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Physiology OSPE — Blood Chapter
1st Semester DPT | UHS Pattern
📌 IMPORTANT TOPICS FOR OSPE (Practical Stations)
1. Red Blood Cells (RBCs / Erythrocytes)
| Feature | Normal Value |
|---|---|
| RBC count (men) | 5.2 million/mm³ (±300,000) |
| RBC count (women) | 4.7 million/mm³ (±300,000) |
| Shape | Biconcave disc |
| Diameter | ~7.8 µm |
| Thickness | 2.5 µm at edges; ~1 µm at center |
| Volume | 90–95 cubic µm |
OSPE Station Tip: You may be shown a blood film slide or diagram — identify RBC morphology (biconcave disc), compare with abnormal shapes (sickle cells, spherocytes).
2. Hemoglobin
| Parameter | Men | Women |
|---|---|---|
| Hb concentration | 15 g/100 mL | 14 g/100 mL |
| Max Hb per cell | 34 g/100 mL cells | — |
| O₂ carrying capacity | ~20 mL O₂/100 mL blood | ~19 mL O₂/100 mL blood |
| O₂ per gram Hb | 1.34 mL O₂/g Hb | — |
Types of Hemoglobin:
- HbA (adult): α₂β₂ — predominant
- HbA₂: α₂δ₂ — minor adult form
- HbF (fetal): α₂γ₂ — higher O₂ affinity (left shift of O₂ dissociation curve)
- Abnormal: HbS (sickle cell), HbC, MetHb, COHb
Functions of Hemoglobin:
- O₂ transport (primary)
- CO₂ transport (as carbaminohemoglobin)
- Acid-base buffering
- CO₂ → HCO₃⁻ transport (via carbonic anhydrase in RBCs)
3. Hematocrit (Packed Cell Volume / PCV)
| Value | Range |
|---|---|
| Men | 40–45% |
| Women | 36–42% |
OSPE Practical: You may be asked to read a hematocrit tube or calculate it. Increased in polycythemia and dehydration; decreased in anemia.
Hematocrit ↑ → Viscosity ↑ → Resistance ↑ → Cardiac workload ↑
4. Erythropoiesis (RBC Production)
Sites by developmental stage:
- Embryo → Yolk sac (early weeks)
- Middle trimester → Liver (main site)
- Late fetal/postnatal → Bone marrow (red marrow: vertebrae, ribs, sternum, pelvis, proximal long bones)
Maturation sequence:
Proerythroblast → Basophilic erythroblast → Polychromatophilic erythroblast → Orthochromatic erythroblast → Reticulocyte → Mature RBC
Key regulatory factor: Erythropoietin (EPO)
- Produced by the kidney (90%) and liver (10%)
- Stimulus: Tissue hypoxia
- Action: Stimulates bone marrow to produce RBCs
- Clinical: Used in anemia of chronic kidney disease
Requirements for RBC production:
- Iron (Hb synthesis)
- Vitamin B₁₂ and Folic acid (DNA synthesis / nuclear maturation)
- Vitamin C, B₆, copper (cofactors)
- Erythropoietin
5. RBC Destruction & Life Span
- Normal RBC life span: 120 days
- Destruction site: Spleen (mainly), liver, bone marrow
- Mechanism: Phagocytosis by macrophages (reticuloendothelial system)
- Hemoglobin breakdown:
- Globin → amino acids (recycled)
- Heme → Fe³⁺ (stored as ferritin/hemosiderin, reused) + biliverdin → bilirubin → excreted via bile
6. ABO Blood Group System (Most Common OSPE Topic)
| Blood Type | Antigen on RBC | Antibody in Plasma | Can Donate To | Can Receive From |
|---|---|---|---|---|
| A | A | Anti-B | A, AB | A, O |
| B | B | Anti-A | B, AB | B, O |
| AB | A & B | None | AB only | All (Universal Recipient) |
| O | None | Anti-A & Anti-B | All (Universal Donor) | O only |
OSPE Practical — Blood Typing:
- Separate RBCs from plasma → dilute with saline
- Mix one portion with Anti-A serum (blue)
- Mix another portion with Anti-B serum (yellow)
- Observe agglutination under microscope
Agglutination = positive reaction
| RBC Type | Anti-A | Anti-B |
|---|---|---|
| O | − | − |
| A | + | − |
| B | − | + |
| AB | + | + |
7. Rh Blood Group System
- Six common antigens: C, D, E, c, d, e
- D antigen is most antigenic and clinically important
- Rh positive = has D antigen (~85% of Whites; ~95% of Black Americans; >95% Asians)
- Rh negative = lacks D antigen
Clinical Importance:
- Erythroblastosis Fetalis (Hemolytic Disease of the Newborn):
- Rh⁻ mother + Rh⁺ father → Rh⁺ fetus
- First pregnancy: sensitization (small fetal blood enters mother → IgG anti-D formed)
- Second pregnancy: maternal IgG anti-D crosses placenta → destroys fetal RBCs
- Prevention: Anti-D immunoglobulin (RhoGAM) given to Rh⁻ mother at 28 weeks and within 72 hrs of delivery
OSPE Viva Q: Why is the first baby usually unaffected?
→ First exposure causes primary immune response (IgM, slow) — not enough IgG crosses placenta. Second exposure causes rapid secondary response (IgG).
8. White Blood Cells (Leukocytes)
Normal WBC count: 4,000–11,000/mm³
Differential Count (Important for OSPE):
| Cell | % | Function |
|---|---|---|
| Neutrophils | 60–70% | Phagocytosis (first responders in bacterial infection) |
| Eosinophils | 2–4% | Allergy, parasitic infections |
| Basophils | 0.5–1% | Allergy (histamine, heparin release) |
| Monocytes | 3–8% | Phagocytosis (tissue macrophages) |
| Lymphocytes | 20–30% | Immunity (B cells → antibodies; T cells → cell-mediated) |
Mnemonic: Never Let Monkeys Eat Bananas (Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils)
9. Platelets (Thrombocytes)
- Normal count: 150,000–400,000/mm³
- Life span: 7–10 days
- Produced from: Megakaryocytes in bone marrow
- Regulator: Thrombopoietin (from liver & kidney)
Functions:
- Platelet plug formation (primary hemostasis)
- Provide phospholipid surface for coagulation cascade
- Release clotting factors, growth factors, vasoactive substances
10. Hemostasis & Coagulation
Three stages:
- Vascular spasm — immediate vasoconstriction
- Platelet plug — platelets adhere to exposed collagen (via vWF), activate, aggregate
- Coagulation cascade — fibrin clot formation
Two pathways:
- Extrinsic pathway → Tissue Factor (Factor III) → Factor VII → X
- Intrinsic pathway → XII → XI → IX → VIII → X
- Common pathway → Xa + Va (Prothrombinase complex) → Prothrombin → Thrombin → Fibrinogen → Fibrin
Important coagulation tests:
| Test | Pathway Tested | Normal Value |
|---|---|---|
| PT (Prothrombin Time) | Extrinsic + Common | 11–15 seconds |
| aPTT | Intrinsic + Common | 25–35 seconds |
| Bleeding time | Platelet plug | 1–6 minutes |
| Clotting time | Intrinsic pathway | 2–8 minutes (Lee-White method) |
11. ESR (Erythrocyte Sedimentation Rate)
- Westergren method: Men ≤ 15 mm/hr; Women ≤ 20 mm/hr
- ↑ ESR: Infections, inflammation, malignancy, pregnancy, anemia
- ↓ ESR: Polycythemia, sickle cell disease, severe dehydration
12. Plasma & Plasma Proteins
- Plasma = 55% of blood volume
- Proteins: Albumin (most abundant, osmotic pressure), Globulins (immunity), Fibrinogen (clotting)
- Normal plasma protein: 6–8 g/dL
🔬 IMPORTANT PRACTICALS (OSPE Stations)
| Practical | What to Know |
|---|---|
| Blood film preparation | Procedure: thin smear, stain with Leishman's/Giemsa stain |
| Differential leukocyte count (DLC) | Count 100 WBCs, identify each type under oil immersion |
| Hemoglobin estimation | Sahli's hemoglobinometer (acid hematin method): compare color with standard |
| Hematocrit (PCV) | Microhematocrit centrifuge, read packed cells %, calculate |
| Blood typing (ABO & Rh) | Tile/slide method with antisera, observe agglutination |
| ESR measurement | Westergren method: blood in anticoagulant tube, read after 1 hour |
| Bleeding time | Duke's method (ear lobe/finger): normal 1–6 min |
| Clotting time | Capillary tube method / Lee-White method: normal 2–8 min |
| Total RBC count | Haemocytometer (Neubauer chamber), dilute 1:200 with Hayem's fluid |
| Total WBC count | Haemocytometer, dilute 1:20 with Turk's fluid (glacial acetic acid + gentian violet) |
🎤 VIVA QUESTIONS (Most Asked)
RBCs & Hemoglobin:
- What is the shape and size of a normal RBC? Why is biconcave shape important?
- What is hematocrit? Normal values?
- Define anemia and polycythemia.
- What is erythropoietin? Where is it produced? What stimulates its release?
- What is the life span of RBC? Where are they destroyed?
Blood Groups:
6. What are agglutinogens and agglutinins? Differentiate.
7. Who is the universal donor? Universal recipient? Why?
8. What is erythroblastosis fetalis? How is it prevented?
9. Why is cross-matching essential before blood transfusion?
10. What is the difference between ABO and Rh blood group systems?
Coagulation & Hemostasis:
11. What is the difference between bleeding time and clotting time?
12. Name the stages of hemostasis.
13. What is the role of Vitamin K in coagulation?
14. What is fibrinolysis? What is the role of plasmin?
15. Differentiate intrinsic and extrinsic pathways.
WBCs & Immunity:
16. What is the differential leukocyte count?
17. What is the function of eosinophils vs. neutrophils?
18. What is leukocytosis? Leukopenia?
ESR:
19. What factors increase ESR? What is its clinical significance?
20. What is Rouleaux formation and how does it affect ESR?
⭐ High-Priority Topics Summary for UHS DPT OSPE
| Priority | Topic |
|---|---|
| ★★★ | ABO & Rh blood typing (theory + practical) |
| ★★★ | Hemoglobin estimation (Sahli's method) |
| ★★★ | DLC — differential count on blood film |
| ★★★ | Hematocrit / PCV |
| ★★★ | Erythroblastosis fetalis |
| ★★ | Erythropoiesis stages and regulation (EPO) |
| ★★ | Coagulation cascade (PT, aPTT, bleeding time) |
| ★★ | ESR — Westergren method, clinical significance |
| ★★ | WBC count and functions |
| ★ | Plasma proteins |
| ★ | Platelet physiology |
Reference: Guyton and Hall Textbook of Medical Physiology (14th Ed.), Chapters 33–36 — covering RBCs, WBCs, resistance/immunity, blood types, and hemostasis. These chapters are the standard for DPT 1st semester UHS curriculum.
Study tip for OSPE: Focus especially on normal lab values (memorize them), procedure steps for each practical, and clinical applications (what happens when values are abnormal). Examiners frequently ask you to interpret a given hematocrit tube reading or identify agglutination on a blood typing tile.
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Blood Physiology DPT Study Guide
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What's inside the PDF (8 sections):
| Section | Content |
|---|---|
| Cover + Contents | Colour-coded title page with topic index |
| 1. RBCs & Hemoglobin | Morphology table, Hb values, Hb types, functions |
| 2. Hematocrit & Normal Values | PCV table, full CBP reference ranges |
| 3. Erythropoiesis | Production sites, maturation sequence + mnemonic, EPO regulation, nutritional requirements, Hb breakdown pathway |
| 4. Blood Groups | ABO compatibility table, agglutination results, Rh system, Erythroblastosis Fetalis step-by-step |
| 5. White Blood Cells | DLC normal values, granulocytes vs agranulocytes, clinical correlations |
| 6. Platelets & Hemostasis | Platelet values, 4 stages of hemostasis, coagulation cascade, all coagulation tests |
| 7. OSPE Practical Procedures | Step-by-step: Sahli's method, PCV, DLC/blood film, blood typing, ESR (Westergren), bleeding time, RBC count, WBC count |
| 8. Viva Questions Bank | 50+ exam-style viva questions across all topics |
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