C. No nucleus and no mitochondria 1. Where did it go relationship to reticulocytes? 4. Does this mean you can t make new RBCs?

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1 I. Characteristics of Erythrocytes A. Biconcave discs--what purpose does this serve? B. 1/3 hemoglobin by volume (remember this with hematocrit) (Fig. 19.4, pg. 673) 1. Heme 2. Globin 3. Fe 4. Oxyhemoglobin 5. Deoxyhemoglobin 6. Cyanosis 7. Relationship with CO 2 8. Nitric oxide (NO) (vasoconstriction) and super nitric oxide (SNO) (vasodilation) a. Function? b. Fe relationship? c. Blood pressure? C. No nucleus and no mitochondria 1. Where did it go relationship to reticulocytes? 2. Why is this important? 3. Can RBCs reproduce? 4. Does this mean you can t make new RBCs? 5. How long does a RBC live? 6. What is the significance of no mitochondria? D. Size 1. Size of RBC compared to diameter of capillary? 2. So their membrane must be tough and flexible explain. 3. Sickle cell disease (in detail see p. 689) Revised Spring

2 II. Red Blood Cell Counts (Review from lab) A. Total red blood cell count 1. What is this? 2. Normals a. Males: b. Females: c. Children 3. Increases due to 4. B. Hematocrit (See previous notes-introduction to Blood & Lab) C. Hemoglobin (See previous notes-hematocrit/hemoglobin relationship & Lab) III. Red Blood Cell Destruction (Fig. 19.5, pg. 674) A. Wear and tear on RBC s B. Macrophages (phagocytosis) 1. Fixed macrophages (liver and spleen) 2. Wandering macrophages (monocytes of tissues) 3. Monocytes vs. neutrophils? C. Floaters D. Heme split from globin (Fig very important) 1. Globin amino acids and reused new proteins (dietary proteins?) 2. Heme a. Iron (Fe 3+ ) removed and conserved 1) Transferrin 2) Ferritin and hemosiderin 3) Reused in red bone marrow for making but what do you need for this to happen? Fe Globin Vitamin B 12 Intrinsic Factor Pernicious anemia Revised Spring

3 b. Biliverdin bilirubin urobilinogen 1) Macrophage activity 2) Bacterial action c. Urobilinogen 1) (Kidney) Urobilin urine 2) (Large Intestine) Stercobilin feces 3. Plasma bilirubin levels a. Test for b. >2mg/100ml c. Jaundice d. Icterus e. Kernicterus 4. Causes for elevated bilirubin levels a. Excessive production of bilirubin 1) Excessive destruction of RBCs 2) Excessive hemolysis 3) Decreased stability of RBC membrane 4) E.g.: Sickle cell, malaria, drugs b. Liver damage 1) Infectious hepatitis 2) Cirrhosis of liver alcoholics 3) Obstruction of common bile duct c. Neonatal jaundice (Icterus neonatorum) 1) 1/3 of all newborns develop neonatal jaundice a few days after birth. 2) Why? 3) Explain what you can do. i. Feedings that promote bowel movements ii. Fluorescent lights d. Breast-feeding? Don t stop!!!!! Revised Spring

4 IV. Red Blood Cell Production Erythropoiesis (Fig. 19.6) A. 2 million per second keeps up with RBC destruction B. Where does this happen? (Previous notes and remember from 1 st semester where do you have red bone marrow as a child vs. as an adult?) C. Erythropoiesis See Fig. 19.6, pg. 675 D. CFU-E Proerythroblast Reticulocyte Erythrocyte E. Control of Erythropoiesis (See Fig diagram negative feedback mechanism) 1. Stimulus=Hypoxia to tissues (detected in kidneys) a. High altitudes b. Circulatory disruptions c. Chronic bleeding d. Chronic lung disease e. Anemias (see below) f. Lack of 2. Renal Erythropoietic Factor (REF) 3. Activates hormone erythropoietin (EPO) 4. Target of erythropoeitin? 5. Proerythroblasts reticulocytes erythrocytes F. Reticulocyte count 1. Diagnostic test for 2. Normal too few too many? a % of mature RBCs b. <.5% c. >1.5% 3. Polycythemia (see previous notes again!) a. Abnormal increase in RBCs b. Strange looking RBCs c. Hematocrit >50% (may be %) d. Increases viscosity decreases flow through vessels and increases risk for thrombosis ( ) resulting in and end-organ damage (explain) e. Causes: 1) Physiologic (due to body s compensating response to low O 2 ) 2) Pathological (tumors) 3) Blood doping? f. Treatment 1) phlebotomy (be very careful before you do it) 2) leeches Revised Spring

5 G. Dietary factors influencing RBC production (relate this to anemia(s) below) 1. Vitamins B 12 and folic acid needed for a. Lack of B 12 b. Disorder of stomach lining c. Parietal cells of gastric glands don t make enough intrinsic factor d. Intrinsic factor important for e. Without intrinsic factor RBCs are 1) Macrocytic 2) Hyperchromic f. Pernicious Anemia g. Treatment h. So is it really a dietary anemia? 2. Iron (Fe) is needed for a. Absorbed in small intestine b. Fe reused what is the significance? 1) Male 1/2 mg/day 2) Menstruating female 2mg/day 3) Pregnant female additional why? c. Lack of Fe 1) What conditions may lead to a lack of Fe? i. absorption of iron ii. loss of iron (bleeding) iii. body demand for iron (pregnancy) iv. iron in diet 2) Hypochromic anemia 3) Becomes microcytic d. Iron Deficiency Anemia Revised Spring

6 3. Dietary proteins (amino acids) a. Needed for b. Lack of proteins results in V. RBC Disorders Anemias Refer to the end of chapter 19 in text and to information above. Complete this on your own. A. Anemias 1. Deficiency of RBCs oxygen carrying capacity 2. Decreased number of or decreased amount of 3. Describe symptoms 4. Decrease viscosity, decrease peripheral resistance, increases work load on heart. Decreased oxygen carrying capacity increases demands on heart. Increased oxygen need can push the heart over its ability heart failure with increased exercise. B. Iron-deficiency anemia C. Pernicious anemia D. Hemorrhagic anemia 1. Abnormal loss of 2. Acute 3. Chronic E. Aplastic anemia F. Hemolytic anemia G. Sickle-cell disease (sickle-cell anemia?) 1. Hemolysis greater than erythropoiesis 2. Permeability to potassium? 3. Relationship to malaria resistance? Revised Spring

7 H. Nutritional anemia (protein deficiency and others? see above) I. Thalassemia 1. Mediterranean populations 2. Resembles Fe deficiency anemia, but potential for Fe overdose 3. Hemolytic/deficient synthesis of Hb, microcytic hypochromic J. Treatment for anemias 1. Iron supplements when and why or why not? a. Bleeding/injury b. Excess menses c. Bleeding ulcers d. Hemolysis e. Sickle cell f. Thalassemia g. Aplastic h. Pregnancy (and what other supplements?) i. Dietary lack of iron 2. Frequent blood transfusions 3. Renal Erythropoietic Factor (REF)/erythropoietin (EPO) when would it be effective? Revised Spring

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