CHAPTER I

PRELIMINARY

A. Background
In the human body, there is a tool that is useful as a drug transport oxygen and
nutrients to all cells of the body and transports carbon dioxide and waste products to
organs expenses. Means of transport in humans coordinated in a system called the
circulatory system. Human circulatory system consists of blood, heart, and blood
vessels.

Blood is a liquid that is present in all living organisms (except plants) high
levels of which serves to transmit substances and oxygen needed by the body tissue,
transporting chemicals products of metabolism, as well as the body's defense against
viruses or bacteria. Medical terms related to blood begins with hemo or hemato word
derived from the Greek word meaning haima which means blood.

Human blood is red, but in this case there are two kinds of color of blood red
color on human blood. Bright red color indicates that the blood contains more oxygen,
while the dark red color indicates that the blood contains little oxygen or in another
sense it contains a lot of carbon dioxide. The red color in the blood caused by the
presence of hemoglobin. Hemoglobin is a protein breathing (respiratory protein)
containing iron (Fe) in the form of heme which is where binds oxygen.

Blood also transports metabolic waste materials, drugs and foreign chemicals
to the liver to be degraded and to the kidney to be excreted as urine.

B. Formulation Of The Problem

1. What is definition of Hematology System?
2. What is composition of blood?
3. What is function of blood?
4. What is Disorders of the Circulatory System?
C. Purpose
1. To know about definition of Hematology System
2. To know about Composition of blood
3. To know function of blood
4. To know disorders of circulatory system

CHAPTER II
LITERATURE REVIEW

A. Definition
Hematology is a branch of medicine concerning the study of blood, the bloodforming organs, and blood diseases. The word "heme" comes from the Greek for
blood.
Hematology is the study of blood in health and disease. It includes problems
with the red blood cells, white blood cells, platelets, blood vessels, bone marrow,
lymph nodes, spleen, and the proteins involved in bleeding and clotting (hemostasis
and thrombosis). A hematologist is a medical doctor who applies this specialized
knowledge to treat patients with blood conditions.
B. Composition of Blood :

1. Blood plasma (liquid part of blood)

Blood plasma is the pale yellow liquid component of blood that
normally holds the blood cells in whole blood in suspension; this makes plasma
the extracellular matrix of blood cells. It makes up about 55% of the body's total
blood volume. It is the intravascular fluid part of extracellular fluid (all body
fluid outside of cells). It is mostly water (up to 95% by volume), and contains
3

dissolved proteins (68%) (i.e.serum albumins, globulins, and fibrinogen),

glucose, clotting factors, electrolytes (Na+, Ca2+, Mg2+, HCO3, Cl, etc.),
hormones, and carbon dioxide (plasma being the main medium for excretory
product transportation). Plasma also serves as the protein reserve of the human
body. It plays a vital role in an intravascular osmotic effect that keeps
electrolytes in balanced form and protects the body from infection and other
blood disorders.
Blood plasma is prepared by spinning a tube of fresh blood containing
an anticoagulant in a centrifuge until the blood cells fall to the bottom of the
tube. The blood plasma is then poured or drawn off. Blood plasma has a density
of approximately 1025 kg/m3, or 1.025 g/ml.
Blood serum is blood plasma without clotting factors; in other words,
"pure" blood. Plasmapheresis is a medical therapy that involves blood plasma
extraction, treatment, and reintegration.
Blood plasma volume may be expanded by or drained to extravascular
fluid when there are changes in Starling forces across capillary walls. For
example, when blood pressure drops in circulatory shock, Starling forces drive
fluid into the interstitium, causing "third spacing."
Standing still for a prolonged period will cause an increase in
transcapillary hydrostatic pressure. As a result, approximately 12% of blood
plasma volume will cross into the extravascular compartment. This causes an
increase in hematocrit, serum total protein, blood viscosity and, as a result of
increased concentration of coagulation factors, it causes orthostatic
hypercoagulability.
Plasma
a. Liquid part of blood; yellow in color because of pigments
b. Consists of serum (liquid portion of plasma) and fibrinogen

c. Contains plasma proteins such as albumin, serum globulins, fibrinogen,

prothrombin, plasminogen
1) Albumin: largest of plasma proteins, involved in regulation of
intravascular plasma volume and maintenance of osmotic pressure
2) Serum globulins: alpha, beta, gamma
a)

Alpha: role in transport of steroids, lipids, bilirubin

b)

Beta: role in transport of iron and copper

c)

Gamma: role in immune response, function of antibodies

3) Fibrinogen, prothrombin, plasminogen (see Coagulation

2. Solid Part of Blood :

a. Red blood cells
1) Bioconcave disc shape, no nucleus, chiefly sacs of hemoglobin
2) Cell membrane is highly diffusible to O2 and CO2
3) RBCs are responsible for oxygen transport via hemoglobin (Hgb)
a) Two portions: iron carried on heme portion; second portion is
protein
b) Normal blood contains 12-18 g Hgb/100 ml blood; higher (14-18 g)
in men than in women (12-14 g)
Production
1) Start in bone marrow as stem cells, released as reticulocytes (immature
cells), mature into erythrocytes
2) Erythropoietin stimulates differentiation; produced by kidneys and
stimulated by hypoxia
3) Iron, vitamin B12, folic acid, pyridoxine (vitamin B 6), and other factors
required for erythropoiesis
5

Hemolysis (destruction)
1) Average life span 120 days
2) Immature RBCs destroyed in either bone marrow or other
reticuloendothelial organs (blood, connective tissue, spleen, liver,
lungs, and lymph nodes)
3) Mature cells removed chiefly by liver and spleen
4) Bilirubin: byproduct of Hgb released when RBCs destroyed, excreted
in bile
5) Iron: freed from Hgb during bilirubin formation; transported to bone
marrow via transferrin and reclaimed for new Hgb production
6) Premature destruction: may be caused by RBC membrane
abnormalities, Hgb abnormalities, extrinsic physical factors (such as
the enzyme defects found in G6PD)
7) Normal age RBCs may be destroyed by gross damage as in trauma or
extravascular hemolysis (in spleen, liver, bone marrow)
b. Leukocytes: granulocytes and mononuclear cells: involved in protection
from bacteria and other foreign substances
Granulocytes: eosinophils, basophils, and neutrophils
1) Eosinophils: involved in phagocytosis and allergic reactions
2) Basophils: involved in prevention of clotting in microcirculation and
allergic reactions
3) Eosinophils and basophils are reservoirs of histamine, serotonin, and
heparin
4) Neutrophils: involved in short-term phagocytosis
a) mature neutrophils: polymorphonuclear leukocytes
b) immature neutrophils: band cells (bacterial infection usually
produces increased numbers of band cells)
c. Mononuclear cells: monocytes and lymphocytes: large nucleated cells
1) Monocytes: involved in long-term phagocytosis; play a role in immune
response
a) largest leukocyte
b) produced by bone marrow: give rise to histiocytes (Kupffer cells of
liver), macrophages, and other components of reticuloendothelial
system

b) Lymphocytes: immune cells; produce substances against foreign cells;

produced primarily in lymph tissue (B cells) and thymus (T cells) (see
also Immune Response)
3. Pieces of blood (platelets)
Platelets, also called thrombocytes (thromb- + -cyte, "blood clot cell"),
are a component of blood whose function (along with the coagulation factors)
is to stop bleeding by clumping and clotting blood vessel injuries. Platelets
have no cell nucleus: they are fragments of cytoplasm that are derived from
the megakaryocytes of the bone marrow, and then enter the circulation. These
unactivated platelets are biconvex discoid (lens-shaped) structures, 23 m in
greatest diameter. Platelets are found only in mammals, whereas in other
animals (e.g. birds, amphibians) thrombocytes circulate as intact mononuclear
cells.
On a stained blood smear, platelets appear as dark purple spots, about 20%
the diameter of red blood cells. The smear is used to examine platelets for size,
shape, qualitative number, and clumping. The ratio of platelets to red blood
cells in a healthy adult is 1:10 to 1:20.
The main function of platelets is to contribute to hemostasis: the process of
stopping bleeding at the site of interrupted endothelium. They gather at the site
and unless the interruption is physically too large, they plug the hole. First,
platelets attach to substances outside the interrupted endothelium: adhesion.
Second, they change shape, turn on receptors and secrete chemical
messengers: activation. Third, they connect to each other through receptor
bridges: aggregation. Formation of this platelet plug (primary hemostasis) is
associated with activation of the coagulation cascade with resultant fibrin
deposition and linking (secondary hemostasis). These processes may overlap:
the spectrum is from a predominantly platelet plug, or "white clot" to a
predominantly fibrin clot, or "red clot" or the more typical mixture. The final
result is the clot. Some would add the subsequent clot retraction and platelet
inhibition as fourth and fifth steps to the completion of the process [8] and still
others a sixth step wound repair.
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Low platelet concentration is thrombocytopenia and is due to either

decreased production or increased destruction. Elevated platelet concentration
is thrombocytosis and is either congenital, reactive (to cytokines), or due to
unregulated production: one of the myeloprolerative neoplasms or certain
other

myeloid

neoplasms.

A disorder

of

platelet

function

is

thrombocytopathy.
Normal platelets can respond to an abnormality on the vessel wall rather
than to hemorrhage, resulting in inappropriate platelet adhesion/activation and
thrombosis: the formation of a clot within an intact vessel. These arise by
different mechanisms than a normal clot. Examples are: extending the fibrin
clot of venous thrombosis; extending an unstable or ruptured arterial plaque,
causing arterial thrombosis; and microcirculatory thrombosis. An arterial
thrombus may partially obstruct blood flow, causing downstream ischemia; or
completely obstruct it, causing downstream tissue death.
C. Function of Blood
Blood has three main functions: transport, protection and regulation.
1. Transport
Blood transports the following substances:
a. Gases, namely oxygen (O2) and carbon dioxide (CO2), between the lungs and
rest of the body
b. Nutrients from the digestive tract and storage sites to the rest of the body
c. Waste products to be detoxified or removed by the liver and kidneys
d. Hormones from the glands in which they are produced to their target cells
e. Heat to the skin so as to help regulate body temperature
2. Protection
Blood has several roles in inflammation:
a. Leukocytes, or white blood cells, destroy invading microorganisms and
cancer cells

b. Antibodies and other proteins destroy pathogenic substances

c. Platelet factors initiate blood clotting and help minimise blood loss
3. Regulation
Blood helps regulate:
a. pH by interacting with acids and bases
b. Water balance by transferring water to and from tissues
D. Disorders of the Circulatory System :
1. Anemia
Anemia (uh-NEE-me-uh) is a condition in which your blood has a lower than
normal number of red blood cells.
Anemia also can occur if your red blood cells don't contain enough
hemoglobin (HEE-muh-glow-bin). Hemoglobin is an iron-rich protein that gives
blood its red color. This protein helps red blood cells carry oxygen from the lungs
to the rest of the body.
If you have anemia, your body doesn't get enough oxygen-rich blood. As a
result, you may feel tired or weak. You also may have other symptoms, such as
shortness of breath, dizziness, or headaches.
Severe or long-lasting anemia can damage your heart, brain, and other organs
in your body. Very severe anemia may even cause death.
the most common types of anaemia are
a. Iron deficiency anaemia
b. Thalassaemia
c. Aplastic anaemia
d. Haemolytic anaemia

e. Sickle cell anaemia

f. Pernicious anaemia
g. Fanconi anaemia

Overview
Blood is made up of many parts, including red blood cells, white blood
cells, platelets (PLATE-lets), and plasma (the fluid portion of blood).
Red blood cells are disc-shaped and look like doughnuts without holes in
the center. They carry oxygen and remove carbon dioxide (a waste product)
from your body. These cells are made in the bone marrowa sponge-like
tissue inside the bones.
White blood cells and platelets (PLATE-lets) also are made in the bone
marrow. White blood cells help fight infection. Platelets stick together to seal
small cuts or breaks on the blood vessel walls and stop bleeding. With some
types of anemia, you may have low numbers of all three types of blood cells.
Anemia has three main causes: blood loss, lack of red blood cell
production, or high rates of red blood cell destruction. These causes might be
the result of diseases, conditions, or other factors.
Outlook
Many types of anemia can be mild, short term, and easily treated. You can
even prevent some types with a healthy diet. Other types can be treated with
dietary supplements.
However, certain types of anemia can be severe, long lasting, and even life
threatening if not diagnosed and treated.
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If you have signs or symptoms of anemia, see your doctor to find out
whether you have the condition. Treatment will depend on the cause of the
anemia and how severe it is.

2. Leukemia
Leukemia is cancer of the blood cells. It starts in the bone marrow, the soft
tissue inside most bones. Bone marrow is where blood cells are made.
a. White blood cells help your body fight infection.
b. Red blood cells carry oxygen to all parts of your body.
c. Platelets help your blood clot.
When you have leukemia, the bone marrow starts to make a lot of abnormal
white blood cells, called leukemia cells. They don't do the work of normal white
blood cells. They grow faster than normal cells, and they don't stop growing when
they should.
Over time, leukemia cells can crowd out the normal blood cells. This can lead
to serious problems such as anemia, bleeding, and infections. Leukemia cells can
also spread to the lymph nodes or other organs and cause swelling or pain.
There are several different types of leukemia. In general, leukemia is grouped
by how fast it gets worse and what kind of white blood cell it affects.
a. It may be acute or chronic. Acute leukemia gets worse very fast and may make
you feel sick right away. Chronic leukemia gets worse slowly and may not
cause symptoms for years.
b. It may be lymphocytic or myelogenous. Lymphocytic (or lymphoblastic)
leukemia affects white blood cells called lymphocytes. Myelogenous leukemia
affects the other type of cells that normally become granulocytes, red blood
cells, or platelets.

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The four main types of leukemia are:

a. Acute lymphoblastic leukemia, or ALL.
b. Acute myelogenous leukemia, or AML.
c. Chronic lymphocytic leukemia, or CLL.
d. Chronic myelogenous leukemia, or CML.
There are less common leukemias, such as hairy cell leukemia. There are also
subtypes of leukemia, such as acute promyelocytic leukemia (a subtype of AML).
Experts don't know what causes leukemia. Some things may increase your
risk, such as being exposed to large amounts of radiation and being exposed to
certain chemicals at work, such as benzene.
Symptoms may depend on what type of leukemia you have, but common
symptoms include:
a. A new lump or swollen gland in your neck, under your arm, or in your groin.
b. Frequent nosebleeds, bleeding from the gums or rectum, more frequent
bruising, or very heavy menstrual bleeding.
c. Frequent fevers.
d. Night sweats.
e. Bone pain.
f. Unexplained appetite loss or recent weight loss.
g. Feeling tired a lot without a known reason.
h. Swelling and pain on the left side of the belly.
3. Hemophilia

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Hemophilia is an inherited bleeding disorder in which a person lacks or has

low levels of certain proteins called clotting factors, and as a result the blood does
not clot properly. There are 13 types of clotting factors, and these work with
platelets (small blood cells that form in bone marrow) to help the blood clot.
According to the World Federation of Hemophilia (WFH), about 1 in 10,000
people are born with this disease
There are three forms of hemophilia: hemophilia A, hemophilia B, and
hemophilia C.
a. Hemophilia A is the most common type of hemophilia, and is caused by a
deficiency in clotting factor VIII. According to the National Heart, Lung, and
Blood Institute (NHLBI), nine out of 10 people with hemophilia have
hemophilia A
b. Hemophilia B (also called Christmas disease) is caused by a deficiency of
clotting factor IX.
c. Hemophilia C is a mild form of the disease that is caused by a deficiency of
Factor XI blood clotting factor. People with this rare type of hemophilia often
do not experience spontaneous bleeding; hemorrhaging typically occurs after
trauma or surgery.
Preventing Hemophilia
Hemophilia is passed from a mother to her child. When you are
pregnant, there is no way of knowing whether your baby has the condition.
However, if the eggs are fertilized in a clinic (in-vitro fertilization), they can
be tested for the condition. Then, only the eggs without hemophilia are
implanted.

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CHAPTER III
CONCLUSION

Hematology

is

the

study

of

blood

and

blood-forming

tissues.

Blood is an essential part of the transport system. Blood is a liquid

tissue

that

consists

of

two

major

parts

of

blood

plasma

and

part korpuskuli. In another sense hematology also known as a branch

of

medical

science

concerning

blood

cells,

blood-forming

organs

and

disorders associated with cell and blood-forming organs.

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REFERENCES

Smeltzer, Suzanne C, etal. Brunner and Suddarths Texbook of Medical Surgical Nursing.
2007. USA : J.B Lippincott Company.
https://en.wikipedia.org/wiki/Blood_plasma
http://haunurses.blogspot.co.id/2007/07/hematologic-system.html

http://haunurses.blogspot.co.id/2007/07/hematologic-system.html
http://www.health24.com/Lifestyle/Your-Blood/Anaemia-20130216-2
http://www.nhlbi.nih.gov/health/health-topics/topics/anemia/
http://www.webmd.com/cancer/tc/leukemia-topic-overview

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