BACHELOR OF SCIENCE IN NURSING

ANPH 111 (Anatomy and Physiology)

COURSE MODULE COURSE UNIT WEEK
2 7 9
The Blood

ü Read course and unit objectives

ü Read study guide prior to class attendance
ü Read required learning resources; refer to unit terminologies for jargons
ü Proactively participate in classroom discussions
ü Participate in weekly discussion board (Canvas)
ü Answer and submit course unit tasks.

VanPutte, Cinnamon. Regan, Jennifer. Russo, Andrew (2016). Seeley’s Essentials of Anatomy &
Physiology Penn Plaza, New York, New York, McGraw-Hill Education, 10th Edition

Computer device or smartphone with internet access (at least 54 kbps; average data
subscription will suffice)
At the end of the course unit (CM), learners will be able to:

Cognitive
• State how blood works
• Describe the origin and production of the components of blood
• Correlate basic clinical conditions related to blood imbalances
• Relate the basis of ABO and Rh Incompatibilities
• Ascertain how Hemostasis is established through blood
• Relate on concepts of blood groups and blood transfusions
• Explain the developmental aspects of blood

Affective

• Listen attentively during class discussions

• Demonstrate tact and respect of other students’ opinions and ideas
• Accept comments and reactions of classmates openly

Psychomotor
• Participate actively during class discussions
• Follow class rules and observe compliance to Netiquette
• Use critical thinking to identify areas of care that could benefit from additional research or
application of evidence-based practices
• Integrate knowledge of trends in Anatomy and Physiology

Anemia - A deficiency of red blood cells or hemoglobin

Basophil - The fewest of the WBCs and secretes heparin
Coagulation - Blood clotting
Eosinophils - White blood cells that protect against parasites and also involved in allergic
reactions
Erythrocytes - Red blood cells
Erythropoietin - Hormone secreted by the kidneys that stimulates the production of RBCs
Fibrin - Insoluble protein fibers involved in forming a blood clot
Fibrinolysis - Process of dissolution of a blood clot
Hematocrit - The percentage of red blood cells in a sample of blood
Hemoglobin - Iron-containing pigment of red blood cells that carries oxygen
Hemolysis - The destruction of red blood cells
Hemopoiesis - The production of blood
Hemostasis - An arrest of bleeding
Leukocytes - White blood cells
Leukocytosis - Elevated white blood cell count
 Leukopenia - Abnormally low white blood cell count
Lymphocytes - Second most numerous of the WBCs; responsible for long-term immunity
Monocytes - Largest and most long-lived of the WBCs; highly phagocytic
Neutrophils - Most abundant of the white blood cells; highly mobile
Plasma - The clear extracellular matrix of blood
Platelets - Blood cell fragments that play a key role in stopping bleeding
Reticulocyte - An immature form of an erythrocyte
Serum - Plasma without the clotting proteins
Viscosity - The thickness or stickiness of blood

7.1 BLOOD
§ Blood transports everything that must be carried from one place to another, such as:
§ Nutrients
§ Wastes
§ Hormones
§ Body heat

Physical Characteristics of the blood

§ Sticky, opaque fluid
§ Heavier and thicker than water
§ Color range
§ Oxygen-rich blood is scarlet red
§ Oxygen-poor blood is dull red or purple
§ Metallic, salty taste
§ Blood pH is slightly alkaline, between 7.35 and 7.45
§ Blood temperature is slightly higher than body temperature, at 38ºC or 100.4ºF

Blood volume
§ About 5–6 liters, or about 6 quarts, of blood are found in a healthy adult
§ Blood makes up 8 percent of body weight

7.2 COMPONENTS OF BLOOD

Components of blood includes the following:
A. Plasma
B. Formed Elements
b.1 Red Blood Cells
b.2 White blood cells
b.3 Platelet
7.2.1 Plasma
§ 90 percent water
§ Straw-colored fluid
§ Includes many dissolved substances
§ Nutrients
§ Salts (electrolytes)
§ Respiratory gases
§ Hormones
§ Plasma proteins
§ Waste products
§ Plasma proteins
§ Most abundant solutes in plasma
§ Most are made by the liver
§ Include:
§ Albumin—an important blood buffer and contributes to osmotic
pressure
§ Clotting proteins—help to stem blood loss when a blood vessel
is injured
§ Antibodies—help protect the body from pathogens

7.2.2 Formed Elements

7.2.2.1 Erythrocytes (Red Blood Cells or RBCs)
§ Main function is to carry oxygen
§ RBCs differ from other blood cells
§ Anucleate (no nucleus)
§ Contain few organelles; lack mitochondria
§ Essentially bags of hemoglobin (Hb)
§ Shaped like biconcave discs
§ Normal count is 5 million RBCs per cubic millimeter (mm3) of blood
§ Hemoglobin is an iron-bearing protein
§ Binds oxygen
§ Each hemoglobin molecule can bind 4 oxygen molecules
§ Each erythrocyte has 250 million hemoglobin molecules
§ Normal blood contains 12–18 g of hemoglobin per
100 milliliters (ml) of blood

§ RBC Clinical Correlation

§ Homeostatic imbalance of RBCs
§ Anemia is a decrease in the oxygen-carrying ability of the blood due
to:
§ Lower-than-normal number of RBCs
 § Abnormal or deficient hemoglobin content in the RBCs
§ Sickle cell anemia (SCA) results from abnormally shaped hemoglobin
§ Polycythemia
§ Disorder resulting from excessive or abnormal increase of
RBCs due to:
§ Bone marrow cancer (polycythemia vera)
§ Life at higher altitudes (secondary polycythemia)
• Increase in RBCs slows blood flow and increases blood viscosity

7.2.2.2 Leukocytes (White Blood Cells or WBCs)

§ Crucial in body’s defense against disease

§ Complete cells, with nucleus and organelles
§ Able to move into and out of blood vessels (diapedesis)
§ Respond to chemicals released by damaged tissues (known as positive
chemotaxis)
§ Move by amoeboid motion
§ 4,800 to 10,800 WBCs per mm3 of blood

Clinical Correlation
§ Leukocytosis
§ WBC count above 11,000 cells per mm3 of blood
§ Generally indicates an infection
§ Leukopenia
§ Abnormally low WBC count
§ Commonly caused by certain drugs, such as corticosteroids
and anticancer agents
§ Leukemia
§ Bone marrow becomes cancerous
§ Numerous immature WBC are produced

Types of leukocytes
§ Granulocytes
§ Granules in their cytoplasm can be stained
§ Possess lobed nuclei
§ Include neutrophils, eosinophils, and basophils
§ Agranulocytes
§ Lack visible cytoplasmic granules
§ Nuclei are spherical, oval, or kidney-shaped
§ Include lymphocytes and monocytes
 7.2.2.2.1 Granulocytes
7.2.2.2.1.1 Neutrophils
§ Most numerous WBC
§ Multilobed nucleus
§ Cytoplasm stains pink and contains fine granules
§ Function as phagocytes at active sites of infection
§ Numbers increase during infection
§ 3,000–7,000 neutrophils per mm3 of blood (40–70% of WBCs)

7.2.2.2.1.2 Eosnophils
§ Nucleus stains blue-red
§ Brick-red cytoplasmic granules
§ Function is to kill parasitic worms and play a role in allergy
attacks
§ 100–400 eosinophils per mm3 of blood (1–4 percent of WBCs)

7.2.2.2.1.3 Basophils
§ Rarest of the WBCs
§ Large histamine-containing granules that stain dark blue
§ Contain heparin (anticoagulant)
§ 20–50 basophils per mm3 of blood (0–1 percent of WBCs)

7.2.2.2.2 Agranulocytes
7.2.2.2.2.1 Lymphocytes
§ Large, dark purple nucleus
§ Slightly larger than RBCs
§ Reside in lymphatic tissues
§ Play a role in immune response
§ 1,500–3,000 lymphocytes per mm3 of blood (20–45% of WBCs)

7.2.2.2.2.2 Monocytes
§ Largest of the white blood cells
§ Distinctive U- or kidney-shaped nucleus
§ Function as macrophages when they migrate into tissues
§ Important in fighting chronic infection
§ 100–700 monocytes per mm3 of blood (4–8 percent of WBCs)

7.2.2.3 Platelets
§ Fragments of megakaryocytes (multinucleate cells)
 § Needed for the clotting process
§ Normal platelet count is 300,000 platelets per mm3 of blood

7.3 HEMATOPOIESIS (Blood Cell Formation)

§ Hematopoiesis is the process of blood cell formation
§ Occurs in red bone marrow (myeloid tissue)
§ All blood cells are derived from a common stem cell (hemocytoblast)
§ Hemocytoblasts form two types of descendants
§ Lymphoid stem cell, which produces lymphocytes
§ Myeloid stem cell, which can produce all other formed elements

7.3.1 Formation of Red Blood Cells

§ Since RBCs are anucleate, they are unable to divide, grow, or synthesize
proteins
§ RBCs wear out in 100 to 120 days
§ When worn out, RBCs are eliminated by phagocytes in the spleen or liver
§ Lost cells are replaced by division of hemocytoblasts in the red bone marrow
§ Formation of Red Blood Cells
§ Rate of RBC production is controlled by a hormone called erythropoietin
§ Kidneys produce most erythropoietin as a response to reduced oxygen
levels in the blood
§ Homeostasis is maintained by negative feedback from blood oxygen levels

7.3.2 Formation of White Blood Cells and Platelets

§ WBC and platelet production is controlled by hormones
§ Colony stimulating factors (CSFs) and interleukins prompt bone
marrow to generate leukocytes
§ Thrombopoietin stimulates production of platelets from megakaryocytes

7.4 HEMOSTASIS
§ Hemostasis is the process of stopping the bleeding that results from a break in a blood
vessel
§ Blood usually clots within 3 to 6 minutes
§ The clot remains as endothelium regenerates
§ The clot is broken down after tissue repair
§ Hemostasis involves three phases
§ Vascular spasms
§ Platelet plug formation
§ Coagulation (blood clotting)
Step 1: Vascular Spasms
§ Immediate response to blood vessel injury
§ Vasoconstriction causes blood vessel to spasm
§ Spasms narrow the blood vessel, decreasing blood loss

Step 2: Platelet Plug Formation

§ Collagen fibers are exposed by a break in a blood vessel
§ Platelets become “sticky” and cling to fibers
§ Anchored platelets release chemicals to attract more platelets
§ Platelets pile up to form a platelet plug (white thrombus)

Step 3: Coagulation
§ Injured tissues release tissue factor (TF)
§ PF3 (a phospholipid) interacts with TF, blood protein clotting factors, and calcium
ions to trigger a clotting cascade
§ Prothrombin activator converts prothrombin to thrombin (an enzyme)
§ Thrombin joins fibrinogen proteins into hairlike molecules of insoluble fibrin
§ Fibrin forms a meshwork (the basis for a clot)
§ Within the hour, serum is squeezed from the clot as it retracts
§ Serum is plasma minus clotting proteins

7.4.1 Disorders of Hemostasis

7.4.2 Undesirable Clotting
7.4.2.1 Thrombus
§ A clot in an unbroken blood vessel
§ Can be deadly in areas such as the lungs
7.4.2.2 Embolus
§ A thrombus that breaks away and floats freely in the
bloodstream
§ Can later clog vessels in critical areas such as the brain
7.4.3 Bleeding Disorders
7.4.3.1 Thrombocytopenia
§ Insufficient number of circulating platelets
§ Arises from any condition that suppresses the bone marrow
§ Even normal movements can cause bleeding from small
blood vessels that require platelets for clotting
§ Evidenced by petechiae (small purplish blotches on the skin)
7.4.3.2 Hemophilia
§ Hereditary bleeding disorder
 § Normal clotting factors are missing
§ Minor tissue damage can cause life-threatening prolonged
bleeding

7.5 BLOOD GROUPS AND TRANSFUSIONS

§ Large losses of blood have serious consequences
§ Loss of 15 to 30 percent causes weakness
§ Loss of over 30 percent causes shock, which can be fatal
§ Blood transfusions are given for substantial blood loss, to treat severe anemia, or for
thrombocytopenia

ANTIGENS
§ Blood contains genetically determined proteins known as antigens
§ Antigens are substances that the body recognizes as foreign and that the immune
system may attack
§ Most antigens are foreign proteins
§ We tolerate our own “self” antigens
ANTIBODIES
§ Antibodies are the “recognizers” that bind foreign antigens
§ Blood is “typed” by using antibodies that will cause blood with certain proteins to
clump (agglutination) and lyse

7.5.1 Human Blood Group

§ There are over 30 common red blood cell antigens
§ The most vigorous transfusion reactions are caused by ABO and Rh blood
group antigens

7.5.1.1 ABO Blood Group

§ Blood types are based on the presence or absence of two antigens
§ Type A
§ Type B
§ Presence of both antigens A and B is called type AB
§ Presence of antigen A is called type A
§ Presence of antigen B is called type B
§ Lack of both antigens A and B is called type O
7.5.1.2 Rh Blood Group
§ Named for the eight Rh antigens (agglutinogen D)
§ Most individuals are Rh+ (Rh-positive), meaning they carry the Rh
antigen
Clinical Correlation
§ If an Rh–(Rh-negative) person receives Rh+ blood:
 § The immune system becomes sensitized and begins
producing antibodies; hemolysis does not occur,
because as it takes time to produce antibodies
§ Second, and subsequent, transfusions involve
antibodies attacking donor’s Rh+ RBCs, and hemolysis
occurs (rupture of RBCs)
§ Rh-related problem during pregnancy
§ Danger occurs only when the mother is Rh–, the father
is Rh+, and the child inherits the Rh+ factor
§ RhoGAM shot can prevent buildup of anti-Rh+
antibodies in mother’s blood
§ The mismatch of an Rh– mother carrying an Rh+ baby
can cause problems for the unborn child
§ The first pregnancy usually proceeds without
problems; the immune system is sensitized after
the first pregnancy
§ In a second pregnancy, the mother’s immune
system produces antibodies to attack the Rh+
blood (hemolytic disease of the newborn)

7.5.2 Blood typing

§ Blood samples are mixed with anti-A and anti-B serum
§ Agglutination or the lack of agglutination leads to identification of blood type
§ Typing for ABO and Rh factors is done in the same manner
§ Cross matching—testing for agglutination of donor RBCs by the recipient’s
serum, and vice versa

7.6 DEVELOPMENTAL ASPECTS OF BLOOD

§ Sites of blood cell formation
§ The fetal liver and spleen are early sites of blood cell formation
§ Bone marrow takes over hematopoiesis by the seventh month
§ Developmental Aspects of Blood
§ Congenital blood defects include various types of hemolytic anemias and hemophilia
§ Incompatibility between maternal and fetal blood can result in fetal cyanosis, resulting
from destruction of fetal blood cells
§ Fetal hemoglobin differs from hemoglobin produced after birth
§ Physiologic jaundice occurs in infants when the liver cannot rid the body of hemoglobin
breakdown products fast enough
§ Developmental Aspects of Blood
§ Leukemias are most common in the very young and very old
§ Older adults are also at risk for anemia and clotting disorders
Rizzo, D. C. (2016). Fundamentals of Anatomy and Physiology (Fourth ed.). Boston,
Massachussetts: Cengage Learning.
Thompson, G. S. (2015). Understanding Anatomy & Physiology: A Visual, Auditory, Interactive
Approach,2nd Edition. Philadelphia: F. A. Davis Company.
Tortora, G. J., & Freudenrich, C. C. (2011). Visualizing Anatomy & Physiology. John Wiley &
Sons, Inc. .
VanPutte, C., Regan, J., & Russo, A. (2016). Seeley's Essentials of Anatomy & Physiology. New
York, New York: McGraw-Hill Education.

To set the tone right, we will help each other in the appreciation of the initial phase of
Anatomy and Physiology by accomplishing the Course Task/s in Canvas