SCIT 1408 Applied Human Anatomy and Physiology II - Blood CH 17

Blood
The only fluid tissue
Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Figure 17.10
Blood Composition
Blood: a fluid connective tissue composed of
Plasma
Formed elements
Erythrocytes (red blood cells, or RBCs)
Leukocytes (white blood cells, or WBCs)
Platelets
Blood Composition
Hematocrit
Percent of blood volume that is RBCs
47% 5% for males
42% 5% for females
Components of Whole Blood
Plasma expanders restore blood volume, not O2

Packed cells restore O2, maybe not volume
Figure 17.1
Physical Characteristics and Volume
Blood is a sticky, opaque fluid with a metallic taste
Color varies from scarlet (> O2) to dark red (<O2)
The pH of blood is 7.357.45
Temperature is 38C
Blood accounts for approximately 8% of body

weight
Average volume: 56 L for males, and 45 L for

females
Functions of Blood
Delivers Oxygen to tissues- from lungs
Picks up Carbon dioxide from the tissues- to

lungs
Distribution
Regulation
Protection
Functions of Blood
1. Distribution of :
O2 and nutrients to body cells
Metabolic wastes to the lungs and kidneys for

elimination
Hormones from endocrine organs to target organs
Functions of Blood
Regulation of
2.
Body temperature by absorbing and distributing

heat
Normal pH using buffers
Adequate fluid volume in the circulatory system
Protection
Hemostasis
Activating plasma proteins & platelets
Clot formation when a vessel is broken
Immune functions
Antibodies- B cells
Activating complement proteins
Activating WBCs to defend the body against

foreign invaders - Tcells
Blood Plasma
Nitrogenous by-products of metabolismlactic

acid, urea, creatinine
Nutrientsglucose, carbohydrates, amino acids
ElectrolytesNa+, K+, Ca2+, Cl, HCO3
Respiratory gasesO2 and CO2
Hormones
Blood Plasma
90% water
Proteins are mostly produced by the liver
60% albumin
36% globulins
4% fibrinogen
Formed Elements
Erythrocytes, leukocytes, and platelets make up the

formed elements
WBCs - cells
RBCs - no nuclei, few organelles; a sack of hgb
platelets - cell fragments; thrombocytes
Megakaryocyte
Components of Whole Blood
Figure 17.2
Erythrocytes (RBCs)
No nucleus
Figure 17.3
Erythrocytes
Structural characteristics contribute to gas transport
Biconcave shapehuge surface area relative to

volume
> 97% hemoglobin (not counting water)
No mitochondria; ATP production is anaerobic; no

O2 is used in generation of ATP
A superb example of complementarity of structure

and function!
Structure of Hemoglobin
Figure 17.4
Hemoglobin (Hb)
Oxyhemoglobin oxygen bound to Hgb (or Hb)
Deoxyhemoglobin - oxygen dissociates from hgb

& diffuses into tissues (reduced Hgb)
Carbaminohemoglobin carbon dioxide bound

Hgb
PLAY
InterActive Physiology :
Respiratory System: Gas Transport, pages 313
Erythrocyte Function
RBCs are dedicated to respiratory gas transport
Hemoglobin binds reversibly with oxygen
Hematopoiesis
Hematopoiesis
Red bone marrow of the:
Axial skeleton (sternum) and girdles (iliac crest)
Epiphyses of the humerus and femur
Hemocytoblasts give rise to all formed elements
Pluripotent cell or stem cell
Production of Erythrocytes: Erythropoiesis

Peripheral Circulation
Bone marrow
Figure 17.5
Regulation of Erythropoiesis
Normal RBC: 4.2-6.1 x 106/ ul whole blood
< RBCs = tissue hypoxia
> RBCs = > blood viscosity
Erythropoietin (kidneys) stimulates RBC production

RBC production Requires:
iron
amino acids
B vitamins
Erythropoietin Mechanism
Im b
ala
n
ce
Start
Homeostasis: Normal blood oxygen levels
Im b
ala
n
ce
Stimulus: Hypoxia due to

decreased RBC count,
decreased amount of
hemoglobin, or decreased
availability of O2
Increases
O2-carrying
ability of blood
Reduces O2 levels
in blood
Enhanced
erythropoiesis
increases
RBC count
Erythropoietin
stimulates red
bone marrow
Kidney (and liver to a smaller

extent) releases erythropoietin
Figure 17.6
1 Low O2 levels in blood stimulate

kidneys to produce erythropoietin.
2 Erythropoietin levels
rise in blood.
RBC life cycle(recycle 80-120 days)
3 Erythropoietin and necessary

raw materials in blood promote
erythropoiesis in red bone marrow.
4 New erythrocytes
enter bloodstream;
function about
120 days.
5 Aged and damaged red

blood cells are engulfed by
macrophages of liver, spleen,
and bone marrow; the hemoglobin
is broken down.
Hemoglobin
Heme
Globin
Bilirubin
Amino
acids
Iron stored
as ferritin,
hemosiderin
Iron is bound to
transferrin and released
to blood from liver
as needed for
erythropoiesis
Bilirubin is picked up from
blood by liver, secreted into
intestine in bile, metabolized
to stercobilin by bacteria
and excreted in feces
Circulation
Food nutrients,
including amino
acids, Fe, B12,
and folic acid
are absorbed
from intestine
and enter blood
6 Raw materials are

made available in
blood for erythrocyte
synthesis.
Figure 17.7
Erythrocyte Disorders Types of Anemia
Anemias - < RBC (normocytic)
Hemorrhagic anemia
Hemolytic anemia
Aplastic anemia
Signs/symptoms include fatigue, paleness,

shortness of breath, and chills
Types of Anemia : Decreased Hemoglobin Content
Iron-deficiency anemia : (microcytic)
(from hemorrhagic anemia)
< dietary iron
Impaired iron absorption
Pernicious anemia : (macrocytic)
Deficiency of vitamin B12
Lack of intrinsic factor needed for absorption of B12
Treatment is intramuscular injection of B12;

application of Nascobal
Types of Anemia: Abnormal Hemoglobin
Thalassemias
defective globin chain gene(s)
Many forms
Mediterranean decent
Sickle-cell anemia
defective globin chain gene with a single aa

substitution
This defect causes RBCs to become sickle-shaped

in < oxygen & > oxygen demand situations
(a) Normal erythrocyte has normal

hemoglobin amino acid sequence
in the beta chain.
146
(b) Sickled erythrocyte results from

a single amino acid change in the
beta chain of hemoglobin.
146
Figure 17.8
Polycythemia
Polycythemia excess RBCs that increase blood

viscosity
Three main polycythemias are:
Polycythemia vera
Secondary polycythemia test pilots
Blood doping atheletes
RX: phlebotomies
Leukocytes (WBCs)
Normal WBC: 5-10,000/ ul whole blood
< WBC - leukopenia
from bone marrow suppression
leads to infection
never normal
> WBC leukocytosis; > 11,000/ul
From: infection, exercise, stress, leukemia
Diapedesis- leaks from blood into tissues
Percentages of Leukocytes
Figure 17.9
Granulocytes
All have granules, segmented nuclei, and are

phagocytic
Neutrophils segs; first ones to site of

inflammation
Eosinophils
Basophils
(a) Neutrophil;
multilobed
nucleus
(b) Eosinophil;
bilobed nucleus,
red cytoplasmic
granules
(c) Basophil;
bilobed nucleus,
purplish-black
cytoplasmic
granules
Figure 17.10 (a-c)
Neutrophils
50-70% total WBC
> Neutrophils bacterial infections
Very active in inflammation
diapedesis
Eosinophils
14% of WBCs
Red-orange granules (acidophilic)
> : allergies, parasitic infections
Basophils
0.5% of WBCs
purplish-black (basophilic) granules;
Histamine
Called mast cells in tissues
(d) Small
lymphocyte;
large spherical
nucleus
(e) Monocyte;
kidney-shaped
nucleus
Figure 17.10d, e
Lymphocytes
25-45% WBCs
> in viral infections
Large, dark-purple, circular nuclei with a thin rim

of blue cytoplasm
Are found mostly enmeshed in lymphoid tissue

(some circulate in the blood)
T cells and B cells
T cells function in cell mediated immune response
B cells produce antibodies in humoral immune

response
Monocytes
48% WBC
largest leukocytes
Macrophages in tissue
Phagocytosis, antigen processing or presentation,

inflammation
Leukocytes
Figure 17.10
Production of Leukocytes
Leukopoiesis- interleukins & (CSFs)
Interleukins are numbered (e.g., IL-1, IL-2),

whereas CSFs are named for the WBCs they
stimulate (e.g., granulocyte-CSF stimulates
granulocytes)
Macrophages and T cells are the most important

sources of cytokines cytotoxic factors
Many hematopoietic hormones are used clinically

to stimulate bone marrow
Stem cells
Hemocytoblast
Myeloid stem cell
Committed
Myeloblast
cells
Myeloblast
Lymphoid stem cell
Myeloblast
DevelopPromyelocyte Promyelocyte Promyelocyte

mental
pathway
Eosinophilic
myelocyte
Basophilic
myelocyte
Neutrophilic
myelocyte
Eosinophilic
band cells
Basophilic
band cells
Neutrophilic
band cells
Eosinophils
Basophils Neutrophils
(a)
(b)
(c)
Lymphoblast
Promonocyte
Prolymphocyte
Monocytes
Lymphocytes
(e)
(d)
Agranular leukocytes
Granular leukocytes
Some become
Macrophages (tissues)
Some
become
Plasma cells
Figure 17.11
Leukocytes Disorders: Leukemias
Leukemias- WBC cancers
Myelocytic leukemia myeloblasts
Lymphocytic leukemia lymphocytes
Acute leukemia- blast-type cells; children
Chronic leukemia more mature cells; adults
Childhood leukemia has high cure rate
Megakaryocyte
Genesis of Platelets
The stem cell for platelets is the hemocytoblast
The sequential developmental pathway is as

shown.
Bone marrow
Stem cell
Hemocytoblast
Developmental pathway
Megakaryoblast
Promegakaryocyte
Megakaryocyte
Platelets
Figure 17.12
Hemostasis
blood stop 3 Phases Involved
1. Vascular spasms immediate vasoconstriction in

response to injury
2. Platelet plug formation
3. Coagulation cascade of rxns ending in fibrin
clot
Platelet Plug Formation
Platelets do not stick to each other or to blood vessels
Upon damage to blood vessel endothelium platelets:
With the help of von Willebrand factor (VWF) adhere to

collagen
Are stimulated by thromboxane A2
Stick to exposed collagen fibers and form a platelet plug
Release serotonin and ADP, which attract still more

platelets
The platelet plug is limited to the immediate area of injury

by prostacyclin
Coagulation
A set of reactions in which blood is transformed from a

liquid to a gel
Coagulation follows intrinsic and extrinsic pathways
The final three steps of this series of reactions are:
Prothrombin activator is formed
Prothrombin is converted into thrombin
Thrombin catalyzes the joining of fibrinogen

into a fibrin mesh
Coagulation
Figure 17.13a
Detailed Events of Coagulation
Figure 17.13b
Figure 17.15
Clot Retraction and Repair
Clot retracts within 30-60
Proteins in platelets squeeze serum from clot
Repair
Platelet-derived growth factor (PDGF) repairs

vessel wall
Fibroblasts form a connective tissue patch
Stimulated by vascular endothelial growth factor

(VEGF), endothelial cells multiply and restore the
endothelial lining
Fibrinolysis & Control of Clot Formation

As soon as clot is formed, a fibrinolytic process
begins to:
1. inhibit growth of clot
2. to break down the clot (within 2 days)
tPA- tissue plasminogen activator = clot buster
Two mechanisms prevent clot growth
Swift removal of clotting factors
Inhibition of activated clotting factors

Hemostasis vs Fibrinolysis
Factors Preventing Undesirable Clotting
Unnecessary clotting is prevented by endothelial

lining the blood vessels
Platelet adhesion is prevented by:
The smooth endothelial lining of blood vessels- no

plaques, rough spots
Heparin and PGI2 secreted by endothelial cells
Vitamin E quinone, a potent anticoagulant
INFLAMMATION may lead to > clots
Hemostasis Disorders:
Thromboembolytic Conditions
Thrombus a clot that develops and persists in an

unbroken blood vessel
Thrombi can block circulation, resulting in tissue

death
Coronary thrombosis thrombus in blood vessel of

the heart
Hemostasis Disorders:
Thromboembolytic Conditions
Embolus a clot on the move (in blood)
Can be fat, cancer cells, etc.
Thromboembolus- blood clot on the move
Pulmonary emboli can impair the ability of the

body to obtain oxygen
Cerebral emboli can cause strokes
Prevention of Undesirable Clots
Substances used to prevent undesirable clots:
Aspirin inhibits prostaglandin - thromboxane A2
Heparin an anticoagulant used clinically for preand postoperative cardiac care
Warfarin used for those prone to atrial fibrillation
Hemostasis Disorders
Disseminated Intravascular Coagulation (DIC): widespread

clotting in intact blood vessels
Poor prognosis
Residual blood cannot clot- thrombin tied up in clot
Blockage of blood flow and severe bleeding follows
Most common in:
Septic shock
A complication of pregnancy
Incompatible blood transfusions
Hemostasis Disorders: Bleeding Disorders
Thrombocytopenia platelets < 50,000/ul
Petechiae
Caused by suppression or destruction of bone

marrow (e.g., malignancy, radiation)
Treated with whole blood transfusions, plasma

exchanges
Hemostasis Disorders: Bleeding Disorders
Liver disease
Cant make procoagulants
Cant make vitamin K
Gene defects in genes for clotting factors:
Hemophilia A - factor VIII
Hemophilia B factor IX
Hemophilia C factor XI (mild)
Blood Transfusions
Whole blood transfusions are used:
When blood loss is substantial
In treating thrombocytopenia
Packed red cells (cells with plasma removed) are

used to treat anemia
Human Blood Groups
RBC membranes have glycoprotein antigens on

their external surfaces
These antigens are:
Unique to the individual
Recognized as foreign if transfused into another

individual
Promoters of agglutination and are referred to as

agglutinogens
Presence or absence of these antigens is used to

classify blood groups
Blood Groups
Humans have 30 varieties of naturally occurring

RBC antigens
ABO and Rh antigens are Landsteiner group
Other blood groups (M, N, Dufy, Kell, and Lewis)
ABO Blood Groups
Table 17.4
Rh Blood Groups
There are eight different Rh agglutinogens, three of

which (C, D, and E) are common
Presence of the Rh agglutinogens on RBCs is

indicated as Rh+
Anti-Rh antibodies are not spontaneously formed

in Rh individuals
However, if an Rh individual receives Rh+ blood,

anti-Rh antibodies form
A second exposure to Rh+ blood will result in a

typical transfusion reaction
Hemolytic Disease of the Newborn
Erythroblastosis fetalis or HDN: Rh+ antibodies

of a sensitized Rh mother cross the placenta and
attack and destroy the RBCs of an Rh+ baby
Usually first birth ok
RhoGAM blocks antibodies against Rh+ fetus
RX- pre-birth transfusions; exchange transfusions

after birth
Transfusion Reactions
Life threatening- mismatched blood is infused
Antigens (cells) & antibodies (plasma) agglutinate:
Diminished oxygen-carrying capacity
Clumped cells that impede blood flow
Ruptured RBCs- release hgb
Hgb ppts in kidneys- renal failure
Blood Typing
Unknown cells
Blood type being tested
Known antisera
RBC agglutinogens
Serum Reaction
Anti-A
Anti-B
AB
A and B
None
Blood being tested
Anti-A
Type AB (contains
agglutinogens A and B;
agglutinates with both
sera)
Serum
Anti-B
RBCs
Type A (contains
agglutinogen A;
agglutinates with anti-A)
Type B (contains
agglutinogen B;
agglutinates with anti-B)
Type O (contains no
agglutinogens; does not
agglutinate with either
serum)
Figure 17.16
Restoring Fluid Volume
Hypovolemic shock
Restore fluid volume-Plasma, plasma expanders
Dextran, plasminate, human serum albumin
OR the following may be better
Normal saline
Electrolyte solution Ringers
Diagnostic Blood Tests
CBC
# RBCs, WBCs, Hgb, Hct, MCV, MCHC
Differential
Microscopic examination reveals variations in

size and shape of RBCs, indications of anemias
Hct
Serum chemistry analysis can provide a

comprehensive picture of ones general health
status in relation to normal values; i.e. blood
glucose
Diagnostic Blood Tests
Differential WBC count
Prothrombin time and platelet counts assess

hemostasis
SMAC, a blood chemistry profile
Complete blood count (CBC)
Developmental Aspects- Hematopoiesis
Fetal blood cells formed in yolk sac, liver, spleen
By 7th month- in red bone marrow
Fetus HbF; > affinity for oxygen than adult

hemoglobin
Developmental Aspects
Age-related blood problems result from disorders

of the heart, blood vessels, and the immune system
Increased leukemias are thought to be due to the

waning deficiency of the immune system
Abnormal thrombus and embolus formation

reflects the progress of atherosclerosis

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Blood

The only fluid tissue

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Blood: a fluid connective tissue composed of

Erythrocytes (red blood cells, or RBCs)

Leukocytes (white blood cells, or WBCs)

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Percent of blood volume that is RBCs

47% 5% for males

42% 5% for females

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Components of Whole Blood

Plasma expanders restore blood volume, not O2

Physical Characteristics and Volume

Blood is a sticky, opaque fluid with a metallic taste

Color varies from scarlet (> O2) to dark red (<O2)

The pH of blood is 7.357.45

Blood accounts for approximately 8% of body

Average volume: 56 L for males, and 45 L for

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Delivers Oxygen to tissues- from lungs

Picks up Carbon dioxide from the tissues- to

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

O2 and nutrients to body cells

Metabolic wastes to the lungs and kidneys for

Hormones from endocrine organs to target organs

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Body temperature by absorbing and distributing

Normal pH using buffers

Adequate fluid volume in the circulatory system

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Activating plasma proteins & platelets

Clot formation when a vessel is broken

Activating complement proteins

Activating WBCs to defend the body against

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Nitrogenous by-products of metabolismlactic

Nutrientsglucose, carbohydrates, amino acids

ElectrolytesNa+, K+, Ca2+, Cl, HCO3

Respiratory gasesO2 and CO2

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Proteins are mostly produced by the liver

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Erythrocytes, leukocytes, and platelets make up the

RBCs - no nuclei, few organelles; a sack of hgb

platelets - cell fragments; thrombocytes

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Components of Whole Blood

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Structural characteristics contribute to gas transport

Biconcave shapehuge surface area relative to

> 97% hemoglobin (not counting water)

No mitochondria; ATP production is anaerobic; no

A superb example of complementarity of structure

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Oxyhemoglobin oxygen bound to Hgb (or Hb)

Deoxyhemoglobin - oxygen dissociates from hgb

Carbaminohemoglobin carbon dioxide bound

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

RBCs are dedicated to respiratory gas transport