BLOOD

The objectives:

- The functions of blood

- The blood cells
- Plasma proteins
- The blood groups: ABO and Rh
- The hemostasis
- Iron, vitamin B12 and Folic acid in erythropoiesis
The functions of blood
- The transport of various molecules: O 2, CO2,
nutrients, metabolites, vitamins, electrolytes…
- Heat: regulation of body temperature
- Transmission of signals: hormones
- Buffering: keep the balance of blood pH
- Immune defense: antibody

The blood volume

- Relative to body weight
- ♂ 0.041 x BW(kg) + 1.53
- ♀ 0.047 x BW(kg) + 0.86
The blood consists of a fluid (plasma) formed elements:

- Red blood cells (RBCs) transport O2 and CO2, and play an important role
in pH regulation.
- White blood cells (WBCs) can be divided into
Neutrophilic, eosinophilic and basophilic granulocytes, monocytes, and
lymphocytes.
Neutrophils play a role in nonspecific immune defense, whereas monocytes
and lymphocytes participate in specific immune responses.
- Platelets (thrombocytes) are needed for hemostasis.
- Hematocrit (Hct) is the volume ratio of red cells to whole blood.
- Plasma is the fluid portion of the blood in which electrolytes, nutrients,
metabolites, vitamins, hormones, gases, and proteins are dissolved.
The blood: - plasma
- cells (formed elements)
The blood cells
Neutrophil a monocyte (left) and
basophil two neutrophils

lympho eosinophil

Alveolar (Lung) Macrophage Attacking E. coli (SEM x10,000)

The formation of blood cells occurs in red bone marrow of flat
bones in adult and in the spleen and liver in the fetus.
ERYTHROCYTES (RED BLOOD CELLS OR RBC'S)
Each milliliter of blood contains about 4 billion
erythrocytes, (or 4,000,000 cells per cubic millimeter).
This number, RBC's/ml of blood is often referred to as
the red blood cell count.
Erythrocytes are flat, disc shaped cells with an
identation in the middle on both sides. So, RBC's are
thin and their shape gives them a large surface area.
Together these two facts allows for better exchange of
O2 and CO2 between RBC's and tissues. Additionally,
the RBC's have a very flexible membrane that allows
them to pass through the narrow capillaries.
The most important feature of erythrocytes is their ability to transport O 2 and
CO2. Erythrocytes can transport oxygen because they contain hemoglobin.

Hemoglobin (Hb) is a molecule made of four protein chains (globin) and

four heme groups which are bound to each of the protein chains. The heme
groups are non-protein molecules that each contain an iron molecule. The
heme groups use their iron atoms to reversibly pick up and release oxygen
atoms.

Most of the O2 carried in the blood is bound to hemoglobin.

Hemoglogin is a pigment (it has a natural color). When hemoglobin has

oxygen bound to it (that is when it is oxygenated), the Hb appears red.
When Hb is deoxygenated (lost it's oxygen) it appears bluish. So, generally
arterial blood appears red while venous blood appears bluish.
HEMOGLOBIN
During their formation, red blood cells lose their cell nuclei, most
organelles, and ribosomes to make room for millions of hemoglobin
molecules. So, an erythrocyte is basically a membrane bound bag of
hemoglobin.

In addition to carrying oxygen, hemoglobin (Hb) can carry carbon

dioxide (CO2) for transport from the tissues to the lungs.
Hb can bind with carbon monoxide (CO), an odorless, colorless gas
found in car and other exhausts fumes. If CO binds to Hb, it prevents
the Hb from carrying oxygen because the CO binds more tightly to Hb
than does oxygen. This is what causes lethal carbon monoxide
poisoning.

An important enzyme called carbonic anhydrase is found within RBC's

in high concentration. Carbonic anhydrase catalyzes a key reaction that
converts carbon dioxide (CO2) into bicarbonate ion (HCO-3) which is
the primary form in which CO2 is transported in the blood. So, carbon
dioxide (CO2) can be carried by hemoglobin or as bicarbonate ion (HCO -
The processes of
hemopoiesis:
The formation of blood cells
occurs in the red bone marrow of
flat bone in adults and in the
spleen and liver of the fetus.
Hematopoietic tissues contain
pluripotent stem cells which, with
the aid of hematopoetic growth
factors, develop into myeloid,
erythroid and lymphoid precursor
cells.
Erythropoietin promotes the
maturation and proliferation of red
blood cells.
LEUKOCYTES

Leukocytes are the white blood cells that play a critical role in the
body's immune defense system. The average total number of
leukocytes is about 7 million cells per milliliter or 7,000 cells per cubic
millimeter. (4,000-9,000 cells per cubic millimeter)
Immunity refers to the body's ability to resist or eliminate harmful
and/or foreign materials or abnormal cells.

The leukocytes play three critical roles that are important for immunity:
1. defend against disease caused by pathogens (bacteria and
viruses).
2. identify and destroy cancer cells.
3. clean up debris left from dead or injured cells.

All leukocytes are derived from the pluripotent stem cells in the bone
marrow. Neutrophils and lymphocytes are found in the greatest numbers
in the blood as compared to the other leukocytes types.
The plasma proteins of blood serve a variety of functions
including:

1. help maintain the osmotic pressure of the blood.

2. partially assist in regulating blood pH.
3. binding to and transporting substances.
4. some plasma proteins are immunoglobins (antibodies) which are
essential for the functions of the immune system.
5. A variety of plasma proteins, particularly fibrinogen, are essential
for coagulation (the blood clotting process).

Serum: Plasma without coagulation factors.

Osmotic Pressure
If in Figure 4–9 pressure were applied to the sodium chloride
solution, osmosis of water into this solution would be slowed,
stopped, or even [Link] exact amount of pressure required to
stop osmosis is called the osmotic pressure of the sodium chloride
solution.
 The principle of a pressure difference opposing osmosis is
demonstrated in Figure 4–10, which shows a selectively permeable
membrane separating two columns of fluid, one containing pure
water and the other containing a solution of water and any solute
that will not penetrate the membrane.
Osmosis of water from chamber B into chamber A causes the
levels of the fluid columns to become farther and farther apart, until
eventually a pressure difference develops between the two sides of
the membrane great enough to oppose the osmotic effect. The
pressure difference across the membrane at this point is equal to the
osmotic pressure of the solution that contains the nondiffusible
solute.
AB0 system: A person’s blood group is determined by the type of antigen
(certain glycolipids) present on the red blood cells (RBCs). In the AB0 system,
the antigens are A and B. In blood type A, antigen A (on RBC) and anti-B
antibody (in serum) are present; in type B, B and anti-A are present; in type AB,
A and B are present, no antibody; in type 0 (zero), no antigen but anti-A and
anti-B are present.
Blood Antigen Antibody Percentage
group (%)
When giving a blood transfusion,
it is important that the blood groups A A Anti B 20
of donor and recipient match, i.e.
that the RBCs of the donor (e.g. A)
do not come in contact with the B B Anti A 28
respective antibodies (e.g. anti-A)
in the recipient.
If the donor’s blood is the wrong
type, agglutination (cross-linking by AB A,B 4
IgM) and hemolysis (bursting) of
the donor’s RBCs will occur.
O Anti 48
A,B
The Rh system: In the Rh system, antibodies against rhesus antigens
(C, D, E) on RBCs do not develop unless prior sensitization has occurred. D is
by far the most antigenic. A person is Rh-positive (Rh+) when D is present on
their RBCs (most people), and Rh-negative (Rh–) when D is absent. Anti-D
antibodies belong to the IgG class of immunoglobulins, which are capable of
crossing the placenta. Rh– individuals can form anti-Rh+ (= anti-D) antibodies,
e.g., after sensitization by a mismatched blood transfusion or of an Rh – mother
by an Rh+ fetus (when mother gives birth).
When an Rh negative mother is carrying an Rh positive fetus, some of the
Rh antigens may enter her circulation when the placenta tears at birth (red
blood cells do not normally cross the placenta during pregnancy). Since these
red blood cells express an antigen (the Rh factor) that is foreign to the mother,
her immune system will eventually be stimulated to produce antibodies that are
capable of destroying the red blood cells of subsequent Rh positive fetuses, a
condition known as hemolytic disease of the newborn, or erythroblastosis
fetalis.
However, erythroblastosis fetalis can be prevented by the administration of
exogenous Rh antibodies known as Rho(D) immune globulin (e.g., RhoGAM)
to the mother within 72 hours after delivery. These antibodies destroy the fetal
Rh positive red blood cells that have entered the maternal circulation before
they can stimulate an immune response in the mother.
Hemostasis

The hemostatic system stops bleeding. Thrombocytes (platelets),

coagulation (or clotting) factors in plasma and vessel walls interact to
seal leaks in blood vessels. The damaged vessel constricts (release of
endothelin), and platelets aggregate at the site of puncture (and attract
more platelets) to seal the leak by a platelet plug. The time required for
sealing (ca. 2 to 4 min) is called the bleeding time. Subsequently, the
coagulation system produces a fibrin meshwork. Due to covalent
cross-linking of fibrin, it turns to a fibrin clot or thrombus that retracts
afterwards, thus reinforcing the seal.
Later recanalization of the vessel can be achieved by fibrinolysis.
HEMOSTASIS

Stopping the flow of blood from a broken blood vessel.

Hemostasis involves three steps:

1. Vascular spasm = vasoconstriction of the blood vessels in the

area of the injury (a sympathetic response).

2. Formation of a platelet plug = platelets attach to the exposed

collagen (fibrous protein in connective tissue) at the site of an
injury. The platelets release factors (such as ADP, thromboxane) that
cause other platelets to stick and form a plug. The plug only seals the
site of injury because healthy, uninjured vessels adjacent to the injury
release prostacyclin, a chemical that inhibits platelet aggregation.

3. Blood coagulation (clotting) = the transformation of fluid blood

into a solid gel. This clotting reaction involves a series of clotting
factors in the plasma that cause the blood to coagulate.
coagulation factors
 Clots are temporary plugs until the vessels have healed. Clots are slowly
dissolved by a fibrin splitting enzyme called plasmin. Plasmin is formed from a
precursor called plasminogen. As plasmin degrades the clot, phagocytic white
cells remove the clot debris.
The lungs and other tissues produce a protein called tissue plasminogen
activator (tPA). tPA is the converts plasminogen into plasmin.
Iron metabolism and erythropoiesis

Iron, vitamin B12 and

Folic acid are required
for erythropoiesis.
An iron defeciency
inhibits Hb synthesis,
leading to hypochromic
microcytic anemia:
MCH<26pg, MCV<70fl,
Hb<110g/L,
MCHC<320g/L
Iron, vitamin B12 and Folic acid are required for erythropoiesis.
Vitamin B12 & folic acid are essential for the synthesis of DNA.
Lack of Vitamin B12 & folic acid causes diminished DNA and failure of nuclear
maturation and division.
Blood volume in liters relative to body weight (BW)
♂0.041xBW (kg) + 1.53, ♀ 0.047xBW (kg) + 0.86
Hematocrit (cell volume/ blood volume):
♂ 0.40–0.54 Females: 0.37–0.47
Erythrocytes (1012/L of blood = 106/ μL of blood):
♂ 4.6–5.9 ♀ 4.2–5.4
Hemoglobin (g/L of blood):
♂ 140–180 ♀ 120–160
MCH, MCV, MCHC—mean corpuscular (MC),
hemoglobin (Hb), MC volume, MC Hb concentration.
Leukocytes (109/L of blood = 103/ μL of blood):
3–11 (64% granulocytes, 31% lymphocytes,
6% monocytes)
Platelets (109/L of blood = 103/ μL of blood):
♂ 170–360 ♀ 180–400
Plasma proteins (g/L of serum):
66–85 (including 55–64% albumin)
Thank you