What is blood?

…
Blood is a fluid consisting of
formed elements and plasma. It is
produced by bone marrow, and
the volume depends on body
weight. An individual weighing
154 pounds has a blood volume
of about 5 quarts/liters.
What is the function of blood?
It provides a means of transportation for…
A. Transporting respiratory gases… oxygen and
carbon dioxide
B. Chemicals, such as those found in food,
hormones, and salts
C. Cells that protect
the body from
foreign
substances
 What is blood plasma?
Plasma is the fluid part
of the blood. It is clear
or straw-colored. It
comprises 55% of the
total blood volume,
and is mostly water
and proteins: albumin
(al BU min), globulin
(GLOB u len),
fibrinogen
(fī BRIN oh jen), and
prothrombin
(pro THROM bin).
What are the ‘formed elements’
found in blood?
Erythrocytes are the red blood cells formed in
the red marrow inside bones. They carry
oxygen and carbon dioxide.
Hematopoiesis
Pluripotent cell/
hemocytoblast

19-6 6
 Hematopoiesis

Myeloid Erythroid
Hematopoietic stem
cell: SC Precursors
1- Self renewal
2- Cell differentiation
Erythropoieti
Transcriptiona n
l GATA1
Factor
 Erythropoiesis
The “Bone Marrow” is the major site with the need of:
Folic acid – Iron “Ferrous” – Vit B12 – Erythropoietin -
Amino acids
minerals - other regulatory factors

Basophilic Intermediate Late Reticulocyt Erythrocyt

Erythroblast
Normoblast Normoblast Normoblast e e

+ ++ +++ ++ + -
Synthesis of
8
Hemoglobin 8
 Normal Ranges
HCT
Indices Male Female
Hemoglobin(g/dL) 13.5-17.5 11.5-15.5
Hematocrit (PCV) (%) 40-52 36-48
Red Cell Count (×10¹²) 4.5-6.5 3.9-5.6
Mean Cell Volume (MCV) (fL) 80-95
Mean Cell Hemoglobin 30-35
(MCH) (pg)

Hb MCV MCH

Microcyti
c Hypochrom
ic
Normocyti
c
Macrocyti
c Normochromic
 ERYTHROPOIESIS
• This takes place in the bone marrow and
therefore, the first recognizable cell which can
be identified as belonging to this series is the
pronormoblast.
• It is from this cell that the red cells develop
through a succession of maturing erythroblast
namely basophilic/ early normoblast,
polychromatic/ intermediate normoblast,
orthochromatic/late normoblast.
10
• Then from here it develops to reticulocyte
and finally ends up with erythrocyte (mature
red cell).
• The whole process takes about 7 days.
• This process of normoblastic maturation is
characterized by the following progressive
changes:-

11
1) The cell size diminishes.
2) Ripening of the cytoplasm. the staining reaction
of the cytoplasm changes, the RNA starts
diminishing) These two things take place
simultaneously.
a) So, colour changes to pink from blue due to
reduction of RNA matter such that in
Romanowsky stains, there is a change in colour
from deep blue to pink due to progressive
formation of acidophilic staining haemoglobin
and the simultaneous reduction of RNA which is
responsible for basophilic of cytoplasm.
12
b) Haemoglobin formation.
3) Ripening (maturing) of the nucleus having the
large reddish, purple, open-network of the
nucleus of a polychromatic normoblast
converted to small deeply staining blue black
structureless nucleus of the orthochromatic
normoblast before it is eventually lost. i.e.
the nucleus of the pronormoblast is larger
than that of the orthochromatic normoblast.

13
• The former (ponormoblast) has structures and
stains reddish purple, while the later
(orthochromatic) stains blue-black and is
structureless.
• Mitotic division of the developing cells in this
series occurs up to the stage of the
polychromatic normoblast and therefore the
orthochromatic normoblast is not considered
capable of mitotic division.

14
 Functions

1. It transports oxygen from the lungs through

the heart to the tissues and carbon dioxide
from the tissues to the lungs and finally out of
the body.
2. They carry antigens.
3. They contain haemoglobin.

15
 Hemoglobin

• Hemoglobin is the protein molecule in RBC that

carries O2 from the lungs to the body's tissues and
returns carbon CO2 from the tissues back to the
lungs.
• Hemoglobin maintains the shape of RBC also.
 Requirement of erythropoiesis

• This can be divided into 2 categories:

a) nutritional requirement.
b) non nutritional requirement.
• Nutritional requirements deal with diet e.g.
iron, vitamin, folates, trace metal, amino acids.
• Non nutritional requirements include hormones
e.g. adrenaline, erythropoietin steroids.

17
 What are the ‘formed elements’ found in blood?
Leukocytes are white blood cells, the body’s
defense against pathogens (bacteria or virus).
They move through cell walls to areas of infection,
ingesting and destroying the pathogens.

Neutrophils are one of the 5 types of leukocytes. A

‘neutrophil count’ identifies the number of white
blood cells that are aren’t busy elsewhere, and are
available to go fight an infection.
 What are the ‘formed elements’
found in blood?
Thrombocytes
are platelets, about half the
size of erythrocytes. They play
an important role in the
clotting of blood.

Red blood cell; platelet; white blood cell

 ANEMIA

• An (without) -aemia (blood)

• Reduction of Hb concentration below the normal

range for the age and gender

• Leading to decreased O2 carrying capacity of

blood and thus O2 availability to tissues (hypoxia)
 Clinical Features

Presence or absence of clinical feature depends on:

1-Speed of onset :
Rapidly progressive anemia causes more symptoms than slow
onset anemia due to lack of compensatory mechanisms:
(cardiovascular system, BM &O2 dissociation curve

2-Severity:
• Mild anemia :no symptoms usually
• Symptoms appear if Hb less than 9g/dL

3- Age:
• Elderly tolerate anemia less than young patients
 Clinical Features
1-General features of
anemia
• Weakness
• Headache
• Pallor Related to anemia
• Lethargy
• Dizziness
• Palpitation (tachycardia)
Related to compensatory
• Angina
mechanism
• Cardiac failure

2-Specific features

Specific signs are associated with particular types of anemia :

 Spoon nail with iron deficiency,
 Leg ulcers with sickle cell anemia
 Jaundice with hemolytic anemia
 bone deformities in thalassemia major
Classification
of Anemia
Hemoglobin DNA RBC count

Blood
Prophyrin DNA
loss
synthesis
Iron Hemolysis
Globin chain RBC production

Acute
bleedin
Megaloblast g Autoimmune
Thalassem Enzymopathy BM failure:
ia ic anemia: Membranopath -Chemotherapy
Iron def. -B12 def. y -Aplastic anemia
anemia -Folate Mechanical -Malignancy
Sidroblast def. Sickle cell Anemia of
ic anemia MDS anemia chronic disease

Hypochromic Macrocyt Normocytic

microcytic ic anemia normochromi
anemia c anemia
 -Thalassemias -Molecular Pathogenesis
i) Promoter region mutations :
Transcription defect:
-  + Thalassemias (Some normal -globin
is synthesized)
ii) Chain terminator mutations :
Translation defect: Premature
termination of mRNA translation
-  0 Thalassemia (Prevention of -globin
synthesis)
iii) Splicing mutations : Most Common:
Both  + &  0 Thalassemias occur
  -Thalassemia-Major Clinical Features

• Extramedullary
hematopoiesis involving liver,
spleen & lymphnodes 
massive enlargement
• Iron overload (Repeated
blood transfusions & 
absorption of dietary iron)
 Hemosiderosis involving
mainly heart, liver &
pancreas
 What are blood groups?
In 1901, Karl Landsteiner discovered the ABO
blood system that contained 4 blood types. This
was a significant discovery for the success of
blood transfusions.
Blood can be lost
from surgery, injury,
or illness. A person
transfused with an
incompatible blood
type may have a life-
threatening reaction.
The body’s immune
system (white blood
cells) attacks it.
 What are blood groups?
Type A blood has ‘A’ antigens located on the
surface of the red blood cells, and ‘anti-B’
antibodies in the plasma. (Antigens and
antibodies are specific protein molecules.) 41%
of the population has this blood type.
People with
Type A blood
can get
transfusions
from people
with Type A
or Type O
blood.
 What are blood groups?
Type B blood has ‘B’ antigens located on the
surface of the red blood cells, and ‘anti-A’
antibodies in the plasma. 10% of the population
has this blood type.

People with
Type B blood
can get
transfusions
from people
with Type B
or Type O
blood.
 What are blood groups?
Type AB blood both A or B antigens located on
the surface of the red blood cells, and no ‘anti-A’
or ‘anti-B’ antibodies in the plasma. Only 4% of
the population has this blood type.
People with
Type AB blood
can get
transfusions
from people
with ANY blood
type. They are
called
universal
receivers.
 What are blood groups?
Type O blood has no A or B antigens located on
the surface of the red blood cells, and both
‘anti-A’ and ‘anti-B’ antibodies in the plasma. 45%
of the population has this blood type.
People with Type O
blood can only get
transfusions from
other people with
Type O blood.
Because the three
other blood types
can take their blood,
they are called
universal donors.
 What is the Rh factor?
The Rh factor refers to the presence or absence
of a substance called an ‘agglutinogen’ in the red
blood cells. When the blood has this agglutinogen
in it, the person is said to be Rh positive.
Mixing Rh positive
and Rh negative blood
groups can result in
agglutination, or
blood clumping. This
can become life-
threatening, especially
if it happens more
than once.
So how do we make sure blood
transfusions are successful?
To make sure a
transfusion is
successful, the blood
is ‘typed’… A, B, AB,
or O. Then it is
cross-matched. That
means that samples
of the donor and Agglutination
recipient blood are
mixed together, and
observed for signs of
agglutination.
 Lymph is the clear, What is lymph?
nearly colorless,
alkaline fluid that
occupies the space
between all cells of
the body. The term for
this is ‘interstitial
fluid’ (in ter STISH awl),
and it is similar to
blood plasma. It is
95% water. It seeps in
and out through the
walls of very small
vessels called Lymph is mostly fluid
capillaries. from blood plasma.
What is the lymphatic system?
The lymphatic
system is connected
to the circulatory
system. It consists
of capillaries,
vessels, ducts, and
nodes. This system
transports lymph
one-way…back to
the blood stream.
There is no pump, but the lymph moves via
skeletal muscle action, respiratory movement, and
contraction of smooth muscle in vessel walls.
 What are the functions of the
lymphatic system?
The lymphatic system has
3 primary functions:
1. Transports proteins
and fluids, lost by
capillary seepage, back to
the bloodstream.
2. Participates in the
body’s immune response.
3. Is the pathway for the
absorption of fats from the
small intestine into the
bloodstream.
 What is the function of lymph nodes?
Lymph nodes are filters, slowing down and
cleaning the lymph before returning it to the blood.
The dark
lumps on the
membrane are
lymph nodes.

Lymph nodes and ducts under the arm.

What is the function of lymph nodes?

Lymph nodes trap and sometimes become

swollen with bacteria that has invaded the body
AND the white blood cells that fight that
bacteria.
 The lymphatic system and cancer…
The lymphatic system
plays an important role
in the development or
spread of cancer.
Cancer that starts in the
lymph nodes is called a
lymphoma. When
cancer cells break off a
tumor and spread into
the lymph nodes, it is
known as metastatic
cancer.
Example: A dye is injected to direct the surgeon to the nearest lymph
node (the sentinel node). If cancer cells are found in this node, they
have spread away from the tumor.
 Accessory organs to the lymphatic
system… the spleen
The spleen is a soft, dark
purple organ found in the
upper-left portion of the
abdomen and surrounded
by blood and lymph
vessels. The red pulp of the
spleen removes old red
blood cells (erythrocytes)
from the blood supply. The
white pulp of the spleen
removes, stores and
produces white blood cells
(lymphocytes).
 Accessory organs to the
lymphatic system… the spleen
If the spleen is severely
damaged, it can be
removed surgically with
a procedure called a
splenectomy. The
majority of its functions
are taken over by the
liver. The individual will
have an increased Normally
susceptibility to 11-12 cm
in length;
infections due to the loss 4½
of immune function. inches
 Accessory organs to the
lymphatic system… the tonsils
The tonsils are located
in masses of tissue in
the back of the throat.
They filter bacteria and
produce white blood
cells. Tonsils are
sometimes removed if
they become so large
they cause an
obstruction or if they
are chronically
inflamed.
Accessory organs to the lymphatic
system… the thymus gland
The thymus gland is
usually considered as
part of the endocrine
system, but is actually Thyroid
gland
part of the lymphatic
system due to its
appearance and function.
It manufactures one
specific type of the
infection-fighting
lymphocytes. They are
Do not confuse the thymus
aptly called T-cells. gland with the thyroid gland.