Chaptor 9

_Blood and .Ha_~ma,tolo ;..eLAQ

Oomposltloo of Blood ~

11111co11neccivc tissue ,,·hose tnatrtx ts a liquid known :u pl.1sm3

in" hkl11hc forrncd cfcn1cnts such
t.s rcrn:iin suspended. JI fs ared,
11&,loodcorpusclcs ~C! • while bJ~ corpuscles (WDC) and pfarck 1.055-1.065, plf 7.3.7.4 and
~pdopaque nu1dwh1ch isnlk:1hnc in rcacrion. Jts specific gr:ivity 1, body wdghl)
pe,qe amount ts$ litres which varies with body weight (about 7. 7% of
and d:irkash \\·hen bkrn
Blood Is a complex fluid \\hich fs scarlet red when taken fron, an .irtcry cJouing is prevented
t,o,na,ein. Jt has a tendency to solidify when it standi. known as
cJouing. When
--( I) Plasrro, (f J) Sol id
'1 llllkoqulants such as heparin, oxalate etc. it is seen to consist of two parts
cellular portion.
blood, and consists of 91 ¾ to
I. Liquid pert is kno,vn as plasma-,\ hich is 55% of the \'Olumc of
substances.
92"aC,vater and 8o/o-9o/o solids. Solid portion consists of the following ic sul,stanccs
1. Organic nbstancts (1. 19►8. 1,,): There arc n1:1inly three types organGlobulin. fibrinogcn,
of
(o) Proteins (7%)-thcrc nrc four lipcs ofproteins namely Albumin,
.. enct help in
Prothrombin. These plasm3 proteins exert anOffllori, pressurt ot2~ 0nu clouing.
regulating blood ,,oJumc and blood•, viscosity. Fibrinogcn helps
jn blood
(6) (I) Jnt ~l sccredon or hormoncs-th~sc arc the chem
ical mcsS(ngcrs from cndo-
ainc glands. •
ibute to blood',
(//) ~ntibodies-thcy are important in immunity reaction, and conlr
viscosity. • •
(/1/) Enzymes e.g. amylases. carbonic anhydrnscs etc.
(t) (I) Non-protein nitrogenous substanccs-Urc3, creatinine.
ammonia, amino ac.ids ere.
tissues
Mainly these arc the products of tissue acli\'ily which arc transported from
to kJdney or skin for excretion.
(ii) Neutral tat~ .g. cholcs1c1rol, phospholipids, pcntoscs
etc. These are food stuffs
absorbed from Intestine to tJssuc for utHization and storage.
. . .
1 /tq,l,o1ory 101t1: e.i Oxyacn and Carbon-di~xidc.Potassium. B1car bo11.1te. lod1 ne, lro11 etc.
1 ~ l e lditanc,s.· e.1. Sodium chloride, Calcium, 1
e ofbJood) in which free
llallricenwar ponion (,vhich is approximately 45% of the total volum n as corpuscles or
::.' -•• • lnled eJcmenll are suspended In lhe plasll13. Tiie cells arc knowhaco1otQCri.l. .Thcre
• IIIL .......,i1iu1111WlllRlalln.lPnd ~orpu,cl~l~~~ ~.Jl~~~!nlincd ~l
--r lDp Uld cl: .
)
- -. . . (RIC) or Eryth~Cytll (4.2-1.4 mllllon/C.m.m of femur and humerus
lldJebonemarnM: IIJJ1bone1vcrtcbrae, ribs and heads
ducl llmnl I lameter °SJ
microns. ~ ctlls do nor have ~udcus. their
 4 ffJ,t~,.,,Jc -of Pl>.JrmJ< tkllc.1/ <'ht•
-~~ . ~,,
• • fI

litIJ,.. . • d ,aiES._ pi&J*-lll liaelnOllobill RBC bc1ps in the transport of oxygen a,

•s•u ek "'
a._. .~"• (WAC) or 1.tucocytes • •
,-.t.··-,_ 'WBC for m:ry SOD RBC. ln normal adult theII' number IS about sooo.1 O
• t i ~ n.e ce1b do not contain any pigment lberc arc fh,·c types of lcucOC},/Jv,,
)t tiltjl bil~ (~1 Eosinopbil(ii1) Basophil(M tym~hocyte M MonOC}1C, The first thrc:
01
!,,
• th~ • graaulocytts since thtir cytoplasm contains granules. The other two i.e. l:,'11\p~t
ge .a moaoq'IC arc blown as non-granular leucocyte_s. . ~
/1)0•• f\zDc.1ioD o{ w.B.C. is body defence against mfect101.1 y the ph3gOC}1cs and produ••
c.
~ by lympbocYICS- • cti~
3. PIMtlets or Thrombocytes (Thrombo II clotting, cyte =cell)
These arc non nutc:catcd fragments ofthe q1optasm of the ,-cry large cells. They arc shaped litt
small flattened discs ofabout 2.4 micrometres in diamde[. They contain many small granules 1'hti
IIIIDlbcr is approximatdv 250,000-500,000/cmm. flateJ'3S dC\-clop to some c.~ent in spleen and bo 1
•:wrow. llvombocytes main function is to assist in haemostasis i.e. pre\'ention of bleedin g~
~opp1ng of bleeding (coagulation of blood) when inJunes occur to the blood \'essels.
'The composition of the blood can be illustrated in brief in the chart given below:
~

Cellular portion (45% Auid portion (55o/.)

II . I I

(Formed elements) (Plasma)

l
' 1 l
, . Red blood 2. Whltl bkX>d ceu 3. Platelets or Solids Water
cell or Erylhrocytes or Leucocytes Thrombocytes (8%. ;%) 91%-92%
1

I 1
1. Organic 2. Gases 3. Inorganic (0.99%)
7.1M.1%) (Oxygen. Carbon- Sodium, Chloride, Bicarbonate
I dioxide etc.l Potassium, Calcium, Copper,
r_[t== ===== =-:----
1 _ _ _ _ _ __:,~_J~Sodi~um, Magnesium
-
ta) Proains (7%) (b) (i) lnllmll (c) ~} Non protein
\ Albumin. Globulin, Secretion er • Nitrogenous
Abrinogen. Hormones substances: Urea,
1
ProChrombin (ii) ~ Uric Acid, Ammonia.
{ill) Enzymes Creatine,
(Arnylu•. Xanthine (ii) Neutral
• Phosphatn•
I

Fats:Phospholipida,
Estarasn. Cholestrol,
Proteases) Pentoaea, Gluco~.
,•

Ah>n~ ~th the lymph and tissue fluids.blood • • •• • • •

cells ofdistant organ and tissueS· 1 carries the setri~'CS asd t~c connectin g link bcm-ccn the indh,~
,. . ·1
cclls ,or JlOWlli and suppl)ing energy Bloodnucarricnts cm'Cdfromd'--' 1
....._roodmateriaJsto~
.•-"4
. / . es oxygen from air through lungs to tissUCS Jtli
 IO I

,e,aatdtait,oa dioxule !tom tissua through IWIIJ to air. It hdps in nwntcnaocc or1\-ater content of
tiS1UO and ~ a , the body t ~ etc

Blood Grouping and Matching

TbC t,nmeh of haematology wruch includes Ille study ofblood poups? lhcir types and the preparation
otbloOd forute iA transfusion is usually ~erred tn as lmmunoh:icmatology.. There arc four common
blood poup_s aame)y A~ B, 0 ai,d AB. The blood group of an individual can be determined by the
fotlowiDI methods:
Blood groups can be classified depending on the presence or absence of certain antigens knoi\'n
aiaggluunogcnsinthcredbloodoclls~ ThcrcdCCll_Sh3veone.bothorncitheroflhemroagglutinogcns
c.slkd Aand B correspondingly the plasma contains one, both or neither of two antibodies known as
aaJulininscallcd Anti A or a. and anti B or~- Agglutinin antibodies cause cells coated with non-self
anriFJ15todumptogcthcr.1bedumping iscalledaggJutination and this process i.e. (agglutination)
of the cell indicates the agglutinogcns they possess, \Vhicb in tum indicates the group to \\·hich they
be.long.
procedure: Tu'O antisera one Anti-A and another Anti-B arc prepared. Blood from the subject to
be teSICd for blood group is drawn in a syringe containing 0.4ml of 3.8% sodium citrate.
Then on a white porcda.in slab oron a slide one drop each ofkno,vn scrum Anti A or o. and anti
Bor ~ is placed. Separate pipette should be used for the each type of scrum. The group of serum is
marked with a pencil. Just near the drops ofnntisera, one or hvo drops of the corpuscular suspension
from the bottom of the citrntcd blood arc placed on the slide as shown in Fig. l. The cells are mixed
wc:11 by rocating or tilting slab or slide. It is allowed to stand undisturbed for a few minutes. The slides
are then examined for clumping or agglutination under a microscopc--Agglutination appears as red
clumps separated from clear scrum. Absence of agglutination appears as bomogcnous suspcftSion of
red blood cells. Sometimes difficulties may arise in blood grouping procedure when infected blood
cells may string together in rouleaux due to an excess of globulin proteins in the antiserum. This
roulcaux formation should not be mistaken ,,ith agglutination. The observation can be ,vrittcn as
follows:
SJ No. AntiA AnliB Conclusion Interpretation
l. Agglutination No Agglutination A- antigen on cell A Group
2 No Agglutination Agglutination B-antigcn on cell B Group
3 Agglutination Agglutination Both A and·B Antigens AB Group
4. No Agglutination No Agglutination Neither A nor B Antigens 0 Group_
Gro11p A s~TMm Group B s~rum
Oroup O blood giva no aglutin.a..
tion since no •Alutiao1ens are
pramt in ltlCSC et-lls ta be c l ~
by tn1.Sffa

Oroup8@1ggJulinogtn1
aavc •&&lutination with
p-oup A saum)
0
r----------..-.=------~::-----,

~
Patimts CIJl>USCUlar Oroup A ( a aaJ-utinogms
SUJpt"fUlOO g,ivc •ututinati<>n \\ith
group B wrum)

O~p AB ( &ivn a.glu•

tan1t1on "ith both
lCS-ts~ra)
Aglu!mtllon
Fig 1.
 .,., To 1Jt,,,,4 ,4 ph(,,,-,,,.,i4.·r"11, u/ (~
,o.,
- . rocaJ rd.1tionslup whh ~fural
"'~
i,.

"·,.
111 human blOOd these natural a,gluuao ~ns 11a,-c rccJJs the A group blood contuns
kno"~ ~ aU)utinJns pmcnt in the S t ~ In oeher "~ unini in the "rum. This rcbtio. :P8 ft
agglutJn1ns and B group blood cont.aim anu A or o..ag& u
illustr3tcd as follows:
Er)fhror)ft contain, Plas,,,o co,,a..._
~ J..'o. Bl'-.
uvu..... , Gro11p
(aggl11llJ106tn} ~;: (agg/1;1,

A Anti 13 or~
1. A Anti Ao,Cl
2. n B
) NiJ
J. A4B
.
1

4.
AB
0 Nil Antl Aorci
• AntiBor~
. .
The U\O\\lcdgc ofbJood group as ofunmense 1mpo
• rtanCC in blood . on. In .COnd'f
. transfusi J 10taa
1
SC\-Crc bleeding. shock bums, SC\-crc anaemia or patients undergoing su~gica opcratJon, d15Cllea·
"hkh thctc is severe ioss of blood then blood from a donor Jus to ~ gn-cn to lhe patient Ind
be take~ to CllSlvt
process is lnown as blood l.13nsfusion. Bcforc a transfusion, prccauu~n 1_11ust 10
the blood of donor and recipient arc cornp:1tiblc. If lhc wrong blood is gi,-cn ~ P3ticnt. ~
red blood cells' m.1y block small blood vessels in ,iuJ organs c g. lung or brain. The ~~.ii
h3cmolysisofagglutirutedccllslll3ylead1oh3emoglobinjnlheurincandC\-entu:lllytokidnq,
andde:uh.
The following ch:ut indiC3tc the comp;itib1Hty of the blood groups:
S. ,\'o. Group Can gn·~ blood lo Con rec~,-.~ bloodfro,,,

l. Group AB Only AD From any group

2. Group A AB and A AandO
i AB3ndB BandO
3. Group B
t' OnlyO
4. GroupO Any group
It is C\-idcnl from the above chan that blood group AD is unh·er53J recipient and blood &l'Olf
universal donor.
It iscssc-ntial to use the S3mcbloodgroupfromdonortothcrecipicnl Thccompatibilityoflk
group can be tested by cross aggluti11.1tion test known as Direct-Cross-Matching.
Cross m3tcbing should be done before t\-CI)' blood uansfusion.
Procedure
l. Pnparal ion or red crlls and "rum. Blood is dra\,n from the recipient or patients. II is .....
to clot and c-cntrifugod. The de3r scrum is l13nsfcrrcd in a dean test tube labelled as RS (red-
scrum). The cell suspcnsiQn or the recipient blood should be kept in a cl~n tube, labcJJed as at:.
pl3ced beside the •RS• labelled tube. Similarly donor•s scrum DS and donor·s cells DC.,.. .
properly fabdled.
\VJth a clca~ capiJLuy pippccteo~~"°'!oflhc donor's scrum DS is placed in 10 • 7.5nun •
"ith anothe~ pippcuc on~ drop of~•~c~i s scrum RS is placed in another lest tube. A droP
cell sus~ns~on of t~c: palleot or rccaptcnl , RC is added lo the donor•s scrum DS and I drop ----
cclls.u..~pens1on D~ u ad~ to m:1p1cn~ strum RS~ The ceUsare m1xcc1 "-cll by sh.akin, aad
to stand for Jo nunu!es. It 1$ now eurruned f~r aalwinalion "ith a hand lens and finall)•
ffiicfocoJ>C: Jfthcrc 1s a hornogcnous suspcnsaonolrtd ~Us on both the lidesoft bc ctoaor it
1of VMtl»$JO R.
Mi Mlle hcd blood tran~fusion I ~ a( incompatible blood is llaJlsfused ,,..
~ 11 ~ . . -.II blood ,-cwls and n-tDtually t-, bae the aaJuta~•--
11
~ It rtlcasc4 jn the blood and it IC(S atauau J.:i mol)-.d. Due to
, cw-ls ia dlC <.OfOIW)'. puJmofW) and mw tlff'Walioe. n die blood and blocll
 ,_r ; ; f 1tWf bl~ 1ransru,ion has SC'\-crc effect on the pati~nt and it an be f.afaJ. Whole blood
~~111forhac morrhagewh entherepl11a :men1ofbloo dvolumei1i~ o«hcr
~~: =p~SC:::.-led for lr:ms!usion in special circumsunccs. They include pl,Uff'b
. . . . . . uaasft,asion has to be checked for any unw31ltC'd cont.1m1nanu before it is u.ted. V11.J
ild gg; -P•• and AIDS arc amone the disc3scs nflich h3\'C been contracted loll~ing transfu•
.W,lsi •• -,o,tan! factor i_n .bl~ transfusion is Rhtsu1 or Rh blood croups named aflcr the
• • al fff med an lhe onganal an,'Cstlgations.
• ,,.a poups are or outst;a.nding clinic:il import3ncc. The origirul discovery was m:tde by
.. %gq,-1 eelll ol ~ s mo~cy into r~bbirs. The rabbit responded to the presence of an antigen
• ....... by .r~mung ~ ant abody ,~ h.ich agglutinates rhesus red cells.. Jt was found lh.1l it the
a ; t 1d rabbit • scrum 1s tcs~~ ag:unst hull\3n red cells. agglutjn31jon occurs in 8.5 ~r cenr, of
_..,ar• are call<:d Rh+ (posauvc) and no agglutination occurcd in J5 per cent and these people
- StdD-<ntpU\'C ).
11iiP.,.1CVCral varieties Rh antigen and Rh antibody; the most common Rh antigen is called D
-••t,,,dy is called anti D. Th7inheritance of Rh antjgcns are controlled by genes. The cells
_ . , . , . . D arc kno"·n as Rh+ 1,·c and those "1thout it are knm,n as Rh-i,·c_
flljWood of a person \\ho is Rh+ ivc is transfused i.nto a person "ho is RJ1 -ivc the rccipicn1'1
...,._., produces an antibody to agglutinogens. The antibody is termed as the anti-Rh !actor..
n-, s,rnocbeany indication of this in compatibility following the first transfusion but the second
a f fm ii often fatal as the anti Rh factor causes sc,·cre dam3ge to the tran.sfuscd Cf)1htOC)1es,
Cc ;:tffcl•ions arise sometimes when a Rh -ivc woman bears a Rh ~ivc foetus. Norm:llly there is
•••1 1'Dfthe foetal and maternal blood cells although the two circulations run close together in
_.,....,.. Occasionally foetal blood can pass through placenta into mother's blood "tuch results
mdll,mduc:tion or anti Rh factor in mother's blood. This anti Rh factor is c3pable of crossing the
r• e t I1Delllbrancs and enter into the blood of lhe foetus and it hacmolyses and destroys the focul
,.._.. ..., it is known as haemolytic disease of the new born kno"n as •JIDNB •.. Trus disease can
'- t J id l,y pving the foetus several transfusions while it is developing inside the uterus. .,,
Mrna p'Ollpins- Anti D is an inununc antjbody. Anti D is usually incapable of' causing tbe
·•2 ff 6m mD<ells (Rh +ivc) on its O\\n. For this reason it is c31led an incomplete antibody. The
allftllcnae coated by anti-D and agglutination may occur when another protein is added. usually
• $a,
111 ◄; !fie test. a drop of 20% bovine albumin is added to a drop of antiserum conuining anti-D.
T,.,1.a4mpof'paticnt•scclls in saline is added. Aflcr3 to5 minutes incubation at room temperature
•< rL.e indicates Rh +ivc cells.
Physiologic al Function of Plasma Protein

:;;.;:-s approximately .S.S% of blood and it Is about .S% of the total body weight. Plasma
ofaolids and 91 % ot·"'ater ofthe solids about 7-8% is protein and the rest ue salts, ions.
r.a1111=aa-l!:I. Plasma proteins consist of four m3jor fractions namely Albumin J.,-4.58-Y-.
.,..._....28%, Fibrinogen 0.2-0.48o/o. Prothrombin 0.02-0.048%.
Of Plasma Proteins
1 k:dons or plasma proteins are as follows.
-•ce ot Colloidal Osmotic Pttuutt. AU the fractions of plasma proteins maintain
f111DObC pressure. Albumins contribute so-:'o of the osmotic pressure whereas globuhn
contribute about 20o/--. The toUI osmotic pressure exerted by plasma pl'Oleins is
IWll•Gf25mm Ha in the Jiving body.
 --·

* I T, .:!--~t,;,( ,,j r,~.Jr-rt.:i.;,.,.t ·

.... .J1 t .
, tf
ft..
.1 Pihiaw11a Md ~ a a« the priaap1l fmon ln ~ c~ting. •••
J. llcf■INaatt., 'iscosit,. Pbma prolCUlS m;urain I~ \ ~ t y of blo:)() "h.:b .
~ mi$t•ntt o t ~ thc:dty bdp m.tinuining bJ~ prcuure. ~,
4. llaiakaw~ ol adJ•basc balatt ol Wood. The proecins arc good buffers anJ lhq, ~
,c,aa" IO ac:tpt ff• iom. . . "~
S. Carriace ol OtMr Sabstaattt.. Pohlxdwide s. lipids, and lir1d soluble s.ubsunecs ~
lipid.,. dlolest.'T01s.11mids. ~ bilirul:in. meul like lron. Zinc etc. arc earned
pnMaas.
~:,t:;
,.
6. Pre41uctioa ol lmmu~ bod~s. >.ll.'ly anu1,odics apinst ,-aricties of antigens SUch as
iSllls cldirhlbcru,. nrJmpS, docL.~x.1yp hoid. s t ~ . sUph? locoed, ~ :;,-.
doseJy au«iJt:d •l:h globulin ~1ron olthc pbrm proteins. Purifaed•globulin ~ ~~
tor immunizing 2pinst these in!~ons.
7. Carri•Et of Carbon dio1idt.. The a.mono acid ccntenr_ of_tile proceins helps fon:.t!i~
cartwnino ccm;,cund :tnd thus hdps oni:Jge of cubond,oDJe. 1
I. F'thri.oogcn ~d globulin fncticns help in roulc2u.'t fomution 311d thus help in ~
xdimeau:ion me cf the corpuscles.
,. Rqvlatioa of Fluid inttn-hancr bttftttn blood aad tissut. fluids arc ~gubrly i n t ~
~ tissues and blood due to the imscnce of nomw concentration of protcins, 'Ilia
oduagc maict1ios hcmcostasis ofinttmal tn\ironmcct
:1. llawne Protrias. During prolonged SW'\'Jlioo pbsma potcins contribute to wcoly the--~·
aced through :t!llino acid pool. though there is no direct C\id~ncc tlut plasma Prot:ms •
direttly intcrclungoble \\ith tisS?JC proteins.
l J. Rt-palrof Dam1~d tiswt. \\'hen p1Jsm3 proteins exude into tissue sp3ccs as in infllrn:mt111
0t intcml hlcmcrrhage, it forms a good medium for gTO\\lh ofY3.rious tissues cssmiJI
~ir.

Role of Blood as Oxygen Carrier

Au,,aSFbac is L'ic sourtc of oxygen 3%\d lungs :ict as a 10C3l depot from "hicb it is suppli:d ro
tissues. This deli,~· ~em ronsists of lw:gs :ind c:udio,'3scubr system which is the tr:wpOft
~mdl OX) ~o is supplied to the tissues. The c.fficic~, ofoA-ygcn dq,ends on the qlllJltity of .
. 3\-:ii!:lNC in Jungs. cffi:iency ofpulmcn~uy ps exchlnge, efficiency afpulmonary blood ilO\\' ud
a;:acjl)· of blood to any o.~-i;en to the tissues.
Transport of Oxygen by Blood
Ox1 ~ diffuses lhrougb the rcspiato,y m:mbr:mc from the 31\"COJ:ir air and into the blood.
csJg:n anying opacity of blood is :Lbout 20 ml ~-ous o.~·gc.n per 100ml ofl'·hote blood
ptbl:1ccaCrr:spzcuo,ypipn:nt,.hxmoglobillinr:dbloodcdlsaa:ountsforabout98%oCthcOX>
112oq.c,n:d to the t!nucs. lt is c:uri:d as OX)·lucmoglobin.
~ The u:110US Nood curies shout 1-t to l5 ml of m)·gen per 100 mJ of blood and is oxygca•:rl
1k hmp wl the blood lta\-cs the lungs as JttcriaJ blood Cln)ing about 19 to 20ml ofo.vP
100ml of'bb>d. OX}-gen is carried in the blood as follcm s:
(,) Iii Pta,sical IOhrdoa. no 2J110UDt of aq-gcn curitd in ph)-iial solution depe8ds •
jASJiPHC ,adimt. t:111p:n1111a-c m:I solubility cocfI"acifflt 1.0ml of blood absorbs o.Q2AIII
•JP at l7'C at a paessme of i<IOmm Hg. Tbe partiaJ prrmuc of oxygm in me ......

iaaee-u,_ m.11 lfm ~came ufox.,gm 1ml llflllood •ill be 100;:au • 0.0031111. n-
• •••·•·t w.ctwWcu,y G.3 al af whaa.11 tllia . . . . pulial ■rec•
Oll)'lal
Ill• , blood will c:my O.llal olOIIQl&A Ml pll)licaf ••ra:.. .-
 per
S rl d rt-'•• tioe with bumo& lobio. Aneraal blood oxygen is about 19 to 20ml
nation
t,ilJ •wF D ID ph~c: at solution is about 0.3 ml. 'I1WI dilfc:rcncc is due to combi
globin has a complex molecular structure consisting of four sub-
•' 1- idtHD Haemo
..: +X
,,,,.,,
arit"lllllains agroup called haem attached to a protein called globin. E3Cb sub-
z • • widl one molecule ofoxygen by a process called oxygenation., the derh-ativc
o.
:;r. :,,.« oxybaernOglobin. oxygen is released from the haemoglobin by dcoxn:cnatio or

.. ,,,.
• a
.,.. • tour sub-units, upto four molecules or oxygen can load

Okne ■atm
Oxyhaemogk>bin
to each molec ule

Jlarr:>&lobin + 01
Hb4 + 401 ;::= === =~ llb4 0 1

n with haemoglobin takes place stepwise as follo,vs:

1':0 11 st'?O of oxyge

globin
11111 C,,dco acfitio nsofte mpera turcat3 7°Can d760m mHgp ressur eeachg ramof haemo
18.0g haemo globin in
co r6he-.idl l.36m1 oxygen. In an adult male there are usually J 3.0g to
Jllllla lblood and in women it is between 11.Sg to 16.Sg.
takes place in
1lt . . - , ol oxygenation and deoxygcnation takes place very rapidly i.e. it
e tension and
• • • dlil process depends on three main factors, oxygen tension. carbon dioxid
disrupts oxygen transport
) ,.........
• - • 1 . S::mdimes the presence of poisons such as carbon monoxide
. carrying
Uadsa dl•con dition s 100 ml of arterial blood transp ons about 19.3ml of o~gen
a tensio n of
ilplz lt:11 IDIUlion and 19.0ml in chemical combination llith h3cmog)obin at
the tissues
,._Ba t1a die blood ofthe capillaries. for supply to the tissues. The oxygen tension of
blood
._ 11~% " Dae to this pressure gradient and absorption of the carbon dioxide by the n
the oxyge n tensio
J P • . _ dae blood to the tissues \\ilhin fraction of a second and thus
•
1111111
.. lr~aa ;d k»40mm Hg in resting conditions. Usually 5.0 to 6.0ml
ofoxygen per 100ml of
l and
.._..._ 11
._:• WliJdle tissues under resting conditions. The oxygc-n d.i1Jcrcncc bcm'ccn arteria
'Ila II lt.0-1 4 O • 41- n rnl per 100 m•
• • • JI ~ axyp utili:zation
1

·.c oxygen taken up by the tissues = -~ x 100 = 26

~.
OX)•ae n content of arterial blood 19
~ utili:zatjon is taken as an index of the activity of the tissues
as it depends
-&•1 activity e.g. during exercise it may be rai~ to soe/4. The
normal coefficient
1,y the heart is about 63%.

Blood Pres sure

called blood pressure.
1'i die flow al blood on the "-alls of the blood vessels isction
oa many facton such as (i) strength ot contra or cardiac muscle
 I
1, -." //( .•« 1 ("
•o f /l/ 1( .1 "'1 Q (:'
J,( ''> t/,,

DIMN:tl'I ri J c o
li ty e tc. Out O fth ~ '",
'1'
U.,1 ;:,"1 2 a.s 5Ys tolic I>ri:i,
d
!I ii u t i ru.. :., d i,
e o
p e
w
:a
m
u n
c
"
~ _ ~ ,, o ~ ~ s .
- -. ,- .. ., .m g a n d J t JS call
xin
ed l) ·
, _ h a lt is rela
*• 11 f i t l t
• tltDII w lr
diasl,o lkis tao
1
w n
Jc
a
:,-
s
cl.
Pulse Prepsshucre
T h e p eri ra i
Th
c
norma res1
u • •*•-b•lo1o1dcP• ~. lre
1 •
5 •uru1ary1blO(Jd,.01~
111 m • • • :ssure.
1 W xi kW.
1
• 22in . ~ o t ~ . n
/k .
,. .h s w " I t:
•

H g ) d l: J sstohigh
• •
• •
- •
il k d 8 ~ m m (
taaU J . u to li c a n d nonn a
- :1 !i i> :: :0 m m J g ) s ,.l'Cs5SIJJ'C more 1ban JOO JS k
•~ lie; OOd pressu~c
_ , M WS
ltlla!IJ i 4J H I" as low bI
1lt 2 i ,•
,:.~:
.. ,. d J R IH
- : . : : ud :::W J:v60mm Hg is
Jmoun

: - : ~ : . •• , : ;
IIJS If I ·11. n
Hypertensio
flo\v. and hean a:J
has~
n ~ to b loo d
ore rcsista hances both syst rc ~
olic
cn, there is m e n
••1"••• rt a io Jes b a rd a nce "'h 1 c h
ad a resist mpe~
Wlaa ;r • y ao co p e " ;m the peripheral J? re ssu re . G radual~y to co ntricle.~
.1,cocla ll _ b l~ y le ~ ve
a 11. , u 21 e ltis ii ca U ed JJ y penension or high 1n dilation o f heart espcc_iall singdepena~
!lj It I pw&
.r& T results ds cau
'l e d b r ll c :u t Jl11Ude l\'hich tra hard n·ork and the heart fa
_ , p ;a a il r m rtQllnota,peupwith this ex
la .
w•1111dlledle . to con,cstive canliac failure
i~
ft0 _ cause is not kno~
j
1
•
,

« .t w o li o d s: ll ·h en th e re a l
ffJipMr t r ia ii on is e~
u t~ n sio n . Primary hypertensi ity, peripheral resistance du
o ra ,n a tf a l IJJ-
p ered
(Cl) r......,., age, an.licty, h
may be due to into h,·o groups:
Ptillury ~ s etc. It is clas
sified ic.
a m n ri a , o t an er io Je
is n o t so se rio us and is chron s es to dangerous level
s
ens i o n : It lood pre ss u re ri
(i l /J o l' lf l ~ this case the b ent.
n a n r lt y p o tm s io n : In
cc ur a n d re q u ir es prompt treatm s like nephritf
(bJ Jla/J g rn:Jy o ause
e renal failure d ue lo definite c n. Some comn.~
am,,.ucauon lik T his IJpc o f hy pc ne n sio n is
o f hypertensio
ry p a tm sJ o n . on th e Se\ 'eri ry
CJ) $ccaaU171 ls. etc. Symptoms depend up n , re ti m l haemorrhage
etc.
llD o u 31pita tio
.,..., h sleeplessness, P
hea d ac h e. ng the cause.
"8iijif0 a ls a e contr o1Jed by treati
f.. 11ae reconda
,y llypcne.nsion is
1f IQ It I e on co
ff I f H yp 1rtea,Jon .
.
Jc no n ~ th e patient has to b
P Jn • J'CIJ cause 1s
no t
Jr:a 1~ •, . _ , ~.pea•'fi:"etD..OD " h e n the
, . labolJod< sodium in the
body
,~ 1 ~ iclll. . . Q llMeisan-J ·
e re is m ore
blood":,';::~~!~~
il th
~tbmeJn t Il sure.
D#J t' lr t adllm - od J:!res andsedlti
1
• i s a . t i~ ~ ~ •u & q g o ran qu illizers
«• · st T
--
-~
. ~ = ~ ~ m o r e r c c o n tm il e p o " 'c ro fh e 3 1 f
nu - - , . : = . ~ umainlydueto
11opoair,1111L il la rn l a • - '
stolic l 40
•:: :ar•.-~•.,. ......
•
$ ; 1H111i; • • • ,,srorIC J20..d=..--..o lk. IO Mild hypertension sy
••ttr.,•..,.,.,._
, . 1I C
fi q ~ ,
,_,,_ Jao ........., diastolic 100.J20. .
wlaea. ..•.,,.~
- ,.. , . . , . _ , .
,
T n ,1 . n c
.
u ;. ,, ,. lenSIOO
C ll ¢ 4 'i a lc 1 ie ,, ._
41:. "'1--41rafC hypcr QI#
I) taMets.. In
a t1 0
~ ' .1 ·~ • 2"~"1"h
i-.,4-:;+llaziile -
. _ C A ld o: IW
":; • ;'~) - } :
. t li e
- • " ,, • ..,.. or
-
 w;ip114• Apnu J07

_.,cmet. hydrallazine or diazoxide can be given intravenously "·ruch reduces

dlPC.
Jaiplyvariable depending upon the factors ofemotion, exercise etc. It indicates
of heart; the more is the blood volume, the more is the systolic pressure.
tadlllindexofthc peripheral resistance and it is the constant pressure in the arteries
. . arterioles and capillaries. Diastolic pressure is the level at which the heart is
jftbe diastolic pressure is raised heart is doing more work. Therefore diastolic
1st zrwtant than ~olic pressure.
Jlloocl pressure 1s !11uch below normal values/. e. about 100/60 in adults. Hypotcnsion
~ the patient may suffer from OCC3Sional Syncape i.e. a sudden suspension
clue to diminution or the blood supply to the brain. In case of hypotcnsion, patient
Jqll protein diet like meat, egg etc. Some important drugs arc hacmotinics and
_, Dlll(lrolonc, mcthan dienone etc.
1111111
• • The mstrumcnts for measuring blood pressure is kno\vn as sphygmomanomctcr.
consists of rubber bag covered \\it~ a cloth .envelope which is \\Tapped round the
.,_ die Bracbial artery. One tube connects the inside of the bag with a manometer
. . ._.IQllr,.. Another tube coMccts the inside ofthe bag to a hand operated pump with a release

cuff'iswrappcd around the arm just above the elbow and air is pumped into the rubber
jiilSPil!O ofthe air inside the bag is raised to about 200mm Hg. which is ~nough to flatten
alll)' in the arm and blood flow in the artery is thus stopped. The microphone of a
liplaced over the brachia! artery, the pressure inside the cuffis slo\\·ly lowered by means
n111-.ap111surc is reached at which the blood can just squeeze through the artery each time. The
lll'tl•t11C0111ttacts,theartcrymakcstappingsoundsnamcdafterKorot.kovwhofirstdcscribcdthis
•••lllfN»:nds to systolic blood pressure. The cuff pressure is no,v lowered still f urthcr until
IINld lows through the artery even bcl\\'CCR ventricular contractions. The Korotkov sounds
. . . _ muffled and disappear. The aiff present at this point corresponds to the diastolic

Coagulation or Clotting of Blood

Ila fJllld when it is inside the blood vessels of the living body but ,vhcn blood is taken out and
;WIUl11•blbeatioom temperature without addition of anticoagulants it becomcjcllificd ,,ithin
;k!9'1 ha Tbis tlaDSformation of blood from liquid to jelly like mass is kno\\n as coagulation or
dt • ltllllood. ONlgulation of blood is a major chemical defense against blood loss.
•cta1i1m -1f Blood Coagulation
*
ItOtr1 du.aAlood is the result ofa chain reactions and the mechanism ofblood coagulation can
. , , . . . . . . . .ges:
~~la~ proccs., is the production ofa lipoprotcin called thromboplastin at the site of
~ - Ii lllc~on ofprothrombin to thrombin.
t....:"!tfe lllheconversion offibrinogcn to fibrin. A series ofcogulating factors has been found
1 ,,-illlreJoaing process some important coagulation factors arc as follo"-s:
No. Common Name
Fibrinosen
Prothrombin
•
11uomboplastin
Calcium ions
llercdituy labile factors like acti,..tor globulin. proaccclcrin.
 J h..ed,.... "' """'•"'~"''''al (' #t
--.;..•':":: ·-n~•~~~ . a.•, ..,..ltlflMl r.ittr ••• -~· ta... j ,.,,,

~f ft1n111 •1.. Ith s_ ......... ...aC'.anw nionA4ic c)craior( s~

•"'.ft
*
.-.-:
~
Astta1·•1 tlMtMt tt <AHi? . ____
ttt I r t tl!t 1 :It f'l&st,:m Component (Pl'C)
•nw n,•••...,~ . .
D I ~ i n Antecedent (PTA)
ff
XII Pnr tr 'liaar.
xm ..._ lllbiH.r.ins factor. Fibnnosc:.
111 . . 1 s r
1111,.1, 1 cldlll\ ollhrmnboplasilii ma7 origJnale Crom undamaged tissuC$
fl lM J aIp I ws • (-0 uttllidc •d.-1,1» 1 \\iacn &issue exuad.wiih Ille help Oftacto V z'll
fl ct • 6J1 r I 1 •1 Im I bide the blood ,uscJ1 and (II) l11tri11sic m,cltanl sm-v. hen U1 ·
JI I t111 afdlJc I CfhWin imidc the blood \'l"ssclJ •itJ1 the help ofsurface contact factors ~rt
kt11v.· w.1X.X andl'bt ddfatto r.
la .,:j 111ftlC di ilaoni&ipjaii,n acts on anoda"r hiactn-e plasma protein kn<m-n as proth,0
• ~ d a,ki•m 10M (factor IV) and con,-cns it into acth•e lhrombin. r.-~
»*•we , 11s1e ttwomttin. an turn. acts on anOlhtt plasma protc-in caJJcd fibrinogen and coo,
a.,._ lkril. •tiida 11 uuolubk and "htn blood cells gel atbched lo the fibrin strands a. blOOd ~
MfOI ■ at tie medwus m of blood dotting can be represented as follows~

,
r-
1
lntttnilo a,...,. ExtrlnaJo Sy.tern

-
II _ ~ COIUC:C r-ac10r1 ()C. XII)
i
:
ract-n V. VII, .UC. X
Plalllet Fattof
Tessue Extract
and
Factors v. vu, X

"~ :A Thrornbop lulrl ~

/
ProlYomb in
l lhrombin

> J
,r- Fllmogln-----------➔ F1brln
ca•• (Insoluble Arm CJot)

A1 ii 8 t■ JOftll l fol blood to cogulite at the site of injury. it is eqU3.Uy importan t that blood d;
• coq,Jnec 1tl I llealth}" ,-cssct Blood coagubtlan is pm-cnt::d in healthy vessels by subsWl;
..,• ., fRIII tie \Uid MU. most imJ)OJ'WJ! among these substance is Proslocyclin. If a,~
·••t d i e ~ ,-t dots not produ:e prosbc:yclin and the platelets coagulate.
HaemotolC>gicaf Agent s·

Ce■.11 All
n..&u p heJ,tn bloiod ~at.Io n and hcotc a,c ~ ia t.ra.u:nent ol sa'CJ'C b:JClllorrtl:
n.t., F IIIJ; to-OO:. Uftl. ofblood ftolD small blood l'tllek and apilJari.cs. 1bCSC dJU~
... ···-'"•Olf'I~
(11-IMI I
,.,, .,... lift
 JO?
d
,.._ .~~ • 51::a QODtrol oodng of blood from minute vessel and are generally api,lics.
~ .... ae111in spo~gc used for controlling oozing of blood from
surface wound
~ aa,ccl is surgical gauze etc.
cnfulncing
•. ~ ~ , , . _ , drugs arc given orally or parcntcrally and stop bleeding by
!
f/1 ~ 5 V of local blood vessels, e.g., Fibrinogcn, Vitamin K. Rutin, Plasma etc.
11111 cogulants are described below:
in~; both
-•~c-• s.nila fatso~ ublcv itami n and_cxis!sin t\\·oforms VitaminK 1, and VJtam
J. ~It • af napbthaq~nonc. Another ,1ta~ n Jeno~ as Vi~m i~ ~ or menadione
is a lipid
K occurs as a
,,,.- ,adrstic napbthaqwnone C?mpound ~nd ~s as _actave as V1tarrun K. Vitamin
essent ial for the
,.:::..C l)•llin e powder, while menadaone 1s a hght yellow oil. Vitamin K is
the human
.._111 atprotmombi~ an~ factors VII, IX, X. Vitami_n K is produced by ~e flora of
r.-..- .~tat 10Jublc V1~m1ns K. and l_(i a~c absorbed 1n the prese~ cc of bale salts. It is an useful
and other
,.... ...~ agent as 1t is able to maintain a normal concentration of prothrombin
be given by
~to liin blood pl~~ by increasing their biosynthesis in liver. Vitamin K can
in K 1•
cit ~ JaldVCIIOUSly. V1tanun K 1 tablets of 5mg and ampoules 10 or 50mg per ml of Vitam
,::;, ..,.w,te. Mcnadione sodium bisulfite injection is also available which c:in be used in
_ rd• t,y Injecting intravenously.
r grey-
6
z.ta.-l aeSul phate . Protaminesare proteins having lowmolccularwejght.Itisa "·hitco
ines are
,.,..,p mcop ic amorphous or crystalline p0\\ der. IJ has slightly astringent taste. Protam
1

ofbasi c amino
...,.1a111rape1m or mature testes ofcertain fish. Protamines are basic due to presence
olllJln i& -• hate is aV8J·1able as 1 per cent soIut1on. • ma1·n1y used as 1..nepan• n antagorust
• I t 1s •
1.e.
•
PJcamiD C MPP
M,,,..i, ■rcsts the anticoagulant effects of hcaprin. 1.0mg ofprot
aminc sulphate neutralizes the
sterilised by
antimplanl dl'ect of 100 units of heparin. These are used as an injection which is
may cause a
8lldoa and b stored at 2°-8°C. It is used as intravenous injection but sometimes it
lllldeD fill ia blood pressure dyspnoea or, transitory flushing etc.
icdthrombin
l.lr,-1.11n1Dbln.ltisanenzymcwhichcanconvcrthumanfibrinogenintofibrin.Dr
By a suitabl e fraction3J
mbc, -,.cdf lom pooled liquid plasma obtained from human subjects.
thrombin in
'"heiqletlleprolhrombin fraction can be separated. Prothrombin can be converted into
on and
ra'Utfcalciumionsand human thromboplastin. This solution can be sterilised by filtrati
••be 6MDd-ctriecl.
r or in
It.is IINd tapically for its clotting effect on blood. Thrombin can be applied as a po\\·dc
nitrogen and
IDlatioaform.Dried thrombin should be stored in sterile containers in an atmosphere of
. . .,,....IIUre.

Antic oagu lant Drug s

coagulation
i::£. !__. .ldJltances which intcd'erewith blood coagulation and thus prolong the
. .
L ~ c a n be classified into: body_ t can~ c~ther
<Z, ti lldlor pm,en ting clotting o!blood inside the vascular system ofthe 1

ts-ea, lain, drug e.g. heparin etc. (b) slo,v acting drug e.g. coumann denvat1ves,
2.. 111 U »Jaivatives etc.
Q- J:':t' ._.• which prevent clotting of blood in vitro.
. . be Uled both in vivo as well as in ,·itro.
~11UC:aat•tu11lllant1 arc as follows:

111ina oral antico aplan ts i.e. these drugs are effective wncn ~dministcrcd ~Y
.,...., ofa benzene ring fused with an a.•pyronc ring. The fi~st Cown an~
Mlll-ta,111ec1 trvm IWCCI clover plant was bishydroxy coumarin or D1coumarol; It
 s '
Cac:-:-aru
00
J
----r~

I
al
!)..a-A:'"!'"afflll

- The ~ c a:-,k,n d ax.:runa &m-zne is &Je i, their ability to p~g the Si~--·
p,oduombiu an.:f ooors \ lf. IX. Xb)· l!J.: fnv.. c.o~:miria ata:Jp)· is (QlM t o ~ t,k
xy~i..
. ~ n b - d . s . Bi~ ,~~= !nibs o:,J:'4•,:n:i.r..Jtct.a..-wn in ,itro.B ishy~c
lwpm lcr.,:4 ~ti=:ni;-9...h.ct :~•=;;rrJ.:dis qti::d :m~~" ~gn u mlly. It ii used in 1he !.
1,~,
• ofpuh r.au,y c:-r.b c:Ji~( ct-~d a:t.,~ c!C(~ umau ti,mju ricsto blood
~,a :_
2. lndandione Derivatives
- lkse ~also sbw"a:1:n, 101i~, h:Msa ad in:txScs cmpoams likepb cn,ooi c~ di;>!e:::=11
azrisindimc etc.. Arncng these the cmpa: .ilduz i imti2Jly-1FJ.S pbcnm.1L:oc and «hers dd':r
mlbe ~c!aa iasud axr~d tdS-P m:rdi aaeis adem "Jli,- ccfin d1ne" md:
d a bmzm : rm, fi:sed r.th q-:J.q,c:Hne r..sir it mmcd as l-¢mr>1-ir..dme-l,J ~ h bl
follo aing ~
7 ,o
6~\ f -~.

~ U lr U
◄ "o
 · -4 11_,,.a1,,io~/cal Agent., ,
"!__.,,,.es
it §hoW S some ~dvers~ reactions Iike ~kin rash, Clltensive ~de m a,jaundi~
~ etc:. Som e of
11 I

--
~ n d s tum the unnc rcd,sh orange. Diphcndionc may caus e nau,5
ca. vom1ttng etc.

.. -:::a inga ntic oagu lant and is obtained from most ccll~ ofliv er.Co
mme rcial heparin iso~t ain~ d
11•~ tuns and the inte~tinal muco sa of pigs and cattle. llcpa rin Is a muco poly
sacc harid e. It 11 whit e
.-ch C •-•red amorphous powd er. It is hyg,ros copic in nature and resis
II ff1l,C c,Ow- tant to an kind s of chem ical
~ · 'n prevents the clotting of bloo d both in vivo and vitro. It prob ably
acts on all the three stage s
1-tt~,tion. I lcparin is not effective orally but it is well abso rbed ancr
subc utan eous injec tion. It
-'~rn ciab oliz ed by a liver eneymc know n~ hcparinasc. Its calcium and
sodium salts are also used .
• - . is I strong electro negative comp ound ~nd its anticoagulant activ
ity is attrib uted to its stron g
~ga tivc cha rge. It form s comp lexes with postivcly charged proteins
inclu ding seve ral prote ins
crntd with blood coagulation and inhibits its action. When llcpa rin is administe
red in thera peut ic
ctJt'- it prolongs the clotting time of blood. I lcparin is used in acute cond
ition s in whic h a rapid
=io n in coaguiability of the blood is desired. It is also used for prev
ention of clott ing of bloo d
dflplc.
4. cttrtc acid
SQ Citric acid is obtained from Citrus fruits like oranges, lemons etc. It is also
prod uced synth etica lly
r,omgtycerol. Citric acid is 2-hy drox y prop ane I, 2, 3. tricarboxylic acid.
It forms salts with pota ssi~m
OH OH

HO OO --C Hj- -1
I_ CHl .coo n IIOOG
____ _ I
Clll 1-- CH 2 .COO Na

COOH COO ll
and sodium. Citric Acid Sodium Citra te
The antic~gulant solution conta ins 2.5 per cent of sodium citrate and
it is used to prev ent bloo d
coagulation in vitro and as an anticoagulant for bloo d to be transfused. Sodi
um citrate soln rcvc nts the
cloning of blood by forming an undissociated calcium citrate complex.