Hematology: Mohamad H Qari, MD, FRCPA
Hematology: Mohamad H Qari, MD, FRCPA
Blood Typing
Clotting disorders
Hematology
Spleen
Spleen
Blood
Blood Kidneys
Kidneys
Hematopoietic
Hematopoietic
System
System
Bone
Bone Liver
Liver
Marrow
Marrow
Hematopoeisis
Three developmental periods
Mesoblastic
Blood islands of yolk sac
Primarily RBC production
Embryonic hemoglobin produced
Hepatic
At 6 weeks cell production in liver
Fetal hemoglobin produced
Spleen, thymus, lymph nodes also active prod.
Myeloid
At 5th month Bone Marrow becomes site of prod.
Liver & spleen now Extramedullary
Hemoglobin A (22)
Requirements For
Hematopoiesis
Stem Cells
Growth Factors
Microenviroment
Stem Cell theory
Pluripotent stem cell originator of all cells
Gives rise to cells committed to specific
development
Research supporting the theory
PHSC has self-maintaining ability
Committed cells differentiate continuously/ No
Reverse Flow
Stem cells in Research
Pluripotent cells derived from:
Cell mass of embryos at blastocyst stage (IVF)
Fetal tissue from terminated pregnancy
Application
Identification of factors of cellular decision-making
Development and testing of drugs
Generation of cells and tissue for therapy
Cytokines & Growth Factors
Cytokines stimulate or inhibit
Prevent apoptosis
Colony-Stimulating Factors produced by
many different cells
Interleukins numbered according to discovery
Components of Blood
Plasma Components
Plasma
Transport mechanism Water
90%
90-92% water.
6-7% proteins
2-3%
Fats
Carbohydrates
(glucose)
Electrolytes
Gases (O2, CO2)
Chemical messengers
Other Protein
3% 7%
Cellular Components
Pluripotent Stem Cell
Unipotent Lymphocytes
Progenitors
WBC’s
Basophils
RBC’s
Eosinophils
Thrombocytes Erythrocytes
Neutrophils
Monocytes Platelet Erythropoietin
s
Components of Blood
Red Blood Cells
Erythrocyte
Hemoglobin – O2
bearing molecule
Comprised of 4
subunits:
• Globin (binds to
1 O2 molecule)
• Heme (iron)
100% saturation = 4
globin subunits
carrying O2
• Each gram of Cellsalive.com
hemoglobin =
1.34 ml O2
Blood Products and Blood Typing
Blood Types
Antigens
A, B, AB, O
Rh factor
Rh+ = ~85%
Rh- = ~15%
Blood transfusion
Components of Blood
Red Blood Cells
(cont.)
Oxygen Transport
Oxy-hemoglobin
dissociation curve
2,3-DPG
Components of Blood
White Blood Cells (Leukocytes)
Margination
Phagocytosis
Cellsalive.com
Components of Blood
Hemostasis-
3 mechanisms
Vascular spasm
Contraction of
tunica media
Platelet plug
Platelet aggregation
Coagulation
Formation of fibrin
clot
Components of Blood
Hemostasis (cont.)
Fibrinolysis
Lysis of clot (plasmin)
Thrombosis
Thrombolytics
Medications affecting clot formation
Alter the enzyme
on the platelet.
Affect the coagulation cascade.
Enhance clotting.
Coagulation Cascade -
Synopsis
This scanning electron micrograph shows the fine structure of
a blood clot. Platelets released from the circulation and
exposed to the air use fibrinogen from the blood plasma to
spin a mesh of fibrin.
General Assessment -
Management
Focused History and
Physical Exam
SAMPLE history
Hematological
disorders are rarely
the chief complaint.
Physical exam
Evaluate nervous
system function.
Skin signs
General Assessment - Management
Physical Exam (cont.)
Lymphatic signs
Gastrointestinal signs
Epistaxis
Atraumatic bleeding gums
Thrush
Atraumatic splenic/hepatic pain
Musculoskeletal signs
Arthralgia (rheumatoid arthritis)
Hemarthrosis
Cardiorespiratory signs
Tachycardia, cx pn, dyspnea - CHF
Genitourinary signs
Hematuria
Menorrhagia
Infection
Blood Products and Blood Typing
Management
Follow general treatment guidelines.
Utilize isolation techniques to limit risk of infection.
Diseases of Leukocytes
Lymphomas
Cancers of the lymphatic system
Hodgkin's
Non-Hodgkins
Presentation
Swelling of the lymph nodes
Fever, night sweats, anorexia, weight loss, fatigue, and
pruritis
Management
Follow general treatment guidelines.
Utilize isolation techniques to limit risk of infection.
Clotting Disorders
Thrombocytosis and Thrombocytopenia
Thrombocytosis
An abnormal increase in the number of platelets
Thrombocytopenia
An abnormal decrease in the number of platelets
Sequestration
Destruction (ITP)
Decreased production
Management
Provide supportive care and follow general treatment
guidelines.
Clotting Disorders
Hemophilia
Deficiency or absence of a blood clotting factor
Deficiency of factor VIII causes hemophilia A.
Deficiency of factor IX causes hemophilia B.
Deficiency is a sex-linked, inherited disorder.
Defective gene is carried on the X chromosome.
Signs & Symptoms
Numerous bruises, deep muscle bleeding, and joint
bleeding.
Clotting Disorders
Hemophilia (cont.)
Management
Treat the patient similarly to others.
Administer supplemental oxygen.
Establish IV access.
Be alert for recurrent or prolonged bleeding, and prevent
additional trauma.
Von Willebrand’s Disease
Deficient component of factor VIII
Generally results in excessive bleeding.
Generally is not serious; provide supportive care.
Clotting Disorders
Disseminated Intravascular Coagulation
Components of Blood
Leukocytes (cont.)
Autoimmune disease
May be specific or general
Alterations in the immune process
Immunosuppression
HIV
Anti-rejection medication
Chemotherapy/Cancer
Fibrinolytics
Activate plasminogen to plasmin = fibrinolysis
Streptokinase
Anistreplase
Tissue Plasminogen Activator
Reteplase
Urokinase
Hemorrhage
Class I Class II Class III Class IV
Blood Loss (ml) Up to 750 750-1500 1500-2000 >2000
Blood Loss (% Up to 15% 15%-30% 30%-40% >40%
volume)
Pulse <100 >100 >120 >140
BP Normal Normal Decreased Decreased
Pulse Pressure Normal or Decreased Decreased Decreased
increased
Resp. Rate 14-20 20-30 30-40 >35
Urine Output (ml/hr) >30 20-30 5-15 Negligible
Mental Status Slightly Mildly Anxious, Confused,
anxious anxious confused lethargic
Fluid Replacement Crystalloid Crystalloid Crystalloid and Crystalloid and
(3:1) rule blood blood
Transfusion Reactions
Hemolytic Reaction
Signs & Symptoms
Facial flushing, hyperventilation, tachycardia, hives,
chest pain, wheezing, fever, chills, and cyanosis
Treatment
Stop transfusion, change all IV tubing, and initiate IV
therapy with normal saline or lactated Ringer’s.
Consider furosemide, dopamine, and diphenhydramine.
Transfusion Reactions
Febrile Non-hemolytic Reactions
Signs & Symptoms
Headache, fever, and chills
Treatment
Stop transfusion, change all IV tubing, and
initiate IV therapy with normal saline or lactated
Ringer’s.
Consider Diphenhydramine and an antipyretic.