Hematology

Hematology
Red Blood Cells

RBCs
Presented by:
Yosri Al- fatih

Blood
Blood
is a type of connective tissues.
 It consist of :
A. Cells.
B. Intracellular substance (plasma).
 The cells are:
1. Red blood cells (RBCs) or erythrocytes.
2. White blood cells (WBCs) or leukocytes.
3. Platelets (Plts) or thrombocytes.
Volume of blood is about 5 litres in an
average adult male. ???
Volume of plasma is about 3.5 L
The Packed Cell
Volume
The cells in the blood can be
separated by centrifugation.
The percentage of cells in blood is
called the packed cell volume (PCV)
or the hematocrit.
Most of these cells are RBCs.
 Normal values = 40-45% in males
and 37-47% in females.
Low PCV indicate Anemia.
High PCV indicates Polycythemia.
Functions of blood
1. Transport of :
Gases (e.g. oxygen & carbon dioxide).
Nutrients (e.g. glucose, amino acids & free
fatty acids ).
Waste products (e.g. urea & uric acid).
Hormones (e.g. insulin & cortisol).
2. Defense by WBCs.
3. Homeostasis: maintains constant
internal environment.
4. Hemostasis: prevention of blood
loss & maintenance of blood in fluid
state.
Sites of hematopoiesis
The sites during pregnancy:
1. First trimester: yolk sac.
2. Second trimester: liver & spleen.
3. Third trimester: red bone marrow.
The sites after delivery:
1. Red bone marrow of all bones at first.
2. Then the active red bone marrow
becomes gradually replaced by
inactive yellow marrow.
At about age of 20y the red marrow
is confined to:
1. The flat bones (skull, scapula, ribs,
sternum, vertebrae & iliac bone ).
2. The end of long bones.
3. Small bones of the hand & feet.
The Red Blood Cells
 Characteristics of RBCs:-
Shape: biconcave disks. ???
Diameter: 7.5 microns.
Thickness: 1-2 microns.
Content: no nucleus & no organelles.
Each cell contains hemoglobin (a red
pigment for transport of O2)
RBCs count: 5 million/mm3 in males &
4.5 million/mm3 in females.
Functions of RBCs
1. Transport oxygen.
2. Transport carbon
dioxide.
3. Contains buffers to
control pH.
Stages of
Erythropoiesis
 Stages in the red bone marrow:-
1. Pluri-potent stem cells (can form
any type of cell).
2. Committed stem cells (can form
one type of cell e.g. RBC).
3. Pro-erythro-blasts.
4. Normo-blasts.
 Stages in the blood:-
1. Reticulocytes:
 The first form that enters the blood
from the bone marrow.
 Constitute about 1% of total RBCs.
2. Erythrocytes (the mature cells).

Haemopoiesis
Control of erythropoiesis
 Normal erythropoiesis requires:
1. Normal bone marrow.
2. Certain cytokines & growth factors.
3. Certain hormones (erythropoietin).
4. Certain nutrients (like iron, folic acid
& vitamin B12).
Erythropoietin
Produced by the kidneys.
Stimulated by hypoxia.
Stimulates replication of stem cells &
formation of erythroblasts.
 Excess erythropoietin e.g. in high altitude
or chronic respiratory diseases causes
polycythemia.
 Deficiency of erythropoietin e.g. in chronic
renal failure causes anemia (normocytic
normochromic anemia).
Used for treatment of anemia of chronic
renal failure.
Nutrient for erythropoiesis
 Amino acids:-
For formation of globin in
hemoglobin.
Found in animal or plant origin food.
Absorbed in the small intestine.
 Iron:-
For formation of heme in hemoglobin.
Found in animal or plant origin food.
Absorbed in the duodenum.
 Vitamin B12:-
For DNA synthesis (cell division).
Found in food of animal origin.
Absorbed in the terminal ileum.
 Folic acid:-
For DNA synthesis (cell division).
Found in food of plant origin.
Absorbed in the jejunum.
Hemoglobin
The red pigment within the RBCs.
Its concentration in the blood:
14-16 g/dl in adult males.
13-15 g/dl in adult females.
18-20 g/dl in neonates.
Structure of Hb
Consist of 4 subunits.
Each subunit consist of (heme + a poly peptide
chain).
Each heme contains iron in reduced state (ferrous or
Fe2+).
The 4 polypeptide chains are known as globin.
Function of Hb
Carries 98% of oxygen in the blood.
Carries some carbon dioxide.
Normal types of Hb
 Hb A:-
Adult Hb = 98% of all Hb in adults.
The 4 polypeptide chains are 2 alpha
& 2 beta chains (α2β2).
 Hb A2:-
Adult Hb = 2.5 % of all Hb in adults.
The 4 polypeptide chains are 2 alpha
& 2delta chains (α2δ2).
 Hb F :-
Fetal Hb
Replaced by Hb A 6 monthes after
birth.
The 4 polypeptide chains are 2 alpha &
2 gamma chains (α2γ2).
 Hb A1c:-
Subtype of Hb A, can bind glucose.
Normally = 5% of total Hb.
Its excess indicates poor control of
diabetes mellitus.
Abnormal types of Hb
 Hb S :-
Sickle cell Hb.
It is a Hb A but the amino acid number 6 in beta
chain (glutamic acid) is replaced by (valine).
This abnormal Hb precipitate in cases of
hypoxia, changing the shape of RBCs to a sickle
shape.
 Complication of Hb S:
Hemolytic anemia.
Jaundice.
Obstruction of small capillaries = atrophy of
organs.
Anemia
The definition :-
Stateof reduction in Hb concentration
below the normal range.
The symptoms :-
1. Headache.
2. Weakness & fatiguability.
3. Palpitation.
4. Pallor in the skin & mucous
membranes.
Classification of anemia
1. Decreased production :
A. Bone marrow diseases e.g. tumors.
B. Lack of nutrients e.g. iron deficiency
anemia, vitamin B12 deficiency
anemia & folic acid deficiency
anemia.
C. Lack of erythropoietin as in chronic
renal failure.
2. Increased destruction :
Abnormal RBC shape as in sickle cell
anemia or congenital spherocytosis.
Lack of RBC enzymes like glucose 6
phosphate dehydrogenase.
Mechanical destruction of RBCs as in
malaria.
3. Blood loss :
Acute blood loss e.g. following trauma.
Chronic blood loss e.g. due to chronic
peptic ulcer.
Diagnosis of anemia :
Low Hb.
Low PCV.
Treatment of anemia :
Treatment of the cause e.g.
correction of the deficient nutrient.
Blood transfusion if Hb is very low.

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Red Blood Cells

Yosri Al- fatih

2. Erythrocytes (the mature cells).

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