Chapter 13 The Blood Copyright 2015 Wolters Kluwer

Key Terms agglutination erythrocyte lymphocyte albumin fibrin megakaryocyte anemia hematocrit monocyte antigen hematopoietic neutrophil antiserum hemoglobin plasma basophil hemolysis platelet (thrombocyte) centrifuge hemorrhage serum coagulation hemostasis thrombin cryoprecipitate leukemia thrombocytopenia eosinophil leukocyte transfusion Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood • Important in maintaining homeostasis • Classified as a connective tissue • Accounts

Functions of the Blood Transportation Gases Nutrients Wastes Regulation Protection p. H Fluid balance

Blood Constituents (cont. ) • Plasma – Liquid portion • Formed elements – Cellular

Blood Constituents (cont. ) Figure 13 -1 Composition of whole blood. Copyright © 2015

Blood Constituents (cont. ) Figure 13 -2 Blood cells as viewed under the microscope.

Blood Constituents (cont. ) Blood Plasma • Plasma is 55% of blood. • Components – Water – Protein • Albumin • Clotting factors • Antibodies • Complement Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Constituents (cont. ) Formed Elements • Produced in red bone marrow from hematopoietic cells – Erythrocytes – Leukocytes • Neutrophils • Eosinophils • Basophils • Lymphocytes • Monocytes – Platelets Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Constituents (cont. ) Erythrocytes • Red blood cells (RBCs)—most numerous • Biconcave shape • Mature cells anuclear • Contain hemoglobin – Binds to oxygen for transport – Carries hydrogen ions for buffering – Carries carbon dioxide for elimination Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Constituents (cont. ) Figure 13 -3 Red blood cells as seen under a

Blood Constituents (cont. ) Leukocytes • White blood cells (WBCs)—colorless, round, with prominent nuclei – Granulocytes • Neutrophils (polymorphs) • Eosinophils • Basophils – Agranulocytes • Lymphocytes • Monocytes • Clear body of foreign material, cellular debris, pathogens Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Constituents (cont. ) Figure 13 -4 Stages in neutrophil development. Copyright © 2015

Blood Constituents (cont. ) Figure 13 -5 Phagocytosis. Copyright © 2015 Wolters Kluwer •

Blood Constituents (cont. ) Platelets (Thrombocytes) • Smallest formed element • Not cells—no nuclei or DNA • Fragments release from megakaryocytes • Essential for blood coagulation (clotting) Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Constituents (cont. ) Figure 13 -6 Platelets (thrombocytes). Copyright © 2015 Wolters Kluwer

Hemostasis and Coagulation (cont. ) • Prevents blood loss when blood vessel ruptures • Events include: – Contraction of smooth muscle in the damaged blood vessel wall – Formation of a platelet plug – Formation of a blood clot • Formation of prothrombinase • Conversion of prothrombin into thrombin (by prothrombinase) • Conversion of fibrinogen into fibrin (via thrombin) Copyright © 2015 Wolters Kluwer • All Rights Reserved

Hemostasis and Coagulation (cont. ) Figure 13 -7 Blood clotting (coagulation). What part of the word prothrombinase indicates that it is an enzyme? What part of the word prothrombin indicates that it is a precursor? Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Types (cont. ) • Blood types must be compatible for blood transfusion from donor to patient. • Proteins (antigens or agglutinogens) on red cells cause incompatibility. – A and B antigens – Rh factor Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Types (cont. ) The ABO Blood Type Group Blood Type Red Blood Reacts Cell with Antigen Serum Plasma Can Take Antibodies from Can Donate to A A Anti-B A, O A, AB B B Anti-A B, O B, AB AB A, B Anti-A, Anti -B None AB, A, B, O O, A, B, AB O None Anti-A, Anti -B Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Types (cont. ) Figure 13 -8 Blood typing. Can you tell from these

Blood Types (cont. ) ABO Blood Type Compatibility • Safest transfusion is with same blood type. • Type O blood can be given to any ABO type. • Type AB blood can receive any ABO type. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Types (cont. ) Rh Factor • Red cell antigen group Rh (D antigen) – Rh-positive blood has antigen. – Rh-negative blood lacks antigen. • Rh incompatibility can lead to hemolytic disease of newborn (HDN). Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Types (cont. ) Figure 13 -9 Rh incompatibility. Copyright © 2015 Wolters Kluwer

Use of Blood and Blood Components (cont. ) • Blood stored in blood banks up to 35 days – Anticlotting solution added – Expiration date added • Blood donated before elective surgery (autologous blood) Copyright © 2015 Wolters Kluwer • All Rights Reserved

Use of Blood and Blood Components (cont. ) Whole-Blood Transfusions • Used for loss of large volume of blood • Massive hemorrhage from serious injuries • During internal bleeding • During or after an operation • Blood replacement in treatment of HDN Copyright © 2015 Wolters Kluwer • All Rights Reserved

Use of Blood and Blood Components (cont. ) Blood Components • Centrifuge separates plasma from formed elements. • Hemapheresis—keeps desired elements and returns remainder to donor. • Plasmapheresis—keeps plasma and returns formed elements to donor. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Use of Blood and Blood Components (cont. ) Use of Plasma • Replace blood volume • Treat circulatory failure (shock) • Treat plasma protein deficiency • Replace clotting factors • Provide needed antibodies Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Disorders (cont. ) • Blood abnormalities • Anemia (low level of hemoglobin or red cells) • Leukemia (increase in white cells) • Clotting disorders (abnormal tendency to bleed) Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Disorders (cont. ) Anemia • Excessive loss or destruction of red cells – Hemorrhagic anemia – Hemolytic anemia – Sickle cell anemia • Impaired production of red cells or hemoglobin – Nutritional anemia – Pernicious anemia – Thalassemia – Bone marrow suppression Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Disorders (cont. ) Figure 13 -10 A blood smear in sickle cell anemia.

Blood Disorders (cont. ) Leukemia • Characterized by enormous increase in white cells – Myelogenous leukemia from bone marrow – Lymphocytic leukemia from lymphoid tissue • Bone marrow transplants sometimes successful in restoring blood-producing stem cells lost after leukemia treatment Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Disorders (cont. ) Figure 13 -11 Leukemia. Copyright © 2015 Wolters Kluwer •

Blood Disorders (cont. ) Clotting Disorders • Abnormal bleeding through disruption of coagulation process – Hemophilia – von Willebrand disease – Thrombocytopenia – Disseminated intravascular coagulation (DIC) Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Studies (cont. ) • Some blood tests are a standard part of a routine physical examination. • Machines can perform several tests simultaneously. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Studies (cont. ) Hematocrit • m. L of red cells per 100 m. L of whole blood • Performed in centrifuge • Adult range for men: 42% to 54% • Adult range women: 36% to 46% Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Studies (cont. ) Figure 13 -12 Hematocrit. Copyright © 2015 Wolters Kluwer •

Blood Studies (cont. ) Hemoglobin Tests • g of hemoglobin per 100 m. L of whole blood • Performed by electrophoresis • Adult range for men: 14 to 17 g/d. L • Adult range for women: 12 to 15 g/d. L Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Studies (cont. ) Blood Cell Counts • Red cell counts – Range: 4. 5 to 5. 5 million cells per microliter (mc. L) • White cell counts – Range: 5, 000 to 10, 000 cells per microliter (mc. L) • Platelet counts – Range: 150, 000 to 450, 000 per microliter (mc. L) Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Studies (cont. ) Blood Slide (Smear) • Complete blood count (CBC) performed on stained blood smear • Red cells examined • Platelets examined • Parasites may be found • Differential white count performed Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Studies (cont. ) Blood Chemistry Tests • Electrolytes • Blood glucose • Nitrogenous waste products (creatine) • Enzymes • Lipids • Plasma proteins • Hormones • Vitamins • Antibodies • Drug levels Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Studies (cont. ) Coagulation Studies • Performed before surgery and during treatment of certain diseases – Amounts of clotting factors – Bleeding time – Clotting time – Capillary strength – Platelet function Copyright © 2015 Wolters Kluwer • All Rights Reserved

Blood Studies (cont. ) Bone Marrow Biopsy • Sample of red marrow through needle from sternum, sacrum, or iliac crest • Used in diagnosing bone marrow disorders – Leukemia – Some types of anemia Copyright © 2015 Wolters Kluwer • All Rights Reserved

Case Study (cont. ) • All of the blood’s formed elements are produced in the red bone marrow. • Continuous cell replacement is essential to life. • Eleanor, losing the protective functions of the blood cells due to her bone marrow damage, exhibited the following symptoms: – Pallor and fatigue due to low red cells and hemoglobin – Hemorrhage due to platelet loss • Eleanor acquired: – An infection due to diminished leukocytes – Strain on her heart and an increased heart rate to compensate for low hemoglobin Copyright © 2015 Wolters Kluwer • All Rights Reserved

Word Anatomy (cont. ) Word Part Meaning Example Blood Constituents erythr/o red, red blood cell An erythrocyte is a red blood cell. hemat/o blood Hematopoietic stem cells form poiesis) all of the blood cells. hemo blood Hemoglobin is a protein that carries oxygen in the blood. kary/o nucleus A megakaryocyte has a very large nucleus. leuk/o white, colorless A leukocyte is a white blood cell. lymph/o lymph, lymphatic system Lymphocytes are white blood cells that circulate in the lymphatic system. Copyright © 2015 Wolters Kluwer • All Rights Reserved (-

Word Anatomy (cont. ) Word Part Meaning Example Blood Constituents (cont. ) macr/o large A macrophage takes in large amounts of foreign matter by phagocytosis. mon/o single, one A monocyte has a single, unsegmented nucleus. morph/o shape The nuclei of polymorphs have many shapes. phag/o eat, ingest Certain leukocytes take in foreign matter by the process of phagocytosis. thromb/o blood clot A thrombocyte is a cell fragment that is active in blood clotting. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Word Anatomy (cont. ) Word Part Meaning Example Hemostasis and Coagulation -gen producing, originating Fibrinogen converts to fibrin in the formation of a blood clot. pro- before, in front of Prothrombinase is an enzyme (-ase) that converts prothrombin to thrombin. loosening, dissolving, separating A recipient’s antibodies to donated red cells can cause hemolysis of the cells. Blood Types -lysis Copyright © 2015 Wolters Kluwer • All Rights Reserved

Word Anatomy (cont. ) Word Part Meaning Example Uses of Blood and Blood Components cry/o cold Cryoprecipitate forms when blood plasma is frozen and then thawed. Blood Disorders –emia (from blood –hemia) Anemia is a lack (an-) of red cells or hemoglobin. -penia Leukopenia is a lack of white cells. lack of Copyright © 2015 Wolters Kluwer • All Rights Reserved