4/26/2023

Blood Physiology

Giảng viên : ThS. BS. Đặng Nguyễn Tường Vân

([email protected])

Bài giảng lý thuyết trực tuyến Khoa Y – ĐHQG HCM |1

Blood volume & composition

• Blood volume
is 70 mL/kg.
• Blood is
composed of
cells that
circulate in
plasma.

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Cells suspended in plasma

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The difference between serum and plasma

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Homopoiesis

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Hemopoietic stem cells

• Hemopoietic stem cells are a rare subtype of

cell in the bone marrow
• All blood cells are derived from these cells
• They express the surface molecule CD34+
• They are supported by a range of cells in the
microenvironment
• This is disturbed in a range of conditions

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3 major types of blood cell

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Red blood cells

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Red blood cells

• 1,000 times more

common than white cells
• Have no nucleus and live
only 120 days
• Major purpose is to carry
oxygen to tissues
• They are 7 microns in
diameter, flexible
biconcave shape that
allows migration through
capillaries

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Erythrocytes

• RBCs derive from

erythroblasts in
the bone marrow.
• They are packed
with hemoglobin
and carry oxygen
to tissue.
• Their production
is regulated by
erythropoietin.

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Reticulocytes
• Reticulocytes carry a lot of
RNA.
• Reticulocytes live for 2 3
days & normally represent
up to 2% of the RBC in the
blood.
• The number of reticulocytes
in the blood is a useful
clinical test:
• When ↑ → the bone marrow is
more active.
• When ↓ → problem with
production of RBC from the
bone marrow.

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Erythropoiesis

• Pronormoblasts in the bone

marrow are the initial
precursors.
• These differentiate into
normoblasts.
• The nucleus is then ejected,
and reticulocytes are
released into the blood.

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RBC and Hemoglobin

• RBC contain hemoglobin
(Hb). Hb consists of 4
protein chains that each
contain a pocket for heme.
• The 4 protein chains in
adult Hb consist of 2 alpha
chains (a) and 2 beta
chains (b).
• Heme contains iron, and
much of the iron in the
body is found within
hemoglobin

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White blood cells

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Lymphocytes

• Lymphocytes are the

cells that mediate the
function of the
immune system
• They can survive for
many years &
circulate around the
blood & through
lymphoid tissues
• The 2 major subtypes
are T cells and B cells

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Lymphocytes

• Lymphocytes
constitute the
immune system. B
cells make
antibodies. T cells
regulate immunity
and helper cells
and can kill virally
infected cells

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Lymphocytes circulate through the

immune system
• 95% of lymphocytes
are found within
lymphoid tissue, and
they circulate
through the immune
system.
• Lymphocytes enter
lymph nodes through
lymph or high
endothelial venules.
• They leave lymph
nodes via lymphatic
vessels

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Mucosal-associated
Lymphoid Tissue
(MALT)

• Most lymphocytes
are within MALT.
• MALT is found in
many tissues
within the body.
• Lymphocytes
activated in these
areas home back
to this region

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Neutrophils

• Neutrophils may play an

important role in
controlling bacterial &
fungal infection
• They are released from
bone marrow & survive for
2-3 days
• They can ingest bacteria
and cells that have
become covered with
antibody
• They kill these using toxic
enzymes & oxygen radicals

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Neutrophils

• Neutrophils have a
characteristic
multilobed
nucleus.
• The nucleus
contains many
granules that
mediate the
destruction of
bacteria

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Phagocytosis

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Monocytes

• These cells migrate to

tissues, where they
become macrophages
• They can ingest
bacteria
• They play an
important role in
triggering immune
responses

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Monocytes

• They play an
important role in
linking the initial
phases of immunity
(innate immunity)
to T-cell and B-cell
immunity (adaptive
immunity)

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Eosinophils and Basophils

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Eosinophils and Basophils

• Eosinophils are
important in the
immune response to
helminths (worms).
They are increased
in allergic
responses.
• The basophil is a
rare cell whose
precise function is
unclear

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Myeloid cells
& monocytes
derived from
a common
precursor cell

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Platelets

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• These are
fragments of
cytoplasm that
bud off
megakaryocytes in
the bone marrow
• They can stick to
areas of damage
within the blood
vessels and
trigger the
formation of a
blood clot

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Bone marrow structure

• Blood is made
in the bone
marrow
• Hemopoietic
bone marrow is
present in
almost all
bones in
children
• In adults it is in
the vertebrae
and proximal
long bones

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Structure of the spleen

• The spleen consists
of areas of red pulp
& white pulp
• The blood system
has a unique
pattern in which it is
not contained within
capillaries
• The spleen has
hemopoietic &
immune functions

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Investigation and diagnosis

of the blood system

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Clinical Approach

Diagnosis is made by the combination of:

• Taking a medical history
• Examination
• Investigation

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Taking a History
• Red cell problems usually present with
anemia (fatigue, shortness of breath).
• White cell deficiency leads to unusual or
prolonged infection.
• Excess white cells in malignant disease
can cause lumps and swelling.
• Disorders of platelets lead to bruising
and bleeding.
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Examination
• Examination of the nails, skin,
and mucous membranes may
suggest anemia.
• Examination of the lymph
nodes may suggest leukemia
or lymphoma.
• Excessive bruising is seen in
platelet disorders.
• The spleen is only palpable
when it is enlarged

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Blood Count

• Blood Count is usually the 1st

• The 3 main components are:
▪ The red cell count and hemoglobin
▪ The total and individual white cell counts
▪ The platelet count

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RBC count & Hemoglobin

• The normal red cell count is 4-6
x 10^12/L.
• The hemoglobin concentration is
expressed in grams per deciliter.
• The normal range in men is
13.5-17.5 g/dL.
• The normal range in women is
11.5-15.5 g/dL.

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Size of the RBC

Automated red cell counters can provide

information on the volume of the red cells:
• The mean cell volume, or MCV
• This is very useful in determining the
cause of anemia:
▪ 80-95 femtoliters (fl) is normal
▪ < 80 fl is microcytic
▪ > 95 fl is macrocytic
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WBC
• The normal range is 4-7 x
10^9/L.
• A decrease is termed
leukopenia.
• An increase is leukocytosis.
• The 2 major subsets of white
cells are lymphocytes &
neutrophils. This leads to the
terms of lymphopenia or
neutropenia and lymphocytosis
or neutrophilia.
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Platelets
• In cases of bleeding or abnormal
blood clotting, it is important to
see if the platelet count is ↓ or ↑.
• The normal level is 150-400 x
10^9/L.
• A low count is called
thrombocytopenia & is seen in
disorders such as poor
production or ↑ destruction of
platelets.
• An ↑ is called thrombocytosis &
may ↑ the risk of blood clots.

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Blood film

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Other assessments

• Blood clotting
test different
components of
the clotting
cascade
• Examination of
the bone
marrow
• Genetic Analysis
• Imaging
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Putting all together

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