FUNCTIONS OF BLOOD

Blood has always fascinated humans, and throughout history they have speculated about its function. Some
societies consider blood the “essence of life” because the uncontrolled loss of it can result in death. Many
cultures around the world, both ancient and modern, believe blood has magical qualities. Blood has also been
thought to define our character and emotions. For example, people of a noble bloodline are sometimes
described as “blue bloods,” whereas criminals are said to have “bad” blood. People commonly say that anger
causes their blood to “boil,” whereas fear makes it “curdle.” The scientific study of blood reveals characteristics
as fascinating as any of these fantasies. Blood performs many functions essential to life. Diagnostic tests that
evaluate the blood composition can reveal much about our health. The heart pumps blood through blood
vessels that extend throughout the body.

Blood helps maintain homeostasis in several ways:

1. Transport of gases, nutrients, and waste products. Blood acts as a major transport medium in the body due
to the many substances that move into and out of the blood.
2. Transport of processed molecules. Many substances must be processed at multiple sites in the body. A
substance may be produced in one organ or tissue, enter the blood and move to a new location where it
is modified.
3. Transport of regulatory molecules. The blood carries many of the hormones and enzymes that regulate
body processes from one part of the body to another.
4. Regulation of pH and osmosis. Buffers (see chapter 2), which help keep the blood’s pH within its normal
limits of 7.35–7.45, are found in the blood.
5. Maintenance of body temperature. As blood flows through areas of the body that are metabolically
active, the heat generated by metabolism warms the blood.
6. Protection against foreign substances. Certain cells and chemicals in the blood constitute an important
part of the immune system, protecting against foreign substances, such as microorganisms and toxins.
7. Clot formation. When blood vessels are damaged, blood clotting protects against excessive blood loss.

COMPOSITION OF BLOOD

o Blood is a type of connective tissue that

consists of a liquid matrix containing cells
and cell fragments. The liquid matrix is
the plasma, and the cells and cell
fragments are the formed elements. The
plasma accounts for slightly more than
half (55%) of the total blood volume, and
the formed elements account for slightly
less than half (45%). The total blood
volume is about 4–5 liters (L) in the
average adult female and 5–6 L in the
average adult male. Blood makes up
about 8% of total body weight.
PLASMA

Plasma is a pale yellow fluid that consists of about 91% water, 7% proteins, and 2% other components, such as
ions, nutrients, gases, waste products, and regulatory substances.

o Albumin - makes up 58% of the plasma proteins.

o Globulins - account for 38% of the plasma proteins.
o Fibrinogen - is a clotting factor that constitutes 4% of plasma proteins.
o Serum - is plasma without the clotting factors.

FORMED ELEMENTS

o Red blood cells (RBCs) or Erythrocytes - are the most abundant of the formed elements. Red blood cells
constitute nearly 95% of all the formed elements.
o White blood cell - remaining 5% of the volume of the formed elements
o Platelets – cell fragments

Production of Formed Elements

o Hematopoiesis - is the process that produces formed elements. This process is continuous throughout our
lives. In the fetus, hematopoiesis occurs in several tissues, including the liver, thymus, spleen, lymph
nodes, and red bone marrow.
o Stem cells - All the formed elements of blood are derived from a single population of cells. These stem
cells differentiate to give rise to different cell lines, each of which ends with the formation of a particular
type of formed element.
Red Blood Cells

Normal red blood cells are disk-shaped, with edges that are thicker than the
center of the cell. The biconcave shape increases the cell’s surface area
compared to a flat disk of the same size. The greater surface area makes it
easier for gases to move into and out of the red blood cell. In addition, the red
blood cell can bend or fold around its thin center, decreasing its size and
enabling it to pass more easily through smaller blood vessels.

 Hemoglobin - which is responsible for the cell’s red color.

Function the primary functions of red blood cells are: to transport oxygen from
the lungs to the various tissues of the body and to help transport carbon
dioxide from the tissues to the lungs. Oxygen transport is accomplished when
oxygen enters red blood cells and binds to hemoglobin. Each hemoglobin
molecule consists of four protein chains and four heme groups

o Each protein chain, called a globin, is bound to one heme, a redpigmented molecule. Each heme
contains one iron atom, which is necessary for the normal function of hemoglobin.
o Hemoglobin picks up oxygen in the lungs and releases oxygen in other tissues. Hemoglobin that is bound to
oxygen is bright red, whereas hemoglobin without bound oxygen is a darker red. 98.5% of the oxygen
transported in blood is bound to hemoglobin molecules within red blood cells. The remaining 1.5% of
oxygen is dissolved in plasma.

Life History of Red Blood Cells

Under normal conditions, about 2.5 million red blood cells are destroyed every second. Fortunately, new red
blood cells are produced just as rapidly.

 Proerythroblasts - which give rise to the red blood cell line.

 Red blood cell production depends on the presence of several vitamins as well as sufficient iron. The
process of cell division that produces new red blood cells requires the B vitamins folate and B12, which are
necessary for the synthesis of DNA.
 Red blood cell production is stimulated by low blood oxygen levels. Typical causes of low blood oxygen are
decreased numbers of red blood cells, decreased or defective hemoglobin, diseases of the lungs, high
altitude, inability of the cardiovascular system to deliver blood to tissues, and increased tissue demand for
oxygen, as occurs during endurance exercises.
 Red blood cell production is regulated to ensure that homeostatic levels of these cells are present in the
blood. An important factor that determines the rate of red blood cell
production is blood oxygen level.
 Erythropoietin - stimulates red bone marrow to produce more red
blood cells, when oxygen levels in the blood decrease, the
production of erythropoietin increases, which increases red blood
cell production. The greater number of red blood cells increases the
blood’s ability to transport oxygen.
 Bilirubin - a yellow pigment molecule. Bilirubin is normally removed
from the blood by the liver and released into the small intestine as
part of the bile.
 If the liver is not functioning normally, or if the flow of bile from the liver
to the small intestine is hindered, bilirubin builds up in the blood. As a
consequence, bilirubin can be deposited into other tissues, resulting in a
condition
 Jaundice - a yellowish color to the skin. Under normal conditions,
after bilirubin enters the intestine, it is converted by bacteria into other pigments.

White Blood Cells

 White blood cells are spherical cells that lack hemoglobin. When the components of blood are separated
from one another, white blood cells as well as platelets make up the buffy coat, a thin, white layer of cells
between plasma and red blood cells.
 White blood cells can leave the blood and travel by ameboid movement through the tissues. In this
process, the cell projects a cytoplasmic extension that attaches to an object.
 Granulocytes - containing large cytoplasmic granules
 Agranulocytes - very small granules that cannot be seen easily with the light microscope

There are three kinds of granulocytes: (1) neutrophils, (2) basophils, and (3) eosinophils.

 Neutrophils - the most common type of white blood cells, have small cytoplasmic granules that stain
with both acidic and basic dyes. Neutrophils usually remain in the blood for a short time (10–12 hours),
move into other tissues, and phagocytize microorganisms and other foreign substances. Dead
neutrophils, cell debris, and fluid can accumulate as pus at sites of infections.
 Basophils - the least common of all white blood cells, contain large cytoplasmic granules that stain blue
or purple with basic dyes. Basophils release histamine and other chemicals that promote inflammation.
 Eosinophils - contain cytoplasmic granules that stain bright red with eosin, an acidic stain. They often
have a two-lobed nucleus . Eosinophils are involved in inflammatory responses associated with allergies
and asthma. In addition, chemicals from eosinophils are involved in destroying certain worm parasites.

There are two kinds of agranulocytes: lymphocytes and monocytes.

 Lymphocytes - are the smallest of the white blood cells . The lymphocytic cytoplasm consists of only a
thin, sometimes imperceptible ring around the nucleus. Lymphocyte activities include the production of
antibodies and other chemicals. The antibodies and other chemicals destroy microorganisms,
contribute to allergic reactions, reject grafts, control tumors, and regulate the immune system.
 Monocytes - are the largest of the white blood cells
  Macrophages - which phagocytize bacteria, dead cells, cell fragments, and any other debris within the
tissues.

Platelets

o Platelets are minute fragments of cells, each consisting of a small amount of cytoplasm surrounded by a
cell membrane. They are produced in the red bone marrow from large cells called megakaryocytes. Small
fragments break off from the megakaryocytes and enter the blood as platelets. Platelets play an important
role in preventing blood loss.

PREVENTING BLOOD LOSS

 The body can tolerate a small amount of blood loss and can produce new blood to replace it. But a large
amount of blood loss can lead to death. Fortunately, when a blood vessel is dam aged, loss of blood is
minimized by three processes: (1) vascular spasm, (2) platelet plug formation, and (3) blood clotting.
 Vascular spasm - is an immediate but temporary constriction of a blood vessel that results when smooth
muscle within the wall of the vessel contracts. This constriction can close small vessels completely and stop
the flow of blood through them. Vascular spasm is stimulated by chemicals released by cells of the
damaged blood vessel wall and by platelets.
 Thromboxanes - which are derived from certain prostaglandins, and endothelial (epithelial) cells lining
blood vessels release the peptide endothelin.

A platelet plug is an accumulation of platelets that can seal up a small break in a blood vessel.

 Platelet adhesion - platelets stick to the collagen exposed by blood vessel damage
 Von Willebrand factor - a protein produced and secreted by blood vessel endothe lial cells. Von
Willebrand factor forms a bridge between collagen and platelets by binding to platelet surface
receptors and collagen.
 Platelet release reaction - platelets release chemicals, such as ADP and thromboxane, which bind to
their respective receptors on the surfaces of other platelets, activating the platelets. These activated
platelets also release ADP and thromboxane, which activates more platelets.
 Fibrinogen receptors - platelets become activated, they express surface receptors, which can bind to
fibrino gen, a plasma protein.
  Platelet aggregation - fibrinogen forms bridges between the fibrinogen receptors of numerous platelets,
resulting in a platelet plug.

Blood Clotting

 Blood vessel constriction and platelet plugs alone are not sufficient to close large tears or cuts in blood
vessels. When a blood vessel is severely damaged, blood clotting, or coagulation (, results in the formation
of a clot.
 Clot - is a network of threadlike protein fibers, called fibrin , that traps blood cells, platelets, and fluid.
 Clotting factors - formation of a blood clot depends on a number of proteins found within plasma.

Clot formation is a complex process involving many chemical reactions, but it can be summarized in three
stages.

1. The chemical reactions can be started in two ways: (a) Inactive clotting factors come in contact with
exposed connective tissue, resulting in their activation, or (b) chemicals, such as thromboplastin, are
released from injured tissues, causing activation of clotting factors. After the initial clotting factors are
activated, they in turn activate other clotting factors. A series of reactions results in which each clotting
factor activates the next until the clotting factor prothrombinase , or prothrombin activator, is formed.
2. Prothrombinase converts an inactive clotting factor called prothrombin to its active form, thrombin.
3. Thrombin converts the plasma protein fibrinogen to fibrin
Control of Clot Formation

 Without control, clotting would spread from the point of its ini tiation throughout the blood vessels
 Anticoagulants - which prevent clotting factors from forming clots under normal conditions.
 Thrombus - When platelets encounter damaged or diseased areas of blood vessels or heart walls, an
attached clot
 Embolus - A thrombus that breaks loose and begins to float through the circulation

Clot Retraction and Fibrinolysis

 Platelets contain the contractile proteins actin and myosin, which operate in a fashion similar to that of the
actin and myosin in muscle. Platelets form small extensions that attach to fibrin through surface receptors.
Contraction of the extensions pulls on the fibrin and leads to clot retraction. During clot retraction, serum,
which is plasma without the clotting factors, is squeezed out of the clot.
 Retraction of the clot pulls the edges of the damaged blood vessel together, helping stop the flow of
blood, reducing the probability of infection, and enhancing healing.
 Fibrinolysis – clots are dissolved, as the damaged tissue is repaired.
 Plasminogen – an inactive plasma protein
 Plasmin – is converted to its active form
 Tissue plasminogen activator (t-PA) - released from surrounding tissues can stimulate the conversion
of plasminogen to plasmin.
 Streptokinase - a bacterial enzyme, and t-PA, produced through genetic engineering, have been
used successfully to dissolve clots.

BLOOD GROUPING

 If large quantities of blood are lost during surgery or due to injury, a patient can go into shock and die unless
red blood cells are replaced to restore the blood’s oxygen-carrying capacity. In this event, either a
transfusion or an infusion is called for.
 Transfusion - is the transfer of blood or blood components from one individual to another.
 Infusion - is the introduction of a fluid other than blood, such as a saline or glucose solution, into the
blood.
 Transfusion reactions - characterized by clumping or rupture of blood cells and clotting within
blood vessels.
 Antigens – molecules in surfaces of red blood cells
 Antibodies - the plasma includes proteins
 Antibodies bind to antigens; how ever, antibodies are very specific, meaning that each antibody can bind
only to a certain antigen. When the antibodies in the plasma bind to the antigens on the surface of the red
blood cells, they form molecular bridges that connect the red blood cells together.
 Agglutination or clumping of the cells
 Hemolysis , or rupture of the red blood cells. The debris formed from the ruptured red blood cells
can cause severe tissue damage, particularly in the kidneys.

ABO Blood Group

 The ABO blood group system is used to categorize human blood.

 Type A blood has type A antigens, type B blood has type B antigens, and type AB blood has both types of
antigens. Type O blood has neither A nor B antigens.
 Transfusion reactions can therefore occur if a person receives blood that does not match her blood type.
This is because plasma from type A blood contains anti-B antibodies, which act against type B antigens;
plasma from type B blood contains anti-A antibodies, which act against type A antigens. Type AB blood
plasma has neither type of antibody, and type O blood plasma has both anti-A and anti-B antibodies. The
ABO blood types do not exist in equal numbers. In caucasians in the United States, the distribution is type O,
47%; type A, 41%; type B, 9%; and type AB, 3%. Among African Americans, the distribution is type O, 46%;
type A, 27%; type B, 20%; and type AB, 7%.
 Donor - is the person who gives blood
 Recipient -is the person who receives it

Rh Blood Group

1. Rh-positive blood has Rh antigens, whereas Rh-negative blood does not.

2. Antibodies against the Rh antigen are produced when an Rh-negative person is exposed to Rh-positive
blood.
3. The Rh blood group is responsible for hemolytic disease of the newborn, which can occur when the
fetus is Rh-positive and the mother is Rh-negative

DIAGNOSTIC BLOOD TESTS

Type and Crossmatch

o Blood typing determines the ABO and Rh blood groups of a blood sample. Typically, the cells are
sepa rated from the serum and then tested with known antibodies to determine the type of antigen on
the cell surface. Agglutination during the typing procedure identifies the antigens on the red blood
cells.
o In a crossmatch, the donor’s blood cells are mixed with the recipient’s serum, and the donor’s serum is
mixed with the recipient’s cells. The donor’s blood is considered safe for transfusion only if no
agglutination occurs in either match.
Complete Blood Count

o A complete blood count (CBC) is an analysis of blood that pro vides much useful information. A CBC
consists of a red blood cell count, hemoglobin and hematocrit measurements, and a white blood cell
count

Red Blood Count

 Blood cell counts are usually performed electronically with a machine, but they can also be done manually
with a microscope. A normal red blood count (RBC) for a male is 4.6–6.2 million red blood cells per microliter
(μL) of blood; for a female, a normal RBC count is 4.2–5.4 million per μL of blood. (A microliter is equivalent
to 1 cubic millimeter [mm3 ] or 10−6 L, and one drop of blood is approximately 50 μL).
 Erythrocytosis - is an overabundance of red blood cells leading to increased blood viscosity,
reduced flow rates and, if severe, plugged capillaries.

Hemoglobin Measurement

 The amount of hemoglobin in a given volume of blood is usually expressed in terms of grams of hemoglobin
per 100 mL of blood. The normal hemoglobin measurement for a male is 14–18 grams (g) per 100 mL of
blood, and for a female 12–16 g per 100 mL of blood.
 Anemia - which is either a reduced number of red blood cells or a reduced amount of hemoglobin
in each red blood cell

Hematocrit Measurement

o The percentage of the total blood volume that is composed

of red blood cells is the hematocrit . One way to determine
hematocrit is to place blood in a capillary tube and spin it in a
centrifuge. The formed elements, which are heavier than the
plasma, are forced to one end of the tube. Of these, the
white blood cells and platelets form the buffy coat between
the plasma and the red blood cells. The red blood cells
account for 40–52% of the total blood volume in males and
38–48% in females. The hematocrit measurement is affected
by the number and size of red blood cells because it is based
on volume.

White Blood Count

 A white blood count (WBC) measures the total number of white blood cells in the blood. There are normally
5000–9000 white blood cells per microliter of blood.
 Leukopenia - is a lower than normal WBC resulting from decreased production or destruction of the
red marrow. Radiation, drugs, tumors, viral infections, or a deficiency of the vitamins folate or B12
can cause leukopenia.
 Leukocytosis- is an abnormally high WBC. Bacterial infections often cause leukocytosis by
stimulating neutrophils to increase in number.
 Leukemia - cancer of the red marrow characterized by abnormal production of one or more of the
white blood cell types, can cause leukocytosis.
Differential White Blood Count

o A differential white blood count determines the percentage of each of the five kinds of white blood
cells. Normally, neutrophils account for 60–70%, lymphocytes 20–25%, monocytes 3–8%, eosinophils 2–4%,
and basophils 0.5–1% of all white blood cells.

Clotting

o There are two common ways to measure the blood’s ability to clot: platelet count and prothrombin
time measurement.

Platelet Count

o A normal platelet count is 250,000–400,000 platelets per microliter of blood. In the condition called
thrombocytopenia , the platelet count is greatly reduced, resulting in chronic bleeding through small
vessels and capillaries. It can be caused by decreased platelet production as a result of hereditary
disorders, lack of vitamin B12 (pernicious anemia), drug therapy, or radiation therapy.

Prothrombin Time Measurement

o Prothrombin time measurement calculates how long it takes for the blood to start clotting, which is
normally 9–12 seconds. Prothrombin time is determined by adding thromboplas tin to whole plasma.
Thromboplastin is a chemical released from injured tissues that starts the process of clotting

Blood Chemistry

o The composition of materials dissolved or suspended in plasma (e.g., glucose, urea nitrogen, bilirubin,
and cholesterol) can be used to assess the functioning and status of the body’s systems