Hemoglobin

Pigment
which is
Present
inside the
RBC is called
Hemoglobin

It is a conjugated protein
 Structure of Hemoglobin
1. Haem: iron
containing
porphyrin
a. iron in ferrous (Fe2+)
b. Each Fe2+ combine
loosely with oxygen
c. Oxygen is carried as
molecular form

2. Globin:
a. 4 polypeptide chain: 2α and 2β
b. Each polypeptide chain is associated with 1 haem
 Varieties of Hb

1. Adult hemoglobin: Hb A(α2 β2)

2. Fetal hemoglobin : Hb F (α2 y2), more

affinity to oxygen

3. Hemoglobin S: HbS
1. One glutamate in each β chain of HbA at position
6 is replaced by valine
2. Increase RBC fragility, causes sickle cell anemia
Derivatives of hemoglobin
• Oxyhemoglobin: Hb combines with
oxygen
• Reduced hemoglobin: Hb without O2
• Carbaminohemoglobin: Hb with CO2
• Carboxy hemoglobin: Hb with CO

• Hb affinity to CO is 200 times greater

than O2
 Normal values
• At birth: 23 gm/dl
• At the end of 3 months: 10.5 gm/dl
• At the end of 1 year: 12.5 gm/dl
• Adult: male (14-16 gm/dl), female (12-14
gm/dl)
 Functions of Hb
• Transport of gases (O2 & CO2)

• Being a protein act as an excellent

Acid base buffer
 Factors necessary for hemoglobin
formation
• Proteins: helps in globin formation
• Minerals:
– Iron: formation of haem
– Copper & cobalt: helps in absorption,
mobilization & utilization of iron
– Calcium : increase absorption of iron from GIT
• Vitamins: vit C, B12 and folic acid helps in
synthesis of nucleic acid (for RBC
maturation)
RBC Vas
ant
h
 Red Blood Corpuscles

• Otherwise called as Erythrocytes

• Plays an important role in transport of gases

• Red in colour because of hemoglobin

Morphology
• Have cell membrane
• Circular, biconcave
• Non-nucleated
• Lack of organelles
• Have hemoglobin pigment

Size :
Diameter : 7.5μm
Thickness : 2 μm
Volume : 86-90 μ3
Normal shape : biconcave
Ankyrin and spectrin gives this shape

Advantages:
1. Helps in equal and rapid diffusion of oxygen
2. Minimal tension is offered on membrane when volume
changes
3. Can squeeze through the capillaries easily
Properties of RBC
• Rouleaux formation
• Specific gravity
• Suspension stability

Normal RBC count:

Women – 3.9-5.9m/mm3
Men - 4.5-6.5 m/mm3
Children – 4-6 m/mm3
 Variations in number of RBC
Physiological Physiological
increase: decrease:
(physiological polycythemia)
Pregnancy
age
Sex
High altitude
Exercise
Pathological increase:
Polycythemia: above 7 million cells/cumm of blood
Polycythemia vera: above 14 million cells / cumm of blood
in bone marrow malignancy

Pathological decrease: Anaemia - below 3million cells/cumm

of blood
 Functions of RBC
• Transport of oxygen from lungs to tissues
• Transport of carbon dioxide from tissue to
lungs
• Contains hemoglobin as a buffer system
 Life span of RBC
After 120 days RBC membrane is more fragile

Destroyed by macrophages in spleen and liver

Destruction of Hemoglobin

heme Globin
Iron for reuse
Amino acids
bilirubin

Liver Excreated along

Intestine feces as
Conjugated bilirubin
urobilinogen stercobiligon

Kidney Excreated along

urine
urobilinogen
 Erythropoiesis
Origin, development, maturation of RBC is known as
erythropoiesis

Site of erythropoiesis:
• at 1st month of gestation: yolk sac
• from 3rd month of gestration: liver, spleen
• from 20th week erythropoiesis begins at bone marrow
• From childhood to adult stage erythropoiesis at long bone
marrow (tibia, femur)
• From adult stage erythropoiesis at flat bone marrow
(pelvic bone, mandible, skull)
 Stages of erythropoiesis
• Starts from a common cell called pluripotent stem
cell.
• Growth factors : CFU (CFU-GEMM, CFU-E).

1. Stem cell
2. Pronormoblast
3. Early normoblast
4. Intermediate normoblast
5. Late normoblast
6. Reticulocyte
s.no Stages Size nucleus Hb staining
(μm)

1 Stem cell 19-23 very large (almost absent Deep

occupies the whole cell) basophilic

2 Pronormoblast 15-20 Large (central) absent Scanty and

Fine reticular chromatin deep
basophilic
3 Early normoblast 12-16 Large absent Still basophilic
Chromatin becomes
thicker & coarse
4 Intermediate 10-14 Condense Appears Acidophilic
normoblast

5 Late normoblast 8-10 Small Increase in Acidophilic

amount

6 Reticulocyte 7-7.5 Remnants of RNA Increase in Acidophilic

strand amount

7 RBC 7.2 absent present Acidophilic

STAGES OF
ERYTHROPOIESIS
Factors affecting Erythropoiesis
• Hormone : Erythropoietin
– this hormone regulates the erythropoiesis
– hypoxia stimulates the kidney to secretes
erythropoietin , this in turn acts on stem cell to
stimulates erythropoiesis
• Maturation factors:
• Dietary factors
• Intrinsic factor
• vitamin B12, folic acid
 Anemia
• Learning & objective:
– Definition
– Grading
– Classification
– Clinical manifestation of anemia
 Anemia
• Decreased RBC count <3 million/cumm or
decreased hemoglobin <12gm/dl level or both is
called anemia.
• Occurs because of
– Decreased production of RBC or increased
destruction of RBC or excess loss of blood from
body
• Grading
– Mild: Hb 8-12 gm/dl
– Moderate: Hb 5-8 gm/dl
– Severe: Hb <5 gm/dl
 Classification of anemia

– Morphological classification
– Aetiological classification
Aetiological classification
• Based on causes
1. Deficiency anemias:
1. Iron deficiency anemia
2. Megaloblastic anemia due to vitamin
B12
3. Megaloblastic anemia due to folic
acid
4. protein deficiency anemia
2. Blood loss anemia:
1. Acute blood loss
3. Hemolytic anemia:
a. Hereditary hemolytic anemia:
1. Thalassaemia
2. sickle cell anemia
3. hereditary spherocytosis

b. Acquired hemolytic anemia

4. Ag-Ab reactions, infections like malaria
4. Aplastic anemia
 Morphological classification
• Normocytic normochromic
• After acute hemorrhage
• All hemolytic anemia except thalassaemia
• Aplastic anemia
• Macrocytic normochromic
• All megaloblastic anemia due to deficiency of vit
B12 , folic acid or intrinsic factor
• Macrocytic hypochromic
• Secondary to liver disease
• Microcytic hypochromic
• Iron deficiency, thalassaemia
Types of causes Morphology of
anemia RBC
Hemorrhagic Acute loss of blood Normocytic
anemia normochromic
Chronic loss of blood Microcytic hypochromic

Liver failure
Renal disorder
Hemolytic anemia Burns Normocytic
Hereditary normochromic

Iron deficiency Microcytic hypochromic

Nutritional Protein deficiency Microcytic hypochromic

deficiency anemia
Vitamin B12 deficiency Macrocytic
normochromic
Folic acid deficiency Macrocytic
normochromic

Aplastic anemia Bone marrow disorder Normocytic

normochromic
 Sickle cell anemia

• In the β chain of
hemoglobin , the 6th
position glutamate is
replaced by valine

• Hypoxia causes
precipitation of Hb
results in sickled RBC.
 Pernicious anemia

• Due to deficiency of vit B12 (from diet)

or intrinsic factor (from stomach)
• RBC fails to mature becomes more
fragile,
 General clinical manifestation of
anemia

• General muscle weakness

• Pallor of skin and mucous membrane
• Palpitation, tachycardia
• Lethargy, headache, faintness
• Nausea, constipation