Transcript blood


A circulating transport system
 A pump (the heart)
 A transport system (blood vessels)
 A fluid medium (blood)
▪ Is specialized fluid of connective tissue
▪ Contains cells suspended in a fluid matrix (plasma)

Whole Blood
 Plasma
▪ Fluid consisting of:
▪ water
▪ dissolved plasma
proteins
▪ other solutes
 Formed elements
▪ All cells and solids

Whole Blood
1. Color: Bright red – purplish/dark red
2. pH – arterial blood pH?
3. Temperature: 100.4 or 38º C
4. Volume: normovolemic (7% of body weight) = 5 L
hypovolemic:
hypervolemic
How does blood volume affect blood pressure?

1. Delivery of O2 from the lungs
& nutrients from the digestive tract to all
cells .

2. Transport of wastes (CO2, metabolic
wastes) to lungs & kidneys for excretion

3. Transport of hormones from the endocrine
organs to their target organs.

4. Maintenance of body temperature

5. Maintenance of normal pH in body tissues

6. Maintenance of blood volume – plasma
proteins & solutes

7. Prevention of blood loss –clotting factors

8. Prevention of infection- WBCs, antibodies,
etc.

Makes up 50–60% of blood
volume

Clear, pale yellow

90% of plasma is water
also contains:


↑Water = ↑ plasma volume
↑ plasma volume = ↑ BP

Plasma expanders ↑ BV
a. Proteins (plasma proteins):
synthesized in liver
-albumin: carrier protein, buffer,
maintains osmotic pressure
-globulins
immunoglobulins: IgG, IgM
transport globulins
-globulins
hormone binding proteins: TBG
metalloproteins: transferrin
apolipoproteins -(lipoprotein)
-fibrinogen: important for blood clotting
-other plasma proteins: hormones,
enzymes
b. Other: dissolved gasses,
nutrients, electrolytes,
hormones, lipids
Serum is plasma without?

Hemopoiesis
(hematopoiesis)
 Process of producing formed
elements
Hemocytoblast: stem cell for all
formed elements

Three Types of Formed Elements
 Red blood cells (RBCs) or
erythrocytes
▪ Transport respiratory gasses
 White blood cells (WBCs) or
leukocytes
▪ Key players in the immune system
 Platelets
▪ Cell fragments involved in clotting

Anucleate
 - live 90 – 120 days
 -aprx. 3 million/second

Lack mitochondria

Disc shaped & flexible

Importance of RBC Shape
and Size
 High surface-to-volume ratio
▪ Quickly absorbs and releases
oxygen
 Discs form stacks called
rouleaux
▪ Smooth the flow through narrow
blood vessels
 Discs bend and flex entering
small capillaries:
▪ 7.8 µm RBC passes through 4 µm
capillary

Most numerous of the formed elements

RBCs make up 99.9% of blood’s formed elements
 1 mm3 contains aprx. 5 million RBCs
 Measured as:
▪ Hematocrit (Hct)
▪ VPRC (volume packed red cells)
▪ PCV (packed cell volume)
Figure 19–2a–c The Anatomy of Red Blood Cells

Normal Hct:
 Males: 44-50%
Females: 36-42%

↑ during dehydration

↓ internal bleeding or
RBC formation
problems
Viscosity –
“thickness” of blood
▪Dependent on Hct
Figure 19–2d
Each RBC contains Hemoglobin (Hb)
Globin: protein – made up of AA
Heme: red pigment
Fe: bind O2
Expressed as grams/100 ml of whole blood
normal 12 - 18g/dl
Functions to bind/transport O2 & CO2
oxyhemoglobin (HbO2)
reduced or deoxyhemoglobin (HHb),
carbaminohemoglobin (HbCO2)

Fetal Hemoglobin
 Strong form of hemoglobin found in embryos
 Takes oxygen from mother’s hemoglobin
3 million/second
As cells differentiate, accumulate hemoglobin then lose
organelles and nucleus
Reticulocyte released from bone marrow, matures into
erythrocyte in blood
Controlled by EPO:
stimulus for release is
hypoxia (anemia,
altitude)
hypoxia stimulates
kidney to release EPO
Testosterone also
triggers EPO release
Restores
O2
delivery
Increased RBC
production &
Hct
Hypoxia
Kidney
releases
EPO
Bone Marrow
stimulates
hemopoiesis
Blood doping:
● taking EPO
● removing blood and
reinfusing it prior to the
event
↑ viscosity of blood
AustrianCyclist
stripped of 3rd place in
Tour de France
Dietary Requirements:
CHO/Fats so protein isn’t
used for energy
Protein
Folic Acid
B12 & Intrinsic factor
B6 necessary for protein
synthesis
Fe
RBC phagocytized (hemolysis) by macrophages in the liver, spleen
and bone marrow
(some RBC hemolyze in the bloodstream and Hb excreted by
kidneys in urine, if excessive=hemoglobinuria)
Hb is split off and cleaved into
globin: broken down into amino acids which are
recycled/reused
heme: Fe is stripped off heme
Fe is stored or transported back to bone marrow by
transferrin
Heme: converted into biliverdin (green) which is then
broken down into bilirubin(yellow)
Bilirubin is:
excreted by liver (bile)
jaundice is caused by bilirubin buildup
converted by intestinal bacteria to urobilins and
stercobilins
Figure 19–5 Recycling of Red Blood Cell Components
Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin
Cummings

Blood types
 Are genetically determined
 ABO and Rh most commonly tested ones
Antigens (agglutinogens): cell
membrane surface proteins
that identify cells to immune
system 
Normal cells are ignored and
foreign cells attacked
Antigen A or Antigen B
Antibody (agglutinins):

found in plasma

Identify and attack foreign
antigens: form antigenantibody complex
(agglutination) or
clumping & hemolzye
Anti- A or Anti- B
 Plasma antibody meets its specific surface antigen
 Blood will agglutinate and hemolyze
 Occur if donor and recipient blood types not compatible
Blood
Group/Type
A
B
AB
O
RBC Antigen
Plasma
Antibodies
Blood that can
be received
Blood
Group/Type
RBC Antigen
A
A
B
AB
O
Plasma
Antibodies
Blood that can
be received
Blood
Group/Type
RBC Antigen
Plasma
Antibodies
A
A
Anti - B
B
AB
O
Blood that can
be received
Blood
Group/Type
RBC Antigen
Plasma
Antibodies
Blood that can
be received
A
A
Anti - B
A, O
B
AB
O
Blood
Group/Type
RBC Antigen
Plasma
Antibodies
Blood that can
be received
A
A
Anti - B
A, O
B
B
AB
O
Blood
Group/Type
RBC Antigen
Plasma
Antibodies
Blood that can
be received
A
A
Anti - B
A, O
B
B
Anti - A
AB
O
Blood
Group/Type
RBC Antigen
Plasma
Antibodies
Blood that can
be received
A
A
Anti - B
A, O
B
B
Anti - A
B, O
AB
O
Blood
Group/Type
RBC Antigen
Plasma
Antibodies
Blood that can
be received
A
A
Anti - B
A, O
B
B
Anti - A
B, O
AB
A&B
O
Blood
Group/Type
RBC Antigen
Plasma
Antibodies
Blood that can
be received
A
A
Anti - B
A, O
B
B
Anti - A
B, O
AB
A&B
Neither Anti - A
nor Anti - B
A, B, AB, O
(universal
recipient)
O
Blood
Group/Type
RBC Antigen
Plasma
Antibodies
Blood that can
be received
A
A
Anti - B
A, O
B
B
Anti - A
B, O
AB
A&B
Neither Anti - A
nor Anti - B
A, B, AB, O
(universal
recipient)
O
Neither A nor B
Blood
Group/Type
RBC Antigen
Plasma
Antibodies
Blood that can
be received
A
A
Anti - B
A, O
B
B
Anti - A
B, O
AB
A&B
Neither Anti - A
nor Anti - B
A, B, AB, O
(universal
recipient)
O
Neither A nor B
Both Anti – A &
Anti - B
Only O
(universal donor)
Type AB can receive all blood types because it doesn’t have plasma
antibodies – cannot fight foreign antigens.
Type O can donate to all types because it doesn’t have RBC antigens (A/B)
so other’s immune cells (antibodies) don’t know its there.
To Perform Blood Typing:
Take sample of blood
Add ANTIBODY serum to sample
Mix and look for clumping of antibody
to antigen
Clumping is + for that antigen

The Rh Factor
 Also called D antigen
 Dominant trait: RR and Rr are Rh+ only rr is Rh Either Rh positive (Rh+) or Rh negative (Rh-)
▪ Only sensitized Rh- blood has anti-Rh antibodies
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Cross-Match Testing for Transfusion
Compatibility
 Performed on donor and recipient blood for
compatibility
 Without cross-match, type O- is universal donor
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

Take drop of blood
Mix with antibodies
(A and B)


Look for reaction
Antibody coagulates
only if antigen present
If mom is blood type O AND Baby is A or B
(or mom is type A and baby is B or mom is B and baby is A)
Mom’s blood has anti-A and anti-B antibodies. Can attack
fetal blood and cause hemolysis.
Can cause anemia in fetus & newborn
Causes severe jaundice – if bilirubin accumulates can cause
brain damage
More commonly occurs with the Rh
factor
If mom is Rh- and fetus is Rh+ (dad is
Rh+) during delivery (or if blood mixes
before) mom’s immune system is
“sensitized” to baby’s Rh antigen.
Her immune system will then make antiRh antibodies.
Is a problem if there is another
pregnancy with an Rh+ baby.
She now has anti-Rh antibodies which will attack and lyse the
Rh+ antigen.

Circulate for short periods - Small numbers in blood
only 5000 to 10,000 per microliter

Most WBCs in connective & lymph tissue

Do not have hemoglobin

Have nuclei and other organelles
WBC functions
1. Defend against pathogens
2. Remove toxins and wastes
3. Attack abnormal cells
WBC Circulation and Movement
Characteristics of circulating WBCs
▪ Can migrate out of bloodstream- diapedesis
▪ Have amoeboid movement
▪ Attracted to chemical stimuli
(positive chemotaxis)
▪ Some are phagocytic:
▪ neutrophils, eosinophils, and monocytes
BC animation
WBC Link
Granulocytes (derived from
myeloblast)
(cytoplasm appears “grainy”)
Agranulocytes
Neutrophils
Lymphocytes
Eosinophils
Monocytes
Basophils
Controlled by colony-stimulating factors (CSF) & cytokines
Figure 19–10a-c White Blood Cells
Figure 19–10d-e White Blood Cells
Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin
Cummings

Neutrophils
 Or polymorphonuclear leukocytes -
PMNs
 Most numerous (50–70% of circulating
WBCs)
 1st Responders
 Pale cytoplasm granules with
▪ Lysosomal enzymes
▪ Bactericides (hydrogen peroxide and
superoxide)
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Neutrophil Action
 Very active, first to attack bacteria
 Engulf pathogens – respiratory burst
 Digest pathogens
▪ defensins (peptides from lysosomes) attack
pathogen membranes
 Release prostaglandins and leukotrienes
 Form pus

Eosinophils
 Attack anything coated with
antibodies
 Attack large parasites
 Excrete toxic compounds
▪ Nitric oxide
▪ Cytotoxic enzymes
 Are sensitive to allergens
 Control inflammation with
enzymes that counteract
inflammatory effects of
neutrophils and mast cells

Basophils
 Rarest - <1% of circulating WBCs
 Accumulate in damaged tissue
 Important for the inflammatory
response
 Release histamine
▪ Dilates blood vessels
 Release heparin
▪ Prevents blood clotting

Lymphocytes
 2nd most numerous - 20–30%
of circulating WBCs
 Derived from lymphoblast
 Migrate in and out of blood
 Mostly in connective tissues
and lymphoid organs
 Are part of the body’s specific
defense system

Three Classes of Lymphocytes
 T cells
▪ Cell-mediated immunity
▪ Attack foreign cells directly
 B cells
▪ Humoral immunity
▪ Differentiate into plasma cells
▪ Synthesize antibodies
 Natural killer (NK) cells
▪ Detect and destroy abnormal
tissue cells (cancers)
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Monocytes
 Stimulated by M-CSF & GM-CSF
 Derived from monoblast
 Enter peripheral tissues and become
macrophages
 Engulf large particles and pathogens
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The Differential Count and Changes in WBC
Profiles
 Detects changes in WBC populations
 Infections, inflammation, and allergic reactions

WBC Disorders
 Leukopenia
▪ Abnormally low WBC count
 Leukocytosis
▪ Abnormally high WBC count
 Leukemia
▪ Extremely high WBC count
Regulation of WBC Production

Colony-stimulating factors = CSFs
 Hormones that regulate blood cell populations:
1. M-CSF stimulates monocyte production
2. G-CSF stimulates granulocyte (neutrophils, eosinophils, and
basophils) production
3. GM-CSF stimulates granulocyte and monocyte production
4. Multi-CSF accelerates production of granulocytes, monocytes,
platelets, and RBCs

150,000 – 400,000 per mm3 of
blood

Megakaryocyte splits into
fragments involved in human
clotting system

Only live for 9–12 days

Are stored in spleen

Three Functions of
Platelets:
1.
Release important clotting
chemicals
2.
Platelet Plug: Temporarily
patch damaged vessel walls
3.
Clot retraction
Thrombocytopoiesis:
▪ formation of platelets
under control of hormones:
TPO & IL-6
 Thrombocytopenia
▪ Abnormally low platelet count
▪ Thrombocytosis:
Abnormally high platelet count
Geoffrey Chan, MD, 2006

Hemostasis is the cessation of bleeding

Consists of three phases
 Vascular phase
 Platelet phase
 Coagulation phase

The Vascular Phase
 A cut triggers vascular spasm that
lasts 30 minutes
 Three steps of the vascular phase
▪ Endothelial cells release:
▪ chemical factors: ADP, tissue factor, and
prostacyclin
▪ local hormones: endothelins
▪ stimulate smooth muscle contraction and
cell division
▪ Endothelial plasma membranes become
“sticky”:
▪ seal off blood flow

The Platelet Phase
 Begins within 15 seconds
 Platelet adhesion (attachment)
▪ To sticky endothelial surfaces
▪ To basal laminae
▪ To exposed collagen fibers
 Platelet aggregation (stick together)
▪ Forms platelet plug
▪ Closes small breaks
Figure 19–11b
Activated platelets release clotting
compounds/factors
1.) ADP (adenosine diphosphate) – stimulates platelet
aggregation
2.) thromboxane A2 – enhance vascular spasm
3.) serotonin - stimulate vascular spasm
Clotting factors
4.) platelet-derived growth factor (PDGF) – promotes
vessel repair
5.) calcium ions – necessary for platelet aggregation
& clotting
6.) prostacyclin – inhibits platelet aggregation limits
platelet plug
7.) protein C (S) – anticoagulant

The Coagulation Phase
 Begins 30 seconds or more after the injury
 Blood clotting (coagulation)
▪ Requires clotting factors
▪ Cascade reactions:
▪ chain reactions of enzymes and proenzymes
Figure 19–12a

Clotting Factors
 Also called procoagulants
 Proteins or ions in plasma
 Required for normal clotting

Two Coagulation Pathways
 Extrinsic pathway
▪ Begins in the vessel wall
▪ Outside bloodstream
▪ Requires TF (Factor III)
 Intrinsic pathway
▪ Begins with circulating proenzymes (PF-3)
▪ Within bloodstream
Common pathway: Where intrinsic and extrinsic pathways converge

The Common Pathway
 Forms enzyme prothrombinase
 Converts prothrombin to thrombin
 Thrombin converts fibrinogen to fibrin
Figure 19–13b The Coagulation Phase of Hemostasis
Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin
Cummings
Procoagulants: enhance clot formation
Anticoagulants: inhibit clot formation
heparin, prostacyclin, protein C, antithrombin-III, aspirin
Normally anticoagulants dominate & clotting is prevented, but when a
vessel is ruptured procoagulant activity increases
Clot formation normally complete within 3-6 min.
Clotting process needs Ca++ and vitamin K
Clotting Animation
Clot Retraction
After clot has formed
▪Platelets contract and pull torn area
together
Takes 30–60 minutes
When healing complete clot is
dissolved (fibrinolysis)
Clot Animation
Clotting Animation
Clotting Animation
1. Anemia: ↓ ability of the blood to carry/deliver
O2
A. Insufficient numbers of RBC:
-hemorrhagic anemia: due to internal or
external bleeding
-hemolytic anemia: RBC are prematurely
lysed, caused by infections, the
immune system, drugs
-aplastic anemia: caused by destruction of
the bone marrow. Can be hereditary
or caused by drugs (anti-cancer drugs,
antibiotics, seizure meds), radiation
-pernicious anemia: lack of vitamin B12
1. Anemia: ↓ ability of the blood to
carry/deliver O2
B. Decreased ability of Hb to carry O2:
-iron deficiency anemia: more common
in females, lack of Fe
C. Abnormal Hb
-sickle cell anemia:
Hypoxia causes Hb to change shape
2. Polycythemia: ↑ in RBCs
-blood doping
3. Leukemias: Bone marrow cancer that results in large
increase in WBCs.
Often “crowds out” RBC & Platelets.
Abnormal WBCs can migrate to lymph nodes/organs.
Named for type of WBC affected (lymphocytic,
myelogenous)
4. Infectious Mononucleosis: caused by
Epstein-Barr virus
flu-like symptoms, usually runs course
may be implicated in chronic fatigue syndrome
5. Thromboembolytic conditions:
thrombus: abnormal blood clot (stationary)
caused by: genetics, lack of anti-coagulants
(protein C deficiency)
over active pro-coagulants, immobilization
(bed rest), slow-flowing blood
thrombus in heart animation
embolism: travelling blood clot
danger is that it will become lodged in a
smaller vessel
Tx: heparin, coumadin (warfarin), dicumarol, TPA, streptokinase, aspirin
6. Hemophilias: x-linked genetic disorder
clotting problem – severity depends on which clotting factor is affected
7. Impaired liver function: liver unable to synthesize procoagulants
liver needs vitamin K to make clotting factors
hepatitis, cirrhosis might affect production of clotting proteins
Common hematology diagnostics: see pages 123-126 in Applications Manual
Synthetic Blood:
Bioengineered from umbilical cords or IVF embryos
Platelet Rich Plasma Therapy