Blood System

General characteristics, components, abnormalities, diseases, and vocabulary

Blood in general
Specialized bodily fluid (8% of HBW)
Oxygenation Nutrients Waste Immunological (transport) Coagulation (transport) Regulation of body pH Regulation of core body temperature Hydraulic

Average density 1060 Kg/m3 Average adult has 5 liters of blood

Medical
Hemo- or Hemato Also Haemo- or Haemato-

Origin
Greek haima blood

Specialized connective tissue

Origin in the bone Presence of fibrinogen (molecular fiber)

Constituents
Plasma
54.3% of the blood

Cell package (corpuscules)

White blood cells leukocytes (0.7%) Red blood cells erythrocytes (45%) Platelets thrombocytes

Specialized fluid dynamics

Plasma
55% of blood fluid
92% by volume is water
2-5 to 3 liters

8% blood plasma proteins

Normal color
Straw-yellow

Serum
No clotting proteins Albumin and immunoglobulins

Erythrocytes
Alternative names
Red blood corpuscles (RBC) Haematids Erythroid cells

Origin
Erythros red Kytos hollow

2.4 million per second

Erythropoieses
Development process takes about 7 days Stimulted by the hormone erythropoietin (EPO) Kidney Cells of origin Erythroblast Normoblast Reticulocytes (1% of RBCs) Erythrocytes live 100-120 days

Hemoglobin
Hb or Hgb Metalloprotein
Heme Globin

Transports blood
Oxygen binds to the Fe ion

Hemoglobin A
2 a and 2 b 2 a and 2 g (infants)

Senescence
Aging produces membrane changes Macrophages recognize and phagocyte Spleen, liver and bone marrow Eryptosis Erythrocyte programmed death All components are recycled Heme iron + bilirubin Hemolysis Abnormal destruction of red cells

Leukocytes
Also known as white blood cells 3 cells of origin myeloblast, monoblast and lymphoblast 2 main groups Granulocytes polymorphonuclear leukocytes Basophils granules contain heparin and histamine Eosinophils phagocytic mainly of allergens Neutrophils sometimes PMN; phagocytic of microorganisms

Leukocytes
Agranulocytes Lymphocytes control de immune response and form antibodies Monocytes phagocytic mainly of dead or dying cells and other debris Neutrophils and Lymphocytes are the most common in the blood stream; 50-70% and 20-40% respectively

Thrombocytes
Also known as platelets They originate from megakaryoblasts which transform into megakaryocytes and then break into platelets They are necessary for coagulation End stage formation of the fibrin clot Several factors are needed Deficiency of VIII or IX produces hemophilia Blood clots are not normal - thrombosis

Blood Types
Type is determined by the antigen and antibodies present in the patient A antigen A, anti-B antibody B antigen B, anti-A antibody AB antigen A and B, no A or B antibodies O no A or B antigen, both A and B antibodies Who is the Universal Donor Recipient?

Rh Factor
Rh has its name from the Rhesus monkey It is a surface antigen that can be present or not
Rh negative or positive Normally no antibodies are produced only after first exposure Remember high risk pregnancies
Type A B AB O Rh + Rh % human 41 10 4 45 85 15 Antigen A B A+B Antibody Anti-B Anti-A None

No A or B Anti-A+B Rh No Rh None If exposed

Blood Pathologies

Red blood cell morphology

Anisocytosis unequal size Hypochromia reduced color (-Hgb) Macrocytosis large cells Microcytosis small cells Poikilocytosis irregular shape Spherocytosis rounded cells

Blood Pathologies - Anemias

Aplastic
Failure of blood cell production due to aplasia of bone marrow cells

Hemolytic
Excessive destruction of cells. Increased reticulocytes

Pernicious
B12 deficiency, increased megaloblasts

Blood Pathologies - Anemias

Sickle cell
Abnormal Hgb (S) genetic multiple genes (Africans)

Thalassemia
Failure to produce Hgb. Hypochromic. Mediterranean

Hemochromatosis
Excess iron throughout

Polycythemia vera
Erythremia increased red blood cells

Blood Pathologies - Clotting

Hemophilia
Excessive bleeding genetic disorder failure to produce factor VIII or IX

Purpura
Petechiae and/or ecchymoses. Thromobcytopenia possibly autoimmune

Blood Pathologies white cells

Leukemia
Increase in cancerous white cells Immature acute Mature Chronic

Acute myelogenous leukemia (AML)

Immature granulocytes Low reds and platelets

Remission - relapse

Acute lymphocytic leukemia (ALL)

Immature lymphocytes Children and teens

Blood pathologies white cells

Chronic myelogenous leukemia (CML)
Mature and immature granulocytes Abnormal proteins Slowly progressive

Granulocytosis
Increased neutrophils infrection or inflammation Eosinophilia
Allergic conditions such as asthma

Basophilia

Chronic lymphocytic leukemia (CLL)

Mature lymphoctes Elderly slowly progressive

Leukemias

Mononucleosis
aka Kissing disease Epstein-barr virus (EBV)

Blood pathologies bone marrow

Multiple myeloma Malignant neoplasm of lymphocytes Excesive production of antibodies Sx include all of autoimmune diseases Sometimes ABMT (autologous bone marrow transplant) will help Most of the Tx are palliative

Blood testing
Alexander Vastem is widely regarded as the first to use a CBC for clinical purposes Complete blood count (CBC) Also known as full blood count (FBC) or full blood exam (FBE) or blood panel Blood is vital abnormally high or low counts may indicate a disease Samples are taken by a phlebotomist (USA)

Blood testing
Automated blood count Flow cytometry light and impedance sensors Some abnormal cells need manual categorization Also estimates total and sigle cell Hgb Manual blood count Requires a counting chamber Subject to sampling error - # counted Mandatory for platelet related diseases

Blood testing - general

Antiglobulin test autoimmune hemolytic anemia and Rh+ child Bleeding time time for blood to stop flowing (<8min) Coagulation time time for blood to clot in a test tube (<15) ESR Erythrocyte sedimentation rate; increased fibrinogen (inflammation, infections) PT Prothrombin time; Ca+thromboplastin appearance of clot PTT Partial thromboplastin time; measures part of coagulation pathway

Blood testing red cells

Total red cells total # per litre Hemoglobin grams per decilitre Hematocrit (PCV; packed cell volume) blood fraction with red cells MCV Mean corpuscular volume; femotlitres MCH Mean corpuscular hemoglobin; picograms MCHC Mean corpuscular hemoglobin concentration RDW Red blood cell distribution width

Blood testing white cells/platelets

Total white blood cells - # per litre Differential Neutrophils Lymphocytes Monocytes Eosinophils Basophils Manual count will give presence of other types of cells Platelet numbers and MPV mean platelet volume (average size)

Blood testing - terms

xxxcytosis or xxxphilia increases in number or percentage Erythrocytosis polycythemia Leukocytosis Lymphocytosis Granulocytosis Neutrophilia Eosinophilia Basophilia Thrombocytosis

Blood testing - terms

xxxpenia or xxxcytopenia decreases in number or percentage Anemia erythroblastopenia Leukopenia Lymphocytopenia Granulocytopenia Neutropenia Eosinopenia Basopenia Thrombocytopenia Pancytopenia

Procedures - General
Apheresis Removal of selected parts of the blood Blood transfusion Needed tests blood type, HIV, Hepatitis, Packed cells given in severe anemias Bone marrow biopsy/transplant Also by syringe called aspirate Hematopoietic stem cell transplant Can have serious consequences

Sources of Information
Images
Electron Microscopy Facility at The National Cancer Institute at Frederick (NCI-Frederick) cells FDHV collection tubes Richard Wheeler (Zephyris) 2007 Hemoglobin model