Red Blood Cell

Dr Gabriel Zaverucha,
MD

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 What is anemia?

Anemia is a reduction of the red blood cell mass

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 Blood composition

RBCs = hematocrit: 45%

Plasma: 55% Illustration from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.

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 Relative anemia (eg, Relative polycythemia (eg,
pregnancy) dehydration, excessive diuresis)
Illustration from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.

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 Basic function of RBCs

O2 transportation (lungs -> tissues)

Other functions:
CO2 transportation (tissues -> lungs)
Acid-base buffer

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 How can RBCs transport O2??
Also called “erithrocytes”

Through Hemoglobin!

Major function of RBCs:

transport hemoglobin

Quantity of hemoglobin in a
single RBC?
MCH (g/dl) = 34

Quantity of hemoglobin in
the blood
Hb(g/dl) = >12.5 Woman, >13.5 Men

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 RBC count

How many RBCs in the blood?

Red cell count:
Women: 4,700,000 per mm3(or 4,7 x 1012/L)
Men 5,200,000 per mm3(or 5,2 x 1012/L)

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 Shape and duration
Biconcave shaped disk
Deformable -> can squeeze through small vessels
Spectrin, ankyrin
Average volume?
MCV = 80-100 fL
<80: Mycrocytic anemia
>100: macrocytic anemia

How many days does one RBC last on

average?
120 days (lack of nucleus)

Photoacoustic signal computation from different erythrocytes - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Biconcave-shape-of-RBC-1_fig1_329427875 [accessed 2 Mar, 2023]

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 Individual RBCs in the blood can vary in size. How can we
measure deviation of the volume?
RDW = 11-15% Cleveland Clinic Journal of Medicine March 2019, 86 (3) 167-172; DOI: https://doi.org/10.3949/ccjm.86a.18072

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 Where RBCs are produced??
Fetal erythropoiesis occurs in:
Yolk sac (3-8 weeks)
Liver (6 weeks-birth)
Spleen (10-28 weeks)
Bone marrow (18 weeks to adult)

Young liver synthesizes blood.

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 Sternum, skull,
vertebrae, scapulae,
pelvic bones

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Illustration from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.
 Hematopoietic CD34 Stem cell
SCF
Myeloid Stem Cell
Lymphoid stem cell

EPO Megakaryoblast B Lymphoblast T Lymphoblast

Monoblast
Erythroblast Native B cells Naïve T cells

Myeloblast
CD8 T cells
Plasma CD4 T cells
cells

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 Basophylic cytoplasm
Large nucleus

Smaller nucleus

• Anucleated
• Wright-Giemsa stain: polychromatophilia
• Methylene blue stain: ribosomal RNA

Biorender
Acydophilic
No organelles (eg, no mitochondria or nucleus)
No mitochondria: energy from glucose (90% glycolysis)
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 Regulation of erythropoiesis in
hypoxia
Hypoxia
KIDNEY
pO2 sensor
HIF

Increased EPO
Increased Red Kidney (90%) and
Blood cells Liver
Normoxia

Bone Marrow
Erythropoiesis

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 Older patients response to hypoxia
Why is it decreased?

Bone marrow: more fat ( +yellow marrow, - red marrow) and less
mass -> decreased reserve of hematopoietic cells
“Damaged” hematopoietic progenitor cells
Impaired cytokines stimulation

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 Compensatory hematopoiesis
Fetal erythropoiesis occurs in:
Yolk sac (3-8 weeks)
Liver (6 weeks-birth)
Spleen (10-28 weeks)
Bone marrow (18 weeks to adult)

Young liver synthesizes blood.

Is this always true? No

Severe chronic hemolysis: extramedullary
hematopoiesis (compensatory
erythropoiesis)

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 Hemoglobin
Heme + globin

Globin chains:
- 4 protein chains (globins)
- Adults (HbA1): 2 alpha globin, 2 beta
globin (ααββ)
- Fetal (HbF): 2 alpha globin, 2 gamma
globin (ααγγ)
- Embryonic (Gower 2): 2 alpha globin,
two epsilon globin (ααεε)

Heme groups: Porphyrin ring + iron atom

Biorender

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 Take Home Points

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 What is anemia?
Anemia is a reduction of the red blood cell mass

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 What is hematocrit? What is
its normal value ?

The percent of blood volume occupied by RBCs; 45%

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 One cause of depressed hematocrit; one cause of elevated hematocrit
Anemia; Polycythemia

What happens to the hematocrit in pregnancy?

Relative anemia

What happens to the hematocrit in dehydration?

Relative polycythemia

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 What gas does RBCs carry to the tissues? And to the lungs?
O2; CO2

What inside the RBCs make them able to carry O2?

Hemoglobin

What represents the quantity of hemoglobin inside a red

blood cell? What represents the size of a RBC
MCH; MCV

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 How do we measure the variation in size between RBCs?
RDW

How many days does RBCs last on average?

120 days

What is the shape of a RBC?

Biconcave shaped disk

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 What is the shape of a RBC?
Biconcave shaped disk

Progression of erythropoiesis:
Yolk sac, liver, spleen, bone marrow

Where does erythropoiesis happens? What does it turns

into with aging? Give the locations of each in the long
bone
Red Marrow (metaphysis, epiphysis); Yellow Marrow
(diaphysis)

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 Sequence from beginning of hematopoiesis to erytrocytes
Hematopoietic CD34 Stem cell -> Myeloid stem cell -> Proerythroblast ->
Erythroblast -> Normoblast -> Reticulocyte -> Erythrocyte (RBC)

What is the first anucleated cell in erythropoiesis?

Reticulocytes

What do we see with Wright-Giemsa stain in a

reticu;locyte? And Methylene blue?
Polychromatophilia; ribosomal RNA

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 Do RBCs have organelles?
No

How RBCs produce energy?

90% glycolysis; 10% HMP shunt

How is the size of reticulocytes compared to

erythrocytes?
Reticulocytes are bigger

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 Very important cause of hypoxia…………
Anemia!!!

What does the hypoxia sensed by the kidney pO2 sensors

triggers? Where?
EPO production (90% kidneys; liver)

What is the effect of EPO?

Increased erythropoiesis in the Bone Marrow -> Normoxia

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 What can happen in severe chronic hemolysis relative to
erythropoiesis?
Compensatory/extramedullary hematopoiesis

HbA1 globin composition; HbF; Embryonic (Gower 2)

ααββ; ααγγ; ααεε

Heme groups are composed of….?

Porphyrin rings + Iron atom

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