Mary Ann Thea M.

Bustamante - color of blood varies depending on the amount

BSN- 1B of oxygen it is carrying
College of Nursing - scarlet (oxygen rich)
- dull red or purple (oxygen-poor)
Composition and Functions of Blood - has a characteristic metallic, salty taste
- slightly alkaline,
BLOOD - with a pH between 7.35 and 7.45.
- only fluid tissue in the body - temperature (38°C, or 100.4°F) is always slightly
- no collagen and elastin fibers typical of other higher than body temperature because of the
connective tissues are from blood friction produced as blood flows through the
plasma vessels
- a nonliving fluid matrix - accounts for approximately 8 percent of body
- where the formed elements are suspended weight,
- dissolved proteins become visible as fibrin - its volume in healthy adults is 5 to 6 liters, or
strands during blood clotting about 6 quarts
- if blood sample is separated the plasma rises to
the top, and the formed elements, fall to the Plasma
bottom - approximately 90 percent water, is the liquid part
- makes up most of the remaining 55 percent of of the blood.
whole blood - Over 100 different substances are dissolved
- straw-colored fluid
erythrocytes - dissolved substances:
- red blood cells nutrients,
- Most of the reddish “pellet” at the bottom of the salts (electrolytes),
tube respiratory gases,
- formed elements that function in oxygen hormones,
transport plasma proteins
- normally account for about 45 percent of the various wastes and products of cell
total volume of a blood sample metabolism

buffy coat Plasma proteins

- a thin, whitish layer called the at the junction - most abundant solutes in plasma.
between the erythrocytes and the plasma - the liver makes most plasma proteins
- contains the remaining formed elements, - not taken up by cells to be used as food fuels or
leukocytes metabolic nutrients
- the composition varies continuously as cells
leukocytes exchange substances with the blood
- white blood cells - slightly alkaline pH range of 7.35 to 7.45.
- act in various ways to protect the body; - transports various substances around the body,
- helps to distribute body heat, a by-product of
platelets cellular metabolism
- cell fragments that help stop bleeding - antibodies
help protect the body from pathogens
hematocrit - blood fraction - albumin
acts as a carrier to shuttle certain molecules
White blood cells and platelets contribute less than 1 through the circulation
percent is an important blood buffer
contributes to the osmotic pressure of blood,
Physical Characteristics and Volume which acts to keep water in the bloodstream
- Clotting proteins
Blood help stem blood loss when a blood vessel is
- sticky, opaque fluid that is heavier than water injured
- about five times thicker, or more viscous
because of its formed elements.
 - When the number of RBC/mm3 increases, blood
viscosity, or thickness, increases
- as the number of RBCs decreases, blood thins
and flows more rapidly. Although the numbers of
RBCs are important, it is the amount of
hemoglobin in the
- A single RBC contains about 250 million
hemoglobin molecules = binding 4 molecules of
oxygen
- normal blood contains 12–18 grams (g) of
hemoglobin per 100 milliliters (ml) of blood

FORMED ELEMENTS

Erythrocytes
- red blood cells (RBCs)
- function primarily to ferry oxygen to all cells of
the body
- differ from other blood cells because they are
anucleate, they lack a nucleus
- contain very few organelles Leukocytes
- mature RBCs circulating in the blood are literally - white blood cells (WBCs),
“bags” of hemoglobin molecules - crucial to body defense
- confined to the bloodstream - there are 4,800 to 10,800 WBCs/mm3 of blood
- Hemoglobin (Hb) - they account for less than 1 percent of total
an iron-bearing protein blood volume
transports most of the oxygen that is carried - contain nuclei and the usual organelles, which
in the blood makes them the only complete cells in blood
It also binds with a small amount of carbon - form a protective, movable army that helps
dioxide defend the body against damage by bacteria,
The more hemoglobin molecules the RBCs viruses, parasites, and tumor cells.
contain, the more oxygen they will be able to - able to slip into and out of the blood vessels — a
carry process called diapedesis (leaping across)
The hemoglobin content is slightly higher in - circulatory system is simply their means of
men (13–18 g/ml) than in women (12–16 transportation to areas of the body
g/ml). - can locate areas of tissue damage and infection
in the body by responding to certain chemicals
- lack mitochondria and make ATP by anaerobic that diffuse from the damaged cells — called
mechanisms, they do not use up any of the positive chemotaxis
oxygen they are transporting - Once they have “caught the scent,” the WBCs
- small, flexible cells shaped like biconcave move through the tissue spaces by amoeboid
discs—flattened discs with depressed centers on motion
both sides - cytoplasmic extensions that help move them
- ideal suited for gas exchange along
- outnumber white blood cells by about 1,000 to 1 - they pinpoint areas of tissue damage and rally
- the major factor contributing to blood viscosity round in large numbers to destroy
microorganisms and dispose of dead cells
- there are normally about 5 million cells per cubic
- Whenever WBCs mobilize for action, the body
millimeter of blood.
speeds up their production, and as many as
 twice the normal number of WBCs may appear — agranulocytes
in the blood within a few hours. – lack visible cytoplasmic granules.
– Their nuclei are spherical, oval, or kidney-shaped.
leukocytosis
 A total WBC count above 11,000 cells/mm3 is  Lymphocytes
referred to as - have a large, dark purple nucleus that occupies
 cytosis = an increase in cells most of the cell volume.
 indicates that a bacterial or viral infection is - Only slightly larger than RBCs, lymphocytes
stewing in the body. tend to take up residence in lymphatic tissues,
leukopenia such as the tonsils
 is an abnormally low WBC count - second most numerous leukocytes in the blood.
 penia = deficiency
 commonly caused by certain drugs, such as  Monocytes
corticosteroids and anticancer agents. - the largest of the WBCs.
WBCs from most to least abundance in the blood — - more abundant cytoplasm and distinctive U- or
Never let monkeys eat bananas (neutrophils, kidney-shaped nucleus,
lymphocytes, monocytes, eosinophils, basophils). - resemble large lymphocytes.
- When they migrate into the tissues, they
two major groups of WBCs change into macrophages with huge appetites.
- Macrophages are important in fighting
- depending on whether or not they contain visible chronic infections, such as tuberculosis, and
granules in their cytoplasm in activating lymphocytes.

— granulocytes
– granule containing WBCs Platelets
– have lobed nuclei, which typically consist of several
rounded nuclear areas connected by thin strands of - technically cells
nuclear material - fragments of bizarre multinucleate cells called
– granules stain specifically with Wright’s stain megakaryocytes
- megakaryocytes pinch off thousands of
 neutrophils anucleate platelet “pieces” that quickly
- most numerous WBCs seal themselves off from the surrounding
- have a multilobed nucleus and very fine fluids.
granules that respond to both acidic and basic - appear as darkly staining, irregularly shaped
stains. bodies scattered among the other blood cells.
- the cytoplasm as a whole stains pink. - normal platelet count in blood is about 300,000
- avid phagocytes at sites of acute infection cells per mm3.
- partial to bacteria and fungi, which they kill - needed for the clotting process that stops blood
during a respiratory burst that deluges the loss from broken blood vessels
phagocytized invaders with a potent brew of
oxidizing substances (bleach, hydrogen
peroxide, and others)

 Eosinophils
- have a blue-red nucleus that resembles
earmuffs and brick-red cytoplasmic granules.
- number increases rapidly during infections by
parasitic worms (tapeworms, etc.) ingested in
food or entering through the skin.
- they gather around and release enzymes from
their cytoplasmic granules onto the parasite’s
surface, digesting it away.

 Basophils
- rarest of the WBCs, have large histamine-
containing granules that stain dark blue
- Histamine is an inflammatory chemical that
makes blood vessels leaky and attracts other
WBCs to the inflamed site
Hematopoiesis (Blood Cell Formation) Clay-colored stool = without bile
- occurs in red bone marrow, or myeloid tissue. Serum ferritin- high level, means fast destruction of RBs
- myeloid tissue - in adults, this tissue is
found chiefly in the axial skeleton, pectoral The entire developmental process from hemocytoblast to
and pelvic girdles, and proximal epiphyses of mature RBC takes 3 to 5 days.
the humerus and femur. erythropoietin - hormone that controls the rate of
- Each type of blood cell is produced in different erythrocyte production
numbers in response to changing body needs
and different stimuli. Formation of White Blood Cells and Platelets
- After they mature, they are discharged into the  colony stimulating factors (CSFs) and interleukins
blood vessels surrounding the area. - prompt red bone marrow to turn out leukocytes
- On average, the red marrow turns out an ounce - enhance the ability of mature leukocytes to protect
of new blood containing 100 billion new cells the body
every day.
- released in response to specific chemical signals
- hemocytoblast (“blood cell former”)- where in the environment, such as inflammatory
all the formed elements arise from which chemicals and certain bacteria or their toxins
resides in red bone marrow
- forms two types of descendants —
 thrombopoietin
 the lymphoid stem cell, which produces - accelerates the production of platelets from
lymphocytes, megakaryocytes
 the myeloid stem cell, which can
produce all other classes of formed  bone marrow biopsy
elements
- special needle is used to withdraw a small sample
Formation of Red Blood Cells of red marrow from one of the flat bones (ilium or
sternum) close to the body surface
- RBCs are unable to synthesize proteins, grow, - this procedure provides cells for a microscopic
or divide examination
- in 100 to 120 days become rigid and begin to fall
apart
- Their remains are eliminated by phagocytes in
the spleen, liver, and other body tissues. Hemostasis
- (hem = blood; stasis = standing still), or stopping the
bleeding
- Three Major Phases:
1. vascular spasms
2. platelet plug formation
3. coagulation, or blood clotting.
- Blood loss at the site is prevented when fibrous tissue
grows into the clot and seals the hole in the blood
vessel
- blood clots within 3 to 6 minutes

1. Vascular spasms occur.

- The immediate response to blood vessel injury is
vasoconstriction, which causes blood vessel
spasms.
- The spasms narrow the blood vessel, decreasing
blood loss until clotting can occur.

2. Platelet plug forms.

- Platelets are repelled by an intact endothelium,
but when the underlying collagen fibers of a
broken vessel are exposed, the platelets become
“sticky” and cling to the damaged site.
- Anchored platelets release chemicals that
enhance the vascular spasms and attract more
platelets to the site.
- As more and more platelets pile up, a platelet plug
forms.
3. Coagulation events occur. proteins (antigens), which identify each person as
- At the same time, the injured tissues are unique.
releasing tissue factor (TF), which interacts
with PF3 (platelet factor 3) - a phospholipid antigens
that coats the surfaces of the platelets
- is a substance that the body recognizes as foreign; it
- This combination interacts with other clotting
factors and calcium ions, to form an activator stimulates the immune system to mount a defense
that leads to the formation of thrombin, an against it
enzyme. - most are foreign proteins, such as those that are part
- Thrombin then joins soluble fibrinogen of viruses or bacteria that have managed to invade
proteins into long, hairlike molecules of the body.
insoluble fibrin. - Although each of us tolerates our own cellular (self)
- Fibrin forms a meshwork that traps RBCs and
antigens, one person’s RBC proteins will be
forms the basis of the clot.
- Within the hour, the clot begins to retract, recognized as foreign if transfused into another
squeezing serum (plasma minus the clotting person with different RBC antigens.
proteins) from the mass and pulling the
ruptured edges of the blood vessel closer antibodies
together. - The “recognizers” present in plasma that attach to
RBCs bearing surface antigens different from those
on the patient’s (recipient’s) RBCs.
- Binding of the antibodies causes the foreign RBCs to
clump = agglutination
- which leads to the clogging of small blood vessels
throughout the body.

 agglutinogens - the RBC antigens that promote this

clumping
 agglutinins - the antibodies that bind them together
are

transfused blood

– during the next few hours, the foreign RBCs are lysed
(ruptured), and their hemoglobin is released into the
bloodstream.
– is unable to deliver the increased oxygen-carrying
capacity hoped for and some tissue areas may be
deprived of blood,
– the most devastating consequence of severe
transfusion reactions is that the freed hemoglobin
molecules may block the kidney tubules, causing
kidney failure and death
– Transfusion reactions can also cause fever, chills,
nausea, and vomiting, but in the absence of kidney
shutdown these reactions are rarely fatal.
Blood Groups and Transfusions
Treatment is aimed at preventing kidney damage by
The treated blood can be stored (refrigerated at 4°C, or infusing fluids to dilute and dissolve the hemoglobin and
39.2°F) until needed for about 35 days. diuretics to flush it out of the body in urine.

Human Blood Groups

different blood groups, and transfusing incompatible

or mismatched blood can be fatal = the plasma
membranes of RBCs bear genetically determined
 the second time and every time thereafter, a typical
transfusion reaction occurs in which the patient’s
antibodies attack and rupture the donor’s Rh+ RBCs.

Rh-related problem occurs in pregnant Rh− women who

are carrying Rh+ babies.

The first such pregnancy usually results in the delivery of

a healthy baby.

But because the mother is sensitized by Rh+ antigens

that have passed through the placenta into her
bloodstream, she will form anti-Rh+ antibodies

30 common RBC antigens in humans RhoGAM vaccine

the antigens of the ABO and Rh blood groups that cause – is given on the 28th week of pregnancy and again
the most vigorous transfusion reactions. shortly after giving birth.
– an immune serum that prevents this sensitization
ABO blood groups and subsequent immune response.
– based on which of two antigens, type A or type B, a
person inherits If she is not treated and becomes pregnant again with an
– Absence of both antigens results in type O blood Rh+ baby, her antibodies will cross through the placenta
– presence of both antigens leads to type AB, and destroy the baby’s RBCs, producing a condition
– presence of either A or B antigen yields type A or B known as hemolytic disease of the newborn.
blood, respectively.
– antibodies form during infancy against the ABO The baby is anemic and becomes hypoxic and cyanotic
antigens not present on your own RBCs Brain damage and even death may result unless fetal
– a baby with neither the A nor the B antigen (group transfusions are done before birth to provide more RBCs
O) forms both anti-A and anti-B antibodies for oxygen transport
– those with type A antigens (group A) form anti-B
antibodies, and so on Blood Typing
– antibodies against a person’s own blood type will
- The general procedure for determining ABO blood
not be produced.
type essentially involves testing the blood by mixing it
Rh blood groups with two different types of immune serum—anti-A and
– are so named because one of the eight Rh antigens anti-B
(agglutinogen D) was originally identified in Rhesus - Agglutination- occurs when RBCs of a group A
monkeys. person are mixed with the anti-A serum but not when
– Rh+ (“Rh positive”), meaning that their RBCs carry they are mixed with the anti-B serum.
Rh antigen. - RBCs of type B blood are clumped by anti-B serum
– anti-Rh antibodies are not automatically formed by but not by anti-A serum.
Rh− (“Rh negative”) individuals. - Cross matching involves testing for agglutination of
– if an Rh− person receives Rh+ blood, shortly after donor RBCs by the recipient’s serum and of the
the transfusion his or her immune system becomes recipient’s RBCs by the donor serum
sensitized and begins producing antiRh+ antibodies
against the foreign blood type.

Hemolysis (rupture of RBCs) does not occur in an Rh−

person with the first transfusion of Rh+ blood because it
takes time for the body to react and start making
antibodies.
 HOMEOSTATIC IMBALANCES pernicious anemia - the elderly are particularly at risk
 anemia for a, caused by a lack of vitamin B12, because the
– (“lacking blood”) stomach mucosa (which produces the intrinsic factor
– A decrease in the oxygen-carrying ability of the required to absorb vitamin B12) atrophies with age.
blood, whatever the reason
– may be the result of  polycythemia
(1) a lower-than-normal number of RBCs – An excessive or abnormal increase in the number of
(2) abnormal or deficient hemoglobin content in the erythrocytes
RBCs – may result from bone marrow cancer (polycythemia
vera)
– It may also be a normal physiologic (homeostatic)
response to living at high altitudes, where the air is
thinner and less oxygen is available (secondary
polycythemia)
– excessive numbers of RBCs means increased
blood viscosity, which causes blood to flow
sluggishly in the body and impairs circulation

blood doping = the infusion of a person’s own RBCs

back into their bloodstream to artificially raise oxygen-
carrying capacity

Leukocytosis is a normal and desirable response to

infectious threats to the body
 sickle cell anemia
– genetic disorder  leukemia
– the body does not form normal hemoglobin – literally “white blood,”
– abnormal hemoglobin is formed that becomes spiky – the bone marrow becomes cancerous, and huge
and sharp numbers of WBCs are turned out rapidly.
– when either oxygen is unloaded or the oxygen – the “newborn” WBCs are immature and incapable of
content in the blood decreases below normal. This carrying out their normal protective functions
change in hemoglobin causes the RBCs to become – the body becomes easy prey for disease-causing
sickled (crescent-shaped), to rupture easily, and to bacteria and viruses
dam up small blood vessels. – because other blood cell lines are crowded out,
– These events interfere with oxygen delivery (leaving severe anemia and bleeding problems result
victims gasping for air) and cause extreme pain.
– Caused by a change in just one of the amino acids  Undesirable Clotting
in two of the four polypeptide chains of the – undesirable clots sometimes form in unbroken
hemoglobin molecule blood vessels, particularly in the legs.
– occurs chiefly in dark skinned people who live in the – thrombus - a clot that develops and persists in an
malaria belt of Africa and among their descendants. unbroken blood vessel
– the same gene that causes sickling makes red – If the thrombus is large enough, it may prevent
blood cells infected by the malaria-causing parasite blood from flowing to the cells beyond the blockage
stick to the capillary walls and then lose potassium, – hypoxia = inadequate oxygen delivery to body
an essential nutrient for survival of the parasite. tissues
– the malaria-causing parasite is prevented from – embolus- If a thrombus breaks away from the
multiplying within the red blood cells vessel wall and floats freely in the bloodstream
– individuals with the sickle cell gene have a better – An embolus is usually no problem unless or until it
chance of surviving where malaria is prevalent. lodges in a blood vessel too narrow for it to pass
– Only individuals carrying two copies of the defective through.
gene have sickle cell anemia. – Undesirable clotting may be caused by anything
– Those carrying just one sickling gene have sickle that roughens the endothelium of a blood vessel
cell trait (SCT); they generally do not display the and encourages clinging of platelets, such as
symptoms but can pass on the sickling gene to their severe burns, physical blows, or an accumulation of
offspring fatty material.
– Slowly flowing blood, or blood pooling, is another
Iron-deficiency anemia - common in women because risk factor, especially in immobilized patients.
of their monthly blood loss during menses.
 – Anticoagulants; important of which are aspirin, – It has a greater ability to pick up oxygen, a
heparin, and warfarin, are used clinically for characteristic that is highly desirable because fetal
thrombus-prone patients. blood is less oxygen rich than that of the mother.
– After birth, fetal blood cells are gradually replaced by
 Bleeding Disorders RBCs that contain the more typical hemoglobin A
Thrombocytopenia (HbA).
– In situations in which fetal RBCs are destroyed so
– platelet deficiency fast that the immature liver cannot rid the body of
– most common causes of abnormal bleeding hemoglobin breakdown products fast enough, the
– results from an insufficient number of circulating infant becomes jaundiced
platelets.
– can arise from any condition that suppresses the Histamine – first substance released during cellular
bone marrow, such as bone marrow cancer, injury
radiation, or certain drugs.
 In this disorder, even normal movements cause
spontaneous bleeding from small blood vessels. This is
evidenced by many small purplish blotches, called
petechiae
 When the liver is unable to synthesize its usual supply
of clotting factors, abnormal and often severe bleeding
episodes occur.
 Transfusions of concentrated platelets provide
temporary relief from bleeding

Hemophilia
– applies to several different hereditary bleeding
disorders that result from a lack of any of the factors
needed for clotting
– even minor tissue trauma results in prolonged
bleeding and can be life-threatening.
– Repeated bleeding into joints causes them to become
disabled and painful.
– When a bleeding episode occurs, hemophiliacs are
given a transfusion of fresh plasma or injections of
the purified clotting factor they lack.
– some have become the victims of blood transmitted
viral diseases such as hepatitis and AIDS.

DEVELOPMENTAL ASPECTS OF BLOOD

In the embryo, the entire circulatory system develops

early.

blood cell formation sites

— the fetal liver and spleen, before birth
— by the seventh month of development, the fetus’s
red marrow has become the chief site of
hematopoiesis, and it remains so throughout life

embryonic blood cells are circulating in the newly

formed blood vessels by day 28 of development.

Fetal hemoglobin (HbF)

– differs from the hemoglobin formed after birth.