Formation of Blood - Red blood cells

 

Formation of Blood

Red blood cells

1.These are formed in the red bone marrow, found in the flat bones, and ends of long bones.

2.Each cell passes through a number of stages before becoming mature red blood cell.

3.Immature red cells are found only in the bone marrow, while mature red cells enter circulation. However in some diseases immature red cells may be found in circulation.

4.The following substances are require for formation of red blood cells.

                       .Iron.

                        .Folic acid.

                        .Vitamin B12: It is obtained from the diet. Articles  rich in it, are liver,mutton,milk,eggs,and cheese.

6.Worms in stools

7.Medications

                .Salicylates.

                .Cytotoxic drugs.

                .Chloramphenicol.

8.Radiation therapy.

9.Occupation :Exposure to toxins.

10.Gastrointestinal disturbances

                   .Gastroenteritis.

                   .Malabsorption syndrome.

                    .Achlorhydria.

11.Bleeding tendency: Coagulopathies.

12.Bone pains.

13.Paresthesia in limbs: Nutritional deficiency.

 

The following points are noted in examination

1.Pallor:In conjunctiva, nails,tongue,Oral muvous membrane.

2.Skin

      .Pallor.

      .Dry and scaly in myxoedema

3.Nails

           .Flat or spoon –shaped in iron deficiency anaemia.

           .Pallor.

4.Conjunctiva

           .Pallor.

           .Icterus in case of haemolytic anaemia.

5.Mouth

            .Pallor.

            .Smooth tongue in  pernicious anaemia.

            .Gingival hypertrophy in leukemia.

            .Stomatitis in megaloblastic anaemia.

6.Abdominal examination

             .Splenomegaly in haemolytic  anaemia and   leukemia.

              .Hepatomegaly.

7.Per rectal examination.

8.Bones.

Investigations

1.Haemoglobin.

2.Haematocrit.

3.RBC count.

4.WBC count.

5.Blood indices: mean corpuscular volume, mean corpuscular haemoglobin concentration.

6.Bone marrow examination.

7.Haemoglobin  electrophoresis.

8.Stools examination:Worms, occult blood.

9.Fractional test meal.

10.Barium meal.

Anaemia Due to Haemorrhage 

Haemorrhage results in  reduction in the haemoglobin level as well as red cell count .

Clinical features

1.If the haemorrhage has been severe, there are features of haemorrhagic shock.

              .Cold,clammy extremities.

              .Rapid,thread pulse.

              .Pallor.

              .Hypotension.

              .Oliguria.

              .Dryness of mouth.

2.Effects of chronic haemorrhage

               .Features of prolonged, steady loss of blood as with worms,peptic ulcer, plies etc.

               .Features of chronic anaemia as discussed before.

 

Treatment

1.Treatment of the cause: Discussed elsewhere.

2. Treatment of haemorrhagic shock

                  .Complete bed rest.

                  .Head low position.

                  .Strict maintenance of the input and output chart.

                  .Intravenous fluids.

                         .Ringer,s lactate.

                          .Blood as soon as possible.

               .Morphine 15 mg IM.

3.Treatment of chronic anaemia

                   .Iron and folic acid.

                   .Diet rich in iron and folic acid.

 

Anaemia Due to Decreased  blood Formation

                  .   

If there is a deficiency of the factors required for the formation of red blood cells  and/or haemoglobin, the patient develops this type of anaemia.

 

Type	Cause
Pernicious anaemia	.Deficiency of the intrinsic factor.
Iron deficiency anaemia	.Dietary deficiency of iron . .Deficiency of hydrochloric acid in stomach .Malabsorption syndrome.
Prematurity	.Low iron stores in the premature baby
Increased demands	.Pregnancy . .Lactation. .Tumours.
Diseases of bone marrow	.Irradiation damage. .Cytotoxic drug induced damage. .Aplastic anaemia. .Leukemia. .Bone marrow infiltrating diseases. .Multiple myeloma.