LectureLectureTHE ANATOMICAL AND PHYSIOLOGICAL THE ANATOMICAL AND PHYSIOLOGICAL

PECULIARITIES OF BLOOD SYSTEM IN CHILDREN OF PECULIARITIES OF BLOOD SYSTEM IN CHILDREN OF DIFFERENT AGE GROUPS. SEMIOTICS OF MAIN DIFFERENT AGE GROUPS. SEMIOTICS OF MAIN

SYNDROMS (ANEMIC, HEMORAGIC, HEMOLYTIC) AND SYNDROMS (ANEMIC, HEMORAGIC, HEMOLYTIC) AND BLOOD SYSTEM DISORDERS (ACUTE AND CHRONIC BLOOD SYSTEM DISORDERS (ACUTE AND CHRONIC

LEUCEMIAS, HEMOPHILIA, HEMORAGIC VASCULITIS). LEUCEMIAS, HEMOPHILIA, HEMORAGIC VASCULITIS). NURSING CARE FOR CHILDREN WITH NURSING CARE FOR CHILDREN WITH

HAEMATOLOGICAL PROBLEMS.HAEMATOLOGICAL PROBLEMS.

Doc. Nykytyuk S.O.Doc. Nykytyuk S.O.

Conception of blood system

Blood system is blood, which consists of 1) blood, which is moving through the vessels, 2) blood forming organs, 3) blood destroying organs, 4) storage of blood, 5) apparatus for regulation

Blood functions

1) respiratory 2) transport of nutritive elements, products of

metabolism, hormones and waste materials 3) thermoregulation 4) maintaining the acid-base balance of the

tissues 5) supporting of oncotic and osmotic pressure 6) help to form a clot 7) protective

Blood volume, notion of blood reserve

6-8 %

The blood depo (storage) are in liver – 30 %; subcutaneus tissue – 20 %; spleen – 1,5-2,5 %

Composition of blood Plasma and cells (red blood cells, white blood cells, and blood

platelets) Plasma: water - 92 %, solids - 8 %; inorganic chemicals: sodium, calcium, potassium,

magnesium, chloride, bicarbonate, phosphate, sulfate; organic chemicals: proteins: serum albumin, serum globulin,

fibrinogen; nonprotein nitrogenous substances: urea, uric acid, creatine, creatinine, ammonium salts, amino acids; nonnitrogenous substances: glucose, fats, cholesterol, hormones, gases: oxygen, carbon dioxide, nitrogen.

Functional meaning of plasma protein The blood plasma include serum albumin, serum globulin, and fibrinogen.

Buffer´s system of blood

pH of arterial blood is between 7,35 and 7,45.

There are 4 buffer systems:

bicarbonate

hemoglobin

phosphate

protein

Quantity of erythrocytes In men – 4,0-5,1•1012/L; in women – 3,7-4,7•1012/L. The

quantity of erythrocytes may be increase – in pregnancy, in physical training, mental work, in

newborn or decrease; and decrease – only in pathology.Functions of erythrocytes

The primary function of the erythrocytes is to carry oxygen to the tissue.

Regulation of erythropoiesis Coused by erythropoietins, which produced in kidneys

and macrophagal system. Thyroid, epinephrine and male sex hormons increase quantity of erythrocytes and

female sex hormones decrease its..

Erythrocytes Erythrocytes

Neonatal periodNeonatal period -5.4x10 12/l-7.2x10 12/l (at the beginning of -5.4x10 12/l-7.2x10 12/l (at the beginning of

the period)the period) -4.7x10 12 (by the end of the period)-4.7x10 12 (by the end of the period) Breast feeding period-14 years 4.2x1012/lBreast feeding period-14 years 4.2x1012/l Older than 14 years -in boys-5.2x10 12/lOlder than 14 years -in boys-5.2x10 12/l -in girls-4.8x1012/l-in girls-4.8x1012/l

Critical number of erythrocytes is Critical number of erythrocytes is 1.0x1012/l1.0x1012/l

HemoglobinHemoglobin

Newborn period- 220-180 g/l -150g/l(till the Newborn period- 220-180 g/l -150g/l(till the end of the period)end of the period)

1 month-5 months -120-150 g/l1 month-5 months -120-150 g/l 1 months-5 years -on average 120-140g/l (but 1 months-5 years -on average 120-140g/l (but

not less than 110 g/l)not less than 110 g/l) Older than 5 years -on average 130-150 g/l Older than 5 years -on average 130-150 g/l

(but not less than 120 g/l)(but not less than 120 g/l) Critical number-20 g/lCritical number-20 g/l

Pathological changesPathological changes

EythropeniaEythropenia (=erythrocytopenia)-reduction in (=erythrocytopenia)-reduction in quantity of erythrocytes in children of 1 month quantity of erythrocytes in children of 1 month of age below 3.5x10 12/lof age below 3.5x10 12/l

Reduction in the quantity of hemoglobin Reduction in the quantity of hemoglobin (below the special level)(below the special level)

-Anemia of different genesis-Anemia of different genesis -Malignant diseases of blood (leucosis)-Malignant diseases of blood (leucosis) -Hyperhydratation, when pseudo-anemia is -Hyperhydratation, when pseudo-anemia is

observedobserved

Osmotic fragility of erythrocytesOsmotic fragility of erythrocytes

MIN.OFE-0.48-0.44%MIN.OFE-0.48-0.44% Max.OFE-0.36-0.28%Max.OFE-0.36-0.28% Exponents of newborn areExponents of newborn are Min.OFE-0.52-0.48%Min.OFE-0.52-0.48% Max.OFE-0.30-0.24%Max.OFE-0.30-0.24%

Pathological changesPathological changes

The decrease in OFE is a sign of congenital The decrease in OFE is a sign of congenital and acquired genesisand acquired genesis

Erythrocyte sedimentation rate (ESR) Erythrocyte sedimentation rate (ESR) in norm is equal toin norm is equal to

Newborn period- 0-2 mm/hourNewborn period- 0-2 mm/hour Breast-feeding age-2-4 mm/hourBreast-feeding age-2-4 mm/hour Further on -4-10 mm/hourFurther on -4-10 mm/hour The increase in ESRThe increase in ESR -inflammatory process of any system-inflammatory process of any system -Allergic reaction-Allergic reaction -malignancy-malignancy

The reduction in ESR is observed The reduction in ESR is observed ratherrather

seldomseldom -exsiccosis-exsiccosis -Anaphylactic shock-Anaphylactic shock -hypotrophy,exhaustion-hypotrophy,exhaustion -peptic ulcer-peptic ulcer -decompensated heart diseases-decompensated heart diseases -can be in acute viral hepatitis-can be in acute viral hepatitis

Color index of bloodColor index of blood

3xHbg/l3xHbg/l ----------------------------------------------------------------------------------------------------------------

-- First three digits in the First three digits in the

number of erythrocytes per one millionnumber of erythrocytes per one million (without the point)(without the point)

Thrombocytes Thrombocytes 150-300x109/l150-300x109/l Critical number is 100 G/lCritical number is 100 G/l Thrombocytosis Thrombocytosis higher than 400G/l higher than 400G/l It is observed that thrombocytosis occurs in It is observed that thrombocytosis occurs in

the postoperative period of splenectomy,the postoperative period of splenectomy, Bad prognosis of chronic myeloid leucosisBad prognosis of chronic myeloid leucosis Thrombocytopenia Thrombocytopenia lower than 100x109/llower than 100x109/l

NormochromiaNormochromia--

the figure is within the limits of the specified the figure is within the limits of the specified norm that indicates normal satiation of norm that indicates normal satiation of erythrocytes with hemoglobinerythrocytes with hemoglobin

HypochromiaHypochromia

--the figure is below normal which indicates the figure is below normal which indicates incomplete satiation of erythrocytes with incomplete satiation of erythrocytes with hemoglobin or microcytosis,or both hemoglobin or microcytosis,or both impairments togetherimpairments together

HyperchromiaHyperchromia

- - the figure is higher than normal-it is only a the figure is higher than normal-it is only a sign of increased volume of erythrocytes, sign of increased volume of erythrocytes, macrocytic hyperchromiamacrocytic hyperchromia

ReticulocytesReticulocytes

absolutely non mature forms of erythrocytes absolutely non mature forms of erythrocytes with the substance,their predecessorswith the substance,their predecessors

Newborn period- 10-30%Newborn period- 10-30% Breast-feeding age- 5-10%Breast-feeding age- 5-10% After 1 year - 2.5-5%After 1 year - 2.5-5%

Reticulocytes-Reticulocytes-

It is a positive index of the efficiency of It is a positive index of the efficiency of treatment in bleeding and anemiatreatment in bleeding and anemia

Indicates the hemolytic character of diseaseIndicates the hemolytic character of disease Sometimes is a diagnostic criterion of latent Sometimes is a diagnostic criterion of latent

bleedingbleeding

ErythremiaErythremia

.simultaneous decrease in number of .simultaneous decrease in number of leucopoiesis and aplasia of hemopoiesis leucopoiesis and aplasia of hemopoiesis condition in the whole.condition in the whole.

AnemiasAnemias Anemia is defined as reduction of red cell Anemia is defined as reduction of red cell

volume or he moglobin concentration to levels volume or he moglobin concentration to levels below normalbelow normal

Stages of aenemiasStages of aenemiasDecreasingDecreasing

1 stage1 stageDecreasing Hb level (before Decreasing Hb level (before 990gr per 0gr per literliter

2 stage Decreasing Hb level (lower 90gr per 2 stage Decreasing Hb level (lower 90gr per literliter

3 stage Decreasing Hb level (lower 70gr per 3 stage Decreasing Hb level (lower 70gr per literliter

Hemoglobin Erythrocytes derive their colour from a complex protein

called hemoglobin. This substance is composed of a pigment, heme, containing iron, and the protein globin. Hemoglobin has the power to attract oxygen molecules and to hold them in a loose chemical combination known as oxyhemoglobin. It

is said, therefore, to have a chemical affinity for oxygen.

MyoglobinHem is also part of the structure of myoglobin, an oxygen-

binding pigment found in red (slow) muscles and in the respiratory enzyme cytochrome c. Porphyrins other than that found in hem play a role in the pathogenesis of a number of metabolic diseases (congenital and acquired porphyria, etc.) It may be the reserve pigments, which give the tissue oxygen

in a small oxygen condition.

Quantity and chemical structure of hemoglobin

In man – 130-160 g/L; in woman – 120-140 g/L.

The iron atoms are bivalent or in the ferrous state. There are 2 pairs of polypeptides in each hemoglobin molecule, 2 of the subunits containing one type of polypeptide and 2 containing another. In normal adult human hemoglobin (HbA), the 2 types of polypeptide are called the a, and the chains.

Methods of definitition

gasometric – definition of gases, such as O2, colorimetric – definition of colour substances, iron metric – definition of iron concentration.

Combination of hemoglobin, their peculiarities

hemoglobin (oxyhemoglobin) reduced hemoglobin Carboxyhemoglobin (with CO) carbhemoglobin methemoglobin

Physiological valuation of white blood

There are two major groups of white cells:

granular, or poly-morphonuclear,

leukocytes (neutrophils, eosinophils, basophils)

and nongranular white cells (lymphocytes and monocytes).

Quantity of leukocytes and their changes White cells numbering is 4-9•109 per liter. The number of lymphocytes are – 18-37 %,monocytes – 3-11 %, eosinophils –0,5-5 %, basophils – 0-1 %, juvenile neutrophile – 0-1 %, relating to stab (rod-shaped) neutrophil – 1-6 %, segmented neutrophil – 47-72 %.

The number of leukocytes and different kind of leukocytes may increase. This condition called – leukocytosis, lymphocytosis, monocytosis, neutrophilosis, eosinophilia, basophilia. The number of leukocytes and different kind of leukocytes may decrease. This condition named – leukopenia, lymphocytopenia, monocytopenia, neutropenia, eosinopenia.

LymphocytesLymphocytes

Physiological role of T-lymphocytes (There are receptors to antigens on the membrane of T-lymphocytes, which helps to distinguish genetic heterologous substances.)

Functional significance of B-lymphocytes (B-lymphocytes syntheses the immunoglobulins such as IgM, IgN, IgA, IgG, IgB, IgE.)

NeutrophilsNeutrophils The neutrophils seek out, ingest, and kill bacteria and have

been called the body‘s first line of defense against bacterial infections. The average half-life of a neutrophil in the circulation is 6 hours. Many of the neutrophils enter the tissues; they first adhere to the endothelium and then insinuate themselves through the walls of the capillaries between endothelial cells by a process called diapedesis. Many of those that leave the circulation enter the gastrointestinal tract and are lost from the body. When bacteria invade the body, the bone marrow is stimulated to produce and release large numbers of neutrophils. Phagocytosis refers to the ability of neutrophils to ingest bacteria or other foreign bodies. They contain protein-digesting enzymes.

EosinophilsEosinophils

These cells make up only 0,5 to 5 percent of the total number These cells make up only 0,5 to 5 percent of the total number of white cells in the blood, but in the tissues they can of white cells in the blood, but in the tissues they can congregate in considerable numbers. There is a rise in the congregate in considerable numbers. There is a rise in the number of eosinophils in some cases of allergy, possibly in number of eosinophils in some cases of allergy, possibly in response to toxic substances released by the allergic reaction.response to toxic substances released by the allergic reaction. The eosinophils attack some parasites, and they inactivate The eosinophils attack some parasites, and they inactivate mediators released from mast cells during allergic reactions. mediators released from mast cells during allergic reactions.

BasophilsBasophils Basophils constitute only 0,5 percent of the white

cells of the blood. Basophils in the blood are said to contain histamine and a heparinlike substance. Histamine dilates capillaries and often permits fluid to move through the capillary wall into the tissues: heparin is an anticoaguiant of the blood. Apparently tissue basophils become the mast cells of the tissues. The large granules of mast cells are thought to store enzymes. The basophils contain histamine and heparin, but their role in the maintenance of normal balance between the clotting and anticlotting systems is uncertain.

System of mononuclear phagocytes These is the system, which connect the cells with one nucleus, it has

common origin from red bone marrow, common function of high specific phagocytosis.

It origines from promonocytes of red bone marrow. Tissue monocytes named macrophage. There are many macrophages in different organs. The macrophage of lungs named alveolar macrophages of lungs, the macrophage of spleen named free or fixed macrophages of spleen, the macrophage of liver named Kupffer cells, the macrophage of skin named Langergans cells, the macrophage of brain named microglia etc.

It has the function of high specific phagocytosis. The monocytes are actively phagocytic and contain peroxidase and

lysosomal enzymes. The macrophages migrate in response to chemotactic stimuli and engulf and kill bacteria by processes that are generally similar to those occurring in neutrophils. They also play a key role in cellular immunity because proliferation of T-lymphocytes requires that they come in physical contact with macrophages that have taken up and processed

antigen.

Definition of “leukocytes formula‘s” notion and its quantitative expression

The number of different kinds of leukocytes in the volume of blood called “leukocytes formula”.

It quantitative determination in 109/L. We has determination the number of leukocytes in 100

leukocytes of the smear, that‘s way the quantity of leukocytes may be occur in percent.

The number of lymphocytes are – 0,18-0,37 (18-37 %), monocytes – 0,03-0,11 (3-11 %), eosinophils –0,005-0,05 (0,5-5 %), basophils – 0-0,01 (0-1 %), juvenile neutrophile – 0-0,01 (0-1 %), relating to stab (rod-shaped) neutrophil – 0,01-0,06 (1-6 %), segmented neutrophil – 0,47-0,72 (47-72 %).

Hemostasis systemHemostasis system Hemostasis is the physiologic system, which

support the blood in the fluid condition and prevent bloodless.

The components of hemostasis are wall of the vessels, blood cells – platelets, erythrocytes, leucocytes, enzymes and nonenzymes components of plasma – clotting and anticlotting substances, fibrinolysis components of hemostasis.

There are 2 kinds of hemostasis: vessel-platelets (primary) and coagulative (secondary) hemostasis. Primary hemostasis activity begin the first after the destroyed of vessels. Secondary hemostasis starts after that in case the primary hemostasis do not stopped the bloodless.

Vessel-platelets hemostasis (or primary

hemostasis) Quantity of platelets is 180-320 G/L. Diameter of platelets is 1-4

micrometers, thickness – 0,5-0,75 micrometers. Platelets circulated in blood from 5 to 11 days and than destroyed in liver, lungs, spleen by the

cells of macrophages system. Function of platelets are: 1. Hemostatic function 2. Angiotrophic function (provide trophic of endotheliocytes of vessel

wall, support structure and functions of microvessels). For one day near 35 G/L platelets do this function.

3. Transport function – transfer the enzymes, ADP, serotonin and other. 4. Phagocytosis function. 5. Regeneratory function – platelets have the growth factor, which help to

grow the endothelial and muscles cells which are present in the vessel wall.

Stages of Stages of vvessel-platelets hemostasisessel-platelets hemostasis 1. Shorting spasm of the vessels – vascular spasm 1. Shorting spasm of the vessels – vascular spasm

duration to 1 minute is caused by catecholamins and duration to 1 minute is caused by catecholamins and other enzymes. other enzymes.

2. Adgesion of platelets – activation of platelets and 2. Adgesion of platelets – activation of platelets and stick it to the place of defect in vessel wall. stick it to the place of defect in vessel wall.

3. Reverse aggregation of platelets – the thromb 3. Reverse aggregation of platelets – the thromb which are formed may make way for plasma. which are formed may make way for plasma.

4. Unreverse aggregation of platelets – the thromb 4. Unreverse aggregation of platelets – the thromb which are formed can not may make way for plasma. which are formed can not may make way for plasma.

5. Retraction of platelets plug – decrease the size of 5. Retraction of platelets plug – decrease the size of plug, pack down the plug.plug, pack down the plug.

HemophyliaHemophylia

Test of primary hemostasisTest of primary hemostasis Tests for capillary wall resistanceTests for capillary wall resistance Amount of thrombocytesAmount of thrombocytes Analyses of adhesive-aggregative function Analyses of adhesive-aggregative function

of thrombocytesof thrombocytes Duration of capillary bleeding according to Duration of capillary bleeding according to

DukeDuke Clot retractionClot retraction

Test for capillary wall resistanceTest for capillary wall resistance

1.Konchalovsky-Rumpel-leede tests1.Konchalovsky-Rumpel-leede tests A)Tourniquet test-tourniquet is put for 3-5 minutes on the lower third A)Tourniquet test-tourniquet is put for 3-5 minutes on the lower third

of arm, so that pulse on radial artery could be felt. After that the of arm, so that pulse on radial artery could be felt. After that the tourniquet is removed and the presence of petechial is determined in tourniquet is removed and the presence of petechial is determined in the elbow bend and in forearm. Normally they should not occur the elbow bend and in forearm. Normally they should not occur (sometimes there may be 2 or 3 of them)(sometimes there may be 2 or 3 of them)

Cuff test: Modern updated test.The arm is squeezed with a cuff for 5 Cuff test: Modern updated test.The arm is squeezed with a cuff for 5 minutes (with the pressure of 90-100 mm Hg);than it is removed/Five minutes (with the pressure of 90-100 mm Hg);than it is removed/Five minutes later ,the number and the size of petechia,formed on the minutes later ,the number and the size of petechia,formed on the upper part of palmar surfaces of forearm on the area of 5 cm in upper part of palmar surfaces of forearm on the area of 5 cm in diameter is established. Conclusion about the lowered resistance of diameter is established. Conclusion about the lowered resistance of capillary wall can be made if 10 or more petechia can be found in the capillary wall can be made if 10 or more petechia can be found in the specified area.At the same time ,hemorrhages under the cuff are also specified area.At the same time ,hemorrhages under the cuff are also important.important.

2.Pinch test:2.Pinch test: Only skin in clavicle area is pinched whith the first and the Only skin in clavicle area is pinched whith the first and the

second fingers of both hands,at a distance of 3 cm from second fingers of both hands,at a distance of 3 cm from each other.Than the right and left hands are either:each other.Than the right and left hands are either:

A)Moved tewards and agains from each other (stretching)A)Moved tewards and agains from each other (stretching) b)right and left hands are moved in opposite directions b)right and left hands are moved in opposite directions

along the length of the skin so that a fold is formed.along the length of the skin so that a fold is formed. Normally skin does not change.Normally skin does not change. Interpretation of analysis: In case of the presence of Interpretation of analysis: In case of the presence of

petechiae, more over ecchymosis, the test is positive, which petechiae, more over ecchymosis, the test is positive, which shows lowered resistance of capillary wall.shows lowered resistance of capillary wall.

The amount of trombocytesThe amount of trombocytes

1.Evaluation of retention of trombocytes on glass (or filters)1.Evaluation of retention of trombocytes on glass (or filters) This methods establishes the degree of adhesiveness of thrombocytes.This methods establishes the degree of adhesiveness of thrombocytes. The main idea of this method is: venous blood is directed through a The main idea of this method is: venous blood is directed through a

standard column with glass balls with a particular speed. Amount of standard column with glass balls with a particular speed. Amount of trombocytes in blood is calculated before and after the blood is passed trombocytes in blood is calculated before and after the blood is passed through the column. The amount of reduction in their number after passing through the column. The amount of reduction in their number after passing in comparison whith their number before passing specifies the degree of in comparison whith their number before passing specifies the degree of adhesiveness. The normal parameter may vary and depends on the adhesiveness. The normal parameter may vary and depends on the structure of column.structure of column.

On the average the amount of thrombocytes should decrease approximately On the average the amount of thrombocytes should decrease approximately by 50%by 50%

Interpretation of analysis; If the results of the analysis is less than the Interpretation of analysis; If the results of the analysis is less than the normal parameter,normal parameter,

It indicates violation of the adhesiveness of thrombocytes.It indicates violation of the adhesiveness of thrombocytes.

Hemolysate-aggregation testHemolysate-aggregation test is a method for stablishing the aggregative property of is a method for stablishing the aggregative property of

thrombocytes. The principle of this method follows: to thrombocytes. The principle of this method follows: to establish hemolysate ability of the washed erythrocyte(in establish hemolysate ability of the washed erythrocyte(in dilution of 10 and 10) to cause aggregation of thrombocytes dilution of 10 and 10) to cause aggregation of thrombocytes when stirredwhen stirred

The result is considered taking into account aggregation and The result is considered taking into account aggregation and speed of its occurrence wich is normaly equal to: speed of its occurrence wich is normaly equal to:

. concentration 10 (in 11-17 sec). concentration 10 (in 11-17 sec) . concentration 10 (in 40-54). concentration 10 (in 40-54) Interpretation of analysis:if the result of analysis is higher than Interpretation of analysis:if the result of analysis is higher than

normal aggregation function of thrombocytes is lowerednormal aggregation function of thrombocytes is lowered

Investigation of vessel-platelets hemostasisInvestigation of vessel-platelets hemostasis

1. Calculation of the platelets quantity 180-320 1. Calculation of the platelets quantity 180-320 G/L. G/L.

2. Determination of duration of capillary 2. Determination of duration of capillary bleeding after Duke’s method – to 3 minute in bleeding after Duke’s method – to 3 minute in norm. norm.

3. Sample of fragility of capillars – to 10 3. Sample of fragility of capillars – to 10 petechias in norm in a round with diameter 5 petechias in norm in a round with diameter 5 santimetres.santimetres.

Duration of capillary bleeding according to DukeDuration of capillary bleeding according to Duke

(U.S pathologist of the 20th century) (U.S pathologist of the 20th century)

Technique: Tip of the 4th finger is pierced (like the blood Technique: Tip of the 4th finger is pierced (like the blood taken for general test) and note the time when bleeding started, taken for general test) and note the time when bleeding started, then with out pressing, the tip of the finger is pointed down then with out pressing, the tip of the finger is pointed down ward. Every 30 seconds the drop of blood that appeared at the ward. Every 30 seconds the drop of blood that appeared at the place of puncture is placed on a filter paper (do not touch the place of puncture is placed on a filter paper (do not touch the wound ). Each time a trace of blood is seen on the paper . As wound ). Each time a trace of blood is seen on the paper . As soon as the trace is no longer observable, bleeding has soon as the trace is no longer observable, bleeding has stopped. Duration of capillary bleeding is the parameter of stopped. Duration of capillary bleeding is the parameter of DukeDuke

The normal duration of bleeding according to Duke equals The normal duration of bleeding according to Duke equals to (2-4 min)to (2-4 min)

The answer is expressed in one figure.The answer is expressed in one figure.

Interpretation of analysis:Interpretation of analysis:

Increased capillary bleeding time according to Increased capillary bleeding time according to Duke is considered pathological, it usually Duke is considered pathological, it usually occurs due to the reduction in the number of occurs due to the reduction in the number of thrombocytes and in thrombocytopathy thrombocytes and in thrombocytopathy

Coagulative (secondary) hemostasis.Coagulative (secondary) hemostasis. There are 12 clotting factors: I – fibrinogen; II – There are 12 clotting factors: I – fibrinogen; II –

prothrombine; III – thromboplastin of tissue; IV – prothrombine; III – thromboplastin of tissue; IV – ions of calcium; V – proaccelerin; VII – proconvertin; ions of calcium; V – proaccelerin; VII – proconvertin; VIII – antihemophylic factor A; IX – Christmas VIII – antihemophylic factor A; IX – Christmas factor or antihemofilic factor B; X – Stuart-Prower factor or antihemofilic factor B; X – Stuart-Prower factor or prothrombinase; XI – plasma factor or prothrombinase; XI – plasma thromboplastin antecedent; XII – Hageman factor; thromboplastin antecedent; XII – Hageman factor; XIII – fibrin stabilizing factor. Some of them are XIII – fibrin stabilizing factor. Some of them are enzymes – II, VII, IX, X, XI, XII,XIII; otherenzymes – II, VII, IX, X, XI, XII,XIII; other are not – are not – I, III, IV, V, VIII. The vitamin K is necessary for the I, III, IV, V, VIII. The vitamin K is necessary for the functional activity of II, VII, IX, X factors.functional activity of II, VII, IX, X factors.

Clot retractionClot retraction

Remember retraction (latin retractio’ –reduction in Remember retraction (latin retractio’ –reduction in size) is the active reduction of blood clot or size) is the active reduction of blood clot or plasma,accompanied by the discharge of serumplasma,accompanied by the discharge of serum

Normal parameter –Normal parameter – (20-24 hours) . i.e this is the time during which (20-24 hours) . i.e this is the time during which

complete contraction of blood clot occurs while complete contraction of blood clot occurs while venous blood in a test tube is placed in thermostat at venous blood in a test tube is placed in thermostat at a temperature of 37a temperature of 37

Retraction index of blood clot: it is the relation of Retraction index of blood clot: it is the relation of the volume of serum (which was formed in the same the volume of serum (which was formed in the same method) to that of the clot.method) to that of the clot.

Normaly this index equals to (0.3-0.5)Normaly this index equals to (0.3-0.5)

CoagulogramCoagulogram

Time of clotting by Ly-Wait – 5-10 minutes; Time of clotting by Ly-Wait – 5-10 minutes; time of plasma recalcification – 60-120 time of plasma recalcification – 60-120 seconds; thrombotest – IV, V, VI degree; seconds; thrombotest – IV, V, VI degree; thromboplastin time – 12-15 seconds; thromboplastin time – 12-15 seconds; thromboplastin index – 80-105 %; thromboplastin index – 80-105 %; concentration of fibrinogen – 2-4 g/L; concentration of fibrinogen – 2-4 g/L; tolerance of plasma to heparin – 6-11 minutes; tolerance of plasma to heparin – 6-11 minutes; heparin time – 50-60 seconds; heparin time – 50-60 seconds;

fibrinolysis – 15-20 %.fibrinolysis – 15-20 %.

Anticoagulative mechanisms. Fibrinolysis.Anticoagulative mechanisms. Fibrinolysis. The primary anticoagulants are antithrombin III;

heparin. Alpha-2-macroglobulin is a similar to antithrombin-

heparin cofactor in that it combines with the proteolytic coagulation factors; Alpha-1-antitripsin; Protein C.

The secondary: products of fibrinolysis or products of products of fibrinolysis or products of fibrinogen degradation (antithrombin-I or fibrin)fibrinogen degradation (antithrombin-I or fibrin).

Primary anticoagulants are produce and present all Primary anticoagulants are produce and present all time in plasma and secondary anticoagulants form in time in plasma and secondary anticoagulants form in a case of blood clotting.a case of blood clotting.

Hepar-Hepar- splenomegaliasplenomegalia

DISEASES OF BLOOD AND DISEASES OF BLOOD AND HEMOPOESIS SYSTEM HEMOPOESIS SYSTEM

AnemiaAnemia Anemia (anaemia. From the Greek negative Anemia (anaemia. From the Greek negative

prefix an and haima-blood) is a condition for prefix an and haima-blood) is a condition for which the reduction of erythrocytes quantity which the reduction of erythrocytes quantity and hemoglobin content (separately or both and hemoglobin content (separately or both signs ) In the unit of blood volume is signs ) In the unit of blood volume is characteristic.characteristic.

The degree of anemia is usually The degree of anemia is usually specified depending on the amount specified depending on the amount

of hemoglobin:of hemoglobin:

I= m|ld - 110-90 g\lI= m|ld - 110-90 g\l II= moderate- -90-70 g\lII= moderate- -90-70 g\l III= severe -lass than 70 g\lIII= severe -lass than 70 g\l

Degree Erythrocytes Erythrocetes Degree Erythrocytes Erythrocetes MCHC Reticulocytes MCHC Reticulocytes

Anemia count (T\l) diameter(Um) Anemia count (T\l) diameter(Um) (%) (%)

I 3.5-3.0 6.8 I 3.5-3.0 6.8 0.8-0.7 10 0.8-0.7 10

II 3.0-2.5 6.7 II 3.0-2.5 6.7 0.7-0.6 18 0.7-0.6 18

III <2.5 6.1 III <2.5 6.1

Laboratory criteria of an anemia in Laboratory criteria of an anemia in neonatal period are the following :neonatal period are the following :

0-14 days -< 145 g\l0-14 days -< 145 g\l 15_28 days -<120 g\l 15_28 days -<120 g\l

The basic complaints and clinical The basic complaints and clinical attributes of iron deflciency anemia ;attributes of iron deflciency anemia ;

. Weakness , fast fatigue or irritability.. Weakness , fast fatigue or irritability. . Headache , dizziness, tinnitus (=ear noise)- are characteristic for significant . Headache , dizziness, tinnitus (=ear noise)- are characteristic for significant

anemia.anemia. . The decrease of visual acuity and disorders in the form of myiodesopsia.. The decrease of visual acuity and disorders in the form of myiodesopsia. . The decreas of appetite (sometimes to anorexia );the pervertion of taste (pica)- . The decreas of appetite (sometimes to anorexia );the pervertion of taste (pica)-

the the Child eats chalk, sand,clay,the ground, raw meat.Child eats chalk, sand,clay,the ground, raw meat. . A short breath and the increase of heart rate during physical over load.. A short breath and the increase of heart rate during physical over load. . Pallor ,the dryness of skin and mucous membranes.. Pallor ,the dryness of skin and mucous membranes. . The fragility of hair .. The fragility of hair . . Quite often: involuntary incontinence of urine during laughter, sneezing; the night . Quite often: involuntary incontinence of urine during laughter, sneezing; the night

enuresis ;dyspepsia.enuresis ;dyspepsia. . The delay of physical and psychological development (about 40%).. The delay of physical and psychological development (about 40%). . Heart auscultation-systolic murmur,tachycardia,the weakening of heart tones.just . Heart auscultation-systolic murmur,tachycardia,the weakening of heart tones.just

remember remember The murmur is of function character.The murmur is of function character. . The decrease of blood pressure.. The decrease of blood pressure.

. Hepatolienal syndrome in severe cases.. Hepatolienal syndrome in severe cases. . Subfebrile condition can be observed.. Subfebrile condition can be observed. The laboratory data-see :The laboratory data-see : .Reduction of erythrocytes quantity and hemoglobin contents..Reduction of erythrocytes quantity and hemoglobin contents. . Poikilocytosis.. Poikilocytosis. . Anisocytosis ,microcytosis.. Anisocytosis ,microcytosis. . Immature erythrocytes . Immature erythrocytes

(erythroblasts,normoblasts,megaloblasts)can be found.(erythroblasts,normoblasts,megaloblasts)can be found. . After some time reticulocytosis (I)can be observed – a . After some time reticulocytosis (I)can be observed – a

positive sign that points out to goodpositive sign that points out to good . The decrease in immunity –often inflammatory processes, ie, . The decrease in immunity –often inflammatory processes, ie,

anemia is an attribute of the aggravation of pre-morbid anemia is an attribute of the aggravation of pre-morbid conditions.conditions.

B 12(folic) deficiency(=pernicious)anemia:B 12(folic) deficiency(=pernicious)anemia: . Exogenous deficiency of vitamin B12 \folic . Exogenous deficiency of vitamin B12 \folic

acid acid

HEMOLYTIC SYNDROMEHEMOLYTIC SYNDROME

Hemolysis (Greek lysis_destruction) Hemolysis (Greek lysis_destruction) (=erythrocysis)in the process of destruction of (=erythrocysis)in the process of destruction of erythrocytes after which hemoglobin releases from erythrocytes after which hemoglobin releases from them into plasma.them into plasma.

To the future researchers: there are scientific data To the future researchers: there are scientific data according to which the violation of the integrity of according to which the violation of the integrity of erythrocytes are not necessary ,and there can be only erythrocytes are not necessary ,and there can be only their functional change in the form of as a stretching their functional change in the form of as a stretching of the cell-membrane also and increasing of its of the cell-membrane also and increasing of its permeability.permeability.

hemolytic factors are:hemolytic factors are:

Hemolytic poisons and toxins:Hemolytic poisons and toxins: . snakes .. snakes . .worms..worms. .Insects-bese, scorpions..Insects-bese, scorpions. . Salts of arsenic ,derivatives of benzene.. Salts of arsenic ,derivatives of benzene. . Many bacterial forms can produce hemotoxin.. Many bacterial forms can produce hemotoxin. . Recently it is established that in ecologically . Recently it is established that in ecologically

adverse territories.adverse territories.

ССandidosisandidosis

Red blood celsRed blood cels

Clinical laboratory analysisClinical laboratory analysis

ophthalmoscopyophthalmoscopy

HemartrosisHemartrosis

Prepare child for laboratory testsPrepare child for laboratory tests

Explain to older children need for repeated venipunctures or Explain to older children need for repeated venipunctures or fingersticks for blood analysis, particularly why a sequence of fingersticks for blood analysis, particularly why a sequence of tests is required tests is required

Allow children to play with laboratory equipment and/or Allow children to play with laboratory equipment and/or participate with test Older children may enjoy looking at participate with test Older children may enjoy looking at blood smears under a microscope or at pictures of blood cellsblood smears under a microscope or at pictures of blood cells

Observe for signs of shock and hypoxia from repeated blood Observe for signs of shock and hypoxia from repeated blood samples samples

Explain to parents reason for replacing withdrawn blood and Explain to parents reason for replacing withdrawn blood and necessity of performing tests.necessity of performing tests.

Hemolytic anemiasHemolytic anemias JJoundance, fever ,enlargement of liver and oundance, fever ,enlargement of liver and

spleenspleen

SICKLE CELL ANEMIASICKLE CELL ANEMIA

Sickle cell anemia is part of a group of Sickle cell anemia is part of a group of diseases called erozygous form of the diseases called erozygous form of the disease (HbA and HbS or disease (HbA and HbS or hemoglobinopathieshemoglobinopathies))

Hepar-Hepar- SplenoSpleno megalymegaly

Leukemia" is a broad term given to a group of Leukemia" is a broad term given to a group of malignant diseases of the bone marrow and malignant diseases of the bone marrow and lymphatic systemlymphatic system

Acute leucosisAcute leucosis

Morphology and cytochemical markersMorphology and cytochemical markers

.. Leukemia is classified according to its predominant Leukemia is classified according to its predominant cell type and level of maturity, as described by the cell type and level of maturity, as described by the following:following:

LymphoLympho—for leukemias involving the lymphoid or —for leukemias involving the lymphoid or lym phatic systemlym phatic system

MyeloMyelo—for those of myeloid (bone marrow) origin—for those of myeloid (bone marrow) origin Blastic and acuteBlastic and acute—for those involving immature —for those involving immature

cellscells Cytic and chronicCytic and chronic—for those involving mature cells —for those involving mature cells

Blood groupsBlood groups

Most of the volume of normal human blood is composed of:Most of the volume of normal human blood is composed of: A. red cells A. red cells B. hemoglobin B. hemoglobin C. plasma C. plasma D. white cells D. white cells E. serumE. serum What is the main hematological feature of acute leukemia? What is the main hematological feature of acute leukemia?

A. WBC count increaseA. WBC count increase B. The absolute increase of monocytes B. The absolute increase of monocytes C. Proliferation of erythroblasts C. Proliferation of erythroblasts D. The relative decrease in white blood cells D. The relative decrease in white blood cells E. Proliferation of blast cells E. Proliferation of blast cells

What is the cause of late anemia in premature newborns? What is the cause of late anemia in premature newborns? A. Deficiency of vitamin D A. Deficiency of vitamin D B. Calcium Deficiency B. Calcium Deficiency C. Erythroplastine DeficiencyC. Erythroplastine Deficiency D. Zinc deficiency D. Zinc deficiency E. Iron deficiency E. Iron deficiency

Answer:1-c,2-e,3-eAnswer:1-c,2-e,3-e

Thank you!Thank you!