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''Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells.^[1] Blood in the circulatory system is also known as peripheral blood, and the blood cells it carries, peripheral blood cells.^[2]

Blood is composed of blood cells suspended in blood plasma. Plasma, which constitutes 55% of blood fluid, is mostly water (92% by volume),^[3] and contains proteins, glucose, mineral ions, hormones, carbon dioxide (plasma being the main medium for excretory product transportation), and blood cells themselves. Albumin is the main protein in plasma, and it functions to regulate the colloidal osmotic pressure of blood.^{[citation needed]} The blood cells are mainly red blood cells (also called RBCs or erythrocytes), white blood cells (also called WBCs or leukocytes) and platelets (also called thrombocytes).^[4] The most abundant cells in vertebrate blood are red blood cells.^[5] These contain hemoglobin, an iron-containing protein, which facilitates oxygen transport by reversibly binding to this respiratory gas thereby increasing its solubility in blood.^[6] In contrast, carbon dioxide is mostly transported extracellularly as bicarbonate ion transported in plasma.

Vertebrate blood is bright red when its hemoglobin is oxygenated and dark red when it is deoxygenated.^[7]

Some animals, such as crustaceans and mollusks, use hemocyanin to carry oxygen, instead of hemoglobin.^[8] Insects and some mollusks use a fluid called hemolymph instead of blood, the difference being that hemolymph is not contained in a closed circulatory system. In most insects, this "blood" does not contain oxygen-carrying molecules such as hemoglobin because their bodies are small enough for their tracheal system to suffice for supplying oxygen.

Jawed vertebrates have an adaptive immune system, based largely on white blood cells. White blood cells help to resist infections and parasites. Platelets are important in the clotting of blood. Arthropods, using hemolymph, have hemocytes as part of their immune system.

Blood is circulated around the body through blood vessels by the pumping action of the heart. In animals with lungs, arterial blood carries oxygen from inhaled air to the tissues of the body, and venous blood carries carbon dioxide, a waste product of metabolism produced by cells, from the tissues to the lungs to be exhaled.

Medical terms related to blood often begin with hemo- or hemato- (also spelled haemo- and haemato-) from the Greek word αἷμα (haima) for "blood". In terms of anatomy and histology, blood is considered a specialized form of connective tissue,^[9] given its origin in the bones and the presence of potential molecular fibers in the form of fibrinogen.^{[citation needed]}

General medical

• Disorders of volume
  • Injury can cause blood loss through bleeding.^[41] A healthy adult can lose almost 20% of blood volume (1 L) before the first symptom, restlessness, begins, and 40% of volume (2 L) before shock sets in. Thrombocytes are important for blood coagulation and the formation of blood clots, which can stop bleeding. Trauma to the internal organs or bones can cause internal bleeding, which can sometimes be severe.
  • Dehydration can reduce the blood volume by reducing the water content of the blood. This would rarely result in shock (apart from the very severe cases) but may result in orthostatic hypotension and fainting.
• Disorders of circulation
  • Shock is the ineffective perfusion of tissues, and can be caused by a variety of conditions including blood loss, infection, poor cardiac output.
  • Atherosclerosis reduces the flow of blood through arteries, because atheroma lines arteries and narrows them. Atheroma tends to increase with age, and its progression can be compounded by many causes including smoking, high blood pressure, excess circulating lipids (hyperlipidemia), and diabetes mellitus.
  • Coagulation can form a thrombosis, which can obstruct vessels.
  • Problems with blood composition, the pumping action of the heart, or narrowing of blood vessels can have many consequences including hypoxia (lack of oxygen) of the tissues supplied. The term ischemia refers to tissue that is inadequately perfused with blood, and infarction refers to tissue death (necrosis), which can occur when the blood supply has been blocked (or is very inadequate).

Hematological

• Anemia
  • Insufficient red cell mass (anemia) can be the result of bleeding, blood disorders like thalassemia, or nutritional deficiencies, and may require one or more blood transfusions. Anemia can also be due to a genetic disorder in which the red blood cells do not function effectively. Anemia can be confirmed by a blood test if the hemoglobin value is less than 13.5 gm/dl in men or less than 12.0 gm/dl in women.^[42] Several countries have blood banks to fill the demand for transfusable blood. A person receiving a blood transfusion must have a blood type compatible with that of the donor.
  • Sickle-cell anemia
• Disorders of cell proliferation
  • Leukemia is a group of cancers of the blood-forming tissues and cells.
  • Non-cancerous overproduction of red cells (polycythemia vera) or platelets (essential thrombocytosis) may be premalignant.
  • Myelodysplastic syndromes involve ineffective production of one or more cell lines.
• Disorders of coagulation
  • Hemophilia is a genetic illness that causes dysfunction in one of the blood's clotting mechanisms. This can allow otherwise inconsequential wounds to be life-threatening, but more commonly results in hemarthrosis, or bleeding into joint spaces, which can be crippling.
  • Ineffective or insufficient platelets can also result in coagulopathy (bleeding disorders).
  • Hypercoagulable state (thrombophilia) results from defects in regulation of platelet or clotting factor function, and can cause thrombosis.
• Infectious disorders of blood
  • Blood is an important vector of infection. HIV, the virus that causes AIDS, is transmitted through contact with blood, semen or other body secretions of an infected person. Hepatitis B and C are transmitted primarily through blood contact. Owing to blood-borne infections, bloodstained objects are treated as a biohazard.
  • Bacterial infection of the blood is bacteremia or sepsis. Viral Infection is viremia. Malaria and trypanosomiasis are blood-borne parasitic infections.

Carbon monoxide poisoning

Substances other than oxygen can bind to hemoglobin; in some cases, this can cause irreversible damage to the body. Carbon monoxide, for example, is extremely dangerous when carried to the blood via the lungs by inhalation, because carbon monoxide irreversibly binds to hemoglobin to form carboxyhemoglobin, so that less hemoglobin is free to bind oxygen, and fewer oxygen molecules can be transported throughout the blood. This can cause suffocation insidiously. A fire burning in an enclosed room with poor ventilation presents a very dangerous hazard, since it can create a build-up of carbon monoxide in the air. Some carbon monoxide binds to hemoglobin when smoking tobacco.

Carbon monoxide poisoning typically occurs from breathing in carbon monoxide (CO) at excessive levels.^[3] Symptoms are often described as "flu-like" and commonly include headache, dizziness, weakness, vomiting, chest pain, and confusion.^[1] Large exposures can result in loss of consciousness, arrhythmias, seizures, or death.^[1][2] The classically described "cherry red skin" rarely occurs.^[2] Long-term complications may include chronic fatigue, trouble with memory, and movement problems.^[5]

CO is a colorless and odorless gas which is initially non-irritating.^[5] It is produced during incomplete burning of organic matter.^[5] This can occur from motor vehicles, heaters, or cooking equipment that run on carbon-based fuels.^[1] Carbon monoxide primarily causes adverse effects by combining with hemoglobin to form carboxyhemoglobin (HbCO) preventing the blood from carrying oxygen and expelling carbon dioxide as carbaminohemoglobin.^[5] Additionally, many other hemoproteins such as myoglobin, Cytochrome P450, and mitochondrial cytochrome oxidase are affected, along with other metallic and non-metallic cellular targets.^[2][6]

Diagnosis is typically based on a HbCO level of more than 3% among nonsmokers and more than 10% among smokers.^[2] The biological threshold for carboxyhemoglobin tolerance is typically accepted to be 15% COHb, meaning toxicity is consistently observed at levels in excess of this concentration.^[7] The FDA has previously set a threshold of 14% COHb in certain clinical trials evaluating the therapeutic potential of carbon monoxide.^[8] In general, 30% COHb is considered severe carbon monoxide poisoning.^[9] The highest reported non-fatal carboxyhemoglobin level was 73% COHb.^[9]

Efforts to prevent poisoning include carbon monoxide detectors, proper venting of gas appliances, keeping chimneys clean, and keeping exhaust systems of vehicles in good repair.^[1] Treatment of poisoning generally consists of giving 100% oxygen along with supportive care.^[2][5] This should generally be carried out until symptoms are no longer present and the HbCO level is less than 3%/10%.^[2]

Carbon monoxide poisoning is relatively common, resulting in more than 20,000 emergency room visits a year in the United States.^[1][10] It is the most common type of fatal poisoning in many countries.^[11] In the United States, non-fire related cases result in more than 400 deaths a year.^[1] Poisonings occur more often in the winter, particularly from the use of portable generators during power outages.^[2][12] The toxic effects of CO have been known since ancient history.^[13][9] The discovery that hemoglobin is affected by CO emerged with an investigation by James Watt and Thomas Beddoes into the therapeutic potential of hydrocarbonate in 1793, and later confirmed by Claude Bernard between 1846 and 1857''.^[9]

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