1. Department of Periodontics I.T.S Dental College, Hospital & Research Centre Greater Noida 3rd April.2013 Moderator- Dr. Kanwarjit Singh Asi Perceptor Dr. Sachit Anand Arora Presented by: Dr. Abhishek Gakhar

2. Introduction Blood may be described as a specialized connective tissue in which there is liquid intercellular substance known as plasma & formed elements, the red blood cells, the white blood cells, the platelets suspended in the plasma.1 3. FUNCTIONS OF BLOOD Transport of respiratory gases. Transport of nutrition: it carries digested food material absorbed from the intestine to the tissue cells for utilization. It also carries nutritive material from one place of the body to the other. For instance, from the storage depots to the tissue cells.2 4. It acts as a vehicle through which the hormones, the vitamins and other essential chemicals are brought to their places of activity. Drainage of waste products: It carries waste products of cellular activity and brings them to the organ of excretion, viz, kidney, lungs, intestine, etc. 5. Maintenance of acid-base equilibrium: By its efficient buffering power (e.g., plasma proteins, reduced & oxidized hemoglobin, etc) and with the help of kidney, skin, & lungs it helps to maintain a constant reaction of the body. 6. Regulation of body temperature: the water content of blood possesses three qualities, which make it very suitable for this purpose. Due to its high specific heat it can absorb a large amount of heat & there by prevent sudden change of body temperature. High conductivity the thermal conductivity of water is higher than that of any other ordinary liquid. This helps quick distribution of heat. High latent heat of evaporation latent heat of evaporation of water is very high and since water is constantly evaporating from skin & lungs a large amount of heat is lost in this way. 7. Defensive action: blood acts as a great defensive mechanism in two ways. The white cells due to their phagocytic properties engulf bacteria and foreign particles. It develops antibodies, which combat toxic agents. By the property of coagulation it guards against haemorrhage. 8. The plasma proteins of blood have various functions. Regulation of blood pressure by changes in volume & viscosity of blood. 9. COMPOSITION OF BLOOD Blood is highly complex fluid, which is composed of two parts a liquid, called the plasma and different types of cells which remain suspended in the plasma.3 The cells are called the blood corpuscles. The plasma constitutes about 55% and the cells about 45%, of the total volume of human blood. 10. CELLS 1) Red blood corpuscles or erythrocytes (R.B.C.) 2) White blood corpuscles or leucocytes (W.B.C.) 3) Platelets or thrombocytes. 11. PLASMA 1) water 91-92% 2) Solids 8-9% a) Inorganic constituents 0.9% sodium, potassium, calcium, magnesium, phosphorus, iron, copper, etc. 12. b) Organic constituents i) Proteins- 7.5% serum albumin, serum globulin, fibrinogen, prothrombin, etc. ii) Non protein nitrogenous substances (NPN) urea, uric acid, creatine, creatinine, ammonia, amino acids, etc iii) Fats neutral fat, phospholipids, cholesterol, etc. iv) Carbohydrate glucose, etc. v) Other substances internal secretions, antibodies and various enzymes (amylases, proteases, lipases, phosphatases, etc.) vi) Coloring matter the yellow color of plasma is due to small amounts of bilirubin, carotene and xanthophyllin. 13. Physical Characteristics Sticky and metallic tasting Color: Scarlet = O2 rich; Dull red = O2 poor Heavier than H2O; 5X thicker3 pH = 7.35 - 7.45 Temp = 38C or 100.4F (higher than normal)3 8% body weight; 5 - 6 liters 14. RELATIVE VOLUME OF CORPUSCLES AND PLASMA In normal human blood, plasma volume is proportionally more than total corpuscular volume. The normal packed cell volume for males is about 45% while that in case of females is a bit lower about 40% of whole blood. The ratio of red blood corpuscles to plasma is expressed as the HAEMATOCRIT. 15. It consists of a specially prepared graduated capillary (wintrobes) tube of uniform bore in which a specimen of blood, treated with an anticoagulant, is taken. It is centrifuged at a speed of 3,000 revolutions per minute for 30 minutes, until plasma & corpuscles are completely separated, and no further shrinkage in volume. 5 16. SPECIFIC GRAVITY OF BLOOD Specific gravity of venous blood at 15C (59F) as determined by the psychometric method is given as 1.048 to 1.066 with averages of 1.052 to 1.063. The clinical average is 1.057 in males & 1.053 in females.6 There is a normal diurnal variation of about 0.003, it being generally lower in the afternoon & after meals & higher after exercise and during the night. The specific gravity of blood serum varies from 1.026 to 1.031 & that of erythrocytes is from 1.092 to 1.095. The specific gravity of fetal blood in full term is highest & that of the mother at the same time is lowest (about 1.050). The specific gravity rapidly falls after birth due to destruction of the red cells. 17. Specific gravity of blood rises3: 1. When water is lost from the body, such as in excessive sweating, diarrhoea, etc. 2. By exudation of fluid into tissues or serous cavities due to inflammation or surgical operation. 3. When water intake is inadequate. 18. It falls3: 1. When large quantity of water is taken. 2. In severe haemorrhage after which fluid is drawn in from the tissue spaces and the blood is diluted. 3. Injection of saline into veins causing dilution of blood. 19. Plasma Proteins Constitute 7-9% of plasma0 Three types of plasma proteins: albumins, globulins, & fibrinogen. Albumin accounts for 60-80% ,plasma protein made by the liver, Creates colloid osmotic pressure that draws H20 from interstitial fluid into capillaries to maintain blood volume & pressure Globulins carry lipids a globulin: Transport lipids and fat soluble vitamins. b globulin: Transport lipids and fat soluble vitamins. g globulin: Antibodies that function in immunity. Gamma globulins are antibodies Fibrinogen Constitutes 4% of plasma proteins. Important clotting factor. Converted into fibrin during the clotting process. Serum is fluid left when blood clots 20. In addition to this about 0.1% of other proteins, such as 4) Prothrombin, seromucoid, etc, are also present. Serum is the fluid part of blood after clotting. It contains only serum albumin & serum globulin. The albumin/globulin ratio (A/G) ratio is ordinarily 1.5: 1.0. Different methods of separation indicate slightly different A/G ratio. 21. Electro phoretic method of separation gives a ratio 1.2: 1.0. This ratio varies in different species but in the same species it remains almost constant in blood, lymph & serous transudations. In liver disease however due to diminished formation of albumin, the ratio may be reversed. 22. FUNCTIONS OF PLASMA PROTEINS: Essential for blood clotting: Fibrinogen & prothrombin are essential for coagulation of blood and take part in this process.4 23. Maintain colloidal osmotic pressure of blood & aid in regulating the distribution of fluid between blood & tissues. All the three proteins take part. Albumin having the smallest and the most symmetrical molecule exerts the maximum osmotic pressure. Osmotic pressure depends upon a number of molecules in the solution. Albumin has a considerably smaller molecular weight than globulin & comprise 52% of plasma protein. One gram of albumin in 100 ml will exert a pressure of 5.5 mm of Hg. Under the same conditions globulin exerts only 1.5 mm of Hg. The total colloidal O.P. varies from 25 to 30 mm of Hg & albumin is responsible for 80% of it. 24. Maintain viscosity and blood pressure. The proteins of plasma, mainly globulins due to larger molecules & asymmetry of their structure are responsible to some extent for the viscosity of blood, & viscosity is an important factoring maintaining blood pressure, which is essential for efficient heart action. Whole blood is isoviscous with 25% albumin, 15% g- globulin & 2% fibrinogen. 6 The relative viscosity of blood is 4.7 for men, 4.4 for women, 4.2 for children, that of plasma as 1.8 and that of serum as 1.5 relative to distilled water at 37C (98.6F).5 25. Concerned with erythrocyte segmentation rate (ESR). The plasma proteins exert a great influence upon the suspension stability of blood. This is chiefly dependent on fibrinogen, less on globulin and least on albumin. An increase in fibrinogen rises the sedimentation rate of red blood corpuscles by increasing the speed of rouleaux formation. It is determined by the methods of wintrobe, westergreen & cutler. 26. Act as buffers. They act as buffers in maintaining acid base balance. Act as a protein reserve. The plasma proteins serve as a storehouse from which the tissue can draw during starvation or inadequate protein diet. 5 Help carbon dioxide carriage by forming carbamino proteins. 27. Form trephones. The leucocytes prepare substances from the plasma proteins, called trephones, which are necessary for the nourishment of the tissue cells grown in culture. Antibodies. The antibodies being g-globulin in nature make up a small fraction of the globulins of plasma for defence against infection. 28. Help transport of certain substances in blood.. Plasma proteins combine with certain substances and help to carry them in the blood stream Some hormones, enzymes, and clotting factors are part of globulin fraction of plasma proteins. Iron (transferrin) & copper (ceruloplasmin) are bound to globulin fractions. 29. VISCOSITY OF BLOOD Viscosity of blood is an important factor, since; it determines the peripheral resistance of the blood flow through blood vessels and thus helps to maintain blood pressure. 6 Human blood is five times more viscous than distilled water. The viscosity of the whole blood is mainly due to cells and that of plasma is due to plasma proteins. 30. The viscosity of plasma is less than that of whole blood. The relative viscosities of water, plasma and whole blood are roughly 1, 1.8 and 4.7 respectively. Viscosity is measured by noting the time of flow of a given volume blood through a specially prepared tube (viscosimeter) and comparing the time taken by the same volume of distilled water to pass through the same tube. 31. Viscosity is affected by various factors. It depends on the amount of plasma proteins, the number & volume of corpuscles & carbon dioxide tension. Viscosity rises in: 1. Acidosis 2. Hyperglcemia 3. Hypercalcaemia 4. Polycythemia 5. Cyanosis 6. Icterus 7. Diabetes mellitus, etc., 32. Viscosity is reduced in 1. Anemia 2. Fever 3. Exercise 4. Edema 5. Malaria 6. Rise of temperature also reduces the viscosity of blood. 33. RBC The mature human erythrocyte is a circular, biconcave, non- nucleated disc. The edges are rounded and thicker than the center. Hence, the central portion appears to have a lighter shade. When viewed from the side it looks like a dumb- bell. 34. In all mammals, excepting camels, the red cells are of this type. In the camels, the shape is oval; otherwise they are same as in others. In the non- mammalian vertebrates the red cells are oval, biconvex and nucleated. The mature red cells are soft and flexible and can readily squeeze through narrow capillaries. Inside the corpuscles there is framework, chiefly composed of proteins and lipids. 35. Composition of Red Blood Cells. Each cell is composed of a colourless envelope enclosing semiliquid material, 65% water and 35% solids of which 33% is haemoglobin bound to 2 % stromal meshwork of proteins, phospholipid, cholesterol, cholesterol esters and neutral fat. Other organic substances such as urea, amino acid, creatinine, adenyl pyrophosphates etc. are also present. 36. The normal average count in adult male is taken is taken as 5 million and in female 4.5 million per cubic millimeter. In infants the count is 6 to 7 million, whereas in foetus 7.8 million. 37. Red blood cells specialisations 2) no nucleus extra space inside 3) contain haemoglobin the oxygen carrying molecule 250million molecules / cell 1) biconcave shape increases the surface area so more oxygen can be carried 38. Variations of red blood cell count under various physiological conditions. Diurnal variations- variations amounting to about 5 % occur in 24 hours. The count is lowest during sleep, then gradually rises and becomes maximum in the evening. Muscular exercise- exercise raises the count temporarily. Altitude- at higher altitude the count rises, whereas at lower altitude the count falls. High external temperature- increases the red cell count. Any condition which lowers the oxygen tension of arterial blood increases the red cell count. Injection of adrenaline and excitement increases the count. 39. Variations in size is known as anisocytosis. Red cells that are larger than normal are macrocytes., those smaller microcytes. Deviations from normal shape is poikilocytosis. 40. Stages of development There are different stages for development. Theses are follows as: Haemocytoblast (endothelial cells) Proerythroblasts (megaloblasts) Early normoblasts (early erythroblasts) Intermediate normoblasts (late erythroblasts) Late normoblasts (normoblasts) Reticulocyte Normal erythrocyte. 41. It takes about 7 days time to pass from the stage of Proerythroblasts to that of reticulocyte and another two days from reticulocyte to mature erythrocyte. Factors controlling erythropoiesis. Certain factors are necessary for the formation and maturation of red cells. They are as follows: Diet. Anoxia and erythropoietin or erythrocyte- stimulating factor (ESF). Stimulus for maturation. 42. Span of life The average span of life of a mature red blood corpuscles was formerly believed to be about 3- 4 weeks. But recent experiments indicate that is about 120 days in man. 43. Functions of Red Blood Corpuscles Respiratory- red cells carry oxygen and carbon dioxide. Acid- base balance- they help to maintain acid- base balance. It is carried out by the buffering action of hemoglobin and other intracellular balance. 44. Red cells maintain ion balance- by the special permeability of the cell membrane, the red cells helps to maintain balance of positive and negative ions in the blood. Viscosity of blood- red cells help to maintain the viscosity of blood. Various pigmentation are derived from hemoglobin after the disintegration of the red cells. 45. VARIATION IN SIZE OF RED BLOOD CELLS MICROCYTES: ANISOCYTESMACROCYTES These are red blood cells of small size and present in iron deficiency anemia, prolonged force breathing, increased osmotic pressure in blood These are red blood cells with larger size (9-12m in diameter) seen in conditions like megaloblastic anemia, muscular exercise and decreased osmotic pressure. The red blood cells with unequal size are called anisocytes which is seen in pernicious anaemia. 46. VARIATION IN SHAPE OF RED BLOOD CELLS: Elliptical shape Sickle shape poikiocytes spherocytes Spherocytosi s: Globular form as in hypotonic solution Sickle cell: Crescentic shape as in sickle cell anaemia Elliptocyto sis: Elliptical shape as in certain types of anaemia Crenation : Shrinkage as in hypertonic solution Poikilocytosis: Unequal shapes due to deformed cell membrane 47. VARIATION IN STRUCTURE OF RED BLOOD CELLS Howell jolly bodies PUNCTATE BASOPHILISM: In this condition, dots of basophilic materials (porphyrin) appear in red blood cells giving a stripped appearance. This appear in condition like lead poisoning. RING: Ring or twisted strands of basophilic material appear in periphery of red blood cells. This is also called the goblet ring HOWELL- JOLLY BODIES: These are nuclear fragments present in ectoplasm of red blood cells. E.G post splenectomy, sickel cell anemia 48. Haemoglobin Haemoglobin (hb) protein constuting of, 1/3 of Red Blood Cells. Synthesis begins at Proerythroblast 65% at Erythroblast Stage 35% at Retulocyte Stage 49. gives red blood cells their colour can carry up to 4 molecules of O2 associates and dissociates with O2 Two Parts Haem Globin 50. Haem & Globin are produced at two different sites in the cells Haem in Mitochondria Globin in Polyribosomes 51. About 95% of the dry weight of the red blood cells is composed of hemoglobin ( or haemoglobin) 100mL of the blood of a normal male contains approximately 15g of hemoglobin all of which is within the red blood cells. Haemoglobin contains about 0.35% of iron and thus there are 50mg of Fe per 100mL blood and 2.5g of iron in the total blood volume of 5000ml in an adult man. 52. Haemoglobin is a conjugated protein having molecular weight of 64,500. Hemoglobin is very sensitive to O2 and hence readily combines with it. Thus when we breathe in oxygen, hemoglobin (Hb) present in our body combines reversibly with the oxygen in the lungs to form oxy- hemoglobin (HbO2 ) Haemoglobin + O2 Oxy- hemoglobin + H2 O (or) Hb + O2 HbO2 + H2 O 53. Structure 54. SUSPENSION STABILITY OF BLOOD (ERYTHROCYTE SEGMENTATION RATE OR ESR) While in circulation, the red cells remain uniformly suspended in the plasma. If an anticoagulant is added to a specimen of blood & stand it in a glass tube, the corpuscles (being heavier than plasma) are found to sediment gradually at the bottom of the tube, while the plasma remains as a clear supernatant fluid. This process is called sedimentation & the rate of settling down or sedimentation is known as the erythrocyte sedimentation rate (ESR). 55. Sedimentation continues in three phases: 1. A short stage of aggregation with a little fall. 2. True sedimentation following maximum velocity of fall. 3. Finally showing until packing is complete leaving an upper layer of clear plasma. 56. ESR depends on: On the differences in densities between red blood corpuscles & plasma. On the degree of adherence of red blood corpuscles to one another (rouleaux formation) related to the plasma protein content. On the resistance that plasma exerts on the red cell surface. 57. Red cells carry a negative charge, and hence any condition, which increases the positive charge in plasma, accelerates ESR. ESR is increased with: Rise in oxygen. Rise in cholesterol. Rise in fibrinogen. Rise in a-globulin. 58. ESR is decreased with: Rise in carbon dioxide. Rise in albumin. Rise in nucleoprotein. 59. It is measured either in relation to a fixed time or distance by the methods of Wintrobe, Westergreen or Cutler. Normal ESR values by wintrobes method is 0.0-6.5 mm per hour for males, average being 3.7 mm per hour and 0.0-15.0 mm per hour for females, average being 9.6 mm per hour. 60. Physiologic variations are as follows: Lowest in new born, 0.0-2.0 mm per hour. In children it is from 3.0-13.0 mm per hour, average 9.0 mm per hour. In pregnancy there is a definite acceleration beginning from the tenth to twelfth week. The rate gradually increases & reaches normal level only at third or fourth week post- partum. In old age the ESR increases. 61. It is a non-specific reaction, & gives information of a general character, but is useful supplement when temperature, pulse, etc., show no clinical disorder. ESR is increased in all acute general infections. One of the most important uses of the test is in calling attention to the presence of more or less occult disease. 62. It is also useful as an aid in differential diagnosis. Other things being equal, an accelerated rate suggests organic disease rather than functional disorder. It acts as a guide to the progress of a disease. 63. Leukocytes or White Blood Cells (WBCs) Complete cells (nuclei, mitochondria and organelles) Move in amoeboid fashion. Can squeeze (leave the blood vessels through) capillary walls (diapedesis), respond to chemicals Almost invisible, so named after stains. Neutrophils are the most abundant WBC, accounts for 50 70% of WBCs. 64. Involved in immune function. Crucial for defense. Positive chemotaxis: they respond to chemical signals and move toward damage or threats. Body increases amount in response to infection Leukocytosis: more than 11,000 cells/mm3 indicates infection. Leukopenia: abnormally low, usually due to corticosteroids and chemotherapy. 65. White blood cells the bodies defence part of the immune system much larger than RBCs far fewer have a nucleus 4000-13000 per mm3 2 types: phagocytes and lymphocytes 66. These cells differ from RBC s in following ways: - They do not contain hemoglobin. Bigger in size. They are nucleated, living cells. They are actively amoeboid. They are much less in number. Life span is shorter. Origin is from extravascular tissue. They have several varieties. 67. Variations in normal count of white blood cells. Diurnal variation- the total count varies from day to day. In the morning or after rest, the count is lowest. Muscular exercise- and any condition leading to asphyxia increases the total count. Injection of adrenaline- increases the count. Emotional stress- fear, pain etc. due to liberation of adrenaline. 68. Age- in the new- born, the count is very high, about 20,000 per cu. mm after second week, the count starts falling, but throughout infancy and childhood, the count remains proportionally higher. Relation with pregnancy and labour- in pregnancy, at full terms the count is higher, being highest during labour. There is also an increase during menstruation. 69. Increased cellular destruction- from infections, surgical operations etc, produces derivatives of nucleic acids and causes a rise in neutrophils leucocytes. Asthma, hay fever, skin diseases- etc and also hostile invasion with parasites there is an increase in eosinophils. Starvation and administration- of certain chemicals like benzene, sulphonamide, etc produce leucopenia. 70. Functions of WBCs- Phagocytosis- the neutrophils polymorphonuclear leucocytes and the monocytes engulf foreign particles and bacteria generally digest them. This process is called Phagocytosis. Antibody formation- lymphocytes manufacture b and g fractions of serum globulin. Immune bodies are associated with g globulins fractions. So, the lymphocytes play an important role in defensive mechanisms of the body of an immunological nature. 71. Formation of fibroblasts- it is believed that the lymphocytes may be converted into fibroblasts in area of inflammation and thus helps the process in repair. Secretion of heparin. Antihistamine function. 72. Definition: Platelets are small, membranebound cell fragments that contain enzymes and other substances important to the process of clotting. Stem cell Developmental pathway Hemocyto- blast Megakaryoblast Promegakaryocyte Megakaryocyte Platelets Influenced by: Colony stimulating factor & Thrombopoietin Liver and kidney:Monocytes & T- lymphocytesMorphology: Cell membrane: ( Glycoproteins, phospholipids) Cytoplasm: Chemical substances ( proteins, enzymes, hormonal substances) Colourless, spherical, oval or rounded granulated bodies 2-5 m in diameter Average volume 5.8 m2 Under light microscope it shows various receptors Precursors of various substances like: prostaglandins, leukotrienes etc PROPERTIES: 1. Adhesiveness: collagen, thrombin, ADP, calcium ions etc 2. Aggregation: ADP and Thromboxane A2. 3. Agglutination: platelet agglutinins FUNCTIONS: 1. Hemostasis: 2. Blood coagulation: Intrinsic Prothrombin Activator 3. Clot retraction: Actin, myosin & Thrombosthenin. 4. Role in defense mechanism: 5. Role in repair of blood vessels: (PDGF) LIFESPAN & FATE: 10 days. Tissue macrophages system in spleen 73. Histology- platelets are non- nucleated round or oval, biconvex dics having various sizes and covered by unit membrane. In light microscope generally, two components of platelets are seen in the stained slide. One is the clear ground substance- the hyalomere that is stained very faintly and the other is deeply stained central portion- the chromatophore or granulomere. 74. Functions of platelets- Initiate blood clotting. Repair capillary endothelium. Haemostatic mechanism. Contains some substances, which are like ABO blood antigens. 75. THANK YOU Blood is that fragile scarlet tree we carry within us. Blood is meant to Circulate, so pass it Around Blood Owners should be Blood Donors. Share a little, Care a little - Donate Blood.. 76. References: Glossary of Haematology Terms. 2nd edition. American academy of Haematology. SembulingamK, Essentials of Medical Physiology: Third edition, New Delhi, Jaypee brothers Medical Publishers (P) LTD: 2004. Guyton and Hall Textbook of Medical Physiology.; Textbook of Medical Physiology:Eleventh Edition Jain A.K.,Textbook of Human Physiology,Fourth edition, Sirmour (H.P), Avichal Publishing Company:2006. Ghom Anil Govindrao,Textbook of Oral Medicine: Second edition, New Delhi, Jaypee brothers Medical Publishers (P) LTD: 2008. Robbins, Cotran, Stanley L,Ramzi S., Pathologic Basis Of Disease: seventh edition, New Delhi,Elsevier (division of Reed Elsevier India Private Limited):2007. Gagong William F., Review of Medical Physiology, twenty second edition: Singapore,McGraw-Hill Company:2005.