HENATOLOCY HENATOLOCY

ENER!TA C. NENDOZA, ENER!TA C. NENDOZA,

R.N., N.D. R.N., N.D.
Blood Blood
Slide 10.1a Slide 10.1a Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O The only fluid tissue in the human body
O Classified as a connective tissue
O Living cells = formed elements
O Non-living matrix = plasma
Blood Blood
Slide 10.1b Slide 10.1b Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
igure 10.1
!hysical Characteristics of Blood !hysical Characteristics of Blood
Slide 10.2 Slide 10.2 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Color range
OOxygen-rich blood is scarlet red
OOxygen-poor blood is dull red
O pH must remain between 7.357.45
O Blood temperature is slightly higher than
body temperature
Blood !lasma Blood !lasma
Slide 10.3 Slide 10.3 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Composed of approximately 90 percent
water
O ncludes many dissolved substances
O Nutrients
O Salts (metal ions)
O Respiratory gases
O Hormones
O !roteins
O Waste products
!lasma !roteins !lasma !roteins
Slide 10.4 Slide 10.4 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O lbumin regulates osmotic pressure
O Clotting proteins help to stem blood
loss when a blood vessel is injured
O ntibodies help protect the body from
antigens
ormed Elements ormed Elements
Slide 10.5a Slide 10.5a Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Erythrocytes = red blood cells
O Leukocytes = white blood cells
O !latelets = cell fragments
Erythrocytes (Red Blood Cells) Erythrocytes (Red Blood Cells)
Slide 10.6 Slide 10.6 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O The main function is to carry oxygen
O natomy of circulating erythrocytes
O Biconcave disks
O Essentially bags of hemoglobin
O nucleate (no nucleus)
O Contain very few organelles
O Outnumber white blood cells 1000:1
Hemoglobin Hemoglobin
Slide 10.7 Slide 10.7 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O ron-containing protein
O Binds strongly, but reversibly, to oxygen
O Each hemoglobin molecule has four
oxygen binding sites
O Each erythrocyte has 250 million
hemoglobin molecules
Leukocytes (White Blood Cells) Leukocytes (White Blood Cells)
Slide 10.8 Slide 10.8 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Crucial in the body's defense against
disease
O These are complete cells, with a
nucleus and organelles
O ble to move into and out of blood
vessels (diapedesis)
O Can move by ameboid motion
O Can respond to chemicals released by
damaged tissues
Leukocyte Levels in the Blood Leukocyte Levels in the Blood
Slide 10.9 Slide 10.9 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Normal levels are between 4,000 and
11,000 cells per millimeter
O bnormal leukocyte levels
O Leukocytosis
O bove 11,000 leukocytes/ml
O Generally indicates an infection
O Leukopenia
O bnormally low leukocyte level
O Commonly caused by certain drugs
Types of Leukocytes Types of Leukocytes
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10.10a 10.10a
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O Granulocytes
O Granules in their
cytoplasm can be
stained
O nclude
neutrophils,
eosinophils, and
basophils
igure 10.4
Types of Leukocytes Types of Leukocytes
Slide Slide
10.10b 10.10b
Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O granulocytes
O Lack visible
cytoplasmic
granules
O nclude
lymphocytes and
monocytes
igure 10.4
Granulocytes Granulocytes
Slide Slide
10.11a 10.11a
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O Neutrophils
O Multilobed nucleus with fine granules
O ct as phagocytes at active sites of infection
O Eosinophils
O Large brick-red cytoplasmic granules
O ound in repsonse to allergies and parasitic
worms
Granulocytes Granulocytes
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10.11b 10.11b
Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Basophils
O Have histamine-containing granules
O nitiate inflammation
granulocytes granulocytes
Slide 10.12 Slide 10.12 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Lymphocytes
O Nucleus fills most of the cell
O !lay an important role in the immune
response
O Monocytes
O Largest of the white blood cells
O unction as macrophages
O mportant in fighting chronic infection
!latelets !latelets
Slide 10.13 Slide 10.13 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O erived from ruptured multinucleate
cells (megakaryocytes)
O Needed for the clotting process
O Normal platelet count = 300,000/mm
3
Hematopoiesis Hematopoiesis
Slide 10.14 Slide 10.14 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Blood cell formation
O Occurs in red bone marrow
O ll blood cells are derived from a
common stem cell (hemocytoblast)
O Hemocytoblast differentiation
O Lymphoid stem cell produces lymphocytes
O Myeloid stem cell produces other formed
elements
ate of Erythrocytes ate of Erythrocytes
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O &nable to divide, grow, or synthesize
proteins
O Wear out in 100 to 120 days
O When worn out, are eliminated by
phagocytes in the spleen or liver
O Lost cells are replaced by division of
hemocytoblasts
Control of Erythrocyte !roduction Control of Erythrocyte !roduction
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O Rate is controlled by a hormone
(erythropoietin)
O Kidneys produce most erythropoietin as
a response to reduced oxygen levels in
the blood
O Homeostasis is maintained by negative
feedback from blood oxygen levels
Hemostasis Hemostasis
Slide 10.18 Slide 10.18 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Stoppage of blood flow
O Result of a break in a blood vessel
O Hemostasis involves three phases
O !latelet plug formation
O Vascular spasms
O Coagulation
!latelet !lug ormation !latelet !lug ormation
Slide 10.19 Slide 10.19 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Collagen fibers are exposed by a break
in a blood vessel
O !latelets become "sticky and cling to
fibers
O nchored platelets release chemicals to
attract more platelets
O !latelets pile up to form a platelet plug
Vascular Spasms Vascular Spasms
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O nchored platelets release serotonin
O Serotonin causes blood vessel muscles
to spasm
O Spasms narrow the blood vessel,
decreasing blood loss
Coagulation Coagulation
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10.21a 10.21a
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O njured tissues release thromboplastin
O !
3
(a phospholipid) interacts with
thromboplastin, blood protein clotting
factors, and calcium ions to trigger a
clotting cascade
O !rothrombin activator converts
prothrombin to thrombin (an enzyme)
Coagulation Coagulation
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10.21b 10.21b
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O Thrombin joins fibrinogen proteins into
hair-like fibrin
O ibrin forms a meshwork
(the basis for a clot)
Blood Clotting Blood Clotting
Slide 10.22 Slide 10.22 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Blood usually clots within 3 to 6 minutes
O The clot remains as endothelium
regenerates
O The clot is broken down after tissue
repair
&ndesirable Clotting &ndesirable Clotting
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O Thrombus
O clot in an unbroken blood vessel
O Can be deadly in areas like the heart
O Embolus
O thrombus that breaks away and floats
freely in the bloodstream
O Can later clog vessels in critical areas such
as the brain
Bleeding isorders Bleeding isorders
Slide 10.24 Slide 10.24 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Thrombocytopenia
O !latelet deficiency
O Even normal movements can cause
bleeding from small blood vessels that
require platelets for clotting
O Hemophilia
O Hereditary bleeding disorder
O Normal clotting factors are missing
Blood Groups and Transfusions Blood Groups and Transfusions
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O Large losses of blood have serious
consequences
O Loss of 15 to 30 percent causes weakness
O Loss of over 30 percent causes shock,
which can be fatal
O Transfusions are the only way to
replace blood quickly
O Transfused blood must be of the same
blood group
Human Blood Groups Human Blood Groups
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10.26a 10.26a
Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Blood contains genetically determined
proteins
O foreign protein (antigen) may be
attacked by the immune system
O Blood is "typed by using antibodies that
will cause blood with certain proteins to
clump (agglutination)
Human Blood Groups Human Blood Groups
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10.26b 10.26b
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O There are over 30 common red blood
cell antigens
O The most vigorous transfusion reactions
are caused by BO and Rh blood group
antigens
BO Blood Groups BO Blood Groups
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10.27a 10.27a
Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Based on the presence or absence of two
antigens
O Type
O Type B
O The lack of these antigens is called
type O
BO Blood Groups BO Blood Groups
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10.27b 10.27b
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O The presence of both and B is called
type B
O The presence of either or B is called
types and B, respectively
Rh Blood Groups Rh Blood Groups
Slide 10.28 Slide 10.28 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Named because of the presence or
absence of one of eight Rh antigens
(agglutinogen )
O Most mericans are Rh
+
O !roblems can occur in mixing Rh
+
blood
into a body with Rh

blood
Rh angers uring !regnancy Rh angers uring !regnancy
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10.29a 10.29a
Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O anger is only when the mother is Rh

and the father is Rh

+
, and the child
inherits the Rh
+
factor
Rh angers uring !regnancy Rh angers uring !regnancy
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10.29b 10.29b
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O The mismatch of an Rh

mother carrying
an Rh
+
baby can cause problems for the
unborn child
O The first pregnancy usually proceeds without
problems
O The immune system is sensitized after the first
pregnancy
O n a second pregnancy, the mother's immune
system produces antibodies to attack the Rh
+
blood (hemolytic disease of the newborn)
Blood Typing Blood Typing
Slide 10.30 Slide 10.30 Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings
O Blood samples are mixed with anti- and
anti-B serum
O Coagulation or no coagulation leads to
determining blood type
O Typing for BO and Rh factors is done in
the same manner
O Cross matching testing for
agglutination of donor RBCs by the
recipient's serum, and vice versa
evelopmental spects of Blood evelopmental spects of Blood
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O Sites of blood cell formation
O The fetal liver and spleen are early sites of
blood cell formation
O Bone marrow takes over hematopoiesis by
the seventh month
O etal hemoglobin differs from
hemoglobin produced after birth
HENATOLOCY HENATOLOCY study of the study of the
formed elements of the blood formed elements of the blood
(red blood cells, while blood (red blood cells, while blood
cells, platelets) as well as blood cells, platelets) as well as blood
typing and blood coagulation. typing and blood coagulation.
HENATOLOC!C SPEC!NENS HENATOLOC!C SPEC!NENS
CBC CBC -- basic tool for enumeration of RBC, WBC, basic tool for enumeration of RBC, WBC,
platelets platelets
RBC RBC
RBC Count RBC Count -- polycythemia, erythrocytosis, polycythemia, erythrocytosis,
high altitude, CvS diseases high altitude, CvS diseases
Hemoglobin Hemoglobin Hg content of blood Hg content of blood
Hematocrit Hematocrit -- volume of packed cells volume of packed cells
RBC !ndices RBC !ndices NCv (vitamin NCv (vitamin
deficiencies) deficiencies)
NCH NCH
NCHC (anemias, NCHC (anemias,
blood loss) blood loss)
RED CELL !ND!CES RED CELL !ND!CES
Nean corpuscular volume: hematocrit/RBC Nean corpuscular volume: hematocrit/RBC
to 3 cubic microns, macrocytosis or to 3 cubic microns, macrocytosis or
microcytosis, pernicious anemia microcytosis, pernicious anemia
Nean corpuscular hemoglobin (NCH): Nean corpuscular hemoglobin (NCH):
hemoglobin/RBC hemoglobin/RBC
to 31 picograms to 31 picograms
Nean corpuscular hemoglobin concentration Nean corpuscular hemoglobin concentration
(NCHC): hemoglobin/hematocrit (NCHC): hemoglobin/hematocrit
3 to 36 g/dL, hyperchromia or hypochromia 3 to 36 g/dL, hyperchromia or hypochromia
N!SCELLANEOUS CELLS N!SCELLANEOUS CELLS
!mmature Cells !mmature Cells -- leukemia, lymphoma leukemia, lymphoma
Atypical lymphocytes (Downey cells, Atypical lymphocytes (Downey cells,
virocytes) virocytes) -- leukemia, viral hepatitis leukemia, viral hepatitis
Plasma cells Plasma cells -- multiple myeloma, leukemia, multiple myeloma, leukemia,
Toxic granulation Toxic granulation stippling in cytoplasm, stippling in cytoplasm,
severe infection or toxemia severe infection or toxemia
ABNORNAL!T!ES !N ABNORNAL!T!ES !N
HENATOLOC!C SPEC!NENS HENATOLOC!C SPEC!NENS
Abnormalities in cell shape Abnormalities in cell shape
ovalocytosis ovalocytosis nucleated RBC nucleated RBC
sickling sickling Howell Howell ]olly bodies ]olly bodies
Burr cells Burr cells spherocytes spherocytes
Hereditary disorders Hereditary disorders
Sickle cell anemia Sickle cell anemia
Thalassemia Thalassemia
hereditary elliptocytosis hereditary elliptocytosis
C6PD deficiency C6PD deficiency
ABNORNAL BLOOD PRODUCTS ABNORNAL BLOOD PRODUCTS
Nethemoglobin Nethemoglobin
increased ferrous iron is oxidized to ferric increased ferrous iron is oxidized to ferric
state ( resulting in deranged oxygen state ( resulting in deranged oxygen
transport) transport)
inborn errors of metabolism inborn errors of metabolism
Carboxyhemoglobin Carboxyhemoglobin
hg + CO, hg + CO, carbon monoxide poisoning carbon monoxide poisoning
* Cyanmethemoglobin * Cyanmethemoglobin -- cyanide poisoning cyanide poisoning
determination determination
OTHER BLOOD TESTS OTHER BLOOD TESTS
Osmotic Fragility Test Osmotic Fragility Test
hemolysis hemolysis
Reticulocyte Count Reticulocyte Count
Erythrocyte Erythrocyte
Sedimentation (ESR) Sedimentation (ESR)
Rate: N>F Rate: N>F
increased in increased in acute acute
and chronic and chronic
inflammatory inflammatory conditions conditions
(PTB, ARF, RA) (PTB, ARF, RA)
Blood Typing Blood Typing ABO ABO
Rhesus factor: Rh+ Rhesus factor: Rh+
(majority) = Rh (majority) = Rh
(minority (minority))
COACULAT!ON D!SORDERS COACULAT!ON D!SORDERS
Hemophilia A Hemophilia A absence of Factor v!!! absence of Factor v!!!
Hemophilia B Hemophilia B -- absence of Factor !X absence of Factor !X
!diopathic Thrombocytopenic Purpura !diopathic Thrombocytopenic Purpura
(!TP) (!TP)
Clanzmann's disease (thrombasthenia) = Clanzmann's disease (thrombasthenia) =
normal platelet count but impaired normal platelet count but impaired
function function
Disseminated !ntravascular Coagulation Disseminated !ntravascular Coagulation
(D!C) (D!C) imbalance between coagulation imbalance between coagulation
and fibrinolysis (trauma, shock, and fibrinolysis (trauma, shock,
pregnancy, parturition) pregnancy, parturition)
PLATELET D!ACNOST!CS PLATELET D!ACNOST!CS
BLEED!NC T!NE BLEED!NC T!NE -- prolonged in deficiencies or prolonged in deficiencies or
abnormalities of platelets abnormalities of platelets
CLOTT!NC T!NE CLOTT!NC T!NE -- from a WHOLE blood from a WHOLE blood
specimen specimen
PLATELET COUNT PLATELET COUNT -- increased in collagen increased in collagen
diseases, decreased in toxic or diseased states diseases, decreased in toxic or diseased states
PROTHRONB!N T!NE PROTHRONB!N T!NE -- time required to form a time required to form a
clot. >1 (!NR) means it is prolonged and may clot. >1 (!NR) means it is prolonged and may
mean a deficiency of prothrombin, vitamin K, mean a deficiency of prothrombin, vitamin K,
anticoagulants anticoagulants
PART!AL THRONBOPLAST!N T!NE PART!AL THRONBOPLAST!N T!NE -- clotting clotting
factor deficiency (N: to 3 secs) factor deficiency (N: to 3 secs)
CLOT RETRACT!ON CLOT RETRACT!ON -- function of platelet function of platelet
activity activity