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Erythrocytes are ____ to _____ times more numerous than white blood cells
500 to 1000 times
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Each erythrocyte carries how many hemoglobin molecules?
- several hundred thousand hemoglobin molecules
- Oxygen is poorly soluble in plasma
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Each molecule of hemoglobin can carry up to ____ molecules of oxygen
four molecules
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True/False: Adult hemoglobin (HbA) has a much higher affinity for oxygen than fetal (HbF) hemoglobin.
False. Fetal hemoglobin has a higher affinity
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The rate of hemoglobin production is dependant on the availability of ____ for heme synthesis
Iron
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Iron is absorbed in the ____ and lost in the ____.
Absorbed in the small intestine, and lost in feces
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Iron is stored in the liver and other organs as ____ which is a protein-iron complex that can easily return iron to the circulation.
ferritin
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Hemosiderin
insoluble form of iron stored inside cells. Usually only occurs when the total quantity of iron in the body is more than ferritin storage pools can accommodate.
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____ ____ ____ can be measured to provide an index of body iron stores.
Serum ferritin levels
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After 20 years of age, erythrocyte production takes place mainly in what membranous bones?
Vertebrae, sternum, ribs, and pelvis
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True/False erythrocytes are produced in the red bone marrow of most bone until about age 5.
true
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Any condition that causes ______ is sensed by the kidneys and liver, which the secrete a hormone called _________.
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90% of erythropoietin is produced in the ____ while the remaining 10% is produced in the ____.
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During the transformation from normoblast to reticulocyte, the cells accumulate _____ and as the nucleus condenses, what occurs?
- Hemoglobin
- after condensing the nucleus is finally ejected
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How long does it take for the stem cell to transform into a reticulocyte?
One week
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The reticulocyte is released into circulation and after _____ hours is a mature erythrocyte.
24-48 hours
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Recombinant Human Erythropoietin (EPO) is used to treat:
- anemia in cases of chronic renal failure
- anemia induced by chemotherapy in persons with malignancies
- anemia in HIV infected person treated with zidovudine
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Mature erythrocytes have a life span of ___ days
120 days
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How can RBCs form small amounts of ATP?
They use cytoplamic enzymes that use glucose
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Erythrocytes must use ____ as a fuel source.
- Glucose!
- Rely on ANAEROBIC glycolysis, end product is pyruvate which is reduced to lactate that is exported to the blood.
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What happens to the metabolic activity of an RBC as it ages?
It decreases with age
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Many aged erythrocytes destruct in the ____ as they squeeze through sinusoids within the red pulp.
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A stained blood smear give information about:
size, color, and shape of erythrocytes and presence of any immature or abnormal cells
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Bone marrow biopsies are commonly sampled from the ___________ or _______.
- Posterior iliac crest
- sternum
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____ accounts for the color of red blood vessels.
Hemoglobin
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Normochromic
- normal color
- normal amount of hemoglobin
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Hypochromic
- less color
- less amount of hemoglobin
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Anemia
abnormally low number of circulating erythrocytes or level or hemoglobin or both, resulting in diminished oxygen carrying capacity
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Anemia results from what 2 main causes?
- Excessive loss(bleeding) or destruction(hemolysis) of erythrocytes
- Less erythropoesis due to nutrition or bone marrow problems
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What are the causes of excessive hemolysis?
- Hyperbilirubinemia
- Jaundice
- Pigment gallstones
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Inappropriately high levels of iron absorption from the gut can lead to iron overload and eventual damage of the endocrine organs and heart. This leads to what cause of Anemia?
less erythropoiesis
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The effects of Amemia are the result of a triad:
- 1. Impaired oxygen transport/tissue hypoxia
- 2. Reduction in hemoglobin levels and odd cells (reticulocytes)
- 3. Signs and symptoms associated with the pathologic process causing the anemia
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The hypoxia that results from blood loss and
the release of _______ stimulates proliferation of erythropoiesis in bone marrow.
erythropoetin
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After 5-7 days of hypoxia from blood loss, an increase of _____ is seen in the blood.
Reticulocytes (immature RBC's)
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If Anemia onset is slow, the body compensates for the decrease in oxygen-carrying capacity of the blood with increases in _____, ______, and ______. These changes can largely compensate for the effects of mild to moderate anemia in otherwise healthy individuals but are less effective in those with compromised respiratory or cardiac function.
- plasma volume
- cardiac output
- and respiratory rate
- These changes can largely compensate for the effects of mild to moderate anemia in otherwise healthy individuals but are less effective in those with compromised respiratory or cardiac function.
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True/False: Chronic blood loss affects overall blood volume.
- False. Blood volume is not affected. Instead, this leads to iron-deficiency anemia when iron stores are depleted.
- Common in GIT bleeds, menstrual disorders
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Mean corpuscular hemoglobin concentration (MCHC)
- concentration of hemoglobin in each cell
- Normochrmoic or hypochromic
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Anemia from Excessive Hemolysis: Inherited disorders of erythrocyte cell membrane:
- Hereditary spherocytosis
- Sickle Cell disease
- Thalassemia
- Inherited enzyme defects (G6PD)
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Anemia from Excessive Hemolysis: Acquired Disorders of RBC cell membrane
Drugs, bacterial toxins, physical trauma
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With Hemolytic Anemia, almost all types show _______ and _______ red cells.
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In hemolytic anemia, bone marrow is hyperactive which results in what?
Increased number of reticulocytes in blood
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Intravascular hemolysis
- destruction of erythrocytes within the vascular compartment
- less common
- caused by mechanical injury from defective valves, exogenous toxic factors
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Extravascular hemolysis
- destruction of erythrocytes within phagocytic cells of reticuloendothelial system (liver and spleen)
- MORE COMMON
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What type of hemolysis is more common? Intravascular or extravasuclar?
Extravascular hemolysis
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Which of the following are signs of Extravascular Anemia?
a. hemoglobinemia
b. hemoglobinuria
c. jaundice
d. hemosiderinuria
e. bilirubin-rich gallstones
- c. jaundice
- e. bilirubin-rich gallstones
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List three major consequences of RBC sickling:
- Chronic hemolytic anemia
- Blood Vessel occlusion
- Chronic hyper bilirubinemia leads to jaundice, and pigment gallstones
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Overall, the mean life span of red cells in persons with sickle cell disease average only ____ days.
20 days
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Thalassemia
group of disorders caused by mutations that decrease the rate of either alpha or beta globlin synthesis for hemoglobin
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Heinz bodies (from Beta Thalassemia)
- insoluble aggregates formed by excess alpha globin chains that precipitate within red cells and produce membrane damage
- causes extravascular hemolysis
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Name the condition where excess iron is deposited in the myocardium, liver, and endocrine organs and induce organ damage.
Beta (B) Thalassemia
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Acquired Hemolytic Anemia: The Direct Coombs test detects the presence of (known antigens/antibodies) on the cell membrane of RBCs.
Antibodies
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Acquired Hemolytic Anemia: The Indirect Coombs test detects the presence of (known antigens/antibodies) on the cell membrane of RBCs.
known antigens
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This type of anemia is common in developing world because of poor diet, parasitic worm infestation leading to chronic blood loss from
gastrointestinal tract. In western world, due to chronic blood loss from ulcers or menstrual flow.
Iron-deficiency anemia
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Lab test results: decreased hemoglobin, decreased hematocrit, low serum ferritin, and microcytic and hypochromic blood cells
Iron-deficiency anemia
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