1. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 13 The Blood

2. Copyright © 2015 Wolters Kluwer All Rights Reserved Key Terms agglutinationerythrocytelymphocyte albuminfibrinmegakaryocyte anemiahematocritmonocyte antigenhematopoieticneutrophil antiserumhemoglobinplasma basophilhemolysisplatelet (thrombocyte) centrifugehemorrhageserum coagulationhemostasisthrombin cryoprecipitateleukemiathrombocytopenia eosinophilleukocytetransfusion

3. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Important in maintaining homeostasis Classified as a connective tissue Accounts for 8% of total body weight

4. Copyright © 2015 Wolters Kluwer All Rights Reserved Functions of the Blood

5. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Constituents (cont.) Plasma –Liquid portion Formed elements –Cellular portion

6. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-1 Composition of whole blood. Blood Constituents (cont.)

7. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-2 Blood cells as viewed under the microscope. Which cells are the most numerous in the blood? Blood Constituents (cont.)

8. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Constituents (cont.) Blood Plasma Plasma is 55% of blood. Components –Water –Protein Albumin Clotting factors Antibodies Complement

9. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Constituents (cont.) Formed Elements Produced in red bone marrow from hematopoietic cells –Erythrocytes –Leukocytes Neutrophils Eosinophils Basophils Lymphocytes Monocytes –Platelets

10. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Constituents (cont.) Erythrocytes Red blood cells (RBCs)—most numerous Biconcave shape Mature cells anuclear Contain hemoglobin –Binds to oxygen for transport –Carries hydrogen ions for buffering –Carries carbon dioxide for elimination

11. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-3 Red blood cells as seen under a scanning electron microscope. Why are these cells described as biconcave? Blood Constituents (cont.)

12. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Constituents (cont.) Leukocytes White blood cells (WBCs)—colorless, round, with prominent nuclei –Granulocytes Neutrophils (polymorphs) Eosinophils Basophils –Agranulocytes Lymphocytes Monocytes Clear body of foreign material, cellular debris, pathogens

13. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-4 Stages in neutrophil development. Blood Constituents (cont.)

14. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-5 Phagocytosis. Blood Constituents (cont.)

15. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Constituents (cont.) Platelets (Thrombocytes) Smallest formed element Not cells—no nuclei or DNA Fragments release from megakaryocytes Essential for blood coagulation (clotting)

16. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-6 Platelets (thrombocytes). Blood Constituents (cont.)

17. Copyright © 2015 Wolters Kluwer All Rights Reserved Hemostasis and Coagulation (cont.) Prevents blood loss when blood vessel ruptures Events include: –Contraction of smooth muscle in the damaged blood vessel wall –Formation of a platelet plug –Formation of a blood clot Formation of prothrombinase Conversion of prothrombin into thrombin (by prothrombinase) Conversion of fibrinogen into fibrin (via thrombin)

18. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-7 Blood clotting (coagulation). What part of the word prothrombinase indicates that it is an enzyme? What part of the word prothrombin indicates that it is a precursor? Hemostasis and Coagulation (cont.)

19. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Types (cont.) Blood types must be compatible for blood transfusion from donor to patient. Proteins (antigens or agglutinogens) on red cells cause incompatibility. –A and B antigens –Rh factor

20. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Types (cont.) The ABO Blood Type Group

21. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-8 Blood typing. Can you tell from these reactions whether these cells are Rh-positive or Rh- negative? Blood Types (cont.)

22. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Types (cont.) ABO Blood Type Compatibility Safest transfusion is with same blood type. Type O blood can be given to any ABO type. Type AB blood can receive any ABO type.

23. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Types (cont.) Rh Factor Red cell antigen group Rh (D antigen) –Rh-positive blood has antigen. –Rh-negative blood lacks antigen. Rh incompatibility can lead to hemolytic disease of newborn (HDN).

24. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-9 Rh incompatibility. Blood Types (cont.)

25. Copyright © 2015 Wolters Kluwer All Rights Reserved Use of Blood and Blood Components (cont.) Blood stored in blood banks up to 35 days –Anticlotting solution added –Expiration date added Blood donated before elective surgery (autologous blood)

26. Copyright © 2015 Wolters Kluwer All Rights Reserved Use of Blood and Blood Components (cont.) Whole-Blood Transfusions Used for loss of large volume of blood Massive hemorrhage from serious injuries During internal bleeding During or after an operation Blood replacement in treatment of HDN

27. Copyright © 2015 Wolters Kluwer All Rights Reserved Use of Blood and Blood Components (cont.) Blood Components Centrifuge separates plasma from formed elements. Hemapheresis—keeps desired elements and returns remainder to donor. Plasmapheresis—keeps plasma and returns formed elements to donor.

28. Copyright © 2015 Wolters Kluwer All Rights Reserved Use of Blood and Blood Components (cont.) Use of Plasma Replace blood volume Treat circulatory failure (shock) Treat plasma protein deficiency Replace clotting factors Provide needed antibodies

29. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Disorders (cont.) Blood abnormalities Anemia (low level of hemoglobin or red cells) Leukemia (increase in white cells) Clotting disorders (abnormal tendency to bleed)

30. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Disorders (cont.) Anemia Excessive loss or destruction of red cells –Hemorrhagic anemia –Hemolytic anemia –Sickle cell anemia Impaired production of red cells or hemoglobin –Nutritional anemia –Pernicious anemia –Thalassemia –Bone marrow suppression

31. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-10 A blood smear in sickle cell anemia. Blood Disorders (cont.)

32. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Disorders (cont.) Leukemia Characterized by enormous increase in white cells –Myelogenous leukemia from bone marrow –Lymphocytic leukemia from lymphoid tissue Bone marrow transplants sometimes successful in restoring blood-producing stem cells lost after leukemia treatment

33. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-11 Leukemia. Blood Disorders (cont.)

34. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Disorders (cont.) Clotting Disorders Abnormal bleeding through disruption of coagulation process –Hemophilia –von Willebrand disease –Thrombocytopenia –Disseminated intravascular coagulation (DIC)

35. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Studies (cont.) Some blood tests are a standard part of a routine physical examination. Machines can perform several tests simultaneously.

36. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Studies (cont.) Hematocrit mL of red cells per 100 mL of whole blood Performed in centrifuge Adult range for men: 42% to 54% Adult range women: 36% to 46%

37. Copyright © 2015 Wolters Kluwer All Rights Reserved Figure 13-12 Hematocrit. Blood Studies (cont.)

38. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Studies (cont.) Hemoglobin Tests g of hemoglobin per 100 mL of whole blood Performed by electrophoresis Adult range for men: 14 to 17 g/dL Adult range for women: 12 to 15 g/dL

39. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Studies (cont.) Blood Cell Counts Red cell counts –Range: 4.5 to 5.5 million cells per microliter (mcL) White cell counts –Range: 5,000 to 10,000 cells per microliter (mcL) Platelet counts –Range: 150,000 to 450,000 per microliter (mcL)

40. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Studies (cont.) Blood Slide (Smear) Complete blood count (CBC) performed on stained blood smear Red cells examined Platelets examined Parasites may be found Differential white count performed

41. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Studies (cont.) Blood Chemistry Tests Electrolytes Blood glucose Nitrogenous waste products (creatine) Enzymes Lipids Plasma proteins Hormones Vitamins Antibodies Drug levels

42. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Studies (cont.) Coagulation Studies Performed before surgery and during treatment of certain diseases –Amounts of clotting factors –Bleeding time –Clotting time –Capillary strength –Platelet function

43. Copyright © 2015 Wolters Kluwer All Rights Reserved Blood Studies (cont.) Bone Marrow Biopsy Sample of red marrow through needle from sternum, sacrum, or iliac crest Used in diagnosing bone marrow disorders –Leukemia –Some types of anemia

44. Copyright © 2015 Wolters Kluwer All Rights Reserved Case Study (cont.) All of the blood’s formed elements are produced in the red bone marrow. Continuous cell replacement is essential to life. Eleanor, losing the protective functions of the blood cells due to her bone marrow damage, exhibited the following symptoms: –Pallor and fatigue due to low red cells and hemoglobin –Hemorrhage due to platelet loss Eleanor acquired: –An infection due to diminished leukocytes –Strain on her heart and an increased heart rate to compensate for low hemoglobin

45. Copyright © 2015 Wolters Kluwer All Rights Reserved Word Anatomy (cont.)

46. Copyright © 2015 Wolters Kluwer All Rights Reserved Word Anatomy (cont.)

47. Copyright © 2015 Wolters Kluwer All Rights Reserved Word Anatomy (cont.)

48. Copyright © 2015 Wolters Kluwer All Rights Reserved Word Anatomy (cont.)