the presentation is about blood, its contents. useful for F.Y B pharm students.

1. The Blood Cell,
Immunity
&
Blood Coagulation
Prepared by: Sayyed Nilofer

2. IntroductionIntroduction
• Blood is liquid connective tissue.
• Contains extracellular matrix, called blood plasma and various suspended
cells and dissolved substances.
• Contains 7% body weight.
• Blood helps to communicate between body cells and external environment.
• The volume and concentration of most of the constituents of blood is
maintained by appropriate control systems and homeostasis is maintained.

3. Functions of Blood
A) Transportation:
•Carries oxygen from lungs to tissues; carbon dioxide.
•Carries nutrients from GIT to body cells.
•Carries hormones from endocrine glands
•Transport heat from most active to less active tissue
•Transport of waste products to kidney
•Transport of antibodies to site of infection.

4. B) Regulation:
•The blood is always in motion, and thus helps to maintain the homeostasis of body
fluids.
•Regulate the pH of body fluids.
•Adjust the body temperature.
•Maintain the correct water content of the cells.
C) Protection:
•In case on injury the blood coagulates and prevents blood loss.’
•WBC protect against diseases by phagocytosis.

5. Composition of BloodComposition of Blood
• More dense and viscous than water.
• Slightly sticky in nature.
• Temperature of blood is 30 .℃
• Alkaline pH ranging from 7.45 – 7.55
• 5-6 litres in average male and
• 4-5 litres in average female.
• Two components:
 Blood plasma
 Blood cells

6. Blood PlasmaBlood Plasma
• Plasma is straw coloured transparent fluid.
• Constitutes about 55% of blood volume.
• 91.5% water and 8.5% solute i.e. dissolved substance
1. Plasma proteins
2. Inorganic salts or mineral salts.
3. Nutrient materials
4. Organic waste products
5. Hormones
6. Antibodies
7. Gases

7. Plasma ProteinsPlasma Proteins
• Hepatocytes synthesize plasma proteins except gamma globulin.
• The main plasma proteins are:
i. Albumin (54%)
ii. Globulin (38%)
iii. Fibrinogen (7%)
iv. Others (regulatory enzymes, proenzymes and hormones)

8. i] ALBUMIN:
•Globular protein.
•Encoded by ALB gene.
•It is unglycosylated protein with mol. Wt. 65000 Daltons.
•Present in blood as negatively charged.
Functions:
1.Plays important role in maintenance of osmotic pressure of blood. (25mm Hg)
2.Act as carrier protein for steroids, fatty acids and thyroid hormones.
3.Stabilize extracellular fluid volume.

9. ii] GLOBULIN:
•Globular protein.
•Higher molecular weight and solubility than albumin
•Produced in liver and immune system.
•Four types: a) Alpha 1 globulin b) Alpha 2 globulin (92 kDa)
c) beta globulin d) gamma globulin (120 kDa)
Functions:
1.Alpha and beta globulin help in transfer of substances i.e. act as transporter.
2.Act as substrate for enzyme in some metabolic reaction.
3.Gamma globulin are immunoglobulin and play role in immunity.

10. iii] FIBRINOGEN:
•Soluble, glycoprotein with molecular weight of 340 kDa.
•Synthesized in liver by hepatocytes.
•It plays important role in coagulation of blood.

11. 2. Inorganic salts or minerals:
•Salts like sodium chloride, sodium bicarbonate, potassium, magnesium, iron,
phosphorus, iron, calcium, iodine, etc.
•These salts maintain the pH of blood (7.35-7.45)
•Involved in contraction of muscles.
3. Nutrient materials:
•Glucose, amino acids, fatty acids, glycerol and vitamins.
•Provide energy, heat and components for repair and replacement of tissues.
4. Organic waste products:
•Urea, uric acid, creatinine are formed in liver.
•Blood carries them to kidney for excretion.
•Carbon dioxide present in plasma is transported to lungs for excretion.

12. 5. Hormones:
•Synthesized by endocrine glands.
•Blood transports hormones to target organ.
•E.g. growth hormone, insulin, etc.
6. Antibodies:
•These are protective substances produced by blood cells in response to foreign
substance or antigen.
7. Gases:
•Oxygen, carbon dioxide and nitrogen are the important gases that are transported all
over the body.

13. Erythrocytes or RBCs
• RBCs are biconcave discs.
• Plasma membrane of RBCs is strong and flexible.
• Their flexibility allows them to squeeze through narrow capillaries without
rupturing.
• Plasma membrane consist of glycolipids i.e. antigen.
• The presence or absence of antigen is responsible for blood groups.
• Nucleus absent.
• Cytoplasm contains hemoglobin molecule.
• Each RBC contains 280 million Hb molecules.

14. Life span and functions of RBCsLife span and functions of RBCs
• Erythrocytes are produced in red bone marrow, which is present in the end of
long bones and in flat and irregular bones.
• Life span in circulation is 120 days.
• The process of development of RBC from pluripotent stem cells takes about 7
days and is called erythropoiesis.
• The stem cells in red bone marrow called hemocytoblast give rise to all elements
of blood.
• Hemocytoblast RBCs (2 million/ sec)
• Vitamin B12 and folic acid are required for RBC synthesis.
2 days

15. • The bone marrow produce erythrocyte at the rate at which they are destroyed.
• The stimulus to increase erythropoiesis is hypoxia i.e. deficient supply of oxygen.
• This is when:
1. Oxygen carrying power of blood is reduced e.g. hemorrhage.
2. Oxygen tension in air is reduced.
 Hemolysis:
• Breakdown of RBC is called hemolysis.
• Carried out by phagocytic reticuloendothelial cells.
• Main site is spleen, bone marrow and liver.
• Iron released is retained in the body and reused by bone marrow to form new Hb
molecule.

16. Hemolysis

17. Types of WBC

18. II] Agranular leucocytes:
1.Lymphocytes:
•Large, round or slightly indented and stain darkly.
•Diameter: S- 6-9μm L- 10-14μm
•Two types: a) T-lymphocytes b) B-lymphocytes
•Normal range: 20-50%
•Function: provide specific protection.
activate activate
Thymosin in thymus glandThymosin in thymus gland Bone marrow & lymphoid tissueBone marrow & lymphoid tissue

19. 2. Monocyte:
•Large mononuclear cells.
•Size: 12-20 μm
•Nucleus: kidney shaped or horse shoe.
•Cytoplasm: blue-gray
•Normal number: 2-10%
•No. increases in conditions of viral infections or fungal infections.
•Count decreases in bone marrow depression.
•Function:
-Protection in the body by phagocytosis
-T and B cells produce interleukin. (endogenous pyrogen)
-Estimation of WBC by hemocytometer.

21. • The human being have the innate ability to prevent the entry and establishment of
microorganism in the body by several mechanism.
• These mechanism provide immediate protection against wide variety of
pathogens.
• Non specific mechanism do not produce specific response to specific invader.
i) First line defense: Skin and mucus membrane
ii) Second line defense: antimicrobial protein, natural killer cells, phagocytosis,
fever, inflammation.

22. ii) Second line defense:
1.Antimicrobial proteins:
Present in blood and interstitial fluid
Interferons: produced from lymphocyte, macrophages and fibroblast infected with
virus.
Neighboring cells.
Synthesis of antiviral protein
Protection from viral infection
Complement system: Inactive protein present in blood plasma and plasma membrane
of cells.
Cytolysis and promote phagocytosis.
Diffuse

23. 2. Natural Killer Cell:
5-10% lymphocytes are NK.
Location: Spleen. Lymph nodes and bone marrow.
Kill infected and tumor cells.
Attack any body cells that display abnormal plasma membrane.
3. Inflammation:
Redness, heat, swelling and pain.
Response occurs in 3 stages;
i.Vasodilation and increase permeability of blood vessels
ii.Emigration of phagocytes
iii.Tissue repair.

24. Specific Defense System
• The ability of body to fight against the specific invader such as bacteria, toxin,
viruses and foreign substances.
• Any substance recognized by the body as foreign substance and initiate
immunity response is called as antigen.
• Antigen has ability to provoke immunity response called immunogenicity.
• Types of immune responses:
1. Cell mediated immune response
2. Antibody mediated immune response

26. ALLERGYALLERGY
 A number of conditions caused by hypersensitivity of the immune system to
something in the environment that usually causes little or no problem in most
people.
 Four types:
1. Type I (Anaphylactic)
2. Type II (Cytotoxic)
3. Type III (Immune complex)
4. Type IV (Cell mediated)

32. Thrombocytes/ Platelets
• Disc-shaped
• Diameter 2-5μm
• Non-nucleated but contain many vesicles
• Normal count: 1,50,000 to 4,00,000/μl of blood.
• Produced in bone marrow from hemocytoblast.
• Life span: 8-11 days
• Production is influenced by hormone thrombopoietin.
• Granules promote blood clotting.

34. Blood GroupsBlood Groups

35. Rh blood groupRh blood group
• The antigen for this blood type was first discovered in the blood of rhesus
monkey.

36. Blood TransfusionBlood Transfusion
• Transfusion is the transfer of whole blood or component into the blood stream or
bone marrow.
• To improve immunity, increase blood volume and to alleviate anemia.
• If blood groups are not compatible to blood leads to clumping of the RBCs.

37. Tissue & Organ TransplantationTissue & Organ Transplantation
• The injured or diseased organ such as heart, liver, kidney, lungs, pancreas are
replaced with an organ donated by another individual.
• The immune system of recipient recognizes the proteins present on the
transplanted organ as foreign and initiate cell mediated and antibody mediated
response against the transplanted organ.
• This reaction is known as Graft Rejection.

38. • The tissue compatibility b/w donor and recipient decreases the probability of
transplant rejection, which depends on histocompatibility antigens present on
transplanted organ.
• Before transplantation Tissue Typing Test is done.
• Technique:
 Mixed leucocyte reaction.
 Micro-cytotoxicity assay
• To reduce risk of graft rejection immunosuppressant drugs are given.
E.g.: cyclosporin.
• These drug will inhibit only T cells but B cells are not inhibited.

40. • HLA- Human Leukocyte Antigen
• MHC- Major Histocompatibility Complex
 HISTOCOMPATIBILITY: Quality of tissues being compatible.
 This term is used in transplant to describe the ability of a donor tissue or organ to be
accepted by the recipient.
• MHC is group of gene in animals.
• In human MHC is called HLA. These are protein present on the surface of WBC
and other tissue.
• The best donor is one whose HLA matches very closely to the patient.
• HLA markers are inherited from parents.

42. ClassificationClassification
• Disorder in which hemoglobin count in blood decreases more than normal.
Anemia
Impaired erythrocyte productionImpaired erythrocyte production Increased erythrocyte lossIncreased erythrocyte loss
Iron deficiency
Megaloblastic anemia
Hypoplastic anemia
Hemolytic anemia
Normocytic anemia

43. I] Iron deficiency anemia
•Normal daily requirement of iron in men is 1-2mg, and women 3mg.
•The anemia is regarded as severe when Hb level is below 9g/dl blood.
•In this type RBCs are microcytic and hypochromic because of low Hb.
Normal requirement, deficient intake:
•Deficiency increases if the daily diet is restricted
Poorly planned vegetarian diets
Weight reducing diets
Babies dependent on milk.
High requirement:
•Occurs during pregnancy, when iron requirement are increased for fetal growth and to
support additional load on mothers cardiovascular system.
•Chronic blood loss i.e. peptic ulcers, heavy menstrual bleeding, hemorrhoids.

44.  Malabsorption:
• Iron absorption is increased during hemorrhage.
• Abnormalities of stomach, duodenum or jejunum.
• Iron absorption is dependent on acid environment of stomach, increase in gastric pH
may reduce it.
• Loss of surface area for absorption. E.g.: after surgical removal.

45. II] Megaloblastic anemia
•Maturation of RBCs is impaired when deficiency of vitamin B12 or folic acid occurs.
•Abnormal large erythrocytes are found in blood (megaloblast).
•During normal erythropoiesis several cell division occur and daughter cells are smaller than
parent cell at each stage since there is not much time for cell enlargement.
•But deficiency of Vitamin B12 or folic acid rate of DNA & RNA production is reduced,
delaying cell division.
•The cells grow larger than normal b/w cell division.
•Circulating cells are immature, some are nucleated, large.
•Hb content is normal or raised.
•Cells are fragile.
•Life span reduced to 40 – 50 days.
•Depressed production and early lysis cause anemia.

46.  Vitamin B12 deficiency anemia:
1. Pernicious Anemia:
• Occurs often in female than males, usually b/w 45-65 years of age.
• Autoimmune disease in which antibodies destroy intrinsic factor and parietal cells in
stomach.
2. Dietary deficiency of B12:
• Rare, except in true vegans, i.e. when no animal products are included in diet.
 Gastrectomy – leaves few cells available to produce IF after partial resection of
stomach.
 Chronic gastritis – these damage the gastric mucosa including parietal cells.
 Malabsorption – if terminal ileum is removed or inflamed (Crohn’s disease)

47. 3. Folic Acid Deficiency Anemia:
•Deficiency in bone marrow causes megaloblastic anemia identical to that seen in B12
deficiency but not associated with neurological damage.
•It occur due to;
Dietary deficiency, e.g. in infants delay in establishing a mixed diet, in alcoholism, in
pregnancy when requirement is raised.
Malabsorption from jejunum, e.g. coeliac disease, anticonvulsant drugs.
Interference with folate metabolism e.g. cytotoxic and anticonvulsant drugs.

48. III] Hypoplastic Anemia & Aplastic Anemia
•Bone marrow function is reduced in hypoplastic anemia and absent in aplastic anemia.
•Causes leucopenia, diminished RBC number and thrombocytopenia.
•When all 3 cell types are low the condition called pancytopenia and accompanied by
anemia with less immunity and tendency to bleed.
•Causes include:
Drugs: e.g. cytotoxic drugs, anti-inflammatory drugs, anticonvulsant drugs, some
antibiotics.
Ionising radiation
Some chemicals, e.g.: benzene and its derivatives.
Viral disease, hepatitis.
Invasion of bone marrow.

49. B] Increased erythrocyte loss
I] Hemolytic anemia
•Occur when red cells are destroyed while in circulation or the cells are removed prematurely
because cells are abnormal.
1. Congenital hemolytic anemia:
•Genetic abnormality leads to the synthesis of abnormal Hb and increased red cell membrane
friability, reducing their oxygen-carrying capacity and life span.
a) Sickle cell anemia:
•Abnormal hemoglobin molecule become misshapen when deoxygenated, making RBC sickle
shaped.
•High proportion of abnormal molecules, sickling is permanent.
•Lifespan of cells is reduced.
•Sickle cells do not move smoothly through the small blood vessels.
•This increases the viscosity of blood, reducing the rate of blood flow leading to intravascular
clotting.

50.  Complication:
• Pregnancy, infection and dehydration predispose development of “Sickle crises”
due to intravascular clotting causing severe pain in long bones. Chest or abdomen.
• Formation of gall stone and inflammation of gall bladder.
b) Thalassemia
• Severe cases death in infants or young children.
• Common in Mediterranean countries.
Reduced globin synthesis
Reduced Hb
Increased friability of cell membrane
Early hemolysis

51. c) Hemolytic disease of new born

52. II] Normocytic Anemia
•The cells are normal but the number is reduced, and the proportion of reticulocyte in
the blood may be increased as the body tries to restore erythrocyte number to normal.
•This occurs:
Chronic inflammation
Following severe hemorrhage
Hemolytic disease.

54. POLYCYTHEMIAPOLYCYTHEMIA

55. • Definition: Abnormal large number of erythrocytes in blood.
- This increases blood viscosity.
- Slows the rate of blood flow
- Increases intravascular clotting, ischemia and infraction.
• This occurs when the RBC count is normal but the blood volume is reduced by fluid
loss, e.g. excessive serum exudate from excessive burns.
• Prolong hypoxia stimulated erythropoiesis.
• Cigarette smoking
• Pulmonary disease
• Bone marrow cancer.