MMSC 200 Chapter 13

Blood System

Blood

Transports nutrients, gases, and wastes, to and from the cells of the body

Other transported items

Chemical messengers, Blood proteins, white blood cells, and platelets

Composition of Blood

Cells and Plasma

Cells

Red blood cells, white blood cells, and Platelets

Plasma

Water, protein, sugar, salts, hormones, lipids, vitamins

Plasma

the liquid, cell-free part of the blood, that has been treated with anti-coagulants.

Serum

the liquid part of the blood after coagulation, therefore, devoid of clotting factors as fibrinogen

Serum= plasma - fibrinogen

If Clotting Factors (Fibrinogen and Prothrombin) are needed (for treating patients), they shall be preserved in _______, by treating whole blood with anticoagulants

plasma

1. Formed Elements (Cells):

These include white blood cells, which fight infections, and platelets, which help stop bleeding by forming clots. White blood cells are important for both innate (general) and acquired (targeted) immunity

2. Serum (Fluid part of blood):

• Serum is the clear liquid that remains after blood has clotted (no clotting factors).

• It contains: Minerals, Salts, Proteins like complement proteins, which help fight infections.

3. Clotting Factors:

• These include fibrinogen and prothrombin, which help blood clot.

• If you add clotting factors to serum, you get plasma.

Plasma = Fluid (called serum) + clotting factors

___ is the liquid fraction in which the clotting factors are removed (emptied) in the blood

Serum

___ is the liquid fraction in which the clotting factors are still present in the blood

Plasma

The liquid portion staying above the blood clot after centrifugation is _____

Serum

Blood Cell Types

Erythrocytes, Leukocytes, Thrombocytes

Erythrocytes

red blood cells transport oxygen and remove CO2

Leukocytes

white blood cells. Fight off infections

Thrombocytes

platelets; clot blood

Types of White Blood Cells

Granulocytes and Agranulocytes

Granulocytes (contain granules in their cytoplasm)

• Neutrophils: Kill germs by eating them (phagocytes); most common WBC

• Eosinophils: Fight parasites and worms with toxic chemicals

• Basophils: Help in allergic reactions; become mast cells in tissues

Agranulocytes (lack visible granules)

• Monocytes- are further matured into effector cells in tissues called macrophages.

• Macrophages are better phagocytes, compared to the original monocytes

• Lymphocytes- control the immune response; make antibodies to antigens

Hematopoiesis

The process of making blood cells in the bone marrow

The liquid portion of the blood tube where the specimen was taken from shall be best named as____

Plasma

In order to make blood smear and view the individual blood cell, what type of specimen shall be used

lower layer of the tube that was added with anticoagulants

Which of the following cells are agranulocytes?

Lymphocytes and Monocytes

Which of the following cells are granulocytes?

Neutrophils, Eosinophils, Basophils

The following leukocytes are made by the myeloid stem cell, EXCEPT____

Neutrophils, Monocytes, Eosinophils, Basophils, Red blood cells & platelets EXCEPT Lymphocytes

Interactions between the activated (also called sensitized) mast cells (originated from basophils) and the allergen associated-IgE antibodies can trigger allergic reactions (like hay fever).

Mast cells (which come from basophils) can cause allergic reactions like hay fever when they interact with IgE antibodies that recognize allergens.

Phagocyte

Cells that eat germs (pathogens and debris). There are two main types- Neutrophils and Macrophages

Neutrophils (PMNs- Polymorphonuclear Leukocytes)

• Found in the blood

• Fast-acting, first responders to infection

• Contain antimicrobial granules

  Short-lived but highly effective at killing microbes

Macrophages

• Develop from monocytes in blood

• Once monocytes enter tissues, they become macrophages

• Live longer and are stronger than neutrophils

• Help show germs to lymphocytes to start the immune response

Phagocytosis Steps

1. Attachment:

   • The phagocyte uses tiny finger-like extensions (filopodia) to grab the germ

2. Membrane Movement:

   • The cell membrane wraps around the germ, pulling it inside

3. Phagosome Formation:

   • The germ is enclosed in a bubble inside the cell called a phagosome.

Order of Arrival at Infection

Neutrophils are the first group of phagocytes arriving at infection sites, followed by monocytes that can be further activated into macrophages.

Blood Clotting

• Coagulation: Process that forms a fibrin clot to stop bleeding

• Anti-coagulants: Medicines that prevent clotting, such as Heparin, Warfarin (Coumadin).

Tests to check clotting

• PT (Prothrombin Time):

  Checks the extrinsic pathway (outside the blood vessel).

• PTT (Partial Thromboplastin Time):

  Checks the intrinsic pathway (inside the blood vessel).

Coagulation Cascade

A series of steps where blood proteins activate each other to form a clot. It has two pathways:

1. Intrinsic pathway (starts inside blood vessels)

2. Extrinsic pathway (starts outside blood vessels)

• Both pathways meet at the common pathway to form a fibrin clot that stops bleeding.

Idiopathic Thrombocytopenic Purpura (ITP)

• An autoimmune disease with antibodies that attack platelets, the cells that help blood clot. This often happens after a viral infection.

• Characterized by purpuric rashes and an increased tendency to bleed

• Lab tests reveal low platelet count (thrombocytopenia) with normal bone marrow and the absence of other causes of thrombocytopenia.

Symptoms of ITP

• Purpura: These are larger purple or red patches on the skin caused by bleeding underneath. They look like fresh blood spots.

• Petechiae: These are tiny, pinpoint-sized red dots on the skin caused by small bleeding spots.

Disorders of Blood Clotting

• Hemophilia: excessive bleeding caused by missing clotting factors (like Factor VIII or IX).

  • Bleeding often happens inside joints (like ankles and knees

• Hypercoagulation: Excessive coagulation caused by overly activated coagulation cascade.

  • Can happen when blood vessels are damaged (like in atherosclerosis)

• Purpura: Small bleeding spots (pinpoint hemorrhages) and blood collecting under the skin

Blood Types and Antigens

• Type A:

  • Has A antigens on red blood cells

  • Has anti-B antibodies in the blood

• Type B:

  • Has B antigens

  • Has anti-A antibodies

• Type AB:

  • Has both A and B antigens

  • Has no antibodies

  • Can receive blood from anyone (universal recipient)

• Type O:

  • Has no A or B antigens

  • Has both anti-A and anti-B antibodies

  • Can donate to anyone (universal donor)

Rh Factor:

• About 85% are Rh positive (have Rh antigen)

• About 15% are Rh negative (no Rh antigen)

Other Blood Group Systems

Examples: Kell, Duffy, Kidd, M, N, P, S, Lutheran, Lewis, Diego, Cartwright...

Total of about 30 different blood group systems known.

Diseases of Erythrocytes

1. Iron Deficiency Anemia

Cause: insufficient dietary intake, impaired absorption of iron, or iron loss from bleeding

Effect: Lack of iron intake or retention results in poor synthesis of hemoglobin in erythrocytes and decreased in number and the size of erythrocytes

2. Aplastic anemia

Cause: Bone marrow fails to produce blood cells because it lacks enough hematopoietic stem cells. Causes include the exposure to chemicals, drugs, radiation, infection, immune disease, and heredity.

Diagnosis: Confirmed by a bone marrow biopsy. Normal bone marrow has 30-70% stem cells, but in aplastic anemia, most are gone and replaced by fat

3. Sickle cell

Cause: Genetic disorder (recessive inheritance). Mutation: Glutamine → Valine at 6th position of the beta (ß) chain of hemoglobin

Effect: Red blood cells become abnormally shaped (sickle-shaped). These sickle cells break down easily (hemolysis)

Symptoms:

• Hemolytic anemia: low red blood cells due to destruction.

• Jaundice: yellow skin from broken-down red cells.

• Splenomegaly: enlarged spleen because spleen destroys sickle cells.

4. Pernicious Anemia

Cause:

• Body cannot absorb vitamin B12 properly because of missing intrinsic factor.

• Intrinsic factor is a protein made by gastric parietal cells in the stomach.

• Vitamin B12 absorption happens in the ileum (part of small intestine)

Effect: Lack of vitamin B12 causes fewer mature red blood cells

Common Reasons:

1. Autoimmune attack destroys gastric parietal cells (so no intrinsic factor is made).

2. Autoantibodies block or inactivate intrinsic factor.

5. Thalassemia

Cause:

• Genetic disorder (autosomal recessive).

• Problem making enough hemoglobin due to defects in either:

  • Alpha (α) globin chains OR

  • Beta (β) globin chains

Effect:

• Makes abnormal red blood cells.

• Less hemoglobin and fewer red blood cells.

• Leads to microcytic anemia (small red blood cells).

• Severity can be mild or severe.

• May need regular blood transfusions.

Normal Hemoglobin:

• Made of 4 protein chains: 2 α + 2 β chains.

Common In:

• People with Mediterranean ancestry

Thalassemia Inheritance

Autosomal recessive disorder

6. Hemochromatosis

Cause:

• Inherited autosomal recessive disorder.

• Causes excess iron buildup in the body (iron overload).

Treatment:

• Regular phlebotomy (bloodletting) to remove extra iron.

7. Hereditary Spherocytosis

Cause:

• Gene changes affect proteins that keep red blood cells their normal shape.

• Inherited as dominant or recessive.

Effect:

• Red blood cells become round instead of donut-shaped.

• Round cells are stiff and get stuck in small blood vessels.

• They break down easily in the spleen, causing anemia.

Symptoms:

• Anemia (low red blood cells)

• Yellow skin (jaundice)

• Big spleen (splenomegaly)

• Feeling tired (fatigue)

Treatment:

• Removing the spleen (splenectomy) to stop red blood cell breakdown.

diseases of erythrocyte

1. Iron Deficiency Anemia

Cause: Not enough iron (poor diet, bleeding, or poor absorption)

Effect: Less hemoglobin → small, pale red blood cells → fatigue

2. Aplastic Anemia

Cause: Bone marrow fails to make blood cells (due to radiation, chemicals, infection, or genetic reasons)

Diagnosis: Bone marrow biopsy shows mostly fat, not stem cells

3. Sickle Cell Anemia

Cause: Genetic mutation (Glutamic acid → Valine in hemoglobin beta chain)

Effect: Red cells become sickle-shaped, break easily

Symptoms: Anemia, Jaundice, Enlarged spleen (splenomegaly)

4. Pernicious Anemia

Cause: Can’t absorb Vitamin B12 (due to lack of intrinsic factor from stomach cells)

Effect: Fewer mature red blood cells (big, immature ones instead)

Often due to: Autoimmune attack on stomach cells

5. Thalassemia

Cause: Genetic disorder (defect in alpha or beta hemoglobin chains)

Effect: Less hemoglobin → smaller red blood cells (microcytic anemia)

Treatment: May need frequent blood transfusions

6. Hemochromatosis

Cause: Genetic disorder → iron overload

Effect: Too much iron builds up in the body

Treatment: Blood removal (phlebotomy)

7. Hereditary Spherocytosis

Cause: Inherited problem with red cell membrane proteins

Effect: Round, stiff red cells that break in the spleen

Symptoms: Anemia, jaundice, large spleen, tiredness

Treatment: Spleen removal (splenectomy)

Summary for Types of Anemia

Hereditary spherocytosis – red cells are less biconcave and fragile.
Pernicious anemia – large, immature megaloblasts.
Normal red blood cells – biconcave shape.
Thalassemia – target cells, hemoglobin concentration is low.
Sickle cell anemia – crescent-shaped, distorted, fragile cells.

Variation of RBCs (Anisocytosis & Anisochromasia)

• Anisocytosis
  - Refers to increased variation in the size of red blood cells (RBCs).

• Anisochromasia:
  - Means different-colored RBCs. Caused by varying hemoglobin levels in the cells

• Paler cells = less hemoglobin

• Darker cells = more hemoglobin

Poikilocytosis

Red blood cells (erythrocytes) have varied shapes.

Polycythemia Vera

• A blood disorder with too many blood cells (red, white, and platelets).

• Caused by a gene defect: JAK2V617F

What Happens

• Too many red blood cells → thicker blood

• Too many platelets → increased clotting

Symptoms

• Itchy skin (especially after a hot shower)

• Burning pain in hands or feet

• Skin may look red or blue

Treatment Options

• Chemotherapy- to lower red blood cells and platelets

• Blood donation- (monthly) to reduce blood volume

• Hemodialysis- less common

Diseases of White Blood Cells

1. Granulocytosis

• Too many granulocytes (a type of white blood cell) in the blood.

• Happens because of infections or leukemia.

• Types:

  • Neutrophilia (too many neutrophils)

  • Eosinophilia (too many eosinophils)

  • Basophilia (too many basophils)

Granulocytopenia

• Too few granulocytes (a type of white blood cell)

• Causes: bone marrow failure, autoimmune disease

Mononucleosis ("Mono")

• A viral infection that causes high lymphocyte count and swollen lymph nodes (especially in the neck)

• Main cause:

  Epstein-Barr Virus (EBV)

• Can also be linked to other infections like: Toxoplasma gondii (a parasite)

Cancers of Blood Cells: Leukemia

• Too many abnormal (cancerous) WBCs in the blood and bone marrow

• Can be acute (fast-growing) or chronic (slow-growing)

• Can affect myeloid or lymphoid cells

Types of Leukemia

• Acute myelogenous leukemia (AML)

• Acute lymphocytic leukemia (ALL)

• Chronic myelogenous leukemia (CML)

• Chronic lymphocytic leukemia (CLL)

Bone Marrow cancer:

Multiple myeloma: Malignant neoplasm of bone marrow. Malignant B lymphocytes destroy bone tissue and cause overproduction of immunoglobulins

A cancer of plasma cells (a type of B lymphocyte) in the bone marrow. Plasma cells become cancerous and multiply uncontrollably.

These cells make too many abnormal antibodies (called monoclonal immunoglobulins).

They damage bones and weaken the immune system.

Bleeding Time Test

• medical test to check how well a person’s platelets (blood-clotting cells) are working

• It involves making a patient bleed then timing how long it takes for them to stop bleeding

• Normal bleeding time shall be < 10 minutes

Erythrocyte Sedimentation Rate (ESR)

• A test that measures how fast red blood cells (RBCs) settle at the bottom of a test tube in 1 hour.

• non-specific test — it shows inflammation but does not pinpoint the cause

How ESR works?

• When inflammation is present, proteins like fibrinogen cause RBCs to stick together forming stacks called rouleaux.

• These stacked RBCs settle faster because they are heavier.

When is ESR high?

is increased in inflammation, pregnancy, anemia, autoimmune disorders (such as rheumatoid arthritis and lupus), and infections

Apheresis

A medical procedure that separates blood into parts, removes a specific component, and returns the rest back to the person.

How apheresis works?

a medical technology in which the blood of a donor (or a patient) is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation. It is thus an extracorporeal (outside of body) therapy

Common uses for apheresis

stem cell donation and the removal of auto-immune antibodies.

Autologous Blood Transfusion

• Collecting blood from a patient and giving it back to the same patient when needed.

• Common Uses:

  • Before cardiac surgery

  • During chemotherapy

How it differs from Allogenic Transfusion

• Autologous: Blood comes from the same person

• Allogenic: Blood comes from a different donor

Advantages

• Reduces risk of infection

• Saves scarce blood supply

• Keeps patient’s own hematopoietic (blood-forming) stem cells

Bone Marrow Biopsy

A test where a small sample of bone marrow is taken with a needle to examine under a microscope. To check for infections, diseases, or problems in the bone marrow

Where is the sample taken from?

Larger bones such as: Spine, Breastbone (sternum), Hips, Ribs, Legs, Skull

-blasto

immature

-poikilo

irregular, varied

-lytic

to reduce, destroy

kary/o

nucleus

-phoresis

carrying, transmission

-gen

giving rise to, producing

-chromo

color

-poiesis

formation

-crit

separate

-myelo

spinal cord, bone marrow

eosino

red, rosy

-oid

resembling, derived from

-penia

deficiency