BLOOD

Fluid Connective Tissue

(PPT10)
 Physical Characteristics
 Fluid HEMOCRIT: Ratio of
◦ Living 45% RBCs to Plasma
 Cells
 RBC Erythrocytes (carry oxygen)
 WBC Leukocytes (immune)
 Platelets (clotting) BUFFY COAT

◦ Non living (Matrix) 55%

 Plasma (straw colored)
 90% water
 10 %
 Salt, nutrients, proteins (albumin), waste, gases, hormones
Blood in the BODY
 5-6 liters = 6 quarts
 pH of 7.35 -7.45
 Color is dependent on amount of Oxygen

◦ More oxygen = brighter the red

◦ Less oxygen = duller the red
BLOOD HISTOLOGY
RED AND WHITE BLOOD CELLS
Erythrocytes
 RBC
◦ Lack Nucleus
◦ Hemoglobin (250,000,000/rbc)
◦ 4 heme molecules nested in four globin molecules
 Heme is composed of protoporphyrin IX ring with Fe+2 at its
center
 Each heme molecule can combine reversibly with one molecule
of oxygen
◦ The globin portion contains two pairs of globin chains, two 
chains and two non- chains
  and  chain producction is controlled by genes on
chromosome __
 , , and  chain production is controlled by genes on
chromosome __
 Chain production is turned on and off through stages of
development leading to production of mainly α and β chains with
maturity
Erythrocytes
Hemoglobin Variants

In the embryo:
 Gower 1 (ζ2ε2)
 Gower 2 (α2ε2)
 Hemoglobin Portland I (ζ2γ2)
 Hemoglobin Portland II (ζ2β2).

In the fetus:
 Hemoglobin F (α2γ2)
Erythrocytes
Hemoglobin Variants
After birth:
 Hemoglobin A (α2β2) – The most common with a

normal amount over 95%

 Hemoglobin A2 (α2δ2) – δ chain synthesis begins
late in the third trimester and, in adults, it has a
normal range of 1.5–3.5%
 Hemoglobin F (α2γ2) – In adults Hemoglobin F is
restricted to a limited population of red cells called
F-cells. However, the level of Hb F can be elevated
in persons with sickle-cell disease and beta-
thalassemia.
Erythrocytes
Hemoglobin Variant forms that cause disease:
 Hemoglobin D-Punjab – (α2βD2) – A variant form of

hemoglobin.
 Hemoglobin H (β4) – A variant form of hemoglobin,
formed by a tetramer of β chains, which may be
present in variants of α thalassemia.
 Hemoglobin Barts (γ4) – A variant form of
hemoglobin, formed by a tetramer of γ chains,
which may be present in variants of α thalassemia.
Erythrocytes
Hemoglobin Variant forms that cause disease:
 Hemoglobin S (α2βS2) – A variant form of

hemoglobin found in people with sickle cell disease

. There is a variation in the β-chain gene, causing a
change in the properties of hemoglobin, which
results in sickling of red blood cells.
 Hemoglobin C (α2βC2) – Another variant due to a
variation in the β-chain gene. This variant causes a
mild chronichemolytic anemia.
Erythrocytes
Hemoglobin Variant forms that cause disease:
 Hemoglobin E (α2βE2) – Another variant due to a

variation in the β-chain gene. This variant causes a

mild chronichemolytic anemia.
 Hemoglobin AS – A heterozygous form causing 
sickle cell trait with one adult gene and one 
sickle cell disease gene
 Hemoglobin SC disease – A compound
heterozygous form with one sickle gene and
another encoding Hemoglobin C.
Erythrocytes
Red Cell Morphopology
a. Size = Normocytic (MCV of 80 to 100 fL)
◦ Microcytic (MCV < 80)
◦ Macrocytic (MCV > 100)
◦ Anisocytosis – variation in size
b. Color = normochromic (MCHC of 32 – 36%)
◦ Hypochromic (MCHC < 32)
◦ Hyperchromic (MCHC >36)
◦ Polychromasia – blue color in rbc (if stained with
reticulocyte stain, these would be reticulocytes)
c. Shape = bi-concave disk
◦ Poikilocytosis – variation in shape
Erythrocytes
Red Cell Morphopology
d. Inclusions
e. Crystals
◦ Hemoglobin C – bar-shaped
◦ Hemoglobin SC – “hand in glove” or “Washington
monument”
Abnormal Red Cell Shapes
Red Cell Inclusion
MONOCYTE
Basophil
EOSINOPHIL
Lymphocyte
Neutrophil
Neutrophil and Lymphocyte
Platelet and Neutrophil
Monocyte and Lymphocyte
Leukocytes (WBC)
 Canmove in and out of circulatory
system (blood and lymph) into tissues
◦ Diapededis
◦ Immune response in areas of trauma to
fight infection.
 4000-11,000 = Normal Levels
> 11,000 Leukocytosis
< 11,000 Leukopenia (drugs/steroids)
Leukocyte Classification
 Granules:

◦ Neutrophil
 Acute infection
◦ Eosinophils
 Allergy
◦ Basophils
 Histamine for sites of inflammation
Leukocyte Classification
 No Granules
◦ Lymphocytes
 B and T cells
 Tumors and viruses
 Long term immunity
◦ Monocytes
 Inactive macrophages
 Chronic infections
 “pac man”
Leukocyte Differential with Reference Range

CELL PERCENT INCREASED IN

Neutrophil 50 – 70% Bacterial infections
Lmphocyte 20 – 40% Viral infections
Monocyte 3 – 10% TB, Syphillis,
malignancies
Eosinophils 0 – 3% Allergies, parasites, CML
Basophil 0 – 2% Immediate
hypersensitivity, CML
White Cell Morphology
MORPHOLOGY ASSOCIATED WITH

Hypersegmented neutrophil Pernicious Anemia

Hyposegmented neutrophil Pelger Huet Anomaly, Pseudo-
Pelger Huet (AML, AIDS)
Toxic Granulation and Vacuoles Bacterial infections, Burns,
Chemotheraphy
Dohle Bodies (RNA) Bacterial Infections, Burns,
May-Hegglin
Atypical Lymphs (increased Infectiious Mono (Epstein Barr
sized and basophilia) Virus)
Other Viral Infection
Platelet
 Platelets
 Megacellsthat “divide and conquer” during
blood loss.
◦ Regulated by thrombopoietin
 Hemostasis “stop blood loss”
◦ Release collagen fibers (net)
◦ Release platelets (stick in net)
 Platelets cause serotonin to be released which
causes the vessel to shrink = less blood
◦ Thrombin
 Release fibrin to cement the clot
 Platelets
8 to 20 /OIF
 If platelets seem low, check feather edge of

slide for platelet clumping or satelitism

 Check for size

◦ Large – Bernard-Soulier syndrome, May-

Hegglin, myeloproliferative disorder, stress
platelets
 IMPORTANT NOTE!!!
 Correlate Abnormal RBC Shapes with Conditions
 Correlate Abnormal RBC Inclusions with Conditions
 RULE OF THREE

Correlation of Hb, Hct and RBC

Hb (g/dL) x 3 = Hct ± 3%
RBC (in millions) x 3 = Hb ± 0.5
If “Rule of Three” doesn’t fit, consider
1. Clotted sample
2. Cold agglutinin (warm sample and rerun)
3. Lipemic or icteric sample
Application of Rule of Three
 WBC: 9.84
 RBC: 4.23
 Hgb: 125
 Hct: 36.7%
Clotting Disorders
 Clotting
◦ Thrombus
 Large clot that reduce blood flow
◦ Embolus
 Broken off thrombus that can lead to an
embolism (stuck in capillary and break
vessel)
 TREATMENT ANTICOAGULANTS
◦ Bleeding
 Lack platelets
 Thrombocytopenia
 Lack all clotting factors
 Hemophilia
 Blood Cell Formation
 Hematopoiesis

◦ Made in red bone marrow (flat bones)

 Precursor cell is a hemocytoblast
◦ Takes 5-7 days to make these cells
◦ Myeloid (red)
◦ Lymphoid (white)
◦ Regulated by erthropoietin (rbcs live 120
days and are broken down by
◦ Liver and spleen