Introduction to Blood Erythrocytes and Anemia Clinical Pathology

Introduction to Blood, Erythrocytes and Anemia Clinical Pathology Ms. Canga

Introduction to Blood, RBCs, and Anemia Topics for discussion: • Function of blood and various components • Composition – Fluid – Cellular (Specific to erythrocytes) • Anemia • Staining

The Function of Blood • Classified as a ___________ tissue – Fun Fact: Approximately ___% of animals body wt. is blood. • _________________________ • _____________

Function: Transportation • Carries _______, nutrients, etc… – To every living cell in the body. – Carried by _______ in erythrocytes – Nutrients, etc. are dissolved and delivered via ______ • Carries waste products of cellular metabolism – Primary waste product is ______ – Carried to disposal organs that excrete from body • _________&______

Transportation continued • Transports ____________ – From _______ glands to target _____ • Transports ____________ – From ____________ in to circulation – Final destination is the _______ as needed • Transports ____________ – To site of _______ within _________ – Clump together to prevent further escape.

Function: Defense • Leukocytes (Will be covered in more detail later) – Defense from foreign invaders • _______________________ • Platelets (Will be covered in more detail later) – Work along side 13 clotting factors in the blood • Are activated when a ____________wall is damaged. • Very complex process in which ALL factors must be activated in ______ and _________ in order for clot to form. • Each factor depends on the _______ factor to activate it.

Function: Regulation • Regulatory system – _______________________ – ____________

Regulation • Acid-base balance – Regulation of blood ______. – Normal range is ________(IDEAL = _____) • Higher p. H = ____________ • Lower p. H = ____________ – Required for ____________ – Assists with neutralizing acidic waste products of cellular metabolism. • Which blood is MORE alkaline? Arterial or venous? • Why?

Regulation continued • Body temperature – Regulators located in the _______are influenced by temperature of the blood that passes over them. • Most dogs and cats average 101. 0 – 102. 5 o. F • Homeostasis – Body tissue fluid is maintained as _________ as possible. – If fluid is lost in large amounts, fluid moves from ____________ into tissues to compensate. • Leaves less plasma in bloodstream, causing ____________. – If fluids are given or excessive fluids are present, fluid moves from ___________ into bloodstream. • Excessive fluid in bloodstream causes ____________.

Composition of Blood • ____________ tissue • Composed of ______and _____ – Cellular portion is composed of: • _______– Responsible for gas exchange • _______– Responsible for defense and immunity • _______– Prevent leakage of blood from vessels – Liquid portion of whole blood is called _____ • Whole Blood: Blood in cardiovascular system, OR blood that contains plasma and all other components. • Plasma is ~90% water.

“Recipe” for an RBC • __________ (for the synthesis of heme-) – _____ is also important in release of iron from tissues into plasma __________ (formation of -globin) Essential _______ (phospholipid bilayer) _________: helps form RBC _________: also helps in RBC formation • __________: works with B 12 to help form RBC. • •

Formation of RBCs • Formerly known as ‘_____’ • Process of formation is called ________. – Erythropoiesis takes place in _________ and is initiated by the cytokine called _________ (EPO). – EPO: produced by _____, is released when kidney cells detect _____in blood. – EPO acts on ______and causes it to begin undergoing _____divisions, developing into several RBC precursors.

Maturation Cycle of an Erythrocyte

Morphological Changes during Maturation • Rubriblast: – Is very large, with royal blue _____. – Contains a large purple nucleus in a loose _____ pattern. • Prorubricyte: – Is slightly smaller, with a _____ cytoplasm. – The _____ composing the nucleus is slightly smaller and _____ and stains _____. • Rubricyte: – Is smaller still, with either a _____or slightly _____ cytoplasm as it begins to acquire the _____molecules.

Morphological Changes during Maturation • Metarubricyte: – Cytoplasm is similar in color to _____ RBC. – Nucleus is now considered _____ (becoming more dense) and stains dark blue. – (__________ may be seen here) • Reticulocyte: – _____is “pushed out” of cell leaving behind __________ composed of RNA. – Cytoplasm stains slightly blue, and __________ may be seen if stained with Wright’s stain. (Deff-Quick is a modified Wright’s stain) – Mature RBC is seen after all __________ is lost from reticulocyte.

Morphological Changes During RBC Maturation

The End Result: Erythrocytes

Erythrocytes • Mature RBC is __________ sac. – Contains ~ _____ % water and _____ % solids (mainly _____) • Canines have _____RBCs; ~_____ in diameter – μ = a micron. One micron is one millionth of a meter (VERY TINY) • Cats, horses, cows, sheep and goats are smaller; ~_____ in diameter.

Erythrocytes - Morphology • Membrane is “__________” • Can change shape, but is not _____. • ________ shape provides more __________ to allow for gas exchange to take place. • Disk shape allows for shorter _____ distance in and out of cell compared to a sphere. – Animals with _____ biconcave shape usually have _____ number of RBCs on average.

Erythrocytes & Hemoglobin • Carry _____ to all tissues of the body. • O 2 carried through hemoglobin, which binds to the oxygen. • _____ = pigment portion – produced in _____ • _____ = protein portion – Produced by _____

Hemoglobin - structure • For every heme group, there is one _____ molecule • Four _____ groups attach to each globin molecule. – This means that each hemoglobin molecule can carry _____ molecules of oxygen.

Hemoglobin molecule

Hemoglobin Types • • _____ hemoglobin (Hb. E) _____ hemoglobin (Hb. F) _____ hemoglobin (Hb) Each type of hemoglobin is found during different stages of development in the animal.

Embryonic and Fetal hemoglobin • Embryonic hemoglobin (Hb. E): is found in early developing _____. • Fetal hemoglobin (Hb. F): is present in fetal blood during mid to late _____. – Is also present up to a couple of months after birth. – Highest concentration of Hb. F is at _____.

Adult Hemoglobin (Hb) • Found in the RBCs of all animals beginning a couple of weeks to months after birth. • Gradually replaces _____ as primary type being produced by the body. • Inside normal RBCs, Hb is __________.

Function of (Adult) Hemoglobin • Transports _____to the tissues • Exists in two normal physiological states. • __________: Carrying oxygen – One oxygen molecule is associated with each iron molecule. – p. H, temperature, and O 2 and CO 2 levels influence ability of Hb to carry O 2 • __________: Has given up oxygen. – Also known as _____ hemoglobin. – CO 2 is transported directly and indirectly in the RBC and is dissolved in the _____.

RBC Life Span and Destruction • Average in dogs is ~____ days • Average in cats is ~____ days • As an RBC ages, they are replaced by young, but mature RBCs from _____ in constant ___________ cycle. • Process of aging is called __________.

Senescence • The process of cellular _____ • Enzyme activity _____ • Cell loses __________ and becomes _____ as its volume decreases. • 90% of destruction of senescent RBCs occurs through __________. – Takes place _____ the cardiovascular system via macrophage __________. – Macrophages of _____ are especially active in removal of senescent RBCs

Extravascular Hemolysis • Once inside a macrophage, the _________ of the RBC is destroyed. • Contents are recovered from the macrophages and ____is transported back to red bone marrow. • Heme is eliminated from the body by being converted to ______. Bilirubin binds to ______ (plasma protein) and is carried to the liver. • Because it is not ____ soluble, it is called ____________ or free bilirubin.

Extravascular Hemolysis, cont’d. • Once in the liver, bilirubin is _________ to ____________, making the combination water soluble. • Conjugated bilirubin is excreted as a ______ pigment into the intestines. • Some conjugated bilirubin is converted into ___________ by bacteria and eliminated in the ______ as urobilin. • Other conjugated bilirubin is converted into ___________ and excreted in the _____ as stercobilin.

Senescence • ____% of RBC destruction takes place through _____________ hemolysis – Takes place within _______________. – Results in blood cell fragmentation and/or destruction • When RBC membrane ruptures in blood vessel, _____ is released directly into the blood. – __________ Hb is picked up by transport protein called _____. – _____carries unconjugated Hb to macrophages in the _____ for breakdown. – Once in liver, __________hemolysis continues.

Senescence • When __________is filled with __________ hemoglobin, the excess unconjugated Hb has nothing to bind to. • Excess Hb is carried to _____ for excretion in urine. – _________hemolysis results in plasma that is pink, red, or brownish. – C/S will be __________. – Urine will be pink, red, or brownish in color.

Anemia • Anemia: a pathological condition resulting in decreased oxygen-carrying capacity of the blood. • May be caused by: – Low number of circulating mature RBCs • Increased _____ (RBC parasites/radiation therapy) • Decrease _____ (Bone marrow suppression) • Inappropriate _____ (hemorrhage) – Not enough __________being produced for normal RBCs present. (Iron deficiency) • Appropriate # of RBCs are present • Insufficient Hb to fill each cell.

Classifying Anemia • Anemia may be classified as either: – Regenerative: Usually caused by hemorrhage or hemolysis. – Non-regenerative: Involves the bone marrow (More on Anemia in next presentation)

Polycythemia • An _____ above normal in the number of RBCs. • Three common types: – _______________________________________ – ____________________

Relative Polycythemia • Seen in __________ • Common in _____ animals due to sensible and insensible losses such as: – Excessive __________, _____or reduced _____intake. – You will learn more about sensible and insensible losses in Special Topics.

Treatment of Relative Polycythemia • Correction of cause of ___________ • Use of __________ • Managing _____ intake is critical

Compensatory Polycythemia • Also known as _____ Polycythemia • Result of _____ • Bone marrow is stimulated to produce more RBCs because tissues aren’t getting enough oxygen. • Animals living in __________ often develop this type of polycythemia. • Patient in heart failure may develop this type of polycythemia because heart isn’t pumping enough blood to tissues, resulting in _____.

Treatment of Compensatory Polycythemia • __________may be required if no inappropriate physiological cause • If there is an underlying _____, surgical correction, followed by _____ treatment is required. (phlebotomy to normalize PCV may also be required)

Polycythemia Rubra Vera • Rare __________ disorder • Characterized by increased ________ of RBCs • EPO levels are _____. Bone marrow is producing _____ stimulation from EPO.

Treatment of Polycythemia Rubra Vera • _____is required – ~_____m. Ls/kg • Simultaneous _____therapy to maintain overall blood _____. • Treatment with Rx: Hydroxyurea will help to suppress the production of RBCs.

Staining of Blood • Different _____ within cell stain specific colors. • Many different hematology stains – Different names but similar staining characteristics. – Many are _________-_____stains (Wright’s stain, Giemsa, Leishman’s, Wright-Giemsa, and May-Grunwald are all Romanovsky-type stains) • Also called __________ stains because they stain more than one color. • Combination of basic blue and acidic red dyes dissolved in _____alcohol. • Allows __________ structures to stain blue • Allows __________ structures to stain red.

Staining Blood • Stain depends on ____ you are performing. – Each test we do in here will have specific stain instructions. • __________stain is the most widely used hematology stain. – Alkaline part is __________ blue – Acidic part is _____ • Modified Wright’s stains offer faster staining times but don’t stain some cellular structures as effectively. – __________ is a Modified Wright’s stain.

Sources • http: //compepid. tuskegee. edu/syllabi/pathobio logy/pathology/clinpath/chapter 2. html • Clinical Anatomy and Physiology for Veterinary Technicians: Colville and Bassert. Second Edition • Merckvetmanuals. com