This chapter will discuss blood composition, the physical and chemical properties of blood, blood cells including erythrocytes, leukocytes and platelets, hemostasis, blood groups, and principles of blood transfusion. Specifically, it will cover the components and characteristics of plasma, hematopoiesis and the life cycle of red blood cells, the roles and regulation of white blood cells and platelets, and the clinical significance of blood groups and cross-matching for transfusion.

1. What will we discuss in this chapter?
(Outline)
I.
Blood composing
II. Physical and chemical characteristics of blood
III. Blood Cells
1. Hemopoietic process and hemopoietic stem cells
2. Hemopoietic microenvironment
3. Erythrocyte Physiology
4. Leukocyte Physiology
5. Platelet or Thrombocyte Physiology
IV. Physiological Hemostasis
1. Physiological Characteristics of Platelet
2. Blood Coagulation
3. Fibrinolysis

2. What will we discuss in this chapter?
(Outline)
V. Blood Group
1. RBC Agglutination
2. ABO blood group system
3. Rh blood group system
4. Relation between blood volume and clinic
5. Principle of Transfusion and Cross-match test

3. I. Blood composing
• Blood composing: plasma +
blood cells
• Hematocrit:
blood cells occupies the
percentage of total blood
volume.
normal value
male: 40-50%
female: 37-48%
newborn: 55%

4. Blood component

5. Chemical component of plasma
• Water: > 90%
• Small molecule: 2%, it is electrolytes, nutriment, metabolic
products, hormone, enzyme, etc.
• Protein: 60-80 g/L, plasma protein include albumin (40-50
g/L), globulin (20-30 g/L,α1-, α2, β-, γ- ) and fibrinogen.
• Most of albumin and globulin made from liver.
• A/G and clinic.

6. Chemical component of plasma
• Function of plasma protein:
(1) transportation,
(2) nutrition,
(3) forming colloid osmotic pressure,
(4) coagulation and anticoagulation,
(5) pH value buffer,
(6) immunity (globulin)

7. Chemical component of plasma
H2 O
90 - 91%
Plasma
血浆
Interstitial fluid Intracellular fluid
组织液
细胞内液
Na+
142
145
12
Cl-
104
117
4
Ca++
2.5
2.4
<0.001
K+
4.3
4.4
139
PO4-
2
2.3
29
Protein
蛋白质
14
0.4
54
(Unit ： mmol/L)

8. II. Physical and chemical
characteristics of blood
• Specific gravity:
– total blood (1.050-1.060) more influenced by red blood
cells;
– plasma (1.025-1.030) more influenced by plasma protein;
– RBC (1.090-1.092) more influenced by Hb.

9. II. Physical and chemical
characteristics of blood
• Viscosity:
– Blood relative viscosity (4~5) mainly depends on the
numbers of red blood cells.
– Plasma relative viscosity (1.6~2.4) is mainly involved in
plasma protein

10. II. Physical and chemical
characteristics of blood
• Plasma osmotic pressure is 300 mmol/L or 770kPa
(1) Crystal osmotic pressure results from NaCl and modulates
water distribution between inside and outside of cells.
(2) Colloid osmotic pressure results from albumin and regulates
water distribution between inside and outside of capillary.

11. II. Physical and chemical
characteristics of blood
• Plasma pH value is about 7.35~7.45, and
• usually buffer systems are:
– NaHCO3/H2CO3 (20:1), protein salt/protein,
– Na2HPO4/ NaH2PO4,
– Hb salt/Hb, HbO salt/ HbO2,
– K2HPO4/ KH2PO4, etc
– [lungs and kidney mainly regulate Plasma pH value ].

12. Osmosis and Osmotic Pressure
• Osmosis is the movement of water down its
concentration gradient.
• Osmosis is determined by the number of
impermeable molecules.
• Osmotic pressure is the force drawing water
down its concentration gradient.

13. Osmosis and Osmotic Pressure
A
B
∗
∗ ∗
∗
Water
∗ ∗ ∗
∗
∗ ∗
∗ ∗
∗
∗
∗
∗
∗
∗
∗ ∗ ∗
∗∗ ∗
∗
∗
∗
[Water] > [Water]
[Salt] < [Salt]
Osmotic Pressure < Osmotic Pressure
Osmosis is the movement of water from a high concentration to a low concentration. In
this illustration, two compartments (A and B) are separated by a semipermeable
membrane (broken vertical line). The water concentration in compartment A is greater
than the concentration in compartment B because of the presence of salt (X) in B.
Therefore, water will move down its concentration gradient from A to B. The force
needed to prevent this water movement is called osmotic pressure.

14. Tonicity
• The tonicity of a solution refers to the effect of the solution
on cell volume.
• A hypertonic extracellular solution is one in which the
water concentration is less outside the cell than inside;
water leaves the cell; cell volume decreases.
• An isotonic extracellular solution is one in which the water
concentration is the same inside and outside the cell;
no water movement; cell volume does not change.

15. Tonicity
• A hypotonic solution is one in which the water
concentration is greater outside than inside the cell;
water enters the cell; cell volume increases.
• An isosmotic solution may not be an isotonic solution if
the particles are permeable to the cell membrane.

16. III.Blood Cells
Blood cells are erythrocyte (red blood cell, RBC), leukocyte (white
blood cell, WBC) and thrombocyte (platelet, P).

17. 3.Erythrocyte Physiology
Shape and number of red blood cells (RBC)
• Shape of RBC: like biconcave disc
Its diameter is about 7~8 µm, peripheral thickness about 2.5 µm,
central thickness about 1 µm and cubage about 90 µm3.

18. Reason for shape of RBC
biconcave disc like

19. Erythrocyte Physiology
Number of RBC: It is most numbers in the blood.
Normal value about RBC
Male adult, 4.5~5.5×1012/L; average, 5.0×1012/L
Female adult, 3.8~4.6× 1012/L; average, 4.2×1012/L
Newborn, ≥ 6.0×1012/L
Protein within RBC is hemoglobin (Hb).
Hb in male adult, 120~160 g/L;
Hb in female adult, 110~150 g/L;
Hb in newborn (within 5 days), ≥ 200 g/L
Pregnant female, numbers of RBC and Hb are relatively less (because of more
plasma).
Dweller lived in plateau, numbers of RBC and Hb are relatively more (because of
compensation for anoxia).

20. Physiological Characteristics and
Functions of RBC
a.
b.
Characteristics of RBC
Permeability: semi permeable membrane, gas and urea freely
passing through, negative ions easily in or out of RBC, and positive
ions not. There are Na-K ATPase as pump on the membrane of RBC
and low-temperature-stored plasma easily has high kalium. Why?
Plasticity and metamorphose:
Plasticity and metamorphose depend on: 1) surface area-cubage ratio, 2)
viscosity of Hb, 3) membrane elasticity and viscosity.

21. Physiological Characteristics and
Functions of RBC
Characteristics of RBC
c. Suspension stability: it cab be described by erythrocyte
sedimentation rate (ESR) which is RBC descending distance
per hour and suspension stability is inverse proportion to
ESR.
Normal value of ESR: male, 0~15 mm/h; female, 0~20 mm/h.
ESR and clinic: some diseases bring about rouleaux formation
(mainly involved in plasma component, e.g. globulin,
fibrinogen, cholesterol) and speed up ESR.

22. Physiological Characteristics and
Functions of RBC
Characteristics of RBC
d.
Osmotic fragility: Changes in RBC put into lower osmotic salty
solution.
Osmotic fragility of aged RBC is large and easily results in rupture
(hemolysis and ghost cell).
Isosmotic solution, e.g. 0.85% NaCl, 1.4%NaHCO 3, 5% glucose, etc.
Isotonic solution, e.g. 0.85% NaCl
Isosmotic solution does not equal to isotonic solution.
Isosmotic solution, isotonic solution and clinic

23. Physiological Characteristics and
Functions of RBC
Functions of RBC
•
RBC can be used for transportation of
O2 and CO2 in the blood.
•
RBC can be served as pH buffer.

24. Erythropoiesis
• Hemopoietic material for erythropoiesis:
iron (Fe++) and protein, [reason for anemia]
• Influencing factors of RBC maturity:
Vitamin B12 and folic acid (DNA metabolism),
[clinic relation]
• Process of erythropoiesis:
Hemopoietic stem cells→multi systemic hemopoietic progenitor cells→RBCcommitted progenitor cells (BFU-E→CFU-E)→original RBC→ earlier infantile
RBC→medium-term infantile RBC→terminal infantile RBC→reticular RBC→mature
RBC→blood for circulation.
This process requires 6~7 days.
[mitosis several times] [apoptosis]

25. Place for Erythropoiesis
Main place for Erythropoiesis is bone marrow. An
other place is liver.

26. Regulation of Erythropoiesis
• 0.8% of total RBCs has self renewal, that is to say, 160×106 RBC
production every minute.
• Burst forming unit-erythroid, BUF-E, important to earlier
erythropoiesis, depends on stimulation of burst promoting
activity, BPA outside body. BPA made by leucocyte is a
glycoprotein whose molecular weight is about 25000~40000
• Colony forming unit-erythroid, CFU-E, important to terminal
erythropoiesis, depends on erythropoietin, EPO which is also a
glycoprotein, molecular weight, 34000, plasma concentration 10
pmol/L, half life 5 hours, increasing release when anoxia.

27. Regulation of Erythropoiesis

28. Life and breakage of RBC
• Life-span: 120 days, about 4 months, each RBC circulates 27 km
averagely in vessels, short life-span for aged RBC
• Breakage: places are liver, spleen and lymphatic node, and after
breakage, Hb released from RBC immediately combine with
plasma α2-globulin (Hb touched protein) which is taken in by
liver for iron reuse.
• Hb, very toxic if it get into blood, normally, it can be
metabolized into bile pigment in liver.
• Clinic relation.

29. Physiological Changes in Numbers
of Leukocyte
• Newborn: Number is higher, 15×109/L, after birth 3 or 4 days to 3
months, being about 10×109/L, mainly, neutrophil, 70%; secondarily,
lymphocyte.
• Circadian changes: Number of WBC is more in the afternoon than in the
morning.
• Food taking, ache and mood excitation: Number of WBC is remarkably
higher.
• Heavy exercise and laboring: Increasing numbers, about 35×109/L,
return to original level after action stop.
• Terminal pregnancy of female: Numbers changes in 12~17×109/L, and
during parturition, 34×109/L, and after parturition 2~5 days, number
return to original level.

30. Normal Value and Function of Platelet
•
•
Normal value: 100×109 ~ 300×109, range from 6%~10%
Normal changes: more number in the afternoon than in the morning, more
in winter than in spring, more in the venous blood than capillary, after
sport↑, pregnacy↑.
• *Functions:
1. It maintains capillary endothelial cells smooth and
integrated (repairing endothelium and providing
nutrition).
2. It is involved in physiological hemostasis.
• Platelet and clinic relation:
decrease of platelet, abnormal immune reaction, will results in hemorrhage
or bleeding, purpuric symptom.

31. Life- Span and Breakage of Platelet
• Life-span: Averagely, 7~14 days in the blood.
It can be consumed when it displays
physiological functions.
• Breakage: Aged platelet can be processed by
phagocytosis in liver, spleen and lymphatic
node.

32. Physiological Hemostasis

33. Blood Clotting Factor
Factor Name
Plasma
Concentration
Synthesizing
Half life Chromosome
site
I Fibrinogen
3000
Liver
II Prothrombin
100
Liver (with Vit K)
III Tissue factor
Endothelial cell
IV Ca2+
100
V Proaccelerin
10
Endothelial cell, platelet
Ⅶ Proconvertin
0.5
Liver (with Vit K)
Ⅷ Antihemophilic factor,AHF
0.1
Liver
Ⅸ Plasma thromboplastic
5
Liver (with Vit K)
component,PTC(Christmas factor)
Ⅹ Stuart-Prower Factor
10
Liver (with Vit K)
Ⅺ Plasma thromoboplastin
5
Liver
antecedent,PTA
Ⅻ Contact factor or Hageman factor 40
Liver
XIII Fibrin-stabilizing factor
10
Liver, platelet
- High-molecular weight
80
Liver
kininogen,HMW-K
- Prekallikrein,Pre-K or Fletcher factor 35
Liver
site
4~5 d
3d
12~15 h
4~7 h
8~10 h
24 h
2d
2~3 d
4
11
1
13
Ⅹ
Ⅹ
13
4
24 h
8d
-
5
6,1
3
-
4

34. Body
sites to
palpate
pulse
Fig. 19.11

35. Principles of Animal Physiology
Circulatory Systems
Circulatory Fluids
•Blood Cell Production (Hemopoiesis)

36. 1) Erythrocytes (continued): Disorders
•
•
Anemia – blood has abnormally low oxygen-carrying capacity
– It is a symptom rather than a disease itself
– Blood oxygen levels cannot support normal metabolism
– Signs/symptoms include:
• fatigue, paleness, shortness of breath, and chills
Types
– Hemorrhagic anemia – result of loss of blood
– Hemolytic anemia – prematurely ruptured RBCs
– Aplastic anemia – destruction/inhibition of red bone marrow
– Iron-deficiency anemia results from lack of iron
– Pernicious anemia results from either deficiency of vitamin B 12 or lack of
intrinsic factor needed for absorption of B12 Treatment is intramuscular injection
of B12
– Thalassemias – absent or faulty globin chain in Hb
– Sickle-cell anemia – results from a defective gene & causes RBCs to become
sickle-shaped in low oxygen situations

37. 2) Leukocytes (continued): Granulocytes
• Granulocytes – neutrophils, eosinophils, and basophils
– Are larger and usually shorter-lived than RBCs
– Have lobed nuclei
– ALL are phagocytic cells
• Three types
A. Neutrophils
B. Eosinophils
C. Basophils
Neutrophils
Eosinophils
Basophil

38. 2. Leukocytes (continued):
Agranulocytes
• Agranulocytes
– Lack visible cytoplasmic granules
– Are similar structurally, but are functionally distinct and
unrelated cell types
• Two types:
– A. Lymphocytes
– B. Monocytes:
Lymphocyte
Monocyte

39. Summary of Formed Elements
Table 17.2.1

40. Summary of Formed Elements
Table 17.2.2

41. Physiological Factors Affecting Red
Cell Count
* Age: it is high in newly born infants and low in old
individuals
* Sex: it s higher in males than in females for two
reasons:
a. androgens stimulate the production of RBC
b. women lose blood via menstration
* High altitude
41