This slide is an overview of basic hematology and blood physiology including RBCs, WBCs, and platelets

1. Basic
Hematology
(Biology
and
Physiology
of
Blood)
Fadel
Muhammad
Garishah
Diponegoro
University
School
of
Medicine
In
affilia:on
Dr.
Kariadi
General
Hospital
Semarang,
CJ,
Republic
of
Indonesia

2. Component
of
blood
Blood
is
the
term
for
the
liquid
substance
within
vascular
system.
It
consisted
of
plasma
(55%),
leukocytes
and
platelet
(<1%)
and
red
blood
cells
(45%).

5. Cellular
basis
of
red
blood
cells

6. Hemoglobin
structure

7. erythropoiesis
Erythropoiesis
is
a
sequence
involving
proliferaFon
and
differenFaFon
of
commiHed
red
marrow
cells
through
the
erythroblast
and
normoblast
stages
to
the
reFculocytes
that
are
released
into
the
bloodstream,
and
finally
become
erythrocytes.

8. RegulaFon
of
erythrocyte
PO2
PO2
PO2
“Still
Hemolysis
Erythropoietin
Kidney
Bone marrow
High altitude, etc.
2 Hemolysis
1 Hypoxia
Spleen
Blood
Bone marrow
RBC formation
Life span:
120 days
Erythrocytes
Break-
down
B. Life cycle of red blood cellsA. Regulation of RBC production
PO2
PO2
Erythropoietin
Hemolysis
Bone marrow
2 Hemolysis
C. Erythrocyte parameters MCH, M

9. Life
cycle
of
erythrocytes
Plate4.1CompositionandFunctionofBlood
“Still good”
Bone marrow
Lymph nodes
Spleen
Liver, etc.
Spleen
Blood
Bone marrow
Test
RBC formation
Phagocytosis
by
macrophages in:
Sinus
“Too old”
Pulpal
arteriole
Life span:
120 days
es
Spenic
pulp
Break-
down

10. Clinically
related
erythrocytes
parameter
89
b
a
MCHC (mean Hb conc. in RBCs)
Hb conc.
= (g/LRBC)
Hct
MCV (mean volume of one RBC)
Hct
= (L/RBC)
red cell count
MCH (mean Hb mass/RBC)
Hb conc.
= (g/RBC)
red cell count
Normal:
320–360g/L
Normal:
80–100fl
Normal:
27–32pg
Centrifugation
Hemoglobin concentration
(g/LBLOOD)
Erythropoietin
Bone marrow
Lymph nodes
Spleen
Liver, etc.
Sinus
arteriole
Red cell count (RCC)
(quantity/LBLOOD)
Hematocrit (Hct)=b/a
(LRBC/LBlood)
Blood sample
C. Erythrocyte parameters MCH, MCV and MCHC

11. Iron
intake
and
metabolism
HCI
Fe
Fe
Fe
FeIII
FeIII
FeIII
Fe2+
FeIII
Fe2+
H
+
Stomach
Liver
Fe absorption:
3–15% of
Fe intake
Normal Fe intake:
10–20 mg/day
5–10 mg/day
Lumen
Ferritin
Blood
Lyso-
some
Cell
turnover
Mucosal
transferrin
Apo-
transferrin
Heme-
FeII
Mucosal cells
(duodenum)
Trans-
ferrin
Non-absorbed Fe in feces:
Normally 85–97% of intake
Heme
FR
FeIII
2 Fe absorption1 Iron intake
A. Iron intake and metabolism

12. Iron
storage
and
recycling
Fe
FeFe
Fe stores
Systemic
blood
Liver
Bone
marrow
Hemo-
siderin
FerritinHeme
Hb
Erythrocytes
Hemo-
pexin
Hapto-
globin
Ferritin
Hemo-
siderin
Transferrin
Macrophages
in spleen, liver and
bone marrow (extravascular)
Already in bone marrow
Vitamin B12
Folic acid
0.05mg/day
Other organs
NADP NADPH +H+
Dihydrofolate
reductase
Non-absorbed Fe in feces:
Normally 85–97% of intake
FeIII
3 Fe storage and Fe recycling
B. Folic acid and vitamin B12 (cobalamins)

13. Folic
acid
and
Cobalamin
(B12)
metabolism
7mg
1 mg
Fe stores
siderinHb
Erythrocytes
globin
Macrophages
in spleen, liver and
bone marrow (extravascular)
Already in bone marrow
Liver
Ileum
Vitamin B12
0.001mg/day
Folic acid
0.05mg/day
Other organs
Stores
Bone marrow
NADP NADPH +H+
Dihydrofolate
reductase
Folate
regeneration
Thymidylate
synthase
7,8-
dihydro-
folate
Tetrahydro-
folate
N5
-tetra-
hydrofolate
Deoxy-
uridylate
Deoxy-
thymidylate
Erythroblast
DNA synthesis
Erythropoiesis
Stomach
Erythrocytes
Intrinsic
factor
Methyl-
cobalamin
B. Folic acid and vitamin B12 (cobalamins)
Despopoulos, Color Atlas of Physiology © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.

14. The
blood
groups
O
A
B
AB
O A B AB
5 10 15 20
2
(After Kownatzki)
Days after first antigen exposure
Compatible
Incompatible
(agglutination)
Anti-A
Anti-B
Antigenonredbloodcells
otrienes
tors
Antibody in serum
ity

15. Biology
of
Rhesus
101
Pla
+
=
A
B
AB
Rh+
Rh+
Rh+ Rh+
Rh–
Rh–
Rh–
Rh–
Rh+
Incompatible
(agglutination)
Anti-A
Anti-B
Antigenonredbl
Agglutination
Hemolysis
Severe hemolysis
in fetus
Father Mother
Subsequent Rh+
childrenFirst Rh+
child
Subsequent mismatched Rh+
transfusion
Rh+
red cells
High
anti-Rh+
titer
Damage
Rh+
red cells
Anti-Rh+
High
anti-Rh+
titer
Damage
Anti-Rh+
antibodyBlood
First mismatched Rh+
transfusion
D. Rh sensitization of mother by child or by Rh-mismatched transfusion

16. Plasmaproteins
wPropertiesofBlood
60% 4% 8% 12% 16%
α1 α2 β γ
0 100 500 1000
Plasma
Albumin Globulins
Electrophoretic protein fractions
65–80g/L
Proteins(100%)
e diameter (µm)
Blood
Plasma
Water
ist effect B. Plasmaproteins
of body fluids

17. Ion
composiFon
of
body
fluids
Plate4.3FlowPropertiesofBlood
2
1
0
1 5 10 50 100 500 1000
Na+
K+
142
4.3
2.6 (1.3*)
1.0 (0.5**)
153
4.6
2.8 (1.3)
1.0 (0.5)
145
4.4
2.5 (1.5)
0.9 (0.45)
ca. 12
ca. 140
<0,001
1.6
150 162 153 ca. 152
Cl–
HCO3
–
*) Total plasma Ca: 2.5mmol/L; **) Total plasma Mg: 0.9mmol/L
Na+
Ca
2+
,Mg2+
Cl–
HCO3
–
HCO3
–
K+
Ca2+
,Mg2+
Na+K+
mval/L (mmol/L)
104
24
2
14
5.9
112
36
2.2
15
6.3
117
27
2.3
0.4
6.2
ca. 3
10
ca. 30
ca. 54
ca. 54
150 162 153 ca. 152
Electrophoretic protein fractions
65–80
Proteins(1
Cations
Plasma Interstitium CytosolSerumIon
Anions
Proteins
Misc.
Sum
Sum
Proteins,phosphates,
etc.
Proteins–
Interstitium Cytosol
Cations Anions Cations Anions
Viscosity
Vessel inside diameter (µm)
Plasma
Water
Free Ca2+
Inorganic phosphate
Inorganic
phosphate
Misc.
Free Mg
2+
C. Ion composition of body fluids

18. The
immunoglobulin
in
serum
IgA 2.25
IgM 1.15
IgD 0.03
IgE 0.0002
IgG 11.0
g/L
100
50
–3 181512963
IgM
IgG
IgA
IgD
IgE
*) Total plasma Ca: 2.5mmol/L; **) Total plasma Mg: 0.9mmol/L
2
14
5.9
2.2
15
6.3
2.3
0.4
6.2
ca. 30
ca. 54
ca. 54
150 162 153 ca. 152
Birth Age (months)
From Mother
(After Hobbs)
Anion
Proteins
Misc.
Sum
Inorganic phosphate
%ofrespective
serumconcentration
inadult
D. Concentrations of immunglobulins in serum
Despopoulos, Color Atlas of Physiology © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.

19. White
blood
cells
(Leukocytes)

20. The
leukocytes
Leukocytes.
(a)
Neutrophil.
(b)
Eosinophil.
(c)
Basophil.
(d)
Small
lymphocyte.
(e)
Monocyte.
In
each
case
the
leukocytes
are
surrounded
by
erythrocytes.
Note
also
the
three
platelets
above
the
lymphocyte
in
(d).
(All
1600×)

21. The
Leukopoiesis
Leukocyte
formaFon.
Leukocytes
arise
from
ancestral
stem
cells
called
hemocytoblasts.
(a–c)
Granular
leukocytes
develop
via
a
sequence
involving
myeloblasts.
(d–e)
Monocytes,
like
granular
leukocytes,
are
progeny
of
the
myeloid
stem
cell
and
diverge
from
a
myeloblast
that
can
become
either
a
neutrophil
or
a
monocyte.
Only
lymphocytes
arise
via
the
lymphoid
stem
cell
line.

22. The
Thrombopoiesis
The
hemocytoblast
gives
rise
to
cells
that
undergo
several
mitoFc
divisions
unaccompanied
by
cytoplasmic
division
to
produce
megakaryocytes.
The
cytoplasm
of
the
megakaryocyte
becomes
compartmentalized
by
membranes,
and
the
plasma
membrane
then
fragments,
liberaFng
the
platelets.
(Intermediate
stages
between
the
hemocytoblast
and
megakaryoblast
are
not
illustrated.)

23. Clo]ng
factors
stops bleeding. Throm-
ulation (or clotting) fac-
l walls interact to seal
The damaged vessel
dothelin), and platelets
puncture (and attract
the leak by a platelet
for sealing (ca. 2 to 4
ng time. Subsequently,
m produces a fibrin
ent cross-linking of fi-
ot or thrombus that re-
reinforcing the seal.
f the vessel can be
103
per µL of blood;
small non-nucleated
d off from megakaryo-
I Fibrinogen Half-life (h): 96
II K
Prothrombin 72
III Tissue thromboplastin
IV Ionized calcium (Ca2+
)
V Proaccelerin 20
VII K
Proconvertin 5
VIII Antihemophilic factor A 12
IX K
Antihemophilic factor B; plasma
thromboplastin component (PTC);
Christmas factor 24
X K
Stuart–Prower factor 30
XI Plasma thromboplastin antecedent
(PTA) 48
XII Hageman factor 50
XIII Fibrin-stabilizing factor (FSF) 250
– Prekallikrein (PKK); Fletcher factor
– High-molecular-weight kininogen
(HMK); Fitzgerald factor

24. Platelet
Mediated
Hemostasis
Plate4.8Hemostasis
vWF
Kollagen
Endothelial
damage
Blood
Change in shape
Vasoconstriction
Slowing of
blood flow
1
2
3
5
PLT aggregation:
Clot formation
4
PLT adhesion
Platelet (PLT)
PLT activation
Fibrinogen
Secretion
ADP,
PAF
TXA2Serotonin,
PDGF
vWF
A. Platelet-mediated hemostasis
B. Blood clotting