# Blood Blood is specialized fluid connective tissue in which there is liquid intracellular substance (plasma) and formed elements – (RBC, WBC, and Platelets) suspended in the plasma. It is red, thick and slightly alkaline.
# Composition of blood
A. Cellular substances: 45% (42-45%)
i) Erythrocytes (RBC)
ii) Leucocytes (WBC)
iii) Platelets (thrombocytes)
B. Liquid intracellular substances: Plasma 55% (55-58%)
i) Liquid: 91-92% water ii) Solid: 8-9%
a. Inorganic substances (0.9%): Na, K, Ca, Mg, P, Fe, Cub. Organic constituents:
i. Proteins- 7.5%: serum albumin, serum globulin, fibrinogen and prothrombin
ii. Non-protein nitrogenous substances: urea, uric acid, xanthine, hypoxanthine, creatine, ammonia, amino acids iii. Fats: Neutral fats, phospholipids, cholesterol.
iv. Carbohydrates: Glucose, sucrose
v. Others: antibodies, enzymes vi. Coloring materials: bilirubin, carotene, and xanthophyll in.
# Properties of blood
i) Blood volume: 5-6 liters ii) Normal reaction: slightly alkaline, pH 7.36-7.45 iii) Specific gravity: 1.052-1.060 iv) Viscosity: 4.5 times more viscous than water v) Temperature: 36-380c vi) Osmotic pressure: 25 mm Hg vii) Taste: Salty viii) Color: Red, due to presence of Hemoglobin in RBC.
# Functions of blood
1. Transport of respiratory gases
It carries O2 from the alveoli of the lungs to the tissues and eliminates CO2 from the tissues to the alveoli of the lungs.
2. Transports of nutrients
It carries digestive food materials absorbed by the intestine to the tissue cells.
3. Acts as vehicles
Hormone, enzyme, vitamin and other chemicals are brought to their places of activity through the bloodstream.
4. Regulation of body temperature
It regulates body temperature as it contains a huge amount of water.
5. Regulation of water and electrolytes balances It maintains the normal body water and electrolyte balance.
6. Maintenance of acid-base balance
By effective buffering power and with the help of kidney, skin, and lungs blood maintain acid-base regulation.
7. Defensive function
WBC by its phagocytotic property, engulf bacteria and foreign particles.
8. Excretory function
The metabolic end product and other waste products are carried out by blood to the organ.
9. Regulation of blood pressure
By changing the volume and viscosity of blood, it regulates the blood pressure.
10. It maintains the colloidal osmotic pressure.
# Plasma
The fluid portion containing ions, inorganic and organic molecules is called plasma. The normal plasma volume is about 5% of body weight or roughly 3500 mL in a 70 Kg man.
Plasma proteins with their percentage are indicated below;
• Albumin (60%), Globulin (35%), Fibrinogen (4%), Regulatory proteins, lipoproteins, and iron-binding proteins (1%)
# Serum
After clotting, the remaining fluid potion of plasma except for the clotting factor (fibrinogen, clotting factor 2, 4 and 8) is called serum. It contains a high amount of serotonin.
# Plasma and serum
Serum Plasma
The serum is the extracellular portion of the blood after adequate coagulation is complete. Plasma is a clear, straw-colored watery portion of the blood in which several types of blood cells are suspended.
The serum is part of the blood which lack clotting factor. Plasma is composed of serum and clotting factors.
Acquired after centrifuging of coagulated blood. Acquired after centrifuging blood with anticoagulant.
Anticoagulant is not needed to separate the serum. Anticoagulant is required to get plasma.
Less volume in comparison to plasma.
[Plasma – Fibrinogen (Clotting factor)=
Serum] Consists of 55% of the total volume of blood.
Difficult to separate and is time-consuming. Comparatively easier and less time consuming than serum.
Lack fibrinogen. Contain fibrinogen.
Consists of 90% water with dissolved proteins, minerals, hormones, and carbon dioxide. Consists of ~92% water with Protein, Salt, Lipids, Glucose.
Density of serum is 1.024g/ml. Density of plasma is 1.025g/ml.
# Plasma protein
The protein which remains in plasma is known as plasma protein. Total normal serum values of plasma protein are 6-8 g/dL.
# Types of plasma protein
1. Albumin: 3.1-4.3 g/dl
2. Globulin: 2.6-4.1 g/dl
I. α1 Globulin
II. α2 Globulin
III. β Globulin
IV. γ Globulin (Immunoglobulin) (IgG, IgA, IgM, IgD, IgE )
3. Fibrinogen: 200-450 mg/dl
4. Prothrombin
5. Others:
• Angiotensinogen
• Transferrin
• Ceruloplasmin
• Isp-hemaglutinin
• Thromboplastin
#Albumin
The albumins are a family of globular proteins, the most common of which is the serum albumins. All the proteins of the albumin family are water-soluble, moderately soluble in concentrated salt solutions. Albumins are commonly found in blood plasma. Substances containing albumins, such as egg white, are called albuminoids.
Serum albumin is the most abundant blood plasma protein and is produced in the liver and forms a large proportion of all plasma protein. The human serum albumin normally constitutes about 50% of human plasma protein.
i. Molecular weight: 69,000 ii. Site of formation: Liver, 200-400 mg/kg/day iii. Serum albumin levels: adults (> 3 y.o.) 3.5 to 5 g/dL. iv. Synthesis of albumin decrease: during starvation v. Synthesis of albumin increase: during nephrosis
Properties:
a. Smallest, highest plasma protein b. Precipitated by full saturation of (NH4)2SO4
c. Soluble in distilled water d. Highest electrophoretic property.
Functions:
a. Maintain colloidal osmotic pressure (75-80% of total blood)
b. Act as carrier and binding protein c. Transport hormone, amino acids, lipids, bilirubin, vitamin and drugs d. Maintain viscosity of blood. Act as acid-base balance regulator f. Acts as a protein reservoir.
# Globulin
The globulins are a family of globular proteins that have higher molecular weights than albumins and are insoluble in pure water but dissolve in dilute salt solutions. Some globulins are produced in the liver, while others are made by the immune system.
i. Molecular weight: 90000-130000 ii. The normal concentration: 2.6-4.6 g/dL.
iii. Site of formation: Liver, plasma cell and lymphoid nodules iv. Classification: α1 Globulin, α2 Globulin, β Globulin, γ Globulin (Immunoglobulin)
v. Functions:
a. It maintains 20% of the total colloidal osmotic pressure of blood.
b. It helps to maintain the viscosity of blood.
c. α1 transport lipid and steroids d. α2 transport Cu as ceruloplasmin
e. β transports Fe as transferrin and helps in blood clotting f. γ (gama) helps in the formation of antibodies.
# Functions of plasma protein
1. Role in coagulation of blood
Fibrinogen is essential for the coagulation of blood. During the coagulation of blood, the fibrinogen is converted into fibrin.
2. Role in defense mechanism of the body
The gamma globulins play an important role in the defense mechanism of the body by acting as antibodies (immune substances).
3. Role in the transport mechanism
Plasma proteins are essential for the transport of various substances like a hormone, enzymes and respiratory gases in the blood.
4. Role in maintenance of pressure in the blood
Because of their large size, the plasma proteins cannot pass through the capillary membrane easily and remain in the blood. In this way, the plasma proteins play an important role in the maintenance of osmotic pressure of blood.
5. Role in regulation of acid-base balance
Plasma proteins, particularly albumin, play an important role in regulating the acid-base balance in the blood. This is because of the virtue of their buffering action
6. Role in viscosity of blood
The plasma proteins provide viscosity to the blood, which is important to maintain the blood pressure.
7. Role in suspension stability of red blood cells
During circulation, the red blood cells remain suspended uniformly in the blood. Globulin and fibrinogen help in the suspension stability of the red blood cells.
8. Role as reserve proteins
During the conditions like fasting, the plasma proteins are utilized by the body tissues. Because of this, the plasma proteins are called the reserve proteins.
# Haemopoiesis
Hematopoiesis or hemopoiesis is the formation of blood cellular components. All cellular blood components are derived from hematopoietic stem cells. In a healthy adult person, approximately 1011–1012 new blood cells are produced daily to maintain steady-state levels in the circulation.
Types:
i. Medullary: Production of blood cells in the hematopoietic tissue of bone marrow.
ii. Extra-medullary: Production of blood cells in organs (Liver, spleen and lymph nodes) other than bone marrow in certain disorders like hemorrhage.
Site of formation:
a. Intra-uterine life
i) 1st – 2nd month: yolk sac
ii) ii) 3rd -7th month: liver and spleen
iii) 5th – birth: bone marrow, liver, spleen and lymph nodes.
b. Extra-uterine life:
i) RBC, granulocytes, and platelets: Bone marrow ii) Lymphocytes: Lymph nodes and bone marrow iii) Monocytes: Bone marrow and spleen.
ERYTHROPOIESIS –STAGES
1. Haemocytoblast
2. Proerythroblast
3. Early erythroblast
4. Late erythroblast
5. Normoblast
6. Reticulocyte
7. Normal Erythrocyte
Erythropoiesis is a highly regulated, multistep process by which the body generates mature RBC.
# Factors affecting erythropoiesis
I. Decreased oxygen supply to tissue (hypoxia)
II. High dietary factors (Protein) for RBC synthesis
III. Metal ions a. Iron b. Copper c. Cobalt
IV. Vitamin C, B12 and folic acid
V. Hormones a. Androgens b. Thyroid c. Glucocorticoids d. Pituitary
# Erythropoietin
Erythropoietin (EPO) is a hormone (glycoprotein) produced by the kidney that promotes the formation of red blood cells by the bone marrow. The kidney cells that make erythropoietin are sensitive to low oxygen levels in the blood. These cells make and release erythropoietin when the oxygen level is too low (anemia). These hormones then promote the bone marrow to produce more RBC in the blood.
# Functions
I. Erythropoietin is an essential hormone for red blood cell production under hypoxic conditions.
II. Vasoconstriction-dependent hypertension
III. Stimulating angiogenesis (formation of new blood vessels)
# Red Blood Cell (Erythrocyte)
Red blood cells (RBCs), also called erythrocytes, are the most common type of blood cell and the vertebrate's principal means of delivering oxygen (O2) to the body tissues—via the circulatory system.
• In humans, mature red blood cells are flexible and oval biconcave disks.
• They lack a cell nucleus, to accommodate maximum space for hemoglobin.
• Approximately 2.4 million new erythrocytes are produced per second in human adults.
• The cells develop in the bone marrow.
• Circulate for about 100–120 days in the body before their components are recycled by macrophages.
• Each circulation takes about 60 seconds.
• Nearly half of the blood's volume (40% to 45%) is red blood cells.
Composition of RBC
I. Water: 65%
II. Solid: 35%
a. Hemoglobin: 33%
b. Stromal mash: 2% (Protein, phospholipid, cholesterol. Ester and neutral fat)
Morphology of RBC
I. Shape and size: Bi-concave
II. Thickness: at center 1µm or less and at margin 2.5µm.
III. Diameter: 7.8 µm
IV. Surface area: 120-140 sq.µ
V. Volume: 90-95 cubic µ VI. Life span: 120 days
The normal count of RBC
I. Adult male: 4.5-5.5 million/ml of blood
II. Adult female: 4.0-5.0 million//mcL of blood III.
Infants: 6-7 million//mcL of blood Structure
I. Inner: Stroma, containing hemoglobin
II. Outer: cell membrane (Composed of two-layer)
a. Stroman layer by protein b. Inulin layer by phospholipid, cholesterol, and carbohydrate
Function
I. Respiratory functions
RBC contains Hb which carries O2 from the lungs to the tissue and CO2 from the tissue to the lungs. II. Acid-base regulation
Helps to maintain acid-base balance, by buffering action of Hb. III. Ion balance
By cell membrane, it helps to maintain intercellular ion balance.
IV. Maintenance of viscosity
It helps to maintain the viscosity of blood.
V. The various pigment is derived from Hb after the disintegration of RBC, like bilirubin. VI. It contains an antigen.
# Hemoglobin
It is a conjugated protein or metalloporphyrins. Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues back to the lungs.
Structure
• Hemoglobin is made up of four protein molecules (globulin chains) that are connected together.
• The normal adult hemoglobin molecule contains two alpha-globulin chains and two beta globulin chains.
• In fetuses and infants, the hemoglobin molecule is made up of two alpha chains and two gamma chains. As the infant grows, the gamma chains are gradually replaced by beta chains, forming the adult hemoglobin structure.
• Each globulin chain contains an important iron-containing porphyrin compound termed heme.
• Embedded within the heme compound is an iron atom that is vital in transporting oxygen and carbon dioxide in our blood.
• The iron contained in hemoglobin is also responsible for the red color of blood.
• Hemoglobin also plays an important role in maintaining the shape of the red blood cells.
• The chromoprotein consists of two parts: Globulin 96% and Heam 4%.
Normal count
• Male: 14-18 gm/100 ml of blood.
• Female: 12-15.5 gm/100 ml of blood.
• At birth: 23 gm/100 ml.
Functions
I. Respiratory functions
Hbcarrys O2 from the lungs to the tissue and CO2 from the tissue to the lungs. II. Acid-base regulation
Helps to maintain acid-base balance with buffering action of Hb.
III. It reserves iron and protein
IV. The various pigment is derived from Hb like bile, stool, and urine.
Synthesis
1. Heam portion
- During the Krebs cycle, acetyl CoA is changed into succinyl Co-A through a series of reactions.
- Two molecules of succinyl Co-A is combined with two molecules of glycine and form a pyrrole compound.
- In turn, four pyrrole compounds combine to form a protoporphyrin compound.
- One of the protoporphyrin compounds called protoporphyrin 1X, then combined with iron to form the heam molecule.
2. Globin portion
- It is composed of four large polypeptide chains, synthesized by the ribosome.
Finally, each heam molecule combines with a very long peptide chain (globin) forming a subunit of hemoglobin, called hemoglobin chain.
Types of hemoglobin
There are two types of variation in Hb, which are only in globin and the heam portion is the same.
A. Physiological variation
I. Hemoglobin A (Hb A1)
It contains 2α and 2β chain of globin. More than 98% of normal adults.
II. Hemoglobin A2 (Hb A2)
It contains 2α and 2δ, where there is a difference between 10 amino acids. Only 2% found in normal adults.
III. Hemoglobin F (Hb F)
It contains 2α and 2δ, where there is a difference between 37 amino acids. Found in the fetus.
B. Pathological variation
I. Hb S or sickle cell hemoglobin.
II. Hb C or Hemoglobin C
III. Hb M or hemoglobin M.
#White blood corpuscle (Leukocyte)
WBC is the nucleated colorless cells of blood and is the mobile unit of the body’s protective system. It is also called leukocytes or leucocyte. All white blood cells are produced and derived from multipotent cells in the bone marrow known as hematopoietic stem cells. All white blood cells have nuclei, which distinguishes them from the other blood cells, like red blood cells (RBCs) and platelets. Morphology
1. Normal size: 10-20 µm
2. Normal counts: 4000-11000 µL/ of blood
3. Life span: A few hours to few days 4. Production: In bone marrow, spleen.
Functions
1. Phagocytosis
By this process, WBC engulf the bacteria and foreign particles.
2. Antibody formation
They produce antibody and play an important role in defensive mechanism.
3. Secretion of heparin
Basophil secrets heparin, that prevent the intravascular clotting.
4. Formation of fibroblasts
They converted into fibroblast at the affected area to accelerate the repair.
5. Anti-histamine functions
Eosinophil produce 5HT that has an anti-histamine property.
6. Chemotaxis
They have a chemotactic property to migrate out of the vessels.
7. Act as scavengers
By removing debris of dead tissues, they do the job of scavengers.
# Types of WBC
On the basis of granule presence or absent, WBC can be divided into two types:
2. Granulocytes
a. Neutrophils
b. Eosinophils
c. Basophils
3. Agranulocytes
a. Lymphocytes b. Monocytes
# Neutrophils
Characteristic
1. Neutrophils are the most abundant type of granulocytes.
2. The extremely small is the size (10-15µm).
3. It is also the most abundant (40% to 75%) type of white blood cells in most mammals.
4. They are formed from stem cells in the bone marrow.
5. They are short-lived (average 6 hours) and highly mobile.
6. They are radish brown or violet in color.
Functions
1. They engulf bacteria by phagocytic activity
2. They secrete a proteolytic enzyme that degrades ingested particles protein
3. They have chemotactic properties
4. They act as a first-line defense mechanism against bacteria
# Eosinophil
Characteristic
1. Eosinophils, sometimes called eosinophils or, less commonly, acidophils
2. They are a variety of white blood cells.
3. They are granulocytes that develop during hematopoiesis in the bone marrow before migrating into the blood.
4. These cells are acid-loving.
5. Normally transparent, but after staining with eosin, they appear brick-red.
6. It makes up about 1–6% of white blood cells
7. They are about 12–17 µm in size.
8. Eosinophils persist in the circulation for 8–12 hours.
Functions
1. Detoxify foreign particles
2. Collect at the sight of allergic reaction
3. Inhibit antigen-antibody reaction
4. Important for the dissolution of the old clot
# Basophil
Characteristic
1. Basophils are a type of white blood cells.
2. They are the least common of the granulocytes, representing about 0.5 to 1% of circulating white blood cells.
3. They are the largest type of granulocyte.
4. They are about 8-10µ
5. Their nucleus is bi-lobed.
Functions
1. They are responsible for inflammatory reactions during the immune response.
2. They can perform phagocytosis (cell eating)
3. They produce histamine and serotonin that induce inflammation, and heparin prevents blood clotting also.
# Lymphocyte
Characteristics
1. A lymphocyte is one of the subtypes of a white blood cell.
2. They are agranulocytes.
3. They are basically found in the lymph.
4. In human adults’ lymphocytes makeup roughly 20 to 40 percent of the total number of white blood cells.
5. They are 12-16µ in size
6. There are three types of lymphocytes: natural killer cells (function in cell-mediated, cytotoxic innate immunity), T cells (for cell-mediated, cytotoxic adaptive immunity), and B cells (for humoral, antibody-driven adaptive immunity).
Functions
1. Carries antibody
2. They give rise to monocytes and plasma cells.
3. They take part in the immune system
4. They can convert to fibroblast & repair tissue damage
# Monocytes
Characteristic
1. Monocytes are a type of white blood cell, or leukocyte.
2. They are the largest type of leukocyte.
3. Originally formed in the bone marrow and they are released into our blood and tissues.
4. When certain germs enter the body, they quickly rush to the site for attack.
5. Their cell size is about 15-20µ
Functions
1. Monocytes can change into another cell form called macrophages before facing the germs.
2. Monocytes help other white blood cells identify the type of germs that have invaded the body.
3. They remove dead cells from the sites of infection.
#Platelets (Thrombocytes)
Platelets, also called thrombocytes, are a component of blood whose function is to stop bleeding. Platelets have no cell nucleus. They are derived from the megakaryocytes of the bone marrow and then enter the circulation. Their normal count is 1.5-3.0 lacs / cu mm of blood. The normal life span is about 8 to 12 days. Platelets are lens-shaped structures and 2–3 µm in diameter. Platelets are found only in mammals.
Functions:
1. Vasoconstriction through the release of 5HT
2. Formation of a platelet plug to prevent bleeding (Hemostasis)
3. Formation of prothrombin activator and help in the coagulation
4. Initiate the blood clotting
5. Repair the damaged capillary endothelium
6. It helps in the defensive mechanism.
# ESR (Erythrocytic sedimentation rate)
When the blood is mixed with a suitable anticoagulant and is made to stand vertically, red blood corpuscles settle down to the bottom. The rate, at which this sedimentation of RBC takes place is known as ESR.
Normal count
1. Western Method:
a. Male: 0-6 mm in 1st Hour
b. Female: 0-12 mm in 1st hour 2. Wintrobe method:
a. Male: 0-12 mm in 1st hour
b. Female: 0-18 mm in 1st hour
Importance
1. To see the prognosis of diseases
2. To assay the condition of some chronic inflammatory diseases, like a. Pulmonary tuberculosis b. Pulmonary embolism c. Myocardial infraction d. Coronary thrombosis e. Rheumatic arthritis f. Carcinoma
4. To see the therapeutic effect of drugs.
ESR increases in ESR decreases in:
1. During pregnancy 1. Dehydration
2. Tuberculosis 2. High red blood cell count (polycythemia)
3. Rheumatic arthritis 3. High white blood cell count (leukocytosis)
4. Chronic inflammation 4. Sickle cell anemia
5. Hemorrhage
6. Tissue necrosis
Hematological Disorders
# Anemia
Anemia is a condition that develops when blood lacks enough healthy red blood cells or hemoglobin. With too few or abnormal red blood cells or hemoglobin, the cells will not get enough oxygen.
Causes
1. Excessive blood loss due to acute or chronic hemorrhage
2. Destruction of bone marrow
3. Reduced production of RBC due to a lack of factors necessary for RBC production. 4. Chronic gastrointestinal hemorrhage: ulcer, gastritis, cancer
5. Use of excessive amounts of aspirin-like NSAID drugs.
6. Menstruation and child birth
Types of anemia
• Iron deficiency anemia
• Aplastic anemia
• Megaloblastic anemia
• Hemolytic anemia
• Pernicious anemia
Symptoms
1. Fatigue
2. Weakness
3. Pale or yellowish skin
4. Irregular heartbeats
5. Shortness of breath
6. Dizziness or lightheadedness
7. Chest pain
8. Cold hands and feet
9. Headache
# Iron deficiency anemia
When the supply of iron to the bone marrow is insufficient for the requirements of Hb synthesis, iron deficiency anemia takes places. It is the most common type of anemia. When there isn’t enough iron in blood stream, the rest of body can’t get the amount of oxygen it needs.
Symptoms
1. Fatigue
2. Weakness
3. Pale skin
4. Shortness of breath
5. Dizziness
6. Cold hands and feet
7. Fast or irregular heartbeat
8. Brittle nails
9. Headaches
Causes
1. Inadequate iron intake
2. Pregnancy or blood loss due to menstruation
3. Internal bleeding
4. Inability to absorb iron
Diagnosis
1. Complete blood count (CBC)
2. Iron level in the blood
3. Total Iron binding capacity (TIBC)
4. Endoscopy for internal bleeding
Treatment
1. Iron tablets
2. Diet (Red meat, green vegetables, dried fruits, nuts)
# Aplastic anemia
Aplastic refers to the inability of the stem cells to generate mature blood cells. Aplastic anemia is a rare disease in which the bone marrow and the reside hematopoietic stem cells are damaged. This causes a deficiency of all three blood cell types (pancytopenia): red blood cells, white blood cells (leukopenia), and platelets (thrombocytopenia).
Symptoms
1. Fatigue
2. Shortness of breath
3. Rapid or irregular heart rate
4. Pale skin
5. Frequent or prolonged infections
6. Prolonged bleeding from cuts
7. Skin rash
8. Dizziness
9. Headache
Causes
1. Radiation and chemotherapy treatments
2. Exposure to toxic chemicals
3. Use of certain drugs
4. Autoimmune disorders
5. A viral infection
6. Pregnancy
7. Unknown factors
Diagnosis
1. CBC
2. Bone marrow biopsy
Treatment
1. Blood transfusions (RBC and platelets)
2. Stem cell transplant
3. Immunosuppressant (Cyclosporine)
4. Bone marrow stimulants (sargramostim, epoetin alfa)
5. Antibiotics, antivirals
# Megaloblastic anemia
Megaloblastic anemia is caused when red blood cells aren’t produced properly. Because the cells are too large, they may not be able to exit the bone marrow to enter the bloodstream and deliver oxygen. It is a blood disorder in which the number of red blood cells is lower than normal. It is due to impaired DNA synthesis as a result of vitamin B12 or folic acid deficiency.
Symptoms Causes
1. Shortness of breath 1. Vitamin B12 deficiency
2. Muscle weakness
3. Abnormal paleness of the skin 2. Chronic pancreatitis
4. Weight loss 3. Folate deficiency
5. Diarrhea 4. Alcoholism
6. Nausea 5.Malabsorption
7. Fast heartbeat 6. Drugs (Anti-cancer)
Diagnosis
1. CBC
2. Schilling test (a blood test that evaluates the ability to absorb vitamin B-12)
Treatment
1. For Vitamin B12 deficiency 2. For folate deficiency a. Eggs a. Oranges b. Chicken b. Leafy green vegetables
Fortified cereals c. Peanuts c. Red meats (especially beef) d. Enriched grains
Sickle cell anemia
This type of anemia is due to a problem with hemoglobin that causes red blood cells to have an abnormal crescent shape. The body destroys these cells quickly and new red blood cells cannot be made fast enough. Sickle cell anemia is a genetic disorder (i.e., it runs in the family).
In this inherited disease, the red blood cells are shaped like half-moons rather than the normal indented circles. This change in shape can make the cells "sticky" and unable to flow smoothly through blood vessels. This causes a blockage in blood flow. This blockage may cause acute or chronic pain and can also lead to infection or organ damage. Sickle cells die much more quickly than normal blood cells—in about 10 to 20 days instead of 120 days—causing a shortage of red blood cells.
Symptoms:
Episodes of pain.
Painful swelling of hands and feet.
Frequent infections.
Delayed growth.
Vision problems.
Pernicious anemia:
Vitamin B12 deficiency anemia/ pernicious anemia is a disease in which not enough red blood cells are produced due to a deficiency of vitamin B12. The most common initial symptom is feeling tired. Other symptoms may include
• shortness of breath
• pale skin
• chest pain,
• numbness in the hands and feet,
• poor balance, a smooth red tongue
• poor reflexes,
• Depression and confusion.
Hemolytic anemia. This type of anemia happens when red blood cells are destroyed by an abnormal process in your body before their lifespan is over. As a result, your body doesn't have enough red blood cells to function, and your bone marrow cannot make enough to keep up with demand.
# Thalassemia
Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form of hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen. The disorder results in large numbers of red blood cells being destroyed, which leads to anemia.
** Two main forms of thalassemia are more serious. In alpha thalassemia, at least one of the alpha-globin genes has a mutation or abnormality. In beta-thalassemia, the beta-globin genes are affected.
Symptoms
1. Bone deformities, especially in the face
2. Dark urine
3. Delayed growth and development
4. Excessive tiredness and fatigue
5. Yellow or pale skin
Causes
Thalassemia occurs when there’s an abnormality or mutation in one of the genes involved in hemoglobin production.
If only one of the parents is a carrier for thalassemia, children develop a form of the disease known as thalassemia. Diagnosis
1. CBC
2. Physical examination of blood to identify the abnormal formation of blood cell
3. Hemoglobin electrophoresis Treatment
1. Blood transfusions
2. Medications (Deferoxamine)
3. Bone marrow transplant
# Jaundice
When free or conjugated bilirubin accumulates in the blood, skin and mucous membranes turn yellow. This yellowness is known as jaundice (icterus) and is usually detectable when the total plasma bilirubin is greater than 2 mg/dl.
** Bilirubin is a waste product, created when red blood cells break down. It's transported in the bloodstream to the liver, where it's combined with a digestive fluid called bile. This eventually passes out of the body in urine or stools. It's bilirubin that gives urine its light yellow color and stools their dark brown color.
Sign
1. Yellowing of the skin, eyes and the lining of the inside of parts of the body, such as the mouth and nose.
2. Pale-colored stools
3. Dark-colored urine
Causes Diagnosis
1. Malaria
2. Sickle cell anemia
3. Thalassemia
4. Viral hepatitis
5. Alcoholism 1.2.3.4.
5. Urine test
Liver functions test
CT scan of liver and bile
MRI scan of the liver
Liver biopsy
6. Drug misuse (paracetamol)
7. Liver cancer
8. Pancreatic cancer
Treatment
1. Medication (in case of malaria)
2. RBC replacement (in case of sickle cell anemia or thalassemia)
3. Prohibition of alcohol
4. Gallbladder surgery
# Leukemia
Leukemia is a group of cancers that usually begin in the bone marrow and result in high numbers of abnormal white blood cells. These white blood cells are not fully developed and are called blasts or leukemia cells.
Symptoms
1. Pain in the bones or joints,
2. Swollen lymph nodes that usually don't hurt
3. Fevers or night sweats
4. Feeling weak or tired
5. Bleeding
6. Frequent infections
7. Discomfort in the abdomen 8. Weight loss or loss of appetite.
Causes
1. Radiation
2. Genetic factors
3. Mutation in DNA
4. Viruses such as human T-lymphotropic virus
5. Chemicals, like benzene and alkylating chemotherapy agents
Diagnosis
1. CBC
2. Lymph node biopsy
3. MRI or CT scan
Treatment
1. Bone marrow transplant
2. Radiation therapy
3. Medication
# Blood coagulation factors
By the action of thrombin, blood fibrinogen (soluble) is converted into fibrin (Insoluble) and makes the blood semisolid mass. This is called blood coagulation. There are several factors involved:
Clotting factors Synonyms
Factor Ι Fibrinogen
Factor ΙΙ Prothrombin
Factor ΙΙΙ Tissue thromboplastin
Factor ΙV Calcium
Factor V Proacelerin
Factor VΙΙ Proconvertin
Factor VΙΙΙ Antihemophilic factor A
Factor ΙX Antihemophilic factor B
Factor X Stuart factor
Factor XΙ Antihemophilic factor C
Factor XΙΙ Hageman Factor
Factor XΙΙΙ Fibrin stabilizing factor
# Antigen
An antigen is a substance, protein or polysaccharide which when introduced into the system in a considerable dose and appropriate route is capable of inducing an immune response leading to the formation of the antibody with which it reacts specifically.
# Antibody
The antibody is a type of globulin produced in response to an antigen with which it reacts specifically. There are five antibodies:
1. IgM
2. IgG
3. IgA
4. IgD
5. IgE
# Blood group
Human blood is divided into one of four main blood types (A, B, AB, and O) and is based on the presence or absence of specific markers on red blood cells. These markers (also called antigens) are proteins and sugars that our bodies use to identify the blood cells as belonging in our own system.
The four main blood groups are:
• Type A. This blood type has a marker known as "A."
• Type B. This blood type has a marker known as "B."
• Type AB. The blood cells in this type have both A and B markers.
• Type O. This blood type has neither A or B markers.
In the classical blood grouping system, this marker (antigen) is called agglutinogen. It is a polysaccharide, present in the cell membrane of RBC and less commonly in the salivary gland, pancreas, kidney, lungs, etc. There are 30 different agglutinogens but primarily agglutinogen A and agglutinogen B is the major.
An agglutinin is a substance in the blood that causes particles to coagulate and aggregate; that is, to change from fluid-like state to a thickened-mass (solid) state.
Some people have an additional marker, called Rh factor (Rhesus Factor), in their blood. Because each of the four main blood groups (A, B, AB, and O) may or may not have Rh factor, scientists further classify blood as either "positive" (meaning it has Rh factor) or "negative" (without Rh factor).
On the basis of classical and Rh factors blood is grouped into:
Blood group Antigen (agglutinogen) Rh factor Donate to Received from
A+ A Present A+ AB+ A± O±
A- A Absent A± AB± A- O-
B+ B Present B+ AB+ B± O±
B- B Absent B± AB± B- O-
AB+ A & B Present AB+ Everyone
AB- A & B Absent AB± AB- A- B- O-
O+ Absent Present O+ A+ B+ AB+ O±
O- Absent Absent Everyone O-
The ABO blood group system.
• Blood type A: your red blood cells have antigen A only.
• Blood type B: your red blood cells have antigen B only.
• Blood type AB: your red blood cells have both A and B antigens.
• Blood type O: you have neither A nor B antigens on your red blood cells.
In your plasma (the liquid component of your blood), you will have antibodies against whichever antigens you don’t have on your own red blood cells i.e. foreign antigens. These antibodies are present without you having contact with the “foreign” blood type. How this occurs is not clear yet.
• If you are blood group A, you will have antibodies to antigen B.
• If you are blood group B, you will have antibodies to antigen A.
• If you are blood type AB, you will not have antibodies to either A or B.
• If you are blood type O, you will have antibodies to both A and B.
• A sample of your blood is tested separately against 2 laboratory solutions – one that contains antibodies against the A antigen (anti-A) and one that contains antibodies against the B antigen (anti-B).
• The way your blood reacts to the antibodies shows which antigens your blood contains. For example, if you have the A antigen on your red blood cells (you are blood group A) when the solution containing anti-A antibodies is added, your blood cells will react by clumping together (agglutinating). If your blood doesn't react to either of the solutions, it must be O type blood
The rhesus (Rh) system
The other blood typing system commonly used is the Rhesus system, also called the Rh system, named after the Rhesus monkey in which it was first discovered. In this system, if you have an antigen called the RhD antigen on the surface of your red blood cells, you are said to be Rhesus positive (Rh+). If you don’t, you are said to be Rhesus negative (Rh-).
Hemostasis or hemostasis is a process which causes bleeding to stop, meaning to keep blood within a damaged blood vessel (the opposite of hemostasis is hemorrhage). It is the first stage of wound healing.
Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a blood clot.
What is the Difference between Hemostasis and Coagulation?
Hemostasis vs Coagulation
Hemostasis is the overall process of arresting bleeding following a vascular injury. Coagulation is the final step of hemostasis in which a stable blood clot is formed by platelets and insoluble fibrin network.
Process
The ultimate result of the hemostasis is the stoppage of bleeding. Soluble plasma fibrinogenpolymerizes into insoluble fibrin during the coagulation and forms a plug to block the hole made by the injury.
Types
Hemostasis can be categorized into two types named primary hemostasis
and secondary hemostasis. Coagulation can be categorized into the intrinsic pathway of blood clotting and the extrinsic pathway of blood clotting.
Disorders
Hemostasis can show platelet disorders. abnormalities due to Coagulation can be impaired by disorders of the liver and inactive or abnormal fibrinogen production.
Bleeding time: It is the measure of how rapidly blood can start to clot formation and become able to stop bleeding.
In this test, a small puncture is made in the skin of the person. By performing this test, it can be easily determined how the platelets work together to form clots.
If there is prolonged bleeding in a person, it indicates that the person has an acquired defect of platelet function.
The normal bleeding time is between 2-7 minutes.
Clotting time:
Clotting time means after injury it takes how much time to stop bleeding which occurs due to clot formation of blood Clotting time is the time required for a sample of blood to coagulate in vitro.
The normal value of clotting time is 8 to 15 minutes.
Prothrombin time
Prothrombin is another protein your liver produces. The prothrombin time (PT) test measures how well and how long it takes your blood to clot.
It normally takes about 25 to 30 seconds. It may take longer if you take blood thinners. Other reasons for abnormal results include hemophilia, liver disease, and malabsorption.
It’s also useful in monitoring those who take medications that affect clotting, such as warfarin (Coumadin).
THE END
0 Comments