Chapter 10

Bone marrow Blood cells Plasma

Whole blood consists of formed elements suspended in a liquid component. 5-6 liters total blood volume in an adult

8% of total body weight

Slightly alkaline: pH 7.35-7.45 Temp.: 38 celsius

Bone marrow
4% - 5% of total body weight Contained within the spongy bones and central cavity of long bones

Red marrow
Site of active cell formation Major blood producing organ (hematopoiesis)

Yellow marrow
Constitutes inactive areas composed mainly of fat

Stem cells
Free, primitive cells present in bone marrow Differentiates into mature blood cells

Blood cells
Hematocrit refers to the percentage of total blood volume composed of cells.

Normal value approximately 45%

Whole blood contains 3 types of mature blood cells
Erythrocytes Leukocytes Thrombocytes

ERYTHROCYTES (RBCs)

Average total RBC count: 5million cells/mm3 of blood

Erythrocyte

major cellular element of circulating blood Bi-concave disks that normally are about 7mm in diameter and containing hemoglobin confined within a plasma membrane

Reticulocytes
Immature erythrocytes
Released prematurely from marrow to circulation under conditions necessitating rapid blood cell production (compensatory mechanism)

Hemoglobin

Consist of an iron-containing pigment and a simple protein

95% of the erythrocyte mass Has the ability to bind oxygen loosely and reversibly Called oxyhemoglobin if combined with oxygen 15g. Of hemoglobin per 100ml of blood

LEUKOCYTES (WBCs)

5,000-10,000 cells/cubic mm of blood Average total WBC count

2 Major Types: 1. Granular Leukocytes

Produced in bone marrow Granulocytes comprise 70% of all WBCs

3 Types of Granulocytes
Neutrophils
Pink stain Multi-lobed nucleus

Eosinophils
Blue red nucleus

Basophils
Dark blue stain

2.

Mononuclear leukocytes

2 groups Lymphocytes

Monocytes

Produced in bone marow Undergo differentiation in lymph tissue Comprise 30% of leukocytes Large purple nucleus Produced in bone marrow Transform into mature forms called macrophages on release into tissues Comprise 5% of total leukocytes Largest WBCs

THROMBOCYTES Normal platelet count is: 150,000 to 450,000/mm3 of blood

Thrombocytes are formed from fragments of membrane and cytoplasm from very large cells in bone marrow, lung, and spleen called megakaryocytes Normal lifespan of thrombocytes: 7-14 days

Liquid portion of whole blood remaining after blood cells are removed 55% of blood volume Contains large quantities of organic and inorganic substances Serum
Fluid remaining when plasma is allowed to clot

PLASMA PROTEINS Albumin

Largest of plasma proteins, produced in the liver

Globulins
Gamma globulins
Consists of antibodies known as immunoglobulins

Alpha and beta fractions

Clotting factors, produced in the liver and transport proteins

Fibrinogen
High-molecular wt. protein important in blood clotting

FACTOR

SYNONYMS

I II

Fibrinogen Prothrombin

NORMAL PLASMA CONCENTRATIONS (mg/dl) 200 400 10

III
IV V

Tissue thromboplastin, 0 tissue factor Calcium ion 45 Pro accelerin, labile factor 1

FACTOR

SYNONYMS

VII

VIII IX

Serum prothrombin conversion accelerator(SPCA), stable factor Antihemophilic factor Christmas factor

NORMAL PLASMA CONCENTRATIONS (mg/dl) 0.05

1-2 0.3

X XI

Stuart-Power factor Plasma thromboplastin antecedent (PTA)

1 0.5

FACTOR

SYNONYMS

XII XIII

Hageman factor

Fibrin stabilizing factor (FSF) Prekallikrein Fletcher factor

NORMAL PLASMA CONCENTRATIONS (mg/dl) 3 12

5

High molecular weight kininogen

Fitzgerald, Flaujeac, Williams factor, contact activation cofactor

Transport oxygen absorbed from lungs and nutrients absorbed from the GIT to body cells for cellular metabolism Transport waste products from tissues to excretory organs Aid in chemical, acid-base, and thermal regulation of the body Transport hormones and other substances internally secreted to their tissue sites of action

Aid in defense against infection through the actons of antibodies and phagocytes Aid in regulation of extracellular fluid volume Promoting hemostasis through the arrest of bleeding blood clot formation, followed by clot dissolution

Produces all blood cells During hematopoiesis:

Stem cells in the bone marrow divide into the myelocyte stem cell line and lymphiod stem cell line

transform into committed precursors,

and eventually differentiate into mature blood cells

ERYTHROCYTES Normal production is stimulated by erythropoietin and requires several nutrients:

Iron Folic acid Pyridoxine (vit. b complex) Ascorbic acid

Transport O2 from lungs to tissues Ave. lifespan is 120 days

LEUKOCYTES
Defend the body against invasion by infectious and parasitic organisms through phagocytosis and antibody production

Neutrophils
Arrive early at the site of inflammatory reaction Increase in number with the onset of infection

Eosinophils and basophils

Alter blood supply to tissues and help mobilize body defenses Eosinophils increases in allergies and infections of parasitic worms Basophils - Contain and release potent biologic materials:
Histamine, serotonin, heparin Makes blood vessels leaky and attracts other WBCs to inflammation site

Monocytes

Largest non-granular leukocytes

Phagocytizes large foreign particles, cell fragments, necrotic tissue

Lymphocytes

Produce substances that aid in attacking foreign cells and substances Produce antibodies

B lymphocytes

T lymphocytes

Kill foreign cells directly or release lymphokines

Natural killer cells (NK)

Defend against microorganisms and some types of malignant cells

THROMBOCYTES Help control bleeding by:

Aggregating and adhering to sites of vascular injury, forming a plug that temporarily stops bleeding Releasing biochemical substances that activate coagulation factors in plasma to form a stable fibrin clot

Part of the ECF of the body and provides a medium for circulation of blood cells Plasma proteins 1. Albumin
Causes osmotic pressure at the capillary membrane Prevents fluid from leaking out of the capillaries into the interstitial spaces Process called colloid osmotic pressure

2.

Globulins Alpha and beta globulins

Transport of other substances by combining with them Acting as substrates for formation of other substances Transporting proteins from part of the body to another

Gamma globulins

Protect body against infections Antibodies that resist infection and toxicity

3.

Fibrinogen High molecular weight protein One of the essential factors in the coagulation process Thrombin acts on fibrinogen to form the reticulum of the clot

Constituent substances in plasma provide for: Blood coagulation

Maintenance of acid-base balance Clot lysis

Fibrinolytic system Plasminogen Fibrinolysis

Vascular phase vessel constriction Platelet phase aggregation at bleeding site Coagulation phase - clot formation

Transportation of nutritional and hormonal substances

Platelet plug forms

Vascular spasm occur

Coagulation events occur

Antigen

Substance recognized by body as foreign Stimulates immune system to release antibodies E.g. foreign substances, part of bacteria

Antibodies

Recognizers Present in the plasma that attach to RBCs

Agglutination

Binding of antibodies causing RBCs to clump

Based on which of 2 antigens A or B a prson inherits Type O

Absence of both antigens

Type AB
Presence of both antigens

Type A or Type B
Presence of either A or B antigen

Blood group AB

RBC antigens A B B A None

B A O

Plasma Blood that antibodies can be received None A, B, AB, O Universal recipient Anti-A B, O Anti-B A, O Anti-A O Anti-B Universal donor

One of the 8 antigens identified with Rhesus monkeys, but later discovered in humans Rh+ RhHemolysis

Throughout life: 7 months: Red marrow Before birth: liver, spleen Red marrow

Whole Blood

Replacement of RBCs and plasma volume to raise Hgb and Hct levels Not commonly used due to fluid overload Preferred replacement of RBCs and plasma volume to raise Hgb and Hct levels RBCs without plasma volume For severe symptomatic anemia or acute blood loss

PRBCs

Fresh frozen plasma

Replacement of plasma without RBCs or platelets Contains most coagulation factors except platelets Used to control bleeding caused by deficiency in clotting factors

Platelets
Replacement of platelets Used to treat severe or symptomatic thrombocytopenia

Albumin
A hyperosmolar solution prepared from plasma that expands vascular volume Used to treat hypovolemic shock or hypoalbumenemia

One of the most common blood diseases worldwide is anemia, which is characterized by an abnormally low number of red blood cells or low levels of hemoglobin. One of the major symptoms of anemia is fatigue, due to the failure of the blood to carry enough oxygen to all of the tissues.

The most common type of anemia occurs because the marrow fails to produce sufficient red blood cells. When insufficient iron is available to the bone marrow, it slows down its production of hemoglobin and red blood cells. The most common causes of iron-deficiency anemia are certain infections that result in gastrointestinal blood loss and the consequent chronic loss of iron. Adding supplemental iron to the diet is often sufficient to cure iron-deficiency anemia.

Some anemias are the result of increased destruction of red blood cells, as in the case of sickle-cell anemia a genetic disease most common in persons of African ancestry. The red blood cells of sickle-cell patients assume an unusual crescent shape, causing them to become trapped in some blood vessels, blocking the flow of other blood cells to tissues and depriving them of oxygen.

Direct cause:
Decrease in RBC Number

Results from:
Sudden hemorrhage Lysis of RBCs as a result of bacterial infections

Direct cause:
Decrease in RBC Number

Results from:
Lack of vitamin B12 Due to lack of intrinsic factor required for absorption of the vitamin; intrinsic factor is formed by stomach mucosa cells

Direct cause:
Decrease in RBC Number

Results from:
Depression/destruction of bone marrow by cancer, radiation, or certain medications

Some white blood cell diseases are characterized by an insufficient number of white blood cells. This can be caused by the failure of the bone marrow to produce adequate numbers of normal white blood cells, or by diseases that lead to the destruction of crucial white blood cells. These conditions result in severe immune deficiencies characterized by recurrent infections.

Any disease in which excess white blood cells are produced, particularly immature white blood cells, is called leukemia, or blood cancer. Many cases of leukemia are linked to gene abnormalities, resulting in unchecked growth of immature white blood cells. If this growth is not halted, it often results in the death of the patient. These genetic abnormalities are not inherited in the vast majority of cases, but rather occur after birth.

Treatment for leukemia typically involves the use of chemotherapy, in which strong drugs are used to target and kill leukemic cells, permitting normal cells to regenerate. In some cases, bone marrow transplants are effective. Much progress has been made over the last 30 years in the treatment of this disease. In one type of childhood leukemia, more than 80 percent of patients can now be cured of their disease.

One disease of the coagulation system is hemophilia, a genetic bleeding disorder in which one of the plasma clotting factors, usually factor VIII, is produced in abnormally low quantities, resulting in uncontrolled bleeding from minor injuries. Although individuals with hemophilia are able to form a good initial platelet plug when blood vessels are damaged, they are not easily able to form the meshwork that holds the clot firmly intact.

As a result, bleeding may occur some time after the initial traumatic event. Treatment for hemophilia relies on giving transfusions of factor VIII. Factor VIII can be isolated from the blood of normal blood donors but it also can be manufactured in a laboratory through a process known as gene cloning.

Thrombus
Clot that develops and persists in an unbroken vessel May prevent blood flow to the cells beyond the blockage

Embolus
Clot (thrombus) that breaks away from the vessel wall and floats freely in the blood stream

RBC WBC

120 days 18 to 36 hrs

Platelets

- 7 to 14 days

Fluosol

Chemically Altered Hemoglobin Artificial RBCs (Neohemocytes)

Main ingredient: perfluorocarbons (PFCs) Depresses the immune system

Harvested hemoglobin from erythrocytes and altered Natural hemoglobin packaged in bubbles made from phospholipids and cholesterol Natural but non human blood substitute Purified hemoglobin extracted from cattle blood

Hemopure

Bone marrow aspiration and biopsy Complete Blood Cell count CBC with Differential WBC count Bleeding time Clotting time Platelet aggregation