Chapter 11Chapter 11BloodBlood

Jeanelle F. Jimenez RN, BSN, CCRNJeanelle F. Jimenez RN, BSN, CCRN

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BLOOD COMPOSITION BLOOD COMPOSITION (Table 11-1)(Table 11-1)

Blood plasmaBlood plasma Definition—blood minus its cellsDefinition—blood minus its cells Composition—water containing many Composition—water containing many

dissolved substances (e.g., foods, salts, and dissolved substances (e.g., foods, salts, and hormones)hormones)

Amount of blood—varies with size and sex; 4 Amount of blood—varies with size and sex; 4 to 6 L about average; about 7% to 9% of body to 6 L about average; about 7% to 9% of body weightweight

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BLOOD COMPOSITIONBLOOD COMPOSITION

Formed elementsFormed elements TypesTypes

• RBCs (erythrocytes)RBCs (erythrocytes)• WBCs (leukocytes)WBCs (leukocytes)

Granular leukocytes—neutrophils, eosinophils, and basophilsGranular leukocytes—neutrophils, eosinophils, and basophils Nongranular leukocytes—lymphocytes and monocytesNongranular leukocytes—lymphocytes and monocytes

• Platelets, or thrombocytesPlatelets, or thrombocytes CountCount

• RBCs—4.5 to 5 million per mmRBCs—4.5 to 5 million per mm33 of blood of blood• WBCs—5000 to 10,000 per mmWBCs—5000 to 10,000 per mm3 3 of bloodof blood• Platelets—300,000 per mmPlatelets—300,000 per mm33 of blood of blood

Formation—red bone marrow (myeloid tissue) forms all Formation—red bone marrow (myeloid tissue) forms all blood cells except some lymphocytes and monocytes, blood cells except some lymphocytes and monocytes, which are formed by lymphatic tissue in the lymph nodes, which are formed by lymphatic tissue in the lymph nodes, thymus, and spleenthymus, and spleen

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BLOOD COMPOSITIONBLOOD COMPOSITION

RBCsRBCs Structure—disk-shaped, without nucleiStructure—disk-shaped, without nuclei Functions—transport oxygen and carbon dioxideFunctions—transport oxygen and carbon dioxide Anemia—inability of blood to carry adequate oxygen to Anemia—inability of blood to carry adequate oxygen to

tissues; caused, for example, by:tissues; caused, for example, by:• Inadequate RBC numbersInadequate RBC numbers• Deficiency of hemoglobinDeficiency of hemoglobin• Pernicious anemia—deficiency of vitamin B12Pernicious anemia—deficiency of vitamin B12

Polycythemia—abnormally high RBC countPolycythemia—abnormally high RBC count

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BLOOD COMPOSITIONBLOOD COMPOSITION

WBCs (leukocytes)WBCs (leukocytes) General function—defenseGeneral function—defense WBC countWBC count

• Differential WBC count reveals proportions of each type of Differential WBC count reveals proportions of each type of WBCWBC

• Leukopenia—abnormally low WBC countLeukopenia—abnormally low WBC count• Leukocytosis—abnormally high WBC countLeukocytosis—abnormally high WBC count

Neutrophils and monocytes carry out phagocytosisNeutrophils and monocytes carry out phagocytosis Lymphocytes produce antibodies (B-lymphocytes) or Lymphocytes produce antibodies (B-lymphocytes) or

directly attack foreign cells (T-lymphocytes)directly attack foreign cells (T-lymphocytes) Eosinophils protect against parasitic irritants that cause Eosinophils protect against parasitic irritants that cause

allergiesallergies Basophils produce heparin, which inhibits clottingBasophils produce heparin, which inhibits clotting

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BLOOD COMPOSITIONBLOOD COMPOSITION

WBC disordersWBC disorders Leukemia—cancerLeukemia—cancer

• Elevated WBC countElevated WBC count• Cells do not function properlyCells do not function properly

Type identified by how quickly symptoms Type identified by how quickly symptoms appear and cell type involvedappear and cell type involved• Acute lymphocytic leukemia (ALL)Acute lymphocytic leukemia (ALL)• Acute myeloid leukemia (AML)Acute myeloid leukemia (AML)• Chronic lymphocytic leukemia (CLL)Chronic lymphocytic leukemia (CLL)• Chronic myeloid leukemia (CML)Chronic myeloid leukemia (CML)

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BLOOD COMPOSITIONBLOOD COMPOSITION

Platelets and blood clotting (Figure 11-6)Platelets and blood clotting (Figure 11-6) Platelets play an essential role in blood clottingPlatelets play an essential role in blood clotting Blot clot formationBlot clot formation

• Clotting factors released at the injury site produce Clotting factors released at the injury site produce prothrombin activatorprothrombin activator

• Prothrombin activator and calcium convert Prothrombin activator and calcium convert prothrombin to thrombinprothrombin to thrombin

• Thrombin triggers formation of fibrin, which traps Thrombin triggers formation of fibrin, which traps RBCs to form a clotRBCs to form a clot

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BLOOD TYPESBLOOD TYPES

ABO system (Figure 11-7)ABO system (Figure 11-7) Antigen—substance that can activate immune systemAntigen—substance that can activate immune system Antibody—substance made by body in response to Antibody—substance made by body in response to

stimulation by an antigenstimulation by an antigen Blood typesBlood types

• Type A blood—type A self-antigens in RBCs; anti-B type Type A blood—type A self-antigens in RBCs; anti-B type antibodies in plasmaantibodies in plasma

• Type B blood—type B self-antigens in RBCs; anti-A type Type B blood—type B self-antigens in RBCs; anti-A type antibodies in plasmaantibodies in plasma

• Type AB blood—type A and type B self-antigens in RBCs; Type AB blood—type A and type B self-antigens in RBCs; no anti-A or anti-B antibodies in plasmano anti-A or anti-B antibodies in plasma

• Type O blood—no type A or type B self-antigens in RBCs; Type O blood—no type A or type B self-antigens in RBCs; both anti-A and anti-B antibodies in plasmaboth anti-A and anti-B antibodies in plasma

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BLOOD TYPESBLOOD TYPES

Rh systemRh system Rh-positive blood—Rh factor antigen present Rh-positive blood—Rh factor antigen present

in RBCsin RBCs Rh-negative blood—no Rh factor present in Rh-negative blood—no Rh factor present in

RBCs; no anti-Rh antibodies present naturally RBCs; no anti-Rh antibodies present naturally in plasma; anti-Rh antibodies, however, appear in plasma; anti-Rh antibodies, however, appear in the plasma of Rh-negative persons if Rh-in the plasma of Rh-negative persons if Rh-positive RBCs have been introduced into their positive RBCs have been introduced into their bodiesbodies

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BLOOD TYPESBLOOD TYPES

Universal donor and universal recipient Universal donor and universal recipient bloodblood Type OType O—universal donor blood—universal donor blood Type ABType AB++—universal recipient blood—universal recipient blood

Erythroblastosis fetalis—may occur when Erythroblastosis fetalis—may occur when Rh-negative mother carries a second Rh-Rh-negative mother carries a second Rh-positive fetus; caused by mother’s Rh positive fetus; caused by mother’s Rh antibodies reacting with baby’s Rh-positive antibodies reacting with baby’s Rh-positive cellscells