Loreto, Bien BMG3FX/MWF/3:00-04:00

Lugo, Mariel

Cabigao, Jean

Red and White Blood Cells

Red and white blood cells have two main functions: the carriage of oxygen and defence
from microbial attack respectively. Together, red cells (erythrocytes) and white cells
(leukocytes) are part of the full blood count (FBC), one of the most frequently requested
haematology tests.

Red Blood Cells

A number of red cell blood tests are used in the diagnosis, treatment and management
of anaemia, polycythaemia and erythrocytosis. These are:

Red cell count (RBC): haemoglobin is a protein found in the red cells that carries
oxygen to the tissues for cellular respiration. The red cell count reveals how many red
cells the blood contains; this can vary between the sexes. Lower levels are present in
menstruating women; in post-menopausal women, levels are still lower than in age-
matched men, who produce testosterone, which stimulates red cell production. See
Table 1 for reference values;

Haematocrit (Hct): this index shows the proportion of the blood made up of red
cells. It is expressed as a percentage (for example 43%) or decimal (for example 0.43);

Mean cell volume (MCV): this is the size of the average red cell, and is important
in many cases in defining the cause of many types of anaemia.

Anaemia

Patients who have difficulty fulfilling basic physiological and lifestyle demands due to
fatigue may have anaemia (insufficient red blood cells or haemoglobin) (Box 1). More
serious signs of the condition include jaundice, hepatomegaly, angina and cardiac
failure, although these may arise from other conditions.
 Anaemia can be classified in a number of ways; the most common are described in Box
2. Red cells are produced in the bone marrow, so infiltration of the bone marrow by
cancer or other cells will inevitably

lead to low numbers and therefore anaemia. A poor diet, low in iron, vitamin B12 or
folate, will lead to anaemia as these are essential for the production of red cells.

Problems with organs may also contribute to anaemia:

Liver: this organ stores iron and vitamins, so liver disease may lead to anaemia
(Blann, 2014);

Kidneys: the kidneys produce erythropoietin to stimulate the bone marrow to

produce red cells, so anaemia may be present in chronic renal failure (Blann, 2014b);

Intestines: intestinal diseases in which iron and vitamins are unable to cross the
gut wall (malabsorption) can lead to anaemia - these include gastric atrophy,
inflammatory bowel diseases such as Crohns disease or diverticulitis; surgery for
gastric cancer or any cancer that requires excision of a section of bowel can also lead to
anaemia.
Haemolytic anaemia is the bursting, destruction or inappropriate break-up of red cells:
causes include high fever and infections such as malaria (Blann and Ahmed, 2014). The
condition can also occur when antibodies erroneously bind to red cells - this is known as
autoimmune haemolytic anaemia.

Red cells may be lost by an acute or chronic bleed, such as heavy menstrual periods.
Hidden or prolonged internal bleeding can lead to chronic blood loss and therefore
anaemia.

The most common congenital haemoglobinopathies are sickle cell disease and
thalassaemia; these genetic conditions are characterised by changes in haemoglobin
that reduce its ability to transport oxygen.

The MCV can be used to classify anaemia. If the cells are larger than normal
(macrocytes), the haemoglobin is low and the patient is symptomatic, macrocytic
anaemia is present, for example in vitamin B12 deficiency.

Some haemoglobinopathies and iron deficient states cause cells to be small

(microcytes), leading to microcytic anaemia.
 Normocytic anaemia is associated with normal-sized cells (normocytes) but a lower
overall haemoglobin level. A prime reason for a normocytic anaemia is the sudden loss
of a large number of healthy red cells, perhaps by an accident or bleeding
gastrointestinal cancer.

Treatment of anaemia

Anaemia and its symptoms cannot be treated without a full understanding of the
aetiology of the condition.

For example, dietary iron supplements will not help anaemia caused by malabsorption,
but intravenous iron may increase haemoglobin levels and so address symptoms such
as fatigue and lethargy. Patients with vitamin B12 deficiency should receive regular
injections of this vitamin.

Anaemia can be caused by certain drugs, such as methyldopa, some antibiotics and
hydrochlorothiazide. This should resolve when the patient stops taking the drug, ideally
as soon as possible - if necessary substituting it with an alternative drug. In some
cases, such as in cancer chemotherapy, cessation or substitution may not be possible,
so the anaemia and its symptoms are treated by blood transfusion.

Autoimmune haemolytic anaemia may be treatable with immunosuppression.

However, some forms of anaemia, such as those caused by thalassaemia and sickle
cell disease, are effectively incurable (except by bone marrow transplantation) and
symptoms are managed by specialist teams.

Increased levels of red cells

There are two types of disease where the concentration of red cells is higher than
normal: both are characterised by raised haemoglobin and Hct.

Polycythaemia: this may arise from a rare malignancy of the bone marrow;

Erythrocytosis: this is often a result of the bone marrows response to reduced

circulating levels of oxygen, often caused by heavy smoking.
 White Blood Cells

White cells (leucocytes) defend the body from viruses, bacteria and parasites; at such
times, cell numbers will be raised. High concentrations are also found in rheumatoid
arthritis and cancer, and after surgery. There are five types of white cells:

Neutrophils: making up to 70% of the white cell count, these recognise, attack
and destroy bacteria;

Lymphocytes: the second most common white blood cell (approximately 20-25%
of the white cell count), are divided into two types - B lymphocytes make antibodies,
while T lymphocytes destroy cells infected with viruses;

Monocytes: these have several functions, including bacteria removal, and are
active in inflammation and in repair of damaged tissues;

Eosinophils and basophils: these cells have roles in hypersensitivity and allergy.
White cells defend the body from most microbial pathogens through two processes:

Inflammation: this develops rapidly and is associated with high neutrophil

numbers, but can lead to the body attacking its own tissues, leading to chronic
inflammation;

An immune response, where lymphocytes are active: this develops slowly, over
days or weeks, and is focused on the invading pathogen.
Inflammatory and immune responses often cooperate. For example, lymphocytes make
antibodies that bind to bacteria and yeast pathogens, making them more palatable to
the neutrophils and monocytes, which aids their removal. Infections occur when either
or both these processes become impaired. Antibodies can also cause autoimmune
diseases such as rheumatoid arthritis and thyroiditis.

Low white cell count: Leucopenia

Virtually all cases of leucopenia are associated with the use of cytotoxic drugs, which
can destroy white cells, increasing patients risk of infections. In these cases,
prophylactic antibiotics may be needed, and stringent infection prevention measures are
essential.
High white cell count: Leucocytosis

Leucocytosis can be a normal response to infections and surgery. Pathological states

associated with it include inflammatory and autoimmune diseases such as rheumatoid
arthritis. The most serious cases of leucocytosis occur in leukaemia.

Leukaemia and other malignancies

The high white cell count in leukaemia is due to changes to how cells develop in the
bone marrow.

Leukaemic cells stop developing prematurely, entering the blood in an immature state
and increased numbers. If this process develops slowly, perhaps over several years, it
is said to be chronic; rapid development, for example, over months, is said to be acute.

Acute leukaemias, frequently characterised by high numbers of immature cells, are

often much more aggressive than the chronic condition, and survival (unless treated)
can be as short as months.

If the major affected cells in the leukaemia are of the neutrophil lineage, it is described
as myeloid; when lymphocytes are predominantly affected, it is known as lymphocytic
leukaemia. A leukaemia dominated by blast cells is called lymphoblastic.

As leukaemia arises in the bone marrow, the production of other cells is reduced. Thus
anaemia and low levels of platelets (thrombocytopenia, with a risk of bleeding and
bruising) are invariably consequences of leukaemia (Table 2).

In advanced disease, leukaemia may invade the lymph nodes, liver and spleen, making
them swollen (lymphadenopathy, hepatomegaly and splenomegaly respectively).
Treatments are aimed at reducing the tumour burden, and are generally cytotoxic drugs.
More severe leukaemias need transplantation of bone marrow stem cells from a donor
or patients themselves.

Differential diagnoses of leukaemia

White cell counts may also be raised in severe infections. The most dangerous and life-
threatening is septicaemia (blood poisoning), where the blood itself is infected with
bacteria. Patients with septicaemia are usually cared for in intensive care units on high
doses of intravenous antibiotics.

Other lymphoid cancers

Lymphoma involves malignant lymphocytes taking over lymph nodes: principle

examples are Hodgkin and non-Hodgkin lymphomas. Lymphomas often progress to
affect more lymph nodes; the spleen, liver and bone marrow (therefore possibly leading
to anaemia) can become involved.

Important differential diagnoses of lymphoma are self-limiting cases of

lymphadenopathy, which may occur in tonsillitis or a nearby infected wound.

Myeloma is a tumour of B lymphocytes, which normally make antibodies to attack

pathogens; it is found in the bone marrow. Myeloma cells may make large amounts of
an incorrect type of antibody, causing a high erythrocyte sedimentation rate.

Blood Types

Although all blood is made of the same basic elements, not all blood is alike. In fact,
there are eight different common blood types, which are determined by the presence or
absence of certain antigens substances that can trigger an immune response if they
are foreign to the body. Since some antigens can trigger a patient's immune system to
attack the transfused blood, safe blood transfusions depend on careful blood typing and
cross-matching.

The ABO Blood Group System

There are four major blood groups determined by the presence or absence of two
antigens A and B on the surface of red blood cells:

Group A has only the A antigen on red cells (and B antibody in the plasma)
Group B has only the B antigen on red cells (and A antibody in the plasma)
Group AB has both A and B antigens on red cells (but neither A nor B antibody
in the plasma)
Group O has neither A nor B antigens on red cells (but both A and B antibody
are in the plasma)

There are very specific ways in which blood types must be matched for a safe
transfusion.
Group O can donate red blood cells to anybody. Its the universal donor.
Group A can donate red blood cells to As and ABs.
Group B can donate red blood cells to Bs and ABs.
Group AB can donate to other ABs, but can receive from all others.

In addition to the A and B antigens, there is a third antigen called the Rh factor, which
can be either present (+) or absent ( ). In general, Rh negative blood is given to Rh-
negative patients, and Rh positive blood or Rh negative blood may be given to Rh
positive patients.

The universal red cell donor has Type O negative blood type.
The universal plasma donor has Type AB blood type.
How Is My Blood Type Determined?
Its inherited. Like eye color, blood type is passed genetically from your parents.
Whether your blood group is type A, B, AB or O is based on the blood types of your
mother and father.

This chart shows the potential blood types you may inherit.

Parent 1 A A A A B A A O O O
B B B B
Parent 2 A B A O B B A B A O
B

O X X X X X X
Possible blood
A X X X X X X X
type of child
B X X X X X X X
AB X X X X

Diseases and Disorders of the Circulatory System

The circulatory system is responsible for moving blood, nutrients, and gases to and from
cells to keep the body in proper balance. The important components of the circulatory
system have different functions. The blood vessels transport blood to and from the
heart, the heart pumps oxygenated blood to the body, and the oxygen, gases, and
nutrients exchange in the capillaries. Anything that affects the integrity of the tubing can
impair the health of the circulatory system.
A circulatory disorder is any disorder or condition that affects the circulatory system.
Circulatory disorders can arise from problems with the heart, blood vessels or the blood
itself. Disorders of the circulatory system generally result in diminished flow of blood and
oxygen supply to the tissues.

Several diseases and disorders can affect this system:

High Blood Pressure

Hypertension, or high blood pressure, occurs when a high force of blood presses
against the artery walls over time. This condition can develop from a diet high in salt,
smoking, kidney disease, or some other underlying medical condition. Untreated high
blood pressure may lead to stroke, heart failure, or visual problems. Most people with
high blood pressure have primary hypertension, meaning it is not caused by another
disease. Although high blood pressure typically causes no symptoms, untreated
hypertension can contribute to a heart attack, heart failure, kidney failure and stroke.
The risk for hypertension increases with age.
Atherosclerosis

Atherosclerosis, or hardening of the arteries, develops when deposits called plaques

form along the inner walls of medium to large arteries. Plaques consist of inflammatory
cells, connective tissue, calcium, certain fats and other components. Left untreated,
atherosclerotic plaques grow over time without causing symptoms until blood flow and
oxygen delivery to the affected areas is critically reduced. Atherosclerosis is responsible
for the overwhelming majority of heart attacks and strokes.

Arteriosclerosis

Arteriosclerosis is a common disease of the circulatory system caused by the buildup of

fat, cholesterol, or other substance in the artery wall. Deposits in the artery cause the
vessel to stiffen and narrow. Diabetes, high cholesterol, smoking, and high blood
pressure can result in stiff arteries that restrict blood flow through the heart.
Aneurysms

Weakening of the blood vessel wall causes a ballooning bulge called an aneurysm.
Most aneurysms develop in arteries, as these blood vessels are under high pressure.
Large or fast-growing aneurysms can rupture, causing rapid blood loss and depriving
organs of a life-sustaining blood supply. Unfortunately, aneurysms typically do not cause
symptoms until a rupture occurs. The aorta -- the largest artery of the body -- is a
common site for aneurysm formation. Most aortic aneurysms occur in the abdomen, but
some occur in the chest. A ruptured aortic aneurysm is a life-threatening medical
emergency. The brain is another frequent site for aneurysms, known as cerebral
aneurysms. A ruptured cerebral aneurysm typically leads to a stroke, which can be fatal.

Thrombotic Disorders
Although blood clot formation, or thrombosis, can be life-saving when an injury occurs,
spontaneous clot development is a common circulatory system disorder. The greatest
danger with a spontaneous clot is loss of blood supply to a vital organ. Blood clots can
form in any blood vessel, but some sites are more frequently involved than others. DVT
can be life-threatening if a piece of the clot breaks off and travels to the lungs, a
condition called pulmonary embolism. The brain is another common site for blood clots.
Formation of a blood clot in one of the arteries supplying the heart is often the triggering
event for a heart attack.

Congenital Defects

A congenital cardiovascular defect describes an abnormality in the formation of one or

more parts of the circulatory system. Some of the more common abnormalities are
minor and often require no treatment. Major congenital heart defects, however, typically
require surgical correction early in life. An arteriovenous malformation, or AVM, is
another type of congenital circulatory system defect. An AVM is a tangle of blood
vessels that involves abnormal connections between the arterial and venous circulation.
AVMs that form in the brain or spinal cord can result in severe problems and even
death. Some genetic disorders increase the risk for congenital heart defects, such as
Down syndrome. However, these malformations often occur spontaneously without any
identifiable genetic or environmental cause.

Coronary Artery Disease

Coronary artery disease (CAD) develops as cholesterol and plaque accumulate on the
interior walls of coronary arteries. This buildup is called atherosclerosis. The arteries
become increasingly blocked, compromising the flow of oxygen-rich blood to heart
tissue. If left untreated, the blockage can lead to chest pain and to a heart attack. It
occurs when the blood vessels that supply oxygen to the heart narrow and stiffen.
Smoking, an unhealthy diet, stress, and a sedentary lifestyle all increase the risk of
heart disease. A heart attack or stroke can occur if the condition is untreated.

Stroke: Ischemic Stroke and Hemorrhagic Stroke

If a blood clot forms in the carotid artery in the neck, some of it will break off and travel
into the arteries supplying the brain. The clot may then lodge in one of those arteries,
cutting off blood supply to part of the organ. This pathology is called an ischemic stroke.
The lack of blood supply destroys brain tissue and causes neurological damage.
Another type of stroke, called a hemorrhagic stroke, occurs when an artery in the brain
bursts and blood flows into the brain.

Myocardial infarction

A myocardial infarction, or heart attack, happens when blood flow to heart tissue is
obstructed. This can occur from a buildup of plaque in the walls of coronary arteries (as
in coronary artery disease). Because oxygenated blood cannot reach part of the heart
muscle that muscle dies or is damaged. The heart weakens and suffers a severe
decrease in pumping ability. Signs of a heart attack include chest discomfort (pressure,
squeezing, or pain), shortness of breath, nausea, and lightheadedness.

Mitral prolapse, stenosis, regurgitation

Mitral Valve Prolapse Affects the Valve Between the Left Atrium and the Left Ventricle of
the Heart. The mitral valve is one of the four heart valves. It controls proper blood flow
from the left atrium into the left ventricle. In mitral valve prolapse, the valve bulges
inward and does not close properly. Most people with mitral valve prolapse are born
with it. In rare cases, blood may leak back into the atrium, a condition called mitral valve
regurgitation.
Angina pectoris

Literally, pain in the chest. But, this is a special kind of pain associated with the heart,
and often accompanied by shortness of breath, fatigue and nausea. Angina is a
symptom of an underlying heart condition that occurs when the flow of blood and
oxygen are restricted to the heart muscles. Anginal pain indicates not enough blood is
getting to the heart muscle, and the heart is protesting and begging for more. People
with a history of angina often take nitroglycerine tablets to relieve the pain by increasing
blood flow to the heart muscle.

Arrhythmia/dysrhythmia

Abnormal heart rates and rhythms all have special names like ventricular tachycardia,
fibrillation, but generically are termed arrhythmias or dysrhythmia, meaning no rhythm
and abnormal rhythm. An arrhythmia occurs when the heart beats too fast, too slow, or
skips a beat. Common symptoms of arrhythmias include: Fatigue, Shortness of breath,
Chest pain. Arrhythmias can develop from a congenital heart defect, diabetes, stress,
medications, a heart attack, or high blood pressure.

Ischemia
Sometimes the heart muscle is not getting enough blood flow, more importantly, the
oxygen the blood carries is insufficient to sustain muscle which has a very high
metabolic rate, and oxygen demand. The term loosely means not quite enough blood.

Chronic Venous Insufficiency

This condition occurs when blood pools or collects in the lower extremities, but its
difficult to return to the heart. Chronic venous insufficiency can result from obesity,
history of varicose veins, deep vein thrombosis, sedentary lifestyle, long periods of
sitting or standing, being over the age of 50, female, or pregnant. Symptoms of chronic
venous insufficiency include: Swelling in the lower legs and ankles, Aching or tired
feeling in the legs, Varicose veins.
 Varicose veins
Varicose veins are another common disease of the circulatory system that happens
when veins in the legs twist, swell, and become painful. Aging, pregnancy, prolonged
standing, and defective valves can all contribute to the development of varicose veins.
Most of the time varicose veins can be treated by elevating the lower extremities,
avoiding prolonged standing or sitting positions, and wearing supportive stockings.
Peripheral Vascular Disease
Peripheral vascular disease occurs when the arteries and veins supplying the lower
extremities narrow and stiffen from the buildup of plaque. Common symptoms of
peripheral vascular disease include: Pain with movement, Tingling, burning, or
numbness in feet when resting, Fatigue, Achiness, Pain and cramps at night.

Systemic Circulation and Pulmonary Circulation

Systemic Circulation is a part of the cardiovascular system which is responsible for

carrying oxygenated blood away from the heart to the body, and return deoxygenated
blood back to the heart. Pulmonary Circulation is a part of the cardiovascular system
which is responsible for carrying de-oxygenated from the heart to the lungs and then
back to the heart for it to transfer the oxygenated blood to the rest of the body.
The heart is an important muscle in the body
and is located between the two lungs. The main
purpose of the heart is to pump blood through
the whole body. This function is performed with
the help of Systemic Circulation and Pulmonary
Circulation, which are responsible for the
circulation of blood. The heart is made up of
four chambers; two upper atria and lower two
ventricles. The right side of the heart is
responsible for dealing with the deoxygenate
blood, while the left side deals with oxygenated
blood. Systemic Circulation is the process of
carrying oxygenated blood to the body, while
the Pulmonary Circulation is the process of carrying oxy-gen depleted blood from the
heart to the lungs. They play a major part in the process and functioning of the heart.

Systemic Circulation is a part of the cardiovascular system which is responsible for

carrying oxygenated blood away from the heart to the body, and return deoxygenated
blood back to the heart. The theory of circulation was first described by William Harvey.
The oxygenated blood leaves through the left ventricle to the aorta, the bodys largest
artery, by the aortic valve. The aorta is divided into arterioles which are further divided
into capillaries. The blood is then transported to major arteries in the upper body before
passing through the diaphragm, where it branches further into arteries which supply the
lower parts of the body through the capillaries.
The oxygenated blood replaces the waste and carbon dioxide from cells with oxygen
through diffusion and carries the waste to the capillaries which then once again merge
into venules, which continue to merge into veins, and then the venae cavae: the lower
inferior vena cava and the upper superior vena cava, through which the blood re-enters
the heart at the right atrium. The heart itself receives oxygen and nutrients through a
small "loop" of the systemic circulation.

During systemic circulation, the blood also passes through the kidneys, which filter as
much waste from the blood as it can. This is known as renal circulation. The blood also
passes through the small intestine during circulation. This is known as portal circulation.
The blood from the small intestine is collected in the portal vein and is carried through
the liver, which filters sugars and stores them for later use.

Pulmonary Circulation is a part of the

cardiovascular system which is responsible for
carrying de-oxygenated from the heart to the lungs
and then back to the heart for it to transfer the
oxygenated blood to the rest of the body. The
theory of pulmonary circulation was first described
by an Arab physician named Ibn al-Nafis. The
deoxygenated blood from the cells enters the heart
from the right atrium. The blood then flows from the
atrium by the contracting muscle through the tricuspid valve, a valve which opens only
one way, to the right ventricle.

Blood is then passed on to the lungs via the pulmonary artery, where it the carbon
dioxide from the blood is replaced with oxygen through diffusion. The oxygenated blood
is passed on to first to the left atrium of the heart by the pulmonary veins and then to the
left ventricle for the systemic circulation to take place. The heartbeats that one hears is
the opening and closing of the one-way valves that allow blood to flow from one
ventricles to the other. This is an important process of pulmonary circulation.

Pulmonary circulation and systemic circulation go hand in hand and are jointly
responsible for sending blood throughout the body. Pulmonary Circulation takes
deoxygenated blood and converts it back to oxygenated blood, while systemic
circulation takes the oxygenated blood to the cells and brings back the deoxygenated
blood that is released by the cells in the body. Pulmonary Circulation deals solely with
the lungs, while systemic circulation deals with the rest of the body.

Different heart of the different animals

The circulatory system varies from simple systems in invertebrates to more complex
systems in vertebrates. The simplest animals, such as the sponges (Porifera) and
rotifers (Rotifera), do not need a circulatory system because diffusion allows adequate
exchange of water, nutrients, and waste, as well as dissolved gases. Organisms that
are more complex, but still have only two layers of cells in their body plan, such as
jellies (Cnidaria) and comb jellies (Ctenophora), also use diffusion through their
epidermis and internally through the gastrovascular compartment. Both their internal
and external tissues are bathed in an aqueous environment and exchange fluids by
diffusion on both sides. Exchange of fluids is assisted by the pulsing of the jellyfish
body.

Animal circulatory systems

(a) Fish have the simplest circulatory systems of the vertebrates: blood flows
unidirectionally from the two-chambered heart through the gills and then to the rest of
the body. (b) Amphibians have two circulatory routes: one for oxygenation of the blood
through the lungs and skin, and the other to take oxygen to the rest of the body. The
blood is pumped from a three-chambered heart with two atria and a single ventricle. (c)
Reptiles also have two circulatory routes; however, blood is only oxygenated through
the lungs. The heart is three chambered, but the ventricles are partially separated so
some mixing of oxygenated and deoxygenated blood occurs, except in crocodilians and
birds. (d) Mammals and birds have the most efficient heart with four chambers that
completely separate the oxygenated and deoxygenated blood; it pumps only
oxygenated blood through the body and deoxygenated blood to the lungs.

Animals without circulatory systems

Simple animals consisting of a single cell layer, such as the (a) sponge, or only a few
cell layers, such as the (b) jellyfish, do not have a circulatory system. Instead, gases,
nutrients, and wastes are exchanged by diffusion.

For more complex organisms, diffusion is not efficient for cycling gases, nutrients, and
waste effectively through the body; therefore, more complex circulatory systems
evolved. Closed circulatory systems are a characteristic of vertebrates; however, there
are significant differences in the structure of the heart and the circulation of blood
between the different vertebrate groups due to adaptation during evolution and
associated differences in anatomy.