Red Blood Cells

RBC are the most abundant cells of

the blood necessary for the delivery
of oxygen to the tissues.
Major function is to transport
hemoglobin which in turn carries
oxygen from the lungs into the
tissues.

Differentiation of RBC

Red Cell Production

yolk sac of the embryo
few weeks
liver, spleen, lymph node
middle trimester
bone marrow of skull, vertebrae,
ribs, sternum
later part of pregnancy

RBC production
5 years old
all bones
After 20 years old
proximal portions of humeri
and tibiae; marrow of long bones
becomes fatty and produce no RBC

RBC Production
21 and above
marrow of membranous
bones: vertebrae, sternum, ribs and
ilia

Red Blood Cell Destruction

Life span
120 days
Destruction
2.5M/sec
1% of red cells/day
Spleen

 Anemia is a medical condition in which the

red blood cell count or hemoglobin is less
than normal
Men-less than 13.5 gram/100 ml
Women-less than 12.0 gram/100 ml.

Most common type of

anemia

Blood Loss
Haemolytic
Megaloblastic
Aplastic

Blood loss anemia

Anemia from excessive bleeding
results when loss of red blood cells
through bleeding exceeds production
of new red blood cells.
When blood loss is rapid, blood
pressure falls, and people may be
dizzy.
Most common cause of anemia

Blood loss anemia

2 types
Acute blood loss
Chronic blood loss

Acute (sudden) blood loss anemia

May be from internal bleeding
external bleeding can produce anemia
in an amazingly short span of time.
in cases of acute hemorrhage, the
initial hematocrit or hemoglobin values
may be normal and, hence, misleading
until intravascular equilibration occurs
and diminished RBC numbers become
apparent.

Chronic Blood Loss

Far more common than a sudden loss
of blood is long-term (chronic) bleeding
which may occur from various parts of
the body
Although large amounts of bleeding,
such as that from nosebleeds and
hemorrhoids are obvious, small
amounts of bleeding may not be
noticed.

 For example, a small amount of

blood may not be visible in the stool.
This type of blood loss is described
as occult.
If a small amount of bleeding
continues for a long time, a
significant amount of blood may be
lost.

Symptoms of Acute Blood

Loss
could result in severe symptoms and
consequences if not addressed promptly.
Dizziness
Lightheadedness
Fatigue
Confusion
Shortness of breath
loss of consciousness can occur with
severe, sudden blood loss anemia

Symptoms of Chronic blood

loss
Change in stool color, including black and tarry
stools (sticky and foul smelling), maroon-colored,
or visibly bloody stools if the anemia is due to
blood loss through the gastrointestinal tract;
rapid heart rate
Low blood pressure
rapid breathing
pale or cold skin
enlargement of the spleen with certain causes of
anemia.

Diagnosis
Blood tests will not only confirm the
diagnosis of anemia, but also help point
to the underlying condition.
Complete blood count (CBC), which
determines the number, size, volume,
and hemoglobin content of red blood cells
Blood iron level and your serum ferritin
level, the best indicators of your body's
total iron stores

Treatment
Anemia Caused by Blood Loss
If you suddenly lose a large volume
of blood, you may be treated with
fluids, a blood transfusion, oxygen,
and possibly iron to help your body
build new red blood cells.

Treatment
Chronic blood loss is treated by
identifying the source of bleeding,
stopping the bleeding, and, if
necessary, providing treatment for
iron-deficiency anemia.

Risk factors

Trauma
Ulcers
kidney or bladder tumors
heavy menstrual bleeding
cancers in the large intestine.
Diverticulosis

Aplastic Anemia

Aplasticanemia
is a rare but serious blood disorder
A disease of a bone marrow
Happens when the body's bone
marrow does not produce new cells,
leaving the body susceptible to
bleeding and infection.
Can be moderate, severe or very
severe.

Symptoms
symptoms are unexplained infections
(due to fewer white blood cells)
unexpected bleeding (due to fewer
platelets)
fatigue (due to fewer red blood cells).

most common symptoms include

Fever
Shortness of breath
Recurring infections and/or flu-like
symptoms
Bruising or bleeding easily
Difficulty in controlling bleeding, even
from very minor wounds
The appearance of small red dots on the
skin that indicate bleeding under the skin

Diagnosis

Examining the bone marrow and

blood under a microscope.
Perform blood and laboratory tests as
well as a bone marrow aspiration and
biopsy.
Laboratory test that evaluates the
level of liver enzymes.

Treatments
Blood transfusions
Blood and Marrow Stem Cell
Transplants
Medicines
Stimulate your bone marrow
Suppress your immune system
Prevent and treat infections

Medicines To Stimulate Bone Marrow

sargramostim (Leukine),
filgrastim (Neupogen) and
pegfilgrastim (Neulasta),
epoetin alfa (Epogen, Procrit)

Medicines To Suppress the Immune System

cyclosporine (Gengraf, Neoral,

Sandimmune)
anti-thymocyte globulin
(Thymoglobulin)
methylprednisolone.

Medicines To Prevent and Treat Infections

Antibiotics
antivirals

Risk Factors

drugs,
chemicals
Radiation
viruses
A number of environmental factors,
including drugs, benzene exposure,
insecticides.

Hemolytic Anemia

Type of anemia: increase destruction

of RBCs
Stems from intrinsic (hereditary) or
extrinsic (acquired) factors
Intrinsic: Hereditary spherocytosis,
and sickle cell anemia
Extrinsic: Erythroblastosis fetalis

pathophysiology

Intravascular or extravascular
Intravascular: RBCs lysed inside the
vascular system Hemoglobin
released into the plasma
Causes: mechanical trauma,
complement fixation, and other toxic
damage to the RBC
Extravascular: RBCs phagocytosed by
macrophages in the liver and, spleen

 Hereditary Spherocytosis

Intrinsic defect in RBC membrane

protein Spherical, non-deformable
cells

Vulnearable to destruction in the

spleen

Transmitted as autosomal dominant

Mutation that weaken interaction of

membrane to the intrinsic proteins
Instability of lipid bilayer with
shedding of vesicles Spherical
shape (Reduced surface area)
Unable to deform so cannot pass
through splenic cord
Clinical features: Jaundice,
splenomegaly, anemia

 Sickle Cell Anemia

Hereditary recessive disorder

Mutation of beta-globin gene: valine

glutamic acid at position 6 (HbS)

Abnormal structure of beta-globin

chain

pathophysiology

 Erythroblastosis Fetalis
Disease of the fetus and newborn characterized
by the agglutination and phagocytosis of RBCs
Occurs when the child is Rh positive and the
mother is Rh negative
Exposure of Rh negative person to Rh positive
blood Develop anti-Rh antibodies
Multiple exposure sensitizes the person to Rh
factor
These antibodies diffuse through the placenta
Agglutination of fetal blood

 DIAGNOSIS:
Peripheral smear: examine the shape of
RBC under microscope
Increased unconjugated bilirubin,
decreased or absence of serum
haptoglobin,increase serum bilirubin
Decrease reticulocyte count (young RBC)
Coombs test:test to detect whether the
body produces antibodies against RBC.

 Treatment

Hereditary Spherocytosis:
Splenectomy (Anemia is only
corrected)

Erythroblastosis neonate: Replace

neonate's blood with Rh-negative
blood

Megaloblastic anemia

that results from inhibition ofDNA

synthesisduringred blood
cellproduction.
Its rather slow onset, especially
when compared to that of other
anemias.

 CAUSES:
-Vitamin B12 deficiencyleading to folate
deficiency
-Folate deficiency
-Combined Deficiency: vitamin B12 & folate.
-Inherited Pyrimidine Synthesis
Disorders:Orotic aciduria
-InheritedDNASynthesis Disorders
-Toxins and Drugs

pathophysiology
defect in DNA synthesis in rapidly
dividing cells
Unbalanced cell growth and impaired
cell division occur since nuclear
maturation is arrested.
More mature RBC precursors are
destroyed in the bone marrow prior to
entering the blood stream
(intramedullary hemolysis)

Treatment
Cobalamin (100-1000 g)
Folate (3-5 mg)

laboratory
Complete blood count (CBC) and peripheral
blood smear; lactate dehydrogenase (LDH),
indirect bilirubin, iron, and ferritin assays
Tests for cobalamin deficiency (e.g. serum
cobalamin, Schilling test, protein-bound
absorption test)
Tests for folate deficiency (e.g. red blood cell
folate, better than serum folate)
Diagnostic imaging studies for possible blind
loop syndrome
Bone marrow aspiration and biopsy