RED BLOOD CELL AND HAEMATOCRIT
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Transcript of RED BLOOD CELL AND HAEMATOCRIT
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DR NILESH KATE
MBBS,MD ASSOCIATE PROF
DEPT. OF PHYSIOLOGY
RED BLOOD CELL.
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OBJECTIVES. Functional Morphology. Red cell Membrane, Composition and
Metabolism
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FUNCTIONAL MORPHOLOGY. Normal size, shape & counts Variations in size, shape & count. Packed cell volume & red cell indices Rouleaux formation and erythrocyte
sedimentation rate.
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FUNCTIONAL MORPHOLOGY. Like other cells
bounded by cell membrane but Non-Nucleated.
Cytoplasm contains pigmented protein – Haemoglobin
It is Chromoprotein – colour giving protein.
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NORMAL SIZE Diameter – 7.2 μm (6.9-
7.4) Thickness – 2 μm at
periphery & 1 μm at center
Surface area – 120-140 μm2
Volume - 80 μm3 (78-86)
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NORMAL SHAPE Circular, biconcave disc. Advantages of biconcave shape –
Flexible , capillaries minimum diameter – 3.5 μm.
Greater surface area Can withstand changes of osmotic
pressure Allow easy exchange of O2 & CO2 &
rapid diffusion of other substances.
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NORMAL COUNTS At birth – 6-7 millions/mm3 Adult males – 5-6.5 millions/mm3 Adult females – 4.5-5.5 millions/mm3
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VARIATIONS IN SIZE ANISOCYTOSIS
Microcytosis Iron deficiency anaemia Prolonged forced breathing Increased osmotic pressure
Macrocytosis Megaloblastic anaemia Muscular exercise Decreased osmotic pressure.
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VARIATIONS IN SHAPE POIKILOCYTOSIS
Crenation /shrinkage – Hypertonic solution.
Spherocytes – Hypotonic solutions
Elliptocytes – anaemias Sickle cells – presence of
abnormal haemoglobin (Hb-S) Poikilocytes – flask shaped,
hammer shaped
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VARIATIONS IN COUNTPHYSIOLOGICAL
Increase AGE – Newborn more –
hypoxia then decreases due to physiological jaundice
SEX – Males > Females HIGH ALTITUDE EXCESSIVE EXERCISE EMOTIONAL CONDITIONS TEMPERATURE - high MEALS
Decrease At high barometric
pressure After sleep In pregnancy
(Haemodilutuion)
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VARIATIONS IN COUNTPATHOLOGICAL
Increase Primary – Myeloproliferative
disoreders Secondary – state of chronic
Hypoxia Congenital heart disease Chronic respiratory disoreders Mild haemorrhges Phospherous, arsenic
poisoning.
Decrease Anaemia
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PACKED CELL VOLUME & RED CELL INDICES
Packed cell volume Determination of PCV Red cell Indices.
Mean corpuscular volume Mean corpuscular Haemoglobin Mean corpuscular Haemoglobin concentration. Colour index
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PACKED CELL VOLUME Percentage of the cellular
elements in the whole blood. Also called Haematocrit value. Normal values in
Males – 45% Females – 42% Increases in polycythemia &
decreases in anaemia.
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DETERMINATION OF PCV Blood mixed with
anticoagulant oxalate & centrifuged in Haematocrit tube/wintrobes tube @ 3000rpm for 30 min.
Layers Superficial – plasma Middle white buffy coat – WBC &
platelets Lower – packed RBC.
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HAEMATOCRIT VALUES Observed Haematocrit –
observed value True Haematocrit –
Multiplying by 0.98 2% plasma trapped in cells
Body Haematocrit – Multiplying by 0.87 Haematocrit for venous blood
is greater than whole body.
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RED CELL INDICES Mean corpuscular
volume Mean corpuscular
Haemoglobin Mean corpuscular
haemoglobin concentration.
Colour index.
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MEAN CORPUSCULAR VOLUME Average volume of single red blood
cell. MCV = PCV x 10
--------------
RBC count/mm3
= 45X10/5 = 90 μm3
Normal value 78-94 μm3
Decreased in Microcytosis
Increased in Macrocytosis
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MEAN CORPUSCULAR HAEMOGLOBIN
Average weight of haemoglobin in each RBC MCH = Hb gm% X 10
-----------------
RBC count/mm3
= 15X10/5X1012 = 30 pg
normal range – 27-33 pg
Increases – Spherocytosis & megaloblastic anaemia
Decreases - anaemia
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MEAN CORPUSCULAR HAEMOGLOBIN CONCENTRATION.
Amount of Hb expressed as percentage of the volume of RBC.
MCHC = Hb gm%
------------------- X 100
PCV/100ml
= 15/45 X 100 = 33.3%
Normal value – 30-33%Decreases – Iron deficiency anaemia
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COLOUR INDEX. Ratio of Haemoglobin to RBC
CI = % of normal Hb
---------------------
% of normal RBC count
= 100/100 = 1
Normal range= 0.85-1.15Insignificant
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ROULEAUX FORMATION AND ERYTHROCYTE SEDIMENTATION RATE.
Rouleaux formation. Erythrocyte sedimentation rate. Methods of determination of ESR.
Westergren’s Method Wintrobe Method.
Clinical significance of ESR. Factors affecting ESR. Physiological variations in ESR Pathological variations in ESR.
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ROULEAUX FORMATION. Tendency of RBC to pile one over
the other like coins Major Role – Discoid shape &
protein coating. Does not occur in circulation due
to plasma proteins Reversible phenomenon different
from agglutination where cells are irreversibly clumped.
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ERYTHROCYTE SEDIMENTATION RATE.
Def – Rate at which red cells sediment when blood containing anticoagulant is allowed to stand in vertical tube.
Unit – expressed in mm at the end of 1 hr.
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METHODS OF DETERMINATION OF ESR.
Westergren’s Method Blood with anticoagulant
3.8% sodium citrate in ratio 4:1 is loaded in westergren’s tube vertically upto mark 0 & allowed to stand for 1 hr.
Reading is taken at the end of 1 hr.
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METHODS OF DETERMINATION OF ESR.
Wintrobe’s Method Blood with
anticoagulant is filled in wintrobe tube with the help of special pippete “Pasture pippete” and then allowed to stand for 1 hr and reading is taken at the end of 1 hr.
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CLINICAL SIGNIFICANCE OF ESRPROGNOSTIC TEST
Normal value By Westergren’s
Method Males – 3-7mm Females – 5-9mm
By Wintrobe’s Method
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FACTORS AFFECTING ESR. Rouleaux Formation – after inflammatory &
neoplastic diseases fibrinogen & other proteins released favour rouleaux formation & ESR
Size of RBC – macrocytes raises ESR No of RBC- Inverse relationship Viscosity of Blood – Inverse relationship
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PHYSIOLOGICAL VARIATIONS IN ESR
Age – less in infant & old age
Sex- males < females Mensturation - raised Pregnancy – raised.
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PATHOLOGICAL VARIATIONS IN ESR.
Increase Tuberculosis Malignant diseases Collagen diseases All anaemia except
sickle cell anaemia Chronic infection.
Decrease Polycythemia Decreased fibrinogen
level Sickle cell anaemia Allergic conditions Peptone shock
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RED CELL MEMBRANE, COMPOSITION AND METABOLISM Red cell membrane.
Structure Permeability.
Composition of red blood cells. Metabolism of Red blood cells.
Embden-Meyerhof Pathway Hexose monophosphate shunt. Utilization of ATP
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RED CELL MEMBRANE. Trilaminar structure with
bimolecular lipid layers & 2 layers of protein.
Imp Lipids – Glycolipids, Phospholipids & cholesterol.
Proteins – peripheral & integral.
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PROTEINS ……. Peripheral Protein – rich in lecithin &
sphingomyelin. Integral Proteins – anion exchange protein
(Band 3) & Glycophorins (Blood group antigen)
Inner surface contains phosphatidylserine & phosphatidyl ethanolamine
Shape & flexibility is maintained by Spectrin, Ankyrin & actin.
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PERMEABILITY SEMIPERMEABLE
MEMBRANE Impermeable to Na, Ca &
Barium ions, fats & sugars Slightly to amino acids Freely permeable to – anions
Cl-, SO4-,HCO3-, urea, ammonia alcohol & bile salts.
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COMPOSITION OF RED BLOOD CELLS.
Water – 60% Haemoglobin – 35% Lipids – 5%, lecithin, cephalin & cholesterol. Proteins- Glutathiones Lipoprotein – elenin (Calvin) Enzymes – Glycolytic system, catalase, carbonic anhydrase Glucose , amino acids Ions – Cl-, PO4-, HCO3- & Non-protein nitrogenous substances – urea, NH4, creatine,
uric acid
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METABOLISM OF RED BLOOD CELLS.
Glucose only fuel used by RBC
Embden-Meyerhof pathway – 90% glycolysis Give 2 ATP
Hexose-Monophosphate shunt- 10% glycolysis
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Thank You