3. It is basically connective tissue in fluid form. It
is called as the fluid of life, as it carries
oxygen from lungs to all parts of the body
and carbondioxide from all parts of the body
to the lungs.
BLOOD
3
4. Color: Scarlet red and Purple red
Volume: In new born-450 ml
Normal healthy male adult-5L
Female-4.5L
3) pH: Slightly alkaline 7.4
4) Specific Gravity: Total blood- 1.052-1.061
Blood cells-1.092-1.101
Plasma-1.022-1.026
5) Viscosity: 5 times more than water
4
7. Plasma is the straw colored liquid component of blood.
It contains 90-92% 0f water and 8-9% of solids.
These solids are the organic and inorganic substances.
The removal of coagulation factors from plasma leaves
a fluid similar to interstitial fluid, known as serum.
PLASMA
7
8. SERUM
Within 45 minutes of clot formation serum oozes out
of the clot
It is different from plasma only by the action of
fibrinogen
Serum = Plasma - Fibrinogen
8
10. FUNCTIONS OF BLOOD
Nutrient supply
Respiratory Function
Excretory Function
Transport Of Hormones And Enzymes
Regulation of Acid-Base Balance
Regulation of body Temperature
Storage Function
Defensive function
10
11. In embryonic stage plasma cells are synthesized by
mesenchymal cells where as in adults they arise from
reticuloendothelial cells of liver and also from spleen,
bone marrow.
Plasma proteins
11
12. •Role in blood coagulation( Fibrinogen).
•Role in Defense Mechanism: γ-globulins act as
antibodies, also called immunoglobulins
•Role in transport mechanism: Albumin,α and β-
globulins are responsible for the transport of hormones
and enzymes
Functions Of Plasma Proteins
12
13. •Role in viscosity of blood: Plasma proteins provide
viscosity which is essential for maintaining BP. Albumin
provides maximum viscosity.
•Role in ESR: globulin and fibrinogen accelerate
rouleaux formation, which in essential for ESR.
•Role as reserve proteins: Act as last source of energy in
case of starving or inadequate food intake
13
14. RED BLOOD CELLS
RBCs also called as erythrocytes are non
nucleated formed elements of the blood.
There red color is due to hemoglobin
Normal Values:
Males: 5 million/cu mm
Females: 4.5 million/cu mm
NORMAL VALUES
14
15. SHAPE AND SIZE
• Normally disk shaped &
bi-concave.
• Central portion thinner
and periphery thicker.
• Size: Diameter = 7.2μ
(6.9-7.5 μ)
Thickness=
• At periphery=2.2 μ
• At center = 1 μ
15
16. Rouleaux formation
When blood is taken
out, RBC pile up one
above another like
pile of coin. This
property of the red
blood cells is called
rouleaux formation.
16
17. Transport of oxygen from lungs to tissues:
Hemoglobin + oxygen = oxyhemoglobin
Transport of carbon dioxide from tissues to lungs:
Hemoglobin + carbon dioxide = carbhemoglobin
In determination of blood groups:
Carries blood group antigens like antigen A,B etc. that
help in determination of blood groups & enables to prevent
reactions due to incompatable blood transfusion
Functions of RBC’s
17
19. Increase In Cell Count
19
PHYSIOLOGICAL VARIATIONS
An increase in the red blood cell count is known as
polycythemia.
1. Age
At birth, the red blood cell count is 8-10 millions/cu mm
of blood. The count decreases within 10 days after birth
due to destruction of cells causing physiological
jaundice in some infants.
20. 2. Sex
Before puberty and after menopause in females the RBC
countis similar to that of males.
3. High altitude
The inhabitants of mountains have an increased red blood
cell count of more than 7 millions/cu mm.
20
21. 21
4. Muscular Exercise
There is a temporary increase in red blood cell
count after exercise.
5. Emotional Conditions
The red blood cell count is increased during the
emotional conditions like anxiety.
22. 6. Increased Environmental Temperature
The rise in the atmospheric temperature causes elevation of
red blood cell count.
7. After Meals
There is a slight increase in the red blood cell count after
taking meals.
22
23. Decrease in cell count
1. High barometric pressures
At high barometric pressures, when the oxygen tension of
blood is higher than the normal, the red blood cell count is
decreased.
2. During sleep
The count of red blood cells is slightly reduced during sleep.
3. Pregnancy
In pregnancy, the red blood cell count is less because of
increase in extracellular fluid volume. 23
25. PRIMARY POLYCYTHEMIA -
POLYCYTHEMIA VERA
Polycythemia Vera is a disease with persistent
increase in red blood cell count above 14 millions/cu
mm of blood.
This is always associated with increased white blood
cell count above 24,000/cu mm of blood.
Polycythemia vera occurs in disorders like
malignancy of red bone marrow.
25
26. SECONDARY POLYCYTHEMIA
This is secondary to some of the pathological
conditions (diseases) such as:
• Respiratory disorders like emphysema.
• Congenital heart disease.
• Chronic carbon monoxide poisoning.
• Poisoning by chemicals like phosphorus and
arsenic.
26
27. Variations In Shape Of RBC
1. CRENATION-shrinkage as in hypertonic solution
2. SPHEROCYTOSIS-Globular form as in hypotonic
solution.
3. ELLIPTOCYTOSIS-Elliptical shape in certain anemia's
4. SICKLE CELL-cresent shape as in sickle cell anemia
5. POIKILOCYTOSIS-unequal shape due to deformed cell
membrane. the shape can be flask, hammer or any
other unusual shape.
27
28. Variations In Structure Of RBC
1. PUNCTATE BASOPHILISM-dots of basophilic
material(porphyrin) appear in the red blood cells
giving a stripped appearance.
This occur in conditions like lead poisoning
2.RING-a ring or twisted strands of basophilic material
appear in the periphery of the RBCs.It is also called as
Cabots ring.
It is present in certain type of anemia.
28
29. 29
3 HOWEL –JOLLY Bodies-in certain anemia's
some nuclear chromatin fragments are present
in RBCs.(in splenectomy pts.)
4- HEINZ-bodies- they are seen in G6PD
deficiency. They represent denatured globin
chains when there is not enough G6PD
around, the bonds between heme and globin
are attacked. Heme is just recycled, but
globin chain become denatured, forming a
little ball that stick to the inside of red cell
membrane.
31. 31
Life span of R.B.Cs
•Average life span of RBCs is about 120 days. They
are destroyed in reticuloendothelial system.
•When cell became older the cell membrane became
fragile.
•Destruction occurs mostly in capillaries of spleen.
•Spleen is called as GRAVEYARD OF R.B.C.s
32. Hemolysis & Fragility of
RBC’s
Hemolysis: destruction of formed elements of
blood/breakdown of RBC’s to liberate hemoglobin
Fragility: it is the susceptibility of RBC’s to hemolysis
32
33. Process of hemolysis
Normally plasma and RBC’s are in equilibrium, but
when this equilibrium is disturbed the cells get effected.
Conditions when haemolysis occurs:
•Hemolytic jaundice
•Antigen-antibody reactions
•Poisoning by chemicals/toxins
33
34. Haemolysins
These are the substances that cause destruction of RBC’s
These can be of 2 types
Chemical substances : alcohol ,benzene, chloroform ,
chemical poisons(nitrobenzene)
Substances of bacterial origin: toxins from bacteria and
venom of poisonous snakes
34
35. Fate of RBC’s
Destruction of RBC’s in spleen
Release of hemoglobin
Globin
Protein pool
Stored & reused
Iron +
Apoferritin
Ferritin
Stored & reused
Porphyrin
Bilirubin
Excreted
35
36. Erythropoiesis
It is the process of origin, maturation and development
of erythrocytes.
Hemopoiesis is the process of origin development and
maturation of all the blood cells.
36
37. Sites of Erythropoiesis
IN FETAL LIFE: erythropoiesis occurs in different sites at
Different periods-
• Mesoblastic stage: during first trimester of
intrauterine life, RBC’s are produced from
mesenchymal cells of the yolk sac.
• Hepatic stage: during second trimester, RBC’s are
produced from the liver. Some cells are also
produced from spleen and lymphoid organs also.
• Myeloid stage: during third trimester, RBC’s are
produced from red bone marrow & liver.
37
38. IN NEW BORN BABIES AND ADULTS:
• Upto the age of 20 years: bone marrow of all
bones
• After the age of 20 years: all membranous
bones and ends of long bones
38
42. Hemoglobin
•Hemoglobin - Structure Content : It is composed of
the protein globin (a polypeptide), and the pigment
heme.
• The hemoglobin has the ability to combine with
oxygen is due to the four iron atoms associated with
each heme group within the molecule.
• A heme group consists of an iron (Fe) ion held in a
heterocyclic ring, known as a porphyrin.
•This porphyrin ring consists of four pyrrole molecules
cyclically linked together (by methine bridges) with the
Iron ion bound in the centre.
42
43. 43
•Hemoglobin (Hb) is a chromoprotein.
•Molecular weight 64,458 Dalton
•Each hemoglobin molecule caries four molecule of
oxygen and each gram of hemoglobin can carry 1.34
ml oxygen.
•About 6.25 grams of hemoglobin is synthesized each
day to replace the hemoglobin lost due to normal
destruction of RBCs
•Synthesis begin from proerythroblast to reticulocyte.
45. Hemoglobin content:
Average Hb content of blood is= 14-16gm/dl.
Varies with age and gender.
At the time of birth, in infants and growing children
the RBC count is more and so is the hemoglobin
content .
In adult males-14-16gm%
In adult females-12-14.5gm%
45
46. Hemoglobin types:
Two types :
Adult (Hb A): the globin contains two alpha
and two beta chains and has less
affinity to oxygen
Fetal (Hb F):there are two alpha and two
gama chains and has more
affinity for oxygen
46
47. 47
METHODS OF ESTIMATION
OF HEMOGLOBIN
Colour based
Based on color of hemoglobin or derivative of hemoglobin
Physical method
Based on specific gravity
Chemical method
Based on iron content of hemoglobin
Gasometric method
Based on oxygen combining capacity of hemoglobin.
Spectrophotometric method
Based on measurement using spectrophotometric devices.
49. 49
SAHLI MEHOD PRINCIPLE
Hemoglobin +0.1 HCL Acid hematin(brown color)
GLOBIN
The resulting color is diluted with water and matched with brown color glass.
56. E S R
ESR is the rate at which the erythrocytes settle down.
When mixed with an anticoagulant and allowed to stand
undisturbed in a vertical tube, the RBC’s settle down
due to gravity With a supernatant layer of clear plasma.
56
57. Two ways of determination
Westergren’s Method:
i. Westgren’s tube is used.
ii. 300 mm long tube, opened on both ends.
iii. Marked from 0-200 mm from above downwards
iv. 1.6 ml of blood is mixed with 0.4 ml of 3.8%
sodium citerate.(4:1)
v. The blood is loaded up to 0 mark above the tube
vi. The reading is taken thereafter.
57
58. Wintrobe’s Method:
i. Wintrobe’s tube is used
ii. It is a short tube, opened at one end
iii. It is 110mm long with 3mm bore
iv. Determines ESR & PCV
v. It shows marking on both sides, from 0-100(ESR)
&100-0(PCV)
vi. 1ml of blood is mixed with ethylene-di-amine-
tetra-acetic acid(EDTA)
vii. Blood is loaded up to 0 mark above
58
59. Normal values of ESR
BY WESTERGREN’S METHOD:
In Males = 3-7 mm in 1 hr.
In Females = 5-9 mm in 1 hr.
Infants = 0-2 mm in 1 hr.
BY WINTROBE’S METHOD:
In Males = 0-9mm in 1 hr.
In Females = 0-15mm in 1 hr.
Infants = 0-5 mm in 1 hr.
59
60. Pathological Variations
Raised in following
conditions:
Tuberculosis
•Anaemia
•Malignant Tumors
•Rheumatoid Arthritis
•Rheumatic Fever
•Liver Diseases
Decreases in
following conditions:
•Allergic Conditions
•Sickle cell anaemia
•Polycythemia
•Leucocytosis
•Hereditary
spherocytosis
60
64. In Males = 40-45%
In Females = 38-42%
Normal Values
64
65. White Blood Cells
• Also known as WBC’s or leucocytes
• Colorless and nucleated formed elements of blood
• Comparatively large in size and lesser in number
• Play a role in defense mechanism of body
65
69. NEUTROPHILS
•Also known as polymorphonuclear
leucocytes because
the nucleus is multilobed
•The number of lobes varies from 1-
6
•With Leishman’s stain, the granules
stain equally
Electr. Micros. view
69
70. •Granules appear violet in color
•Diameter= 10-12μ
•Ameboid and phagocytic in nature
Along with monocytes neutrophils provide Ist line of
defense.
They wander freely through out the body.
70
71. Mechanism of action:
Released in large number from the blood.
Move by diapedesis to the infection site by means of
chemotaxis.
Each neutrophil can hold upto 15-20 micro-organism
at a time.
Start destroying the bacteria by means of
phagocytosis.
71
72. • Coarse large granules that stain
pink with eosin.
• Nucleus is bilobed (spectacle
shaped)
• Diameter=10-14μ
Eosinophils
H&E staining
GEIMSA staining
Elect. Micros. view
Provides defense against parasitic
infections and allergic conditions.
They are responsible for detoxification,
disintegration and removal of foreign
proteins.
72
73. Mechanism of action:
Attack the invading organism by secreting cytotoxic
substances.
These substances are lethal and destroy the parasites
They are eosinophil peroxidase,major basic protein
(MBP), eosinophil derived neurotoxin and interleukin 4
and 5
73
74. • Also have Coarse large
granules
• Stain purple blue with
methylene blue
• Nucleus is bilobed
• Diameter = 8-10μ
Basophils:
Elect. Micros. view
These play an important role in
healing process and acute
hypersensitivity reactions.
74
75. Mechanism of action:
Basophils execute functions by releasing important
substances from their granules such as heparin and
histamines,proteases and myeloperoxidases and
interleukin-4.
75
76. • Largest WBC’s, Diameter = 14-18μ
• Cytoplasm clear without granules
• Nucleus is oval, bean shaped or kidney
shaped
• Nucleus is in the center pushed to one
side
• Large amount of cytoplasm is seen
Monocytes
76
77. These are the largest cells among the WBC’s.
Like neutrophils they are motile and phagocytic in
nature.
They are the precursors of the tissue macrophages.
Matured monocytes stay in blood for few hours.
After which they enter the tissues and become tissue
macrophages.
77
78. These act by secreting substances like interleukin-1,
colony stimulating factor and platlet activating factor.
Mechanism of action:
78
79. Lymphoytes:
• Cytoplasm clear without granules
• Nucleus is oval, bean shaped or
kidney shaped
and occupies whole of the
cytoplasm.
• only a rim of cytoplasm may be
seen
79
80. •Depending upon the size, they are divided into two
types:
•Large lymphocyte: younger cells diameter= 10-12μ
•Small lymphocytes: older cells with a diameter= 7-10μ
•depending upon functions they are further divided
into:
T-lymphocyte- concerned with cellular
B-lymphocytes-concerned with humoral immunity
• These are responsible for development of immunity.
80
81. Physiological Varriations
Age: In infants and children, WBC count is more-
20,000/cumm
In adults it is 4000 to 11000/cumm of blood
Sex: Slightly more in males than in females.
Exercise: Increases slightly
Emotional conditions: Increases slightly
Pregnancy: Increases
81
82. Pathological Variations
Leucocytosis: occurs in following pathological conditions
Infections
Allergy
Common cold
Tuberculosis
Glandular
Leukopenia: occurs in following pathological conditions
Anaphylactic shock
Cirrhosis of liver
Disorders of spleen
Viral infections
Pernicious anaemia 82
83. Leukemia:
Characterized by abnormal and uncontrolled increase.
Increase in WBC’s, above 1000,000/cumm.
Also called blood cancer.
All the WBC’s may not increase at one time.
Leucocytosis occurs because of increase in any one of the
WBC’s
83
86. Properties of WBC’s
Diapedesis: property of WBC’s to squeeze through narrow
blood vessels.
Ameboid movement: neutrophils, monocytes and
lymphocytes show amebic movement characterized by
protrusion of the cytoplasm and change in shape.
Chemotaxis : Attraction of WBC’s towards the injured
tissues by chemical substances released at the site of injury
Phagocytosis : Neutrophils and Monocytes engulf the
foreign bodies by means of phagocytosis.
86
87. Functions of WBC’s
WBC’s generally play an important role in the defense
mechanism of the body.
In the defense mechanism each type of WBC’s act in a
different way
87
88. NATURAL KILLER CELLS
•They have large granular cell with independent
nucleus.
•Considered as third type of lymphocyte.
•Kills invading organism or virus and virus infected
cell, malignant cell
•First line of defense against viruses.
88
89. PLATELETS
.Thrombocytes (platelets) are fragments of
megakaryocytes(red bone marrow)
Cytoplasm is present but do not have a nucleus
Have cell membrane with microtubules below it.
2–3 µm in diameter
Normal range : 150,000 to 400,000 per cmm
Circulation in blood – 8-12 days
89
90. Platelets- functions
•The main function of platelets is the maintenance of
hemostasis.
•Repair of ruptured blood vessels
• Clot retraction
• Procoagulant
• Inflammation
•Role in defense mechanism.
90
91. Thrombopoiesis
Platelets are produced in bone marrow, by budding off
from megakaryocytes.
Megakaryocyte and platelet production is regulated by
thrombopoietin, a hormone usually produced by the liver and
kidneys
Each megakaryocyte produces between 5,000 and 10,000
platelets.
Reserve platelets are stored in the spleen, and are released
when needed by sympathetically induced splenic contraction.
Old platelets are destroyed by phagocytosis in the spleen
and by Kupffer cells in the liver
91
92. MAST CELLS
These are large tissue cell resembling the
basophil.
Present in bone marrow and around cutaneous
blood vessels.
It do not enter blood circulation
They play important role in producing
hypersensitivity reaction like allergy and
anaphylaxis.
It secretes histamin serotonin and hydrolytic
enzymes. 92
93. COMPLETE BLOOD COUNT(CBC)
• The complete blood count, or CBC, lists a number of many
important values. Typically, it includes the following:
• White blood cell count (WBC or leukocyte count)
• WBC differential count
• Red blood cell count (RBC or erythrocyte count)
• Hematocrit(Hct)
• Hemoglobin(Hbg)
• Mean corpuscular volume (MCV)
• Mean corpuscular hemoglobin (MCH)
• Mean corpuscular hemoglobin concentration(MCHC)
• Red cell distribution width (RDW)
• Platelet count
• Mean Platelet Volume (MPV
93
94. 94
•WBC (white blood cell) (TLC)4,300 and 11,000 cells per cubic
millimeter (cmm).
•RBC (red blood cell) ranges between 4.2 to 5.9 million cells per
cmm.
•Hemoglobin (Hbg) 13 to 18 grams per deciliter (one-hundredth of a
liter) for men and 12 to 16 grams per deciliter for women.
•Hematocrit (Hct) 45%-52% for men and 37%-48% for women.
•Mean corpuscular volume (MCV) ranges between 80 to 100
femtoliters (a fraction of one-millionth of a liter).
•Mean corpuscular hemoglobin (MCH) ranges between 27 to 32
picograms (a small fraction of a gram).
•Mean corpuscular hemoglobin concentration (MCHC) ranges
between 32%-36%.
•Red cell distribution width (RDW) ranges between 11 to 15.
•Platelet count ranges between 150,000 to 400,000 per cmm.
•Mean platelet volume (MPV). The normal range is between 6 to 12
femtoliters.
