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ERYTHROPOIESIS

Dr. Ni Kadek Mulyantari, Sp.PK(K)


(Department of Clinical Pathology Medical Faculty Udayana
University/Sanglah General Hospital Denpasar)

HEMATOPOIESIS
Hematopoiesis merupakan proses pembuatan sel
darah
Berasal dari bahasa yunani haima (darah) dan poiein
(membuat). Rata rata untuk dewasa, sum-sum
tulang ~5x1011 sel per hari.
Sel dari darah dibagi menjadi erythrocytes (red blood
cells), leukocytes (white blood cells) berbagai macam,
dan platelets.
Erythrocytes : Erythropoiesis
Leukocytes : Leukopoiesis
Thrombocyte : Thrombopoiesis
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THE LOCATION OF
HEMATOPOIESIS
Hematopoiesis dimulai di yolk sac saat bulan
pertama dari embryogenesis tapi secara
perlahan berpindah ke hati dan, dengan jumlah
lebih sedikit, limfa.
Hati merupakan tempat hematopoiesis saat
trimester kedua.
Sum-sum tulang menjadi tempat hemopoiesis
utama setelah bulan ketujuh.
Setelah lahir, sum-sum tulang menjadi tempat
satu-satunya hematopoiesis (intramedullary
hematopoiesis).
Hematopoiesis may resume in the liver and
spleen after birth in conditions associated with
fibrosis of the bone marrow (extramedullary

NUTRITIONAL REQUIREMENT OF
ERYTHROPOIESIS

Vitamin B12
Folic acid
Vitamin B6
Trace Metals
Iron
Other Vitamins ( Vit C, Vit A,
Vit E)
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ERYTHROPOIESIS
The earliest recognizable RBC
precursor is proerythroblast,
The last nucleated RBC precursor is
the orthochro- matophilic
erythroblast, which is
characterized by wellhemoglobinized cytoplasm; the
nucleus is then lost, producing the
reticulocyte.
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Reticulocytes are identified using


supravital stains such as new methylene
blue; BCB
they cannot be definitively identified with
routine Wright-Giemsa stains.
Reticulocytes contain ribonucleic acid
(RNA) for 4 days; normally, the first 3
days are spent in the marrow and fourth
in the blood. However,under intense
stimulation by erythropoietin,
reticulocytes may be released into the
blood early where they may contain RNA
for 2.0 to 2.5 days (shift reticulocytes).

ERITROPOESIS

The maturation of erythrocytes


follows the common pathway of
all hematologic cells
Cell size is reduce
Cytoplasmic RNA production
decrease,(in erythrocyte,
hemoglobin starts at the
polychromatic normoblast stage and
increases until the cell reaches
maturity)
The cytoplasma-to-nucleus ratio
become greater (nucleus become
smaller)
Nuclear chromatin becomes more

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Proerythroblasts
the earliest, least mature cells in the
erythrocyte forming series
(erythropoiesis).
Proerythrocytes exist in circulating
blood only under pathological
conditions (extramedullary
hematopoiesis; breakdown of the
bloodbone marrow barrier by tumor
metastases, erythroleukemia)
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Polychromatic and Orthochromatic


Erythroblasts (Normoblasts)
The results of mitosis of erythroblasts are called
normoblasts
Polychromatic and orthochromatic erythroblasts may
be released into the bloodstream whenever
hematopoiesis is activated, e.g., in the compensation
or treatment stage after hemorrhage or iron or
vitamin deficiency.
They are always present when turnover of blood cells
is chronically increased (hemolysis).
the presence of erythroblasts in the blood should
prompt consideration of two other disorders:
extramedullary production of blood cells in
myeloproliferative diseases and bone marrow
carcinosis with destruction of the bloodbone marrow
barrier.
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RETICULOCYTE
Reticulocytes mengandung
ribonucleic acid (RNA)
Normal value in peripheral blood
0,5 1,5 %
Cell size : Sedikit lebih besar
dari sel dewasa(7-9 )
Ukuran sel: Bundar
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RETICULOCYTE
Cytoplasma :fully hemoglobinized;
nucleus extruded from cell, leaving a
slightly polychromatic red cell when
by romanowsky (identified using
supravital stains such as new
methylene blue; BCB)
: Hemolytic anemia, acute
bleeding, th/ anemia

: Aplastic anemia, ACD


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ERYTHROCYTES
Cell size : 6,7-7,7
Cell shape : Round
Cytoplasm : Staining:
pink, with slightly
more intense color at
the peripheral and
lighter color in the
center
Nucleus : not present

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ERYTHROCYTES

Composition :
- 60% Air
- 28% hemoglobin :
* blood pigmen
* sarana transport O2
* 96% globin
* 4% heme
- 7% Fat
- Carbohydrat, Electrolyte, Enzyme,
Metabolite
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Ukuran Erythrocyte
1. Normal (normositer)
Aplastic anemia, acute
bleeding, hemolytic anemia
2. Micrositer Iron def
Anemia, ACD, thalasemia,
sideroblastic anemia
3. Macrositer Folic acid &
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Erythrocyte Form
Normal : biconcave
Abnormal : ovalocyte, spherocyte, stomatocyte, target
cells, ect

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Ovalocyte

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Tear drop cells

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Target cells

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Stomatocyte

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Spherocyte

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Poikilocytosis

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The Erythrocyte colors


Normal : normochromic
:pink(central palor < 1/3
erythrocyte dianmeter)
The erythrocyte color depend on
hemoglobin concentration
Hipochromic : central pallor
>1/2 erythrocyte dianmeter (low
hemoglobin level)
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