![Page 1: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/1.jpg)
Dr Nervana Bayoumy
TEXTBOOK OF MEDICAL PHYSIOLOGY
GUYTON & HALL 12TH
EDITION
1
![Page 2: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/2.jpg)
![Page 3: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/3.jpg)
Blood
![Page 4: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/4.jpg)
![Page 5: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/5.jpg)
Objectives
At the end of this lecture you should be
able to:
1. Describe Cellular and non-cellular components
of blood.
2. Recognize functions of blood.
3. Define Erythropoiesis; leucopoiesis,
thrombopoiesis.
4. Recognize sites of RBC formation at different
developmental age.
5
![Page 6: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/6.jpg)
5. Describe different stages of RBC differenation.
6. Describe features of RBC maturation.
7. Describe regulation of RBC production and
erythropoietin hormone secretion in response to
hypoxia.
8. Recognize clinical conditions associated with high
level of erythropoitein in the blood.
6
Objectives cont…
![Page 7: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/7.jpg)
Blood Composition
![Page 8: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/8.jpg)
![Page 9: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/9.jpg)
Blood Film
![Page 10: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/10.jpg)
BLOOD COMPOSITION
1. Cellular components:
○ Red Blood Cells (Erythrocytes) ○ White Blood Cells (Leucocytes) ○ Platelets (Thrombocytes)
2. Plasma:
○ 98% water + ions + plasma proteins e.g. (Albumin, globulin, Fibrinogen)
○ Same ionic composition as interstitial
fluid.
10
ECF
![Page 11: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/11.jpg)
FUNCTIONS OF BLOOD
1. Transport
O2, CO2, nutrient, hormones,
waste product
2. Homoeostasis
○ Regulation of body temperature,
ECF pH
3. Protecting against infections
○ White Blood Cells, Antibodies
4. Blood clotting prevent blood loss
11
![Page 12: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/12.jpg)
Blood Volume
5 liter in adult:
○ 45% is packed
cells volume
(PCV).
○ 55% is plasma
volume.
12
![Page 13: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/13.jpg)
Blood Cells Formation
Erythropoiesis: Formation of RBC (erythrocytes)
Leucopoiesis: Formation of WBC (leucocytes)
Thrombopoiesis: Formation of platelets (thrombocytes)
13
![Page 14: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/14.jpg)
Red Blood Cells
(RBC):
Function: O2 transport
CO2 transport
Buffer
14
![Page 15: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/15.jpg)
Red Blood Cells
Shape & size
Flat Biconcave Disc.
Non-nucleated.
Diameter 7-8 µmx2.5µmx1 µm.
Flexible
Average volume 90-95 µm3
Number = 4.7 - 5 x106
Hb = 14-16 g/dl in the blood
15
![Page 16: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/16.jpg)
Production of RBC In-utero:
Early few weeks of embryo nucleated RBCs are formed in yolk sac.
Middle trimester mainly in liver & spleen & lymph nodes.
Last months RBCs are formed in bone marrow of all bones
----------------------------------------------------------------------------
After Birth:
Bone marrow of flat bone continue to produce RBC into adult life
Shaft of long bone stop to produce RBC at puberty while epiphysis continued
16
![Page 17: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/17.jpg)
![Page 18: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/18.jpg)
![Page 19: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/19.jpg)
![Page 20: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/20.jpg)
Production of RBC
20
![Page 21: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/21.jpg)
Pluripotent Stem Cells in Bone Marrow and Cord Blood By Ambreen Shaikh and Deepa Bhartiya
![Page 22: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/22.jpg)
![Page 23: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/23.jpg)
![Page 24: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/24.jpg)
Genesis (Production) of RBC
All blood cell are formed from Pluripotential hematopoietic stem cells committed cells:
Committed stem cells for RBC Committed stem cells for WBC
Growth of different stems cells are
controlled by different growth factors
24
![Page 25: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/25.jpg)
Genesis (production) of RBC
25
![Page 26: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/26.jpg)
Stages of differentiation of RBC
Stages of RBC development: ○ Committed stem cell Proerthroblast basophil erythroblast polychromatophil erythroblast orthochromatic erythroblast Reticulocytes Mature erythrocytes
○ In cases of rapid RBC production reticlocytes in the circulation.
26
![Page 27: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/27.jpg)
Erythropoiesis
RBC development is characterize by: decrease in cell size.
disappearance of nucleus.
appearance of hemoglobin (Hb)
27
![Page 28: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/28.jpg)
Regulation of RBC production
Erythropoiesis is stimulated by erythropoietin hormone produced by the kidney in response to hypoxia (low oxygen in the blood)
Hypoxia ( oxygen) caused by: Low RBC count (Anaemia) Hemorrhage High altitude Prolong heart failure Lung disease
28
![Page 29: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/29.jpg)
Tissue oxygenation and RBC formation
29
![Page 30: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/30.jpg)
Erythropoietin:
Glycoprotein.
90% from renal cortex 10% liver.
Stimulate the growth of early stem cells.
Does not affect maturation process.
Can be measured in plasma & urine.
Conditions like:
anemia
High altitude
Heart failure
Lung Disease
Result in High erythropoietin levels and polycythemia
30
![Page 31: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/31.jpg)
Role of the kidneys in RBC formation
31
![Page 32: Dr Nervana Bayoumy - KSUMSC. Foundation...Bone marrow of flat bone continue to produce RBC into adult life Shaft of long bone stop to produce RBC at puberty while epiphysis continued](https://reader030.vdocuments.net/reader030/viewer/2022041113/5f1f70ba3062e721f7158edd/html5/thumbnails/32.jpg)