Module 6

Blood

Overview and Introduction

The blood together with the lymp is the only tissue that has the ability to flow. Though it is
fluid, it is composed of different cells with different functions. Along with are transport of oxygen,
defence from pathogens and hemostasis.

Course objectives
At the end of this module, you are expected to
1. Describe the formation of blood
2. identify the different cellular and non-cellular components of blood
3. discuss the process of homeostasis

Course contents

The Blood

The blood is a connective tissue consisting of plasma and formed elements. It is the only
body’s fluid tissue. The formed elements includes the Erythrocytes or Red Blood Cells (RBC),
Leukocytes or White Blood Cells (WBC) and Thrombocytes or Platelets. Each of these have their own
function. The Plasma is made mainly of water, electrolytes with some plasma proteins. These plasma
proteins are made of albumin, which helps in maintaining fluid balance, immunoglobulins which
helps in immune system, fibrinogen which helps in blood clotting. The electrolytes like sodium,
potassium, calcium, magnesium and many more are found dissolved in plasma

Blood helps maintain homeostasis in several ways.

1. Transport of gases, nutrients, waste products
2. Transport of processed molecules
3. Transport of regulatory molecules
4. Regulation of pH and osmosis
5. Maintenance of body temperature
6. Protects against foreign substances such as microorganisms and toxins
7. Blood clotting prevents fluid and cell loss and is part of tissue repair

The percentage of RBCs out of the total blood volume is called haematocrit. This can be measured by
putting the extracted blood in a centrifuge. The normal haematocrit level is 35% to 45%, meaning
35% to 45% of the blood is made of RBC. Increase or decrease of this percentage may mean a
medical condition, which will be discussed in higher nursing subjects. The normal pH of the blood is
7.35 to 7.45. it is slightly alkaline and this pH is maintained by different organs such as the kidneys
and lungs. The body contains approximately 8% of body weight or 4- 5Liters of blood but this
depends on the body size.

The Plasma
The plasma is a pale yellow fluid containing over 100 solutes. 92% of the plasma and 7% of it
is made of proteins. These proteins are 58% albumin, 38% globulins, 4% are fibrinogen. Ions,
nutrients, waste products and respiratory gases compose the 2% of the plasma.
The Formed Elements

About 95% of formed elements are Erythrocytes, 5% are Leukocytes and the platelets were
just cell fragments. Most formed elements survive in the blood stream for only a few days. Formed
elements came from a cell in the bone marrow known as Stem cell. This stem cell differentiates into
a myeloid stem cell and lymphoid stem cell. Lymphoid Stem cells forms the B Lymphocytes and T
Lymphocytes. These cells are important in the immune response. The rest of the formed elements
comes from the differentiation of the Myeloid stem cell.
The Erythrocytes

The Erythrocytes are biconcave discs, anucleated and

essentially have no organelles. These cells are dedicated in the
transport of oxygen. The RBCs are filled with haemoglobin where
each molecule of haemoglobin can carry four molecules of
oxygen. One RBC contains 250 Million haemoglobin groups, thus
it carries 1 Billion of oxygen molecules. These oxygen are picked
from the lungs and are unloaded to the tissues. The biconcave
shape has a huge surface area relative to its volume. This allowing
the RBC to carry oxygen efficiently. It is also a flexible cell, making
it able to squeeze itself to blood vessels that have smaller
diameter. During its maturation period, the nucleus of the RBC is
removed making it lighter. The removal of its nucleus also caused
the formation of its matured shape. The RBC carries oxygen but it
is anaerobic, meaning it does not consume the oxygen it carries.
The haemoglobin molecules changes its configuration depending
on the presence of surrounding gases, making it load or unload
oxygen.

About 98.5% of oxygen is transported bound to haemoglobin, 1.5% dissolved in plasma. On

the other hand, 70% of Carbon dioxide is transported as bicarbonate ion (HCO3) and 23% bound to
haemoglobin and 7% of it is dissolved in plasma. Carbon Dioxide diffuses into RBC and combines
quickly with water to form carbonic acid (H2CO3), which quickly dissociates into hydrogen ions and
bicarbonate ions.

CO2 + H2O  H2CO3  H+ + HCO3–

Carbon dioxide Water Carbonic acid Hydrogen ion Bicarbonate ion

In RBC, carbonic anhydrase reversibly catalyzes the conversion of carbon dioxide and water to
carbonic acid

Erythropoiesis is the production of RBCs. A hemocytoblast is transformed into a

proerythroblast. Proerythroblasts develop into early erythroblasts. The developmental pathway
consists of three phases

1. Ribosome synthesis in early erythroblasts

2. Hb accumulation in intermediate erythroblasts and late erythroblasts

3. Ejection of the nucleus from late erythroblasts and formation of reticulocytes

Reticulocytes are released from the red bone marrow into the
circulating blood, which contains ~1-3% reticulocytes. Reticulocytes
then become mature erythrocytes. The number of circulating
erythrocytes remains constant and it reflects the balance of RBC
production and destruction. Too few RBCs leads to tissue hypoxia. Too
many RBCs causes undesirable viscosity. Formation of RBC is
hormonally controlled and depends on adequate supplies of iron,
amino acid, and B vitamins. Erythropoietin is released from the kidneys
stimulates RBC production. This hormones can be released due to hypoxia, decreased oxygen
availability or increased tissue demand for oxygen. If the kidneys are damaged such as in kidney
failure, erythropoietin are not available making the patient deficient with RBCs.

The life span of RBCs is 100 to 120 days. Old RBCs become rigid and fragile, and their
haemoglobin begins to disintegrate. Dying RBCs are engulfed by macrophages located in the spleen
or liver. Heme and globin in hemoglobin are separated and the iron is salvaged for reuse Globin
chains are broken down to individual amino acids and are metabolized or used to build new
proteins. Iron released from heme is transported to the red bone marrow and is used to produce
new hemoglobin. Heme becomes bilirubin that is secreted in bile. In the intestines bilirubin is
converted by bacteria into other pigments. This gives feces its brown color and also gives urine its
yellow color

White Blood Cells

 The White blood cells are the only blood components that are complete cells. They make up
1% of the total blood volume. They can leave the capillaries via ameboid movement or diapedesis
and move through tissue spaces. Their main functions are protecting the body against invading
microorganisms and removal of dead cells and debris from the tissues by phagocytosis. They are
grouped according to their staining properties when seen in microscopes. They are generally called
Granulocytes and Agranulocytes. Granulocytes may be neutrophils, eosinophils or basophils. These
cells are all phagocytic cells and have a lobed nuclei.

Neutrophils most common type of WBC. Have two types of granules that take up both acidic
and basic dyes, give the cytoplasm a lilac color. It cntain peroxidases, hydrolytic enzymes, and
defensins (antibiotic-like proteins). Neutrophils are our body’s bacteria slayers. Pus is an
accumulation of dead neutrophils, cell debris and fluid at sites of infections. Basophils account for
0.5% of WBCs. Have large, purplish-black (basophilic) granules that contain Histamine, an
inflammatory chemical that acts as a vasodilator and attracts other WBCs (antihistamines counter
this effect) and it also contains Heparin, a chemical prevents the formation of clots. Eosinophils
account for 1–4% of WBCs . it has a red-staining, bilobed nuclei connected via a broad band of
nuclear material. Have red to crimson (acidophilic) large, coarse, lysosome-like granules. Eosinophils
lessen the severity of allergies by reducing inflammation. It lead the body’s counterattack against
parasitic worms.

Agranulocyes are the lymphocytes and monocytes. They lack visible cytoplasmic granules,
are similar structurally, but are functionally distinct and unrelated cell types. Agranulocytes have
spherical (lymphocytes) or kidney-shaped (monocytes) nuclei. Lymphocytes account for 25% or more
of WBCs, have large, dark-purple, circular nuclei with a thin rim of blue cytoplasm, are found mostly
enmeshed in lymphoid tissue (some circulate in the blood). There are two types of lymphocytes,T
cells and B cells. The B cells are stimulated by bacteria or toxins and give rise to plasma cells, which
produce antibodies. The T cells protect against viruses and other intracellular microorganisms. T
Cells attack and destroy the cells that are infected. Monocytes account for 4–8% of leukocytes. They
are the largest leukocytes. They leave the circulation, enter tissue, and differentiate into
macrophages which are are highly mobile and actively phagocytic. They also help activate
lymphocytes to mount an immune response by presenting fragments of dead microbes to the other
components of the immune system.

The Platelets

Platelets are fragments of megakaryocytes with a blue-staining outer region and a purple
granular center. They function in clotting by two mechanisms, first by the formation of platelet
plugs, which seal holes in small vessels and formation of clots, which help seal off larger wounds in
the vessels. Their granules contain ADP and thromboxanes which are important in making the
platelet responsive to tissue injury.

A series of reactions for stoppage of bleeding occurs. ThetThree phases occur in rapid
sequence, first is vascular spasms, wherein there is an immediate vasoconstriction in response to
injury. This decreases the blood flow to the injured area. Thromboxanes and endothelin can cause
vascular spasms. The platelet will then becomes sticky and clump with each other forming a Platelet
plug. Platelets do not stick to each other or to blood vessels. Upon damage to blood vessel
endothelium platelets, with the help of von Willebrand factor (VWF) adhere to collagen are
stimulated by and then release more thromboxane and ADP, which attract still more platelets stick
to exposed collagen fibers and form a platelet plug. The platelet plug is limited to the immediate
area of injury by prostacyclin. It can seal up a small breaks in a blood vessels that occur many times
each day.

Lastly, plasma proteins come into play and forms a fibrous network that stabilizes the
platelet plug, a process known as Coagulation (blood clotting). Blood clotting, or coagulation, is the
formation of a clot (a network of protein fibers called fibrin). Blood clotting begins with the extrinsic
or intrinsic pathway. Both pathways end with the production of activated factor X. Extrinsic pathway
begins with the release of thromboplastin from damaged tissue. Intrinsic pathway begins with the
activation of factor XII. Activated factor X, factor V, phospholipids, and Ca 2+ form prothrombinase.
Prothrombin is converted to thrombin by prothrombinase. Fibrinogen is converted to fibrin by
thrombin. These Insoluble fibrin strands form the structural basis of a clot. Fibrin causes plasma to
become a gel-like trap. Fibrin in the presence of calcium ions activates factor XIII that Cross-links
fibrin and Strengthens and stabilizes the clot. Away from the site of injury anticoagulants in the
blood, such as antithrombin and heparin, prevent clot formation.

Clot Retraction or Fibrinolysis

Clot retraction happens when stabilization of the clot by squeezing serum from the fibrin
strands results from the contraction of platelets, which pull the edges of damaged tissue closer
together. Serum, which is plasma minus fibrinogen and some clotting factors, is squeezed out to the
clot. This process results into approximation of the injury making it heal faster.

Thrombin and tissue plasminogen activator activate plasmin, which dissolves fibrin
(fibrinolysis)
Teaching Learning activity

1. cut the throat of a chicken and get the blood. Describe what happens for 5 minutes

2. prick your fingers and let it bleed. Measure the time until a bleeding stops

3. find someone with kidney failure. Identify the medication that helps them retain hematopoiesis

Assessment task

1. describe the formation of Red Blood Cells

2. Describe the formation of white blood cells

3. describes the blood clotting process

References:
Geb, Elaine N. (2019), Essentials of Human Anatomy and Physiology, 8 th Edition
Philip (2009), Seely’s Principles of Anatomy and Physilogy