RBCs, HGB and HCT

carries oxygen to tissues, exchanges for CO2, then circulate back to the lungs for oxygen and the cycle is repeated

What is the purpose of RBCs?

120 days

What is the life cycle of a normal RBC?

RBCs, WBCs, and platelets

What cells are circulating throughout the body in response to the need for nutrients, oxygen, or disease/infection prevention?

Hematopoiesis

Blood cells are made in bone marrow through what process?

proteins (cytokines)

Hematopoietic stem cells (precursor cells) proliferate and differentiate influenced by __________ that affect there function

peripherial blood

Once hematopoietic stem cells mature, they are released into ________ to be utilized as needed

Erythropoiesis

production of red blood cells

kidneys, bone marrow, liver, spleen

What are the 4 blood organs?

(the organs involved with the production of RBCs (erythropoiesis))

kidneys

secrete erythropoietin for RBC production

bone marrow

site for RBC production

Colony-Forming Unit-Erythrocyte

What does CFU-E stand for?

liver

stores blood

spleen

the site for RBC destruction and recycling of a certain components

Erythrocytes

aka Red Blood cells (RBCs)

4.6-6.2 mil/ul

normal RBCs range for males

4.2-5.4 mil/ul

normal RBCs range for females

5.0-6.5 mil/ul

normal RBCs range for newborns

Erythropoietin

A glycoprotein hormone secreted by the kidneys in response to the need for more RBCs

- stimulates the bone marrow to produce more RBCs

1. low oxygen to tissues (hypoxia)

2. low intracellular oxygen tension (PO2)

What 2 things stimulate the need for more RBCs?

hypoxia

low oxygen to tissues

PO2

partial pressure of oxygen

bone marros

Erythropoietin stimulates ________ to produce more RBCs

anemia

cardiac or pulmonary disorders

abnormal hemoglobin

high altitudes

What conditions stimulate erythropoiesis?

true

T or F:

Levels of Erythropoietin can be decreased in cases of renal insufficiency or end stage renal disease

kidneys shut down, leading to decreasing erythropoietin & RBC count

Levels of Erythropoietin can be decreased in cases of renal insufficiency or end stage renal disease due to:

Pronormoblast

Basophilic normoblast

Polychromatic normoblast

Orthochromic normoblast

Polychromatic erythrocyte

Erythrocyte

Maturation process of the RBC starting with:

Pronormoblast

Rubriblast

Prorubricyte

Rubricyte

Metarubricyte

Reiculocyte

Erythrocyte

Maturation process of the RBC starting with:

Rubriblast

bone marrow

Pronormoblasts (Rubriblast) → Orthochromic normoblasts (Metarubricyte) are commonly seen where?

peirpherial blood

Reticulocyte (Polychromatic erythrocyte) → Erythrocyte are commonly seen where?

Pronormoblast (Rubriblast) - Orthochromic normoblasts (Metarubricyte)

What RBCs are commonly seen in the bone marrow?

Reticulocyte (Polychromatic erythrocyte) - Erythrocyte

What RBCs are commonly seen in the peripherial blood?

hemoglobin

A protein that serves as a vehicle for the transport of oxygen & carbon dioxide

- Erythrocytes are composed

Porphyrin Ring (4), Globin chains (2), Iron (4)

Hemoglobin Structure:

red cell mitochondria

location of heme synthesis (iron incorporating into the porphyrin ring)

heme

ferrous iron (Fe2+)

globin

protein made up of amino acids

mitochondria; cytoplasm

Heme will leave the _________ to combine with globin chain in the __________

hemoglobin

forms when heme complexes with globin chains

Gower I, Portland's, Gower II, Hgb F

What are the globin chain types fetal hemoglobin?

Hgb A, Hgb A1c, Hgb A2, Hgb F

What are the globin chain types adult hemoglobin?

alpha & zeta

2 alpha-like globin chains:

141

How many amino acids does the alpha-like chains have?

beta, delta, epsilon, gamma

4 non-alpha globin chains:

146

How many amino acids does the non-alpha chains have?

nonhelical

__________ segments of the beta chain allows for the chains to fold up on themselves

tetrameric

Hemoglobin is ___________

2 pairs of unlike chains (2 alpha-like & 2 non-alpha)

What does tetrameric mean?

zeta

Which alpha-like chain is seen in utero?

alpha

Which alpha-like chain is seen at birth?

2 zeta, 2 epsilon

Fetal hgb:

Gower 1

2 zeta, 2 gamma

Fetal hgb:

Portland's

2 alpha, 2 epsilon

Fetal hgb:

Gower II

2 alpha, 2 gamma

Fetal & Adult hgb:

Hgb F

34-36 weeks gestation

90-95% of total Hgb F production in the fetus takes place up until how many weeks gestation?

50-85%

At birth, what percent of Hgb F is present?

2 alpha, 2 beta

Adult hgb:

Hgb A

92-95%

What percent do we see Hgb A in adults?

2 alpha, 2 beta-NH-glucose

Adult Hgb:

Hgb A1c

3-5%

What percent do we see Hgb A1c in adults?

2 alpha, 2 delta

Adult Hgb:

Hgb A2

2-3%

What percent do we see Hgb A2 in adults?

1-2%

What percent do we see Hgb F in adults?

Hemoglobin Polypeptide Chain Curve

What is this?

epsilon chain

Line A represents:

alpha chain

Line B represents:

gamma chain

Line C represents:

beta chain

Line D represents:

delta chain

Line E represents:

PO2

Hemoglobin's affinity to oxygen is usually expressed as:

(partial pressure of oxygen)

P50

50% of the hemoglobin is saturated with oxygen is written as:

Oxygen Dissociation Curve

A graph that represents the fractional saturation of hemoglobin (y-axis) plotted against the concentration of oxygen measured as the PO2 (x-axis)

temperature, CO2, O2, 2,3-BPG concentration and pH

List the components that cause the shift in the Oxygen Dissociation curve:

normal/baseline

What does the bold black line on the ODC represent?

7.4

What is the pH of the bold black line?

26mmHg

What is the PO2 of the black line?

50%

The hemoglobin is what % saturated with oxygen?

increased oxygen affinity in RBC

reduced oxygen delivery to tissues

What are the implications of a left shift in the Oxygen Dissociation Curve?

high pH (more basic)

low temps

low 2,3-BPG

fetal Hgb (Hgb F)

methemoglobinemia

carboxyhemoglobinemia

high O2 affinity Hgb variants

List the examples that can cause a left shift in the Oxygen Dissociation Curve?

newborns

A left shifted OCD curve is typically seen in which population?

reduced oxygen affinity in RBCs

increased oxygen delivery to tissues

What are the implications of a right shift in the Oxygen Dissociation Curve?

low pH (more acidic)

increased CO2 (hypoxia)

high temps

high 2,3-BPG

low O2 affinity Hgb variants

List the examples that can cause a right shift in the Oxygen Dissociation Curve?

anemic

A right shifted OCD curve is typically seen in which population?

2,3-BPG

product in the glycolytic pathway to breakdown glucose into pyruvate so it can be further broken down into ATP & NADH that affects the oxygen affinity of hemoglobin

give RBC its red color

2,3-Biphophoglycerate

What does 2,3-BPG stand for?

Embden-Meyrhoff pathway

The glycolytic pathway that produces 2,3-BPG was formally known as:

maintain shape, flexibility and membrane integrity

ATP energy is crucial for the RBC to:

intracellular cation concentrations

ATP also regulates _____________ in the RBC

decrease

increase O2 in the cell = __________ 2,3-BPG

increase

decrease O2 in the cell = __________ 2,3-BPG

2,3-DPG

What is another name for 2,3-BPG?

reduced; Ferric (Fe+++)

Deoxyhemoglobin contains Iron in a (reduced / oxidized) state, represented as (Ferric / Ferrous) (Fe +++ / Fe++).

oxidized; Ferrous (Fe++)

Oxyhemoglobin contains Iron in a (reduced / oxidized) state, represented as (Ferric / Ferrous) (Fe +++ / Fe++).

Deoxyhemoglobin

Hemoglobin - Oxygen

- reduced state; Ferric (Fe+++)

Oxyhemoglobin

Hemoglobin + Oxygen

- oxidized state; Ferrous (Fe++)

Carboxyhemoglobin

Methemoglobin

Sulfhemoglobin

The three clinically significant hemoglobin's:

Carboxyhemoglobin

clinically significant hemoglobin that is bound to carbon monoxide (CO)

cherry red in color

caused by smoke inhalation or high pollution

- ex. patients in a house fire (exposed to a lot of smoke in short amount of time)

cherry red

What color is Carboxyhemoglobin?

5 g/dL

toxic level of carboxyhemoglobin

Methemoglobin

clinically significant hemoglobin that is also called deoxyhemoglobin

chocolate brown in color

increased levels seen in people who are exposed to oxidizing chemicals, drugs, or aniline dyes

chocolate brown

What color is Methemoglobin?