This document provides an overview of blood and its components. It discusses the composition and functions of blood, the cellular components including red blood cells, white blood cells and platelets. It describes complete blood count tests and normal ranges. Conditions that cause increases or decreases in various blood cell counts are outlined. The document emphasizes the importance of understanding blood and hemostasis as an oral surgeon dealing with medically compromised patients.

1. BLOOD
PRESENTED BY
PAREEKSIT BAGCHI
I MDS
DEPT OF ORAL AND MAXILLOFACIAL SURGERY

2. CONTENTS
• Introduction
• Composition
• Functions of blood
• Individual components
• Complete blood count
• Blood products
• Hemostasis
• Hemostatic agents
• Conclusion
• Reference

3. Introduction
• As oral and maxillofacial surgeons, we are faced with
medically compromised patients with systemic diseases,
which alter hemostasis, and those who are
therapeutically taking coagulation-altering therapy on a
daily basis.
• Careful management of the patient with risk for altered
hemostasis or taking anticoagulant drugs in the
perioperative period is essential in treating our surgical
patients.

4. • The patient with a congenital or therapeutic
coagulopathy requires a surgeon who is “familiar
with both departments of medicine.” The surgeon
must employ both his or her medical knowledge
and surgical skill to achieve a balance between
thromboembolism and perioperative bleeding.

5. BLOOD COMPOSITION
• Blood is the main circulating fluid in the
human body.
• Study of blood is called HAEMATOLOGY.
• It is a fluid connective tissue derived from
mesoderm.
• Bright red in colour, slightly alkaline(pH 7.4),
salty, and heavier than water.
• The adult has 5lit of blood which constitute
about 8% of the total body weight.

6. Blood is divided into two constituents
1.cellular composition
2.non-cellular composition

8. Functions of blood
• TRANSPORTATION :
Respiration
Nutrient carrier from
• GIT
Transportation of hormones from
endocrine glands
Transportation of metabolic waste.
REGULATION :
Regulates pH
Adjusts and maintain
body temperature
Maintains water
contents of cells
PROTECTION :
WBCs protects against disease
by phagocytosis
Reservoir for substances like
water,electrolytes.
Performs haemostasis.

10. • Erythrocytes are also called
as red blood corpuscles.
• They are circular , biconcave ,
enucleated cells.
• Its size 7 micron metre in
diameter to 2.5 micron
metre in thickness.
• There are about 5.1 to 5.8
million RBCs per cu.mm in
adult male and in adult female
it is about 4.3 to 5.2 million.
• Average life span is of 120 days.
ERYTHROCYTERBCs:

11. Hemoglobin
Hb is the iron containing coloring matter of
RBC
If the count is low –
chronic inflammation(inflammation is a
body process that can result in pain swelling
warmth or redness)
Low hematocrit and hemoglobin counts may
be signs that your medication is causing a
loss of blood from your stomach and
passing through your bowel.
Low counts also may indicate a decrease in
red blood cell production.
Bone marrow problem

12. If the count is more –
blood volumeincrease
in case of smoking
high altitude
Normal Count : 14 – 16 g/dL
but it can vary from age to age
At birth : 25g/dL
After 3rd month : 20g/dL
After 1 year : 17g/dL
from puberty onwards : 14 – 16g/dL
Adult males : 15g/dL
Adult females : 14.5g/dL

13. Erythrocyte sedimentation rate (ESR)
This test also called "sed rate determines if you have
inflammation. The sed rate can measure the amount of
inflammation present.
The test measures how fast red blood cells cling together,
fall, and settle toward the bottom of a glass tube in an
hour's time, like sediment.

14. • The higher the sed rate, the greater the amount of
inflammation. As inflammation responds to medication,
the sed rate usually goes down.
• This is an example of a test your doctor might order
several times. Another test used to measure this is the
C-Reactive Protein (CRP) test.
Normal Values - by westergenmethod-
in males-3-7 mm in one hour
in females- 5-9 mm in one hour
in infants-0-2 mm in onehour

16. • Leucocytes are also known
as white blood corpuscles.
• They are colourless , nucleated ,
amoeboid , and phagocytes cells.
• Due the amoeboidal movement
they squeez out of blood
capillaries, this is called as
DIAPEDESIS.
• It i of size 8 to 15 micron metre.
• They are about 5000 to 9000
WBCs per cu.mm
• The average life span is of 3 to 4
days.
LEUCOCYTESWBCs:

17. Leucocytes are divided in two types on the
basis of presence of granules are as follows

18. DIFFERENTIAL COUNTS

20. ABSOLUTE NEUTROPHIL COUNT
 {(% of Neutrophils+ % of Bands) X WBC}/100

21. NEUTROPENIA Decreased production in
the bone marrow due to:
aplastic anemia
arsenic poisoning
cancer, particularly
blood cancers
certain medications
hereditary
disorders (e.g. congenital
neutropenia, cyclic
neutropenia)
radiation
Vitamin B12, folateor copper
deficiency
 Increased destruction:
autoimmune neutropenia
chemotherapy treatments,
such as for cancer and
autoimmune diseases
 Marginalisation
and
sequestration:
Hemodialysis
Medications
Flecainide (a class 1C cardiac
antiarrhythmic drug) Phenytoin
Indomethacin
Propylthiouracil
Carbimazole
Chlorpromazine
Trimethoprim/
sulfamethoxazole
(cotmoxazole)
Clozapine
Ticlodipine
r
i
Often, a mild neutropenia is seen in
viral infections. Additionally, a
condition called morning
pseudoneutropenia might be a side
effect of certain antipsychotic
medications.

22. NEUTROPHILIA
 Post splenectomy
 Cigarette smoking
 Hypoxia
 Epinephrine
 Exercise
• Acute or Chronic
Infection
• Myeloprofilerative
disorders
• Acute stress
• Lukemoid reactions
• Drugs (steroids)
• Chronic Inflammation
• Tumors
• Myelophthisis
• Hyperactive marrow

23. EOSINOPHIL
Cytoplasmic granules
which are stained with
acidic dyes such as eosin.
Nucleus is bilobed
constitutes 3% of total
WBCs.
 Functions: They are
non-phagocytic and
increase during ellergic
reactions
 They show anti-
histamine property.
 Increase in number of
eosinophil is called as
EOSINOPHILIA.

24. EOSINOPHILIA
 Asthma, allergies such as hay fever
 Drug reactions
 Parasitic infections
 Inflammatory disorders (celiac
disease, inflammatory bowel disease)
 Some cancers, leukemias or lymphomas
LOW EOSINOPHILS
 Numbers are normally low
in the blood. One or an
occasional low number is
usually not medically
significant

25. Basophil
Cytoplasmic granules,
that stained with basic
dyes such as methylene
blue .
Twisted nucleus.
They constitute about
• 0.5% of total WBCs.
Functions : they are
non-phagocytic .
They release
heparin(anti-
coagulant) and
histamine also.

26. BASOPHILIA
 Rare allergic reactions (hives, food allergy)
 Inflammation (rheumatoid arthritis, ulcerative colitis)
 Some leukemias
BASOPENIA :
 As with eosinophils, numbers are normally low in
the blood; usually not medically significant

27. Lymphocyte :
Large round nucleus .
It constitute about
25 - 33% of total
WBCs.
Functions : it
produces antibodies
and responsible for
immune response of
the body.

28. LYMPHOCYTOSIS
 Acute viral infections (e.g., chicken
pox, cytomegalovirus (CMV),
Epstein-Barr virus (EBV), herpes,rubella)
 Certain bacterial infections
 (e.g. pertussis, whooping cough, tuberculosis (TB))
 Toxoplasmosis
 Chronic inflammatory disorder (e.g., ulcerative colitis)
 Lymphocytic leukemia, lymphoma
 Stress (acute)

29. LYMPHOCYTOPENIA
 Autoimmune disorders (e.g., lupus,
Rheumatic
Arthritis)
 Infections (e.g., HIV, viral
hepatitis, typhoid fever, inluenza)
 Bone marrow damage
 (e.g., chemotherapy,
radiation therapy)
 Corticosteroids

30. Monocytes :
Largest of all WBCs,
kidney shaped nucleus
It constitute about
3- 9% of total WBCs.
Functions : they are
phagocytic in
function, so they
known as
SCAVENGER.

31. MONOCYTOSIS
 Chronic infections (e.g., TB, Fungal Infections)
 Infection within the heart (bacterial
endocarditis)
 Collagen vascular diseases (e.g.,
lupus, scleroderma, rheumatoid arthritis,
vasculitis)
 Monocytic or myelomonocytic leukemia
(acute or chronic)

32. LOW MONOCYTES
 Usually, one low count is not medically
significant.Repeated low counts can indicate:
 Bone marrow damage or failure
 Hairy cell leukemia

33. • This are small fragments of bone
marrow cells and therefore not
really classified as cells themselves.
 Functions :
1. Secret vasoconstriction.
2. Form temporary platelet plug to
stop bleeding.
3. Secret procoagulants to promotes blood
clotting.
4. Dissolved blood clots.
5. Digest and destroy bacteria.
6. Secretes some chemicals to attract
neutrophil and monocyte to the site of
inflammation.
7. secret growth factor to maintain the lining
of blood vessel.
PLATELETS

34.  Reactive
Chronic infection
Chronic inflammation
Malignancy
Hyposplenism (post-splenectomy)
Iron deficiency
Acute blood loss
 Myeloprofirative disorders –
platelets are
both elevated and activated
Essential Thrombocytosis
Polycythemia Vera
 Associated with other myeloid
neoplasms
 Congenital
 Cancer (lung,
gastrointestinal,
breast,ovarian, lymphoma)
• Kawasaki disease
Soft tissue sarcoma
Osteosarcoma
Dermatitis (rarely)
Inflammatory bowel
disease
Rheumatoid arthritis
Nephritis
Nephrotic syndrome
Bacterial diseases,
including pneumonia,
sepsis, meningitis,
urinary tract infections,
and septic arthritis
THROMBOCYTOSIS

35.  Immune Thrombocytopenias (ITP) – formerly known as immune
thrombocytopenia purpura and idiopathic thrombocytopenic
purpura
 Cirrhosis
 Splenomegaly
Gaucher’s disease
 Familial thrombocytopenia
 Chemotherapy, radiotherapy
 Babesiosis, Dengue, Onyalai, Rocky mountain spotted fever
 Thrombotic Thrombocytopenic Purpura
 HELLP Syndrome
 Hemolytic Uremic Syndrome
 Drug Induced Thrombocytopenia (Heparin Induced
Thrombocytopenia, acetaminophen, quinidine, sulfa drugs)
 Pregnancy associated
 Neonatal alloimmune associated
 Aplastic Anemia, leukemia, lymphoma
 Transfusion associated
THROMBOCYTOPENIA

36. MEAN PLATELET VOLUME
 Typical range of platelet volumes is 9.7–12.8 fL
 Low value indicates average size of platelets is
small; older platelets are generally smaller than
younger ones and a low MPV may mean that a
condition is affecting the production of platelets by
the bone marrow.
 High volume indicates a high number of larger,
younger platelets in the blood; this may be due to
the bone marrow producing and releasing platelets
rapidly into circulation.

37. PLATELET DISTRIBUTION WIDTH
 A high PDW means increased variation in the size
of the platelets, which may mean that a condition is
present that is affecting platelets

38. Significance
If the count is less (thrombocytopenia)
more bleeding TB
infections and otherdisease
If the count is more- (thrombocytosis) allergic
conditions hemorrhage
bone fracture rheumatic
fever trauma

39. • It is straw coloured , slightly
, alkaline , viscous fluid.
• It contains90-92 %
water , 10% of
solutes and 7% of
protein.
• Plasma proteins such as
serum albumin , serum
globulin , heparin ,
fibrinogen and prothrombin
as a coagulating factors in
the inactive form.
PLASMA

40. • Other nutrients such as glucose,
amino acids, & glycerols.
• Nitrogenous waste as urea,
uric acid , ammonia, and
creatinine.
• Gases like oxygen, carbon-
dioixde, nirtogen.
• Regulatory substances such as
enzymes and hormones .
• Inorganic substances
like bicarbonates ,
chlorides, phosphates,
sulphates, Na, K, Ca &
Mg ions, etc.

42. COMPLETE BLOOD COUNT
 A complete blood count (CBC) is an
important and readily available
investigation that focuses on Red
Blood Cells, White Blood Cells and
Platelets, and their various
parameters. It can help to serve as a
screening test for many disorders and
as a prognostic or follow up tool.

44. HEMATOCRIT OR PCV • High Hct
• Increased risk of Dengue
Shock Syndrome
• Polycythemia Vera
• COPD
• EPO or Erythropioten use
• Dehydration
• Capillary leak syndrome
• Sleep apnea
• Anabolic Steroid use
• Low Hct
• Due to anemia
• Anemia can be
characterised by using
the indices
 Males normal 45%
 Females normal 40%

45. MEAN CORPUSCULAR VOLUME
 Normal 77-95fL
 Low MCV indicates RBCs are smaller than normal
(microcytic); caused by iron deficiency anemia,
or thalassemias, Congenital sideroblastic Anemia,
Lead Poisoning, pyridoxine deficiency, anemia of
chronic disease
 High MCV indicates RBCs are larger than normal
(macrocytic)

46. MCH AND MCHC
 Mean corpuscular hemoglobin (MCH) measures the
amount, or the mass, of hemoglobin present in one RBC.
The weight of hemoglobin in an average cell is obtained by
dividing the hemoglobin by the total RBC count. The result
is reported by a very small weight called a picogram (pg).

47. • Mean corpuscular hemoglobin concentration
(MCHC) measures the proportion of each
cell taken up by hemoglobin. The results are
reported in percentages, reflecting the
proportion of hemoglobin in the RBC. The
hemoglobin is divided by the hematocrit and
multiplied by 100 to obtain the MCHC

48. Blood Products
• Blood products are used in the management of
multiple coagulation disorders. However, there is a
debate in the medical literature concerning the
appropriate use of blood and blood products.
Clinical trials investigating their use suggest that
waiting to transfuse at lower hemoglobin levels is
recommended.
• A proper knowledge and understanding of the
different blood products allows clinicians to
optimize their patients’ clinical outcomes.

50. RBC
• Packed red blood cells (RBCs) are prepared from
whole blood by removing 250 mL of plasma. One
unit of packed RBCs should increase hemoglobin
levels by 1 g/dL and hematocrit by 3%.
• In most areas, packed RBC units are filtered to
reduce leukocytes before storage, which limits
febrile nonhemolytic transfusion reactions, and are
considered cytomegalovirus safe

51. RBC transfusions are used to treat hemorrhage as well
as improve oxygen delivery to tissues.
Indications for RBC transfusion include:
• Restoration of oxygen-carrying capacity in case of
acute hemorrhage: acute blood loss (>1500 mL or 30%
of blood volume)
• Treatment of symptomatic anemia
• Prophylaxis in life-threatening anemia
• Exchange transfusion in different diseases, including:
Acute sickle cell crisis
Severe parasitic infection (malaria,babesiosis)
Severe methemoglobinemia
Severe hyperbilirubinemia of newborn

52. • Recommended dosage and administration include:
• One unit of RBC increases the hemoglobin level of an
average-sized adult by w1 g/Dl (or increases hematocrit
w3%)
• The ABO group of RBC products must be compatible
with the ABO group of the recipient
• Ideally, the RBC product must be serologically
compatible with the recipient
• Rate of transfusion
• Transfuse slowly for the first 15 minutes
• Complete transfusion within 4 hours (per US Food and
Drug Administration [FDA])

53. PLASMA
Plasma is acellular and composed primarily of water
(90%) and proteins (7%). The remaining 2% to
3% is made up of nutrients, crystalloids, hormones,
and vitamins. The protein component contains
the clotting factors von Willebrand factor
(vWF); factor VIII (mostly bound to vWF); factor
XIII; fibrinogen; and the vitamin K–dependent factors
II, VII, IX, and X.

54. Indications for the use of
plasma product transfusions
include conditions in which
multiple coagulation defects
exist, such as liver disease,
massive transfusion, DIC,
rapid reversal of warfarin, and
replacement therapy for an
inherited factor deficiency for
which no factor concentrate
exists or is available (factor II,
V, X deficiencies)

55. FRESH FROZEN PLASMA, PLASMA
FROZEN
WITHIN 24 HOURS, THAWED PLASMA

56. CRYOPRECIPITATE

57. PROTHROMBIN COMPLEX
CONCENTRATES

58. FACTOR VIIA

59. FACTOR VIII

60. FACTOR IX

61. FACTOR XIII

62. FACTOR XIII-A SUBUNIT

63. ANTI-INHIBITOR
COAGULANT COMPLEX

64. FIBRINOGEN CONCENTRATE

65. TRANSFUSION COMPLICATIONS
Acute transfusion reactions are rare. They usually
occur at 0.24% of transfusions
Acute transfusion reactions are typically classified
into the following entities56:
• Volume overload
• Bacterial contamination and endotoxemia
• Acute hemolytic reactions
• Nonhemolytic febrile reactions
• TRALI
• Allergic reactions

67. HEMOSTASIS

68. VASOCONSTRICTION
PLUG FORMATION
CLOTTING OF BLOOD
CLOT REMOVAL

70. Types of bleeding during Surgery

71. Factors influencing Surgical
bleeding
• Type of procedure
• Patient position
• Surgical incisions
• Exposed bone
• Large surfaces of
exposed capillaries
• Unseen sources of bleeding
• Tissues that cannot be
sutured or low-pressure
suture lines
• Adhesions stripped during
surgery
Procedural
factors
• Specific anatomical
considerations
• Medications (eg.
Anticoagulants)
• Coagulopathies
•Platelet dysfunction or
deficiency
•Fibrinolytic activity
•Coagulation factor
deficiencies
• Medical conditions
• Nutritional status
Patient factors

72. Adverse effects of Surgical bleeding
• Visual obstruction of the surgical field
• Need for blood transfusions
• Reduction in core temperature
• Thrombocytopenia
• Hypovolemic shock
• Economic consequences

73. Characteristics of an Ideal hemostatic
agents for prehospital/battlefield use:
(1)capability to stop large vessel arterial and venous
bleeding within minutes of application when applied to an
actively bleeding wound through a pool of blood;
(2)no requirement for mixing or pre-application
preparation;
(3)simplicity of application by wounded victim, buddy, or
medic;
(4)light weight and durable;
(5)long shelf life in extreme environments;
(6)safe to use with no risk of injury to tissues or
transmission of infection;
(7)cost-effective

74. Methods of Hemostasis
Mechanical methods . Direct pressure
. Fabric pads/sponges/gauzes
. Sutures/staples/ligating clips
Thermal/energy based methods . Electrosurgery
. Monopolar
. Bipolar
. Bipolar vessel sealing device
. Argon enhanced coagulation
. Ultrasonic device
. Laser
Chemical methods
. Pharmacological agents . Epinephrine
. Vitamin K
. Protamine
. Desmopressin
. Lysine analogues
. rFVIIa

75. . Topical hemostatic agents
. Passive (mechanical) agents
. Active agents
. Collagen based agents
. Cellulose
. Gelatin
. Polysaccharide spheres
. Thrombin products
. Others . Flowables
. Sealants
. Fibrin sealants
. Polyethylene glycol (PEG)
polymers
. Albumin and glutaraldehyde
. Cyano-acrylate

76. Topical Hemostatic Agents
CLASSIFICATION
• Scaffold/matrix
• Biological
• Antifibrinolytics
• Natural procoagulants
• Tissue sealants
• Tissue adhesives
• Occlusives

77. A basic tenet of surgery is understanding haemostasis.
The surgeon must be knowledgeable with disease
processes associated with abnormal haemostasis, be able
to recognize signs and symptoms identifying potential
abnormal haemostasis, be familiar with the growing list
of coagulation altering therapy, and be up-to-date with
management protocols to optimize patient care.
Conclusion

78. References
• Textbook of Oral and Maxillofacial Surgery by Neelima Anil
Malik (3rd edition).
• Textbook of Oral and Maxillofacial Surgery by S.M. Balaji (2nd
edition).
• Textbook of Surgery for Dental Students by Sanjay Marwah (1st
edition).
• Essentials of Pathology for Dental Students by Harsh Mohan (4th
edition).
• Landesberg R L, Ferneini E M. Blood Products What Oral and
Maxillofacial Surgeons Need to Know. 1042-3699/16/ 2016
Elsevier Inc. All rights reserved.
• Hee´bert PC, Wells G, Blajchman MA, et al. A multicenter,
randomized, controlled clinical trial of transfusion requirements
in critical care. Transfusion Requirements in Critical Care
Investigators, Canadian Critical Care Trials Group. N Engl J Med
1999;340(6):409–17.

79. • Vezeau P J. Topical Hemostatic Agents What the
Oral and Maxillofacial Surgeon Needs to Know.
1042-3699/16/2016 Elsevier Inc.
• Bennett J D, Ferneini E M. Coagulopathy
Management: The Balance Between
Thromboembolism and Hemorrhage. 1042-
3699/16/2016 Published by Elsevier Inc
• Halaszynski T M. Administration of Coagulation-
Altering Therapy in the Patient Presenting for Oral
Health and Maxillofacial Surgery. 1042-3699/16/
2016 Elsevier Inc

80. THANK YOU