Educational literature of TSMU
CLINICAL PATHOPHYSIOLOGY OF
THE RED BLOOD SYSTEM
Tutorial
ISBN 978 -5 -98301 -202 -8
Publishing house «Medicina DV»
690600, Vladivostok, 4 Ostryakova ave
Vladivostok
9 785 98 3 0 1 2 0 2 8
Тел.: (423) 245-56-49. E-mail: m edicinaDV@m ail.ru
Medicina DV
2020
Стр.1
Federal State Budgetary Educational Institution
Pacific State Medical University
Ministry of Public Health of Russia
(FSBEI HE PSMU of Ministry of Public Health of Russia)
CLINICAL PATHOPHYSIOLOGY OF
THE RED BLOOD SYSTEM
Tutorial
Рекомендовано Координационным советом по области образования
«Здравоохранение и медицинские науки» в качестве учебного пособия
для использования в образовательных учреждениях, реализующих
основные профессиональные образовательные программы высшего
образования уровня специалитета по направлению подготовки
31.05.01 «Лечебное дело»
Vladivostok
Medicina DV
2020
Стр.2
UDC 616.15-092 (075.8)
LBC 54.11ya73
C 60
It is recommended by the Editorial and Publishing Board o f
Pacific State Medical University
Reviewers:
M.V. Osikov - Dr. habil. med., professor, head o f the Pathological Physiology
Department o f FSBEI HPE «South Ural State Medical University» o f Ministry
o f Public Health o f the Russian Federation
N.A. Nikolaev - Professor, Department o f Faculty Therapy, Occupational
Diseases, Vice-Rector fo r Medical Activities and Regional Health Care, Federal
State Budgetary Educational Institution o f Higher Education, Omsk State
Medical University, Ministry o f Health o f the Russian Federation, Doctor o f
Medical Sciences, Associate Professor
Authors:
Chagina E.A., Markelova E.V., Malkov V.A., Knish C.V., Shubina A.Yu.
C 60
Clinical pathophysiology of the red blood system: tutorial / E.A. Chagina,
E.V. Markelova, V.A. Malkov and other authors. - Vladivostok: Medicina DV, -
88 p. Table 7, Figure 40, Bibliography: 15 items.
ISBN 978-5-98301-202-8
The tutorial unravels the concepts: erythron, anemia.
It describes the etiopathogenesis features of the main forms of the red blood system
pathology, including in gerontology.
The up-to-date information resources are used as the tutorial basis. In the tutorial,
there are case problems and test check tasks.
The tutorial is compiled on “Pathophysiology, clinical pathophysiology” discipline,
in accordance with the requirements of the Federal State Educational Standards and is
intended for students pursuing specialist’s programs «General Medicine»/
UDC 616.15-092 (075.8)
LBC 54.11ya73
ISBN 978-5-98301-202-8
© Team of authors, 2020
© Medicina DV
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Table of contents
It describes the etiopathogenesis features of the main forms of the red blood system
pathology, including in gerontology.
List of abbreviations.............................................................................................................................4
Introduction.............................................................................................................................................6
CHAPTER I .............................................................................................................................................8
1. The concept of ery thron..........................................................................................8
2. Erythropoiesis............................................................................................................11
3. Quantitative and qualitative characteristics of red blood............................19
4. Erythrocyte hemolysis............................................................................................29
Test tasks (Chapter I)................................................................................................... 30
CHAPTER I I ......................................................................................................................................... 34
1. Definition of the concept, classification of anem ias.................................... 34
2. Posthaemorrhagic anemias................................................................................... 41
3. Hemolytic anemias...................................................................................................48
4. Dyserythropoietic anemias...................................................................................54
Test tasks (Chapter I I ) ................................................................................................ 67
Case problems (Chapter II)........................................................................................71
CHAPTER ( I I I ) ....................................................................................................................................75
1. Features of red blood system in gerontology..................................................75
Test tasks (Chapter I I I ) .............................................................................................. 82
Answers to test tasks...........................................................................................................................84
Answers to case problems................................................................................................................84
Recommended Literature.................................................................................................................. 86
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List of abbrev iat ions
■ ACTH
ATP
- adrenocorticotropic hormone
ATP-ase
ACD
BFU
GM-CSF
DNA
DPGA
IDA
GT
■ RPI
CFU
■ CSF
CBV
RNA
■ SA
■ MCH (AHGE)
■ HSC
■ STH
■ TF
4
- adenosine triphosphoric acid
- adenosine triphosphatase
- anemia in chronic diseases
- burst-forming unit
- granulocyte-macrophage colony-stimulating factor
- deoxyribonucleic acid
- diphosphoglyceric acid
- iron deficiency anemia
- gastrointestinal tract
- reticulocyte production index
- colony-forming unit
- colony-stimulating factor
- circulating blood volume
- ribonucleic acid
- sideroblastic anemia
- mean cell haemoglobin
- hematopoietic stem cell
- somatotropic hormone
- Transforming Factor
List of abbreviations
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■ TNFa
■ CDLD
■ CNPD
■ BCI
■ EPO
■ JGA
■ Fi
- tumor necrosis factor
- chronic diffuse liver diseases
- chronic non-obstructive pulmonary disease
- blood color index
- renal erythropoietin
- juxtaglomerular apparatus
- Farb index
■ GATA-1
■ Hb
■ Ht
■ NFE-2
- intra-core transcription regulator in erythron
- hemoglobin
- hematocrit
- nuclear factor (derived from erythroids 2), 45 kDa
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Introduction
The blood system includes:
• Blood and lymph
• Hemopoietic system
• Organs of blood destruction and immunity
• Blood cells being in connective and epithelial tissues
The red blood system is a functional system supporting the normal lifesustaining
activity of the body. It is a complex functional structure combining a
set of erythrocytes functioning in the blood-stream, organs of their production
and destruction together with a complex of receptors, effectors and regulators
providing a normal state and restructuring it in accordance with the changing
needs of the body.
This system performs the gaseous exchange function and is able to
maintain homeostasis in conditions of multiple factor effect due to effective
feedback. In addition to gaseous exchange, erythrocytes perform other
functions: participate in water-salt metabolism, in blood buffer systems
operation, in adsorption of toxins and protein splitting products, in various
enzymatic processes and other processes. The red blood system is a part of the
general blood system.
Blood consists of plasma and formed elements - erythrocytes, leucocytes,
platelets. In one liter of blood, formed elements, mainly erythrocytes, account
for men 4,5-5,7x1012/l (Ht 40,7-50,3%), and for women 3,9-5x1012/l (Ht 36,144,3%).
The amount of blood in a person is 7-8% of his body weight, so about
5 liters of blood in a person weighing about 70 kg.
Blood subtly reflects the effect of various exogenous and endogenous
factors on the body. Thus, with anemia, in most cases, the amount of
erythrocytes in the blood decreases (Ht is below normal), but the circulating
blood volume (CBV) remains normal due to plasma. In this case, due to the
hemoglobin deficiency, the oxygen capacity of the blood decreases and hemic
hypoxia develops.
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Introduction
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With an increase in the number of erythrocytes in the blood against the
normal CBV background, excluding some pathology forms, one may talk of
compensatory erythrocytosis caused by hypoxia of various genesis, neutralized
by increasing in the oxygen capacity of the blood. A significant increase of Ht
may indicate an increase in blood viscosity and microcirculation processes
disruption.
The blood system diseases by its prevalence, severity and possible
consequences pose a serious problem for modern medicine. At the same time,
the progress in studying the genesis of the blood system pathology dictates the
urgent need to generalize and systematize constantly accumulating material.
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Chapter
I
1. The concept of erythron
The term “erythron” was introduced by English therapists Castle and
Minot in 1953, they defined it as the entire mass of erythroid cells of the body,
inclusive nuclear bone marrow forms, reticulocytes, and mature erythrocytes.
As defined by modern functional hematology, erythron combines a totality
of erythrocytes functioning in the vascular bed, organs of their production
and breakdown with a complex of receptors and effectors that ensure the
system constancy and its variation according to the body needs under the
specific conditions, as well as the erythrokinetics processes and quantitative
characteristics (erythron volume).
It was stated that erythrocytes in the norm do not represent a homogeneous
mass of cells detected by a smear or a native erythrocytes preparation
microscopy, but form a system in which cells of different age, morphology and
functional state are consistently combined. Qualitative differences between
individual erythrocytes are found, for example, when determining their
resistance to hemolytics of different nature by the dispersion analysis method,
etc.
An important characteristic of the blood system physiology and pathology
is the quantitative and qualitative composition of the erythrocyte population,
one of the most important parts of erythron.
The red blood system is one of the examples of balanced biological
systems. In case of the dynamic equilibrium impairment, not only quantitative
indicators but also qualitative ones vary - changes occur in the distribution of
the cells by diameters, physicochemical properties, biochemical composition.
Therefore, the qualitative composition of the erythrocytes population in the
vascular bed is an adjustable sign of erythron.
The fundamental difference between erythron and other tissues of
the body is that the destruction of erythrocytes is carried out mainly by
macrophages due to a process called erythrophagocytosis (Figure 1). The
8
Chapter I
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resulting products of destruction and, primarily, iron, are used to build new
cells. Thus, erythron is a partially closed-loop system in which, under normal
conditions, the number of erythrocytes destroyed corresponds to the number
of newly formed erythrocytes.
Figure 1. Macrophage with phagocytosed erythrocyte
(Н.В. Kolesnik, 2010).
Erythrocytes live from 60 to 120 days in the blood flow. The blood cell
survival in men is 10-20 days longer than in women.
When the erythrocyte aging, its membrane properties change, and
the cationic exchange with plasma is also significantly disrupted. In old
erythrocytes, there is a “malfunction” of the antioxidant enzyme system,
which is represented by super-oxides mutase, glutathione peroxidase, and
catalase, which leads to the strengthening of peroxide oxidation of lipids
and acid radicals accumulation. At the same time, the membrane loses
sialic acid, which reduces the negative charge of the erythrocyte. Finally, the
antigenic composition of the membrane changes at the erythrocyte aging,
as antigenic determinants are unmasked, capable to form complexes with
immunoglobulins, so those old erythrocytes are recognized by the immune
system cells as non-self ones. All these processes lead to the erythrocyte
destruction in prospect. Up to 20% of erythrocytes are destroyed as a
result of intravascular hemolysis (Fig. 2). At the same time, hemoglobin
enters the plasma directly and is bound by a special plasma protein related
to a2globulins - haptoglobin. Very soon about half of the generated
haptoglobin-hemoglobin complexes leave the plasma and are absorbed by
Chapter I
9
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