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Learning objectives:
Composition of blood.
Functions of blood.
How plasma is separated from the blood cells.
Hematocrit /PCV and its clinical significance
ESR and its clinical significance
Plasma proteins types , functions
Functions of lymph
Rouleaux formation
Westergrens
tube
Plasma
Non nucleated
Central pallor
Biconcave disc
Elastic - can squeeze through
narrow capillaries
Normal count
Diameter 6.8 8.8 m
Surface area - 140m2
ANISOCYTOSIS
Variations in size
Microcytes:
Decrease in the red cell size. Red cells are smaller than 7m in
diameter.
Found in:
Iron deficiency anemia.
Thalassaemia N
Lead poisoning.
Anemia of chronic disease
Macrocytes: Morphology:
Increase in the size of a red cell. Red cells are larger than 9m
in diameter. May be round or oval in shape.
Found in:
N
Folate and B12 deficiencies (oval)
Liver disease (round)
Reticulocytosis (round) POIKILOCYTOSIS
Variations in shape
Spherocytes
Normochromic
Hypochromic
Erythropoiesis
Definition: A process of formation of a mature RBC from its
precursor stem cells. Duration: 6-7 days
Sites of erythropoiesis:
Mesoblastic stage (first 3 months of intrauterine life )mesoderm of yolk sac(area vasculosa)
Hepatic stage: third month to fifth month of fetal life- Liver
and spleen form blood cells Myeloid stage : 5th month of IUL
onwards - bone marrow form blood forming organ In adultsBone marrow is the sole source for erythropoiesis
Bone marrow:
Types red and yellow
At birth all bone marrows are red in nature- source for
erythropoiesis
As age advances, red bone marrow replaced by yellow
bone marrow
At the age of 20,
Erythropoiesis
(Basophilic erythroblast)
(Orthochromatic
erythroblast)
The differentiation and proliferation of RBC.
Common features during erythropoiesis
Cell size change
Staining property
Accumulation of Hb
Disappearance of nucleoli and nucleus
Mitotic cell division
Reticulocyte:
Is an immature erythrocyte.
Importance
Must Not fall
To supply oxygen from lungs to tissues
Must Not rise
Blood viscosity may increase
May impede blood flow
Hormones
Tissue Oxygenation Crucial
Regulator of Erythropoiesis
High altitudes
Cardiac Failure
Lung diseases
All conditions have one common problem
Erythropoietin
Glycoprotein
Mol weight 34000
Sites of production
KIDNEYS, liver and spleen
Stimulants of Erythropoietin production
clinical features
Treatment
The lifespan of RBCs
Site of destruction
Process of destruction.
Applied aspect- jaundice.
Iron :
Daily requirement
Adult man 10mg/day
Menstruating women 20mg/day
Pregnant and lactating woman- 40 mg/day
Children - >10mg/day
menorrhagia
peptic ulcer
stomach cancer
ulcerative colitis
intestinal cancer
Haemorrhoids
DECREASED IRON INTAKE
INCREASED IRON REQUIRMENT ( PREGNANCY,
LACTATION)
Features:
Fatigue, dizziness, palpitation, dry, pale skin, spoon shaped nails
(koilonychia), hair loss pica (apetite for non food substances such as
an ice, clay)
Peripheral blood :
KOILONYCHIA
Depapillated tongue
Treatment:
Administration of ferrous(Fe++) - oral /intramuscular route
Maturation factors: vitamin B12 and folic acid :
Vitamin B12:
Daily requirement is about 1 g.
Is stored in the liver to the extent of 1000 g.
Is absorbed at the ileum part of small intestine.
Absorption in the intestine requires Intrinsic factor secreted by
the parietal cells of stomach.
Folic acid sources
Folic acid daily requirement is about 75 100 g.
Both vit.B12 and folic acid required for the formation of
thymidine triphosphate, the essential building blocks of DNA.
lack of vitamin B12 or folic acid - abnormal and diminished
DNA- failure of nuclear maturation and cell division.
The erythroblastic cells of the bone marrow -fail to
proliferate rapidly, produce larger than normal red cells
called macrocytes.
Macrocyte has a fragile membrane and is often irregular,
large, and oval instead of the usual biconcave disc.
Normal oxygen carrying capacity but short life span
Deficiency may be due to deficiency of intrinsic factor
(pernicious anemia) vitamin B12in the diet.
delayed maturation of RBC, decreased cell division
This type of anemia is called as megaloblastic anemia.
Pernicious anemia: vitamin B12 deficiency due to lack of
intrinsic factor
Changes seen in
Blood peripheral blood smear
Bone marrow
Central nervous system (CNS)
Peripheral nervous system (PNS)
Gastro intestinal tract (GIT)
a. Peripheral blood smear changes are:
Size of red blood cells will be more than normal
(macrocytes).
More hemoglobin will be present per cell mean corpuscular
hemoglobin (MCH) increases. (Normal is 28-32 pg.)
Mean corpuscular volume (MCV) is more than normal. (Normal
is 78-94 3)
The average volume of RBC occupied by hemoglobin alone is
known as mean corpuscular hemoglobin (MCHC) and normally
this will not get affected. (Normal range is 32 38 g %)
Red blood cell count will be markedly decreased.
decreased red blood cell count, along with decrease in
leucocytes and platelet count pancytopenia.
b. Bone marrow changes are:
Instead normal normoblastic type, it will be megaloblastic
type.
There will be hyperplasia(abnormal increase in number of
cells ) of bone marrow.
Red bone marrow can be observed in the shafts of long bones
even in the adult Gastro intestinal tract changes are:
No hydrochloric acid secretion in the stomach
Atrophy of gastric mucosa.
Tongue becomes more smooth and glistening.
Central nervous system changes are:
Tracts in the spinal cord are affected especially in the
lateral white matter area of spinal cord and lead to sub acute
combined degeneration of the cord (both ascending and
descending tracts are affected).
Peripheral nervous system changes are:
Degeneration of myelin sheath in the nerves leads to
numbness and tingling sensation.
Treatment:
Injection of cobalminMegaloblastic bone marrow to normal
Reticulocytosis in a week after treatment
Folic acid administration corrects the anemia due to folic
acid deficiency
Life span of RBCs 120days
Site of destruction of RBCs:
RBC Indices
RBC indices include:
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular Hemoglobin
Concentration (MCHC)
RBC Distribution Width (RDW)
MCV
Mean corpuscular volume
MCV is the volume of single RBC
MCV =
PCV in liter
RBC (millions/cubic mm)
Expressed in femtoliter (fL) or cubic microns(m3)
If 80-94 fL, normal range, RBCs considered normocytic
If < 80 fL are microcytic
If > 94 fL are macrocytic
MCH
MCH is average amount of hemoglobin in a single RBC.
MCH =
Hb x 10
RBC (millions)
Expressed in picograms(pg)
40
Anemia
Learning objectives:
Definition
Features of anemia
Classification : based on
Etiology
morphology
Based on etiology:
Hemorrhagic anemia- loss of blood
Dietary deficiency anemia- iron, vitamin B12 deficiency
Dyshemopoietic anemia- aplastic anemia
Hemolytic anemia malaria, erythroblastosis fetalis
Based on morphology :
Normocytic normochromic anemia Microcytic
hypochromic anemia Macrocytic normochromic anemia.