Basics in hematology
Msc Balqees Mohammad AL Rafayah
Lecture (1)
Introduction to Hematology
Terms in hematology
• Haematology: a study of blood and
blood disorders
• Haeme: iron, 70% of blood is iron.
• Anemia: An, without.
Blood
•
Blood: is the fluid where the cells are free
and suspended.
1. It can cross the tissues.
2. Has red color.
3. Has volume of 5-6 liters, this is 7-8% of
the total body weight.
4. Has pH of 7.3-7.4 (alkaline)
Functions
Blood is a constantly circulating fluid
providing the body with:
• Transport
1. Nutrition
2. 2. Oxygen
3. 3. and waste removal
• Haemo stasis
• Homeo stasis
Composition of the Blood:
• Composition of the Blood:
• The blood composed of two parts:
1-liquid part called plasma and constitute
about 55% of whole blood
2-cellular part (formed elements) 45 %
Plasma consists of 90% water, and 10%
solids (plasma proteins,
lipoproteins,crystalloids, gases)
Plasma proteins 7gm%
•
Albumin (highest con, low mW, function OP)
• Globulin
• fibrinogen( Highest mW, plasma viscosity)
• Prothrombin
Functions of plasma proteins
•
1.
2.
3.
4.
Specific
Albumin ( effective colloidal oncotic) OP
Globulin ( gamma globulin)
Fibronogen ( plasma viscosity, blood pressure)
Prothrombin (blood clotting)
• Other
1. Adsorption and conservation
2. Buffer 15% proteinc acid/ Na proteinate
Full blood count (FBC ) or complete blood
count (CBC)
It is a very common test, used routinely to evaluate
the most important substances in human body
provide important Information about the blood cells.
Names:
• Full blood count (FBC)
• Complete blood count (CBC)
• Complete blood Picture (CBP)
• General blood count (GBC)
• General blood picture (GBP)
The blood count test used to evaluate:
1. Anemia ➡️ low RBC count
2. Infection ➡️ High WBC
3. Bleeding disorders ➡️ low PLT count
4. Blood cancers (leukemia, lymphoma)
5. Metastatic cancer cells count
6. Blood parasites (malaria, etc)
Parts of CBC :
1-Erythrocytes
1. Hemoglobin (Hb)
2. Hematocrite (Hct) or PCV
3. RBCc
4. RBC INDICIES ..MCV , MCH , MCHC, and
RDW
Erythrocyte indices:
1. MCV = HCT/RBCs - average volume of red blood cells.
2. Femtolitter (fl) : Unit
3. 80_100 fl
• MCH= HGB / RBC - the average content of hemoglobin in erythrocytes
• Unit : Pg/dl
• 27_33 pg/dl
• MCHC= HGB / HCT - the average concentration of hemoglobin in
erythrocytes
• 30-36.6 ٪
Spherocytosis : pathological condition in abnormal RBCs shape
• Two types :
• Heridetry spherocytosis : defect in the gene which is responsible for spectrin and ankyrin
protein synthesis
•
1.
2.
3.
Acquired spherocytosis :
Auto immune hemolytic spherocytosis (AHS)
Dehydration
Sever burning
⬇️MCV ⬆️⬆️⬆️MCHC
Normochromic
Spherical shape ⬆️Basophil
Megaloblastic anemia : pathological condition in abnormal RBCs element(maturation
factor) level
1. ⬇️B12
2. ⬇️B9 or both
⬆️MCV ⬆️MCH ⬆️Hb normal MCHC
Iron deficiency anemia :
⬇️MCV ⬇️MCH ⬇️MCHC
Reasons :
1.
2.
3.
4.
⬇️ iron uptake
Absorbtion problems
⬆️require
⬆️loss
Normocytic Normochromic :
1. Bleeding
2. Hemolytic Anemia
3. Failur in bone marrow
•
Acute bleeding : MCV, MCH, MCHC➡️ Normal.
•
1.
2.
•
Chronic bleeding : ⬇️ MCH, ⬇️MCV
Non_GIT : ( Hematourea, blood transfusion)
GIT : common( peptic ulcer, Ancyloctoma, colon cancer)
in IDA, plts increase ⬆️.
• RDW “Red cell distribution wedth :
CV(%), SD(fl)
Poikilocytosis: abnormal variation in shape
Anisocytosis : abnormal variation in size
• Important for anemia diagnosis
• more sensitive than MCV in size
• RDW ⬆️⬆️ in IDA
• RDW ⬇️⬇️ in Thalassemia
• Retics count :
0. 2_2% in pb
• severity of anemia is measured by # f NRBCs
• Reticulocytosis… ⬆️Retics… Hyperactive bone marrow ( blood loss, Thalasemia,
Hemolytic rises, Hypersplenisim)
• Reticulocytopenia… ⬇️ Retics… Defect in bone
marrow
• in treatment of IDA there is ⬆️⬆️ Reticulocytosis… Why??
• Reticulocytosis : effective ⬆️
• Not Reticulocytosis : non effective
Leukocytes “WBCs”
• 5 types of WBCs depend on the presence of a specific granules :
1. Granulocytes ( Neutrophil, Basophil, Eosinophil)
2. Agranulocytes ( Lymphocytes, Monocytes)
Basophil: (Acid)
Eosinophil : (Basic)
Neutrophil : ( neutro)
Lysosome, irregular granules, a Zoro granule : common in all WBCs
4000-11000 cell in mm3
RBCs: millions, WBCs : thousands, plts: hundred thousands
Why in infant the WBCs is more than in adults?
1. Technical reason
2. Physiological reasons
• decay products of tissue
• Bleeding that occur during childbirth
•
How to differentiate between Basophil and Neutrophil?
Physiological reasons increase in WBCs:
1. pregnant women
2. Infant
3. after food intake
4. after exercise
5. cold bath
• pathological reasons increase in WBCs:
1. any inflammation
2. Any infection
• When luekopenia happen?
1. increase uses of Antibiotics for long time leading to suppression
2. Some drugs uses for thyroid disease “ hyper/hypothyroidism
•
1.
2.
•
•
differential count
Absolute
Relative = Absolute / total *100%
In diagnosis relative is easier
In diagnosis absolute is more precise
•
1.
2.
3.
4.
Why in Covid_19 people suffer from luekopenia?
direct killing of virus
consuming WBCs especially Lymphocytes
Shiffting of Lymphocytes from peripheral blood to the lung
Cytokine store
•
1.
2.
3.
Anemia of chronic disease :
Positive acute phase reactive protein
WBCs increase, (this infection is the cause of Anemia)
Cytokine increase ( lead to suppression of Epo from kidney cortex, that responsible for
anemia also.
• Hepcidin ( negative control Absorbtion of Iron)
• 30% of people of chronic disease… IDA
• 70% of people of chronic disease… Normocytic Normochromic “ decrease Absorbtion”
Mentzer index : MCV/ #RBCs
• > 13➡️ IDA
• < 13 ➡️ Thalasemia
• Why in Thalassemia the #RBCs is high?
• MCV/ ⬆️RBCs = Thalasemia
• MCV/ ⬇️RBCs = IDA
• Example :
63.1/6.13= 10.29<13 ➡️ Thalasemia
Need to Electrophoresis
,⬆️⬆️HbA2, ⬆️⬆️HbF
•
Platelets (Thrombocytes) : stop bleeding (plts plug)
150-450*10^3 in 1ul
<150 Thrombocytopenia
1. depression of bone marrow
Ultra violet
Tumor or malignancy in bone marrow
Chemicals
2. Splenomegaly
3. Hepatomegaly
4. Insrease utilising plts (DIC), (TTP), chronic blood loss
>450000 Thrombocytosis
• One megakaryocyte cell produce 4000 plts By fragmentation
• 30% store in spleen