Hematology Lecture Notes 2024 PDF

Hematology Lec1&2 Dr Sura Al Shamma Pathology department 2024 Heamatology Is the science that study diseases related to the blood and its component. Blood is a viscous fluid that is composed of formed elements (cells)and a fluid component , plasma.. The total volume of...

Hematology Lec1&2 Dr Sura Al Shamma Pathology department 2024 Heamatology Is the science that study diseases related to the blood and its component. Blood is a viscous fluid that is composed of formed elements (cells)and a fluid component , plasma.. The total volume of blood of an average adult is about 5 L, and it circulates throughout the body within the circulatory system.  Erythropoiesis The “Bone Marrow” is the major site with the need of: Folic acid – Iron “Ferrous” – Vit B12 – Erythropoietin -Amino acids minerals - other regulatory factors Basophilic Intermediate Late Erythroblast Reticulocyte Erythrocyte Normoblast Normoblast Normoblast + ++ +++ ++ + - Synthesis of Hemoglobin 6 6  ANEMIA An (without) -aemia (blood) Reduction of Hb concentration below the normal range for the age and gender Leading to decreased O2 carrying capacity of blood and thus O2 availability to tissues (hypoxia) -less than 135 g/L in adult males and -less than 115 g/L in adult females. -From the age of 2 years to puberty, less than 110 g/L -newborn infants have a high haemoglobin level, 140 g/ L is taken as the lower limit at birth  Clinical Features Many factors affect the presence or absence of clinical features : 1. Speed of onset -Rapidly progressive anaemia causes more Symptom 2. Severity -Mild anaemia often produces no symptoms or Signs 3. Age- The elderly tolerate anaemia less well than the young because normal cardiovascular compensation is impaired. 4. Haemoglobin O2dissociation curve :rise in 2,3 DPG in the red cells and a shift in the O2 dissociation curve to the right so that oxygen is given up more readily to tissue  Clinical Features 1-General features of anemia Weakness Headache Pallor Related to anemia Lethargy Dizziness Palpitation (tachycardia) Related to compensatory Angina mechanism Cardiac failure 2-Specific features Specific signs are associated with particular types of anemia :  Spoon nail with iron deficiency,  Leg ulcers with sickle cell anemia  Jaundice with hemolytic anemia  bone deformities in thalassemia major  DIAGNOSIS OF ANEMIA Lab investigation. A complete blood count, CBC, will include: RBC count: The normal range for males is 4.5-5.9 x 106/ul The normal range for females is 3.8-5.2 x 106/ul Hematocrit (Hct) or packed cell volume(PCV) in % or (L/L) The normal range for males is 41-53% (0.41-0.53) The normal range for females is 38-46% (0.38-0.46) Hemoglobin concentration in grams/deciliter. The normal range for males is 13.5-17.5 g/dl The normal range for females is 12-16 g/dl RBC indices – these utilize results of the RBC count, hematocrit, and hemoglobin to calculate 4 parameters: DIAGNOSIS OF ANEMIA Red Cell (RBC) indices 1. Mean corpuscular volume (MCV) – is the average volume/RBC in femtoliters (10-15 L) Hct (in %)/RBC (x 1012/L) x 10 In adults the normal range is 80-100 femtoliters The MCV is used to classify RBCs as: Normocytic (80-100) Microcytic (100) Macrocytic Microcytic Normocytic DIAGNOSIS OF ANEMIA 2. Mean corpuscular hemoglobin concentration (MCHC) – is the average concentration of hemoglobin in g/dl (or %) Hgb (in g/dl)/Hct (in %) x 100 In adults the normal range is 31-37 The MCHC is used to classify RBCs as: Normochromic (31-37) Hypochromic ( 14.5 means that there is increased variation in cell size above the normal amount (anisocytosis) DIAGNOSIS OF ANEMIA Reticulocyte count gives an indication of the level of the bone marrow activity. Done by staining a peripheral blood smear with new methylene blue to help visualize remaining ribosomes and ER. The number of reticulocytes/1000 RBC is counted and reported as a %. The normal range in an adult (i.e. in an individual with no anemia) is 0.5-1.5%. Note that this % is not normal for anemia where the bone marrow should be working harder and throwing out more reticulocytes per day. In anemia the reticulocyte count should be elevated above the normal values. Classification of anemia: Anemia can be classified, according to the cause, into anemia due to: 1.Inadequate production of normal RBCs by the bone marrow. a. Due to deficiency of essential factors (iron, vitamin B12 and folic acid). b. Aplastic anemia (bone marrow aplasia or dysfunction ). 2.Excessive destruction of RBCs (hemolysis). 3.Blood loss (hemorrhage). a. Acute hemorrhage b. Chronic hemorrhage Classification of anemia: Anemia can also be classified, according to the blood indices (the most commonly used one ), into : 1. Hypochromic microcytic anemia (MCV