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1. blood definition

2. plasma definition


1. Differentiated cells, generally nondividing, suspended in a solution called plasma


2. Plasma is composed of coagulation proteins in solution with other proteins and solutes known as Serum


Bone marrow definition

- Source of multipotential stem cells and their differentiated progeny 

- source of cellular material of blood

- source of immunologically active cells of the body (reticuloendothelial system)

- source of an adherent bed of cells essential to hematopoietic proliferation, immunomodulation, and cell survival (stroma)



pronormoblast->basophlic normoblast->polychromatophiilic normoblast->orthochromic normoblast->reticulocyte->mature erythrocyte (red blood cell)


Blood formation- embryology

19 days- yolk sac (early precursors)

6 wks- liver ( main site wks 9-24), Spleen (blood, nodes, thymus)

10-11 wks- bone marrow (main site >24 wks)

- cord blood has many hematopoietic stem cells

by 2 week postpartum- hematopoiesis usally confined to marrow



As erythrocyte cell matures:

1. cytoplasm initally blue with increased protein synthesis and then takes more and more red color as hemoglobin is produced-- (pink cytoplasm)

2. mitochondria lost and protein syn stops

3. nuceus becomes inactive, condense, shrunken and clumped (pyknotic) and eventually extruded from cell.

4. when loses its nucleus becomes a reticulocyte. Young cells can have blueish tint. Contains somes residual RNA

5. RNa lost after 1-2 days in circulation and becoes mature erythrocyte.



1. Red blood cell count

2. hemoglobin

3. hematocrit

4. retic count

1. RBC count

Men 4.4-6

women 4.2-5.5


2. hemoglobin 

men 14-18

women- 12-16


3. hematocrit

men 40-54%

women 37-47%


4. retic count



Retic index

2 corrections:

1. retic % x HgB (patient)/Hgb (control)

2. if nucleated RBCs are present, correct for 2 day lifespan of retic (/ 2)




RBC terminology

1. microcytic

2. macrocytic

3. hypochromic

4. anisocytosis

5. poikylocytosis

6. polythemia

7. polycythemia

8. anemia

1. RBC smaller than normal

2. RBC larger than normal

3. Less HG/ Cell (larger central clear area)

4. variation in size of RBC

5. Variation in shape of RBCs

6. Too many RBCS

7. too few RBCS


hypoproliferative anemia

- most common type

- charecterized by reticulocytipenia

- charecterized by low or NL MCV

- induced by elements that impair the production of intact heoglobin or regulators of hematopoiesis

- disorders of erythrocyte production, of production of mature hemoglobin, of hematopoietic stem cell, of bone marrow microenviroment


disorders of erythrocyte production



- deficiencies on erthropoietin

- chronic renal insufficiency

- pure erthrocyte aplasia


disorders of production of mature hemoglobin

1. disorders of iron

- iron deficiency

- iron sequestration (anemia of chronic disease/inflammation, sideroblastic anemia)

2. Disorders of heme

- thalassemia

- lead intoxication

- Hemoglobin E

- sideroblastic anemia


Iron regulation in the body

- HgB 67%

- plasma <.2>

- stores 30%

- heme enzymes, myoglobin 3%

- no active secretion mechs

- lost only when cells lost (urine, skin, gut) about 1mg a day

- 20-30 mg turnover between RBC destruction and production

- regulation mainly by absorption

- overload= oxidant damage

- deficiency= O2 transport, e- transport



Iron deficeincy anemia- most common cause of anemia

chronic blood loss





Mechanisms of iron deficiency

- GI blood loss

- mentrual blood loss

- blood loss in pregnancy and lactation

- urinary blood loss

- dietary deficiency

- intestinal malabsorption

- atransferrinemia


clinical manifestation of iron deficiency

1. anemia

- hypoproliferative, reticulocytopenic, microcytic

2. epithelial changes

- koilonychia, depapillated toungue, esophageal webs and strictures

3. skeletal changes

- growth retardation

- skull changes


anemia of chronic disease

1. Decreased RBC production secondary to decreased FE availability and erythropoietin dysfunction (reutilization defect)

2. FE essential for microorganismsgrowth and division

3. Inflamation leads to cytokine release, which lead to rxns to withhold FE from organisms and RBCs


Ineffective disirders of hematopoiesis

- charecterized by nuclear -cytoplasmic dissociation

- intramedullary maturation arrest 

- intramedullary hemolysis

- reticulocytopenia with macrocytosis

- may not be restricted to hematopoiesis



Folate Deficiency

- megoblastic anemia, mucosal changes,

- nutritional

- infancy

- pregnancy and lactation

- drugs

- malabsorption


B-12 absorption

- intrinsic factor- a required cofactor for B12 absorption secreted by the parietal cells of the gastric mucosa

- terminal ileum- B12 bound to intrinsic factor is taken up by specific receptors in the terminal ileum

- transcobolamin II- physiologic transport protein in the blood. Transports from ileum and rleases to tissues (bone marrow)


Vitamin B12 deficiency

- megaloblastic anemia, neuro Sx, mucosal changes, Low B12 in blood

- pernicious anemia= defiency in Intrinsic factor activity

- Malabsoprtion

- competition (fish tapeworm D. latem)

- dietary (rare)

- hereditary (rare)


B12 CNS symptoms

- presthesias hands and feet

- decreased vibration and position sense

- coordination, ataxia

- mental disturbances,, psychoses