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Blood

  1. Normal vol. 5-6 L, 7.36-7.45 pH, Sp. Gravity 1050-1060, 45% cells & 55% plasma
  2. PLASMA PROTEINS: Normal 6.4-8.3 gm% ,55% albumin & 38% globulin (α, β & γ)  A/G ratio – 1.7:1
  • Albumin – 60,000 MW, oncotic pressure, transport
  • Transferrin – 90,000 MW, iron transport (GIT to bone marrow)
  • Ceruloplasmin – α globulin, copper storage & transport (deficiency leads to Wilsons disease)
  • Fibrinogen – 0.3 gm% ,clotting, synthesized in liver only
  • Prothrombin – 40 mg% , clotting
  • Fetuin – in fetus, growth

Hemoglobin

  1. Haem – Fe2+ containing porphyrin tetra pyrrole.  Globin – 4 polypeptide chains. HbA(α2β2)  HbF(α2 γ 2)
  2. Normal values birth – 19-23 gm% M - 14-18 gm% F- 12-15.5 gm%
    1. Methemoglobin – Fe2+ oxidizes to Fe3+  dark coloured appears in urine.
      1. HbA2  α2δ2  normally 2.5%. increases in thalassemia
      2. HbS – sickle cell hemoglobin. Substitution of glutamic acid with valine at 6th position in β chain
      3. HbA1C binds to glucose. Used for finding control of diabetes.

RBCs

  1. Biconcave disc, no nucleus, vol. 90 cu.µm. M- 5-6 million/cu.mm F- 4.5-5.5 million/cu.mm Dia. 8µm
  2. Life span 120 days, Tissue macrophage system. Osmotic fragility 0.48-0.34% NaCl sol.
  3. Polycythemia – birth, high altitude, congenital heart disease,
  4. RBC Indices -  MCV 100 µm3
  5. MCH   28-32 pg
  6. MCHC 32-38%
  7. ERYTHROPOIESIS
  8. STEM CELL →  Proerythroblast → Normoblast (nucleus +) → Reticulocyte (nucleus-,RNA+)  →  RBC
  9. Hb starts appearing in intermediate Normoblast.

WBCs

  1. WBCs: normal WBC count 4000-11000/cu.mm
  2. Granulocytes – neutrophil (50-70%), basophil (<1%) & Eosinophil (1-4 %)
  3. Agranulocytes – lymphocytes (20-40%) & monocytes (2-8%)   
  4. Decrease count in – starvation, morning, typhoid, viral infections, bone marrow depression
  5. Increase count in – newborns, evening, exercise, stress, pregnancy,steroids, pyogenic infections
  6. Neutrophil : 2-6 lobes of nucleus, fine granules, phagocytosis, inc in acute infections( 1st line of Defence)
  7. Eosinophil : brick red coarse granules, contain histamine, MBP etc. inc in allergic & parasitic inf.
  8. Basophil:     coarse blue granules(histamine), cover nucleus. Phagocytosis. Inc. in pox, TB, flu
  9. Lymphocytes: cell mediated immunity. B & T type. Inc in chronic infections like TB, leprosy
  10. Monocytes:  2nd line of defence. Phagocytosis, form tissue macrophages. Inc in TB, syphilis
  11. WBCs are sequestered in spleen. Contraction(sympathetic),removal of spleen increases WBC count.

Platelets

  1. Platelets: Small, non nucleated, granulated cells. 1.5-4 lakh/cu.mm Membrane has receptor for collagen, fibrinogen von Willebrand’s factor.
  2. Granule contains serotonin(from GIT), ADP, PDGF, thromboxane A2, Prostacyclins. Increase count when there is sympathetic stimulation,thrombopoietin, splenectomy, stress. Count falls in marrow depression, drugs, viral infections like dengue.
  3. FUNCTIONS: Hemostasis – by temp. hemoststic plug.3 steps platelet adhesion, activation & aggregation
     
    a. Blood coagulation – definitive plug.    
     
    b. Clot retraction – 30 min due to platelet contraction(most sensitive test for platelet function.)
     
    c. Phagocytosis & storage
  4. BT – bleeding time 1-4 min., depends on vasoconstriction & platelet
  5. CT – clotting time   3-5 min.
     
    Anti thrombin III – Liver. Inactivates IX,X,XI & XII
  6. Normally blood doesnot clot inside cause of :- smooth endothelial lining, negative charge of epithelium,Velocity of blood, natural anticoagulant (heparin, protein C)
  7. THROMBOMODULIN: by all endothelial cells except of cerebral circulation . converts thrombin to protein C activator, increases activity of tissue plasminogen activator.
  8. Anticoagulants: Heparin : by basophils & mast cells. Activates Anti thrombin III ,Vitamin K antagonists(warfarin, dicoumarol) – decrease II, VII, IX, X., Calcium chelators like oxalates , EDTA
  9. HEMOPHILIA A (CLASSICAL) – def. of factor VIII. X linked. Normal BT, inc CT. t/t transfusion
  10. PURPURA : due to capillary abnormality,bleeding spots. CT normal, BT inc. Platelet count normal.Types thrombocytopenic, a thrombocytopenic, thromboasthenic. t/t ACTH, splenectomy





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