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LECTURE II-fate of RBC

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245 views20 pages

LECTURE II-fate of RBC

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thecurepublishing
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LECTURE II

• FATE OF RBC
• IRON
• JAUNDICE
• PCV
• BLOOD INDICES
• RBC FRAGILITY
• HEMOLYSIS
FATE OF RBC
• OLD RBC
– ↑ WEAR & TEAR
– ↓ METABOLIC PROCESS
– CELL LESS VIABLE
– CELL MEMBRANE MORE FRAGILE
– EVENTUALLY FRAGMENT IN RED PULP
OF SPLEEN (GRAVE YARD OF RBC)
Macrophage
OLD RBC MACROPHAGES
SPLEEN, LIVER, BONE MARROW

FRAGMENTED

Hb RELEASED GLOBIN

HEME IRON BM

LIVER
PORPHYRIN
ALBUMIN
BILIRUBIN Conjugates with
glucoronic acid

stercobilinogen Small Bile


Intestine duct Kidney

Urobilinogen
Feces
Urine
MACROPHAGES

OLD RBC

RES
BILIRUBIN

CIRCULATION BILE DUCT


FATE OF RBC

SI

URINE
FECES
JAUNDICE
• Yellow colour of skin,
conjunctiva & mucous
membrane
• Due to excess
bilirubin in plasma &
body fluids
• Bilirubin > 2mg%
(normal 0.2-0.8 mg%)
CAUSES OF JAUNDICE
PRE HEPATIC HEPATIC
• HEMOLYTIC JAUNDICE • Infectious or toxic
• EXCESS HEMOLYSIS damage to liver cells
OF RBC
– Hepatitis
– Alcohol
POST HEPATIC
• OBSTRUCTIVE
JAUNDICE
• Common bile duct stones
• Pancreatic cancer
• Liver metastasis
JAUNDICE OF THE NEW BORN
• PLASMA BILIRUBIN > 1 mg%
• CONTINUES TO RISE IN THE 1ST WK
• DECLINES AFTER THAT
• CAUSE : EXCESS HEMOLYSIS
• IMMATURITY OF HEPATIC CONJUGATING
ENZYMES
• TREATMENT : PHOTOTHERAPY
– BILIRUBIN LUMIRUBIN
• LUMIRUBIN – SHORTER HALF LIFE
• DRUGS – PHENOBARBITONE - INCREASES
GLUCURONYL TRANSFERASE
IRON
• TOTAL QUANTITY OF IRON – 4-6gms%
• 70% Hb, 20% - FERRITIN, 10% MYOGLOBIN AND
CYTOCHROME
• DALILY REQUIREMENT 1mg/DAY
• ↑ IN PREGNANCY AND LACTATION
• DAILY CONSUMPTION APPROX 20mg/day
• MOST FOOD CONTAINS IRON IN FERRIC STATE
• ABSORPTION ONLY IN FERROUS STATE
• AIDED BY HCL AND VITAMIN C
TRANSPORT & STORAGE
FOOD INTAKE LIVER
Bile duct

APOTRANSFERRIN
SMALL INTESTINE

Fe- pinocytosis
Receptors on RBC
PLASMA Cell membrane
Release where Fe - Transferrin
ever Endocytosis
Necessary
Erythroblast

Excess Mitochondria
Fe+Apoferritin
Ferritin Iron
Hemosiderin Heme synthesis
(storage form)
PACKED CELL VOLUME -PCV
• HEPARINIZED BLOOD
• CENTRIFUGED AT 3000rpm
FOR 30 MIN
• CELLS SETTLES DOWN
• CLEAR PLASMA ABOVE
• COLUMN OF RED CELLS – PCV
• HAEMATOCRIT
• BUFFY COAT – WBC & PLATELETS
• NORMAL PCV – 45%
PACKED CELL VOLUME
VARIATION OF PCV
PHYSIOLOGICAL↑in RBC PATHOLOGICAL↑in RBC
• HIGH ALTITUDE • POLYCYTHEMIA VERA
• NEW BORN INFANTS • CONGENITAL HEART DIS
• SEX [MALE > FEMALE] • CHRONIC LUNG DISE
• EXERCISE • LEUKEMIA
• HYPER THYROIDISM

PHYSIOLOGICAL↓in RBC PATHOLOGICAL↓in RBC


• CHILDREN • ANAEMIA
• PREGNANCY
(HEMODILUTION
RELATIVE ↑ IN PCV
• OLD AGE
BURNS, DEHYDRATION
VOMITING, DIARRHOEA
BLOOD INDICES
• MEAN CORPUSCULAR
• COLOUR INDEX HEMOGLOBIN (MCH)
• % OF Hb • Hb (gm/L)
% OF RBC(PCV) RBC COUNT
• 0.9 – 1.1 • 29.5 – 2.5 pg
• ↓ - HYPOCHROMIA
• ↓ Hb
• DUE TO ↓ IRON
• THALASSEMIA
BLOOD INDICES
• MEAN CORPUSCULAR Hb • MEAN CORPUSCULAR
CONCENTRATION VOLUME (MCV)
• MCHC=(Hb%/PCV)*100 • PCV (L)/RBC COUNT
• (MCH/MCV) * 100 • 80-90 3 (Fentolitre)
• 30-37 % • ↑ - MACROCYTOSIS
• 37% PHYSIOLOGICAL UPPER – B12 DEFICIENCY
LIMIT
• MORE RELIABLE
– FOLATE DEFICIENCY
(NO RBC COUNT USED) • ↓- MICROCYTOSIS
• ↑ - DEHYDRATION OF RBC – IRON DEFICIENCY
– SPHEROCYTOSIS – GLOBIN DEFIENCY
• ↓ - Hb FORMATION
– Fe DEFECIENCY
– THALASSEMIA
ERYTHROCYTE
SEDIMENTATION RATE
• BLOOD MIXED WITH
ANTICOAGULANT
– LEFT TO STAND
– RBC SETTLES DOWN
• NORMAL VALUE
WINTROBE WESTERGENS
MALE 0-9 mm 0-5 mm I hour
FEMALE 0-20 mm 0-7 mm I hour
FACTORS INFLUENCING ESR
• FIBRINOGEN AND GLUBULIN
– ↑ ROULEAUX FORMATION
– ↑ ESR
• CHOLESTEROL - ↑ ESR
• TEMPERATURE - ↑ ESR
• ALBUMIN - ↓ ESR
• PCV ↑ - ↓ ESR
• LECITHIN - ↓ ESR
SIGNIFICANCE OF ESR
• USED AS A PROGNOSTIC TOOL
• ASSESS PROGRESS OF PATIENTS
DURING TREATMENT FOR CHRONIC
DISEASE
• INTENSITY OF PYOGENIC INFECTION
VARIATION IN ESR
PHYSIOLGICAL ↑ PHYSIOLOGICAL ↓
• NEW BORN • MALE
• FEMALE
• PREGNANCY
• OLD AGE
PATHOLOGICAL ↑ PATHOLOGICAL ↓
• TB, LEUKEMIA, • SICKLE CELL ANAEMIA
NEPHROSIS • SPHEROCYTOSIS
RHEUMATIC FEVER,
• POLYCYTHEMIA
RHEUMATIC ARTHRITIS,
PYOGENIC INFECTIONS
• MALIGNANT TUMOR
RBC FRAGILITY
• TENDENCY OF RBC RBC FRAGILITY ↑
TO BREAK DOWN • ANAEMIA
– SPHEROCYTOSIS
• NORMAL 0.48-0.32%
– SICKLE CELL ANAEMIA
SALINE – THALASSEMIA
• ABNORMALITY IN • METHAEMOGLOBINAEMIA
PROTEIN NETWORK • G6PD DEFICIENCY
OF RBC MEMBRANE • ALLERGIES
• DEFECT IN Band 3, RBC FRAGILITY ↓
Spectrin, Ankyrin • IRON DEFICIENCY
• DEFECTIVE RBC– ANAEMIA
Removed by SPLEEN
HEMOLYSIS
BREAKDOWN OF RBC & RELEASE OF Hb
HEMOLYTIC AGENTS
• HYPOTONIC SALINE (< 0.42%)
• CHEMICALS
– Ether, Chloroform
Dissolves lipid cell membrane
– Dilute acids & alkalis
Altering pH & Saponification
• BACTERIAL TOXINS
• SNAKE VENOM 0.9 0.5 0.4 0.3

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