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Introduction to hematology
Dr mukhtar jama nour , MBBS
Amoud University for health and scienceinstitute
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Hematology is the study of blood hich is
com!osed of !lasma "#$$%&, and theformed elements hich are' (he erythrocytes ")B*s& "#+$%&
(he eukocytes "-B*s& and !latelets
"thrombocytes& "#.%&
-hat is hematology/
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Hemato!oiesisis the formation and
develo!mentof blood cells0 *ells of the blood are constantly being lost ordestroyed0 (hus, to maintain homeostasis, thesystem must have the ca!acity for self reneal0 (hissystem 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!readlym!hatic system and only mature cellsare released intothe !eri!heral blood0
-hat is hematology/
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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
-hat is hematology/
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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
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(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 oflym!ho!oiesis throughout life, but blood !roduction inthe other areas decreases and finally ceases as thebone marro becomes the !rimary site ofhemato!oiesis at about 5 months of gestation andcontinues throughout life0
-hat is hematology/
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Hemato!oiesis
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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 byathletes , cyclist to cheat0
9!o " erthro!oietin&
-hat is hematology/
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Hemoglobin !erforms the main function of red cells
carrying o6ygen to the cells and returning *3:0
Adult hemoglobin"HbA& consist to beta al!ha and
beta, the other "HbA:& consist to beta and to
gamma and fetal hemoglobin "Hb;& consist of to
beta and to delta globins0
Hemoglobin synthesis
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(he mononuclear !hagocytic system "also called the
reticular endothelial system or )9S& is involved incellular destruction and it includes' *irculating blood monocytes
;i6ed macro!hages in the bone marro, liver, s!leen, andlym!h nodes
;ree macro!hages' involved in'
9ngulfing !articulate matter
1rocessing of antigens for lym!hocyte !resentation
)emoval of damaged or senescent cells
-hat is hematology/
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S!leen < contains the largest collection of
lym!hocytes and mononuclear !hagocytes in thebody0 (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 decreasein the surface 7 volume ratio of the )B* resulting ins!herocytes0
9nforcing close contact of blood borne antigens ithlym!hocytes and !hagocytic cells envelo!ed organisms hichare they
Stre!tococcus !neumonia , H0 influen2ae , and meningococus
-hat is hematology/
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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 isless effective in !erforming all of the s!lenic functions
Hy!ers!lenism"s!lenomegaly& < in a number of conditionsthe s!leen may become enlarged and through an
e6aggeration of its normal functions of filtering, anddestruction and se4uestering, it may cause anemia,leuko!enia, or thrombocyto!eniaor combinations of thesecyto!enias0 -hen all three cell ty!es are decreased this iscalled !ancyto!enia0 (here are to ty!es ofhy!ers!lenism'
-hat is hematology/
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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
-hat is hematology/
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Bone marro < is located inside s!ongy bone
In a normal adult, > of the bone marro ishemato!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 itgradually decreases ith age to the adult level of $?%0
In certain !athologic states the bone marro can increaseits activity to $@.? its normal rate0 When this happens, the bone marrow is said to be
hyperplasticbecause it replaces the yellow marrow withred marrow0
-hat is hematology/
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This occurs in conditions where there is increased orineffective hematopoiesis.
The degree to which the the bone marrow becomeshyperplastic is related to the severity and duration ofthe pathologic state.
Pathologic states that cause this include:
Acute blood loss in which there is a temporary
replacement of the yellow marrow Severe chronic anemia erythropoiesis may
increase to the etent that the marrow starts toerode the bone itself.
!alignant disease both normal red marrow andfatty marrow may be replaced by proliferating
abnormal cells.
-hat is hematology/
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(he hemato!oietic tissue may also become inactive or
hy!o!lastic0 (his may be due to' *hemicals
enetics
Myelo!roliferative disease that re!laces hemato!oietic
tissue ith fiberous tissue
-hat is hematology/
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Hemato!oietic cells can be divided into threecellular com!artments based on maturity' 1luri!otential stem cellca!able of self@reneal and
differentiation into all blood cell lines0
*ommitted !roginator stem cellsdestined to develo!
into distinct cell lines Mature cellsith s!eciali2ed functions
Derivation of blood cells
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Hemato!oiesis
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Hemato!oiesis
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"asic investigation in hematological
diseases
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Hb' " male &' [email protected] g7dl
" ;emale &' [email protected]$ g7dl -B*' +???@..???7mm=
neutro!hil' :???@$??7mm=
lym!hocytes' .$??@+???
monocytes' :??@C?? eosino!hils' +?@+??
baso!hils' .?@.??
*B*
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Anemias # based on cell si$e %!&'( and amount of )gb
%!&)(
M*E F loer limit of normal' microcytic anemia
M*E normal range' normocytic anemia
M*E G u!!er limit of normal' macrocytic anemia M*H F loer limit of normal' hypochromic anemia
M*H ithin normal range' normochromic anemia
M*H G u!!er limit of normal' hyperchromic anemia
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*ed &ell 'olume +istributionWidth %*+W(
)eflects the variability in cell !oikilocytosis "sha!e&
anisocytosis "si2e& Aids in further differentiating beteen s!ecific
etiologies of microcytic, normocytic, and macrocytic
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%periphersal blood film("lood smear
Assess the si2e, color, and sha!e of redcells
ook for abnormalities 8.5m diameter
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LEPTOCYTE
Hypohromi ell !ith a
normal diameter and
derea"ed MC#
Thala""emia.
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TAR$ET CELL
Hypohromi !ith
entral %target% o&
hemoglo'in. Li(er
di"ea"e)thala""emia)
hemoglo'in *)
po"t"plenetomy
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TEAR *ROP CELL
Tear drop+"haped erythroyte) o&ten miroyti.
Myelo&i'ro"i" and in&iltration o& marro! !ith t,mor.
Thala""emia
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ELL-PTOCYTE
O(al to igar
"haped.
Hereditary
elliptoyto"i")ertain anemia"
parti,larly
(itamin /+01 and
&olate de&iieny2
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ECH-3OCYTE /4RR CELL2
E(enly di"tri',ted
"pi,le" on ",r&aeo& R/C") ,",ally 0+
6. 4remia) pepti
,ler) ga"tri
arinoma) pyr,(i7ina"e de&iieny
.
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ACA3THOCYTE
i(e to 0 "pi,le" o&
(ario," length" and
at irreg,lar inter(alon ",r&ae o& R/C".
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9TOMATOCYTE
9litli7e area o& entralpallor in erythroyte.
Li(er di"ea"e) a,te
aloholi"m)
malignanie")hereditary
"tomatoyto"i") and
arti&at
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9CH-9TOCYTE
ragmented helmet+ or
triang,lar+"haped R/C".Miroangiopathi anemia)
arti&iial heart (al(e") ,remia)
malignant hyperten"ion
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!icrocytic and )ypochromic
9maller than normal :; m
diameter
Le"" hemoglo'in in ell.
Enlarged area o& entral
pallor.
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Sickle cell and S!herocytes in blood
film
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*ontd
IE0 Marro e6amination
A0 As!irate
.0 97 ratio
:0 *ell mor!hology
=0 Iron stain
B0 Bio!sy
.0 *ellularity :0 Mor!hology 97 ratio, ratio of erythroid
to granulocytic !recursors0
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*eticulocyte &ount
)eticulocyte !roduction inde6
-ndiate" !hether the /M i"
appropriately re"ponding to anemia
RP- >6 < in prod = 'lood
lo""hemoly"i"
RP- :1 < de prod ine&&eti(e prod
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