BLOOD

FUNCTION
• absorbs and transports nutrients
• delivers the wastes to the excretory system
• transports hormones
• thermoregulatory function
• immune function
• buffer effect
•
Human Circulatory System
CLOSED Type
• The blood remains WITHIN a completely enclosed system of vessels
• Materials move between the blood and interstitial fluid through the thin walls of capillaries

PROPERTIES:
• 4-5x thicker than water
• temperature of 38° C
• pH = 7.35-7.45
• isotonic at 0.85% of NaCl
• usually 5L in a 60Kg man
• ~8%of body weight

Blood
FUNCTIONS:
1.Transport
• soluble products of digestion/absorption
– glucose, amino acids, vitamins and minerals
• waste products of metabolism
– urea, creatinine, and lactate
• hormones
– insulin, peptide, testosterone, steroids, adrenaline
• respiratory gases
– oxygen and carbon dioxide
• plasma proteins
– fibrinogen, albumin, globulins

2.Regulatory
• blood solutes
– Na+ ions and plasma proteins
• water content
– temperature regulation
• pH maintenance
– blood buffer system (hydrogen carbonate and phosphate)

3.Protective
• platelets, plasma proteins
– protect against blood loss
• Leukocyctes
– phagocytosis and antibody production
–

BLOOD COMPONENTS
- If blood is spun for a few minutes in a high-speed centrifuge, it separates into two layers.
Plasma
- liquid portion of blood (55%)
- if (–) fibrinogen  SERUM (serum is the name given to plasma from which the protein fibrinogen has
been removed)

Cells
 - solid portion of blood (45%)
- RBC’s, WBC’s and platelets (blood cells originate from stem cells in the bone marrow by the process of
hematopoiesis)

PLASMA
• FLUID PORTION OF THE BLOOD (55%)
• water (91-92%)
• plasma proteins
• albumin, globulin and fibrinogen
• regulatory and protective proteins
• hormones, antibodies and enzymes
• FLUID PORTION OF THE BLOOD (55%)
• organic substances
– wastes and nutrients
• inorganic substances
– Na+, Cl-, K+, Ca+2, Mg+2, HCO3 –, Fe
• gases
– O2, CO2 and N2

Erythrocytes
• Red Blood Cells
• biconcave and anucleus
• transport of O2 & CO2 through hemoglobin (Hgb)
• contribute to the buffering capacity of the blood
• (+) Rouleaux formation
• 90-120 days (127days)
• destroyed in the spleen

Erythropoiesis
• formation of RBC’s
• 2million RBC’s per second
• occur in hemopoietic organs like yolk sac, liver and myeloid tissue in bone marrow
• requires Vit. B12 and Folic Acid
STIMULUS:
• hypoxia (oxygen deficiency in high altitude)
• activates kidney cells to release “renal erythropoietic factor” (REF)
• REF/erythrogenin activates globulin/erythropoietinogen erythropoietin
• Erythropoietin activates erythropoiesis
• Erythrocyte / RBC
• after 127 days
• phagocytosis
• RBC  Fe Group and Heme Group
• Fe Group  Liver (stored there) and Bone marrow (used to synthesize Hgb again)
• Heme Group  Bilirubin (goes to bloodstream then to the liver to be excreted)

Hematocrit
• percent of RBC in the blood
• Males: 42-52%
• Females: 37-47%
•  hematocrit =  RBC,  water
• therefore, person is dehydrated

Thrombocytes
• platelets
• fragments of megakaryocytes
• involved in hemostasis (blood clotting)
• disintegrate to release thromboplasts
• life span of 10 days
• 150,000-450,000 cells per cc of blood
Leukocytes
• (+) nuclei
• 5000-9000 cells per cc of blood
• GRANULOCYTES
– Neutrophils
– Basophils
– Eosinophils
• AGRANULOCYTES
– Monocytes
– Lymphocytes

Neutrophils
• most abundant WBC’s
• very short lived (12-72 hrs)
• contain non-staining granules
• responsible for phagocytosis of microorganisms
• replaced at the rate of about 100,000,000,000 per day.

Basophils
• aka MAST CELLS
• have an S-shaped nucleus and granules which stain BLUE
• secrete large amounts of histamine and heparin

Eosinophils
• have a double-lobed nucleus and granules which stain red.
• Help control the allergic response
• secrete enzyme which inactivate histamine
• increase during allergic reactions and in response to some parasitic infections

Monocytes
• 2nd line of defense
• LARGEST of the WBC’s
• non-granular cytoplasm
• have a large bean-shaped nucleus
• spend a short time in the circulatory system (2-3days) before they mature into phagocytic
MACROPHAGES

Lymphocytes
• make up about 30% of circulating leukocytes
• produced in the bone marrow and continue to develop and mature in the:
– lymph nodes, thymus and spleen.
– responsible for specific immune response
– T-lymphocytes direct cell destruction
– B-lymphocytes produce antibodies
• identified by deeply staining nucleus and a thin “halo” of clear cytoplasm

THE A-B-O BLOOD GROUP

 thus, a patient can only receive blood from a person of the same blood type or from O only
 Since O can be received by any blood type, it is considered as universal donor
 Since AB can receive any of the blood types, it is the universal recipient
 Possible side effects of Incompetent Transfusion:
• oxygen carrying capacity of RBC is disrupted
• RBC’s clump in small vessels and it hinders blood flow to tissues beyond these points
• will cause fever, chills, nausea and vomiting
• Hgb released in the bloodstream will cause kidney blocks leading to renal breakdown and possible death

Rh Blood Group
 • Named because the antigen was discovered in the blood of the Rhesus macacca monkeys
• People where RBCs have Rh antigens are designated as Rh +
• People who lack Rh antigens are designated Rh -
• Normally, plasma does not contain anti-Rh antibodies

CHARACTERISTICS OF RH TRANSFUSION:
• Upon 1st exposure:
• no immediate reaction
• delayed transfusion reaction occurs
• body starts to make antibodies or isoantibodies
• On the 2nd exposure:
• the previously formed anti-Rh antibodies ATTACK the Rh  agglutination
• Erythroblastosis Fetalis
• a problem can only arise when the mother is Rh - & the baby is Rh+
• At birth, a small quantity of fetal blood usually leaks across the placenta into the maternal bloodstream
• Upon exposure to Rh antigen, the mother’s immune system responds by making anti-Rh antibody.

• Because baby is already born, it suffers no damage

• During a subsequent pregnancy, however, the maternal antibodies cross the placenta into the fetal
blood.
• If the 2nd fetus is Rh+ , the antigen-antibody reaction cause hemolysis of the fetal RBCs 
• anemic & hypoxic 
• BRAIN DAMAGE OR DEATH

BLOOD CLOTTING
Hemostasis
• injury to wall of blood vessel 
• vasoconstriction 
• platelet plug formation 
• clot formation 
• EXTRINSIC PATHWAY (from tissues)
• INTRINSIC PATHWAY (from blood)

Extrinsic Pathway
• Injured tissue releases thromboplastin 
• thromboplastin reacts with Ca+2 
• thromboplastin & Ca+2 activates FACTOR X 
• FACTOR X converts prothrombin to thrombin 
• thrombin converts fibrinogen to fibrin

Intrinsic Pathway
• FACTOR XII activates FACTOR X 
• FACTOR X converts prothrombin to thrombin 
• thrombin converts fibrinogen to fibrin

Fibrin
• forms a net over the platelets
• RBC’s are attracted and are stuck in this net
• RBC’s and platelets are entangled within the fibrin net which forms the BLOOD CLOT
• This is a STRONGER & MORE PERMANENT plug to stop blood loss

Clot Dissolution
• During tissue repair, clot contracts by withdrawal of “pseudopods”
• TO DISSOLVE A CLOT:
• plasminogen is converted to plasmin 
• plasmin lyse (break up) the fibrin net
BLOOD DISORDERS
1. Anemia
•  in Hgb
• decrease in O2 carrying capacity of blood
• causes/leads to muscle weakness and fatigue

Types of Anemia
Crocytic/Megaloblastic
• d/t Vit. B12 and Folic acid deficiency (RBC’s cannot complete maturation so malaki pa rin sila, so they
cannot transport through the capillaries and so there’s no effective gas exchange)

Microcytic/Hypochromic
• aka Iron-deficiency anemia (iron needed for manufacturing of Hgb)
• cannot manufacture Hgb  pale/blank RBC’s (without Hgb, RBC’s cannot transport O2, so there’s no
effective gas exchange)

Thalassemia
• hereditary anemia  pale/blank RBC’s (microcytic and hypochromic)

Normocytic/Hemorrhagic
•  in number of RBC’s d/t blood loss

Pernicious
•  in number of intrinsic factors
• cannot absorb Vit. B12

Hemolytic
• lysis of RBC’s as a result of bacterial infection

Aplastic
• depression/destruction of bone marrow by cancer, radiation, or certain medications

Sickle Cell Disease

• RBC’s contain an abnormal kind of Hgb
• Hb-S
• Hb-S gives up oxygen to the interstitial fluid
• erythrocytes bend into sickle shape cells
• The sickled cells rupture easily
• This leads to anemia  shortness of breath, fatigue, paleness, and delayed growth and development

Leukocytes
• Leukocytosis
• increase in number of WBC’s
• indicates bacterial and/or viral infection
• Leukopenia
• abnormally low count of WBC’s
• renders the person prone to infection (immunocompromised/immunodeficient/immunosuppressed)
• Leukemia
• abnormal/cancerous WBC’s multiply uncontrollably in the red bone marrow
• accumulation of the cancerous WBC’s interferes with the production of RBC’s, WBC’s and platelets
• accumulation of the cancerous WBC’s interferes with the production of RBC’s, WBC’s and platelets.
• As a result the:
• oxygen-carrying capacity of the blood is reduced (RBC)
• an individual is more susceptible to infection (WBC)
• and blood clotting is abnormal (platelets)
Thrombocytes
• Thrombocytosis
 •  number of platelets
• formation of thrombosis  occlusion of blood vessels
• Thrombocytopenia
• abnormally low count of platelets
• problems in blood clotting  bleeding
• SIGNS OF BLEEDING:
• petechiae
• ecchymosis

Hemophilia
• hereditary disorder in which one or more of the blood clotting factors are absent
• leading to impaired clot formation (bleeding)

Types of Hemophilia
• Hemophilia A
• absence of factor VIII
• Hemiphilia B
• lack of factor IX
• occur primarily among males
• Hemophilia C
• lack of factor XI
• affects both males and females

Vitamin K Deficiency
• decreased Vitamin K
• leads to decrease in prothrombin synthesis 
• (-) prothrombin  (-) thrombin activation 
• (-) thrombin  fibrinogen cannot be converted to fibrin
• (-) fibrin net  impaired clot formation
BLOOD VESSELS

Layers of B. Vessels
Tunica intima
- aka endothelium; inner lining/wall of b. vessels
2. Tunica media/intermedia
-made up of smooth muscle; very well developed in arteries
3. Tunica adventitia/externa
-outermost layer of b. vessels; very well developed in veins
Peripheral Vasculature
1.Capillaries
- site of gas exchange
 - walls composed only of a thin endothelium
2. Arteries
- carry oxygenated blood AWAY from the heart
3. Veins
-carry deoxygenated blood TOWARDS the heart
- have valves to prevent backflow and so prevent pooling of blood on the LE
- walls are less rigid and readily change shape when muscles press on them

The Lymphatic System

FUNCTIONS
• drains excess fluid from the interstitial space, removing excess fluid, blood waste, and protein molecules
(substances that have leaked out from capillaries)
• (+) immune functions; protect the body from infection and disease

HEART
The heart of a healthy 70 kg person pumps approximately 7200 L
(approximately 1900 gallons) of blood each day at a rate of 5 L/min. For
most people, the heart continues to pump for more than 75 years.
FUNCTIONS:
• Generating blood pressure
• Routing of blood
• Ensuring one-way blood flow
• Regulating blood supply
DESCRIPTION:
• Hollow, cone-shaped, about the same size as a person’s fist
• Females: 250 g (8 oz)
• Males: 300 g (10 oz)
LOCATION:
• Rests on the diaphragm
• Near the midline of the thoracic cavity in the MEDIASTINUM
APEX:
• Pointed end of the heart; directed anteriorly, inferiorly, & to
the (L)
• Located at the 5th intercostal space (ICS), (L) midclavicular line
BASE:
• Broad portion of the heart
• directed posteriorly, superiorly, & to the (R)
• 4 chambers
• 2 atria and 2 ventricles

STRUCTURE:
• Pericardium
• The membrane that surrounds & protects the heart
• Consists of two parts
• Fibrous
• Superficial, tough, inelastic
• provides protection, & anchors the heart in the mediastinum
• prevents overstretching of the heart
• Serous
• A thinner, more delicate membrane that forms a double layer around the heart
• Made up of two layers: parietal and visceral

Serous Pericardium
• Parietal
• outer layer
• fused to the fibrous pericardium
• Visceral
• inner layer
 • adhered tightly to the outermost surface of the heart (epicardium)
Pericardial Fluid**
a thin, slippery secretion of the pericardial cells that reduces the friction between the membranes as the heart
moves

STRUCTURE:
• WALLS OF THE HEART
• epicardium
• myocardium
• endocardium
STRUCTURE:
• CHAMBERS OF THE HEART
• right and left ATRIA
• receiving chambers
• divided by the interatrial septum
• right and left VENTRICLES
• pumping chambers
• divided by the interventricular septum

STRUCTURE:
• VALVES OF THE HEART
• atrioventricular valves
• between atria and ventricles
• tricuspid on (R); bicuspid on (L)
• semilunar valves
• between ventricles and arteries
• PULMONARY valves (RV  pulmo artery)
• AORTIC valves (LV  aorta)
Valves of the Heart
• valves operate AUTOMATICALLY as
• the pressure changes
• Valves OPEN if
• atrial pressure > ventricular pressure
• Valves CLOSE if
• ventricular pressure > atrial pressure
STRUCTURE AND FUNCTION
Myocardium
• composed of cardiac muscles
• (+) intercalated discs
• has a long refractory period
• interval between two consecutive excitatory impulses
• eliminates danger of fatigue
Right Ventricle
• generates pressure to pump DEOXYGENATED blood to the pulmonary circulation
Pulmonary Valve
• pulmonary (SEMILUNAR) valve
• composed of THREE cusps
• prevents backflow of blood into the right ventricle
• flaps/cusps are forced together when the pressure in the pulmonary artery exceeds that in the right
ventricle (PA > RV)
Pulmonary Artery
• delivers the blood from the RV to the pulmonary circulation (to the lungs) for oxygenation
• the ONLY artery in the body that carry deoxygenated blood
Pulmonary Vein
• delivers the OXYGENATED blood from the lungs to the left atrium
• the ONLY vein in the body that carry oxygenated blood
Left Atrium
• receives the OXYGENATED blood from the pulmonary circulation
Mitral Valve
• Mitral / Bicuspid (atrioventricular) valve
• prevents backflow of blood to the LA
• ensures blood flow from LV to the aorta
Chordae Tendinae
• connects to free edges of atrioventricular valves to prevent “BLOW-BACK” of valves during ventricular
contraction

Papillary Muscles
• tightens the chordae tendinae just BEFORE the ventricles contract
Left Ventricle
• generates pressure to force blood into the SYSTEMIC circulation (to the rest of the body)
Aortic Valve
• aortic (SEMILUNAR) valve
• prevents backflow of blood into the left ventricle
• flaps/cusps are forced together when the pressure in the aorta exceeds that in the left ventricle (AO >
LV)
• delivers the O2 blood from the LV to the systemic circulation (to the body)
• more ELASTIC fibers than smooth muscles
• allows the walls of the aorta to accommodate the surge of blood associated with contraction of the
heart
Vena Cava
• Superior and Inferior Vena Cava
• carry DEOXYGENATED blood from the systemic circulation to the right atrium
Right Atrium
• receives the DEOXYGENATED blood from the systemic circulation
Tricuspid Valve
• Tricuspid / Right (atrioventricular) valve
• has THREE fibrous flaps
• prevents backflow of blood to the RA
• ensures blood flow from RV to the pulmonary artery

Pulmonary Circulation
• occupies the RIGHT side of the heart
• carries deoxygenated blood from the right ventricle to the respiratory surfaces of the lungs for
AERATION / OXYGENATION
• from the HEART  LUNGS
• then LUNGS  HEART

Systemic Circulation
• occupies the LEFT side of the heart
• for distribution of OXYGENATED blood to various parts of the body
• from the LUNGS  HEART
• then HEART  TISSUES OF THE BODY
CONDUCTION SYSTEM OF THE HEART
Intrinsic Conduction System
• consists of specialized cardiac cells
• initiate and distribute impulses throughout the heart from atrium to ventricle
• conduction of impulses happens very rapidly such that the heart “BEATS NEARLY AS ONE CELL”
• conduction travels through the cross bridge with gap junction

Components
• Sinoatrial node
• Atrioventricular node
• AV bundle of His
• (L) & (R) bundle branches
• Purkinje fibers
 • Ventricular myocardium
• TIME ELAPSE = 0.22 sec.
AP propagate through the conduction system in the following sequence:
Sinoatrial (SA) Node
Located in the ® atrial wall just inferior to the opening of the superior vena cava
Normal Pacemaker of the Heart
Start of the cardiac excitation
Atrioventricular (AV) Node
Located in the interatrial septum. Just anterior to the opening of the coronary sinus
Acts as the pacemaker of the heart if SA node becomes damaged → spontaneous depolarization is 40-
60x/min.
Atrioventricular (AV) Bundle / Bundle of His – the only site where action potential can conduct from the atria to
the ventricles
® & (L) Bundle Branches – extends through the interventricular septum to the apex
Purkinje Fibers – conduct action potential from the apex upward to the remainder of the ventricular myocardium
→ (+) contraction of the ventricles
If activity of both nodes is suppressed: → inadequate blood flow to the brain → (+) Artificial pacemaker
ECG
• Instrument used: Electrocardiograph
• A recording of the electric currents as action potentials propagate through the heart
• Can determine if:
– The conducting pathway is abnormal
– The heart is enlarged
– Certain regions of the heart are damaged

Three clearly recognizable waves appear with each heartbeat:

P wave – atrial depolarization
QRS complex – rapid ventricular depolarization
T wave – ventricular repolarization
CARDIAC CYCLE
• associated with one heartbeat
• alternate contraction and relaxation of the heart
• consists of:
– systole and diastole of atria
– systole and diastole of ventricles
HEART SOUNDS
S1
• “LUB”
• caused by blood turbulence associated with the closure of AV valves
• blood from the atria strike the stationary blood in the ventricles
S2

• “DUB”
• caused by blood turbulence associated with the closure of SL valves
• blood from the ventricles strike the stationary blood in the arteries (aorta and pulmonary arteries)
S3
• caused by blood turbulence during rapid ventricular filling
S4
• caused by blood turbulence during atrial systole

Cardiac Output
Cardiac output (CO) is the volume of blood ejected from the left ventricle (or the right ventricle) into the aorta (or
pulmonary trunk) each minute. Cardiac output equals the stroke volume (SV), the volume of blood ejected by the
ventricle during each contraction, multiplied by the heart rate (HR), the number of heart beats per minute:
CO = SV x HR
(mL/min) (mL/beat) (beats/min)
In a typical resting adult male, stroke volume averages 70 mL/beat, and heart rate is about 75 beats/min. Thus,
average cardiac output is
5250mL/min or 5.25L/min
5250mL/min or 5.25L/min
• increased if either stroke volume and heart rate increase
Stroke Volume
• Preload
– degree of stretch on the heart before it contracts
• Contractility
– force of contraction
• Afterload
– pressure that must be exceeded before ejection of blood from the ventricles occur
Frank-Starling’s Law
• heart can beat more forcefully or less forcefully depending on the volume of the blood entering the heart
• Frank-Starling’s Law of the Heart
• the capacity of the heart to adjust the force of contraction depending on the amount of blood
•  vol. of blood =  force of contraction
Blood Pressure
• force exerted by the blood against the wall of the blood vessels
• controlled by modifying the activity of the vasomotor centers in the medulla
• Pressor area
– vasoconstriction;  BP
• Depressor area
– vasodilation;  BP