Haematology

actualy

hematology is the science that deals with blood elements

Blood elements
RBCs , WBCs and coagulation
science of investigation not science of clinical diagnosis
investigations
yolk sac

3rd week

IntraUterina

hematologist

RBCs

physiology

RBC

liver and spleen

BoneMarrow

fourth month

Bone marrow
hemolytic anemia

limited to end of long bones and flat bones

RBCs

liver & spleen

shaft

hepatosplenomegaly

undifferentiated

replace

proliferating

shaft

proliferate

and bone marrow expansion

stem cells

BM

RBCs

RBCs

cells
RBCs

bone marrow

stage

rbcs , wbcs or platlets

pleuripotent cells

nucleus

nucleus
reticulocytes

stem cell

RBCS
Mature RBCs

%2

maximum 2 %

RBCs

haemolysis

reticulcytes

immature

anemia

reticulcytes

reticulcytes

iron

reticulcytosis

bone marrow

RBCs

bone marrow

iron

RBCS

reticulocytes

Mature RBCs

medical treatment

nucleas

RBCs

Bone marrow

success of treatment

haemolysis and haemorhhage

iron deficnecy anemia

reticulcytes

pan

bone marrow failure

reticulcytes

hypersplenism or bone marrow failure

reticulocyte

spleen

reticulcytes

hypersplenism

cytopenia

bone marrow failure

bone marrow activity

reticulocytes
reticulocyte

RBCs

Reticulocytosis

COUNT

reticulocytes

large cells in blood

Macrocytosis
RBCs

stimulate

Androgen

=D

female
35 ml

male =D
Androgen

Male : 4-6 Mil

Female : 3.5 to 4.5 Mill
Male
female

androgen

menstrual cycle
androgen

production of RBCs

Female

Bone marrow failure

stimulate production of RBCs

polycythemia

RBCs

sicke cell ad spherocytes

biconcave

packed cell volume

centrifuge
011

Hemtaocrite

centrifuge
55

011
55

RBCs

shape

hematocrite
011
, 55

hematocrite
plasma
packed RBCs

Count

RBCs

55

hypervolemia

anemia

hypervolemia

anemia

hematocrite
diluted

hematocrite

dehydration or polycythemia

hypervolemia
2

21

01

mean corpuscular volyme

mean corps volume

RBC

RBC

RBC

count
69 86

range

macrcyte

range

69

hematocrite
90 U

5 million

Microcyte

69

RBcs
,

Microscope
megalo

diameter of RBC
02

RBC

macro
megalo

45 ml

mcq

normocyte

size

microcyte 97.

macor

macro

micron 97.6

megalo

megaloblastic Macrocytic
macrocytic non megaloplastic

haemoglobin
Male : 14-16
Female 13.5-14
polycythemia
0

01

RBCs
5

anemia

hemoglobin
05

01

RBC

15gm

mean corpuscular haemoglobin

RBC

heamoglobin

hyperchromic
mean

haemoglobin
RBC

02

hemoglobin

26

range

RBC

hemoglobin

hypochromic

RBC

hypo , hyper or normochromic

hematocrite

30 Pg

hemoglobin

corpuscular haemoglobin

mean corpuscular hemoglobin concentration

the value of blood film in diagnosing anemia
size , shape , count , mean corpuscular volume

the value of blood

01

items
smear

infection , inflammation and malignancy

3

ESR

Capillary tube
RBCs

RBCs

RBCs

blood
5

ESR

2 hours

RBCs should be attached

RBCs

Repulsion
negative

ESR

negative charge
albumin

RBCs

RBCs

to eacth other

nephrotic syndrome
negative charges

negative charge

albumin

albumin

ESR

charges
ESR

infection and

globulin

negative charges from RBCs

globulin and fibrinogen

inflammation
ESR
ESR

negative charges

pregnancy

fibrinogen

and malignancy , Infection and inflammation , pregnancy and nephrotic syndrome

antibodies

MCQ

Malignancy , TB

ESR

malignancy
Charges

collagen disease

RBCs

ESR

011

ESR

MCQ

abnormal shape of rbcs

Value of blood film in diagnosin anemia

General Rules

general rules
general rules
anemia

General rules

anemia is the decrease in RBCs or hemoglobin or hematocrite in same age sex

adult

09

02
Caucasian

actually am not

female

low hemoglobin

05

anemic

anemic ?
polycythemia

and race

hemoglobin 14 is abnormal

male

diluted

Anemia by definition

0.

02
dehydrated

negros

Sex
Race

sex , age and race

RBCs

is it possible to do this ?
RBC

01

anemic

RBCs

IV

technetium labeled RBCs

chromium or technetium

gamma camera

RBCs
hypervolemia

hypervolemia

anemia

RBCs

RBCs
not practical

acc to morphology

acc to etiology

classification of anemia
Acc to etiology

etiological
enough

hemoglobin deficiency anemia

anemia of bone marrow

Bone marrow

RBCs

hemorrhage and hemolytic anemia

failure

Deficiency anemia , Anemia of bone amrrow failure , hemorrhage and

according to etiology
hemolytic anemia

normocytic normochromic anemia

hypo chromic

69

morphology
microcytic

microcytic hypochromic
28
Microcytic hypochromic anemia
Microcytic hypochromic anemia

heme and
iron

heme

globulins

heme

iron +

heme

globulin

deficiency anemia
thallassemia
acute

RBCs

globulin

Normocytic normochronic anemia

bone marrow failure , acute hemolysis ,hemorrhage

5

megaloblastic

02

reticulocytosis

non megaloblastic

02

megaloblastic

liver cell failure

Macrocytic anemia

non megaloblastic

macrocytic anemia

Vb12 and folic acid

reticulocytosis

RBCs
reticulocytes

liver cell failure , alcoholism and reticulocytosis

Macrocytic non megaloplastic

classification of anemia
etiology

physiology

etiology

general rules

physiology of iron

etiology

HCL

iron deficiency anemia

absorbtion

iron

HCL

of iron deficiency anemia

FOG P

Clinical picture
decrease of o2 delivery to tissue

retinal edema

vasodilatation

hypoxia

Fatigue F

fundus

blurring of vision
tissue hypoxia
Heart

acute anemia

vaso dilatation

edema

Oedema

sever anemia and long standing

anemic HR
failure

consent
Heart failure

075

hemoglobin
Heart failure

vasodilatation GIT

vasodilatation peripheral
hypoprotenemia

anorexia

acute

edema

malabsorbtion

Git congestion

GIT Congestion
CNS , CVS , Respiratory , Renal
headache

cerebral edema

CNS

General systems

Vasodiltation

CNS

hypoxia of nerve , peripheral neuritis

tumor

headache , anorexia and bluring of vision

pseudo tumor cerebri

Heart

severe long standing anemia

, palpitation , tachycardia

Nocturia

it has similar features like a brain tumor

hyperdynamic circulation
CVS

Renal blood flow

specific features
haemolytic
6

jaundice

anemia

FOG P

VD

failure
polyurea Renal

specific
spooning

FOG P

C/P of the cause

epigastria pain and constipation

iron deficiency anemia

etiology
C/P of the cause
2

ESR

specific feature
of nails

C/P of the cause

specific feature

hematocrite

FOG P

RBCs

MCV & MCH

microcytic hypochromic or macrocytic
hemoglobin
iron deficncy

specific investigation
microcytic hypochromic

thalassemia

.9

iron deficncy

61

MCV

MCV

iron level

thalassemia

hemoglobin

Bone marrow failure

hematocrite
anemia

specific investigation

reticulocyte

hemolytic or hemorrhage

BM failure

Investigation of the cause

iron

microcytic anemia

.0

MCV

stool analysis for parasite

iron deficncy anemia

Treatment
Tratemnt of cause
Blood transfusion if HB<7 or there is HF

0
2

Iron deficiency anemia

rules
physiology
physiology
Diet
duodenum

ferrous

ferric

HCL

duodenum
regulate absorbtion
1mg

absorption of iron
apoferritin

iron
iron
absorption

absorbtion of iron

absorbtion

duodenum
absorbtion only to 1 mg

Mucosal block theory

7

1mg

absorbtion

apoferritin

transferring

transferrin

blood

iron

Iron
, Transferrin saturated

iron

iron

01
% 01

total binding capacity

transferrin saturation

iron deficncey

iron

transferrin

total iron binding capacity

myoglobin

catalase

iron

enzymes

enzymes

ferrtitin

Muscles

tissue

liver
physiology

Etiology

Starvation , malnutrition *
milk

9
9

diminced HCl

iron

female

iron deficiency
gastrc carcinoma

atrophic gastritis , gatsrectomy

stomack

malabsorbtion duodenum

HCL
rare

Iron deficiency anemia

congenital

chronic blood loss

parasite and menstrual irregularity
anclystoma

cancer colon

iron deficiency anemia

peptic ulcer virus hemoptysis

parasite

parasite

51
colonoscopy
hematuria

clinical picture
affect metabolism
proliferate

tissue

FOG P
specific

enzymes

tissue proliferating

proliferate

metabolism

tissues

0
2
0

skin an GIT
loss of hair and

iron deficiency

proliferation and replacement

SKIN
spooning of nails

proliferation and

papillae
red glazed tongue

GIT

proliferation

replacement

clinical picture of the cause

gatsrectomy
epigastria pain constipation and pellagra

diminished absorption
parasite manifestations
Plummer Vinson syndrome ?

splenomegaly dysphagia

ESR

female

cancer esophagus

hematocrite

Investigations

RBCs

Type of anemia : microcytic hypochromic anemi

MCV & MCH

total iron binding capacity

transferring saturation

ferrtitin
reticulocytosis

iron

Investigation of cause
female

esinophilia
infertility
esinophilia

worm or ova

Stool analysis

hemoglobin

anclystoma

worm or ova
coloncopy

stool analysis

51

Treatment
iron

ferrous sulphate

ferrous sulphate & ferrous gluconate

absorbtion
gastritis

Ferrous

iron

acid
dark stool stool

absorption

iron

malabsorbtion

ferrous

vein

acid

rapid correction
parentral

parentral and oral have the same rate of correction

thrombophlebitis

capsule

oral iron

rapid correction

acid

iron

acid

parentral iron

iron

Iron

oral

gastric irritation

malabsorbtion
mg 0

parentral

IV

parentral

vein
vein

MCQ

acid IV ?
dilution

acid

ferrous
vein

thrombosis

IM
proton pumb inhibitor

peptic ulcer

mebendazole

anclystoma
Iron deficncey anemia
Discuss Iron deficncey anemia
anemia of chronic hemorrhage
discuss anklystoma duednalis
etiology

Anemia of chronic illness

chronic infection- chronic inflammation- and malignancy

chronic illness
tb

chronic infection

Inflammation : collagen disease

Tumor Malignancy
inflammatory mediators cytokines
.1

021

suppression of BoneMarrow
normocytic

Kidney

suppression erythropoietin
transferritin

cytokines
serum

RBC

Iron Bone marrow

iron

cytokines

normochromic anemia
iron release to the tissue

iron

iron

shortening life span of RBC

iron deficncy anemia

iron

BM
BM
iron

microcytic hypochromic

normochromic normocytic

ferrritin

inhibition of iron release to the tissue

serum iron
ttt of underlying

anemia of choronic illness

investigation

iron

Microcytic hypochromic

iron deficny anemia

clinical picture

total binding capacity

cause

iron

cytokines

failure to utilize iron

anemia of choronic illness

iron
sideroplastic anemia

iron and protoporphyrin

heme

heme + globin

10

MCQ

Sideroblastic anemia
siderblastic anemia
glycine

gamma amino levulinic acid

aminoacid

1h :36
folic acid

VIT B6

enzyme

Gamma amino levilunic synthetase

synthesis
sideroblastic anemia
congenital

VIT B6 metabolism

INH

Not present *

VIt B 6 deficncy , folic acid deficncy

protoporphyrin

inhibition

siderblastic anemia

lead poisiong

protoporphyrin

iron

RBCs
-

cases

Vitamine B12 deficiency

Vit B12
Vit B12
intrinsic

parietal cells

blood

B12

GIT

stomach
absorbtion

CNS

RBCs

Oral

Vb12 is only animal sources

terminal ileum

Bone maroow

B12

plasma

.. factor

transcobalamine -2

2 years

liver

=D

animal source Source

excess Vit B12

under basal condition

Function *

division

cells

cytoplasm

DNA

nucleas

vit B12

b12

double

cytoplasm and nucleas

DNA

double

cytoplasm

B12

divide

double

Nucleas

megaloblasts
RBCs , WBCs

cells

Megaloblasts

stem cells

proliferate
anemia

Bone
11

cells

bilirubin

divide

bone marrow
B12

proliferate

cells

and platlet

anemia
bilirubin

normoblast

stage

marrow
erythroblast

mature

at variable stage of development

nucleas

WBCs

thrombocytopenia

platelet

RBCs
serum muramidase

multinucleated

enzyme

immature

6 lobes

3 lobes

WBCs

nucleas

multilobated nuclueas
mylination of Nerve fibers
Vit B12

Vit B 12

proliferate

GIT
proliferation

etiology
Diminshed intake
=D vegetarian

vegetarian Egyptian

Starvation, vegeterians
American vegetarian

=D

=D

, vegeterians

Starvation

Diminshed intake

diminished absorbtion

intrinsic factor
automimmune disease

Addissonian pernicious anemia

gatsrectomy, gastritis.

Antibodis against parietal cells

0

antibodies

antibodies against intrinsic factor

antibodies against terminal ileum

high incidence against gastric carcinoma
,

against parietal cells

European female

disease

blue eye fair head females

illeal disease
2 , 2 infection , 2 inflammation ,
TB & regional ileitis 2 infection ,
crohns and ulcerative colitis 2 inflammati
contents

peristalsis

Intestine

blind loop syndrome

proliferation of bacteria

12

2
stagnant

Transcobalamine deficiency congenital

malignancy

B12

proliferating

pregnancy

bone marrow

hemolytic anemia

increase requirement

V B12

proliferate

cells

B12

Clinical picture
FOG P
purpra

hepatosplenomegaly

jaundice

red glaze tonge

specific

sub acute combined degeneration

demylination
Cp of the cause

Diminshed intake
examination

Addisoninan pernicious
investigation

Investigations
ESR

RBCs

Type Megaloblastic normochromic anemia

MCHC

MCV

Specific nvestigations
anisocytosis , poikilocytosis , cabbot rings
specific
muramidase

mulitlobated WBCs
BM

thrombocytopena

serum LDH

High bilirubin

No reticulcytes
reticulocytosis

TTT

Inv of the cause

endoscopy

stomach
antibodies 0

obsolete

Intestine

B12

Vit B12

chilling test

UG

urine

perniciose anemia

IM

urine

Vit B12
absorbtion

intestine
test
test

urine
intrinsic factor
bacterial over growth

13

aborbtion
intrinsic factor
antibiotic

B12

vit b 12
HCL and pepsin

pernicious anemia

tb

underlying cause
HF

HB

Blood transfusion

Discuss vit b 12 deficency

Discuss subacute combined degeneration
discuss addisonian pernicious anemia

Folic Acid deficiency

carrier
GIT and

intestine

absorption

tetra hydro foliate

liver

vegetables source

activation
CNS

inactive

Vit B12

bone marrow
0

Etiology
Deficient Intake 0

anorexia and alcoholism

anti epileptics
b12

anticonvulsant

dialysis

malabsorbtion syndrome

dialysis

folic acid
activation

drugs

carrier

Blood

dialysis

drugs

tetrahydrofolate

Deficient absorbtion

2
0

carrier
activation

folic acid

malignancy , pregnancy and hemolytic anemia

requirements
CNS

B12

5
Clinical picture
Investigations

aminoacid

absolete

folic acid
glutamic

glutamic acid
FIGLU

FIGLU test
FIGLU

Histidine

chilling test

FIGLU

B12

Histidine

folic acid deficnecny

Urine

FIGLU
treatment
folic acid
underlying cause

B12
14

MCQ

Folic acid

=D

751

151

MCQ

Bone marrow failure Aplastic anemia

=D
Unipotent and pleuripotent
platelet and WBCs

RBCs

diamond blackfan syndrome

in one element
congenital

RBCS

phalanges 0
Renal failure

anti erythropoietin
TAR

BM

thumb

erythropoietein

Unipotent

Thumb

acquired

bronchogenic carcinoma or thymoma

wisckot Aldrich syndrome

platlet
syndrome
idiopathic

WBCs

.
Unipotent

BM

BM failure

Pleuripotent
failure
% 61

Idiopathic and drugs

corticosteroids
b cells
BM

idiopathic

B cells

autoimmune
T

T Cells

antibodies

anti emetic , antithyroid , antibiotic , antidiabetic

Antis

Drugs

infection , immunological, irradtion

tb and hepatitis
SLE

Infection

Immunological

leukemia and lymphoma Infiltration

myetophthitic anemia
=D

Infiltration of BM
benzene

chemicals
BM failure
Clinical picture
BM

FOG P
15

RBCs

bleeding tendency
severe up to septic shock

organisms

already

platlet

Infection

WBCs

CP of the cause
investigations
ESR

hematocrite

RBCs

normocytic normochromic
MCV & MCH normal

WBCs and platlets Inv of the cause

BM biopsy
biopsy

aspiration

Under local anaesthia

fibrosis of bone

aspiration

aspiration
fibrosis

BM aspiration

iliac crest

BM cavity

biopsy

marrow

Treatment
RBCs

platlets

WBCs

packed RBCs
platlet
WBCs

=D

WBCs

anti fungal , antibiotic and antiviral

antigen

androgen or erythropoietin

RBCs
danazol

granulocyte GCSF

stimulate BM
platlet

side effects

lithium

wbcs
stimulating factor
idiopathic

cyclosporine
0.5

stimulate BM

MCQ

Hemolytic anemia
021
proliferate

RBCs Normal
BM

S
Hemolytic anemia

shortening life span of RBCS

hemolysis

IF RBCs are destroyed before 120 day this called hemolysis

021
rbcs

hemolysis

Replace damaged cells

replacement but no anemia

BM

replacement and no anemia

.1
60
40

maximum capacity
replacement

bone marrow

LIFE span

replacement
hemolysis only 021

16

05

05

proliferate
anemia

05

life span

% 65

extra vascular

spleen and liver

RBCs
intravascular

RBCs

disease

% 65

hemolytic anemia

Extravascular

intravascular hemolysis

disease

Liver and spleen

RBCs

hepatosplenomegaly
ESR

RBCs

damage extravascular

RBCs extravascular

HT

FOG P

anemia

Bone marrow expansion

hair on end appearance wide medulla and thin cortex

heme

heme + globin
TIBC

iron

RBCs

BM

RBC s

XRay

hemeoglobin

iron

disease

LDH
Mongloid features

extravascular ,

iron

iron and protophorphyrin

Transferring saturation
neuritis

CNS

hemosiderosis

tissue

cardiomyopathy

CVS

abdomen
liver cirrhosis liver
interstitial lung fibrosis
renal tubular disfunction
damage testies , suprarenal and pituitary

urine

ID bilirubin

indirect bilirubin

urobilinogen

indirect

endocrine

lung
Kidney

genetalia

biliverdin

protoporphyrin

cinically jaundice , gall bladder stones

stercobilinogen in stool

hemolytic

disease extravscular

hepatosplenomegaly .. jaundice ,
LDH

ESR

extravascular
HT

RBCs
0

inv
urobilinogen ,

extravascular
0

Hematology
17

extravascular

disease
hemosidern
stercobilinogen

18