D. Pharm Ist Year Biochemistry and Clinical Pathology

1. D. Pharm.
BIOCHEMISTRY AND CLINICAL PATHOLOGY
Unit-5 (Therapeutics: Pathology of Blood & Urine)
Presented by
Dr. ARUN KUMAR
Principal
(M. Pharm., PDCTM, PhD)
PARMARTH COLLEGE OF PHARMACY, HAPUR

2. BLOOD
• Blood is body fluid in humans and other
animals which circulated in the body and
delivers necessary substances such as
Nutrients, Oxygen to the cells and transport
Metabolic waste products away from those
same cells.

3. • Blood has specific concentration of many
substances required for use by the tissues
or have some unwanted chemicals.
• Any change in the concentration of these
substances in blood explains the
pathological state of the body.

5. 1. PLASMA:
• Plasma is the clear, straw (yellowish)-colored liquid
portion (55%) of blood that remains after RBCs,
WBCs, platelets and other cellular components are
removed.
• It is the single largest component of human blood
which contains water (95%), salts, enzymes,
antibodies, proteins (albumin, globulin,
fibrinogen), glucose, electrolytes, CO2 and O2.
• It plays a vital role:- keeps electrolyte
concentration balanced and protects the body
from infection and other blood disorders.

6. 2. ERYTHROCYTES (RBC):
• RBCs (Red Blood Cells- life span 120 days), which
is typically a circular, biconcave disc without a
nucleus in humans.
• Erythrocytes contain the pigment haemoglobin,
which imparts the red colour to blood, and carries
oxygen from lungs to various parts and carbon
dioxide from the tissues.
• Normal haemoglobin content of blood is about
13-14g/100ml for males and 11-12g/100ml for
females.
• Normal RBC count of blood is 4.5-6.0 millions/ cu
mm.

8. Abnormal conditions due to RBC:
• ANAEMIA: it is a decrease in the total amount of
RBCs or hemoglobin in the blood, or a lowered
ability of the blood to carry oxygen.
• It may occur due to loss of blood from the body
by any injury or by peptic ulcer or during
menstruation cycle or in case of piles or other
reasons.
• Symptoms of anaemia are fatigue,
breathlessness, dyspepsia, anorexia, dizziness,
vision problem, headache and insomnia.

9. Types of Anaemia:
• Macrocytic: (Pernicious or Megaloblastic Anaemia)
Occurs due to deficiency of vitamin B12 or folic acid
in the blood. RBCs size becomes large with low
haemoglobin content.
• Microcytic: ( Hyprochromic Anaemia)
Occurs due to deficiency of Iron in blood. RBCs size
becomes small.
• Haemolytic anaemia:
Occurs due to excessive destruction of RBCs and is
caused by bacterial infection, malaria, snake bite.

10. • Aplastic anaemia:
Reduction in all types of blood cells count. In this bone
marrow is degraded due to exposure of body to
irradiation like X-rays or chemicals.
• Sickle cell anaemia:
Occurs due to faulty haemoglobin and RBC to take a
sickle shape. This is a hereditary disorder.
• Betathalassemia:
Occurs due to formation of immature nucleated RBCs in
blood which are extremely thin and fragile. This is also a
hereditary disorder.
• Polycythemia:
It is an increase in number of RBCs.

11. Erythrocyte Sedimentation Rate (ESR)
• An ESR is a type of blood test that measures how
quickly erythrocytes (RBCs) settle at the bottom of a
test tube that contains a blood sample.
• Normally, RBCs settle relatively slowly.
• A faster than normal rate may indicate inflammation
in the body.
• Normal ESR by Westergren’s method:
For men is 3-5 mm/ hr and for women & children is 4-7
mm/ hr.
• Normal ESR by Wintrobe’s method:
For men is 0-9 mm/ hr and for women & children is 0-
20 mm/ hr.

12. • Increased ESR indicates pregnancy,
menstruation, rheumatic fevers, tuberculosis,
anaemia, certain drugs, cancers etc.
• Decreased ESR, generally uncommon but is seen
in congestive heart failure, polycythemia etc.

13. 3. LEUCOCYTES (WBC):
• White Blood Cells are large, colorless, nucleated
cells of the immune system and function for
body defense.
• The normal or Total Leucocyte Count (TLC) is
about 4,000-11,000/ ml of blood.
• TLC is higher at birth around 20,000/ ml of blood
and decreases after 2nd week, and reaches the
normal count within 5-10 years of age.

14. Types of WBCs

15. • Lymphocytes:
Produced in bone marrow and directly released into
the lymphatic system.
• They are two types:-
• T- lymphocytes:
About 75% of total lymphocytes, produced in
thymus and defense against bacteria, protozoa,
viruses & fungi.
• B- lymphocytes:
Also called B-cells and responsible for the synthesis
of antibodies (immunoglobulins) thus helps in
immunity.

16. • Monocytes:
Normal count is 2-8% of blood and help as second
line of defense.
• Neutrophils:
Normal count is 50-70% of blood and help as
phagocytosis (ingesting the bacteria).
• Eosinophils:
Normal count is 1-4% of blood and help as
phagocytosis and in allergy.
• Basophils:
Normal count is less than 1% and help as
phagocytosis and in preventing blood coagulation.

17. Abnormal conditions due to WBC:
• AIDS (Aquired Immuno Deficiency Syndrome):
Caused by a virus called HLTV III (Human
Lymphocyte T-virus III). It reduces cellular immunity
by destroying T-lymphocytes.
• Leukemia:
Abnormal increase in TLC above 50,000/ ml or (cu
mm) of blood which is a cancerous condition.
• Leucopenia:
Decrease in TLC less than 4,000/ ml of blood due to
conditions like starvation, viral, bacterial infections
or bone marrow depression.

18. • Leucocytosis:
Increase in TLC above 11,000/ ml of blood due to
conditions like pregnancy, manstruation, lactation
and infections.
• Neutrophilia:
Increase in neutrophil count due to infections, tissue
destruction.
• Neutropenia:
Decrease in count due to viral infections, typhoid
fevers.
• Eosinophilia:
Increase in eosinophil count due to allergic
conditions and in worm infestations.

19. 4. PLATELETS (THROMBOCYTES):
• They are oval or spindle, non- nucleated, fragile
and very small cells of about 2-4 µ size.
• They play a vital role in formation of clot in blood
to stop bleeding.
• Normal range is about 3 lakh/ml of blood.

20. Abnormal conditions due to Platelets:
• Haemophilia:
It is due to the absence of factor VIII with normal
platelet count. Bleeding continues unstopped even
with small injuries.
• Thrombosis:
Occurance of clots in capillaries (heart muscles) due
to atherosclerosis, narrowing of blood vessels.
• Thrombocytopenia:
Platelet count is very low (less than 4,000/ ml of
blood due to anaemia, acute infections, bone
marrow diseases, mosquito bite (Dengue fever).

21. Other Problems Relating to Blood:
• Blood Sugar:
Normal glucose value in blood is 80-110 mg/ dl
(fasting) & 120- 140 mg/ dl (after meal). Higher
values described as Hyperglycemia.
• Blood Urea:
Normal range of urea in blood is 8-25 g/ liter. Excess
value indicates Uremia (impaired kidneys).
• Hypercholesterolemia:
Normal range of cholesterol in plasma is 120-200
mg/ 100 ml. Increase level can cause hardening of
blood vessels (Atherosclerosis).

22. • Alkaline Phosphatatse:
It is an enzyme and normal range in blood 13-39 units/
liter.
High level of this enzyme may be due to obstruction of
bile ducts, liver cell damage and some cancers.
• Transaminase:
Enzymes required for amino acid biosynthesis and
normal range is between 5-30 IU/ liter.
Two types-
SGPT (Serum Glutamate Pyruvic Transaminase) &
SGOT (Serum Glutamate Oxaloacetate Transaminase).
Higher level of SGPT/ SGOT means liver cirrhosis,
hypoxia & cardiac infarction.

23. • Blood Calcium:
Normal range is 8.5-10.5 mg/ 100 ml of blood. The
diseases is associated with bone mineralization,
blood coagulation and muscle sensitivity.
• Bilirubin:
RBC has a life span of 120 days. Afterwards they
break and haemoglobin to released into heme &
protein part.
Heme degraded to biliverdin, bilirubin & iron.
Bilirubin is secreted through bile into the intestine
and excreted in faeces & urine.
Normal range is 1 mg/ 100 ml.
Increase level cause hepatitis & jaundice.

24. URINE
• Urine is a clear liquid by-product of metabolism in
humans and in many other animals.
• Urine flows from the kidneys through the ureters
to the urinary bladder and excreted (1 liter/ day)
from the body through the urethra.
• Specific gravity of urine is 1.015- 1.020. Its pH is
about 5.5.
• Normal urine contains 93-97% water and 3-7%
solids like inorganic, organic constituents,
vitamins, hormones etc.

26. NORMAL CONSTITUENTS OF URINE
TYPE OF CONSTITUENT CONSTITUENT AMOUNT EXCRETED IN 24 hrs
INORGANIC
Chloride 10-15 g
Sodium 3-5 g
Phosphorous 1-1.2 g
Potassium 1-3 g
Sulphate 0.6-2 g
Calcium 100-300 mg
Magnesium 100-200 mg
Iodine 100-200 mg
Lead 0.03-0.08 mg
ORGANIC
Urea 20-35 g
Creatinine 1-1.8 g
Ammonia 0.5-1.2 g
Uric acid 0.6-1 g
Amino acids 0.15-2 g

27. ABNORMAL CONSTITUENTS OF URINE
ABNORMAL
CONSTITUENT
PATHOLOGICAL
CONDITION
CAUSES
Proteins Protinuria Severe exercise, Kidney
disease, high protein diet,
pregnancy
Glucose Glycosuria Diabetes mellitus, Endocrine
disorder
Ketone bodies Ketonuria Starvation, Diabetes,
Excessive fatty metabolism
Blood Haematuria Kidney damage, Renal
stones
Pigments (Bilirubin) Jaundice