMATOPOIESIS.
• Erythropoiesis (RBC formation), is stimulated by
hormone called erythropoietin produced by kidneys

• Leukopoiesis (WBC formation) is stimulated by

chemicals called cytokines –Interleukins (secreted by
WBC).
• Thrombopoiesis (platelets formation):
Thrombopoietin (cytokine) stimulates platelets
formation by stimulating the proliferation and the
maturation of megakaryocytes.

• Leuko/Thrombo—cytosis means elevated No.

• Leuko/Thrombo—penia means low No.

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Blood cell formation in red bone
marrow
 Red Blood
Cells
• The most numerous cells.

• Red blood cells (erythrocytes) are small biconcave

disks (to increase surface area for gas diffusion).

• When mature, RBCs lack a nucleus and mitochondria

• There are 4.3-6 million RBCs per mm3 of whole

blood in males (females = 4.3-5.2).
• Another way to measure RBC is Hematocrit ; a test
to determine the percentage of RBC.

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• Hematocrit (PCV=packed cell volume) =Percent of
RBC volume/Total blood volume in centrifuged blood
sample

• Hematocrit reading is 45% RBC, and 54% of the plasma.

The buffy coat consists of WBC & platelets (1%).

• 36%-46% woman
• 41%-53% men

Both Hematocrit and

RBC count are part of
CBC count

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• Each RBC contains hemoglobin molecules.
• Hemoglobin contains four globin protein chains, each with an
iron-containing heme group (red pigmented molecule that
contains iron).
• The iron atom of a heme group loosely binds with an O2
molecule; thus, blood carries oxygen.
• The determination of hemoglobin level is also part of CBC.
• The normal range is 12 -18 gm per 100 ml of blood.
• Hemoglobin also carries about 10% of CO2.

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• Anemia is either a lack of enough RBC (low RBC count ) or
insufficient hemoglobin; an individual suffers from a tired,
run-down feeling.
• Anemia types:
• 1-Iron deficiency anemia. Due to reduction in dietary iron
• 2-Pernicious anemia due to Vitamin B12 or intrinsic factor
deficiency, caused by atrophy of stomach glandular mucosa
which secretes a protein called intrinsic factor. Intrinsic
factor is a chemical that combines with B12 and enhances
its absorption by small intestine.
• 3-Aplastic anemia due to bone marrow destruction caused
by radiation or chemicals i.e benzene and arsenic.
• Polycythemia means high RBC count.
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Sickle Cell Anemia (SCA)

Low Oxygen

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➢ RBCs are manufactured at a rate of 2.5 million cell per second in the
red bone marrow (Myloid tissue) of the skull, ribs, vertebrae, and the
ends of long bones (200 billion per day). This process needs iron,
vitamin B12, and folic acid.
➢ Stimulus for production: hypoxia kidneys: erythropoietin.

➢ The growth factor erythropoietin is secreted by the kidneys acts on

stem cells and stimulates their mitosis; as a drug it helps people
with anemia.

➢ Red blood cells have a life span of about 120 days; then they are
destroyed by phagocytic cells in liver, spleen, & red bone marrow.
 RBCs are destroyed
➢ In macrophages of liver or spleen:
➢ Globin portion is broken down into amino acids & used for
synthesis of new proteins.
➢ The Heme portion cannot be recycled and is a waste product. it
undergoes chemical degradation.
➢ Heme is converted to bilirubin by macrophages . The liver
removes bilirubin from circulation and excretes it into bile. Bile
is secreted by the liver into the duodenum, and passes through
small intestine and colon then eliminated in feces.
➢ If bilirubin is not excreted properly, perhaps due to liver
disease , Jaundice develops.
Jaundice : excessive accumulation of bilirubin in the blood.
Jaundice is a sign of liver diseases such as cirrhosis or hepatitis.
Hepatic Jaundice.
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 Iron is recovered and returned to
the bone marrow
➢ Iron(Fe+3)
– transported in blood attached to transferrin protein
– stored in liver, muscle or spleen attached to ferritin or
hemosiderin protein.
– in bone marrow being used for hemoglobin synthesis

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WBC
 White Blood Cells
a. White blood cells (leukocytes) differ from RBCs in being
larger and in having a nucleus and mitochondria . 5000-
10000 leukocytes/µl of blood.
b. Their production is stimulated by cytokines.
c. They have amoeboid ability, which enable them to
squeeze through pores in capillary walls and move to sites
of infection called diapedesis, whereas RBC remain
confined.
d. WBC carry out functions in blood, tissue fluid or lymphoid
tissue.
e. All WBC have general function which is to protect the body
from infectious diseases and to provide immunity

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• There are 2 groups:
Granular leukocytes
contain granules in their
cytoplasm and a lobed
nucleus. life span 100-300
days
• 2. Agranular life span 12hr
to 3 days.

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 Granulocytes
1) Neutrophils most abundant (50-70% of WBC),
have granules that stain slightly pink & 2-5 lobe
nuclei. Spherical cells that readily squeeze through
capillary walls.
• They are amoeboid phagocytize of pathogens (first
line-defense).

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 Granulocytes

• 2) Eosinophils 2-4% of WBC; granules are basic

so they take up the red dye eosin and appear
pinkish; have 2 lobe nucleus.
• Detoxify foreign proteins.
• Protect from parasitic worms.
• Increase in number during allergic reaction.

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 Granulocytes

• 3) Basophils dark blue; <1% of WBC; Have acidic

granules that take up a basic dye, staining them deep blue
2 lobe nucleus.
• Basophils contain granules of heparin and histamine.
• Histamine : released as part of inflammation process,
works as vasodilator promotes blood flow to tissues and
make capillaries more permeable.
• Basophils contain anticoagulant heparin, which prevents
abnormal clotting within blood vessels. 30
B) Agranulocytes/Mononucleocytes: no granules; have a circular
or indented nucleus. two types:
1-lymphocytes (20-30% WBC), smallest of all WBC (6-9 µm);
for specific immunity.
2-Monocytes largest of leukocytes (14-20 µm); kidney-shaped
nuclei; 3-8% of WBC; phagocytic (second line).

lymphocytes

Monocytes
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 Monocytes
• Monocytes are amoeboid phagocytic (second line) and
able to enter tissues where they transform into
macrophages.
• Neutrophils are more abundant phagocytes, but monocytes
are more efficient phagocytes because they differentiate
into Macrophages which phagocytized dead or damaged
tissue making repair possible.
• 2-lymphocytes (20-30% WBC), smallest of all WBC (6-9 µm);
for specific immunity.
• Lymphocytes play a key role in fighting infection and include
two major types.
• a) T cells are lymphocytes that directly attack virus-infected
cells.
• b) B cells become plasma cell that produce one type of
antibody specific for one type of antigen.
• An antigen is any substance stimulating production of
antibodies; antigen is foreign to the body.
• Antibodies combine with antigens to promote their being
phagocytized by a macrophage.
• A person is actively immune when many B cells produce a
specific antibody for an infection.
• Less numerous third kind is Natural killer cells: destroy
foreign cells by chemically rupturing their membrane.

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• Leukocytosis : is an indication of infections. A
large number of immature leukocytes in blood
sample is diagnostic of Leukocytosis.
• Leukopenia: low WBC count may result from
poor nutrition or from radiation. Patient is
susceptible for infection.
• Leukemia: is malignancy of blood forming
tissue

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 3. Platelets / Thrombocytes
• Fragments of large bone marrow cells called megakaryocytes.
A megakaryocyte (mega- + karyo- + -cyte, "large-nucleus cell")
• Platelet life span 5-9 days; count 150,000-300,000 / µl; they are
destroyed by spleen & liver;
Thrombocytosis: due to the liver secreting more thrombopoietin which
occurs under various medical conditions such as inflammation, acute
blood loss, and cancer…

Thrombopenia: occurs as a result of bone marrow depletion in patients

undergoing chemotherapy for cancer

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• Function of Platelets :
• 1- Chemical clotting.
• 2-Vasospasm: platelets in area of rupture in large vessels release
serotonin (a chemical which cause vasoconstriction) for blood
vessels repair.
• 3-Platelet plugs – capillaries. When capillaries rupture the
damage is too small to initiate the clot formation. The rough
surface causes the platelet to change shape becoming spiky and
sticky. They stick to the edges of the brake and to each other.

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 Disturbances of Hemostasis
BLOOD CLOTTING
Breakage of the endothelial lining exposes the subendothelial collagen to the
blood, initiating 3 overlapping mechanisms:
(1) vasoconstriction,
(2) formation of a platelet plug (Plt. Adhesion + Plt. Aggregation)
(3) fibrin production.

Opened Injured Blood Vessel Formation of Physiological Thrombus 37

Clotting Factors: Formation of Fibrin
• When a blood vessel is damaged,
The conversion of fibrinogen into fibrin occurs via either of
2 pathways:
(1) intrinsic pathway, where blood left in a test tube will
clot without the addition of any external chemicals.
(2) extrinsic pathway where damaged tissue release
chemicals that initiates the formation of fibrin. Because
chemicals are not part of blood the pathway is called
extrinsic
intrinsic & extrinsic pathway finally merge to form a
Common Pathway leading to the formation of a fibrin
clot ! 39
40
a. When a blood vessel is
damaged, platelets clump at the
site of the puncture and
partially seal the leak.
b. The platelets and damaged
tissue cells release a clotting
factor called prothrombin
activator.
c. With calcium ions,
prothrombin activator converts
prothrombin to thrombin.
d. Thrombin acts as an enzyme
to stimulate fibrinogen

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• e. forming long threads of fibrin.

• f. Fibrin making the clot appear red.

• h. When blood vessel repair is initiated,

plasmin destroys the fibrin network and
restores plasma fluidity.

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• d. At least 12 clotting factors in the
blood participate in blood clotting.
Factors are designated by a roman
numeral
• e. Hemophilia is an inherited
disorder where the liver is unable
to produce one of the clotting
factors.
• f. In hemophilia, minor bumps can
cause internal bleeding; bleeding
into the brain causes death.

• g. Vitamin K is necessary to
produce prothrombin; deficiency
of vitamin K causes hemorrhagic
disorders.

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 Blood Type Reactions 1. ABO System
Antigens:
certain molecules ( protein-oligosaccharides) present on the
surface of all the cells of the body that can be recognized as
foreign by the immune system of another person. The
presence or absence of type A or/and B antigens on red
blood cells determine a person’s blood type.

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a. If the person has type A blood, the A antigen is
on the red blood cells; if the person is type B, the
B antigen is on the red blood cells. The genes A
and B are shown as IA and IB while the gene O
is shown as I thus type A person is either IA IA
or IA i
c. In the ABO system, there are four blood types: A,
B, AB, O. RBCs with a particular antigen
agglutinate then undergo hemolysis when
exposed to corresponding antibodies, e.g., type A
of RBCs will agglutinate in the presence of anti-
A antibody (as would be found in the blood of a
type B individual).

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To receive blood, the recipient’s plasma must not have an
antibody that causes donor cells to agglutinate.
a) Recipients with type AB blood can receive any type blood;
they are the universal recipient.
b) Recipients with type O blood cannot receive A, B, or AB;
but they are a universal donor.
c) Recipients with type A blood cannot receive B or AB.
d) Recipients with type B blood cannot receive A or AB.

Transfusion error can lead to hemolysis (rupture of RBC

which may damage the kidney and other organs.
O is Universal donor and AB is universal recipients.

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Blood Transfusions

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 Rhesus Blood Group
• 1. Rh factor is an important antigen in human blood types.
The Rh antigen is termed D and is indicated as RhoD : 85%
of population Rh+; 15% are Rh-.

• 2. Rh positive (Rh+) has the Rh factor on red blood cells;

Rh negative (Rh-) lacks the Rh antigen on RBCs
 Rh System
• 3. Rh-negative individuals do not have antibodies to Rh factor
but make them if exposed to Rh+ blood.

• Rh positive is a genetically dominant trait; an Rh negative

mother and an Rh positive father pose a Rh conflict.

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1. Rh factor is particularly important if Rh negative mother is
pregnant with Rh positive child Erythroblastosis fetalis
Hemolytic disease of the newborn is possible if the mother is Rh
negative and the father is Rh positive.

2. Normally during pregnancy the maternal blood and the fetal

blood are kept separate across the plasenta.

3. At time of birth variable degrees of exposure may occur. The

child’s Rh positive RBCs can leak across the placenta into the
mother’s circulatory system when the placenta breaks down.
4. The mother immune system may produce antibodies against Rh
antigen
5. Anti-Rh antibodies pass across the placenta and destroy the
RBCs of the Rh positive child. Baby is born with hemolytic
disease of newborn called Erythroblastosis fetalis

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• 9. The Rh problem has been solved
by giving Rh- women an Rh
immunoglobulin (antibody)
injection (called Rho-Gam) either
midway through the first pregnancy
or no later than 72 hours after giving
birth to an Rh+ child.

• 1) The injection includes anti-Rh

antibodies that attack and destroy
any fetal RBCs that have entered
the mother circulation before her
immune system can respond to
produce antibodies.

• 2) The injection is not effective if the

mother has already produced
antibodies; timing is important. 55
 Hemolytic Disease of the Newborn

• Erythroblastosis fetalis in severe cases is lethal. In less severe cases

baby will be born anemic and jaundiced from loss of RBCs 56