Introduction to hematology

Dr mukhtar jama nour , MBBS Amoud University for health and science institute

Dr mukhtar jama nour,MBBS

01/13/14

-hat is hematology/
Hematology is the study of blood hich is com!osed of !lasma "#$$%&, and the formed elements hich are'
(he erythrocytes ")B*s& "#+$%& (he ,eukocytes "-B*s& and !latelets "thrombocytes& "#.%&

Dr mukhtar jama nour,MBBS

01/13/14

-hat is hematology/
Hemato!oiesis is the formation and develo!ment of blood cells0

*ells of the blood are constantly being lost or destroyed0 (hus, to maintain homeostasis, the system must have the ca!acity for self rene al0 (his system involves'

1roliferation of !rogeny stem cells Differentiation and maturation of the stem cells into the functional cellular elements0 In normal adults, the !roliferation, differentiation, and maturation of the hemato!oietic cells ")B*s, -B*s, and !latelets& is limited to the bone marro and the ides!read lym!hatic system and only mature cells are released into the !eri!heral blood0
3 01/13/14

Dr mukhtar jama nour,MBBS

-hat is hematology/

Hemato!oiesis begins as early as the nineteenth day after fertili2ation in the yolk sac of the embryo 3nly erythrocytes are made (he )B*s contain uni4ue fetal hemoglobins

Dr mukhtar jama nour,MBBS

01/13/14

 Do you kno fetal hemoglobin / It contain gamma and beta globins At about 5 eeks of gestation, yolk sac !roduction of erythrocytes decreases and !roduction of )B*s in the human embryo itself begins0

Dr mukhtar jama nour,MBBS

01/13/14

-hat is hematology/
(he fetal liver becomes the chief site of blood cell !roduction0 (he s!leen, kidney, thymus, and lym!h nodes serve as minor sites of blood cell !roduction0 (he lym!h nodes ill continue as an im!ortant site of lym!ho!oiesis throughout life, but blood !roduction in the other areas decreases and finally ceases as the bone marro becomes the !rimary site of hemato!oiesis at about 5 months of gestation and continues throughout life0

Dr mukhtar jama nour,MBBS

01/13/14

Hemato!oiesis

Dr mukhtar jama nour,MBBS

01/13/14

-hat is hematology/
Hemato!oiesis in the bone marro is called medullary hemato!oiesis Hemato!oiesis in areas other than the bone marro is called e6tramedullary hemato!oiesis'
In liver and s!leen of an adult hen the bone marro cannot meet the !hysiologic needs of the tissues0 (his can lead to he!atomegaly and7or s!lenomegaly0 8idneys can also increases hemato!oiesis , through hat mechanism/ Hint this is sometimes used by athletes , cyclist to cheat0 9!o " erthro!oietin&
Dr mukhtar jama nour,MBBS 8 01/13/14

Hemoglobin synthesis

Hemoglobin !erforms the main function of red cells carrying o6ygen to the cells and returning *3:0 Adult hemoglobin"HbA& consist t o beta al!ha and beta, the other "HbA:& consist t o beta and t o gamma and fetal hemoglobin "Hb;& consist of t o beta and t o delta globins0

Dr mukhtar jama nour,MBBS

01/13/14

-hat is hematology/
(he mononuclear !hagocytic system "also called the reticular endothelial system or )9S& is involved in cellular destruction and it includes'
*irculating blood monocytes ;i6ed macro!hages in the bone marro , liver, s!leen, and lym!h nodes ;ree macro!hages'
involved in' 9ngulfing !articulate matter 1rocessing of antigens for lym!hocyte !resentation )emoval of damaged or senescent cells
Dr mukhtar jama nour,MBBS 10 01/13/14

-hat is hematology/
S!leen < contains the largest collection of lym!hocytes and mononuclear !hagocytes in the body0 (he s!leen functions in'

;iltering and destruction of senescent "aged& or damaged )B*S < also called culling )emoval of !articles "are found in some ty!es of anemia& from )B* membranes < also called !itting < this causes a decrease in the surface 7 volume ratio of the )B* resulting in s!herocytes0 9nforcing close contact of blood borne antigens ith lym!hocytes and !hagocytic cells envelo!ed organisms hich are they Stre!tococcus !neumonia , H0 influen2ae , and meningococus
11 01/13/14

Dr mukhtar jama nour,MBBS

-hat is hematology/
Se4uestering .7= of the !latelet mass < in massive s!lenomegaly this can lead to !eri!heral thrombocyto!enia After s!lenectomy, )B* inclusions and abnormal )B* sha!es are seen0 *ulling is taken over by the liver hich is less effective in !erforming all of the s!lenic functions Hy!ers!lenism "s!lenomegaly& < in a number of conditions the s!leen may become enlarged and through an e6aggeration of its normal functions of filtering, and destruction and se4uestering, it may cause anemia , leuko!enia, or thrombocyto!enia or combinations of these cyto!enias0 -hen all three cell ty!es are decreased this is called !ancyto!enia0 (here are t o ty!es of hy!ers!lenism'
Dr mukhtar jama nour,MBBS 12 01/13/14

-hat is hematology/

1rimary < no underlying disease identified Secondary < caused by an underlying disorder such as'
Inflammatory diseases Infectious diseases Blood disorders that cause com!ensatory or orkload hy!ertro!hy of the organ such as' Abnormal blood cells, antibody coated blood cells, hereditary s!herocytosis, I(1 (he effects of these are relieved by s!lenectomy

Dr mukhtar jama nour,MBBS

13

01/13/14

-hat is hematology/
Bone marro < is located inside s!ongy bone

In a normal adult, > of the bone marro is hemato!oietically active "red marro & and > is inactive, fatty marro "yello marro &0 (he marro contains both 9rythroid ")B*& and leukocyte "-B*& !recursors as ell as !latelet !recursors0 9arly in life most of the marro is red marro and it gradually decreases ith age to the adult level of $?%0 In certain !athologic states the bone marro can increase its activity to $@.?A its normal rate0
When this happens, the bone marrow is said to be hyperplastic because it replaces the yellow marrow with red marrow0
14

Dr mukhtar jama nour,MBBS

01/13/14

-hat is hematology/
This occurs in conditions where there is increased or ineffective hematopoiesis. The degree to which the the bone marrow becomes hyperplastic is related to the severity and duration of the pathologic state. Pathologic states that cause this include: Acute blood loss in which there is a temporary replacement of the yellow marrow Severe chronic anemia erythropoiesis may increase to the e tent that the marrow starts to erode the bone itself. !alignant disease both normal red marrow and fatty marrow may be replaced by proliferating abnormal cells. Dr mukhtar jama nour,MBBS 15

01/13/14

-hat is hematology/

(he hemato!oietic tissue may also become inactive or hy!o!lastic0 (his may be due to'
*hemicals Benetics Myelo!roliferative disease that re!laces hemato!oietic tissue ith fiberous tissue

Dr mukhtar jama nour,MBBS

16

01/13/14

Derivation of blood cells

Hemato!oietic cells can be divided into three cellular com!artments based on maturity'
1luri!otential stem cell ca!able of self@rene al and differentiation into all blood cell lines0 *ommitted !roginator stem cells destined to develo! into distinct cell lines Mature cells ith s!eciali2ed functions

Dr mukhtar jama nour,MBBS

17

01/13/14

Hemato!oiesis

Dr mukhtar jama nour,MBBS

18

01/13/14

Hemato!oiesis

Dr mukhtar jama nour,MBBS

19

01/13/14

"asic investigation in hematological diseases

Dr mukhtar jama nour,MBBS

20

01/13/14

*B*
Hb' " male &' .=@.C g7dl " ;emale &' ..0$@.50$ g7dl -B*' +???@..???7mm= neutro!hil' :???@D$??7mm= lym!hocytes' .$??@+??? monocytes' :??@C?? eosino!hils' +?@+?? baso!hils' .?@.??
21 01/13/14

Dr mukhtar jama nour,MBBS

Anemias # based on cell si$e %!&'( and amount of )gb %!&)(

M*E F lo er limit of normal' microcytic anemia M*E normal range' normocytic anemia M*E G u!!er limit of normal' macrocytic anemia M*H F lo er limit of normal' hypochromic anemia M*H ithin normal range' normochromic anemia M*H G u!!er limit of normal' hyperchromic anemia

Dr mukhtar jama nour,MBBS

22

01/13/14

*ed &ell 'olume +istribution Width %*+W(

)eflects the variability in cell !oikilocytosis "sha!e& H anisocytosis "si2e& Aids in further differentiating bet een s!ecific etiologies of microcytic, normocytic, and macrocytic

Dr mukhtar jama nour,MBBS

23

01/13/14

%periphersal blood film(

"lood smear

Dr mukhtar jama nour,MBBS

Assess the si2e, color, and sha!e of red cells ,ook for abnormalities < macrocyte, le!tocyte, target cell, (ear dro!, 9lli!tocytosis,burr cell,acanthocyte, Schistocytes,S!herocytosis,Sickle cells,1oikilocytes ,Anisocytosis, 1olychromasia
24

01/13/14

MACROCYTE

Larger than normal >8.5 m diameter

Dr mukhtar jama nour,MBBS

25

01/13/14

LEPTOCYTE

Hypo hromi ell !ith a normal diameter and de rea"ed MC# Thala""emia

Dr mukhtar jama nour,MBBS

26

01/13/14

TAR$ET CELL
Hypo hromi !ith entral %target% o& hemoglo'in. Li(er di"ea"e) thala""emia) hemoglo'in *) po"t"plene tomy

Dr mukhtar jama nour,MBBS

27

01/13/14

TEAR *ROP CELL

Tear drop+"haped erythro yte) o&ten mi ro yti . Myelo&i'ro"i" and in&iltration o& marro! !ith t,mor. Thala""emia

Dr mukhtar jama nour,MBBS

28

01/13/14

ELL-PTOCYTE
O(al to igar "haped. Hereditary ellipto yto"i") ertain anemia" .parti ,larly (itamin /+01 and &olate de&i ien y2

Dr mukhtar jama nour,MBBS

29

01/13/14

ECH-3OCYTE ./4RR CELL2

E(enly di"tri',ted "pi ,le" on ",r&a e o& R/C") ,",ally 05+ 65. 4remia) pepti ,l er) ga"tri ar inoma) pyr,(i 7ina"e de&i ien y

Dr mukhtar jama nour,MBBS

30

01/13/14

ACA3THOCYTE
8i(e to 05 "pi ,le" o& (ario," length" and at irreg,lar inter(al on ",r&a e o& R/C".

Dr mukhtar jama nour,MBBS

31

01/13/14

9TOMATOCYTE

9litli7e area o& entral pallor in erythro yte. Li(er di"ea"e) a ,te al oholi"m) malignan ie") hereditary "tomato yto"i") and arti&a t
Dr mukhtar jama nour,MBBS 32 01/13/14

9CH-9TOCYTE

8ragmented helmet+ or triang,lar+"haped R/C". Mi roangiopathi anemia) arti&i ial heart (al(e") ,remia) malignant hyperten"ion
Dr mukhtar jama nour,MBBS 33 01/13/14

!icrocytic and )ypochromic

9maller than normal . :; m diameter Le"" hemoglo'in in ell. Enlarged area o& entral pallor.

Dr mukhtar jama nour,MBBS

34

01/13/14

Sickle cell and S!herocytes in blood film

Dr mukhtar jama nour,MBBS

35

01/13/14

*ontd

II0 )eticulocyte count III0 Iron su!!ly studies A0 Serum iron B0 (otal iron@binding ca!acity *0 Serum ferritin, marro iron stain

Dr mukhtar jama nour,MBBS

36

01/13/14

*ontd
IE0 Marro e6amination A0 As!irate .0 97B ratio :0 *ell mor!hology =0 Iron stain B0 Bio!sy .0 *ellularity :0 Mor!hology 97B ratio, ratio of erythroid to granulocytic !recursors0
Dr mukhtar jama nour,MBBS 37 01/13/14

*eticulocyte &ount
)eticulocyte !roduction inde6 -ndi ate" !hether the /M i" appropriately re"ponding to anemia RP- >6 < in prod = 'lood lo"">hemoly"i" RP- :1 < de prod > ine&&e ti(e prod
Dr mukhtar jama nour,MBBS 38 01/13/14

Dr mukhtar jama nour,MBBS

39

01/13/14