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Terms in this set (206)
The study of blood
The normal blood volume in an adult male of 70 kg
What is the respiratory function of blood?
Respiratory function includes supply of oxygen from lungs to tissues and removal of carbon dioxide from the tissues to lungs for elimination.
Excretory function of blood?
refers to transport of metabolic waste products urea, uric acid and creatinine from the tissue to the kidneys for excretion.
Nutritive function of blood?
includes supply of all the materials, required by the tissues to obtain its energy demands to carry on the metabolic activities.
How does blood regulate the transfer of heat?
Regulate body temperature by helping in heat transfer mechanism from one body to another along the thermal gradient by physical processes like convection, radiation, conduction and vaporization.
Protective function of blood?
is brought about by the presence of leucocytes and immunoglobulin (gamma globulins). These cells and proteins respectively protect the body from infections. Platelets also help in the prevention of blood loss from the body when there is any breach in the blood vessel by the processes namely homeostasis and blood coagulation.
pH of blood?
around 7.4; which is essential for the normal functioning of enzymes.
the fluid connective tissue
It is composed of plasma and formed elements.
The formed elements of blood are made up of
RBCs (erythrocytes), WBCs (leucocytes) and Platelets (thrombocytes).
The percentage volume of the formed elements in 100 ml of blood is about
packed cell volume (PCV) or haematocrit value
45% men, 40% women
Normally haematocrit refers to the
% volume of RBCs alone
Buffy coat contains
WBCs and platelets and will be about 1%.
blood is made up of ________ % plasma
The hematocrit or packed cell volume (PCV) is the
proportion of blood volume that is occupied by red blood cells.
Method to determine haematocrit value
Collect about 5 ml of blood from a vein and Mix it with proper anticoagulant
Fill the Wintrobe's tube with the blood sample (taking care to avoid air bubbles)
Centrifuge the tube at 3000 rpm (revolutions per minute) for ½ an hour.
Increase in PCV is known as
as hemoconcentration and it occurs when body water content is decreased for any reason like severe vomiting, diarrhea, burns and excessive sweating.
severe vomiting, diarrhea, burns and excessive sweating causes?
In haemoconcentration there will be only a relative increase in the
In polycythemia there will be an absolute increase in the
erythrocyte count and an increase in PCV (formed elements).
Decrease in PCV is known as
Haemodilution occurs in all types of
anemias, immediately after blood loss, pregnancy, administration of intra venous fluids
Plasma is the fluid part of
blood that keeps the formed elements suspended for easy circulation throughout the cardiovascular system.
Plasma is composed of
water (91 - 92%) and solids (7 - 9%).
Solids can be divisible into organic and inorganic components.
important organic components in blood are
Plasma proteins, Urea, Glucose, Cholesterol, Uric acid & Creatinine
important inorganic components in blood are
Na+, K+, Ca++, Cl-, HCO3-
Albumin, Globulin, Fibrinogen and Prothrombin
4 - 4.8 g %
15 - 40 mg%
Normal albumin globulin ratio
is about 2:1
Reversal of the ratio albumin globulin occurs in
liver and kidney
Colloidal osmotic pressure is about
25 mm Hg and 80% of this is contributed by albumin alone
Maintenance of colloidal osmotic pressure is essential to
maintain the fluid balance between the intravascular compartment and interstitial spaces
Why do some amount of fluid goes out into the tissue spaces?
At the level of capillaries hydrostatic pressure, which is about 35 mm Hg at the arterial end, tries to drive out water from the intravascular compartment into interstitial spaces. This is opposed by the colloidal osmotic pressure, which is about 25 mm Hg. However since the hydrostatic pressure at the arterial end is greater than the colloidal osmotic pressure some 35 mm Hg unt of fluid goes out into the tissue spaces.
At the level of capillaries hydrostatic pressure at the arterial end is
35 mm Hg
At the venous end of the capillary, the colloidal osmotic pressure remains
the same because the capillary is almost impermeable to plasma proteins.
the hydrostatic pressure is reduced to 16 mm Hg due to
resistance offered by the capillary wall and gradual decrease of blood volume in the capillary due to leaking out of the fluid into tissue spaces
at the venous end of the capillary the colloidal osmotic pressure remains
high compared to hydrostatic pressure
Why do fluid enter the intravascular compartment?
because at the venous end of the capillary the colloidal osmotic pressure remains high compared to hydrostatic pressure
Why is the hydrostatic pressure reduced in the capillaries?
It is reduced due to gradual decrease of capillary wall and gradual decrease in blood volume because of leaking of fluid into tissue space
What happens to the small amount of fluid left in the tissue spaces?
it is brought back to circulation by lymphatic so as to maintain the blood volume.
When plasma protein level decreases
it leads to the fall in the colloidal osmotic pressure thereby leads to accumulation of fluid in tissue spaces (EDEMA).
Which plasma protein greatly influences osmotic pressure?
Abnormal accumulation of fluid in interstitial spaces of tissues.
What conditions causes edema?
occurs in diseases of the liver, kidney and in malnutrition (due to decrease in plasma albumin content).
Fibrinogen and prothrombin help in
the process of blood coagulation
Immunoglobulin acts as an
antibodies against bacterial antigen.
By this way plasma proteins provide specific immunity throughout
the life span of the person, (Immunoglobulin)
pH of blood is regulated by
Plasma proteins have free
NH2 and COOH terminals, which can either, accept or donate H+ readily for the maintenance of pH of blood within the narrow range.
When pH falls below 7.4
Plasma proteins help to transport many of the substances
in the circulation
Plasma proteins transport
carbon dioxide, hormones like cortisol, thyroxin, metals like iron and copper.
Blood is more viscous than
water by about 4-6 times
Plasma proteins and formed elements contribute equally for maintenance of
Fibrinogen is the most important in the maintenance of
viscosity as it has got irregular shape
Viscosity plays an important role in the maintenance of
Where are plasma proteins produced?
in the Liver
Albumin, fibrinogen, prothrombin are produced exclusively in the
Plasma proteins content markedly decreases in
Liver and kidney diseases and malnutrition
Why does plasma protein decrease in liver disease
It decreases because the rate of synthesizing decreases due to the malfunctioning of the liver
Why does plasma protein decrease in kidney disease?
due to the excretion of proteins along with urine
Why does plasma protein decreases in malnutrition?
due to lack of proteinecious material in the diet.
What are the formed elements?
The formed elements are erythrocytes, leucocytes and platelets
The most numerous formed elements are
Red blood cells
A. Non-nucleated, biconcave disc or dumbbell shaped bodies.
B. Have a mean diameter of about 7.2.
C. Normal count is about 5.5 million/cu mm of blood in adult male. In females it is about 4.5 millions and in newborn infant it is about 6 - 7 millions.
D. One of the most important components of this cell is Hemoglobin (Hb). All the functions attributed to red blood cells are because of this pigment present in the cell.
Refers to an increase in red blood cell count, occurs in physiological conditions like high altitude. Also occurs in pathological conditions like chronic diseases of lung and congenital heart diseases associated with cyanosis
is the process in which the erythrocytes break down, leading to hemoglobin release from the cell.
What can cause hemolysis?
snake venom, infection by microorganisms, malaria, increased activity of the reticuloendothelial system (RES),
The average life span of red blood cell is about
The process by which mature erythrocytes are produced from the precursor stem cells
The site of erythropoiesis varies: the first 3 months of intrauterine life
1. From the mesoderm of yolk sac
The site of erythropoiesis varies: from 3rd to 5th month of intrauterine life
2. In the liver and spleen
The site of erythropoiesis varies: from 5th month of intrauterine life and throughout the life span of the person
3. From the red bone marrow
the first 3 months of intrauterine life
from 3rd to 5th month of intrauterine life
5th month of intrauterine life and throughout the life span of the person
decreased supply of oxygen to the tissues)
erythropoiesis is stimulated by
Describe how erythropoiesis is regulated?
Where there is a decreased oxygen level in the blood, the oxygen level to the tissue is also decreased. The tissue suffers from hypoxia and this acts on the kidney's. The kidneys then secrete erythropoietin, which then acts on the erythropoietin sensitive stems cells in the bone marrow. This causes an increase production of erythrocytes, which increases the oxygen capacity of the blood. This causes an increase in oxygen supply to the tissues and decreases hypoxia.
What happens when RBC is maturing?
The cell size decreases and hemoglobin is incorporated into the cell, then the nucleus is ejected from the cell.
What are the factors that influences erythropoiesis?
A. Hypoxia and erythropoietin.
B. Vitamin B12 and folic acid.
C. Metals like iron and copper.
D. Endocrine factors like testosterone, growth hormone and thyroxin. Testosterone increases the erythropoietin formation.
E. Good protein diet
How does estrogen affect erythropoietin?
decreases erythropoietin formation and inhibits the bone marrow and hence the red blood cell count is less in females.
Why do females have less red blood cells?
due to the effect of estrogen
• Kidneys are essential for the formation of
What leads to anemia
• In renal failure, since kidneys are damaged, there will be deficiency of erythropoietin production. This leads to anemia.
Why is erythropoietin injected in chronic renal disease?
in order to prevent anemia.
This is essential for synthesis of hemoglobin?
Why do pregnant women and those who are lactating need more iron?
the mother has to supply iron to the developing fetus and the neonate
What are some of the common causes of iron deficiency anemia?
bleeding from the gums, piles, peptic ulcer and hookworm infestation.
Where is Vit. B12 absorbed?
Is absorbed at the ileum.
Absorption in the intestine requires Intrinsic factor secreted by the
parietal cells of gastric glands.
Vit. B12 deficiency can be due to to either
lack of intrinsic factor or the vitamin itself in the diet; this is called maturation factors.
Anemia caused due to the deficiency of intrinsic factor is known as
What is it called when you are deficient in intrinsic factors and you lack vitamin B12 in your diet?
What happens when you lack maturation factors?
it will lead to delayed maturation of RBC, decreased cell division and this type of anemia is called as megaloblastic (cells immature and will be large) anemia.
cells immature and will be large
is the pigment present in red blood cells
Hemoglobin is made up of
two parts namely Haem (iron containing protoporphyrin ring) and globin (polypeptide chains 4 in number of which 2 are alpha and 2 beta chains).
How much hemoglobin do adults have?
Adult male has approximately 15 g%, in a female it is slightly less and in children it is about 18 -22 g %.
All the functions of red blood cells (transport of respiratory gases in blood and regulation of pH of blood) are due to the
hemoglobin present in the cell. 1g of hemoglobin can carry about 1.34 ml of oxygen when fully saturated. This is known as oxygen combining capacity of Hb.
What are the functions of hemoglobin?
• Transport of oxygen
• Transport of carbon dioxide.
• Regulation of pH of blood
• Can be defined as qualitative or quantitative decrease in either red blood cells or hemoglobin concentration or both.
What are all the causes of anemia?
• Cause can be due to deficiency of iron, vitamin B12, and folic acid, depression of bone marrow, total renal failure, hemolysis and repeated blood loss.
• Jaundice is yellow discoloration of skin, mucus membrane and sclera of the eyes.
What is the cause of jaundice
• Is due to increase in the serum bilirubin > 2mg% (by product of Hb break down) level in circulation.
Normal serum bilirubin level?
• Normal serum bilirubin level is about 0.2 - 0.8 mg%.
What happens when normal serum bilirubin level is exceeded?
• When it exceeds 2 mg % it results in clinical jaundice.
i. Excessive red blood cell destruction (hemolysis) that leads increase production of
bilirubin which may exceed the capacity of liver to excrete it.
How does liver disease affect bilirubin levels?
ii. Liver diseases may limit its ability to handle the bilirubin
How does obstruction of the bile duct affect bilirubin levels?
iii. Obstruction in the bile duct so that bilirubin cannot be removed and it enters into the circulation.
What is pre-hepatic (hemolytic) jaundice?
Jaundice caused by increased hemolysis for any reason like in malaria, incompatible blood transfusion, sickle cell anemia. (Increased production of bilirubin and the liver cannot metabolize all the bilirubin).
What is hepatic jaundice?
viral hepatitis. (failure of metabolism of bilirubin)
What is Post hepatic (obstructive) jaundice?
Obstruction to the biliary tract. (failure of removal of metabolized bilirubin)
LEUCOCYTES (WHITE BLOOD CELLS)
Are the only nucleated cells in circulation
Size of leukocytes?
Size of the cell can range from as little as 8 to as much as 22.
Normal level of leukocytes?
Normal count in adult can be from 4 to 11 thousand cells per cu mm of blood. In children it can be as much as 18 to 25 thousand cells per cu mm.
The leucocytes can be classified as granulocytes or agranulocytes based on the presence or absence of
granules in cytoplasm (when stained with Leishman stain).
In the granulocyte leukocyte group the nucleus is
lobed unlike in agranulocyte in which it is not lobed.
Types of cells in the granulocyte group
are neutrophils, basophils and eosinophils
Types of cells in the agranulocyte group are
lymphocytes and monocytes
Average life span of all granulocytes is around
Lymphocytes can be divisible into small and large lymphocyte based on the size of the cell. They can also be classified into T and B-lymphocytes based on the function.
Life span of lymphocytes ranges from few days to few years.
When leukocyte count is above the normal range
When is leukocytosis seen?
. This is seen in acute pyogenic (pus forming) infections like appendicitis, tonsillitis etc. Count is also increased in tuberculosis, following myocardial infarction. In leukemia, the increase in cell number will be very high and it may be as high as 80,000 to 1, 50,000. In addition to this, in leukemia, the cells present in peripheral circulation will be very immature
When the count is less than the normal range
in leukemia, the cells present in peripheral circulation will be very
differential leukocyte count (DLC)
When 100 white blood cells are counted and the percentage of different types of cells determined in that
Increase in the count of Neutrophil above the range
decrease in neutrophil count
Increase in the count of eosinophils
Basophil Increase in the count
Increase in the count of Lymphocyte
is known as lymphocytosis
decrease Lymphocyte, caused by AIDS
Monocyte , When the count is above the normal range
FUNCTIONS OF LEUCOCYTES
Phagocytic function—which is termed as non specific/innate/passive immunity. Specific/acquired/active immunity function
Role in allergic reactions and parasitic infections.
Function of Neutrophils
Phagocytosis: is because of neutrophils (microphages) and monocytes (macrophages).
The neutrophils are termed as
1st line of defense
monocytes are termed
2nd line of defense
The neutrophils phagocytose less number
(about 20) of bacteria when compared to monocytes (about 100)
The monocytes of bone marrow are
young and get matured in tissues(marcophages).
Neutrophiles and monocytes are
Both types of cells indiscriminately phagocytose any type of bacteria and hence the immunity is known as non-specific.
Steps of phagocytosis?
3. +Ve chemotaxsis
4. Phagocytosis proper
5. Enzymatic digestion
Most of the allergens are proteins.
Detoxify, disintegrate and remove foreign proteins.
During allergic reaction there will be production of histamine that is carried by eosinophils to the site of detoxification, which is the liver.
They also have a parasiticidal function.
Where is the site of detoxification
are capable of ingesting foreign particles and produce heparin and histamine (chemicals which induce inflammation), and are often associated with asthma and allergies.
What are pathogens?
Harmful or disease-causing microorganisms. They are "antigens".
A substance or part of substance (both living and nonliving) that
1./ is recognized as foreign by the immune system
2./ activates the immune system
3./ reacts with immune system cells or their products.
4./ is usually a 'foreign protein'.
Gamma Immunoglobulins (Ig): A protein molecule that is
released by plasma cells ( a daughter cell of an activated B lymphocytes) and
that binds specifically to an antigen.
1. Ability of the body to resist many agents (both living and nonliving) that can cause disease.
2. Resistance to disease.
T& B lymphocytes
Both cells are produced by bone marrow but T cells are processed by thymus hence called T lymphocytes and B cells are produced by bone morrow itself hence B.
Why is the Tlymphocytes called "T" lymphocytes
T cells are processed by thymus hence called T lymphocytes
After processing both T & B lymphocytes resides in
in lymph node where it comes in contact with antigens.
The contact with antigens activates the T cells to form
cyto-toxic T cells, helper T cells, and memory T cells and B cells to plasma cells.
The cytotoxic T cells release various
cytokines that kills the viruses and helper T cells are in need to keep the whole immune system active
The memory T cells makes the T cell mediated immunity to react faster if we get it contact with same antigen
a second time.
The activated B cells are called as
plasma cells which produces the antibodies that fight against the antigens.
Immunity mediated by B cells is called as
humoral mediated immunity.
Explain the process of antibody-mediated immunity (Humoral immunity)
Activated B Cells - produce plasma cells & memory B cells
plasma cells secrete antibodies into body fluids
antibodies immobilize antigens until destroyed
memory B cells stay in body and respond to subsequent exposures to the same antigen
Explain the process of cell-mediated immunity (cellular immunity)
Activated T Cells - manage immune response
Helper T cells stimulates production of B and T cells
Cytotoxic T cells attack and destroy body cells that are either infected or cancerous
Suppressor T cells stop immune response
3rd type of cell among the formed elements of blood.
Size is between 2 and 4.
Normal count is about 150,000 to 450,000 per cu mm of blood.
Life span is about 10 days.
The cells are produced by the megakayocytes present in red bone marrow.
Site of destruction is spleen, which contains reticuloendothelial system.
Normal level of platelets
Normal count is about 150,000 to 450,000 per cu mm of blood.
Where is platelets destroyed?
Site of destruction is spleen, which contains reticuloendothelial system
Magakaryocytes produce which cell?
Plaletets: The cells are produced by the megakayocytes present in red bone marrow.
Physiological properties of platelets are:
Adhesion, Aggregation & Agglutination
When the platelet count is above the normal limit
When the platelet count is below the normal limit
decrease in count is called as thrombocytopenia
Functions of platelets:
• Blood coagulation
• Clot retraction etc
Immediately after injury platelets gets
activated when it comes in contact with the subendothelial collagen (basement membrane). The activated platelet releases platelet factors that causes Vasoconstriction & aggregation of more platelets which is called as temporary platelet plug that is responsible of temporary cessation of bleeding. (For permanent stoppage of bleeding, the platelet plug should be reinforced by fibrin threads which is formed by action
the bleeding time
The time interval from the onset of bleeding to the cessation of blood flow from the injured surface gives us
Normal bleeding time is about
1 to 4 minutes
Increase in bleeding time occurs when there is
Bleeding time reflects the platelet function
Blood that is in circulation is in fluid state. When fluid state of blood is converted to semisolid jelly like mass it is called
coagulation or clotting of blood
platelet count < 50,000; Is a condition in which there are hemorrhagic spots beneath skin (cachetic state), mucus membrane.
Purpura is due to
It is due to decrease in platelet count; platelet count < 50,000; Bleeding time is increased, but clotting time remains normal
- hematologic disorder which results in blood clot formation in small blood vessels; also known as primary purpura
At the site of injury clotting occurs over the platelet plug that has formed and hence it converts the temporary platelet plug into a permanent sealing of the injured area. This is very much essential as the platelet plug will not be very strong without superseded clot and will get washed away in course of time
What are the steps to blood coagulations
1. Formation of pro-thrombin activator
2. conversion of pro-thrombin to thrombin by prothrombin activator. 3. Conversion of fibrinogen to fibrin by thrombin and clot formation.
Prothrombin activator can be formed by either
intrinsic or extrinsic mechanism. In intrinsic system the formation of prothrmobin activator is by exposure of the collagen to platelets whereas in extrinsic system the substances released by damaged tissues are responsible
When clotting occurs in the body, it will involve both the
intrinsic and extrinsic systems and these systems will complement each other.
Xa along with phospholipids, Ca++, Va acts as
Prothrombin activator. This converts Prothrombin to thrombin. Thrombin later on converts fibrinogen to fibrin monomers by a process of proteolyis. This fibrin monomer is converted to fibrin polymer which is unstable. Unstable fibrin polymer will be acted upon by factor XIIIa, leads to the formation of stable fibrin threads. These threads entangle RBCs to form a stable clot.
Clotting time is the time interval from the onset of bleeding till the appearance of fibrin threads
is a disorder of coagulation of blood; • Is sex linked inherited disease.
• Manifests only in males and females are the carriers
• The gene responsible is a recessive gene and is present on the X chromosome.
• In male there is only one X chromosome and if the hemophilic gene is present on it, they suffer from the disease.
In hemophilia the clotting time is
prolonged but bleeding time and prothrombin time will be normal. At times people continue to bleed for hours.
a clotting disorder similar to hemophilia A but caused by a congenital deficiency of factor IX
Stored blood plasma can't be given as
factor VIII is destroyed during storing of blood.
Treatment for hemophilia
• Can be treated by administering fresh plasma or cryoprecipitate (concentrated form of deep frozen fresh plasma) or factor number VIII (anti hemophilic globulin).
The presence or absence of the group specific agglutinogen on the RBC forms the basis for
The chemical nature of these substances can be either
glycoproteins or polysaccharides
There are certain substances, which may be present in plasma and act against specific agglutinogen. These substances are termed as
When a particular agglutinogen reacts with a corresponding agglutinin, the reaction is termed as
agglutination. This reaction leads to agglutination (clumping) of the red blood cells.
A and B agglutinogens are considered in
D agglutinogen is considered in
M and N agglutinogens are considered in
The blood group specific agglutinogen can also be present in certain bodily secretions like saliva, semen, and gastric juice. People in whom the group specific agglutinogen is present in the saliva etc are called as
"secretors". About 85% of the people are secretors.
There are certain agglutinins/antibodies that are present in plasma. These agglutinins are called
naturally occurring antibodies. The agglutinins are (anti A) and (anti B) with respect to ABO system of blood grouping
Based on the presence or absence of aforesaid agglutinogen and agglutinin, Karl Land -Steiner deduced the following law, which states that 1st part of the law
When a particular agglutinogen is present on the red blood cell the corresponding agglutinin will be absent in the plasma. The 1st part of the law is a logical outcome of the situation; otherwise there will be agglutination of the red blood cells. This part of the law holds good for all the systems of blood grouping.
Based on the presence or absence of aforesaid agglutinogen and agglutinin, Karl Land -Steiner deduced the following law, which states that 2nd part of the law
When a particular agglutinogen is absent on the red blood cell, the corresponding agglutinin will be present in the plasma. The 2nd part of the law is applicable only to ABO system, as the agglutinins of ABO are naturally occurring one, unlike for Rh system. In Rh system it is only when the Rh +ve cells are introduced into the body of Rh-ve individual, there will be production of anti D agglutinin. Hence this agglutinin is not naturally occurring one. Because of this Rh system will not obey the 2nd part of the law
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