6. o All Blood Cells made in bone marrow.
o Bone Marrow is the spongy centers of bones
sometimes seen in cuts of meat
oStem cells are young cells
oThey get “drafted” as RBCs, WBCs or platelets
depending on the body’s needs
7.
8.
9. • May be affected by
Activity
Diet
Stress
Geography
medications
Time of the day
10.
11.
12.
13.
14.
15. HB% gm%(13-17gm%)
HCT volume of blood occupied by RBCS(35-45%)
MCV average volume of individual RBC.(80-100fl)
RETIC % of immature RBCs in blood(1-2%)
RDW (10-15%)
RBCS. COUNT IS ADDITIONAL TO DIAGNOSIS
RBCSX3=HBX3=HCT (If not -indicates micro or
macrocytosis or hypochromia).
PBS is additional privilge.
depend on both
total red cell mass
and plasma volume
BM activity
Degree of
anisocytosis
16.
17.
18. 50 100 200 fl
RBC
%
width" refers to the width of the
volume curve (distribution
width), not the width of the cells.
Correlate with the degree of
anisocytosis
normal RDW+ mic. Anaemia thalassemia
high RDW + mic.anaemia iron deficiency
high RDW + mac.anaemia vit B12&folate def.
high RDW + norm.anaemia hge
19.
20. Is the pt. anaemic?
Low HB = anaemia
Look to MCV
Normal =normocytic anaemia?
A. Acute hge= normal Hct
B. explore for the site by HX&PE(shock,revealed
or concealed hge)
C. Haemolysis= high retic.,
( high LDH,low haptoglobin,& indirect
hyperbilirubinaemia,jaundice)
Acute haemolysis, incompatible blood trans.
Chronic haemolysis (Hbpathy,enzymopathy,
membranopathy)
47. PROLIFERATIVE OR LEUKOPENIA
PROLIFERATIVE MAY BE REACTIVE OR
NEOPLASTIC
DIFFERENTIATION BENIGN FROM MALIGNANT
DISORDERS IS OF UTMOST IMPORTANCE.
49. Leukocytosis
(neoplastic &prolifrative)
Identify infection,inflammation,&tissue
damage
More than100000/cmm. seen in leukaemia.
Stress & steroids are reversible soon
50. Morphology.
Granulocytosis.
Early in acute infection x agranulocytes!!
Shift to left indicate overwhelming
infections.(bands or stabs)
Shift to right indicate tissue damage or
necrosis.(segs.)
56. Decrease production(CT,RT.).
Neutropenia (aka,granulocytopenia)
Neutrophil<2000/ul.
Bone marrow exhaustion(prolonged severe
inf
Increased destruction(hyperspleenism)
Antithyroid,antidepressant,NSAID.
Protect pt.,avoid surgery if possible.
57. Severe neutropenia(aka.agranulocytosis)
Neutrophil,< 500/ul.
Pt.is predisposed to serious,G-ve,G+ve,&
fungal infections.
Red flags
person particularly unwell
lymphadenopathy, hepatosplenomegaly
58. Leukocytosis signals infections.
Leukopenia signals BM depression.
Neutropenic precautions
Care of invasive maneuvres.
Avoid crowding& recent vacc.children
Avoid steroids&antipyretics.
Avoid raw &uncooked foods.
Reporting high temp.
59. Outpt . VS inpt.
Norms:150-400.000/ml
TPO is the primary regulatory protein in the
production of platelets
60. The primary reason for evaluating
thrombocytopenia is to assess the risk of
bleeding and assess the presence of
underlying disorders (TTP, HIT etc.)
< 20 000 increased risk of bleeding
20 to 50000 rarely have increase risk of
spontaneous bleeding but increase risk of
bleeding from procedures
50 to 100000 no increased risk of spontaneous
bleeding and can undergo most procedures
61. Thrombocytopenia is
defined as a platelet
count less than
150,000
2.5 percent of the
normal population
will have a platelet
count lower than
this
62. Pseudothrombocytopenia
Decreased Production- suggested by:
other cytopenias
normal sized/small platelets suggest a reduced bone
marrow response to need
Increased Destruction- suggested by:
Microangiopathic blood picture (fragmented
RBCs, high LDH)
Large platelets on smear
Associated autoimmune disease
64. Petechiae
Purpura —
Ecchymoses
The most common
cause of
thrombocytopenia
developing for the
first time in an ICU
patient is
sepsis, accounting
for one-half of the
cases
Bone marrow
suppression from
infection
Platelet
microaggregation
Production of toxins
Consumption of
coagulation factors
(DIC)
65. If blood sample is inadequately
anticoagulated, platelet clumps can be
counted as WBC’s
0.1% of patients have EDTA dependent
agglutinins
66. Viral infections
Direct megakaryocyte damage-HIV
Post CT,RT
Acquired bone marrow hypoplasia- Fanconi
anemia.
alcohol toxicity
B12 or folate deficiency