Name: ABDUL AHAD

Class: First Semester Sec (A)

Reg No: Su-24-01-191-001
Subject: Anatomy And Physiology
Assignment No: 1
Submitted To: Mr .Gohar

BLOOD
 blood, fluid that transports oxygen and nutrients to the cells and carries
away carbon dioxide and other waste products. Technically, blood is a
transport liquid pumped by the heart (or an equivalent structure) to all parts of
the body, after which it is returned to the heart to repeat the process. Blood is
both a tissue and a fluid. It is a tissue because it is a collection of similar
specialized cells that serve particular functions. These cells are suspended in a
liquid matrix (plasma), which makes the blood a fluid. If blood flow ceases,
death will occur within minutes because of the effects of an
unfavourable environment
on highly susceptible cells.

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.
Reference: Marieb & Hoehn, Human Anatomy & Physiology, 11th Edition.

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. In
larger and more-complex animals, transport of adequate amounts of oxygen and
other substances requires some type of blood circulation. In most such animals
the blood passes through a respiratory exchange membrane, which lies in the gills,
lungs, or even the skin. There the blood picks up oxygen and disposes of carbon
dioxide.
Reference: Widmaier et al., Vander’s Human Physiology, 15th Edition.

The cellular composition of blood varies from group to group in the animal
kingdom. Most invertebrates have various large blood cells capable of
amoeboid movement. Some of these aid in transporting substances; other are
capable of surrounding and digesting foreign particles or debris (phagocytosis).
Compared with vertebrate blood, however, that of the invertebrates has
relatively few cells. Among the vertebrates, there are several classes of
amoeboid cells (white blood cells, or leukocytes) and cells that help
stop bleeding (platelets, or thrombocytes).
Oxygen requirements have played a major role in determining both the
composition of blood and the architecture of the circulatory system. In some
simple animals, including small worms and mollusks, transported oxygen is
merely dissolved in the plasma. Larger and more-complex animals, which have
greater oxygen needs, have pigments capable of transporting relatively large
amounts of oxygen. The red pigment hemoglobin, which contains iron, is found
in all vertebrates and in some invertebrates. In almost all vertebrates, including
humans, hemoglobin is contained exclusively within the red cells
(erythrocytes). The red cells of the lower vertebrates (e.g., birds) have
 a nucleus, whereas mammalian red cells lack a nucleus. Red cells vary
markedly in size among mammals; those of the goat are much smaller than
those of humans, but the goat compensates by having many more red cells per
unit volume of blood. The concentration of hemoglobin inside the red cell
varies little between species. Hemocyanin, a copper-
containing protein chemically unlike hemoglobin, is found in some crustaceans.
Hemocyanin is blue in colour when oxygenated and colourless when oxygen is
removed. Some annelids have the iron-containing green pigment
chlorocruorin, others the iron-containing red pigment hemerythrin. In many
invertebrates the respiratory pigments are carried in solution in the plasma,
but in higher animals, including all vertebrates, the pigments are enclosed in
cells; if the pigments were freely in solution, the pigment concentrations
required would cause the blood to be so viscous as to impede circulation.

Blood components :
In humans, blood is an opaque red fluid, freely flowing but denser and more
viscous than water. The characteristic colour is imparted by hemoglobin, a unique
iron-containing protein. Hemoglobin brightens in colour when saturated with
oxygen (oxyhemoglobin) and darkens when oxygen is removed
(deoxyhemoglobin). For this reason, the partially deoxygenated blood from
a vein is darker than oxygenated blood from an artery. The red blood cells
(erythrocytes) constitute about 45 percent of the volume of the blood, and the
remaining cells (white blood cells, or leukocytes, and platelets, or thrombocytes)
less than 1 percent. The fluid portion, plasma, is a clear, slightly sticky, yellowish
liquid. After a fatty meal, plasma transiently appears turbid. Within the body the
blood is permanently fluid, and turbulent flow assures that cells and plasma are
fairly homogeneously mixed.

Plasma :
The liquid portion of the blood, the plasma, is a complex solution containing more
than 90 percent water. The water of the plasma is freely exchangeable with that
of body cells and other extracellular fluids and is available to maintain the normal
state of hydration of all tissues. Water, the single largest constituent of the body, is
essential to the existence of every living cell.

Blood cells :
There are four major types of blood cells: red blood cells
(erythrocytes), platelets (thrombocytes), lymphocytes, and phagocytic cells.
Collectively, the lymphocytes and phagocytic cells constitute the white blood
cells (leukocytes). Each type of blood cell has a specialized function: red cells take
up oxygen from the lungs and deliver it to the tissues; platelets participate in
forming blood clots; lymphocytes are involved with immunity; and phagocytic
cells occur in two varieties—granulocytes and monocytes—and ingest and break
down microorganisms and foreign particles. The circulating blood functions as
a conduit, bringing the various kinds of cells to the regions of the body in which
they are needed: red cells to tissues requiring oxygen, platelets to sites of injury,
lymphocytes to areas of infection, and phagocytic cells to sites of microbial
invasion and inflammation. Each type of blood cell is described in detail below.

Red blood cells (erythrocytes)

The red blood cells are highly specialized, well adapted for their primary function
of transporting oxygen from the lungs to all of the body tissues. Red cells are
approximately 7.8 μm (1 μm = 0.000039 inch) in diameter and have the form of
biconcave disks, a shape that provides a large surface-to-volume ratio. When fresh
blood is examined with the microscope, red cells appear to be yellow-green disks
with pale centres containing no visible internal structures. When blood is
centrifuged to cause the cells to settle, the volume of packed red cells
(hematocrit value) ranges between 42 and 54 percent of total volume in men and
between 37 and 47 percent in women; values are somewhat lower in children.
Normal red blood cells are fairly uniform in volume, so that the hematocrit value
is determined largely by the number of red cells per unit of blood. The normal
red cell count ranges between four million and six million per cubic millimetre.
Hemoglobin
About 95 percent of the dry weight of the red blood cell consists of hemoglobin,
the substance necessary for oxygen transport. Hemoglobin is a protein; a
molecule contains four polypeptide chains (a tetramer), each chain consisting of
more than 140 amino acids. To each chain is attached a chemical structure known
as a heme group. Heme is composed of a ringlike organic compound known as
a porphyrin, to which an iron atom is attached. It is the iron atom that reversibly
binds oxygen as the blood travels between the lungs and the tissues. There are
four iron atoms in each molecule of hemoglobin, which, accordingly, can bind four
atoms of oxygen. The complex porphyrin and protein structure provides the
proper environment for the iron atom so that it binds and releases oxygen
appropriately under physiological conditions. The affinity of hemoglobin for
oxygen is so great that at the oxygen pressure in the lungs about 95 percent of the
hemoglobin is saturated with oxygen. As the oxygen tension falls, as it does in the
tissues, oxygen dissociates from hemoglobin and is available to move
by diffusion through the red cell membrane and the plasma to sites where it is
used. The proportion of hemoglobin saturated with oxygen is not directly
proportional to the oxygen pressure. As the oxygen pressure declines, hemoglobin
gives up its oxygen with disproportionate rapidity, so that the major fraction of
the oxygen can be released with a relatively small drop in oxygen tension. The
affinity of hemoglobin for oxygen is primarily determined by the structure of
hemoglobin, but it is also influenced by other conditions within the red cell, in
particular the pH and certain organic phosphate compounds produced during the
chemical breakdown of glucose, especially 2,3-diphosphoglycerate (see
below Respiration).

Functions of blood
Broadly conceived, the function of the blood is to maintain the constancy of the
internal environment. The circulating blood makes possible adaptability to
changing conditions of life—the endurance of wide variations of climate and
atmospheric pressure; the capacity to alter the amount of physical activity; the
tolerance of changing diet and fluid intake; the resistance to physical injury,
chemical poisons, and infectious agents. The blood has an exceedingly complex
structure, and many components participate in its functional activities. Some of
the regulatory mechanisms with which the blood is involved include sensors that
detect alterations in temperature, in pH, in oxygen tension, and in concentrations
of the constituents of the blood. Effects of these stimuli are in some instances
mediated via the nervous system or by the release of hormones (chemical
mediators). Some of the major functions of the blood are outlined in the
paragraphs that follow.

Respiration
In terms of immediate urgency, the respiratory function of the blood is vital. A
continuous supply of oxygen is required by living cells—in particular those of
the brain, since deprivation is followed in minutes by unconsciousness and death.
A normal male at rest uses about 250 millilitres of oxygen per minute, a
requirement increased manyfold during vigorous exertion. All of this oxygen is
transported by the blood, most of it bound to the hemoglobin of the red cells. The
minute blood vessels of the lungs bring the blood into close apposition with
the pulmonary air spaces (alveoli), where the pressure of oxygen is relatively high.
Oxygen diffuses through the plasma and into the red cell, combining with
hemoglobin, which is about 95 percent saturated with oxygen on leaving the
lungs. One gram of hemoglobin can bind 1.35 millilitres of oxygen, and about 50
times as much oxygen is combined with hemoglobin as is dissolved in the plasma.
In tissues where the oxygen tension is relatively low, hemoglobin releases the
bound oxygen.
The two main regulators of oxygen uptake and delivery are the pH (a measure of
the acidity or basicity) of tissues and the content of 2,3-diphosphoglycerate (2,3-
DPG) in red cells. The pH of blood is kept relatively constant at the slightly alkaline
level of about 7.4 (pH less than 7 indicates acidity, more than 7 alkalinity). The
effect of pH on the ability of hemoglobin to bind oxygen is called the Bohr effect:
when pH is low, hemoglobin binds oxygen less strongly, and when pH is high (as in
the lungs), hemoglobin binds more tightly to oxygen. The Bohr effect is due to
changes in the shape of the hemoglobin molecule as the pH of
its environment changes. The oxygen affinity of hemoglobin is also regulated by
2,3-DPG, a simple molecule produced by the red cell when it metabolizes glucose.
The effect of 2,3-DPG is to reduce the oxygen affinity of hemoglobin. When the
availability of oxygen to tissues is reduced, the red cell responds by synthesizing
more 2,3-DPG, a process that occurs over a period of hours to days. By contrast,
tissue pH mediates minute-to-minute changes in oxygen handling.
Carbon dioxide, a waste product of cellular metabolism, is found in relatively high
concentration in the tissues. It diffuses into the blood and is carried to the lungs to
be eliminated with the expired air. Carbon dioxide is much more soluble than
oxygen and readily diffuses into red cells. It reacts with water to form carbonic
acid, a weak acid that at the alkaline pH of the blood appears principally as
bicarbonate.
The tension of carbon dioxide in the arterial blood is regulated with extraordinary
precision through a sensing mechanism in the brain that controls the respiratory
movements. Carbon dioxide is an acidic substance, and an increase in its
concentration tends to lower the pH of the blood (i.e., becoming more acidic).
This may be averted by the stimulus that causes increased depth and rate of
breathing, a response that accelerates the loss of carbon dioxide. It is the tension
of carbon dioxide, and not of oxygen, in the arterial blood that normally controls
breathing. Inability to hold one’s breath for more than a minute or so is the result
of the rising tension of carbon dioxide, which produces the irresistible stimulus to
breathe. Respiratory movements that ventilate the lungs sufficiently to maintain a
normal tension of carbon dioxide are, under normal conditions, adequate to keep
the blood fully oxygenated. Control of respiration is effective, therefore, in
regulating the uptake of oxygen and disposal of carbon dioxide and in maintaining
the constancy of blood pH.

Nutrition
Each substance required for the nutrition of every cell in the body is transported
by the blood: the precursors of carbohydrates, proteins, and fats; minerals and
salts; vitamins and other accessory food factors. These substances must all pass
through the plasma on the way to the tissues in which they are used. The
materials may enter the bloodstream from the gastrointestinal tract, or they may
be released from stores within the body or become available from the breakdown
of tissue.
The concentrations of many plasma constituents, including blood sugar (glucose)
and calcium, are carefully regulated, and deviations from the normal may have
adverse effects. One of the regulators of glucose is insulin, a hormone released
into the blood from glandular cells in the pancreas. Ingestion of carbohydrates is
followed by increased production of insulin, which tends to keep the blood
glucose level from rising excessively as the carbohydrates are broken down into
their constituent sugar molecules. But an excess of insulin may severely reduce
the level of glucose in the blood, causing a reaction that, if sufficiently severe, may
include coma and even death. Glucose is transported in simple solution, but some
substances require specific binding proteins (with which the substances form
temporary unions) to convey them through the plasma. Iron and copper, essential
minerals, have special and necessary transport proteins. Nutrient substances may
be taken up selectively by the tissues that require them. Growing bones use large
amounts of calcium, and bone marrow removes iron from plasma for hemoglobin
synthesis.

Excretion
The blood carries the waste products of cellular metabolism to the excretory
organs. The removal of carbon dioxide via the lungs has been described
above. Water produced by the oxidation of foods or available from other sources
in excess of needs is excreted by the kidneys as the solvent of the urine. Water
derived from the blood also is lost from the body by evaporation from the skin
and lungs and in small amounts from the gastrointestinal tract. The water content
of the blood and of the body as a whole remains within a narrow range because of
effective regulatory mechanisms, hormonal and other, that determine the urinary
volume. The concentrations of physiologically important ions of the plasma,
notably sodium, potassium, and chloride, are precisely controlled by their
retention or selective removal as blood flows through the kidneys. Of special
significance is the renal (kidney) control of acidity of the urine, a major factor in
the maintenance of the normal pH of the blood. Urea, creatinine, and uric acid are
nitrogen-containing products of metabolism that are transported by the blood
and rapidly eliminated by the kidneys. The kidneys clear the blood of many other
substances, including numerous drugs and chemicals that are taken into the body.
In performing their excretory function, the kidneys have a major responsibility for
maintaining the constancy of the composition of the blood. (See also renal
system.) The liver is in part an excretory organ. Bilirubin (bile pigment) produced
by the destruction of hemoglobin is conveyed by the plasma to the liver and is
excreted through the biliary ducts into the gastrointestinal tract. Other
substances, including certain drugs, also are removed from the plasma by the
liver.

Immunity
Cells of the blood and constituents of the plasma interact in complex ways to
confer immunity to infectious agents, to resist or destroy invading organisms, to
produce the inflammatory response, and to destroy and remove foreign materials
and dead cells. The white blood cells (leukocytes) have a primary role in these
reactions. Granulocytes and monocytes phagocytize (ingest) bacteria and other
organisms, migrate to sites of infection or inflammation and to areas containing
dead tissue, and participate in the enzymatic breakdown and removal of cellular
debris. Lymphocytes are concerned with the development of immunity. Acquired
resistance to specific microorganisms is in part attributable to antibodies, proteins
that are formed in response to the entry into the body of a foreign substance
(antigen). Antibodies that have been induced by microorganisms not only
participate in eliminating the microbes but also prevent reinfection by the same
organisms. Cells and antibodies may cooperate in the destruction of invading
bacteria; the antibodies may attach to the organisms, thereby rendering them
susceptible to phagocytosis. Involved in some of these reactions is complement, a
group of protein components of plasma that participates in certain immunologic
reactions. When certain classes of antibodies bind to microorganisms and other
cells, they trigger the attachment of components of the complement system to
the outer membrane of the target cell. As they assemble on the cell membrane,
the complement components acquire enzymatic properties. The activated
complement system is thus able to injure the cell by digesting (lysing) portions of
the cell’s protective membrane.

BLOOD TYPES :
A blood group also called a BloodType  Classification of blood is based on the
presence or absence of inherited antigenic substances on the surface of red blood
cells (RBCs)  These antigens may be proteins, carbohydrates, glycoproteins, or
glycolipids, depending on the blood group system.

 The ABO blood group system is the most important blood type system (or
blood group system) in human blood transfusion. ABO blood types are also
present in some other animals for example rodents and apes such as
chimpanzees, bonobos and gorillas.
Determination of ABO blood groups depends upon the immunological reaction
between antigen and antibody. Antigens are also called agglutinogens because of
their capacity to cause agglutination of RBCs.

HISTORY :
Karl Landsteiner discovered the ABO Blood Group System in 1901.  Adriano Sturli
and Alfred von Decastello who were working under Landsteiner discovered type
AB a year later in 1902  Landsteiner was awarded the 1930 Nobel Prize in
Physiology or Medicine for his work.
Janský is credited with the first classification of blood into the four types (A, B, AB,
O) in 1907, which remains in use today. Reuben Ottenberg successfully
transfused blood between two people at Mount Sinai Hospital in New York. He
was the first person to record pre-transfusion testing for blood compatibility in a
clinical setting. Later in 1954 he was the first to be awarded with Karl Landsteiner
Award.

ABO BASICS
Based on the presence or absence of antigen A and antigen B, blood is divided
into four groups: ‘A, B, AB and ‘O ’group. Blood having antigen A belongs to ‘A’
group. This blood has β-antibody in the serum.
Blood with antigen B and α-antibody belongs to ‘B’ group. If both the antigens
are present, blood group is called ‘AB’ group and serum of this group does not
contain any antibody. If both antigens are absent, the blood group is called ‘O’
group and both α and β antibodies are present in the serum.

Principle of Blood Grouping

Blood grouping is done on the basis of agglutination.
Agglutination means the collection of separate particles like RBCs into clumps or
masses.
Agglutination occurs if an antigen is mixed with its corresponding antibody which
is called isoagglutinin, i.e. occurs when A antigen is mixed with anti-A or when B
antigen is mixed with anti-B.
During blood transfusion, only compatible blood must be used. The one who gives
blood is called the „donor‟ and the one who receives the blood is called
„recipient‟. While transfusing the blood, antigen of the donor and the antibody of
the recipient are considered.
The antibody of the donor and antigen of the recipient are ignored mostly. Thus,
RBC of ‘O’ group has no antigen and so agglutination does not occur with any
other group of blood. So, ‘O’ group blood can be given to any blood group persons
and the people with this blood group are called „universal donors‟.
Plasma of AB group blood has no antibody. This does not cause agglutination of
RBC from any other group of blood. People with AB group can receive blood from
any blood group persons. So, people with this blood group are called „universal
recipients‟.
In mismatched transfusion, the transfusion reactions occur between donor’s RBC
and recipient’s plasma. So, if the donor’s plasma contains agglutinins against
recipient’s RBC, agglutination does not occur because these antibodies are diluted
in the recipient’s blood.

TRANSFUSION REACTIONS DUE TO ABO INCOMPATIBILITY

Transfusion reactions are the adverse reactions in the body, which occur due to
transfusion error that involves transfusion of incompatible (mismatched) blood.
The reactions may be mild causing only fever and hives (skin disorder
characterized by itching) or may be severe leading to renal failure, shock and
death.
The Rh blood group system is one of thirty five current human blood group
systems. It is the most important blood group system after ABO. Rh blood
group system consists of 50 defined blood-group antigens, among them there are
six common types of Rh antigens. Each of which is called an Rh factor. These
types are designated C,D, E, c, d, and e .
The type D antigen is widely prevalent in the population and considerably more
antigenic than the other Rh antigens. Anyone who has this type of antigen is said
to be Rh positive, whereas a person who does not have type D antigen is said to
be Rh negative.
This antigen was discovered by Karl Landsteiner and Alexander Wiener in 1940.
It was first discovered in Rhesus macaque and hence the name 'Rh factor’.

Erythroblastosis Fetalis (“Hemolytic Disease of the Newborn”)

Erythroblastosis fetalis is a disease of the fetus and newborn child characterized
by agglutination and phagocytosis of the fetus’s red blood cells. In most
instances of erythroblastosis fetalis, the mother is Rh negative and the father Rh
positive. The baby has inherited the Rh-positive antigen from the father, and the
mother develops anti-Rh agglutinins from exposure to the fetus’s Rh antigen. In
turn, the mother’s agglutinins diffuse through the placenta into the fetus and
cause red blood cell agglutination.
Thirty-five major blood group systems were recognized by the International
Society of Blood Transfusion (ISBT) in October 2012. In addition to the ABO
antigens and Rhesus antigens, many other antigens are expressed on the red
blood cell surface membrane .

Reference: Young et al., Wheater’s Functional Histology: A Text and Colour Atlas, 6th Edition.

Reference: Fox, Human Physiology, 16th Edition.

Reference: Silverthorn, Human Physiology: An Integrated Approach, 8th Edition.Blood grou