1. Chapter Blood

2. Blood Blood is a liquid tissue
Blood flows everywhere through the human body
Main founction of blood is to transport
Blood is composed of cellular part and non-cellular part

3. Self-study： 1. What’s blood? 2. Blood composition and its functions
3. Blood volume in human body
4. The physical and chemical characteristics of blood
5. Crystal and colloid osmotic pressure and their functions
6. Some important terms in clinic: hematocrit、 plasma
osmotic pressure, plasma pH, blood viscosity,
specific density of blood, suspension stability of RBC
and erythrocyte sedimentation, osmotic fragility of
RBC, isosmotic solution, isotonic solution
Hematocrit血细胞比容;p specific density of blood血液比重
blood viscosity血液粘度； erythrocyte sedimentation 血沉； osmotic fragility of RBC 渗透脆性

4. Physiological Hemostasis
Part 1
Physiological Hemostasis

5. I. Physiological Hemostasis
Definition:
The physiological process arresting blood
leakage when a vessel is damaged
Index — Bleeding Time
The time from the start to the arrest of bleeding(1-3 min normally)
Process:

6. Vascular constriction
Formation of the platelet plug
3. Formation of the blood clot (blood coagulation)

7. Hemostasis: BV Injury Coagulation Blood Vessel Platelet Neural
Stable Hemostatic Plug
Coagulation
Activation
Blood Vessel
Constriction
Platelet
Aggregation
Primary Hemostatic Plug
Reduced
Blood Flow
Stoppage of Bleeding

8. Formation of Platelet Plug
Platelets in normal state
Actived platelets

9. Platelet Activation Pathways (1)
ADP
Adrenaline
Collagen
Thrombin
ADP
GpIIb/IIIa
Aggregation
GpIIb/IIIa
Aggregation
GpIIb/IIIa
Aggregation
GpIIb/IIIa
Adhesion
Platelet
GpIb
Adrenaline
Adhesion
vWF
Exposed collagen
Endothelium

10. Chen J, Lopez JA. Hartwig JH.
Interactions of platelets with subendothelium and endothelium. Microcirculation Apr-May;12(3):
Hartwig JH.
The platelet: form and function. Semin Hematol Jan;43(1 Suppl 1):S

11. Platelet Activation Pathways (2)
Thrombin
ADP
TXA2
Platelet
Fibrinogen binding site
Fibrinogen
Platelet aggregation

12. Blood Coagulation
Process of conversion of blood from fluid to gel
Process of conversion of fibrinogen to fibrin
Blood in fluid
Blood in gel

13. Clotting Factors(1) Factors Synonyms Factors Synonyms I IX fibrinogen
antihemophilic f. B II
prothrombin X
Stuart-Prower f.
III
tissue factor XI
antihemophilic f. C IV
Ca++
XII
contact factor V
proaccelerin
XIII
fibrin-stabilizing f.
proconvertin
HMW-K (kininogen)
Prekallikrein (PK)
VII
VIII
antihemophilic f. A

14. Clotting Factors(2) All exist in blood except III
All are proteins except Ca2+
Many are synthesized by liver
Synthesization is dependent on Vit K:
II,VII,IX,X

15. Clotting Factors(3) Many are proteolytic proenzymes that need
be actived

16. Structure of Clotting Factors(4)

17. Three Basic Stages Intrinsic pathway XII Extrinsic pathway III 1.
Formation of prothrombin activator
II→IIa (prothrombin→thrombin) 2.
I→ Ia (fibrinogen→ fibrin) 3.

19. Structure of Fibrinogen
Fibrinogen molecules are comprised of two sets of disulfide-bridged , , and  chains
Therefore, composed of six polypeptide chains

20. Fibrin Polymerization

21. Scanning Electron Micrograph of Blood Clot, Showing Red and White Blood Cells Caught in Fibrin Mesh

22. Initiation of Coagulation
in Vivo

24. Clot Retraction 30-60 minutes Platelets contain actomyosin
As the clot is contracted,serum is
squeezed from the mass
Serum

25. II.Control of Coagulation
Antithrombin III and Heparin
Proteins C and S
TFPI –
balance
Procoagulants Anticoagulants

26. Heparin and Antithrombin

27. Protein C and S (1)
EPCR
Blood Flow
Protein C
APC
Thrombin
Thrombus

28. Protein C and S (2)
Blood Flow
VIIIa Va
Thrombus
Vai
VIIIai PS
APC
APC

29. TFPI

30. III.Fibrinolysis

31. IV.Abnormalities of Hemostasis
1.Hemophilia
Cause: deficiency of VIII,IX,XI
Therapy: injection of purified clotting factors
2.Throbocytopenia
Cause: the number of platelet＜ 50,000/ul
(normally: 150,000 ~ 300,000/ul)

32. Part 2
Blood Groups

33. Blood Fact
If someone is in an accident, has surgery or gets cancer, they may need another person’s blood to help them survive.
There is no substitute for blood transfusion.
This blood comes from blood donors.

34. I. Definition of Blood Groups
Blood Groups (Types)
Types of the specific antigens of the red blood cells
antigens
Antigen——Agglutinogen
Antibody——Agglutinin

35. II. Major RBC Blood Group System
1. ABO System (Karl Landsteiner, 1901)
Antigens: A and B agglutinogens

36. Blood Types A O B AB B Antigen A & B Antigens Neither A nor B Antigens
Antibodies bind with antigens to cause clumping of blood cells (agglutination) so people with type A blood have circulating antibodies for type B, while people with blood type AB have neither A nor B antibodies and people with blood type O circulate both A and B antibodies.
A Antigen

37. RBC Agglutination
Blood Group Ag.
Antibody
(Agglutination) 26

38. Incompatible Transfusion
Transfusion Reaction
Incompatible Transfusion 
Transfusion Reaction
Agglutination
Hemolysis

39. Antibodies: Anti-A and Anti-B agglutinin (Natural Antibodies; Ig M)
Significance: Serious transfusion reaction occurs
in the first imcompatible blood
transfusion

41. There are 4 main blood types, distinguished by their carbohydrate antigens

43. A transferase
H A antigen
A gene
B transferase
H B antigen
B gene

44. ABO genes:A and B—dominant,O—recessive
ABO phenotypes and genotypes:
1. Group A phenotype = A/A or A/O genotype
2. Group B phenotype = B/B or B/O genotype
3. Group O phenotype = O/O genotype
4. Group AB phenotype = A/B genotype

45. A Antigen B Antigen H Substance A and B Antigens Precursor Substance
AA,AO genes
BB,BO genes
B Antigen
H Substance
A and B Antigens
HH,Hh genes
AB genes
OO genes
Precursor Substance
H Substance
hh genes
ANY GENES
Precursor Substance
No Antigen
Bombay

46. ABO System Three alleles A, B, O.
A & B genes code for glycosyltransferases, add terminal sugar to H substance (l.fucose)
galactosamine by A (A1 is stronger than A2)
galactose by B
Bombay group – absent H substance

47. Subgroups of A type:Decreased amounts of A antigen on the red blood cells;inherited conditions
Significance: Distinguish A2 and O,A2B and B

48. Article1
Article2

49. Blood Typing Test Type A Type B Type AB Type O anti-A anti-B anti-A

50. Incidence (%) of ABO Blood Groups in the US Population
ABO Group
Whites
Blacks O 45 49 A 40 27 B 11 20 AB 4

51. 2. Rh System (Landsteiner & Weiner, 1940)
Antigen ——Rhesus factor( D, E, C, c, e)
Grouping:
Antigen D
Rh positive
Rh negative –
Antibodies:
No natural antibodies; Ig G
Incidence: - 0.2% in Chengdu’s population

52. Hemolytic Disease of the Newborn
If father D+, mother D-, & fetus is D+
First pregnancy not affected –
Fetal D+ RBCs enter mother’s circulation in the last trimester and during delevery
Mother makes anti-D weeks later
In the next pregnancy (if baby is Rh+) these IgG cross the placenta and cause hemolytic disease in baby
Anti-D immunization after birth prevents

53. Hemolytic Disease of the Newborn
First Preg Later Next Preg 28

54. III. Principles of Blood Transfusion
1. Blood transfusion is allowed among people
with same type of bloods
2. Cross-matching test must be carried out in
any case

55. Cross-matching Test RBC RBC Donor Recipient Serum Serum Primary side:
secondary
side
Primary side:
the donor’s blood cells with the recipient’s serum

56.   Secondary Blood Primary Transfusion Side    (a little amount,—   —   — 
(a little amount,
slowly, observed)

57. References 1.Human Physiology From Cells to Systems,
4th edition,Lauralee Sberwood
北京：中国协和医科大学出版社，2002
2.Textbook of Medical Physiology,10th edition,
Guyton & Hall
北京：北京医科大学出版社，2002
3.生理学（七、八年制教材），姚泰
北京：人民卫生出版社，2005

58. Review questions 1. What is hemostasis and its basic process？
2. What is blood coagulation its basic process ？
3. What is serum and its difference from plasma
4. What is clotting factors and their characteristics ？
5. What are the characteristics of intrinsic and extrinsic
pathways and the relationship between two pathways?
6. What are the roles of platelet in hemostasis?
7. What are there physiological anticoagulants in
the body？
8. What are the composition of fibrinolysis and
its siginificance
9.What is blood type and principles of blood
transfusion ?How is ABO blood type determined?