Introduction to hematology
- 2. Hematology Cellular Components Components of Blood Red Blood Cells White Blood Cells Inflammatory process Coagulation Hemorrhage Blood Typing Clotting disorders Transfusion Medicine www.freelivedoctor.com
- 3. Hematology www.freelivedoctor.com Spleen Kidneys Liver Bone Marrow Blood Hematopoietic System
- 4. Cellular Components WBC’s RBC’s Platelets www.freelivedoctor.com Pluripotent Stem Cell Myeloid Multipotent Stem Cells Common Lymphoid Stem Cells Unipotent Progenitors Basophils Eosinophils Neutrophils Monocytes Lymphocytes Erythrocytes Thrombocytes Erythropoietin
- 5. Components of Blood Plasma Transport mechanism 90-92% water. 6-7% proteins 2-3% Fats Carbohydrates (glucose) Electrolytes Gases (O 2 , CO 2 ) Chemical messengers www.freelivedoctor.com
- 6. Components of Blood Red Blood Cells Erythrocyte Hemoglobin – O 2 bearing molecule Comprised of 4 subunits: Globin (binds to 1 O 2 molecule) Heme (iron) 100% saturation = 4 globin subunits carrying O 2 Each gram of hemoglobin = 1.34 ml O 2 Cellsalive.com www.freelivedoctor.com
- 7. Components of Blood Red blood cell production Erythropoiesis Erythropoietin Hemolysis Sequestration Laboratory analysis of red blood cells Red blood cell count Hematocrit Hemoglobin www.freelivedoctor.com
- 8. Components of Blood Platelets (Thrombocytes) Megakaryocytes Thrombopoietin Thrombocytopenia Thrombocytosis www.freelivedoctor.com
- 9. Hemorrhage www.freelivedoctor.com Class I Class II Class III Class IV Blood Loss (ml) Up to 750 750-1500 1500-2000 >2000 Blood Loss (% volume) Up to 15% 15%-30% 30%-40% >40% Pulse <100 >100 >120 >140 BP Normal Normal Decreased Decreased Pulse Pressure Normal or increased Decreased Decreased Decreased Resp. Rate 14-20 20-30 30-40 >35 Urine Output (ml/hr) >30 20-30 5-15 Negligible Mental Status Slightly anxious Mildly anxious Anxious, confused Confused, lethargic Fluid Replacement (3:1) rule Crystalloid Crystalloid Crystalloid and blood Crystalloid and blood
- 10. Blood Products and Blood Typing Blood Types Antigens A, B, AB, O Rh factor Rh+ = ~85% Rh- = ~15% Blood transfusion www.freelivedoctor.com
- 11. Blood Products and Blood Typing www.freelivedoctor.com Blood Typing - ABO Blood type Antigen present on erythrocyte Antibody present in serum O AB B A None A and B B A Anti-A, Anti-B None Anti-A Anti-B
- 12. Blood Products and Blood Typing = no reaction + = reaction www.freelivedoctor.com Compatibility Among ABO Blood Groups Reaction with serum of Recipient Donor Cells AB B A O AB B A O - - - - + - + - + + - - + + + -
- 13. Blood Products and Blood Typing Brady; Paramedic Care Principles and Practice www.freelivedoctor.com
- 14. Diseases of Erythrocytes Anemias Anemia is a sign, not a separate disease process. Signs and symptoms may not be present until the body is stressed. Differentiate chronic anemia from acute episode. Treat signs and symptoms. Maximize oxygenation and limit blood loss. Establish IV therapy if indicated. www.freelivedoctor.com
- 15. Diseases of Erythrocytes Brady; Paramedic Care Principles and Practice www.freelivedoctor.com
- 16. Diseases of Erythrocytes Sickle Cell Disease Normal red cells maintain their shape as they pass through the capillaries and release oxygen to the peripheral tissues (upper panel). Hemoglobin polymers form in the sickle rell cells with oxygen release, causing them to deform. The deformed cells block the flow of cells and interrupt the delivery of oxygen to the tissues (lower panel). www.freelivedoctor.com
- 17. Diseases of Erythrocytes Sickle Cell Disease (cont.) Sickle cell crises Vaso-occlusive Musculoskeletal/abdominal pain Priapism Renal/cerebral infarctions Hematological Lowered hemoglobin Splenic sequestration Infectious Management Follow general treatment guidelines prn. Consider analgesics. www.freelivedoctor.com
- 18. Diseases of Erythrocytes Polycythemia Overproduction of erythrocytes. Occurs in patients > 50 years old or with secondary dehydration. Most deaths due to thrombosis Results in bleeding abnormalities: Epistaxis, spontaneous bruising, GI bleeding. Management: Follow general treatment guidelines. www.freelivedoctor.com
- 19. Diseases of Leukocytes Leukopenia/Neutropenia Too few white blood cells or neutrophils. Follow general treatment guidelines and provide supportive care. Leukocytosis An increase in the number of circulating white blood cells, often due to infection. Leukemoid reaction www.freelivedoctor.com
- 20. Diseases of Leukocytes Leukemia Cancer of hematopoietic cells Initial presentation Acutely ill, fatigued, febrile and weak, anemic. Thrombocytopenia Often have a secondary infection. Management Follow general treatment guidelines. Utilize isolation techniques to limit risk of infection. www.freelivedoctor.com
- 21. 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. www.freelivedoctor.com
- 22. 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. www.freelivedoctor.com
- 23. 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. www.freelivedoctor.com
- 24. 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. www.freelivedoctor.com
- 25. Clotting Disorders Disseminated Intravascular Coagulation System activation of coagulation cascade. Results from sepsis, hypotension, OB complications, severe tissue or brain injury, cancer, and major hemolytic reactions. Multiple Myeloma Cancerous disorder of plasma cells. Pathologic fractures are common. www.freelivedoctor.com