BLOOD PHYSIOLOGY

I. Blood composition
II. Physical and chemical characteristics of blood
III.Blood Cells
1.Hemopoietic process and hemopoietic stem cells
2.Hemopoietic microenvironment
3.Erythrocyte Physiology
4.Leukocyte Physiology
5.Platelet or Thrombocyte Physiology
IV.Physiological Hemostasis
1.Endocrine functions of vessel endothelial cells
2.Physiological Characteristics of Platelet
3.Blood Coagulation
4.Fibrinolysis
V. Blood Group
1.RBC Agglutination
2.ABO blood group system
3.Rh blood group system
4.Relation between blood volume and clinic
5.Principle of Transfusion and Cross-match test
 BLOOD AND INTERNAL
ENVIRONMENTAL



H OMEOSTASIS
Blood is that part of extracellular fluid within the cardiovascular system
Blood formation

m
 The role of blood in internal environmental =
homeostasis
Blood, the most active component in extracellular fluid, display functions as
follows:
(1) transport;
(2) pH buffer;
(3) temperature or thermal maintenance;
(4) immunity and defense
 I. BLOOD COMPOSITION
 Blood composed of :
plasma + blood cells
 Hematocrit:

the percentage of total

blood volume that blood
cells occupy.
normal value
male: 40-50%
female: 37-
48%
newborn: 55%
BLOOD COMPONENT (SUMMING-UP)
CHEMICAL COMPONENT OF PLASMA
H2 O 90 - 91%
血血
Plasma Interstitial
组组 Intracellular
细细胞胞
fluid fluid
浆浆 织织 内内液液
Na+ 142 145
液液 12
Cl- 104 117 4

Ca++ 2.5 2.4 <0.001

K+ 4.3 4.4 139

PO4- 2 2.3 29

蛋蛋白
Protein 14 0.4 54
白质质 (Unit ：
mmol/L)
 II. PHYSICAL AND CHEMICAL
CHARACTERISTICS OF BLOOD
 Specific gravity: total blood (1.050-1.060) more
influenced by red blood cells; plasma (1.025-1.030)
more influenced by plasma protein; RBC (1.090-
1.092) more influenced by Hb.
 Viscosity:

Blood relative viscosity (4~5) mainly depends

on the numbers of red blood cells.
Plasma relative viscosity (1.6~2.4) is mainly involved in
plasma protein
 Plasma osmotic pressure is 300 mmol/L or 770kPa
(1)Crystal osmotic pressure results from NaCl and
modulates water distribution between inside and
outside of cells.
(2)Colloid osmotic pressure results from albumin
and regulates water distribution between inside and
outside of capillary.
 Plasma pH value is about 7.35~7.45.
 Osmosis is the movement of water down its
concentration gradient.
 Osmosis is determined by the number of
impermeable molecules.
 Osmotic pressure is the force drawing water down
its concentration gradient.
 OSMOSIS AND OSMOTIC PRESSURE
A B

Water

[Water] > [Water]

[Salt] < [Salt]
Osmotic Pressure < Osmotic
Pressure
Osmosis is the movement of water from a high concentration to a low concentration. In this
illustration, two compartments (A and B) are separated by a semipermeable membrane
(broken vertical line). The water concentration in compartment A is greater than the
concentration in compartment B because of the presence of salt (X) in B. Therefore, water
will move down its concentration gradient from A to B. The force needed to prevent this
 TONICITY
 The tonicity of a solution refers to the effect of the solution
on cell volume.
 A hypertonic extracellular solution is one in which the
water concentration is less outside the cell than inside;
water leaves the cell; cell volume decreases.
 An isotonic extracellular solution is one in which the water
concentration is the same inside and outside the cell; no
water movement; cell volume does not change.
 A hypotonic solution is one in which the water concentration
is greater outside than inside the cell; water enters the cell;
cell volume increases.
 An isosmotic solution may not be an isotonic solution if the
particles are permeable to the cell membrane.
 III.BLOOD CELLS
Blood cells are erythrocyte (red blood cell, RBC),
leukocyte (white blood cell, WBC) and thrombocyte
(platelet, P).
 BLOOD CELLS
 The forming processes of erythrocyte (red blood cell, RBC),
leukocyte (white blood cell, WBC) and thrombocyte (platelet, P)
originating from hematopoietic stem cells are hemopoiesis.
 Transfer of blood cells forming place:

yolk sac hemopoiesis (early embryo period) → liver and spleen

(second embryo month) → marrow↑and liver, spleen↓ (after
fourth embryo month) → marrow (fetus birth time) and liver,
spleen as complementary role.
During adulthood (after 18), red marrow (flat bones, e.g.
vertebra,ilium, sternum, rib, skull and long bone ending) rather
than yellow marrow has hematopoietic functions.
HEMOPOIETIC PROCESS
HEMOPOIETIC PROCESS
 3.ERYTHROCYTE PHYSIOLOGY

Shape and number of red blood cells (RBC)

 Shape of RBC: like biconcave disc

Its diameter is about 7~8 µm, peripheral thickness about

2.5 µm, central thickness about 1 µm and cubage about 90 µm3.
 REASON FOR SHAPE OF RBC

biconcave disc like

 ERYTHROCYTE PHYSIOLOGY
Number of RBC: It is most numbers in the blood.
Normal value about
RBC Male adult, 4.5~5.5×1012/L; average,
5.0×1012/L Female adult, 3.8~4.6× 1012/L;
average, 4.2×1012/L Newborn, ≥ 6.0×1012/L
Protein within RBC is
hemoglobin (Hb).
Hb in male adult,
120~160 g/L;
Hb in female adult,
110~150 g/L;
Hb in newborn (within
5 days), ≥ 200 g/L
Pregnant female, numbers of RBC and Hb are relatively less
 PHYSIOLOGICAL CHARACTERISTICS AND
FUNCTIONS OF RBC

Characteristics of RBC
① Permeability: semipermeable membrane, gas and urea
freely passing through, negative ions easily in or out of
RBC, and positive ions not. There are Na-K ATPase as
pump on the membrane of RBC and low-temperature-
stored plasma easily has high kalium. ②Plasticity and
metamorphose:

Plasticity and metamorphose depend on:

1) surface area-cubage ratio, 2) viscosity of Hb, 3) membrane
PHYSIOLOGICAL CHARACTERISTICS AND
FUNCTIONS OF RBC

Functions of RBC
 RBC can be used for transportation
of O2 and CO2 in the blood.
 RBC can be served as pH buffer.
 ERYTHROPOIESIS
 Hemopoietic material for erythropoiesis:
iron (Fe++) and protein, [reason for anemia]
 Influencing factors of RBC maturity:

Vitamin B12 and folic acid (DNA metabolism),

[clinic relation]
 Process of erythropoiesis:

Hemopoietic stem cells→multi systemic hemopoietic

progenitor →terminal infantile
RBC→reticular RBC→mature RBC→blood for
circulation.
This process requires 6~7 days.
 PLACE FOR
ERYTHROPOIESIS

Main place for Erythropoiesis is bone

marrow. Aother place is liver.
LIFE AND BREAKAGE OF RBC

 Life-span: 120 days, about 4 months, each RBC

circulates 27 km averagely in vessels, short life-span
for aged RBC
 Breakage: places are liver, spleen and lymphatic node,
and after breakage, Hb released from RBC
immediately combine with plasma α2-globulin (Hb
touched protein) which is taken in by liver for iron
reuse.
 Hb,
very toxic if it get into blood, normally, it can
be metabolized into bile pigment in liver.
 Clinic relation.
 LEUKOCYTEs
CLASSIFICATION AND NUMBERS OF
LEUKOCYTE

 Number of Leukocyte (white blood cells, WBC):

(4.0~10)×109/L
 Classification: It is granulocyte (neutrophil,
eosinophil, basophil), monocyte and lymphocyte.
 CLASSIFICATION AND NUMBERS OF
LEUKOCYTE
TABLE. Classification and normal value of Leukocyte
Absolute Value (×10 9 /L)
Percentage (%)
Total numbers of leukocytes 4.0~10.0

Neutrophil (bacilliform nucleus) 0.04~0.5 1~5

Neutrophil (foliiform nucleus) 2.0~7.0 50~7

0
Eosinophil 0.02~0.5
0.5~
Basophil 0.0~0.1 5
Monocyte 0.12~0.8 0~1
Lymphocyte 0.8~4.0 3~8

20~
Physiological changes of number of
leukocytes

 Newborn: Number is higher, 15×109/L, after birth 3 or 4 days to

3 months, being about 10×109/L, mainly, neutrophil, 70%;
secondarily, lymphocyte.
 Circadian changes: Number of WBC is more in the afternoon

than in the morning.

 Food taking, ache and mood excitation: Number of WBC is

remarkably higher.
 Heavy exercise and laboring: Increasing numbers, about

35×109/L, return to original level after action stop.

 Terminal pregnancy of female: Numbers changes in

12~17×109/L, parturition 2~5 days, number return to

original level.
 PHYSIOLOGICAL CHARACTERISTICS AND
FUNCTIONS OF WBC
Terminology
 Diapedisis: Metamorphosed WBCs
pass through vessel wall getting into
interstitial fluid.
 Chemotaxis: It is a process that WBCs WBC
shift to some chemical material

Diapedisis
(metabolic production, antigen-
antibody complex, bacteria, toxin, etc).
 Phagocytosis: It is a process that WBCs
enclose and engulf exotic or Blood

extraneous material, and use Vessel

intracellular enzyme digesting them.
Metamorphose
 PHYSIOLOGICAL CHARACTERISTICS
AND FUNCTIONS OF WBC
① Neutrophil
 Another name, polymorphonuclear, PMN, 6~8 h in the vessels,
diapedisis, chemotaxis and phagocytosis (using its hydrolyzed
enzyme)
 Function: It plays a very important role in nonspecific cellular
immunity system which is against pathogenic microorganism,
such as bacteria, virus, parasite, etc.
 Clinic relation:
Number of neutrophil greatly increase occurring in
acute inflammation and earlier time of chronic
inflammation.
number decrease of neutrophil will result in poor
resistibility and easily suffering from infection.
 PHYSIOLOGICAL CHARACTERISTICS
AND FUNCTIONS OF WBC

② Eosinophil
 Circadian changes: Its number is lower in the morning
and higher at night.
 Function:
1. It limits and modulates the effects of basophil on fast
allergic reaction.
2. It is involved in immune reaction against worm with
opsonization.
 Clinic relation: Its number increase when person suffers
from parasite infection or allergic reaction.
 PHYSIOLOGICAL CHARACTERISTICS
AND FUNCTIONS OF WBC

③ Basophil
 Circulatory time: 12 hours
 Basogranules contain heparin, histamine, chemotactic factors and
chronic reactive material for allergic reaction.
 Function: It is also involved in allergic reaction.
1. Heparin serves as lipase cobase and speeds up fatty
decomposition.
2. Histaminepermeability
and chronic of
reactive material
capillary increasebronchia smooth
and contract
muscle, and result in allergic reaction such as measles ,
asthma.
3. Eosinophil chemotactic factor A released by basophil can
attract eosinophil collection and modify eosinophil function.
 PHYSIOLOGICAL CHARACTERISTICS
AND FUNCTIONS OF WBC
④ Monocyte
Its body is large, diameter about 15~30 µm without granule
Function:
1. It contains many nonspecific lipase and displays the
powerful phagocytosis.
2. As soon as monocytes get into tissue from blood , it change
name called macrophage activating monocyte- macrophage
system to release many cytokins, such as colony stimulating
factor (CSF), IL-1, IL-3, IL-6, TNFα, INF-α,β ,etc.
3. Cytokins induced by monocyte may modulate other cells
 PHYSIOLOGICAL CHARACTERISTICS
AND FUNCTIONS OF WBC

⑤ Lymphocyte
 Classification: It can be separated into T- Lymphocyte and
B- Lymphocyte.
 Function:
1. Lymphocytes serve as a nuclear role in immune
responsive reaction.
2. T- Lymphocytes involved in cellular immunity.
3. B- Lymphocytes involved in humoral immunity.
 Clinic relation: Numbers increase of lymphocytes occur in
 LEUKOPOIESIS, REGULATION AND
BREAKAGE

 Birth place: bone marrow, originating from hemopoietic stem cells,

and leukopoiesis process is similar to RBC.
 Leukopoiesis, differentiation and growth are influenced by
hemopoietic growth factor, HGF which are glycoprotein secreted
by lymphocyte, monocyte- macrophage, fibrous cell and
endothelial cell.
 Colony stimulating factor, CSF, such as GM-CSF, G-CSF, M-CSF,
Multi-CSF (IL-3) also influence Leukopoiesis.
 Life span: several hours to 3 or 4 days.

 Leukocyte breakage: site are liver, spleen and lymphatic node.

 Pus or purulence forming

Platelets

 The platelet, a tiny anucleate biconcave blood cell 2–4 μm in

diameter, has major an diverse roles in health and disease
 Approximately 1x 1011 new platelets are released each day
into the circulation from bone marrow where they are formed
by fragmentation from megakaryocytes .
 Thrombopoietin is the most important cytokine regulating
platelet production
 Contained within the platelet cytoplasm are three types of
granule, namely α-granules, dense granules an lysosomes
 α-Granules are the most abundant granules and contain a large
number of proteins, many of which play a role in regulating the
balance of thrombosis and fi brinolysis, such as α2-antiplasmin
and plasminogen activator inhibitors
 The membranes of α-granules also contain proteins that are
expressed on the cell surface following platelet activation,
including glycoprotein (GP) IIb/IIIa and P-selectin
 NORMAL VALUE AND FUNCTION OF
PLATELET
 Normal value: 100×10 9 ~ 300×109 , range from 6%~10%
 Normal changes: more number in the afternoon than in the morning,
more in winter than in spring, more in the venous blood than
capillary, after sport↑, pregnacy↑.
 *Functions:

1. It maintains capillary endothelial cells smooth and

integrated (repairing endothelium and providing
nutrition).
2. It is involved in physiological hemostasis.
 Platelet and clinic relation:

decrease of platelet, abnormal immune reaction, will

results in
hemorrhage or bleeding, purpuric symptom.
 LIFE- SPAN AND BREAKAGE OF
PLATELET
 Life-span: Averagely, 7~14 days in the blood. It can be

consumed when it displays physiological functions.

 Breakage: Aged platelet can be processed by phagocytosis
in liver, spleen and lymphatic node.
38
 IV. PHYSIOLOGICAL HEMOSTASIS
 *Definition: The process from vessel bleeding to automatic
hemostasia.
 *Bleeding time: The time from vessel bleeding to automatic
hemostasia. Normal time is 1~3 min and it is longer when platelet
decrease.
 Process of hemostasis:
1.Blood vessel contraction or convulsion (induced by
neuroreflex; 5-hydroxytryptamine,5-HT; thromboxane A2,
TXA2; endothelin, ET )
2.Platelet thrombosis forming (made by platelet adhesion,
aggregation, release and contraction)
3.fibrin, clot forming and maintenance (made by blood
coagulation activation)
PHYSIOLOGICAL HEMOSTASIS
1.ENDOCRINE FUNCTIONS OF VESSEL
ENDOTHELIAL CELLS
① Material related to hemostasis are basal membrane, collagen (III, I)V ,
microfibril, elastin, laminin, ectonectin, fibronectin, von Willebrand factor
(vWF), protein enzyme, protein enzyme inhibitor, adhesive amylose, etc.
② Anticoagulative material: They are prostacyclin (PGI2), endothelium-derived
relaxing factor (EDRF or nitric oxide, NO), tissue-type plasminogen
activator (tPA), uPA, ADPase, ATIII, heparin sulfate, protein C,
thrombomomodulin (TM), plasminogen activator (PA).
③ Promoting coagulative material: Tissue factor, vWF, blood clotting factor V,
plasminogen activator inhibitor (PAI-1, PAI-2), TNFα, interleukin-1 (IL-1).
④ Vessel constricting and relaxing modulators: endothelin-1 (ET-1),
EDRF (NO), PGI2, etc.
ROLES OF VESSELS IN ENDOTHELIAL
CELLS IN PHYSIOLOGICAL
HEMOSTASIS
Roles are close related to its endocrine functions
① Vessel endothelium serves as barrier between underendothelial
structure (namely, collagen) and blood. As soon as collagen expose to
blood, hemostasis of platelet is immediately activated to form
thrombus blocking wounded vessels.

② Platelet activation can releases constrictive factors (TXA2, ET-1, 5-

HT, etc) making vessel convulsion, lasting about 60 sec.

③ Stimulated vessel endothelial cells release coagulative factors and

Promoting coagulative material to realize, speed up blood
coagulation. At the same time, cells also release anticoagulative
factors and fibrinolysis material to modify blood coagulation.
INACTIVE PLATELET

Under the electronic microscope

HEMOSTASIS
Under the electronic
microscope
 Thrombocyte adhesion: its membrane glycoprotein (GP,
GPIb/IX and GPIIa/IIIb), collagen (underendothelial
structure), vWF (plasma component), fibrinogen are involved
in adhesion.
Mechanism: Exposed collagen+vWF →vWF changes
→platelet membrane glycoprotein+changed vWF →
Thrombocyte adhesion.
 Thrombocyte aggregation: induced by physiological factors such
as ADP, thromboxane A2 (TXA2), epinephrine, 5-HT, histamine,
collagen, thrombin, prostacyclin,etc and by pathological factors
like bacteria, virus, immune complex, drugs, etc.
 ROLES OF PLATELET IN
HEMOSTASIS
 Activation of platelet: Stimulus brings about thrombocyte adhesion,
aggregation, release and contraction.
 Loose platelet thrombus forming: First phase of hemostasis.
 Blood coagulation activation by platelet: Fibrin net forming, second phase of
hemostasis.
 *Roles of platelet in hemostasis:
1.Activated platelets supply lecithoid (phospholipid) surface for blood
clotting factor and involve in activating factor X and prothrombin.
2.Surface of platelet membrane combine with many blood clotting factor,
such as fibrinogen, FV, FXI, FXIII to speed up coagulation.
3.Activated platelets release α-granule which contains fibrinogen to intensify
fibrin forming and blood coagulation.
4.Activated platelets contract clot with its contractive protein to solidify blood
coagulation.
 TWO PHASES OF PHYSIOLOGICAL
HEMOSTASIS

First Phase Second Phase

MECHANISM1 OF PLATELET IN
HEMOSTASIS
MECHANISM2 OF PLATELET IN
HEMOSTASIS
50
BLOOD COAGULATION

Intrinsic and extrinsic passway

Presentation
 4.FIBRINOLYSIS
 Fibrinolytic system is involved in fibrinolysis, tissue repair and vessel
rebirth.
 Two fibrinolytic systems: cellular one and plasma one. The former is
leucocyte, macrophage, endothelial cell, mesothelial cell and platelet to
engulf and digest fibrin. The latter is plasminogen activators (PA) and its
inhibitors (PAI), plasminogen, plasmin.
 Basic steps:

 presentation
V. BLOOD GROUP and Agglutination

presentation
 QUANTIFICATION OF BLOOD
VOLUME
 Blood volume is an important determinant of systemic arterial
pressure.
 Circulatory system is essentially a closed container including a
volume of blood equal to approximately 5 liters or 70-80mL/Kg
of the body weight (in kilograms).
 4. RELATION BETWEEN BLOOD VOLUM E
AND CLINIC
 When you donate 10 % of total blood volume, your body
compensates so that blood pressure does not change, and the
volume is replaced through the normal ingestion of fluids.
 Volume loss up to 30-40 % of total blood volume can be tolerated if
the loss is corrected within 30 min (e.g. artery contraction increases
peripheral resistance but artery blood pressure can not maintain the
normal levels which occur in symptoms such as light-headed, dazzled,
force-lacked, etc)
 Blood loss more than 40 % of total blood volume will threaten the
life, results in shock and the measures in the hospital should be
immediately taken for life survival [Transfusion].
 5. PRINCIPLE OF TRANSFUSION
 Transfusion is widely used in clinic treatment.
 Principle of transfusion*:

1.Identification of blood group must be taken before

transfusion.
2. Cross-match test must be done before transfusion.
3.The same tpyes of blood group for transfusion shoul be firstly
d
considered.
4.The different tpyes of blood group for transfusion should be
very careful, small amount and slow import and if condition is
better,
 TYPES OF TRANSFUSION

 According to source of transfusion, allogenetic

transfusion (more use), autologous transfusion.
 According to component of transfusion, whole blood
transfusion, transfusion of blood components
 Autologous transfusion has some advantages:
① It decreases infection.
② It blocks syndrome (fever, hemolysis) induced by
allogenetic transfusion.
③ It stimulates bone marrow hemopoiesis towards
RBC.
 Transfusion of blood components is good.
End