3. Introduction
Properties of blood
Composition of blood
Functions of blood
Red blood cells
Erythropoiesis
4/15/2014 3BLOOD AND ITS COMPONENTS
5. Coagulation of blood
Test for clotting
Bleeding time
Clotting time
Prothrombin time
Partial Prothrombin time
Thrombin time
Bleeding disorders
4/15/2014 5BLOOD AND ITS COMPONENTS
6. Connective tissue in fluid form
Fluid of life
Fluid of growth
Fluid of health
4/15/2014 6BLOOD AND ITS COMPONENTS
7. Color
Volume
Reaction and pH
Specific gravity
Viscosity
4/15/2014 7BLOOD AND ITS COMPONENTS
8. Blood cells
RBC
WBC
Platelets
Plasma
Serum
4/15/2014 8BLOOD AND ITS COMPONENTS
10. Plasma –
Straw colored clear liquid part of the blood
Contains 91-92% water and 8-9% solids
Serum –
Clear straw colored fluid that is left after blood
has been clotted.
Serum is same as plasma but only difference
serum is devoid of fibrinogen ( its absent because
fibrinogen is converted into fibrin during blood
clotting).
4/15/2014 10BLOOD AND ITS COMPONENTS
11. MOLECULAR WEIGHT:-
Albumin:69,000
Globulin:1,56,000
Fibrinogen:4,00,000
ONCOTIC PRESSURE –
The plasma proteins are responsible for the
oncotic or osmotic pressure. Normally it is about
25 mm Hg.
SPECIFIC GRAVITY-
The specific gravity plasma proteins is
1.026.
BUFFER ACTION –
Hydrogen ions is responsible for buffer
action. The plasma protein have 1/6th of
total buffering action of blood.
4/15/2014 11BLOOD AND ITS COMPONENTS
12. Nutrient function
Respiratory function
Excretory function
Transport of hormones and enzymes
Regulation of water balance
Regulation of acid – base balance
Regulation of body temperature
Storage function
Defensive function
4/15/2014 12BLOOD AND ITS COMPONENTS
13. Non – nucleated cells
Normal value
4 and 5.5 millions per cu mm of blood
Males – 5 millions/ Cu mm
Females – 4.5 millions/ Cu mm
4/15/2014 13BLOOD AND ITS COMPONENTS
14. Morphology of RBC
Disk shaped and biconcave
Advantages of biconcave shape of RBC
Normal size
Diameter – 6.9 – 7.4µ
Thickness – Periphery – 2.2µ
and centre - 1µ
Surface area – 120 sq. µ
Volume – 85 - 90 cu.µ
4/15/2014 14BLOOD AND ITS COMPONENTS
15. Rouleaux formation
Specific gravity
1.092 to 1.101
Packed cell volume
Suspension stability
Lifespan of RBC – 120 days. After the lifetime
the senile RBC are destroyed in
reticuloendothelial system.
4/15/2014 15BLOOD AND ITS COMPONENTS
16. Transport of oxygen from lungs to the tissues
Transport of CO2 from tissues to the lungs
Buffering action in blood – Hb acts as buffer
In blood group determination
4/15/2014 16BLOOD AND ITS COMPONENTS
18. Physiological variations
Increase in RBC count
Age
Gender
High altitude
Muscular exercise
Emotional conditions
Increased environmental temp.
After meals
Decrease in RBC count
High barometric pressure
During sleep – all the activities decreases
Pregnancy – decrease in ECF vol. – increase in plasma
vol. resulting in hemodilution.
4/15/2014 18BLOOD AND ITS COMPONENTS
19. Birth – 8 to10
millions/cc
Count decreases
causing
physiological
jaundice
Infants and
growing children
have increased
count
4/15/2014 19BLOOD AND ITS COMPONENTS
20. Before
puberty and
menopause
count is same
as males
During
reproductive
age the
count is less
than that of
males
4/15/2014 20BLOOD AND ITS COMPONENTS
21. Temporary
increase in
RBC count
after exercise
mild hypoxia
and
contraction of
spleen.
Spleen stores
RBC.
Hypoxia
increases the
sympathetic
activity
resulting in
secretion of
adrenaline.
Adrenaline
contracts the
spleen and
hence RBC
are produced
4/15/2014 21BLOOD AND ITS COMPONENTS
22. High altitude
hypoxia
Stimulation of
kidney
Production of
erythrpotein
Stimulation of
bone marrow
Production of
RBC
Emotional
conditions
Increased
sympathetic activity
Increased secretion
of adrenaline
Contraction of
spleen
Release of RBC
4/15/2014 22BLOOD AND ITS COMPONENTS
23. Pathological variations
Pathological polycythemia
RBC count increases 7millions/cc of blood
Two types:
1.Primary
2.Secondary
4/15/2014 23BLOOD AND ITS COMPONENTS
24. Persistent increase in RBC count above 14
millions/cc of blood.
Always associated with increased white blood
cell count above 24ooo/cc of blood.
Occurs in myeloproliferative disorders like
malignancy of red bone marrow
4/15/2014 24BLOOD AND ITS COMPONENTS
25. Secondary to some of the pathological
conditions:
Respiratory disorders like emphysema
Congenital heart disease
Ayerza’s disease – hypertrophy of right ventricle
and obstruction of blood flow to lungs.
Chronic carbon monoxide poisoning
Poisoning by chemicals like phosphorus, and
arsenic
Repeated mild hemorrahages
4/15/2014 25BLOOD AND ITS COMPONENTS
26. Process of origin, development and
maturation of erythrocytes.
4/15/2014 26BLOOD AND ITS COMPONENTS
28. Changes during Erythropoiesis
Reduction in size of RBC
Disappearance of nucleoli and nucleus
Appearance of hemoglobin
Change in the cytoplasm properties of the
cytoplasm
4/15/2014 28BLOOD AND ITS COMPONENTS
29. STAGES OF ERYTHROPOIESIS
The various stages between stem cells and
matured red blood cell are;
Proerythroblasts
Early normoblasts
Intermediate normoblasts
Late normoblasts
Reticulocytes
Matured erythrocytes
4/15/2014 29BLOOD AND ITS COMPONENTS
32. RBCs after 120 days
Fragile
Membranes of RBC rupture
Phagocytized by Reticulo endothelial system
Tissue macrophages
Kupffer cells
Spleen
FATE OF RBC
4/15/2014 32BLOOD AND ITS COMPONENTS
33. Heme Globin Amino acid
pool- reuse
Free Iron Straight chain of
4 pyrole nuclei
Transported in
blood by transferrin
Reused
4/15/2014 33BLOOD AND ITS COMPONENTS
34. Straight chain of 4 pyrole nuclei
Biliverdin
Free Bilirubin (released by Macrophages)
Combination with plasma Albumin
Blood Interstitial fluids
Liver kidney-- Nil
Free Bilirubin
HEME OXYGENASE
BILIVERDIN REDUCTASE
4/15/2014 34BLOOD AND ITS COMPONENTS
35. The rate at which the erythrocytes
settle down.
Methods:
Westergren’s method
Wintrobe’s method
4/15/2014 35BLOOD AND ITS COMPONENTS
36. Normal values:
Westergren's method
Males – 3 to 7 mm
Females – 5 to 9 mm
Infants – 0 to 2 mm
Wintrobe’s method
Males – 0 to 9 mm
Females – 0 to 15 mm
Infants – 0 to 5 mm
4/15/2014 36BLOOD AND ITS COMPONENTS
37. Physiological variation
Age – less in children and infants
Gender – more in females than in males
Menstruation – increases because of loss of blood
Pregnancy – from 3rd to paturition ESR increases
because of hemodilution
4/15/2014 37BLOOD AND ITS COMPONENTS
38. Pathological variation
Increased in
Tuberculosis
All types of anemia except sickle cell anemia
Malignant tumors
Rheumatoid arthritis
Rheumatic fever
Liver diseases
Decreased in
Allergic conditions
Sickle cell anemia
Polycythemia
Severe leukocytosis
4/15/2014 38BLOOD AND ITS COMPONENTS
39. ESR is an easy, inexpensive and non specific
test , which helps in diagnosis as well as in
prognosis.
Certain disorders like:
Pulmonary TB
Rheumatoid arthritis
Polymyalgia rheumatica
Temporal arteritis
4/15/2014 39BLOOD AND ITS COMPONENTS
40. Specific gravity of RBC – Increases so ESR also
increases
Rouleaux formation – increases the ESR
Increase in size of RBC – increases so ESR also
increases
Viscosity of blood – increases so ESR
decreases
RBC count – increases so viscosity increases
so ESR decreases.
4/15/2014 40BLOOD AND ITS COMPONENTS
43. Hb is the iron containing coloring matter of
RBC
The main function of red cells is to carry O2
to the tissues and to return carbon dioxide
(CO2) from tissues to the lungs.
In order to achieve this gaseous exchange the
red cells contain the specialized protein
haemoglobin.
Each red cell contains approximately 640
million Hb molecules.
4/15/2014BLOOD AND ITS COMPONENTS 43
44. Average Hb in blood is 14 to 16g/dL
Age
At birth – 25g/dL
After 3rd month – 20g/dL
After 1 year – 17g/dL
From puberty onwards – 14 – 16g/dL
Gender
In adult males – 15g/dL
In adult females – 14.5g/dL
4/15/2014BLOOD AND ITS COMPONENTS 44
45. Transport of gases
Oxygen
Oxygen + Hb known as oxygenation occurs resulting in
the formation of oxyHb
Iron in this state remains as ferrous
Its an unstable compound and the combination is
reversible
Carbon dioxide
Carboxyhaemoglobin is formed
Unstable and reversible
Hb has 250 times affinity for Co2 as compared to
oxygen
4/15/2014BLOOD AND ITS COMPONENTS 45
47. IRON
In ferrous form, unstable and loose form
In some abnormal conditions gets converted into
ferric form – stable form
Porphyrin
Pigment part
Formed by 4 pyrrole rings
Attached by methane bridges
Globin
4 polypeptide chains
2 alpha and 2 beta
4/15/2014BLOOD AND ITS COMPONENTS 47
51. Hb A Hb A2 Hb F
structure a2b2 a2d2 a2g2
Normal % 96-98 % 1.5-3.2 % 0.5-0.8 %
4/15/2014 51BLOOD AND ITS COMPONENTS
52. Haem synthesis starts with
the condensation of
glycine and succinyl
coenzyme A under the
action of a rate limiting
enzyme -aminolaevulinic
acid synthase.
-ALA will be formed.
Pyridoxal phosphate (vit.
B6) is a coenzyme for this
reaction.
4/15/2014 52BLOOD AND ITS COMPONENTS
53. A series of biochemical
reactions will follow.
Two molecules of -ALA
condense to form a pyrrole
called porphobilinogen
(PBG)
Four PBG condense to form
a tetrapyrrole
uroporphyrinogen III.
UPG III is then converted
to coproporphyrinogen.
4/15/2014 53BLOOD AND ITS COMPONENTS
54. CPG then changes to
protoporphyrin which
ultimately combines with
iron in the ferrous state
(Fe2+) to form haem.
Iron is brought to the
developing red cells by a
carrier protein (
transferrin) which attaches
to special binding sites on
the surface of these cells.
Transferrin releases iron
and returns back to
circulation.
4/15/2014 54BLOOD AND ITS COMPONENTS
55. Each molecule of haem
combines with a globin
chain.
A tetramer of four
globin chains each with
its own haem group in
a pocket is formed to
make up a
haemoglobin molecule.
4/15/2014 55BLOOD AND ITS COMPONENTS
56. Heme Globin Amino acid
pool- reuse
Free Iron Straight chain of
4 pyrole nuclei
Transported in
blood by transferrin
Reused
4/15/2014 56BLOOD AND ITS COMPONENTS
57. Straight chain of 4 pyrole nuclei
Biliverdin
Free Bilirubin (released by Macrophages)
Combination with plasma Albumin
Blood Interstitial fluids
Liver kidney-- Nil
Free Bilirubin
HEME OXYGENASE
BILIVERDIN REDUCTASE
4/15/2014 57BLOOD AND ITS COMPONENTS
70. Hemoglobin S –
Found in SC anemia
Alpha chains are normal and beta chains are
abnormal
Hemoglobin C –
Beta chains are abnormal
In people with HB C diseases characterized by mild
hemolytic anemia and splenomegaly
Hemoglobin E
Beta chains are abnormal
Hemoglobin M
Abnormal Hb present in the form of methHB
Occurs due to mutation
Blue baby syndrome
4/15/2014BLOOD AND ITS COMPONENTS 70
71. HB in thalessemia and related disorders
Abnormal Hb are present
Polypeptide chains are decreased
4/15/2014BLOOD AND ITS COMPONENTS 71
73. Thalassemia is an inherited blood disorder
that causes mild or severe anemia.
The anemia is due to reduced hemoglobin
and fewer red blood cells than normal.
Hemoglobin is the protein in red blood cells
that carries oxygen to all parts of the body.
4/15/2014 73BLOOD AND ITS COMPONENTS
74. In people with thalassemia, the genes that
code for hemoglobin are missing or variant
(different than the normal genes). Severe
forms of thalassemia are usually diagnosed in
early childhood and are lifelong conditions.
4/15/2014 74BLOOD AND ITS COMPONENTS
75. Alpha and beta, are named for the two
protein chains that make up normal
hemoglobin.
The genes for each type of thalassemia are
passed from parents to their children. Alpha
and beta thalassemias have both mild and
severe forms.
4/15/2014 75BLOOD AND ITS COMPONENTS
76. Four genes are involved in making the alpha
globin part of hemoglobin—two from each
parent.
Alpha thalassemia occurs when one or more
of these genes is variant or missing.
4/15/2014 76BLOOD AND ITS COMPONENTS
77. People with only one gene affected are
called silent carriers and have no sign of
illness.
People with two genes affected (called
alpha thalassemia trait, or alpha
thalassemia minor) have mild anemia and
are considered carriers.
People with three genes affected have
moderate to severe anemia, or
hemoglobin H disease.
Babies with all four genes affected (a
condition called alpha thalassemia major,
or hydrops fetalis) usually die before or
shortly after birth.
4/15/2014 77BLOOD AND ITS COMPONENTS
78. If two people with alpha thalassemia trait
(carriers) have a child, the baby could have a
mild or severe form of alpha thalassemia or
could be healthy.
4/15/2014 78BLOOD AND ITS COMPONENTS
79. Two genes are involved in making the beta
globin part of hemoglobin—one from each
parent. Beta thalassemia occurs when one or
both of the two genes are variant.
4/15/2014 79BLOOD AND ITS COMPONENTS
80. If one gene is affected, a person is a carrier
and has mild anemia. This condition is called
beta thalassemia trait, or beta thalassemia
minor.
If both genes are variant, a person may have
moderate anemia (beta thalassemia
intermedia, or mild Cooley’s anemia) or severe
anemia (beta thalassemia major, or Cooley’s
anemia).
Cooley’s anemia, or beta thalassemia major, is
a rare condition. A survey in 1993 found 518
Cooley’s anemia patients in the United States.
Most of these persons had the severe form of
the illness, but there may be more who are
not diagnosed.
4/15/2014 80BLOOD AND ITS COMPONENTS
81. 1. Thalassemia is passed from parents to
children through their genes.
2. Thalassemia affects both males and
females.
3. Beta thalassemias affect people of
Mediterranean origin or ancestry
(Greek, Italian, Middle Eastern) and
people of Asian and African descent.
4. Alpha thalassemias mostly affect people
of Southeast Asian, Indian, Chinese, or
Filipino origin or ancestry.
4/15/2014 81BLOOD AND ITS COMPONENTS
82. The symptoms of thalassemia depend on the
type and severity of the disease.
Symptoms occur when not enough oxygen
gets to various parts of the body due to low
hemoglobin and a shortage of red blood cells
in the blood (anemia).
4/15/2014 82BLOOD AND ITS COMPONENTS
83. 1. Fatigue (feeling tired) and weakness
2. Pale skin or jaundice (yellowing of the skin)
3. Protruding abdomen, with enlarged spleen and
liver
4. Dark urine
5. Abnormal facial bones and poor growth
Babies with all four genes affected (a condition called
alpha thalassemia major, or hydrops fetalis) usually
die before or shortly after birth
4/15/2014 83BLOOD AND ITS COMPONENTS
84. 1. Thalassemia is diagnosed using blood
tests, including a complete blood count (CBC)
and special hemoglobin studies.
2. A CBC provides information about the amount
of hemoglobin and the different kinds of
blood cells, such as red blood cells, in a
sample of blood. People with thalassemia
have fewer red blood cells than normal and
less hemoglobin than normal in their blood.
Carriers of the trait may have slightly small
red blood cells as their only sign.
3. Hemoglobin studies measure the types of
hemoglobin in a blood sample.
4/15/2014 84BLOOD AND ITS COMPONENTS
85. is usually diagnosed in early childhood because
of signs and symptoms, including severe anemia.
Some people with milder forms of thalassemia
may be diagnosed after a routine blood test
shows that they have anemia.
Doctors suspect thalassemia if a child has
anemia and is a member of an ethnic group that
is at risk for thalassemia.
4/15/2014 85BLOOD AND ITS COMPONENTS
86. To distinguish anemia caused by iron deficiency
from anemia caused by thalassemia, tests of the
amount of iron in the blood may be done.
Iron-deficiency anemia occurs because the body
doesn’t have enough iron for making
hemoglobin.
The anemia in thalassemia occurs not because
of a lack of iron, but because of a problem with
either the alpha globin chain or the beta globin
chain of hemoglobin. Iron supplements do
nothing to improve the anemia of thalassemia,
because missing iron is not the problem.
4/15/2014 86BLOOD AND ITS COMPONENTS
87. Family genetic studies are also helpful in
diagnosing thalassemia. This involves taking a
family history and doing blood tests on family
members.
Prenatal testing can determine if an unborn
baby has thalassemia and how severe it is likely
to be.
4/15/2014 87BLOOD AND ITS COMPONENTS
88. Treatment for thalassemia depends on the type
and severity of the disease.
People who are carriers (they have
thalassemia trait) usually have no symptoms
and need no treatment.
4/15/2014 88BLOOD AND ITS COMPONENTS
89. Those with moderate forms of thalassemia (for
example, thalassemia intermedia) may need
blood transfusions occasionally, such as when
they are experiencing stress due to an infection.
If a person with thalassemia intermedia worsens
and needs regular transfusions, he or she is no
longer considered to have thalassemia
intermedia; instead, the person is said to have
thalassemia major, or Cooley’s anemia.
4/15/2014BLOOD AND ITS COMPONENTS 89
90. 1. Those with severe thalassemia have a
serious and life-threatening illness.
2. They are treated with regular blood
transfusions, iron chelation therapy, and
bone marrow transplants.
3. Without treatment, children with severe
thalassemia do not live beyond early
childhood.
4/15/2014 90BLOOD AND ITS COMPONENTS
91. Severe forms of thalassemia are treated by
regular blood transfusions.
A blood transfusion, given through a needle in a
vein, provides blood containing normal red
blood cells from healthy donors. In thalassemia
treatment, blood transfusions are done on a
schedule (often every 2–4 weeks) to keep
hemoglobin levels and red blood cell numbers at
normal levels. Transfusion therapy can allow a
person with severe thalassemia to feel better,
enjoy normal activities, and live longer.
4/15/2014 91BLOOD AND ITS COMPONENTS
92. Transfusion therapy, while lifesaving, is
expensive and carries a risk of transmitting viral
and bacterial diseases (for example, hepatitis).
Transfusion also leads to excess iron in the blood
(iron overload), which can damage the liver,
heart, and other parts of the body. To prevent
damage, iron chelation therapy is needed to
remove excess iron from the body.
4/15/2014 92BLOOD AND ITS COMPONENTS
93. Iron chelation therapy uses medicine to
remove the excess iron that builds up in the
body when a person has frequent blood
transfusions. If the iron is not removed, it
damages body organs, such as the heart and
liver.
4/15/2014 93BLOOD AND ITS COMPONENTS
94. The medicine, deferoxamine, works best when
given slowly under the skin, usually with a small
portable pump overnight.
This therapy is demanding and sometimes is
mildly painful, so some people stop chelation
therapy. A pill form of iron chelation
therapy, deferasirox, was approved in November
2005 for use in the United States.
People who have iron overload should not take
vitamins or other supplements that contain
iron.
4/15/2014 94BLOOD AND ITS COMPONENTS
95. Surgery may be needed if body organs, such
as the spleen or gall bladder, are affected.
For example, if the spleen becomes inflamed
and enlarged, it may be removed.
If gallstones develop, the gall bladder may
be removed.
4/15/2014 95BLOOD AND ITS COMPONENTS
96. Bone marrow or stem cell transplants have
been used successfully in some children with
severe thalassemia. This is a risky
procedure, but it offers a cure for those
children who qualify.
4/15/2014 96BLOOD AND ITS COMPONENTS
97. People with severe thalassemia are more likely
to get infections that can worsen their anemia.
They should get an annual flu shot and the
pneumonia vaccine to help prevent infections.
Folic acid is a B vitamin that helps build red
blood cells. People with thalassemia should
take folic acid supplements.
Researchers are also studying other
treatments, such as gene therapy and fetal
hemoglobin.
4/15/2014 97BLOOD AND ITS COMPONENTS
99. They are the measurements that describe the size
and oxygen carrying protein (hemoglobin) content
of red blood cells. The indices are used to help in
the differential diagnosis of anemia.
The relationships between the hematocrit, the
hemoglobin level, and the RBC are converted to
red blood cell indices through mathematical
formulas.
The indices include these measurements: mean
corpuscular volume (MCV); mean corpuscular
hemoglobin (MCH); and mean corpuscular
hemoglobin concentration (MCHC).
4/15/2014 99BLOOD AND ITS COMPONENTS
100. The MCV is the average volume of the RBC in cubic
microns
MCV = Hct (%) X 10 / RBC count (10-12/L)
Example: Hct = 45%, RBC count = 5.0x1012/L;
therefore,
MCV = 45.0x10 / 5.0 = 90fL
Cells of normal size (MCV is 80-100cu. microns) are
called normocytic, smaller cells are microcytic, and larger
cells are macrocytic.
4/15/2014 100BLOOD AND ITS COMPONENTS
101. Microcytic cells are found in:
Patients with iron deficiency anemia.
Thalassemia.
Macrocytic cells are found in:
Patients with liver disease or hypothyroidism
When there is asynchrony in RBC maturation (termed
megaloblastic anemia's).
Folate and vitamin B12 deficiencies.
4/15/2014 101BLOOD AND ITS COMPONENTS
102. The MCH is the average weight of Hb in an RBC,
expressed in the units of picograms (pg), or 10-12g:
MCH = Hb (g/dL) X 10 / RBC count (1012/L).
The reference range for adults is 28-32pg.
The MCH is not generally considered in the
classification of anemia's.
Example:
Hb=16.0 g/fl.
RBC count=5.0x1012/l.
MCH=16.0x10 / 5.0 = 32.0pg
4/15/2014 102BLOOD AND ITS COMPONENTS
103. The MCHC is the average concentration of Hb
in each individual erythrocyte. The
units used are gram per deciliter (formerly
referred to as a percentage).
MCHC = Hb (g/dL) X 100 / Hct (%).
Example: Hb =16 g /dl, Hct = 48%;
MCHC=16 X 100 / 48 = 33.3g/dL
4/15/2014 103BLOOD AND ITS COMPONENTS
104. Values of normochromic cells range from 32 to
37g/dL.
Hypochromic cells are less than 32g/dL, and
those of hyperchromic cells are greater than
37g/dL.
Hypochromic erythrocytes occur in thalassemia
and iron deficiency.
Because there is a physical limit to the amount of
hemoglobin that can fit in a cell, there is no
hyperchromic category, a cell does not really
contain more than 37g/dL of Hb, but its shape
may have become spherocytic, making the cell
appear full.
4/15/2014 104BLOOD AND ITS COMPONENTS
105. Hematocrit is defined as the volume occupied by
erythrocytes in a given volume of blood and is
usually expressed as a percentage of the volume of
the whole blood sample.
The hematocrit may also be referred to as Packed
Cell Volume (PCV).
4/15/2014 105BLOOD AND ITS COMPONENTS
106. Principle:
• The hematocrit is usually determined by spinning a blood-
filled capillary tube in a centrifuge.
Specimen:
• Venous blood anticoagulated with EDTA or capillary blood
collected directly into heparinized capillary tubes can be
used. Specimens should be centrifuged within 6 hours of
collection.
• Hemolyzed samples cannot be used for testing.
4/15/2014 106BLOOD AND ITS COMPONENTS
107. Reagents and equipment:
• Capillary tubes, heparinized for finger sticks (red tip) or
plain for anticoagulated blood (blue tip)
• Clay-type tube sealant
• Microhematocrit centrifuge
• Microhematocrit reader
• Kimwipes or gauze
4/15/2014 107BLOOD AND ITS COMPONENTS
108. Procedure:
1. Fill two capillary tubes approximately three quarters
full with blood anti-coagulated with EDTA or heparin.
Alternatively, blood for heparinized capillary tubes
may be collected by capillary puncture. Wipe any
excess blood from the outside of the tube.
2. Seal the end of the tube with the colored ring with
nonabsorbent clay
4/15/2014 108BLOOD AND ITS COMPONENTS
109. 3. Balance the tubes in the centrifuge with the clay ends
facing the outside away from the center, touching the
rubber gasket.
4. Tighten the head cover on the centrifuge and close
the top. Activate the centrifuge for 5 minutes
between 10,000 and 15,000 rpm
5. Determine the HCT by using a microhematocrit
reading device Read the level of RBC packing.
6. The values of the two Hcts should agree within 2%
(0.02).
4/15/2014 109BLOOD AND ITS COMPONENTS
117. Excessive loss of blood
Acute and chronic
Acute
Accident
Decreased RBC count causes hypoxia which stimulates
the bone marrow to produce more no. of RBC.
Chronic
Internal or external bleeding over a long period of
time
Like peptic ulcer, purpura, hemophilia and
menorrhagia
4/15/2014 117BLOOD AND ITS COMPONENTS
118. Excessive destruction of RBC
Two types:
Extrinsic
Liver failure
Renal disorder
Hypersplenism
Burns
Infections
Intrinsic
Generally inherited like sickle cell anemia and
thalassemia
4/15/2014 118BLOOD AND ITS COMPONENTS
119. Sickle cell anemia/ SS disease/ Sickle cell
disease
inherited blood disorder
Alpha chains normal
beta chains abnormal
Mainly seen in black race
and in central Africa where
falciparum malaria is endemic
4/15/2014 119BLOOD AND ITS COMPONENTS
120. Anemia – severe hemolytic anemia.
Vaso – occlusive phenomenon – recurrent
vaso – occlusive due to obstruction to
capillary blood flow by sickled cells upon
deoxygenation or dehydration
Micro infarcts – abdomen, chest , and joints
Macro infarcts – bones, liver, kidney, spleen
Other symptoms like impaired growth and
development and increased susceptibility to
infection due to markedly impaired splenic
function.
4/15/2014BLOOD AND ITS COMPONENTS 120
124. Country Men (%) Women
(%)
Pregnant
Women (%)
S. India 6 35 56
N. India 64 80
Latin America 4 17 38
Israel 14 29 47
Poland 22
Sweden 7
USA 1 13
4/15/2014 124BLOOD AND ITS COMPONENTS
125. Functions as electron transporter; vital
for life
Must be in ferrous (Fe+2) state for activity
In anaerobic conditions, easy to maintain
ferrous state
Iron readily donates electrons to oxygen
Ferric (Fe+3) ions cannot transport
electrons or O2
Organisms able to limit exposure to iron
had major survival advantage
4/15/2014 125BLOOD AND ITS COMPONENTS
126. Blood Loss
Gastrointestinal Tract
Menstrual Blood Loss
Urinary Blood Loss (Rare)
Blood in Sputum (Rarer)
Increased Iron Utilization
Pregnancy
Infancy
Adolescence
Polycythemia Vera
Malabsorption
Tropical Sprue
Gastrectomy
Chronic atrophic gastritis
Dietary inadequacy (almost never sole cause)
Combinations of above
4/15/2014 126BLOOD AND ITS COMPONENTS
127. Stainable Iron, Bone Marrow Aspirate
Serum Ferritin - Low in Iron Deficiency
Desaturation of transferrin
Serum Iron drops
Transferrin (Iron Binding Capacity)
Increases
Blood Smear - Microcytic, Hypochromic;
Aniso- & Poikilocytosis
Anemia
4/15/2014 127BLOOD AND ITS COMPONENTS
128. Fatigue - Sometimes out of proportion to
anemia
Atrophic glossitis
Pica
Koilonychia (Nail spooning)
Esophageal Web
4/15/2014 128BLOOD AND ITS COMPONENTS
129. Correction of the disorder
Correction of iron deficiency
Oral therapy
Ferrous sulphate – 6omg TID
Ferrous gluconate – 37mg
Parenteral therapy
Dose is calculated by multiplying the
grams of Hb below normal with 250.
Given as single IM iron
dextran(interferon)
Repeated inj. Of iron sorbitol citrate
(jectofer)
4/15/2014 129BLOOD AND ITS COMPONENTS
131. Diet & nutrition education
eat more fruits and vegetable
no coffee or tea with meals
programmes should be targeted
to at risk groups
reduce phytic content of cereals
and legumes by fermentation
4/15/2014 131BLOOD AND ITS COMPONENTS
132. Short term approach:
supplementation with iron tablets.
Long-term approach:
food fortification with iron either for the whole
population (blanket fortification) or for specific
target groups like infants. It requires no
cooperation from users unlike taking iron
supplements.
4/15/2014 132BLOOD AND ITS COMPONENTS
133. Iron compounds used in food fortification can
be divided into 4 groups
Freely water soluble (ferrous sulphate,
gluconate, lactate & ferric ammonium
citrate).
Poorly water soluble (ferrous fumarate,
succinate & saccharate).
Water insoluble (ferric pyrophosphate, ferric
orthophosphate & elemental iron).
4/15/2014 133BLOOD AND ITS COMPONENTS
134. The major factors governing the choice of
iron compound include:
Bioavailability
Organoleptic problems
Cost
Safety
Ideally we should go for a safe, cheap, highly
bioavailable iron, which causes no
organoleptic side-effects
4/15/2014 134BLOOD AND ITS COMPONENTS
135. Freely water soluble iron are the most
bio-available, but causes unacceptable
colour & flavour change in many foods.
Insoluble iron compounds are inert with
no organoleptic effects but it is poorly
absorbed
Cost-wise elemental iron is the cheapest,
ferrous sulphate costs 10 times more, but
most expensive is EDTA
Safety is of concern with EDTA & Bovine
Hb only because of potential problems
4/15/2014 135BLOOD AND ITS COMPONENTS
137. 137
1. Vit. B12 deficiency
2. Folic acid deficiency
3. Other causes like drugs which interfere with DNA
synthesis, acquired defects of hemopoietic stem
cells and congenital enzyme deficiency.
4/15/2014BLOOD AND ITS COMPONENTS
138. 138
Vitamin B12 Folic acid
Sources meat, fish green
vegetables, yeast
Daily requirement 2-5 ug 50-100 ug
Body stores 3-5 mg (liver) 10-12mg (liver)
Places of absorption ileum duodenum and proxymal
segment of
small intestine
4/15/2014BLOOD AND ITS COMPONENTS
140. First described by Addison in 1855 as a
chronic disorder of middle aged and elderly
individual of either sex in which intrinsic
factor secretion ceases owing to atrophy of
the gastric mucosa.
Average age is 60yrs.
Bur rarely can be seen in children ( juvenile
pernicious anemia)
Mostly seen in northern European descent
and American blacks and is uncommon in
South European.
4/15/2014BLOOD AND ITS COMPONENTS 140
141. Insidious onset and progress slowly
Mainly due to Vit. B12 deficiency
Anemia, Glossitis, Neurological abnormalities
( neuropathy, subacute combined
degeneration of the spinal cord, retrobulbar
neuritis) GIT manifestation ( diarrhoea,
anorexia, weight loss, dyspepsia),
hepatospleenomegaly, congestive heart
failure and hemorrhagic manifestation
4/15/2014BLOOD AND ITS COMPONENTS 141
142. Hypergastrinaemia
Pentagastrinaemia
Haematologic findings -
Rise in serum
bilirubin, LDH, haptoglobin, ferrritin and
iron.
Chromosomal abnormalities are frequently
present in bone marrow cells which
disappear after therapy.
4/15/2014BLOOD AND ITS COMPONENTS 142
143. Replacement therapy with vitamin B12
Vitamin B12 administration intramuscular in dose 1000 (100) μg
per day for a week , then 100 μg 2x per week for 2 weeks, 1 x
per week 100μg for month
Reticulocytosis begins 2 or 3 days after therapy started and
maximal number reached on day 5 to 8.
Serum iron monitoring, after 7-10 days of vit.B12 treatment,
If Fe deficiency is diagnosed we should start iron substitution
100 ug vit.B12 i.m. every month, regimen that must be
maintained for the rest on the patients life.
Physiotherapy for neurologic deficits and occasionally blood transfusion
Follow up early detection of cancer of the stomach
4/15/2014BLOOD AND ITS COMPONENTS 143
146. 146
1. Symptoms of anemia
2. Symptoms associated with vit. B12 or Folic acid
deficiency
neurologic manifestations (exclusivly in wit. B12 deficiency)
- megaloblastic madness or psychosis,
- subacute, combined degeneration of the
spinal cord (proprioceptive and vibratory
sensation, spinal ataxia)
gastrointestinal compraints (vit.B12 and folic acid
deficiency)
- loss of appetite
- glosstis (red, sore, smooth tongue)
- diarrhea or constipation
4/15/2014BLOOD AND ITS COMPONENTS
147. 147
1. Blood cell count:
macrocytic anemia
thrombocytopenia
leucopenia (granulocytopenia)
low reticulocyte count
2. Blood smear:
hypersegmentation of granulocytes
macroovalocytes , anisocytosis, poikilocytosis
4/15/2014BLOOD AND ITS COMPONENTS
148. 148
3. Laboratory features
indirect hyperbilirubinemia
elevation of lactate dehrogenase (LDH)
serum iron concentration- normal or increased
4. Bone marrow smear
hypercellular
increased erythroid /myeloid ratio
erythroid cell changes (megaloblasts, RBC precursor a abnormally
large with nuclear- cytoplasmic asynchrony)
myeloid cell changes (giant bands and metamyelocytes
, hypertsegmentation)
megakariocytes are decreased and show abnormal morphology
4/15/2014BLOOD AND ITS COMPONENTS
149. 149
1. Establishing megaloblastic anemia
2. History: causes of folate deficiency
3. Absence neurologic symptoms
4. Low serum and red blood cell folic acid
4/15/2014BLOOD AND ITS COMPONENTS
150. 150
FOLIC ACID DEFICIENCY ANEMIA
1. Oral administration of Ac. folicum 1 (5) mg
per day, for 3 months, and maintenance
therapy if it’s necessary.
2. Reticulocytosis after 5-7 days
3. Correction of anemia is over after 1-2
months therapy
4. Maintenance therapy if necessary
4/15/2014BLOOD AND ITS COMPONENTS