Blood  Work-practice

procedures
after performing

 Blood signifies life, and for good

reason it has many vital functions.
Whole Blood
 Type of connective tissue whose  Slightly heavier
cells are suspended in a liquid  Three to four times more viscous
extracellular matrix. Essential in than water
transporting substances between
 Its cells form mostly in red bone
body cells and the external
marrow
environment, thereby promoting
 Cells and platelets “formed
homeostasis.
elements” of the blood
Universal Precautions  Liquid portion – plasma

 Blood can contain more than cells, Hematocrit (HCT)

nutrients, proteins, and water. A
 Red blood cells – 45%
single drop from an infected
 White blood cells and platelets – 1%
individual can harbor billions of
viruses  Plasma – 55%
 “Universal precautions,” which are
Blood Volume
specific measures that health-care
workers should take to prevent  Body size
transmission of blood borne  Changes in fluid and electrolyte
infectious agents in the workplace. concentrations
 The CDC singled out HIV and the  Amount of adipose tissue
hepatitis B virus
 Refers to the assumption that any
patient may have been exposed to a
pathogen that can be transmitted in a
body fluid.

Specific recommendations
include:
 Uses of personal protective
equipment, such as gloves, goggles,
and masks
 Engineering controls, such as fume
hoods and sharp containers
  An average-size adult has a blood
volume of about 5 liters (5.3 quarts)
1. Transportation Blood Plasma
 Transports oxygen from the lungs to
 Straw-colored liquid called (or
the cells of the body and carbon
simply plasma)
dioxide form the body cells to the
 Blood plasma is about 91.5% water
lungs for exhalation
 8.5% solutes (7% by weight) are
 It carries nutrients from the
proteins
gastrointestinal tract to body cells
and hormones from endocrine  Play a role in maintaining proper
glands to other body cells. blood osmotic pressure. Important
factor in the exchange of fluids
 Transport heat and waste products to
across capillary walls
various organs for elimination form
the body.
2. Regulation
 Circulation blood helps maintain
homeostasis
 Helps regulate pH through the use
of buffers
 Helps adjust body temperature
through the heat absorbing and
coolant properties of the water in
blood plasma
 Blood osmotic pressure influences
the water content of cells, mainly
through interactions of dissolved
ions and proteins.
3. Protection
 Clot, which protects against its
excessive loss from the
cardiovascular system after an
injury
 White blood cells protect against
disease by carrying on phagocytosis
 Blood proteins – antibodies,
interferon, and complement, help
protect against disease
  They cannot synthesize proteins of
divide
 Produce ATP through glycolysis
only and use none of the oxygen they
carry because they also lack
mitochondria
 Typical range for:
o Adult males is 4,700,000 to
6,100,000 cells per microliter
o Adult females is 4,200,000 to
5,400,000 cells per microliter

Red Blood Cell Production and

Blood Cells Its Control
Red Blood Cell (Erythrocytes)  Erythropoiesis – initially occurs in
the yolk sac, liver, and spleen
 Biconcave discs-adaption for
 After birth, these cells are produced
transporting gases
almost exclusively red bone marrow
 Increases the surface area through
 Hematopoietic stem cells or
which gases can diffuse
hemocytoblasts
 Places the cell membrane closer to
 120 days – average life span of red
oxygen-carrying hemoglobin
blood cell
molecules in the cell
 About one-third hemoglobin by
Cyanosis
volume
 This protein imparts the color of  Prolonged oxygen deficiency
blood (Hypoxia)
o Oxyhemoglobin – when  Skin and mucous membranes appear
hemoglobin binds oxygen bluish due to an abnormally high
(bright red) blood concentration of
o Deoxyhemoglobin - when Deoxyhemoglobin in the superficial
oxygen is released (darker) blood vessels – slow blood flow,
 Have nuclei during their early stages allowing removal of more oxygen
of development, but lose their nuclei than usual from the blood flowing
as they mature, providing more space through the vessels, increasing the
for hemoglobin amount of Deoxyhemoglobin
Erythropoietin
 Hormone – controls the rate of red
blood cell formation through
negative feedback
 The kidneys, and to a lesser extent
the liver, release erythropoietin in
 The small intestine absorbs iron
response to prolonged oxygen
slowly from food body reuses much
deficiency
of the iron released by the
 Polycythemia – an excessive
decomposition of hemoglobin from
increase in red blood cells – increase
damage red blood cells
blood viscosity, slowing blood flow
and impairing circulation Anemia
 Each RBC contains 280 million
hemoglobin molecules  Deficiency of red blood cells or a
 A hemoglobin molecule consists: reduction in the amount of
o Globin – four polypeptide hemoglobin they contain
chains (two alpha and two  Reduces the oxygen carrying
beta chains) capacity of the blood
o A ring like no protein  Affected person may appear pale and
pigment called a “heme” is lack energy
bound to each of the four
chains

Dietary Factors Affecting Red

Blood Cell Production
 Availability of B-complex vitamins –
vitamin B12 and folic acid
significantly influences red blood
cell production
 Required for DNA synthesis,
necessary for the growth and division
of cells
 Cell division is rapid in blood- Hemochromatosis
forming (hematopoietic) tissue
 Hemoglobin synthesis and normal
red blood cell production require iron
  An inherited disorder – small Destruction of Red Blood Cell
intestine absorbs iron at ten times the
normal rate  Near the end of their three month life
 Iron builds up in organ, to toxic span more fragile and may be
levels damaged simply passing through
 Treatment is periodic blood removal capillaries, particularly those in
every week active muscles that must withstand
 The blood is discarded strong contractile forces
 Macrophages phagocytize and
destroy damaged red blood cells,
primarily in the liver and spleen
Sickle Cell Disease
 Single DNA base mutation changes
one amino acid in the protein part of
hemoglobin, causing hemoglobin to
crystallize in a low-oxygen
environment
 Bends the red blood cells with
abnormal hemoglobin into a sickle
shape
 Tend to get stuck and block flow in
small blood vessels, causing
excruciating joint pain and damaging
organs
 Typically diagnosed at birth
 Usually damaged early on, so they
receive antibiotics daily for years to
prevent infection
 Hydroxyurea – used to activate
production of a form of hemoglobin
normally produced only in the fetus
 The fetal hemoglobin slows sickling,
enables the red blood cells to reach
the lungs, where fresh oxygen
restores the cell’s normal shape
 A bone marrow transplant or an
umbilical cord stem cell transplant Jaundice (icterus)
from a donor can completely cure
sickle cell disease but have a 15%  Accumulation of bilirubin turns the
risks of fatality skin and eyes yellowish
  New borns physiologic jaundice a  Useful because the relative
few days after birth-result of proportions of white blood cells may
immature liver cells that change in particular diseases
ineffectively secrete bilirubin into
the bile Granulocyte
 Treatment-exposure to fluorescent
light-breaks down bilirubin %  About twice the size of a red blood
feedings that promote bowel cell
movements  Develop in red bone marrow
 Have short life spans, averaging
White Blood Cells (Leukocytes) about 12 hours
o Neutrophils
 Develop from hematopoietic stem o Eosinophils
cells in the red bone marrow in o Basophils
response to hormones
 These hormones fall into two groups: Neutrophils
o Interleukins – numbered
o Colony – stimulating factors  Fine cytoplasmic granules that
– named for the cell appear light purple in neutral stain
population they stimulate  Nucleus of an older neutrophil is
 Blood transport white blood cells to lobes consist of two to five sections
sites of infection connected by thin strands of
 White blood cells may then leave the chromatin
bloodstream  Younger neutrophils bands nuclei are
C shaped
White Blood Cells Counts  Neutrophils account 54-62% of the
leukocytes in a typical blood sample
 3,500-10,000 cells from an adult
 Change in response to abnormal
conditions Eosinophils
 Leucocytosis total number of white
blood cells exceeding 10,500 per  Contain coarse, uniformly sized
microliter of blood constitutes cytoplasmic granules that appear
 Leukopenia – a total white blood cell deep red in acid stain
count below 3,500 per microliter of  Nucleus usually has only two lobes
blood bilobed
 A differential white blood cell count  1-3% of the total number of
(DIFF) lists percentages of the circulating leukocytes
various types of leukocytes in a
blood sample Basophils
  Similar to eosinophils in size and in  Are not complete cells
the shape of the nuclei, but they have  Arise from very large cells in red
fewer, more irregularly shaped bone marrow, called megakaryocytes
cytoplasmic granules that appear  That fragment, releasing small pieces
deep blue in basic stain platelets into the circulation
 Usually account for less than 1% of  Megakaryocytes develop long
the circulating leukocytes cellular extensions that break off in
small sections to from platelets in the
bone marrow
 Platelets develop from hematopoietic
Agranulocyte Group stem cells in response to the
hormone thrombopoietin
Monocytes  Lack a nucleus
 Less than had the size of the red
 Largest blood cells
blood cell
 Two to three greater in diameter than  Capable of amoeboid movement
red blood cells
 May live for about ten days
 Nuclei vary in shape and are round,
 Platelet count varies from 150,000 to
kidney-shaped, oval, or lobed
350,000 per microliter
 Make-up 3-9% of the leukocytes
 Live for several weeks or even Hemostasis
months
 Process that stops bleeding
Lymphocytes  Vitally important when blood vessels
are damage
 Only slightly larger than red blood
 Several actions help to limit or
cells
prevent blood loss
 Large, round nucleus surrounded by
o Blood vessel spasm
a thin rim of cytoplasm
o Platelet plug formation
 Account for 25-33% of circulating
leukocyte o Blood coagulation
 May live for years
Blood Vessel Spasm
Diapedesis  The contraction of smooth muscle in
 White blood cells, by contrast, are its walls
able to slip into and out of the blood  Blood loss lessens almost
vessel immediately, and the ends of the
severed vessel may close completely
Platelets (thrombocytes)  Reflex response may last only a few
minutes
  The effect of the direct stimulation
usually continues for about 30
minutes platelet plug has formed,
blood is coagulating
 Platelets release serotonin, contracts
smooth muscle in the blood vessel
walls, vasoconstriction further helps
to reduce blood loss

Platelet Plug Formation

 Conversion of the soluble plasma
 Platelets adhere to the collagen protein fibrinogen – fibrin
underlying the endothelium lining  Formation of fibrin takes several
blood vessels steps
 Platelets also adhere to each other,  First, damage tissues release tissue
forming a platelet plug in the thromboplastin, initiating a series of
vascular break- control blood loss reactions that results in the
from a small break, but a larger production of prothrombin activator
break may require a blood clot to halt  This series of changes requires
bleeding calcium ions as well as certain
proteins and phospholipids
Blood Coagulation
Prothrombin
 Most effective hemostatic
mechanism, forms a blood clot in a  Alpha globulin that the liver
series of reactions, each one continually produces
activating the next  A normal constituent of plasma
 Complex and utilizes clotting factors  Prothrombin activator converts
promote coagulation, and other prothrombin into thrombin, which in
inhibit it turn catalyzes a reaction that joins
 Result on injury (trauma) – fragments of fibrinogen into long
biochemical that favour coagulation, threads
and the blood may coagulate  Once fibrin threads form they stick
to the exposed surfaces of damaged
blood vessels, creating a meshwork
that entraps blood cells and platelets
 The resulting mass is a blood clot,
which may block a vascular break
and prevent further blood loss
  The clear, yellow liquid that remains  Plasmin formation may dissolve a
after the clot forms is called “serum”. whole clot
o Serum is plasma minus the  Clots that fill large blood vessels are
clotting factors seldom removed naturally
 The amount of prothrombin activator
in the blood is directly proportional Thrombus – a blood clot abnormally
to the degree of tissue damage forming in a vessel
 Once a blood clot begins to form, it
Embolus – A clot that dislodges or a
promotes additional clotting because
fragment of break loose and is carried
thrombin also acts directly on blood
away by the blood flow
clotting factors other than fibrinogen,
causing prothrombin to form more
thrombin

 This is an example of a positive

feedback system, in which the Tissue plasminogen activator
original action stimulates more of the
same type of action
(TPA)
 Such as positive feedback  Drug based on “clot-busting” can be
mechanism produces unstable lifesaver
conditions and can operate for only a  Restore blocked cerebral circulation
short time without disrupting the if given within 3 to 4 ½ hours of a
stable internal environment stroke
 Streptokinase may also be successful
Laboratory tests commonly used
 Urokinase an enzyme produced
to evaluate the blood coagulation  Heparin and Coumadin are drugs that
interfere with clot formation, but do
 Prothrombin Time (PT)
not dissolve clots
 Partial Thromboplastin Time (PTT)
 Measures the time it takes for fibrin Abnormal Clot Formation
threads to form in a sample of
plasma  Associated with conditions that
 A result of blood leakage change the endothelial linings of
(hematomas) – disappear in time vessels
 Dissolution requires conversion of  Atherosclerosis – accumulations of
plasma protein, plasminogen, to fatty deposits change arterial linings,
plasmin sometimes initiating inappropriate
 Digest fibrin threads and other clotting
proteins associated with blood clots
 the agglutination of the donated red
blood cells

Agglutination and Coagulation

are not the same
Agglutination
 Reaction between antigens and
specific antibodies
 Happens when antigens on
mismatched donated red blood cells
react with antibodies in plasma

Coagulation
Blood Groups and  Is an enzymatic reaction that changes
Transfusion soluble fibrinogen to insoluble fibrin
threads leadings to the formation of a
 Compatibility is determined by blood clot
examining the mixture under a
microscope for agglutination, the Mismatched Blood Transfusion
clumping of red blood cells
 Signs of agglutination
Antigens and Antibodies  Anxiety
 Breathing difficulty
 An antigen is any molecule that  Facial flushing
triggers an immune response  Headache
 When the immune system encounters  Severe pain in the neck, chest, and
an antigen not found on the body’s lumbar area
own cells it will attack, producing  Red blood cells burst, releasing free
antibodies hemoglobin
 In a transfusion reaction, antigens  Liver cells and macrophages
(agglutinogens) on the surface of the phagocytize bilirubin yellow skin of
donated red blood cells react with jaundice
antibodies (agglutinins) in the  Free hemoglobin
plasma of the recipient, resulting in  Kidney fails
ABO Blood Group  Blood in the umbilical cord at birth is
rich in stem cells that can be used to
 Based on the presence (or absence) treat a variety of disorders, including
of two major antigens on red blood leukaemia, sickle cell disease, and
cell membranes other hemoglobin abnormalities, and
 Antigen A and Antigen B certain inborn errors of metabolism
 A and B antigens are carbohydrates
attached to glycolipids projecting Rh Blood Group
from the red blood cell surface
 Rhesus monkey
 A person’s erythrocytes have on their
 In humans, this group includes
surfaces one of four antigen
several Rh antigen (factors)
combinations:
o A, only B, both A and B, or  Antigen D – most prevalent, trans
membrane protein
neither A nor B
 Rh-positive-Rh antigens are present
on the red blood cell membranes
 Rh-negative-red blood cells lack Rh
A person with: antigens
 Inherited trait
 Antigen A has type A blood
 Anti-Rh antibodies (anti-Rh_ form
 Antigen B has type B blood
only in Rh-negative individuals in
 Both antigens A and B has type AB
response to the presence of red blood
blood
cells with Rh antigens
 Neither antigens A nor B has type O
 If the Rh-negative person who is
blood
now sensitized to Rh-positive blood
 ABO blood type is inherited, result receives another transfusion of Rh-
of DNA encoding an enzyme- positive blood some months later, the
catalyzes the final step in the donated red cells are likely to
synthesis of the A and B antigen agglutinate
 In United States the most common
ABO blood types are: Erythroblastosis Fetalis
o O – 47%
o A – 41%  An Rh-negative woman who might
o B – 9% carry an Rh-positive fetus is given an
o AB – 3% injection
 Type AB blood lacks both anti-A  Rho GAM – injection is composed
and anti-B antibodies can receive a of anti-Rh antibodies, which bind to
transfusion of blood of any other and shield any Rh-positive fetal cells
type – universal recipients that might contact the woman’s cells
and sensitive her immune system
 Given within 72 hours of possible
contact with Rh-positive cells
including giving birth, terminating a
pregnancy, miscarrying or
undergoing amniocentesis