Blood is the connective tissue in fluid form. It carries oxygen from lungs to all parts of the body & carbon dioxide from all parts of the body to the lungs.

It is also called fluid of health.

1. COLOR 2. VOLUME 3. REACTION & PH 4. VISCOSITY

1. Nutrient function

2. Respiratory function

3. Excretory function

4. Transport of hormones & enzymes

5. Regulation of water balance

6. Regulation of acid base balance

7. Regulation of body temperature

8. Storage function

9. Defensive function

Blood cells – formed elements

Liquid portion – plasma

1. BLOOD CELLS:

-RBC

-WBC

-PLATELETS

2. PLASMA:

-91-92% of water

-8-9% solids {organic & inorganic substance}

Ways of obtaining blood: ◦ Capillary or Peripheral blood ◦ Venous blood

Peripheral blood:

For total and differential blood counts and for haemoglobin estimation

Sites:

Lobe of the ear

Palmar surfaces of the tip of finger

For infants: from the plantar surface of the heel and toe

Venous blood:

For haematological exercises venous blood is better.

- Erythrocytes - Red in colour due to presence of Hb - Vital role in transport of respiratory gases - Disk or biconcave in shape - Diameter – 7.2 microns - Non nucleated, DNA, mitochondria, golgi-

apparatus are absent. - Energy is produced from glycolytic process - They do not have insulin receptor so glucose

uptake by this cell is not controlled by insulin. - Life span – 120 days - RBC have special type of cytoskeleton which is

made up of actin & spectrin.

Transport of oxygen from lungs to the tissues

Transport of carbon dioxide from the tissues to the lungs

Buffering action in blood

Blood group determination

Rouleaux formation

Sp. Gravity

Suspension stability

Packed cell volume or hematocrit

The rate at which the erythrocytes settle down is called ESR

DETERMINED BY

1. WESTERGRENS METHOD 2. WINTROBES METHOD FACTORS AFFECTING ESR: 1. Sp gravity 2. Rouleaux formation 3. Increase in size of RBC 4. Viscosity 5. RBC count

PHYSIOLOGICAL VARIATIONS 1. Age 2. Sex 3. Menstruation 4. Pregnancy

PATHOLOGICAL VARIATIONS 1. Tuberculosis 2. All type of anaemia { sickle cell anaemia}

3. Malignant tumour 4. Rheumatoid arthritis 5. Rheumatoid fever 6. Liver disease

ESR DECREASES IN

1. Allergic condition

2. Sickle cell anaemia

3. Peptone shock

4. Polycythemia

5. Extreme leukocytosis

Physiological variation:

Increase – polycythemia 1. Age

2. Sex 3. High altitude

4. Muscular exercise 5. Emotional condition

6. After meals

Decrease: 1. High barometric pressure

2. During sleep 3. pregnancy

Primary polycythemia:

- Polycythemic vera

Secondary polycythemia:

- Respiratory disorder like emphysema

- Congenital heart disease

- Ayerzas disease

- Chronic carbon monoxide poisoning

- Poisoning by chemicals like phosphorous & arsenic

- Repeated mild haemorrhages

Morphological:

1. Normocytic normochromic

2. Macrocytic normochromic

3. Microcytic hypochromic

PATHOPHYSIOLOGIC:

1. Anaemia due to increased blood loss

a. Acute

b. Chronic

2. Anaemia due to impaired red cell production a. Cytoplasmic maturation defects - iron def anaemia - thalassaemic syndromes b. Nuclear maturation defects - megaloblastic anaemia c. Defect in stem cell proliferation & differentiation - aplastic anaemia d. Anaemia of chronic disorders e. Bone marrow infiltration f. Congenital anaemia 3. Anaemia due to increased red cell

destruction{haemolytic anaemia} a. Extrinsic b. intrinsic

1. Skin

2. Cvs

3. Respiration

4. Digestion

5. Metabolism

6. Kidney

7. Reproductive system

8. Neuromuscular system

Type of anaemia causes Morphology of RBC

1. HAMORRHAGIC Acute loss of blood Normocytic, normochromic

Chronic loss of blood Microcytic, hypochromic

2. HEMOLYTIC ANAEMIA Liver failure Normocytic, normochromic

Renal disorder Normocytic, normochromic

Hyper splenism Normocytic, normochromic

Burns Normocytic, normochromic

Congenital or acquired default in the shape of RBC

Sickle cell anaemia – sickle shape Thalassemia – small, irregular shape

3. APLASTIC ANAEMIA Bone marrow disorder Normocytic, normochromic

TYPE OF ANAEMIA CAUSES MORPHOLOGY OF RBC

4. Nutrition deficency anaemia

Iron def Microcytic, hypochromic

Protein def Macrocytic, hypochromic

Vitamin B12 def Macrocytic, hypo/normochromic

Folic acid def Megaloblastic, hypochromic

5. Anaemia of chronic disease

Non-infectious inflamatory disease

Normocytic, normochromic

Chronic infections Normocytic, normochromic

VARIATION IN SIZE OF RBC:

1. Microcytes – decrease in size

2. Macrocytes – increase in size

3. Anisiocytes – cells with out uniform size

VARIATION IN SHAPE OF RBC:

1. Crenation

2. Spherocytosis

3. Elliptocytosis

4. Sickle cell

5. poikilocytosis

Leukocytes are colourless & nucleus formed elements. Larger in size & lesser compared with RBC.

Plays a defensive mechanism & protect the body from invading organism.

GRANULOCYTES

1. Neutrophils – 50-70%

2. Eosinophils – 2-4%

3. Basophils – 0-1%

AGRANULOCYTES

1. Monocytes – 2-4%

2. Lymphocytes – 20-30%

- large lymphocytes – 10-12 microns

- small lymphocytes – 7-10 microns

LIFE SPAN

Depends of its body & function

1. Neutrophils – 2-5 days

2. Eosinophils - 7-12 days

3. Basophils – 12-15 days

4. Monocytes – 2-5 days

5. Lymphocytes – 1 day

PROPERTIES

1. Diapedesis

2. Ameboid movement

3. Chemotaxis

4. phagocytosis

Total WBC count – 4000-11000 cu mm of blood

PHYSIOLOGICAL VARIATION

1. Sex

2. Diuranal variation

3. Exercise

4. Sleep

5. Emotional condition

6. Pregnancy

7. menstruation

PATHOLOGICAL VARIATION:

Leukocytosis

1. Allergy

2. Infection

3. Common cold

4. Tuberculosis

5. Glandular fever

NEUTROPHILIA: 1. Acute infection 2. Metabolic disorders 3. Infection of foreign proteins 4. Injection of vaccine 5. After acute haemorrhage EOSINOPHILIA 1. Allergic condition 2. Asthma 3. Scarlet fever 4. Blood parasitism BASOPHILIA 1. Small pox 2. Chicken pox 3. Polycythemic vera

MONOCYTOSIS

1. Tyberculosis 2. Syphilis

3. Malaria 4. Kala-azar

5. Glandular fever LYMPHOCYTOSIS

1. Diphtheria

2. Mumps 3. Malnutrition

4. Rickets 5. Syphilis

6. Thyrotoxicosis

7. Infectious hepatitis

LEUKEMIA - Abnormal & uncontrolled increase in

leukocyte count more than 100000 cu mm - Also called blood cancer

LEUKOPENIA Decrease in WBC

1. Anaphylactic shock 2. Cirrhosis of liver

3. Disorder of spleen 4. Pernicious anaemia 5. Typhoid & para-typhoid 6. Viral infection

Are colourless , small , non nucleated & moderately refractive bodies.

Diameter – 2.5 microns

Shape – spherical or rod shape becomes oval or disc when inactivated

Normal count – 250000 cu mm of blood

Life span – 10 days

Platelets are formed from bone marrow

STRUCTURE & COMPOSITION 1. Cell membrane - glycoproteins - phospholipids 2. Microtubules 3. Cytoplasm - proteins - enzymes - hormonal substance - other chemical substance PROPERTIES 1. Adhesiveness 2. Aggregation 3. agglutination

FUNCTION

1. Role in blood clotting

2. Role in clot retraction

3. Role in prevention of blood loss

4. Role in repair of ruptured blood vessel

5. Role in defence mechanism

PHSIOLOGICAL VARIATION

1. Age

2. sex

3. High altitude

4. After meals

PATHOLOGICAL VARIATION Thrombocytopenia

1. Acute infection 2. Acute leukemia 3. Chicken pox 4. Splenomegaly 5. Thypoid 6. Tuberculosis 7. Purpura 8. Aplastic & pernicious anaemia

THROMBOCYTHEMIA –persistent & abnormal increase 1. Carcinoma 2. Chronic leukemia 3. Hodgkins disease

THROMBOCYTOSIS – increase in platelet

1. Allergic condition

2. Asphyxia

3. Haemorrhage

4. Bone fracture

5. Surgical operation

6. Rheumatoid fever

7. Trauma

- Serum is different from plasma - It only contains albumin & globulin Thus serum = plasma – fibrinogen NORMAL VALUES

Total proteins – 7.3 gm% Serum albumin – 4.7 gm% Serum globulin – 2.3 gm% Fibrinogen – 0.3 gm% A/G ratio – 2:1

PROPERTIES:

1. Molecular wt

2. Osmotic pressure

3. Sp. Gravity

4. Buffer action

ORIGIN:

Embryo – mesenchyme cells

Adults – reticuloendothelial of liver, spleen, bone marrow & other tissue cells

- Gamma globulin is synthesised from B-lympocytes

1. Role in coagulation of blood

2. Role in defence mechanism of the body

3. Role in transport mechanism

4. Role in maintains of osmotic pressure in blood

5. Role in regulation of acid base balance

6. Role in viscosity of blood

7. Role in ESR

8. Role in reserve proteins

9. Role in production of trephone substance

10. Role in suspension stability of RBC

PLASMA PROTEIN WHEN INCREASES WHEN DECREASES

TOTAL PROTEINS Dehydration Diarrhea

Haemolysis Haemorrhage

Leukemia Burns

Rhematoid arrthritis Pregnancy

Alcoholism Mal nutrition

ALBUMIN Dehydration Malnutrition

Congenitive cardiac failure

Cirrosis of liver

Burns

Hypothyroidism

Excessive intake of water

GLOBULIN Cirrhosis of liver Emphysema

Chronic infection Hypogammaglobulinemia

Nephrosis Acute hemolytic

PLASMA PROTEIN WHEN INCREASES WHEN DECREASES

FIBRINOGEN Acute infection Liver dysfunction

Rhematoid arthritis Use of anabolic steroids

Stroke Use of phenobarbital

Trauma

Myocardial infarction

A/G RATIO Hypothyroidism Liver dysfunction

Excess of glucocoticoids

nephrosis

Intake of high carbohydrate & protein diet

hypogammaglobulinemia

Majority of the disease is directly or indirectly relate with the blood.

So haematological investigation plays a vital role in conforming the diagnosis

ORAL MEDICINE - BURKET’S 8TH EDITION

HUMAN PHSIOLOGY – SEMBULINGAM

ORAL MEDICINE - GARY C. COLEMAN J.F NELSON

ORAL MEDICINE – KERR ASH MILLER

GENERAL PATHOLOGY – HARSH MOHAN