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THE PHYSIOLOGY

OF BLOOD
AN INTRODUCTION AND
OVERVIEW
By
Dr.M.ANTHONY DAVID, MD.

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WHAT IS BLOOD?
 IT IS A LIQUID CONNECTIVE
TISSUE
 IN AN AVERAGE 70 Kg MAN:
 100 Trillion cells.
 Of which 25 trillions are Red Blood
Cells!
 The average blood volume is 5 – 6 lts.
 It is roughly 7% of the total body
weight.

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HEMATOL OGY: TH E S TU DY OF B LOOD
MAD E POSSIBLE BY MIC ROSCOPY

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THE COMPOSITION OF BLOOD
PLASMA
 The Liquid: Plasma:
 Water, the solvent
 The solute: BLOOD
PLASMA
 Proteins:
 Albumin
 Globulins:#
 Fibrinogen
 Electrolytes:
 Na+
 K+
 Ca++ PROTEINS
 Organic molecules ELECTRO
 Urea WATER SOLUTES -LYTES
 Glucose
ORGANIC
 Lipids MOLECULES

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THE FORMED ELEMENT:
CELLS

BLOOD CELLS

ERYTHROCYTES LEUCOCYTES THROMBOCYTES

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BLOOD: COMPOSITION

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FUNCTIONS OF BLOOD
 NUTRITIVE
 RESPIRATORY
 EXCRETORY
 BODY DEFENCE: IMMUNITY
 TRANSPORT:
 HORMONES
 VITAMINS
 DRUGS
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BLOOD:TRANSPORTING
HORMONE MOLECULES

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OXYGEN & CO2
TRANSPORT

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FUNCTIONS OF BLOOD
 HOMEOSTATIC FUNCTION:
 ACID BASE BALANCE.
 ELECTROLYTE BALANCE.
 HEMOSTASIS.
 THERMOREGULATION.

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WHAT IS BLOOD VOLUME?
 The total amount of blood in
circulation plus the amount
of blood in the reservoirs
constitutes the “Blood
Volume”
 The average adult 70 kg man

has a blood volume of 5 to 6


litres.
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EXPRESSION OF BLOOD
VOLUME
 Usually Blood Volume is
expressed in liters.
 It can also be expressed in
relation to body weight.
 It is 7% Body Weight
 Another way to express it is in
terms of Body Surface Area.
 Whole Blood : 2.8 Lts/M2
 Plasma : 1.5 Lts/M2
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METHODS OF MEASURING
BLOOD VOLUME
 IN HUMANS: ONLY INDIRECT
METHODS
 DYE DILUTION TECHNIUE:
 PRINCIPLE:
 Injection of a known volume of non
toxic substance into the circulation.
 Measuring the dilution of this
injected dye after some time.
 This gives us the Plasma volume.

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DYE DILUTION TECHNIQUE

V1 = VOLUME
C1 = CONCENTRATION
V2 = VOLUME
OF DYE
C2 = CONC. OF DYE
V1 X C 1 = V 2 X C 2
OR
V2 = V1 X C 1 = Amount of Dye injected
C2 Conc. Of the dye in the Plasma
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HEMATOCRIT (PCV)
 The volume of erythrocytes
in the whole blood expressed
in percentage is the
Hematocrit.
 This is also called as Packed

Cell Volume or PCV.


 This is determined by the

Wintrobe’s tube, using a


Centrifuge.
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HEMATOCRIT
 A mixture of blood and double
oxalate (K – NH4) is taken upto 100
mark in the Wintrobe’s tube.
 The tube is placed in the
centrifuge.
 It is rotated at 3,000 rpm for 30
minutes.
 The Hematocrit is then read off the
tube.
 Blood Volume = Plasma Volume X
100 NOMAD:2005: BP: INTROVERVIEW 16
100 - PCV
HEMATOCRIT

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BLOOD VOLUME:
PHYSIOLOGICAL VARIATIONS
 AGE  PREGNANCY
 SEX
 EXERCISE
 TEMPERATUR
 POSTURE
E
 HYPOXIA
 BODY

WEIGHT  EMOTIONS

 BODY

SURFACE NOMAD:2005: BP: INTROVERVIEW 18


BLOOD VOLUME & AGE
AGE BLOOD VOLUME in
AT BIRTH Liters
0.3
6 Months 0.5
1 year 0.7
2yrs 6 1.0
months
4 years 1.3
7 years 1.7
10 years 2.5(Girls); 3.2 (Boys)
ADULTS 5 (Men) 4.5 (Women)
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BLOOD VOLUME:
PHYSIOLOGICAL VARIATIONS
1. SEX:
 Males have more
blood volume
than females.
2. TEMPERATURE:
 Acute exposure
to cold causes
reduction in
blood volume due
to Plasma water
loss to tissues.
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BLOOD VOLUME:
PHYSIOLOGICAL VARIATIONS
3. BODY WEIGHT:
 It is usually 7% of the Body

Weight.
4. BODY SURFACE AREA:
 2.8 Lts/Square Meters of BSA

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BLOOD VOLUME:
PHYSIOLOGICAL VARIATIONS
5. PREGNANCY:
 Increases by 20 – 30%
due to mass of fetus.
6. EXERCISE:
 Vigorous exercise
causes an increase.
7. POSTURE:
 Changing from lying
down to erect.
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BLOOD VOLUME:
PHYSIOLOGICAL VARIATIONS
8. HYPOXIA:
 Seen in High
altitudes.
  Erythrocytes
 So  Blood
volume.
9. EMOTIONS:
 Excitement
causes an
increase in the
Blood volume.
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BLOOD VOLUME:
PATHOLOGICAL VARIATIONS
 DECREASE IN BLOOD VOLUME IS
HYPOVOLEMIA. CAUSES:
1. BLOOD LOSS:
2. SHOCK:
 Crushing Injury

 Cardiogenic

 Neurogenic

 Psychogenic.

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HYPOVOLEMIA: CAUSES
(contd)

3. HEMOLYSIS:
 Mismatched
transfusion
 Snake bite
 Black water
fever
 Hemorrhagic
Plagues/Dengue
 Measles
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HYPOVOLEMIA: CAUSES
(contd)
4. DEHYDRATION:
 Diarrhoea
 Cholera
 Gastroenteritis
 Burns
 Hyperemesis.

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HYPOVOLEMIA: CAUSES (contd)

5. ANEMIA:
 Decreased RBC volume
 Plasma may increase.
6. OBESITY:
 Blood volume per body weight decreases
though Blood volume per BSA may be
normal.
7. HYPOTHYROIDISM (MYXEDEMA):
 Decrease in Blood volume.
8. ACUTE COLD: Decreases blood
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TREATMENT FOR BLOOD
LOSS
 TRANSFUSION OF WHOLE
BLOOD OF THE SAME
BLOOD GROUP & TYPE.
 INFUSION OF PLASMA

 INFUSION OF DEXTRAN OR

NORMAL SALINE.

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HEMOPOIESIS &
ERYTHROPOIESIS
By
Dr. M.Anthony David.MD.

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HEMOPOIESIS: INTRO
 Hemo: Referring to blood cells
 Poiesis: “The development or production of”
 The word Hemopoiesis refers to the
production & development of all the blood
cells:
 Erythrocytes: Erythropoiesis
 Leucocytes: Leucopoiesis
 Thrombocytes: Thrombopoiesis.
 Begins in the 20th week of life in the fetus
& continues in the red bone marrow till
death.

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STEM CELL THEORY
 All blood cells are produced by the bone
marrow.
 They come from a single class of primitive
mother cells called as:
 PLURIPOTENT STEM CELLS.
 These cells give rise to blood cells of:
 Myeloid series: Cells arising mainly from the
bone marrow.
 Lymphoid series: cells arising from lymphoid
tissues.
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PROGENITOR CELLS
 Committed stem cells lose their capacity
for self-renewal.
 They become irreversibly committed.
 These cells are termed as “Progenitor cells”
 They are regulated by certain hormones or
substances so that they can:
 Proliferate
 Undergo Maturation.

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BLOOD CELLS: DEVELOPMENT

PROG ENI TOR


CE LL S

LY MPHO ID PRO MEGA


MYELO BLA ST MONOBL AST
CE LLS NORMOBL AST KA RYO BL AST

LYMP HO CY TESERYTHROCYTESTH ROMB OCY TES GRANUL OCYTE S MONOCYTE S

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ERYTHROPOIESIS:
SITES/PHASES
 INTRA UT ER INE LIF E:
 INTRAVASC UL AR PH ASE : Up to 3 rd mo nth
of Intr a U te ri ne Life.
 End ot helial cell s = = = RBCs
 HEPATI C P HAS E : 3 rd t o 5 th mo nth IU L
 Li ver & Sp lee n
 nR BCs from M ese nchymal cell s.
 MYEL OI D PH ASE : Fr om 5 th m onth of IUL
onwar ds.
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ERYTHROPOIESIS: SITES/PHASES
contd.

 POST NATAL LIFE:


 CHILDREN:
 Predominantly Red Bone Marrow of skeleton:
 Axial &
 Appendicular.
 ADULTS:
 Red Bone Marrow of Axial Skeleton.

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ERYTHROPOIESIS
PROERYTHROBLAST

BASOPHILIC
ERYTHROBLAST

POLYCHROMAT OPHILIC
ERYTHROBL AST

ORTHOCHROMATIC
ERYTHROBLAST

RETICULOCYTE

MATURE ERYTHROCYTES
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FACTORS REGULATING
ERYTHROPOIESIS
 SINGLE MOST IMPORTANT REGULATOR:
“TISSUE OXYGENATION”
 BURST PROMOTING ACTIVITY
 ERYTHROPOIETIN
 IRON
 VITAMINS:
 Vitamin B12
 Folic Acid
 MISCELLANEOUS
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ERYTHROPOIETIN
 A hormone p ro duced by the Ki dn ey.
 Now adays a vailabl e a s Syn thet ic
Epo ie ti
 Incre as es the n umbe r of :
 Nucl eate d p recur so rs i n t he m ar ro w.
 Ret icul ocyte s & Matur e Er yth rocyte s i n
the blood .

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VITAMINS
 B 12 : Cya noco ba la mi ne & Fol ic Ac id:
 Is also cal led Ex tr insi c Facto r of Ca stle .
 Needs th e Intr insi c Facto r from th e
Gastri c j ui ce for ab so rpti on f rom S mal l
Inte sti ne.
 De ficiency cause s Per nicious (Wh en I F
is mi ssi ng) o r Me gal ob lasti c An emi a.
 Sti mulat es Er yt hrop oiesis
 Is foun d in meat & diar y prod ucts.
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IRON
 Esse ntia l f or the synthe si s o f
Hem og lo bin .
 Def icie ncy ca use s Microc yti c,
Hypoc hro mic A nemi a.
 Def icie ncy ca use s the c ommone st
typ e o f Anem ia .

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