NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 11
ERYTHROCYTES, ERYTHROCYTES, HEMOGLOBIN & ANEMIASHEMOGLOBIN & ANEMIAS
ByBy
Dr.M.Anthony David MDDr.M.Anthony David MD
Professor of PhysiologyProfessor of Physiology
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 22
25 Trillion in an average 70 kg adult man.25 Trillion in an average 70 kg adult man. Men have aboutMen have about 4.5 to 5.5 Millions/cu.mm4.5 to 5.5 Millions/cu.mm Women have about Women have about 4 to 5 Millions/cu.mm4 to 5 Millions/cu.mm Decrease in the Erythrocyte Count is Decrease in the Erythrocyte Count is
called Anemiacalled Anemia Increase is called Increase is called PolycythemiaPolycythemia
POLYCYTHEMIAPOLYCYTHEMIA Increase in the number Increase in the number of Erythrocytesof Erythrocytes
Is of two typesIs of two types Primary Polycythemia Primary Polycythemia Secondary Secondary PolycythemiaPolycythemia
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 44
ERYTHROCYTE MORPHOLOGYERYTHROCYTE MORPHOLOGY
They are biconcave discs in shape They are biconcave discs in shape about 7.5 Microns in diameterabout 7.5 Microns in diameter
They are about 2 – 3 Microns thickThey are about 2 – 3 Microns thick They have no nuclei.They have no nuclei. Why?Why? They make place for HemoglobinThey make place for Hemoglobin Hemoglobin takes up a third of Hemoglobin takes up a third of
the volume of each erythrocytethe volume of each erythrocyte
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 55
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 66
HEMOGLOBINHEMOGLOBIN
A A CHROMO PROTEIN CHROMO PROTEIN MOLECULE.MOLECULE. IS PRESENT EXCLUSIVELY IS PRESENT EXCLUSIVELY
WITHIN THE ERYTHROCYTE.WITHIN THE ERYTHROCYTE. ROUGHLY ROUGHLY ONE THIRD OF THE ONE THIRD OF THE
VOLUME VOLUME OF THE ERYTHROCYTE OF THE ERYTHROCYTE IS OCCUPIED BY HEMOGLOBIN.IS OCCUPIED BY HEMOGLOBIN.
IS A COMPLEX PROTEIN WITH IS A COMPLEX PROTEIN WITH TWO MOIETIES: TWO MOIETIES: HEME + GLOBIN.HEME + GLOBIN.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 77
HEMOGLOBIN MOLECULEHEMOGLOBIN MOLECULE
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 88
SYNTHESIS OF HEMOGLOBINSYNTHESIS OF HEMOGLOBIN
REQUIRES:REQUIRES: Nutrients such as Proteins, Nutrients such as Proteins,
Vitamins & Minerals.Vitamins & Minerals. TAKES PLACE ONLY WITHIN THE TAKES PLACE ONLY WITHIN THE
NORMOBLASTCELLS.NORMOBLASTCELLS.(INTRACELLULAR)(INTRACELLULAR)
HEMOGLOBIN = HEME + GLOBINHEMOGLOBIN = HEME + GLOBIN HEME = PIGMENTHEME = PIGMENT GLOBIN = PROTEINGLOBIN = PROTEIN
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 99
HEMEHEME Iron containing Porphyrin.Iron containing Porphyrin. Iron-Protoporphyrin IXIron-Protoporphyrin IX Porphyrin is formed from 4 Pyrrole Porphyrin is formed from 4 Pyrrole
rings joined by four methane bridges.rings joined by four methane bridges. The side chains 1,3 5, & 8 are Methyl.The side chains 1,3 5, & 8 are Methyl. The side chains 2 & 4 are Vinyl.The side chains 2 & 4 are Vinyl. The side chains 6 & 7 are Propionic The side chains 6 & 7 are Propionic
Acid.Acid.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 1010
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 1111
HEMOGLOBIN CATABOLISMHEMOGLOBIN CATABOLISM
Macrophages, mainly the Kupffer cells in the liver phagocytose Hemoglobin.
HEMOGLOBIN = HEME + GLOBINHEME Fe++ + PORPHYRIN
PORPHYRIN BILVERDIN + CO.CO TO THE LUNGS AND OUT.BILVERDIN REDUCED TO BILIRUBIN AND
SENT TO BLOOD & LIVER FOR EXCRETION.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 1212
Fe++ + TRANSFERRIN TO BONE MARROW FOR REUSE.
Fe++ + PORPHYRIN HEME(In the presence of the enzyme,
Heme Oxidase.) HEME + GLOBIN HEME + GLOBIN HEMOGLOBIN
HEMOGLOBIN CATABOLISMHEMOGLOBIN CATABOLISM
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 1313
HEMOGLOBIN:NORMAL HEMOGLOBIN:NORMAL LEVELSLEVELS
MALES: 14 – 18 Gm%MALES: 14 – 18 Gm% FEMALES: 12 – 15 Gm%FEMALES: 12 – 15 Gm% AT BIRTH: 23 Gm%AT BIRTH: 23 Gm% FALLS TO 10.5Gm% BY THIRD FALLS TO 10.5Gm% BY THIRD
MONTHMONTH RISES GRADUALLY TO 12.5 RISES GRADUALLY TO 12.5
Gm% AT 1 YEAR OF AGE.Gm% AT 1 YEAR OF AGE.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 1414
1 Gm OF HEMOGLOBIN, WHEN 1 Gm OF HEMOGLOBIN, WHEN FULLY SATURATED, COMBINES FULLY SATURATED, COMBINES WITHWITH 1.34 ml OF OXYGEN. 1.34 ml OF OXYGEN.
HEMOGLOBIN CONCENTRATION HEMOGLOBIN CONCENTRATION IS THEREFORE AN INDEX OF THE IS THEREFORE AN INDEX OF THE OXYGEN CARRYING CAPACITYOXYGEN CARRYING CAPACITY OF OF THE BLOOD.THE BLOOD.
HEMOGLOBIN LEVELS : HEMOGLOBIN LEVELS : SIGNIFICANCESIGNIFICANCE
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 1515
HEMOGLOBIN FORMATION: HEMOGLOBIN FORMATION: FACTORSFACTORS
1. PROTEINS:1. PROTEINS: HIGH POTENCY: ANIMAL HIGH POTENCY: ANIMAL
PROTEINS LIKE LIVER, SPLEEN PROTEINS LIKE LIVER, SPLEEN KIDNEY & HEART MOST POTENTKIDNEY & HEART MOST POTENT
MUSCLE PROTEINS MEDIUM MUSCLE PROTEINS MEDIUM POTENTPOTENT
LEAST POTENCY: CEREALS, LEAST POTENCY: CEREALS, DAIRY PRODUCTS, VEGETABLES DAIRY PRODUCTS, VEGETABLES & FRUITS& FRUITS
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 1616
2. IRON: HEMOGLOBIN HAS 2.5 2. IRON: HEMOGLOBIN HAS 2.5 Gms OF THE TOTAL BODY Gms OF THE TOTAL BODY IRON OF 4 - 5 Gms IN AN IRON OF 4 - 5 Gms IN AN AVERAGE HEALTHY ADULT.AVERAGE HEALTHY ADULT.
HEMOGLOBIN FORMATION: HEMOGLOBIN FORMATION: FACTORSFACTORS
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 1717
HEMOGLOBIN: STRUCTUREHEMOGLOBIN: STRUCTURE
HAS FOUR POLYPEPTIDE CHAINS OF HAS FOUR POLYPEPTIDE CHAINS OF TWO TYPES: EACH IN DUPLICATE.TWO TYPES: EACH IN DUPLICATE.
HbA: ADULT HEMOGLOBIN HAS:HbA: ADULT HEMOGLOBIN HAS: 2 2 αα CHAINS AND CHAINS AND 2 2 ββ CHAINS. CHAINS.
EACH CHAIN IS ASSOCIATED WITH EACH CHAIN IS ASSOCIATED WITH ONE HEME GROUP.ONE HEME GROUP.
THUS THERE ARE FOUR HEMES TO THUS THERE ARE FOUR HEMES TO THE MOLECULE, A TETRAMER OF MW THE MOLECULE, A TETRAMER OF MW 68,00068,000
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 1818
STRUCTURE & FUNCTIONSTRUCTURE & FUNCTION
Hb A = Hb A = αα22 ββ22
HEMOGLOBIN COMBINES LOOSELY & HEMOGLOBIN COMBINES LOOSELY & REVERSIBLY WITH OXYGEN.REVERSIBLY WITH OXYGEN.
IT’S AFFINITY TO OXYGEN IS IT’S AFFINITY TO OXYGEN IS DECREASED IN THE PRESENCE OF 2,3, DECREASED IN THE PRESENCE OF 2,3, DIPHOSPHO GLYCERATE (2,3 DPG)DIPHOSPHO GLYCERATE (2,3 DPG)
2,3 DPG IS A PRODUCT OF GLUCOSE 2,3 DPG IS A PRODUCT OF GLUCOSE METABOLISM.METABOLISM.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 1919
2,3 DPG 2,3 DPG AFFINITY OF Hb TO O AFFINITY OF Hb TO O22
THIS CAUSES THE OXYGEN TO BE THIS CAUSES THE OXYGEN TO BE FREELY DISSOCIATED.FREELY DISSOCIATED.
THIS HAPPENS AT THE TISSUE THIS HAPPENS AT THE TISSUE LEVEL.LEVEL.
ENSURES FREE AVAILABLITY OF ENSURES FREE AVAILABLITY OF OO2 2 TO THE TISSUES.TO THE TISSUES.
THUS OXYGEN DELIVERY IS A THUS OXYGEN DELIVERY IS A BASIC FUNCTION OF HEMOGLOBINBASIC FUNCTION OF HEMOGLOBIN
STRUCTURE & FUNCTIONSTRUCTURE & FUNCTION
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 2020
HEMOGLOBIN: VARIETIESHEMOGLOBIN: VARIETIES
HEME IS THE SAMEHEME IS THE SAME VARIETIES ARE DUE TO CHANGES VARIETIES ARE DUE TO CHANGES
IN THE PEPTIDES OF THE GLOBIN IN THE PEPTIDES OF THE GLOBIN MOIETY.MOIETY.
PHYSIOLOGICAL VARIETIES:PHYSIOLOGICAL VARIETIES:1. ADULT Hb: Hb A:1. ADULT Hb: Hb A:
Hb A: Hb A: αα22 ββ22: PREPONDERANT FORM: : PREPONDERANT FORM: 68,00068,000
Hb A2: Hb A2: αα22 δδ2 2 : A MINOR COMPONENT: A MINOR COMPONENT
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 2121
Hb:PHYSIOLOGICAL Hb:PHYSIOLOGICAL VARIETIESVARIETIES
2. FETAL HEMOGLOBIN:2. FETAL HEMOGLOBIN: Hb F : Hb F : αα22 γγ22 γγ : GAMMA CHAINS HAVE MORE : GAMMA CHAINS HAVE MORE
AFFINITY TO OXYGEN. AFFINITY TO OXYGEN. THIS HELPS THE FETUS TO THIS HELPS THE FETUS TO
ACQUIRE OXYGEN FROM THE ACQUIRE OXYGEN FROM THE MOTHER.MOTHER.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 2222
Hb: PATHOLOGICAL : Hb: PATHOLOGICAL : SICKLE CELL DISEASESICKLE CELL DISEASE
CAUSE: ABNORMAL POLYPEPTIDES DUE TO
SUBSTITUTION OF AMINO ACIDS SUPRESSION OF SYNTHESIS OF
POLYPEPTIDE CHAINS. Hb S:
OCCURS IN 0.3 to 1 % OF WEST AFRICAN & AMERICAN BLACK PEOPLE
VALINE IS SUBSTITUTED FOR GLUTAMIC ACID AT 6 POSITION OF BETA CHAIN.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 2323
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 2424
SICKLE CELL DISEASESICKLE CELL DISEASE
WHEN Hb S IS REDUCED, IT BECOMES WHEN Hb S IS REDUCED, IT BECOMES LESS SOLUBLE & ‘GELS’LESS SOLUBLE & ‘GELS’
THIS CHANGES THE SHAPE OF THE THIS CHANGES THE SHAPE OF THE ERYTHROCYTES.ERYTHROCYTES.
THEY BECOME ‘SICKLE’ SHAPEDTHEY BECOME ‘SICKLE’ SHAPED THEY INCREASE THE BLOOD THEY INCREASE THE BLOOD
VISCOSITY AND UNDERGO HEMOLYSIS.VISCOSITY AND UNDERGO HEMOLYSIS. THIS IS A SERIOUS CONDITION, CAN THIS IS A SERIOUS CONDITION, CAN
BE FATAL BY MIDDLE AGE.BE FATAL BY MIDDLE AGE.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 2525
A SICKLED ERYTHROCYTEA SICKLED ERYTHROCYTE
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 2626
Hb: PATHOLOGICAL : Hb: PATHOLOGICAL : THALASSEMIASTHALASSEMIAS
DEFECT IN THE SYNTHESIS OF EITHER DEFECT IN THE SYNTHESIS OF EITHER ALPHA & BETA CHAINS OF GLOBIN.ALPHA & BETA CHAINS OF GLOBIN.
OCCURS IN HOMOZYGOUS OFFSPRING OCCURS IN HOMOZYGOUS OFFSPRING OF HETEROZYGOUS PARENTS.OF HETEROZYGOUS PARENTS.
BETA THALASSEMIA IS MORE COMMON. BETA THALASSEMIA IS MORE COMMON. BETA CHAIN NOT FORMED.BETA CHAIN NOT FORMED.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 2727
BETA THALASSEMIABETA THALASSEMIA
ERYTHROCYTES ARE ERYTHROCYTES ARE ABNORMAL: HAVE LESS Hb A ABNORMAL: HAVE LESS Hb A AND MORE OF Hb AAND MORE OF Hb A22 & Hb F. & Hb F.
RAPID HEMOLYSIS OCCURS IN RAPID HEMOLYSIS OCCURS IN VIVO.VIVO.
CAUSES HYPOCHROMIC ANEMIA.CAUSES HYPOCHROMIC ANEMIA. CHILDREN FAIL TO THRIVE.CHILDREN FAIL TO THRIVE. THEY DIE YOUNG.THEY DIE YOUNG.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 2828
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 2929
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 3030
IRON METABOLISM IRON METABOLISM & ANEMIAS& ANEMIAS
ByBy
Dr.M.ANTHONY DAVID, MDDr.M.ANTHONY DAVID, MD
Professor of Physiology Professor of Physiology
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 3131
IRON IN THE BODYIRON IN THE BODY
BIOCHEMICAL BIOCHEMICAL FORMFORM
SITESITE CONC.CONC. % OF % OF TOTALTOTAL
HEMOGLOBINHEMOGLOBIN ErythrocytesErythrocytes 2.5 Gms2.5 Gms 60-6560-65
STORAGE Fe STORAGE Fe (ferritin & (ferritin &
hemosiderin)hemosiderin)
Phagocytes & Phagocytes & Hepatic Hepatic
Parenchymal Parenchymal cellscells
1 – 1.5 1 – 1.5 GmsGms
25 -3025 -30
MYOGLOBINMYOGLOBIN
MyohemogloMyohemoglobinbin
Red Muscle Red Muscle FibresFibres
0.2 Gms0.2 Gms
150-150-200mg200mg
44
Trace Heme Trace Heme Tissue Tissue
enzymesenzymes
Tissue CellsTissue Cells < 0.1 < 0.1 GmsGms
11
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 3232
IRON BALANCEIRON BALANCE ADULT MEN:ADULT MEN: DIET : DIET : 5 – 10 mg/day 5 – 10 mg/day LOSS:LOSS: 0.4 mg : Urine0.4 mg : Urine 0.8 mg : Bile0.8 mg : Bile Traces : Mucosa of GI tract.Traces : Mucosa of GI tract.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 3333
HAVE MORE IRON LOSS:HAVE MORE IRON LOSS: Monthly Menstrual Periods: 50 – 80 mlMonthly Menstrual Periods: 50 – 80 ml Child Bearing & Rearing : 15 Months: Child Bearing & Rearing : 15 Months:
900 mg (2mg/day) How?900 mg (2mg/day) How? Fetal Iron Content : 400mg.Fetal Iron Content : 400mg. Iron in Placenta/Uterus : 150mg.Iron in Placenta/Uterus : 150mg. Blood loss in Parturition:170mg.Blood loss in Parturition:170mg. Iron in Breast milk : 180mg.Iron in Breast milk : 180mg. TOTAL : 900mg.TOTAL : 900mg.
IRON BALANCE: womenIRON BALANCE: women
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 3434
IRON ABSORPTIONIRON ABSORPTION SITE: Duodenum/Upper Jejunum via
brush border. Ferrous form better absorbed than
Ferric form Ascorbic Acid (Vit C) helps absorption. Phosphates/Phytates reduce ionic Iron
absorption by forming insoluble salts. Heme in diet is directly absorbed Iron deficiency states enhance Iron
absorption.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 3535
ANEMIASANEMIAS
Deficiency of Hb in the blood caused by either:
RBC Count or Hb in the RBCs
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 3636
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 3737
ANEMIAS: CLASSIFICATION
HEMORRHAGIC ANEMIAHEMORRHAGIC ANEMIA APLASTIC ANEMIAAPLASTIC ANEMIA MEGALOBLASTIC ANEMIAMEGALOBLASTIC ANEMIA PERNICIOUS ANEMIAPERNICIOUS ANEMIA HEMOLYTIC ANEMIAHEMOLYTIC ANEMIA SICKLE CELL ANEMIASICKLE CELL ANEMIA IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA SECONDARY ANEMIA (RENAL)SECONDARY ANEMIA (RENAL)
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 3838
1. HEMORRHAGIC ANEMIA 1. HEMORRHAGIC ANEMIA (BLOOD LOSS) (BLOOD LOSS)
ACUTEACUTE: Sudden loss of blood: Sudden loss of blood RBC Count decreased for 1 – 3 RBC Count decreased for 1 – 3
daysdays RBCs are restored in 3 – 6 weeksRBCs are restored in 3 – 6 weeks CHRONIC BLOOD LOSSCHRONIC BLOOD LOSS:: They cannot absorb Fe enough to They cannot absorb Fe enough to
form Hbform Hb Have Hypochromic, Microcytic Have Hypochromic, Microcytic
Anemia.Anemia.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 3939
2. APLASTIC ANEMIA:2. APLASTIC ANEMIA:
Lack of functioning Red Bone Lack of functioning Red Bone Marrow, the hemopoietic tissue.Marrow, the hemopoietic tissue.
Caused by exposure to gamma ray Caused by exposure to gamma ray radiation (Nuclear Bomb Blast)radiation (Nuclear Bomb Blast)
Excessive exposure to X raysExcessive exposure to X rays Exposure to certain industrial Exposure to certain industrial
chemicals.chemicals.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 4040
3. MEGALOBLASTIC ANEMIA:3. MEGALOBLASTIC ANEMIA:
Deficiency of Vit BDeficiency of Vit B12 12 and or Folic Acid.and or Folic Acid. Intrinsic Factor can also be deficient.Intrinsic Factor can also be deficient. Production of Erythrocytes becomes Production of Erythrocytes becomes
slow.slow. They remain large, have odd shapes They remain large, have odd shapes
and are called ‘Megaloblasts’and are called ‘Megaloblasts’ Atropy of Stomach mucosa can cause Atropy of Stomach mucosa can cause
loss of Intrinsic factor & this anemia is loss of Intrinsic factor & this anemia is called Pernicious Anemia. called Pernicious Anemia.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 4141
MEGALOBLASTIC ANEMIA:MEGALOBLASTIC ANEMIA:
Intestinal Sprue or Malabsorption Intestinal Sprue or Malabsorption Syndrome can also cause this.Syndrome can also cause this.
Megaloblasts are over sized, Megaloblasts are over sized, anisocytic.anisocytic.
They have fragile membranes and They have fragile membranes and rupture easily.rupture easily.
TREATMENT: Vitamin B12 Folic Acid if TREATMENT: Vitamin B12 Folic Acid if it is nutritional. it is nutritional.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 4242
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 4343
4. HEMOLYTIC ANEMIAS4. HEMOLYTIC ANEMIAS
Mostly heriditary.Mostly heriditary. Cells are fragile, rupture easily as Cells are fragile, rupture easily as
they move through the capillaries.they move through the capillaries. The life span of erythrocytes is The life span of erythrocytes is
reduced.reduced.
HERIDITARY SPHEROCYTOSIS:HERIDITARY SPHEROCYTOSIS: Small spherical erythrocytes.Small spherical erythrocytes. Cannot be compressed even slightlyCannot be compressed even slightly Rupture and are lysed very easily.Rupture and are lysed very easily.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 4444
5. SICKLE CELL ANEMIA5. SICKLE CELL ANEMIA Affects 0.3 to 1% of West African & Affects 0.3 to 1% of West African &
African blacks.African blacks. The Beta chains of Hemoglobin are The Beta chains of Hemoglobin are
defective.defective. They have Hb SThey have Hb S Sickling occurs when Hb loses Oxygen.Sickling occurs when Hb loses Oxygen. A vicious circle of events occurs: A vicious circle of events occurs:
Oxygen tension Oxygen tension Sickling Sickling Rupture of Rupture of Erythrocytes Erythrocytes Further Further Oxygen tension Oxygen tension
This is called a crisis in sickle cell This is called a crisis in sickle cell disease.disease.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 4545
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 4646
ERYTHROBLASTOSIS FETALISERYTHROBLASTOSIS FETALIS
Rh Isoimmunisation causes this Rh Isoimmunisation causes this diseasedisease
Antigen antibody reaction causes Antigen antibody reaction causes lysis of erythrocytes.lysis of erythrocytes.
Seen in Neonates and is also Seen in Neonates and is also called Icterus Gravis Neonatorum.called Icterus Gravis Neonatorum.
Excess Bilirubin enters the brain, Excess Bilirubin enters the brain, causing ‘kernicterus’causing ‘kernicterus’
Can become fatal.Can become fatal.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 4747
IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA
The most common type of anemiaThe most common type of anemia.. Caused by nutritional deficiency of Iron.Caused by nutritional deficiency of Iron. Erythrocytes are smaller and have less Erythrocytes are smaller and have less
Hb.Hb. So they are called Microcytic & So they are called Microcytic &
Hypochromic.Hypochromic. Treated by taking Iron rich diets.Treated by taking Iron rich diets. Dark green leafy vegetables: esp Dark green leafy vegetables: esp
Drumstick leaves.Drumstick leaves. Meats like Liver & spleen.Meats like Liver & spleen.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 4848
IRON RICH DIETSIRON RICH DIETS
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 4949
SECONDARY ANEMIA(RENAL)SECONDARY ANEMIA(RENAL)
Renal Diseases can cause Renal Diseases can cause decreased decreased ErythropoietinErythropoietin..
Erythropoietin is essential for Erythropoietin is essential for proper production of erythrocytes proper production of erythrocytes (Erythropoiesis)(Erythropoiesis)
Renal disease thus causes Anemia.Renal disease thus causes Anemia.
REVIEWREVIEW Erythrocytes:Erythrocytes:
4.5 – 5.5 Million/cc of blood in Males4.5 – 5.5 Million/cc of blood in Males 4 – 5 Million/cc of blood in females4 – 5 Million/cc of blood in females
Biconcave discsBiconcave discs 7.5 Microns X 2.5 Microns7.5 Microns X 2.5 Microns No nucleusNo nucleus Hemoglobin takes up a third Hemoglobin takes up a third
volumevolumeNOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 5050
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 5151
REVIEWREVIEW Hemoglobin is a chromoprotein Hemoglobin is a chromoprotein
present exclusively within the present exclusively within the erythrocytes.erythrocytes.
Hb synthesis takes place within the Hb synthesis takes place within the normoblasts.normoblasts.
Hemoglobin = Heme + Globin.Hemoglobin = Heme + Globin. Heme is an Iron containing Porphyrin.Heme is an Iron containing Porphyrin. Iron is present in the Ferrous form.Iron is present in the Ferrous form. Oxygen can be loosely attached to Hb.Oxygen can be loosely attached to Hb.
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 5252
Normal blood levels of Normal blood levels of Hemoglobin:Hemoglobin: Males : 14 – 18 Gm%Males : 14 – 18 Gm% Females : 12 – 15 Gm%Females : 12 – 15 Gm%
1 Gram of Hemoglobin combines 1 Gram of Hemoglobin combines with 1.34 ml of Oxygen.with 1.34 ml of Oxygen.
Varieties of Hemoglobin include: Varieties of Hemoglobin include: Hb A, Hb FHb A, Hb F
Hb S, Hb AHb S, Hb A22
REVIEWREVIEW
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 5353
Anemia is a decrease in either Hb or Anemia is a decrease in either Hb or RBCs.RBCs.
Types of Anemia:Types of Anemia: HemorrhagicHemorrhagic AplasticAplastic MegaloblasticMegaloblastic PerniciousPernicious HemolyticHemolytic Sickle CellSickle Cell Iron deficiencyIron deficiency Secondary (Renal)Secondary (Renal)
REVIEWREVIEW
NOMAD:2006: BP: HBANEM NOMAD:2006: BP: HBANEM 5454