LECTURE NO (-) Blood Physiology
Red Blood Cells
RBCs
Faculty Of Medicine [Link] Physiology
Blood
▪ Blood is a type of connective tissues.
➢ It consist of :
❖ Cells
❖ Intracellular substance
➢ The cells are:
▪ Red blood cells (RBCs) or erythrocytes.
▪ White blood cells (WBCs) or leukocytes.
▪ Platelets or thrombocytes.
▪ Volume of blood is about 5 litres in an average
adult male.
▪ 8% of the total body weight.
▪ Volume of plasma is about 3.5 L (5% of total
body weight)
The packed cell volume
▪ The cells in the blood can be separated by
centrifugation.
▪ The percentage of cells in blood is called the
packed cell volume (PCV) or the hematocrit.
▪ Most of these cells are RBCs.
➢ Normal values = 40-45% in males and 37-47% in
females.
▪ Low PCV indicate anemia.
▪ High PCV indicates polycythemia.
Functions of blood
➢ Transport of :
▪ Gases (e.g. oxygen & carbon dioxide).
▪ Nutrients (e.g. glucose, amino acids & free fatty
acids ).
▪ Waste products (e.g. urea & uric acid).
▪ Hormones (e.g. catecholamines, insulin & cortisol)
➢ Defense by WBCs.
➢ Homeostasis: maintains constant internal
environment.
➢ Hemostasis: prevention of blood loss &
maintenance of blood in fluid state.
Sites of hematopoiesis
❖The sites during pregnancy:
▪ First trimester: yolk sac.
▪ Second trimester: liver & spleen.
▪ Third trimester: red bone marrow.
❖The sites after delivery:
▪ Red bone marrow of all bones at first.
▪ Then the active red bone marrow becomes
gradually replaced by inactive yellow marrow.
▪ At about age of 20y the red marrow is confined to:
• The flat bones (skull, scapula, ribs, sternum,
vertebrae & iliac bone ).
• The end of long bones.
• Small bones of the hand & feet.
The red blood cells
➢ Characteristics of RBCs:-
▪ Shape: biconcave disks.
▪ Diameter: 7.5 microns.
▪ Thickness: 1-2 microns.
▪ Content: no nucleus & no organelles.
▪ Each cell contains hemoglobin (a red pigment for
transport of O2)
❖ RBCs count: 5 million/mm3 in males & 4.5
million/mm3 in females.
Functions of RBCs
▪ Transport oxygen.
▪ Transport carbon dioxide.
▪ Contains buffers to control pH.
Stages of erythropoiesis
➢ Stages in the red bone marrow:-
❖ Pluripotent stem cells (can form any type of cell).
❖ Committed stem cells (can form one type of cell
e.g. RBC).
❖ Proerythroblasts.
❖ Normoblasts.
➢ Stages in the blood:-
❖ Reticulocytes:
▪ The first form that enters the blood from the bone
marrow.
▪ Constitute about 1% of total RBCs.
▪ High reticulocyte count (more than 2%) indicates
hyperactivity in the bone marrow e.g. in hemolytic
anemia.
❖ Erythrocytes (the mature cells).
Haemopoiesis
Control of erythropoiesis
➢ Normal erythropoiesis requires:
▪ Normal bone marrow.
▪ Certain cytokines & growth factors.
▪ Certain hormones (erythropoietin).
▪ Certain nutrients (like iron, folic acid & vitamin
B12).
Erythropoietin
▪ Glycoprotein.
▪ Produced by the kidneys.
▪ Stimulated by hypoxia.
▪ Stimulates replication of stem cells & formation of
erythroblasts.
➢ Excess erythropoietin e.g. in high altitude or
chronic respiratory diseases causes polycythemia.
➢ Deficiency of erythropoietin e.g. in chronic renal
failure causes anemia (normocytic normochromic
anemia).
▪ Used for treatment of anemia of chronic renal
failure.
Nutrient for erythropoiesis
➢ Amino acids:-
▪ For formation of globin in hemoglobin.
▪ Found in animal or plant origin food.
▪ Absorbed in the small intestine.
➢ Iron:-
▪ For formation of heme in hemoglobin.
▪ Found in animal or plant origin food.
▪ Absorbed in the duodenum.
▪ Deficency causes microcytic hypochromic anemia.
➢ Vitamin B12:-
▪ For DNA synthesis (cell division).
▪ Found in food of animal origin.
▪ Absorbed in the terminal ileum.
▪ Deficiency causes macrocytic normochromic
anemia
➢ Folic acid:-
▪ For DNA synthesis (cell division).
▪ Found in food of plant origin.
▪ Absorbed in the jejunum.
▪ Deficiency causes macrocytic normochromic
anemia.
Hemoglobin
▪ The red pigment within the RBCs.
▪ Its concentration in the blood:
▪ 14-16 g/dl in adult males
▪ 13-15 g/dl in adult females.
▪ 18-20 g/dl in neonates.
Structure of Hb
▪ Consist of 4 subunits.
▪ Each subunit consist of heme + a poly peptide
chain.
▪ Each heme contains iron in reduced state (ferrous
or Fe2+).
▪ The 4 polypeptide chains are known as globin.
Function of Hb
▪ Carries 98% of oxygen in the blood.
▪ Carries some carbon dioxide.
▪ Act as a buffer.
Normal types of Hb
➢ Hb A:-
▪ Adult Hb = 98% of all Hb in adults.
▪ The 4 polypeptide chains are 2 alpha & 2 beta
chains (α2β2).
➢ Hb A2:-
▪ Adult Hb = 2.5 % of all Hb in adults.
▪ The 4 polypeptide chains are 2 alpha & 2delta
chains (α2δ2).
➢ Hb F :-
▪ Fetal Hb
▪ Replaced by Hb A 6 monthes after birth.
▪ The 4 polypeptide chains are 2 alpha & 2 gamma
chains (α2γ2).
➢ Hb A1c:-
▪ Subtype of Hb A, can bind glucose.
▪ Normally = 5% of total Hb.
▪ Its excess indicates poor control of diabetes
mellitus.
Abnormal types of Hb
➢ Hb S :-
▪ Sickle cell Hb.
▪ It is a Hb A but the amino acid number 6 in beta
chain (glutamic acid) is replaced by (valine).
▪ This abnormal Hb precipitate in cases of hypoxia,
changing the shape of RBCs to a sickle shape.
➢ Coplication of Hb S:
▪ Hemolytic anemia.
▪ Jaundice.
▪ Obstruction of small capillaries = atrophy of
organs.
Anemia
➢The definition :-
▪ State of reduction in Hb concentration below the
normal range.
➢The symptoms :-
▪ Headache.
▪ Weakness & fatiguability.
▪ Palpitation.
▪ Pallor in the skin & mucous membranes.
➢Classification of anemia :-
❖Decreased production :
▪ Bone marrow diseases e.g. tumors.
▪ Lack of nutrients e.g. iron deficiency anemia,
vitamin B12 deficiency anemia & folic acid
deficiency anemia.
▪ Lack of erythropoietin as in chronic renal failure.
❖Increased destruction :-
▪ Abnormal RBC shape as in sickle cell anemia or
congenital spherocytosis.
▪ Lack of RBC enzymes like glucose 6 phosphate
dehydrogenase.
▪ Mechanical destruction of RBCs as in malaria.
❖Blood loss :-
▪ Acute blood loss e.g. following trauma.
▪ Chronic blood loss e.g. due to chronic peptic ulcer.
➢ Diagnosis of anemia:-
▪ Low Hb.
▪ Low PCV.
➢ Treatment of anemia:-
▪ Treatment of the cause e.g. correction of the
deficient nutrient.
▪ Blood transfusion if Hb is very low.
A tissue section
showing red cells in a
small blood vessel.
The red cell must be able to
change shape and squeeze
through small capillaries.