Red blood cells

 Origin, development and lifecycle of RBCs

o Haemopoiesis
 In adults, mainly occurs in the
bone marrow, especially in;
 Pelvis
 Femur
 Sternum
o Derived from Haemopoietic stem cells
(HSCs) in the bone marrow
 HSCs give rise to;
 Lymphoid Stem Cells
 Myeloid Stem Cells
o RBCs
o Granulocytes
o Monocytes
o Platelets
 Abilities of HSCs;
 Self-renewal
o Some daughter cells remain as Haemopoietic stem
cells
o This ensures that the ‘pool’ of stem cells is not
depleted
 Differentiation into mature progeny
o Other daughter cells follow differentiation pathways
 Erythropoietin and the regulation of Erythropoiesis
o Erythropoiesis;
 Erythropoietin is synthesised based of need;
 Anaemia
 Hypoxia
 Juxtatubular intestinal cell (Interstitial
fibroblasts / Pericytes)
 Sire of synthesis in the kidney
 90% of synthesis
 Hepatocytes and interstitial cells
 10% of erythropoietin synthesis
 Liver
 Overview of Iron, B12 and Folate
o Iron
 Haemoglobin
 Each Fe2+ can bind to one oxygen molecule
 Iron absorption is tightly controlled;
 Excess iron is toxic to organs
 Reducing substances
o Increase absorption
 Phytates
o Reduce absorption
 Iron storage
 Macrophages in the bone marrow
 Iron from Haem returns to the bone marrow and is then sent to
splenic macrophages
o Vitamin B12 and Folate
 Deficiency in Vit. B12 and Folic acid à
 Round RBCs
 Oval RBCs
 Important in DNA synthesis and cellular replication
 Deficiency effects rapidly proliferating tissue;
o Epithelial
o GI tract
o Bone marrow

 Vitamin B12
 Intrinsic factor
o Binds to Vitamin B12 (secreted by the stomach) in the
stomach and is absorbed in the small intestine.
 Causes of Vitamin B12 deficiency;
o Inadequate intake
o Inadequate secretion of intrinsic factor
o Malabsorption in the small intestine
 Which dietary origin;
o Meat
o Liver and kidney
 o Fish
o Oysters and clams
o Eggs
o Milk and cheese
o Fortified cereals
 Folate
 Which dietary origin;
o Green leafy vegetable
o Cauliflower
o Brussel sprouts
o Liver and kidney
o Whole grain cereals
o Yeast
o Fruit
 Reference ranges and normal ranges
o Definitions
 Reference range
 Carefully defined population
o You can specify
 Analyse blood of healthy volunteers in the same way as you are
going to analyse patients
 Does your apparently healthy population represent health?
 Normal range
 Can be effected by;
o Age
o Gender
o Ethnic origin
o Physiological status
 Pregnancy
o Altitude
o Nutritional status
o Cigarette smoking
o Alcohol intake
 RBC terminology
o Size
 Seen on film
 Can measure diameter
 Can compare to nucleoside
 Can be;
 Microcytic
 Normocytic
 Macrocytic
 Anisocytosis
 Large variation in cell size
o Colour
 Polychromatic
 Immature RBCs
o Also are Macrocytic
 Many colours
 Contains ribosomes, therefore still synthesizing Haemoglobin
 Hypochromia
 Features;
o Smaller area of central colour than normal
o Middle thin with not enough Haemoglobin
 Not enough Haemoglobin
 Often goes with microcytosis
 Hyperchromia
 Larger central colour than normal
 Normochromia
o Age
 Reticulocytes
 Stain shows higher RNA content
o New Methylene Blue
 Response to;
o Anaemia
o Not enough RBCs
 Physiological
o Shape – seen on blood film

 Poikilocytosis
 When there is more variation in shape than normal
 Different variations in shape seen;
 Spherocytes
 o Spherical
 Irregularly contracted
o Looks small and irregular
 Sickle cells
o High concentration of Haemoglobin S
o Sickle cell anaemia
 Abnormal β-globin gene
 Only one copy causes target cells
 Target cells
o Sickle cell trait
o High Bilirubin
 Obstructive Jaundice
o Liver disease
o Spleen
 Removal
 Non-functioning
 Elliptocytes
o Elliptical
 Fragments
o Piece of red cell