Introduction to Blood Dr.

Mohamed Balfas

Blood consists of cellular elements (red blood cells, white blood cells, and platelets) as well as
plasma, the fluid in which the blood cells are suspended. Normally, total circulating blood volume is
about about 5 liters.
The cellular elements of the blood have a short life span and must be continuously replaced.
The formation of red blood cells, white blood cells, and platelets, collectively, is referred to as
hematopoiesis. This process takes place in the red bone marrow. In adults, red bone marrow is found
in the pelvis, ribs, and sternum.

Figure 1: Blood.
Plasma:
The plasma, accounts for 55 to 60% of total blood volume and is about 90% water. The
remaining 10% contains proteins (8%) and other substances (2%) including hormones, enzymes,
nutrient molecules, gases, electrolytes, and excretory products. The three major plasma proteins
include: • Albumin • Globulins • Fibrinogen

Figure 2: Blood contents.

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Erythrocytes (red blood cells):
On average, there are 5 million red blood cells per microliter (ml) of blood. The percentage of
the blood made up of red blood cells is referred to as hematocrit. An average hematocrit is about 45%.

Figure 3: Erythrocyte.
Red blood cells are small biconcave discs with neither nucleus nor cell organells. Each cell is
approximately 7.2 microns in diameter and 2.2 microns thick. This shape facilitates the diffusion of
oxygen across the cell membrane. Furthermore, red blood cells are very flexible and easily change
their shape. This feature allows them to squeeze through capillaries as narrow as 3 microns in
diameter. However, as the red blood cells age, their membranes become quite fragile and the cells are
prone to rupture. Aged cells are removed by the spleen. The average life span of a red blood cell is
about 120 days.
The primary function of red blood cells is to transport oxygen to the tissues. The red, oxygen-
carrying molecule within the red blood cell is hemoglobin. Hemoglobin (Hb) is a large molecule
consisting of four individual polypeptide chains, each with iron-containing heme group that can bind
O2. The average hemoglobin content in the blood is about 15 g/100 ml of blood, all of it within the red
blood cells.

Figure 4: Hemoglobin.
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Introduction to respiratory physiology:
The functions of the respiratory system include:
• Supply oxygen to the body’s cells.
• Remove carbon dioxide from the body.
Parts of the respiratory system:
1- The upper respiratory tract consists of the parts outside the chest cavity; the nasal cavity,
pharynx, larynx, and upper trachea.
2- The lower respiratory tract consists of the parts found within the chest cavity; the lower trachea,
the primary bronchi, and the lungs.
As the primary bronchi enter the lungs, they divide into smaller tubes. The smallest tubes are
called bronchioles, which end in tiny air sacs known as alveoli.

A B

Figure 5: A- The upper and lower respiratory tract. B- The lung.

Lungs:
Lungs are the major organs of the respiratory system. It consists of alveoli, which are the sites
of gas exchange in the lungs (see Figure 5b). There are 300 million alveoli in the lungs, and there are
as many as 1000 capillaries per alveolus.
Each alveolus consists of the following:
1. Made of alveolar type I cells; thin to permit diffusion of gases.
2. Surrounded by pulmonary capillaries, which are made of thin endothelial cells.
3. A thin layer of tissue fluid lines each alveolus; essential to permit rapid diffusion of gases.
4. Alveolar type II cells produce pulmonary surfactant that mixes with the tissue fluid lining to
decrease surface tension to maintain inflation of the alveoli.

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5. Alveolar macrophages phagocytize foreign material.

Figure 6: Alveolar structure showing type I and type II cells, and alveolar macrophages.
Mechanism of ventilation (breathing):
Ventilation is the movement of air into and out of the lungs: inspiration and expiration.
Ventilation requires:
-- Respiratory centers (in the brainstem “medulla and pons”).
-- Respiratory muscles are the diaphragm and external intercostal muscles.
Inspiration: It is an active process.
1. Motor impulses from medulla travel along phrenic nerves to diaphragm, which contracts and moves
down. Impulses are sent along intercostal nerves to external intercostal muscles, which pull ribs up
and out.
2. The chest cavity is expanded.
3. The lungs are expanded and air rushes into the lungs.
Expiration: It is a passive process.
1. Motor impulses from the medulla decrease, and the diaphragm and external intercostal muscles
relax.
2. The chest cavity becomes smaller and compresses the lungs.
3. The air is forced out of the lungs.

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Figure 7: Respiratory muscle activity during; (A) inspiration and (B) expiration.
Gas movement:
Gases (O2 and CO2) move by diffusion from an area of higher concentration to an area of
lower concentration until equilibrium state.
The lung alveoli contain air with high concentration of O2 and low concentration of CO2. The
right side of the heart pumps deoxygenated blood to the lungs (pulmonary circulation), so that blood
uptake of O2 and elimination of CO2 can take place. Then the oxygenated blood return to the left side
of the heart, and it pumps it to the tissue cells (systemic circulation) where concentration of O2 is low
while the concentration of CO2 is high, so that blood elimenation of O2 and uptake of CO2 can take
place.

Figure 8: (A) Gas movement in the lungs and (B) transport of gases by the blood.
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Transport of gases in the blood:
Most oxygen is carried in the blood bonded to the iron of hemoglobin (98.5%) in red blood
cells (RBCs). A small amount of O2 is carried dissolved in plasma.
The oxygen–hemoglobin bond is formed in the lungs where O2 concentration is high. When
blood passes through tissues with a low O2 concentration, the bond breaks, and oxygen is released to
the tissues.

Figure 9: Transport of oxygen.

Carbon dioxide (CO2) is carried in blood in the following forms:
1. Dissolved in the plasma and red blood cells (10%).
2. Carried by hemoglobin – carbminohemoglobin (20%).
3. Most CO2 is carried in the plasma in the form of bicarbonate ions (HCO3–) (70%). When CO2 enters
the blood, most diffuses into red blood cells, which contain the enzyme carbonic anhydrase. This
enzyme catalyzes the reaction of carbon dioxide and water to form carbonic acid:
CO2 + H2O → H2CO3
The carbonic acid then dissociates: H2CO3 → H+ + HCO3–. The bicarbonate ions diffuse out of
the red blood cells into the plasma, leaving the hydrogen ions (H+) in the red blood cells. The many H+
ions would tend to bind to hemoglobin.
• When blood reaches the lungs, CO2 is reformed again, diffuses into the alveoli, and is expired.

Figure 10: Carbon dioxide transport in the blood.

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Carbon monoxide (CO):
Carbon monoxide is a colorless, odorless gas that is produced during the combustion of fuels
such as gasoline, coal, oil, and wood. Carbon monoxide combines with hemoglobin at the same point
on the hemoglobin molecule as does oxygen; it can therefore displace oxygen from the hemoglobin.
The reason CO is so toxic is that it forms a very strong and stable bond with the hemoglobin in
RBCs, about 250 times as much tenacity as oxygen (carboxyhemoglobin). Hemoglobin with CO
bonded to it, cannot bond to and transport oxygen.

Figure 11: Carbon monoxide toxicity and poisoning.