The Red Cell and Anaemia
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The red cell and basic concepts of anemia
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The Red Cell and Anaemia
- 1. The Red Cell & BASIC ASPECTS OF ANAEMIA Created by MEDtable group
- 6. Red cell structure • Red cells lack nuclei and cytoplasmic structures such as ER and mitochondria. • Exist as biconcave discs, but able to change the shape. • Membrane and cytoskeleton was referred to as stroma. Membrane has proteins (band 3 protein) and glycophorins.Cytoskeleton has proteins called spectrin, Band 4.1 protein and ankyrin • Over 90% of cytoplasm is haemoglobin
- 9. Metabolism of red cell • Survival of red cells is dependent on ATP supply by glycolysis (90%) • A constant supply of ATP is necessary for cation pump • Large amounts of 2-3DPG is present in cytosol and it regulates oxygen affinity to Hb A. • Remaining 10% glucose enters HMP shunt and produces NADPH necessary to keep the oxidised proteins in reduced state.
- 10. Methhaemoglobinaemia • Fe++ Fe+++ • Haemoglobin molecule is unable to carry oxygen • Cyanosed appearance • Congenital or acquired
- 11. Function of red cell •Main function is oxygen and carbon dioxide transport. •The affinity of oxygen binding to haemoglobin depends on the: nature of globin chain, pH 2-3 DPG level.
- 13. Red cell values Red cell indices • Haemoglobin level(Hb) • Red cell count (RCC) • Haematocrit (PCV) • Mean corpuscular volume (MCV) • Mean corpuscular haemoglobin (MCH) • Mean corpuscular haemoglobin concentration (MCHC)
- 14. Anaemia • Anaemia is present when the haemoglobin level in the blood is below the lower extreme of the normal range for the age and the sex of the individual. • Anaemia causes tissue hypoxia and body has some adaptations for it these are increase in 2-3DPG concentration, increased cardiac output, increase in plasma volume to maintain blood volume and by redistribution of blood flow (low skin blood flow and increased cerebral and muscle blood flow)
- 15. Lower limit of normal normal haemoglobin
- 16. Clinical features of anaemia (General) •Fatigue and weakness •Pallor •CVS Dyspnoea on exertion Angina murmurs and CCF *CNS *Optic fundi pale/haemorhages
- 17. Specific signs /symptoms • Koilonychia-Iron deficiency • Jaundice- Haemolytic/megaloblastic • Leg ulcers –sickel cell anaemia • Bone deformities – thalassaemia major • Excess infections- neutropenia • Bruising- thrombocytopenia
- 20. Investigation of the anaemic patient •Hb 129-175 g/l •RCC 4.5-5.7x1012 /L •PCV 40-47% •MCV 80-96fl •MCH 27-33pg •MCHC 320-350g/l •Blood picture normochromic/hypochromic normocytic/microcytic/macrocytic
- 23. Morphological classification of anaemia Hypo/micro Normo/normc macrocytic MCV ↓ Normal ↑ MCH ↓ Normal ↑ MCHC ↓ normal
- 24. Mechanism of anaemia •Blood loss •Decreased red cell lifespan (haemolysis) • Congenital defects ( Hb SS, Spherocytosis) • Acquired defect (malaria) •Impaired red cell formation • Insufficient erythropoiesis due to lack of necessary nutrients • Ineffective erythropoiesis •Pooling and destruction of red cells in an enlarged spleen (hypersplenism) •Increased plasma volume (pregnancy)
- 25. Blood film examination • Red cells size shape pattern of staining inclusions association • White cell number morphology • Platelets number morphology
- 27. Red Cell Shape Spherocyte Elliptocyte Poikilocyte Irregularly contracted cells
- 28. Pattern of staining Hypochromic Hyperchromic& polychromatic Reticulocyte Target cells
- 29. Red cell inclusions Malaria parasite Pappen heimer bodies Heinz bodies
- 30. 0000 000
- 31. MCQ s
- 32. 2.1 Which ONE of these statements is TRUE about haemoglobin? A. One molecule contains 1 atom of iron B. It is broken down in macrophages C. It is different in children and adults D . It has a low level in blood at birth compared with adult life E. Synthesis continues in red cells in circulation
- 33. 2.2 Which ONE of these statements is TRUE about reticulocytes? A. They contain DNA not RNA B. They are raised in megaloblastic anaemia C. They are raised in bone marrow hypoplasia. D.They are raised after haemorrhage E.They contain reticulin fibres
- 34. 2.3 Which ONE of these statements is NOT TRUE concerning erythropoietin? A. 90% of the hormone is made in the liver B. It contains a hypoxia response gene C. One stimulus to production is a low atmospheric oxygen level D. Levels in blood are high if a tumour secreting erythropoietin is causing polycythaemia but are low in severe renal disease. E. Levels are low in polycythaemia vera
- 35. 2.4 Which ONE of these statements is TRUE concerning the therapeutic use of erythropoietin? A. Side effects include hypotension and bleeding disorders B. The main indication is in patients with leukaemia C. Oral or parenteral iron is often needed to optimise the response D. Oral administration reduces the frequency of treatment E. Serum Epo level not useful in predicting the response
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