Whole blood

solid
Organic
1) Protein - albumin, globulin, fibrinogen,
prothrombin
2) Internal secretion, antibodies, enzymes
3) Non proteins like urea, uric acid, creatinine
4) Neutral fat, cholesterol, glucose
Inorganic
sodium chloride, sodium bicarbonate,
calcium, iron
Gases
Oxygen, carbon diaoxide, nitrogen
 RBC
Major function – carries oxygen through
hemoglobin
Contains carbonic anhydrase which catalyses
reaction between water and carbon diaoxide
and transport it from tissue to lung in the form
of bicarbonate ion
Responsible for buffering of the blood
 Shape and size
Shape – biconcave disc
shape changes while passing through
capillaries
It is like a bag which can change into
any
shape because of excess of cell
membrane
Size- Diameter -7.8 micrometer
thickness- 2.5 micrometer at thickest
1 micrometer at the center
Production
Early weeks of embryonic life- yolk sac
Middle trimester – liver also spleen and lymph
node
Last month and after birth- bone marrow
Till 5 years – all the bone marrow
After around 20 years – membranous bones
like vertebra, sternum ribs
Concentration
5.2 million in male
4.2 million in female per cubic mililter
 Quantity of hemoglobin
Whole blood contains 16 gm per deciliter in
males
 14 gm per deciliter
in females
Factors controlling growth and reproduction
Growth inducers- IL1, IL6, IL3
IL3- promotes growth for all types of cells.
Others only specific type of committed cells
Growth factors promote growth but not
differentiation
This function done by protein called as
differentiation inducers
Formation of growth and differentiation
inducers in turn controlled by factors outside
the marrow like low oxygen tension in case of
RBC and infections in case of WBC
Regulation of RBC production
 Reduced tissue oxygenation - high altitudes,
destruction of
marrow,
circulation
disorders
• Erythropoietin
Principle factor
formed in kidney 90 % (renal tubular
epithelial cells) and also in liver10%
• Effect – hypoxia induces production of
erythropoietin within minutes and RBC
Maturation – Vitamin B & 12

Folic acid
Bone marrow cells are most rapidly
reproducing and growing cells.
Maturation and rate of production are
affected by nutritional status.
For maturation Vit B12 and folic acid are
needed
Both are needed for synthesis of DNA as they
are required in formation of thymidine
phosphate which a building block of DNA
Lack of Vit B12 and folic acid leads to failure of
nuclear maturation and division
Forms larger than normal cells with normal
oxygen carrying capacity but fragile cell walls
leading reduced life.
This is called as maturation failure
Hemoglobin

• Formation begins at proerythroblats and

continues into reticulocyte stage.
• Steps - 2succinyl CoA + 2glycine -> pyrrole
• 4 pyrrole-> protoporphyrine IX
• protoporphyrine IX +Fe -> heme
• heme + polypeptide -> hemoglobin
chain
Types of hemoglobin chains – alpha,
beta, gamma chains and delta chains
Most common form of hemoglobin is hemoglobin
a made up of 2 alpha and 2 beta chains
Fetal hemoglobin ( hemoglobin F) is made up of a
alpha and 2 gamma. This type facilitates
movement of oxygen from maternal to fetal
circulation and is replaced by adult circulation
soon after the birth.

There are 4 iron atoms attached in each Hb

molecule
Each iron atom can bind to 1 molecule oxygen
making it total of 4 molecules of oxygen.
Iron metabolism.
Iron is absorbed from small intestine
Transported in plasma by formation of
transferrin and can be released to any tissue
cell.
Excess amount of iron is stored mainly in
hepatocytes in the form of ferritine
Destruction of RBC
Life span of RBC is 120 days
Metabolic system of RBC become
progressively less active with time and cell
become more fragile.
These fragile cell rupture while passing
through tight spot in circulation mostly in
spleen as the spaces between trabeculae is a
very small.
Destruction of hemoglobin – hemoglobin
released during destruction of RBC is
phagocytized by macrophages, mainly by
The iron is released back in circulation by
macrophages
Which is carried by tranferrin to bone marrow
for reuse or liver and other tissues for
storage.
The porphyrine portion is converted to
bilirubin
Anemia
Anemia means deficiency red blood cells with
reduced oxygen carrying capacity.
Causes
Blood loss – acute and chronic
Nutritional deficiency – Iron deficiency
megaloblastic
anemia
hemolytic anemia – Spherocytosis
sickle cell anemia
Aplastic anemia - radiation, drugs like
chloramphenicol
Leukocytes
Granulocytes - neutrophil, eosinophil,
basophill
Agranulocytes – lymphocyte and monocyte
Granulocyte and monocyte are formed in
bone marrow
Lymphocyte are mainly produced in
lymphogenous organ like thymus, lymph
glands and spleen.
Neutrophil 62%
Eosinophil 2.3%
Basophill 0.4%
Granulocytes
Neutrophil, eosinophil, basophil
The granules contain biologically active
substances
Multilobed nucleus no of lobes increases with
time
Neutrophil
Forms 1st line of defense takes part in
inflammatory responses
Average half life is 6 hours
Neutrophil enter tissue spaces by diapedesis
One in tissue spaces it moves around in
Chemotaxis – bacterial toxin, degenerated
products, complement complex
Phagocytosis
Cellular ingestion of offending agent
Slective process
Opsonisation –C3 molecule of complement
system
Neutrophil attaches itself with to the particles
and then project pseudopodia which meet at
opposite side and fuse
The enclosed chamber is then filled with
neutrophillic granule and digested.
The granules contain defensin which are
In addition to this NADPH oxidase is activated
which produces large amount of toxic oxygen
metabolites
Also myelopeoxidase is discharged which
produces potent oxidants
Neutrophil kills bacteria with hydrogen
peroxide and hydroxyl ion
Eosinophil
Like neutrophil it releases proteins, cytokines
and chemokines which kills bacteria and also
causes inflammation
Active against parasite because of larvacidal
polypeptide called major basic protein
Numbers increase in allergic reaction like
Basophill
Releases protein and cytokines
Resembles mast cells and contains heparin
and histamine
Takes part in in immediate type of
hypersensitive reaction

Monocytes
 after leaving bone marrow it gets fixed in
tissue and acts a macrophages
Skin- histiocyte
Liver – kupffer cell
Combination of monocyte, tissue
macrophage, mobile macrophage and
specialized cells endothelial cell in marrow,
spleen and lymph node is called as
reticuloendothelial system
Lymphocyte
Key element in production of immunity
2 types – B lymphocyte and T lymphocyte
Originates from bone marrow and are
processed in thymus or brusal equivalent
Located more extensively in lymph nodes also
in spleen, GIT, bone marrow
T lymphocyte
Processed in thymus
Provides cell mediated immunity
Divide extensively in thymus and develops
specificity against antigens
This continues till there are different
lymphocyte with specificity against millions of
different antigens
Now it leaves thymus and gets lodge in
different lymph node in body
Once T lymphocyte comes in contact with
specific antigens the same type of
lymphocytes are produced in large no called
as clone of lymphocytes
T cell marker – these are surface receptor
proteins present on the T lymphocyte. It is
highly specific against the antigens
B lymphocyte
Destined to form antibodies
it is processed in liver during fetal life and in
bone marrow after birth
This population of cell was first seen in birds
where it is processed in bursa of fabricus and
that’s why it is called as B lymphocyte.
Disorders of leucocyte
Nonneoplastic - Leucopoenia – reduced
number
Leucocytosis – increased in
number
Neoplastic - Malignant lymphoma (hodgkins
and non hodgkins lymphoma)
Lymphomas are malignant neoplasm of cell
native to lymphoid tissue
Leukemia's – malignant neoplasm of stem cells
characterized by diffuse replacement of bone
marrow by malignant cells
Acute – acute lymphoblastic and acute
myeloblastic leukemia
Platelets
3oo,ooo/ùL
Half life about 4 days
60 – 75% of platelet are in circulation and
remainder are in spleen
There membrane contain receptor for
collagen , von Willibrand factor and fibrinogen

Cytoplasm has granules containing non

proteins like serotonin, ADP
And proteins like clotting factor and PDGF.
Platelet production controlled by colony
stimulating factor acting on megakaryocye
And by thrombopoietin a circulating protein
factor
When platelet count is low – thrombocytopinic
purpura
When circulating platelets are abnormal –
thrombasthenic pupura
Blood groups
 There At least 30 group systems most of
them are weak
Two particular types are most likely than
others – OAB and Rh system
OAB system
There two antigens A & B occur on the
surface of RBC
These are also called as agglutinogen
Major types
Type A when agglutinogen A is present
Type B when agglutinogen B is present
Type AB when agglutinogen A & B both are
present
Type O when both are absent
Agglutinins - antibodies
when particular type of antigens are missing,
antibodies against it develops
Antibodies are IgM and IgG types
Blood type Agglutinoge Agglutinin
n
O - Anti-A and
Anti B
A A Anti B

B B Anti A

AB A and B -
Rh blood types
Difference - Agglutinin are formed instantly in
OAB system but in Rh system it is not
In Rh system there must be massive blood
transfusion for formation of antibodies.
Rh positive and Rh negative
Six common type of antigens
C, D, E, c, d, and e
The person having C antigen does not have c
antigen and vice a versa. Same is true for
other antigens
Type D is widely present and more antigenic
than other Rh factors
Therefore person having D antigen is called
as Rh positive and person not having D
antigen is called as Rh negative
About 85% of population is Rh positive and
15% Rh negative.
If Rh negative person receives Rh positive
blood for first time then immediate reaction
will not occur.
Mild reaction develops after 2 to 4 weeks.
But on subsequent transfusion reaction will be
greatly enhanced
Erythroblastosis Fetalis
Rh negative mother having Rh positive child
First child no does not develop complication
Second Rh positive child develop
erythroblastosis fetalis due to presence of
antibodies in mothers blood which act against
child's RBC
Antibody diffuse through placental membrane
and causes agglutination
Jaundice, anemia, kernicterus
Treatment – replacement with Rh negative
blood.
Blood transfusion
 Indications
2) Acute haemorrhage
3) Major surgeries
4) Deep burns – destruction of rbc and
hemolysis
5) Preoperatively for anaemic patient
6) Anaemic patient with Hb below 10gm/100ml
7) Coagulation disorders and also during
chemotherapy for malignant diseases there
is bone marrow depression
Collection of blood
Screen the donor for diseases which can be
transferred through blood like HIV and
hepatitis
Donor lies down sphygmomanometer is
applied and inflated to 80mm h\Hg 15 gauge
needle is inserted in
 medial cuboidal vein
Blood is collected n plastic bag containing 70
ml of anticoagulant.
About 410 ml of blood is collected
Anticoagulants – 2 types 1) CPD containing
trisodium citrate, citic acid and sodium
dihydrogen phosphate
 Stored at 4 degree Celsius in refrigerator
 Shelf life is 3 to 5 weeks
 RBC loose ability to release oxygen in 7 days
 Platelets useful up to 24 hours
 Types of blood transfusion
6) CPD stored blood
7) Warm blood – cardiopulmonary operations to
reduce risk of cardiac arrest
8) Filtered blood to filter off platelet and
leukocyte aggregate
9) Auto transfusion
10)Exchange transfusion – erythroblastosis
fetalis
Packed red cells – chronic anemia, low cardiac
reeve. Old patient
Amount of blood transfusion – 500ml of blood
raises Hb by 10%
Complications
1)incompatibility - after expiry date,
already hemolysed blood
2) Pyerexial reactions
3) allergic reaction to plasma products
4) sensitisation to leucocytes and platelets
5) transmission of diseases
 Reaction caused by massive
transfusions
 Acid base imbalance
 Hyperkalaemia- shift of potassium out of rbc
 Citrate toxicity
 Hypothermia
 Failure of coagulation due to dilution
 Blood substitutes
8) Fresh frozen plasma – factor V and VIII
9) Platelet rich plasma - - thrombocytopinic
purpura
10)Fibrinogen – stored in powdered form and
mixed with distilled water. Used in DIC
4) Cryoprecipitate – if frozen plasma is allowed
to bring at a temperature of 4 degree Celsius
it divides into precipitate and plasma this
precipitate is called cryoprecipitate it is a rich
source of factor VIII
Synthetically prepared solutions
Dextran - increases plasma volume, used in
restoring plasma volume for longer time
Gelatin- less effective than dexran
Hydroxyethylstarch- plasma volume expander
Fluorocarbons- colorless, odorless, dens liquid
inert and soluble
It binds and release oxygen. Also considered as
red cell substitute
Capillary circulation
It is also called a microcirculation
Transport of nutrients
Extremely thin structure with highly
permeable endothelial cells.
Structure
Artery ( Divides 6 – 8
times )

Arteriole ( Divides 2- 5
times)

Meta arteriole

Capillary

Preferential arteriole True

capillaries
 Structure of capillary wall
 Wall – unicellular layer of endothelial cells.
 Pores – intercellular cleft- thin slit between
endothelial cells .the size is slightly smaller
than albumin protein molecule.
 Special types of pores.
5) Brain – tight junction of cells – Blood- brain
barrier
6) Liver- wide open junction – so all dissolved
substances including plasma protein can
pass
7) In kidney special arrangement for filtering
the blood
Vasomotion
Flow is not continuous instead it is
intermittent
It is because of contraction of metarterioles
and precapillary sphincters
Regulation – Depends on oxygen demand
Lymphatic system
Accessory rout by which fluid can flow from
interstitial spaces into the blood.
Carries protein and large particulate matter
away from blood which can not be removed
by capillaries
This is essential function without which
person can die in 24 hours.
Lymph channels of body
All lymph from lower part flows up thoracic
duct and empties into venous system at the
junction of left internal jugular vein and
subclavian vein
Lymph from right side of head , neck right
arm and parts of chest enters right lymph
duct which empties in to junction between
right subclavian and internal jugular vein.
• Terminal lymphatic capillaries
and its permeability
1/10th of fluid from capillary system enters
lymphatic system
Total quantity is about 3 liters per day.
This minute quantity is very important as high
molecular weight substances can pass
through easily which can not be reabsorbed in
any other way
Rate of lymph flow
100 ml/hour flows through thoracic duct
More the interstitial fluid pressure more is the
flow
elevated capillary pressure
increased capillary permeability
increased fluid protein
Lymphatic pump increases lymph flow –
valves
Intrinsic pumping by lymph vessels
Extrinsic compression by surrounding muscle
of body
movement of body, arterial pulsation,
Role of lymphatic
protein leaks into the
interstitium

increased osmotic pressure

fluid is pulled in to interstitium

this causes raised fluid volume
and pressure

this leads to increased rate of

lymph flow
and excess fluid and protein is
Lymphatic disorders
Lymphengitis – infection spreading into
lymphatics mainly caused by beta hemolytic
streptococci
 Lymphedema
Primary secondary
Congenital Obstruction
removal
fibrosis
filariasis