Hematology - Introduction PDF

Hematology- Introduction AHMED HAMANDI ‫‪Joke‬‬ ‫نكتة‬ ‫سويناها و صارت‬  ‫ﺗﻜﻮﯾﻦ اﻟﺪم‬ Composition of Blood.....‫اﻟﺪم ﻣﺴﺆول ﻋﻦ‬ ‫ﻧﻘﻞ اﻟﻐﺎزات )اﻷﻛﺴﺠﯿﻦ وﺛﺎﻧﻲ أﻛﺴﯿﺪ اﻟﻜﺮﺑﻮن( ﻧﻘﻞ اﻟﻨﻔﺎﯾﺎت ﻧﻘﻞ اﻟﻌﻨﺎﺻﺮ اﻟﻐﺬاﺋﯿﺔ اﻟﻤﺴﺎﻋﺪة ﻓﻲ إزاﻟﺔ‬...

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