This document provides an overview of basics of haematology. It discusses the properties, functions and components of blood including erythrocytes, leukocytes and platelets. It also describes haemopoiesis, blood grouping systems, blood indices, anaemia, blood coagulation factors, and common blood disorders. Key topics covered include the ABO and Rh blood grouping systems, haemostasis, coagulation testing, and haematopoiesis in the bone marrow and fetal liver.

1. Basics of Haematology
Presented by:
Rayaz Ahmad Bhat
Student:
M.Pharm Pharmacy PracticeM.Pharm Pharmacy Practice
National Institute Of Pharmaceutical Education And
Research,Guwahati, Assam
Mentor Institute: National Institute Of Biologicals , Noida , Delhi
Mentor:
Dr. Akanksha Bisht
Officer Incharge – HvPI & Scientist Grade-III

2. Flow Of Presentation
• Properties and
Functions
• Components
• Blood Indices
Blood: Introduction
• Erythropoiesis
• Leukopoiesis
• Thrombopoiesis
Haematopoiesis
Blood Grouping Systems
Blood Products: Storage , Shelf-life

3. Blood
Blood is a connective tissue in fluid form.
Blood is considered as:
fluid of life
fluid of growth
fluid of health

4. Properties
Color: Blood is red in color.
o Arterial blood is scarle red
o Venous blood is purple red
o Reaction and pH: Blood is slightly alkaline and its pH
in normal conditions is 7.4.
o Specific gravity:
o Specific gravity of total blood : 1.052 to 1.061o Specific gravity of total blood : 1.052 to 1.061
o Specific gravity blood cells : 1.092 to 1.101
o Specific gravity of plasma : 1.022 to 1.026
o Volume:
o Normal adult male: 5 L
o Normal adult female: 4.5 L
o New born baby: 450 ml
o Viscosity: Blood is five times more viscous than water

5. Functions
o Nutritive function
o Respiratory function
o Excretory function
o Transport of enzymes and hormoneso Transport of enzymes and hormones
o Regulation of water balance
o Regulation of Acid-Base balance
o Regulation of body temperature
o Storage function
o Defensive function

6. Composition
Blood consists of two major components:
Plasma: Liquid portion
1. Water
2. Organic substances
3. Inorganic substances3. Inorganic substances
4. Gases
Formed Elements:
1. Red Blood Cells or erythrocytes
2. White Blood Cells or leukocytes
3. Platelets or thrombocytes.

7. Hematocrit

8. Plasma
Plasma is a straw- colored clear liquid part of blood.

9. • Normal values:
• Normal values of the plasma proteins are:
• Total proteins : 7.3 g/dL (6.4 to 8.3 g/dL)
• Serum albumin : 4.7 g/dL
• Serum globulin : 2.3 g/dL
• Fibrinogen : 0.3 g/dL• Fibrinogen : 0.3 g/dL
• Albumin/Globulin ratio:
• Ratio between plasma level of albumin and globulin is
called albumin/globulin (A/G) ratio.
• It is an important indicator of some diseases involving
liver or kidney.
• Normal A/G ratio is 2 : 1

10. Properties of Plasma Proteins
• Molecular weight
• Albumin : 69,000
• Globulin : 1,56,000
• Fibrinogen : 4,00,000
• Thus, the molecular weight of fibrinogen is greater
than that of other two proteins.than that of other two proteins.
• Oncotic pressure
• Normally, it is about 25 mm Hg . Albumin plays a
major role in exerting oncotic pressure.
• Specific gravity: 1.026
• Buffer action: 1/6th total buffering action of blood

11. Function of Plasma Proteins
o Role in coagulation of blood
o Role in defense mechanism of body
o Role in transport mechanism
o Role in maintenance of osmotic pressure in
blood
o Role in regulation of acid-base balanceo Role in regulation of acid-base balance
o Role in viscosity of blood
o Role in erythrocyte sedimentation rate
o Role in suspension stability of red blood
cells
o Role in production of trephone substances
o Role as reserve proteins

12. Red Blood Cells
(Erythrocytes)
Red blood cells (RBCs) are the non-nucleated,
disc shaped, biconcave formed elements in blood.
Normal Value: 4 to 5.5 milliom/mm3 blood.

13. Properties of RBC’s
• Rouleaux formation
• Specific gravity of RBC is 1.092 to 1.101
• Packed Cell Volume
• Suspension Stability

14. Life Span of RBC’s
Average lifespan of RBC is about 120 days. After
the lifetime the senile (old) RBCs are destroyed in
reticuloendothelial system.
Fate of RBC’sFate of RBC’s
When the cells become older (120 days), the cell
membrane becomes more fragile.
The destruction occurs mainly in the capillaries of red
pulp of spleen .So, the spleen is called ‘graveyard of
RBCs’.

15. Fate of RBC’s

16. Function of RBC’s
• Transport of Oxygen from the Lungs to the
tissues
• Transport of Carbon Dioxide from the tissues to• Transport of Carbon Dioxide from the tissues to
the Lungs
• Buffering Action in Blood
• In Blood Group Determination

17. Variations in RBC count
Physiological
• Increase-Polycythemia
• Decrease
• Pathological• Pathological
• Increase
• Primary Polycythemia – Polycythemia Vera
• Secondary Polycythemia
• Decrease
• Anemia

18. Variations in size
• Microcytes
• Microcytes are present in:
• i. Iron-deficiency anaemia
• ii. Prolonged forced breathing
• iii. Increased osmotic pressure in blood.• iii. Increased osmotic pressure in blood.
• Macrocytes
• Macrocytes are present in:
• i. Megaloblastic anaemia
• ii. Decreased osmotic pressure in blood
• Anisocytes
• Anisocytes occurs in pernicious anemia

19. Variation in shape
Shape of RBCs is altered in many conditions
including different types of anemia.
• 1. Crenation• 1. Crenation
• 2. Spherocytosis
• 3. Elliptocytosis
• 4. Sickle cell
• 5. Poikilocytosis

20. Packed Cell Volume
• Normal PCV:
• In males = 40% to 45%
• In females = 38% to 42%
• PCV increases in:
• 1. Polycythemia
• 2. Dehydration• 2. Dehydration
• 3. Dengue shock syndrome: Dengue fever (tropical
disease caused by flavivirus transmitted by mosquito
Aedes aegypti) of grade III or IV severity
• PCV decreases in:
• 1. Anaemia
• 2. Cirrhosis of liver
• 3. Pregnancy
• 4. Haemorrhage due to ectopic pregnancy.

21. Significance of PCV
• Determination of PCV helps in:
• 1. Diagnosis and treatment of anemia
• 2. Diagnosis and treatment of polycythemia• 2. Diagnosis and treatment of polycythemia
• 3. Determination of extent of dehydration and
recovery from dehydration after treatment
• 4. Decision of blood transfusion

22. Blood Indices
• Blood indices are the calculations derived from RBC
count, haemoglobin content of blood and PCV. Blood
indices help in diagnosis of the type of anaemia.
• Blood indices include:
• 1. Mean corpuscular volume (MCV) .Normal MCV is 90
cu μ (78 to 90 cu μ).cu μ (78 to 90 cu μ).
• 2. Mean corpuscular haemoglobin (MCH) . Normal
value of MCH is 30 pg (27 to 32 pg).
• 3. Mean corpuscular haemoglobin concentration
(MCHC) . Normal value of MCHC is 30% (30% to 38%).
• 4. Colour Index : Normal colour index is 1.0 (0.8 to
1.2).

23. Anaemia
• Anaemia is the blood disorder, characterized by the
reduction in:
• 1. Red blood cell (RBC) count
• 2. Haemoglobin content
• 3. Packed cell volume (PVC).3. Packed cell volume (PVC).
• Classification of Anemia
• Anaemia is classified by two methods:
• 1. Morphological classification
• 2. Etiological classification

24. Morphological Classification
• Normocytic Normochromic Anemia
• Macrocytic Normochromic Anemia
• Macrocytic Hypochromic Anemia
• Microcytic Hypochromic Anemia

25. Etiological Classification
• 1. Hemorrhagic anemia
• 2. Hemolytic anemia
• 3. Nutrition deficiency anemia• 3. Nutrition deficiency anemia
• 4. Aplastic anemia
• 5. Anemia of chronic diseases.

26. White Blood Cells
(Leukocytes)
• White blood cells (WBCs) or leukocytes are
the colorless and nucleated formed elements
of blood (leuko is derived from Greek word
leukos = white).
• Compared to RBCs, the WBCs are larger in size
and lesser in number with shorter life span.
• Two Classes:
– Granulocytes
– Agranulocytes

27. Granulocytes

28. Agranulocytes
• T-Lymphocytes• T-Lymphocytes
• B-Lymphocytes

29. Size, Lifespan and Normal Values
Total WBC Count: 4000-11000/mm3 of Blood
Diameter and lifespan of WBCs
Differential WBC count

30. Properties of WBC’s
• Diapedesis
• Ameboid Movement• Ameboid Movement
• Chemotaxis
• Phagocytosis

31. Functions of WBC’s
• NEUTROPHILS
• Neutrophils play an important role in the defense mechanism of the
body
• EOSINOPHILS
• Eosinophils play an important role in the defense mechanism of the
body against the parasites.
• BASOPHILS
• Basophils play an important role in healing processes. So their number
increases during healing process.
• MONOCYTES
• Monocytes are the largest cells among the leukocytes.
• Like neutrophils, monocytes also are motile and
phagocytic in nature. These cells wander freely through all tissues of
the body
• LYMPHOCYTES
• Lymphocytes play an important role in immunity

32. Pathological Variations In WBC’s

33. Platelets
(Thrombocytes)
• Platelets are small colorless, non-nucleated and
moderately refractive bodies of variable shapes.
• Normal platelet count is 2,50,000/cu mm of
blood. It ranges between 2,00,000 and
4,00,000/cu mm of blood.4,00,000/cu mm of blood.

34. Properties and Functions
• Properties of Platelets
• Platelets have three important properties (three ‘A’s):
• 1. Adhesiveness
• 2. Aggregation
• 3. Agglutination• 3. Agglutination
• Functions:
• Role in blood clotting
• Role in clot retraction
• Role in prevention of
• Role in blood loss (hemostasis)
• Role in repair of ruptured blood vessel
• Role in defense mechanism
A. Inactive platelets. B. Activated platelets

35. Platelet Disorders
• Thrombocytopenia
• Thrombocytosis
• Thrombocythemia
• Glanzmann’s thrombasthenia

36. Haemostasis

37. Blood Coagulation
Clotting Factors
13 Clotting factors
Factor I - Fibrinogen
Factor II - Prothrombin
Factor III - Thromboplastin
(Tissue factor)
Factor IV - Calcium
Factor V - Labile factor
(Factor VI - Presence has not
been proved
Factor VII - Stable factorFactor VII - Stable factor
Factor VIII -Antihemophilic
factor
Factor IX - Christmas factor
Factor X -
Stuart-Prower factor
Factor XI- Plasma
thromboplastin antecedent
Factor XII - Hageman factor
(Contact factor)
Factor XIII - Fibrin-stabilizing
factor (Fibrinase).

38. Anticoagulants
Substances which prevent or postpone coagulation of
blood are called anticoagulants.
Anticoagulants are of three types:
1. Anticoagulants used to prevent blood clotting inside1. Anticoagulants used to prevent blood clotting inside
the body, i.e. in vivo.
2. Anticoagulants used to prevent clotting of blood that
is collected from the body, i.e. in vitro.
3. Anticoagulants used to prevent blood clotting both in
vivo and in vitro.

39. Heparin
• Heparin is a naturally produced anticoagulant in the
body.
• Heparin is a conjugated polysaccharide
• Commercial preparation is available in liquid form or dry
form as sodium, calcium, ammonium or lithium salts.
• Heparin is used as an anticoagulant both in vivo and in
vitro.
• Expensive

40. How Heparin Acts

41. • Coumarin Derivatives
• Warfarin and dicoumoral are the derivatives of coumarin
• EDTA
• Ethylenediaminetetraacetic acid (EDTA) is a strong anticoagulant. It is available
in two forms:
• i. Disodium salt (Na2 EDTA).
• ii. Tripotassium salt (K3 EDTA
• OXALATE COMPOUNDS• OXALATE COMPOUNDS
– Oxalate compounds prevent coagulation by forming calcium oxalate, which is
precipitated later.
• CITRATES
– Sodium, ammonium and potassium citrates are used as anticoagulants.
– Citrates are used to store blood in the blood bank as:
– a. Acid citrate dextrose (ACD): 1 part of ACD with 4 parts of blood
– b. Citrate phosphate dextrose (CPD): 1 part of CPD with 4 parts of blood

42. Tests for Blood Clotting
• Bleeding time: 3-6 minutes, Purpura
• Clotting time: 3-8 minutes, Haemophilia
• Prothrombin time: 12-14 seconds• Prothrombin time: 12-14 seconds
• Partial Prothrombin Time: 30 -45 seconds
• International Normalized Ratio: 1-1.5
• Thrombin time: 12-20 seconds

43. Bleeding Disorders
• Bleeding disorders are the conditions
characterized by prolonged bleeding time or
clotting time.
• Bleeding disorders are of three types:
• 1. Hemophilia.
• 2. Purpura.
• 3. von Willebrand disease

44. Haemopoiesis
• After birth and throughout life haemopoiesis
takes place in the bone marrow.
• Fetal haemopoiesis occurs mainly in liver and
spleen in the early stages.
• The haemopoietic stem cell is the pluripotent• The haemopoietic stem cell is the pluripotent
progenitor cell from which the cells of blood and
lymphoid systems are ultimately derived.
• The HSC’s are capable of self-renewal as well
as proliferation and differentiation.
• Their proper function depends on haemopoietic
niche.

45. General Outline

46. Actual Process of Haemopoiesis

47. Blood Grouping
Discovery of blood groups by the Austrian Scientist
Karl Landsteiner, in 1901. He was honoredKarl Landsteiner, in 1901. He was honored
with Nobel Prize in 1930 for this discove
Landsteiner Law

48. Blood Grouping Systems
• At present, 36 blood group systems are listed by the
International Society of Blood Transfusion.
• Among these Systems ABO and Rh systems are
most important in transfusion and transplantation .most important in transfusion and transplantation .
• According to this system, we have

49. ABO Blood Typing

50. Inheritance of ABO Group

51. Blood Matching
• Matching
Recipients RBC’s + Anti-sera
• Cross Matching
Recipients Serum + Donor RBC’s

52. Rh System
• Rh factor is an antigen present in RBC’s
discovered by Landsteiner and Wiener in
Rhesus monkey.
• Many Rh antigens, D more antigenic in humans.
• Among Indian population, 85% of people are Rh
positive and 15% are Rh negative. Percentage
of Rh positive people is more among black
people.

53. Inheritance of Rh Antigen

54. Rh Incompatibility

55. Other Blood Groups
• Lewis group
• MNS group
• Auberger groups
• Diego group• Diego group
• Bombay group
• Duffy group
• Lutheran group

56. Blood Components
Cellular components
• Red cell concentrate
• Leucocytes-reduced red
cells
• Platelet concentrates
Plasma Components
• Fresh frozen plasma
• Single donor plasma
• Cryoprecipitate
• Cryo-poor plasma
• Platelet concentrates
• Leucocytes-reduced
platelet concentrates
• Platelet Apheresis
• Granulocytes, Apheresis
Plasma derivatives
• Albumin 5% & 25%
• Plasma protein fractions
• Factor viii concentrate
• Immunoglobulin
• Fibrinogen
• Other coagulation factors

57. Blood components and Products
• Rule 122-EA, Part X-B, D&C Rules 1945 Item
‘e’
“ BloodComponent” means a drug prepared,
obtained, derived or seperated from a unit of
blood drawn from a donar.blood drawn from a donar.
• Rule 122-EA, Part X-B , D&C Rules,1945, Item
‘f’
“Blood product” means a drug manufactured or
obtained from pooled plasma of blood by
fractionation, drawn from donors.

58. Categories Of Blood Components
• Part XII-B ,Section III, Rule E of D&C Rules,1945
• Concentrated Human Red Blood Corpuscles
• Platelet Concentrates• Platelet Concentrates
• Granulocyte Concentrates
• Fresh Frozen Plasma
• Cryoprecipitate

59. Indications
• Anaemia
• Major surgical operations
• Accidents
• Cancer patients• Cancer patients
• Women's in child birth in some cases
• Patients of hereditary diseases like Haemophilia,
Thalassaemia, Sickle cell disease
• Severe burn victims

60. Legal Framework
• Conditions for Donor-D&C Rules 1945,Part XII-
B, Rule-H
• Anticoagulants- Rule I, 4 (b)• Anticoagulants- Rule I, 4 (b)
CPDA 14ml for 100ml of blood
ACD 15ml for 100 ml of blood
• Additives used: Rule I , item 4b-iii– SAGM,
ADSOL, NUTRICEL

61. Whole Human Blood
• 122-EA, c, D&C Rules 1945
Means Blood + Anticoagulant
Storage Conditions :
Volume Storage Shelf-lifeVolume Storage Shelf-life
45o ml blood + 63 ml
CPD
2-6 oC 42 Days unopened
359 ml blood + 49 ml
CPD
2-6 oC 42 Days unopened
45o ml blood + 63 ml
CPDA-1
2-6 oC 35 Days unopened
359 ml blood + 49 ml
CPDA-1
2-6 oC 35 days unopened

62. • Indications
Red Cell replacement in acute blood loss
Exchange transfusion
Note: Transfusion should be started within
30 minutes after blood is taken out of
storage.

63. Platelet Concentrates
• Storage:
20- 24 o C for 5 days
Indications:Indications:
Bleeding Disorders due to
• Thrombocytopenia
• Platelet function defects

64. • Granulocyte Concentrate
Storage:
20 – 24 o C for 24 hours
Indications:Indications:
• Chronic Granulomatous Disease(Congenital
Neutrophil defects)
• Chemotherapy induced Neutropenia
• Treatment of infection
• Infection prophylaxis
• Aplastic Anaemia
• Neonatal Sepsis

65. Plasma Components
• Fresh Frozen Plasma:
– Plasma frozen within 6 hours of being collected,
containing all coagulations factors.
Storage:
Minus 30 o CMinus 30 o C
Shelf-life : 1 year
Indications:
Multiple coagulation factor deficiencies
Liver diseases
Warfarin overdose

66. Cryoprecipitate
• Concentrate of plasma rich in anti-
haemophilliac factor and fibrinogen ,
prepared by thawing of FFP.
• Storage: Minus 30 o C• Storage: Minus 30 o C
• Shelf-life: 1 year
• Indications:
– Inherited deficiency of factor Viii
– Haemophilia

67. Mandatory screening tests for donated
blood
• ELISA for HIV I & II
• Test for Hepatitis B surface antigen
• ELISA for Hepatitis C Antibody
• Test for Malarial parasite
• VDRL/RPR for Syphills

68. References
K Sembulinga, Prema Sembulingam;Essentials
of Medical Physiology; Section 2;Body
Fluids;Page:51-139
The Drugs and Cosmetics Rules,1945 as
amended by The Drugs and Cosmetics ( Second
The Drugs and Cosmetics Rules,1945 as
amended by The Drugs and Cosmetics ( Second
Amendment)Rules,2016 (23 0f 1940)
UpToDate.com: Granulocyte transfusions
Intenational Society of Blood Transfusions web
Hemogenomics blog: Hemogenomics.com