Blood Health Article

Platelets

Platelets are not cells; they are fragments of cells that function in blood clotting. Platelets number about 250,000 to 400,000 per liter of blood. Blood clotting is a complex process that involves a cascade of reactions that leads to the formation of a blood clot. Platelets contain chemicals called clotting factors. These clotting factors first combine with a protein called prothrombin. This reaction converts prothrombin to thrombin. Thrombin, in turn, converts fibrinogen (present in plasma) to fibrin. Fibrin is a thread-like protein that traps red blood cells as they leak out of a cut in the skin. As the clot hardens, it forms a seal over the cut.

This process works for relatively small cuts in the skin. When a cut is large, or if an artery is severed, blood loss is so severe that the physical pressure of the blood leaving the body prevents clots from forming. In addition, in the inherited disorder called hemophilia, one or more clotting factors are lacking in the platelets. This disorder causes severe bleeding from even the most minor cuts and bruises.

Platelets have a short life span; they survive for only five to nine days before being replaced. Platelets are produced in red bone marrow and are broken off from other red blood cells.

Blood substitutes

Researchers hope to create synthetic blood substitutes to ease the burden of dwindling blood donations that are needed to meet the demand for surgeries, transfusions, and emergencies. Currently under development are blood substitutes that use perfluorocarbons or modified hemoglobin to carry oxygen to tissues.

Perfluorocarbons are long, fatty hydrocarbon chains containing fluorine that have the ability to pick up oxygen in lungs and release it into tissues. The artificial blood is a mixture of perfluorocarbons with saline (physiological salt water) using surfactants, substances that allow the mixing of oil and water. The solution then can be administered to patients. Over time, as the artificial blood helps deliver oxygen to tissues, the perflourocarbon molecules are exhaled from the body.

Hemoglobin solutions contain hemoglobin that has been isolated from red blood cells and chemically altered to increase its lifespan in the bloodstream and to ensure adequate oxygen-carrying capabilities.

Strictly, these substances are not whole blood substitutes since they only have the ability to carry oxygen and cannot replace the other important functions of blood. However, they would be valuable in eliminating the risk of transmitting disease during transfusions as well as preventing accidental blood type mismatches.

ABO BLOOD GROUPS. An interesting aspect of red blood cells is that they carry certain proteins, called antigens, on their plasma membranes. These antigens are responsible for the various blood groups known as A, B, AB, and O:

• A person with A antigens is type A and has antibodies to B antigens.
• A person with B antigens is type B and has antibodies to A antigens.
• A person with both antigens is type AB and does not have antibodies to either antigen.
• A person with none of the antigens is type O and has antibodies to both A and B antigens.

These combinations are necessary to know when performing a blood transfusion. For instance, if a type A individual donates blood to a type B individual, the A antibodies in the recipient's B blood will react with the A antigens of the donor's A blood. This reaction, called the agglutination reaction, causes the blood cells to clump together. Agglutination can be fatal. Until blood typing was worked out early in this century, many deaths from blood transfusions occurred due to incompatibility of antigens and antibodies.

HLA ANTIGEN GROUPS. Like red blood cells, the plasma membranes of white blood cells also contain antigens. These surface antigens are called the human leukocyte associated (HLA) antigens. Like the red blood cell types, these HLA antigens represent different white blood cell "groups." When a person receives an organ transplanted from a donor, the recipient and the donor must have the same HLA antigen group for the transplant to be successful. If the donor and recipient are two different HLA antigen groups, the recipient's body will "reject" the organ; in other words, the recipient's immune system will be activated by the foreign cells of the organ and initiate an immune response against the organ.