I. Blood composingI. Blood composing

II. Physical and chemical characteristics of bloodII. Physical and chemical characteristics of blood

III. Blood CellsIII. Blood Cells

1. Hemopoietic process and hemopoietic stem cells1. Hemopoietic process and hemopoietic stem cells

2. Hemopoietic microenvironment2. Hemopoietic microenvironment

3. Erythrocyte Physiology3. Erythrocyte Physiology

4. Leukocyte Physiology4. Leukocyte Physiology

5. Platelet or Thrombocyte Physiology5. Platelet or Thrombocyte Physiology

IV. Physiological HemostasisIV. Physiological Hemostasis

1. Physiological Characteristics of Platelet1. Physiological Characteristics of Platelet

2. Blood Coagulation2. Blood Coagulation

3. Fibrinolysis3. Fibrinolysis

What will we discuss in this chapter?What will we discuss in this chapter?(Outline)(Outline)

V. Blood GroupV. Blood Group

1. RBC Agglutination1. RBC Agglutination

2. ABO blood group system2. ABO blood group system

3. Rh blood group system3. Rh blood group system

4. Relation between blood volume and clinic4. Relation between blood volume and clinic

5. Principle of Transfusion and Cross-match test 5. Principle of Transfusion and Cross-match test

What will we discuss in this chapter?What will we discuss in this chapter?(Outline)(Outline)

I. Blood composingI. Blood composing• Blood composing: plasma +

blood cells• Hematocrit: blood cells occupies the

percentage of total blood volume.

normal value male: 40-50% female: 37-48% newborn: 55%

Blood componentBlood component

Chemical component of Chemical component of plasmaplasma

• Water: > 90%

• Small molecule: 2%, it is electrolytes, nutriment, metabolic

products, hormone, enzyme, etc.

• Protein: 60-80 g/L, plasma protein include albumin (40-50

g/L), globulin (20-30 g/L,α1-, α2, β-, γ- ) and fibrinogen.

• Most of albumin and globulin made from liver.

• A/G and clinic.

• Function of plasma protein:

(1) transportation,

(2) nutrition,

(3) forming colloid osmotic pressure,

(4) coagulation and anticoagulation,

(5) pH value buffer,

(6) immunity (globulin)

Chemical component of Chemical component of plasmaplasma

Chemical component of Chemical component of plasmaplasma

540.414蛋白质

292.32PO4-

1394.44.3K+

<0.0012.42.5Ca++

4117104Cl-

12145142Na+

细胞内液组织液血浆

540.414蛋白质

292.32PO4-

1394.44.3K+

<0.0012.42.5Ca++

4117104Cl-

12145142Na+

细胞内液组织液血浆

(Unit ： mmol/L)

H2O 90 - 91%

Plasma Interstitial fluid Intracellular fluid

Protein

II. Physical and chemical II. Physical and chemical characteristics of blood characteristics of blood

• Specific gravity:

– total blood (1.050-1.060) more influenced by red blood

cells;

– plasma (1.025-1.030) more influenced by plasma protein;

– RBC (1.090-1.092) more influenced by Hb.

II. Physical and chemical II. Physical and chemical characteristics of blood characteristics of blood

• Viscosity:

– Blood relative viscosity (4~5) mainly depends on the

numbers of red blood cells.

– Plasma relative viscosity (1.6~2.4) is mainly involved in

plasma protein

• Plasma osmotic pressure is 300 mmol/L or 770kPa

(1) Crystal osmotic pressure results from NaCl and modulates

water distribution between inside and outside of cells.

(2) Colloid osmotic pressure results from albumin and regulates

water distribution between inside and outside of capillary.

II. Physical and chemical II. Physical and chemical characteristics of blood characteristics of blood

• Plasma pH value is about 7.35~7.45, and

• usually buffer systems are:

– NaHCO3/H2CO3 (20:1), protein salt/protein,

– Na2HPO4/ NaH2PO4,

– Hb salt/Hb, HbO salt/ HbO2,

– K2HPO4/ KH2PO4, etc

– [lungs and kidney mainly regulate Plasma pH value ].

II. Physical and chemical II. Physical and chemical characteristics of blood characteristics of blood

Osmosis and Osmotic PressureOsmosis and Osmotic Pressure

• Osmosis is the movement of water down its concentration gradient.

• Osmosis is determined by the number of impermeable molecules.

• Osmotic pressure is the force drawing water down its concentration gradient.

Osmosis and Osmotic PressureOsmosis and Osmotic Pressure

Water

A B

[Water] > [Water][Salt] < [Salt]

Osmotic Pressure < Osmotic PressureOsmosis is the movement of water from a high concentration to a low concentration. In this illustration, two compartments (A and B) are separated by a semipermeable membrane (broken vertical line). The water concentration in compartment A is greater than the concentration in compartment B because of the presence of salt (X) in B. Therefore, water will move down its concentration gradient from A to B. The force needed to prevent this water movement is called osmotic pressure.

TonicityTonicity

• The tonicity of a solution refers to the effect of the solution

on cell volume.

• A hypertonic extracellular solution is one in which the

water concentration is less outside the cell than inside;

water leaves the cell; cell volume decreases.

• An isotonic extracellular solution is one in which the water

concentration is the same inside and outside the cell;

no water movement; cell volume does not change.

TonicityTonicity

• A hypotonic solution is one in which the water

concentration is greater outside than inside the cell;

water enters the cell; cell volume increases.

• An isosmotic solution may not be an isotonic solution if

the particles are permeable to the cell membrane.

III.Blood CellsIII.Blood Cells

Blood cells are erythrocyte (red blood cell, RBC), leukocyte (white Blood cells are erythrocyte (red blood cell, RBC), leukocyte (white blood cell, WBC) and thrombocyte (platelet, P).blood cell, WBC) and thrombocyte (platelet, P).

3.Erythrocyte Physiology3.Erythrocyte Physiology

Shape and number of red blood cells (RBC)• Shape of RBC: like biconcave disc

Its diameter is about 7~8 µm, peripheral thickness about 2.5 µm, central thickness about 1 µm and cubage about 90 µm3.

Reason for shape of RBCReason for shape of RBC

biconcavebiconcave disc like disc like

Erythrocyte PhysiologyErythrocyte PhysiologyNumber of RBC: It is most numbers in the blood.

Normal value about RBCMale adult, 4.5~5.5×1012/L; average, 5.0×1012/LFemale adult, 3.8~4.6× 1012/L; average, 4.2×1012/LNewborn, ≥ 6.0×1012/L Protein within RBC is hemoglobin (Hb).Hb in male adult, 120~160 g/L;Hb in female adult, 110~150 g/L;Hb in newborn (within 5 days), ≥ 200 g/LPregnant female, numbers of RBC and Hb are relatively less (because of more

plasma).Dweller lived in plateau, numbers of RBC and Hb are relatively more (because of

compensation for anoxia).

Physiological Characteristics Physiological Characteristics and Functions of RBCand Functions of RBC

Characteristics of RBCCharacteristics of RBC

①① Permeability:Permeability: semi permeable membrane, gas and urea freely passing semi permeable membrane, gas and urea freely passing through, negative ions easily in or out of RBC, and positive ions not. through, negative ions easily in or out of RBC, and positive ions not. There are Na-K ATPase as pump on the membrane of RBC and low-There are Na-K ATPase as pump on the membrane of RBC and low-

temperature-stored plasma easily has high kalium. temperature-stored plasma easily has high kalium. Why?Why?②② Plasticity and metamorphose: Plasticity and metamorphose:

Plasticity and metamorphose depend on: 1) surface Plasticity and metamorphose depend on: 1) surface areaarea--cubagecubage ratio, 2) ratio, 2) viscosityviscosity of Hb, 3) membrane of Hb, 3) membrane elasticityelasticity and and viscosityviscosity. .

Characteristics of RBC③ Suspension stability: it cab be described by erythrocyte

sedimentation rate (ESR) which is RBC descending distance per hour and suspension stability is inverse proportion to ESR.

Normal value of ESR: male, 0~15 mm/h; female, 0~20 mm/h. ESR and clinic: some diseases bring about rouleaux formation

(mainly involved in plasma component, e.g. globulin, fibrinogen, cholesterol) and speed up ESR.

Physiological Physiological Characteristics and Characteristics and Functions of RBCFunctions of RBC

Physiological Physiological Characteristics and Characteristics and Functions of RBCFunctions of RBC

Characteristics of RBCCharacteristics of RBC

④④ Osmotic fragility: Changes in RBC put into lower osmotic salty solution.Osmotic fragility: Changes in RBC put into lower osmotic salty solution.

Osmotic fragility of aged RBC is large and easily results in rupture Osmotic fragility of aged RBC is large and easily results in rupture

(hemolysis and ghost cell).(hemolysis and ghost cell).

Isosmotic solution, e.g. 0.85% NaCl, 1.4%NaHCOIsosmotic solution, e.g. 0.85% NaCl, 1.4%NaHCO33, 5% glucose, etc. , 5% glucose, etc.

Isotonic solution, e.g. 0.85% NaCl Isotonic solution, e.g. 0.85% NaCl

Isosmotic solution does not equal to isotonic solution.Isosmotic solution does not equal to isotonic solution.

Isosmotic solution, isotonic solution and clinicIsosmotic solution, isotonic solution and clinic

Physiological Physiological Characteristics and Characteristics and Functions of RBCFunctions of RBC

Functions of RBCFunctions of RBC• RBC can be used for transportation ofRBC can be used for transportation of

OO22 and CO and CO22 in the blood. in the blood.

• RBC can be served as pH buffer. RBC can be served as pH buffer.

EErythropoiesisrythropoiesis

• Hemopoietic material for erythropoiesis: iron (Fe++) and protein, [reason for anemia]

• Influencing factors of RBC maturity: Vitamin B12 and folic acid (DNA metabolism),

[clinic relation]• Process of erythropoiesis: Hemopoietic stem cells→multi systemic hemopoietic progenitor cells→RBC-

committed progenitor cells (BFU-E→CFU-E)→original RBC→ earlier infantile RBC→medium-term infantile RBC→terminal infantile RBC→reticular RBC→mature RBC→blood for circulation.

This process requires 6~7 days. [mitosis several times] [apoptosis]

Place for EPlace for Erythropoiesisrythropoiesis

Main place for EMain place for Erythropoiesisrythropoiesis is bone marrow. is bone marrow. Aother place is liver.Aother place is liver.

Regulation of Regulation of EErythropoiesisrythropoiesis

• 0.8% of total RBCs has self renewal, that is to say, 160×100.8% of total RBCs has self renewal, that is to say, 160×1066 RBC RBC production every minute.production every minute.

• Burst forming unit-erythroid, BUF-E, important to earlier Burst forming unit-erythroid, BUF-E, important to earlier eerythropoiesisrythropoiesis, depends on stimulation of burst promoting , depends on stimulation of burst promoting activity, BPA outside body. BPA made by leucocyte is a activity, BPA outside body. BPA made by leucocyte is a glycoprotein whose molecular weight is about 25000~40000glycoprotein whose molecular weight is about 25000~40000

• Colony forming unit-erythroid, CFU-E, important to terminal Colony forming unit-erythroid, CFU-E, important to terminal eerythropoiesisrythropoiesis, depends on erythropoietin, EPO which is also a , depends on erythropoietin, EPO which is also a glycoprotein, molecular weight, 34000, plasma concentration 10 glycoprotein, molecular weight, 34000, plasma concentration 10 pmol/L, half life 5 hours, increasing release when anoxia. pmol/L, half life 5 hours, increasing release when anoxia.

Regulation of Regulation of EErythropoiesisrythropoiesis

Life and breakage of RBCLife and breakage of RBC

• Life-span: 120 days, about 4 months, each RBC circulates 27 km Life-span: 120 days, about 4 months, each RBC circulates 27 km averagely in vessels, short life-span for aged RBCaveragely in vessels, short life-span for aged RBC

• Breakage: places are liver, spleen and lymphatic node, and after Breakage: places are liver, spleen and lymphatic node, and after breakage, Hb released from RBC immediately combine with breakage, Hb released from RBC immediately combine with plasma plasma αα22-globulin (Hb touched protein) which is taken in by -globulin (Hb touched protein) which is taken in by

liver for iron reuse.liver for iron reuse.• Hb, very toxic if it get into blood, normally, it can be Hb, very toxic if it get into blood, normally, it can be

metabolized into bile pigment in liver. metabolized into bile pigment in liver. • Clinic relation. Clinic relation.

Physiological Changes in Physiological Changes in Numbers Numbers

of Leukocyteof Leukocyte• Newborn: Number is higher, 15×10Newborn: Number is higher, 15×1099/L, after birth 3 or 4 days to 3 /L, after birth 3 or 4 days to 3 months, being about 10×10months, being about 10×1099/L, mainly, neutrophil, 70%; secondarily, /L, mainly, neutrophil, 70%; secondarily, lymphocyte.lymphocyte.

• Circadian changes: Number of WBC is more in the afternoon than in the Circadian changes: Number of WBC is more in the afternoon than in the morning.morning.

• Food taking, ache and mood excitation: Number of WBC is remarkably Food taking, ache and mood excitation: Number of WBC is remarkably higher.higher.

• Heavy exercise and laboring: Increasing numbers, about 35×10Heavy exercise and laboring: Increasing numbers, about 35×1099/L, /L, return to original level after action stop.return to original level after action stop.

• Terminal pregnancy of female: Numbers changes in 12~17×10Terminal pregnancy of female: Numbers changes in 12~17×1099/L, and /L, and during parturition, 34×10during parturition, 34×1099/L, and after parturition 2~5 days, number /L, and after parturition 2~5 days, number return to original level. return to original level.

Normal Value and Function of Normal Value and Function of PlateletPlatelet

• Normal value: 100×109 ~ 300×109, range from 6%~10%• Normal changes: more number in the afternoon than in the morning, more

in winter than in spring, more in the venous blood than capillary, after sport↑, pregnacy↑.

• *Functions: 1. It maintains capillary endothelial cells smooth and integrated (repairing endothelium and providing nutrition). 2. It is involved in physiological hemostasis.• Platelet and clinic relation: decrease of platelet, abnormal immune reaction, will results in hemorrhage

or bleeding, purpuric symptom.

Life- Span and Breakage of Life- Span and Breakage of PlateletPlatelet

• Life-span:Life-span: Averagely, 7~14 days in the blood. Averagely, 7~14 days in the blood. It can be consumed when it displays It can be consumed when it displays physiological functions.physiological functions.

• Breakage:Breakage: Aged platelet can be processed by Aged platelet can be processed by phagocytosis in liver, spleen and lymphatic phagocytosis in liver, spleen and lymphatic node. node.

Physiological HemostasisPhysiological Hemostasis

I Fibrinogen 3000 Liver 4~5 d 4II Prothrombin 100 Liver (with Vit K) 3 d 11III Tissue factor - Endothelial cell - -IV Ca2+ 100 - - -V Proaccelerin 10 Endothelial cell, platelet 12~15 h 1

Ⅶ Proconvertin 0.5 Liver (with Vit K) 4~7 h 13 Ⅷ Antihemophilic factor,AHF 0.1 Liver 8~10 h Ⅹ

Ⅸ Plasma thromboplastic 5 Liver (with Vit K) 24 h Ⅹ component,PTC(Christmas factor)

Ⅹ Stuart-Prower Factor 10 Liver (with Vit K) 2 d 13 Ⅺ Plasma thromoboplastin 5 Liver 2~3 d 4

antecedent,PTA Ⅻ Contact factor or Hageman factor 40 Liver 24 h 5

XIII Fibrin-stabilizing factor 10 Liver, platelet 8 d 6,1 - High-molecular weight 80 Liver - 3 kininogen,HMW-K - Prekallikrein,Pre-K or Fletcher factor 35 Liver - 4

Factor Name Plasma Synthesizing Half life Chromsome

Concentration site site

Blood Clotting FactorBlood Clotting Factor

Body sites to palpate pulse

Fig. 19.11

Principles of Animal PhysiologyCirculatory Systems

•Blood Cell Production (Hemopoiesis)Circulatory Fluids

• Anemia – blood has abnormally low oxygen-carrying capacity– It is a symptom rather than a disease itself– Blood oxygen levels cannot support normal metabolism– Signs/symptoms include:

• fatigue, paleness, shortness of breath, and chills• Types

– Hemorrhagic anemia – result of loss of blood– Hemolytic anemia – prematurely ruptured RBCs– Aplastic anemia – destruction/inhibition of red bone marrow– Iron-deficiency anemia results from lack of iron– Pernicious anemia results from either deficiency of vitamin B12 or lack of intrinsic factor

needed for absorption of B12 Treatment is intramuscular injection of B12

– Thalassemias – absent or faulty globin chain in Hb – Sickle-cell anemia – results from a defective gene & causes RBCs to become sickle-shaped in

low oxygen situations

1) Erythrocytes (continued): Disorders

2) Leukocytes (continued): Granulocytes• Granulocytes – neutrophils, eosinophils, and basophils

– Are larger and usually shorter-lived than RBCs– Have lobed nuclei– ALL are phagocytic cells

• Three typesA. Neutrophils B. EosinophilsC. Basophils

Neutrophils Eosinophils Basophil

• Agranulocytes– Lack visible cytoplasmic granules– Are similar structurally, but are functionally distinct and

unrelated cell types• Two types:

– A. Lymphocytes– B. Monocytes:

2. Leukocytes (continued): Agranulocytes

Lymphocyte Monocyte

Summary of Formed Elements

Table 17.2.1

Summary of Formed Elements

Table 17.2.2

41

Physiological Factors Affecting Red Cell Count

* Age: it is high in newly born infants and low in old Age: it is high in newly born infants and low in old individualsindividuals

* Sex: it s higher in males than in females for two * Sex: it s higher in males than in females for two

reasons:reasons: a. androgens stimulate the production of RBCa. androgens stimulate the production of RBC b. women lose blood via menstrationb. women lose blood via menstration

* High altitude* High altitude