1

Haematology

actualy

hematology is the science that deals with blood elements

Blood elements

RBCs , WBCs and coagulation

science of investigation not science of clinical diagnosis

hematologist investigations

RBCphysiology RBCsIntraUterina 3rd weekyolk sac

liver and spleen

fourth month BoneMarrow

Bone marrow

limited to end of long bones and flat bones hemolytic anemia

bone marrow proliferating replace RBCs

proliferate shaft shaft spleen liver &

and bone marrow expansion hepatosplenomegaly

RBCs BM stem cells undifferentiated

rbcs , wbcs or platlets cells RBCs

pleuripotent cells stage RBCs

2

RBCS nucleasstem cellnucleus nucleus

RBCSreticulocytes reticulocytes

bone marrow Mature RBCs Mature RBCs

RBCs 2%maximum 2 %

haemolysis RBCs bone marrow

reticulcytes immature reticulcytes

haemolysis and haemorhhage reticulcytesanemia medical treatment

iron deficnecy anemia Bone marrow RBCs iron iron

reticulcytessuccess of treatment reticulcytosis

reticulcytes bone marrow failure pan

cytopenia hypersplenism or bone marrow failure reticulcytes

bone marrow failure hypersplenism spleen reticulocyte

bone marrow activity

Reticulocytosis reticulocytes

reticulocytesRBCs reticulocyte

Macrocytosis large cells in blood

COUNT RBCs

Male : 4-6 Mil

Female : 3.5 to 4.5 Mill

femaleMale female =D Androgen stimulate

production of RBCs menstrual cycle 35 ml

Female androgen male =D

Bone marrow failure androgen Androgen

stimulate production of RBCs

CountRBCs polycythemia

shapebiconcave sicke cell ad spherocytes

hematocritepacked cell volume

hematocrite 011011centrifuge centrifuge

RBCs plasma 55 ,RBCs 5555Hemtaocrite 011

55packed RBCs

3

hematocriteanemia hypervolemia anemia hypervolemia

diluted

dehydration or polycythemia hematocrite

hypervolemia

01212

RBC mean corpuscular volyme

hematocrite count RBC mean corps volume

45 ml5 million 90 U3range 86 69RBC

69Microcyte 69macrcyte range

normocyte mcq RBcs

size RBC diameter of RBCMicroscope ,

97.6micron 97.microcyte 6macro 02megalo

megalo macro macor megalo

Macrocyticmegaloblastic

macrocytic non megaloplastic

haemoglobin

Male : 14-16

Female 13.5-14

anemia polycythemia

haemoglobin RBC 01010

15gm hemoglobin RBCs

hemoglobin RBC ular haemoglobinmean corpusc055

30 Pgrange 2602heamoglobin RBC

hemoglobin RBC hyperchromic

hemoglobin RBC hypochromic mean

corpuscular haemoglobin hypo , hyper or normochromic

mean corpuscular hemoglobin concentration hematocrite

the value of blood film in diagnosing anemia

size , shape , count , mean corpuscular volume

items 01the value of blood

smear

ESRgnancy maliinflammation and infection ,

4

ESR Capillary tube

blood RBCs RBCs

5ESR 5RBCs

2 hours 6

RBCs RBCs should be attached

to eacth other RBCs negative charge Repulsion

albumin negative charge nephrotic syndrome albumin negative

charges ESR albumin negative charges RBCs

ESR

globulin and fibrinogen negative charges from RBCs globulin infection and

inflammation

ESR

fibrinogen pregnancy negative charges ESR

ESR and malignancy , Infection and inflammation , pregnancy and nephrotic syndrome

malignancy antibodies

ESR RBCs Charges

MCQ ESR 0110Malignancy , TB collagen disease

abnormal shape of rbcs MCQ

Value of blood film in diagnosin anemia

general rules

general rules

General rules anemia

Anemia by definitionin or hematocrite in same age sexanemia is the decrease in RBCs or hemoglob

and race

hemoglobin 14 is abnormal 09adult

Sex female 02male

Race negros low hemoglobin Caucasian

050diluted

02anemic ?anemic actually am not

dehydrated 0.polycythemia

General Rules

5

sex , age and race

RBCs

01

anemic is it possible to do this ?

chromium or technetium IV RBCs RBC

gamma camera technetium labeled RBCs

RBCs

anemia hypervolemia hypervolemia

RBCs RBCs

not practical

classification of anemia acc to etiology acc to morphology

Acc to etiology

etiological

enough

deficiency anemia hemoglobin

RBCs Bone marrow anemia of bone marrow

failure hemorrhage and hemolytic anemia

according to etiology Deficiency anemia , Anemia of bone amrrow failure , hemorrhage and

hemolytic anemia

morphologynormocytic normochromic anemia

microcytic hypochromic microcytic 69hypo chromic

28

Microcytic hypochromic anemia

Microcytic hypochromic anemiaheme and

globulinheme iron + heme globulins heme iron

deficiency anemia

globulin thallassemia

Normocytic normochronic anemiaRBCs acute

hemorrhage , acute hemolysis ,bone marrow failure

6

Macrocytic anemiamegaloblastic02non megaloblastic 602megaloblastic

Vb12 and folic acid non megaloblastic liver cell failure reticulocytosis

RBCs reticulocytosis macrocytic anemia

reticulocytes

Macrocytic non megaloplastic liver cell failure , alcoholism and reticulocytosis

classification of anemia

general rules physiology etiology

iron deficiency anemia physiology of iron etiology

iron absorbtion HCL etiology

of iron deficiency anemia HCL

Clinical picture FOG P

FFatigue decrease of o2 delivery to tissue

F fundus hypoxia vasodilatation retinal edema

blurring of vision

OOedema edema vaso dilatation tissue hypoxia

anemic HR sever anemia and long standing acute anemia Heart

failure

consent

hemoglobin 075Heart failure

acute Heart failure

edema vasodilatation peripheral vasodilatation GIT

Git congestion malabsorbtion anorexia hypoprotenemia

GIT Congestion

G eneral systemsGCNS , CVS , Respiratory , Renal CNS Vasodiltation CNS cerebral edema headache

hypoxia of nerve , peripheral neuritis

headache , anorexia and bluring of vision tumor

pseudo tumor cerebri

it has similar features like a brain tumor

CVS hyperdynamic circulation palpitation , tachycardia ,severe long standing anemia Heart

failure

Renal polyurea VD Renal blood flow Nocturia

specific features

FOG P anemia jaundice haemolytic

7

specific

specific feature C/P of the causeFOG P spooning

of nails iron deficiency anemia epigastria pain and constipation

C/P of the cause etiology

FOG P specific feature C/P of the cause

RBCs hematocrite ESR 2

MCV & MCH

microcytic hypochromic or macrocytic

specific investigationhemoglobin

hematocrite MCV .9microcytic hypochromic iron deficncy

anemia thalassemia iron level iron deficncy thalassemia

specific investigationhemoglobin MCV 61

BM failure hemolytic or hemorrhage reticulocyte Bone marrow failure

Investigation of the cause

MCV .0microcytic anemia iron

iron deficncy anemia stool analysis for parasite

Treatment 0 Tratemnt of cause

2 Blood transfusion if HB

8

iron blood transferrin transferring

Iron

010iron .iron Transferrin saturated ,

01 % total binding capacity

iron deficncey transferrin saturation

total iron binding capacitytransferrin iron

Muscles myoglobin

tissue enzymes enzymes iron catalase

liver ferrtitin

physiology

Etiology Starvation , malnutrition *

diminced HCl 9milk

9female iron 99

iron deficiency

stomack HCL atrophic gastritis , gatsrectomy gastrc carcinoma

duodenum malabsorbtion

congenital rare

chronic blood loss Iron deficiency anemia

parasite and menstrual irregularity

parasite parasite anclystoma

51iron deficiency anemia cancer colon

colonoscopy peptic ulcer virus hemoptysis

hematuria

clinical picture

0 FOG P

2 specific enzymes affect metabolism

0 tissues metabolism proliferate tissue proliferating tissue proliferate

skin an GIT

SKIN proliferation and replacement iron deficiency loss of hair and

spooning of nails

9

GIT papillae proliferation and

replacementproliferation red glazed tongue

clinical picture of the cause

diminished absorption gatsrectomy

parasite manifestations epigastria pain constipation and pellagra

Plummer Vinson syndrome ?

cancer esophagus female splenomegaly dysphagia

Investigations

RBCs hematocrite ESR

Type of anemia : microcytic hypochromic anemi

MCV & MCH

transferring saturation total iron binding capacity

ferrtitin

iron reticulocytosis

Investigation of cause Stool analysis worm or ova esinophilia female

anclystoma hemoglobin infertility

stool analysis worm or ova esinophilia

51coloncopy

Treatment Iron oral parentral ferrous sulphate & ferrous gluconate ferrous sulphate iron

capsule iron acid iron Ferrous absorbtion

acid gastric irritation gastritis

acid stool dark stool malabsorbtion

oral iron absorption 0mg

rapid correction parentral iron

parentral malabsorbtion rapid correction

MCQ parentral and oral have the same rate of correction

parentral IV ferrous iron acid iron

ferrous acid IV ? vein vein

thrombosis vein acid dilution vein thrombophlebitis

10

IM

anclystoma mebendazole peptic ulcer proton pumb inhibitor

Iron deficncey anemia

Discuss Iron deficncey anemia

anemia of chronic hemorrhage

discuss anklystoma duednalis

etiology

chronic illness chronic infection- chronic inflammation- and malignancy

chronic infection tb

Inflammation : collagen disease

Malignancy Tumor

cytokines inflammatory mediators

shortening life span of RBC 021.1

cytokines suppression of BoneMarrow

RBC suppression erythropoietin Kidney normocytic

normochromic anemia

iron release to the tissue iron transferritin

BM Bone marrow Iron iron cytokines

BM iron iron deficncy anemia iron serum

iron

anemia of choronic illness normochromic normocytic microcytic hypochromic

Microcytic hypochromic inhibition of iron release to the tissue ferrritin

iron deficny anemia investigation serum iron

total binding capacity clinical picture iron ttt of underlying

cause

anemia of choronic illnessfailure to utilize iron cytokines iron

iron

sideroplastic anemia

heme + globin heme iron and protoporphyrin

Anemia of chronic illness

11

MCQ

siderblastic anemia

aminoacid glycine gamma amino levulinic acid

1h :36

synthesis Gamma amino levilunic synthetase enzyme VIT B6 folic acid

sideroblastic anemia

Not present * congenital

VIt B 6 deficncy , folic acid deficncy INH VIT B6 metabolism

lead poisiong inhibition protoporphyrin

RBCs iron protoporphyrin siderblastic anemia

- cases

B12 Vit

Sourceanimal source Vit B12

Vb12 is only animal sources Oral stomach parietal cells intrinsic

factor .. B12 terminal ileum absorbtion B12 blood

transcobalamine -2 plasma Bone maroow RBCs CNSGIT

excess Vit B12 liver 2 years

under basal condition =D

Function *

b12 nucleas DNA cytoplasm cells division

cytoplasm and nucleas double vit B12

DNA

B12 cytoplasm double

Nucleas double divide

divide megaloblasts

bone marrow stem cells cells RBCs , WBCs

and platlet cells proliferate B12 proliferate Megaloblasts

anemia anemia

bilirubin bilirubin cells Bone

Sideroblastic anemia

Vitamine B12 deficiency

12

marrow stage normoblast

erythroblast

at variable stage of development mature

nucleas

RBCs platelet thrombocytopenia WBCs

enzyme serum muramidase

immature multinucleated

nucleas WBCs 3 lobes 6 lobes

multilobated nuclueas

Vit B 12 mylination of Nerve fibers

GIT proliferate Vit B12

proliferation

etiology

0 Diminshed intake

Starvation, vegeterians vegetarian Egyptian vegetarian =D

American vegetarian

=D =D

0 Diminshed intakeStarvationvegeterians ,

2 diminished absorbtion

intrinsic factor

gatsrectomy, gastritis. Addissonian pernicious anemia automimmune disease

Antibodis against parietal cells

disease 0

antibodies against parietal cells

antibodies against intrinsic factor

antibodies against terminal ileum

,high incidence against gastric carcinoma European female

blue eye fair head females

0 illeal disease

2 infection , 2 inflammation , ,2

2 infection ,TB & regional ileitis

2 inflammaticrohns and ulcerative colitis

2 blind loop syndrome Intestine peristalsis contents

stagnant proliferation of bacteria

13

congenital Transcobalamine deficiency

5 increase requirementpregnancy B12 malignancy

cells proliferate V B12 hemolytic anemia bone marrow proliferating

B12

Clinical picture 0 FOG P

2 specific jaundice hepatosplenomegaly purpra

demylination sub acute combined degeneration red glaze tonge

0 Cp of the cause

Diminshed intake

Addisoninan pernicious examination

investigation

nvestigationsI RBCs ESR

Megaloblastic normochromic anemiaType

MCV MCHC

Specific nvestigations

specific anisocytosis , poikilocytosis , cabbot rings

High bilirubin serum LDH thrombocytopena mulitlobated WBCs muramidase

No reticulcytes BM

TTT reticulocytosis

Inv of the cause

endoscopy stomach

perniciose anemia 0antibodies

chilling testVit B12 Intestine obsolete

Vit B12IM UGB12

absorbtion urine urine

intestine

aborbtion urine test

intrinsic factor intrinsic factor test

B12antibiotic bacterial over growth

14

vit b 12

underlying cause tb pernicious anemia HCL and pepsin

Blood transfusion HB .HF

Discuss vit b 12 deficency

Discuss subacute combined degeneration

discuss addisonian pernicious anemia

source vegetables absorption intestine carrier

inactive activation tetra hydro foliate GIT and

bone marrow Vit B12 CNS liver

0

Etiology

0 Deficient Intake anorexia and alcoholism

2 Deficient absorbtion malabsorbtion syndrome drugs anticonvulsant anti epileptics

0 Blood carrier dialysis dialysis b12

carrier dialysis folic acid

5 folic acid activation tetrahydrofolate drugs activation

5 requirements malignancy , pregnancy and hemolytic anemia

linical pictureCB12 CNS

Investigations

B12 chilling test FIGLU test absolete aminoacid

Histidine H FIGLUFIGLU glutamic acid folic acid

folic acid deficnecny Histidine FIGLU glutamic

FIGLU Urine

treatment

folic acid

underlying cause

Folic acid MCQ B12

Folic Acid deficiency

15

MCQ 151751=D

=D

Unipotent and pleuripotent

Unipotent elementin one RBCs platelet and WBCs

BM RBCS congenital diamond blackfan syndrome

Thumb thumb0phalanges

acquired Renal failure erythropoietein

bronchogenic carcinoma or thymoma anti erythropoietin

platlet wisckot Aldrich syndrome TAR

syndrome

.WBCs idiopathic

Unipotent

PleuripotentBM failure BM

failure

Idiopathic and drugs 61%

idiopathiccorticosteroids

autoimmune T B cells b cells

antibodies T Cells T BM

DrugsAntis anti emetic , antithyroid , antibiotic , antidiabetic

infection , immunological, irradtion

Infection tb and hepatitis

Immunological SLE

Infiltration leukemia and lymphoma

Infiltration of BMmyetophthitic anemia

chemicals benzene =D

BM failure

Clinical picture

BM

RBCs FOG P

Bone marrow failure Aplastic anemia

16

platletbleeding tendency

WBCs Infection already organismssevere up to septic shock

CP of the cause

investigations

RBCs hematocrite ESR

normocytic normochromic

MCV & MCH normal

Inv of the cause WBCs and platlets

BM biopsy

BM aspiration aspiration Under local anaesthia aspiration biopsy

iliac crest aspiration fibrosis of bone

marrow biopsy BM cavity fibrosis

reatmentT RBCspacked RBCs

platlets platlet

WBCs anti fungal , antibiotic and antiviral WBCs =D WBCs

antigen

stimulate BM RBCs androgen or erythropoietin

stimulate BM platlet danazol

wbcs lithium side effects GCSF granulocyte

stimulating factor

idiopathic cyclosporine

- MCQ 0.5

S

Hemolytic anemiashortening life span of RBCS RBCs Normal 210

before 120 day this called hemolysis IF RBCs are destroyed

rbcs 021hemolysis BM proliferate

Replace damaged cells hemolysis

.1BM replacement but no anemia

60 replacement and no anemia

40

LIFE span 05bone marrow maximum capacity

proliferate replacement replacement

life span 05anemia 05021hemolysis only

Hemolytic anemia

17

RBCs spleen and liver 65%extra vascular

intravascular

Extravascular 65%hemolytic anemia disease RBCs

extravascular , disease intravascular hemolysis

damage extravascularLiver and spleen

disease RBCs extravascular hepatosplenomegaly RBCs

anemia FOG P HT RBCs ESR

RBCs LDH

BM Bone marrow expansion Mongloid features

XRay hair on end appearance wide medulla and thin cortex

RBC s hemeoglobin heme + globin heme

iron and protophorphyrin iron iron TIBC

Transferring saturation iron

tissue hemosiderosis CNS neuritis

CVS cardiomyopathy

abdomen

liver liver cirrhosis

lung interstitial lung fibrosis

Kidney renal tubular disfunction

genetalia endocrine damage testies , suprarenal and pituitary

protoporphyrin biliverdin indirect bilirubin ID bilirubin

cinically jaundice , gall bladder stones indirect urobilinogenurine

stercobilinogen in stool

disease extravscular hemolytic

disease extravascularhepatosplenomegaly .. jaundice ,

hemosidern inv RBCs HT ESR LDH

stercobilinogen , urobilinogen 0

extravascular

extravascular 0

Hematology

18