haemoglobinfac.ksu.edu.sa/sites/default/files/hemoglobin_and_anemia_1.pdfhemoglobin (tetramer) is...
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![Page 1: Haemoglobinfac.ksu.edu.sa/sites/default/files/hemoglobin_and_anemia_1.pdfHemoglobin (tetramer) is composed of the protein globin, made up of two alpha chains (141 a.a) and two beta](https://reader033.vdocuments.us/reader033/viewer/2022041916/5e69c77fac9b9c7f93319c7b/html5/thumbnails/1.jpg)
Haemoglobin
O2 O2 O2
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98% travels in oxyhaemoglobin (in red blood cells)
2% is dissolved in plasma (compared to carbon dioxide, oxygen is relatively insoluble in plasma)
O2 is not very soluble – thus needs a carrier !
O2 O2 O2
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Myoglobin, Haemoglobin, Cytochromes bind O2
Oxygen is transported from lungs to various tissuesvia blood in association with haemoglobin
In muscle, haemoglobin gives up O2 to myoglobinwhich has a higher affinity for O2 than heamoglobin
Cytochromes participate in redox reactions and arecomponents of the electron transport chain
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Haemoglobin (Hb or Hgb) is the primaryconstituent of RBCs
This molecule gives the characteristic red colourto erythrocytes and to the blood
The primary function of haemoglobin is totransport oxygen (O2) from the lungs to thetissue cells of the body and to carry carbondioxide (CO2)
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Hemoglobin (tetramer) iscomposed of the protein globin,made up of two alpha chains (141a.a) and two beta chains (146 a.a),each bound to a heme group
Alpha and beta are similar but notidentical in a.a. sequence
Each heme group bears an atomof iron, which can bind to oneoxygen molecule
Each hemoglobin molecule cantransport 4 molecules of oxygen
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Abundant in skeletalmuscles
Consists of one hemeand globin consists ofsingle polypeptidechain (monomeric:153 aa; 17,200 MW)
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1. Hb A:o Makes up about 95%-98% of Hb found in adults;
o contains two alpha (α) protein chains and two
beta (β) protein chains
2. Hb A2:o Makes up about 2%-3% of Hb;
o Has two alpha (α) and two delta (δ) protein chains
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3. Hb F:
o Makes up to 2% of Hb found in adults;
o Has two alpha (α) and two gamma (γ) protein
chains;
o The primary haemoglobin produced by the
fetus during pregnancy, its production usually
falls to a low level shortly after birth
o Foetal Hb has a higher affinity for oxygen than
adult haemoglobin
o This means that the fetus can receive oxygen
from the mother across the placenta.
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Responsible for the O2-
binding capacity of Hb
Consists of an iron (Fe) ion held in a heterocyclic ring, known as a porphyrin
The protoporphyrin made up of four pyrrole rings linked by methane bridges
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A Fe atom in its ferrous state (Fe+2) is at the center of protoporphyrin
Fe+2 has 6 coordination bondso 4 bonded to the 4 pyrrole N
atoms (The nucleophilic N prevent oxidation of Fe+2)
o The 2 additional binding sites are one on either side of the hemeplane:
✓ One of these is occupied by the imidazole group of His
✓ The second site can be reversibly occupied by O2
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When Hb is bound to O2, it is called oxyHb. This is the relaxed (R ) state
The form with a vacant O2 binding site is called deoxyHb and corresponds to the tense (T) state
If iron is in the oxidized state as Fe+3, it is unable to bind O2
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R state has a higher affinity for O2
T state is more stable in the absence of O2
conformational change
The subunits slide and rotate making the central cavity smaller
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O2-binding curves show Hb saturation as a function of the partial pressure for O2
4 subunits, so 4O2-binding sites: If one heme group has a bound O2, it increases the ability of the other heme groups to bind O2 (last O2
affinity is 300 times greater than its affinity for 1st O2)
Cooperative binding
Segmoidal curve
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Myoglobin has a higher O2
affinity than Hb
Myoglobin O2 dissociation curve is hyperbolic
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A number of factors reduce the affinity of Hb for O2 so that more O2 is released to tissues
As the curve shifts from A to B (to right) the affinity for O2 decreases
H+, PCO2, and BPG modify the structure of Hb and alter its affinity for oxygen:
Increases of these factors:
◦ Decrease hemoglobin’s affinity for oxygen
◦ Enhance oxygen unloading from the blood
Decreases act in the opposite manner
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A number of factors reduce the affinity of Hb for O2 so that more O2 is released to tissues
Increasing temperature also shift the curve to the right
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CO2 in blood present in 3 forms:
1. 7% dissolved in plasma
2. 70% travels as HCO3- ions
(hydrogencarbonate ions)
3. 23% travels as carboamino compounds
In red blood cells
CO2 = waste product of cellular metabolism (the end-product)
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CO2 reacts directly with Hb to form the carboaminoHb;
reversible reaction
Small quantity of CO2 reacts with plasma proteins -
less significant (quantity of proteins 1/4th that of Hb)
R N H
H
+ CO2 R N H
COO-
+ H+
Carboamino compoundProtein
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Dissolved CO2 in blood reacts with water to form Carbonic Acid
CO2 + H2O H2CO3 H+ + HCO3-
Carbonic Anhydrase present inside RBCs (but not plasma) catalyzes this reaction
Carbonic acid rapidly dissociates into ion H+ and bicarbonate ion
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Bohr ShiftThe relationship between the binding of O2, H
+, CO2 to hemoglobin (allosteric site), is knowing as Bohr effect
H2CO3
(carbonic acid)
H+
Trapped in cytoplasm
acidification in the red blood cell
Bohr Shift
HCO-3
Leaves the red blood cell
CO2 enters the
blood
Tissues
With high level of activity
Hb
affinity with O2
Release of O2
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The dissociation curve moves to the right at higherconcentration of carbon dioxide. This shows that carbondioxide lowers the affinity of Hb for oxygen.
Hb tends to give up O2 in area of high CO2 such as therespiring tissues that need it most.
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The build up of hydrogen carbonate ions causesthem to diffuse out of the RBC leaving the inside ofthe RBC positively charged
In order to balance this electric charge chloride ionsdiffuse into the RBCs from the plasma this isknown as the chloride shift
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When blood gets to the lungs, all the reactions are reversed
The hydrogen carbonate and hydrogen ions recombine releasing CO2
The chloride shift is reversed
Carbamino-haemoglobin breaks down to release CO2
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Figure 27–7
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Hemoglobin acts as a buffer in blood by picking up CO2 or H+
In tissues:
Hemoglobin becomes more basic when it is deoxygenated, i.e. it binds H+ more tightly
In the lung:
Hemoglobin is oxygenated, becomes more acidic, (i.e. it is a more powerful H+ donor), and releases its H+
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SenescentRBCs
LIVER
Bilirubin diglucuronide(water-soluble)
2 UDP-glucuronic acid
via bile duct to intestine
Stercobilinexcreted in feces
Glucuronic acid is removed and bilirubin is converted to urobilinogen which is then oxidized by intestinal bacteria
KIDNEY
Urobilinexcreted in urine
CO
Biliverdin
Heme oxygenase
O2
Bilirubin (water-insoluble)
NADP+
NADPH
Biliverdinreductase
Heme
Globin
Hemoglobin
reabsorbedinto blood (Portion of
urobilinogen)
Bilirubin (water-insoluble)
via blood to the liver (complexed with albumin)
INTESTINE
Catabolism of hemoglobin
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Unconjugated bilirubin Toxic to tissues
Not soluble in aqueous solutions
Tightly complexed to albumin
Cannot be excreted in the urine even when blood levels are high
Conjugated bilirubin Water-soluble
Non-toxic
Loosely bound to albumin
Excreted in urine (bilirubinuria)
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Jaundice describes the yellowing of sclera, skin and mucosal membranes due to increased circulating bilirubin in the plasma
This becomes clinically evident when serum bilirubin reaches about 80-100 mol/l.
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A. Hemolytic anemia
excess hemolysis
unconjugated bilirubin(in blood)
conjugated bilirubin (released to bile duct)
B. Hepatitis C. Biliary duct stone
unconjugated bilirubin(in blood)
conjugated bilirubin (in blood)
Figure : Examples of hyperbilirubinemia
Hemolytic Jaundice Hepatic jaundice Obstructive jaundice
unconjugated bilirubin(in blood)
conjugated bilirubin secreted by liver into bile
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Anemia is due to deficiency of Hb in blood due to lack of erythrocytes and/or their Hbcontent
Normal Hb concentration
o Adult male =14g/dl (14-17)
o Adult female not pregnant = 12g/dl (12-14)
o Adult female pregnant = 11g/dl (11-12)
What is anemia?
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The most common symptom of anemia is tiredness.
Other signs and symptoms of anemia include:
1. Weakness,
2. pale skin,
3. brittle nails,
4. Dizziness,
5. irritability.
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Excess blood loss due to bleeding
Undernutrition: deficiencies of several vitamins and minerals like vitamins A, B2, B6, B12, C, iron, calcium and folic acid along with protein all of which can cause anaemia.
Pregnancy
Others causes: include worm infestation and chronic disease like AIDS, cancer or kidney disease, cancer treatment, and hereditary diseases
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Hemolytic anemia is a disorder in which the red blood cells are destroyed prematurely
RBCs are destroyed faster than the bone marrow can produce them
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Extrinsic:
Red blood cells are produced healthy but are later destroyed by becoming trapped in the spleen, destroyed by infection, or destroyed from drugs that can affect red blood cells
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intrinsic:
oThe destruction of the red blood cells due to a defect within the red blood cells themselves
o Intrinsic hemolytic anemia is often inherited, such as sickle cell anemia and Glucose-6-Phosphate Dehydrogenase deficiency cells
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Sickle Cell anemia is a hereditary disease which causes the body to make abnormally shapes red blood cells (“ C “ form)
Causes complications because the blood cells are not able to reach certain parts of the body
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The α chains in mutant Hb (HbS) are the same as in normal Hb (HbA)
A point mutation in the Hb β gene is responsible for the sickling of RBCs seen in sickle cell anemia
Substitution of non polar
valine for a charged Glu
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Normal hemoglobin Sickle Cell hemoglobin
No oxygen
No Oxygen: stick together No Oxygen: Separate
No Oxygen
Substitution of non polar valine for a charged Glu
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Causes tissue anoxia (Interruption in O2 supply)
This blocking can produce micro vascular occlusions which can cause necrosis (death) of the tissue and pain
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(25%)(25%)
(50%)
Do not express the disease symptoms
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During electrophoresis, HbS moves slowly towards
anode than HbA at alkaline pH
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Lysine replaces glutamic acid at position 6 of the β globin gene.
Mild chronic haemolytic anaemia
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Mixture of Sickle hemoglobin (Hb S) + (Hb C)
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Thalassemia is inherited disorders characterized reduced or absent amounts of hemoglobin
Two major types of thalassemia:
1. Alpha (α): Caused by defect in rate of synthesis of alpha chains (usually caused by gene deletion)
2. Beta (β): Caused by defect in rate of synthesis in beta chains (usually caused by mutation)
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Absence of 1 α gene (silent carrier): no symptoms, may be slightly anemia, does not require therapy
Absence of 2 α gene (α Thalassemia trait): no serious symptoms, except slight anemia
Absence of 3 α genes (Hb H disease): microcytic anemia (small RBC), splenomegaly
Absence of 4 α genes (Hydrops fetalis): most serious form, death before birth
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Usually caused by point mutations and short insertions or deletions limited to a few nucleotides
Two situations have clearly to be distinguished: 1. βo thalassemia: No β-globin chain is made
2. β+ thalassemia: decreased β-globin chain is made
Disease results in an over-production of α-globin chains, which precipitate in the cells
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Inadequate absorption
Inadequate dietary intake of foods high in Fe
Excess loss of iron due to bleeding, some parasites, menstrual loss and gastrointestinal bleeding
In pregnancy iron is taken from mother by growing fetus, so iron supplement must be taken by pregnant women
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Folic Acid (also known as vitamin B9) Deficiency causes megablastic anemia (RBCs that are large and fewer in number)
Deficiency can be due to:
1. Poor dietary intake2. Malabsorption syndromes3. Drugs that inhibit absorption4. Alcohol abuse5. Hemodialysis6. Increased requirement (pregnancy)
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Vitamin B12 is a water soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood
Dangerous anemia
It is a type of megablastic anaemia due to malabsorption of Vit B12 (decreased gastric intrinsic factor IF which is needed for absorption of vit B12)
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The primary defect is a reduction in ordepletion of hematopoietic precursor stemcells with decreased production of all cell lines.
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Aplastic anemia is a severe, life threatening
syndrome in which production of erythrocytes,
WBCs, and platelets has failed.
Aplastic anemia may occur in all age groups
and both genders.
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Incidence (acquired)
◦ 2/1000000
◦ rare < 1 year; plateaus 20-60 yrs; increase > 60 yrs
The disease is characterized by peripheral
pancytopenia and accompanied by a
hypocellular bone marrow.
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