BLOOD AND ITS SIGNIFICANCE

INTRODUCTION-

Blood is red liquid that circulates in the arteries and veins of humans and other vertebrate animals, carrying
oxygen to and carbon dioxide from the tissues of the body. It is a type of liquid connective tissue.

PROPERTIES-

 Colour: It is an opaque fluid and it is red in colour. Arterial blood is scarlet red & venous blood is
purple red.
 Volume:5 litres (Normal adult)
 Specific Gravity:
1. Of total blood: 1.052 to 1.061
2. Of blood cells: 1.092 to 1.101
3. Of plasma: 1.022 to 1.026
 Viscosity: blood is 5 times more viscous than water. Mainly due to red blood cells & plasma proteins.
 Reaction & pH: Slightly alkaline and its pH in normal condition is 7.4

FUNCTION OF BLOOD-

 Nutrient function: nutritive substances like glucose, amino acids, lipids and vitamins derived from
digested food are absorbed from gastrointestinal tract and carried by blood to different parts of the body
for growth and for production of energy.
 Respiratory function: transport of respiratory gases is done by the blood. The oxygen is carried from
the alveoli of lungs to different tissues and carbondioxide is carried from tissues to alveoli.
 Transport of hormones and enzymes: the hormones and some of the enzymes are carried by blood to
different parts of the body from the source of secretion.
 Regulation of water balance: Water content of the blood is freely interchangeable with interstitial
fluid. This helps in the regulation of water content of the body.
 Regulation of acid base balance: the plasma proteins and haemoglobin function as buffers and help in
regulation of acid base balance.
 Regulation of body temperature: because of the high specific heat of blood, it is responsible for
maintaining the thermo regulatory mechanism in the body i.e., the balance between heat loss and heat
gain in the body.
 Storage function: water and some important substances like proteins, glucose, sodium and potassium
are constantly required by the tissue.
 Defensive mechanism: Neutrophils and monocytes engulf the bacteria by phagocytosis. Lymphocytes are
involved in immunity. Eosinophil's are responsible for detoxication, disintegration and removal of foreign
proteins.
 Excretory function: waste products formed during various metabolic reactions in the tissues are
removed by blood and carried to the excretory organs like kidney, skin, liver, etc.
COMPOSITION OF BLOOD

 Blood contains formed elements called blood cells & liquid portion known as plasma.
 Blood cells: Also called the formed elements. These are as follows:
 Red blood cells or erythrocytes.
 White blood cells or leucocytes.
 Platelets or thrombocytes.

PLASMA

PLASMA PROTEINS
Normal values of the plasma proteins are:
Introduction: Plasma proteins are:
 Total proteins : 7.3 g/dL (6.4 to 8.3 g/dL)
 Serum albumin  Serum albumin : 4.7 g/dL(Mol. Wt- 69,000)
 Serum globulin  Serum globulin : 2.3 g/dL ( mol wt- 1,56,000)
 Fibrinogen  Fibrinogen : 0.3 g/dL(mol wt-4,00,000 )

FUNCTION OF PLASMA PROTEINS

 Role in coagulation of blood

 Role in defense mechanism of body
 Role in maintenance of osmotic pressure in blood:
 Role in regulation of acid-base balance
 Role in erythrocyte sedimentation rate
 Role in suspension stability of red blood cells
 Role as reserve proteins
ERYTHROCYTES

NORMAL VALUE:

 RBC count ranges between 4 and 5.5 million/cu mm of blood.

 In adult males, it is 5 million/cu mm and
 In adult females, it is 4.5 million/cu mm

MORPHOLOGY

NORMAL SHAPE: Normally, the RBCs are disk shaped and biconcave (dumbbell shaped). Central portion is
thinner and periphery is thicker. The biconcave contour of RBCs has some mechanical and functional
advantages.

 Advantages of Biconcave Shape of RBCs

 Biconcave shape helps in equal and rapid diffusion of oxygen and other substances into the interior
of the cell.
 Large surface area is provided for absorption or removal of different substances.
 Minimal tension is offered on the membrane when the volume of cell alters.
 Because of biconcave shape, while passing through minute capillaries, RBCs squeeze through the
capillaries very easily without getting damaged.

NORMAL SIZE

 Diameter : 7.2 μ (6.9 to 7.4 μ).

 Thickness : At the periphery it is thicker with 2.2 μ and at the center it is thinner with 1 μ. This
difference in thickness is because of the biconcave shape.
 Surface area : 120 sq. μ.
 Volume : 85 to 90 cu μ.

NORMAL STRUCTURE:

 Red blood cells are non-nucleated. Only mammal, which has nucleated RBC is camel.
 Other organelles such as mitochondria and Golgi apparatus also are absent in RBC.
 Because of absence of mitochondria, the energy is produced from glycolytic process.

PROPERTIES

 ROULEAUX FORMATION: When blood is taken out of the blood vessel, the RBCs pile up one
above another like the pile of coins..
 SPECIFIC GRAVITY: Specific gravity of RBC is 1.092 to 1.101.
 PACKED CELL VOLUME: Packed cell volume (PCV) is the proportion of blood occupied by RBCs
expressed in percentage. It is also called hematocrit value. It is 45% of the blood and the plasma
volume is 55%.

FUNCTION OF RBC

 Transport of Oxygen from the Lungs to the Tissues

 Transport of Carbondioxide from the Tissues to the Lungs
 Buffering Action in Blood
 In Blood Group Determination
VARIATION IN RBC

Variations In Number Of Red Blood Cells

Polycythemia

1. physiological polycythemia(Age, Sex, High altitude, Muscular exercise, Emotional conditions

2. Pathological Polycythaemia
a. Primay(Primary polycythemia is otherwise known as polycythemia vera. It is a disease
characterized by persistent increase in RBC count above 14 million/cu mm of blood.)
b. Secondary(This is secondary to some of the pathological conditions (diseases)

Variations In Size Of Red Blood Cells

 Microcytes (smaller cells)( Iron-deficiency anemia, Prolonged forced breathing, Increased osmotic
pressure in blood.)
 Macrocytes (larger cells) (Megaloblastic anemia, Decreased osmotic pressure in blood.)
 Anisocytes (cells with different sizes)( pernicious anemia)

Variations In Shape Of Red Blood Cells

 Crenation: Shrinkage as in hypertonic conditions.

 Spherocytosis: Globular form as in hypotonic conditions.
 Elliptocytosis: Elliptical shape as in certain types of anemia.
 Sickle cell: Crescent shape as in sickle cell anemia.
 Poikilocytosis: Unusual shapes due to deformed cell membrane. The shape will be of flask,
hammer or any other unusual shape.

Variations In Structure Of Red Blood Cells

 PUNCTATE BASOPHILISM: Striated appearance of RBCs,It occurs in conditions like lead poisoning.
 RING IN RED BLOOD CELLS: This is also called the Goblet ring. This appears in the RBCs in certain
types of anemia.
 HOWELL-JOLLY BODIES: In certain types of anemia, some nuclear fragments are present in the
ectoplasm of the RBCs. These nuclear fragments are called Howell-Jolly bodies.
ERYTHROPOESIS

DEFINITION:

 Erythropoiesis is the process of the origin, development and maturation of erythrocytes.

 Hemopoiesis or hematopoiesis is the process of origin, development and maturation of all the blood
cells.

SITE OF ERYTHROPOIESIS

1. IN FETAL LIFE- In fetal life, the erythropoiesis occurs in three stages:

 Mesoblastic Stage- During the first two months of intrauterine life, the RBCs are produced from
mesenchyme of yolk sac.
 Hepatic Stage -From third month of intrauterine life, liver is the main organ that produces RBCs.
Spleen and lymphoid organs are also involved in erythropoiesis.
 Myeloid Stage During the last three months of intrauterine life, the RBCs are produced from red bone
marrow and liver.

2. IN NEWBORN BABIES, CHILDREN AND ADULTS

 In newborn babies, growing children and adults, RBCs are produced only from the red bone marrow.
 Up to the age of 20 years: RBCs are produced from red bone marrow of all bones (long bones and all
the flat bones).
 After the age of 20 years: RBCs are produced from membranous bones like vertebra, sternum, ribs,
scapula, iliac bones and skull bones and from the ends of long bones. After 20 years of age, the shaft of
the long bones becomes yellow bone marrow because of fat deposition and looses the erythropoietic
function.

STAGES-

 Proerythroblast
 Early normoblast
 Intermediate normoblast.
 Late normoblast
 Reticulocyte
 Matured erythrocyte.
FACTORS NECESSARY FOR ERYTHROPOIESIS

„ GENERAL FACTORS MATURATION FACTORS

 Erythropoietin  Vitain B-12

 Thyroxine  Intrinsic Factor
 Hemopoietic growth factors  Folic Acid
 Vitamins.

FACTORS FOR FORAMTION OF HEMOGLOBIN

 First class proteins and amino acids

 Iron
 Copper
 Cobalt and nickel
 Vitamins
ANEMIA

INTRODUCTION: Anemia is the blood disorder, characterized by the reduction in:

 Red blood cell (RBC) count
 Hemoglobin content
 Packed cell volume (PVC).
Generally, reduction in RBC count, hemoglobin content and PCV occurs because of:
 Decreased production of RBC
 Increased destruction of RBC
 Excess loss of blood from the body.
CLASSIFICATION

Anemia is classified by two methods:

 Morphological classification
 Etiological classification.
SIGNS AND SYMPTOMS OF ANEMIA

 SKIN AND MUCOUS MEMBRANE: Color of the skin and mucous membrane becomes pale. Paleness is
more constant and prominent in buccal and pharyngeal mucous membrane, conjunctivae, lips, ear lobes,
palm and nail bed. Skin looses the elasticity and becomes thin and dry. Thinning, loss and early
grayness of hair occur. The nails become brittle and easily breakable.
 CARDIOVASCULAR SYSTEM: There is an increase in heart rate (tachycardia) and cardiac output. Heart
is dilated and cardiac murmurs are produced. The velocity of blood flow is increased.
 RESPIRATION: There is an increase in rate and force of respiration.
 Sometimes, it leads to breathlessness and dyspnea (difficulty in breathing).
  DIGESTION: Anorexia, nausea, vomiting, abdominal discomfort and constipation are common. In
pernicious anemia, there is atrophy of papillae in tongue. In aplastic anemia, necrotic lesions appear in
mouth and pharynx.
 METABOLISM: Basal metabolic rate increases in severe anemia.
 KIDNEY: Renal function is disturbed. Albuminuria is common.

ORAL MANIFESTATION OF ANEMIA

Pernicious anemia/vitamin B12 deficiency anemia:

 The patients with pernicious anemia usually complaint of burning sensation in the lips, mucosal sites
and tongue (glossopyrosis).
 The tongue and mucosa may be smooth (because of papillary atrophy in case of tongue) or may have
patchy areas of erythema.
 In literature, cases with aphthous like ulcerations, dysphagia and taste alteration have also been reported.
Aplastic anemia:
 The oral manifestations of aplastic anemia may be the very first clinical symptoms of the disease and are
directly associated to pancytopenia.
 The common features include petechial purpuric spots or frank mucosal hematomas of oral mucosa at
any site, while gingival hemorrhage may be seen in some cases, these findings are seen because of
platelet deficiency.
 Ulcerative lesions of oral mucosa and pharynx are seen as the result of lack of resistance of infection due
to neutropenia.

Iron deficiency anemia:

 Glossitis, glossodynia, angular cheilitis, erythematous mucositis, oral candidiasis, recurrent oral ulcers
and burning mouth are the common oral complaints and iron deficiency anemia should be suspected in
any such case.

Plummer Vinson syndrome:

 It is also known as Patterson–Brown–Kelly syndrome, and is characterized by iron deficiency anemia
along with atrophic glossitis or angular cheilitis and dysphagia due to pharyngoesophageal ulcerations
and esophageal webs. It is also associated with koilonychias or spoon nails.

Sickle cell anemia:

 It is characterized by various oro-facial manifestations which include, “step-ladder” trabeculae pattern
enamel hypomineralization, calcified canals, diastema, increased overbite and increased overjet.
 Anesthesia or paresthesia of the mental nerve and asymptomatic pulp necrosis may also be seen.
Osteomyelitis of mandible is one common complication Interruption of blood supply may lead to
anesthesia of inferior alveolar nerve.
Thalassemia:
 The oral manifestation of thalassemia include overdevelopment of maxilla and mandible secondary to
bone marrow hyperplasia, which leads to prominent cheekbones, sunken nose and labially inclined
maxillary incisors, giving rise to incompetent lips, this representation is referred to as “rodent or
chipmunk facies”.