Review of anatomy and

PHYSIOLOGY
Of
H A E M AT O L O G Y

Mrs. NEELAM
VA S H I S H T H A
 1.Blood- function
Blood is a type of liquid
connective tissue.
The major function of
blood is transport.
 Subfunctions
Respiration :
-if oxygen and carbon dioxide are transported
Trophic :
-when the nutrient materials are delivered to
the tissues
Excretive :
-when the metabolites are delivered from
tissues to excretory organs
Regulative :
-if the hormones and BAS are transported
 Subfunctions
 Homeostatic :
- maintenance of water content and acid-
base
balance
Protective :
- immunity and non-specific resistance;
- blood coagulation
Maintenance of body temperature :
-as a result of a redistribution of blood
volume between skin and the internal organs at
high and low temperature of external
environment.
 Blood
 Blood as a system

Blood Organs for haemopoiesis

Regulatory
(peripheral and destruction of
apparatus
& circulating) blood
(nervous

& humoral)
 Blood
The total blood volume makes up
about 6-8 percent of the body’s
weight.
Accordingly, a 70-kilogram person
will have 5 to 6 litres of blood.
Circulating blood volume will be
lesser than total blood volume,
because some amount of blood will
be deposited in organs like liver.
 Blood composition
Blood consists of
liquid plasma
(volume-55-60%)
formed elements
(cells)
(volume-40-45%)
 Blood
Formed elements include

Erythrocytes (red
blood cells);
Leukocytes (white
blood cells);
Thrombocytes
(platelets)
 Hematocrit
The hematocrit , also
known as packed cell
volume (PCV) or
erythrocyte volume
fraction (EVF), is the
volume percentage
(%) of red blood
cells in the blood. It
is normally about
40-48% for men and
36-42% for women
 Hematocrit
If a portion of blood is centrifuged
or allowed to stand for a sufficient
long time, it will be found that the
blood cells will settle towards the
bottom of the test tube while the
plasma remains on top.
By this means the percentage of
blood cells in whole blood can be
determined.
 Haemopoiesis
 Haemopoiesis is the formation
of blood cellular components. All
cellular blood components are derived
from pluripotent haemopoietic stem
cells which is present in the bone
marrow.
In a healthy adult person,
approximately 1011–1012 new blood
cells are produced daily in order to
maintain steady state levels in the
peripheral circulation.
Haemopoiesis
Blood Composition
 Regulation of haemopoiesis
Humoral regulation by
hormones:
Erythropoietin
Leucopoietin
Thrombopoietin
These hormones are produced by
kidney and liver.
 2. Blood plasma
 Composition :
90-92% of water
8-10% of dry substance
mainly consisting from
proteins (6-8%)
Dry substance includes :
inorganic (mineral)
organic components
 Blood plasma
The main (inorganic) mineral components :
(0.9-1.5 %):
Cations : Anions :

Sodium (Na+),
Chlorides(Cl⁻)
Potassium (K+), Phosphates
(PO4⁻)
Calcium (Ca++),
Bicarbonates(HCO3⁻)
Magnesium (Mg++)
 Blood plasma
A solution with the same salt
concentration 0.9% is named
isotonic solution.
If salt concentration more than
0.9% such solution is called
hypertonic.
If salt concentration is less than
0.9% – hypotonic solution.
Tonicity effects
 Blood plasma
The organic components of
plasma include :

proteins
lipids
carbohydrates
Plasma proteins and their role
Plasma proteins include :
 Albumin - Transportation
(65-85 g/l) Regulation of oncotic
pressure
Regulation of pH

Globulin - α
(28 g/l) β - Transportation

γ - Defense
Fibrinogen - Blood clotting
 Lipids and carbohydrates in plasma
The major plasma carbohydrate is
glucose
(3.3-5.5 mmol/L) .
Plasma normally contains varying
amounts of hormones, enzymes,
pigments, and vitamins.
The composition of plasma varies with
the body’s activity and different
physiological states.
Blood Composition
 Serum
When fibrinogen is removed
from plasma as a result of
coagulation,
such plasma without
fibrinogen is called serum.
3.Physico-chemical constants of blood

Osmotic pressure
Oncotic pressure
Blood pH
Viscosity
Specific gravity
Erythrocyte sedimentation rate(ESR)
 Osmosis
Osmosis
-movement of water from higher
concentration to lower
concentration.
(or)
-movement of dissolved
substances
from lower concentration to higher
concentration.
 Osmotic pressure ( 7.6 atm)
Osmotic pressure :
-is defined as the minimum amount
of
pressure needed to prevent
osmosis.
Dissolved particles maintain the osmotic pressure.
Among them, the most active is
-NaCl (0.9 % isotonic)
- and also glucose (5 % isotonic).
In hypotonic solution
- swelling and bursting occurs.
In hypertonic solution
- shrinkage occurs.
Osmotic pressure
 Oncotic pressure
Oncotic pressure, or colloid osmotic
pressure, is a form of osmotic
pressure exerted by blood plasma proteins.
It usually tends to pull water (fluid) into the
circulatory system(capillaries).
It is the opposing force to hydrostatic
pressure
Its normal value is :
0.03-0.04 atm
(or)
20-25 mm Hg
 pH of blood
pH is a measure of
the acidity or basicity of an aqueous
solution.
It is the negative decimal logarithm of
hydrogen concentration
Normal pH of blood is :
(arterial blood) 7.45 – 7.35
(venous blood)
If pH is less than 7.3 , it is acidosis
If pH is more than 7.5, it is alkalosis
 pH of blood
pH is maintained by :
 The excretion of carbon dioxide by the
lungs
 The excretion of H+ or OH- by the kidneys.
 By the action of buffer system

Carbonate Phosphate Protein

Haemoglobin
( HA H⁺ + A⁻ )
 Viscosity
Blood viscosity can be described as the
thickness and stickiness of blood.
It is a measure of the resistance of blood to
flow.
The viscocity of blood is 5 times more than
that of water
(based on time taken for the flow of both in
a tube)
It depends on :
RBCs
Plasma proteins
 Specific gravity
Specific gravity is the ratio of
the density of a substance to the
density of a reference substance.
Specific gravity is also called
relative density.
Blood normally has a specific
gravity of :
1.05 - 1.06 g/L
 Specific gravity
Specific gravity depends on :
RBCs Plasma
proteins
The higher the concentration of RBCs and
plasma proteins, higher will be the specific
gravity.

1.03 1.04 1.05

 4. Erythrocytes
Red blood cells, or erythrocytes,
are the most abundant type
of blood cell.
Approximately 2.4 million new
erythrocytes are produced per
second.
Approximately a quarter of the
cells in the human body are red
blood cells.
 Erythrocytes -Structure
In humans, mature red blood
cells are oval biconcave disks and
they are flexible.
A typical human erythrocyte has
a disk diameter of
approximately 6.2–8.2 µm
 They lack a cell nucleus and
most organelles, in order to
accommodate maximum space
for haemoglobin.
 Erythrocytes
 Since RBCs have a elastic membrane,
they are able to change their shape when
they pass through the capillaries.
The cells develop in the bone
marrow and circulate for about 100–120
days in the body before their components
are recycled by macrophages.
Human red blood cells take on average
20 seconds to complete one cycle
of circulation.
 RBC Count
Normal range :

 In male : 4.0-5.0 ×
1012/L

 In female : 3.5-4.5 ×
1012/L
 RBCs - Functions
The major function of these cells is a
transport of haemoglobin, which in
turn carries oxygen from lungs to the
issues
Red blood cells contain carbonic
anhydrase, which catalyzes the
reaction between carbon dioxide and
water, that has a significance in
transporting carbon dioxide (CO2)
from tissues to lungs.
 RBCs - Functions
The haemoglobin is an excellent
acid-base buffer.
Maintanence of acid-base
balance.
Blood group determination.
 Erythropoiesis
Erythropoiesis is the process by
which red blood cells (erythrocytes)
are produced.
It is stimulated by decreased O2 in
circulation, which is detected by
the kidneys, which then secrete the
hormone erythropoietin.
The whole process lasts about 7 days.
Through this process erythrocytes are
continuously produced in the red bone
marrow of large bones, at a rate of
 Erythropoiesis

Mature red blood cells live in blood circulation for about

100 to 120 days. At the end of their lifespan, they become
senescent, and are removed from circulation by the
macrophages. This process is termed eryptosis,
erythrocyte programmed cell death.
 Red Blood Cells
 According to size :
Normocytes - Normal sized RBCs
Microcytes - Small sized RBCs
Macrocytes - Large sized RBCs
 According to colour :
Normochromia - Normal coloured RBCs
Hyperchromia - Darker,due to increased hemoglobin
Hypochromia - Paler, due to decreased hemoglobin
 They are determined by measuring the :
Mean corpuscular haemoglobin (MCH)
Mean corpuscular haemoglobin
concentration
(MCHC)
Red Blood Cells-Pathological shapes
Red Blood Cells-Pathological forms
 Erythrocytosis - (Polychythemia)
If the erythrocyte count is more than
normal, such state is called
erythrocytosis.
 Erythrocytosis

Physiological
Pathological
 Erythrocytosis
Physiological
Pathological

Absolute Primary
- In high altitude. -Bone
marrow

disorder.
Relative Secondary
-Exercises. -due to
any CV or
 Erythropenia
If the erythrocyte count is less than
normal, such state is called
erythropenia.
A deficiency in number of RBCs or
reduced haemoglobin levels in RBCs is
known as anaemia.
Erythropenia may be because of :
Problems in production
Excessive destruction
(haemolysis)
Blood loss
 Erythropenia
Physiological
Pathological

Absolute Primary
- Deficiency of -Bone
marrow
production
disorder.
Relative Secondary
- Pregnancy -due to
any kidney
5.Erythrocyte Sedimentation Rate (ESR)
The erythrocyte sedimentation
rate (ESR), is the rate at which red
blood cells sediment in a period of one
hour.
RBC and plasma will be separated.
 It is a common hematology test.
Normal values :
Men - 2-10 mm/hr
Women - 2-15 mm/hr
Erythrocyte Sedimentation Rate (ESR)
Factors influencing the ESR :

Plasma proteins mainly

fibrinogen and globulin
negative charge of the
erythrocytes
(zeta potential)
Erythrocyte Sedimentation Rate (ESR)
Increased ESR may be due to :
Pregnancy
Inflammation
Cancer.
Decreased ESR may be due to :
Polycythemia
Sickle cell anemia
Hereditary
spherocytosis
Congestive heart
 6.Haemolysis of RBCs, its types
Haemolysis is the rupturing of
erythrocytes and the release of
their contents (cytoplasm) into
surrounding fluid (blood plasma).
 Hemolysis may occur in
vivo or in vitro (inside or outside
the body).
 Haemolysis of RBCs
Causes :
Inherited defects in the blood cells
(e.g., Hereditary spherocytosis ,
Thalassemia)
Chemicals, venoms
The toxic products of microorganisms
Transfusion of the wrong blood type or
Rh incompatibility of fetal and maternal

blood, a condition called erythroblastosis

fetalis.
 Types of haemolysis
Types of haemolysis :
Intrinsic - Due to problems within the
RBC
Physical - Radiation injury
Osmotic - In hypotonic solution
Mechanical - Due to pressure
Thermal - Due to heat
Biological - Blood transfusion, poison
Chemical - Due to drugs
Extrinsic - Antibodies against

RBC(Immunological).
Osmotic resistance of RBCs
Concentration at which complete
hemolysis of erythrocytes occurs
Normal value –
0.35 - 0.45%
Due to elasticity of erythrocyte's
membrane
 7.Haemoglobin - Structure
Content :
It is composed of the
protein globin (a
polypeptide), and the
pigment heme.
Structure :
The hemoglobin has the
ability to combine with
oxygen is due to the four
iron atoms associated
with each heme group
 Haemoglobin
Physiological role :
The main function of
erythrocytes
is carried out by means
hemoglobin.
Normal range of haemoglobin :
In men - 135-180 g/L
In women - 120-140 g/L
 Compounds of haemoglobin
 Physiological associations of haemoglobin :
 Oxyhemoglobin :
- Oxygen combines weakly
with
the haemoglobin molecule. Such association is called
oxyhemoglobin . It is formed in lungs.
 Deoxyhemoglobin :
- When the oxygen is released to the
tissues of the body, the haemoglobin is called
reduced
haemoglobin or deoxyhemoglobin.
 Carbhemoglobin :
- In tissues Hb combines with
carbon dioxide and
form carbhemoglobin.
 Compounds of haemoglobin
Pathological combinations of
haemoglobin :
 Carboxyhemoglobin - is combination
of hemoglobin and carbon monoxide.
It is gas without smell and color that
easily associates with hemoglobin
(more easily than oxygen).
Methemoglobin - is such hemoglobin
in which iron has potential not 2++ as
usually, but 3++. Such iron creates
strong chemical connection and not
 Treatments for pathological associations
Treatments for pathological
associations of haemoglobin are :
For carboxyhaemoglobin (HbCO) :
- Oxygenotherapy
For methaemoglobin (HbMt) :
- Blood transfusion
But only if small amount of
methaemoglobin is present (which is
normal), then an enzyme called
methhaemoglobin reductase which is
present in the RBCs, act on them and
actively eliminate them.
 Haemoglobin
If a concentration of the
pathological associations of
hemoglobin is too high then,
hypoxia (decrease of oxygen
in tissues) can develop.
 Types of haemoglobin
Types of hemoglobin :

Fetal hemoglobin (HbF) -

(α2γ2)
Adult hemoglobin (HbA)
- (α2β2)
Primitive hemoglobin (HbP) -
(α2ε2)
(Embryo)
 Types of haemoglobin
 Embryo has HbP (primitive) - (α2ε2)
 Adults have HbA - (α2β2)
 Fetal hemoglobin (HbF)-Before birth (α2γ2)
The fetal hemoglobin (HbF) is different
from the adult type (HbA)
It has more affinity to oxygen and can
be saturated with oxygen at a lower
oxygen tension.
In infants, the hemoglobin molecule is made up of
2 α chains and 2 γ chains. The gamma chains are
gradually replaced by β chains as the infant grows.
 Haemoglobin
If a changing of amino acid order
occurs in globin part of hemoglobin
molecule, they may lead to formation of
pathological types of Hb.
Anemia is developed due to formation
HbS when only one amino acid change
its place in globin chain of hemoglobin.
At this state the erythrocytes change
their forms and transport oxygen badly.
But obtain a resistance to malaria
 Colour index
The average content of
hemoglobin in one erythrocyte is
called color parameter of blood.
Formula :
Colour index = Haemoglobin
content(g/L) ×3
First three numerals
of RBC count
It fluctuates between 0.8 - 1 unit.
 8. Leucocytes (WBC)
White blood cells have nuclei
Size 9-12 μk
They make up approximately 1%
of the total blood volume in a
healthy adult.
They live for about three to four
days in the average human body.
Normal count of WBC :
4-9 x 109/L
 Leucocytes-functions
The major function of
leucocytes is :
Protective function.
It provides immunity and
thus defends the body.
 Leucopoiesis
It is the production of leucocytes.
It is produced from pluripotent
haemopoietic stem cells, which is present in
the bone marrow.
Differentiation of lymphocytes - in the
lymph tissue.
 Leucopoiesis
Granulocytes Monocyte Lymphocyte

Myeloblast Monoblast
Lymphoblast
Promonocyte
Promyelocyte prolymphocyte
monocyte
Myelocyte Lymphocyte
(neutrophilic, The lymphocytes
eozinopilic, end differentiation
basophilic) in the lymphoid
Metamyelocyt tissue (thymus )
e
(neutrophilic,
eozinophilic,
 Role of Leucopoietins

It is a hormone produced by

liver and kidney
It provides humoral
regulation of leucopoiesis.
 Leucocytosis
Increased amount of leucocytes in blood.
It may be :
Physiological
Pathological
Food intake
Inflammation
Exercises Cancer
Emotion
Stress
 Leucopenia
Abnormally low concentration of
leucocytes in blood.
 Only pathological :
Severe viral infections
Autoimmune disease
Chemotherapy
Radiation injury
 10. Types of leucocytes
Leucocytes are of 2 types :

 Granulocytes :
Agranulocytes :
Neutrophil
Monocyte
Basophil
Lymphocyte
Eosinophil
 Neutrophils (2.5–7.5 x 109/L)
Neutrophils :
 47 - 72%
Juvenile – 1% , Immature – 6% , Segmented – 60%
Functions :
First line of defense (first cells that come
to
the area of inflammation).
Multi functional cells that attack and
destroy
viruses and bacteria.
 Neutrophils
Phagocytosis -cellular ingestion of
bacteria
with enzymes proteases,
peroxidases, cationic
proteins
Microphagocyte – upto 15 or 20 only.
Respiratory burst – also
called oxidative burst is
the rapid release of
chemicals from immune
cells when they encounter with a
bacteria or
 Basophils (0.01-0.1 x 109/L)

Basophils contain :
Histamine – for vasodilation
Heparin – anticoagulant
Has IgE and thus participates in
allergic reaction along with mast cells
in tissues
Promotes functions of other
leucocytes
 Eozinophils (0.04-0.4 x 109/L)
Eosinophils- Functions :
They migrate to the site of infection.
Weak phagocytes.
Antiparasitic (kills parasites including
worms).
Contains histaminase – and so it
reduces
allergic reaction.
Eosinophilia – increased level of
eosinophils
 Monocytes (0.2–0.8 x 109/L )
Monocytes - Functions :
They differentiate into macrophages which
can phagocytose upto 100 bacteria.
Antigen – presentation function.
 Monocytes
In tissues
Wandering
Kupffer cells Goes to the
site of
Alveolar macrophages
inflammation.
Microglia
 Lymphocytes (1.5–3.5 x 109/L)
Provides immunity.
Two types : B – lymphocytes and T- lymphocytes.
B – lymphocytes provide humoral immunity.
T – lymphocytes provides cell-mediated immunity.
B – cells differentiate into plasma cells which
further produces 5 classes of antibodies that
provides immunity
T- cytotoxic cells aims to eliminate :
Virus-infected cells
Cancer cells
and also causes graft
rejection.
 Diagnostic importance
↑Neutrophils – inflammation
↑Eozinophils – allergy, parasitic
infections
↓ Eozinophils – stress
↑ Lymphocytes – cancer
(leukemias – cancerous
production of lymphoid cells)
 9.Leucogram
A blood leucocyte profile
(leucogram) provides
information on total
leucocyte count, differential
leucocyte count and leucocyte
morphology.
 Leucogram- Normal count

Total Eosin Baso Juven Imm Segm Lymp Mono

no. ophil phils i at ented hocyt cytes
of s neutr neutr neutr es
leuc ophil ophil ophil
ocyt s s s
es
Norma 4-9 x 0.5- 0- 1% 1% 6% 60% 18- 3-11%
l 109/L 5% 37%

Range
 Leucogram- variations
Shift to left (regenerative shift ):

If the amount of young neutrophil is

normal but the
amount of mature neutrophil is very
low , then

We conclude as : Infection by pathogen

Total Eosin Baso Juven Imm Segm Lymp Mono
hocyt cytes
The leucogram
no. below
ophil philsis ian example
at of this
ented
es
shift.
of s neutr neutr neutr
leuc ophil ophil ophil
ocyt s s s
es
Norma 9 x 5% 1% 6% 4% 10%
l 109/L 39% 35%
 Leucogram- variations
Shift to right (degenerative shift ):

If the amount of mature neutrophil is

normal but
the amount of young neutrophil is
zero , then

We conclude as : Problem in bone marrow

Total Eosin Baso Juven Imm Segm Lymp Mono
hocyt cytes
The leucogram
no. below
ophil philsis ian example
at of this
ented
es
shift.
of s neutr neutr neutr
leuc ophil ophil ophil
ocyt s s s
es
Norma 11 x 3% 1% 0% 0% 5%
l 109/L 70% 21%
 Physiological decussation

Neutrophils

Lymphocytes 3-5 3-5

days years
 Physiological decussation
Normally in adults neutrophil level is
higher than the level of lymphocytes
At birth, the amount of neutrophils and
lymphocytes are in the ratio as in adults
At 3 - 5 days,lymphocytes increase and
neutrophil decrease and remains same
until 3– 5 years, and then again
becomes normal
This is called the physiological cross of
leucocytes in ontogenesis
 11.Immunity
Immunity is the capability to
resist from pathogens, that tend
to damage the tissues or organs,
through biological defense.
Leucocytes play a major role in
providing immunity.
 Types of immunity
Cellular
Innate
(non-specific)
Humoral
Immunity

Acquired Cellular
(specific) Cellular
(adaptive) Humoral
 Types of immunity-Role of leucocytes
Innate Acquired

Cellular Humoral Cellular Humoral

Neutrophils Lyzozymes Provided by Provided by

Basophils Interferon T- cells B-cells

Eosinophils Complement system

Macrophages Stomach acid Plasma

cells
NK- cells Tear & saliva
Phagocytosis Skin
Antibodies
Mucous membrane
 Types of immunity
Acquired

Active Passive

After an encounter with Eg;-

Vaccination.
a disease , the body
Serum.
produces own antibodies.
 12.Agglutination of RBCs
The clumping of RBCs due to binding of
antibody with the corresponding antigen
is called haemagglutination.
Example :
Anti -A binds A antigen and anti-B binds
B antigen
It has two common uses :
Blood typing and
The quantification of
virus dilutions.
 Agglutination
 Agglutinogens (antigens) are
proteins that exist on the surface of
every red blood cell.
This agglutinogen , which is present
on the surface of RBCs, will stimulate
the production of agglutinin
(antibody) in the plasma in case of
incompatible blood transfusion.
Helps in determining the blood type
of a person.
 ABO blood group system
According to the ABO blood
typing system there are four
different kinds of blood types: O,
A, B, AB.
I(O) - α,β (40%);
II(A) -β (39%);
III(B) - α (10-15%);
IY(AB) - (5%).
ABO blood group system
 CDE blood group system
Out of C,D and E D is the strongest
antigen.
Also called Rhesus(Rh) system
85% of the population is - Rh⁺
If Rh-D antigen is present in
blood(RBC)
- Rh⁺
If Rh-D antigen is absent in
blood(RBC),
- Rh⁻
 Rh incompatibility
In blood transfusion :
Rh⁻ person cannot receive blood from Rh⁺
person, whereas Rh⁺ person can receive blood
from Rh⁻ person without any problems.
If a Rh⁻ person receive blood from Rh⁺ person
for the first time, due to this exposure, there
will be formation antibodies(anti-RhD)
So, if a second transfusion is done again with
Rh⁺ blood, then, the antibodies which are
already present causes clumping.
 Rh incompatibility
Erythroblastosis fetalis :
If a Rh⁻ mother carry a Rh⁺ fetus, due to
placental barrier the blood doesn’t mix. However
during delivery some Rh⁺ from fetus reaches
mother. So mother will start producing antibodies
against Rh⁺ . During consecutive pregnancies, this
may
cause destruction of RBCs in the fetus causing
haemolytic anaemia(erythroblastosis fetalis). So after
each pregnancy, the mother will receive anti-RhD
(prophylaxis)to prevent this incompatibility.
 13.Blood transfusion
Blood transfusion is :
The process of receiving blood products
into
one's circulation intravenously. Transfusions are
used in
a variety of medical conditions to replace lost
components of the blood. Early transfusions
used whole
blood, but modern medical practice commonly uses
only components of the blood, such as red blood
cells, white blood cells, plasma, clotting factors,
and platelets.
Types of blood transfusion

Direct
 Indirect
Autohemotransfusi
on
 Rules of blood transfusion
Check for ABO blood group compatibility.
Check for Rhesus (Rh factor) compatibility.
Cross-match(individual tests):
By taking RBC from donor and
plasma from recipient. Agglutination must
be absent.
Biological test :
Three times introducing donor’s blood
in small portions like -10-25 ml into the
recipient and check for any complaints or
deviation of physiological parameters.
 14.Thrombocytes (platelets)
Fragments of megakaryocytes
(red bone marrow)
Do not have a nucleus
 2–3 µm in diameter
Normal range : 180-320 x 109/L
Circulation in blood – 8-12 days
 Platelets- functions
The main function of platelets is the
maintenance of hemostasis.
Trophic (endothelium)
Transport of BAS
Immunity(Phagocytosis)
Clot retraction
Procoagulant
Inflammation
 Thrombopoiesis
Platelets in bone marrow, by budding off
from megakaryocytes.
Megakaryocyte and platelet production is
regulated by thrombopoietin, a hormone
usually produced by the liver
and kidneys.
Each megakaryocyte produces between
5,000 and 10,000 platelets.
 Thrombopoiesis
Around ₁₀11 platelets are produced each
day by an average healthy adult.
Reserve platelets are stored in the
spleen, and are released when needed by
sympathetically induced splenic
contraction.
Old platelets are destroyed
by phagocytosis in the spleen and
by Kupffer cells in the liver.
 Haemostasis
Haemostasis is a process which causes bleeding to
stop, meaning to keep blood within a damaged blood
vessel .
It is the first stage of wound healing. Most of the
time this includes blood changing from a liquid to a
solid state
The opposite of hemostasis is hemorrhage.
 Hemostasis has three major steps:
Vasoconstriction,
Temporary blockage of a break by a platelet
plug,
Blood coagulation, or formation of a clot that
seals the hole until tissues are repaired.
 Haemostasis - its types
Two types :
Vascular-thrombocytes hemostasis :
Stoppage of blood loss from the
microcirculatory
vessels having low blood pressure.
Finally – Platelet plug is formed
Coagulation hemostasis :
Stoppage of blood loss from the large vessels
having higher blood pressure.
Finally – Blood clot is formed
Vascular-thrombocytes hemostasis
Vessel is injured

Vasoconstriction due to nervous reflex

Von-Willebrand factor
Adherence of platelets to collagen-Positive feedback
(platelets undergo shape change and release ADP and ATP ,Ionized
calcium, Serotonin, Epinephrine, Thrombaxane A2 from
granules)
Adhesion

Secretion

Aggregation

(Primary) Temporary platelet plug

(Stable) Permanent platelet plug – more stable

Cellular (platelet) clotting factors
Cellular clotting factors are present in the
granules of
thrombocytes.
These factors are released when the
platelets undergo
degranulation.
They are :
ADP and ATP
Ionized calcium
Serotonin
Epinephine
Thrombaxane A2
15.Coagulatory haemostasis
Stages of coagulatory haemostasis
1. Activation of prothrombin activator
2. Prothrombin → Thrombin
3. Fibrinogen → Fibrin-
monomer - fibrin-polymer – cross-linked
fibrin-polymer

Significance :
Stoppage of blood loss from the large
vessels
having higher blood pressure by the
formation of
 Plasma clotting factors (13)
 Factor number Name

I - Fibrinogen
 II - Prothrombin
 III - Tissue Factor
 IV - Ca2+
V a - Proaccelerin
 VII - Proconvertin
 VIII - Antihemophilic Factor
 IX - Christmas Factor
X - Stuart Factor
 XI - Plasma thromboplastin antecedent
 XII - Hageman factor
 XIII - Fibrin Stabilizing Factor
 16.Fibrinolysis
Tissue plasminogen Protein C
activator
Factor 12 a Plasminogen
kallikrein activator
inhibitor - 1

Plasminogen Plasmin

α-2
Streptokinase antiplasmin

Activation Fibrin

Inhibition
Fibrin degradation
products
 Fibrinolytic system
Function:
Lysis of blood clots (for a
few days).
Clot destroyed by plasmin
(fibrinolysin)
which formed from plasminogen
(profibrinolysin).
This reaction is activated by
blood and
 17.System of anticoagulation
The pre-existing (primary)
anticoagulants :
(natural) Heparin
Antithrombin III
(artificial) Dicumarin
Pelentan
Inactive clotting factors (13)
System of anticoagulation
Rapid blood flow.
Smoothness of endothelium.
Same charge on formed elements
and walls of vessels.
Presence of glycoproteins and
prostaglandins on its surface.
 Regulation of haemostasis
Sympathetic nervous system
– stimulation of coagulation.
Parasympathetic nervous system –
stimulation of anticoagulation system
(according to some data).
Thank you