경희대학교 의과대학·의학전문대학원

혈액학

/ 영상과검사의학

진단검사의학과 박태성 2014 년 1 학기

강의 일정 안내

적혈구의 구조와 생리

Red Blood Cells

혈액학

(Anemia/Erythrocytos is)

수혈의학

Phlebotomy: blood specimen collection

Blood collection

Blood collection TechniqueTechnique

Tube

Tube

Guide

Guide

Order of Draw Name Laboratory use Number of inversions

Collection

volume 비 고 Plain 7ml 면역부 (Cold, Cryo, Drug Test)_{혈액은행 (X-matching,)} None 7ml

CTAD 2.7ml 혈액부 (PT, APTT) 면역부 (Protein C, Protein S, W.F(Ag, Activity)) 3~4 2.7ml SST 9.5ml EDTA 3ml 혈액부 (CBC) 생화학부 (HbA₁C) 면역부 (PLT associated Ab, CD4, CD8, CSA)

혈액은행 (Direct Coombs’ test)

8 3ml

Needle 21G Luer Adapter Blood Collection Set 23G (Butterfly Needle)

SST 6ml

1 Blood-culture tubes (yellow)

2 Coagulation sodium citrate tube (blue stopper)

3 _{Serum tubes with or without clot activator or gel separator}

4 _{Heparin tubes with or without gel (green stopper)}

5 Ethylenediaminetetraacetic acid (EDTA) tubes (lavender stopper)

6 Glycolytic inhibitor tubes (gray stopper)

TABLE 3-6 Order of Draw: Evacuated Tube and Syringe

Henry’s Clinical Diagnosis and Management

올바른 채혈 순서

1. Blood culture

2. Citrate tube

3. Plain tube or SST tube

4. Heparin tube

5. EDTA tube

Peripheral blood & Bone marrow

aspirates

Diagnostic

hematology

RBC

HEMATOLOGY

적혈구의 구조와 생리

Red Blood Cells

혈액학

(Anemia/Erythrocytos is)

수혈의학

Normoblast

Reticul-ocyte

RBC

BM

_PB

Erythropoiesis

Normoblast

Reticul-ocyte

RBC

BM

PB

Erythropoiesis

Erythropoiesis

Structure of Red Blood Cells

• Biconcave disk shape

– Diameter 7.5-8 um

• Lipid Bilayer

– Membrane skeleton

• RBCs shape & reversible deformability

– Diffuse, passive, & active transport – RBC membrane defect

적혈구가 착하고 고마운 5 가지 이유 ( 권석 운 )

Normoblast

Reticul-ocyte

RBC

Heme

= a porphyrin ring + an iron atom

Hemoglobin = one heme

Heme and Hemoglobin

• Heme

– Synthesis : bone marrow(85%), liver, etc – Succinyl coA + glycine [mitochondrion] – ALA synthetase

• Hemoglobin

– One heme group + one polypeptide chain – 1g of Hb binds 1.34mL of oxygen

– 600g (normal adult red blood cells) of Hb

• Normal Human hemoglobin(Hb A)

= two pairs of polypeptide chain

• Three normal hemoglobins

– Hb A α2β2

– Hb A2 α2δ2

– Hb F α2γ2

• Globin chain genes

– Gene Number Chromosome – α 2/2 16

– β 1/1 11 – γ 1/1 11 – δ 1/1 11

• Main function of hemoglobin

“

Oxygen delivery”

관여하는 factor

1. Hemoglobin molecule

• Amino acid substitution

2. Blood flow, rate of diffusion of oxygen, oxygen affinity

• Oxygen Dissociation Curve

– Relationship btw the amount of oxyhemoglobin(% saturation) and partial pressure of oxygen(oxygen tension)

• pH, 2,3-DPG, temp.

• P₅₀

• Oxygen affinity of Hb

• Partial pressure of oxygen at the Hb is half-oxygenated

• Inversely related to O₂ affinity • 37’C, PCO₂ 40mmHg, pH 7.4

• p50 27mmHg • Ferrous hemoglobin(2+₎

• Ferric hemoglobin(3+₎

• loss of oxygen delivery

Iron Metabolism

•

_Iron

– _{Heme iron [ Hb, myoglobin, heme proteins]} – Non-heme iron [ferric state]

•

Iron distributed in six compartments

– Hemoglobin(1ml packed RBC contains 1 mg iron) – _{Storage iron (ferritin, hemosiderin)}

– Myoglobin

– _{Labile iron pool} – Tissue iron

• Absorption of iron

– Balance

• Daily losses (M: 1mg, 2mg F)

– Mucosal receptor on duodenum/upper jejunum

– Normal state ; ingested iron 5 ~ 20% absorbed

– Mechanism unclear

– Absorbed iron

• Sequestrated within the mucosal epi. Cell • Enter the circulation

• Iron transport…Transferrin

– Plasma iron carrier protein(transport)

– Synthesis in the liver

– Inversely regulated by body’s iron stores

– Normal state

• 1/3 of binding sites of transferrin are saturated with iron

– Transferrin-iron complex to erythrocyte

• Majority of iron – heme systhesis

– Small ferritin granule—sideroblast(1 ~ 5) – 20 ~ 60% of normoblasts

– Number of sideroblasts

• Availability of iron

• The incorporation of iron into heme

Normoblast Siderobl

ast

• Storage of iron

– In the RBCs… splenic macrophages

– Hb catabolized into iron, protophophyrin, globin – Iron is stored in RES system (spleen, BM, liver) – Two forms- ferritin(major), hemosiderin

– s-Ferritin reflects body iron storages

• Ferritin in RES system leaks into circulation

• Decrease s-ferritin– valid indication of decreased iron stores • Not useful s-ferritin

– Acute phase reactant, prolonged elevated

• Soluble transferrin receptor

• Bone marrow …Prussian blue stain

– Storage iron – Sideroblast

강의 일정 안내