RED BLOOD

CELLS
Part 1

By D.R Siwale (MSc.Human Physiology)

 How can you define blood?

It’s a red colored fluid that circulates through the vascular

system in humans and other vertebrates, carrying
nutrients and oxygen and waste products
 List any 5 unique properties of Blood?
• 1. Color: Blood is red in color. Arterial blood is scarlet red because it
contains more oxygen and venous blood is purple red because of more
carbon dioxide.
• 2. Volume: Average volume of blood in a normal adult is 5 L. In a
newborn baby, the volume is 450 ml. It increases during growth and
reaches 5 L at the time of puberty. In females, it is slightly less and is
about 4.5 L. It is about 8% of the body weight in a normalyoung
healthy adult, weighing about 70 kg.
• 3. Reaction and pH: Blood is slightly alkaline and its pH in normal
conditions is 7.4.
• 4. Specific gravity:Specific gravity of total blood : 1.052 to 1.061
• Specific gravity blood cells : 1.092 to 1.101, Specific gravity of plasma :
1.022 to 1.026
• 5. Viscosity: Blood is five times more viscous than water. It is mainly
due to red blood cells and plasma proteins.
What are the major composition of blood?
 List any 9 function of Blood?

FUNCTIONS OF BLOOD
1. NUTRITIVE Function
2. RESPIRATORY FUNCTION
3. EXCRETORY FUNCTION
4. TRANSPORT OF HORMONES AND ENZYMES
5. REGULATION OF WATER BALANCE
6. REGULATION OF ACID-BASE BALANCE
7. REGULATION OF BODY TEMPERATURE
8. STORAGE FUNCTION
9. DEFENSIVE FUNCTION
What are the major plasma proteins and their normal values?
 What are RED blood cells?

• Red blood cells (RBCs) are

the non-nucleated
formed elements in the
blood.
• Red blood cells are also
known as erythrocytes
(erythros = red).
• .
What's the normal RBC count?
Mention any 3 properties of redblood cells?
What is the life span of RBC?
What's the fate of red blood cells?
 What role do RBC play?
• Major function of RBCs is the transport of
respiratory gases. Following are the functions
of RBCs:
• 1. Transport of Oxygen from the Lungs to the
Tissues:
• 2. Transport of Carbon Dioxide from the
Tissues to the Lungs:
• 3. Buffering Action in Blood
• 4. In Blood Group Determination
 SUMMARY
• Rbc do not have nucleus
• Life span of RBC is 120 days
• RBC transport gases (oxygen and Carbon
dioxide)
• Normal RBC count is 4 to 5.5 million cells/mL
of Blood.
 What is erythropoeisis?

• Erythropoiesis is the process of the origin,

development and maturation of erythrocytes.
• Hemopoiesis or hematopoiesis is the process
of origin, development and maturation of all
the blood cells.
Where does erythropoeisis take place?
Erythropoeisis take place in various sites depending at
the stage of life
• Fetal Life; first is yolk sac, second is liver, spleen and
lymphoid organs, Third is red bone marrow and liver
• Newborn; Red bone marrow
• Children; Red bone marrow of all long and flat bones
• Adults; Above 20 years red bone marrow of
vertebra, sternum, ribs, scapula, iliac bones and skull
bones and from the ends of long bones
What FACTORS are NECESSARY FOR
ERYTHROPOIESIS?
 Whats role of Hb in the body?

• „ TRANSPORT OF RESPIRATORY GASES

• Main function of hemoglobin is the transport of
respiratory gases:
• 1. Oxygen from the lungs to tissues.
• 2. Carbon dioxide from tissues to lungs.
• 1. Transport of Oxygen
• When oxygen binds with hemoglobin, a physical
process called oxygenation occurs, resulting in
the formation of oxyhemoglobin.
• 2. Transport of Carbon Dioxide
• When carbon dioxide binds with hemoglobin,
carbhemoglobin is formed. It is also an
unstable compound and the combination is
reversible, i.e. the carbon dioxide can be
released from this compound.
• The affinity of hemoglobin for carbon dioxide
is 20 times more than that for oxygen.
Describe structure of hemoglobin?
Mention any 4 differences between HbA and HbF?
 ABNORMAL HEMOGLOBIN

• Abnormal types of hemoglobin or hemoglobin variants are

the pathologic mutant forms of hemoglobin. These
variants are produced because of structural changes in the
polypeptide chains caused by mutation in the genes of the
globin chains.
• Most of the mutations do not produce any serious
problem. Occasionally, few mutations result in some
disorders.
• There are two categories of abnormal hemoglobin:
• 1. Hemoglobinopathies
• 2. Hemoglobin in thalassemia and related disorders
 Types of abnormal hemoglobin
• 1. Hemoglobinopathies: Hemoglobinopathy is a genetic disorder caused by
abnormal polypeptide chains of hemoglobin.
• Some of the hemoglobinopathies are:
• i. Hemoglobin S: It is found in sickle cell anemia. In this, the α-chains are normal
and β-chains are abnormal.
• ii. Hemoglobin C: The β-chains are abnormal. It is found in people with
hemoglobin C disease, which is characterized by mild hemolytic anemia and
splenomegaly.
• iii. Hemoglobin E: Here also the β-chains are abnormal. It is present in people
with hemoglobin E disease which is also characterized by mild hemolytic anemia
and splenomegaly.
• iv. Hemoglobin H: The alpha chain is decreased, absent or abnormal
• v. Hemoglobin M: It is the abnormal hemoglobin present in the form of
methemoglobin. It occurs due to mutation of genes of both in α and β chains,
resulting in abnormal replacement of amino acids.
• It is present in babies affected by hemoglobin M disease or blue baby syndrome.
It is an inherited disease, characterized by methemoglobinemia.
• 2. Hemoglobin in Thalassemia and Related Disorders
• In thalassemia, different types of abnormal
hemoglobins are present.
• The polypeptide chains are decreased, absent or
abnormal.
• In α-thalassemia, the α-chains are decreased, absent
or abnormal and in β-thalassemia, the β-chains are
decreased, absent or abnormal.
• Some of the abnormal hemoglobins found in
thalassemia are hemoglobin G, H, I, Bart’s, Kenya,
Lepore and constant spring.
Hemoglobin derivatives
Carboxyhemoglobin
Methemoglobinemia
SULFHEMOGLOBIN
 Define erythrocyte sedimentation rate?
Erythrocyte sedimentation rate (ESR) is the rate at which the erythrocytes settle down.
Normally, the red blood cells (RBCs) remain suspended uniformly in circulation. This is
called suspension stability of RBCs.
 Normal value of ESR
ESR Westergren Methood (mm Wintrobe
in 1 hour) method (mm
in 1 hour)

MALES 3 to 7 0 to 9

FEMALES 5 to 9 0 to 15

Infants 0 to 2 0 to 5
Significance of determining ESR
• Erythrocyte sedimentation rate (ESR) is an easy, inexpensive and non-
specific test, which helps in diagnosis as well as prognosis. It is non-
specific because it cannot indicate the exact location or cause of
disease.
• But, it helps to confirm the diagnosis.
• Prognosis means monitoring the course of disease and response of
the patient to therapy.
• Determination of ESR is especially helpful in assessing the progress of
patients treated for certain chronic inflammatory disorders such as:
• 1. Pulmonary tuberculosis
• 2. Rheumatoid arthritis
• 3. Polymyalgia rheumatica (inflammatory disease characterized by
pain in shoulder and hip)
• 4. Temporal arteritis (inflammation of arteries of head).
• „ FACTORS INCREASEING ESR
• 1. Specific Gravity of RBC
• When the specific gravity of the RBC increases, the
cells become heavier and sedimentation is fast. So
ESR increases.
• 2. Rouleaux Formation
• Rouleaux formation increases the ESR. Globulin and
fibrinogen accelerate the rouleaux formation.
• 3. Increase in Size of RBC
• When the size of RBC increases (macrocyte), ESR also
increases
• FACTORS DECREASING ESR
• 1. Viscosity of Blood: Viscosity offers more resistance for
settling of RBCs. So when the viscosity of blood increases, the
ESR decreases.
• 2. RBC count: When RBC count increases, the viscosity of
blood is increased and ESR decreases. And when the RBC
count decreases, ESR increases.
PHYSIOLOGICAL VARIATION of ESR

• 1. Age: ESR is less in children and infants because of

more number of RBCs.
• 2. Sex: It is more in females than in males because of
less number of RBCs.
• 3. Menstruation: The ESR increases during
menstruation because of loss of blood and RBCs
• 4. Pregnancy: From 3rd month to parturition, ESR
increases up to 35 mm in 1 hour because of
hemodilution.
PATHOLOGICAL VARIATION
• ESR increases in diseases such as the following
condition
• 1. Tuberculosis
• 2. All types of anemia except sickle cell anemia
• 3. Malignant tumors
• 4. Rheumatoid arthritis
• 5. Rheumatic fever
• 6. Liver diseases.
Definition

• Packed cell volume (PCV) is the proportion of blood

occupied by RBCs, expressed in percentage.

• It is the volume of RBCs packed at the bottom of a

hematocrit tube when the blood is centrifuged.

• It is also called hematocrit value or erythrocyte

volume fraction (EVF).
Method of measuring PCV
Significance of determining pcv

• Determination of PCV helps in:

• 1. Diagnosis and treatment of anemia
• 2. Diagnosis and treatment of polycythemia
• 3. Determination of extent of dehydration and
recovery from dehydration after treatment
• 4. Decision of blood transfusion.
• NORMAL VALUES
OF PCV
• Normal PCV:
• In males = 40% to
45%
• In females = 38%
to 42%
• INCREASE IN PCV: PCV increases in:
• 1. Polycythemia
• 2. Dehydration
• 3. Dengue shock syndrome: Dengue fever
(tropical disease caused by flavivirus
transmitted by mosquito Aedes aegypti) of
grade III or IV severity.
• DECREASE IN PCV: PCV decreases in:
• 1. Anemia
• 2. Cirrhosis of liver
• 3. Pregnancy
• 4. Hemorrhage due to ectopic pregnancy (pregnancy
due to implantation of fertilized ovum in tissues
other than uterine wall), which is characterized by
vaginal bleeding.
Blood indices
• Blood indices are the calculations derived
from RBC count, hemoglobin content of blood
and PCV.
• Blood indices help in diagnosis of the type of
anemia.
DIFFERENT BLOOD INDICES

• Blood indices include:

• 1. Mean corpuscular volume (MCV).
• 2. Mean corpuscular hemoglobin (MCH).
• 3. Mean corpuscular hemoglobin
concentration (MCHC).
• 4. Color Index (CI).
 1. Mean Corpuscular Volume (MCV)

• MCV is the average volume of a single RBC and it is

expressed in cubic micrometers (μm3).
• Normal MCV is 90 µm3 (78 to 90 µm3).
• When MCV is normal, the RBC is called normocyte.
• When MCV increases, the cell is known as a
macrocyte
• and when it decreases, the cell is called microcyte.
• In pernicious anemia and megaloblastic anemia, the
RBCs are macrocytic in nature.
• In iron deficiency anemia the RBCs are microcytic.
 2. Mean Corpuscular Hemoglobin (MCH)

• MCH is the quantity or amount of

hemoglobin present in one RBC.
• It is expressed in micromicrogram or picogram
(pg).
• Normal value of MCH is 30 pg (27 to 32 pg).
• (1 pg = 10-12g)
3. Mean Corpuscular Hemoglobin
Concentration (MCHC)
• MCHC is the concentration of hemoglobin in one RBC.
• It is the amount of hemoglobin expressed in relation to the volume of
one RBC.
• So, the unit of expression is percentage.
• This is the most important absolute value in the diagnosis of anemia.
• Normal value of MCHC is 30% (30% to 38%).
• When MCHC is normal, the RBC is normochromic.
• When the MCHC decreases, the RBC is known hypochromic.
• In pernicious anemia and megaloblastic anemia, RBCs are macrocytic
and normochromic or hypochromic.
• In iron deficiency anemia, RBCs are microcytic and hypochromic.
• A single RBC cannot be hyperchromic because, the amount of
hemoglobin cannot increase beyond normal.
4. Color Index (CI)
• Color index is the ratio between the percentage of
hemoglobin and the percentage of RBCs in the blood.
• Actually, it is the average hemoglobin content in one cell of
a patient compared to the average hemoglobin content in
one cell of a normal person.
• Normal color index is 1.0 (0.8 to 1.2).
• It was widely used in olden days. However, it is useful in
determining the type of anemia.
• It increases in macrocytic (pernicious) anemia and
megaloblastic anemia.
• It is reduced in iron deficiency anemia. And, it is normal in
normocytic normochromic anemia.
 CALCULATION OF BLOOD INDICES

• Blood indices are calculated by using different formula.

• These calculations require the values of RBC count,
hemoglobin content and PCV.
• For example, in the blood of a male subject:
• RBC count = 4 million/cu mm.
• Hemoglobin content = 8 g/dL
• PCV = 30%

• CALCULATE THE; Color index, MCV, MCH and MCHC.

What type of anemia is this person suffering from
 More examples
• The mean corpuscular (or cell) volume (MCV) is the index
most often used because it reflects the average volume of
each red blood cell. It is calculated as follows:

• Cells of normal size are described as normocytic. Cells with a low MCV are
microcytic, and the ones with a high MCV are macrocytic. Th ese size
categories are used to classify anemias. MCV is less useful when mixed cell
populations are present.
• The mean corpuscular (or cell) hemoglobin (MCH) value is an estimate of
the average Hgb content of each red blood cell. It is derived as follows:

• MCH values usually rise or fall as the MCV is increased or decreased. Th e

MCH is also oft en related to the mean corpuscular (or cell) hemoglobin
concentration (MCHC) because the RBC is usually related to the Hct.
Exceptions to this rule yield important diagnostic clues.
• The MCHC provides an index of the average Hgb content
in the mass of circulating red blood cells. It is calculated
as follows;

• Low MCHC indicates deficient Hgb synthesis, and the cells are described as
hypochromic. High MCHC values are rare, because normally, the Hgb
concentration is close to the saturation point in red cells.
• MCHC can only be elevated when sphere-shaped erythrocytes are
produced rather than the normal biconcave disk-shaped cells.
 QUESTION
• A 37 weeks pregnant 25-year-old woman was undergoing a
routine medical check-up and has the following vital signs
for her blood: Hb 12.0 g/dL, Hct 40%, RBCs 3.0 x 10 12 cells/L.
• Sickle-shaped cells. WBCs 3 x 10⁹ cells/L; Differential count:
Eosinophil – 0, Basophil – 1.5%, Neutrophils: Stab – 20%
segmented – 40%, Lymph – 60%, Mon – 25%.

• A)Calculate the MCH, MCV, MCHC and the Colour Index.

• B)Highlight what each of the values entail.
• C) What type of anemia does she have?
• ………. END…………
Blood Physiology
(ANEMIA)

Part 7
By D.R Siwale (Human Physiology)
 What is Anemia?

• Anemia is the blood disorder, characterized by the reduction in:

• 1. Red blood cell (RBC) count
• 2. Hemoglobin content
• 3. Packed cell volume (PVC).
• Generally, reduction in RBC count, hemoglobin content and PCV
occurs because of:
• 1. Decreased production of RBC
• 2. Increased destruction of RBC
• 3. Excess loss of blood from the body.
• All these incidents are caused either by inherited disorders or
environmental influences such as nutritional problem, infection
and exposure to drugs or toxins.
 Classification of Anemia
• Anemia is classified by two methods:
• 1. Morphological classification
• 2. Etiological classification (whitbeys).
 Morphological classification

• Morphological classification depends upon the size and color

of RBC.
• Size of RBC is determined by mean corpuscular volume
(MCV).
• Color is determined by mean corpuscular hemoglobin
concentration (MCHC).
 Etiological (Whitby’s) classification

• On the basis of etiology (study of cause or

origin),anemia is divided into five types
• 1. Hemorrhagic anemia
• 2. Hemolytic anemia
• 3. Nutrition deficiency anemia
• 4. Aplastic anemia
• 5. Anemia of chronic diseases.
 1. Hemorrhagic Anemia
• Hemorrhage refers to excessive loss of blood. Anemia due to
hemorrhage is known as hemorrhagic anemia. It occurs both
in acute and chronic hemorrhagic conditions.
 2. Hemolytic Anemia

• Hemolysis means destruction of RBCs. Anemia

due to excessive hemolysis which is not
compensated by increased RBC production is
called hemolytic anemia. It is classified into
two types:
• A. Extrinsic hemolytic anemia.
• B. Intrinsic hemolytic anemia.
• A. Extrinsic hemolytic anemia: It is the type of anemia caused by
destruction of RBCs by external factors. Healthy RBCs are hemolized by
factors outside the blood cells such as antibodies, chemicals and drugs.
• Extrinsic hemolytic anemia is also called autoimmune hemolytic anemia.
• Common causes of external hemolytic anemia:
• i. Liver failure
• ii. Renal disorder
• iii. Hypersplenism
• iv. Burns
• v. Infections like hepatitis, malaria and septicemia
• vi. Drugs such as penicillin, antimalarial drugs and sulfa drugs
• vii. Poisoning by chemical substances like lead, coal and tar
• viii. Presence of isoagglutinins like antiRh
• ix. Autoimmune diseases such as rheumatoid arthritis and ulcerative colitis.
Hemolysis and liver failure
Renal failure and hemolysis
• B. Intrinsic hemolytic anemia: It is the type of
anemia caused by destruction of RBCs because of the
defective RBCs.
• There is production of unhealthy RBCs, which are
short lived and are destroyed soon.
• Intrinsic hemolytic anemia is often inherited and it
includes sickle cell anemia and thalassemia.
• Because of the abnormal shape in sickle cell anemia
and thalassemia, the RBCs become more fragile and
susceptible for hemolysis.
• Sickle cell anemia
• Sickle cell anemia is an inherited blood disorder, characterized by
sickleshaped red blood cells. It is also called hemoglobin SS
disease or sickle cell disease.
• It is common in people of African origin.
• Sickle cell anemia is due to the abnormal hemoglobin called
hemoglobin S (sickle cell hemoglobin).
• In this, α-chains are normal and β-chains are abnormal.
• The molecules of hemoglobin S polymerize into long chains and
precipitate inside the cells.
• Because of this, the RBCs attain sickle (crescent) shape and
become more fragile leading to hemolysis .
• Sickle cell anemia occurs when a person inherits two abnormal
genes (one from each parent).
• In children, hemolyzed sickle cells aggregate and
block the blood vessels, leading to infarction
(stoppage of blood supply).
• The infarction is common in small bones.
• The infarcted small bones in hand and foot results in
varying length in the digits.
• This condition is known as hand and foot syndrome.
• Jaundice also occurs in these children.
• Thalassemia
• Thalassemia is an inherited disorder, characterized by
abnormal hemoglobin.
• It is also known as Cooley’s anemia or
Mediterranean anemia.
• It is more common in Thailand and to some extent in
Mediterranean countries.
• Thalassemia is of two types:
• i. α-thalassemia
• ii. Β-thalassemia.
• The β- thalassemia
• is very common among these two.
• In normal hemoglobin, number of α and β polypeptide chains
is equal.
• In thalassemia, the production of these chains become
imbalanced because of defective synthesis of globin genes.
• This causes the precipitation of the polypeptide chains in the
immature RBCs, leading to disturbance in erythropoiesis.
• The precipitation also occurs in mature red cells, resulting in
hemolysis.
• α-Thalassemia:
• It occurs in fetal life or infancy. In this α-chains are less, absent or
abnormal.
• In adults, β-chains are in excess and in children, γ-chains are in excess.
• This leads to defective erythropoiesis and hemolysis.
• The infants may be stillborn or may die immediately after birth.
• β-Thalassemia
• In β-thalassemia, βchains are less in number, absent or abnormal with an
excess of αchains.
• The αchains precipitate causing defective erythropoiesis and hemolysis.
 3. Nutrition Deficiency Anemia

• Anemia that occurs due to deficiency of a nutritive substance necessary

for erythropoiesis is called nutrition deficiency anemia.
• The substances which are necessary for erythropoiesis are iron, proteins
and vitamins like C, B12 and folic acid.
• The types of nutrition deficiency anemia are:
• Iron deficiency anemia: Iron deficiency anemia is the most common type
of anemia. It develops due to inadequate availability of iron for
hemoglobin synthesis.
• RBCs are microcytic and hypochromic.
• Causes of iron deficiency anemia:
• i. Loss of blood
• ii. Decreased intake of iron
• iii. Poor absorption of iron from intestine
• iv. Increased demand for iron in conditions like growth and pregnancy.
• Features of iron deficiency anemia: Features
of iron deficiency anemia are brittle nails,
spoon shaped nails (koilonychias), brittle hair,
atrophy of papilla in tongue and dysphagia
(difficulty in swallowing).
• Protein deficiency anemia: Due to deficiency of proteins, the
synthesis of hemoglobin is reduced. The RBCs are macrocytic and
hypochromic. Pernicious anemia or Addison’s anemia
• Pernicious anemia is the anemia due to deficiency of vitamin B12. It
is also called Addison’s anemia. It is due to atrophy of the gastric
mucosa because of autoimmune destruction of parietal cells.
• The gastric atrophy results in decreased production of intrinsic
factor and poor absorption of vitamin B12, which is the maturation
factor for RBC. RBCs are larger and immature with almost normal or
slightly low hemoglobin level. Synthesis of hemoglobin is almost
normal in this type of anemia. So, cells are macrocytic and
normochromic/hypochromic. Before knowing the cause of this
anemia, it was very difficult to treat the patients and the disease
was considered to be fatal. So, it was called pernicious anemia.
• Pernicious anemia is common in old age and it is more common in
females than in males. It is associated with other autoimmune diseases
like disorders of thyroid gland, Addison’s disease, etc. Characteristic
features of this type of anemia are lemon yellow color of skin (due to
anemic paleness and mild jaundice) and red sore tongue. Neurological
disorders such as paresthesia (abnormal sensations like numbness,
tingling, burning, etc.),
• progressive weakness and ataxia (muscular incoordination) are also
observed in extreme conditions.
• Megaloblastic anemia: Megaloblastic anemia is due to the deficiency of
another maturation factor called folic acid. Here, the RBCs are not
matured. The DNA synthesis is also defective, so the nucleus remains
immature. The RBCs are megaloblastic and hypochromic.
• Features of pernicious anemia appear in megaloblastic anemia also.
However, neurological disorders may not develop.
 4. Aplastic Anemia

• Aplastic anemia is due to the disorder of red bone

marrow. Red bone marrow is reduced and replaced by
fatty tissues. Bone marrow disorder occurs in the
following conditions:
• i. Repeated exposure to Xray or gamma ray radiation.
• ii. Presence of bacterial toxins, quinine, gold salts,
benzene, radium, etc.
• iii. Tuberculosis.
• iv. Viral infections like hepatitis and HIV infections.
• In aplastic anemia, the RBCs are normocytic and
normochromic.
 5. Anemia of Chronic Diseases
• Anemia of chronic diseases is the second common type of anemia (next to iron
deficiency anemia).
• It is characterized by short lifespan of RBCs, caused by disturbance in iron metabolism
or resistance to erythropoietin action.
• Anemia develops after few months of sustained disease.
• RBCs are normocytic and normochromic. Common causes anemia of chronic diseases:
• i. Noninfectious: inflammatory diseases such as rheumatoid arthritis (chronic
inflammatory autoimmune disorder affecting joints).
• ii. Chronic infections like tuberculosis (infection caused by Mycobacterium
tuberculosis) and abscess (collection of pus in the infected tissue) in lungs.
• iii. Chronic renal failure, in which the erythropoietin secretion decreases (since
erythropoietin is necessary for the stimulation of bone marrow to produce RBCs, its
deficiency causes anemia).
• iv. Neoplastic disorders (abnormal and disorganized growth in tissue or organ) such as
Hodgkin’s disease (malignancy involving lymphocytes) and cancer of lung and breast.
• RBCs are generally normocytic and normochromic in this type of anemia. However, in
progressive disease associated with iron deficiency the cells become microcytic and
hypochromic.
 „
SIGNS AND SYMPTOMS OF ANEMIA
• „ SKIN AND MUCOUS MEMBRANE
• Color of the skin and mucous membrane becomes
pale. Paleness is more constant and prominent in
buccal and pharyngeal mucous membrane,
conjunctivae, lips, ear lobes, palm and nail bed.
• Skin looses the elasticity and becomes thin and
dry. Thinning, loss and early grayness of hair occur.
• The nails become brittle and easily breakable.
• „
• CARDIOVASCULAR SYSTEM
• There is an increase in heart rate (tachycardia) and
cardiac output. Heart is dilated and cardiac murmurs
are produced. The velocity of blood flow is increased.
• „ RESPIRATION
• There is an increase in rate and force of respiration.
• Sometimes, it leads to breathlessness and dyspnea
(difficulty in breathing).
• Oxygenhemoglobin dissociation curve is shifted to
right.
• „ DIGESTION
• Anorexia, nausea, vomiting, abdominal
discomfort and constipation are common. In
pernicious anemia, there is atrophy of papillae
in tongue. In aplastic anemia, necrotic lesions
appear in mouth and pharynx.
• „ METABOLISM
• Basal metabolic rate increases in severe
anemia.
• „ KIDNEY
• Renal function is disturbed. Albuminuria is
common
REPRODUCTIVE SYSTEM

• „ In females, the menstrual cycle is disturbed.

• There may be menorrhagia, oligomenorrhea
or amenorrhea
 NEUROMUSCULAR SYSTEM

• Common neuromuscular symptoms are

increased sensitivity to cold, headache, lack of
concentration, restlessness, irritability,
drowsiness, dizziness or vertigo (especially
while standing) and fainting.
• Muscles become weak and the patient feels
lack of energy and fatigued quite often and
quite easily
….END….