Erythropoiesis

and Bilirubin Metabolism

V. Sutarmo Setiadji

VSS

Blood cells production - During intrauterine development, erythrocytes are produced first by yolk sac and then by the developing liver and spleen until the bone marrow is formed and takes over erythrocytes production exclusively. - In adults such extramedullary hematopoiesis may occur in diseases in which the bone marrow becomes destroyed or fibrosed.
VSS

- In children, blood cells are actively produced in the marrow cavities of all the bones. - By age 20, the marrow in the cavities of long bones, except for the upper humerus and femur, has become inactive. Marrow in the cavities of short and cancellous bones are active as blood cells manufacturer.

IL-1 GM-CSF IL-6 G-CSF IL-3 SCF

VSS

SCF = Stem Cell Factor is needed for the Proliferation and self renewal of pluripotent haematopoietic stem cell Colony-stimulating-factor (CSF) granulocyte-macrophage CSF granulocyte CSF macrophage CSF Interleukin-1 (IL-1), IL-6, IL-3 is needed to convert pluripotent uncommited stem cells to commited progenitor cells
(WF Ganong: Review of Medical Physiology)
VSS

13 March 201412 Jan, 2009

VSS

Red Blood Cells (Erythrocytes)

- Carry hemoglobin - Biconcave disks - Manufactured in the bone marrow

- Before matured, in the peripheral circulation they have nuclear residue, and are called reticulocytes - In the circulation the matured cell has no nuclei - Survive in the circulation for an average of 120 d - About 5.4 million/mL in men, 4.8 million/mL in women - About 7.5 mm in diameter and 2 mm thick - Each contain about 29 pg of hemoglobin
VSS

VSS

12 Jan, 2009

VSS

Erythropoiesis in the bone marrow is increased when an individual bleed or becomes hypoxic. The adjustment is brought about by circulating level of erythropoietin, a circulating glucoprotein that contains 165 amino acid residues and four oligosaccharide chains. Its blood level is markedly increased in anaemia. Erythropoietin (EPO) increases the number of EPO-sensitive committed stem cells in the bone marrow.
VSS

Erythropoietin are produced by the kidney. Patient with chronic kidney disease usually has anaemia. The treatment of anaemia has some alternatives. One alternative is using erythropoiesis stimulating agent (ESA), especially for anaemia related cancer. Now some kinds of ESA are developed.

VSS

-aminolevulinic acid (ALA)

URIDINE DIPHOSPHATE GLUCURONIC ACID