The document discusses blood physiology and erythropoiesis. It provides details on the composition of blood including plasma, red blood cells, white blood cells and platelets. It also describes the production of blood cells known as hematopoiesis starting from pluripotent stem cells and progenitor cells that give rise to the various cell lineages through a series of differentiation steps in the bone marrow. Specifically, it outlines the process of erythropoiesis or red blood cell production from the proerythroblast stage through the basophilic, polychromatophilic and orthochromic stages in both the fetal liver and postnatal bone marrow.

1. THE PHYSIOLOGY OF
BLOOD
By
Dr.M.ANTHONY DAVID, MD.
NOMAD:2005: BP: 1
INTROVERVIEW

2. WHAT IS BLOOD?
• IT IS A LIQUID CONNECTIVE TISSUE
• IN AN AVERAGE 70 Kg MAN:
• 100 Trillion cells.
• Of which 25 trillions are Red Blood
Cells!
• The average blood volume is 5 – 6
lts.
• It is roughly 7% of the total body
weight.
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INTROVERVIEW

3. HEMATOLOGY: THE STUDY OF BLOOD
MADE POSSIBLE BY MICROSCOPY
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INTROVERVIEW

4. THE COMPOSITION OF PLASMA
• The Liquid: Plasma:
• Water, the solvent
• The solute:
• Proteins:
• Albumin
• Globulins
• Fibrinogen
• Electrolytes:
• Na+
• K+
• Ca++
• Organic molecules
• Urea
• Glucose
• Lipids
NOMAD:2005: BP: 4
INTROVERVIEW

5. THE FORMED ELEMENT: CELLS
BLOOD CELLS
ERYTHROCYTES LEUCOCYTES THROMBOCYTES
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INTROVERVIEW

6. BLOOD : COMPOSITION
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INTROVERVIEW

7. FUNCTIONS OF BLOOD
• NUTRITIVE
• RESPIRATORY
• EXCRETORY
• BODY DEFENCE: IMMUNITY
• TRANSPORT:
• HORMONES
• VITAMINS
• DRUGS
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INTROVERVIEW

8. BLOOD : TRANSPORTING
HORMONE MOLECULES
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INTROVERVIEW

9. OXYGEN & CO2 TRANSPORT
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INTROVERVIEW

10. FUNCTIONS OF BLOOD
• HOMEOSTATIC FUNCTION:
•ACID BASE BALANCE.
•ELECTROLYTE BALANCE.
•HEMOSTASIS.
•THERMOREGULATION.
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INTROVERVIEW

11. BLOOD VOLUME
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INTROVERVIEW

12. WHAT IS BLOOD VOLUME?
• The total amount of blood in
circulation plus the amount of
blood in the reservoirs
constitutes the “Blood Volume”
• The average adult 70 kg man has
a blood volume of 5 to 6 litres.
NOMAD:2005: BP: 12
INTROVERVIEW

13. EXPRESSION OF BLOOD VOLUME
• Usually Blood Volume is expressed
in liters.
• It can also be expressed in relation
to body weight.
• It is 7% Body Weight
• Another way to express it is in
terms of Body Surface Area.
• Whole Blood : 2.8 Lts/M2
• Plasma : 1.5 Lts/M2
NOMAD:2005: BP: 13
INTROVERVIEW

14. METHODS OF MEASURING BLOOD
VOLUME
• IN HUMANS: ONLY INDIRECT METHODS
• DYE DILUTION TECHNIQUE:
• PRINCIPLE:
• Injection of a known volume of non toxic
substance into the circulation.
• Measuring the dilution of this injected dye
after some time.
• This gives us the Plasma volume.
NOMAD:2005: BP: 14
INTROVERVIEW

15. DYE DILUTION TECHNIQUE
V1 = VOLUME
C1 = CONCENTRATION
OF DYE V2 = VOLUME
C2 = CONC. OF DYE
V1 X C1 = V 2 X C2
OR
V2 = V1 X C1 = Amount of Dye injected
C2 Conc. Of NOMAD:2005: BP: the Plasma
the dye in 15
INTROVERVIEW

16. HEMATOCRIT (PCV)
• The volume of erythrocytes in
the whole blood expressed in
percentage is the Hematocrit.
• This is also called as Packed Cell
Volume or PCV.
• This is determined by the
Wintrobe’s tube, using a
Centrifuge.
NOMAD:2005: BP: 16
INTROVERVIEW

17. HEMATOCRIT
• A mixture of blood and double oxalate
(K – NH4) is taken upto 100 mark in the
Wintrobe’s tube.
• The tube is placed in the centrifuge.
• It is rotated at 3,000 rpm for 30
minutes.
• The Hematocrit is then read off the
tube.
• Blood Volume = Plasma Volume X 100
100 - PCV
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INTROVERVIEW

18. HEMATOCRIT
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INTROVERVIEW

19. BLOOD VOLUME: PHYSIOLOGICAL
VARIATIONS
• AGE • PREGNANCY
• SEX • EXERCISE
• TEMPERATURE
• POSTURE
• BODY WEIGHT
• HYPOXIA
• BODY
SURFACE AREA • EMOTIONS
NOMAD:2005: BP: 19
INTROVERVIEW

20. BLOOD VOLUME & AGE
AGE BLOOD VOLUME in Liters
AT BIRTH 0.3
6 Months 0.5
1 year 0.7
2yrs 6 months 1.0
4 years 1.3
7 years 1.7
10 years 2.5(Girls); 3.2 (Boys)
ADULTS 5 (Men) 4.5 (Women)
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INTROVERVIEW

21. BLOOD VOLUME: PHYSIOLOGICAL
VARIATIONS
1. SEX:
• Males have more
blood volume than
females.
2. TEMPERATURE:
• Acute exposure to
cold causes reduction
in blood volume due
to Plasma water loss
to tissues.
NOMAD:2005: BP: 21
INTROVERVIEW

22. BLOOD VOLUME: PHYSIOLOGICAL
VARIATIONS
3. BODY WEIGHT:
• It is usually 7% of the Body Weight.
4. BODY SURFACE AREA:
• 2.8 Lts/Square Meters of BSA
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INTROVERVIEW

23. BLOOD VOLUME: PHYSIOLOGICAL
VARIATIONS
5. PREGNANCY:
• Increases by 20 – 30%
due to mass of fetus.
6. EXERCISE:
• Vigorous exercise causes
an increase.
7. POSTURE:
• Changing from lying
down to erect.
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INTROVERVIEW

24. BLOOD VOLUME: PHYSIOLOGICAL
VARIATIONS
8. HYPOXIA:
• Seen in High
altitudes.
•  Erythrocytes
• So  Blood volume.
9. EMOTIONS:
• Excitement causes an
increase in the Blood
volume.
24
NOMAD:2005: BP:
INTROVERVIEW

25. BLOOD VOLUME: PATHOLOGICAL
VARIATIONS : hypovolemia
1. BLOOD LOSS:
2. SHOCK:
• Crushing Injury
• Cardiogenic
• Neurogenic
• Psychogenic.
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INTROVERVIEW

26. HYPOVOLEMIA: CAUSES
3. HEMOLYSIS:
• Mismatched
transfusion
• Snake bite
• Black water fever
• Hemorrhagic
Plagues/Dengue
• Measles
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INTROVERVIEW

27. HYPOVOLEMIA: CAUSES
4. DEHYDRATION:
• Diarrhoea
• Cholera
• Gastroenteritis
• Burns
• Hyperemesis.
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INTROVERVIEW

28. HYPOVOLEMIA: CAUSES (contd)
5. ANEMIA:
• Decreased RBC volume
• Plasma may increase.
6. OBESITY:
• Blood volume per body weight decreases
though Blood volume per BSA may be normal.
7. HYPOTHYROIDISM (MYXEDEMA):
• Decrease in Blood volume.
8. ACUTE COLD: Decreases blood volume.
NOMAD:2005: BP: 28
INTROVERVIEW

29. TREATMENT FOR BLOOD LOSS
• TRANSFUSION OF WHOLE
BLOOD OF THE SAME BLOOD
GROUP & TYPE.
• INFUSION OF PLASMA
• INFUSION OF DEXTRAN OR
NORMAL SALINE.
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INTROVERVIEW

30. NOMAD:2005: BP: 30
INTROVERVIEW

31. HEMOPOIESIS &
ERYTHROPOIESIS
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INTROVERVIEW

32. HEMOPOIESIS: INTRO
• Hemo: Referring to blood cells
• Poiesis: “The development or production
of”
• The word Hemopoiesis refers to the
production & development of all the
blood cells:
• Erythrocytes: Erythropoiesis
• Leucocytes: Leucopoiesis
• Thrombocytes: Thrombopoiesis.
• Begins in the 20th week of life in the
fetus & continues in the red bone
marrow till death. BP:
NOMAD:2005:
INTROVERVIEW
32

33. STEM CELL THEORY
• All blood cells are produced by the
bone marrow.
• They come from a single class of
primitive mother cells called as:
• PLURIPOTENT STEM CELLS.
• These cells give rise to blood cells of:
• Myeloid series: Cells arising mainly from
the bone marrow.
• Lymphoid series: cells arising from
lymphoid tissues.
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INTROVERVIEW

34. PROGENITOR CELLS
• Committed stem cells lose their capacity for
self-renewal.
• They become irreversibly committed.
• These cells are termed as “Progenitor cells”
• They are regulated by certain hormones or
substances so that they can:
• Proliferate
• Undergo Maturation.
NOMAD:2005: BP: 34
INTROVERVIEW

35. BLOOD CELLS: DEVELOPMENT
PROGENITOR
CELLS
LYMPHOID PRO MEGA
MYELOBLAST MONOBLAST
CELLS NORMOBLAST KARYOBLAST
LYMPHOCYTES ERYTHROCYTES THROMBOCYTES GRANULOCYTES MONOCYTES
NOMAD:2005: BP: 35
INTROVERVIEW

36. ERYTHROPOIESIS: SITES
• INTRAUTERINE LIFE:
• INTRAVASCULAR PHASE: Upto 3rd month of Intra
Uterine Life.
•Endothelial cells = = = RBCs
• HEPATIC PHASE: 3rd to 5th month IUL
•Liver & Spleen
•nRBCs from Mesenchymal cells.
• MYELOID PHASE: From 5th month of IUL onwards.
NOMAD:2005: BP: 36
INTROVERVIEW

37. ERYTHROPOIESIS: SITES contd.
• POST NATAL LIFE:
• CHILDREN:
•Predominantly Red Bone Marrow of
skeleton:
•Axial &
•Appendicular.
• ADULTS:
•Red Bone Marrow of Axial Skeleton.
NOMAD:2005: BP: 37
INTROVERVIEW

38. ERYTHROPOIESIS
PROERYTHROBLAST
BASOPHILIC
ERYTHROBLAST
POLYCHROMATOPHILIC
ERYTHROBLAST
ORTHOCHROMATIC
ERYTHROBLAST
RETICULOCYTE
NOMAD:2005: BP: 38
INTROVERVIEW MATURE ERYTHROCYTES

39. FACTORS REGULATING
ERYTHROPOIESIS
• SINGLE MOST IMPORTANT
REGULATOR: “TISSUE
OXYGENATION”
• BURST PROMOTING ACTIVITY
• ERYTHROPOIETIN
• IRON
• VITAMINS:
• Vitamin B12
• Folic Acid
• MISCELLANEOUS
NOMAD:2005: BP: 39
INTROVERVIEW

40. ERYTHROPOIETIN
•A hormone produced by the Kidney.
•Nowadays available as Synthetic Epoietin
•Increases the number of:
•Nucleated precursors in the marrow.
•Reticulocytes & Mature Erythrocytes in
the blood.
NOMAD:2005: BP: 40
INTROVERVIEW

41. VITAMINS
• B12: Cyanocobalamine & Folic Acid:
•Is also called Extrinsic Factor of Castle.
•Needs the Intrinsic Factor from the
Gastric juice for absorption from Small
Intestine.
•Deficiency causes Pernicious (When IF is
missing) or Megaloblastic Anemia.
•Stimulates Erythropoiesis
•Is found in meat & diary products.
NOMAD:2005: BP: 41
INTROVERVIEW

42. IRON
•Essential for the synthesis of
Hemoglobin.
•Deficiency causes Microcytic,
Hypochromic Anemia.
•Deficiency causes the commonest
type of Anemia.
NOMAD:2005: BP: 42
INTROVERVIEW

43. NOMAD:2005: BP: 43
INTROVERVIEW