Hemotology

1. Hematology

2. Hematology
• The study of blood and blood forming organs

3. Hematopoiesis
• The process through which pluripotent stem
cells differentiate into various types of blood
cells.
• Before birth, this happens in spleen, liver,
lymph nodes, and thymus
• After birth, happens in bone marrow

6. Blood Volume
• 6% of total body weight
• Body can compensate for .5 liters blood loss
• Fluid shift can easily alter amount of blood
• Number of red blood cells remain constant
• Red blood cells confined to vascular space

8. Blood Components
• Plasma
• Red blood cells
• White blood cells
• Platelets

9. Plasma
• 90-92 % water
• 6-7% proteins
• Large proteins (Albumin) won’t cross
membranes
• Osmotic Pull (Oncotic pressure)- water
retention

10. Erythropoietin
• Hormone responsible for red blood cell
production

11. Red Blood Cells
• Erythrocyte- red blood cell
• No nucleus when mature

12. Hemoglobin
• Oxygen-bearing molecule in RBC
• Made up of iron-rich pigment- heme and
protein- globin
• Each hemoglobin has 4 subunits of globin
• Each globin can carry one Oxygen molecule

13. Oxygen Transport
• Normal pO2 is 95 mmHg
• Bohr effect- Uptake of O2 in lungs:
• Alkalosis makes hemoglobin bind to oxygen
more tightly
• Acidosis makes hemoglobin release oxygen

14. Erythropoeisis
• Production of red blood cells

15. Hemolysis
• Destruction of red blood cells

16. Lab Values H&H
• Hematocrit - Packed red cell volume
• Normal 40 -52%
• Hemoglobin
• Normal 12 – 15 g/dL for males
• Normal 10.5-14.0 g/dL for females

18. White Blood Cell Production
• Leukopoiesis (differentiation of WBC)
• Immature WBC:
– Myeloblasts
– Monoblasts
– Lymphoblasts

19. White Blood Cells
• Granulocytes
• Monocytes
• Lymphocytes

21. Granulocytes
• Basophils- primary function in allergic
reaction… contain histamine….
• Eosinophils-Fight parasitic infection… can
counteract allergic reactions
• Neutrophils- count can rise rapidly… fight
infection

22. Monocytes
• May circulate as monocytes or mature into
“Macrophages”
• Garbage collectors

23. Lymphocytes
• Primary cells involved in immune response
• T- Cells (thymus)
• B- Cells (bone marrow)

24. Autoimmune Disease
• Condition in which the body makes antibodies
against own tissues

25. Inflammatory Response
• Nonspecific defense mechanism that wards
off damage from microorganisms or trauma

26. White Blood Cells
• Leukocytes
• Many (marginalized) loiter on walls of blood
vessels.
• Demargination- recirculation of WBC in
response to stress, corticosteroids, seizures,
epinephrine, and exercise

27. Phagocytosis
• When white blood cells engulf and destroy an
invader

28. Platelets
• Throbocytes
• 150,000 – 450,000 per microliter of blood
• Live 7 – 10 days
• Removed by the spleen
• Thrombocytosis – too many

29. Hemostasis
• Vascular Spasms
• Platelet Plug
• Stable Fibrin Blood Clots

30. Blood Clot Destruction
• Plasminogen- released from fibrin clot
• Turned into plasmin…
• Fibrinolyis- plasmin dismantles blood clot
• Takes hour to days

31. Blood Types
• A
• B
• AB
• O

32. Rh Factor

33. Blood Compatibility

35. • AB- universal recipient
• 0- universal donors
• Type A- A-antigens, anti-B antibodies

36. Types of Transfusions
• Whole blood
• Packed red blood cells
• Platelets
• Fresh frozen plasma
• Clotting factors

37. Transfusion Reactions
• Facial flushing, hyperventilation, tachycardia,
sense of dread
• Hives, chest pain, wheezing, fever, chills,
cyanosis

38. Patient Assessment
• Petechiae (tiny red dots in skin)
• Purpura (large purplish blothces)- high
bilirubin
• Epistaxis
• Enlarges spleen
• Bleeding from gums
• Arthralgia-pain and swelling in joints
• Bleeding around IV site

43. Diseases of RBC
• Polycythemia- too many
• Anemia- inadequate number of RBC or
inadequate hemoglobin

44. Anemia
• Symptom, not a disease
• Hematocrit < 37 % in women < 40% in men
• Pica- craving of unusual substances as ice or
clay

45. Sickle Cell Disease
• Inherited disorder of RBC production
• Mom Xx Dad Xx
• Babies XX Xx Xx xx
• Xx – carriers of sickle cell trait
• xx have disease

47. Polycytemia
• Hematocrit too high
• > 50%
• Rare disorder
• 50 y/o +

48. WBC Diseases
• Leukopenia – too few (treatment is
supportive)- prevent infection
• Leukocytosis – too many
– Look for neutrophils with segmented nuclei
(bands)

50. Leukemia
• ALL, AML, CLL, CML, Hairy cell leukemia
• High risk of infection

51. Lymphoma
• Cancers of the lymphatic system
– Hodgkin’s lymphoma (better survival rate)
– Nonhodgkin’s lymphoma

52. Platelet Diseases
• Thrombocytosis - Increase in number of
platelets
• Thrombocytopenia- abnormal decrease in
number of platelets

53. Hemophelia
• Disease in which one of the proteins
necessary for blood clotting is missing or
defective
• Hemophelia A- Deficiency in factor VIII (most
common)
• Hemophelia B (Christmas Disease)- Deficiency
if factor IX rarer and more severe

56. Hemophelia
• Sex- Linked
• Normal Dad + Carrier Mom
• XY + Xx
• Children XX Xx (carrier) XY
xY (hemophelia)

57. Von Willebrand’s Disease
• vWF component of factor VIII is deficient

58. Multiple Myeloma
• Cancerous disorder of plasma cells
• Pain in ribs or back
• Pathological fractures

59. DIC
• Disseminated Intravascular Coagulation
• Caused by systemic activation of the
coagulation cascade
• Widespread thrombosis
• Bleeding due to decreased fibrinogen level,
consumption of coagulation factors,
thrombocytopenia