BLOOD

Definition – Blood is highly specialized liquid connective tissue of the body consisting of a straw colored fluid
called plasma in which the cellular parts called formed elements are suspended.

Physical characteristic of blood ---

 Slightly alkaline in nature (PH- 7.35-7.45) and salty in taste.
 It is a viscous fluid, about 5 times more than distilled water.

Volume –male --- 5 – 6 lit

female --- 4 – 5 lit

composition of blood : If blood is centrifuged, it divides into 3 portions:

(1) Plasma makes up roughly 55%;
(2) Packed RBCs make up roughly 45%; and
(3) The Buffy layer (containing WBCs and platelets) makes up <1%. The % of blood consisting of packed RBCs is
known as the hematocrit.

Blood’s color ranges from scarlet (oxygen-rich) to dark red (oxygen poor). Its viscosity is 5x that of water, due
primarily to the presence of formed elements. Blood temperature is typically 100°F.

Function of the blood -----

Blood has 3 main distribution functions:
(1) It carries O2 (from lungs) and nutrients (from GI tract and body stores) to all cells;
(2) It carries wastes from all cells to elimination sites (lungs for CO2; kidneys for nitrogenous wastes); and
(3) It carries hormones (chemical signals) from endocrine organs to target tissues.

Blood has 3 main regulatory functions: (1) It regulates body T° by absorbing and distributing heat; (2) It
maintains body pH by virtue of its many buffers; and (3) It maintains adequate fluid volume in the body.

Blood has 2 main protective functions: It prevents blood loss by initiating clotting mechanisms in response to
blood vessel damage; and (2) It prevents infection via WBCs and plasma immune proteins.

Substances in blood plasma ---

Constituent Description
Water ( 91.5%) Liquid portion of blood ,acts as a suspending medium for
components of blood ,absorbs ,transport and releases heat .
Proteins -------(7.0%)Proteins are 3
types –Albumin , Globulin and
Fibrinogen
Albumin Formed in liver ,maintains osmotic pressure
Globulin Produced by liver and by plasma cells helps attack viruses and
bacteria , helps in transport of iron ,lipid and fat soluble vitamin .
Fibrinogen Produced by liver . Plays essential roles in blood clotting .
Other solutes (1.5%)
1) They are salts of Nacl ,NaHCO3, s
alts of K, Ca ,Mg, P , Fe , Copper ,
iodine , fluoride etc .
Helps maintain osmotic pressure and play essential roles in the
function of the cells
2) Nutrients Amino acids from protein , glucose from carbohydrates ,fatty
acids ,glycerol vitamins and minerals .
3) Gases O2 , CO2 AND NO2
4) Regulatory substances i) Enzymes – Produced by body cells . Enzymes are amylase , lipase ,
protease etc

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 ii) Hormones – Produced by endocrine glands . Enzymes and
hormones regulate metabolism , growth and development in the body
5) Waste products Include urea , uric acid , ammonia ,bilirubin, creatinine are carried out
by blood to the organs of excretion .

From left to right: Red blood cell (erythrocyte); Platelet (thrombocyte); White blood cell (leukocyte).

FORMED ELEMENTS :

Formed elements

Red blood cells (RBC) White blood cells

Platelets (150000- 400000/ µl)
4.8 -5.4 MILLION /µL (5000 -10000 /µl)

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 WHITE BLOOD CELL (WBC)

Agranulocytes

Granulocytes

Monocytes
(3 -8 %)
Neutrophils Basophils Lymphocyt
(60 -70 %) Eosinophils (0.5 -1.0%) es (20 -
(2 – 4 %) 25%)

Formation of blood cells - The process of formation and development of blood cells is called hemopoiesis
( poiesis= making ) or hematopoiesis .

It takes place in ---

First occurred in the yolk sac of an embryo and later in the liver, spleen, thymus and lymph nodes of a fetus .

In the last three months and onwards ---- Red bone marrow become the primary sites for hematopoiesis.

RED BLOOD CELLS ( RBCS)

i) Also called erythrocytes ( erythro = red and cyte = cell)

ii) Contain the O2 carrying protein hemoglobin.
iii) Hemoglobin is a pigment which gives blood its red color

Normal red blood cells count :-

Adult male – 5.4 million of RBC/ µL

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Adult female – 4.8 million/ µL
RBC anatomy ----
1. RBCs are biconcave disc with a diameter of 7 – 8 µm and 1.5 – 2.0µm in thickness .
2. RBCs lack a nucleus and other organelles so it can neither reproduce nor carry on extensive metabolic activities.

3. They are generally equal in size. However under certain pathological conditions variation in size has become
noticed which may be larger called macrocytes or smaller called microcytes. Such variation on in size is known as
Anisocytosis and deviation from normal shape is known as poikilositosis.

RBCs physiology -----

1. Highly specialized for their O2 transport function
2. It lacks mitochondria and hence generate ATP anaerobically. However they do not use the oxygen that they
carry
3. Each RBC s contains 280 million molecules of hemoglobin and each hemoglobin can carry up to 4 oxygen
molecules.

Life cycle of RBC -----

Life cycle of the RBC is only about 120 days, due to the lack of the nucleus and other organelles, RBC can’t
synthesize new components to replace damaged one . As they become old the plasma membrane of the RBC become
more fragile and the cells are more likely to burst So these ruptured red blood cells are removed from the
circulation and destroyed in the spleen ,liver and red bone marrow , and the break down products are recycled as
follows ------
1. When RBC breaks, Hb released out and broken into two parts --- globin and heme portion.
2. Globin is broken down in to amino acids, which can be reused by the body.
3. From heme portion Iron is removed and that iron is transported to the liver by a plasma protein,
transferrin. In the liver iron is stored as ferritin or hemosiderin. When iron is removed, the non iron
portion of heme is converted to biliverdin a green pigment and then in to bilirubin a yellow orange
pigment.
4. Bilirubin enters the blood and is transported to the liver.
5. The liver modifies the bilirubin and secrets it into the small intestine as part of bile, then in to the large
intestine.
6. In the large intestine ,bacteria converts bilirubin into urobilinogen
7. Some urobilinogen is absorbed back in to the blood, converted to a yellow pigment called urobilin, and
excreted in urine.
8. Most urobilinogen is eliminated in feces in the form of a brown pigment called stercobilin, which gives
feces its characteristic color.

Production of the RBC (ERYTHROPOIESIS) – The process by which erythrocytes are formed is called
erythropoiesis. Erythropoiesis requires iron & vitamin B12. A kidney hormone, erythropoietin controls the
rate of erythropoiesis.
All the blood cells arise from a hemopoitic stem cell called haemocytoblast

Function ---
1. Hemoglobin which is in RBC transport most of the oxygen and part of the carbon dioxide in the blood .
2. RBC can maintain the acid –base balance of the blood as well as help to maintain the viscosity of the blood.

What is haemolysis?
It is a phenomenon of disruption of red blood cells with the liberation of hemoglobin corpuscles to the plasma.
It may be caused due to several factors like ----Addition of drugs like quinine may cause hemolysis
------ Various pathological conditions may induce hemolysis
------ Addition of incompatible blood may render hemolysis.
------- Addition of viper snake venom may seriously cause hemolysis .

Anemia is a condition caused by low levels of red blood cells and hemoglobin.
Anemia can be caused by the following:

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 • Loss of blood due to injury,
• Infestations of blood-sucking parasites, or low levels of red cell production due to poor nutrition

Hemoconcentration is a condition in which there is an above normal level of red blood cells.
Hemoconcentration is normally caused by dehydration (loss of body fluid), which can be the result of vomiting,
diarrhea, or any chronic disease characterized by high body temperatures.

White blood cells (WBC)

White Blood cells or leucocytes (leuco= white), differ from red cells in having a nucleus and not containing
hemoglobin . They are variable in size and shape and exhibit characteristic amoeboid movement. Under certain
physiological and pathological condition WBC can produce pseudopodia and can come out of the blood vessels by a
process which is called Diapedesis.

Normal WBC count --- Normal range of WBC of an adult person is – 5000 – 10000cells per µl of blood .

Leucocytosis-- An increase number of WBC above 10000/µl of blood is called leucocytosis .

Leucopenia --- An abnormally low level of white blood cells is termed leucopenia.

Span of WBC --- Their life span is comparatively shorter in comparison to RBC. Ranging from 12- 15 days
according to the verity of WBC .During a period of infection they may live even only for a few hours.

Origin of WBC --- The granulocytes originate from red bone marrow and agranulocytes originate from the
spleen and lymphatic glands and to some extent from the bone marrow.

Functions - The main functions are –

1. Phagocytes
2. Antibody formation
3. Formation and secretion of lysozome, heparin, antihistamines etc.

Classification of WBC ----

Granular leucocytes ---- They are three types

1. Neutrophils --- Number – 60 -70 %

Characteristic features – 10 – 12 µm in diameter . Nucleus has 3-5 lobes connected

by thin strands of chromatin cytoplasm have very fine , pale lilac granules .

Function: Phagocytosis. Destruction of bacteria with the help of Lysozyme.

2. Eosinophils --- Number 2 – 4% of all WBC

Eosinophils is 10–12 µm in diameter, nucleus has 2 -3lobes,

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 large granules filled the cytoplasm .

Function – They take part in the destruction of toxins of protein origin and foreign protein to defend against the
allergic conditions. Eosinophilia is encountered in allergic disorders,
many skin disease, parasitic infection of the tissues etc.

2. Basophiles--Number - 0.5 -1.0 % of all WBC.

CF- 8 -10 µm diameter, nucleus has two lobe, large cytoplasmic granules appear deep
blue purple.

Functions --- Due to presence of heparin ,histamine and serotonin , they

hamper the intravascular coagulation of the blood in the site of inflammation and
thus facilitate re absorption( check) and healing .

A granular leucocytes -- They are two types

T –Cells Natural killer Cells

B- Cells
1. Lymphocytes
Number—20- 25 % of all WBC
It is the major soldier of the immune system to fight against the invasion [viral infection and leukemia]
Small lymphocytes are 6 – 9 µm in diameter. Larger is 10 – 14 µm in diameter. Nucleus is round or slightly
indented, cytoplasm form a rim around the nucleus that looks sky blue, the larger the cell, the more cytoplasm is
visible.

Functions – Mediate immune responses including antigen antibody reaction. B cells develop in to plasma cells,
which secrete antibodies.
T cells attack invading viruses, cancer cells and transplanted tissue cells.
Natural killer cells attack a wide verity of infectious microbes and certain spontaneously arising tumor cells

2. Monocytes --- Number – 3 -8 % of all WBC.

12 – 20 µm in diameter. Nucleus is kidney shaped. Cytoplasm is blue gray and has foamy appearance.
Function --- They are body “scavengers”. They actively destroy foreign bodies, bacteria, protozoa etc, by the
process of phagocytosis.

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s

What is differential white blood cells count?

It is the count of each of the five types of white blood cells to detect infection or inflammation

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Platelets ------

Or thrombocytes are disc shaped, non nucleated. They are the smallest of all the formed elements of blood
measuring 2 -4 µm in diameter in diameter .
Normal platelets count --- 150000 – 400000 / µL

ORIGIN OF PALTELETS – Under the influence of the hormone thrombo poietin myeloid stem cells develop in to
precursor cells called megakaryoblasts . Megakaryoblasts transform in to the megakaryocytes , from
megakaryocytes platelets are formed .
Life span of platelets -- 5 – 9 days .

Functions –
1. Initiation of blood clotting by liberation thrombo plastin on their disintegration and there by activate the
conversion of prothrombin to thrombin .

2. Repair of capillary endothellium

3. Liberation of histamine and serotonin .
4. Vasoconstriction by serotonin causing stoppage of bleeding (or form platelet plug in hemostasis, release
chemicals that promotes vascular spasm and blood clotting )

Coagulation of blood --- When a blood vessels cut , the blood is coming out from the vessels , but soon a clot is
formed on the wound and the flow of the blood is stopped . This is a complex process . Clotting involves several
substances known as clotting factors . This factors include calcium ions , several inactive enzymes that are
synthesized by hepatocytes ( liver cells ) and released in to the blood stream

The factors which are involved listed down bellow –

Factor numbers Name of the factors

I Fibrinogen
II Prothrombin
III Tissue factor (thromboplastin )
IV Calcium ions ( ca²+)
V Labile factor, proaccelarin
VII Stabile factor ,proconvertin
VIII Antihaemophilic globin ,
Antihemophilic factor A
IX Christmas factor , Plasma thromboplastin component ,
antihemophilic factor B
X Stuart power factor
XI Plasma thromboplastin antecedent (PTA)
XII Hageman factor
XIII Fibrin stabilizing factor

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Vitamin K Is essential for synthesizes of factor II, , VII, IX and X .

N.B . There is no factors VI

Clotting occurs in a series of steps as follows ---

1.The injured tissue cells and the platelets which disingrate at the site of the wound release a substance
thromboplastin ( also
called thrombokinase)

2. Thromboplastin acts as an enzyme and with the help of the Ca²+ ions present in plasma , It converts a substance
prothrombin of the plasma in to thrombin .

3. Thrombin reacts with the soluble fibrinogen of the plasma to convert it in to insoluble fibrin . Fibrin is a solid
substance that forms threads . these microscopic threads of fibrin are sticky and form a network at the wound

4. Blood corpuscles are trapped in the network of the fibrin, the network then shrinks and squeeze out the rest of
the
plasma. The solid mass, which is left behind is called clot or thrombus.

The three major reactions in blood coagulation are –

----- Thromboplastin + prothrombin + Calcium = Thrombin

------ Thrombin + fibrinogen = Fibrin
------ Fibrin + blood corpuscles = Clot

Q.Why does not blood clot in the vessels ?

Normal human blood contains an anti coagulant , heparin a glycol protein , a product of basophiles which
prevents the conversion of prothrombin in to thrombin . it acts as an anti thrombin and there by hinders the
intravascular clotting . In addition to the activity of heparin , intravascular clotting is also prevented by the
smoothness of the inner lining layer of the blood vessels which favors easy flow of blood and prevents the rupture
of the platelets responsible for clotting .

Q. What is thrombosis?
It is a phenomenon of the formation of clot ( thrombus ) in an unbroken blood vessels . When thrombus is formed
inside the unbroken coronary blood vessels it is called coronary thrombosis and when it is in unbroken cerebral
blood vessels is called cerebral thrombosis. It may damage tissues by cutting off the oxygen supply or it may block
the circulation in a smaller vessel of any vital organ .

Role of vitamin K in clotting .

Normal clotting depends on adequate vitamin K in the body . Although vitamin K is not involved in actual clot
formation . It is required for the synthesis of four clotting factors by hepatocytes: Factor II (PROTHROMBIN ) VII ,
IX , X .Vitamin K , which is normally produced by bacteria that inhabit the large intestine , is a fat soluble vitamin ,
and it can be absorbed through the lining of the intestine and into the blood only if absorption lipids is normal .
People suffering from disorders that slow absorption of lipids often experience uncontrolled bleeding as a
consequence of vitamin K deficiency .

BLOOD DISORDERS –

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Anemia --- is a condition in which the oxygen – carrying capacity of blood is reduced . All of the many types of
anemia are characterized by reduced numbers of RBCs or a decreased amount of hemoglobin in the blood . The
persons fells fatigued and is intolerant of cold ,both of which are related to lack of oxygen needed for ATP and heat
production . Also the skin appears pale , due to the low content of red colored hemoglobin circulating in skin blood
vessels . The types of anemia are – iron deficiency anemia , pernicious anemia , hemorrhagic anemia , hemolytic
anemia , aplastic anemia etc .

Leukemia -- is a malignant disease of blood –forming tissues characterized by uncontrolled production and
accumulation of immature leucocytes . In chronic leukemia ,mature leucocytes accumulate in the blood stream
because they do not die at the end of their normal life span . The human T cell leukemia – lymphoma virus I
(HTLV-1) IS STRONGLY ASSOCIATED WITH SOME TYPES OF LEUKEMIA . The abnormal accumulation
of immature leucocytes may be reduced by treatment with X –RAYS AND ANTILEUKEMIC drugs . In some
cases , a bone marrow transplant can cure the leukemia .

Hemophilia—is an inherited deficiency of clotting in which bleeding may occur spontaneously or after only minor
trauma . Different types of hemophilia are due to deficiencies of different blood clotting factors . The most common
type is hemophilia A , in which factor VIII is absent . people with hemophilia B lack factor IX . Hemophilia C is
caused by lack of factor XI . Hemophilia is characterized by spontaneous or traumatic subcutaneous and
intramuscular hemorrhaging , nose bleeds , blood in the urine and hemorrhages in joints that produce pain and
tissue damage .

What is complete blood count [CBC]?

- Usually includes the counts of RBCs, WBCs and platelets per μL of whole blood;
- Hematocrit and differential WBC count
- The amount of hemoglobin in g/μl of blood is determined

The hemogram or complete blood count (CBC) is used as a broad screening test to check for such disorders as
anemia, infection, and many other diseases. It is actually a profile of tests that examines different parts of the blood
and includes the following:

 Hematocrit measures the percentage of red blood cells in a given volume of whole blood.
 Hemoglobin measures the amount of oxygen-carrying protein in the blood.
 Mean Corpuscular Volume (MCV) is a measurement of the average size of your red blood cells. The
MCV is elevated when your red blood cells are larger than normal (macrocytic), for example in anemia
caused by vitamin B12 deficiency. When the MCV is decreased, your red blood cells are smaller than
normal (microcytic) as is seen in iron deficiency anemia or thalassemias.
 Mean Corpuscular Hemoglobin (MCH) is a calculation of the average amount of oxygen-carrying
hemoglobin inside a red blood cell. Macrocytic red blood cells are large so they tend to have a higher
MCH, while microcytic red blood cells would have a lower value.
 Mean Corpuscular Hemoglobin Concentration (MCHC) is a calculation of the average concentration of
hemoglobin inside a red cell. Decreased MCHC values (hypochromia) are seen in conditions where the
hemoglobin is abnormally diluted inside the red cells, such as in iron deficiency anemia and in thalassemia.
Increased MCHC values (hyperchromia) are seen in conditions where the hemoglobin is abnormally
concentrated inside the red cells, such as in burn patients and hereditary spherocytosis, a relatively rare
congenital disorder.
 Platelet Count is the number of platelets in a given volume of blood. Both increases and decreases can
point to abnormal conditions of excess bleeding or clotting.
 Red Cell Distribution Width (RDW) is a calculation of the variation in the size of your red blood cells. In
some anemias, such as pernicious anemia, the amount of variation (anisocytosis) in red blood cell size
(along with variation in shape – poikilocytosis) causes an increase in the RDW.

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 Red Blood Cell (RBC) Count is a count of the actual number of red blood cells per volume of blood. Both
increases and decreases can point to abnormal conditions.
 White Blood Cell (WBC) Count is a count of the actual number of white blood cells per volume of blood.
Both increases and decreases can be significant.

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