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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 [email protected]? 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 [email protected] 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*' [email protected]???7mm=

    neutro!hil' :[email protected]$??7mm=

    lym!hocytes' [email protected]+???

    monocytes' :[email protected]?? eosino!hils' [email protected]+??

    baso!hils' [email protected]??

    *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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