pathological physiology of blood system. pathophysiology of blood system.… · posthemorrhagic...

Pathological

physiology of blood

system

Department of pathological physiology– 2017

Azerbaijan Medical

University

The types of pathological

changes of blood system

Blo

od

syst

emThe changes of general

volume of blood

The changes of physical-chemical properties of blood

Quantitative and qualitative changes of blood cells,

disturbances of hemostasis.

The changes of general volume of

bloodNormovolemy

Hypovolemy

Hypervolemy

Formed elements

Plasma

Simple normovolemy

Oligocythemic normovolemy

Polycythemic normovolemy

Simple hypovolemy

Oligocythemic hypovolemy

Polycythemic hypovolemy

Simple hypervolemy

Oligocythemic hypervolemy

Polycythemic hypervolemy

The changes of general volume of blood

Hypervolemy

Simple Oligocythemic

Hypovolemy

Polycythemic

The changes of physical-chemical

properties of blood

• Special mass of blood

• Viscosity of blood

• Osmotic pressure of blood

• Resistance of erythrocytes

• Erythrocyte sedimentation rate(ESR)

Erythrocyte sedimentation rate

Increases

During increased concentration of

the high molecular proteins

Alkalosis

Anemia

Hydremia

Decreases

During increased concentration of low

molecular proteins artması

Acidosis

Erythrocytosis

Dehydration

Pathology of erythrocyte

system

Quantitative changes:

• Absolute and relative

Erythrocytosis

Erythropenia

Qualitative changes:

Regenerator forms of erythrocytes

Degenerative changes in erythrocytes

Cells of pathological regeneration

Erythrocyte indexes

MCV (mean corpuscular volume) – 80-98 fl

MCH (mean corpuscular hemoglobin) – 26-33 pq

MCHC (mean corpuscular hemoglobin concentration)

CLASSIFICATION OF ANEMIA

POSTHEMORRHAGIC DYSHEMOPOIETIC

HEMOLYTIC

Classification of anemia

According to the color index

normochrome

hypochrome

hyperchrome

According to the regenerator

ability

regenerator

hyporegenerator

hyperregenerator

According to the course

acute

chronic

According to the type of

erythropoiesis

normoblastic

meqaloblastic

Posthemorrhagic anemia

Stages of the acute posthemorrhagic anemia

Vascular-reflex stage

First 8-12 hour

Hydremicstage

1-2 days after

Medullarystage

4-5 days after

Iron deficiency anemia

Hematological signs:

• Hyperchrome anemia

• hyporegenerator anemia

• microcytosis, poikilocytosis

• Decreased level of iron(1000 mkq/l in norm),ferritin (12–32 mkM/l in norm), transferrin and increasing of general iron-binding ability of plasma

Anemia of chronic diseases

B12 deficiency

anemia

Hemotological signs:

• Megaloblasts and megalocytes

• Decreased amount of erythrocytes and

concentration of hemoglobin

• hyperchromia

• anisocytosis (makrocytosis), poikilocytosis

(especially oval-shape cells), pathological

derivatives (Jolly body, Kebot rings)

• Decreased amount of leukocytes and

thrombocytes, hypersegmented giant

neutrophiles.

• bilirubinemia

Food

R-protein

Parietal cells of

mucous membrane of

stomach

R-B12 complex

Intrinsic

Castle factor

Pancreas

ProteasesDegradation

of R-B12

complex

Gastromucopr

otein-B12

complex

Ileum

Portal

vein

Receptor for

intrinsic Castle

factor

Transcobalamin

The types of aplastic anemia

Total (hereditary)

• Fanconi anemia, Estren-

Dameshec anemia

• pancytopenia (decreasing

of amount of all blood

cells),

• panmyelopathy (decreasing

of amount of all cellular

elements in bone marrow)

Partial (hereditary)

• Deficiency of only

erythroid cells in blood

and bone marrow

• Blekfend-Daymond

anemia, partial red-

cellular aplasia

Hemolytic anemia

Signs of hemolysis The types of hemolysis

intravascular extravascular

Localization Vessels MFS

Yellowness of skin and

mucous membrane

a little Significantly

Enlargement liver and

spleen

a little Significantly

Laboratory indices Normochrome anemia, reticulocytosis, hypersideremia,

hyperplasia of erythrocytic cells in bone marrow

Hyperbilirubinemia

Hemoglobinemia

Hemoglobinuria

Hemosiderinuria

Hyperbilirubinemia

Hereditary membranopathy:

hereditary spherocytosis

Spherocyte

Macrophage of

spleen

Spectrin

Lipid layer

Hereditary

enzymopathies:

glucose-6-phosphate-

dehydrogenase

deficiency hemolytic

anemia

Glucose-6-

phosphate

6-phosphoglucanate

Glutathione

reductase

Glutathione

peroxidase

Hereditary hemoglobinopathies:

sickle-cell anemia

Thalassemiaα

-thal

asse

mia α-thalassemia

major

α-thalassemia intermedia

α-thalassemia minor

α-thalassemia minimum β

-thal

asse

mia

β0-thalassemia

β+-thalassemia (major və minor)

Extravascular hemolysis during

β-thalassemia

Immune hemolytic anemia: rhesus

incompatibility

Pathology of leukocyte system

Quantitative changes

• Leukocytosis: physiological and pathological

• Leukopenia

Qualitative changes

• Hypersegmentation

• Vacuolization

• Botkin-Qumprext shadow

• Toxic granularity

• Knyazkov-Dele bodies

• Auer sticks

• Ridder forms

• Nuclear shift and etc.

Hemopoiesis

(formation of blood cells)

HEMOBLASTOSES

LEUKEMIAS

(LEUKOSES) HEMATOSARCOMAS

(LYMPHOMAS)

Leukoses

Acute leukoses

No-differentiated leukoses

Myeloblast leukoses

Lymphoblast leukoses

Monoblast leukoses

Plazmoblast leukoses

Erithromyeloblast leukoses

Megacaryoblast leukoses

Chronic leukoses

Myelocytic origin: chronic

myeloleukoses, erithromyeloz

(erithremia)

Lymphocytic origin: chronic

lympholeukoses,

paraproteinemic (myeloma,

Valdenstrem

macroglobulinemia)

Monocytic origin: histiocytoses

Difference between

acute and chronic

leukoses

Normal bone

marrowLeukosic

tissue

Myeloblast

Hiatus

leukaemicus

Metamyelocyte

Stick-nuclear neutrophil

Segmented-nuclear neutrophil

LYMPHOMAS

HODGKIN

LYMPHOMAS

NON-HODGKIN

LYMPHOMAS

PATHOLOGY OF

HEMOSTASIS

The types of hemostasis pathology

Pathology connected with damage of vascular wall

Pathology connected with quantitative and qualitative changes of

thrombocytes

Pathology connected with disturbance of coagulation cascade

Willebrand disease and Bernard

Soulier syndrome

COAGULATION CASCADE

Pathology

connected with

damage of

vascular wall

Randyu-Osler

syndrome

Shenleyn-Genochdisease

ScorbutusEhlers-Danlos

syndrome

Pathology connected with quantitative and

qualitative changes of thrombocytes

Thrombocytopenia

Verlhof disease

trombotic-

trombocytopenic

purpura

hemolytic-uremic

syndrome, ets.

Thrombocytopathy

Willebrand disease

Bernard-Sulye

disease

Qlansman-Negeli

thrombostenia, etc.

Coagulopathy

Hemophilia

Prouer-Stuart

disease

Afibrinogenemia

Disseminated intravascular

coagulation syndrome (DIC)