Composition of Blood

Dr Paul Hubbard

paul.Hubbard@ncl.ac.uk

Case 4
 Learning Outcomes
• Describe the composition of blood and the primary function of the
various constituents
•  Describe the structure and function of the spleen
• Describe the role of plasma proteins in capillary filtration and the oncotic
pressure of plasma

Further Reading
•   Describe the different blood groups, including the ABO and Rhesus
systems

Case 4 Essentials of
Medical Practice
 Links to Case
• Anaemia is a disease of the blood. To understand anaemia it is
important to understand the constituents of blood

Case 4 Essentials of
Medical Practice
Links to Case - Mr Moulton’s Blood results…
Test Result Normal range
Total White Blood Count ( WBC)   6.2  4.5 to 11.0 × 109/L 

Red Blood Cell count- ( RBC)  3.2 Male 4.5 to 6.5 x1012/L  

Haemoglobin (Hb)  89 Male  135 to 175 grams per litre

Platelet count 230 140 – 400 x109/L 

Mean Cell Volume ( MCV) 72  80-96 fL/red cell in adults

Mean Cell Haemoglobin (MCV) 27 27-33 picograms (pg)/cell in adults

Mean Cell Haemoglobin Concentration ( MCHC) 22 33-36 g/dL in adults

Reticulocyte count 4% 0.2-2% in adults

Serum Ferritin 3.2 25 – 350 ng/mL ps: normal
4
 Reading Material

Kumar and Clarke - 8th Edition p370 Chapter 8

Boron – Medical Physiology 2nd Edition p448 Chapter 18

Case 4 Essentials of
Medical Practice 5
 OMBEA

Ra.ombea.com
Session ID: HubTalk
 NOT a constituent of blood
A. Erythrocyte
B. Leukocyte
C. Astrocyte
D. Platelets
E. Plasma

A B C D E
Case 4 Essentials of
Medical Practice 7
 Main Function of an erythrocyte
A. Antibody Production
B. Blood Clotting
C. Phagocytosis
D. Oxygen Transport
E. Carbon dioxide
Transport

A B C D E
Case 4 Essentials of
Medical Practice 8
 Blood Facts
Accounts for about 6-8% body weight

Total 4.5-5.5 Litres Female, 5-6 Litres Male

◦ (8-10 pints Female, 9-11 pints Male)

Approximately60, 000 miles of blood vessels in

Human (around 96,500 Kilometres)

Case 4 Essentials of
Medical Practice 9
 Learning Outcomes

 Describe the composition of blood and the

primary function of the various constituents

Case 4 - Describe the composition of blood and the primary function of the various constituents Essentials of
Medical Practice 10
 Composition of Blood
Basics – main components:-

Red blood cells – Erythrocytes

White blood cells – Leukocytes
Platelets – Thrombocytes

Extracellular fluid - Plasma

Case 4 - Describe the composition of blood and the primary function of the various constituents Essentials of
Medical Practice 11
 Composition of Blood
Centrifuge blood

Plasma

55%
Leukocytes (buffy coat)
◦ platelets
100%

Erythrocytes
45%
◦ Haematocrit – Hct
 Male – 40-50%
 Female
Case 4 - Describe the composition – 34-45%
of blood and the primary function of the various constituents Essentials of
Medical Practice 12
 Erythrocyte Sedimentation Rate (ESR)

Polycythaemia Anaemia

Too many RBC Too few RBC

Haematocrit Haematocrit
(70%) (30%)

ESR ESR

Blood settling under gravity – mm/hr

Case 4 - Describe the composition of blood and the primary function of the various constituents Essentials of
Medical Practice 13
 Role of cells
Erythrocytes
◦ 6-8mm diameter (2mm thick)
◦ Approx 5 million per mL
◦ Packed with haemoglobin
◦ Carry oxygen
◦ No nucleus, few organelles
◦ Flat ‘disk’ like shape, concave surface
◦ Live approx 120 days

Case 4 - Describe the composition of blood and the primary function of the various constituents Essentials of
Medical Practice 14
 Role of cells
Leukocytes
◦ 10-20mm diameter
◦ 7000-10000 cells per mL
◦ Many different types
◦ Various roles in immune system
 Phagocytosis
 Produce antibodies
 Destroying infected cells (t-killer)

Area to read around

Case 4 - Describe the composition of blood and the primary function of the various constituents Essentials of
Medical Practice 15
16
 ce ll
pe r
Role of cells p ro
o t a
Platelets N
◦ 2-4mm
◦ Circulate 7-14 days
◦ 150000-350000 per mL blood
◦ Fragment of a cell called a ‘megakaryocyte’
 Membrane bound bodies, no nuclei
 Involved in blood clotting

Case 4 - Describe the composition of blood and the primary function of the various constituents Essentials of
Medical Practice 17
 Composition of Plasma
Whole blood minus cells and platelets
◦ (different to serum, which also lack coagulation factors)

‘Straw’ coloured 1 litre of plasma contains:-

930g water
60g protein li t y
Also contains o a
l (K+, Na+ etc)
8g inorganic solutes
dissolved gases sm
O organic substances
2g non-protein
(glucose etc)

Case 4 - Describe the composition of blood and the primary function of the various constituents Essentials of
Medical Practice 18
 Electrolytes
Cation (positive charge) Anion (Negative charge)

Na+ 140mM Cl- 110mM

K+ 4mM HCO3- 20mM
Ca2+ 2.4mM Phosphate 1mM
Mg2+ 1mM

 Maintaining osmotic balance

Case 4 - Describe the composition of blood and the primary function of the various constituents Essentials of
Medical Practice 19
 Other substances
Substance Role

Glucose Nutrition, energy source

Amino Acids Protein synthesis
Hormones Various roles – chemical
messengers
Dissolved gases O2, CO2, N2 O2 for respiration,
CO2 waste product
Vitamins, Minerals Nutrition, various roles
Urea, Uric acid Waste product

Case 4 - Describe the composition of blood and the primary function of the various constituents Essentials of
Medical Practice 20
 Learning Outcomes
 Describe the composition of blood and the primary
function of the various constituents
 Describe the structure and function of the spleen

Case 4 - Describe the structure and function of the spleen Essentials of

Medical Practice 21
Structure of the Spleen
Situated left Hypochondrium

Splenic Artery and Splenic vein

From Lammon et al., 1995.

Renal Surface
Gastric Surface

Hilum

Public Domain, https://commons.wikimedia.org/w/index.php?

http://togotv.dbcls.jp/ja/togopic.2014.20.html
curid=1394146 22
 Function of the Spleen
Lymphoid Further reading
organ
The spleen in local and
systemic regulation of
immunity, Immunity. 39(5):
Remove old erythrocytes- Red pulp 806–818. (2013)
https
://www.ncbi.nlm.nih.gov/pmc/
articles/PMC3912742
Screen for pathogens - White pulp /
Introduction Only – and Image

Structure and function of the

Stores platelets spleen - Nature Reviews
Immunology, volume5, pages6
06–616 (2005) https://
www.nature.com/articles/nri16
69

Case 4 - Describe the structure and function of the spleen Essentials of

Medical Practice 23
 Learning Outcomes
 Describe the composition of blood and the primary
function of the various constituents
 Describe the structure and function of the spleen
Describe the role of plasma proteins in capillary
filtration and the oncotic pressure of plasma

Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 24
 Functions of Plasma
Components

Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 25
 Proteins - general
1. Reserve supply of amino acids
◦ Nutrition
2. Carriers for other molecules
◦ Eg lipids
3. Act as buffers
◦ Bind H+ or OH- regulate pH
4. Help blood to coagulate
5. Oncotic pressure (later)

Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 26
Proteins – main types
Globulins Albumin
40% Plasma protein Molecular mass 69000
a1 – various, glycoproteins (69kDa)
a2 – various, prothrombin,  60% Plasma protein

erythropoietin 80% oncotic pressure

b1 – transport Transports substances

◦ lipid carrier proteins eg eg, drugs, hormones,

LDL fatty acids
◦ carrier some vitamins, Fibrinogen
metals etc.
g Blood clotting
– Immunoglubulins
27
 Summary
Describe the role of plasma proteins

Next
Capillary filtration and the oncotic pressure of
plasma

Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 28
Normal range of Leukocyte numbers in blood?

A. 5x106 per mL
B. 7-10x103 per mL
C. 1.5-3.5x105 per mL
D. 7-10x104 per mL
E. 1.5-3.5x106 per mL

A B C D E

29
In 1 litre of blood plasma let’s assume there is 1g
Glucose (MW 180) and 930g H2O. What is the
osmolality of glucose?
A. 0.05 Osmol per Kg H2O
B. 0.005 Osmol per Kg H2O
C. 0.06 Osmol per Kg H2O
D. 0.006 Osmol per Kg H2O
E. 0.07 Osmol per Kg H2O

1 = 0.0056 mol = 0.0056 Osmol

180

0.0056 = 0.006 Osmol per Kg H2O A B C D E

0.930
30
 Plasma Proteins and oncotic pressure
 Oncotic pressure AKA colloid osmotic pressure

KEY POINT
Osmotic pressure due to ALL dissolved particles
Oncotic pressure = proportion of osmotic pressure
due to proteins

Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 31
Plasma Proteins and oncotic pressure
Total Osmotic Pressure

80% due to
Albumin
99.5% Small
molecules
(Electrolytes,
Glucose, Urea etc)

0.5% Oncotic
Pressure 32
So why is oncotic pressure important?
Interstitial Space Small molecules move
freely across capillary wall
Reach diffusion
equilibrium
Blood Capillary

Capillary
Endothelium
Proteins cannot cross
through capillary wall
Interstitial Space
therefore reduce water
H2O potential in capillary
33
 Which best explains the Gibbs-Donnan effect

A. +ve proteins, retain cations, lower

water potential, water in
B. -ve proteins, retain cations, lower
water potential, water in
C. +ve proteins, retain anions, lower
water potential, water out
D. -ve proteins, retain anions, lower
water potential, water in
E. -ve proteins, retain cations, increase A B C D E
water potential, water in
Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 34
 Gibbs-Donnan effect

- - - + + - + +
+
+ + - -
+ - - + - - +
+ -
- - + +
-
- + + -

H2O
Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 35
 Balance between hydrostatic and oncotic pressure

Blood Capillary

Hydrostatic Pressure Oncotic Pressure

Arterial End Venus End

Note on Pressure – US and old text books use millimetres
mercury (mmHg), newer textbooks use kilo Paschal (kPa)
Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 36
 Capillary Filtration - Normal Balance
High Hydrostatic pressure leads
to loss of fluid from capillaries Oncotic Pressure

Low Hydrostatic pressure

leads to gain of fluid due to
oncotic pressure
Pressure

Hydrostatic Pressure
Loss = Gain - no net change

Arterioles Venules
Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 37
 Couple of caveats
In reality not all fluid filtered out from capillary at arterial
end taken back up at venous end

Role of Lymphatic system to take up fluid

Throughout process interstitial pressure remains constant

Interstitial oncotic pressure rises slightly towards venous

end as fluid absorbed

Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 38
 Increased Hydrostatic Pressure
Heart Failure

INCREASED Hydrostatic
pressure at venous end leads
to LESS gain of fluid due to
oncotic pressure
Pressure

Loss > Gain

Arterioles Venules
Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 39
 Decreased Oncotic Pressure
Nephrosis

DECREASED Oncotic
pressure (less protein in
plasma) leads to LESS gain
of fluid
Pressure

Loss > Gain

Arterioles Venules
Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 40
 Oedema (Edema)
 From greek ‘Oidema’ meaning ‘swelling’

Too much interstitial fluid

Increased hydrostatic pressure
◦ Heart failure

Decreased oncotic pressure

◦ Loss of protein

Leaky blood vessels

Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 41
 Lymphatic System and Oedema
Normal role in removing waste
products and interstitial fluid

Requires muscle movement

 Minor Oedema
◦ Standing long periods
◦ On long flights Localised Oedema
following removal
lymph nodes
Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 42
 Immune System and Oedema
Some immune cells (eg mast cells)
release chemical mediators
◦ eg, histamine
◦ Increase capillary permeability
◦ Localised swelling

Problems with immune system

◦ Angioedema
◦ Anaphylaxis
Case 4 - Describe the role of plasma proteins in capillary filtration and the oncotic pressure of plasma Essentials of
Medical Practice 43
 Learning Outcomes
• Describe the composition of blood and the primary function of the
various constituents
•  Describe the structure and function of the spleen
• Describe the role of plasma proteins in capillary filtration and the oncotic
pressure of plasma

Further Reading
•   Describe the different blood groups, including the ABO and Rhesus
systems

Case 4 Essentials of
Medical Practice
 Blood Groups
Over 30 different blood group typing systems
◦ International Society of Blood transfusion

Only need to know 2

◦ ABO
◦ Rhesus

Case 4 - Describe the different blood groups, including the ABO and Rhesus systems Essentials of
Medical Practice 45
 Blood Groups
A B AB O

Antibodie
s Present
Anti B Anti A Anti B Anti A

Antigens
Present A Antigen B Antigen A and B Antigen O Antigen (H)

UK % 42 10 4 44
Case 4 - Describe the different blood groups, including the ABO and Rhesus systems Essentials of
Medical Practice 46
 Blood Group Antigens
ABO antigens are short sugar chains

Can be attached to lipids (glycolipids) or

proteins (glycoproteins)

Synthesised by enzymes – glycosyltransferases

◦ Different versions of enzymes lead to different sugar
chains

Case 4 - Describe the different blood groups, including the ABO and Rhesus systems Essentials of
Medical Practice 47
Blood Group Antigens
O-Antigen (H) A-Antigen B-Antigen
N-acetylgalactosamine Galactose

Further Reading – Blood Groups and Red cell Antigens via NCBI
48
 Blood Transfusions – ABO system
Universal Donor
O

A B

AB
Universal Acceptor
Haemolytic disease
Case 4 - Describe the different blood groups, including the ABO and Rhesus systems Essentials of
Medical Practice 49
 The Rhesus Antigen
Another antigen – antigen D
AB+
85% rhesus positive eg.
O-
Can be problematic in pregnancy
◦ Haemolytic disease of the newborn

Case 4 - Describe the different blood groups, including the ABO and Rhesus systems Essentials of
Medical Practice 50
 Learning Outcomes
• Describe the composition of blood and the primary function of the
various constituents
•  Describe the structure and function of the spleen
• Describe the role of plasma proteins in capillary filtration and the oncotic
pressure of plasma

Further Reading
•   Describe the different blood groups, including the ABO and Rhesus
systems

Case 4 Essentials of
Medical Practice