By Dr. Manal Said: Physiology Lecturer, Ain Shams University

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By Dr. Manal Said

Physiology lecturer, Ain shams
university
Erythrocytes
(red blood cells)
Q11: Stimulants of Erythropoieten production:
 Hypoxia: high altitudes- hemorrhage-lung disease

 Alkalosis (high altitudes)
 Androgen hormone  RBC s number and
haematocrit value are
 Catecholamines higher in male
 Cobalt
 Corticosteroids, growth hormone and thyroxin.
Q12:List Requirements for Erythropoiesis
 Healty bone marrow:Bone marrow failure=aplastic

anemia
 Hormones: erythropoeitin, Androgens, thyroxine
and glucocorticoids
 Healthy liver: form proteins, store iron and vitamins
 Proteins: especially of high biological value to form
globin part of Hb
 Minerals as : Iron
 Vitamins as: folic acid, vitamin b12
Folic acid Vitamin B12 {extrinsic factor} Iron Q13: Nutritional
requirements in
erythropoeisis
green Found in animal products as Liver Source
vegetables, meats, eggs, dairy products, and Meat
some fruits, liver Egg
liver Milk
Green vegetables
intestine Terminal ileum stored in liver In Duodenum absorption
- Protected from destruction by helped by vitamin C
intrinsic factor secreted from
stomach
DNA DNA maturation Formation of heme importance
maturation part of Hb
Megaloblastic In atrophic gastritis or defect in heme Deficiency
anemia gasterectomy----intrinsic factor formation
deficiency { microcytic
Failure of RBCs maturation hypochromic
Megaloblastic cells anemia}
normal
Microcytic hypochromic
RBCs breakdown
Summary
 Erythropoeitin is formed mainly in the kidney
 Erythropoeitin is stimulated mainly by hypoxia
 Erythropoeisis needs healthy bone marrow, liver,
enough proteins, iron, vitamin B12, folic acid
 Iron is absorbed in duodenum, its deficiency leads to
iron deficiency anemia (microcytic hypochromic)
 Vitamin B12 absorbed in terminal ileum, needs
intrinsic factor produced by gastric parietal cells, its
deficiency leads to megaloblastic anemia (macrocytic)
 Anemia
Definition:
Decrease RBC s number or

Hb concentration
according to age and sex
Q14: Classify anemia according to its cause
1-Aplastic anemia Bone marrow X-ray, Pancytopenia
failure chemotherapy
2-Deficiency anemia: Less Hb formation -Deficient iron Microcytic
A-Iron deficiency intake hypochromic anemia
- Excess demand,
puberty pregnancy
-Poor iron
absorption
-- chronic bleeding
B-Vitamin B12 Erythroblast fail to -Malabsorption Pernicious anemia
proliferate or -- Atrophic gastritis Macrocytic
mature into RBCs hyperchromic
-Treated by vitamin anemia +
B12 injections Neurological defects
C- Folic acid Erythroblast fail to Nutritional defect Macrocytic
proliferate or hyperchromic
mature into RBCs anemia
Microcytic hypochromic Macrocytic hyperchromic
anemia anemia
[megaloblastic anemia}
 Small size RBCs  Large size, immature
 Less Hb odd shaped, fragile
RBCs
 Severe number
reduction
Q14: Classify anemia according to its cause: 3- hemolytic
anemia
Corpuscular Extracorpuscular
1-Hereditary  Incompatible blood

spherocytosis transfusion
2-Sickle cell anemia  Rh incompatability
3-Glucose 6 p  Malaria infection
dehydrogenase  Sulfonamide
deficiency  Snake venum
4-Thalassemia  Lead
1- Hereditary spherocytosis
 Spectrin is the most
abundant protein in this
cytoskeleton
Its deficiency
Spherocytes
That rupture
easily
(Haemolysis)
Tough supporting
cytoskeleton
2-Sickle cell disease and Hb S

Hb A: 4 polypeptide chains:2
alpha, 2 beta

Hb S: Normal glutamic acid aa
(polar) in position 6 on the 
chain is substituted by Valine aa
α β
(non-polar).
 Oxygenated :Soluble
β α
 Deoxygenated: precipitates into
long crystals
 leading to sickled cells which
will are fragile and liable to
haemolysis
3-Glucose 6 phosphate dehydrogenase enzyme
 It is an enzyme that helps in producing the

antioxidant {NADPH}
 Coded by gene on X chromosome
G6P dehydrogenase deficiency{Favism}:
-X-linked recessive disorder
-Leads to acute intravascular hemolysis
on exposure to oxidizing agent
- The oxidizing agents as: fava beans,
sulfonamides
4-Thalasemia
 defect or absence of one or more of genes
responsible for synthesis of α or β chains
Classification according to the cause
4- Hemorrhagic RBC s loss Wound bleeding Normocytic

anemia: acute normochromic
anemia
chronic iron loss Bleeding piles, Microcytic

excessive mensis hypochromic
anemia
5- Renal anemia insufficient RBC s defect in Normocytic
production erythropoeitin normochromic
anemia
Q15: Classify anemia according to the cell
appearance:
Normocytic Microcytic Macrocytic

normochromic hypochromic anemia
RBCs size normal small large
Hb content per normal decreased Normal or

cell increased
Cause -Aplastic anemia -Iron Deficiency - Vitamin B12,

-Renal failure anemia folic acid
-Acute -- Thalassemia deficiency anemia
haemorrhage
- Acute
haemolysis
Anemia Symptoms
In haemolytic
anemia
Effects of anemia
1-Decreased tissue oxygenation: especially during
exercise.
2-Increased work load on the heart due to:
Decreased blood viscosity due to decrease number of
RBCs will decrease the resistance to blood flow so that
greater quantities of blood flow through the tissues and
then return to the heart.
Hypoxia (decreased oxygen tension): will dilate the
peripheral tissue vessels causing increase in blood
returned to the heart increasing cardiac output.
Q15:Erythrocyte Sedimentation Rate (ESR)
 Definition:
 It is the rate of
sedimentation of RBCs
in anticoagulated
blood kept in a vertical
narrow tube. RBCs
sedimented to the
bottom of the tube,
leaving a layer of clear
plasma above it.
ESR
 RBCs greater in denisty, negatively
charged
 In presence of abundant plasma
globulin, fibrinogen the red blood cells

form rouleaux
 Measured in the form of distance
(mm/hour):
 In males = 4 – 6 mm/hour
In females = 8 mm/hour.
Increase in many conditions
Causes of increased ESR
 a) Physiological causes:
 - In females during menstruation,
pregnancy and lactation
 - After meals.
 - After exercise
 b) Pathological causes:
 - Inflammatory conditions as in T.B (due
 Prognostic not
to increase γ globulin). diagnostic
 - Destructive conditions as coronary
thrombosis, cancer, rheumatic fever.
 - Allergic conditions (increase γ
globulin).
 - Fracture of bones and wounds (increase
both fibrinogen and γ globulin).
Q16:Osmotic fragility
 Red blood cells put in

hypotonic solution are at
first swollen then are
haemolysed.
 Swelling starts at first till
0.45% haemolysis starts 0.9% less than 0.9% more than 0.9%
 Normal Range:
 Hemolysis starts at
0.45% and is complete

at 0.35%
 Increased osmotic
fragility as in
spherocytosis
 Hemolysis starts at
0.75% and is complete
at 0.45%

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By Dr. Manal Said: Physiology Lecturer, Ain Shams University

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By Dr. Manal Said

 Hypoxia: high altitudes- hemorrhage-lung disease

 Healty bone marrow:Bone marrow failure=aplastic

Decrease RBC s number or

1-Hereditary  Incompatible blood

 It is an enzyme that helps in producing the

4- Hemorrhagic RBC s loss Wound bleeding Normocytic

chronic iron loss Bleeding piles, Microcytic

Normocytic Microcytic Macrocytic

RBCs size normal small large

Hb content per normal decreased Normal or

Cause -Aplastic anemia -Iron Deficiency - Vitamin B12,

globulin, fibrinogen the red blood cells

 Red blood cells put in

0.45% and is complete

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