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HIS 7 - Haemopoiesis Describe the composition of whole blood & its components

70 kg man = 5.6L of blood, 22% solid, 78% water Plasma (55%) - complex aqueous solution of (gases, salts, proteins, carbs, lipids) Formed Elements (45%) - RBC (99%), platelets (<1%), WBC (<1%)

Review/summarize the sites, steps & factors involved in haemopoiesis , with particular reference to erythropoiesis
Red marrow functions to produce RBC (33%) and WBC (66%) [shorter half life]

Erythropoisis occurs in: o Foetus: Yolk sac, liver, spleen, red bone marrow o Adult: Red bone marrow and extramedullary (only in certain situations) Erythropoisis requires: o Iron, vitamins (B12+Folate), amino acids Erythropoisis: Proerythroblast Basophilic Erythroblast Polychromatic Erythroblast Orthochromatic Erythroblast Reticulocytes Mature RBC

Describe the characteristics and life cycle of erythrocytes

Life span: 120 days, removed by macrophages, and recycled: o Globin (amino acids reused), iron (reutilized) and haem (excreted in bile)

Evaluate haematological indices

Red blood count = 4.5 - 5.4 x 106 per uL (4.5 - 5.4 x 1012 L) Reticulocytes (%) = 0.2 - 2% Useful index of erythropoietic activity in the bone marrow.

Packed cell volume = haematocrit = 45% Measures the fraction of blood occupied by RBC

Hemoglobin = 14-18 g/dL male, 12-16 g/dL females Amount of Hb in blood, indicator of iron binding capability

Mean Cell Volume (MCV) Volume of average RBC (80-90fl) hamatocrit/RBC count

Mean Cell Haemoglobin (MCH) Concentration of Hb in average RBC Hb concentration/ red-cell count = 27-33 pg

Mean Cell Haemoglobin Concentration (MCHC) Concentration of Hb in average RBC Hb concentration/haematocrit = 32-35 g/dl

Discuss anaemia and polycythaemia

Anaemia - Deficiency of haemoglobin in the blood. Decreased rate of erythropoisis, loss of erythrocytes or deficiency in haemoglobin content of erythrocytes. Decrease in Hb/ RBC/ PCV below reference range for age and gender. Occurs in iron deficiency, blood loss B12 or folate deficiency Divisions of Anaemia - Cause: 1. Due to blood loss Acute blood loss: trauma, postpartum bleeding Chronic blood loss: excessive menstrual loss (RBC smaller and lower haemoglobin)

2. Due to lack of RBC production Deficiency - iron, vitamin B12, folate Marrow failure - aplastic anaemia Marrow invasion - leukaemias Maldevelopment - sickle cell anaemia

3. Due to high rates of RBC destruction Genetic disorders

Divisions of Anaemia - Size: 1. Microcytic - Small RBC's Ex: iron deficiency (most common cause of anaemia) 2. Normocytic - Normal size, but overall haemoglobin levels decreased (chronic disease) 3. Macrocytic - Large size, Ex: B12/intrinsic factor/folate deficiency - Red cells grow too large with odd shapes (Megaloblast,pernicious anaemia)

Polycythaemia - Excess RBC, decreased blood flow, increased viscosity and slower
oxygen delivery 1. Primary polycythamia (Up to 80%, Norm: 45%) Tumor-like condition of the bone marrow in which erythropoiesis at uncontrolled rate. Ex: Polycythamia Vera 2. Secondary polycythamia (Up to 60%) Caused by either natural or artificial increases in the production of erythropoietin Altitude sickness: where RBC are produced at a greater rate to oxygen delivery.

3. Relative polycythamia Body loses fluid but not erythrocytes o Loss of fluid in vomiting/diarrhea

Explain the clinical evaluation of anaemia

Pallor: An abnormal loss of skin or mucous membrane colour. Koilonychia - When nail curves upwards and becomes spoon-shaped. Angular stomatitis - Deep cracks and splts form at corners of mouth. Glossitis - Inflammation or infection of the tongue.

Interpret a Full Blood Count (FBC)

Most common lab tests, measures blood count of RBC, WBC and platelets.