Erythropoiesis: Production of RBCs

Erythropoiesis (e-rith′-rō-poy-Ē-sis), the production of RBCs, starts

in the red bone marrow with a precursor cell called a proerythroblast
(prō-e-RITH-rō-blast) (see Figure 19.3). The proerythroblast divides
several times, producing cells that begin to synthesize hemoglobin.
Ultimately, a cell near the end of the development sequence ejects its
nucleus and becomes a reticulocyte (re-TIK-ū-lō-sīt). Loss of the
nucleus causes the center of the cell to indent, producing the red
blood cell’s distinctive biconcave shape. Reticulocytes retain some
Clinical Connection
Blood Doping
Delivery of oxygen to muscles is a limiting factor in muscular feats from
weightlifting to running a marathon. As a result, increasing the oxygen-
carrying capacity of the blood enhances athletic performance, especially
678 CHAPTER 1 9 The Cardiovascular System: The Blood
Checkpoint
9. Describe the size, microscopic appearance, and functions of RBCs.
10. How is hemoglobin recycled?
11. What is erythropoiesis? How does erythropoiesis affect
hematocrit? What factors speed up and slow down
erythropoiesis?

19.4 White Blood Cells

OBJECTIVE
• Describe the structure, functions, and production of white blood
cells.
Types of White Blood Cells
Unlike red blood cells, white blood cells (WBCs) or leukocytes (LOO-
kō-sīts; leuko- = white) have nuclei and a full complement of other
organelles but they do not contain hemoglobin. WBCs are classified
as either granular or agranular, depending on whether they contain
conspicuous chemical-filled cytoplasmic granules (vesicles) that are
made visible by staining when viewed through a light microscope.
in endurance events. Because RBCs transport oxygen, athletes have tried
several means of increasing their RBC count, known as blood doping or
artificially induced polycythemia (an abnormally high number of RBCs),
to gain a competitive edge. Athletes have enhanced their RBC production
by injecting epoetin alfa (Procrit® or Epogen®), a drug that is used to treat
anemia by stimulating the production of RBCs by red bone marrow. Prac-
tices that increase the number of RBCs are dangerous because they raise
the viscosity of the blood, which increases the resistance to blood flow and
makes the blood more difficult for the heart to pump. Increased viscosity
also contributes to high blood pressure and increased risk of stroke. Dur-
ing the 1980s, at least 15 competitive cyclists died from heart attacks or
strokes linked to suspected use of epoetin alfa. Although the International
Olympics Committee bans the use of epoetin alfa, enforcement is difficult
because the drug is identical to naturally occurring erythropoietin (EPO).
So-called natural blood doping is seemingly the key to the success
of marathon runners from Kenya. The average altitude throughout
Kenya’s highlands is about 6000 feet (1829 meters) above sea level;
other areas of Kenya are even higher. Altitude training greatly improves
fitness, endurance, and performance. At these higher altitudes, the body
increases the production of red blood cells, which means that exercise
greatly oxygenates the blood. When these runners compete in Boston,
for example, at an altitude just above sea level, their bodies contain more
erythrocytes than do the bodies of competitors who trained in Boston. A
number of training camps have been established in Kenya and now attract
endurance athletes from all over the world.
FIGURE 19.6 Negative feedback regulation of erythropoiesis (red
blood cell formation). Lower oxygen content of air at high altitudes,
anemia, and circulatory problems may reduce oxygen delivery to body
tissues.
The main stimulus for erythropoiesis is hypoxia, an oxygen deficiency
at the tissue level.
Q How might your hematocrit change if you moved from a
town at sea level to a high mountain village?
STIMULUS
CONTROLLED CONDITION
RESPONSE
Return to
homeostasis when
oxygen delivery to
kidneys increases
to normal

–
Output
Input Detect low oxygen levels,
increasing erythropoietin
secretion into blood
RECEPTORS
CONTROL CENTER
EFFECTORS
Disrupts homeostasis
by decreasing
Increased oxygen
delivery to tissues
More reticulocytes
enter circulating blood
Proerythroblasts
in red bone
marrow mature
more quickly
into reticulocytes
Kidney cells
Larger number
of red blood cells
in circulation
Oxygen delivery to kidneys
(and other tissues)
19.4 White Blood Cells 679
cell, the more cytoplasm is visible. Lymphocytes are classified by
cell diameter as large lymphocytes (10–14 μm) or small lymphocytes
(6–9 μm). Although the functional significance of the size difference
between small and large lymphocytes is unclear, the distinction is
still clinically useful because an increase in the number of large lym-
phocytes has diagnostic significance in acute viral infections and in
some immunodeficiency diseases.
• Monocyte. The nucleus of a monocyte (MON-ō-sīt′) is usually
kidney-shaped or horseshoe-shaped, and the cytoplasm is blue-gray
and has a foamy appearance (Figure 19.7e). The cytoplasm’s color
and appearance are due to very fine azurophilic granules (az′-ū-rō-
FIL-ik; azur- = blue; -philic = loving), which are lysosomes. Blood is
merely a conduit for monocytes, which migrate from the blood into
the tissues, where they enlarge and differentiate into macrophages
(MAK-rō-fā-jez = large eaters). Some become fixed (tissue) mac-
rophages, which means they reside in a particular tissue; exam-
ples are alveolar macrophages in the lungs or macrophages in the
spleen. Others become wandering macrophages, which roam the
tissues and gather at sites of infection or inflammation.
White blood cells and all other nucleated cells in the body have
proteins, called major histocompatibility (MHC) antigens, protrud-
ing from their plasma membrane into the extracellular fluid. These
“cell identity markers” are unique for each person (except identical
twins). Although RBCs possess blood group antigens, they lack the
MHC antigens.
Functions of White Blood Cells
In a healthy body, some WBCs, especially lymphocytes, can live for
several months or years, but most live only a few days. During a period
of infection, phagocytic WBCs may live only a few hours. WBCs are far
less numerous than red blood cells; at about 5000–10,000 cells per
microliter of blood, they are outnumbered by RBCs by about 700:1.
Leukocytosis (loo′-kō-sī-TO
- -sis), an increase in the number of WBCs
above 10,000/μL, is a normal, protective response to stresses such as
invading microbes, strenuous exercise, anesthesia, and surgery. An
abnormally low level of white blood cells (below 5000/ μL) is termed
Granular leukocytes include neutrophils, eosinophils, and basophils;
agranular leukocytes include lymphocytes and monocytes. As shown
in Figure 19.3, monocytes and granular leukocytes develop from
myeloid stem cells. In contrast, lymphocytes develop from lymphoid
stem cells.
Granular Leukocytes After staining, each of the three types
of granular leukocytes displays conspicuous granules with distinctive
coloration that can be recognized under a light microscope. Granular
leukocytes can be distinguished as follows:
• Neutrophil. The granules of a neutrophil (NOO-trō-fil) are smaller
than those of other granular leukocytes, evenly distributed, and pale
lilac (Figure 19.7a). Because the granules do not strongly attract
either the acidic (red) or basic (blue) stain, these WBCs are neutro-
philic (= neutral loving). The nucleus has two to five lobes, con-
nected by very thin strands of nuclear material. As the cells age, the
number of nuclear lobes increases. Because older neutrophils thus
have several differently shaped nuclear lobes, they are often called
polymorphonuclear leukocytes (PMNs), polymorphs, or “polys.”
• Eosinophil. The large, uniform-sized granules within an eosinophil
(ē-ō-SIN-ō-fil) are eosinophilic (= eosin-loving)—they stain red-
orange with acidic dyes (Figure 19.7b). The granules usually do not
cover or obscure the nucleus, which most often has two lobes con-
nected by either a thin strand or a thick strand of nuclear material.
• Basophil. The round, variable-sized granules of a basophil (BĀ-sō-
fil) are basophilic (= basic loving)—they stain blue-purple with basic
dyes (Figure 19.7c). The granules commonly obscure the nucleus,
which has two lobes.
Agranular Leukocytes Even though so-called agranular
leukocytes possess cytoplasmic granules, the granules are not visible
under a light microscope because of their small size and poor staining
qualities.
• Lymphocyte. The nucleus of a lymphocyte (LIM-fō-sīt) stains dark
and is round or slightly indented ( Figure 19.7d). The cytoplasm
stains sky blue and forms a rim around the nucleus. The larger the
FIGURE 19.7 Types of white blood cells.
The shapes of their nuclei and the staining properties of their cytoplasmic granules distinguish
white blood cells from one another.
Q Which WBCs are called granular leukocytes? Why?
all 1600xLM
(a) Neutrophil (b) Eosinophil (c) Basophil (d) Lymphocyte (e) Monocyte
Courtesy Michael Ross, University of Florida
680 CHAPTER 1 9 The Cardiovascular System: The Blood
antibody complexes and are effective against certain parasitic worms.
A high eosinophil count often indicates an allergic condition or a para-
sitic infection.
At sites of inflammation, basophils leave capillaries, enter tissues,
and release granules that contain heparin, histamine, and serotonin.
These substances intensify the inflammatory reaction and are in-
volved in hypersensitivity (allergic) reactions. Basophils are similar in
function to mast cells, connective tissue cells that originate from
pluripotent stem cells in red bone marrow. Like basophils, mast cells
release substances involved in inflammation, including heparin,
histamine, and proteases. Mast cells are widely dispersed in the body,
particularly in connective tissues of the skin and mucous membranes
of the respiratory and gastrointestinal tracts.
Lymphocytes are the major soldiers in lymphatic system battles
(described in detail in Chapter 22). Most lymphocytes continually
move among lymphoid tissues, lymph, and blood, spending only a
few hours at a time in blood. Thus, only a small proportion of the total
lymphocytes are present in the blood at any given time. Three main
types of lymphocytes are B cells, T cells, and natural killer (NK) cells.
B cells are particularly effective in destroying bacteria and inactivat-
ing their toxins. T cells attack infected body cells and tumor cells, and
leukopenia (loo′-kō-PĒ-nē-a). It is never beneficial and may be
caused by radiation, shock, and certain chemotherapeutic agents.
The skin and mucous membranes of the body are continuously
exposed to microbes and their toxins. Some of these microbes can
invade deeper tissues to cause disease. Once pathogens enter the
body, the general function of white blood cells is to combat them by
phagocytosis or immune responses. To accomplish these tasks, many
WBCs leave the bloodstream and collect at sites of pathogen invasion
or inflammation. Once granular leukocytes and monocytes leave the
bloodstream to fight injury or infection, they never return to it. Lym-
phocytes, on the other hand, continually recirculate—from blood to
interstitial spaces of tissues to lymphatic fluid and back to blood. Only
2% of the total lymphocyte population is circulating in the blood at
any given time; the rest is in lymphatic fluid and organs such as the
skin, lungs, lymph nodes, and spleen.
RBCs are contained within the bloodstream, but WBCs leave the
bloodstream by a process termed emigration (em′-i-GRĀ-shun; e- =
out; -migra- = wander), also called diapedesis (dī-a-pe-DĒ-sis), in
which they roll along the endothelium, stick to it, and then squeeze
between endothelial cells ( Figure 19.8). The precise signals that
stimulate emigration through a particular blood vessel vary for the
different types of WBCs. Molecules known as adhesion molecules
help WBCs stick to the endothelium. For example, endothelial cells
display adhesion molecules called selectins in response to nearby in-
jury and inflammation. Selectins stick to carbohydrates on the sur-
face of neutrophils, causing them to slow down and roll along the en-
dothelial surface. On the neutrophil surface are other adhesion
molecules called integrins, which tether neutrophils to the endotheli-
um and assist their movement through the blood vessel wall and into
the interstitial fluid of the injured tissue.
Neutrophils and macrophages are active in phagocytosis (fag′-
ō-sī-TO
- -sis); they can ingest bacteria and dispose of dead matter (see
Figure 3.13). Several diff erent chemicals released by microbes and
inflamed tissues attract phagocytes, a phenomenon called chemo-
taxis (kē-mō-TAK-sis). The substances that provide stimuli for
chemotaxis include toxins produced by microbes; kinins, which are
specialized products of damaged tissues; and some of the colony-
stimulating factors (CSFs). The CSFs also enhance the phagocytic
activity of neutrophils and macrophages.
Among WBCs, neutrophils respond most quickly to tissue de-
struction by bacteria. After engulfing a pathogen during phagocytosis,
a neutrophil unleashes several chemicals to destroy the pathogen.
These chemicals include the enzyme lysozyme (LI
--sō-zīm), which de-
stroys certain bacteria, and strong oxidants, such as the superoxide
anion (O 2−), hydrogen peroxide (H 2O 2), and the hypochlorite anion
(OCl−), which is similar to household bleach. Neutrophils also contain
defensins, proteins that exhibit a broad range of antibiotic activity
against bacteria and fungi. Within a neutrophil, vesicles containing
defensins merge with phagosomes containing microbes. Defensins
form peptide “spears” that poke holes in microbe membranes; the
resulting loss of cellular contents kills the invader.
Eosinophils leave the capillaries and enter tissue fluid. They are
believed to release enzymes, such as histaminase, that combat the
effects of histamine and other substances involved in inflammation
during allergic reactions. Eosinophils also phagocytize antigen–
FIGURE 19.8 Emigration of white blood cells.
Adhesion molecules (selectins and integrins) assist the emigration of
WBCs from the bloodstream into interstitial fluid.
Q In what way is the “traffic pattern” of lymphocytes in the
body different from that of other WBCs?
Endothelial cell
Emigration
Interstitial fluid
Rolling
Sticking
Squeezing between
endothelial cells
Neutrophil
Selectins on
endothelial cells
Key:
Integrins on
neutrophil
Blood flowBlood flow
19.5 Platelets 681
Checkpoint
12. What is the importance of emigration, chemotaxis, and
phagocytosis in fighting bacterial invaders?
13. How are leukocytosis and leukopenia different?
14. What is a differential white blood cell count?
15. What functions do granular leukocytes, macrophages, B cells,
T cells, and natural killer cells perform?

19.5 Platelets
OBJECTIVE
• Describe the structure, function, and origin of platelets.
Besides the immature cell types that develop into erythrocytes and
leukocytes, hemopoietic stem cells also differentiate into cells that
produce platelets. Under the influence of the hormone thrombo-
poietin, myeloid stem cells develop into megakaryocyte colony-
forming cells that in turn develop into precursor cells called
megakaryoblasts (see Figure 19.3). Megakaryoblasts transform into
megakaryocytes, huge cells that splinter into 2000 to 3000 fragments.
Each fragment, enclosed by a piece of the plasma membrane, is a
platelet. Platelets break off from the megakaryocytes in red bone mar-
row and then enter the blood circulation. Between 150,000 and 400,000
platelets are present in each microliter of blood. Each is irregularly disc-
shaped, 2–4 μm in diameter, and has many vesicles but no nucleus.
Their granules contain chemicals that, once released, promote
blood clotting. Platelets help stop blood loss from damaged blood
vessels by forming a platelet plug. Platelets have a short life span, nor-
mally just 5 to 9 days. Aged and dead platelets are removed by fixed
macrophages in the spleen and liver.
Table 19.3 summarizes the formed elements in blood.
Clinical Connection
Complete Blood Count
A complete blood count (CBC) is a very valuable test that screens for ane-
mia and various infections. Usually included are counts of RBCs, WBCs, and
platelets per microliter of whole blood; hematocrit; and differential white
blood cell count. The amount of hemoglobin in grams per milliliter of blood
also is determined. Normal hemoglobin ranges are as follows: infants, 14–
20 g/100 mL of blood; adult females, 12–16 g/100 mL of blood; and adult
males, 13.5–18 g/100 mL of blood.
Checkpoint
16. How do RBCs, WBCs, and platelets compare with respect to size,
number per microliter of blood, and life span?
are responsible for the rejection of transplanted organs. Immune re-
sponses carried out by both B cells and T cells help combat infection
and provide protection against some diseases. Natural killer cells at-
tack a wide variety of infected body cells and certain tumor cells.
Monocytes take longer to reach a site of infection than neutro-
phils, but they arrive in larger numbers and destroy more microbes.
On their arrival, monocytes enlarge and differentiate into wandering
macrophages, which clean up cellular debris and microbes by phago-
cytosis after an infection.
As you have already learned, an increase in the number of circu-
lating WBCs usually indicates inflammation or infection. A physician
may order a differential white blood cell count, or “diff”, a count of
each of the five types of white blood cells, to detect infection or in-
flammation, determine the effects of possible poisoning by chemicals
or drugs, monitor blood disorders (for example, leukemia) and the
effects of chemotherapy, or detect allergic reactions and parasitic
infections. Because each type of white blood cell plays a different role,
determining the percentage of each type in the blood assists in diag-
nosing the condition. Table 19.2 lists the significance of both high
and low WBC counts.
TA B L E 1 9 . 2 Significance of High and Low White Blood Cell Counts
WBC TYPE
HIGH COUNT
MAY INDICATE
LOW COUNT MAY
INDICATE
Neutrophils Bacterial infection,
burns, stress,
inflammation.
Radiation exposure,
drug toxicity,
vitamin B 12 deficiency,
systemic lupus
erythematosus (SLE).
Lymphocytes Viral infections, some
leukemias, infectious
mononucleosis.
Prolonged illness,
HIV infection,
immunosuppression,
treatment with
cortisol.
Monocytes Viral or fungal
infections, tuberculosis,
some leukemias, other
chronic diseases.
Bone marrow
suppression,
treatment with
cortisol.
Eosinophils Allergic reactions,
parasitic infections,
autoimmune diseases.
Drug toxicity, stress,
acute allergic
reactions.
Basophils Allergic reactions,
leukemias, cancers,
hypothyroidism.
Pregnancy,
ovulation, stress,
hypothyroidism.
Courtesy Michael Ross, University of Florida
682 CHAPTER 1 9 The Cardiovascular System: The Blood
TA B L E 1 9 . 3 Summary of Formed Elements in Blood
NAME AND APPEARANCE NUMBER CHARACTERISTICS* FUNCTIONS
RED BLOOD CELLS (RBCS) OR
ERYTHROCYTES
4.8 million/μL in females;
5.4 million/μL in males.
7–8 μm diameter, biconcave discs,
without nuclei; live for about
120 days.
Hemoglobin within RBCs transports
most oxygen and part of carbon
dioxide in blood.
WHITE BLOOD CELLS (WBCS)
OR LEUKOCYTES
5000–10,000/μL. Most live for a few hours to a few
days.†
Combat pathogens and other foreign
substances that enter body.
Granular leukocytes
Neutrophils 60–70% of all WBCs. 10–12 μm diameter; nucleus has
2–5 lobes connected by thin strands
of chromatin; cytoplasm has very
fine, pale lilac granules.
Phagocytosis. Destruction of bacteria
with lysozyme, defensins, and strong
oxidants, such as superoxide anion,
hydrogen peroxide, and hypochlorite
anion.
Eosinophils 2–4% of all WBCs. 10–12 μm diameter; nucleus usually
has 2 lobes connected by thick
strand of chromatin; large, red-
orange granules fill cytoplasm.
Combat effects of histamine in allergic
reactions, phagocytize antigen–
antibody complexes, and destroy
certain parasitic worms.
Basophils 0.5–1% of all WBCs. 8–10 μm diameter; nucleus has
2 lobes; large cytoplasmic granules
appear deep blue-purple.
Liberate heparin, histamine, and
serotonin in allergic reactions that
intensify overall inflammatory
response.
Agranular leukocytes
Lymphocytes (T cells,
B cells, and natural
killer cells)
20–25% of all WBCs. Small lymphocytes are 6–9 μm in
diameter; large lymphocytes are
10–14 μm in diameter; nucleus
is round or slightly indented;
cytoplasm forms rim around
nucleus that looks sky blue; the
larger the cell, the more cytoplasm
is visible.
Mediate immune responses, including
antigen–antibody reactions. B cells
develop into plasma cells, which
secrete antibodies. T cells attack
invading viruses, cancer cells, and
transplanted tissue cells. Natural killer
cells attack wide variety of infectious
microbes and certain spontaneously
arising tumor cells.
Monocytes 3–8% of all WBCs. 12–20 μm diameter; nucleus is
kidney-or horseshoe-shaped;
cytoplasm is blue-gray and appears
foamy.
Phagocytosis (after transforming into
fixed or wandering macrophages).
PLATELETS 150,000–400,000/μL. 2–4 μm diameter cell fragments
that live for 5–9 days; contain many
vesicles but no nucleus.
Form platelet plug in hemostasis;
release chemicals that promote
vascular spasm and blood clotting.
*Colors are those seen when using Wright’s stain.
†
Some lymphocytes, called T and B memory cells, can live for many years once they are established.
Juergen Berger/Science Source Images
Courtesy Michael Ross, University of FloridaCourtesy Michael Ross, University of Florida
Mark Nielsen
19.7 Hemostasis 683
3. They are less likely to cause graft-versus-host disease, so the match
between donor and recipient does not have to be as close as in a
bone marrow transplant. This provides a larger number of poten-
tial donors.
4. They are less likely to transmit infections.
5. They can be stored indefinitely in cord-blood banks.
Checkpoint
17. How are cord-blood transplants and bone marrow transplants
similar? How do they differ?

19.7 Hemostasis
OBJECTIVES
• Describe the three mechanisms that contribute to hemostasis.
• Explain the various factors that promote and inhibit blood clotting.
Hemostasis (hē-mō-STĀ-sis), not to be confused with the very similar
term homeostasis, is a sequence of responses that stops bleeding.
When blood vessels are damaged or ruptured, the hemostatic
response must be quick, localized to the region of damage, and care-
fully controlled in order to be eff ective. Three mechanisms reduce
blood loss: (1) vascular spasm, (2) platelet plug formation, and
(3) blood clotting (coagulation). When successful, hemostasis pre-
vents hemorrhage (HEM-o-rij; -rhage = burst forth), the loss of a large
amount of blood from the vessels. Hemostatic mechanisms can pre-
vent hemorrhage from smaller blood vessels, but extensive hemor-
rhage from larger vessels usually requires medical intervention.
Vascular Spasm
When arteries or arterioles are damaged, the circularly arranged
smooth muscle in their walls contracts immediately, a reaction called
vascular spasm. This reduces blood loss for several minutes to sev-
eral hours, during which time the other hemostatic mechanisms go
into operation. The spasm is probably caused by damage to the
smooth muscle, by substances released from activated platelets, and
by reflexes initiated by pain receptors.
Platelet Plug Formation
Considering their small size, platelets store an impressive array of
chemicals. Within many vesicles are clotting factors, ADP, ATP, Ca 2+,
and serotonin. Also present are enzymes that produce thromboxane
A2, a prostaglandin; fibrin-stabilizing factor, which helps to strengthen
a blood clot; lysosomes; some mitochondria; membrane systems that
take up and store calcium and provide channels for release of the
contents of granules; and glycogen. Also within platelets is
platelet-derived growth factor (PDGF), a hormone that can cause

Stem Cell Transplants from

19.6

Bone Marrow and Cord Blood

OBJECTIVE
• Explain the importance of bone marrow transplants and stem cell
transplants.
A bone marrow transplant is the replacement of cancerous or abnormal
red bone marrow with healthy red bone marrow in order to establish nor-
mal blood cell counts. In patients with cancer or certain genetic diseases,
the defective red bone marrow is destroyed by high doses of chemother-
apy and whole body radiation just before the transplant takes place.
These treatments kill the cancer cells and destroy the patient’s immune
system in order to decrease the chance of transplant rejection.
Healthy red bone marrow for transplanting may be supplied by a
donor or by the patient when the underlying disease is inactive, as
when leukemia is in remission. The red bone marrow from a donor is
usually removed from the iliac crest of the hip bone under general an-
esthesia with a syringe and is then injected into the recipient’s vein,
much like a blood transfusion. The injected marrow migrates to the
recipient’s red bone marrow cavities, where the donor’s stem cells
multiply. If all goes well, the recipient’s red bone marrow is replaced
entirely by healthy, noncancerous cells.
Bone marrow transplants have been used to treat aplastic anemia,
certain types of leukemia, severe combined immunodeficiency disease
(SCID), Hodgkin’s disease, non-Hodgkin’s lymphoma, multiple myelo-
ma, thalassemia, sickle-cell disease, breast cancer, ovarian cancer, tes-
ticular cancer, and hemolytic anemia. However, there are some draw-
backs. Since the recipient’s white blood cells have been completely
destroyed by chemotherapy and radiation, the patient is extremely
vulnerable to infection. (It takes about 2–3 weeks for transplanted bone
marrow to produce enough white blood cells to protect against infec-
tion.) In addition, transplanted red bone marrow may produce T cells
that attack the recipient’s tissues, a reaction called graft-versus-host
disease. Similarly, any of the recipient’s T cells that survived the chemo-
therapy and radiation can attack donor transplant cells. Another draw-
back is that patients must take immunosuppressive drugs for life. Be-
cause these drugs reduce the level of immune system activity, they
increase the risk of infection. Immunosuppressive drugs also have side
effects such as fever, muscle aches, headache, nausea, fatigue, depres-
sion, high blood pressure, and kidney and liver damage.
A more recent advance for obtaining stem cells involves a cord-
blood transplant. The connection between the mother and embryo
(and later the fetus) is the umbilical cord. Stem cells may be obtained
from the umbilical cord shortly after birth. The stem cells are removed
from the cord with a syringe and then frozen. Stem cells from the cord
have several advantages over those obtained from re