blood

1. BLOOD
Presented by- Riddhika kochar
Guided by- Jasuma Rai

2. CONTENTS
1. Introduction
2. Composition and properties
3. Functions of blood
4. Erythropoiesis
5. Erythrocyte sedimentation rate
6. Plasma protein
7. Red blood cells
8. White blood cells
9. Platelets
10.Hemostasis
11.Coagulation of blood
12.Blood groups
13.Conclusion

3. Introduction
Fluid of life
Fluid of growth
Fluid of Health
Blood is a connective tissue in a fluid form .

4. COMPOSITION OF BLOOD
-Blood contains the blood cells which are
called formed elements and the liquid
portion known as plasma .
-Total blood Volume- 5-6 liters
(8% of total body weight , 80ml/kg body
weight)

6. Substance Normal value
Glucose 100 to 120 mg/dl
Creatinine 0.5 to 1.5mg/dl
Cholesterol Up to 200mg/dl
Plasma Proteins 6.4 to 8.3g/dl
Bilirubin 0.5 to 1.5g/ dl
Iron 50 to 150ug/dl
Copper 9 to 11 mg/dl
Potassium 3.5 to 5.0mEq/L
NORMAL VALUES OF SOME IMPORTANT SUBSTANCES IN BLOOD
Ref- Sembulingam K, Sembulingam P. Essentials of medical physiology. JP Medical Ltd; 2012 Sep 30

7. PROPERTIES OF BLOOD
1) Color of blood – Blood is red in color.
Arterial blood is scarlet red, Venous blood is purple in color.
2) Volume of blood- 5L
3) Ph- 7.4 (slightly Alkaline)
4) Specific gravity- Total blood- 1.052 to 1.061
Blood cells -1.092 to 1.010
Plasma – 1.022 to 1.026
5) Viscosity- Blood is 5 times more viscous than the water due to red
blood cells and plasma proteins.

8. Functions of blood
• Respiratory gases
• Nutrient carrier from GIT
• Transports hormone from endocrine glands
• Transports Metabolic waste
Transposition
• Regulation of acid- base balance
• Adjusts and maintain body temp
• Maintain water content of cells.
Regulation
• WBC protect against diseases by phagocytosis.
• Reservoir for substances like water, electrolyte etc.
• Performs hemostasis.
Protection

9. Erythropoiesis
• Pro- erythroblast
• Early normoblast
• Intermediate normoblast
• Late normoblast
• Reticulocyte
• Matured erythrocyte
STAGES OF ERYTHROPOIESIS Site of erythropoiesis
It is the process of the origin, development and maturation of erythrocytes.
1. Mesoblastic stage- first two month of
IU life from mesenchyme of yolk sac.
2. Hepatic stage- from 3rd month in liver
3. Myeloid stage- last 3 month produced
in red bone marrow and liver

11. ERYTHROCYTE SEDIMENTATION RATE
• It is the rate at which the erythrocytes settle down.
• Suspension stability.
• ESR is also called sedimentation rate , sed rate or Biernacki reaction. It was
first demonstrated by Edmund Biernacki in 1897.
• Demonstration of ESR
• There are two methods to determine ESR:
1.Westergren method
2.Wintrobe method

12. NORMAL VALUES OF ESR
• By Westergren method:
• In males: 3 to 7 mm in 1 hour
• In females: 5 to 9 mm in 1 hour
• Infants : 0 to 2 mm in 1 hour
• By Wintrobe method:
• In males: 0 to 9 mm in 1 hour
• In females: 0 to 15 mm in 1 hour
• Infants : 0 to 5 mm in hour

13. FACTORS AFFECTING ESR
• FACTORS INCREASING ESR :
1.Specific gravity of RBC
2.Rouleaux formation
3.increase in size of RBC
• FACTORS DECREASING ESR :
1.Viscosity of blood
2.RBC count
Significance of ESR
- Non- specific test
-Helps to confirm the diagnosis
- helps in prognosis as it monitor the
course of disease and response to the
therapy.

14. PLASMA PROTIENS
Normal values-
Total protiens-7.3g/dl
Serum albumin- 4.7g/dl
Serum globulin- 2.3g/dl
Fibrinogen- 0.3g/dl
Plasma
proteins
are
Serum albumin
Serum globulin
Fibrinogen

15. PROPERTIES
Oncotic
pressure
Molecular
weight
Buffer
action
Role in coagulation
of blood
Role in defense
mechanism of body
Role in transport
mechanism
Role in
maintenance of
osmotic pressure
Role in Erythrocyte
Sedimentation rate
Role in regulation
of Acid –Base
Balance
FUNCTIONS

16. Variation in Plasma protein level
Elevation of all fractions of plasma protein is called Hyperproteinemia.
• Dehydration
• Hemolysis
• Leukemia
• Acute infections
Decrease in all fractions of plasma protein is called Hypoprotienemia.
• Diarrhea
• Hemorrhage
• Burns
• Pregnancy

17. RED BLOOD CELLS
-Red blood cells (RBCs) are the non-nucleated
formed elements in the blood.
-Red blood cells also known as Erythrocytes.
-Red color of the red blood cells is due to the
presence of the coloring pigment called
hemoglobin.
Normal value - 4 to 5.5 million/cu mm of blood
Adult males - 5 million / cu mm
Adult-Females – 4.5 million / cu mm

18. Normal Size and Shape
Shape- disk shaped and biconcave (dumbbell
shaped)
Diameter : 7.2 μ
Thickness : At the periphery it is thicker with 2.2μm
and at the center it is thinner with 1μm because of
the biconcave shape.
Surface area : 120 sq. μ
Volume : 80– 90 cu μ
Lifespan : 120 days

19. Properties of Red blood cells
Rouleaux
formation
Specific
gravity
Packed cell
volume
Suspension
Stability
1.092
to
1.101

20. Fate of Red blood cells
□ The lifespan of RBC is about
120 days.
□ It is determined by
radioisotope method.

21. Functions of Red blood cells
1.Transport of oxygen from the lungs to the tissues.
2.Transport of carbon dioxide from the tissues to the lungs.
3. Buffering action of blood
4.In blood group determination

22. Physiological Variations in Number of Red blood cells
• a) Increase in RBC count
• Age
• Sex
• High altitude
• Increased environmental temperature
• b) Decrease in RBC count
• High barometric pressure- deep sea
• During sleep
• Pregnancy

23. Pathological Variations in Red blood cells
INCREASE IN RBC COUNT
: POLYCYTHEMIA
Primary
polycythemia:
polycythemia
vera
Secondary
polycythemia
DECREASE IN RBC COUNT
Anemia

24. Variation in SIZE of Red blood cells
Microcytes
Iron deficiency anemia
Increased osmotic
pressure in blood
Prolonged force
breathing
Macrocytes
Megaloblastic anemia
Decreased osmotic
pressure in blood
Liver disease
Anisocytes
Pernicious anemia
In Physiological conditions : Size of RBCs in Venous blood is slightly
larger than those in Arterial blood.
In Pathological conditions

25. Variation in SHAPE of Red blood cells

26. Variation in STRUCTURE of Red blood cells
Punctate Basophilism
•Found in lead poisoning
Howell- Jolly Bodies
•Seen in patient undergone
splenectomy
Ring in RBCs / Goblet rings
•Seen in certain type of anemia

27. WHITE BLOOD CELLS
• Leukocytes are the colorless & nucleated formed elements of blood.
• Plays an important role - defense mechanism of the body & protect the body
from invading organisms (acts like soldiers.)
• Larger in size than RBCs and less in number, nucleated, are of many types,
granules are present in some types of WBCs & the lifespan is shorter.
• Normal count : 4,000 – 11,000 cells/cu mm of blood.
- An increase in the number is called leukocytosis.
- An decrease in the number is called leukopenia.

28. CLASSIFICATION
• Based on the presence or absence of granules in the cytoplasm
Granulocytes
Neutrophills Eosinophills
Basophills
Agranulocytes
Monocytes Lymphocytes
LEUKOCYTES

29. Normal values
50 to 70%
2 to 4%
0 to 1%
20 to 30%
2 to 6%

31. Ref- Sembulingam K, Sembulingam P. Essentials of medical physiology. JP Medical Ltd; 2012 Sep 30

32. Properties of WBCs
1. Diapedesis 2.Ameboid Movement 3. Chemotaxis

33. PLATELETS
□It is small, colorless, non nucleated & moderately refractive bodies.
□Size
Diameter:2.5 μ, Volume: 7.5 cu μ
□Platelets constitutes of a cell membrane, microtubules & cytoplasm.
□Microtubules provide structural support for the inactive platelets to
maintain disk like shape.
□Normal platelet count : 2,50,000 per cubic mm of blood to 4,00,000
per cubic mm of blood.
□Average life span- 10 days

34. Functions of platelets
1. Role in blood clotting
2. Role in repair of ruptured blood vessels
3.Role in prevention of blood loss
4.Role in clot retraction

35. Properties of Platelets
1.Adhesiveness
2.Aggregation
3. Agglutination

36. Applied physiology – Platelet disorders
decrease in platelet count
THROMBOCYTOPENIA
•Acute leukemia
•Chickenpox
•Small pox
•typhoid
increase in platelet count
THROMBOCYTOSIS
•Allergic conditions
•Hemorrhage
•Bone fracture
Persistent and abnormal increase in platelet count
THROMBOCYTHEMIA
•Carcinoma
•Chronic leukemia

37. HEMOSTASIS
-Defined as arrest or stoppage of blood.
STAGES OF HEMOSTASIS
Vasoconstriction
Platelet Plug
Formation
Coagulation of
Blood

39. COAGULATION OF BLOOD
• Process in which blood
loses its fluidity and
becomes a jelly- like mass
few minutes after it shed
out.

40. Stages of Blood clotting
1.
Formation
of
Prothrombin
activator
2.
Conversion
of
prothrombin
into
thrombin
3.
Conversion
of
fibrinogen
into fibrin

42. Test for blood clotting
□ Bleeding time
□ Clotting time
□ Prothrombin time
□ Activated partial thromboplastin time
□ Thrombin time
□ International normalized ratio

43. Bleeding time Clotting time
Time interval from oozing of blood after a cut or injury
till the arrest of bleeding
Time interval from oozing of blood after a cut injury till
the formation of clot
Duke’s method Capillary tube method
Normal duration- 3 to 6 minutes Normal duration – 3 to 8 minutes
Prolonged in purpura Prolonged in Hemophilia

44. Prothrombin Time (PT) Partial Prothrombin Time(PTT) or
Activated Prothrombin Time (APTT)
Thrombin Time (TT)
Extrinsic Pathway Intrinsic Pathway
Time taken by blood to clot after adding
thromboplastin
Time taken for the blood to clot after
adding an activator such as phospholipid
and calcium
Time taken for the blood to clot after
adding thrombin to it.
Normal value is 10 to 12 seconds. Normal range is 30 to 45 seconds. Normal duration is 12 to 20 seconds
Prolonged in deficiency of prothrombin,
factors 1,5,7,10 but normal in
hemophillia.
Prolonged in Heparin or warfarin therapy
and hemophillia
Prolonged in Heparin therapy and during
dysfibrinogenemia.
To monitor levels when taking blood
thinning medicines
To check liver disease to screen for liver
transplant
Useful in monitoring the pt taking
anticoagulants
Investigate the presence of heparin in
plasma . Fibrinogen abnormalities

45. CLINICAL
CONDITION
PROTHROMBIN
TIME
ACTIVATED
PARTIAL
THROMBIN
TIME
THROMBIN
TIME
BLEEDING
TIME
CLOTTNIG
TIME
HEREDITARY
HEMORRHAGE
TELEANGIETASIA
NORMAL NORMAL NORMAL NORMAL NORMAL
VON WILLEBRANDS
DISEASE
NORMAL LONG NORMAL LONG NORMAL
HEMOPHILIA A NORMAL LONG NORMAL LONG LONG
HEMOPHILIA B NORMAL LONG NORMAL NORMAL LONG
HEMOPHILIA C NORMAL LONG NORMAL NORMAL NORMAL
LIVER DISEASE LONG LONG NORMAL NORMAL NORMAL
Ref -Rose LF, Genco RJ, Cohen DW, Mealey BL. Periodontal medicine. BC Decker.; 2000.

46.  INTERNATIONAL NORMALIZED RATIO
□ International normalized ratio (INR) was devised as a way to standardize
measurements of prothrombin time.
□ The manufacturer assigns an international sensitivity index (ISI), which indicates the
activity of the tissue factor with a standardized sample
□ The INR usually varies between 1.0 and 2.0.
□ The normal range for INR in a healthy person is 0.9 to1.3
□ The normal PT is about 12 seconds .

47. INR VALUES TREATEMNT
4.0 or greater No surgical treatment until INR is reduced.
< 3.5 to 4.0 Scaling, Root planning only
< 2.5 to 3.0 Curettage, Periodontal surgery and
Gingivectomy.
1.5 to 2.4 Full mouth extractions, multiple bony
impactions, gingivectomy, multiple quadrant
flap surgery
Ref - Morimoto Y, Niwa H, Minematsu K. Hemostatic management for periodontal treatments in patients on oral antithrombotic
therapy: a retrospective study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2009 Dec
1;108(6):889-96.

48. BLOOD GROUPS
Blood groups were discovered by Austrian scientist Karl Landsteiner in
1901
• Landsteiner law :-
1.If a particular agglutinogen (antigen) is present in the RBCs,
corresponding agglutinin (antibody) must be absent in the serum.
2.If a particular agglutinogen is absent in the RBCs, the
corresponding agglutininmust be present in the serum.

49. RH factor
• It is an antigen present in RBCs
• Discovered in Rhesus monkey hence name as Rh factor
Hemolytic disease of fetus and newborn –
ERRYTHROBLASTOSIS FETALIS
 Hemolytic disease is the disease in fetus and newborn, characterized by the
presence of abnormal hemolysis of RBCs. It is due to Rh incompatibility.
 When a mother is Rh negative and fetus is Rh positive usually first child escapes
the complication of Rh incompatibility. This is because the Rh antigen cannot
pass from fetal blood into mother’s blood through placental barrier.

50. Other Blood groups
• MNS blood group – reaction with anti-M ,N,S
• Bombay blood group-Rare phenotype / hh blood group
There is no ill effect with being H deficient but if blood
transfusion is ever needed, people with this blood type can receive
blood only from other donors who are H deficient.

51. AUTHOR TITLE METHODOLOGY RESULTS CONCLUSION LEVEL OF
EVIDENCE
A.P. H. Lee, C.A Effectiveness in 16 patients with 13 patients TAMW use after dental 1B
Boyle et al 2005 controlling haemophilia completed the scaling was as effective
haemorrhage participated. The study. No as using FRT
After intervention experiment statistically beforehand in
dental scaling in transfusing each patient significant controlling gingival
people with with saline before scaling difference was haemorrhage for people
haemophilia by both quadrants on one found in gingival with
using side of the mouth bleeding and haemophilia
tranexamic acid followed by TAMW four mouthwashing .
BRISTISH mouthwash. times daily for up to eight Five patients
DENTAL days. The control group reported no gingival
JOURNAL involved giving each bleeding with either
VOLUME 2 patient FRT before the ETR or the CR.
scaling the opposite side All subjects found
of the mouth followed by the
use of a placebo TAMW. ETR acceptable and
Both the operator and the easy and reported
patients were blinded in feeling safe in using
the study. TAMW alone to
control gingival
bleeding after
dental scaling.

52. CONCLUSION
It is important to have a thorough knowledge of blood and blood cells,
clotting factors in order to diagnose various disorders which will help us
a clinician in daily dental practices.
Hence,. in turn helping patients to maintain a healthy lifestyle.

53. REFERENCES
• Sembulingam K, Sembulingam P. Essentials of medical physiology. JP
Medical Ltd; 2012 Sep 30.
• Rose LF, Genco RJ, Cohen DW, Mealey BL. Periodontal medicine. BC
Decker.; 2000.
• Lee, A., Boyle, C., Savidge, G. et al. Effectiveness in controlling
haemorrhage after dental scaling in people with hemophilia by using
tranexamic acid mouthwash. Br Dent J 198, 33–38 (2005).
https://doi.org/10.1038/sj.bdj.4811955
• Walter J, High K . Haemophilias. Encyclopedia of life sciences. Nature
Publishing Group. www.els.net 2001 [accessed on 4 July 2001].

54. THANK YOU