Module 1 - Introduction to Hematology PDF

9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE Module 1 - Introduction to Hematology Site: New Era University Virtual Learning Environment Printed by: Faith Mar...

9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE Module 1 - Introduction to Hematology Site: New Era University Virtual Learning Environment Printed by: Faith Marcee C. Palma Course: MTH311-18 - Hematology 1 Date: Sunday, 22 September 2024, 10:24 PM Book: Module 1 - Introduction to Hematology https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 1/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE Description This module contains the historical development in hematology, general characteristics of blood, components and functions of blood. It also covers the important characteristics of cellular elements of blood. Learning Outcomes: At the end of this module, student will be able to: 1. Identify the pioneers in hematology and their contributions, 2. Summarize the historical developments of hematology, 3. Learn important dates in the history of hematological science, 4. Identify the general characteristics and components of blood, 5. Indicate the major functions of blood , and 6. Characterize cellular elements of the blood Lesson 1 - Historical Developments The major breakthrough in the study of blood occurred in 1942 when Anton van Leeuwenhoek, a Dutch microscopist, built a microscope and identified blood cells and compared their size with that of a grain of sand. In the 18th century, English physiologist, William Hewson, the "Father of Hematology" , introduced the clotting features of blood and shared his knowledge of leukocytes or white blood cells. Bone marrow was recognized as the site of blood-cell formation along with the first clinical descriptions of pernicious anemia, leukemia and a number of other disorders of the blood. In 1963, Boston hematologist William Dameshek wrote an essay in the journal he'd founded 17 years earlier, Blood, describing 18th century English anatomist William Hewson's detailed studies of the thymus. Gabriel Andal (1797-1876) and Alfred Francoise Donne (1001-1878) described changes in blood cell composition during various systemic diseases. George Hayem (1841 -1933) was credited being the first to count platelets in the blood and also wrote seminal papers on hemolytic anemias and hematopoiesis. German hematologists have made the case that Paul Ehrlich (1854 - 1915) whose aniline dye staining techniques first distinguished granulocyte subtypes and established the concepts of humoral immunity - deserves a Vater designation. Robert Virchow (1821 - 1902) codescribed leukemia in 1845. Canadian-American William Osler (1849 -1919) published numerous observation on platelets and vascular disorders. Bostonian George Minot (1885 -1950) and Wisconsinite William Murphy (1892 -1987) developed the first specific treatment for a hematologic malady when they cured pernicious anemia with raw liver in the 1920's as well as Austrian Canadian-American Maxwell Wintrobe 1(901 - 1906) invented the hematocrit, trained many hematology department chairs and published the most influential hematology textbook of the 20th century. Russian-American Dameshek made a key contribution in 1951, when he proposed a unified concept of "myeloproliferative disorders" and therefore is often called the father of these neoplasms. Janet Rowley (1925 - 2013) made a groundbreaking discoveries about chromosomal rearrangements in leukemia in the 1970's and beyond. New machines are being developed at present and automation has considerably improved the precision and accuracy of testing. Assessment: https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 2/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE Direction: Choose the BEST answer for each question. 1. Who is known as the "Father of Hematology"? A. Donne C. Hewson B. van Leeuwenhoek D. Blundell 2. A Russian-American scientist who proposed a unified concept of "myeloproliferative disorders"? A. van Leeuwenhoek C. Murphy B. Dameshek D. Osler 3. He made a groundbreaking discoveries about chromosomal rearrangements in leukemia in the 1970s and beyond A. J. Rowley C. M. Wintrobe B. R. Virchow D. P. Ehrlich 4. He invented the hematocrit and published the most influential hematology textbook of the 20th century A. G. Hayem C. M. Wintrobe B. P. Ehrlich D. R. Virchow 5. He wrote seminal papers on hemolytic anemias and hematopoiesis A. R. Virchow C. R. Hewson B. L. Pasteur D. G. Hayem References: 1. https://www.ashclinical news.org 2. https://study.com.academy.lesson Lesson 2: BLOOD Blood is the vital, life-sustaining fluid circulating in a closed system of blood vessel and the heart. The systemic circulation provides the functional blood supply to all body tissues. It carries oxygen and nutrients to the cell and picks up carbon dioxide and waste products. Systemic circulation carries oxygenated blood from the left ventricle through the arteries to the capillaries in the tissues of the body. General Characteristics: 1. Color: The color of the blood is due to the pigment hemoglobin within the red cells. The color of the blood varies with its oxygen content. Arterial blood is bright red color due to its high level of oxygen. Venous blood has given much of its oxygen and thus has a darker dull red color. 2. Viscosity: Viscosity means thickness or resistance to flow blood. Whole blood is about 4.5 to 5.5 times as viscous as water, indicating that it is more resistant to flow than water. This viscosity is vital to the function of blood because of blood flows or with too much resistance, it can strain the heart and lead to severe cardiovascular problems. Viscosity is increased by the presence of cells of the blood and plasma proteins. https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 3/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE This also contributes to normal blood pressure. 3. pH of the blood: The normal pH range of blood is 7.35 - 7.45 (average is 7.4) which is slightly alkaline. The venous blood has a lower pH than the arterial blood because of the presence of more carbon dioxide. Blood pH is controlled by the buffer system of the blood. 4. Temperature: Temperature of blood is 38 degrees Celsius (100 degrees Fahrenheit). 5. Osmolality: It is a measure of how much one substance has dissolved in another substance. The greater the concentration of the substance dissolved, the higher the osmolality. Very salty water has higher osmolality than water with a just a hint of salt. When your body is functioning properly, it makes specific adjustments to maintain an appropriate osmolality. For example, you may need to urinate frequently if your blood osmolality is too low. This helps your body get rid of excess water, raising the osmolality of your blood. Blood osmolality is measured in milliosmoles per kilogram. A normal result is typically 275 to 295 milliosmoles per kilogram for adults and older adults. 6. Specific Gravity: This is the ratio of the weight or density of blood to the density of an equal volume of water at a specified temperature (25 degrees Celsius). It represents the amount of dissolved substances and solid in the blood. The specific gravity of blood is 1.048 - 1.066. If the liquid you are comparing has a specific gravity lower than one (1) gram per mL, it will float in water. If it has a specific gravity higher than one (1) gram per mL, it will sink. 7. Volume: The volume of blood (Red blood cells and plasma) in the circulatory system of any individual is regulated by the kidney. Blood constitutes about 20% of the extracellular fluid amounting to 8% of the total body mass. The blood volume is 5 liters to 6 liters (1.5 gal) in an average sized adult male and 4 liters to 5 liters (1.2 gal) in an average sized adult female. Newborn's blood volume is 250 to 350 mL of the total blood volume. Normovolemia refers to normal blood volume. Hypervolemia refers to increased volume of blood during a) excessive fluid intake, (b) blood transfusion, and (c) intravenous injection of body fluids. Hypovolemia refers to decreased volume of blood seen in the following: (a) loss of blood (bleeding or hemorrhage), (b) loss of erythrocyte (hemolytic anemia), (c) loss of plasma (burns) and (d) loss of body fluids (diarrhea, loose bowel movement, excessive sweating). Blood volume can be calculated given the hematocrit (Hct, the fraction of blood that is red blood cells) and plasma volume (with the hematocrit being regulated via the blood oxygen content regulation). Measurement may be used in people with congestive heart failure, chronic hypertension, kidney failure and critical care. Components of Blood: https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 4/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE Blood is composed of different kinds of cells (occasionally called corpuscles), namely erythrocytes, leukocytes and platelets. These formed elements of the blood constitute about 45% of whole blood. The other 55% is blood plasma. When a blood specimen is centrifuged, leukocytes and platelets make up the buffy coat (small white layer of cells) lying between the packed red blood cells (erythrocyte layer) and the plasma. A. Blood Plasma When the formed elements are removed from blood , a straw-colored liquid called plasma is left. Plasma is about 91.5% water and 8.5% solutes, most of which by weight (7%) are proteins. Some of the proteins in plasma are also found elsewhere in the body, but those confined to blood are called plasma proteins. These proteins play a role in maintaining proper blood osmotic pressure which is important in total body fluid balance. Most plasma proteins are synthesized by the liver, including the albumins (54% of plasma proteins), globulins (38%) and fibrinogen (7%). Other solutes in plasma include waste products, such as urea, uric acid, creatinine, ammonia, and bilirubin; nutrients; vitamins; regulatory substances such as enzymes and hormones, gases and electrolytes. B. Formed Elements The formed elements of the blood are so named because they are enclosed in a plasma membrane and have a definite structure and shape. All formed elements are cells, broadly classified as red blood cells (erythrocytes), white blood cells (leukocytes) except for platelets (thrombocytes), which are tiny fragments of bone marrow cells. Their numbers remain remarkably constant for each individual in health. 1. Red Blood Cells (RBCs) They are most numerous cells in the blood. In adults, they are formed in the marrow of the bones that form the axial skeleton. Mature red cells are non-nucleated (anucleate) and are shaped like flattened, bilaterally indented spheres, a shaped often referred to as biconcave disc with a diameter 7.0-8.0 µm and thickness of 1.7 - 2.4 µm. In stained smears, only the flattened surfaces are observed; hence the appearance is circular with an area of central pallor (or one third of their center) corresponding to the indented region. They are primarily involved in tissue respiration. The red cells contain the pigment hemoglobin which has the ability to combine reversibly with oxygen. In the lungs, the hemoglobin in the red cell combines with oxygen and releases it to the tissues of the body (where oxygen tension is low) during the circulation. Carbon dioxide, a waste product of metabolism is then absorbed from the tissues by the red cells and is transported to the lungs to be exhaled. The red cell normally survives in the bloodstream for approximately 120 days after which time it is removed by the phagocytic cells of the reticuloendothelial system (RES), broken down and some of its constituents re-utilized for the formation of new cells. RBCs counted in measured volumes can detect anemia or polycythemia. Anemia means loss of oxygen-carrying capacity and is often reflected in a reduced RBC count or decreased RBC hemoglobin concentration. Polycythemia means an increased RBC count reflecting increased circulating RBC mass, a condition that leads to hyperviscosity. 2. White Blood Cells (WBCs) WBCs protect their host from infection and injury.They are transported in the blood from their source, usually bone marrow or body cavity destination. They are so named because they are nearly colorless in an unstained cell suspension. Leukopenia – decreased WBC count (fewer than 4500/µL and increased WBC count (leukocytosis (more than 11,500/µL).Their production is in the bone marrow and lymphoid tissues (lymph nodes, lymph nodules and spleen). https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 5/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE There are five distinct cell types each with a characteristic morphologic appearance and specific physiologic role. These are a. Polymorphonuclear leukocytes/granulocytes They have, a single nucleus with a number of lobes. They contain small granules in their cytoplasm, and hence the name granulocytes. There are three types according to their staining reactions. (a) Neutrophils Their size ranges from 10-12 um in diameter. They are capable of amoeboid movement. There are 2 - 5 lobes to their nucleus that stain purple violet. The cytoplasm stains light pink with pinkish dust like granules. Normal range is 2.0-7.5 x 103/µL. Their number increases in acute basement infections. (b) Eosinophils They have the same size as neutrophils or may be a bit larger (12 -14 µm). There are two lobes to their nucleus in a "spectacle" arrangement. Their nucleus stains a little paler than that of netrophils, Eosinophils cytoplasm contains many , large, round/oval orange pink granules. They are involved in allergic reactions and in combating helminthic infections. Normal range is 40-400 µL. Increase in their number (eosinophilia) is associated with allergic reactions and helminthiasis. (c) Basophils Their size ranges from 10 - 12 µm in diameter. basophils have a kidney-shaped nucleus frequently observed by a mass of large deep purple/blue staining granules. their cytoplasmic granules contain heparin and histamine that are released at the site of inflammation. Normal range is 20 - 200 µL. Basophilia is rare except in cases of chronic myeloid leukemia. b. Mononuclear Leukocytes (a) Lymphocytes There are two varieties: 1. Small lymphocytes: Their size range from 7 - 10 µm in diameter. They have round, deep purple staining nucleus which occupies most of the cell. There is only a rim of pale blue staining cytoplasm. They are the predominant form found in the blood. 2. Large lymphocytes: Their size ranges from 12 - 14 µm in diameter. Large lymphocytes have a little paler nucleus than small lymphocytes that is usually eccentrically placed in the cell. They have more plentiful cytoplasm that stains pale blue and may contain a few reddish granules. The average number of lymphocytes in the peripheral blood is 2500 µL. Lymphocytes are seen in viral infections especially in children. (b) Monocytes These are the largest white cells measuring 14 - 18 µm in diameter. They have a centrally placed, large and "horseshoe" shaped nucleus that stains pale violet. Their cytoplasm stains pale grayish blue and contains reddish blue dust-like granules and a few clear vacuoles.. They are capable of ingesting bacteria and particulate matter and act as "scavenger cells" at the site of infection. Normal range is 700 - 1500 µL. Monocytosis is seen in bacterial infections, (e.g. tuberculosis) and protozoan infections. https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 6/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE 3. Platelets (thrombocytes) These are small, non-nucleated, round/oval cells/ cell frgments that stain pale blue and contain many pink granules. Their size ranges 1 - 4 µm in diameter. They are produced in the bone marrow by fragmentation of cells called megakaryocytes which are large and multinucleated cells. Their primary function is preventing blood loss from hemorrhage. When blood vessels are injured, platelets rapidly adhere to the damaged vessels and with one another to form a platelet plug. During this process, the soluble blood coagulation factors are activated to produce a mesh of insoluble fibrin around the clumped platelets. This assists and strengthens the platelet plug and produces a blood clot which prevents further blood loss. Normal range: 150 - 400 x 103/µL. https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 7/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE Functions of Blood 1. Transportation Blood transport oxygen from the lungs to the cells of the body and carbon dioxide from the cells to the lungs. It also carries nutrients from the gastrointestinal tract to the cells, heat and waste products away from cells and hormones from endocrine glands to other body cells. 2. Regulation Blood regulates pH through buffers. It also adjusts body temperature through the heat absorbing and coolant properties of its water content and its variable rate of flow through the skin, where excess heat can be lost to the environment. Blood osmotic pressure also influences the water content of cells, principally through dissolved ions and proteins. 3. Protection The clotting mechanism protects against blood loss and certain phagocytic white blood cells or specialized plasma proteins such as antibodies, interferon, and complement protect against foreign microbes and toxins. Homeostasis: The body’s tendency to move toward physiological stability. In vitro testing of blood and other body fluids must replicate exact environmental body conditions. These conditions should include the following: Osmotic concentration: the body/cellular water concentration, composed of 0.85% sodium chloride. This normal osmotic concentration is termed isotonic. Hypotonic solution (greater amount of water in relationship to lesser amount of solutes) – water enters the cell; the cell swells and may lyse. Hypertonic solution (lesser amount of water in relationship to greater amount of solutes) – water leaves the cell; the cell may crenate. https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 8/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE Basic Hematology Terminology 1. a - without 13. micro - small 2. - blast youngest 14. myelo - marr 3. - chronic colored 15. normo - normal 4. - cyte cell 16. - oid like 5. dys abnormal 17. - osis increased 6. - emia in the blood 18. Pan - all 7. ferro - iron 19. - penia decreased 8. hyper - increased 20. - plasia formation 9. hypo - decreased 21. - poiesis cell production 10. iso - equal 22. Poly - many 11. macro large 23. Pro - before 12. mega - very large/huge 24. Thrombo clot Activities: Read Chapter 1 of RODAK'S HEMATOLOGY: Clinical Principles and Applications. 6th ed. Saunders Assessment: Direction: Choose the BEST answer. 1. All of the following statements about platelets are correct except A. Disk-shaped cell particles B. Also called thrombocytes C. Numerous: 140-440 x 103/µL of blood D. Able to clump together to begin the coagulation process 2. What is the name of the iron-containing protein that gives red blood cells their color? A. Hemocyanin C. Hemoglobin B. Pyrite D. Myoglobin 3. All of the following statements are true except A. Blood consists of plasma and formed elements B. Plasma is a straw-colored clear liquid containing cellular elements and solutes https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 9/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE C. Plasma is approximately 92% water D. All of the above statements are also true of serum 4. The percentage of formed elements in the blood is A. 45% C. 55% B. 50% D. 65% 4. What are the three major functions of blood? ------------------------------------------------------- ------------------------------------------------------- ------------------------------------------------------- References: 1. Elaine M. Keohane, Larry J. Smith and Jeanine M. Walenga. RODAK'S Hematology: Clinical Principles and Applications. 6th ed. Saunders 2. Hoffbrand, A. Victor. Color Atlas of Clinical hematology. 4th ed. Philadelphia: Mosby/ Elsevier, c2012. R616.15 h69C 2010. 3. Turgeon, Mary L., Clinical Hematology Theory and Procedure. 4th ed. (2006). Lippincott Williams & Willis 4. Turgeon, Mary L. Clinical Laboratory Science, The Basics and Routine Techniques. 5th ed. 2007. Mosby, Elsevier 5. McPherson, Richard A. and Pincus Matthew R. HENRY'S Clinical Diagnosis and Management by Laboratory methods. 22nd ed. Elsevier Saunders https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 10/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE Table of contents 1. Introduction/Overview 2. Learning Outcomes https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 11/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE 1. Introduction/Overview Content here... https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 12/13 9/22/24, 10:25 PM Module 1 - Introduction to Hematology | NEUVLE 2. Learning Outcomes Content here... https://college2425.neu.edu.ph/mod/book/tool/print/index.php?id=54780 13/13