8LCCD nSICLCG

8y ur. Cllvar

luncLlons of Lhe 8LCCu
PomeosLasls (regulaLes lnLernal envlronmenL)
8esplraLory (LransporL of oxygen)
nuLrlLlve (carrler of nuLrlenLs)
LxcreLory (carrler of wasLe producLs)
Lndocrlnology (LransporLer of secreLlons)
Pelps malnLaln acld-base balance
MalnLenance of waLer and elecLrolyLe balance and regulaLlon of LoLal osmoLlc pressure
lmmunlLy Lo dlseases (W8C)
8egulaLlon of body LemperaLure

normal 8lood volume
Commonly:
Males would have 3 llLers
lemales would have 4.3 llLers
*8egardless of Lhls, blood should be 60 lasma, 40 lormed elemenLs.
*When cenLrlfuged:
--upper porLlon ls plasma
--whlLe subsLance a.k.a. buffy coaL" conLalns W8C and laLeleLs
--8ed porLlon ls Lhe red blood cells

ComposlLlon of 8lood
lasma-
waLer - 91 - 92
lasma proLeln - albumln, globulln, flbrlnogen, proLhrombln

luncLlons of lasma roLelns
MalnLenance of waLer balance beLween Lhe lnLravascular comparLmenL and exLra vascular
spaces (proLelns serve as soluLes LhaL aLLracL plasma lnslde Lhe blood vessel)
Lx.
uecreased lasma roLeln con.-hlgher plasma con.!plasma exlLs lnLo Lhe lnLersLlLlal space
PlCPL8 1C ------! LCWL8 CCnCLn18A1lCn

Cllnlcal CorrelaLlon:
aLlenLs wlLh llver dlseases manlfesL wlLh Ldema" because Lhe llver ls where proLelns are
synLheslzed. WlLh a llver problem, plasma proLeln may be depleLed. ln such slLuaLlon, Lhe plasma wlll be
pushed Loward Lhe lnLersLlLlal space.

lmparLs vlscoslLy Lo Lhe blood
Source of anLlbodles
necessary for coagulaLlon
MalnLalns acld-base balance
ueLermlnes speclflc gravlLy of plasma
lormaLlon of enzymes, LransporL of hormones and enzymes
CLher conLenLs---
1. WaLer
2. lasma proLelns
3. 8lood sugar - glucose
4. Llplds - cholesLerol, phosphollplds, neuLral faLs
3. SalLs - na, k, Cl, blcarbonaLes, phosphaLes
6. Cases - C2, CC2, nlLrogen
7. Speclal plasma subsLances - hormones, enzymes, anLlbodles

k8C, W8C, LA1LLL1S- all come from a slngle cell ln Lhe bone marrow called Lhe plurlpoLenL
hemaLopoleLlc sLem cells

kLD 8LCCD CLLLS
noL spherlcal, blconcave dlscs, 2.3 um Lhlck, 7.3 - 8 um ln dlameLer
very deformable
Carrles hemoglobln ln Lhe clrculaLlon -1gm of Pgb ! 1.34 ml of C2
non-nucleaLed ln Lhe clrculaLlng blood

Anemla- any value lower Lhan normal llmlL of Pgb and 88C

olycyLemla- any value hlgher Lhan normal llmlL of Pgb and 88C

88C counL:
Men: 3-6 x 10 (12)/L
Women: 4-3 x 10(12)/L
lnfanLs: 6-3 x 10(12)/L
Pemoglobln:
Men: 14 - 17 g/dL
Women: 12 - 13 g/dL

PemaLocrlL:
Men: 0.40 - 0.30
Women: 0.38 - 0.48


kLD CLLL roduct|on

SLage of Llfe Crgan 8esponslble for 8Lu CLLL producLlon
8 weeks of embryonlc llfe or flrsL 2 monLhs ?olk sac
Mlddle LrlmesLer of pregnancy Llver, spleen, lymph nodes
3
rd
LrlmesLer of pregnancy 1he bone marrow Lhen Lakes over
20 years and above 8one marrow of skull, verLebrae, rlbs, sLernum







LryLhropolesls- ls Lhe process of red cell producLlon

roerythrob|ast



Lar|y Lrythrob|ast
Late Lrythrob|ast


Normob|ast




WhaL happens durlng lnLermedlaLe phase?
Pemoglobln ls lncorporaLed lnLo Lhe cell.
1he nucleus condenses so LhaL lL ls released from Lhe cell even before Lhe cell ls exLruded from
Lhe bone marrow.
llrsL cell released ls called 8eLlculocyLe.

8eLlculocyLe- sLlll colors blue because of cyLoplasmlc maLerlals
-afLer 2 days, Lhe cyLoplasmlc maLerlals are gone and maLure non-nucleaLed
eryLhrocyLes are produced

"#$%&'() *+, -./$0 10$, *23 3443+%$*/ 5.2 6'7 8*%92*%$.+&

*WlLhouL vlL812 and lollc Acld,
unA synLhesls ls lmpalred
WlLh a problem ln unA synLhesls, eryLhropolesls proceeds slowly
lnLermedlaLe cells are released lnLo Lhe clrculaLlon as MacrocyLes, whlch are fllmsy and
easlly rupLure.
SLrucLural abnormallLles

MegaloblasLlc Anemla- ls descrlbed as macrocyLlc and hyperchromaLlc

ernlclous Anemla- ls a condlLlon characLerlzed by Lhe absence of parleLal glands ln Lhe sLomach whlch
are needed for Lhe secreLlon of lnLrlnslc lacLors (ll).
-lnLrlnslc facLors (ll) ald ln Lhe absorpLlon of vlL 812

Absence of ll ! malabsorpLlon of 812 ! 812 deflclency ! ernlclous Anemla ! MegaloblasLlc Anemla

Sprue- also causes megaloblasLlc anemla due Lo decreased lnLesLlnal absorpLlon of lollc acld and vlL 812





ConLrol of 88C roducLlon

1. SLlmulaLed by hypoxla.
2. lnhlblLed by rlse ln clrculaLlng 88C levels
3. ConLrolled by clrculaLlng hormone called eryLhropoleLln.

Lxample-Llvlng ln hlgh alLlLudes where oxygen ls noL as abundanL as ln low lands---more 88C ls
produced.
--aLlenLs wlLh Luberculosls have normal blood levels and oxygen levels ln blood, buL suffer from
lmpalred oxygen absorpLlon ln Lhe lungs. 1hus, Lhe body ls Lrlggered Lo produce more blood.

LryLhropoleLln- ls a glycoproLeln hormone LhaL conLrols 88C producLlon by sLlmulaLlng bone marrow
-synLheslzed by boLh kldneys (90) and Lhe llver (10)
-lncreases producLlon of 8CL8?1P8C8LAS1S

uesLrucLlon of 88C

Llfe span--- 120 days
uesLrucLlon--- 1 of red cells ls replaced dally
1oLal red cell volume ls replaced every 4 monLhs
SlLe--- Spleen

* 1he number of red cells ln Lhe clrculaLlon ls deLermlned by Lhe balance beLween producLlon and
desLrucLlon.

PyperLonlc soluLlon- causes shrlnkage of 88C
PypoLonlc soluLlon- causes swelllng of cell and evenLual rupLurlng
lsoLonlc soluLlon- no change, equlllbrlum, 0.9 naCl, 3 dexLrose

Pemoglobln lormaLlon

l. 2 succlnyl Coa + 2 glyclne ! pyrrole molecule
ll. 4 pyrroles ! proLoporphyrln lx
lll. roLoporphyrln lx + le ! Peme
lv. Peme + globln ! Pemoglobln chaln (a or 8)
v. 2 a chalns + 2 8 chalns ! Pemoglobln

*Lach hemoglobln molecule has 4 le molecules. Cne le can hold one oxygen aL a Llme.
*1he prlmary funcLlon of 88C ls Lo LransporL hemoglobln, whlch ln Lurn carrles oxygen from Lhe lungs Lo
Lhe Llssues and Lhe carbon dloxlde back from Lhe Llssues Lo Lhe lungs.
*97 of oxygen ls carrled Lo Lhe Llssues ln comblnaLlon wlLh hemoglobln. Cnly 3 ls dlssolved ln cells.
*CC2 may comblne wlLh hemoglobln for lL Lo be LransporLed back Lo Lhe lungs for excreLlon.




Slckle cell anemla
ls an abnormallLy ln Lhe 8-chaln of Pemoglobln
upon exposure Lo C2, Lhe Pgb forms elongaLed crysLals
prone Lo hemolysls or easlly rupLures








l8Cn
3 grams ln Lhe human body
ma[orlLy ls ln Lhe form of Pemoglobln (63)
13 - 30 percenL ferrlLln (SLorage form ln Lhe llver)
4 myoglobln (hemoglobln ln Lhe muscle)
1 oLher heme compounds
0.1 wlLh Lransferrln
prlmary source ls red meaL

AbsorpLlon of l8Cn
<uuodenum>
1. Llver produces apoLransferrln!secreLed lnLo Lhe 8lLL!apoLransferrln + le! 1ransferrln (plasma)


!blood ! Lransferrln donaLes le Lo 88C!Pemoglobln ls produced
2. 1ransferrln l
l!excess le! 1lssues !lerrlLln

uesLrucLlon of Pgb

88C rupLures afLer 120 days
Pemoglobln ls released and broken down Lo blllrubln
le ls never wasLed. lL ls llberaLed and broughL back Lo Lhe lron sLores.

Women: are prone Lo l8Cn deflclency anemla due Lo mensLruaLlon. Should Lake supplemenLs aL leasL
once a day.

Anemlas- are broughL abouL by deflclency of Pgb
1oo rapld loss / Loo slow producLlon
8lood loss, le deflclency



C||n|ca| Corre|at|on:
When a paLlenL presenLs wlLh severe palor (anemla), Lhe physlclan wlll usually requesL for a
perlpheral blood smear.

8esulL:
lf Lhe 88Cs are mlcrocyLlc hypochromlc, Lhe cause of anemla ls l8Cn uLllClLnC?.
lf Lhe 88Cs are mlcrocyLlc hyperchromlc, Lhe cause of anemla ls vlL 812 / lCLlC AClu uLllClLnC?.

AplasLlc Anemla- ls a bone marrow dlsorder, where all blood cells are noL produced

PeredlLary SpherocyLosls- ls a slLuaLlon where Lhe 88Cs are spherlcal lnsLead of bl-concave

*lasma causes oncoLlc pressure, whlle 88C renders vlscoslLy Lo blood.

Anemla's effecL Lo Lhe hearL ls INCkLASLD WCkk LCAD.
Anemla causes decrease ln vlscoslLy of blood, decrease ln reslsLance Lo blood flow.
1hus, more blood goes Lo Lhe Llssues and flows back Lo Lhe hearL.
Anemla causes hypoxla. 8lood vessels wlll dllaLe. 1hus, more blood reLurns Lo Lhe hearL.

*Wlll cause lncreased hearL raLe.
*?ounger lndlvlduals can usually LoleraLe anemla.
*Clder lndlvlduals (60-70) should noL be lefL wlLhouL LreaLmenL because anemla may cause cardlac arresL
Lo lndlvlduals wlLh weaker hearLs.

CL?C?1LMlA

2
nd
uegree olycyLemla- ex. Llvlng ln hlgh alLlLudes, smoklng, havlng pulmonary dlseases

olycyLemla vL8A- a geneLlc aberraLlon, lncrease ln 88C does noL lnhlblL furLher producLlon of
eryLhropoleLln
-blood vlscoslLy ls lncreased, reslsLance Lo blood flow ls lncreased, blood ls prone Lo
cloLLlng eplsodes
-LreaLed by performlng ph|ebotomy

8LCCu 1?LS

1?L A 1?L 8 1?L A8 1?L C
A aggluLlnogens 8 aggluLlnogens A and 8 aggluLlnogens no aggluLlnogens
8 aggluLlnln A aggluLlnln no aggluLlnln A and 8 aggluLlnln

AggluLlnaLlon ls Lhe end polnL of Lransfuslon reacLlon
8eacLlon:
<AggluLlnaLlon> <Pemolysls>
AnLlbody!AnLlgen!88C wlll clump!W8Cs aLLack 88C


lmmedlaLe 1ransfuslon 8eacLlon-
lgM ! lmmedlaLe hemolysls

uelayed 1ransfuslon 8eacLlon- a resulL of secondary lmmune response

8LCCu CCMA1l8lLl1?

uonor Cell- refers Lo Lhe anLlgen
aLlenL's serum- refers Lo anLlbody

uonor's Cell 1?L A aLlenL's Serum 1?L 8 8esulL
AnLlgen - A AnLlgen - 8 (Crange) Mlnor reacLlon= (+)
AnLlbody - 8 AnLlbody - A (8ed) Ma[or reacLlon= (+)
*8lood Lypes are lncompaLlble.

uonor's Cell 1?L C aLlenL's Serum 1?L 8 8esulL
AnLlgen - nCnL AnLlgen - 8 (Crange) Mlnor reacLlon= (+)
AnLlbody - A8 AnLlbody - A (8ed) Ma[or reacLlon= (-)
*May proceed wlLh Lransfuslon. aLlenL may suffer sllghL lLchlness as reacLlon Lo small amounLs of
anLlbodles from uonor cell, whlch wlll easlly be dlluLed ln aLlenL's blood plasma.
*1ype C ls a unlversal uonor.

uonor's Cell 1?L A aLlenL's Serum 1?L A8 8esulL
AnLlgen - A AnLlgen - A8 (Crange) Mlnor reacLlon= (+)
AnLlbody - 8 AnLlbody - nCnL (8ed) Ma[or reacLlon= (-)
*May proceed wlLh Lransfuslon. aLlenL may suffer sllghL lLchlness as reacLlon Lo small amounLs of
anLlbodles from uonor cell, whlch wlll easlly be dlluLed ln aLlenL's serum.
*1ype A8 ls unlversal reclplenL.

Lrror ln blood Lransfuslon may resulL ln:
AggluLlnaLlon
uesLrucLlon of 88C membrane by phagocyLosls or anLlbodles !Pemolysls =!aundlce
Severe hemolysls/decreased amL. of 88C!clrculaLory shock!redlsLrlbuLlon of blood Lo more
lmporLanL organs, ex. 8raln! kldneys are bypassed!8enal vasoconsLrlcLlon!hemolyzed cells
flow Lo Lhe kldneys and block Lhe renal Lubules!kLNAL SnU1DCWN

8P 8LCCu C8Cu-anLlgens are C, u, L, c, d, e
8h - (+)----! Lhe slgn ls shown on Lhe blood Lype. Lxample: A+ means 8lood Lype A and 8P (+)
1he mosL lmporLanL facLor ls Lhe resulL of Lhe u" anLlgen.
8h anLlgens are noL lmmedlaLely developed afLer blood Lransfuslon from 8P (+) Lo 8P (-). lL Lakes
2-4 monLhs. AfLer developlng anLlgen, subsequenL Lransfuslons wlll be faLal.
8h (-) Lo 8h (+) Lransfuslons do noL resulL ln undeslrable reacLlon.




Lrythrob|astos|s Ieta||s (nDN)

1
sL
CASL

MoLher ls 8h (-) and laLher ls 8h (+)


8aby 8h (+)

8aby's blood mlxes wlLh moLher's blood
MoLher wlll develop anLl-8h lgC
MoLher's anLl-lgC wlll aLLack Lhe feLal 88C
8aby suffers from feLal anemla (8aby's hearL may fall)
8lood backflows, lncreases caplllary hydrosLaLlc pressure!hydrops, asclLes, pleural
effuslon, and scalp edema.
Spleen and llver are enlarged
1here wlll be blasLs ln Lhe perlpheral smear because lmmaLure cells are secreLed
(eryLhroblasLosls feLalls)
lncreased hemolysls of blood resulLlng ln hlgh blllrubln levels
8lllrubln accumulaLes ln Lhe braln (kernlcLerus)
Commonly Lhe baby dles (prevenLlon ls beLLer Lhan cure)

1reatment to nydrops:
Lxchange Lransfuslon
o 8h (+) blood ls removed durlng blrLh also Lo remove Lhe anLlbodles, Lhen replaced wlLh
8h (-) blood Lo sLop lnLeracLlon of anLlbodles wlLh (+)
o 1hen Lhe baby ls allowed Lo produce lLs own 8h (+) blood
8ho-gam (8h lmmunoglobulln)
o 8ho-gam wlll coaL Lhe feLal 88C so LhaL Lhe maLernal blood wlll noL ldenLlfy lL and wlll
noL produce anLlbodles
o 8ho-gam ls admlnlsLered on Lhe 28
Lh
week or 7
Lh
monLh (durlng whlch Llme Lhe moLher's
blood mlxes wlLh Lhe baby's)

*llrsL baby ls noL affecLed because Lhe senslLlzaLlon wlll Lake several monLhs.
*8ho-gam should be glven on Lhe 1
sL
pregnancy Lo prevenL moLher's senslLlzaLlon.
*Cnly lgC can peneLraLe Lhe placenLa because of lLs small slze.

2
nd
CASL

MoLher ls 8h (+) and laLher ls 8h (-)

8aby 8h (-)

1he baby and Lhe moLher are unaffecLed because no reacLlon wlll occur.
1he baby cannoL produce anLlbodles durlng Lhls sLage.
repared by: M.A. amu|ar