HAEMATOLOGY

Col Kamran Afzal

 INTRODUCTION
 Blood is the life-maintaining fluid that circulates
through the body's heart, arteries, veins, and
capillaries
 Functions of blood:
 Carries away waste matter and carbon dioxide
 Brings nourishment, electrolytes, hormones,
vitamins, antibodies, heat, and oxygen to the tissues
 Many disorders that require clinical care
 Benign (non-cancerous)
 Malignant (cancerous)
HAEMATOPOIESIS
 The process through which
pluripotent stem cells
differentiate into various
types of blood cells
 Before birth, this happens in
spleen, liver, lymph nodes,
and thymus
 After birth, happens in bone
marrow
CELLS OF BLOOD
HAEMATOPOEISIS
ERYTHROPOEISIS
 Production of red blood cells - Erythropoeitin

 Hemolysis - Destruction of red blood cells

BLOOD VOLUME
 6% of total body weight
 Body can compensate for 0.5 liters blood loss

 Fluid shift can easily alter amount of blood

 Number of red blood cells remain constant

 Red blood cells are confined to vascular space

BLOOD COMPONENTS
 Red blood cells - carry oxygen to the tissues
 Platelets - help the blood to clot

 White blood cells - help to fight infection and aid

in the immune process
 Plasma - helps to maintain blood
pressure; provides proteins for blood
clotting; balances the levels of
sodium and potassium
 Cryoprecipitate - portion of the plasma
containing clotting factors that help to
control bleeding
 Albumin, immune globulins, and
clotting factor concentrates may also
be separated and processed for
transfusions
LAB WORK-UP
 Hemoglobin
 Oxygen-bearing molecule in RBC
 Made up of an iron-rich pigment – heme, and a
protein - globin
 Each hemoglobin has 4 subunits of globin
 Each globin can carry one oxygen molecule

 Oxygen Transport
 Normal pO2 is 95 mmHg
 Bohr effect - Uptake of oxygen in lungs:
 Alkalosis makes hemoglobin bind to oxygen more tightly
 Acidosis makes hemoglobin release oxygen
 DISORDERS OF BLOOD
 Anaemia – reduced RBCs
 Leukemias – progressive proliferation of abnormal
leukocytes
 Hodgkin's Disease – marked by chronic enlargement
of the lymph nodes
 Non-Hodgkin's Lymphoma – lymphoma other than
Hodgkin’s disease
 Thrombocythemia (Thrombocytosis) – high number of
platelets in the circulating blood
 Thrombocytopenia – Reduced number of platelets
 Haemophilia – defect in the blood coagulation
mechanism due to deficiency of clotting factor
 Hemochromatosis – disorder of iron metabolism
characterized by excessive absorption and deposition
ANAEMIA
 Anaemia is a decrease in the total amount of red
blood cells (RBCs) or haemoglobin in the blood
 Lowered ability of the blood to carry oxygen

 Haematocrit < 37 % in females and < 40% in

males
TYPES
 Macrocytic anaemia: Megaloblastic anaemia and
non-megaloblastic macrocyctic anaemia
 Microcytic anaemia: Occurs due to haemoglobin
synthesis shortage or collapse
 Normocytic anaemia: Occurs when Hb levels
decreases overall, the size of RBC remains
normal
 Iron-deficiency anaemia – hypochromic
microcytic anaemia characterized by low serum
iron, increased serum iron-binding capacity,
decreased serum ferritin, and decreased marrow
iron stores
 Megaloblastic (pernicious) anaemia –
predominant number of megaloblastic
erythroblasts, and relatively few normoblasts,
among the hyperplastic erythroid cells in the
bone marrow
 Haemolytic anemia – increased RBC destruction
 In the blood vessels (intravascular haemolysis)
 Elsewhere in the human body (extravascular, but
usually in the spleen)
 Sickle cell anaemia – crescent- or sickle-shaped
RBCs and accelerated haemolysis
 Aplastic anaemia – greatly decreased formation
of RBCs and haemoglobin, usually associated
with granulocytopaenia and thrombocytopaenia
 G6PD deficiency - Defective red cell metabolism

 Chronic anaemia - Anaemia of chronic disorder

 Signs/ symptoms of anaemia
Lab Diagnosis of anaemia
 Blood Complete Picture

 Red Cell Indices

 Red Cell Morphology

 Bone Marrow Aspiration Biopsy

POLYCYTHEMIA
 Haematocrit (vol of RBCs in the blood) is
elevated due to
 An increase in the number of RBCs ("absolute
polycythemia“)
 A decrease in the volume of plasma ("relative
polycythemia")
 Primary polycythemia (Polycythemia vera)
 Due to factors intrinsic to red cell precursors, bone
marrow, myeloproliferative disease
 Secondary polycythemia
 Due to chronic hypoxaemia, which triggers increased
production of erythropoeitin from kidneys
WHITE BLOOD CELL PRODUCTION
 Leukopoiesis (Differentiation of WBCs)
 Immature to Mature WBCs:
 Myeloblasts - Granulocytes
 Monoblasts - Monocytes
 Lymphoblasts – Lymphocytes
 Granulocytes
 Basophils – Role in allergic reaction, contain histamine
 Eosinophils - Fight parasitic infection, and allergic
reactions
 Neutrophils - Fight infection

 Monocytes
 May circulate as monocytes or mature into
“Macrophages”
 Garbage collectors / Scavangers

 Lymphocytes
 Involved in immune response
 T Cells (thymus)
 B Cells (bone marrow)
 DISORDERS OF LEUKOCYTES
 Leukocytosis
 An increase in the number of circulating white blood
cells, often due to infection
 Leukemoid reaction
 Leukopenia/Neutropenia
 Reduced number of WBCs (mostly neutrophils)
 Leukemia
 Cancer of white blood cells
 Types of Leukemia:
 Acute Lymphocytic Leukemia (ALL)
 Acute Myeloid Leukemia (AML)
 Chronic Lymphocytic Leukemia (CLL)
 Chronic Myeloid Leukemia (CML)
Acute or chronic leukemia
 Acute leukemia - The new or immature cells,
called blasts, cannot perform their functions, the
blasts increase in number rapidly, and the
disease progresses quickly
 Chronic leukemia - There are some blast cells
present, but they are more mature and are able
to perform some functions, the cells grow and
increase in number slowly, so the disease
progresses gradually
 Lymphomas
 Cancer of the lymphatic system
 Hodgkin's - Cells in the lymphatic system abnormally
reproduce, making the body less able to fight infection
 Non-Hodgkins – Caused by some bacteria and viruses,
treatable in early stages
PLATELETS
 Thrombocytes
 150,000 – 450,000 per microliter of blood
 Life is 7 – 10 days
 Removed by the spleen
 Thrombocytosis – Increased number
 Thrombocytopaenia – Decreased number
HAEMOSTASIS
 Injury - vascular spasm
 Platelet - fibrin blood clot

 Platelet plug – blood clot

 Blood clot destruction

 Plasminogen- released from fibrin
clot
 Turned into plasmin
 Plasmin dismantles blood clot -
Fibrinolyis
 Takes hour to days to dissolve
COAGULATION CASCADE

Tissue injury
 CLOTTING DISORDERS
 Thrombocytosis and Thrombocytopenia
 Thrombocytosis
 An abnormal increase in the number of platelets
 Thrombocytopenia
 An abnormal decrease in the number of platelets
 Sequestration

 Destruction (ITP)

 Decreased production
THROMBOCYTHEMIA
 It is a myeloproliferative blood disorder

 It is characterized by the production of excessive

platelets in the bone marrow
 Excessive platelets make normal clotting of blood
difficult
 Etiology is idiopathic
 Hemophilia
 Deficiency or absence of a blood clotting factor
 Deficiency of factor VIII causes hemophilia A
 Deficiency of factor IX causes hemophilia B

 Deficiency is a sex-linked, inherited disorder

 Defective gene is carried on the X chromosome

 Signs and Symptoms

 Numerous bruises, deep muscle bleeding, joint bleeding, intra-
cerebral bleeding, excessive bleeding due to sports
 Von Willebrand’s Disease
 Deficient component of factor VIII
 Generally results in excessive bleeding
 Immune Thrombocytopenic Purpura (ITP)
(Thrombocytopenia)
 Abnormally decreased number of platelets, which
results in internal bleeding, due to some immune
reaction
 Acute thrombocytopenic purpura
 Young children, following a virus infection
 Chronic thrombocytopenic purpura
 Any age, but more common in adults
 Causes – Medicines, infection, pregnancy, immune
disorders, about 50% are idiopathic
 Symptoms - Internal bleeding, which may cause:
ecchymosis, bruising, petechiae, occasionally
bleeding from the nose, gums, digestive tract,
urinary tract
 Disseminated Intravascular Coagulation (DIC)
 Systemic activation of coagulation cascade
 Widespread thrombosis
 Bleeding due to decreased fibrinogen level,
consumption of coagulation factors,
thrombocytopenia
 Results from sepsis, hypotension, OBS complications,
severe tissue or brain injury, cancer, and major
hemolytic reactions
 Multiple Myeloma
 Cancerous disorder of plasma cells
 Pathologic fractures are common