SANTO TORIBIO DE MOGROVEJO CATHOLIC UNIVERSITY

SCHOOL OF MEDICINE

TEORICAL SESSION N° 6

ERYTHROPOYESIS: Red
blood cell, Iron and Globin

RBC DISORDERS
Blgst. JOSÉ LLONTOP NUÑEZ, MSc.
CLINICAL LABORATORY-2022-II
CLINICAL LABORATORY : BASIC HEMATOLOGY-ANEMIA MARKERS VI-MEDICINE USAT

Competencias:

 Explica los fundamentos fisiopatológicos de la

eritropoyesis y desórdenes eritrocitarios.
 Proponen un plan diagnóstico laboratorial para el
estudio hematológico de la función y trastornos de
los eritrocitos.

Blgst. JOSÉ LLONTOP NUÑEZ, MSc.

CLINICAL LABORATORY-2022 II
 CLINICAL LABORATORY : BASIC HEMATOLOGY-ANEMIA MARKERS VI-MEDICINE USAT

ERYTHROPOIESIS: Erythroid maturation

Erythropoiesis occurs (5-7 days) in the bone marrow and is a complex, regulated process for maintaining
adequate numbers of erythrocytes in the peripheral blood.
EPO-R
(Receptor)
Half-life: 4 - 6 h
22-54 mU/ml
EPO
(Erithropoietin)
(Pronormoblast)
(Rubriblasts) CFU-E
(Pronormoblast) (Basofilic normoblast)
(Erithroid cells)

Kidney glomeruli

(Basofilic (Prorubricytes)
normoblast)
Reduced oxygen tension
(Hypoxia)
2,3-DPG
Oxygen affinity of Hb (Polychromatophilic (Orthochromic
+ β chains
normoblast) normoblast)
(Rubricytes) - Low blood volumen.
(Polychromatophilic - Anemia.
normoblast) - Low hemoglobin.
- Poor blood flow.
- Pulmonary disease.
(Metarubricytes) - High altitude.
(Orthochromic normoblast)

Shift reticulocyte – BM
(Reticulocyte – PB)
Shift reticulocyte –
BM (Reticulocyte – PB)

Blgst. JOSÉ LLONTOP NUÑEZ, MSc.

CLINICAL LABORATORY-2022 II Hubbard, J., 2010. A concise review of clinical laboratory science
CLINICAL LABORATORY : BASIC HEMATOLOGY-ANEMIA MARKERS VI-MEDICINE USAT

ERYTHROPOIESIS/IRON METABOLISM
(Transferrin: 0.05 mmol as Fe3+)

(Bone
marrow: 2.7
mmol)

(Fe3+:10% of
ingested as
Fe2+)
(Red blood
cells: 45 (Mθs: 9
mmol) mmol)

(Liver:
4.5
mmol)

Blgst. JOSÉ LLONTOP NUÑEZ, MSc.

CLINICAL LABORATORY-2022 II Gonzales, A. Principios de Bioquímica Clínica y Patología Molecular, 2010.
CLINICAL LABORATORY : BASIC HEMATOLOGY-ANEMIA MARKERS VI-MEDICINE USAT

HEMOGLOBIN SYNTHESIS
Heme synthesis Diet
Synthesis occurs on the mitochondria of normoblasts. Vit. B9

Vit. B12
Nucleus 4-Hydrofolate Homocystein
(C16, α; Fat acids Metilmalonil
C11,ε,β,γ,δ) Vit. B12
AAs synthesis
Vitamin B6
Globin synthesis
(Porphobilinogen)
α2γ2 α2β2 (δ-Amino levulinic acid)

Hemoglobin

Hb F Hb A

Urine and heces

(Coproporphobilinogen)

Blgst. JOSÉ LLONTOP NUÑEZ, MSc.

CLINICAL LABORATORY-2022 II Gonzales, A. Principios de Bioquímica Clínica y Patología Molecular, 2010.
CLINICAL LABORATORY : BASIC HEMATOLOGY-ANEMIA MARKERS VI-MEDICINE USAT

ANEMIAS
Anemias: Red Blood Cell Morphology and Approach to Diagnosis

Functional definition: ↓in the oxygen carrying capacity of the blood.

Conventional definition: ↓Hb, RBCs and Hto. below the reference range for healthy individuals
of the same age, sex, and race, under similar environmental conditions.

CLASSIC SYMPTOMS: MECHANISMS OF ANEMIA:

Fatigue and shortness of breath. Ineffective and Insufficient Erythropoiesis,
Acute Blood Loss and Hemolysis.

LABORATORY DIAGNOSIS OF ANEMIA:

Complete Blood Cell Count: Red Blood Cell Indices.

Reticulocyte Count
Peripheral Blood Film Examination
Bone Marrow Examination
Other Laboratory Tests: urinalysis with a microscopic
examination and analysis of stool, renal and hepatic function
tests, Iron studies. Serum vitamin B12 and serum folate
assays, a direct antiglobulin test (Coombs) and IB, LDH test.

Blgst. JOSÉ LLONTOP NUÑEZ, MSc.

CLINICAL LABORATORY-2022 II Rodak, H et al.; 2012. Hematology Clinical Principles and Application, 4th Ed.
CLINICAL LABORATORY : BASIC HEMATOLOGY-ANEMIA MARKERS VI-MEDICINE USAT

PATHOPHYSIOLOGY OF ERYTHROCYTE SHAPES

Normochromic-normocytic discocyte Stomatocytes Echinocytes Acanthocytes

Spherocytes Schiztocytes Elliptocytes

(Esferocitosis hereditaria, (Anemia hemolítica y (Eliptocitosis hereditaria,
hemóslis) quemaduras severas) Sickle cells (Drepanocytes) anemias megaloblásticas)

Target cells (Codocytes): (Dacryocytes):

Enfermedad hepática Anemia megaloblástica, anemia
crónica,Talasemias, Hbpatías hemolítica adquirida) Horn cell (Keratocyte).

Blgst. JOSÉ LLONTOP NUÑEZ, MSc.

CLINICAL LABORATORY-2022 II Rodak, H et al.; 2012. Hematology Clinical Principles and Application, 4th Ed.
CLINICAL LABORATORY : BASIC HEMATOLOGY-ANEMIA MARKERS VI-MEDICINE USAT

ANEMIAS BASED ON ABSOLUTE RETs COUNT and MCV

DIC, Disseminated intravascular coagulation; Hb, hemoglobin; HUS, hemolytic uremic syndrome; RBC, red blood cell; TTP, thrombotic thrombocytopenic
purpura.

Blgst. JOSÉ LLONTOP NUÑEZ, MSc.

CLINICAL LABORATORY-2022 II Rodak, H et al.; 2012. Hematology Clinical Principles and Application, 4th Ed.
CLINICAL LABORATORY : BASIC HEMATOLOGY-ANEMIA MARKERS VI-MEDICINE USAT

ANEMIAS BASED ON MEAN CELL VOLUME (MCV)

Anemia caused by
disturbance of Hb synthesis

RDW High RDW Normal RDW Normal

Anemia caused Anemia caused by decreased

by increased production of Red Blood cells
RDW Normal RDW High
Red Blood cell Anemia caused by disturbance of proliferation
destruction or and differentiation of erythroid precursors
Anemia caused by loss RDW Normal
disturbance of DNA RDW High
synthesis

Blood loss
(Acute blood loss anemia)

(TTP, HUS, DIC, HELLP)

(Sickle cell anemia) (Autoimmune hemolytic (Traumatic cardiac hemolysis)
(Spherocytocis)
(G-6-PD deficiency anemia, cold agglutinin
anemia) disease, transfusión
reaction, hemolytic disease
of the fetus and newborn)
Blgst. JOSÉ LLONTOP NUÑEZ, MSc.
CLINICAL LABORATORY-2022 II Rodak, H et al.; 2012. Hematology Clinical Principles and Application, 4th Ed.
CLINICAL LABORATORY : BASIC HEMATOLOGY-ANEMIA MARKERS VI-MEDICINE USAT

MICROCYTIC/HYPOCHROMIC ANEMIAS

Peripheral blood film from a patient with hypochromic, Bone marrow smear for a patient with iron deficiency anemia. Ringed sideroblasts (arrows) in bone
microcytic anemia. Variation in RBC diameters is termed The late-nucleated red blood cells show the characteristic marrow shown with Prussian blue stain
anisocytosis and corresponds to an elevated RBC “shaggy” blue cytoplasm due to asynchrony in maturation (×1000).
distribution width (RDW). Hypochromia, microcytosis, and (×1000). (Courtesy Ann Bell, University of Tennessee,
an elevated RDW may indicate iron deficiency anemia. Memphis.)

Blgst. JOSÉ LLONTOP NUÑEZ, MSc.

CLINICAL LABORATORY-2022 II Rodak, H et al.; 2012. Hematology Clinical Principles and Application, 4th Ed.
CLINICAL LABORATORY : BASIC HEMATOLOGY-ANEMIA MARKERS VI-MEDICINE USAT

MEGALOBLASTIC ANEMIAS
Anemias Caused by Defects of DNA Metabolism: Megaloblastic anemia

Oval macrocytes, teardrop Hypersegmented neutrophil in

cells (dacryocytes), other megaloblastic anemia (peripheral blood,
red blood cell abnormalities, ×1000).
and a small lymphocyte for
size comparison in
megaloblastic anemia
(peripheral blood, ×500).

Blgst. JOSÉ LLONTOP NUÑEZ, MSc.

CLINICAL LABORATORY-2022 II Rodak, H et al.; 2012. Hematology Clinical Principles and Application, 4th Ed.
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