Stoppage of blood loss- Stages –
Vasoconstriction – After injury there is constriction of blood vessels
this decreases loss of blood from damaged vessel. Activated platelets
secrete serotonin and causes vasoconstriction. Prothrombin activator is
formed due to damage of vessels.
Formation of platelet plug- When platelet adhere to collagen of
ruptured blood vessel these secrete ADP and Thromboxane Az. These
two substances attract more and more platelets and activate them. More
platelets aggregate and form plug which closes the vessel and prevents
the blood loss.
Coagulation of blood – When blood shed it looses its liquidity and
becomes a jelly like mass structure known as clotting.
COAGULATION
BY DR.SHILPA YERME

COAGULATION
• When blood looses its fluidity & get converted into
semisolid jelly like substance it is called as coagulation
.
• There are various factors involved in this process.
normally in bloodstream due to presence of natural
anticoagulants it does not coagulate. After rupture of a
vessel coagulating factors from that area of tissue
damage get collected ,actived & forms a clot.

FACTORS INVOLVED IN CLOTTING
• Factor I – Fibrinogen
• Factor II – Prothrombin
• Factor III – Thromboplastin ( tissue factor )
• Factor IV – Calcium
• Factor V – Labile factor
• Factor VI – Not named
• Factor VII – Stable factor
• Factor VIII – Antihemophilic factor
• Factor IX – Christmas factor
• Factor X – Stuart – Prower factor
• Factor XI – Plasma thromboplastin antecedent
• Factor XII – Hageman factor
• Factor XIII – Fibrin stabilizing factor
• nature -All clotting factors are protein in nature

• Stages-
• prothrombin activator + ca Prothrombin 
Thrombin
• Thrombin Fibrinogen  Fibrin
• Fibrin + Blood cells  Clot

• .–
• Two pathways
•
• Extrinsic Intrinsic
•
• Tissue trauma Blood trauma
•
• Thromboplastin . Activated XII converts into factor xi activates
factor ix --activates
factor x
• presence of vii ca
. Glycoprotein .. release of phospholipids
phospholipids
.
Factor vii
Convert factor x into actived factor x
• Activated factor x reacts with factor v
• Forms prothrombin activator
• Thrombin activated factor x reacts with platelet
phospholipids
•
• Fibrinogen
•
• Fibrin

• Clot Retraction – Once a clot is formed it plugs ruptured
area of blood vessels and stops blood loss. Clot retraction
is consolidation or tightening of fibrin clot. After 30 to 45
min a straw coloured fluid called serum oozes out of clot.
• clotting time is the time interval from oozing of blood after
rupture of vessel & formation of clot. Normal clotting time –
3 to 9 min.
• Hemophilia – Increase in clotting time. It is hereditary
bleeding disorder affects male, females are carriers.
• Affected Queen Victoria’s Son.
• Symptom intramuscular hemorrhage, nose bleeds, Blood in
urine, hemorrhage in Jonits- pain.

TYPES
HEMOPHILIA – A) FACTOR VIII - 85%.
HEMOPHILIA – B) CHRISTMAS FACTOR 15
HEMOPHILIA - C) FACTOR XI DEFICIENCY.
RARE DISORDER
ANTICOAGULANTS
• Heparin – it is a powerful anticoagulant in body
secreted by many different cells but mostly from
basophilic mast cells located in pericapillary
connective tissue all over body,these cell
continuously secrete small quantity of heparin
diffuse in circulatory system.basophilic cell of
blood release small amount of heparin in plasma.

• Mast cells are also found in lungs ,liver.
• Functions- prevents blood clotting
• Combine with antithrombin III & removes thrombin from
circulation.
• Inactivates active form of other clotting factors.
• EDTA – used as anticoagulant for preserving blood
sample.& intravenously used in lead poisoning.

• Oxalate compounds- it is used vitro as a anticoagulant .
• Citrates –sodium ,ammonium, potassium citrates are
used as anticoagulants to preserve blood in laboratory .
• Coumaurin derivatives –warferin , dicoumoral are used
as oral anticoagulants.
Thrombosis –clotting of blood inside the body is
thrombosis.
Common causes –injury to blood vessel ,agglutination
of rbc ‘roughened endothelial lining ,chemical
poisoning ,sluggish blood flow etc.

IRON METABOLISM
•
• Iron is necessary for formation of hemoglobin.
Total quantity. – 4 -5 gms.
• 65 to 68 % - In HB
• 4% - Muscle 1% - 0.1% - Transferrin.
• 15 to 30% - stored in R.E.System Liver .
• Dietary Iron – Heme Fish, Meat, Chicken.
• Non heme – Vegetables, grains, cereals.
• Absorption is mainly from small intestine, bile is
necessary for absorption of iron. After absorption
immediately combines with beta globulin called apo
transferrin to form transferrin – Transported in the plasma.
Stored in liver.

IRON LOSS
• Loss In males - about 1 mg of iron is excreted every day
through feces. In females the amount of iron loss is high –
(Menstruation)
• 1gm HB Contains 3.34 mg of iron. 100 ml of blood
contains 15 gm HB.
• In females during every menstrual cycle about 50 ml of
blood is lost out of which 25 mg of iron is lost.
• If 450 ml of blood is donated about 225 mg of iron is lost.

ANEMIA
• Anemia is a condition in which RBC, HB, PCV, values
decreases.
• Classification –
• Morphological
• Etiological
• A) Morphological -
• Normocytic Normochromic - Size is normal count is
reduced.
• macrocytic normochromic –size normal ,count less

• Macrocytic hypochromic - R.B.C. Immature ,large & HB
reduces.
• Microcytic hypochromic - R.B.C. Small in size. Mcv,
MCHC reduces .

• B) Etiological -
• 1) Nutrition Deficiency Anemia - It is of various types
(Most Common in India)
• Iron deficiency - less iron supply. This is due to loss of
blood, decreased intake of iron, poor absorption,
increased demand of iron.
• Protein deficiency – due to deficiency of proteins.
• Atrophy of gastric mucosa - B12 absorption is poor it is
called as pernicious anemia.
• Folic acid –due to deficiency red cell becomes large
odd shapes called megaloblasts.

NUTRITION DEFICIENCY ANEMIA

3)Hemolytic - Excessive destruction of R.B.C -.
• Extrinsic- external factors-Chemical poisoning, like lead,
tar, infections like malaria, septicemia, presence of
isoagglutinins like anti Rh,autoimmune
diseases,burns,renal disorders etc.
• Intrinsic – due to defective RBCS which lives for short
period & destroy soon. ex. Sickle cell anemia
,thalassemia .
2) Hemorrhagic - Any condition in which there is
loss of blood. Accidents, ulcer, uterine bleeding.
Purpura, hemophilia, etc. hemorrhage may be
chronic or acute.

• 4) Aplastic - It is due to disorder of redbone marrow.
Bone Marrow depression is due to repeated exposure to
x-ray, bacterial toxins, quinine, gold salts, benzene,
radium etc. TB, hepatitis, HIV.

5) Sickle cell - Congenital anomaly found
mostly in blacks. It is due to abnormal Hbs. Alpha chains
normal beta chains abnormal. R.B.C. becomes, Sickle
crescent shaped, become more fragile leading to hemolysis.

SICKLE CELL ANEMIA
Trait –it means individuals having sickle cell gene & one
normal gene , means they don’t have anemia .

• 6) Thalassemia - (Cooley’s anemia) More common in
thailand Mediterranean countries. Inherited disease
having abnormal of Hb.
• a type – Fetal life / Infancy- a chains are less, absent. In
adults B chains are excess & children y- chains are
excess.
• B type – B chains are less in number, absent & excess
of a chains. causes - defective erythropoiesis &
hemolysis.

• Sign. & Symptoms of Anemia -
• Skin - pale color conjunctiva, lips, ear lobes, Palm & nail
bed.
• Tachycardia. - increase in hart rate.
• Respiration Rate Increases.
• Digestion - anorexia, nausea, vomiting, constipation.
• Albuminuria.
• Loss of weight.
• Headache. restlessness, irritability, drowsiness,
• Liver enlargement
• Renal function disturbances- albuminuria
• In females menstrual cycle disturbances.

SYMPTOMS OF ANEMIA

NORMAL VALUES
• Blood
• Total blood volume = 5-6 liters – 70 ml /kg
• RBC count – Male –4. 5 to 6.5 million/cu mm, in females
3.9 to 5.6 millions/ cu mm.
• Total WBC count = 4500 to 12000 /cu mm of blood.
• Hemoglobin concentration-
• Males = 14 to 18 gm % and in females 12 to 16
gm%.newborns 14- 20 gm %
• O2 carrying of blood = Hb conc. X 1.34 ml. of O2

• Packed Cell Volume –
• Male = 40 to 45%, female= 38 to 42%
• MCV = 78 to 90cu u
• MCH = 27 to 32 p g
• MCHC = 30 to 38%
• Reticulocyte count = 0.5 to 1%
• Color index = 1
• Differential count-
• Neutrophils = 50 to 70%
• Eosinophils = 2 to 5
• Basophils = 0 to 1%
• Lymphocytes = 20 to 30%
• Monocytes = 2 to 6%

• ESR -
• Westergren methods = 3 to 7 mm/hour (males)
• = 5to 9 mm/hour (females)
• Wintrobe methods = 0 to 9 mm/hour (males)
• = 0 to 20 mm/hour (females)
• Clotting time = 3 to 9 (average 6 min.)
• Bleeding time = 1-4 (average 3 min.)
• Prothrombin time = 12 to 14 sec

• Blood Characters -
• Blood pH = 7.4 specific gravity = 1.052 to 1.061
• Specific gravity of blood plasma = 1.022 to 1.026
• Specific gravity of red blood cells = 1.092 to 1.101
• Fragility of blood = 0.45% to 0.33% of Nacl solution.
• Plasma -
• Total proteins in plasma = 5 to 8 g/dl

• Albumin = 4.7 g/ dl
• Globulins = 2. 3 g/dl
• Fibrinogen = 0.3 g/dl
• Normal plasma contents –
• Plasma glucose (fasting) = 80 – 120 mg/100ml

• Blood chemistry –
• Blood sugar level (fasting) = 80 to 120 mg%
• Blood sugar level (post - prandial) = 120 to 140 mg%
• Random Blood Sugar = 160 to 180 mg%
• Blood urea = 8 to 26 mg/dl
• SGOT = 5 to 40 units (5 to 25 IU/L)
• SGPT = 5 to 35 units (3 to 26 IU/L)
• S. Lactic dehydrogenase = 71 to 207 u/l
• Serum non protein nitrogen (SNPN) = 15 to 35 mg%
• S. bilirubin (Direct) = 0.1 to 0.3 mg/dl
• S. bilirubin (Indirect) = 0.2 to 0.7 mg/dl
• S. cholesterol = 150 to 200 mg%, 15 to 180 mg% in females.
• S. fatty acids = 150 to 200 mg%, 140 to 270 mg% in females.

• Blood glucose -100 to 120 mg/dl
• Blood creatinine -0.5 to 1.5 mg /dl
• Cholesterol –up to 200 mg /dl
• Bilirubin -0.5 to 1.5 mg / dl
• Iron -50 to 150 ug /dl
• Copper – 100 to 200 mg / dl
• Calcium -9 to 11 mg / dl
• Magnesium -1.5 to 2.0 mEq/l
• Chloride -100 to 110 mEq/l
• Bicarbonate 22 to 26 mEq/l
• Chlorides = 120 to 250 mEq/l

• Normal Clinical Values -
• Pulse = 70 to 80 beats/min.
• Blood pressure = 80 to 120 mm of Hg. Adult 90 to 150 mm
Hg.
• Temperature- 37 to 38oC or 98 to 99oF
• Respiratory rate = 12 to 18 cycles/min. tidal volume = 500 to
600 ml.
• Inspiratory reserve volume (IRV) = 1600 to 2500ml.
• Expiratory reserve volume (ERV) = 1000 to 1600ml.
• Residual volume = 1600ml,
• Total lung capacity = 2 to 6 lit. Vital capacity = 5 to 6 liters,
• Arterial oxygen tension = 95 to 98 mm of HG,
• Arterial CO2 tension = 40 to 45 mm. of Hg.,

• Normal basal metabolic rate (BMR) -
• In males it is about 40 cal/sq. meter are/hour.
• In females about 36 cal/sq. meter area/hour.
Urine -
Daily urine output is 1200 to 1500 ml. pale
yellow color.
Specific gravity = 1.002 to 1.030.
pH = 6

• ABBREVATIONS USED
• R.B.C. = Red Blood cells or Corpuscles
• W.B.C. = White Blood cells or Corpuscles
• Hb = Hemoglobin B.T = Bleeding time
• C.T = Clotting time E.S.R. = Erythrocyte Sedimentation
Rate
• P.C.V. = Packed Cell volume,Temp. = Temperature
• B.P. = Blood Pressure ,Ppt. = precipitate.
• M.C.H.C. = Mean corpuscular hemoglobin concentration
• M.C.H. = Mean corpuscular hemoglobin
• M.C.V. = Mean corpuscular volume
• mm = Milimeter Wt = Weight
• Sp.gravity = Specific Gravity