Blood

Basics

1. Blood is natural colloid,Connecting Tissue

2. pH 7.4 (Base)

3. Normal Blood pressure 120,80

4. Blood amount

   • Male: 5.5L

   • Female: 5L (Because of less Hemoglobin, less amount of blood is formed)

5. Cholesterol level 200gm/dL

6. Hemoglobin (Hb) Male 14g/dL, Female 13g/dL

(Hemoglobin stores iron, in female hemoglobin is low , so less amount of iron makes females soft , and males hard)

Blood circulatory System, introduced by William Harvey

1. Formation of Blood

   • In Bone Marrow

   • In Mother's liver's Mesoderm (for Unborn child/ Embryo, because unborn child doesnot have any proper formed bone)

2. Storage for Blood

   • Spleen

(Spleen is also called Blood bank & also Grave Yard of blood because dead RBC also stored in spleen)

1. Function of Blood

   1. Maintain Temperature

   2. Transportation

      • Gas

      • Nutrients

      • Harmful material

Blood

Composition

1. Liquid- Plasma (60%)

2. Particle- Corpuscle (40%)

Plasma

• Fibrinogen

• Prothrombin

By removing Fibrinogen and Prothrimbin, blood will look like yellow less concentrated liquid called Serum. We determine disease from serum.

Corpuscle

• RBC (Erythrocyte)

• WBC (Leukocyte)

• Platelets (Thrombocyte)

RBC

RBC (Erythrocyte)

50lakh, 120 days lifetime

• Shape circular with indentation

• red colour

• Lissome absent (Lissome consume or destroys dead cells, due to absent of lissome dead RBC floats in the blood, at last consumed by spleen)

• Nucleus absent ( Can't get DNA data from RBC)

• 95% of blood is RBC

WBC

WBC (Leukocyte)

4500-11000, 4 days lifetime

• Shape: Irregular

• colorless

• Protect against diseases. Antibody (Idetifies Harmful substance in body)

• Parts of WBC

  • 40-60% Neutrophil protect from many types of infections, particularly those involving fungi or bacteria

  • 20-40%Lymphocyte (T-cell) (Kills the harmful substance)

  • 2-8% Monocyte (Activates by antibody. Monocyte consume dead harmful bodies, and gets bigger. Thats why most big part of WBC is Monocyte .)

  • 1-4% Eosinophil

  • 0.5-1% Basophil

• Nucleus present. (Can get DNA data from WBC)

Platelet

Platelets (Thrombocyte)

2lakh , 7 dyas lifetime

• Shape like convex lens

• Nucleus absent. (can't get DNA data form platelets)

• Less platelets decreases stamina of body.

Karl Landsteiner, discovered in 1901

Two antigens: Antigen A and Antigen B

O blood group contains H antigen

Antigen on the RBC surface

Antibodies in Plasma

Even though components of blood are the same for all humans, there are various blood types. In fact, there are more than 40 blood groups, but all of them are not clinically significant.

• The ABO blood type is the most important blood type system in human blood.

• ABO blood types are also present in some other animals like chimpazes, bonobos and gorillas

• Determination Blood groups depends upon the immunological reaction between antigen and antibody

• Antigens are also called agglutinogens because of their capacity to cause agglutination of RBC.

Landsteiner Rule

If an antigen is present on RBC, the corresponding antibody will not be present in the patients plasma, under normal condition.

ABO incompatibility

Symptoms:

• mild fever

• skin disease (can cause itching)

• Sever case can lead to renal failure, shock, and death.

The immune system forms autibodies against which ever antigens. are not found on the individuals" RBCs. Thus, a group A individual will have anti B 6B individual will have auti A and agroup B basis of Rh-group: The Rhesus (RH) group locus is composed of two orelated structural gene; D and Celes that encode vied cell membrane proteins carrying the D. Cc, Ee antigens. The Rh-D-positive / negetive poly. morphism is associated with the presence on the absence of the D gene. D-gene is dominant over other every genes

Discovered by Scientist Karl Landsteiner and A.S. Weiner in 1940.

Rh factor is a type of protein on the outside of the RBC

Test occurs on Rhesus monkey's blood. Thats why name is Rh factor.

• Person having D antigen is called RH+

• without D antigen is called Rh

Significance

The Rh factor is used to indicate whether the blood of two different people is compatible when mixed or transfused.

And by detecting that we can prevent many vital disease like Erythroblastosis fetalis.

Hemolytic disease of the fetus and newborn (HDFN) or erythroblastosis fetalis.

• It is caused by the destruction of neonatal RBC cells by maternal immunoglobulin G (IgG) antibodies.

• The formation of maternal antibodies in response to a fetal antigen is called Isoimmunization

Cause

Rh incompatibility

1. when a Rh-negative mother is impregnated by a Rh+ positive father. The result can be a Rh+ positive baby.

2. Baby’s Rh antigens will be perceived as foreign invaders

3. Blood cells attack the baby, as a protective mechanism that can end up harming the child

4. first baby, Rh incompatibility isn’t as much of a concern

5. Body will create antibodies against the Rh factor. These antibodies will attack the blood cells if ever become pregnant with another Rh-positive baby.

Result

1. swollen, pale, or jaundiced after birth

2. anemia or a low RBC count

3. larger-than-normal liver or spleen

4. In severe cases, it can destroy the child.

Platelets/Thrombocyte + Air= Prothromboplastin (platelets comes in conntact with air)

• clotting or cascading process takes 4 minute

• Vitamin K, Ca promotes blood clotting

Anti-clotting

Heparin (Heparin dead when comes in contact with air, due to which blood outflows stops)

#arindam

Named for the city in which it was first discovered

The "Bombay phenotype" describes individuals whose RBCs lack the H antigen.

Genotype Explanation

Individuals with Bombay phenotype inherit the homozygous recessive (hh) genotype instead of the homozygous dominant (HH) or heterozygous (Hh) genotypes of the ABO blood group.

As the A and B antigens cannot be formed without the H antigen precursor, their red blood cells also lack these antigens.

Precautions

1. Check your blood pressure, pulse and temperature

2. Cross matching test should done before transfussion

3. compatible with recipient

4. blood should be disease free

5. Sterilized appparatus

6. hemoglobin concentration above 10 g/dL

7. Transfussion of blood must be slow. rapid infusion can cause load on heart and many complication.

Hazards

Blood transfusions are generally considered safe, but there is some risk of complications.

Common reactions include

allergic reactions, which might cause hives and itching, and fever

Severe reaction

Acute Immune Hemolytic Reaction

• when the donor blood is not a proper match

The attack triggers a release of a substance that damages the kidneys.

Symptoms include nausea, fever, chills, chest and lower back pain, and dark urine.

Anemia is defined as a low number of RBC

• low hemoglobin or hematocrit

  • Hemoglobin is the main protein in your red blood cells.

  • It carries oxygen, and delivers it throughout your body.

  • If you have anemia, your hemoglobin level will be low too. If it is low enough, your tissues or organs may not get enough oxygen. 

• Symptoms of anemia like fatigue or shortness of breath happen because your organs aren't getting what they need to work the way they should.

• Fatigue

• Weakness

• Pale or yellowish skin

• Irregular heartbeats

• Shortness of breath

• Dizziness or lightheadedness

• Chest pain

• Cold hands and feet

• Headaches

3 main reasons of anemia:

1. blood loss

2. deacreased or faulty RBC production

   1. Bone marrow and stem cell problems

   2. Iron-deficiency anemia

   3. Sickle cell anemia

   4. Vitamin-deficiency anemia

   5. Chronic anemia

3. destruction of RBC

   • Hemolytic anemia

1. Blood lossthrough bleeding internally or externally

2. Aplastic anemiadon’t have enough stem cells or have none at all

   because of genes or because bone marrow injury by medications, radiation, chemotherapy, or infection

3. Iron-deficiency anemiadon’t have enough of the mineral iron in body

   bone marrow needs iron to make hemoglobin

4. Sickle cell anemiaRBC become crescent- shaped because of a problem in genes, and red blood cells break down quickly.

5. Vitamin deficiencynot enough vitamin B12 and folate

   need two vitamins to make red blood cells b12 or folate

6. Thalassemiainherited blood disorder due to abnormal form of RBC

7. Hemolytic anemiaRBC are fragile, can’t handle the stress of traveling through body, and burst.

Treatment

1. Blood loss

   1. may surgery to find and fix the bleeding

   2. Blood transfusion

2. Aplastic anemia

   1. medication

   2. blood transfusions (in which you get blood from another person)

   3. or a bone marrow transplant (in which you get a donor’s stem cells)

3. Iron-deficiency anemia

   1. iron supplements and change your diet

4. Sickle cell anemia

   1. painkillers

   2. folic acid supplements

   3. oxygen therapy

   4. A drug called hydroxyurea (decrease sickle cell pain crises )

   5. voxelator (Oxbryta) whichcan help your red blood cells keep their proper shape.

5. Vitamin B12

   1. supplements

6. Thalassemia

   1. doesn’t usually need treatment,

   2. but in severe case, might have blood transfusions, a bone marrow transplant, or surgery.

7. Hemolytic anemia

   1. medication that will hold back your immune system.

Diagnosis

1. CBC

2. Blood Smear (cheak shape of RBC, unusual cells)

What

• Thalassemia is an inherited(বংশগত) blood disorder

• in which the body makes an abnormal form of hemoglobin

Result

• The disorder results in excessive destruction of red blood cells, which leads to anemia

Hemoglobin is the protein molecule in red blood cells that carries oxygen.

Anemia is a condition in which body doesn’t have enough normal, healthy red blood cells.

• bone deformities(বিকৃতি), especially in the face

• dark urine

• delayed growth and development

• excessive tiredness and fatigue

• yellow or pale skin

• Thalassemia can cause mild anemia.

Not everyone has visible symptoms of thalassemia. Signs of the disorder also tend to show up later in childhood or adolescence.

Cause

Abnormality or mutation in one of the genes, which involved in hemoglobin production.

Inherit this genetic abnormality from parents

• If only one of the parents is a carrier for thalassemia, child may develop a form of the disease known as Thalassemia minor. Probably won’t have symptoms, but will be a carrier

• If both of your parents are carriers of thalassemia, have a greater chance of inheriting a more serious form of the disease Thalassemia major.

Types

There are 2 main types of thalassemia:

• beta

  • occurs when body can’t produce beta globin

  • Two genes, one from each parent, are inherited to make beta globin.

• alpha

  • occurs when the body can’t produce alpha globin.

  • In order to make alpha globin, need to have four genes, two from each parent.

• blood transfusions

• bone marrow transplant

• medications and supplements

• possible surgery to remove the spleen or gallbladder

• Other small things to note down:

  • avoid taking vitamins or supplements containing iron

  • If receiving a blood transfusion, patient may also need chelation therapy.

    
    

Chelation therapy

This generally involves receiving an injection of a chemical that binds with iron and other heavy metals. This helps remove extra iron from your body.

• Sickle cell anemia, or sickle cell disease (SCD), is a genetic disease of the red blood cells (RBCs).

• Normally, RBCs are shaped like discs, which gives them the flexibility to travel through even the smallest blood vessels. However, with this disease,

• the RBCs have an abnormal crescent(অর্ধচন্দ্র) shape resembling a sickle.

• This makes them sticky and rigid and prone to getting trapped in small vessels, which blocks blood from reaching different parts of the body. This can cause pain and tissue damage.

• SCD is an autosomal recessive condition. Need two copies of the gene to have the disease. If has only one copy of the gene, That is sickle cell trait.

Symptom

• excessive fatigue or irritability, from anemia

• fussiness, in babies

• bedwetting, from associated kidney problems

• jaundice, which is yellowing of the eyes and skin

• swelling and pain in hands and feet

• frequent infections

• pain in the chest, back, arms, or leg

Types

1. Hemoglobin SS

2. Hemoglobin SC

3. Hemoglobin SB+ (beta)

4. Hemoglobin SB 0 (beta zero)

5. Hemoglobin SD, Hemoglobin SE, Hemoglobin SO

6. Sickle Cell Trait

Treatment

• The red blood cells are more likely to deform and assume the sickle shape in dehydration. Rehydration with intravenous fluids helps red blood cells return to a normal state.

• The stress of an infection can result in a sickle cell crisis. Treating underlying or associated infections is an important part of the treatment.

• Blood transfusions improve transport of oxygen and nutrients as needed.

• Supplemental oxygen is given through a mask. It makes breathing easier and improves oxygen levels in the blood.

• Pain medication is used to relieve the pain during a sickle crisis. (strong prescription pain medication like morphine.)

• (Droxia, Hydrea) helps to increase production of fetal hemoglobin. It may reduce the number of blood transfusions.

• Immunizations can help prevent infections. Patients tend to have lower immunity.

• Bone marrow transplant has been used to treat sickle cell anemia.

Home care

• Use heating pads for pain relief.

• Take folic acid supplements

• Exercise regularly and reduce stress

• Eat an adequate amount of fruits, vegetables, and whole-wheat grains to make more RBC in body.

Leukocytes (WBC) that help protect human body against illness and infection.

Increased levels of leukocytes in the blood → Leukocytosis

Types

There are five different types of leukocytosis

• Lymphocytosis

• Monocytosis

• Neutrophilia

• Eosinophilia

• Basophilia

Causes

1. allergic reaction

2. Viral infection

3. leukemia or other blood or bone marrow related cancer

4. certain type of skin disease

5. spleen removed

6. smoking

Symptoms

Common Symptoms

• fever

• pain

• difficulty breathing

• weight loss

• night sweats

Very high levels of WBC → blood become very thick → impair blood flow → Hyperviscosity syndrome

• stroke

• vision problems

• difficulty breathing

• bleeding from the intestines, mouth, or stomach

Diagnosis

CBC Test

WBC Count: Over 11,000

Treatment

Treatment is fixing the cause of Leucocytosis.

Breathing problem inhalers for asthma

Infection antibiotics for bacterial infections

Cancer cancer treatments like chemotherapy, radiation, or stem cell transplants for leukemia

Stress medications to treat stress or anxiety

Inflamation treatment for inflammatory conditions

Preventions

Not Smoking

Avoiding potential allergens

reducing stress levels

Maintaining a healthy, active lifestyle.

WBC level is lower then ideal range → Leukopenia

leukopenia is often caused by a decrease in neutrophils

some people use the terms “leukopenia” and “neutropenia” interchangeably.

Types

Neutropenia Low neutrophil level

Lymphocytopenia Low lymphocytes

Cause

1. Blood cell or bone marrow conditions (bone marrow and spleen helps in production of WBC)

2. Enlarged Spleen

3. Treatments for cancer

4. Infectious diseases (flue viral infection)

5. Autoimmune disorders

6. Malnutrition vitamin or mineral deficiencies

7. Medications side effects of many medicine

Symptoms

1. a fever of 100.4˚F (38˚C) or above

2. sweating

3. sore throat

4. cough or shortness of breath

5. an area of your body that’s become red, swollen, or painful

6. an injury that’s draining pulse

7. mouth sores or white patches in your mouth

8. painful urination

Diagnosis

1. CBC

2. erythrocyte sedimentation rate (ESR)

3. Tests for viral infections

Treatment

1. Stopping treatments or medications that cause leukopenia

2. Medicination for underlaying infections

3. Granulocyte colony-stimulating factor and other growth factors derived from bone marrow can help body to produce more WBCs.

Preventions

• Eating Well

• avoiding infections

• washing hands to stay away from germs

WBCs are mostly produced in the bone marrow

Once formed, WBCs travel through your bloodstream and lymphatic vessels to fight

infection in the body’s tissues

Types

Acute myeloid leukemia AML

Acute lymphocytic leukemia ALL

Chronic myeloid leukemia CML

Chronic lymphocytic leukemia CLL

Causes

• previous chemotherapy or radiation for other types of cancers

• genetic disorders like Down syndrome

• other blood cancer disorders

• repeated exposure to the chemical benzene, which is found in cigarette smoke

Symptoms

• excessive sweating, especially at night (called “ night sweats ”)

• fatigue and weakness that do not go away with rest

• unintentional weight loss

• bone pain and tenderness

• painless, swollen lymph nodes (especially in the neck and armpits)

• enlarged liver or spleen

• red spots on the skin, called petechiae

• bleeding easily and bruising easily

• fever or chills

• frequent infections

Treatment

Depends on the type and stage of the cancer .

It also depends on the patientʼs overall health and other medical conditions .

Some forms of leukemia grow slowly and do not need immediate treatment.

• Chemotherapy

Radiation therapy

Stem cell transplantation or bone marrow transplant

Biological or immune therapy

Targeted therapy

Purpura, also called blood spots or skin hemorrhages, refers to purple-colored spots that are most recognizable on the skin.

Types

• Non-thrombocytopenic Normal platelet levels

• Thrombocytopenic Low platelet levels

Diagnosis

Need to examine the skin

may need to test for platlets

Treatment

• medications

• Sometime need to stop medications, which impair platelet function

• In sever cases may need to do Splenectomy

Erythropoietin (EPO)

What

1. Glycoprotein Hormone

2. Produced by peritubular cells In kidney

3. Stimulates the production of RBC

4. PO2 (pertial pressureof oxygen) regulates EPO production

When secrets

PO2 level is low detected by the oxygen sensors located in the kidny

Function

Excessive Secretion leads to

• Polycythemia (excessive RBC)

• Tumor in kidney

TPO or Thrombopoetin

• Glycoprotien

• produced from liver(mianly) and kidney

• Regulates the production of platelets

• converts prothrombin to thrombin

• helps in blood clotting

Thrombopoetin regulates two process

1. Thrombocytopenia

   High plasma thrombopoeitin concentration

   acts on bone marrow

2. Thrombocytocis

   Low plasma thrombopoeitin concentration

   acts on bone marrow

Steady-state platelet production

TC Total Count

Counts total number of WBC in body

DC Differential Count

Counts the Percentage or specific amount of each type of WBC (Neutrophil, Basophil etc.)

ESR Erythrocyte Sedimentation Rate

Counts how much time takes RBC to sediminate below

PCV Packed Cell Volume

MCV Mean Corpuscular Volume

Average size or volume of RBC

MCH Mean Corpuscular Hemoglobin

average quantity of hemoglobin present in a single RBC

MCHC Mean Corpuscular Hemoglobin Concentration

average quantity of hemoglobin present in a RBC

TC Total Count

DC Differential Count

ESR Erythrocyte Sedimentation Rate

PCV Packed Cell Volume

MCV Mean Corpuscular Volume

MCH Mean Corpuscular Hemoglobin

MCHC Mean Corpuscular Hemoglobin Concentration