Blood functions and classifications.ppsx

Blood

2. Functions of blood
1. Place of exchange of substances between
interstitial fluid and external environment
2. Transport
3. Buffer function
4. To keep body temperature relatively constant
5. Hemostasis
6. Defense function

3. Blood properties and its
components

4. Physical and chemical properties of blood
(1) Specific gravity
blood: 1.050～1.060. (RBC number)
plasma: 1.025～1.030. (Content of plasma proteins)
RBC:1.090 ～1.092. (hemoglobin)
(2) Viscosity
Viscosity of plasma is 1.2-1.3 times
that of water, viscosity of whole
blood is 2.4 times of plasma.

5. (3) Plasma osmolality
Colloid osmotic pressure:
maintain intra-and extracapillary water
equilibrium
Crystal osmotic pressure:
maintain intra-and extracellular water
equilibrium
4. RBC fragility
5. Plasma pH 7.35-7.45

7. Components of blood
• Plasma
• Cells
- Red blood cells (erythrocytes)
- White blood cells (leukocytes)
- Platelets (thrombocytes)

Blood volume: 70-80ml/Kg

8. 90% Water
8% Solutes:
•Proteins
Albumin (60 %)
Alpha and Beta Globulins
Gamma Globulins
Fibrinogens
•Gases
•Electrolytes
Components of Plasma

9. •Organic Nutrients
Carbohydrates
Amino Acids
Lipids
Vitamins
•Hormones
•Metabolic waste
CO2
Urea

10. Formed elements of blood (Cells)

11. Erythrocytes
•RBCs are flattened biconcave
discs
–Shape provides increased
surface area for diffusion
–Lack nuclei & mitochondria
–Each RBC contains hemoglobin
13-9

12. Erythrocyte7.5m in diameter
·   Men- 5.5 million cells/mm
3
·   Women- 4.5 million cells/mm
3
·  

Life span 100-120 days and then destroyed in
spleen .

14. Hematopoiesis
•Hematopoiesis (hemopoiesis):
blood cell formation
–Occurs in red bone marrow of axial
skeleton, girdles and proximal
epiphyses of humers and femur

15. Hematopoiesis
•Hemocytoblasts (hematopoietic stem
cells)
–Give rise to all formed elements
–Hormones and growth factors push the cell
toward a specific pathway of blood cell
development
•New blood cells enter blood sinusoids

16. Erythropoiesis
•Erythropoiesis: red blood cell
production
–A hemocytoblast is transformed into a
proerythroblast
–Proerythroblasts develop into early
erythroblasts

17. Erythropoiesis
–Phases in development
1.Ribosome synthesis
2.Hemoglobin accumulation
3.Ejection of the nucleus and
formation of reticulocytes
–Reticulocytes then become
mature erythrocytes

18. Stem cell
Hemocytoblast
Proerythro-
blast
Early
erythroblast
Late
erythroblast
Normoblast
Phase 1
Ribosome
synthesis
Phase 2
Hemoglobin
accumulation
Phase 3
Ejection of
nucleus
Reticulo-
cyte
Erythro-
cyte
Committed
cell
Developmental pathway

19. Regulation of Erythropoiesis
•Too few RBCs leads to tissue hypoxia
•Too many RBCs increases blood viscosity
•Balance between RBC production and
destruction depends on
–Hormonal controls
–Adequate supplies of iron, amino acids, and B
vitamins

20. Hormonal Control of Erythropoiesis
•Erythropoietin (EPO)
–Direct stimulus for erythropoiesis
–Released by the kidneys in
response to hypoxia

21. Causes of hypoxia
– Hemorrhage or increased RBC destruction
reduces RBC numbers
–Insufficient hemoglobin (e.g., iron
deficiency)
–Reduced availability of O
2
(e.g., high
altitudes)

22. •Effects of EPO
–More rapid maturation of committed bone
marrow cells
–Increased circulating reticulocyte count in
1–2
 days
•Testosterone also enhances EPO
production, resulting in higher RBC
counts in males

23. Formation & Destruction of RBCs

24. RBC Antigens & Blood Typing
•Antigens present on RBC surface specify blood
type
•Major antigen group is ABO system
–Type A blood has only A antigens
–Type B has only B antigens
–Type AB has both A & B antigens
–Type O has neither A or B antigens
13-15

25. Transfusion Reactions
•People with Type A blood make
antibodies to Type B RBCs, but
not to Type A
•Type B blood has antibodies to
Type A RBCs but not to Type B
•Type AB blood doesn’t have
antibodies to A or B
•Type O has antibodies to both
Type A & B
•If different blood types are
mixed, antibodies will cause
mixture to agglutinate

26. Transfusion Reactions
•If blood types don't match, recipient’s
antibodies agglutinate donor’s RBCs
•Type O is “universal donor” because lacks A
& B antigens
–Recipient’s antibodies won’t agglutinate
donor’s Type O RBCs
•Type AB is “universal recipient” because
doesn’t make anti-A or anti-B antibodies
–Won’t agglutinate donor’s RBCs

27. Rh Factor
RH- indicates no protein
RH+ indicates proteinRH+ indicates protein
  
                                                                                                           

28. Type AB- universal recipients
Type O- universal donor
Rh factor:
Rh+ 85% dominant in pop
Rh- 15% recessive
Blood Type Clumping Antibody
A antigen A anti-A serum antibody anti-b
B antigen B anti-B serum antibody anti-a
AB antigen A & Banti A & B serum -
O neither A or Bno clumping w/ either anti A or B anti-a, anti-b

29. Anemia- when blood has low O
2 carrying
capacity; insufficient RBC or iron deficiency.
Factors that can cause anemia as B12 deficiency
Polycythemia- excess of erythrocytes,  viscosity
of blood;
8-11 million cells/mm
3
Usually caused by cancer, tissue hypoxia,
dehydration (naturally occurs at high elevations)

30. Anemia
•Inability of blood to supply tissues with adequate
oxygen for proper metabolic function.
•Diagnosis made by patient history, physical
examination, signs and symptoms, and hematological
laboratory findings.
•Usually associated with decreased levels of hemoglobin
or hematocrit (packed red cell volume) - Abnormal
hemoglobin may give appearance of anemia
(methemoglobin).
•Usually associated with decreased RBCs.
30

31. Anemia
•Classified as moderate (Hb 7-10 g/dl) or severe (Hb
<7g/dl).
•Physical signs include difficulty breathing (dyspnea),
vertigo, muscle weakness and headaches. Rapidly
developing anemia may be associated with
hypotension and tachycardia.
•Two general forms of anemia:
   Absolute anemia
(decrease in red cell mass) and relative Anemia
(increased plasma volume gives appearance of
anemia).
 
31

32. Causes of Anemia
•Nutritional deficiencies
•Hemolytic disorders
•Blood loss
•Bone marrow (hypoproliferative)
•Infection
•Toxicity
•Hemopoetic stem cell damage (maturation
disorder)
•Heredity or acquired defect
32

33. Classification of Anemias
•Have a variety of ways - depending on
criteria used:
–Functional
–Morphological
–Clinical
–Quantitative
33

34. Functional Classification of Anemias
•Decreased RBC production (hypoproliferative)
–Defective hemoglobin synthesis
•Fe deficiency
•B12 deficiency
•Folate deficiency
–Impaired bone marrow or stem cell function, as in
leukemia
•Increased RBC destruction, as in sickle cell anemia or
glucose 6 phosphatase deficiency or hemolytic anemia
34

35. Morphological
Classification of Anemias
•Morphological based on sizes and color of
RBCs
–Normochromic Normocytic
–Normochromic Microcytic
–Normochromic Macrocytic
–Hypochromic Microcytic
35

36. Clinical
Classification of Anemias
•According to their associated causes:
–Blood loss
–Iron deficiency
–Hemolysis
–Infection
–Nutritional deficiency
–Metastatic bone marrow replacement
36

38. Quantitative
Classification of Anemias
•Quantitatively by:
–Hematocrit
–Hemoglobin
–Blood cell indices
–Reticulocyte count
38

39. ديدحلاصقنايمينأ
-Iron deficiency anemia
• ديدحلاIron عاخن ةردق ىلع كلذ سكعني هصقن ةلاح يف و ، ءارمحلا مدلا ايلاخل يساسأ نوكم
ىلع يوتحت يتلا ءارمحلا مدلا ايلاخ جاتنإ ةبسن لقت ثيح ، مدلا ايلاخل عنصملا رمحلأا مظعلا
.نيبولجوميهلا
•:ديدحلا صقن نع جتانلا مدلا رقف بابسأ
.
) رمحلأا محللا و دبكلا ( لثم ديدحلاب ةينغلا ةيذغلأا لوانت ةلق -
.ديدحلا صاصتما نم دحت يتلا تابورشملا و ةيذغلأا لوانت ةرثك -
.ةضومحلا تاداضم و ةيويحلا تاداضملاك ةيودلأا عاونأ ضعب لوانت -
ءاعملأا لومخ و مضهلا رسع لثم يمضهلا زاهجلا ةفيظو بارطضا و ةيهشلا فعض -
فنلأا فيزن و تاباصلإا ةلاح يف وأ ءاسنلا دنع ثمطلا يف امك رركتم لكشب مدلا نادقف -

40. ب نيماتيف صقن ايمينأ12 Vitamin B12 Deficiency Anemia
• ب نيماتيف صقن نع ةجتان ايمينأ ةلاح يه12 مدع نع ةجتان وأ ماعطلا يف
ىلإ يدؤي صقنلا اذه .ماعطلا نم ماهلا نيماتيفلا اذه صاصتما ىلع ةردقلا
.ماظعلا عاخن يف رمحلا مدلا ايلاخ جاتنإ ةقاعإ
• ةريبك رمح مد ايلاخ ضرملا اذه يف نوكتت
•ب نيماتيف دجوي12.نابللأاو موحللا تاجتنم يف طقف ´
• ب نيماتيف نزتخي12دبكلا يف

41. ةيلجن
Jملا ايمينلأا
sickle cell anemia
• ةيلجنملا ايمينلأاsickle cell anemia بيصت يتلا مدلا رقف عاونأ دحأ يه
رهشأ نم ربتعتو ،ءارمحلا مدلا تايركةيثارولا مدلا ضارمأ رسكت ببست يتلا
مدلا تايرك نلأ كلذو ،لجنملا نم ةذوخأم ةيلجنم ةملكو .ءارمحلا مدلا تايرك
.نيجسكلأا صقن دنع للاهلا وأ لجنملا لكش ذخأت ءارمحلا
• ةيلجنم ءارمحلا مدلا تايرك ،ةيعيبطلا ريغ ايلاخلا نإف ضارعلأل ةبسنلاب امأ
للاخ مدلا رورم قيعت دقو ،اهجاتنإ نم ةريصق ةرتف دعب ةداع للحتت ،لكشلا
ةفلتخم ءازجأ يف ةحربم املاآ ببستف مدلا ةيعوأ دست دقو ،ةيومدلا تاريعشلا
دست دقو .رهظلاو فارطلأا ماظع يف صاخ لكشبو ماظعلا يف ةصاخ مسجلا نم
ةيويحلا ءاضعلأا يف ةيومدلا ةيعولأا نم ءاعو يأ ةيلجنملا ءارمحلا تايركلا
ةريطخ تافعاضم ببست كلذبو ،خملا ىتح وأ نطبلا وأ نيتئرلا لثم مسجلا يف
.باصملا صخشلا اهنم يناعي يتلا ةحربملا ملالآا ىلإ ةفاضإ

42. ةيلجنملا
ايلاخلا ايمينأ
Sickle Cell Anemia
•Genetic disease يثارو ضرم
•Red blood cells become
sickle shape مدلا ايلاخ هيف حبصت
لكشلا ةيلجنم ءارمحلا
•Can’t carry as much oxygen
لمح ايلاخلا هيف عيطتست لا
يفاكلا نيجسكلأا

43. Sickle-cell anemia
•Sickle cell disease: genetic disease
–Defect in hemoglobin (The beta subunit has the
amino acid valine at position 6 instead of the
glutamic acid that is normally present )
43

45. Blood Tests

46. •Component of the CBC:
• Red Blood Cells (RBCs)
• Hematocrit (Hct)
• Hemoglobin (Hgb)
• Mean Corpuscular Volume (MCV)
• Mean Corpuscular Hemoglobin
Concentration (MCHC)
• White Blood Cells (WBCs)
• Platelets

47. Hemoglobin
:
M: 14 to 16 gm/dL
F: 12 to 14 gm/dL
Hematocrit
:
(packed cell volume)
It is ratio of the volume of red cell to the
volume of whole blood.
M: 40 to 50 %
F: 36 to 44 %

48. Hemoglobin (Hgb) Tests
(In the Diagnosis of Anemia)
•Hgb is the main component of RBCs and
carries oxygen to tissues.
•Three methods to measure hemoglobin:
–Cyan-met-hemoglobin (recommended method)
–Oxyhemoglobin
–Iron Content
 
48

49. Cyan-met-hemoglobin
(method to measure Hgb)
•1. Blood is diluted in a solution of potassium
ferricyanide and potassium cyanide, which
oxidizes the hemoglobin to form met-
hemoglobin.
•2. Then methemoglobin forms
cyanmethemoglobin in the presence of the
potassium cyanide.
•3. Absorbance of solution is read in
spectrophotometer at 540 nm.

50. Hematocrit (packed cell volume)
PCV

52. RBC Indices
•RBC indices include:
–Mean Corpuscular Volume (MCV)
–Mean Corpuscular Hemoglobin (MCH)
–Mean Corpuscular Hemoglobin Concentration
(MCHC)
52

53. –MCV = mean corpuscular volume
HCT/RBC count= 87 fL
•small = microcytic
•normal = normocytic
•large = macrocytic
-
MCH
(mean corpuscular hemoglobin)
HB/RBC count = 27-32 pg
–MCHC= mean corpuscular hemoglobin
concentration HB/HCT= 26-34%
•decreased = hypochromic
•normal = normochromic

54. MCV
•Mean cell volume
•MCV is average size of RBC
•MCV = Hct x 10
RBC (millions)
•If 80-100 fL, normal range, RBCs considered
normocytic
•If < 80 fL are microcytic
•If > 100 fL are macrocytic
•Not reliable when have marked anisocytosis
54

55. MCH
•MCH is average weight of hemoglobin per
RBC.
•MCH = Hgb x 10
RBC (millions)
= 27-32 pg
55

56. MCHC
•MCHC is average hemoglobin concentration per
RBC
•MCHC = Hgb x 100
Hct (%)
= 26-34%
•If MCHC is normal, cell described as
normochromic
•If MCHC is less than normal, cell described as
hypochromic
•There are no hyperchromic RBCs
56

57. •This important value is needed in the evaluation
of any anemia.
•Normal range 1-2%
 

•count goes up with Hemolytic anemia
•goes down with
 
Nutritional deficiencies
•Diseases of the bone marrow itself

58. Erythrocyte Sedimentation Rate
•It is the distance sedimented by R.B.Cs. In a
vertical blood column at the end of one and
two hours.
•It is measured by the height of clear plasma
formed at the top of blood which is kept fluid
by adding an anticoagulant

59. Figure 17.16
Serum
Anti-A
RBCs
Anti-B
Type AB (contains
agglutinogens A and B;
agglutinates with both
sera)
Blood being tested
Type A (contains
agglutinogen A;
agglutinates with anti-A)
Type B (contains
agglutinogen B;
agglutinates with anti-B)
Type O (contains no
agglutinogens; does not
agglutinate with either
serum)