Department of Medical Physics

Asst.Lec Nusaibah AL-Zubaidi

Blood and its Components

Blood is an essential fluid carries out the critical functions of transporting oxygen
and nutrients to our cells and getting rid of carbon dioxide, ammonia, and other
waste products. In addition, it plays a vital role in our immune system and in
maintaining a relatively constant body temperature. Blood is a highly specialized
tissue composed of more than 4,000 different kinds of components. Four of the
most important ones are red cells, white cells, platelets, and plasma.

1- Red Cells
Red cells, or erythrocytes, are relatively large
microscopic cells without nuclei. In this latter
trait, they are similar to the primitive prokaryotic
cells of bacteria. Red cells normally make up 40-
50% of the total blood volume. They transport
oxygen from the lungs to all of the living tissues
of the body and carry away carbon dioxide. The
red cells are produced continuously in our bone Human erythrocytes or "red cells"
(cell diameter about .0003 inches)
marrow from stem cells at a rate of about 2-3
million cells per second. Hemoglobin is the gas transporting protein molecule
that makes up 95% of a red cell. Each red cell has about 270,000,000 iron-rich
hemoglobin molecules. People who are anemic generally have a deficiency in red
cells, and subsequently feel fatigued due to a shortage of oxygen. The red color of
blood is primarily due to oxygenated red cells. Human fetal hemoglobin molecules
differ from those produced by adults in the number of amino acid chains.

2- White Cells
White blood cells, or leukocytes, exist in variable numbers and types but make up
a very small part of blood's volume--normally only about 1% in healthy people.
Department of Medical Physics
Asst.Lec Nusaibah AL-Zubaidi

Leukocytes are not limited to blood. They occur elsewhere in the body as well,
most notably in the spleen, liver, and lymphglands. Most are produced in our bone
marrow from the same kind of stem cells that produce red blood cells. Others are
produced in the thymus gland, which is at the base of the neck.
Some white cells are involved in defending the body against both infectious
disease and foreign materials. There are several different types of white blood
cells. They all have many things in common but are all distinct in form and
function. A major distinguishing feature is the presence of granules; white blood
cells are often characterized as granulocytes or a granulocytes.

A-Granulocytes
Granulocytes, also known as polymorphonuclear leukocytes are characterized by
differently stained granules as viewed in their cytoplasm under light microscopy.
These granules are membrane-bound enzymes that act primarily in the digestion of
endocytosed particles. There are three types of granulocytes :

- Neutrophils defend against bacterial or fungal infection and other very small
inflammatory processes. They are usually the first responders to microbial
infection; their activity and death in large numbers forms pus.
-Eosinophils primarily deal with parasitic infections. They are also the
predominant inflammatory cells in allergic reactions.
Department of Medical Physics
Asst.Lec Nusaibah AL-Zubaidi

-Basophils are chiefly responsible for allergic and antigen response by releasing
the chemical histamine, which causes dilation of the blood vessels.

B-Agranulocytes
Agranulocytes, or mononuclear leukocytes, are leukocytes characterized by
absence of granules in their cytoplasm. Agranulocytes contain lysosomeswhich are
small vesicles containing digestive enzymes that break down any foreign matter
that is endocytosed by the cell. A granulocytes cells include:

1- Lymphocytes: come in three types :

 B-lymphocytes, which produce antibodies in thehumoral immune response.
 T-lymphocytes which participate in the cell-mediated immune response.
 The null group which contains natural killer cells; cytotoxiccells that
participate in the innate immune response.

2- Monocytes present pieces of pathogens to T cells so that the pathogens may be

recognized again and killed, or so that an antibody response may be mounted.
Department of Medical Physics
Asst.Lec Nusaibah AL-Zubaidi

3- Macrophages are monocytes that have migrated out of the blood stream and
into the body tissues. They take up and destroy necrotic cell debris and foreign
material including viruses, bacteria, and tattoo ink.

3-Platelets
Platelets , or thrombocytes , are cell fragments without nuclei that work with
blood clotting chemicals at the site of wounds. They do this by adhering to the
walls of blood vessels, thereby plugging the rupture in the vascular wall. They
also can release coagulating chemicals which cause clots to form in the blood that
can plug up narrowed blood vessels. Thirteen different blood clotting factors, in
addition to platelets, need to interact for clotting to occur. They do so in a
cascading manner, one factor triggering another. Hemophiliacs lack the ability to
produce either blood factor 8 or 9.

Platelets are not equally effective in clotting blood throughout the entire day. The
body's circadian rhythm system (its internal biological clock) causes the peak of
platelet activation in the morning. This is one of the main reasons that strokes and
heart attacks are more common in the morning. Recent research has shown that
platelets also help fight infections by releasing proteins that kill invading bacteria
and some other microorganisms.
Department of Medical Physics
Asst.Lec Nusaibah AL-Zubaidi

In addition, platelets stimulate the immune system. Individual platelets are about
1/3 the size of red cells. They have a lifespan of 9-10 days. Like the red and white
blood cells, platelets are produced in bone marrow from stem cells.

4-Plasma
Plasma is the relatively clear, yellow tinted water (92%), sugar, fat, protein and
salt solution which carries the red cells, white cells, and platelets. Normally, 55%
of our blood's volume is made up of plasma. Plasma helps maintain blood pressure
and regulates bodytemperature. plasma brings nourishment to them and removes
the waste products ofmetabolism. It contains a complex mix of substances used
by the body to perform important functions.These substances include minerals,
salts, hormones and proteins.
Three important proteins found in plasma are:

a-albumin:
Serum albumin, often referred to simply as blood albumin, (a type of
globular protein Albumin cleans the blood, carries substances around the body, and
helps maintain the correct amount of fluid circulating in the body. without
albumin, the high pressure in the blood vessels would force more fluids out into the
tissues. It also acts as a plasma carrier by non-specifically binding
several hydrophobic steroid hormones and as a transport protein
for hemin and fatty acids. Too much or too little circulating serum albumin may be
harmful. Human albumin solution can be used as a treatment to help people with
severe burns, sepsis, liver disease or kidney disease.

b- Globulin
The globulins are a family of globular proteins that have higher molecular
weights than albumins and are insoluble in pure water but soluble in dilute salt
solutions. Some globulins are produced in the liver, while others are made by the
immune system. The normal concentration of globulins in human blood is about
2.6-4.6 g/dL. Immunoglobulins are part of the immune system(the body's natural
defence against infection and illness).
Department of Medical Physics
Asst.Lec Nusaibah AL-Zubaidi

Immunoglobulins are antibodies that the body produces to fight a variety of

infections. For example, they're used to fight health conditions such as:
chickenpox, hepatitis, rabies .

c- Fibrinogen
Fibrinogen (factor I) is a glycoprotein in vertebrates that helps in the formation of
blood clots. The fibrinogen molecule is a soluble, large, and
complex plasma glycoprotein, that is converted
by thrombininto fibrin during blood clot formation. The concentration of
fibrinogen in the blood plasma is 200–400 mg/dL.
Hypoproteinemia is a decreased level of protein(s) in the blood. It occurs when
protein is not properly absorbed during digestion (protein-losing
gastroenteropathy). This can be caused by several gastrointestinal conditions,
including impaired pancreatic function, bacterial overgrowth in the small intestine,
gastrointestinal infection, parasite infections ,diarrhea, Crohn's disease, or
ulcerative colitis. In addition, individuals who have had part of the intestine
removed surgically may experience hypoproteinemia. Low blood levels of proteins
can also occur in other illnesses including kidney disease, liver disease, lymphoma,
and AIDS. Certain drugs (neomycin, alcohol) may decrease protein absorption,
thereby resulting in hypoproteinemia. Finally, a severe lack of protein in the diet
(malnutrition) can also cause hypoproteinemia.
 plasma salts, the salts present in plasma include sodium,
potassium, calcium, magnesium, chloride, and bicarbonate. These salts
function in many important body processes. calcium functions in muscle
contraction; sodium, chloride, and potassium function in nerve impulse
transmission in nerve cells; and bicarbonate regulates pH. These salts are also
called electrolytes. An imbalance of electrolytes, which can be caused by
dehydration, can be a serious medical condition. Many gastrointestinal
illnesses, such as cholera, cause a loss of electrolytes through severe diarrhea.
When electrolytes are lost, they must be replaced with intravenous solutions of
water and salts or by having the patient drink solutions of salts and water.
Department of Medical Physics
Asst.Lec Nusaibah AL-Zubaidi

 plasma contains nutrients include amino acids, glucose, or sugars; and fatty
acids and glycerol, the components of lipids (fats). In addition to nutrients,
plasma also contains enzymes, or small proteins that function in chemical
reactions, and hormones, which are transported from glands to body tissues.
These waste products include creatinine, uric acid, and ammonium salts. Blood
transports these waste products from the body tissues to the kidneys, where they
are filtered from the blood and excreted in the urine.

Blood tests
A blood test is a laboratory analysis performed on a blood sample that is usually
extracted from a vein in the arm using a needle, or viafingerprick. Multiple tests
for specific blood components (such as a glucose test or a cholesterol test) are
often grouped together into onetest panel called a blood panel or blood work.
Blood tests are often used in health care to determine physiological and
biochemical states, such as disease, mineral content, pharmaceutical drug
effectiveness, and organ function. Typical clinical blood panels include abasic
metabolic panel or a complete blood count. Blood tests are also used in drug
tests to detect drug abuse.

Blood Specimen Collection and Processing

Venipuncture is useful as it is a minimally invasive way to obtain
cells and extracellular fluid (plasma) from the body for analysis. Blood flows
throughout the body, acting as a medium which provides oxygen and nutrients to
tissues and carries waste products back to the excretory systems for disposal. The
state of the bloods stream is affected by many medical conditions. For these
reasons, blood tests are the most commonly performed medical tests.
If only a few drops of blood are needed, a fingerstick is performed instead of
drawing blood from a vein.
Department of Medical Physics
Asst.Lec Nusaibah AL-Zubaidi

Phlebotomists: a laboratory practitioners and nurses are those charged with patient
blood extraction. However, in special circumstances, and emergency
situations, paramedics and physicians sometimes extract blood. Also, respiratory
therapists are trained to extract arterial blood to examine arterial blood gases.
1- Complete Blood Count
The complete blood count, or CBC, lists a number of many important values.
Typically, it includes the following:

a- White Blood Count (WBC).

White blood cells are larger than red blood cells, but there are fewer of them in
numbers. In infection, an increased number of white blood cells are sent from the
bone marrow to attack the bacteria or virus that is causing the infection. An
increased number of white blood cells may occur with mild infections,
appendicitis, pregnancy, leukemia, hemmorrhage and hemolysis.

b- Red Blood Count (RBC).

Red blood cells are the most common type of cell in the blood ,body contains
millionsupon millions of these disc-shaped cells.Red blood cells are produced by
the bone marrowcontinuously in healthy adults. The cells contain hemoglobin
which carries oxygen andcarbon dioxide throughout the body.The RBC determines
if the number of red blood cells in the body is low (called anemia) or high (called
polycythemia).
Common causes of an abnormal RBC include :

 iron deficiency (anemia) due to chronicblood loss (i.e. menstruation, small

amounts of bleeding due to colon cancer), acute blood loss(i.e. acute
bleeding ulcer, trauma), and hereditary disorders (i.e. sickle cell anemia).
People with low hemoglobin levels have anemia and usually have a low red
blood cell count and a low hematocrit. Signs and symptoms of anemia
(paleness, shortness of breath, fatigue) will start to show when the
hemoglobin is too low. In general, females have lower red blood counts and
hemoglobin values than men.
Department of Medical Physics
Asst.Lec Nusaibah AL-Zubaidi

 Polycythemia is relatively uncommon. Red blood cells contain hemoglobin,

themolecules that carry oxygen and carbon dioxide in the blood. Measuring
hemoglobin givesan exact picture of the ability of the blood to carry oxygen.
The oxygen is used by the cellsto produce energy. The blood also brings
carbon dioxide, the waste product of this energyproduction process, back to
your lungs, where it is exhaled.

c- Hemoglobin Concentration (HGB).

The purpose of this test is to determine the ratio of plasma (clear liquid part of the
blood)to red cells in the blood .

d- Hematocrit measurement
The hematocrit (Ht or HCT), British English spelling( haematocrit), also known
as packed cell volume (PCV) or erythrocyte volume fraction (EVF), is
the volume percentage (%) of red blood cells in blood. It is normally 45% for men
and 40% for women. It is considered an integral part of a person's complete blood
count results. Because the purpose of red blood cells is to transfer oxygen from the
lungs to body tissues, a blood sample's hematocrit—the red blood cell volume
percentage—can become a point of reference of its capability of delivering
oxygen. Additionally, the measure of a subject's blood sample's hematocrit levels
may expose possible diseases in the subject. Anemia refers to an abnormally low
hematocrit, as opposed to polycythemia, which refers to an abnormally high
hematocrit. For a condition such as anemia that goes unnoticed, one way it can be
diagnosed is by measuring the hematocrit levels in the blood. Both are potentially
life-threatening disorders.
e- MCV (Mean Cell Volume):
Measures the average size of red blood cells. In patients with anemia, it is the
MCV measurement that allows classification as either a microcytic anemia (MCV
below normal range), normocytic anemia (MCV within normal range)
or macrocytic anemia (MCV above normal range). Normocytic anemia is usually
deemed so because the bone marrow has not yet responded with a change in cell
Department of Medical Physics
Asst.Lec Nusaibah AL-Zubaidi

volume. It occurs occasionally in acute conditions, namely blood loss and

hemolysis.

f- MCH (Mean Cell Hemoglobin):

Reflects the average weight of hemoglobin found in the red blood cell.
("normochromic") in macrocytic anemias (due to larger cell size, though the
hemoglobin amount or MCH is high, the concentration remains normal).

g- MCHC (Mean Cell Hemoglobin Concentration):

macrocytic anemias (due to larger cell size, though the hemoglobin amount or
MCH is high, the concentration remains normal). MCHC is elevated
("hyperchromic")

h- RDW (Red Cell Distribution Width):

RCD isa histogram (visual), which is a measure of the range of variation
of red blood cell (RBC) volume.

i- MPV (Mean Platelet Volume):

Reflects the average volume of platelet. Platelets are the smallest type of cell found
in the blood. Platelets help stop bleeding after an injury by gathering around the
injury site, plugging the hole in the bleeding vessel and helping the blood to clot
more quickly.

j- Platelet count.
platelet counts are often done in bruising or in surgery.The platelet count may
change with bleeding disorders, heart disease, diabetes, inflammatory disorders,
and anemias. People with a low WBC are more likely to catch colds or other
infectious diseases. Low WBC counts may be seen in overwhelming infections like
mumps, lupus, cirrohsis of the liver and cancer. In addition, radiation therapy and
certain types of drug therapy tend to lower the WBC.

k- Erythrocyte Sedimentation Rate (ESR)

Also called an ESR or sedimentation rate test, measures the speed at which red
blood cells settle to the bottom of an upright glass test tube. This measurement is
Department of Medical Physics
Asst.Lec Nusaibah AL-Zubaidi

important because when abnormal proteins are present in the blood, typically due
to inflammation or infection, they cause red blood cells to clump together and sink

more quickly, which results in a high ESR value.The ESR is useful in detecting
inflammation in the body that may be caused by infection, some cancers, and
certain autoimmune diseases such as juvenile idiopathic arthritis, lupus,
and Kawasaki disease. The ESR alone can't be used to diagnose any one specific
disease, however.

2- Blood typing
Is a test that determines a person’s blood type. The test is essential in blood
transfusion or in donate blood. Not all blood types are compatible, so it is
important to blood group to ensure that in transfusion the body doesn’t make
antibodies to attack the donor blood.

The Blood Types

The ABO blood typing system groups blood into one of four categories:
 O: type O individuals can donate blood to anyone, but can receive blood only from
other type O individuals.
 A: type A individuals can donate to other type A individuals and type B
individuals. Type A individuals can receive blood only from other type A
individuals and type O individuals.
 B: type B individuals can donate blood to other B individuals and AB individuals.
Type B individuals can receive blood only from type B individuals and type O
individuals.
 AB: type AB individuals can give blood only to other AB individuals, but can
receive blood of any type.
The Rh factor blood grouping system:
 Rh+: People with Rh-positive blood have Rh antigens on the surface of their
red blood cells. People with Rh+ blood can receive Rh+ or Rh- blood.
 Rh-: People with Rh-negative blood do not have Rh antigens. People with
Rh- blood can receive only blood that is also Rh-.
Department of Medical Physics
Asst.Lec Nusaibah AL-Zubaidi

Together, the ABO and Rh grouping systems yield your complete blood type.
There are eight possible types: O+, O-, A+, A-, B+, B-, AB+, and AB-.