HEMATOLOGY

हे सादरीकरण मी स्वत: तयार क
े ले आहे .
या सादरीकरणात वापरण्यात आलेल्या इमेजेस
अथवा माहहती ,हित्रे फक्त हवषय अहिक स्पष्ट
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क
ु ठलाही उद्देश नाही.हवद्याथी अथवा सामान्य
व्यक्तीींना हा हवषय िाींगला समजावा या साठी हे
सादरीकरण आहे .

BLOOD
Blood is a connective tissue in fluid form. It
contains two portions solid known as blood
corpuscles liquid known as plasma, Carries O2
from lungs to all parts of body & Co2 from all
parts of body to lungs.
It is called as fluid of growth, health, carries
nutritive substances from digestive system &
hormones from endocrine gland to all tissues, it
protects body against diseases.

Plasma is a straw
colored liquid part of
blood . It composes
92% water,8% solids.
Serum is a straw colored fluid
which comes from clot . If we
keep a clot for 45 min serum
oozes out from clot .fluid
without fibrinogen is serum,
which is used for clinical
investigation.
SERUM & PLASMA

Liquid in nature.
It is red in color.
The Volume of blood is 5 lit.
The reaction of blood is slightly alkaline & its
PH is 7.4.
SP. Gravity of total blood - 1.052 to 1.061
Cell – 1.022 to 1.101
Plasma – 1.022 to 1.026
Viscosity – It is five times more viscous than
water.
The temp of blood is 38ºc.
PROPERTIES OF BLOOD

BLOOD COMPOSITION

RBC

Plasma 55%
91% to 92% Water 8% to 9% Solids
Proteins – albumin, globulin, fibrin
Carbohydrates, Fats – Phospholipids cholesterol, Amino
acids, Nonprotein nitrogenous substances,
Ammonia, creatine, Xanthine, hypoxanthine, urea, Uric
acid.
Enzymes – amylase, carbonic anhydrase, Phosphatase,
lipase, esterase, protease.
Inorganic substances – Na, Ca, Mg, P, Cu, I, Io, O2, Co2.
45% Blood cells
- R.B.C. (erythrocytes)
WBC(Leukocytes),platelets(thrombocytes )
COMPOSITION OF BLOOD

–
Nutrient function – Nutritive substances like glucose,
amino acids, lipids, vitamins derived from digested food
are absorbed from GI tract & Carried by blood to
different parts of body for growth.
Respiratory Function – Transport of gases, carries O2
from lung to tissues & Co2 from tissues to alveoli.
Excretory Function – Waste products formed during
metabolic activities are removed by blood & carried to
excretory organs like kidney, skin, liver.
Transport of Hormones & Enzymes – Hormones
and enzymes are carried by blood to different parts of
body from source of secretion.
FUNCTIONS OF BLOOD

Water Balance – Water content of blood is freely
interchangeable with interstitial fluid. This help in
the regulation of water content of the body.
Regulation of Acid Base Balance – Plasma
proteins and hemoglobin act as buffers and help in
regulation of acid base balance.
Regulation of Body Temp – due to high specific
heat of blood it maintains the thermoregulatory
mechanism in the body ie the Balance between heat
loss & heat gain in body.
FUNCTIONS OF BLOOD

Storage Function – Water, some proteins,
glucose, sodium, potassium are constantly
required by the tissue. Blood serve as a
readymade source for these substance. These are
useful for the conditions like starvation, fluid
loss, electrolyte loss etc.
Defense Mechanism – The white cells of blood
engulf the bacteria by phagocytosis , neutrophils
& monocytes are active in process.
FUNCTIONS OF BLOOD

When the formed elements are removed from
blood a straw colored liquid called blood plasma
is left it has 92% water 8% solids. Most of which
are proteins. The proteins present are called
plasma Proteins
1) Serum albumin (54%)
2) Serum globulin (38%)
3) Fibrinogen (7% ) 4) Others (1%)
PLASMA PROTEINS

Osmotic pressure – Plasma Proteins are
responsible for osmotic pressure -is the
pressure exerted by proteins in the plasma is
called colloid osmotic pressure.
Sp. Gravity - 1.026
Buffer action – They are having 1/6 of total
buffering action of blood.
PROPERTIES –

Role in coagulation of blood – fibrinogen is
essential for coagulation, In the process of
coagulation Fibrinogen is converted into fibrin.
Role in Defense Mechanism – Gamma
globulins play an important role in defense
mechanism of the body by acting as antibodies.
Role in transport
Essential for transport of various substances in
the blood ,alpha & beta globulin are active.
FUNCTIONS OF PLASMA
PROTEINS

Role in Regulation of Acid Base Balance –
Albumin play an important role in regulating acid
base balance in the blood
Role in maintenance of osmotic pressure -
the osmotic pressure exerted by plasma proteins
is about 25mmhg, but the molecular weight is
larger so they remain in the blood.
Role in viscosity of blood – They provide
viscosity to the blood which is imp to maintain
blood pressure.
FUNCTIONS OF PLASMA
PROTEINS

Role in E.S.R – Globulin & fibrinogen of
plasma accelerate the tendency of rouleaux
formation by red blood cells. rouleaux formation
is responsible for E.S.R.
Role in Suspension stability of red cell –
During circulation red cells remain suspended
uniformly in the blood this property of red blood
cells is called suspension stability. Globulin and
fibrinogen help in suspension stability of red
blood cell.
.
FUNCTIONS OF PLASMA PROTEINS

Role in production of Trephone substances-
Trephone substances are necessary for nourishment of
tissue cells in culture. These substances are produced
from plasma proteins.
Role as Reserve proteins – During conditions like
fasting, starvation, these proteins are utilized by body
tissues.
Hypoproteinemia – decrease level -in Hemorrhage,
extensive burns, pregnancy, prolonged starvation,
Cirrhosis of liver.Hyperproteinemia – Increase Level
– Dehydration, Acute infection, hepatitis, nephiritis.
FUNCTIONS OF PLASMA PROTEINS

HEMOPOIESIS

Morphology-
Life span -120days, Dia. – 7.2µ Surface area – 120
sq. µ
Thickness – 2.2 µ Volume – 85-90 µ
Shape – Disc like – Biconcave, Dumbbell shaped.
Advantage of biconcave shape –
-Equal & rapid diffusion of O2.,Large surface area
is provided for absorption. ,-Minimal tension is
offered., -While passing through minute capillaries
can squeeze easily through it.
ERYTHROCYTE /R.B.C.

O2 Transport from lung to tissues.
Co2 Transport from tissues to lungs.
Buffer Actions- hemoglobin regulates h-ion &
helps to maintain ph.
R.B.C. Carry Blood group antigens like A
agglutinogen, B- agglutinogen, Rh factor. By
this blood groups are identified.
FUNCTIONS OF R.B.C –

Is the process by which origin, development
maturation of red cell occurs.
Site of Erythropoiesis – Fetal Life.
Mesoblastic stage – first two months – yolk sac.
Hepatic stage – 2-6 months
Liver,spleen,lymphnodes
Myeloid stage – 7-9 months Red bone marrow
& liver.
ERYTHROPOIESIS

Age of 5 to 6 years - Red Bone Marrow of all
bones.
6th to 20th years – Long bones.
After 20 years – vertebra, sternum, ribs, scapula,
Iliac bones, skull bones.
After 20 Years the shaft of long bones becomes
yellow bone marrow.
Changes during Erythropoiesis –
Reduction in size of cell.
Disappearance of nucleoli & nucleus.
Appearance of HB.
Change in staining property of cytoplasm.
RBC PRODUCTION

BONE MARROW

General Factors –
Erythropoietin – Secreted by kidney. Erythropoietin
promotes production of proerythroblasts from stem
cells in C FO – E of bone marrow; development of
proerythroblast into matured red blood cell through
normoblastic stage, release of matured erythrocytes
into blood through capillary membrane from bone
marrow. Thyroxin – It accelerates the process of
erythropoiesis, at many levels in hyperthyroidism,
polycythemia.
FACTORS NECESSARY FOR
ERYTHROPOIESIS –

Hemopoietic growth factors – interleukins,
glycoproteins.
Colony stimulating factors – The colony stimulating
factors (CSF) Cause the formation of colony
forming blastocytes.
Vitamins – B6 – Anemia & Pellagra. D – Anemia,
rickets. C Anemia, scurvy, E- Anemia, malnutrition.
Maturation Factors –
Vit B12 (Cynocobalmin) – Essential for (Synthesis
of DNA) maturation of cell deficiency causes
pernicious anemia.
Intrinsic factor of castle – Produced in gastric
mucosa helps in absorption of B12 vit.

DIETARY CONTENT

Intrinsic factor of castle – Produced in gastric
mucosa essential for absorption of vit B12
from intestine into blood. in gastritis, ulcers,
gastrectomy – Production is less.
Folic Acid – Required for synthesis of DNA in
the absence synthesis is reduced causing failure
of maturation.
Factors Necessary for HB Formation.
First class proteins and amino acids.
Iron – Formation of heme.
Cu – absorption of Iron from GI Tract.
Cobalt & Nickel – Essential for Utilization of
iron during HB formation. Vitamins – Vit C,
Riboflavin, Nicotinic acid pyridoxine.

Changes during Erythropoiesis –
Reduction in size of cell -25- to 7.2.u
Disappearance of nucleoli & nucleus.
Appearance of HB- intermediate Normoblast
stage
Change in staining property of cytoplasm & from
basophilic it becomes acidophilic .
ERYTHROPOIETIC CHANGES

ERYTHROPOIESIS

Changes during Erythropoiesis –
Reduction in size of cell.
Disappearance of nucleoli & nucleus.
Appearance of HB.
Change in staining property of cytoplasm.
CHANGES OF
ERYTHROPOIESIS

Physiological Variation – R.B.C. count
Age – At birth. 8-10 millions/cu mm.
After 10 days – count decreases (Physiological /
jaundice.)
Sex – Before puberty & after menopause – same.
Reproductive life (12-50) less than male. 3.5 to 5.5
millions/cu mm.
High Altitude – More than 7 millions/cu mm this is
due to hypoxia in high attitude erythropoietin, is released
from kidneys – stimulates – bone marrow R.B.C
Production increases.

Muscular Exercise – R.B.C. Count increases.
Emotional Conditions – The red cell count is increased
during the emotional conditions like anxiety, because of
sympathetic stimulation.
Temp – The increase in temp increases red cell count.
High barometric pressures – As in deep sea, O2 tension of
blood is higher red cell count decreases.
After sleep – decreases slightly after sleep.
Pregnancy – R.B.C count decrease because of extra cellular
fluid volume in late pregnancy.
Pathological Variations –
Polycythemia – abnormal increase in red cell count is called
polycythemia. Above 7 millions.
Primary -secondary

Erythrocyte sedimentation rate – it is a rate at which
RBCS settles down when they are mixed with
anticoagulant & kept in vertical position .due to gravity
cells settles down at bottom.
Types – ESR is measured by two methods.
a) Westergren method – this tube is 300mm long ,
having marking from 0 to 200 mm ,used only for esr
.blood sample is mixed with anticoagulant & filled in
this tube & fitted vertically on stand . Ratio of blood
& coagulant is 4: 1 . Reading is taken after 1 hour.
E.S.R.

Wintrobes tube- it is a short tube opened at one end.it is
110 mm long with 3 mm bore. Graduated on both
sides.on one side 0 to 100( used for ESR) another side
from 100 to 0 ( pcv )
Normal values –
westergren method – wintrobe method
Male 3 to 7 0 to 9
Female 6 to 9 0 to 15
Infants 0 to 2 0 to 5

ESR it is a nonspecific test , it does not indicate cause of
disease , helps to confirm diagnosis . It helps also in
prognosis of disease .
Factors affecting esr-
Specific gravity of rbc –specific gravity increases esr also
increases.
Rouleaux formation – it increases esr
Decrease in rbc – due to decrease number of rbc
viscosity of blood decreases causing more esr .

Size of rbc- increase in size increases esr
Physiological variation –
Age- it is less in children & infants
Sex –it is more in females then males due to less rbc in
females.
Menstruation –it increases during menses due to loss of
blood.
Pregnancy- due to hemodilution esr increases from 3rd
monnth to labour .

Pathological variation
Increase in ESR – tuberculosis all types of anemia except
sickle cell , malignant tumor, rheumatic arthritis ,liver
diseases.
Decrease in ESR –allergic condition , sickle cell anemia
,polycythemia ,severe leukocytosis .
Packed cell volume – it is volume of RBCS packed at
bottom of hematocrit tube when blood is centrifuged

Significance - -diagnosis & treatment of anemia ,
polycythemia . Determination of extent of
dehydration & recovery from dehydration.
Decision of blood transfusion.
Normal values
Males -40 to 45% ,female -38 to 42 %
Increase in pcv –polycythemia ,dehydration
Decrease in pcv –anemia ,pregnancy, cirrhosis of
liver .

In red blood cell instead of nucleus HB is
present. It is the coloring matter gives red color to
blood. Made up of hem + globin.
95% - dry weight –
30% - Wet weight.
Normal Values – 14 to 16 gm%
At Birth – 23 gm%
After 1 year – 17 gm%
Adult male -15 gm%
Adult Female – 14.5 gm%
HEMOGLOBIN
Functions of
HB -
O2 & Co2
Transport.
PH balance.

STRUCTURE OF HEMOGLOBIN –
Iron (Fe++)-in ferrous form
Porphyrin – 4 Pyrol rings
Globin – Four Polypeptide
chains 2 alpha 2 beta.
types-HbA- adult hemoglobin
2-a & 2b chains
HbF – fetal hemoglobin 2a &
2y chains –having more affinity
towards o2

HBS – Sickle cell Anemia – alpha chains normal,
Beta chains abnormal.
HBc – Beta Chains abnormal.
Thalassemia – Polypeptide chains are
decreased,absent,abnormal.
Hemoglobin M -Methmoglobin
Sulphahemoglobin-hydrogen sulfide &
hemoglobin combination.
HEMOGLOBINOPATHIES

Hemoglobin - heme & globin –re-synthesis of hb
1) Iron
Ferritin (again reused for synthesis of HB)
2) Porphyrin
Billrubin & biliverdin
Enter in liver
Passes into small intestine
kidney Large intestine
Urobilinogen Stercobilinoqen
Uroblin Stercobilin
Colur of urine. Color of stool
FATE OF HEMOGLOBIN

Colorless, nucleated formed element of blood
Morphology Size - 8 to 12 µ microns, oval,
spherical.
A) Agranulocytes
Granules absent - Monocytes
- Lymphocytes.
B) Granulocyte - Contains granules
Neutrophils Eosinophil ,basophil
.
LEUKOCYTES/WBC

White in color.
HB absent nucleus is present.
Larger in size, less in number.
R.B.C - W.B.C. Ratio 7:1
Phagocytic in nature swallowing of foreign body.
Diapedesis - They can squeeze through narrow blood
vessels.
Ameboid Movement - move by changing shape.
Chemotaxis - Due to chemotaxis WBCS get attracted
towards phagocytes.
Life span is shorter (2 Weeks)
More active metabolically.
PROPERTIES

Stages - Stages -
Metamyelocyte
Metamyelocyte
Stages -
Metamyelocyte
LEUKOPOIESIS

Dia - 10 to 12 µm The granules take acidic,& basic stains,
after staining appear violet, ameboid in character.
2-5 lobed ,Count - 50 to 70%
Lifespan - 2-5 days.
Functions –
Defense mechanism. Active in phagocytosis. They can
ingest bacteria & dispose dead matter. Chemicals, inflamed
tissues attract phagocytes - called chemotaxis.
Neutrophil contain enzymes like proteases,
myeloperoxidases, elastases, defensins which are active
against bacteria & fungi, Bacteriocidal,antimicrobal action.
NEUTROPHIL (POLYMORPHS)

Neutrophilia – increase in count
acute infections ,drug poisioning like hg,campher
,benzene ,etc. metabolic disorders ,after acute
hemorrhage
Neutropenia-decrease in count
Bone marrow disorders, Tuberculosis,typhoid, vit
deficiencies etc.
VARIATION IN COUNT

Granules Larger stains bright orange The nucleus
is bi-lobed. The 10-14 µ Dia.
Normal Count – 1% to 6%.life span-7-12 days.
Functions - Defense of body - Eosinophils are
specifically meant for acting against parasites
action- There granules contains many substance
which destroys helminths , bacteria, tumor cells,
digest parasites completely release of Histamine
in allergic conditions.
EOSINOPHIL

Eosinophilia – Increase in Eosinophil count
Allergic condition,parasitism –malaria,filariasis
Asthma,, scarlet fever
Eosinopenia – decrease in count
cushing’s syndrome , stress, bacterial infections,
prolonged use of steroids ACTH, Epinephrine.
VARIATION IN COUNT

Coarse granules in cytoplasm the granules stain
purple blue, nucleus is bi –lobed 8 to 10 µ.
Normal count - 0 to 1% Lifespan – 12-15 days.
Basophil - Coarse granules
BASOPHIL
Functions – Play an imp. Role in
healing process action- Release
some substances like histamine
produces acute hypersensitivity

BASOPHIL
heparin- essential for preventing internal blood
clotting ,mast cell is Lage tissue which is present in
basophil and play imp. role in producing
hypersensitivity reactions like allergy and an
anaphylaxis.
Basophilia- increase in count-small pox, chicken
pox, cancers, allergic condition.
Basopenia- chemotherapy –radiation , stress
hyperthyrodism.

Largest having dia -14 to 18 µ cytoplasm is clear without
granules nucleus is round, oval, horseshoe, kidney, shaped
Normal count - 2 to 6%
Life span – 2- 5 days.-
Functions - Defense - They are also motile and
phagocytic secrete interleukin-1, colony stimulating
factors, Platelet, activating factor.
Monocytosis-increase count- Tuberculosis, syphilis,
malaria, kala ajar, viral, fungal infections TB, leukemia,
Monocytopenia-Less count - Bone marrow suppression.
AIDS, prolong use of prednisone.
MONOCYTE

-
Clear cytoplasm without granules the nucleus
is oval shaped.
Types - large (10-12 µ) - small (7 to 10µ )
Functions - T Lymphocytes - cellular immunity
viruses fungi
B Lymphocytes - humoral immunity.
Destroying bacteria
Normal count - 20to 30 % count
Life span- 12 to a day.
Fuctions Role in immunity. T-cellular immunity
,B- humoral immunity
LYMPHOCYTE

Lymphocytosis-increase in count
Diphtheria, mumps, malnutrition, Rickets,
syphilis, TB, Thyrotoxicosis, viral infection.
Lymphocytopenia - decrease in count-
Prolonged illness , AIDS ,radiation ,steroid
intake
VARIATION IN COUNT

Diurnal Variation – cell count is minimum in early
morning maximum in afternoon.
Exercise – WBC count increases.
Sleep – decreases.
Emotions – increases.
Pregnancy - increases.
Leukocytosis – increases in count.
Leukopenia – decreases in count
Leukemia – abnormal increase in count up to
1,000,000/ cu mm.

White colored
4000-11000 /cu mm
Size Large7-18u dia.
Irregular shape
Hb absent & nucleus present
Granules present in some types
5 subtypes
1- 15 day each differ life span
Defense function
ERYTHROCYTE LEUKOCYTES
RBC & WBC DIFFERENCE
Red colored
4.5 to 5.5 millions /cu mm
Small size 7.4 u diameter
Biconcave shape
Hb present & nucleus
absent
granules absent
no subtypes
120 day lifespan
Nutrition function

)
Small colorless, non-nucleated moderately
refraction bodies.
Dia. – 2.5u, Normally spherical or rod shaped
Volume – 7.5 cu u Structure-
They have a cell membrane .microtubules forms
a ring around cytoplasm & below the cell
membrane. Cell membrane is 6 mm thick,
contains lipids, cholesterol, carbohydrates,
proteins, glycoproteins.
Cytoplasm contains cellular organelles, Golgi
apparatus, mitochondria ,vessels ,granules.
PLATELETS /THROMBOCYTES

DEVELOPMENT
Development – In bone marrow – Stem
cell
Colony forming unit
Megakaryocyte
Platelets.
Lifespan – 8-11 days
They are destroyed by tissue macrophages
system in spleen.
Normal count – 2,50,000/cu mm (2,20,000 to
4,00,000 /cu mm)

Adhesiveness – when they come in
contact with any wet surface or rough
surface these are activated and stick to
surface.
Aggregation – (Grouping of platelets) -
The activated platelets group together
and become sticky.
Agglutination – it is clumping together
of platelets.
PROPERTIES –

-
FUNCTION
-Role in blood clotting – substances secreted from
platelets are responsible for clotting.
Role in clot retraction - in blood clot cell entrapped in
between the fibrin threads. The contractile proteins present
are responsible for clot retractions.
-Role in prevention of blood . (Hemostasis)
platelets forms plug, constriction of vessel by adhesive
property reduces the blood loss.
-Role in repair of ruptured blood vessel - Platelets
derived growth factor of platelet is useful for repair of
endothelium.
-Role in Defense - Platelets encircle the foregin bodies and
kill them by the process of phgocytosis.

.
Physiological variation-
Age- Less in infants – after 3rd month normal.
Sex- No difference.
Females – reduced during menstruation.
High Attitude- increases, After meals – increases..
Pathological variation-
Thrombocytopenia- decrease in count –acute infec
-tions ,smallpox, chicken pox aplastic-anemia etc.
Thrombocytosis-increase in count- allergic condition
,hemorrhage ,surgical operations ,bone factures,
VARIATION IN COUNT

Blood Volume
The total amount of blood present in the
circulatory system, blood reservoirs, organs,
tissue, together constitute blood volume ie-5 Lit.
about 6-8% of total body weight, in relation with
body surface area blood volume is 2.8 to 3.1 lit
/sq .m.
Circulatory volume will be less then total of
volume as some amount may be deposited in
organs like liver.
BLOOD VOLUME

BLOOD VOLUME

Age-At birth Blood volume is less increases slowly as age
advances but more as compare to body weight and less as
compared to body surface. 6 month to 6 years.->80 ml kg. 10
years- 75ml kg 15 years- 70 ml kg body wt.
Surface area of body - Blood Volume is directly
proportional to surface area of body.
Body weight – Volume is directly proportional to body
weight.
Atmospheric Temp – exposure to cold reduces blood
volume and exposure to warm increases the blood volume.
Pregnancy- during early stage blood volume increases by 20
to 30% due to increased Fetal mass and Na retention.
.
BLOOD VOLUME VARIATION

High attitude- increase in high attitude This is
because of hypoxia which stimulates secretion of
erythropoietin.- RBC increases & volume rises.
Emotion- excitement increases blood volume .
.
Posture – erect posture reduces the blood volume by
about 15% This is because of pooling of Blood in
lower limbs while standing increases the hydrostatic
pressure and passage of fluid from blood vessels into
tissue spaces, reduces volume.
Exercise- increases blood volume by release of
erythropoietin and production of more Rbc.

Blood loss[
ANEMIA- from frequent blood sampling for laboratory testing, combined
with insufficient RBC production
TRAUMA - SURGERY causing acute blood loss
Gastrointestinal tract lesions, causing either acute bleeds (e.g. variceal
lesions, Ulcers or chronic blood loss (
Gynecologic disturbances, also generally causing chronic blood loss
From menstruation mostly among young women or older women who
have fibroids .
Many type of cancers, including colorectal cancer and cancer of the bladder
may cause acute or chronic blood loss, especially at advanced stages
and the whipworm
blood loss from repeated blood draws and medical procedures.
ANEMIA

Hemolytic anemia is due to hemolysis , the abnormal
breakdown (RBCs), either in the blood vessels (intravascular
hemolysis) or elsewhere in the human body (extra vascular).This
most commonly occurs within the spleen, but also can occur in
the reticuloendothelial system or mechanically (prosthetic valve
damage). Hemolytic anemia accounts for 5% of all existing
anemia's. It has numerous possible consequences, ranging from
general symptoms to life-threatening systemic effects. The
general classification of hemolytic anemia is either intrinsic or
extrinsic. Treatment depends on the type and cause of the
hemolytic anemia.
HEMOLYTIC ANEMIA

Intrinsic causes
Hereditary (inherited) hemolytic anemia can be due to :
Defects of red blood cell membrane production (as
in hereditary spherocytosis
Defects in hemoglobin production (as thalessmia , sickle
cell )
Defective red cell metabolism (as in glucose 6 phosphate
dehydrogenase deficiency & pyruvate kinase deficiency

Extrinsic causes mainly leads hemolysis in liver spleen bone
marrow lymphnodes .
Any of the causes of hypersplenism (increased activity of the
spleen), such as portal hypertension
Acquired hemolytic anemia is also encountered in burns and as a
result of certain infections (e.g. malaria)
Lead poisoning resulting from the environment causes non-
immune hemolytic anemia.
Similarly, poisoning by arsine also causes hemolytic anemia.
Runners can suffer hemolytic anemia due to “ foots strike
hemolysis ", owing to the destruction of red blood cells in feet at
foot impact.
Low-grade hemolytic anemia occurs in 70% of prosthetic heart
valve recipients, and severe hemolytic anemia occurs in 3%.
EXTRINSIC CAUSES

Vitamin B12 deficiency anemia, of which pernicious
anemia (PA)
Deficiency in intrinsic factor
symptoms may include shortness of breath, tirdness , pale skin,
chest pain, numbness in the hands and feet, poor balance, a
smooth red tongue, poor reflexes, depression and
confusion. Without treatment some of these problems may
become permanent. Blood tests may show few & large blood
cells low numbers of young blood cells low levels of vitamin
B12, and antibodies to intrinsic factor.
Gastric causes gastritis, gastractomy etc
PERNICIOUS ANEMIA

Iron-deficiency anemia is caused by blood loss ,
insufficient dietary intake, or poor absorption of iron
from food. Sources of blood loss can include
heavy menses, childbirth, utrine fibroids, stomach
ulcers, colon ulcers, uti bleeding etc.
Poor absorption of iron from food may occur as a
result of an intestinal disorder such as inflammatory
bowl diseases or celiac disease , or surgery such as
a gastric bypass In the condition like parasitic worm
malaria , hiv infection risk] Diagnosis is confirmed
by blood tests.
IRON DEFICIENCY ANEMIA

iron-deficiency anemia is associated with poor neurological
development, including decreased learning ability and altered motor
functions. Iron deficiency may affect brain neuron development.
Preterm infants
Low birth weight infants
Infants fed with cow's milk under 12 months of age
Breastfed infants who have not received iron supplementation after
age 6 months, or those receiving non-iron-fortified formulas
Children between the ages of 1 to 5 years old who receive more than
24 ounces (700 mL) of cow milk per day
Children with low socioeconomic status
Children with special health care needs
Children of Hispanic ethnicity
Children who are overweigh

Megaloblastic anemia- is a type of macrocytic anemia that
results from inhibition of DNA synthesis during rbc
production.
The defect in red cell DNA synthesis is most often due
to hypovitaminosis , specifically vitamin b12 or folate deficiency .
L
Folate deficiency, loss of micronutrients may also be a cause.
MEGALOBLASTIC ANEMIA

Aplastic anemia is a condition in which the body fails to
produce blood cells in sufficient numbers. Blood cells are
produced in the bone marrow by stem cell that reside
there.
Aplastic anaemia causes a deficiency of all blood cells.
Rbc, wbc, platelets
causes - chemicals, drugs, radiation, infection, immune
disease; in about half the cases, a definitive cause is
unknown. It is not a familial line hereditary condition, nor is
it contagious.
A PLASTIC ANEMIA

Bone marrow aspirate and biopsy: to rule out other causes of
pancytopenia (i.e. neoplastic infiltration or significant myelofibrosis).
History of iatrogenic exposure to cytotoxic chemotherapy: can cause
transient bone marrow suppression
X-rays, computed tomography (CT) scans, or ultrasound imaging tests:
enlarged lymph nodes (sign of lymphoma), kidneys and bones in arms
and hands (abnormal in Fanconi anemia)
Chest X-ray: infections
Liver tests: liver diseases
Viral studies: viral infections
Vitamin B12 and folate levels: vitamin deficiency
First line treatment is immunosuppressive agent, corticosteroids .

Thalassemias
are inherited blood disorder characterized by
decreased hemoglobin production.
Infection , bone deformity, enlarge spleen , slow growth rate

Sickle cell disease (SCD) is a group of blood
disorder typically inherited from parents. The most common type
is known as sickle cell anemia (SCA). It results in an
abnormality in the oxygen-carrying protein HB found in RBC
This leads to a rigid, sickle -like shape under certain
circumstances.[Problems in sickle cell disease typically begin
around 5 to 6 months of age.A number of health problems may
develop, such as attacks of pain ("sickle cell crisis"), anemia,
swelling in hands, pain long term may develop as people get
older. The average life expectancy in the developed world is 40 to
60 yrs

References
1 ) essentials of medical physiology -7th Edition k.sembulingum
,prema sembulingum
The health sciences publisher
2) Textbook of medical physiology
11th edition guyton & hall
Text book of medical physiology –guyton & Hall ,second south
asia edition ,elsevier
3) Principles of anatomy & physiology
Willy internaional edition 11th edition
4) Image source –www.google.com.
REFERENCES