BLOOD

- the only “fluid” tissue in the body

- complex connective tissue
- Blood sample collection: a. venipuncture
b. fingerstick or heelstick
c. arterial blood (Arterial blood gas)
A. Functions of Blood
1. Transportation
a. oxygen and carbon dioxide
b. nutrients, heat, waste products
c. hormones
2. Regulation
a. blood pH through buffers
b. body temperature
c. blood osmotic pressure
3. Protection
a. clotting system
b. white blood cells
c. antibodies
B. Physical Characteristics and Volume
a. opaque and with metallic taste
b. color varies from scarlet (O2 rich) to dull red (O2 poor)
c. heavier in water and 5x thicker because of formed elements
d. slightly alkaline (7.35 – 7.45)
e. temp is slightly higher than body temp (38ºC)
f. accounts for 8% of body weight
g. 4-5L in females; 5-6L in males
C. Composition
1. Plasma
a. Makes up 55% of the whole blood
b. Liquid part of the blood which is 91.5% water and 8.5% solutes (7% of it are
proteins)
c. Straw colored fluid where nutrients are dissolved
d. Most abundant solutes in the plasma are plasma proteins
e. Proteins in the plasma are:
Albumin: smallest and most numerous plasma proteins
: produced in the liver
: transports proteins fro several steroid hormones and fatty acids
Globulins: Protein group to which Ab (immunoglobulins) belong
: Produced by liver and plasma cells which develop from B lymphocytes
: Ab attack viruses and bacteria
: Alpha and Beta globulins transport iron, lipids and fat soluble vitamins
: Gamma globulins: Immunoglobulins: IgG, IgA, IgM, IgE, IgD
Fibrinogen: Produced by liver
: role in blood clotting
f. Contains other solutes such as:
Electrolytes: Inorganic salts, anions, cations
: helps maintain osmotic pressure
Nutrients: amino acids, glucose, fatty acids, glycerol, vitamins & minerals
Gases: O2, CO2, Nitrogen
Regulatory substances: enzymes, hormones
Wastes: most are breakdown products of protein metabolism
: urea, uric acid, creatinine, creatine, bilirubin, ammonia
2. Formed Elements: blood cells and cell fragments
:45% of the whole blood
: 99% are RBC’s; 1% are WBCs and platelets
: “buffy coat”- layer which contains the WBCs, platelets
a. Red Blood Cells/ erythrocytes:
▪ contains the O2 carrying protein HEMOGLOBIN which is a pigment giving the blood its red
color
▪ 7-8µm in diameter
▪ Males: 5.4million/mm³; Females: 4.8million/mm³
▪ Anucleated; Biconcave (greater surface area); plasma membrane is strong and flexible
▪ No mitochondria
▪ Life cycle: 120 days
▪ Erythropoiesis: production of RBC’s
▪ Erythropoietin: stimulates production of RBCs
▪ Hematocrit (Hct): percentage of the total blood volume occupied
by RBCs NV: females: 38-46%; males: 40 – 54%
▪ Testosterone: stimulates synthesis of erythropoietin in males
▪ Transports Nitric Oxide and Super Nitric Oxide which helps adjust BP
 ▪Clinical Correlation: Anemia: significant drop in Hct
causes: blood loss
Polycythemia: Hct 65% or higher
causes: DHN, blood doping, hypoxia
b. White Blood Cells/ leukocytes:
▪ Nucleated; no hemoglobin
▪ 1. Granular Leukocytes: neutrophils, eosinophils, basophils
2. Agranular Leukocytes: lymphocytes and monocytes

Granular Leukocytes
Name and Number Characteristics Functions
Appearance
Neutrophils 60 – 70% of all 10-12 µm in diameter Phagocytosis: destruction of bacteria
WBCs Nucleus has 2-5 lobes with lysozyme, defensins (broad range of
connected by thin strands of antibiotic activity) and strong oxidants
chromatin
Cytoplasm has fine pale lilac
granules
Eosinophils 2-4% of all 10-12 µm in diameter Combats effects of histamine in allergic
WBCs Nucleus with 2 or 3 lobes reactions
Cytoplasm has large red Phagocytize Ag-Ab complex
orange granules Destroys certain parasitic worms
Basophils 0.5-1% of all 8-10 µm in diameter Liberate heparin, histamine, serotonin in
WBCs Nucleus has 2 lobes allergic reactions that intensify the
Large cytoplasmic granules overall response
appear deep blue purple

Agranular Leukocytes
Name and Number Characteristics Functions
Appearance
Lymphocytes (T 20-25% of all Small lymphocytes: 6-9µm in Mediate immune responses including
cells, B cells and WBCs diameter Ag-Ab reactions
natural killer cells) Large lymphocytes: 10-14mm B cells develop into plasma cells which
in diameter secrete Ab
Nucleus round or slightly T cells attack invading viruses, cancer
indented cells and transplanted tissue cells
Cytoplasm forms a rim around Natural killer cells attack a wide variety
the nucleus that looks sky blue; of infectious microbes and certain
the larger the cell, the more spontaneously arising tumor cells
cytoplasm is visible
Monocytes 3-8% of all 12-20 µm in diameter Phagocytosis (after transforming into
WBCs Nucleus is kidney shaped or fixed or wandering macrophages)
horseshoe shaped Monocytes migrate into the tissues,
Cytoplasm is blue gray and has enlarge, differentiate into
foamy appearance macrophages (fixed and wandering)

c. Platelets/ Thrombocytes
- 150,000-450,000/mm³
- 2-4µm in diameter; cell fragments live for 5-9 days
- contains many granules but no nucleus
- Forms platelet plugs in hemostasis, release chemicals which promote vascular spasm and
clotting
- aged and dead platelets are removed by fixed macrophages in the spleen and liver

RBC LIFE CYCLE:

1. Macrophages in the spleen. Liver or red bone marrow phagocytize worn out blood vessels.
2. The globin and heme portions of Hgb are split apart
3. Globin is broken down into amino acids which can be reused to synthesize other proteins.
4. Fe removed from the heme portion is in the form of Fe³+ which associates with a plasma protein, transferrin, a transporter of
Fe in the bloodstream.
5. In muscle fibers, liver cells and macrophages of the spleen and liver, Fe detaches from the transferring and attaches to the
iron-storage proteins called ferritin and hemosiderin.
6. Upon release from a storage site or absorption from the GI tract, Fe³+ reattaches to the transferring.
7. The Fe³+ -transferrin complex is then carried to the bone marrow, where RBC precursor cells take it up through receptor
mediated endocytosis for use in Hgb synthesis. Fe is needed for the heme portion of the Hgb molecule, whereas amino
acids are needed for the globin portion. Vit. B12 is also needed for synthesis of the Hgb.
8. Erythropoiesis in red bone marrow results in the production of RBCs, which enter the circulation.,
9. When Fe is removed from heme, the non Fe portion of heme is converted to biliverdin, a green pigment, an then into
bilirubin, a yellow orange pigment.
10. Bilirubin enters the blood and transports it into the liver.
11. Within the liver, bilirubin is secreted by liver cells into bile, which passes into the small intestine and then into the large
intestine.
12. In the large intestine, bacteria converts bilirubin into urobilinogen.
13. Some urobilinogen is absorbed back into the blood, converted to a yellow pigment called urobilin and excreted in urine.
14. Most urobilinogen is eliminated in the feces in the form of a brown pigment called stercobilin which gives feces its
characteristic color.
ERYTHROPOIESIS: Production of RBCs
In the red bone marrow, precursor cell (proerythroblast) near the end of the developmental sequence releases its
nucleus >>> reticulocyte>>> release into bloodstream >>> after 1-2 days >>> erythrocyte

NEGATIVE FEED BACK REGULATION OF ERYTHROPOIESIS

WBC Physiology:
Entry of pathogens in the body >>> WBCs migrate to the affected areas by a process called EMIGRATION ( wbcs
roll in the endothelium, stick to it and squeeze between endothelial cells)

Lymhocytes: continually recirculate from blood to interstitial spaces of tissues to lymphatic tissues and back to
blood
: major types: a. T cells: attacks virus, fungi, transplanted cells, Ca cells, some bacteria
b. B cells: destroys bacteria and inactivates their toxins
c. Natural killer cells: attacks a wide variety of infectious microbes and some spontaneously
arising tumor cells
Granulocyte and monocyte: leave the bloodstream to fight infections and never return to it.
Neutrophils and macrophages: active in phagocytosis
: microbes and bacteria attract phagocytes by a phenomenon called CHEMOTAXIS
Neutrophils respond most quickly to tissue destruction by bacteria >>> after engulfing the bacteria >>> neutrophil
releases destructive chemicals: a. lysozyme: destroys bacteria
b. strong oxidants: similar to the household bleach; ex: H2O2, hypochlorite ion,
superoxide anion
: contains DEFENSINS: exhibit against a broad range of antibiotic activity against bacteria, fungi
Monocytes: take longer to reach site of infection but arrives in larger numbers
: enlarges and differentiates into wandering macrophages w/c clean up cellular debris and microbes
Eosinophils: enters tissue fluid; releases histaminase w/c combats effects of histamine
: phagocytizes Ag-Ab complexes; effective against some parasitic worms
Basophils: involved in inflammatory and allergic reactions
; leaves capillaries, enters tissues and develop into mast cells – liberate heparin, histamine, serotonin
: intensifies an inflammatory reaction and is involved in allergic reactions.

** an increase in circulating WBCs usually indicates infection or inflammation

differential white blood cell count

PLATELET FORMATION;
Hormone thrombopoietin >>> myeloid stem cells develop into megakaryocyte colony forming cells >>> develop into
precursor cells called MEGAKARYOBLASTS >>> megakaryocyte >>> platelets
HEMOSTASIS:
- sequence of responses that stops bleeding
- when blood vessels are damaged or ruptured, the hemostatic response must be quick and localized to the
region of damage and carefully controlled
3 Mechanisms:
1. Vascular spasm
- blood vessels are made of muscles >>> substances are released from the activated platelets
- reflexes are initiated by pain receptors
2. Platelet plug formation
a. Platelet Adhesion
- during an injury, platelets would go to the and stick to the parts of a damaged blood vessel
b. Platelet Release Reaction
- plts become activated and extends many projections that enable them to contact and interact with
each other
- they begin to liberate their contents: ADP- activates other plts
Serotonin- causes vasoconstriction
▪ contraction of smooth muscles
▪ decreased blood flow to the affected area
Thromboxane A2 (TXA2)- causes vasoconstriction
- also an aggregant
c. Platelet Aggregation
- makes other platelets sticky and adherent
- formation of a platelet plug which are initially loose and then is tightened by fibrin threads
3. Blood Clotting
- when blood forms a gel
- culminates in the formation of fibrin threads
- involves the clotting factors in the blood clotting cascade

BLOOD CLOTTING CASCADE (clotting factors and clotting cascade>>>refer to table and diagram)

CLOT RETRACTION
- consolidation or tightening of the fibrin clot
- fibrin threads attach to the damaged surfaces and gradually contract as the platelets pull on them
- as the clot retracts, it pulls the edges of the damages vessels together, decreasing the risk of further damage
- permanent repair of the blood vessel ensues
ROLE OF VITAMIN K
- required for the synthesis of factors II, VII, IX, X
- Normally produced by the bacteria in the large intestines
HEMOSTATIC CONTROL MECHANISM
1. Fibrinolytic System
o dissolves small inappropriate clots
o Fibrinolysis: dissolution of a clot
o Plasminogen: enzyme incorporated in a clot
: activated to plasmin or fibrinolysin by: thrombin
activated factor XII
tissue thromboplasminogen activator
: once formed, it can dissolve the clot by digesting Fibrin
: also inactivates Fibrinogen, Prothrombin, Factors V, VIII, XII
2. Prostacycline:
- From the endothelial cells and WBC’s
- opposes the action of thromboxane A2
- powerful inhibitor of platelet adhesion and release
3. Anticoagulants
a. Antithrombin:
- blocks the action of Factors XII, XI, X, IX, II
b. Heparin:
- produced by basophils and mast cells
- combines with antithrombin and increases its effectiveness in blocking thrombin
c. Activated Protein C
- inactivates Factors V, VIII which are factors not blocked by antithrombin
- enhances the activity of plasminogen activators
d. Warfarin (Coumadin):
- antagonist to Vit. K
- blocks the synthesis of Factors II, VII, IX, X
e. EDTA ( Ethylene Diamine Tetra Acetic acid)
f. CPD (Citrate Phosphate Dextrose)
- prevents clotting of donated blood by removing Calcium
g. Aspirin
- low doses inhibits vasoconstriction and platelet aggregation by blocking synthesis of TXA2
ABO AND Rh Blood Groups
- Agglutinogens/ Isoantigens: Antigens found on the surface of the RBC
HEMOLYTIC DISEASE OF THE NEWBORN (Erythroblastosis fetalis)