A&P 302 Blood Lecture Notes:

Blood General Characteristics:

The only fluid tissue

Has 2 components:
o Formed elements
o Fluid (plasma)
Blood is a Connective tissue and the ONLY fluid tissue
Platelets = broken off fragments of the cell

Blood Elements:

Erythrocytes
o Red blood cells
Buffy coat
o White blood cells
o Platelets
o Buffy coat is very small
Plasma
There are EQUAL RBCs to Plasma

Blood Hematocrit:
Percentage of blood made up of erythrocytes WILL be on test

Normal:
o Men - 47%
o Women - 42%

Blood Function:

Distribution
Regulation (Hormones are distributed through the blood regulates body
function)
Protection (1. clotting factors prevents bleeding and 2. WBCs &
antibodies protect against pathogens)

Blood (Function) Distribution:

Delivers oxygen and nutrients

Transports metabolic waste
Transports hormone

Blood (Function) Regulation:

Maintain appropriate body temperature

Maintain normal pH Doesnt like this point. pH is actually regulated
by the Lungs and Kidneys.
Maintain adequate fluid volume

Blood (Function) Protection:

Prevent blood loss

Prevent infection

Blood Components:

Plasma
Formed elements

Plasma Components:

Water 90%
Solutes extremely important.
Solutes have Osmotic pole. If solutes particularly Sodium (and
glucose too) are high they will draw/keep water IN the plasma. If
solutes is, low water will move OUT of the blood/plasma.

Plasma Solutes:

Proteins Also have an Osmotic pole

Non-protein Nitrogenous Substances

Plasma Proteins:

Predominately produced by the liver

Components
o Albumin (protein in the blood)
o Globulins (immunoglobulins)
o Clotting proteins
Proteins are made in the LIVER
o If a pt has liver dz, they will not make as much protein so fluid
will leak out of the blood (causing swelling in the periphery) and
the liver will become stiff. They are also susceptible to ascites

Plasma Non-proteins:

Nutrients (like Glucose)

Electrolytes (Sodium, Potassium, and Chloride)
Respiratory gases (Oxygen and Carbon Dioxide)
Glucose is important because remember, it also has an Osmotic pole
Sodium is highest in the blood in the cell there is lots of potassium
and little sodium and vice versa outside the cell there is little
potassium and lots of sodium.

(Blood) Formed Elements Components:

Erythrocytes
Leukocytes
Platelets

Erythrocytes Structure:

Biconcave disc with depressed centers

Anucleate
No organelles
Spectrin protein cell wall
RBCs have NO metabolism/organelles why is this important??
o It DELIVERS Oxygen and CARRIES OFF Carbon Dioxide.
o Because it has virtually no metabolism it doesnt USE the
Oxygen it is carrying to the tissues.
Why is it important that is a biconcave disc??
o Firstly, it allows it to bend through tight places easier
o But more importantly the shape Increases SURFACE AREA
(allowing it to pick up more O2 and CO2.)

Erythrocytes Structural Characteristics:

Huge surface area

97% hemoglobin

Does not use oxygen (no mitochondria)

Erythrocytes Function:

Carries oxygen and carbon dioxide via hemoglobin

The hemoglobin carries Oxygen an Carbon Dioxide on DIFFERENT
sites/sides so there is NO competition for the receptor.

Erythrocytes Hemoglobin:

Protein globin
Pigment heme

Normal values:

o Infants 14-20 g/100 ml

o Males 13-18
o Females 12-16
Same thing applies with hemoglobin as with hematocrit.
If taking a pts blood count you would order an H&H (Hemoglobin and
Hematocrit) you will NEVER see where one is low and the other is

high (i.e. Hemoglobin high and Hematocrit low or vice versa) because
their percentages of each other.

Hemoglobin Oxygen States:

Oxyhemoglobin ruby red and change shapes

Deoxyhemoglobin oxygen detaches becomes dark

Hemoglobin Transport Carbon Dioxide:

Binds to the globins amino acid

Forms carbaminohemoglobin
How does a RBC know when to pick up more Carbon Dioxide and
release more Oxygen? There is a concentration gradient (i.e. in the
lungs there is a high amount of Oxygen and low amount of Carbon
Dioxide so the Oxygen binds to the RBC in the periphery it is the
opposite. There is a low amount of Oxygen and a high amount of
Carbon Dioxide so the Carbon Dioxide binds to the cell to be taken
away)
And
Carbon Monoxide binds to the SAME receptor as Oxygen
o BUT it binds even tighter than Oxygen so the Oxygen isnt able
to attach
o Will a pt with monoxide poisoning look dusky & blue or pink?
PINK, because the Carbon Monoxide that is binding to that site
is whats causing the cell to become bright red, so the pt will
look pink.

Blood Cells Production:

Hematopoiesis
Occurs in the red bone marrow
o Axial skeleton and girdle (IN ADULTS)
All blood cells come from hematopoietic stem cell or hemocytoblast
Hemodilation drop in hematocrit if bleeding isnt controlled
In CHILDREN EVERY bone is able to produce blood cells! (Which is why
their hematocrit is higher)
ALL blood cells (RBCs, WBC,s platelets, et.c) share from/come from the
SAME germ/stem cellwhat causes it to become one or the other?
o A Chemical signal

Erythrocytes Production:
Process is called erythropoiesis

Hemocytoblast becomes proerythroblasts

Proerythroblasts becomes early erythroblasts and enters a developmental pathway
Dont have to know all the different stages or names (in the picture),
just focus on the bottom of the picture.

Erythropoiesis: - WILL BE ON TEST!

Phase 1 ribosome synthesis (ribosomes in the cell are what makes the

protein aka hemoglobin)

Phase 2 hemoglobin accumulation
Phase 3 ejection of the nucleus

Erythropoiesis Phase 1:

Proerythroblasts become an early (basophilic) erythroblast

Produce huge numbers of ribosome
Hemoglobin synthesis and iron accumulation
Early erythroblasts become late erythroblasts
Dont have to name names (proerythroblasts, etc.)

Erythropoiesis Phase 2:

Late erythroblast becomes a normoblast

Hemoglobin accumulates
At a concentration of hemoglobin at 34% organelles are ejected
DIDNT talk about this slide

Erythropoiesis Phase 3: KNOW This Stage!

Normoblast ejects the nucleus and becomes a reticulocyte

Reticulocytes are ejected into the blood stream and mature to become erythrocytes
It kicks out the nucleus and the RBC is released into circulation.
Blood cells that come out of Plasma are known as Reticulocytes (this
is important!) has blue spots (stippling)
o In ANY anemia that doesnt involve a problem with the bone
marrow a NORMAL response to anemia is to produce more
Reticulocytes
o Can get a Reticulocyte count test done Normal is about 1%

Erythropoiesis Regulation:
Controlled by erythropoietin (EPO)

Produced by the kidney

Triggered by a drop in blood oxygen: KNOW!

1. Loss of blood cells

2. Reduced availability of oxygen
3. Increased tissue need
EPO is the chemical signal that decides what type of blood cell needs
to be made (RBC, WBC, etc.)
o EPO is produced by the Kidney if it senses that you arent
carrying enough oxygen in the blood
o EPO also comes in an injectable form
o Also Elevation and smoking will Increase EPO

Erythrocytes Iron:
65% of iron is in hemoglobin

Iron is stored in cells as ferritin and hemosiderin

Iron in blood is bound to transferrin
Iron is necessary to produce RBCs/Hemoglobin
Ferritin checked if you think a pt has low iron levels
Most of iron is stored in liver and liver damage can occur if
take too much
Transferrin Almost everything in blood is carried by a transfer
molecule (like Transferrin).
Iron-binding capacity and Total iron binding capacity
o How much Iron is on Transferrin (and other binding molecules).
o They measure how many open spots are on the Transferrin.

o An increased iron binding capacity means it is DOWN (there are

empty receptors)

Erythrocytes Destruction:

Live about 120 days

Dying erythrocytes are engulfed by macrophages

Iron is salvaged Important point!

Heme becomes bilirubin

Bilirubin is picked up by liver cells and secreted into the intestine as bile
In the intestine is converted to urobilinogen
- If there is an obstruction (such as a gallstone) between the liver and
intestine the urine will be dark d/t the increase of urobilinogen in
the urine and the stool will be pasty white d/t an absence of
stercobilin.
Degraded pigment is excreted in stool as stercobilin
Hematocrit definition percentage of RBCs in plasma (blood)
Blood made in red bone marrow
If a woman doesnt take iron supplements after pregnancy it
would take 3 years to get her stores back up to normal!
Elevated bilirubin JAUNDICE (esp. in infants because their livers
after able to break down the bilirubin into products)

Leukocytes Structure: DIDNT go over!

Complete cells with nuclei

Leukocytes Functional Characteristics:

Diapedesis - able to slip out of capillaries

Amoeboid motion movement through tissue (crawls through the tissue)
Positive chemotaxis chemical trail released by damaged cells

Leukocytes Classification:

Granulocytes
o Neutrophils
o Basophils
o Eosinophils
Agranulocytes
o Lymphocytes
o Monocytes

Leukocytes Mnemonic: KNOW!

Never Let Monkeys Eat Bananas

Lists of cells from the order of most abundant to least
WBCs in the highest concentration should be Neutrophils (to the
point that its hard to find Basophils on a slide of blood)

Granulocytes Characteristics: KNOW!

1) Larger than erythrocytes
2) Lobed nuclei
3) Shorter lived than erythrocytes
o A Neutrophil only lives a couple days in the periphery (has to be
replaced often, which is why it has a nucleus)

Granulocytes Neutrophils:

Also known as polymorphonuclear leukocytes (PMNs or polys)

Very fine granules
Lilac colored

o Absorb both acidic and basic dyes

Neutrophils Functional Characteristics:

Attracted to bacteria and fungi

Contain defensins antibiotic like proteins
Kills bacteria by respiratory burst (oxidation) WILL BE A TEST Q!
An immature Neutrophil is called a Band Cell a pit will have an
increase in band cells if there is a serious infection
Fungal infections Neutrophils will ONLY be elevated if there is a
serious infection (fungus growing in the sinuses, etc.) this is RATE.
o If neutrophils are elevated you expect to be because of Bacteria!

Granulocytes Eosinophils:

Deep red nucleus

Nucleus has 2 lobes connected by a broad band
Coarse granules absorb acid (eosin) dyes

Eosinophils Function:

Elevated in:
Neoplasm
Asthma

 Allergy
Connective tissue disease

Parasites

(NAACP)
Inactivates inflammatory reactants in allergic reactions
Neoplasms, Asthma, and Allergies are the zebras if Eosinophils are
raised you think PARASITES

Granulocytes Basophils:

Large coarse histamine containing granules

Deep purple U or S shaped nucleus with 2 3 constrictions
Related to mast cells (also contain histamine)

Basophils Function: DIDNT GO OVER!

Binds to immunoglobulin E that cause the release of histamine

Histamine is a vasodilator that attracts other white blood cells

Agranulocytes Lymphocytes:

Large dark purple nucleus (almost all nucleus)

Nucleus is round and occupies most of the cell volume

Lymphocytes Functional Cell Types:

T lymphocytes or T cells
B lymphocytes
B Cells produce antibodies in an immune reaction
T Cells 2 common types: 1) Helper T cells helps B cells and
produces antibodies and 2) Cytotoxic T Cells the only cell capable of
killing another cel
Remember B & Helper T cells are part of Humoral Immunity
And Cytotoxic T cells are part of Cell Mediated Immunity (CMI)l

Lymphocytes T Cells:

Act against viruses

Acts against tumor cells
RARE to see Lymphocytes elevated in cancer, you think VIRUS
So you would expect to see Lymphocytes or Neutrophils elevated in a
pt with a fever.
In a viral infection the Neutrophils will increase before the
Lymphocytes

Lymphocytes B Cells:

Give rise to plasma cells

Release antibodies
B cell releasing antibodies are known as Plasma cells
What becomes of nave B cells? Remember from Immunology, half will
become plasma cells and the other half will become memory cells

Agranulocytes Monocytes:

Pale blue cytoplasm

Kidney shaped nucleus

Monocytes Function:

Leaves the circulatory system to become macrophages

Fights
o viruses,
o intracellular bacterial parasites,

o and chronic infections

Elevated in chronic diseases Theyre the work horse of the immune
system

Leukocytes Production:

Called leukopoiesis
Hormonally controlled
For each strain of WBC there is a different chemical signal (aka
cytokine) telling it to be released

DONT have to remember the whole thing that takes palce

Leukopoiesis Hormones:

Released by macrophages and T lymphocytes

Interleukins (numbered IL3)

Colony-stimulating factors (CSFs named e.g. granulocyte CSF)

Leukopoiesis Cell Lines: DONT Have to Know!

Hemoblasts divide into either myeloid stem cells or lymphoid stem cells
Lymphoid stem cells give rise to lymphocytes and plasma cells only
Myeloid stem cells give rise to all others

Leukopoiesis Committed Cells: DONT Have to Know!

Myeloblast
Monoblast
Lymphoblast

Leukopoiesis Developmental Pathway: DONT Have to Know!

Lymphoblasts become prolymphocytes

Monoblasts become promonocytes
Myeloblasts become promyelocytes
Promyelocytes differentiate into
o Eosinophilic myelocytes
o Neutrophilic myelocytes
o Basophilic myelocytes
Myelocytes develop into band cells

Platelets Description:

Cell fragments not a cell

Blue staining outer segment with purple staining granules
Essential for blood clotting
Picture of cell: Only exists in the bone marrow, its too big which is why
platelets are broken down cell fragments

Platelets Formation:

Megokaryoblasts differentiate into megokarocytes

This process is regulated by thrombopoietin
Cell fragments break off and enter the blood
Platelets are filled with chemicals that are important to clotting

Hemostasis Description:

Fast, localized, controlled reaction

Has to be localized so you dont start clotting in other parts of your
body

Hemostasis Steps: KNOW!!

1) Vasospasm
2) Platelet plug formation
3) Coagulation (blood clotting)

Hemostasis Vasospasm:

Chemicals released by damaged endothelial cells and platelets

Reflexes initiated by local pain receptors
Lasts 20 30 minutes
Pain reflex: More geared toward arteries but it goes for vein, etc. too.
But arteries have many pain fibers
The reflexes are like manually applying pressure (there are muscles
around the arteries which makes it easier to constrict)

Hemostasis Platelet Plug Formation:

Provide a temporary plug

Release chemicals that enhance hemostasis
In healthy blood vessels chemicals are telling the platelets to NOT stick
together, when its damaged it sends a chemical signal for the Platelets
to start sticking d/t VWF
Aspirin makes platelets less sticky

Platelet Plug Formation Initial Event:

Broken endothelial tissue releases von Willebrand factor (VWF)

You CAN have a von Willebrand factor deficiency this makes it harder
to clot and easier to bleed

Platelets Chemical Release: KNOW!

Serotonin enhances vasospasm
Adenosine diphosphate (ADP) attracts more platelets
Thromboxane A2 stimulates both vasospasm and platelet aggregation

Theses are the chemicals IN platelets

They either stimulate vasospasm or attract more platelets, ONLY
Thromboxane A2 does both
There has never been a deficiency in these chemicals

Platelet Regulation:
Endothelial cells produce prostacyclin PGI 2

Produced by intact (healthy) endothelial cells

Prevent aggregation of platelets
Prostacyclin PGI 2 is the chemical that sends signals to platelets to
NOT clot in a healthy vessel

Coagulation Description:

Blood transformed from a liquid to a gel

Has three phases:

1) Prothrombin Activation
2) Thrombin Activation
3) Fibrin Mesh

Fibrin (like the fibers in Velcro) makes the platelets stick together
better.
BUT Fibrin needs to be INACTIVE in the blood Prothrombin and
thrombin speed up the activation of fibrin

Coagulation Prothrombin Activation:

KNOW the difference between the two pathways

Two pathways:
o Intrinsic (comes from within)
o Extrinsic (comes from outside)
Both require the presence of PF3
This is a cascade there are very few in the body
Hemophilia can occur if there is a problem with any of the clotting
factors.
o How is it treated? You give an injected of the deficient clotting factor, but it must
be given every day and immediately if they cut themselves.
o Complications bleeding in joints leads to arthritis at a young age so they
have horrible joint damage
o Older pts dont have hemophilia as much. Why? Because AIDS was in Clotting
Factor 7 & 8 so a lot of them died.
o More common in Males

Prothrombin Activation Intrinsic Pathway:

Slower
All factors are present in the blood
Only way clotting occurs outside the body
All of the factors necessary for the intrinsic pathway are already in the
blood

Prothrombin Activation Extrinsic Pathway:

Utilizes tissue factor (TF) or factor III or tissue thromboplastin

Short cut to prothrombin activation
You DONT find TF floating around freely in the blood
Its faster why it is called the short cut

Prothrombin Activation Common Factors: WILL BE ON TEST!

Both require calcium
Both require factor X

Once you go either the intrinsic or extrinsic pathway Factor X (1)

comes in

Coagulation Pathway to Thrombin:

Same for either pathway

Prothrombin activator transform prothrombin into thrombin
Prothrombin time measure of clotting
Blood thinners prevents coagulation (doesnt actually thin the blood
by dropping the hematocrit)

Coagulation Fibrin Mesh:

Thrombin converts fibrinogen into fibrin

Thrombin activates factor XIII (fibrin stabilizing factor)
Fibrin entraps formed elements
How it is localized? By factors that stop Fibrin from be produced and
local factors that stabilize it so it doesnt clot.

Clot Retraction Platelets Role:

Platelets contain actin and myosin that contract bringing torn endothelial edges
together
Causes serum to be squeezed out
Secrete platelet-derived growth factor which induces smooth muscle and fibroblasts to
divide

If you have a vessel thats broken/split (2 blood clots are needed),

you need to reestablish blood flow, but it doesnt directly reconnect.
o It rebuilds a new section (like below the two sections for
example), and that is done by Platelet-derived growth factor

Coagulation Regulation:

Limiting factors that prevent clotting in the intact blood vessel

Fibrinolysis of the clot breaking down of the clot
Regulation = localization
It HAS to be localized, therefore you have to limit where the blood
clotting will take place and thats what limiting factors are

Coagulation Limiting Factors:

Those factors that prevent clotting in intact (healthy) vessels

Thrombin attaches to fibrin
Free thrombin is quickly inactivated by antithrombin III
Antithrombin III, protein C and protein S (3 chemicals that prevent clotting)
inhibit other intrinsic pathway procoagulants produced by basophils and mast cells by
activating antithrombin III
What if your deficient in one of those? You can develop a blood blot.
Is there a particular population that is concerned with blood clots
(based in part on meds they may take)? Its 1) birth control (in
particular estrogen) 2) women in late 30s or early 40s, especially if
they smoke.
If any woman has a deficiency in ANY of these 3 chemicals
(Antithrombin III, Protein C, or Protein S) they cant take birth control!

Coagulation Fibrinolysis:
Presence of a clot causes endothelial cells secrete tissue plasminogen activator

(TPA)
TPA transformed plasminogen into plasmin
Plasmin dissolves the clot
TPA is seen when a patient has a stroke or MI
When injecting TPA (particularly for a stroke,) you want as little TPA as
possible and where the clot is, so you do a cath.