Blood Biochemistry
Blood Biochemistry
Blood Biochemistry
dealing with:
Substance distribution
Regulation of blood levels of particular
substances
Body protection
Blood transports:
Oxygen from the lungs and nutrients from the
digestive tract
Metabolic wastes from cells to the lungs and
kidneys for elimination
Hormones from endocrine glands to target organs
Blood maintains:
Appropriate body temperature by absorbing and
distributing heat to other parts of the body
Normal pH in body tissues using buffer systems
Adequate fluid volume in the circulatory system
Blood prevents blood loss by:
Activating plasma proteins and platelets
Initiating clot formation when a vessel is
broken
Blood prevents infection by:
Synthesizing and utilizing antibodies
Activating complement proteins
Activating WBCs to defend the body against
foreign invaders
Average volume of blood:
5–6 L for males; 4–5 L for females (Normovolemia)
Hypovolemia - low blood volume
Hypervolemia - high blood volume
Viscosity (thickness) - 4 - 5 (where water = 1)
The pH of blood is 7.4
Osmolarity = 300 mOsm or 0.3 Osm
This value reflects the concentration of solutes in the plasma
Salinity = 0.85%
Reflects the concentration of NaCl in the blood
Temperature is 38C, slightly higher than “normal”
body temperature
Blood accounts for approximately 8% of body weight
Blood is the body’s only fluid tissue (a
connective tissue)
2 major components
Liquid
= plasma (55%)
Formed elements (45%)
Erythrocytes, or red blood cells (RBCs)
Leukocytes, or white blood cells (WBCs)
Platelets - fragments of megakaryocytes in marrow
Plasma
(55% of whole blood)
Buffy coat:
leukocyctes and
platelets
(<1% of whole blood)
Formed
elements
Erythrocytes
1 Withdraw blood 2 Centrifuge (45% of whole blood)
and place in tube
Blood plasma components:
Water = 90-92%
Proteins = 6-8%
Albumins; maintain osmotic pressure of the blood
Globulins
Alpha
and beta globulins are used for transport purposes
Gamma globulins are the immunoglobulins (IgG, IgA, etc)
Fibrinogen; a clotting protein
Organic nutrients – glucose, carbohydrates, amino
acids
Electrolytes – sodium, potassium, calcium,
chloride, bicarbonate
Nonprotein nitrogenous substances – lactic acid,
urea, creatinine
Respiratory gases – oxygen and carbon dioxide
Formed elements comprise 45% of blood
Erythrocytes, leukocytes, and platelets make up
the formed elements
Only WBCs are complete cells
RBCs have no nuclei or organelles, and platelets are
just cell fragments
Most formed elements survive in the
bloodstream for only a few days
Most blood cells do not divide but are renewed
by cells in bone marrow
Biconcave disc
Folding increases surface area (30% more surface area)
Plasma membrane contains spectrin
Give erythrocytes their flexibility
48
Iron deficiency anemia occurs when the
dietary intake or absorption of iron is
insufficient, and hemoglobin, which contains
iron, cannot be formed
49
Sickle-cell disease is a genetic disease that
results in abnormal hemoglobin molecules
When these release their oxygen load in the
tissues, they become insoluble, leading to mis-
shaped red blood cells
50
51
These sickle shaped red cells are rigid and
cause blood vessel blockage, pain, strokes,
and other tissue damage
Thalassemia is a genetic disease that results
in the production of an abnormal ratio of
hemoglobin subunits
52
Spherocytosis is a genetic disease that causes
a defect in the red blood cell's cytoskeleton,
causing the red blood cells to be small,
sphere-shaped, and fragile instead of donut-
shaped and flexible
Pernicious anemia is an autoimmune disease
wherein the body lacks intrinsic factor,
required to absorb vitamin B12 from food
53
Vitamin B12 is needed for the production of
hemoglobin
Aplastic anemia is caused by the inability of
the bone marrow to produce blood cells
Pure red cell aplasia is caused by the
inability of the bone marrow to produce only
red blood cells
54
Hemolysis is the general term for excessive
breakdown of red blood cells. It can have
several causes
The malaria parasite spends part of its life-
cycle in red blood cells, feeds on their
hemoglobin and then breaks them apart,
causing fever
55
Both sickle-cell disease and thalassemia are
more common in malaria areas, because
these mutations convey some protection
against the parasite
Polycythemias (or erythrocytoses) are
diseases characterized by a surplus of red
blood cells. The increased viscosity of the
blood can cause a number of symptoms
56
In polycythemia vera the increased number
of red blood cells results from an
abnormality in the bone marrow
Several microangiopathic diseases, including
disseminated intravascular coagulation and
thrombotic microangiopathies, present with
pathognomonic (diagnostic) RBC fragments
called schistocytes
57
These pathologies generate fibrin strands
that sever RBCs as they try to move past a
thrombus
Several blood tests involve red blood cells,
including the RBC count (the number of red
blood cells per volume of blood) and the
hematocrit (percentage of blood volume
occupied by red blood cells)
58
The blood type needs to be determined to
prepare for a blood transfusion or an organ
transplantation
59
60
Anemia (AmE) or anaemia (BrE), from the
Greek (Ἀναιμία) (an-aîmia) meaning "without
blood," is defined as a qualitative or
quantitative deficiency of hemoglobin, a
molecule found inside RBCs
Since hemoglobin normally carries oxygen
from the lungs to the tissues, anemia leads
to hypoxia (lack of oxygen) in organs
61
Since all human cells depend on oxygen for
survival, varying degrees of anemia can have
a wide range of clinical consequences
62
Anemia is the most common disorder of the
blood
There are several kinds of anemia, produced
by a variety of underlying causes
63
The three main classes of anemia:
Excessive blood loss (acutely such as a
hemorrhage or chronically through low-volume
loss)
Excessive blood cell destruction (hemolysis)
Eeficient RBC production (ineffective
hematopoiesis)
64
Anemia can be classified in a variety of ways,
based on the morphology of RBCs, underlying
etiologic mechanisms, and discernible
clinical spectra, to mention a few
65
There are two major approaches of
classifying anemias
The "kinetic" approach which involves evaluating
production, destruction and loss
The "morphologic" approach which groups anemia
by red blood cell size
The morphologic approach uses a quickly
available and cheap lab test as its starting
point (the MCV)
66
On the other hand, focusing early on the
question of production may allow the
clinician more rapidly to expose cases where
multiple causes of anemia coexist
67
68
Anemia goes undetected in many people, and
symptoms can be small and vague
Most commonly, people with anemia report a
feeling of weakness or fatigue in general or
during exercise, general malaise and
sometimes poor concentration
69
People with more severe anemia often report
dyspnea (shortness of breath) on exertion
Very severe anemia prompts the body to
compensate by increasing cardiac output,
leading to palpitations and sweatiness, and
to heart failure
70
Pallor (pale skin, mucosal linings and nail
beds) is often a useful diagnostic sign in
moderate or severe anemia, but it is not
always apparent
Other useful signs are cheilosis and
koilonychia
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75
Pica, the consumption of non-food such as
dirt, paper, wax, grass, ice and hair, may be
a symptom of iron deficiency, although it
occurs often in those who have normal levels
of hemoglobin
76
Chronic anemia may result in behavioral
disturbances in children as a direct result of
impaired neurological development in
infants, and reduced performance in
children of school age
77
Generally, clinicians request complete blood
counts in the first batch of blood tests in the
diagnosis of an anemia
Apart from reporting the number of RBCs and
the hemoglobin level, the automatic
counters also measure the size of the RBCs
by flow cytometry, which is an important
tool in distinguishing between the causes of
anemia
78
Examination of a stained blood smear using a
microscope can also be helpful, and is
sometimes a necessity in regions of the world
where automated analysis is less accessible
79
In modern counters, four parameters (RBC
count, hemoglobin concentration, MCV and
are measured, allowing others (hematocrit,
MCH and MCHC) to be calculated, and
compared to values adjusted for age and sex
Some counters estimate hematocrit from
direct measurements
80
For adult men, a hemoglobin level less than
13.0 g/dl is diagnostic of anemia, and for
adult women, the diagnostic threshold is
below 12.0 g/dl
81
Reticulocyte counts, and the "kinetic"
approach to anemia, have become more
common than in the past in part because
some automatic counters now have the
capacity to include reticulocyte counts
82
A reticulocyte count is a quantitative
measure of the bone marrow's production of
new red blood cells
The reticulocyte production index is a
calculation of the ratio between the level of
anemia and the extent to which the
reticulocyte count has risen in response
83
If the degree of anemia is significant, even a
"normal" reticulocyte count actually may
reflect an inadequate response
If an automated count is not available, a
reticulocyte count can be done manually
following special staining of the blood film
84
In manual examination, activity of the bone
marrow can also be gauged qualitatively by
subtle changes in the numbers and the
morphology of young RBCs by examination
under a microscope
Newly formed RBCs are usually slightly larger
than older RBCs and show polychromasia
85
Even where the source of blood loss is
obvious, evaluation of erythropoiesis can
help assess whether the bone marrow will be
able to compensate for the loss, and at what
rate
86
When the cause is not obvious, clinicians use
other tests: ESR, ferritin, serum iron,
transferrin, RBC folate level, serum vitamin
B12, hemoglobin electrophoresis, renal
function tests (e.g. serum creatinine)
87
When the diagnosis remains difficult, a bone
marrow examination allows direct
examination of the precursors to red cells
88
89
Sickle-cell disease or sickle-cell anemia is a
blood disorder characterized by red blood
cells that assume an abnormal, rigid, sickle
shape
Sickling decreases the cells' flexibility and
results in their restricted movement through
blood vessels, depriving downstream tissues
of oxygen
90
The disease is chronic and lifelong:
Individuals are most often well, but their lives
are punctuated by periodic painful attacks and a
risk of various other complications
Life expectancy is shortened, with older
studies reporting an average life expectancy
of 42 and 48 years for males and females,
respectively
91
Sickle-cell disease occurs more commonly in
people (or their descendants) from parts of
the world such as sub-Saharan Africa, where
malaria is or was common, but it also occurs
in people of other ethnicities
92
This is because those with one or two alleles
of the sickle-cell disease are resistant to
malaria since the sickle red blood cells are
not conducive to the parasites - in areas
where malaria is common there is a survival
value in carrying the sickle-cell genes
93
Sickle-cell disease may lead to various acute
and chronic complications, several of which
are potentially lethal
The vaso-occlusive crisis is caused by sickle-
shaped red blood cells that obstruct
capillaries and restrict blood flow to an
organ, resulting in ischemia, pain, and organ
damage
94
Abnormal hemoglobin forms can be detected
on hemoglobin electrophoresis,
95
The diagnosis can be confirmed with high
performance liquid chromatography (HPLC)
Genetic testing is rarely performed, as other
investigations are highly specific for HbS and
HbC
96
Sickle-cell anemia is caused by a point
mutation in the β-globin chain of
hemoglobin, causing the glutamate to be
replaced with the valine at the sixth position
The β-globin gene is found on the short arm
of chromosome 11
97
The association of two wild-type α-globin
subunits with two mutant β-globin subunits
forms haemoglobin S (HbS)
Under low oxygen conditions, the absence of
a polar amino acid at position six of the β-
globin chain promotes the polymerization of
hemoglobin, which distorts RBCs into a sickle
shape and decreases their elasticity
98
99
The cells include:
Lymphocytes
Monocytes
Macrophages
There are three types of granulocytes:
Neutrophils
Basophils
Eosinophils
100
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Platelets, or thrombocytes, are the cells
circulating in the blood that are involved in
the cellular mechanisms of primary
hemostasis (bleeding stop) leading to the
formation of blood clots
The term platelet should be reserved for
anucleated thrombocytes of mammals
102
103
An abnormality or disease of the platelets is
called a thrombocytopathy which could be
either a decrease in number ie
thrombocytopenia, decrease in function ie
thrombasthenia or an increase in number ie
thrombocytosis
104
Functions of platelets can be generalized
into a number of categories:
Adhesion
Aggregation
Clot retraction
Pro-coagulation
Cytokine signaling
Phagocytosis
105
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MW 66 000
Single chain, 580 amino acids, sequence is
known
Dimensions - Heart shaped molecule
108
109
Albumin is the major transport protein in
blood plasma and can reversibly bind a wide
range of molecules
110
“Colloid” osmotic pressure of blood is 80%
due to albumin
relativelylow molecular weight
regulates water distribution
Transport of fatty acids
Liver to tissues, binding
111
Source of amino acids for tissue cells
(pinocytosis)
60% albumin in tissue (interstitial) fluid
112
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20% of plasma proteins
“” refers to electrophoretic mobility
Represents a group of proteins of variable
structure
immunoglobulins
114
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Basic 4 chain structural unit
MW = 160000
Constant - same amino acid sequence for all
of the molecules
Variable - varies between molecules- results
in specificity of molecules
116
Two heavy and two light chains joined by
disulfide bonds
Variable region - red - binds the antigen
Constant region (black) can activate
complement pathway or attach the Ab to
cells such as macrophages
117
1. IgG – Identifies microorganisms for
engulfment or lysis
2. IgE – Inhibits parasite invasion; involved in
allergic reactions
3. IgD – Unknown
118
4. IgA – Basis for passive immunity provided
by breast milk, agglutinates infectious
agents in secretions outside the body,
present in tears, mucous
5. IgM – Identifies microorganisms for
engulfment or lysis
119
Primary function is antigen binding (immune
response)
Secondary function is complement binding
(after antigen)
120
In lymphocytes (T and B)
Made in response to presence of antigen
(“foreign” macromolecule, virus particle etc)
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Coagulation
Structure
MW 340 000
Sequence of amino acids is known (3000)
123
Coagulation - very important consideration
when processing blood outside of the body
Structure must incorporate the ability to be
easily broken down after clotting
124