BLOOD

Normal vol​. 5-6 L, 7.36-7.45 ​pH​, ​Sp. Gravity​ 1050-1060, 45% cells & 55% plasma

PLASMA PROTEINS
Normal 6.4-8.3 gm% 55% albumin 38% globulin (α, β & γ) A/G ratio – 1.7:1

▪ Albumin​ – 60,000 MW, oncotic pressure, transport, t​1/2​ 10 days

▪ Transferrin​ – 90,000 MW, iron transport (GIT to bone marrow)
▪ Ceruloplasmin​ – α globulin, copper storage & transport (deficiency leads to Wilsons disease)
▪ Fibrinogen​ – 0.3 gm% ,clotting, synthesized in liver only
▪ Prothrombin​ – 40 mg% , clotting

FUNCTIONS OF PLASMA PROTEINS

1.Coagulation 2. Oncotic pressure 3. Viscosity (BP, flow) 4. pH 5. Immunity 6. Transport

HEMOGLOBIN
Haem – Fe​2+​ containing porphyrin tetra pyrrole. Globin – 4 polypeptide chains. ​HbA(α​2​β​2​) HbF(α​2​ γ​ 2​)
Normal values birth – 19-23 gm% M - 14-18 gm% F- 12-15.5 gm%
​Methemoglobin​ – Fe​2+​ oxidizes to Fe​3+ ​dark coloured appears in urine.
​HbA​2​ ​ α​2​δ​2 normally​
​ 2.5%.
​ increases in thalassemia
​HbS​ – sickle cell hemoglobin. Substitution of glutamic acid with valine at 6​th​ position in β chain
​HbA​1C​ binds​
​ to
​ glucose. Used for finding control of diabetes.

RBCs
Biconcave​ disc, ​no nucleus​, ​vol​. 90 cu.µm. M- 5-6 million/cu.mm F- 4.5-5.5 million/cu.mm ​Dia​. 8µm
Life span ​120 days(stored blood 60 days)​, Tissue macrophage system. Osmotic fragility 0.48-0.34% NaCl sol.
Polycythemia ​– birth, high altitude, congenital heart disease, Polycythemia Vera
RBC Indices​ - MCV 100 fL.
MCH 28-32 pg
MCHC 32-38%
ERYTHROPOIESIS
STEM CELL → Proerythroblast → Normoblast (nucleus +) → Reticulocyte (nucleus-,RNA+) → RBC
Hb starts appearing in intermediate Normoblast. Ist trimester in yolk sac (3 weeks onwards), 2​nd​ in liver(24 weeks)
and 3​rd​ in marrow.

WBCs
Granulocytes​ – neutrophil (50-70%), basophil (<1%) & Eosinophil (1-4 %)
Agranulocytes​ – lymphocytes (20-40%) & monocytes (2-8%) normal WBC count 4000-11000/cu.mm
Decrease count in – starvation, morning, typhoid, viral infections, bone marrow depression
Increase count in – newborns, evening, exercise, stress, pregnancy,steroids, pyogenic infections
● Neutrophil​ : 2-6 lobes of nucleus, fine granules, phagocytosis, inc in acute infections( 1​st​ line of Defence),
Half-life in blood is only 6-8 hrs, 1-4 day lifespan.
● Eosinophil​ : half life: 8 hours, brick red coarse granules, contain histamine, MBP etc. inc in allergic &
parasitic inf.
● Basophil​: coarse blue granules(histamine), cover nucleus. Phagocytosis. Inc. in pox, TB, flu
● Lymphocytes​: cell mediated immunity. B & T type. Inc in chronic infections like TB, leprosy
● Monocytes​: 2​nd​ line of defence. Phagocytosis, form tissue macrophages. Inc in TB, syphilis. t ​½ 1-3
​ days
WBCs are sequestered in spleen. Contraction(sympathetic),removal of spleen increases WBC count.

PLATELETS

Small, ​non nucleated​, granulated cells. 1.5-4 lakh/cu.mm Membrane has receptor for collagen, fibrinogen von
Willebrand’s factor. Granule contains serotonin(from GIT), ADP, PDGF, thromboxane A2, Prostacyclins. ​Increase
count when there is sympathetic stimulation,thrombopoietin, splenectomy, stress. ​Count falls ​in marrow depression,
​ ife span is 7-10 days
drugs, viral infections like dengue. L
FUNCTIONS​: ​Hemostasis​ – by temp. hemoststic plug.3 steps platelet adhesion, activation & aggregation
​Blood coagulation​ – definitive plug.
 ​Clot retraction​ – 30 min due to platelet contraction(most sensitive test for platelet funct.)
​Phagocytosis & storage
BT – ​bleeding time 1-4 min., depends on vasoconstriction & platelet
CT​ – clotting time 3-5 min.
The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT or APTT) is a performance
indicator measuring the efficacy of both the "intrinsic" and the common coagulation pathways. Increases in any
clotting factor defiecney except factors VII or XIII . Prothrombin time (PT) measures the extrinsic pathway, whcih
depends on factor VII. Factor VII has a short half-life and the carboxylation of its glutamate residues requires vitamin
K.

Anti thrombin III​ – Liver. Inactivates IX,X,XI & XII

Normally blood doesnot clot inside cause of ​:- smooth endothelial lining, negative charge of epithelium
Velocity of blood, natural anticoagulant (heparin, protein C)
THROMBOMODULIN​: by all endothelial cells ​except of cerebral circulation . converts thrombin to protein C
activator, increases activity of tissue plasminogen activator.
Factor VII present in both plasma and serum.

Anticoagulants: Heparin : ​by basophils & mast cells. Activates ​Anti thrombin III
Vitamin K antagonists​(warfarin, dicoumarol) – decrease II, VII, IX, X.
​Calcium chelators​ like oxalates , EDTA
HEMOPHILIA A (CLASSICAL) – ​def. of factor VIII. X linked. Normal BT, inc CT., normal PT, Inc. aPTT
PURPURA : ​due to capillary abnormality,bleeding spots. CT normal, BT inc. Platelet count normal.
Types thrombocytopenic, a thrombocytopenic, thromboasthenic. t/t ACTH, splenectomy

IMMUNITY: ​Natural & Acquired (cell mediated & humoral)

NK Cells​ – Natural Killer cells, nonT non B lymphocytes.10% of lymphocytes. no activation for action.