Clinical Hematology Lecture Notes PDF

CLINICAL HEMATOLOGY LECTURE Endothelial cells CHAPTER 1 -...

CLINICAL HEMATOLOGY LECTURE Endothelial cells CHAPTER 1 - release Nitric oxide prostacyclin (PGI2) = INACTIVATES PLATELETS - Has embedded Heparin Sulfate, a natural INTRODUCTION TO HEMATOLOGY anticoagulant and the AT3 (Antithrombin 3) will bind to the Heparin Sulfate = INACTIVATE FII, FIX, FX - Has embedded Thromodulin, so the thrombin will bind to it and have the thrombin - thrombomodulin complex and will activate the iProtein C and become activated Protein C (aProtein C) = INACTIVATES Factor 2, Factor 9 and Factor 12 2. Color: Blood is red in color -> HEMOGLOBIN 3. Volume: Average volume (normal adult) 5-L Newborn baby 450 ml Females, slightly less and are about 4.5. It is about 8% of the body weight in a normal young healthy adult, weighing about 70 kg - Because of muscle mass (small muscle mass in females Historical Background - More estrogen in female which inhibits hematopoiesis 4. Reaction and pH: Blood is slightly alkaline and Haima (blood) + Logos (study) → Greek word its pH in normal conditions is 7.4. (7.35-7.45) (STUDY OF BLOOD) - Because of Bicarbonate buffer system 5. SG=1.055 (1.045-1.065) - due to the presence Athanasius Kircher Worms in the blood of solutes and analytes (1657) No proper identification Whether RBC, WBC, or platelets 6. Viscosity: Blood is 3.5-4.5 times thicker than Water and more viscous than water. Anton van Discovered the presence Leeuwenhook of RBCs (1674) Composition of Blood Giulio Bizzozero Platelets (petites plaques (1800) James Homer Wright's Stain Wright (1902) - Is used to differentiate cells found in the body according to the cytoplasm and nucleus Staining Principle: Basic is attracted to the acidic material of the cell Acidic is attracted to the basic material of the cell Physical Characteristic of Blood Albumin 1. Liquid in vivo; may clot in vitro - Prevent water inside the blood vessels - Because of ENDOTHELIAL CELLS - Increase oncotic and osmotic pressure (Maintains the fluid State) - Produce by the liver  red cell distribution and width Functions of the Blood Measure how variant of RBC size 1. Transport of gasses, nutrients and waste Degree of anisocytosis products ➔ Anisocytosis - Hemoglobin responsible to carry - describes red blood cells that oxygen (yes it is direct) are of different sizes - Is it direct that the blood carries CO2? (No, it use Hydrogen) FUNCTIONS 2. Transport process molecule 1. To differentiate anemia, polycythemia, and 3. Transport regulatory molecules systemic conditions that affects red blood cells 4. Regulation of Osmosis 2. To detect and diagnose the disease 5. Maintenance of body temperature 3. To assess and monitor the disease 6. Protection against foreign substances 7. Clot formation Red Blood Cells Parameters Reticulocytes I. Young RBCs, an RBC parameter Overview of Red Blood Cells II. Polychromatophilic Erythrocytes (Wright's Also known as erythrocytes Anucleate, stain) biconcave, discoid - Supravital stain (Reticulocytes) Contains hemoglobin (contribute to red color) III. Indicative of bone marrow regeneration during Pink to red, 7-8um in diameter blood loss and certain types of anemia Cell that carries Oxygen - Red Blood Cells IV. Supravital staining (BCB, NMB) Zone of pallor that occupies 1/3 of the diameter - BCB - Brilliant Cresyl Blue - Zone of Pallor - NMB - New Methylene Blue ➔ Color white because it don't V. Live red cells are utilized in order the RINA have hemoglobin (Normal) would be stained ➔ Increase (Abnormal) -ANEMIA Major function: Oxygen delivery Overview of White Blood Cells Anemia - Also known as leukocytes - means loss of oxygen-carrying capacity and is - Major functions: Protection often reflected in a reduced RBC count or Granular decreased RRC hemoglobin concentration. - there are granules found in the cytoplasm of Polycythemia the cell - means an increased RBC count reflecting Basophils increased circulating RBC mass, a condition Eosinophils that leads to hyperviscosity Neutrophils Agranular - without granules in the cytoplasm of the cell Red Blood Cells Parameters Lymphocytes Hemoglobin (hb, hgb) Monocytes Oxygen is attached to the hemoglobin Hematocrit (hct)/PCV (pack cell volume) Examples Consist of packed cell 1. Neutrophil RBC count - Phagocytic cells whose major purpose RBC Indices is to engulf and destroy can be computed using the 3 RBC parameters microorganisms and foreign material, (hgb, hct, RBC count) either directly or after they have been MCV labeled for destruction by the immune mean cell volume based on the hematocrit of system. The term segmented refers to the patient together with the RBC count their multilobed nuclei. MCV = Hematocrit x 10 / RBC - size within - Increase = neutrophilia (bacterial the population infection) MCH - Decrease = neutropenia, often caused mean cell hemoglobin by certain medications or viral infection Hemoglobin and RBC count of the patient 2. Lymphocytes MCH = Hgb X 10 / RBC - single RBC Functions: MCHC - Recognize foreign antigens. mean cell hemoglobin concentration based on - Mount humoral (antibody) and cell-mediated Hemoglobin and Hematocrit (hgb/hct) responses. MCHC = Hgb X 100 / Hematocrit - - Appearance on Wright-stained blood film: population of RBC Nearly round, slightly larger than RBCs. RDW  CLINICAL HEMATOLOGY LECTURE Round, featureless nuclei. Thin rim of Kidney Renal MACs/ Mesangial Cells nongranular cytoplasm. Lymphocytosis: Increase in lymphocyte count. Brain Microglial Cells Often associated with viral infections. Accompanied by variant/reactive lymphocytes Skin Langerhans Cells with characteristic morphology Spleen Splenic/ Littoral cells Lymphopenia/Lymphocytopenia: Abnormally low lymphocyte count. Often associated with Intestines Intestinal MACs drug therapy or immunodeficiency. Lymphocytes in Leukemia: Chronic Peritoneum Peritoneal MACs lymphocytic leukemia: More common in people Synovial Tissue Type A Cells over 65. Acute lymphoblastic leukemia: Most common Reproductive Organ Reprod. Organ MACs childhood leukemia. Bone Osteoclast 3. Monocytes - Immature macrophages in transit from bone Placenta Hofbauer Cells marrow to targeted tissue. - Comprising a minor component of peripheral blood WBCs. Overview of Platelets - Appearance on Wright-stained blood film: Maintains vascular integrity, controls hemostasis and Slightly larger than other WBCs. Blue-gray controls bleeding cytoplasm with fine azure granules. Nucleus Primary hemostasis usually indented or folded. - involves platelets Monocytosis: Secondary hemostasis - Increase in the number of - involves coagulation factors monocytes. Characteristics: - Found in certain infections, Very small (2-4 mu), round, anucleated, slightly collagen-vascular diseases, or granular acute and chronic leukemias. Ability to aggregate and adhere with one Monocytopenia: another - decreased monocyte count. 4. Eosinophil Endothelial Cells - are cells characterized by bright orange-red cytoplasmic granules filled with proteins that - Veins are composed of simple squamous cells play a role in regulating the immune system. - Maintains vascular integrity An elevated eosinophil count, known as - Maintenance or normaid eosinophilia, typically indicates a response to - Storage site of some cytokines involved in allergies or parasitic infections. hemostasis 5. Basophil ➔ Example: Von Willebrand Factors - are cells with dark purple, irregular cytoplasmic stored in the endothelial cells granules that often obscure the nucleus. These granules contain histamines and other Complete Blood Count proteins. An elevated basophil count, known as Type of specimen: Capillary blood and Venous basophilia, is rare and typically indicates a blood hematologic disease. Measures all the parameters under rbc, wbc, and platelet Hemocytometer counting - 5,000- 10,000/cumm Cbc specimen should not have presence of Similar RaC, involved in counting fibrin manually - Formulation of fibrin indicates the activation of coagulation factors Leukopenia low WBC count Leukocytosis high WBCs count Differential count Wright's staining Macrophage on the Specific Location Liver Kupffer Cells Lungs Alveolar MACs/ Dust Cells