Blood Physiology

Blood Values
1. RBC
a. Male: 5.2-6.5 million/mm3
b. Female: 4.5-5.5 million mm3
2. Hematocrit: percentage of RBC in formed elements
a. Male: 42-52%
b. Female: 37-47%
3. Hemoglobin
a. Males: 13-18 g/dL (avg: 16 g/dL)
b. Females: 12-16 g/dL (avg: 13 g/dL)
4. Erythrocytes Sedimentation Rate: hallmark of inflammation
a. Male: <15 mm/hr
b. Female: <25 mm/hr
5. WBC
a. Male = Female: 5000-10,000/mm3 (5K-10K)
6. Platelets
a. Male = Female: 150,000-400,000/mm3
7. Bleeding Time: 1-6 minutes
8. Clotting time: 6-10 minutes

Contraindications to Exercise
1. Hct: <27%
2. Hgb: <8 g/dL
3. Platelets: <20,000/mm3
a. 50,000 – light exercise
4. WBC: <5,000

Blood
 8% of the total body weight
 5x thicker than water
 Normal blood volume
o Females: 4-5 L
o Males: 5-6 L
 Function

B uffer System
L evels T°
O2 Transport
O smosis
D elivers Nutrients
P rotetection
H ormonal Transport

Buffer System

Alkalosis Acidosis
“Mother” pH: 7.35-7.45 ↑ ↓
Respiratory PaCO2: 35-45 mmHg ↓ ↑
Metabolic HCO3: 22-26 mEq/L ↑ ↓
1. Compensation: “Yes or no”
a. Is the pH normal?
b. Is there opposing factors?
2. Legend

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a. If there are “2 Yes” -> Fully compensated

b. If there is “1 Yes” -> Partially Compensated
c. If there is “2 No” -> Uncompensated
d. The value that copies pH, it is the term
3. Example

Alkalosis Acidosis
“Mother” pH: 7.35-7.45 7.48 ↑ ↓
Respiratory PaCO2: 35-45 mmHg 49 ↓ ↑
Metabolic HCO3: 22-26 mEq/L 28 ↑ ↓
MC Cause of Resp Alka: Hyperventilization
MC Cause of Resp Acid: Hypoventilation
MC Cause of Metabolic Alka: Vomiting
MC Cause of Metabolic Acid: Diarrhea

a. Partially Compensated Metabolic Alkalosis

Components of Blood
1. Formed Elements: 45% of Blood
a. RBC “Erythrocytes”
b. Platelets: “Thrombocytes”
c. WBC “ Leukocytes
Hematopoiesis: process of blood formation
a. Origin while fetus: liver, thymus, spleen, lymph nodes, bone marrow
b. Origin after birth: bone marrow
2. Plasma: 55% of Blood
a. H2O
b. Plasma Proteins
i. Albumin (most abundant)
1. The most abundant protein in the body: collagen
2. The most abundant protein in the blood: albumin
ii. Globulin
1. For immunity
iii. Fibrinogen
1. A clotting factor
c. Other Substances
W aste Products
I ons
N utrients
G ases
S ubstances

3. RBC “Erythrocytes”
a. Fxn: Oxygen Transport
b. Characteristics
i. Biconcave Disc (shaped like a donut)
ii. (-) nucleus
iii. It contains Hemoglobin
1. Hemoglobin: gives color to blood
2. 65% of iron in the body is in HgB
iv. Pliable: can bend or fold its thin center, allowing it to pass easier
v. Lifespan: 120 days
vi. Graveyard: spleen

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Red Blood Cells “Erythrocytes”

I. RBC Formation (PoBRE)
 All formed elements are derived from a single population of cells called
o Pluripotential Hematopoietic Stem Cells/Hemocytoblasts

PHSC
↓
Proerythroblast
↓
Basophil Erythroblast
– 1st Generation Blood Cells –
– starts to acquire Hgb –
↓
Reticulocytes
– young RBC –
– ejection of nucleus –
↓
Erythrocytes
 Erythropoiesis: process of RBC formation
o Needs hormone: erythropoietin
 Principal stimulus for the formation of RBC in the bone marrow
 90% produced by kidney
 10% produced by liver

II. Factors that Increases RBC Formation

B one Marrow Disease
A ltitude is High
T issue Hypoxia
C irculatory Disease
H emorrhage

III. Vitamins Necessary for RBC Formation

1. Vitamin B12 “Cyanocobalamin”
a. Best absorbed in the ileum
b. Important for the synthesis of DNA
2. Folic Acid “Pterygoglutamic Acid”
a. Best absorbed in the ileum
b. Important for the synthesis of DNA

 (-) Vit B12 & Folic Acid – may lead to megaloblastic anemia:
 RBC becomes Macrocytic, Normochromic color
 Has Flimsy membrane

3. Iron
a. Important for Hgb Synthesis
b. Best absorbed in the duodenum “duoFenum”

IV. Cell Terminology

1. Cell Amount
a. ↑: “-cytosis”
b. ↓: “-penia”
2. Cell Size (-Cytic)
a. Large: macrocytic

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b. Normal: normocytic
c. Small: microcytic
3. Cell Color (-chronic)
a. ↓: hypochronic
b. Normal: normochromic

V. Oxygen Related Condition

1. Anemia: decreased oxygen carry capacity of Blood (RBC)
2. Hypoxia: decreased oxygen in tissues
3. Hypoxemia: decreased oxygen in the blood

VI. Types of Anemia

1. Iron Deficiency
a. MC in Females 2° to menstrual Cycle
b. Microcytic & hypochromic
c. S/Sx:
H eadache
I rritability
chronic iron deficiency anemia
complete depletion of Iron
P lummer Vison Syndrome
form of esophageal web
Difficulty in Swallowing

d. Causes:
i. Poor Diet
ii. Poor Absorption
iii. (+) Hemorrhage
2. Post-Hemorrhage Anemia
a. A result of bleeding
b. Acute: normocytic, normochromic
c. Chronic: microcytic, hypochromic
d. S/Sx
i. % of blood loss
1. 20-30% of blood: dizziness + hypotension
2. 30-40% of blood: diaphoresis (excessive sweating), ↑ ADH, hypotension
3. 40-50% of blood: hypovolemic shock + potential death
3. Pernicious Anemia
a. Lack of iron of intrinsic factor
b. Absent or ↓ Vit B12
c. Macrocytic, normochromic
d. S/Sx: Affects Dorsal Column Pathway
i. ↓ vibratory sense
ii. ↓ proprioception
iii. ↓ two point discrimination
iv. (+) Romberg’s Test
e. May lead to Posterior Cord Syndrome
4. Aplastic Anemia
a. 2° to aplasia & destruction of bone marrow
b. Bone marrow replaced with fats
c. Idiopathic
d. Dx: bone marrow Aspiration
5. Hemolytic Anemia
a. ↑ destruction of RBC before its 120th day
6. Thalassemia
a. Normal RBC production

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b. There is a problem with HgB (A&B chain is absent)

7. Sickle Cell Anemia
a. (+) Hemoglobin S
b. Exposure to low oxygen --> sickle shape
c. (+) Pain Crisis – pain felt anywhere in the body or in any major organ
8. Polycythemia Vera (Primary Polycythemia)
a. Genetic D/O
b. There is an abnormal increase in RBC --> sluggish blood flow
c. Associated with myeloproliferative D/O
9. Hereditary Spherocytosis
a. RBC cannot withstand compression

Platelets “Thrombocytes”
 Fxn: clot formation
 Lifespan: 8-10 days
 Characteristics
o Sticky – (+) Glycoproteins
o Fatty – (+) phospholipids (activates the clot formation
o Contractile in Nature – (+) actin & myosin

I. Stimulus for Platelet Formation

 Stimulus: Vessel Injury
1. Vascular Spasm
a. Immediate but temporary constriction of blood vessel resulting from contraction of smooth muscle
2. Platelet Plug Formation
a. Accumulation of platelets that can seal up small breaks
i. Ex: Vessel Injury -> exposure of collagen -> Platelets bind with collagen using Von Willebrand
Factor (a protein secreted by BV endothelial cells that serves as mediator between collagen &
platelets) -> PPF
3. Blood Clotting
a. Ca2+ + Labile (5) + Stuart (10) + Phospholipids = forms prothrombin activating factor/Prothrombinase
b. Prothrombinase: converts prothrombin to thrombin
c. Thrombin converts fibrinogen into fibrin (Fibrin Stabilizing Factor)

II. Clotting Factors

 Father Please Tell Cupid Love Should Always Be Sweet Caring Devoted Forever
1. Fibrinogen
2. Prothrombin
3. Thromboplastin (Tissue Factor)
4. Ca2+ Ions
5. Labile Factor
7. Stable Factor
8. Anti-Hemophilic Factor A
9. Anti-Hemophilic Factor B (Christmas Disease; Christmas is 9 letters)
10. Stuart Factor
11. Anti-Hemophilic Factor C
12. Anti-Hemophilic Factor D (Hageman)
13. Fibrin Stabilizing Factor

III. Blood Typing

Type Antigen Antibody Blood Transfusion
A A B A, O
B B A B, O
AB AB (-) A, B, AB, O Universal Recipient

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O (-) AB O Universal Donor

Clumping is Antigen

Rh Incompatibility
 Mother Rh- + Father Rh+ = Baby Rh+
 This Condition is called Erythroblastosis Fetalis/Hemolytic Disease of the Newborn
 Only allows the first baby to be normal at birth
 Succeeding babies will die or live with complication (CP Athetoid)
 Rhogam Injection given 72 hours for the protection of the fetus

IV. Pathologies
1. Thrombocytopenia
a. ↓ # of platelets
b. May lead to bleeding
c. Causes
i. Dengue
ii. ↓ Vitamin K Supply
iii. Leukemia
iv. Liver Disease (Hepatitis & Cirrhosis)
2. Thrombocytosis
a. ↑ # of platelets
b. Dangerous
c. Causes: Immobility, trauma, Atherosclerosis
d. Mx:

Blood Thinners
I V
H eparin
O ral
W arfarin (Coumadin)

3. Hemophilia
a. X-Linked Recessive (Mother is the Carrier)
b. Affected: Son
c. Types
i. A: Classic Hemophilia
1. Most Common Type
2. (-) AHF A/CF8
ii. B: Christmas Disease
1. (-) AHF B/CF9
iii. C: (-) AHF C/CF11
iv. D: (-) AHF D/CF12
d. Mx:
i. Transfusion of Clotting Factors
e. MC Manifestation: Hemarthrosis
f. Contraindicated: Stretching, Strenuous Activity

WBC “Leukocytes”
1. For Inflammation & infection
2. For Immunity

I. Types
1. Neutrophils
a. Most abundant WBC

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b. Lifespan: blood (4-8 hours); Tissue (4-5 days)

c. Fxn: responsible for bacterial infection
2. Eosinophils
a. Responsible for parasitic Infection
3. Basophils
a. Responsible for allergic reactions because it release histamine
4. Lymphocytes
a. 2nd most abundant WBC
b. Types: T Cells & B Cells
5. Monocytes
a. Largest WBC
b. If Matured to tissue --> macrophage
i. Macrophage lifespan
1. Blood: 10-20 hours
2. Tissues: ~3months

II. Inflammation & Infection

 Neutrophils: can ingest up to 20 bacteria
 Macrophages: can ingest up to 100 bacteria
 Events that takes place during inflammation & infection
1. Stimulus: Trauma and/or infection -> damaged tissue will release a chemotactic substance (affects
macrophages & neutrophils)
2. 1st Line of Defense: Macrophage
K uppffer Cells (Liver)
A lveolar Macrophage
L ympoid Macrophages
B rain (Microglia)
S kin (histiocytes)

3. 2nd Line of Defense: Neutrophils (Circulation)

 2 Process
 1. Margination – Neutrophils adhere to blood vessel wall
 2. Diapedesis – Neutrophils squeeze into BV Capillaries
4. 3rd Line of Defense: 2nd wave of macrophages
5. 4th line of Defense: Bone marrow will produce more macrophage and neutrophils

III. Immunity
Passive Active
Inherited from the Mother
Type of immunity acquired from exposure to
ex: Breastfeeding
Natural disease
IgG – Only immunoglobulin that crosses the placenta
ex: chicken pox
“Napass”
came from a donor attenuated bacteria
Artificial
ex: transfusion of Ig, clotting factors ex: Vaccine

IV. Lymphocytes
 Types
1. B Cells
1. Origin: bone marrow
2. Fxn: resp for hormonal medicated immunity because it releases Ig

G only Ig that crosses placenta

A fluid antigen
M Food Antigen
E allergy

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D Activates B-Cells
2. T-Cells
1. Origin: Thymus
2. Fxn: resp for cell mediated immunity
3. Types:
i. Helper T Cells (CD4)
1. Regulates and directs T Cells & B Cells
2. (-) AIDS
ii. Cytotoxic/Killer T-Cells (CD8)
1. Attacks foreign materials
iii. Suppressor T-Cells
1. Stops the activity of T-Cells and B-Cells
2. (-) GBS
Immune Response
1. Stimulus: Bacteria
2. Macrophage will partially digest the bacteria
3. Macrophages will present the bacteria to cytotoxic/Killer T Cells
4. Killer T-Cells will destroy the bacteria
5. Suppressor T-Cells will stop the activity of cytotoxic/Killer T-Cell

V. Types of Allergic Reaction (ACID)

1. Anaphylactic
a. Ex: Asthma – Stimulus: Allergens
b. If severe: anaphylactic shock
i. Widespread vasodilation
ii. Ex. Bee Stings
2. Cytotoxic
a. Ex: graft rejection, blood transfusion Reaction
3. Immune Complex
a. Ex: SLE, RA
4. Delayed Hypersensitivity
a. Ex: Contact dermatitis/Eczema; cosmetics

VI. Pathologies
1. Leukemia
a. ↑ # of WBC
b. Types:
i. Myelogenous: Cancer of Bone Marrow
ii. Lymphogenous: affects lymphoid tissues
c. S/Sx: Bone pain, bleeding, weight loss, infection
2. Leukopenia
a. ↓ # of WBC
b. (+) Infection
c. S/Sx: Mouth & colon ulcers
d. Tx: Antibiotics

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