BY D.M.G.I.P DEHIGAMA FOR PHARMACIST EXTERNAL STUDENTS IN SRI LANKA

1. BLOOD
BLOOD

2. BLOOD
• The transport medium of the circulatory
system
• Connective tissue

3. Composition of blood
Total circulating blood volume = 8% of body weight
Total circulating plasma volume = 5% of body weight

4. Composition of plasma
• Water – 90%
• Plasma proteins – 8%
albumin (most abundant)
globulin (α, β, γ)
fibrinogen
• Inorganic ions – Na+, K+, HCO3
-,Cl-,Ca2+,Mg2+
• Other substances- organic substances, waste
products ,hormones ,gases

5. Origin of plasma proteins
• Except γ globulin fraction of plasma protein
most of other plasma proteins are synthesized
in LIVER
• γ globulin is synthesized by plasma cells

6. Functions of plasma proteins
• Maintain the oncotic pressure that pulls water
in to the blood
• Responsible for buffering capacity of blood
• Some have specific functions – antibodies,
clotting factors
• Act as transporters – hormones like thyroid
• Albumin also act as carrier for metal, ions,
fatty acids, amino acids, bilirubin, enzymes
and drugs

7. What is serum
• Plasma without
blood clotting proteins, fibrinogen
• If blood is allowed to clot and clot is removed
the remaining fluid is called SERUM
• Serum has higher serotonin content due to
break down of platelets during clotting

8. Haemopoiesis
formation of blood cells
• Erythropoiesis- formation of red blood cells
• Myelopoiesis – formation of granulocytes and
monocytes
• Thrombopoiesis – formation of platelets
• Lymphopoiesis – formation of lymphocytes

9. • During fetal life blood cells are formed in liver
and spleen
• After that bone marrow take over the blood
cell formation-medullary haemopoiesis
• In children, blood cells produce in marrow
cavities of all bones
• But after 20 years of age marrow cavities of
long bones except for humerus and femur
become inactive

10. • Extramedullary haemopoiesis
when the bone marrow becomes
destroyed or fibrosed ,liver and spleen can
resume their fetal haemopoietic role again
• Red marrow – active cellular marrow
• Yellow marrow – inactive marrow which is
infiltrated with fat

11. Committed stem cells
Haemopoietic stem cell (capable of producing any type of cells)
Erythroid
progenitors
Red cells
erythropoietin megakaryocytes
platelets
thrombopoietin
basophils
eosinophils
Neutrophils
monocytes

12. Lymphopoiesis
Haemopoietic stem cell (capable of producing any type of cells)
Lymphoid progenitor cells
T lymphocytes B lymphocytes
Most of lymphocytes formed in Lymph node ,thymus and spleen from progenitor
cells that originally came from the bone marrow

13. • During the process of haemopoiesis action of
various growth factors play a key role
stem cell factor
colony stimulating factor
• Erythropoietin – for erythropoiesis
• Thrombopoietin – for thrombopoiesis

14. Red blood cells
• Biconcave disc -------- increase surface area:
volume
• No nucleus
• Life span -120 days
• 4.5-5.6 ×10 12/L in males
3.9-4.9 × 10 12/ L in females
• Contains haemoglobin

15. Functions of RBC
• Transport of O2 and CO2
• Buffering action
• Contain carbonic anhydrase enzyme
• Binding of oxygen to Hb – oxyhaemoglobin
• Binding of CO to Hb - carboxyhaemoglobin

16. Erythropoietin
Hypoxia , Haemorrhages , low Hb , poor blood flow , lung diseases
Reduce oxygen for tissues
Kidney ( 85%) Liver
erythropoietin
Bone marrow
erythrocytes

17. Requirements for normal
erythropoiesis
• Erythropoietin
• Iron – for haemoglobin synthesis
• Vitamin B12 and folic acid for DNA synthesis
• Other vitamins – B6, A, C and riboflavin
• Trace metals – zinc, copper and cobalt
• Hormones – androgens and thyroxine

18. Haemoglobin
• O2 carrying pigment
• Has 4 sub units
• Haem moiety + polypeptide chain
• Two types of polypeptide chains – α, β
2 α + 2β ----------- HbA
2 α + 2 γ ----------- HbF
2 α + 2 δ -----------HbA2

19. Red cell destruction

20. Jaundice
• When total plasma bilirubin level is greater
than 2mg/dl
ANAEMIA
Reduction in concentration of haemoglobin
below the accepted normal range
(sex, age, ethnic group, altitude )

21. Causes for anaemia
• Increase loss due to haemorrhage
• Increase destruction – haemolytic anaemia
• Decrease production – nutritional deficiency
reduce bone marrow
erythroid cells ,renal disease

22. White blood cells

23. • WBC – 4000 – 11 000/ micro liter
• Neutrophils – 50-70%
• Eosinophils – 1-4%
• Basophils – 0.4%
• Lymphocytes – 20-40 %
• Monocytes – 2-8%
Acting together these cells provide powerful
defenses against tumor cells, viral, bacterial and
parasite infections

24. Cell type features Important points
neutrophil Lobulated nucleus (2-5)
Very fine granules in the cytoplasm
Increase in Bacterial
infection
Eosinophil Bi-lobed nucleus
Pinkish granules in the cytoplasm
Increase in Allergic reaction
And Parasite infection
Basophil Large basophilic purplish colour
granules
Nuclear lobulation is not clear
because of the granules
Contain heparine and
histamine
So important in
hypersensitivity reactions
monocytes Largest WBC type
Kidney shape nucleus
Become macrophages and
activated macrophages
engulf and kill bacteria by
process similar those
occurring in neutrophil
lymphocytes Nucleus is round in shape
Thin rim of cytoplasm
Immunity
Increase in viral infection

26. Immunity
• Ability to resist almost all type of organisms or
toxins that tend to damage tissues and organs
immunity
Innate immunity
Acquired immunity
Humoral (B cell ) immunity
Cell mediated (T cell )
immunity

27. Innate immunity includes
• Phagocytosis by WBCs and cells of the tissue
macrophage system
• Destruction of swallowed organisms by acids
and digestive enzymes in GIT
• Resistance of skin
• Certain chemical compounds in blood-
complement complexes ,natural killer
lymphocytes etc.
• Sneezing and coughing reflexes

28. Platelets
• Small granulated bodies
• No nuclei
• Life span is 7-10 days
• 60-75% are in the circulation , remainder is in
the spleen
• 150-400 × 10 9/L

29. • Thrombocytopenia – decrease in the platelet
count
• Thrombocytosis – increase in the platelets
count
• Thrombasthenia – abnormal platelet function

30. Average half life of blood cells
• RBC – 120 days
• Neutrophils – 6hr
• Monocytes – circulate in blood for 72 hours
and then enter in to tissues and become
macrophages
• Platelets – 7-10 days

31. Haemostasis
• When there is damage to a blood vessel wall blood
clotting (coagulation )occurs to prevent bleeding
• Coagulation involves a series of events which results in
the formation of a fibrin mesh (blood clot)which traps
RBC and platelets
• In healthy people there is a balance between
coagulation and fibrinolysis (dissolution of clot)
• When the balance is disturbed either by poor clot
formation or by excessive fibrinolysis ,haemorrhage is
likely to occur

32. Haemostasis
• Balance between procoagulant and anticoagulants
Injury to blood vessel
Bleeding
Formation of clot
Stop bleeding
procoagulants
Anticoagulants
Break down of the clot once the
damage is repaired
Prevent intravascular coagulation
or thrombus formation

33. Vessel injury
Vasoconstriction
(vascular response )
Exposure of collagen Tissue thromboplastin
Platelets response
Formation of
temporary platelet
plug
Clotting response
Formation of definitive
clot
Clotting response is an enzymatic process involving several clotting factors in plasma

34. Clotting response
• Formation of activated factor X by intrinsic or
extrinsic pathway .This is the rate limiting step
• Conversion of prothrombin (II) to thrombin
• Conversion of fibrinogen(l) to fibrin
(fundamental reaction in the clotting of
blood)

36. What are Blood groups ?
• Nobel Laureate Karl Landsteiner discovered
the blood groups in 1901
• Though there are > 500 billion known blood
group phenotypes the ABO and Rh blood
group systems are the most important

37. • Blood groups are determined by the presence
or absence of antigens and antibodies
(agglutinin )
• The antigens are found on the surface of the
RBC where as the antibodies are in plasma
• There are 4 blood groups in the ABO system
depending on the presence or absence of the
A and B antigen
• Two antibodies are Anti A and Anti B
• Early in the life person develop antibodies for
the antigen that are not present in a person’s
RBC

39. Rh blood group
• Rh system has 3 main antigens – C,D,E
• D antigen is the most antigenic component
• If D antigen is present --------person is Rh +
• If D antigen is absent ---------person is Rh –
• Unlike the ABO system, Anti D antibodies do
not form unless a Rh negative person is
exposed to D antigen

40. Inheritance of blood group antigens
• ABO SYSTEM
the A and B antigens are inherited in a
Mendelian co-dominant manner
A person inherits one blood group antigen
from each parents
• A person could be either homozygous or
heterozygous for ABO genotype
ex: homozygous – AA
heterozygous – A0

41. Functions of blood
• Transport of soluble organic compounds
• Transport of soluble excretory materials to organs of
excretion
• Transport of hormones from the glands to target
organs
• Transport of gases
• Clotting mechanism – prevent excessive blood loss
• Maintain optimal pH value
• Defense against tumors, viruses, bacteria and parasites

42. Normal values for peripheral blood
male female
Hb ( g/dl ) 13.5-16.5 11.8-14.8
PCV% 40-47 36-44
Red cell count (1012/L) 4.5-5.6 3.9-4.9
Reticulocytes % 0.2-2 0.2-2

43. Thank you