Hematology

May, 2021

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 What is hematology?
• Haematology:
– Branch of medical sciences involved with the
study of blood, blood forming organs and
diseases of blood
– The study of blood diseases includes:
• etiology,
• diagnosis,
• treatment,
• prognosis,
• and prevention

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 Review of the Basics
• The human body is made up mostly of water
(~65% by weight)
– most (almost 2/3rd’s) is in our body cells
– about 30% in between cells (tissue spaces)
– only ~8% of that water is in the circulatory
system
• The body’s transport system plays key role in
balancing fluids in the body’s compartments
• Strictly speaking, blood is not a “body fluid” like
tears, mucous, or saliva or urine
– it is a living tissue consisting of cells within a liquid
‘matrix’
– the total blood volume varies due to conditions like
dehydration, hemorrhage etc.
• An average person has about 5 L of blood
– loss of 15-30% of blood leads to pallor and weakness
– loss of >30% results to severe shock, death
 Review of basics
• Blood leaves the heart in
arteries
• The arteries branch into arterioles and then into
tiny vessels-capillaries:
– Oxygen and nutrients diffuse out
– CO2 and wastes diffuse in
• Capillaries join venules-veins- going to the heart
• The blood leaves the right side of the heart for the
lungs to pick up O2 and release CO2
• Blood goes back to the left side of the heart to start
all over
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 Composition of blood
• Blood is a specialized connective tissue comprising of
plasma (~55%), and the formed elements (cells)
which are:
– The erythrocytes (RBCs) (~45%)
• Contain hemoglobin
• Function: transport of O2 and CO2
– The Leukocytes (WBCs) and platelets (thrombocytes) (~1%)
• Leukocytes are involved in the body’s defense against the invasion of
foreign antigens.
• Platelets are involved in hemostasis which forms a barrier to limit
blood loss at an injured site.
– The blood cells (formed elements) are suspended in plasma

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 Blood
• When blood is centrifuged (spunned) it separates
into: Plasma, RBCs (Hematocrit);
– In between plasma and RBCs is a buffy coat comprising of
leukocytes (white blood cells) and platelets
– Hematocrit/packed cell volume (PCV)
• % of blood volume consisting of erythrocytes (red blood cells)
• Male average 45; female average 40
– Plasma at top (55%, about 2.7–3.0 liters): fluid part of the
blood, straw coloured;
• Water: 92%,
• Plasma proteins and other trace amounts of other materials: 8%
• Plasma:
– Circulates dissolved nutrients, such as glucose, amino acids, and fatty
acids (dissolved in the blood or bound to plasma proteins), enzymes,
hormones
– Removes waste products, such as carbon dioxide, urea, and lactic acid.

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• The most solutes in plasma are proteins
• 3 types of important plasma proteins:
– Albumin: 55%-
– required for maintenance of colloid osmotic pressure
(oncotic pressure)
– Maintain viscosity
– Helps buffer blood
– transports many solutes by binding to them: e.g. drugs,
penicillin, pigments, fatty acids, bile salts
– Globulins: 38%- play an important role in immune function
(gamma globulins- immunoglobulins)
– Fibrinogen: required in blood coagulation
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• Serum: plasma that remains after removal of clotting
proteins (fibrinogen)
– Blood that is allowed to stand clots
• The fluid left is serum

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Electron microscopy of blood
cells

Stained blood
smear on a light
microscope

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 Hematopoiesis/hemopoiesis
• Process of formation of blood
cellular components
• Blood cells arise from pluripotent
hematopoietic stem cells residing
in the bone marrow
• Blood stem cells divide into:
– myeloid stem cells or
– lymphoid stem cells

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• As the cells divide they become “committed,”
that is, they can only become one kind of cell
(colony-forming units);
– In order to sustain themselves, some daughter
hematopoietic stem cells after proliferation
remain as hematopoietic stem cells without
differentiation
• Structural differentiation occurs to give rise to
the different blood cell types

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All except for
lymphocytes
arise from
myeloid stem
cells

All originate in
the bone
marrow

Not shown are

mast cells,
osteoclasts,
dendritic cells 17
Bone marrow structure and the microenvironment

• The marrow is located in the medullary cavity of bone,

– It is the sole site of effective hematopoiesis in humans
• Marrow types:
– Red marrow (active)- regresses after birth until late
adolescence, after which it is focused in the lower skull,
vertebrae, shoulder and pelvic girdles, ribs, and sternum
– Yellow marrow: found in bones of the hands, feet, legs, and
arms
• It is comprised of fat cells that replace hematopoietic cells
• Approximately 50 percent of the space of red marrow in
an adult is fat
 Bone marrow structure and the microenvironment

• Bone marrow barrier

– A barrier comprising of blood vessels of the bone
marrow that inhibits immature blood cells from
leaving the marrow.
– Only mature blood cells contain the membrane
proteins required to attach to and pass the blood
vessel endothelium
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 Complete Blood Count (CBC)
• CBC, probably one of the commonest
tests done, is a measure of how much
of each type of blood cells

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 Complete Blood Count (CBC)
• Hemoglobin:
– Male: 13.5-17.5 grams/dL
– Female: 12.0-15.5 grams/dL
• Hematocrit:
– Male: 38.8-50.0 %
– Female: 34.9-44.5 %
• RBC count:
– Male: 4.7 to 6.1 million cells/mcL
– Female: 4.2 to 5.4 million cells/mcL
• WBC: 3.5–11 x 109/L
– Differential if required can broken down to amount of each type of WBC
• Platelet count: 140–450 x 109/L
 Erythrocytes
• Also called red blood cells (RBCs)
• Biconcave discs and flexible
• Plasma membrane but no nuclei
or organelles
• Packed with hemoglobin
molecules
– Oxygen carrying protein
– 4 chains of amino acids, each with
iron which is binding site for oxygen;
CO2 also carried
• Young ones still containing
ribosomes are called reticulocytes
• Live for 100-120 days

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 Leukocytes/white blood cells (WBCs)
– Classified on basis of presence or absence of
granules (staining):
• Granulocytes : neutrophils, eosinophils and basophils
– Possess granules and lobed nuclei
• Agranulocytes: lymphocytes and monocytes

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• Leukocytes and the corresponding targets/functions:
– Neutrophil: bacteria, fungi
– Eosinophils:
• Larger parasites
• Modulation of anti-inflammatory responses
– Basophil:
• releases histamine for inflammatory responses
– Lymphocytes:
• B cells- release antibodies
• T cells-
– CD4+ (helper T cells) cells-activate and regulate T and B cells
– CD8+ cytotoxic T cells: kill virus-infected and tumor cells
• Natural killer cells- kill virus-infected and tumor cells
– Monocyte, macrophages
– Dendritic cells- antigen presenting cells
 Lymphocytes:

Involved in specific response to antigens (foreign proteins or

parts of cells)

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 T cells attack foreign cells directly

• Cytotoxic or CD8+

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 B cells
• Differentiate into plasma cells (antibody
secreting cells ) or memory B cells
• Antibodies flag cells for destruction by
macrophages

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 Platelets
(Thrombocytes)
• Small fragments
broken off from
megakaryocytes
• Required in forming
clots in damaged
vessels

*
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Clots
Platelet__________________

Platelet and several RBCs trapped

in a fibrin mesh

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 The lymphoid tissue
• The lymphoid tissues:
– Primary lymphoid organs: sites where lymphocytes develop from
progenitor cells into functional and mature lymphocytes. Includes the
marrow and thymus
• The marrow: the major primary site where all lymphocyte progenitor cells reside
and initially differentiate
• Thymus-the site where progenitor cells from the marrow differentiate into mature
thymus-derived (T) cells.
– secondary lymphoid organs: sites where lymphocytes interact with each
other and nonlymphoid cells to generate immune responses to antigens.
• Includes: the spleen, lymph nodes, and mucosa-associated lymphoid tissues
(MALT).
• The structural organization of these tissues is important in understanding immune
mechanisms- both specific and nonspecific defenses against invading pathogens.
 Haematological disorders
• Red blood cell disorders
• White blood cell disorders
• Coagulation/hemostasis disorders
 Approach to study
• Introduction:
– Definition of disorders and classification
– Epidemiology
– Review of relevant aspects of anatomy and physiology
• Pathophysiology
• Clinical presentation
• Investigations
• Differential diagnosis
• Management:
– Medical
– Nursing
• Prognosis