Blood

Composition of blood
• Total volume of blood – 5 to 6 litres
• Specific gravity – 1050 – 1060
• Viscosity – four to five times that of
water
• pH: 7.4,
• Components – plasma and cells
Plasma
• Plasma is a clear, straw-coloured fluid portion of blood. 55%
of the total blood volume.
• Contains: 91% water & 9% solids
• Solids consists of
• i) inorganic molecules – Na+, Ca2+, Cl-, K+, Mg2+, Fe
• ii) organic molecules – plasma proteins, non-protein
nitrogenous substances (urea, uric acid, creatine,
creatinine), sugars, fats, enzymes and hormones
Plasma protein
• Normal value- 6.4 – 8.3 g/dL
• Albumin – 3-5 g/dL
• Globulin – 2-3 g/dL
• Fibrinogen – 0.3 g/dL
• Prothrombin – 40 mg/dL
Functions of Blood
• Transport of gases – O2 and Co2
• Supply of nutrients – conveys absorbed food materials from
GIT to other organs
• Transport of waste materials –urea, uric acid from the body
to kidney, skin and intestine for removal
• Homeostatic function
• Regulation of body temperature
• Plasma protein useful in coagulation and helpful in
maintenance of colloidal osmotic pressure
Activity - blood, plasma
and serum difference?
Blood cells
Haemopoiesis
• Haemopoiesis is the development of blood cells i.e RBC,
WBC and Platelets
• Erythropoiesis – development of RBC
• Leucopoiesis – development of WBC
• Megakaryopoiesis – development of platelets
• All cells are derived from pluripotent stem cells
Erythrocyte - Red cell corpuscle
• RBC is a circular, biconcave, non-nucleated disc
• Composition
– 62.5% water
– 35% Haemoglobin
– 2.5% nutrients, enzymes, vitamins and ions
Count
At birth – 6 – 7 millions/μL
Male – 4.5 – 5.5 millions/μL
Females – 4.5 – 5.5 millions/μL
Life span – 120 days
Functions of RBC
• Identify blood groups
• All functions of Hemoglobin
 Hemoglobin
• Hemoglobin is the red oxygen carrying
pigment in the RBCs.
• It is made up of protein globin combined
with the heme
• Globin is made up of 4 polypeptide chain,
2 alpha and 2 beta in adults called HbA
• Iron in heme part combines with the oxygen
loosely and reversibly with one molecule of
oxygen
• Each Hb molecule can carry 4 molecules of
oxygen
Synthesis of Hb

• Requirement – nutrients and it takes place in the developing

RBC
• Protein – useful in globin formation
• Minerals – iron – heme formation
• Vitamins – vitamin c, B12 and folic acid are useful in the
synthesis of nuclei acid which is required for the
development of RBC
Destruction of Hb

• Destroyed by tissue-macrophage system

• Hb broken down to bilirubin and iron.
• Bilirubin gets secreted in urine and feces and iron gets
recycled to form new RBC
Variants of Hb
• Adult Hb – α2β2
• Fetal Hb – α2γ2
– Fetal Hb has higher affinity for oxygen
– Lifespan – 80 days
Normal Hb levels
• Birth 23 g/dL
• Adult male – 14 -18 g/dL, female – 12 - 15.5 g/dL
Functions of Hb
• Transport of oxygen from lungs to tissue
• Transport of carbon-di-oxide from tissue to the lungs
• Helps in acid base balance
Anaemia
• Anaemia is a clinical condition wherein there is a decrease
in Hb content or RBC count leading to decrease in oxygen
carrying capacity of the blood
• Mild anaemia – 8-12 g/dL
• Moderate anaemia – 5 -8 g/dL
• Severe anaemia -
Jaundice
• Jaundice is a yellowish discoloration of the eyes, skin and
other body tissues
• Caused by the excess accumulation of bilirubin
• Normal bilirubin – 0.2 to 0.8 mg/dL
• > 2 mg/dL - jaundice
Leukocyte – White blood
corpuscle
 Normal DLC
Absolute count
Granulocytes
• Neutrophil 40-70% 1600-7700 cells/ μL
• Eosinophil 1-4% 40-440 cells/ μL
• Basophil 0-1% 0-110 cells/ μL
Agranulocytes
• Lymphocyte 20-40% 800-4400 cells/ μL
• Monocyte 2-8% 80-880 cells/ μL
Total Leukocyte count
• At birth – around 20,000/μL
• In adults – 4000 – 11000 /μL
• Leucopenia – decrease in TLC less than 4000 /μL
• Leukocytosis – count more than 11000 /μL
 Neutrophil
• Size: 10-14 μm
• Nucleus: 2-6 lobes
• Cytoplasm: bluish
• Granules: fine, purple-pink
• Functions – Phagocytosis –
First line of defence
Variations
• Neutrophilia
a)Physiological causes
-severe muscular exercise
-pregnancy
-food intake
b)Pathological causes
-acute pyogenic infections (tonsillitis, appendicitis)
-surgery
-trauma
• Neutropenia
-typhoid fever
-viral infections
-bone marrow depression
-certain drugs like chloramphenicol
 Eosinophil
• Size: 10-14 μm
• Nucleus: bilobed, connected
by chromatin band
• Cytoplasm: light pink/
eosinophilic
• Granules: large, coarse,
brick-red
• Functions – collect at the site
of allergic reactions – limit
the effects of inflammatory
mediators
• Eosinophilia
-allergic conditions like bronchial asthma, hay fever,
eczema
-parasitic infestation (tapeworm, roundworm)
• Eosinopenia
-stress
-glucocorticoid administration
 Basophil
• Size: 10-14 μm
• Nucleus: irregular or S-shaped,
overlaid with granules
• Cytoplasm: bluish/basophilic
• Granules: large, coarse, deep
purple, completely fill the cell
covering the nucleus
• Functions – mild phagocytosis
• Liberates heparin
• Liberates histamine
• Basophilia
-chronic myeloid leukemia
• Basopenia
-pyogenic infections
 Lymphocyte
• Size: 10-14 μm for large
lymphocyte and 7-9 μm for
small lymphocyte
• Nucleus: single large
nucleus almost fills the cell
• Condensed chromatin
• Cytoplasm: thin crescent of
clear blue cytoplasm
• N/C ratio: high
• No visible granules
• Lymphocytosis
- newborns (physiological)
-chronic infections like tuberculosis
-viral infections(CMV, Infectious mononucleosis)
-chronic lymphocytic leukemia
• Lymphopenia
-steroid therapy
-human immunodeficiency virus infection
-strenuous exercise
-bone marrow depression
 Monocyte
• Size: 12-20 μm
• Nucleus: single, large, indented,
horseshoe shaped, covers <2/3rd
size of cell
• Cytoplasm: abundant, frosty,
blue in colour
• N/C ratio: less than that of
lymphocyte
• No visible granules
• Functions – active phagocytosis
– second line of defence, tissue
macrophages, kill tumor cells
• Monocytosis
- TB, SABE, Syphilis
-infectious monocytosis
-kala azar
-malaria
• Monocytopenia
- Overwhelming infection in Immunocompromised patients
- Hemodialysis
- Steroid therapy
- EBV infection
-bone marrow depression
Platelets or Thrombocytes
• Platelets are the smallest blood cell and nucleus is absent
• Contents – Golgi apparatus, ER, mitochondria, lysosomes
and granules – serotonin a vasoconstrictor agent
• Normal count – 1.5 to 4 lakh/μL
• Lifespan – 8 -12 days
• Thrombocytopenia – viral infection –dengue,
hypersplenism, bone marrow depression
• Thrombocytosis – after trauma, spleenectomy
Functions
• Haemostasis
• Blood coagulation
• Clot retraction
• Phagocytosis
• Storage and transport function
Hemostasis and Blood coagulation
• The term hemostasis refers to the process of stoppage of
bleeding after blood vessels are punctured, cut or damaged.
• Steps of vasoconstriction
– Vasoconstriction – reflex contraction of blood vessels
– Primary hemostasis – formation of platelet plug
– Secondary hemostasis – formation of fibrin thread
– Clot stabilization and resorption
Blood coagulation or clotting
Clotting takes place in three essential steps:
1. In response to rupture of the vessel or damage to the blood
itself, a complex cascade of chemical reactions occurs in the
blood which results is the formation of prothrombin activator.
2. The prothrombin activator catalyzes the conversion of
prothrombin into thrombin.
3. The thrombin acts as an enzyme to convert fibrinogen into
fibrin fibers that enmesh platelets, blood cells, and plasma to
form the clot.
Common pathway
Intrinsic pathway
Extrinsic pathway
Bleeding and clotting disorder
• Purpura - thrombocytopenia
• Hemophilia – clotting factor deficiency
Blood grouping
Blood groups
• RBC membrane contains a variety of antigens which is also
called as agglutinogens
• Common blood groups are
Classical ABO blood group
Rhesus (Rh) blood group
Classical ABO blood group
• Four major blood types
Agglutination

• The rection between antigen (agglutini0gen) and the

suitable antibody cause clumping of RBC, which is known as
agglutination
Landsteiner’s Law
• If an agglutinogen is present in RBC of an individual, the
corresponding agglutinin must be absent from the plasma
• If an agglutinogen is absent in RBC of an individual, the
corresponding agglutinin must be present in the plasma
Rh system

• Rh antigen or rhesus antigen is also called D antigen

• If Rh antigen is present in the antibody the person is called
Rh positive individual and if its absent it is called Rh
negative individual
Uses of blood grouping
• In blood transfusion
• In pregnancy to avoid hemolytic disease of new born
• Medicolegal value
Blood transfusion uses
• To replaces volume in case of hemorrhage
• To treat various diseases.. Eg??
Concept of universal donor and recipient
• No longer valid
• AB persons does not have any agglutinins and therefore can
receive blood from any individual – universal recipient
• O persons does not have agglutinogens – universal donors
Lymphoid tissue and Immunity
Lymphoid tissue
• They are the fundamental structure involved in all types of
immune response

• Sites – Bone marrow, spleen, lymph nodes, tonsils,peyers

patches, thymus

• Important cells : tissue macrophages, lymphocytes and

plasma cells
Tissue macrophages
• Can ingest large foreign bodies – macro – large phage –
phagocytes
• Scattered throughout the body hence called tissue macrophage
system (previously called reticuloendothelial system)
• Functions
• They ingest bacteria – defense of the body against infection.
• Ingest antigens – stimulate the formation of antibody formation
by plasma cells
• Ingest old RBC to release bilirubin.
Phagocytosis
Lymphocytes
• Types – B lymphocyte and T lymphocyte
• Formation – bone marrow
• Maturation – B cells in bone marrow and T cells in thymus
• B cells – humoral immunity via plasma cells
• T cells – Cell mediated immunity
Plasma cells
• Found in medullary cords of lymphoid follicles.
• Secret antibodies in blood and other body fluids
• Specific antibodies are produced against the antigens
Immunity
• First line of defense – Innate immunity
• Second line of defense – Acquired immunity
Innate immunity vs acquired immunity
Innate immunity Acquired immunity
Available since birth Acquired after exposure to
micro-organism
Non specific to micro-organism Specific for each micro-
organisms
Does not show immunological Shows immunological memory
memory
Limited diversity Very large diversity
Humoral response– antibodies
complement system
Cellular response - phagocytes lymphocytes
Acquired immune system
Features Humoral response Cellular response
Type of response Involves antibodies Cell mediated
Cell involved B lymphocytes T lymphocytes
Act against Bacteria and virus Fungi, parasite and
intracellular virus
Effect of stimulation Bacteria – b Fungi – activated T
lymphocyte – secretion lymphocytes –
of antibodies- cytotoxic T
antibodies attack lymphocytes – attack
bacteria the infected cell
Cell mediated and humoral immunity
Antibodies or Immunoglobulins

Name of Function
IG
IgG Opsonization, complement activation
Can cross placenta
IgA Mucosal immunity. Blocks at the entry site of micro-
organisms
IgM Primary immune response. Complement activation

IgE Defense against parasite, allergy

IgD Helps in antigen recognition and presentation

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