INDEX

S. No Topics Page
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1 INTRODUCTION 1

2 COMPONENTS OF BLOOD 2

3 TYPES OF BLOOD 3

4 TYPES OF WHITE BLOOD CELL 4

5 WHAT ARE ABO AND RH BLOOD GROUPS 7

6 BLOOD COAGULATION 8

7 PLATELET ACTIVATION 10

8 CONCLUSION 11
 BLOOD

INTRODUCTION

If there is one thing that can be called as the lifeline, it most certainly will be blood. Without it, the food that
you eat cannot be transported to different cells. Oxygen cannot reach the cells nor can waste be eliminated.
Even growth cannot happen, as hormones in our body flow through the system, through blood.

Blood is one of the most important components of life. Almost any animal that possesses a circulatory
system has blood. From an evolutionary perspective, blood was speculated to have risen from a type of cell
that was responsible for phagocytosis and nutrition. Billions of years later, blood and the circulatory system
have drastically helped the evolution of more complex lifeforms.

Blood is a special fluid that is actually a connective tissue. We can call it a transport liquid which is pumped
by the heart to different parts of the body, after which it comes back again to the heart. This is a process that
happens continuously in your body, till your heart beats. The cells of the body are highly susceptible and
they need a constant supply of blood. If its flow stops, death can occur within minutes.

The constancy of the composition of the blood is made possible by the circulation, which conveys blood
through the organs that regulate the concentrations of its components. In the lungs, blood acquires oxygen
and releases carbon dioxide transported from the tissues. The kidneys remove excess water and dissolved
waste products. Nutrient substances derived from food reach the bloodstream after absorption by
the gastrointestinal tract. Glands of the endocrine system release their secretions into the blood, which
transports these hormones to the tissues in which they exert their effects. Many substances are recycled
through the blood; for example, iron released during the destruction of old red cells is conveyed by the
plasma to sites of new red cell production where it is reused. Each of the numerous components of the blood
is kept within appropriate concentration limits by an effective regulatory mechanism. In many instances,
feedback control systems are operative; thus, a declining level of blood sugar (glucose) leads to accelerated
release of glucose into the blood so that a potentially hazardous depletion of glucose does not occur.

Unicellular organisms, primitive multicellular animals, and the early embryos of higher forms of life lack
a circulatory system. Because of their small size, these organisms can absorb oxygen and nutrients and
can discharge wastes directly into their surrounding medium by simple diffusion. Sponges and coelenterates
(e.g., jellyfish and hydras) also lack a blood system; the means to transport foodstuffs and oxygen to all the
cells of these larger multicellular animals is provided by water, sea or fresh, pumped through spaces inside
the organisms.

It consists of the following components:

 Plasma (fluid matrix)
 Blood cells

The three types of blood cells are erythrocytes or RBCs, leucocytes or WBCs and thrombocytes or platelets.
They account for 45 per cent of the blood.

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COMPONENTS OF BLOOD:

There are many cellular structures in the composition of blood. When a sample of blood is spun in a
centrifuge machine, they separate into the following constituents: Plasma, buffy coat and erythrocytes. Thus,
blood contains RBC, WBC, platelets and plasma.

PLASMA:

The liquid state of blood can be contributed to plasma as it makes up ~55% of blood. It is pale yellow in
colour and when separated. Blood plasma consists of salts, nutrients, water and enzymes. Blood plasma also
contains important proteins and other components necessary for overall health. Hence, blood plasma
transfusions are given to patients with liver failure and life-threatening injuries.

Components of Blood Plasma:

Blood plasma has several protein components. Proteins in blood plasma are:

 Serum globulin
 Serum albumin
 Fibrinogen

The serum contains only globulin and albumin. Fibrinogen is absent in serum because it is converted into
fibrin during blood clotting.

Functions of Blood Plasma:

Blood plasma plays a crucial role in maintaining homeostasis in the body. It serves as the medium through
which nutrients, hormones, and waste products are transported to and from the body's cells. Additionally,
plasma contains clotting factors that are essential for wound healing and the prevention of excessive
bleeding. By carrying antibodies and other immune proteins, plasma also helps the body fight infections and
maintain a stable immune response. It also serves as a buffer to help maintain the body's pH level, ensuring
that blood remains slightly alkaline, which is vital for proper cellular function.
Blood plasma is not only important for human health but also used in various medical therapies. Plasma-
derived treatments, such as immunoglobulins, are administered to patients suffering from immune
deficiencies. Plasma donations are critical in treating a range of conditions, including trauma, burns, and
clotting disorders. For these reasons, plasma is often referred to as "liquid gold" in the medical field due to
its lifesaving properties.

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TYPES OF BLOOD:

We have seen blood consist of cells known as formed elements of blood. These cells have their own
functions and roles to play in the body. The blood cells which circulate all around the body are as follows:

Red Blood Cells (Erythrocytes):

RBCs are biconcave cells without nucleus in humans; also known as erythrocytes. RBCs contain the iron-
rich protein called haemoglobin; give blood its red colour. RBCs are the most copious blood cells produced
in bone marrows. Their main function is to transport oxygen from and to various tissues and organs.

RBCs or erythrocytes exhibit a diameter of 7-8 µm possessing an atypical structure in comparison to most
other body cells of humans. The RBC structure resembles a donut, they are biconcave wherein their
periphery is thicker than their central portion. Courtesy to this feature, the total surface of the cell membrane
is maximized enabling exchange of gases and their transport.

These cells are anuclear and do not have any other intracellular organelles as they are lost in erythropoiesis.
There are two main structures – cytoplasm engirdled by a cell membrane.

Cytoplasm – It is filled with haemoglobin which in turn contains acidophilia causing erythrocytes to stain
intense red with eosin on the samples of tissues stained with hematoxylin and eosin.

Cell membrane – This membrane is a lipid layer containing two types of membrane proteins – peripheral
and integral.

The RBC membrane is a two-dimensional structure comprising a cytoskeleton and a lipid bilayer bound
together. The lipid bilayer has different types of cholesterol, phospholipids, sphingolipids, and integral
membrane proteins like the glycophorin.

The peripheral membrane proteins extend into the cytoplasm only, as they are found on the inner surface of
the plasma membrane. The proteins are interconnected by several intracellular filaments which form a
complex mesh-like cytoskeletal network through the inner cell membrane. This network is responsible for
imparting strength and elasticity to RBCs enabling its even passage into the thinnest and smallest capillaries
without any breakage/leakage.

Integral membrane proteins are innumerable, stretching throughout the thickness of the cell membrane. It
binds haemoglobin serving as anchor points for the cytoskeletal network of RBCs. Additionally, they
express antigens of ABO blood groups. Erythrocyte surface antigens are necessary for blood transfusions.

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White Blood Cells (Leucocytes):

Leucocytes are colourless blood cells. They are colourless because it is devoid of haemoglobin. They are
further classified as granulocytes and agranulocytes. WBCs mainly contribute to immunity and defence
mechanism.

TYPES OF WHITE BLOOD CELLS:

There are five different types of White blood cells and are classified mainly based on the presence and
absence of granules.
 Granulocytes
 Agranulocytes

Granulocytes:

They are leukocytes, with the presence of granules in their cytoplasm. The granulated cells include-
eosinophil, basophil, and neutrophil.

Eosinophils:

 They are the cells of leukocytes, which are present in the immune system.
 These cells are responsible for combating infections in parasites of vertebrates and for controlling
mechanisms associated with allergy and asthma.
 Eosinophil cells are small granulocyte, which are produced in the bone marrow and makes 2 to 3 per
cent of whole WBCs. These cells are present in high concentrations in the digestive tract.

Basophils:

 They are the least common of the granulocytes, ranging from 0.5 to 1 per cent of WBCs.
 They contain large cytoplasmic granules, which play a vital role in mounting a non-specific immune
response to pathogens, and allergic reactions by releasing histamine and dilating the blood vessels.
 These white blood cells have the ability to be stained when exposed to basic dyes, hence referred to
as basophil.
 These cells are best known for their role in asthma and their result in inflammation and
bronchoconstriction in the airways.
 They secrete serotonin, histamine and heparin.

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Neutrophils:

 They are normally found in the bloodstream.

 They are predominant cells, which are present in pus.
 Around 60 to 65 per cent of WBCs are neutrophils with a diameter of 10 to 12 micrometres.
 The nucleus is 2 to 5 lobed and the cytoplasm has very fine granules.
 Neutrophil helps in the destruction of bacteria with lysosomes, and it acts as a strong oxidant.
 Neutrophils are stained only using neutral dyes. Hence, they are called so.
 Neutrophils are also the first cells of the immune system to respond to an invader such as a bacteria
or a virus.
 The lifespan of these WBCs extends for up to eight hours and is produced every day in the bone
marrow.

Agranulocytes:

They are leukocytes, with the absence of granules in their cytoplasm. Agranulocytes are further classified
into monocytes and lymphocytes.

Monocytes:

 These cells usually have a large bilobed nucleus, with a diameter of 12 to 20 micrometres.
 The nucleus is generally half-moon shaped or kidney-shaped and it occupies 6 to 8 per cent of
WBCs.
 They are the garbage trucks of the immune system.
 The most important functions of monocytes are to migrate into tissues and clean up dead cells,
protect against bloodborne pathogens and move very quickly to the sites of infections in the tissues.
 These white blood cells have a single bean-shaped nucleus, hence referred to as Monocytes.

Lymphocytes:

 They play a vital role in producing antibodies.

 Their size ranges from 8 to 10 micrometres.
 They are commonly known as natural killer cells.
 They play an important role in body defence.
 These white blood cells are colourless cells formed in lymphoid tissue, hence referred to as
lymphocytes.
 There are two main types of lymphocytes – B lymphocytes and T lymphocytes.
 These cells are very important in the immune systems and are responsible for humoral and cell-
mediated immunity.

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Platelets (Thrombocytes):

Platelets, also known as thrombocytes, are special blood cells with an important function. Platelets control
blood clotting, which means they are critical for healing wounds and stopping bleeding.

Platelets get their name from their appearance. They look like tiny, colorless plates. When a blood vessel
tears, platelets stick together to form a clot, plugging the tear to stop bleeding.
Platelets are one of three types of blood cells. (Red blood cells and white blood cells are the other types of
blood cells.) Platelets form in the bone marrow from cells known as megakaryocytes.
Platelets form clots through a multi-step process that includes:

1. Adhesion: This is the first step in which platelets rush to the site that's bleeding. For example, if you
cut your finger and rupture a blood vessel, it will bleed. To stop the blood flow, platelets within that
broken vessel start attaching to the site of the injury. They then send out chemical signals for more
help.
2. Aggregation: In the next step, more platelets answer the call and begin to connect to each other to
form a clot.
3. Coagulation: As platelets build up at the site of the wound, they seal up the blood vessel in what's
called a coagulation cascade. A structural protein known as fibrin joins the platelets to knit the clot
together. Fibrin is what forms the scab on a cut.

What Causes Low Platelets?

If the body doesn't have enough platelets circulating in the blood, you may develop a condition
called thrombocytopenia. This occurs when your bone marrow makes too few platelets, which means you're
at greater risk for bruising and prolonged bleeding that takes a long time to slow down. You may need
medical treatment for this condition.
The following are some factors that may contribute to low platelet count:
 Chemotherapy or radiation therapy: These treatments suppress or kill off the blood-producing
cells in your bone marrow, leading to low platelet production.
 Viral infections: Hepatitis C or human immunodeficiency virus (HIV) infections may attack bone
marrow, affecting thrombocyte production.
 Autoimmune conditions: Platelets may be affected by conditions such as lupus (an autoimmune
disease that affects many different tissues and organs) or immune thrombocytopenic purpura (ITP, a
condition of low platelets).
 Pregnancy: Hemolysis, elevated liver enzymes, low platelet count syndrome, better known as
HELLP, is a condition that may occur during pregnancy. It's a type of preeclampsia (characterized by
high blood pressure) and may result in the breakdown of blood cells and platelets.
 Medications: Anticoagulants such as warfarin and Lovenox (heparin) may stop platelet production.
Other examples of conditions that may cause thrombocytopenia include having a mechanical heart valve,
chronic alcohol use disorder, liver disease, severe sepsis (a life-threatening infection), and toxic exposures.

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What Causes High Platelets?

If the body has too many platelets in circulation, it may be related to one of two conditions:
 Thrombocythemia: This occurs when the bone marrow makes too many platelets. If you have
thrombocythemia, you may have other blood cell disorders.
 Thrombocytosis: This is a high platelet count caused by another pre-existing condition.
Disorders that may contribute to high platelet count include the following:
 Primary bone marrow disorder: Essential thrombocytosis is a condition in which the
megakaryocytes (cells that make platelets) in the bone marrow produce too many platelets,
increasing the risk of blood clots.
 Chronic inflammation in the body: Inflammatory conditions such as rheumatoid arthritis (RA, an
autoimmune disease attacking the joints) and inflammatory bowel disease (IBD, Crohn's, and
ulcerative colitis, which affect the digestive tract) may result in high platelet counts because the bone
marrow makes more white blood cells and platelets to combat cellular damage caused by
inflammation.
 Infection: Bone marrow cells increase the production of white blood cells and platelets to help fight
infection.
 Iron deficiency anemia: Reactive or secondary thrombocytosis may result when the body is
undergoing a breakdown of red blood cells. The bone marrow cells go into overproduction to meet
the body's needs.
 Spleen removal: Up to one-third of platelets are stored in the spleen at any time. Removing this
organ causes a greater number of platelets to stay in the bloodstream since they can't be stored in the
spleen. This is usually a temporary condition.
 Cancer: High platelet counts can also be seen in cancer, especially with gastrointestinal cancer as
well as lymphoma, lung, ovarian, and breast cancer. This may be caused by inflammation related to
cancer.
In addition, a temporary increase in the platelet count can happen after major surgery or trauma.

WHAT ARE ABO AND RH BLOOD GROUPS?:

During the blood transfusion, the two most important group systems examined are the ABO-system and
the Rhesus system.

The ABO blood group system consists of 4 types of blood group – A, B, AB, and O and is mainly based on
the antigens and antibodies on red blood cells and in the plasma. Both antigens and antibodies are protein
molecules in which antigens are present on the surface of Red Blood Cells and antibodies are present in the
plasma which is involved in defending mechanisms.

On the other hand, the Rh blood group system consists of 50 defined blood group antigens. In the Rh
system, the most important antigens are D, C, c, E, and e. The ABO and Rh blood systems are discussed in
detail below.

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ABO BLOOD GROUP SYSTEM:

The basis of ABO grouping is of two antigens- Antigen A and Antigen B. The ABO grouping system is
classified into four types based on the presence or absence of antigens on the red blood cells surface and
plasma antibodies.

 Group A – contains antigen A and antibody B.

 Group B –contains antigen B and antibody A.
 Group AB –contains both A and B antigen and no antibodies (neither A nor B).
 Group O – contains neither A nor B antigen and both antibodies A and B.

The ABO group system is important during blood donation or blood transfusion as mismatching of blood
group can lead to clumping of red blood cells with various disorders. It is important for the blood cells to
match while transfusing i.e. donor-recipient compatibility is necessary. For example, a person of blood
group A can receive blood either from group A or O as there are no antibodies for A and O in blood group A.

RH BLOOD GROUP SYSTEM:

In addition to the ABO blood grouping system, the other prominent one is the Rh blood group system. About
two-thirds of the population contains the third antigen on the surface of their red blood cells known as Rh
factor or Rh antigen; this decides whether the blood group is positive or negative. If the Rh factor is
present, an individual is rhesus positive (Rh+ve); if an Rh factor is absent individual is rhesus negative (Rh-
ve) as they produce Rh antibodies. Therefore, compatibility between donor and individual is crucial in this
case as well.

BLOOD COAGULATION:

Blood coagulation or clotting is an important phenomenon to prevent excess loss of blood in case of injury
or trauma. The blood stops flowing from a wound in case of injury. The blood clot or ‘coagulum’ is formed
by a network of fibrin threads. In this network, deformed and dead formed elements (erythrocytes,
leukocytes and platelets) get trapped.

BLOOD COAGULATION PATHWAY:

The process of blood coagulation leads to haemostasis, i.e. prevention of bleeding or haemorrhage. Blood
clotting involves activation and aggregation of platelets at the exposed endothelial cells, followed by
deposition and stabilisation of cross-linked fibrin mesh.

Primary haemostasis involves platelet aggregation and formation of a plug at the site of injury, and
secondary haemostasis involves strengthening and stabilisation of platelet plug by the formation of a

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network of fibrin threads. The secondary haemostasis involves two coagulation pathways, the intrinsic
pathway and the extrinsic pathway. Both pathways merge at a point and lead to the activation of fibrin, and
the formation of the fibrin network.

BLOOD COAGULATION CASCADE:

The process of coagulation is a cascade of enzyme catalysed reactions wherein the activation of one factor
leads to the activation of another factor and so on.

The three main steps of the blood coagulation cascade are as follows:
1. Formation of prothrombin activator
2. Conversion of prothrombin to thrombin
3. Conversion of fibrinogen into fibrin

Formation of Prothrombin Activator:

The formation of a prothrombin activator is the first step in the blood coagulation cascade of secondary
haemostasis. It is done by two pathways, viz. extrinsic pathway and intrinsic pathway.

Extrinsic Coagulation Pathway:

It is also known as the tissue factor pathway. It is a shorter pathway. The tissue factors or tissue
thromboplastins are released from the damaged vascular wall. The tissue factor activates the factor VII to
VIIa. Then the factor VIIa activates the factor X to Xa in the presence of Ca 2+.

Intrinsic Coagulation Pathway:

It is the longer pathway of secondary haemostasis. The intrinsic pathway begins with the exposure of blood
to the collagen from the underlying damaged endothelium. This activates the plasma factor XII to XIIa.
XIIa is a serine protease, it activates the factor XI to XIa. The XIa then activates the factor IX to IXa in the
presence of Ca2+ ions.
The factor IXa in the presence of factor VIIIa, Ca2+ and phospholipids activate the factor X to Xa.

Common Pathway:

The factor Xa, factor V, phospholipids and calcium ions form the prothrombin activator. This is the start of
the common pathway of both extrinsic and intrinsic pathways leading to coagulation.

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Conversion of Prothrombin to Thrombin:

Prothrombin or factor II is a plasma protein and is the inactive form of the enzyme thrombin. Vitamin K is
required for the synthesis of prothrombin in the liver. The prothrombin activator formed above converts
prothrombin to thrombin. Thrombin is a proteolytic enzyme. It also stimulates its own formation, i.e. the
conversion of prothrombin to thrombin. It promotes the formation of a prothrombin activator by activating
factors VIII, V and XIII.

Conversion of Fibrinogen into Fibrin:

Fibrinogen or factor I is converted to fibrin by thrombin. Thrombin forms fibrin monomers that polymerise
to form long fibrin threads. These are stabilised by the factor XIII or fibrin stabilising factor. The fibrin
stabilising factor is activated by thrombin to form factor XIIIa. The activated fibrin stabilising factor (XIIIa)
forms cross-linking between fibrin threads in the presence of Ca2+ and stabilises the fibrin meshwork. The
fibrin mesh traps the formed elements to form a solid mass called a clot.

PLATELET ACTIVATION:

The blood circulating in the blood vessel does not clot under normal circumstances. The blood coagulation
process is stimulated when there is any damage to the endothelium of blood vessels. It leads to platelet
activation and aggregation. When collagen is exposed to the platelets due to injury, the platelets bind to
collagen by surface receptors. This adhesion is stimulated by the von Willebrand factor released from
endothelial cells and platelets. This forms additional cross-linking and activation of platelet integrins, which
facilitate tight binding and aggregation of platelets at the site of injury. This leads to primary haemostasis.

Once the platelets are activated, they undergo a shape change that allows them to release chemical signals
that further amplify the clotting process. These signals include substances like adenosine diphosphate
(ADP), thromboxane A2, and serotonin, which recruit additional platelets to the site of injury, causing them
to stick together and form a platelet plug. This aggregation process is essential in creating the initial barrier
that prevents further blood loss. The formation of this platelet plug is often referred to as primary
hemostasis because it is the first step in the blood clotting process.

Following the formation of the platelet plug, secondary hemostasis begins. This phase involves the
activation of the coagulation cascade, a series of enzymatic reactions that result in the formation of fibrin, a
fibrous protein that weaves through the platelet plug, strengthening and stabilizing it. Fibrin threads trap red
blood cells and other blood components, forming a solid clot that securely seals the injured vessel. Platelet
activation and subsequent fibrin formation are highly regulated processes, as excessive clotting can lead to
conditions like thrombosis, while insufficient clotting may result in excessive bleeding.

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CONCLUSION:

In summary, blood is a vital connective tissue that plays essential roles in the body, comprising various
components that work harmoniously to maintain homeostasis and overall health. The primary components of
blood include plasma, red blood cells (RBCs), white blood cells (WBCs), and platelets. Plasma, constituting
approximately 55% of blood volume, is crucial for transporting nutrients, hormones, and waste products.
Red blood cells are responsible for oxygen delivery and carbon dioxide removal, while white blood cells are
key players in the immune response, defending the body against pathogens.

The types of blood—A, B, AB, and O—are determined by the presence of specific antigens and antibodies,
which are critical during blood transfusions. The ABO and Rh blood group systems ensure compatibility
between donors and recipients, preventing potentially dangerous reactions. The presence or absence of the
Rh factor determines whether an individual's blood type is positive or negative, further complicating
transfusion protocols.

Understanding blood coagulation and platelet activation is equally important in the context of injury and
healing. The coagulation process is a complex series of events that begins with the activation of platelets in
response to vascular injury. This leads to the formation of a platelet plug, a critical first step in preventing
blood loss. The subsequent cascade of events results in fibrin formation, which solidifies the clot and aids in
tissue repair.

Ultimately, the intricate interplay between blood components, their types, and the mechanisms of
coagulation underscores the remarkable efficiency of the circulatory system. Continuous research in
hematology not only enhances our understanding of blood's multifaceted functions but also informs medical
practices, paving the way for improved treatment strategies for various blood disorders and transfusion-
related complications.

Moreover, the study of blood components and their functions has significant implications in medical
science, particularly in the fields of transfusion medicine and hematology. Advancements in blood banking
and screening techniques have greatly improved the safety and efficacy of blood transfusions, allowing for
better matching between donors and recipients. As our understanding of blood group systems continues to
evolve, we can better address the challenges associated with blood type incompatibility and reduce the risks
of transfusion-related reactions. This knowledge not only enhances patient safety but also plays a crucial
role in emergency medicine, where timely access to compatible blood products can be life-saving.
Furthermore, ongoing research into the mechanisms of blood coagulation and platelet activation has opened
new avenues for developing targeted therapies for bleeding disorders and thrombotic conditions. Conditions
such as hemophilia, thrombocytopenia, and thrombosis highlight the need for continued exploration of
blood's complex biology. By uncovering the underlying molecular pathways involved in coagulation and
platelet function, researchers are paving the way for innovative treatments that can more effectively manage
these conditions. Ultimately, a deeper understanding of blood and its components is essential for advancing
clinical practices and improving patient outcomes in a wide range of medical scenarios.

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