Heamat ology taza


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by dr.khlid hammasalih

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Heamat ology taza

  1. 1. HEAMATOlogy Erythropoiesis Site: 1 ST 8 WEEKS FROM 8 WEEK UP TO 6 MONTHS FROM 6 MONTHS AND ONWARDS IN YOLK SAC IN LIVER IN BONE MARROW  In infants & young children  red & white marrow are involved in hematopoiesis.  In adults  red marrow only. ------  Very important :-- Active bone marrow contain:Erythroid cells ………………...give RBCs Myeloid cells ………................give WBCs Megakaryocytic cells ……….. produce platlets Normally : myeloid erythroid ratio is 21 In erythroid hyperplasia ( eg. Heamolytic anemia ) this ratio become less than 2l1 . . Factors affecting erythropoiesis: 1- The factory healthy bone marrow 2- primitive material nutrional element 3- manager of factory 4- secrtary 5- workers Hemoglobin: erythropitin hormone other hormones healthy organs such as liver
  2. 2.  It represents about 1/3 of RBC mass.  It consists of a globin molecule attached to 4 heme groups.  In normal adults  there are 3 types of Hb: 1. Hb A  adult Hb. (97%). 2. Hb F  Fetal Hb. (0.5%). Its production decreases after birth. 3. hb A2  (2- 2.5%). 4. at 3-6 th months ther is switching from gama to beta chain hemoglobin so this is age of manifestation of thalassemia.  RBC life span  120 days.  RBC splits into: 1. Globin  which enters the protein metabolic pool. 2. Heme  is converted into bilirubin which is excreted by the liver Anemia Definition: It means decrease of hemoglobin concentration below t he normal level for age & sex.
  3. 3. Diagnosis: A- History: 1)presentation & duration 2)history of presenting illness 3)prenatal natal post natal history: Infant and mother's blood type History of exchange or intrauterine transfusion, and a history of anemia in the early neonatal period Gestational age at birth is important, as premature infants may have iron or vitamin E deficiencies resulting in anemia. The presence of jaundice or need for phototherapy may signify the presence of an inherited hemolytic anemia. 4)past medical history a-Hemorrhage (acute or chronic)  e.g. Anklystoma, Accidents & Menorrhagia. b-Jaundice & dark urine (Hemolytic anemia 5)past surgical history. 6)Drug history  Drugs can cause anemia through: - B.M. depression (chloramphenicol & sufa). - Hemolysis through: G6PD deficiency & autoimmune hemolysis (quinine). 7)nutritional history  Nutritional anemia 8) family history  Congenital anemia (e.g. thalassemia). B- Clinical picture: (general C/P of all types of anemia). Skin, mucosae – pallor, dryness, purpura Hands – koilonychias, palmar crease pallor Facies – skull bossing, maxillary hyperplasia Eyes – jaundice, pallor
  4. 4. Mouth – glossitis, cheilosis, ulcers Heart – tachycardia, functional murmurs, CCF Lungs – breathlessness Abdomen – hepatosplenomegaly PR – bleeding, occult blood Others – lymphadenopathy. C- Investigations: (Steps) (1) Is it a case of anemia or not? By a- Hb (15gm%). – In cases of anemia: b- RBCs count (4-6 million/mm3).  the 3 parameters. c- Hematocrit value (45%). (2) What is the type of anemia? 3types according to RBCs size & Hb content (blood indices). a. Microcytic hypochromic. b. Normocytic normochromic. C. Macrocytic. (3) What is the cause of anemia? i. Microcytic hypochromic anemia: a) Iron deficiency anemia (IDA). b) Thalassemia. c) Sideroblastic anemia ii. d) Chronic infection e) CRF. f) Lead poisoning. Normocytic normochromic anemia: (a) Hemolytic anemia (except Thalassemia). (c) Aplastic anemia (b) Hemorrhagic anemia iii. (d) Leukemia Macrocytic anemia: A) Anemia of newborn (excluded by age). B) Megaloblastic anemia. (4) Classification of normocytic normochromic anemia: Reticulocytic count
  5. 5. (Normal: 1-2% of RBCs count) High count low count Hemorrhagic leukemia hemolytic Aplastic Coombs test +ve -ve Immune Iso-immune auto immune non- immune congenital Acuired
  6. 6. Blood indices: 1) Mean Corpuscular volume (MCV): MCV =  MCV  Microcytosis (< 70 fl).  MCV  Macrocytosis (>100 fl). 2) Mean corpuscular hemoglobin (MCH):
  7. 7. MCH = (normal: 27- 32 picogram)  MCH  Hypochromic (< 27 picogram). 3) Mean corpuscular hemoglobin concentration (MCHC): (normal: 33- 37 gram%). N.B.: * Coombs' test: > A test for detection of antibodies against RBCs. > Either: 1. Direct  detects Abs on the surface of RBCs. 2. Indirect  detects Abs in plasma. * Reticulocytic count: > It is the single test to detect hemolytic anemia.