AHMADU BELLO UNIVERSITY ZARIA

FACULTY OF CLINICAL SCIENCE

DEPARTMENT:
MBBS

COURSE. HPHY 205

BLOOD AND BODY FLUID

REG NO.
U21MD1120

NAME.
HADIZATU AHMADU ZUMMO

15TH MARCH, 2024

RED BLOOD CELLS (RBC)
RBC stands for Red Blood Cell, also known as erythrocyte. They are the most common type of
blood cell and are responsible for transporting oxygen from the lungs to the body's tissues and
carbon dioxide from the tissues back to the lungs for exhalation. RBCs contain a protein called
hemoglobin, which binds to oxygen and carries it throughout the body.
The main functions of RBCs include:
1. Oxygen Transport: RBCs pick up oxygen in the lungs, where it binds to hemoglobin, and
transport it to tissues throughout the body.
2. Carbon Dioxide Transport: RBCs carry carbon dioxide, a waste product of cellular
metabolism, from the tissues back to the lungs, where it is exhaled.
3. Buffering pH: RBCs help maintain the pH balance of the blood by absorbing and releasing
hydrogen ions.
RBCs are produced in the bone marrow through a process called erythropoiesis, which is
regulated by hormones such as erythropoietin (EPO). The lifespan of RBCs is typically around
120 days, after which they are removed from circulation by the spleen and liver.
Abnormalities in RBC count, size, shape, or function can lead to various blood disorders,
including anemia, polycythemia, sickle cell disease, and thalassemia. Therefore, monitoring RBC
parameters is essential for diagnosing and managing hematological conditions and ensuring
optimal oxygen delivery to tissues throughout the body.
PHYSIOLOGICAL AND PATHOLOGICAL VARIATION OF RBC
Red blood cells (RBCs) exhibit both physiological and pathological variations. Which include:
1. Physiological Variations:
- Hematopoiesis: RBCs are continually produced in the bone marrow through a process
called hematopoiesis. This is a normal physiological process necessary to maintain adequate
oxygen transport in the body.
- Erythropoiesis Regulation: Erythropoiesis, the production of RBCs, is tightly regulated by
various factors including erythropoietin (EPO) levels, oxygen tension, and availability of
nutrients like iron, vitamin B12, and folate.
- RBC Lifespan: Normally, RBCs have a lifespan of about 120 days before they are removed
from circulation by macrophages in the spleen and liver.
- Oxygen Transport: RBCs play a crucial role in transporting oxygen from the lungs to
tissues and carrying carbon dioxide back to the lungs for exhalation.
2. Pathological Variations:
 - Anemia: Anemia occurs when there is a decrease in the number of RBCs or a decrease in
the amount of hemoglobin within RBCs. This leads to reduced oxygen-carrying capacity,
resulting in symptoms such as fatigue, weakness, and shortness of breath.
- Polycythemia: Polycythemia is characterized by an increase in the number of RBCs. It can
be primary (polycythemia vera) due to abnormal proliferation of bone marrow cells or secondary
to conditions like chronic hypoxia, kidney disease, or certain tumors stimulating excess
erythropoietin production.
- Hemolytic Disorders: Hemolytic disorders involve the premature destruction of RBCs,
leading to anemia. Conditions such as sickle cell disease, thalassemia, and autoimmune
hemolytic anemia are examples of hemolytic disorders.
- Bone Marrow Disorders: Diseases affecting the bone marrow, such as leukemia,
myelodysplastic syndromes, and aplastic anemia, can disrupt normal RBC production, leading to
abnormalities in RBC count, size, and shape.
- Nutritional Deficiencies: Deficiencies in nutrients essential for erythropoiesis, such as iron,
vitamin B12, and folate, can impair RBC production and lead to anemia.
- Hypoxia: Chronic hypoxia, as seen in high-altitude environments or lung diseases, can
stimulate erythropoiesis and result in an increase in RBC production.
SEX VARIATION
Pathological and physiological variations of red blood cells (RBCs) based on sexes:
1. Physiological Variation:
- Hormonal Influence: Testosterone, the primary male sex hormone, stimulates
erythropoiesis, the production of RBCs. As a result, adult males typically have higher RBC
counts compared to females.
- Hematocrit: Hematocrit, the percentage of blood volume occupied by RBCs, tends to be
higher in males than in females. This is partly attributed to hormonal differences and contributes
to the higher RBC count in males.
- Blood Oxygenation: Oxygen-carrying capacity can influence RBC production. Males
generally have larger body sizes and muscle mass, which may necessitate a higher RBC count to
meet oxygen demands.
2. Pathological Variation:
- Anemia: Both males and females can develop various types of anemia, which result in
decreased RBC count or reduced hemoglobin levels. Causes of anemia include nutritional
deficiencies, chronic diseases, genetic disorders, and blood loss.
 - Iron Deficiency Anemia: Iron deficiency anemia is more prevalent in females, especially
during reproductive years, due to menstrual blood loss and increased iron demands during
pregnancy. However, it can also affect males, particularly those with poor dietary iron intake or
conditions causing chronic blood loss.
- Hormonal Disorders: Hormonal imbalances, such as those seen in polycystic ovary
syndrome (PCOS) or hypogonadism, can affect erythropoiesis and lead to alterations in RBC
count.
FOOD VARIATION
Pathological and physiological variations of red blood cells (RBCs) based on food:
1. Physiological Variation:
- Nutrient Intake: A balanced diet rich in nutrients essential for erythropoiesis, such as iron,
vitamin B12, and folate, supports healthy RBC production.
- Iron: Iron is a crucial component of hemoglobin, the protein in RBCs that binds oxygen.
Adequate dietary iron intake is necessary for normal erythropoiesis. Foods rich in iron include
red meat, poultry, fish, legumes, and fortified cereals.
- Vitamin B12 and Folate: Vitamin B12 and folate are essential for DNA synthesis and RBC
maturation. Deficiencies in these nutrients can impair erythropoiesis and lead to megaloblastic
anemia. Food sources of vitamin B12 include meat, fish, dairy products, and fortified cereals,
while folate-rich foods include leafy green vegetables, beans, and fortified grains.
2. Pathological Variation:
- Nutritional Deficiencies: Inadequate intake or absorption of iron, vitamin B12, or folate
can lead to various types of anemia, including iron deficiency anemia, megaloblastic anemia, and
macrocytic anemia.
- Iron Deficiency Anemia: Insufficient dietary iron intake or conditions causing chronic
blood loss (e.g., gastrointestinal bleeding, menstruation) can result in iron deficiency anemia,
characterized by low RBC count and hemoglobin levels.
- Megaloblastic Anemia: Inadequate intake of vitamin B12 or folate, or conditions impairing
their absorption (e.g., pernicious anemia, malabsorption disorders), can lead to megaloblastic
anemia, characterized by large, immature RBCs (megaloblasts).
- Malnutrition: Severe malnutrition, such as in cases of starvation or eating disorders, can
lead to overall nutrient deficiencies, including those necessary for RBC production, resulting in
anemia.
3. Other Considerations:
 - Dietary Preferences: Individuals following restrictive diets (e.g., vegetarian or vegan) may
be at higher risk of certain nutritional deficiencies, such as iron or vitamin B12, if they do not
adequately supplement their diet with alternative sources of these nutrients.
- Supplementation: In cases of confirmed or suspected nutrient deficiencies contributing to
anemia, supplementation or dietary modifications may be prescribed to correct the deficiency
and support RBC production.
EMOTIONAL VARIATION
Certainly, let's explore the pathological and physiological variations of red blood cells (RBCs)
based on emotion:
1. Physiological Variation:
- Autonomic Nervous System: Emotions trigger responses in the autonomic nervous system,
leading to physiological changes such as increased heart rate, blood pressure, and respiratory
rate.
- Hormonal Response: Emotional states can influence the release of hormones like
adrenaline and cortisol, which can affect blood flow and oxygen delivery to tissues.
- Stress Response: During emotional arousal or stress, the body may prioritize oxygen
delivery to vital organs, potentially altering RBC distribution in the body.
2. Pathological Variation:
- Chronic Stress: Prolonged or chronic stress can dysregulate the hypothalamic-pituitary-
adrenal (HPA) axis, leading to increased cortisol levels, which may suppress immune function
and affect bone marrow activity, including RBC production.
- Psychological Disorders: Mental health conditions such as depression and anxiety may
impact appetite, sleep patterns, and overall physiological functioning, potentially leading to
nutritional deficiencies and anemia.
- Behavioral Factors: Emotional states may influence dietary habits and lifestyle factors such
as sleep quality, physical activity levels, and substance use, which can indirectly affect RBC
production and overall health.
3. Acute Responses:
- Fight or Flight Response: During acute stress or fear, the body may activate the "fight or
flight" response, increasing heart rate and blood pressure to prepare for physical activity. This
transiently affects RBC distribution but typically does not lead to pathological changes.
 - Vasomotor Changes: Emotional arousal can cause vasomotor changes, altering blood flow
to different organs and tissues, including the bone marrow, which may influence RBC production
temporarily.
4. Long-term Effects:
- Chronic Illness: Prolonged emotional stress or psychological disorders may contribute to
chronic conditions such as cardiovascular disease, autoimmune disorders, or gastrointestinal
disorders, which can indirectly affect RBC production and lead to anemia.
- Medication Effects: Some medications used to manage psychological disorders or stress-
related conditions may have side effects that impact RBC production or function.
POLYCYTHEMIA
Certainly, let's discuss the pathological and physiological variations of red blood cells (RBCs)
based on polycythemia:
1. Physiological Variation:
- High Altitude Acclimatization: Physiological polycythemia can occur in response to
chronic hypoxia at high altitudes. The body compensates for reduced oxygen availability by
increasing RBC production to enhance oxygen-carrying capacity.
- Smoking: Chronic exposure to cigarette smoke can stimulate erythropoiesis, leading to a
mild increase in RBC count and hematocrit levels. This is considered a form of relative
polycythemia.
2. Pathological Variation:
- Primary Polycythemia (Polycythemia Vera): This is a myeloproliferative disorder
characterized by abnormal proliferation of bone marrow cells, particularly erythrocyte
precursors. It results in an absolute increase in RBC count, hematocrit, and total blood volume.
Polycythemia vera is associated with mutations in the JAK2 gene, leading to uncontrolled
erythropoiesis.
- Secondary Polycythemia: This can result from conditions that stimulate excess production
of erythropoietin (EPO), such as chronic hypoxia (e.g., chronic obstructive pulmonary disease,
living at high altitudes), certain tumors (e.g., renal cell carcinoma, hepatocellular carcinoma),
and certain genetic disorders (e.g., congenital heart disease with right-to-left shunting).
Secondary polycythemia is characterized by increased RBC production as a compensatory
response to tissue hypoxia.
- Apparent Polycythemia: Also known as stress or Gaisböck syndrome, this condition is
characterized by elevated hematocrit levels due to hemoconcentration rather than true
polycythemia. It is typically associated with dehydration, smoking, obesity, or alcoholism.
3. Effects of Polycythemia:
- Increased Blood Viscosity: Elevated RBC count and hematocrit levels increase blood
viscosity, which can impair blood flow and predispose individuals to thrombotic events such as
stroke, heart attack, or deep vein thrombosis.
- Hypervolemia: Polycythemia vera and secondary polycythemia are associated with
expanded blood volume, which can lead to hypertension and heart failure.
- Splenomegaly: Chronic stimulation of erythropoiesis can lead to splenomegaly (enlarged
spleen) due to increased sequestration and destruction of RBCs in the spleen.
- Pruritus: Pruritus (itching), particularly following exposure to warm water or during
bathing (aquagenic pruritus), is a common symptom in polycythemia vera, likely due to
histamine release from activated mast cells.
1. Primary Polycythemia (Polycythemia Vera):
- Pathological Variation:
- Polycythemia vera is a myeloproliferative disorder characterized by abnormal proliferation
of bone marrow cells, particularly erythrocyte precursors.
- It results in an absolute increase in RBC count, hematocrit, and total blood volume due to
uncontrolled erythropoiesis.
- Other myeloid cell lines, such as platelets and granulocytes, may also be increased.
- Polycythemia vera is associated with mutations in the JAK2 gene, leading to dysregulated
signaling pathways and increased cell proliferation.
- Physiological Variation:
- While there are no physiological variations associated with primary polycythemia itself, the
body may exhibit compensatory responses to the increased RBC mass, such as increased blood
flow and oxygen delivery to tissues.
2. Secondary Polycythemia:
- Pathological Variation:
- Secondary polycythemia results from conditions that stimulate excess production of
erythropoietin (EPO).
- Common causes include chronic hypoxia (e.g., chronic obstructive pulmonary disease,
living at high altitudes), certain tumors (e.g., renal cell carcinoma, hepatocellular carcinoma),
and certain genetic disorders (e.g., congenital heart disease with right-to-left shunting).
 - The increased EPO production leads to increased RBC production as a compensatory
response to tissue hypoxia.
- Physiological Variation:
- Physiological variations in secondary polycythemia are primarily related to the underlying
condition causing the increase in EPO production.
- For example, in chronic hypoxia at high altitudes, the body responds by increasing RBC
production to enhance oxygen-carrying capacity and maintain tissue oxygenation.
- Similarly, in conditions such as chronic obstructive pulmonary disease, increased EPO
production stimulates erythropoiesis to compensate for impaired oxygen exchange in the lungs.
3. Effects of Polycythemia:
- Both primary and secondary polycythemia can lead to increased blood viscosity,
hypervolemia, hypertension, and increased risk of thrombotic events.
- Complications may include thrombosis, hemorrhage (due to platelet dysfunction),
splenomegaly, and pruritus (especially in polycythemia vera).
- Treatment strategies may include phlebotomy to reduce blood volume, medication to suppress
erythropoiesis (e.g., hydroxyurea), and addressing underlying conditions contributing to
secondary polycythemia.

When red blood cell (RBC) count increases or decreases beyond normal levels, it can lead
to various physiological and pathological consequences:
1. Increase in RBC Count (Polycythemia):
- Increased Blood Viscosity: Elevated RBC count leads to increased blood viscosity, making
blood thicker and more resistant to flow. This can impair circulation and increase the risk of
thrombotic events such as stroke or heart attack.
- Hypervolemia: Higher RBC count can result in expanded blood volume, leading to
hypertension and increased strain on the cardiovascular system.
- Splenomegaly: Chronic stimulation of erythropoiesis may cause enlargement of the spleen
(splenomegaly) due to increased sequestration and destruction of RBCs.
- Pruritus: Itching, particularly following exposure to warm water (aquagenic pruritus), is a
common symptom in polycythemia vera, possibly due to histamine release from activated mast
cells.
2. Decrease in RBC Count (Anemia):
 - Reduced Oxygen-Carrying Capacity: Decreased RBC count leads to reduced hemoglobin
levels and diminished oxygen-carrying capacity of the blood. This can result in symptoms such
as fatigue, weakness, shortness of breath, and dizziness.
- Tissue Hypoxia: Inadequate oxygen delivery to tissues can lead to tissue hypoxia,
impairing cellular function and metabolism.
- Compensatory Responses: The body may respond to anemia by increasing heart rate
(tachycardia) and respiratory rate to enhance oxygen delivery to tissues. Bone marrow may also
increase erythropoiesis in an attempt to restore RBC levels.
- Cardiovascular Effects: Severe or chronic anemia can lead to cardiac complications such as
heart failure, as the heart works harder to compensate for reduced oxygen delivery.
- Pallor: Anemia can cause pale skin and mucous membranes due to decreased blood flow
and reduced oxygenation of tissues.