The Blood

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 Fluids of the Body

• Cells of the body are serviced by 2 fluids

– blood
• composed of plasma and a variety of cells
• transports nutrients and wastes
– interstitial fluid
• bathes the cells of the body
• Nutrients and oxygen diffuse from the blood into the
interstitial fluid & then into the cells
• Wastes move in the reverse direction

2
 Functions of Blood

• Transportation
– O2, CO2, metabolic wastes, nutrients, heat & hormones
• Regulation
– helps regulate pH through buffers
– helps regulate body temperature
• coolant properties of water
• vasodilatation of surface vessels dump heat
– helps regulate water content of cells by interactions with
dissolved ions and proteins
• Protection from disease & loss of blood

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 Physical Characteristics of Blood

• Thicker (more viscous) than water and flows more slowly

than water
• Temperature of 100.4 degrees F
• pH 7.4 (7.35-7.45)
• 8 % of total body weight
• Blood volume
– 5 to 6 liters in average male
– 4 to 5 liters in average female
– hormonal negative feedback systems maintain constant
blood volume and osmotic pressure

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 COMPONENTS OF BLOOD

• Blood consists of 55% plasma and 45% formed elements

• Blood plasma consists of 91.5% water and 8.5% solutes.

• Principal solutes include proteins (albumins, globulins,

fibrinogen), nutrients, enzymes, hormones, respiratory
gases, electrolytes, and waste products.

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 Components of Blood

• Hematocrit
– 55% plasma
– 45% cells
• 99% RBCs
• < 1% WBCs and platelets

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 Blood Plasma
• 0ver 90% water
• 7% plasma proteins
• created in liver
• confined to bloodstream
– albumin
• maintain blood osmotic pressure
– globulins (immunoglobulins)
• antibodies bind to foreign
substances called antigens
• form antigen-antibody complexes
– fibrinogen
• for clotting
• 2% other substances
– electrolytes, nutrients, hormones, gases, waste products

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 Formed Elements of Blood
• Red blood cells ( erythrocytes )
• White blood cells ( leukocytes )
– granular leukocytes
• neutrophils, eosinophils, basophils
– agranular leukocytes
• lymphocytes = T cells, B cells, and natural killer cells
• monocytes
• Platelets (special cell fragments)

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 Hematocrit

• Percentage of blood occupied by cells

– female normal range
• 38 - 46% (average of 42%)
– male normal range
• 40 - 54% (average of 46%)
• testosterone
• Anemia
– not enough RBCs or not enough hemoglobin
• Polycythemia
– too many RBCs (over 65%)
– dehydration, tissue hypoxia, blood doping in athletes

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 Formation of Blood Cells

• Most blood cells types need to be continually replaced

– die within hours, days or weeks
– process of blood cells formation is hematopoiesis or
hemopoiesis
• In the embryo
– occurs in yolk sac, liver, spleen, thymus, lymph nodes & red
bone marrow
• In adult
– occurs only in red marrow of flat bones like sternum, ribs,
skull & pelvis and ends of long bones

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Hematopoiesis

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 Stages of Blood Cell Formation
• Pluripotent stem cells
– .1% of red marrow cells
– replenish themselves as they differentiate into either myeloid or lymphoid stem
cells
• Myeloid stem cell line of development continues:
– progenitor cells(colony-forming units) no longer can divide and are specialized
to form specific cell types
• example: CFU-E develops eventually into only red blood cells
– next generation is blast cells
• have recognizable histological characteristics
• develop within several divisions into mature cell types
• Lymphoid stem cell line of development
– pre-B cells & prothymocytes finish their develop into B & T lymphocytes in the
lymphatic tissue after leaving the red marrow

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 Blood Cells
• Myeloid stem cells give rise to RBCs, platelets, and all
WBCs except for lymphocytes.

• Lymphoid stem cells give rise to lymphocytes.

• This process of hemopoiesis (or hematopoiesis) is

stimulated by several hematopoietic growth factors.

• These hematopoietic growth factors stimulate differentiation

and proliferation of the various blood cells.

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 Red Blood Cells or Erythrocytes
• Contain oxygen-carrying protein hemoglobin that gives blood
its red color
– 1/3 of cell’s weight is hemoglobin
• Biconcave disk 8 microns in diameter
– increased surface area/volume ratio
– flexible shape for narrow passages
– no nucleus or other organelles
• no cell division or mitochondrial ATP formation
• Normal RBC count
– male 5.4 million/drop ---- female 4.8 million/drop
– new RBCs enter circulation at 2 million/second

Principles of Human Anatomy and Physiology, 11e 14

 (Hormones)Hemopoietic Growth Factors

• Erythropoietin increases the number of RBC precursors.

• Thrombopoietin increases the number of platelet

precursors.
• Cytokins (colony-stimulating factors and interleukins)
increase the number of WBC precursors.

• Growth factors, available through recombinant DNA

technology, hold great potential for use in patients who
cannot normally form the blood cells.

Principles of Human Anatomy and Physiology, 11e 15

 Hemoglobin

• Globin protein consisting of 4 polypeptide chains

• One heme pigment attached to each polypeptide chain
– each heme contains an iron ion (Fe+2) that can combine reversibly
with one oxygen molecule

Principles of Human Anatomy and Physiology, 11e 16

 RBC Life Cycle

• RBCs live only 120 days

– wear out from bending to fit through capillaries
– no repair possible due to lack of organelles
• Worn out cells removed by fixed macrophages in spleen &
liver
• Breakdown products are recycled

Principles of Human Anatomy and Physiology, 11e 17

 Recycling of Hemoglobin Components

• In macrophages of liver or spleen

– globin portion broken down into amino acids & recycled
– heme portion split into iron (Fe+3) and biliverdin (green pigment)

Principles of Human Anatomy and Physiology, 11e 18

 Fate of Components of Heme

• 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
• Biliverdin (green) converted to bilirubin (yellow)
– bilirubin secreted by liver into bile
• converted to urobilinogen then stercobilin (brown
pigment in feces) by bacteria of large intestine
• if reabsorbed from intestines into blood is converted to
a yellow pigment, urobilin and excreted in urine

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 Erythropoiesis: Production of RBCs
• Erythrocyte formation, called erythropoiesis, occurs in adult
red bone marrow of certain bones
• The main stimulus for erythropoiesis is hypoxia

• Reticulocytes escape from bone marrow into the blood

• In 1-2 days, they eject the remaining organelles to become
a mature RBC

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 Feedback Control of RBC Production

• Tissue hypoxia (cells not getting

enough O2)
– high altitude since air has less O2
– anemia
• RBC production falls below
RBC destruction
– circulatory problems
• Kidney response to hypoxia
– release erythropoietin
– speeds up development of
proerythroblasts into reticulocytes

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 WHITE BLOOD CELLS

• Leukocytes (white blood cells or WBCs) are nucleated cells

and do not contain hemoglobin. Two principal types are
granular (neutrophils, eosinophils, basophils) and agranular
(lymphocytes and monocytes)
• Granular leukocytes include eosinophils, basophils, and
neutrophils based on the straining of the granules.
– Agranular leukocytes do not have cytoplasmic granules
and include the lymphocytes and monocytes, which
differentiate into macrophages (fixed and wandering).
• Leukocytes have surface proteins, as do erythrocytes. They
are called major histocompatibility antigens (MHC), are
unique for each person (except for identical siblings), and
can be used to identify a tissue.
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 WBC Physiology
• Less numerous than RBCs
– 5000 to 10,000 cells per drop of blood
– 1 WBC for every 700 RBC
• Leukocytosis is a high white blood cell count
– microbes, strenuous exercise, anesthesia or surgery
• Leukopenia is low white blood cell count
– radiation, shock or chemotherapy
• Only 2% of total WBC population is in circulating blood at any
given time
– rest is in lymphatic fluid, skin, lungs, lymph nodes &
spleen

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 Function of WBCs
• Different WBCs combat inflammation and infection in different ways.
– Neutrophils and wandering or fixed macrophages (which develop
from monocytes) do so through phagocytosis.
– Eosinophils combat the effects of histamine in allergic reactions,
phagocytize antigen-antibody complexes, and combat parasitic
worms.
– Basophils develop into mast cells that liberate heparin,
histamine, and serotonin in allergic reactions that intensify the
inflammatory response.
– B lymphocytes, in response to the presence of foreign
substances called antigens, differentiate into tissue plasma cells
that produce antibodies.
– T lymphocytes destroy foreign invaders directly.

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 Function of WBCs

• WBCs leave the blood stream by emigration

• Some WBCs, particularly neutrophils and macrophages, are
active in phagocytosis.
• The chemical attraction of WBCs to a disease or injury site
is termed chemotaxis.

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 WBC Anatomy and Types

• All WBCs (leukocytes) have a nucleus and no hemoglobin

• Granular or agranular classification based on presence of
cytoplasmic granules made visible by staining
– granulocytes are neutrophils, eosinophils or basophils
– agranulocytes are monocyes or lymphocytes

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 Neutrophils (Granulocyte)

• Polymorphonuclear Leukocytes or Polys

• Nuclei = 2 to 5 lobes connected by thin strands
– older cells have more lobes
– young cells called band cells because of horseshoe
shaped nucleus (band)
• Fine, pale lilac practically invisible granules
• Diameter is 10-12 microns
• 60 to 70% of circulating WBCs

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 Eosinophils (Granulocyte)

• Nucleus with 2 or 3 lobes connected by a thin strand

• Large, uniform-sized granules stain orange-red with
acidic dyes
– do not obscure the nucleus
• Diameter is 10 to 12 microns
• 2 to 4% of circulating WBCs

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 Basophils (Granulocyte)

• Large, dark purple, variable-sized granules stain with

basic dyes
– obscure the nucleus
• Irregular, s-shaped, bilobed nuclei
• Diameter is 8 to 10 microns
• Less than 1% of circulating WBCs

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 Lymphocyte (Agranulocyte)

• Dark, oval to round nucleus

• Cytoplasm sky blue in color
– amount varies from rim of blue to normal amount
• Small cells 6 - 9 microns in diameter
• Large cells 10 - 14 microns in diameter
– increase in number during viral infections
• 20 to 25% of circulating WBCs

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 Monocyte (Agranulocyte)

• Nucleus is kidney or horse-shoe shaped

• Largest WBC in circulating blood
– does not remain in blood long before migrating to the tissues
– differentiate into macrophages
• fixed group found in specific tissues
– alveolar macrophages in lungs
– kupffer cells in liver
• wandering group gathers at sites of infection
• Diameter is 12 - 20 microns
• Cytoplasm is a foamy blue-gray
• 3 to 8% o circulating WBCs

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Emigration & Phagocytosis in WBCs
• WBCs roll along endothelium, stick to
it & squeeze between cells.
– adhesion molecules (selectins)
help WBCs stick to endothelium
• displayed near site of injury
– molecules (integrins) found on
neutrophils assist in movement
through wall
• Neutrophils & macrophages
phagocytize bacteria & debris
– chemotaxis of both
• kinins from injury site & toxins

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 Neutrophil Function

• Fastest response of all WBC to bacteria

• Direct actions against bacteria
– release lysozymes which destroy/digest bacteria
– release defensin proteins that act like antibiotics & poke
holes in bacterial cell walls destroying them
– release strong oxidants (bleach-like, strong chemicals )
that destroy bacteria

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 Monocyte Function

• Take longer to get to site of infection, but arrive in

larger numbers
• Become wandering macrophages, once they leave
the capillaries
• Destroy microbes and clean up dead tissue following
an infection

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 Basophil Function

• Involved in inflammatory and allergy reactions

• Leave capillaries & enter connective tissue as mast
cells
• Release heparin, histamine & serotonin
– heighten the inflammatory response and account
for hypersensitivity (allergic) reaction

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 Eosinophil Function

• Leave capillaries to enter tissue fluid

• Release histaminase
– slows down inflammation caused by basophils
• Attack parasitic worms
• Phagocytize antibody-antigen complexes

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 Lymphocyte Functions

• B cells
– destroy bacteria and their toxins
– turn into plasma cells that produces antibodies
• T cells
– attack viruses, fungi, transplanted organs, cancer cells &
some bacteria
• Natural killer cells
– attack many different microbes & some tumor cells
– destroy foreign invaders by direct attack

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 Complete Blood Count

• Screens for anemia and infection

• Total RBC, WBC & platelet counts; differential WBC;
hematocrit and hemoglobin measurements
• Normal hemoglobin range
– infants have 14 to 20 g/100mL of blood
– adult females have 12 to 16 g/100mL of blood
– adult males have 13.5 to 18g/100mL of blood

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 Differential WBC Count

• Detection of changes in numbers of circulating WBCs

(percentages of each type)
– indicates infection, poisoning, leukemia, chemotherapy,
parasites or allergy reaction
• Normal WBC counts
– neutrophils 60-70% (up if bacterial infection)
– lymphocyte 20-25% (up if viral infection)
– monocytes 3 -- 8 % (up if fungal/viral infection)
– eosinophil 2 -- 4 % (up if parasite or allergy reaction)
– basophil <1% (up if allergy reaction or hypothyroid)

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 PLATELETS

• Platelets help stop blood loss from damaged vessels by forming a

platelet plug. Their granules also contain chemicals that promote blood
clotting.

• Thrombopoietin stimulates myeloid stem cells to produce platelets

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Platelet (Thrombocyte) Anatomy

• Disc-shaped, 2 - 4 micron cell fragment with

no nucleus
• Normal platelet count is 150,000-
400,000/drop of blood
• Other blood cell counts
– 5 million red & 5-10,000 white blood cells

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 Platelets--Life History

• Platelets form in bone marrow by following steps:

– myeloid stem cells to megakaryocyte-colony forming
cells to megakaryoblast to megakaryocytes whose
cell fragments form platelets
• Short life span (5 to 9 days in bloodstream)
– formed in bone marrow
– few days in circulating blood
– aged ones removed by fixed macrophages in liver
and spleen

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 HEMOSTASIS

• A clot is a gel consisting of a network of insoluble protein

fibers (fibrin) in which formed elements of blood are trapped

• The chemicals involved in clotting are known as coagulation

(clotting) factors; most are in blood plasma, some are
released by platelets, and one is released from damaged
tissue cells

• Blood clotting involves a cascade of reactions that may be

divided into three stages: formation of prothrombinase
(prothrombin activator), conversion of prothrombin into
thrombin, and conversion of soluble fibrinogen into insoluble
fibrin

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 HEMOSTASIS

• The clotting cascade can be initiated by either the extrinsic

pathway or the intrinsic pathway.

• Normal coagulation requires vitamin K and also involves clot

retraction (tightening of the clot) and fibrinolysis (dissolution
of the clot).

• The fibrinolytic system dissolves small, inappropriate clots

and clots at a site of damage once the damage is repaired.
• Plasmin (fibrinolysin) can dissolve a clot by digesting fibrin
threads and inactivating substances such as fibrinogen,
prothrombin, and factors V, VIII, and XII.

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 Hemostasis

• Stoppage of bleeding in a quick & localized fashion when

blood vessels are damaged
• Prevents hemorrhage (loss of a large amount of blood)
• Methods utilized
– vascular spasm
– platelet plug formation
– blood clotting (coagulation = formation of fibrin threads)

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 Vascular Spasm

• Damage to blood vessel produces stimulates pain receptors

• Reflex contraction of smooth muscle of small blood vessels
• Can reduce blood loss for several hours until other
mechanisms can take over
• Only for small blood vessel or arteriole

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 Platelet Plug Formation
• Steps in the process
– (1) platelet adhesion (2) platelet release reaction (3)
platelet aggregation

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 Platelet Adhesion

• Platelets stick to exposed collagen underlying

damaged endothelial cells in vessel wall

Principles of Human Anatomy and Physiology, 11e 48

 Platelet Release Reaction
• Platelets activated by adhesion
• Extend projections to make contact with each
other
• Release thromboxane A2 & ADP activating
other platelets
• Serotonin & thromboxane A2 are
vasoconstrictors decreasing blood flow through
the injured vessel

Principles of Human Anatomy and Physiology, 11e 49

 Platelet Aggregation

• Activated platelets stick together and activate

new platelets to form a mass called a platelet
plug
• Plug reinforced by fibrin threads formed during
clotting process

Principles of Human Anatomy and Physiology, 11e 50

 Overview of the Clotting Cascade

• Prothrombinase is formed by either the

intrinsic or extrinsic pathway
• Final common pathway produces fibrin
threads

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 Extrinsic Pathway

• Damaged tissues leak tissue factor

(thromboplastin) into bloodstream
• Prothrombinase forms in seconds
• In the presence of Ca+2, clotting factor
X combines with V to form
prothrombinase

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 Intrinsic Pathway

• Activation occurs
– endothelium is damaged &
platelets come in contact with
collagen of blood vessel wall
– platelets damaged & release
phospholipids
• Requires several minutes for
reaction to occur
• Substances involved: Ca+2 and
clotting factors XII, X and V

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 Final Common Pathway

• Prothrombinase and Ca+2

– catalyze the conversion of prothrombin
to thrombin
• Thrombin
– in the presence of Ca+2 converts
soluble fibrinogen to insoluble fibrin
threads
– activates fibrin stabilizing factor XIII
– positive feedback effects of thrombin
• accelerates formation of
prothrombinase
• activates platelets to release
phospholipids

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 Clot Retraction & Blood Vessel Repair

• Clot plugs ruptured area of blood vessel

• Platelets pull on fibrin threads causing
clot retraction
– trapped platelets release factor XIII
stabilizing the fibrin threads
• Edges of damaged vessel are pulled
together
• Fibroblasts & endothelial cells repair the
blood vessel

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 Role of Vitamin K in Clotting

• Normal clotting requires adequate vitamin K

– fat soluble vitamin absorbed if lipids are present
– absorption slowed if bile release is insufficient
• Required for synthesis of 4 clotting factors by
hepatocytes
– factors II (prothrombin), VII, IX and X
• Produced by bacteria in large intestine

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 Hemostatic Control Mechanisms
• Fibrinolytic system dissolves small, inappropriate clots & clots at a site of a
completed repair
– fibrinolysis is dissolution of a clot
• Inactive plasminogen is incorporated into the clot
– activation occurs because of factor XII and thrombin
– plasminogen becomes plasmin (fibrinolysin) which digests fibrin
threads
• Clot formation remains localized
– fibrin absorbs thrombin
– blood disperses clotting factors
– endothelial cells & WBC produce prostacyclin that opposes
thromboxane A2 (platelet adhesion & release)
• Anticoagulants present in blood & produced by mast cells
–

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 Intravascular Clotting
• Thrombosis
– clot (thrombus) forming in an unbroken blood vessel
• forms on rough inner lining of BV
• if blood flows too slowly (stasis) allowing clotting factors
to build up locally & cause coagulation
– may dissolve spontaneously or dislodge & travel
• Embolus
– clot, air bubble or fat from broken bone in the blood
• pulmonary embolus is found in lungs
• Low dose aspirin blocks synthesis of thromboxane A2 &
reduces inappropriate clot formation
– strokes, TIAs and myocardial infarctions

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 Anticoagulants and Thrombolytic Agents
• Anticoagulants suppress or prevent blood clotting
– heparin
• administered during hemodialysis and surgery
– warfarin (Coumadin)
• antagonist to vitamin K so blocks synthesis of clotting factors
• slower than heparin
– stored blood in blood banks treated with citrate phosphate
dextrose (CPD) that removes Ca+2
• Thrombolytic agents are injected to dissolve clots
– directly or indirectly activate plasminogen
– streptokinase or tissue plasminogen activator (t-PA)

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 Hemostatic Control Mechanisms

• Clots are generally localized due to fibrin absorbing

thrombin into the clot, clotting factors diffusing through
blood, and the production of prostacyclin, a powerful
inhibitor of platelet adhesion and release.
• Substances that inhibit coagulation, called anticoagulants,
are also present in blood. An example is heparin.
• Patients who are at increased risk of forming blood clots
may receive an anticoagulant drug such as heparin or
warfarin. To prevent clots in donated blood, a substance
that removes Ca+2 such as EDTA or CPD may be added to
the blood.
• Despite the anticoagulating and fibrinolytic mechanisms,
blood clots sometimes form within the cardiovascular
system.

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 HEMOSTASIS

• Clotting in an unbroken blood vessel is called thrombosis.

• A thrombus (clot), bubble of air, fat from broken bones, or
piece of debris transported by the bloodstream that moves
from its site of origin is called an embolus.
• At low doses aspirin inhibits vasoconstriction and platelet
aggregation thereby reducing the chance of thrombus
formation. Thrombolytic agents are injected into the body to
dissolve clots that have already formed. Streptokinase or
tissue plasminogen activator (TPS) are thrombolytic agents.

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 ABO Group

• In the ABO system, agglutinogens (antigens) A and B

determine blood types

• Plasma contains agglutinins (antibodies), designated as a

and b, that react with agglutinogens that are foreign to the
individual.

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 Blood Groups and Blood Types

• RBC surfaces are marked by genetically determined

glycoproteins & glycolipids
– agglutinogens or isoantigens
– distinguishes at least 24 different blood groups
• ABO, Rh, Lewis, Kell, Kidd and Duffy systems
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 ABO Blood Groups
• Based on 2 glycolipid isoantigens called A and B found on the
surface of RBCs
– display only antigen A -- blood type A
– display only antigen B -- blood type B
– display both antigens A & B -- blood type AB
– display neither antigen -- blood type O
• Plasma contains isoantibodies or agglutinins to the A or B
antigens not found in your blood
– anti-A antibody reacts with antigen A
– anti-B antibody reacts with antigen B

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 RH blood groups

• Antigen was discovered in blood of Rhesus monkey

• People with Rh agglutinogens on RBC surface are Rh+.
Normal plasma contains no anti-Rh antibodies
• Antibodies develop only in Rh- blood type & only with exposure
to the antigen
– transfusion of positive blood
– during a pregnancy with a positive blood type fetus
• Transfusion reaction upon 2nd exposure to the antigen results
in hemolysis of the RBCs in the donated blood

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 Hemolytic Disease of Newborn

• Rh negative mom and Rh+ fetus will have mixing of blood at birth
• Mom's body creates Rh antibodies unless she receives a RhoGam shot soon after
first delivery, miscarriage or abortion
– RhoGam binds to loose fetal blood and removes it from body before she reacts
• In 2nd child, hemolytic disease of the newborn may develop causing hemolysis of the
fetal RBCs

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 Transfusion and Transfusion Reactions

• Transfer of whole blood, cells or plasma into the

bloodstream of recipient
– used to treat anemia or severe blood loss
• Incompatible blood transfusions
– antigen-antibody complexes form between plasma antibodies &
“foreign proteins” on donated RBC's (agglutination)
– donated RBCs become leaky (complement proteins) & burst
– loose hemoglobin causes kidney damage
• Problems caused by incompatibility between donor’s cells and
recipient’s plasma
• Donor plasma is too diluted to cause problems

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 Universal Donors and Recipients

• People with type AB blood called “universal

recipients” since have no antibodies in plasma
– only true if cross match the blood for other
antigens
• People with type O blood cell called “universal
donors” since have no antigens on their cells
– theoretically can be given to anyone

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 Typing and Cross-Matching Blood for Transfusion

• The Rh and ABO blood groups may be detected by a simple

medical test, blood typing, in which a sample of blood is
mixed with serum containing agglutinins to each of the
major agglutinogens (AB, B, and Rh)

• Typing is the determination of blood types, whereas cross-

matching is the mixing of donor and recipient blood for
compatibility.

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DISORDERS: HOMEOSTATIC IMBALANCES

• Anemia
• Sickle-cell
• Hemophilia
• Disseminated intravascular clotting
• Acute leukemia
• chronic leukemia

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 Anemia = Not Enough RBCs
• Symptoms
– oxygen-carrying capacity of blood is reduced
– fatigue, cold intolerance & paleness
• lack of O2 for ATP & heat production
• Types of anemia
– iron-deficiency =lack of absorption or loss of iron
– pernicious = lack of intrinsic factor for B12 absorption
– hemorrhagic = loss of RBCs due to bleeding (ulcer)
– hemolytic = defects in cell membranes cause rupture
– thalassemia = hereditary deficiency of hemoglobin
– aplastic = destruction of bone marrow (radiation/toxins)

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 Sickle-cell Anemia (SCA)

• Genetic defect in hemoglobin molecule (Hb-S) that

changes 2 amino acids
– at low very O2 levels, RBC is deformed by changes in
hemoglobin molecule within the RBC
• sickle-shaped cells rupture easily = causing anemia
& clots
• Found among populations in malaria belt
– Mediterranean Europe, sub-Saharan Africa & Asia
• Person with only one sickle cell gene
– increased resistance to malaria because RBC
membranes leak K+ & lowered levels of K+ kill the
parasite infecting the red blood cells

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 Hemophilia
• Inherited deficiency of clotting factors
– bleeding spontaneously or after minor trauma
– subcutaneous & intramuscular hemorrhaging
– nosebleeds, blood in urine, articular bleeding & pain
• Hemophilia A lacks factor VIII (males only)
– most common
• Hemophilia B lacks factor IX (males only)
• Hemophilia C (males & females)
– less severe because alternate clotting activator exists
• Treatment is transfusions of fresh plasma or concentrates of
the missing clotting factor

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 Disseminated Intravascular Clotting

• Life threatening paradoxical presence of blood clotting

and bleeding at the same time throughout the whole body
– so many clotting factors are removed by widespread
clotting that too few remain to permit normal clotting
• Associated with infections, hypoxia, low blood flow rates,
trauma, hypotension & hemolysis
• Clots cause ischemia and necrosis leading to
multisystem organ failure

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 Leukemia

• Acute leukemia
– uncontrolled production of immature leukocytes
– crowding out of normal red bone marrow cells by
production of immature WBC
– prevents production of RBC & platelets
• Chronic leukemia
– accumulation of mature WBC in bloodstream because
they do not die
– classified by type of WBC that is predominant---
monocytic, lymphocytic.

75
end

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