Hematology - Introduction PDF

Hematology- Introduction AHMED HAMANDI Joke ‫نكتة‬ ‫ﺗﻜﻮﯾﻦ اﻟﺪم‬ ‫سويناها و صارت‬ Composition of Blood.....‫اﻟﺪم ﻣﺴﺆول ﻋﻦ‬ ‫ﻧﻘﻞ اﻟﻐﺎزات )اﻷﻛﺴﺠﯿﻦ وﺛﺎﻧﻲ أﻛﺴﯿﺪ اﻟﻜﺮﺑﻮ...

Hematology- Introduction AHMED HAMANDI Joke ‫نكتة‬ ‫ﺗﻜﻮﯾﻦ اﻟﺪم‬ ‫سويناها و صارت‬ Composition of Blood.....‫اﻟﺪم ﻣﺴﺆول ﻋﻦ‬ ‫ﻧﻘﻞ اﻟﻐﺎزات )اﻷﻛﺴﺠﯿﻦ وﺛﺎﻧﻲ أﻛﺴﯿﺪ اﻟﻜﺮﺑﻮن( ﻧﻘﻞ اﻟﻨﻔﺎﯾﺎت ﻧﻘﻞ اﻟﻌﻨﺎﺻﺮ اﻟﻐﺬاﺋﯿﺔ اﻟﻤﺴﺎﻋﺪة ﻓﻲ إزاﻟﺔ‬ ‫اﻟﺴﻤﻮم ﻣﻦ اﻟﺠﺴﻢ‬  Blood is responsible for…..  Transporting gases (oxygen & carbon dioxide)  Transporting waste products  Transporting nutrients  Helping remove toxins from the body Zahraa Sabah 🩵.‫اﻟﺪم ھﻮ ﻧﺴﯿﺞ داﺋﺮي ﯾﺘﻜﻮن ﻣﻦ ﺛﻼﺛﺔ أﻧﻮاع ﻣﻦ اﻟﺨﻼﯾﺎ‬ ‫ ﺧﻼﯾﺎ اﻟﺪم اﻟﺤﻤﺮاء → ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء‬.1 ‫ ﺧﻼﯾﺎ اﻟﺪم اﻟﺒﯿﻀﺎء → اﻟﻜﺮﯾﺎت اﻟﺒﯿﺾ‬.2 ‫ اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﯾﺔ → اﻟﺼﻔﯿﺤﺎت‬.3.‫ ﻣﻦ إﺟﻤﺎﻟﻲ وزن اﻟﺠﺴﻢ‬٪8-6 ‫ﯾﺸﻜﻞ اﻟﺪم‬ plas ‫اﻟﺨﻼﯾﺎ اﻟﻤﺬﻛﻮرة أﻋﻼه ﻣﻌﻠﻘﺔ ﻓﻲ ﺳﺎﺋﻞ ﯾﻌﺮف ﺑﺎﺳﻢ‬  Blood makes up 6–8% of our  Blood is a circulating tissue consisting of three types of cells. total body weight. 1. Red Blood Cells → Erythrocytes.‫ ﻟﺘﺮات‬5 ‫ﺣﺠﻢ اﻟﺪم اﻟﻄﺒﯿﻌﻲ ﻟﻠﺒﺎﻟﻐﯿﻦ ھﻮ‬ 2. White Blood Cells → Leukocytes  Normal adult blood volume is 5 L. 3. Platelets → Thrombocytes.‫ﯾﺘﻜﻮن اﻟﺪم ﻣﻦ ﻣﺎدة ﺧﻠﻮﯾﺔ ﻓﻲ ﺳﺎﺋﻞ ﯾﺴﻤﻰ اﻟﺒﻼزﻣﺎ‬  Blood is made up of cellular  The cells listed above are suspended in a liquid known as plasma. material in a fluid called plasma. Zahraa Sabah 🩵 Zahraa Sabah 🩵 ‫ﺗﻜﻮﯾﻦ اﻟﺪم‬ ‫ﺗﻜﻮﯾﻦ اﻟﺪم‬ Formation of Blood Composition of Blood ‫ﺗﻜﻮﯾﺖ اﻟﺪم‬ ‫ﺗﻜﻮﯾﻦ وﺗﻄﻮر ﺧﻼﯾﺎ اﻟﺪم‬  Hematopoiesis → the formation and development of blood cells.‫ ﯾﺘﻢ إﻧﺘﺎج اﻟﻌﻨﺎﺻﺮ اﻟﺨﻠﻮﯾﺔ ﻓﻲ ﻧﺨﺎع اﻟﻌﻈﺎم‬،‫ﻓﻲ اﻟﺒﺎﻟﻐﯿﻦ‬ The blood is made up of cells  In adults the cellular elements are produced in the bone marrow. Zahraa Sabah 🩵.‫ﺗﻨﺘﺞ ﺑﻌﺾ ﺧﻼﯾﺎ اﻟﺪم اﻟﺒﯿﻀﺎء ﻓﻲ اﻷﻧﺴﺠﺔ اﻟﻠﻤﻔﺎوﯾﺔ وﻧﺨﺎع اﻟﻌﻈﺎم‬ that are suspended in liquid  Some WBCs are produced in the lymphatic tissue and bone marrow..‫ﯾﺘﻜﻮن اﻟﺪم ﻣﻦ ﺧﻼﯾﺎ ﻣﻌﻠﻘﺔ ﻓﻲ ﺳﺎﺋﻞ ﯾﺴﻤﻰ اﻟﺒﻼزﻣﺎ‬.‫ﺗﺤﺘﺎج ﺧﻼﯾﺎ اﻟﺪم إﻟﻰ ﺑﻌﺾ اﻟﻌﻨﺎﺻﺮ اﻟﻐﺬاﺋﯿﺔ ﻟﺘﺘﺸﻜﻞ ﺑﺸﻜﻞ ﺻﺤﯿﺢ‬ called plasma. ‫ ﻣﻦ اﻟﻜﺘﻠﺔ‬٪55 ‫ﺗﺸﻜﻞ اﻟﺒﻼزﻣﺎ‬  Blood cells need certain nutrients to form properly.  Examples include….. 12 ‫ ﻓﯿﺘﺎﻣﯿﻦ ب‬- ‫ ﺣﻤﺾ اﻟﻔﻮﻟﯿﻚ‬- ‫ اﻟﺤﺪﯾﺪ‬-.....‫ﺗﺸﻤﻞ اﻷﻣﺜﻠﺔ‬ Plasma makes up 55% of the blood. —Iron —Folic acid —Vitamin B12  All blood cells formed come.‫ﺟﻤﯿﻊ ﺧﻼﯾﺎ اﻟﺪم اﻟﻤﺘﻜﻮﻧﺔ ﺗﺄﺗﻲ ﻣﻦ ﺧﻠﯿﺔ ﺟﺬﻋﯿﺔ ﻣﻜﻮﻧﺔ ﻟﻠﺪم‬ from a hematopoietic stem cell..‫ﯾﻤﻜﻦ أن ﺗﺼﺒﺢ ھﺬه اﻟﺨﻼﯾﺎ أي ﺧﻠﯿﺔ دم‬  These cells can become any blood cell. Zahraa Sabah 🩵  Major Plasma Proteins ‫ﺑﺮوﺗﯿﻨﺎت اﻟﺒﻼزﻣﺎ اﻟﺮﺋﯿﺴﯿﺔ‬ Composition of Blood Protein Function ‫اﻷﻟﺒﻮﻣﯿﻦ اﻟﺤﻔﺎظ ﻋﻠﻰ اﻟﻀﻐﻂ اﻟﺘﻨﺎﺿﺤﻲ اﻟﻐﺮوي؛ ﻧﻘﻞ اﻟﻤﺴﺘﻘﻠﺒﺎت ﻏﯿﺮ‬ ‫ ﻣﻦ اﻟﻤﺎء و‬٪90 ‫اﻟﺒﻼزﻣﺎ ﻣﺼﻨﻮﻋﺔ ﻣﻦ‬ Plasma is made of 90% water and Albumin Maintain colloid osmotic pressure; ‫اﻟﻘﺎﺑﻠﺔ ﻟﻠﺬوﺑﺎن اﻟﺠﻠﻮﺑﯿﻮﻟﯿﻦ‬ ‫ ﻣﻦ اﻟﺒﺮوﺗﯿﻨﺎت واﻟﺪھﻮن واﻟﻜﺮﺑﻮھﯿﺪرات واﻷﺣﻤﺎض اﻷﻣﯿﻨﯿﺔ واﻷﺟﺴﺎم اﻟﻤﻀﺎدة واﻟﮭﺮﻣﻮﻧﺎت واﻹﻟﻜﺘﺮوﻟﯿﺘﺎت واﻟﻨﻔﺎﯾﺎت واﻷﻣﻼح واﻷﯾﻮﻧﺎت‬10٪ transport insoluble metabolites 10% proteins, lipids, carbohydrates, Globulins ‫و ﻏﻨﻲ ﻏﻨﻲ ﻋﻦ ﻧﻘﻞ أﯾﻮﻧﺎت ﻣﻌﺪﻧﯿﺔ ودھﻮن ﻣﺮﺗﺒﻄﺔ ﺑﺎﻟﺒﺮوﺗﯿﻦ وﻓﯿﺘﺎﻣﯿﻨﺎت ﻗﺎﺑﻠﺔ ﻟﻠﺬوﺑﺎن ﻓﻲ اﻟﺪھﻮن‬ amino acids, antibodies, hormones,  and  Transport metal ions, protein-bound lipids, lipid-soluble vitamins ‫اﻷﺟﺴﺎم اﻟﻤﻀﺎدة ﻟﻠﺪﻓﺎع ﻋﻦ اﻟﻤﻀﯿﻒ‬ electrolytes, waste, salts, and ions  Antibodies for host defense.‫ اﻟﻤﺘﺒﻘﯿﺔ ﻣﻦ اﻟﺪم‬٪45 ‫ﺗﺸﻜﻞ ﺧﻼﯾﺎ اﻟﺪم ﻧﺴﺒﺔ‬ ‫ﺑﺮوﺗﯿﻨﺎت اﻟﻤﻜﻤﻞ ﺗﺪﻣﯿﺮ اﻟﻜﺎﺋﻨﺎت اﻟﺤﯿﺔ اﻟﺪﻗﯿﻘﺔ‬ Blood cells make up the remaining Complement proteins Destruction of microorganisms ‫ﻋﻮاﻣﻞ اﻟﺘﺨﺜﺮ ﺗﻜﻮﯾﻦ ﺟﻠﻄﺎت اﻟﺪم‬ 45% of the blood. Clotting factors Formation of blood clots ‫اﻟﺒﺮوﺗﯿﻨﺎت اﻟﺪھﻨﯿﺔ ﻓﻲ اﻟﺒﻼزﻣﺎ ﻧﻘﻞ اﻟﺪھﻮن اﻟﺜﻼﺛﯿﺔ و‬.‫ ﻣﻦ ﺧﻼﯾﺎ اﻟﺪم‬٪99 ‫ﺗﺸﻜﻞ ﺧﻼﯾﺎ اﻟﺪم اﻟﺤﻤﺮاء‬ Plasma lipoproteins Transport of triglycerides and Red blood cells make up 99% of the blood cells. cholesterol to/from liver Zahraa Sabah 🩵.‫ أﺧﺮى‬٪1 ‫ﺗﺸﻜﻞ ﺧﻼﯾﺎ اﻟﺪم اﻟﺒﯿﻀﺎء واﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﯾﺔ‬ ‫إﻟﻰ اﻟﻜﺒﺪ‬/‫اﻟﻜﻮﻟﯿﺴﺘﺮول ﻣﻦ‬ White blood cells and platelets make up the other 1%. Zahraa Sabah 🩵 Zahraa Sabah 🩵 Zahraa Sabah 🩵.‫ﯾﺆدي ﻛﻞ ﻧﻮع ﻣﻦ ﺧﻼﯾﺎ اﻟﺪم وظﯿﻔﺔ ﻣﺨﺘﻠﻔﺔ‬ (‫ﺧﻼﯾﺎ اﻟﺪم اﻟﺤﻤﺮاء )ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء‬ (‫ﺧﻼﯾﺎ اﻟﺪم اﻟﺒﯿﻀﺎء )اﻟﻜﺮﯾﺎت اﻟﺒﯿﺾ‬ Red Blood Cells (‫اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﯾﺔ )اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﯾﺔ‬ ‫ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء أو ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء‬  Each type of blood cell performs a different function. Erythrocytes or RBCs (‫ ﻣﻼﯾﯿﻦ ﻟﻜﻞ ﻣﯿﻜﺮوﻟﺘﺮ ﻣﻦ اﻟﺪم‬6 - ‫ ﻣﻼﯾﯿﻦ‬4) ‫اﻟﺨﻼﯾﺎ اﻷﻛﺜﺮ وﻓﺮة ﻓﻲ اﻟﺪم‬ — Most abundant cell in the blood  Red blood cells (Erythrocytes) (4 million – 6 million per microliter of blood) — Formed in the bone marrow — Mature forms do NOT have a  White blood cells (Leukocytes) nucleus ‫ ﻣﯿﻜﺮوﻣﺘﺮ‬8-6 ‫ ﯾﺒﻠﻎ ﻗﻄﺮھﺎ‬- ‫ ﻋﻠﻰ ﺷﻜﻞ أﻗﺮاص ﻣﻘﻌﺮة‬- ‫ اﻷﺷﻜﺎل اﻟﻨﺎﺿﺠﺔ ﻻ ﺗﺤﺘﻮي ﻋﻠﻰ ﻧﻮاة‬- ‫ﺗﺸﻜﻠﺖ ﻓﻲ ﻧﺨﺎع اﻟﻌﻈﺎم‬ — Shaped as biconcave disks — 6-8 micrometers in diameter  Platelets (Thrombocytes) Zahraa Sabah 🩵 Zahraa Sabah 🩵 Red Blood Cells White Blood Cells Erythrocytes or RBCs Leukocytes or WBCs —Life span of about 120 days — Hemoglobin (iron protein)is — Largest sized blood cells found in the RBC — Lowest numbers in the blood — Hemoglobin carries oxygen from the (4,500 – 11,000 per microliter) lungs to the rest of the body and carbon ‫ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء أو ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء‬ — Formed in the bone marrow dioxide binds to the RBC and is taken ‫ اﻟﮭﯿﻤﻮﻏﻠﻮﺑﯿﻦ )ﺑﺮوﺗﯿﻦ اﻟﺤﺪﯾﺪ( ھﻮ‬- ‫ ﯾﻮﻣﺎ‬120 ‫ اﻟﻌﻤﺮ اﻻﻓﺘﺮاﺿﻲ ﺣﻮاﻟﻲ‬- and some in lymph glands — Primary cells of the immune ‫ ﯾﺤﻤﻞ اﻟﮭﯿﻤﻮﻏﻠﻮﺑﯿﻦ اﻷﻛﺴﺠﯿﻦ ﻣﻦ‬- RBC ‫ﯾﻮﺟﺪ ﻓﻲ‬ to ‫اﻟﺮﺋﺘﯿﻦ ﻟﺒﻘﯿﺔ اﻟﺠﺴﻢ واﻟﻜﺮﺑﻮن‬ the lungs to be exhaled. — system ‫ أﻗﻞ اﻷرﻗﺎم ﻓﻲ اﻟﺪم‬- ‫ أﻛﺒﺮ ﺣﺠﻢ ﺧﻼﯾﺎ اﻟﺪم‬- ‫اﻟﻜﺮﯾﺎت اﻟﺒﯿﺾ أو ﺧﻼﯾﺎ اﻟﺪم اﻟﺒﯿﻀﺎء‬ ‫ﯾﺮﺗﺒﻂ ﺛﺎﻧﻲ أﻛﺴﯿﺪ اﻟﻜﺮﺑﻮن ﺑﺨﻼﯾﺎ اﻟﺪم اﻟﺤﻤﺮاء وﯾﺘﻢ ﻧﻘﻠﮫ إﻟﻰ‬ ‫ ﺗﺸﻜﻠﺖ ﻓﻲ ﻧﺨﺎع اﻟﻌﻈﺎم وﺑﻌﻀﮭﺎ ﻓﻲ اﻟﻐﺪد اﻟﻠﯿﻤﻔﺎوﯾﺔ‬- (‫ ﻟﻜﻞ ﻣﯿﻜﺮوﻟﺘﺮ‬11000 - 4500.‫ﺳﯿﺘﻢ زﻓﯿﺮ اﻟﺮﺋﺘﯿﻦ‬ ‫ اﻟﺠﮭﺎز‬- ‫ اﻟﺨﻼﯾﺎ اﻷوﻟﯿﺔ ﻟﻠﻤﻨﺎﻋﺔ‬- — Fights disease and foreign Zahraa Sabah 🩵 White Blood Cells Platelets ،‫ ﺗﺤﺘﻮي ﻋﻠﻰ ﻧﻮى ﻣﻊ اﻟﺤﻤﺾ اﻟﻨﻮوي‬- ‫اﻟﻜﺮﯾﺎت اﻟﺒﯿﺾ أو ﺧﻼﯾﺎ اﻟﺪم اﻟﺒﯿﻀﺎء‬ Leukocytes or WBCs PLTs ‫اﻟﺼﻔﯿﺤﺎت أو‬ —Contain nuclei with DNA, ‫ﯾﻌﺘﻤﺪ اﻟﺸﻜﻞ ﻋﻠﻰ ﻧﻮع اﻟﺨﻠﯿﺔ‬ — Thrombocytes or PLTs the shape depends on ‫ﻣﻀﺎدة‬ type of cell ‫ﺗﺸﻜﻠﺖ ﻓﻲ ﻧﺨﺎع اﻟﻌﻈﺎم‬ ‫ﺗﻨﺘﺞ ﺑﻌﺾ ﺧﻼﯾﺎ اﻟﺪم اﻟﺒﯿﻀﺎء أﺟﺴﺎﻣﺎ‬ — Formed in the bone marrow — Certain WBCs produce antibodies ‫ﺷﻈﺎﯾﺎ ﻣﻦ اﻟﺴﯿﺘﻮﺑﻼزم ﻣﻦ اﻟﺨﻼﯾﺎ اﻟﻨﻮوﯾﺔ اﻟﻀﺨﻤﺔ‬ — Life span is from 24 hours ‫ ﺳﺎﻋﺔ إﻟﻰ ﻋﺪة ﺳﻨﻮات‬24 ‫اﻟﻌﻤﺮ اﻻﻓﺘﺮاﺿﻲ ﻣﻦ‬ to several years ‫ ﻣﯿﻜﺮوﻣﺘﺮ ﻓﻲ اﻟﻘﻄﺮ‬20-8 ‫اﻟﺤﺠﻢ ھﻮ‬ — Fragments from the cytoplasm of megakaryocytes —Size is 8-20 micrometers in diameter ‫ھﻨﺎك ﺧﻤﺴﺔ أﻧﻮاع ﻣﺨﺘﻠﻔﺔ ﻣﻦ ﺧﻼﯾﺎ اﻟﺪم اﻟﺒﯿﻀﺎء‬ ‫أﺻﻐﺮ ﺧﻼﯾﺎ اﻟﺪم‬ —There are five different types of WBCs — Smallest of the blood cells ‫ ﻣﯿﻜﺮوﻣﺘﺮ‬4-1 ‫ﻗﻄﺮ‬ 1. Neutrophils — 1-4 micrometers in diameter 2. Eosinophils 3. Basophils Zahraa Sabah — Shape can be round, oval, or appear spiky 4. Lymphocytes 🩵 ‫ ﯾﻮﻣﺎ‬12-8 ‫ اﻟﻌﻤﺮ اﻻﻓﺘﺮاﺿﻲ ﺣﻮاﻟﻲ‬- ‫ﯾﻤﻜﻦ أن ﯾﻜﻮن اﻟﺸﻜﻞ ﻣﺴﺘﺪﯾﺮا أو ﺑﯿﻀﺎوﯾﺎ أو ﯾﺒﺪو ﺷﺎﺋﻜﺎ‬ 5. Monocytes — Life span of around 8-12 days  ‫اﻟﺼﻔﺎﺋﺢ اﻟﺪﻣﻮﯾﺔ‬ - ‫ اﻟﻤﺴﺎﻋﺪة ﻓﻲ إﺻﻼح اﻷوﻋﯿﺔ اﻟﺘﺎﻟﻔﺔ‬- ‫ ﺧﺘﻢ اﻟﺠﺮوح وﻣﻨﻊ ﻓﻘﺪان اﻟﺪم‬- ‫ اﻟﻤﺸﺎرﻛﺔ ﻓﻲ ﻋﻤﻠﯿﺔ اﻟﺘﺨﺜﺮ‬- Zahraa Sabah 🩵 ‫ ﻟﻜﻞ ﻣﯿﻜﺮوﻟﺘﺮ ﻣﻦ اﻟﺪم‬400,000 - 150,000  Platelets — Involved in the clotting process PRP ‫ﻋﻠﻢ )زرع ﻧﺨﺎع( و ﺑﺤﺚ )ﻋﻼج اﻟﺴﻜﺮي( و دﺟﻞ )؟؟؟؟؟( اﻟﺒﻼزﻣﺎ اﻟﻐﻨﯿﺔ‬ plt  PRP plt rich plasma ‫ﻋﻮاﻣﻞ اﻟﻨﻤﻮ‬ — Seal wounds and prevent blood loss ‫ ﻣﻌﻄﻒ ﺑﺮﺗﻘﺎﻟﻲ‬،‫ ﺟﮭﺎز طﺮد ﻣﺮﻛﺰي‬،‫ ﺳﻢ ﻣﻜﻌﺐ دم‬5-10  Growth factors ‫اﻟﻌﻼج ﺑﺎﻟﺨﻼﯾﺎ اﻟﺠﺬﻋﯿﺔ‬ — Help repair damaged vessels Zahraa Sabah 🩵  5-10 cc blood, centrifuge , buffy coat — 150,000 – 400,000 per microliter of blood  Stem cell therapy )‫علم (زرع النخاع) و بحث (عالج السكري) و دجل (؟؟؟؟؟‬ — Platelets stain bluish with reddish or purple granules Zahraa Sabah 🩵 Zahraa Sabah 🩵 RCT ‫ﺗﺠﺎرب اﻟﺘﺤﻜﻢ اﻟﻌﺸﻮاﺋﯿﺔ‬  RCT randomized control trials  Response........ ،‫ اﻟﻮزن‬،‫ دﯾﺲ‬،‫ اﻟﺠﻨﺲ‬،‫ اﻟﻌﻤﺮ‬،‫ﻣﺠﻤﻮﻋﺘﺎن‬  2 groups , age, sex, dis, weight, …….. GA - PRP  MeanA MeanB ‫رد ﻓﻌﻞ‬ GB - ‫ وھﻤﻲ‬،‫ﻻ ﺷﻲء‬  GA – PRP GB – nothing, placebo  Hypothesis is it due a chance? ‫ﯾﻌﻨﻲ‬ ‫ اﻟﻮﻓﺎة ﻓﻲ اﻟﻤﺴﺘﺸﻔﻰ‬-AE SAE ‫اﻵﺛﺎر اﻟﺴﻠﺒﯿﺔ ل‬ ‫ﯾﻌﻨﻲ ب‬ ‫ أﻋﻤﻰ ﻣﺰدوج‬،‫أﻋﻤﻰ‬  AE adverse effects SAE- death hospitalization  P value < 0.05 0.2 non significant ‫اﻟﻔﺮﺿﯿﺔ ھﻞ ھﻲ ﻓﺮﺻﺔ ﻣﺴﺘﺤﻘﺔ؟‬ P