CH5 - Hematology & Hemostasis

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Define “Hematology”

Medicine branch studying the formed elements of blood (blood cells) and the blood-forming tissues.

Where does the term “Hematology” come from?

Greek words “haima” and “logos”

Define “Hemostasis”

Complex interaction between blood vessels, platelets and biochemical factors in the plasma that not only create clots that stop bleeding but also dissolve clots through fibrinolytic process as injured vessels are healed.

Define Blood

• Nutritive fluid that circulates through the body, carrying nutrients, oxygen, and waste to and from tissues.

• A suspension of RBCs (erythrocytes), WBCs (leukocytes), and platelets (thrombocytes).

What are the functions of blood?

• Respiration

• Excretion

• Nutrition

• Transportation (of hormones and other endocrines)

• Buffer

• Maintenance (of body temp and tissue alkalinity)

• Protection

Blood makes up how much total body weight?

6-8%

In normal adults, how much blood is present?

6 Liters

The normal pH range of blood is?

7.35 - 7.45

The thickness and viscosity of blood is due to?

Proteins and cells

Blood is fluid due to what element?

Heparin (anticoagulant)

Blood is color red because of?

Hemoglobin (Hb)

The fishy odor of blood is due to?

Iron

Blood has a salty-sweet taste due to?

Glucose and Sodium Chloride

What percentage of blood volume is plasma?

50-60

What percentage of Formed Elements and Liquid Elements is blood composed of?

45 & 55

What does plasma contain? (there is a lot)

• Water

• Proteins

• Carbohydrates

• Vitamins

• Hormones

• Enzymes

• Lipids

• Salt

• Minerals

• Electrolytes

• Non-protein nitrogen

What is the ratio of cellular elements? (White Blood Cells, Platelets, Red Blood Cells)

1 : 30 : 500

All blood cells originate from these, which replicate and differentiate.

Hematopoietic Stem Cells

The replacement of active marrow by adipocytes during development is called?

Retrogression

Plasma vs Serum. Which has anticoagulant?

Plasma. Serum has no anticoagulant.

Plasma vs Serum. Which can clot?

Serum. Plasma cannot clot.

Plasma vs Serum. Which has clotting factors still present?

Plasma. Serum used up all its clotting factors.

Plasma vs Serum. Which has Fibrin, and which has Fibrinogen?

Plasma has Fibrinogen / Serum has Fibrin.

What are Red Blood Cells (RBCs) also known as?

Erythrocytes

Red Blood Cells are _____________ in shape.

Biconcave

The central concave area of an RBC is ____ of the whole cell’s size.

1/3

The lifespan of an RBC is how many days?

120

The diameter of an RBC is how many microns?

7-9

In a Hemoglobin molecule, what is present?

• 4 x Polypeptide of Globin Chains

• 4 x Heme Groups

• 4 x Ferrous Iron atom

• 4 x Protoporphyrin IX

• 1 x 2,3 DPG

What are two disorders associated with Erythrocytes?

• Anemia

• Erythrocytosis

The characteristics of anemia are?

• Decreased production

• Abnormal maturation

• Increased destruction

• Blood loss

What are White Blood Cells (WBCs) also known as?

Leukocytes

How many types of Leukocytes are there?

5

What are PMN cells?

Poly-Morpho-Nuclear cells

What does PMN mean?

The nucleus has more than one lobe

Define Phagocytosis

Cell uses its plasma membrane to engulf and eliminate invader cells.

Which kinds of WBCs are PMN?

Neutrophils, Eosinophils, Basophils

Which kinds of WBCs are mononuclear?

Lymphocytes, Monocytes

Neutrophils have ________ granules.

Lavender

Neutrophils are the ___ most abundant WBC in circulation.

1st

Neutrophils make up ______% of circulating WBCs.

40-80

In what infections/diseases are Neutrophils increased?

Bacterial

Which WBCs are able to conduct phagocytosis?

Neutrophils, Monocytes, Eosinophils, Basophils

What are neutrophils to the immune system?

First responders

Lymphocytes are the ___ most abundant WBC in circulation.

2nd

Lymphocytes have ________ granules.

No visible

Lymphocytes make up ______% of circulating WBCs.

10-45

In what infections/diseases are Lymphocytes increased?

Viral

What are lymphocytes to the immune system?

Slow responders

What kind of immunity are lymphocytes part of?

Adaptive

What are the characteristics of Cytoplasm in lymphocytes?

Scanty, light to dark blue, lesser/insufficient

Which WBC is predominant in children <4 years of age?

Lymphocytes

What are the two types of Lymphocytes?

“B” cells and“T” cells

What is the job of “B” cells?

Antibody production

What is the job of “T” cells?

• Helps “B” cells secrete antibodies

• Helps macrophage recognize targets

• Activates natural killer/cytotoxic cells

Monocytes are the ____ WBCs in circulation.

Largest

Monocytes have ____________ cytoplasm.

Amorphous

In what infections/diseases are Monocytes increased?

Chronic or autoimmune

Monocytes have ________ granules.

No visible

Eosinophils have ________ granules.

Orange-red

In what infections/diseases are Eosinophils increased?

Allergic and parasitic

What are the characteristics of a Basophil?

• PMN. Two or three lobes.

• Rare. 0.01% of WBC population.

• Large, irregular sized, blue-black granules that can cover the nucleus

• Releases histamine, calming down allergic reactions.

• Slightly smaller than Neutrophil.

Basophils make up ______% of circulating WBCs.

0.01

Basophils have ________ granules.

Blue-black

Basophils are able to release this to calm allergic reactions.

Histamine

What are some disorders associated with Leukocytes?

Reaction: Leukocytosis, Leukopenia
Malignancy: Leukemia

What are platelets also known as?

Thrombocytes

The bodies of platelets are colored?

Blue/colorless

The granules of platelets are colored?

Red/purple

Platelets have this ability which can change their shape.

Polymorphous

Platelets are not true cells; they are fragments from this substance in bone marrow.

Megakaryocyte cytoplasm

The lifespan of platelets is how many days?

10

The main function of platelets is?

Thrombosis

In a Wright Stained PBS, there are _____ platelets per 100u field.

7-21

Define Thrombocytosis

Excess platelets

Define Thrombocytopenia

Low amount/lack of platelets

What is Hemostasis?

Blood clotting process. Includes tissue repair.

This hemostatic component involves tissues.

Extravascular

This hemostatic component involves blood vessels.

Vascular

This hemostatic component involves platelets and plasma proteins.

Intravascular

Define Coagulation

Process whereby upon vessel injury, plasma proteins, tissue factors and calcium interact on the surface of platelets to form a fibrin clot.

Define Fibrinolysis

Process where the temporary fibrin clot is systematically and gradually dissolved.

What does Hypocoagulable states refer to?

Bleeding.

What do Hypercoagulable states refer to?

Thrombosis (blood clot in a blood vessel)

What are the 4 phases of Hemostasis?

1. Vasoconstriction

2. Platelet Adhesion

3. Platelet Activation

4. Platelet Aggregation

What are the two possible specimens used in the Hematology lab?

Venous or Capillary blood

What are the common anticoagulants used in the Hematology lab?

• EthyleneDiamineTetraacetic Acid (EDTA) (Lavender top)

• 3.2% buffered sodium citrate (Blue top)

What is the most frequently ordered test in Hematology?

Complete Blood Count (CBC)

What does the CBC test include?

• RBC count

• Hemoglobin

• Hematocrit

• WBC count

• WBC Differential

  • all 5 WBC types

• RBC morphology

• Estimated platelet count

What is the normal values for platelet count?

140 - 440 × 10^9 / L

What are some coagulation tests?

• Prothrombin time

• Activated Partial Thromboplastin time

• Clotting time, Bleeding time

This gene mutation causes high RBC production.

Polycythemia vera

This gene mutation causes variation in normal color.

Anisochromia

This gene mutation causes different sizes of cells, down to their pallor.

Anisocytosis