JIGJIGA UNIVERSITY

Histology of Blood

For Medicine Students

 Blood
• Blood volume = accounts to~8% of the body
weight (about 5.5 Liters).
• Major Components of blood
1. Formed elements (45%)- the actual cellular
components of blood
a. Erythrocytes- (Red blood cells)
b. Leukocytes- (White blood cells)
c. Platelets- (Thrombocytes)
2. Plasma (55%)- It is the fluid portion of the
blood
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 Major Functions of the Blood
1.Transport
a. Gases (O2 and CO2)
b. Nutrients (organic and inorganic like electrolytes)
c. Hormones
d. Waste products
2. Defense: against infections by means of
a. WBC (phagocytosis, antibody formation)
b. Platelets (prevention from bleeding)
3. Regulation
a. Temperature regulation
b. Acid-base balance.
c. Blood volume regulation, etc.
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 Plasma and it’s composition
•Plasma is the liquid portion of the blood and
accounts to about 55% of the total blood volume.
•Plasma is composed of:
– Water (92%): is the solvent in which formed elements
are suspended and proteins and solutes are dissolved
– Plasma proteins (7%): Albumins, globulins,
fibrinogen & regulatory proteins.
– Other solutes (1%):
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 Plasma proteins
The major plasma proteins include:
•Albumin: the most abundant plasma protein &
made in the liver.
– Exerts osmotic force to retain fluid within the
microvasculature
– Contributes to blood’s viscosity
– Binds and transports some fatty acids, electrolytes,
hormones and drugs
•α- globulins: made by liver, transport lipids and
some metal ions.
•β-globulins: made by liver, transport iron ions
and lipids in bloodstream.
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 Plasma proteins cont…
• Gamma-globulins: are immunoglobulins
(antibodies) secreted by plasma cells.
• Fibrinogen: the largest plasma protein, made in the
liver, which is important for blood clotting.
• Complement proteins: a system of factors important
in inflammation and destruction of microorganisms.

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– Other solutes (1%):
Waste product: lactic acid, urea, bilirubin,
ammonia & creatinine
Nutrient: amino acids, glucose, cholesterol,
vitamins, fatty acids.
Regulatory substance: enzyme & hormone
Electrolyte: sodium, potassium, calcium, chloride,
iron, bicarbonate, and hydrogen
Respiratory gases: oxygen and carbon dioxide

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Composition of whole blood

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 Red blood cells (erythrocytes)
• Contains oxygen carrying protein hemoglobin-
pigment gives red color.
– Hemoglobin constitutes 33% of the cell wt.

• Appears as biconcave discs and lack nucleus

• RBCs are the only blood cells whose function does

not require them to leave the vasculature.

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 Red blood cells cont…
• RBC is a flexible biconcave cell that is thinner at the
center and thicker at the edges
– They are approximately 7.5μm in diameter, 2.6μm thick at
the rim, but only 0.75μm thick in the center.
• They can bend and twist to pass through the narrow
capillaries very easily.
• The biconcave shape provides a large surface-to-
volume ratio and facilitates gas exchange.
• The normal concentration of erythrocytes in blood
– 3.9 to 5.5 million per microliter in women and
– 4.1- 6.0 million/μL in men.
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(a) Colorized SEM micrograph of normal erythrocytes with each side concave
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 Red blood cells cont…
• The plasmalemma of the erythrocyte consists of:
– About 40% lipid, 10% carbohydrate, and 50% protein.
• Most of the proteins are integral membrane proteins
including ion channels, the anion transporter called
band 3 protein, and glycophorin A.
– The glycosylated extracellular domains of the glycophorin A
include antigenic sites that form the basis for the ABO blood
typing system.
• Erythrocyte cytoplasm lacks all organelles but is
densely filled with hemoglobin.
– The tetrameric O2-carrying protein

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 Red blood cells cont…
• When combined with O2 or CO2, hemoglobin
forms oxyhemoglobin or carbaminohemoglobin,
respectively.
– The reversibility of these combinations is the basis for
the gas-transporting capability of hemoglobin.
• The combination of hemoglobin with carbon
monoxide (CO) is irreversible,
– Reducing the cells’ capacity to transport O2.
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 Red blood cells cont…

• Human erythrocytes normally survive in the

circulation for about 120 days.
• Worn-out RBCs are removed from the
circulation, mainly by macrophages of the
spleen, liver, and bone marrow.

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 Anemia
• Anemia is the condition of having a concentration of
erythrocytes below the normal range.
• With fewer RBCs per milliliter of blood, tissues are
unable to receive adequate O2.
• Symptoms of anemia include lethargy, shortness of
breath, fatigue, skin pallor, and heart palpitations.
• Anemia may result from:
– Insufficient red cell production
– Due to iron deficiency, or
– From blood loss with a stomach ulcer or excessive
menses.

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 Polycythemia (Erythrocytosis)
• It is an increased concentration of erythrocytes
in blood.
• It may be a physiologic adaptation found in
individuals who live at high altitudes, where
O2 tension is low.
• Elevated hematocrit:
– Increases blood viscosity, putting strain on the
heart, and,
– If severe, can impair circulation through the
capillaries.
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 Sickle Cell Disease
• It is caused by a single-point mutation in the gene that
encodes the β-globin chain of hemoglobin A.
• The result of this mutation is an abnormal β-globin
chain in which the amino acid valine is substituted
for glutamic acid in position 6.
• When the altered hemoglobin (called HbS) is
deoxygenated in capillaries,
– It polymerizes and forms rigid aggregates that cause a
characteristic sickle shape.
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 Sickle Cell Anemia cont…
• The sickled erythrocyte is less flexible and more fragile
and has a shortened life span that can lead to anemia.
• It increases the blood viscosity and can damage the
wall of blood vessels, promoting blood coagulation.
• Sickle cells can block capillaries, restricting O2 delivery
to tissues and leading to varying degrees of ischemia or
anoxia and organ damage.

Normal RBC
Sickle RBC

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Sickle cell erythrocyte

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 Leukocytes, WBC
• Leukocytes leave the blood and migrate to the
tissues where they become functional and
perform various activities related to immunity.
• According to the type of cytoplasmic granules and
their nuclear morphology, leukocytes are divided into
two groups:
– Granulocytes and
– Agranulocytes.
• Both types are spherical while suspended in blood
plasma, but they become amoeboid and motile after
leaving the blood vessels and invading the tissues.

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 Granulocytes
• Possess two major types of cytoplasmic
granules:
– Azurophilic granules (Lysosomes) in blood cells &
– Specific granules that bind neutral, basic, or acidic
stains and have specific functions.
• Have polymorphic nuclei with two or more
distinct nuclear lobes. Includes:
– Neutrophils (57-67%)
– Eosinophils (1-3%)
– Basophils (0-0.75%)
• All granulocytes are terminally differentiated cells with
a life span of only a few days. 21
 Agranulocytes
• Do not have specific granules, but they do
contain azurophilic granules (lysosomes), with
affinity for the basic stain azure A.
• The nucleus is spherical or indented but not
lobulated. This group includes:
– Lymphocytes (25-33%)
– Monocytes (3-7%)

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 Leukocytes cont…
• All leukocytes are key players:
– In the defense against invading microorganisms &
– In the repair of injured tissues.
• At such sites factors termed cytokines are
released from various sources and
– These trigger loosening of intercellular junctions
in the endothelial cells of local postcapillary
venules.

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 Leukocytes cont…
• Simultaneously the cell adhesion protein P-
selectin appears on these cells’ luminal
surfaces.
– P-selectin interact with neutrophils and other
leukocytes and cause cells flowing through the
venules to slow down.
• Other cytokines stimulate the slowly rolling
leukocytes to express integrins and other
adhesion factors that produce firm attachment
to the endothelium

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 Leukocytes cont…
• In a process called diapedesis, the leukocytes
– Send extensions through the openings between the
endothelial cells,
– Migrate out of the venules into the surrounding
tissue space, and
– Head directly for the site of injury or invasion.
• The attraction of neutrophils to bacteria
involves:
– Chemical mediators in a process of chemotaxis,
• Which causes leukocytes to rapidly accumulate where
their defensive actions are specifically needed.
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• The major initial events of neutrophil migration
during inflammation are summarized here:
1. Local macrophages activated by bacteria or
tissue damage release proinflammatory
cytokines such as interleukin-1 (IL-1) or tumor
necrosis factor-α (TNF-α).
– These signal endothelial cells of nearby
postcapillary venules to rapidly insert glycoprotein
selectins on the luminal cell surfaces.
2. Passing neutrophils bind the selectins, which
causes such cells to adhere loosely to the
endothelium and “roll” slowly along its surface.
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The neutrophil migration cont…
3. Exposure to these and other cytokines causes
– Expression of new integrins on the rolling
leukocytes and
– Expression of the integrin ligand ICAM-1
(intercellular adhesion molecule-1) on the
endothelial cells.
4. Integrins and their ligands provide firm
endothelial adhesion of neutrophils to the
endothelium,
– Allowing the leukocytes to receive further
stimulation from the local cytokines.
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The neutrophil migration cont…
5. Neutrophils
– Become motile, probe the endothelium with
pseudopodia &
– Being attracted by other local injury-related factors
called chemokines,
– Finally migrate by diapedesis between the loosened
cells of the venule.
•All leukocytes first become functional in the
ECM after emerging from the circulation by this
process.
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 Diagram of events involving leukocytes in a
postcapillary venule at sites of inflammation.

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 Granular Leukocytes

1. Neutrophil: (Neutrophilic = neutral loving)

• The nuclei have 2-5 lobes and are the most numerous

• Neutrophils are active phagocytes of bacteria and

• Are usually the first leukocytes to arrive at sites of

infection, where they actively pursue bacterial cells
using chemotaxis
Red blood cells and Neutrophil in the center
 Neutrophils

The arrow indicate a condensed X chromosome appears as a drumstick

appendage to a nuclear lobe of neutrophil from a female.
 Neutrophil cont…
• The cytoplasmic granules of neutrophils provide the
cells’ functional activities and are of two main types.
1. Azurophilic primary granules: are large, dense
vesicles and have a major role in both killing and
degrading engulfed microorganisms.
• They contain proteases and antibacterial proteins,
including the following:
– Myeloperoxidase (MPO), which generates hypochlorite and
other agents toxic to bacteria
– Lysozyme, which degrades components of bacterial cell walls
– Defensins, small cysteine-rich proteins that bind and disrupt
the cell membranes of many types of bacteria and other
microorganisms.
 Neutrophil cont…
2. Specific secondary granules
•Are smaller and less dense, stain faintly pink &
•Have diverse functions, including
– Secretion of various ECM-degrading enzymes
such as collagenases,
– Delivery of additional bactericidal proteins to the
phagolysosomes, and
– Insertion of new cell membrane components.

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• The small, pale, more
variably stained
specific granules (S)
• The larger, electron-
dense azurophilic
granules (A).
• The nucleus (N) is
lobulated and
• the central Golgi
apparatus (G) is
small.

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 Neutrophil cont…
• Activated neutrophils at infected or injured sites
also have important roles in the inflammatory
response.
• They release polypeptide:
– Chemokines that attract other leukocytes and
– Cytokines that direct activities of leukocyte and local
cells of the tissue.
– Important lipid mediators of inflammation
are also released from neutrophils.

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 Neutrophil cont…
• Neutrophils contain glycogen,
– Which is broken down into glucose to yield energy via the
glycolytic pathway.
• The ability of neutrophils to survive in an anaerobic
environment is highly advantageous,
– Because they can kill bacteria and help clean up
debris in poorly oxygenated regions,
• For example, damaged or necrotic tissue lacking normal
microvasculature.
• Neutrophils are short-lived cells with 6 to 8 hours in blood
and a life span of 1 to 4 days in connective tissues before
dying by apoptosis.

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 Neutrophil in killing bacteria
• Neutrophils look for bacteria to engulf by
pseudopodia and internalize them in vacuoles called
phagosomes.
• Immediately thereafter, specific granules fuse with
and discharge their contents into the phagosomes
which are then acidified by proton pumps
• Azurophilic granules then discharge their enzymes
into this acidified vesicle, killing and digesting the
engulfed microorganisms.

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 Neutrophil in killing bacteria cont…
• During phagocytosis, a burst of O2 consumption
leads to the formation of superoxide anions
and hydrogen peroxide.
• Superoxide anions is a short-lived, highly
reactive free radical,
– Together with MPO and halide ions, forms a
powerful microbial killing system inside the
neutrophils.
• The protein lactoferrin avidly binds iron, a
crucial element in bacterial nutrition
– lack of availability causes bacteria to die.
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 Neutrophil in killing bacteria cont…
• A combination of these mechanisms will kill most
microorganisms, which are then digested by lysosomal
enzymes.
• Apoptotic neutrophils, bacteria, semi-digested material, and
tissue fluid form a viscous, usually yellow collection of fluid
called pus.

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 2. Eosinophil: (eosinophilic, eosin-loving)

• Constitute only 1% to 3% of leukocytes.

• The main identifying characteristic is:

– The abundance of large, acidophilic specific
granules typically staining pink or red.

• About the same size as neutrophils but have

bilobed nuclei & more abundant coarse
cytoplasmic granules.
 Eosinophil cont…
• The cytoplasm is often filled with brightly
eosinophilic specific granules & some azurophilic
granules.
• The eosinophilic specific granules contains major
basic proteins (MBP),
– An arginine-rich factor that accounts for the granule’s
acidophilia and
– Constitutes up to 50% of the total granule protein.
• MBPs, along with eosinophilic peroxidase, other
enzymes and toxins, act to kill parasitic worms or
helminths.
 Eosinophil cont…
• Eosinophils also modulate inflammatory responses by
releasing chemokines, cytokines, and lipid mediators,
– With an important role in the inflammatory response
triggered by allergies.

• The number of circulating eosinophils increases

during helminthic infections and allergic reactions.
• These leukocytes also remove antigen-antibody
complexes from interstitial fluid by phagocytosis.
(a) Micrograph shows an eosinophil (E) next to a neutrophil (N) and a small lymphocyte (L).
(b) Even with granules filling the cytoplasm, the two nuclear lobes of eosinophils are usually
clear.
(c) Ultrastructurally a sectioned eosinophil clearly shows the unique specific eosinophilic
granules (EG). These granules, along with a few lysosomes and mitochondria (M), fill
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the cytoplasm around the bilobed nucleus.
 Eosinophil cont…

• Eosinophils are particularly abundant:

– In connective tissue of the intestinal lining and

– At the sites of chronic inflammation, such as lung

tissues of asthma patients.
 Eosinophilia
• An increase in the number of eosinophils in
blood (eosinophilia) is associated with allergic
reactions and helminth parasitic infections.
• These cells produce substances that modulate
inflammation by inactivating the leukotrienes
and histamine produced by other cells.
• Corticosteroids produce a rapid decrease in the
number of blood eosinophils,
– probably by interfering with their release from the
bone marrow into the bloodstream.
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 Basophil: basophilic (basic loving)
• Make up less than 1% of blood leukocytes.
– Therefore, difficult to find in normal blood
smears.
• The nucleus is divided into two irregular
lobes, but the large specific granules
overlying the nucleus usually obscure its
shape.
• Produce heparin, so act as natural
inhibitors of blood clotting.
• They also release histamine, serotonin, etc.
 Basophil cont…
• The specific granules typically stain purple with the basic
dye of blood smear stains and
– Are fewer, larger, and more irregularly shaped than the granules
of other granulocytes.
• The strong basophilia of the granules is due to the presence
of heparin and other sulfated GAGs.
• Basophilic specific granules also contain much histamine
and various other mediators of inflammation, including:
– Platelet activating factor,
– Eosinophil chemotactic factor, and
– The enzyme phospholipase A that catalyzes an initial step in
producing leukotrienes.
 Basophil cont…
• By migrating into connective tissues, basophils
appear to supplement the functions of mast
cells.
• Both basophils and mast cells:
– Have metachromatic granules containing heparin
and histamine,
– Have surface receptors for immunoglobulin E &
– Secrete their granular components in response to
certain antigens and allergens.

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(a-c) Basophils have large, strongly basophilic specific granules that usually obstruct
the appearance of the nucleus which usually has two large irregular lobes.
(d) A TEM of a sectioned basophil reveals the single bilobed nucleus (N) and the
large, electron-dense specific basophilic granules (B). 50
 Anaphylactic shock
• In some individuals a second exposure to a
strong allergen, may produce an intense,
adverse systemic response.
• Basophils and mast cells may rapidly
degranulate,
– Producing vasodilation in many organs and
– A sudden drop in blood pressure leading to
anaphylaxis or anaphylactic shock.

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 Immediate or type 1 hypersensitivity.
• Basophils and mast cells also are central to immediate or type
1 hypersensitivity.
• In some individuals certain pollen proteins or specific proteins
in food are allergenic,
– i.e., elicit production of specific IGE antibodies, which bind to mast
cells and basophils.
• Upon subsequent exposure, the allergen combines with IGE
molecules, causing rapid exocytosis of the cytoplasmic
granules.
• Release of the inflammatory mediators result in bronchial
asthma, cutaneous hives, rhinitis, conjunctivitis, or allergic
gastroenteritis.

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 Agranular Leukocytes
Lymphocyte
• The most numerous type of agranulocyte in normal
blood smears or CBCs.
• Contain spherical nuclei.
• Are the smallest leukocytes.
• Lack the specific granules characteristic of granulocytes.
• Lymphocytes circulating in blood generally range in size
from 6 to 15 μm in diameter.
• Classified arbitrarily as small, medium, and large.
 Lymphocyte cont…
• Lymphocyte are the central cells of the immune system,
responsible for adaptive immunity
• Can be subdivided into functional groups by distinctive
surface molecules ( “cluster of differentiation” or CD
markers)
1. B-Lymphocyte
2. T-Lymphocyte
3. Natural killer cells
55
 a. B Lymphocytes
• B lymphocytes has surface receptors able to recognize
antigens.
• Differentiated into plasma cells, which produce
antibody.
• In most cases, the activation of B cells requires the
assistance of T lymphocytes known as T helper cells.
 b. T Lymphocytes
•Three important subpopulations of T cells are:

1. Helper T cells
– Which produce cytokines that promote
differentiation of B cells into plasma cells.
– Activate cytotoxic T lymphocytes

– Induce many parts of an inflammatory reaction.

2. Cytotoxic T cells
•Act directly against foreign cells or virus-
infected cells by two main mechanisms
– They attach to the cells to be killed and release
proteins called perforins that create holes in the cell
membrane of the target cell, with consequent cell
lysis.
– They attach to a cell and kill it by triggering
mechanisms that induce programmed cell death, or
apoptosis
3. Regulatory T cells
– Play crucial roles in allowing immune tolerance,
maintaining unresponsiveness to self-antigens and
suppressing excessive immune responses.
– These cells produce peripheral tolerance, which
backs up the central tolerance emerging in the thymus
 c. Natural Killer Cells
• The natural killer lymphocytes lack the marker
molecules characteristic of B and T cells
• Their name derives from the fact that they attack virus-
infected cells, transplanted cells, and cancer cells
without previous stimulation
• For this reason they are involved in what is called an
innate immune response
 Lymphomas

• Lymphomas are a group of disorders involving

neoplastic proliferation of lymphocytes or the
failure of these cells to undergo apoptosis.
• Although often slow-growing, all lymphomas
are considered malignant
– because they can very easily spread widely throughout
the body.

61
 Agranular Leukocytes…
Monocyte
• The nucleus -kidney-shaped or horseshoe-shaped.
• Are precursors to macrophages and other cells of the
mononuclear phagocyte system.
• Promonocytes leave the bone marrow and differentiate
into circulating monocytes.
 Monocytes circulate in the blood for about 8 hrs, and
then migrate to the tissues and differentiate into tissue
specific macrophages.
• Macrophages are highly phagocytic cells that can ingest
many bacteria's, parasites and debris etc.
63
• Circulating monocytes have diameters of 12 to 15 μm,
but macrophages are somewhat larger.
• The cytoplasm of the monocyte is basophilic and
contains many small lysosomes or azurophilic
granules.
• Macrophages have different names depending on their
location in the body:
 Alveolar macrophages: Lungs
 Histocytes: Connective tissue
 Kupffer cells: Liver
 Mesengial cells: Kidney
 Microglial cells: Brain
 Osteoclast: Bone
 Medical application
• Extravasation or the accumulation of immigrating
monocytes occurs in the early phase of inflammation
following tissue injury.
• Acute inflammation is usually short-lived as
macrophages undergo apoptosis or leave the site.
• But chronic inflammation usually involves the
continued recruitment of monocytes.
• The resulting continuous presence of macrophages
can lead to excessive tissue damage that is typical of
chronic inflammation.

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 Disturbances of WBC
Leukemia (increased WBC No): cancerous
production of WBC.
•These occurs:
a. In the bone marrow
b. In the lymph
•Their increased production takes the space of
platelets & RBC causing anemia + impaired
blood clotting

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 Leucopenia

• Decreased production of WBC.

Cause
-Bone marrow stops producing them
-Drug poison
-X-rays
• Differential count is usually undertaken in the
laboratory to know the proportions of WBC.

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 Platelets (thrombocytes)
• Blood platelets are very small non-nucleated,
membrane-bound cell fragments only 2 to 4 μm in
diameter.
• Platelets promote blood clotting and help
repair minor tears or leaks in the walls of small blood
vessels.
– preventing loss of blood from the microvasculature.
• Normal platelet counts range from 150,000 to
400,000/μL of blood.
• Circulating platelets have a life span of about 10 days.

68
 Platelets cont…
• In stained blood smears, platelets often appear in
clumps.
• Each individual platelet is generally discoid with:
– A very lightly stained peripheral zone, the hyalomere &
– A darker-staining central zone containing granules, called
the granulomere.
• A sparse glycocalyx surrounding the platelet
plasmalemma is involved in adhesion and
activation during blood coagulation.

69
(a) In a blood smear, platelets
(arrows) are often found as
aggregates.
• Individually they show a lightly
stained hyalomere region
surrounding a more darkly
stained central granulomere
containing membrane-enclosed
granules

70
 Platelets cont…
• Hyalomere contains two systems of membrane channels.
– An open canalicular system of vesicles is connected to
invaginations of the plasma membrane,
• Facilitate platelets’ uptake of factors from plasma.
– A much less prominent set of irregular tubular vesicles is
derived from the ER and stores Ca2+ ions.
• Together, these two membranous systems facilitate the
extremely rapid exocytosis
of proteins from platelets (degranulation)
– upon adhesion to collagen or other substrates outside the
vascular endothelium.

71
 Platelets cont…
• The central granulomere region contains
– Small dense delta granules (δG): contain ADP, ATP,
and serotonin (5-hydroxytryptamine) taken up from
plasma.
– Larger and more numerous alpha granules (αG):
contain platelet-derived growth factor (PDGF), platelet
factor 4, and several other platelet-specific proteins &
– Mitochondria and glycogen particles

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• An open
canalicular system
(OCS)
• Small dense delta
granules (δG)
• Larger and more
numerous alpha
granules (αG):
• Glycogen (G).

73
 Platelets cont…
• The role of platelets in controlling hemorrhage and in
wound healing can be summarized as follows:
Primary aggregation: Disruptions in the
microvascular endothelium, allow the platelet
glycocalyx to adhere to collagen.
– Thus, a platelet plug is formed as a first step to stop
bleeding.
Secondary aggregation: Platelets in the plug
release a specific adhesive glycoprotein & ADP
– These induce further platelet aggregation and
increase the size of the platelet plug.
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• Platelets (P)
• Fibrin meshwork (F)
• Erythrocytes (E) 75
 Role of platelets in controlling bleeding cont…
Blood coagulation: During platelet aggregation,
– Fibrinogen from plasma,
– Von Willebrand factor released from the damaged
endothelium, and
– Platelet factor 4 from platelet granules
• Promote the sequential interaction (cascade) of plasma
proteins,
– giving rise to a fibrin polymer trapping red blood cells
and more platelets to form a blood clot, or thrombus

76
 Role of platelets in controlling bleeding cont…
Clot retraction: The clot that initially bulges into
the blood vessel lumen contracts slightly because
of the interaction of platelet actin and myosin.
Clot removal: Protected by the clot:
– The endothelium and surrounding tunic are restored
by new tissue, and
– The clot is then removed, mainly dissolved by the
proteolytic enzyme plasmin,
• Formed continuously through the local action of
plasminogen activators from the endothelium.

77
 Medical Application

• Aspirin and other nonsteroidal anti-

inflammatory agents have an inhibitory effect
on platelet function and blood coagulation
– because they block the local prostaglandin
synthesis that is needed for platelet aggregation,
contraction, and exocytosis at sites of injury.

78
 Hemophilia
• Hemophilia A and B are clinically identical,
differing only in the deficient factor.
– The patients with hemophilia A is deficient or defect in
clotting factor VIII
– The patient with hemophilia B, the defect is in factor IX.
• Both are due to sex-linked recessive inherited
disorders.
• Blood from hemophiliac patients does not coagulate
normally: the blood clotting time is prolonged.
• Persons with this disease bleed severely even after
mild injuries, such as a skin cut, and may bleed to
death after more severe injuries.
 Hemophilia cont…
• In severe cases the blood is incoagulable.
– There are spontaneous hemorrhages in body cavities,
such as major joints and the urinary tract.
• Generally, only males are affected by hemophilia A,
because the recessive gene to factor VIII is on the X
chromosome.
• Females may have one defective X chromosome, but
the other one is usually normal.
• Females develop hemophilia only when they have the
abnormal gene in both X chromosomes, a rare event.
– However, women with a defective X chromosome may
transmit the disease to their male children.