Chapter 11 Blood hem/o, hemat/o. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate...

Chapter 11Chapter 11BloodBlood

hem/o, hemat/ohem/o, hemat/o

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

BloodBlood

The main functions of Blood is transportation The main functions of Blood is transportation and protectionand protection

The two systems that help accomplish these The two systems that help accomplish these functions are the Circulatory Lymphatic functions are the Circulatory Lymphatic Systems.Systems.

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BLOOD COMPOSITION BLOOD COMPOSITION (Table 11-1)(Table 11-1)

Blood plasmaBlood plasma Definition—blood minus its formed elementsDefinition—blood minus its formed elements Composition—water containing many dissolved Composition—water containing many dissolved

substances (e.g., foods, salts, and hormones)substances (e.g., foods, salts, and hormones) Amount of blood—varies with size and sex; 4 to 6 L Amount of blood—varies with size and sex; 4 to 6 L

about average; about 7% to 9% of body weightabout average; about 7% to 9% of body weight Blood plasma also contains Blood plasma also contains plasma proteinsplasma proteins: :

albumins (thicken & maintain blood volume), albumins (thicken & maintain blood volume), globulins (containing antibodies to fight infection), globulins (containing antibodies to fight infection), fibrinogen (needed for blood clotting).fibrinogen (needed for blood clotting).

SerumSerum is plasma minus the clotting factor, is plasma minus the clotting factor, fibrinogenfibrinogen

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BLOOD COMPOSITIONBLOOD COMPOSITION

Formed elements of bloodFormed elements of blood TypesTypes

• RBCs (erythrocytes)RBCs (erythrocytes)• WBCs (leukocytes)WBCs (leukocytes)

Granular leukocytesGranular leukocytes—neutrophils, eosinophils, and basophils—neutrophils, eosinophils, and basophils Nongranular leukocytesNongranular leukocytes—B & T lymphocytes and monocytes—B & T lymphocytes and monocytes

• Platelets, or thrombocytesPlatelets, or thrombocytes CountCount

• RBCs—4.5 to 5 million per mmRBCs—4.5 to 5 million per mm33 of blood of blood• WBCs—5000 to 10,000 per mmWBCs—5000 to 10,000 per mm3 3 of bloodof blood• Platelets—300,000 per mmPlatelets—300,000 per mm33 of blood of blood

Formation—red bone marrow (myeloid tissue) forms all Formation—red bone marrow (myeloid tissue) forms all blood cells except some lymphocytes and monocytes, blood cells except some lymphocytes and monocytes, which are formed by lymphatic tissue in the lymph which are formed by lymphatic tissue in the lymph nodes, thymus, and spleennodes, thymus, and spleen

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RBCsRBCs Structure—disk-shaped, without nucleiStructure—disk-shaped, without nuclei Functions—transport oxygen and carbon dioxideFunctions—transport oxygen and carbon dioxide Anemia—inability of blood to carry adequate oxygen to tissuesAnemia—inability of blood to carry adequate oxygen to tissues; ;

caused, for example, by:caused, for example, by:• Inadequate RBC numbersInadequate RBC numbers• Deficiency of hemoglobinDeficiency of hemoglobin• Pernicious anemia—deficiency of vitamin B12Pernicious anemia—deficiency of vitamin B12

Polycythemia—abnormally high RBC countPolycythemia—abnormally high RBC count Hematocrit (Hct) test—medical test in which a centrifuge is used to Hematocrit (Hct) test—medical test in which a centrifuge is used to

separate whole blood into formed elements and liquid fraction (Figure separate whole blood into formed elements and liquid fraction (Figure 11-3)11-3)

• Buffy coat is WBC and platelet fractionBuffy coat is WBC and platelet fraction• Normal RBC level is about 45%Normal RBC level is about 45%• Erroneous test result can be caused by dehydrationErroneous test result can be caused by dehydration

In the adult hemapoeisis (the creation of RBCs) mainly occurs In the adult hemapoeisis (the creation of RBCs) mainly occurs in the sternum, ribs, and hipbones. Small amounts are made in the sternum, ribs, and hipbones. Small amounts are made vertebrae, clavicles, and cranial bones. Erythrocytes live for vertebrae, clavicles, and cranial bones. Erythrocytes live for about 4 months.about 4 months.

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There are 3 main types of anemia in our textbook: There are 3 main types of anemia in our textbook: Hemorrhagic anemia, results from a decreased number of RBCs caused by Hemorrhagic anemia, results from a decreased number of RBCs caused by

hemorrhage resulting from accidents &/or internal bleeding.hemorrhage resulting from accidents &/or internal bleeding. Aplastic anemia, characterized by a reduction in RBCs resulting from the Aplastic anemia, characterized by a reduction in RBCs resulting from the

destruction of blood-forming bone marrow. Bone-marrow is chiefly destroyed destruction of blood-forming bone marrow. Bone-marrow is chiefly destroyed by exposure to certain toxic chemicals, high-dose irradiation (x-rays), certain by exposure to certain toxic chemicals, high-dose irradiation (x-rays), certain drugs, and chemotherapy agents.drugs, and chemotherapy agents.

Pernicious anemia, is a term used to describe the deficiency of RBCs Pernicious anemia, is a term used to describe the deficiency of RBCs resulting from a failure of the stomach lining to produce “intrinsic factor”—the resulting from a failure of the stomach lining to produce “intrinsic factor”—the substance that allows for Vit. B12 absorption (needed for the formation of substance that allows for Vit. B12 absorption (needed for the formation of RBCs).RBCs).

Sickle cell anemiaSickle cell anemia, a genetic disease that creates abnormal RBC , a genetic disease that creates abnormal RBC hemoglobin with solid crystals formed on its surface causing the RBC to fold hemoglobin with solid crystals formed on its surface causing the RBC to fold over on itself making it less soluble. A person can have a form of this over on itself making it less soluble. A person can have a form of this disease called sickle cell trait caused inheriting only one defective gene from disease called sickle cell trait caused inheriting only one defective gene from one parent. The gene can also be inherited from both parents, in which case one parent. The gene can also be inherited from both parents, in which case the disease becomes more severe.the disease becomes more severe.

Iron deficiency anemiaIron deficiency anemia, is caused by an inadequate intake of iron in the , is caused by an inadequate intake of iron in the diet. Iron is essential in the formation of hemoglobin. This is a global diet. Iron is essential in the formation of hemoglobin. This is a global problem and is seen in the poor throughout the world. problem and is seen in the poor throughout the world.

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A centrifuge is used to spin down the blood. Remember that the RBCs are more dense and therefore will go to the bottom of the test tube. WBCs and platelets are less dense, therefore rest in the buffy coat. The remainder of the blood, plasma is the least dense and that is why it is on the top of the test tube. See figure 11-3.



WBCs (leukocytes)WBCs (leukocytes) General function—defenseGeneral function—defense WBC countWBC count

• Differential WBC count reveals proportions of each type of Differential WBC count reveals proportions of each type of WBCWBC

• Leukopenia—abnormally low WBC count ( less than Leukopenia—abnormally low WBC count ( less than 5,000) ex. AIDS5,000) ex. AIDS

• Leukocytosis—abnormally high WBC count (usually Leukocytosis—abnormally high WBC count (usually bacterial infection)bacterial infection)

Neutrophils and monocytes carry out phagocytosisNeutrophils and monocytes carry out phagocytosis Lymphocytes produce antibodies (B-lymphocytes) or Lymphocytes produce antibodies (B-lymphocytes) or

directly attack foreign cells (T-lymphocytes)directly attack foreign cells (T-lymphocytes) Eosinophils protect against parasitic irritants that cause Eosinophils protect against parasitic irritants that cause

allergiesallergies Basophils produce heparin, which inhibits clottingBasophils produce heparin, which inhibits clotting

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WBC disordersWBC disorders Leukemia—cancerLeukemia—cancer

• Elevated WBC countElevated WBC count• Cells do not function properlyCells do not function properly

Type identified by how quickly symptoms Type identified by how quickly symptoms appear and cell type involvedappear and cell type involved• Acute lymphocytic leukemia (ALL)Acute lymphocytic leukemia (ALL)• Acute myeloid leukemia (AML)Acute myeloid leukemia (AML)• Chronic lymphocytic leukemia (CLL)Chronic lymphocytic leukemia (CLL)• Chronic myeloid leukemia (CML)Chronic myeloid leukemia (CML)

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Platelets and blood clotting (Figure 11-6)Platelets and blood clotting (Figure 11-6) Platelets play an essential role in blood clottingPlatelets play an essential role in blood clotting Blot clot formationBlot clot formation

• Clotting factors released at the injury site produce Clotting factors released at the injury site produce prothrombin activatorprothrombin activator

• Prothrombin activator and calcium convert Prothrombin activator and calcium convert prothrombin to thrombinprothrombin to thrombin

• Thrombin triggers formation of fibrin, which traps Thrombin triggers formation of fibrin, which traps RBCs to form a clotRBCs to form a clot

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BLOOD TYPESBLOOD TYPES

ABO system (Figure 11-7)ABO system (Figure 11-7) Antigen—substance that can activate immune systemAntigen—substance that can activate immune system Antibody—substance made by body in response to Antibody—substance made by body in response to

stimulation by an antigenstimulation by an antigen Blood typesBlood types

• Type A blood—type A self-antigens in RBCs; anti-B type Type A blood—type A self-antigens in RBCs; anti-B type antibodies in plasmaantibodies in plasma

• Type B blood—type B self-antigens in RBCs; anti-A type Type B blood—type B self-antigens in RBCs; anti-A type antibodies in plasmaantibodies in plasma

• Type AB blood—type A and type B self-antigens in RBCs; Type AB blood—type A and type B self-antigens in RBCs; no anti-A or anti-B antibodies in plasmano anti-A or anti-B antibodies in plasma

• Type O blood—no type A or type B self-antigens in RBCs; Type O blood—no type A or type B self-antigens in RBCs; both anti-A and anti-B antibodies in plasmaboth anti-A and anti-B antibodies in plasma

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Rh systemRh system Rh-positive blood—Rh factor antigen present Rh-positive blood—Rh factor antigen present

in RBCsin RBCs Rh-negative blood—no Rh factor present in Rh-negative blood—no Rh factor present in

RBCs; no anti-Rh antibodies present naturally RBCs; no anti-Rh antibodies present naturally in plasma; in plasma; anti-Rh antibodies, however, appear anti-Rh antibodies, however, appear in the plasma of Rh-negative persons if Rh-in the plasma of Rh-negative persons if Rh-positive RBCs have been introduced into their positive RBCs have been introduced into their bodiesbodies

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Universal donor and universal recipient Universal donor and universal recipient bloodblood Type OType O—universal donor blood—universal donor blood Type ABType AB++—universal recipient blood—universal recipient blood

Erythroblastosis fetalis—may occur when Erythroblastosis fetalis—may occur when Rh-negative mother carries a second Rh-Rh-negative mother carries a second Rh-positive fetus; caused by mother’s Rh positive fetus; caused by mother’s Rh antibodies reacting with baby’s Rh-positive antibodies reacting with baby’s Rh-positive cellscells

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Chapter 11 Blood hem/o, hemat/o. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate...

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