1. Chapter 14 The Cardiovascular System: Blood
Copyright 2010, John Wiley & Sons, Inc.

2. Copyright 2010, John Wiley & Sons, Inc.
Functions
Transportation: water, gases, nutrients, wastes, heat, etc.
Regulation: pH, temperature, water balance
Protection: blood clotting, defense:
Copyright 2010, John Wiley & Sons, Inc.

3. Copyright 2010, John Wiley & Sons, Inc.
Blood Volume
Varies with
body size
changes in fluid concentration
changes in electrolyte concentration
amount of adipose tissue
about 8% of body weight
about 5 liters
Copyright 2010, John Wiley & Sons, Inc.
14-3

4. Copyright 2010, John Wiley & Sons, Inc.
Composition
Plasma(~55%): soluble materials
mostly water; lighter so at top of tube
Formed elements (~45%): cells
heavier so at bottom of tube
Mostly red blood cells (RBCs)
Percent of blood RBCs = hematocrit (Hct)
Normal hematocrit: 42-47%
Females: 38 to 46%; males: 40 to 54%
Buffy coat: white blood cells (WBCs) and platelets
Copyright 2010, John Wiley & Sons, Inc.

5. Copyright 2010, John Wiley & Sons, Inc.
Composition
Copyright 2010, John Wiley & Sons, Inc.

6. Plasma: Liquid Portion of Blood
Water: 91.5%
Plasma proteins: 7%
Albumin:
Globulins:
Fibrinogen:
Other: 1.5%
Electrolytes, nutrients, gases, hormones, vitamins, waste products
Copyright 2010, John Wiley & Sons, Inc.

7. Copyright 2010, John Wiley & Sons, Inc.
Plasma Proteins
Albumins
most numerous
originate in liver
help maintain osmotic pressure of blood
Alpha and Beta Globulins
originate in liver
transport lipids and fat-soluble vitamins
Gamma Globulins
originate in lymphatic tissues
constitute the antibodies of immunity
Fibrinogen
originate in liver
plays key role in blood coagulation
Copyright 2010, John Wiley & Sons, Inc.
14-22

8. Copyright 2010, John Wiley & Sons, Inc.
Plasma Lipoproteins
VLDLs
relatively high concentration of triglycerides
produced in the liver
transport triglycerides from liver to adipose cells
Chylomicrons
high concentration of triglycerides
transport dietary fats to muscles and adipose cells
LDLs
relatively high concentration of cholesterol
formed from VLDLs
deliver cholesterol to various cells
HDLs
relatively high concentration of proteins
transport remnants of chylomicrons to liver
Copyright 2010, John Wiley & Sons, Inc.
14-24

9. Copyright 2010, John Wiley & Sons, Inc.
Gases and Nutrients
Gases
oxygen
carbon dioxide
nitrogen
Nutrients
amino acids
simple sugars
nucleotides
lipids
lipoproteins
Copyright 2010, John Wiley & Sons, Inc.
14-23

10. Nonprotein Nitrogenous Substances
Urea – product of protein catabolism; about 50%
Uric acid – product of nucleic acid catabolism
Amino acids – product of protein catabolism
Creatine – stores phosphates
Creatinine – product of creatine metabolism
BUN – blood urea nitrogen; indicate health of kidney
Copyright 2010, John Wiley & Sons, Inc.
14-25

11. Copyright 2010, John Wiley & Sons, Inc.
Plasma Electrolytes
sodium – most abundant
potassium – most abundant
calcium
magnesium
chloride
bicarbonate
phosphate
sulfate
Copyright 2010, John Wiley & Sons, Inc.
14-26

12. Copyright 2010, John Wiley & Sons, Inc.
Formed Elements
I. Red Blood Cells (RBCs)
II. White blood cells (WBCs)
Granular leukocytes
Neutrophils
Eosinophils
Basophils
Agranular leukocytes
Lymphocytes and natural killer (NK) cells
Monocytes
III Platelets
Copyright 2010, John Wiley & Sons, Inc.

13. Formation of Blood Cells
Called hemopoiesis or hematopoiesis
Occurs throughout life
Specific hormones  stem cells  form blood cells
Pluripotent stem cells in red marrow
Lymphoid stem cells  lymphocytes (in lymphatic tissues)
Myeloid stem cells  all other WBCs, all RBCs, and platelets
Copyright 2010, John Wiley & Sons, Inc.

14. Formation of Blood Cells
Copyright 2010, John Wiley & Sons, Inc.

15. Formation of Blood Cells
Copyright 2010, John Wiley & Sons, Inc.

16. Copyright 2010, John Wiley & Sons, Inc.
Erythrocytes (RBCs)
Hemoglobin (red pigment)
Carries 98.5% of O2 and 23% of CO2
RBC count: about 5 million/µl
Male: 5.4 million cells/µl; female: 4.8 million/µl
Structure of mature RBC
No nucleus/DNA
biconcave disc shape with extensive plasma membrane
maximal gas exchange
flexible for passing through capillaries
RBCs live only 3 to 4 mos
Copyright 2010, John Wiley & Sons, Inc.

17. Copyright 2010, John Wiley & Sons, Inc.
Red Blood Cells
Copyright 2010, John Wiley & Sons, Inc.
14-6

18. RBC Synthesis: Erythropoiesis
Stimulus - low O2 delivery (hypoxia) in blood passing to kidneys 
Kidneys release erythropoietin (EPO) 
Stimulates erythropoiesis in red marrow 
increased O2 delivery in blood (negative feedback mechanism)
Copyright 2010, John Wiley & Sons, Inc.

19. RBC Synthesis: Erythropoiesis
Cells lose nucleus; then released into bloodstream as reticulocytes
develop into erythrocytes after 1-2 days in bloodstream
High reticulocyte count - indicates high rate of RBC formation
Copyright 2010, John Wiley & Sons, Inc.

20. Red Blood Cell Production
Copyright 2010, John Wiley & Sons, Inc.
14-8

21. RBC Synthesis: Erythropoiesis
lower-than-normal RBC count  changes in skin, mucous membranes, and finger nail beds
Cyanosis: bluish color
Anemia: pale color
Copyright 2010, John Wiley & Sons, Inc.

22. Copyright 2010, John Wiley & Sons, Inc.
RBC Recycling
Cleared by macrophages (liver and spleen)
Recycled components
Globin  amino acids recycled to form proteins
Heme broken down into: Fe
Carried in blood by transferrin
Recycled in bone marrow; proteins and vitamin B12 required also
Non-Fe portion of heme  biliverdin  bilirubin
Bilirubin to liver  bile  helps absorb fats
Intestinal bacteria convert bilirubin into other chemicals that exit in feces (stercobilin) or urine (urobilin)
Copyright 2010, John Wiley & Sons, Inc.

23. Life Cycle of Red Blood Cell
Copyright 2010, John Wiley & Sons, Inc.
14-9

24. Copyright 2010, John Wiley & Sons, Inc.
Formation and Destruction of RBC’s
Amino
acids
Reused for
protein synthesis
Globin
Circulation for about
120 days
Red blood cell
death and
phagocytosis
Transferrin
Fe3+
Liver +
Vitamin B12
Erythopoietin
Key:
in blood
in bile
Erythropoiesis in
red bone marrow
Macrophage in
spleen, liver, or
Ferritin
Heme
Biliverdin
Bilirubin 9 8 7 6 5 4 3 2 1
Amino
acids
Reused for
protein synthesis
Globin
Circulation for about
120 days
Bilirubin
Red blood cell
death and
phagocytosis
Transferrin
Fe3+
Liver +
Vitamin B12
Erythopoietin
Key:
in blood
in bile
Erythropoiesis in
red bone marrow
Macrophage in
spleen, liver, or
Ferritin
Heme
Biliverdin 10 9 8 7 6 5 4 3 2 1
Amino
acids
Reused for
protein synthesis
Globin
Urine
Stercobilin
Bilirubin
Urobilinogen
Feces
Small
intestine
Circulation for about
120 days
Bacteria
Red blood cell
death and
phagocytosis
Transferrin
Fe3+
Liver +
Vitamin B12
Erythopoietin
Key:
in blood
in bile
Erythropoiesis in
red bone marrow
Kidney
Macrophage in
spleen, liver, or
Ferritin
Urobilin
Heme
Biliverdin 13 12 11 10 9 8 7 6 5 4 3 2 1
Amino
acids
Reused for
protein synthesis
Globin
Circulation for about
120 days
Red blood cell
death and
phagocytosis
Transferrin
Fe3+
Liver +
Vitamin B12
Erythopoietin
Key:
in blood
in bile
Erythropoiesis in
red bone marrow
Macrophage in
spleen, liver, or
Ferritin
Heme 8 7 6 5 4 3 2 1
Amino
acids
Reused for
protein synthesis
Globin
Stercobilin
Bilirubin
Urobilinogen
Feces
Small
intestine
Circulation for about
120 days
Bacteria
Red blood cell
death and
phagocytosis
Transferrin
Fe3+
Liver +
Vitamin B12
Erythopoietin
Key:
in blood
in bile
Erythropoiesis in
red bone marrow
Macrophage in
spleen, liver, or
Ferritin
Heme
Biliverdin 12 11 10 9 8 7 6 5 4 3 2 1
Amino
acids
Reused for
protein synthesis
Globin
Red blood cell
death and
phagocytosis
Transferrin
Fe3+
Liver +
Vitamin B12
Erythopoietin
Key:
in blood
in bile
Macrophage in
spleen, liver, or
red bone marrow
Ferritin
Heme 7 6 5 4 3 2 1
Globin
Red blood cell
death and
phagocytosis
Key:
in blood
in bile
Macrophage in
spleen, liver, or
red bone marrow
Heme 2 1
Red blood cell
death and
phagocytosis
Key:
in blood
in bile
Macrophage in
spleen, liver, or
red bone marrow 1
Amino
acids
Reused for
protein synthesis
Globin
Red blood cell
death and
phagocytosis
Key:
in blood
in bile
Macrophage in
spleen, liver, or
red bone marrow
Heme 3 2 1
Amino
acids
Reused for
protein synthesis
Globin
Red blood cell
death and
phagocytosis
Transferrin
Fe3+
Key:
in blood
in bile
Macrophage in
spleen, liver, or
red bone marrow
Heme 4 3 2 1
Amino
acids
Reused for
protein synthesis
Globin
Red blood cell
death and
phagocytosis
Transferrin
Fe3+
Liver
Key:
in blood
in bile
Macrophage in
spleen, liver, or
red bone marrow
Ferritin
Heme 6 5 4 3 2 1
Amino
acids
Reused for
protein synthesis
Globin
Red blood cell
death and
phagocytosis
Transferrin
Fe3+
Liver
Key:
in blood
in bile
Macrophage in
spleen, liver, or
red bone marrow
Ferritin
Heme 5 4 3 2 1
Amino
acids
Reused for
protein synthesis
Globin
Urine
Stercobilin
Bilirubin
Urobilinogen
Feces
Large
intestine
Small
Circulation for about
120 days
Bacteria
Red blood cell
death and
phagocytosis
Transferrin
Fe3+
Liver +
Vitamin B12
Erythopoietin
Key:
in blood
in bile
Erythropoiesis in
red bone marrow
Kidney
Macrophage in
spleen, liver, or
Ferritin
Urobilin
Heme
Biliverdin 14 13 12 11 10 9 8 7 6 5 4 3 2 1
Copyright 2010, John Wiley & Sons, Inc.

25. Regulation of Erythropoiesis
Copyright 2010, John Wiley & Sons, Inc.

26. Copyright 2010, John Wiley & Sons, Inc.
Types of Anemia
Iron deficiency anemia
hemoglobin deficient
lack of iron
Aplastic anemia
bone marrow damaged
toxic chemicals
radiation
Pernicious anemia
excess of immature RBCs
inability to absorb B12
Sickle cell anemia
abnormal shape of RBCs
defective gene
Thalassemia
hemoglobin deficient
RBCs short-lived
defective gene
Copyright 2010, John Wiley & Sons, Inc.
14-10

27. Copyright 2010, John Wiley & Sons, Inc.
Hemolytic Anemia
RBCs destroyed
toxic chemicals
Copyright 2010, John Wiley & Sons, Inc.
14-11

28. White Blood Cells (WBCs or Leukocytes)
Appear white  lack hemoglobin
Normal WBC count: 5,000-10,000/µl
usually increases in infection
Two major classes - presence or absence of granules (vesicles)
Granular:
Neutrophils usually make up 2/3 of all WBCs
Agranular:
Major function: defense against
Infection and inflammation
Antigen-antibody (allergic) reactions
Copyright 2010, John Wiley & Sons, Inc.

29. Copyright 2010, John Wiley & Sons, Inc.
Neutrophils
First responders to infection
Phagocytosis
Release bacteria-destroying enzyme - lysozyme
light blue granules in acid-base stain
lobed nucleus
elevated in bacterial infections
Copyright 2010, John Wiley & Sons, Inc.
14-13

30. Copyright 2010, John Wiley & Sons, Inc.
Basophils
Intensify inflammatory responses and allergic reactions
Release chemicals that dilate blood vessels:
histamine and serotonin
heparin (anticoagulant)
deep blue granules in basic stain
Copyright 2010, John Wiley & Sons, Inc.
14-14

31. Copyright 2010, John Wiley & Sons, Inc.
Eosinophils
Phagocytose antibody-antigen complexes
Help suppress inflammation of allergic reactions
Respond to parasitic infections
deep red granules in acid stain
bilobed nucleus
Copyright 2010, John Wiley & Sons, Inc.
14-15

32. White Blood Cell Functions
Lymphocytes
About the size of RBC
Large spherical nuclei - thin rims of cytoplasm
Three types
T cells
B cells
Natural killer (NK) cells
Play major roles in immune responses
B lymphocytes  foreign substances (antigens) cause cells to produce antibodies.
Antibodies attach to and inactivate the antigens.
T lymphocytes directly attack microbes.
Copyright 2010, John Wiley & Sons, Inc.

33. Copyright 2010, John Wiley & Sons, Inc.
Monocytes
Macrophages (“big eaters”)
Largest blood cell
Kidney-shaped or oval nuclei
Copyright 2010, John Wiley & Sons, Inc.
14-16

34. White Blood Cell Functions
Major histocompatibility (MHC) antigens
Proteins on plasma membrane of WBCs (and most other body cells)
Called “self-identity markers”
Unique for each person (except for identical twins)
Used to “type tissues” to check for compatibility and reduce risk of rejection
Copyright 2010, John Wiley & Sons, Inc.

35. Copyright 2010, John Wiley & Sons, Inc.
WBC Life Span
RBCs outnumber WBCs about 700:1
Life span: typically a few hours to days
Abnormal WBC counts
Leukocytosis: high WBC count in response to infection, exercise, surgery
Leukopenia: low WBC count
Differential WBC count: measures % of WBCs made up of each of the 5 types
Copyright 2010, John Wiley & Sons, Inc.

36. Copyright 2010, John Wiley & Sons, Inc.
Diapadesis
Leukocytes squeeze through capillary walls to enter tissue space outside the blood vessel
Copyright 2010, John Wiley & Sons, Inc.
14-18

37. Copyright 2010, John Wiley & Sons, Inc.
Platelets
Myeloid stem cells  megakaryocytes  2000–3000 fragments = platelets
Normal count: 150, ,000/µl blood
Functions
Plug damaged blood vessels
Promote blood clotting
Life span 5–9 days
Copyright 2010, John Wiley & Sons, Inc.

38. Hemostasis: “Blood Standing Still”
Vascular spasm - smooth muscle contracts
Response to damage
Triggered by pain receptors, platelet release, or serotonin
Quick reduction of blood loss
Platelet plug formation
Platelets become sticky when contact damaged vessel wall
Adhere to rough surface to form a plug
Triggered by exposure of platelets to collagen
Copyright 2010, John Wiley & Sons, Inc.

39. Hemostasis: “Blood Standing Still”
3. Blood clotting (coagulation)
Series of chemical reactions involving clotting factors   
triggered by cellular damage and blood contact with foreign surfaces
Copyright 2010, John Wiley & Sons, Inc.

40. Blood Clotting (Coagulation)
Extrinsic pathway
Tissue factor (TF) from damaged cells
Triggered by thromboplastin (not found in blood)
Triggered when blood contacts a foreign surface
Intrinsic Pathway
Triggered by Hageman factor
Triggered when blood contacts damaged tissue
Copyright 2010, John Wiley & Sons, Inc.

41. Blood Clotting (Coagulation)
Common pathway: 3 major steps
Prothrombinase  (enzyme)
Prothrombin  thrombin
Fibrinogen  fibrin  clot
Ca++ plays important
Copyright 2010, John Wiley & Sons, Inc.

42. Platelet Plug Formation
Copyright 2010, John Wiley & Sons, Inc.
14-28

43. Copyright 2010, John Wiley & Sons, Inc.
Blood Coagulation
Copyright 2010, John Wiley & Sons, Inc.
14-29

44. Clot Retraction and Vessel Repair
Clot plugs ruptured area
Gradually contracts (retraction)
Pulls sides of wound together
Repair
Fibroblasts replace connective tissue
Epithelial cells repair lining
Copyright 2010, John Wiley & Sons, Inc.

45. Prevention of Coagulation
The smooth lining of blood vessels discourages the accumulation of platelets
As a clot forms, fibrin absorbs thrombin and prevents the reaction from spreading
Antithrombin interferes with the action of excess thrombin
Copyright 2010, John Wiley & Sons, Inc.
14-32

46. Hemostatic Control Mechanisms
Fibrinolysis: breakdown of clots by plasmin
Inactivated plasminogen 
Activated (by tPA)  plasmin
Inappropriate (unneeded) clots
Thrombosis
Loose (on-the-move) clot = Embolism
Anticoagulants: decrease clot formation
Heparin
Warfarin (Coumadin)
Copyright 2010, John Wiley & Sons, Inc.

47. Copyright 2010, John Wiley & Sons, Inc.
Stages of Clotting
Tissue trauma
Tissue
factor
(TF)
Blood trauma
Damaged
endothelial cells
expose collagen
fibers
(a) Extrinsic pathway
(b) Intrinsic pathway
Activated XII
Ca2+
platelets
Platelet
phospholipids
Activated X
Activated
PROTHROMBINASE V
Prothrombin
(II)
THROMBIN
(c) Common
pathway 1 2 +
Copyright 2010, John Wiley & Sons, Inc.

48. Blood Groups and Blood Types
RBCs have antigens (agglutinogens)
Each blood group consists of two or more different blood types
There are > 24 blood groups
Blood types determined by genetics
Copyright 2010, John Wiley & Sons, Inc.

49. Copyright 2010, John Wiley & Sons, Inc.
ABO Group
Two types of antigens on RBCs: A or B
Type A has only A antigen
Type B has only B antigen
Type AB has both
Type O has neither
Most common types in US: type O and A
Typically blood has antibodies in plasma
React with antigens
Two types: anti-A antibody or anti-B
Blood lacks antibodies against own antigens
Type A blood has anti-B (not anti-A)
Type AB blood has neither anti-A nor anti-B
Copyright 2010, John Wiley & Sons, Inc.

50. Copyright 2010, John Wiley & Sons, Inc.
ABO Group
Copyright 2010, John Wiley & Sons, Inc.

51. Copyright 2010, John Wiley & Sons, Inc.
Rh Blood Group
Rh: antigen found in rhesus monkey
If RBCs have Rh antigen: Rh+
If RBCs lack Rh antigen: Rh–
Rh+ blood type in % of U.S. population
Normally neither Rh+ nor Rh– has anti-Rh antibodies
Antibodies develop in Rh- persons after first exposure to Rh+ blood in transfusion (or pregnancy  hemolytic disease of newborn)
Copyright 2010, John Wiley & Sons, Inc.

52. Copyright 2010, John Wiley & Sons, Inc.
Transfusions
If mismatched blood given, antibodies bind to antigens on RBCs  hemolyze RBCs
Type AB called “universal recipients”
Type O called “universal donors”
Misleading because many other blood groups must also be matched
Copyright 2010, John Wiley & Sons, Inc.

53. Copyright 2010, John Wiley & Sons, Inc.
Agglutination
Copyright 2010, John Wiley & Sons, Inc.
14-34

54. Copyright 2010, John Wiley & Sons, Inc.
Clinical Application
Leukemia
Myeloid Leukemia
bone marrow produces too many immature granulocytes
leukemic cells crowd out other blood cells
anemia
bleeding
susceptible to infections
Lymphoid Leukemia
lymphocytes are cancerous
symptoms similar to myeloid leukemia
Treatments
blood transfusions
marrow transplants
anti-cancer drugs
stem cell transplants
Copyright 2010, John Wiley & Sons, Inc.
14-36