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
Components of BloodComponents of Blood
Red blood cell production Erythropoiesis
Erythropoietin Hemolysis Sequestration Laboratory analysis
of red blood cells Red blood cell count Hematocrit Hemoglobin
Components of BloodComponents of Blood
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 Products and Blood Blood Products and Blood TypingTyping
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
Blood Products and Blood Blood Products and Blood TypingTyping
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
Blood Products and Blood Blood Products and Blood TypingTyping
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.
Diseases of ErythrocytesDiseases of Erythrocytes
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).
Diseases of ErythrocytesDiseases of Erythrocytes
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.
Diseases of ErythrocytesDiseases of Erythrocytes
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
Diseases of LeukocytesDiseases of Leukocytes
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.
Diseases of LeukocytesDiseases of Leukocytes
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.
Clotting DisordersClotting Disorders
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.
Clotting DisordersClotting Disorders
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.
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