2008 my lecture introduction to hematology

HematologyHematology

Dr.Mohamed Iqbal Musani, Dr.Mohamed Iqbal Musani, MDMD

HematologyHematology Cellular ComponentsCellular Components Components of BloodComponents of Blood

Red Blood CellsRed Blood Cells White Blood CellsWhite Blood Cells Inflammatory processInflammatory process CoagulationCoagulation

HemorrhageHemorrhage Blood TypingBlood Typing Clotting disordersClotting disorders Transfusion MedicineTransfusion Medicine

HematologyHematology

SpleenSpleen

KidneysKidneys

LiverLiverBoneMarrowBone

Marrow

BloodBlood

HematopoieticSystem

HematopoieticSystem

Cellular ComponentsCellular Components

Pluripotent Stem Cell

Myeloid Multipotent Stem Cells

Common LymphoidStem Cells

Unipotent Progenitors

BasophilsEosinophilsNeutrophilsMonocytes

Lymphocytes

ErythrocytesThrombocytes

Erythropoietin

WBC’sRBC’s

Platelets

Components of BloodComponents of Blood

PlasmaPlasma Transport Transport

mechanismmechanism 90-92% water. 90-92% water. 6-7% proteins6-7% proteins 2-3% 2-3%

FatsFats Carbohydrates Carbohydrates

(glucose)(glucose) ElectrolytesElectrolytes Gases (OGases (O22, CO, CO22)) Chemical Chemical

messengersmessengers

Plasma Components

Other3%

Protein7%

Water90%

Components of BloodComponents of Blood Red Blood CellsRed Blood Cells

ErythrocyteErythrocyte Hemoglobin – OHemoglobin – O22

bearing moleculebearing molecule Comprised of 4 Comprised of 4

subunits:subunits: Globin (binds to Globin (binds to

1 O1 O22 molecule) molecule) Heme (iron)Heme (iron)

100% saturation = 100% saturation = 4 globin subunits 4 globin subunits carrying Ocarrying O22

Each gram of Each gram of hemoglobin = hemoglobin = 1.34 ml O1.34 ml O22

Cellsalive.com


Red blood cell production Erythropoiesis

Erythropoietin Hemolysis Sequestration Laboratory analysis

of red blood cells Red blood cell count Hematocrit Hemoglobin


Platelets (Thrombocytes)Platelets (Thrombocytes) MegakaryocytesMegakaryocytes

ThrombopoietinThrombopoietin ThrombocytopeniaThrombocytopenia ThrombocytosisThrombocytosis

HemorrhageHemorrhageClass IClass I Class IIClass II Class IIIClass III Class IVClass IV

Blood Loss (ml)Blood Loss (ml) Up to 750Up to 750 750-1500750-1500 1500-20001500-2000 >2000>2000

Blood Loss (% Blood Loss (% volume)volume)

Up to Up to 15%15%

15%-30%15%-30% 30%-40%30%-40% >40%>40%

PulsePulse <100<100 >100>100 >120>120 >140>140

BPBP NormalNormal NormalNormal DecreasedDecreased DecreasedDecreased

Pulse PressurePulse Pressure Normal or Normal or increasedincreased

DecreaseDecreasedd

DecreasedDecreased DecreasedDecreased

Resp. RateResp. Rate 14-2014-20 20-3020-30 30-4030-40 >35>35

Urine Output Urine Output (ml/hr)(ml/hr)

>30>30 20-3020-30 5-155-15 NegligibleNegligible

Mental StatusMental Status Slightly Slightly anxiousanxious

Mildly Mildly anxiousanxious

Anxious, Anxious, confusedconfused

Confused, Confused, lethargiclethargic

Fluid Fluid Replacement Replacement (3:1) rule(3:1) rule

CrystalloiCrystalloidd

CrystalloiCrystalloidd

Crystalloid Crystalloid and bloodand blood

Crystalloid Crystalloid and bloodand blood

Blood Products and Blood Blood Products and Blood TypingTyping

Blood TypesBlood Types AntigensAntigens

A, B, AB, OA, B, AB, O Rh factorRh factor

Rh+ = ~85%Rh+ = ~85% Rh- = ~15%Rh- = ~15%

Blood transfusion


Blood Typing - ABOBlood Typing - ABO

Blood typeBlood type Antigen Antigen present on present on erythrocyteerythrocyte

Antibody Antibody present in present in

serumserum

OO

ABAB

BB

AA

NoneNone

A and BA and B

BB

AA

Anti-A, Anti-BAnti-A, Anti-B

NoneNone

Anti-AAnti-A

Anti-BAnti-B


Compatibility Among ABO Blood Compatibility Among ABO Blood GroupsGroups

Reaction with serum of RecipientReaction with serum of Recipient

Donor CellsDonor Cells ABAB BB AA OO

ABAB

BB

AA

OO

--

--

--

--

++

--

++

--

++

++

--

--

++

++

++

---= no reaction+ = reaction


Brady; Paramedic Care Principles and Practice

Diseases of ErythrocytesDiseases of Erythrocytes

AnemiasAnemias Anemia is a sign, not a separate disease Anemia is a sign, not a separate disease

process.process. Signs and symptoms may not be present Signs and symptoms may not be present

until the body is stressed.until the body is stressed. Differentiate chronic anemia from acute Differentiate chronic anemia from acute

episode.episode. Treat signs and symptoms.Treat signs and symptoms.

Maximize oxygenation and limit blood loss.Maximize oxygenation and limit blood loss. Establish IV therapy if indicated.Establish IV therapy if indicated.


Brady; Paramedic Care Principles and Practice

Diseases of ErythrocytesDiseases of Erythrocytes Sickle Cell DiseaseSickle Cell Disease

Normal red cells maintain Normal red cells maintain their shape as they pass their shape as they pass through the capillaries through the capillaries and release oxygen to the and release oxygen to the peripheral tissues (upper peripheral tissues (upper panel). Hemoglobin panel). Hemoglobin polymers form in the polymers form in the sickle rell cells with sickle rell cells with oxygen release, causing oxygen release, causing them to deform. The them to deform. The deformed cells block the deformed cells block the flow of cells and interrupt flow of cells and interrupt the delivery of oxygen to the delivery of oxygen to the tissues (lower panel). the tissues (lower panel).


Sickle Cell Disease (cont.)Sickle Cell Disease (cont.) Sickle cell crisesSickle cell crises

Vaso-occlusiveVaso-occlusive Musculoskeletal/abdominal painMusculoskeletal/abdominal pain PriapismPriapism Renal/cerebral infarctionsRenal/cerebral infarctions

HematologicalHematological Lowered hemoglobinLowered hemoglobin Splenic sequestrationSplenic sequestration

InfectiousInfectious ManagementManagement

Follow general treatment guidelines prn.Follow general treatment guidelines prn. Consider analgesics.Consider analgesics.


PolycythemiaPolycythemia Overproduction of erythrocytes.Overproduction of erythrocytes.

Occurs in patients > 50 years old or with Occurs in patients > 50 years old or with secondarysecondary dehydration. dehydration.

Most deaths due to thrombosisMost deaths due to thrombosis Results in bleeding abnormalities:Results in bleeding abnormalities:

Epistaxis, spontaneous bruising, GI Epistaxis, spontaneous bruising, GI bleeding.bleeding.

Management:Management: Follow general treatment guidelines.Follow general treatment guidelines.

Diseases of LeukocytesDiseases of Leukocytes

Leukopenia/NeutropeniaLeukopenia/Neutropenia Too few white blood cells or neutrophils.Too few white blood cells or neutrophils. Follow general treatment guidelines and Follow general treatment guidelines and

provide supportive care.provide supportive care. LeukocytosisLeukocytosis

An increase in the number of circulating An increase in the number of circulating white blood cells, often due to infection.white blood cells, often due to infection. Leukemoid reactionLeukemoid reaction


LeukemiaLeukemia Cancer of hematopoietic cellsCancer of hematopoietic cells Initial presentationInitial presentation

Acutely ill, fatigued, febrile and weak, Acutely ill, fatigued, febrile and weak, anemic.anemic.

ThrombocytopeniaThrombocytopenia Often have a secondary infection.Often have a secondary infection.

ManagementManagement Follow general treatment guidelines.Follow general treatment guidelines. Utilize isolation techniques to limit risk of Utilize isolation techniques to limit risk of

infection.infection.


LymphomasLymphomas Cancers of the lymphatic systemCancers of the lymphatic system

Hodgkin'sHodgkin's Non-HodgkinsNon-Hodgkins

PresentationPresentation Swelling of the lymph nodesSwelling of the lymph nodes Fever, night sweats, anorexia, weight loss, fatigue, Fever, night sweats, anorexia, weight loss, fatigue,

and pruritisand pruritis ManagementManagement

Follow general treatment guidelines.Follow general treatment guidelines. Utilize isolation techniques to limit risk of infection.Utilize isolation techniques to limit risk of infection.

Clotting DisordersClotting Disorders Thrombocytosis and ThrombocytopeniaThrombocytosis and Thrombocytopenia

ThrombocytosisThrombocytosis An abnormal increase in the number of plateletsAn abnormal increase in the number of platelets

ThrombocytopeniaThrombocytopenia An abnormal decrease in the number of plateletsAn abnormal decrease in the number of platelets

SequestrationSequestration Destruction (ITP)Destruction (ITP) Decreased productionDecreased production

ManagementManagement Provide supportive care and follow general Provide supportive care and follow general

treatment guidelines.treatment guidelines.

Clotting DisordersClotting Disorders

HemophiliaHemophilia Deficiency or absence of a blood clotting Deficiency or absence of a blood clotting

factorfactor Deficiency of factor VIII causes hemophilia A.Deficiency of factor VIII causes hemophilia A. Deficiency of factor IX causes hemophilia B.Deficiency of factor IX causes hemophilia B. Deficiency is a sex-linked, inherited disorder.Deficiency is a sex-linked, inherited disorder.

Defective gene is carried on the X chromosome.Defective gene is carried on the X chromosome.

Signs & SymptomsSigns & Symptoms Numerous bruises, deep muscle bleeding, Numerous bruises, deep muscle bleeding,

and joint bleeding.and joint bleeding.


Hemophilia (cont.)Hemophilia (cont.) ManagementManagement

Treat the patient similarly to others.Treat the patient similarly to others. Administer supplemental oxygen.Administer supplemental oxygen. Establish IV access.Establish IV access.

Be alert for recurrent or prolonged bleeding, and Be alert for recurrent or prolonged bleeding, and prevent additional trauma.prevent additional trauma.

Von Willebrand’s DiseaseVon Willebrand’s Disease Deficient component of factor VIIIDeficient component of factor VIII

Generally results in excessive bleeding.Generally results in excessive bleeding. Generally is not serious; provide supportive care.Generally is not serious; provide supportive care.


Disseminated Intravascular CoagulationDisseminated Intravascular Coagulation System activation of coagulation cascade.System activation of coagulation cascade. Results from sepsis, hypotension, OB Results from sepsis, hypotension, OB

complications, severe tissue or brain injury, complications, severe tissue or brain injury, cancer, and major hemolytic reactions.cancer, and major hemolytic reactions.

Multiple MyelomaMultiple Myeloma Cancerous disorder of plasma cells.Cancerous disorder of plasma cells. Pathologic fractures are common.Pathologic fractures are common.

2008 my lecture introduction to hematology

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Transcript of 2008 my lecture introduction to hematology