ERYTHROPOESIS

It is the physiologic process of production of RBC

CHANGES DURNG ERYTHROPOESIS

 Reduction in size of cell

 Disappearance of nucleus
 Appearance of haemoglobin
 Changes in staining property of RBC
 BONE MARROW

Proerythroblast, basophilic cytoplasm,

Nucleus with nucleoli

Early normoblast, basophilic cytoplasm,

Nucleoli disappear

Intermediate normoblast, polychromasia.

Hb disappears, nucleus condenses

Late normoblast, pyknotic nucleus, Hb

maximam

Reticulocyte –Reticulum of basophilic

material in cytoplasm
Ejection of nucleus

Mature RBC

REGULATION OF ERYTHROPOESIS
FACTORS AFFECTING ERYTHROPOESIS

FACTORS ROLE IN ERYTHROPOESIS DEFICIENCY DISORDERS

Protein Supply amino acid for Hb synthesis Nutritional anaemia
Iron Essential for synthesis of Hb Iron deficiency anaemia
Extrinsic factors Essential for DNA synthesis Mebaloblastic anaemia
Vitamin B12 Needed for cell multiplication and
Folic acid maturation of RBC
Intrinsic factors Protective covering for extrinsic factors Pernicious anaemia
Glycoprotein from
gastric mucosa
Vitamins Essential for erythropoesis Anaemia, scury
B1, B2 and B6
Minerals Essential for production of RBC
Copper, cobalt,
bismuth, nichel
Burst promoting Stimulate bone marrow and increase
action proliferation of cell
Protiens secreted
by agranulocytes
Hypoxia Stimulate kidney for erythropoietin
production
Androgen, Stimulate bone marrow increase the
corticosteroids, fotmation of erytrhopoetin
thyroxine, growth
hormone and
prolactin
Oestrogen Decrease erythropoesis

ERYTHROCYTE SEDIMENTATION RATE (ESR)

It is defined as the rate at which RBC settle down when sample of blood mixed with an
anticoagulant and allowed to stand in a graduated vertical tube.

NORMAL RANGE0-0-20 mm/hr

METHODS OF DETERMINATION

There are two methods

1. Westergrens method
Blood sample mixed with anticoagulant(sodium citrate) pipetted in to westergens pipette.
placed in a vertical stand and after 1 hour clear plasma formed at the tip is noted.
2. Win robe method
It is also performed in similar way using wint robe tube which is smaller in size. So the test
is les sensitive than the other method.
 VARIATIONS IN ESR

PHYSIOLOGIC VARIATION PATHOLOGIC VARIATION

INCREASE INCREASE

Pregnancy acute and chronic infection

DECREASE collagen disorder

Age-less in infant and more in adult malignancy

Sex-more in female than male iron deficiency anaemia

DECREASE

Allergy

Polycythemia

Sickle cell anemia

Hereditary spherocytosis

FACTORS AFFECTING ESR

1. RBC count-RBC increases ESR decreases

2. Roulex (aggregation of RBC) formation of RBC
Increase in plasma protiens (globulin and fibrinogen) increase Roulex formation which
increase ESR
Increase in plasma protiens (albumin) oppose Roulex formation which decrease ESR
3. Increase in oxygen level increase ESR
4. Increase in CO2 level decrease ESR
5. Plasma lipids
Increase in cholesterol increase ESR
Increase lecithin decrease ESR
6. Viscosity of blood
7. Increase in viscosity of blood decrease ESR

SIGNIFICANCE OF ESR

ESR is of much prognostic importance than diagnostic importance. It increase in wide variety of
infective diseases. It indicates the severity of disease. It also helps to differentiate benign and
malign ant tumours. In malignancy ESR is very high.