Hematology 🩸

what are the three physiologic principles of the hematologic system?

hematopoiesis

erythropoiesis

physiologic adaptations

when we say "cells" what do we refer to?

RBC, WBC, platelets

what is blood?

liquid connective tissue (heavier, thicker, and more viscous than water)

what is blood made of?

Blood = cells + plasma

how much plasma is there in the blood compared to cells?

55% plasma

45% cells

why is the blood made up of more plasma than it is cells?

because the plasma is what carries everything through the body like hormones

what can plasma also be called?

intravascular fluid (ECF)

Dehydration → ↓ECF → ___plasma

Overhydration →___ ECF → ___plasma

Hemorrhage → ___ECF → ↓ plasma

IV fluids →___ECF → ___plasma

Dehydration → ↓ECF → ↓plasma

Overhydration → ↑ ECF → ↑ plasma

Hemorrhage → ↓ ECF → ↓ plasma

IV fluids → ↑ ECF → ↑ plasma

what is plasma made of?

plasma = solutes + solvent (water)

what are the solutes found in plasma?

Gases (oxygen, carbon dioxide)

Regulatory substances (hormones, enzymes)

Nutrients (glucose, amino acids, fatty acids, glycerol)

Waste products

Electrolytes

Proteins (albumins, globulins, clotting factors, fibrinogen)

what are erythrocytes?

RBC

biconcave discs with flattened centers - no nucleus, few organelles, full of hemoglobin

what is the function of RBCs?

transport oxygen and carbon dioxide

what two groups can leukocytes be brother into?

granulocytes and agranulocytes

what are examples of granulocytes?

neutrophils, eosinophils, basophils (contain histamine)

what are examples of agranulocytes?

lymphocytes ( T cells, B cells, natural killer cells)

Monocytes (phagocytes and macrophages)

what is the main function of leukocytes?

immune response

protection against microbes

what is the main function of thrombocytes?

hemostasis (clotting so you dont bleed out)

what is the lifespan of a RBC?

120 days

when do RBCs carry oxygen vs carbon dioxide?

Carry O2 from lungs to body

Carry CO2 from body to lung

what is a deficiency of RBC called?

anemia

what is excess RBC called?

polycythemia

what is leukopenia vs leukocytosis?

leukopenia is too little WBC (neutropenia)

leukocytosis is too many

what is hematopoiesis?

the production of all cellular components of blood

occurs during embryonic development and throughout life

what are sites of hematopoiesis?

bone marrow and spleen

what is the lifespan of WBC and which WBC has the longest lifespan?

hours-years

monocytes have the longest

what is the lifespan of platelets?

9-12 days

what do all cells originate from?

one hematopoietic stem cell

where does the greatest bone marrow occur?

adults: vertebrae, sternum, ribs

children: long bones

RBC. WHC, and platelets all come from...?

the same stem cell

what does erythropoietin lead to the formation of?

reticulocytes and erythrocytes (RBCs)

↑ bone marrow activity → ___ precursor cells →___ red blood cells

↑ bone marrow activity → ↑ precursor cells → ↑ red blood cells

how will radiation affect RBC production?

Radiation → ↓ bone marrow activity → ↓ precursor cells → ↓ red blood cells

↑ EPO(erythropoiten) →___ bone marrow activity →___precursor cells → ___red blood cells

↑ EPO → ↑ bone marrow activity → ↑ precursor cells → ↑ red blood cells

how will CRF affect production of RBC? why does this happen?

CRF → ↓ EPO → ↓ bone marrow activity → ↓ precursor cells → ↓ red blood cells

EPO is made in kidneys, so if kidneys dont work, then no EPO

how will hemorrhage affect RBC production?

Hemorrhage → ↑ blood loss → ↓ blood cells → ↑ red blood cell production

how will hemolytic processes like sickle cell, thalassemia, and G6PD deficiency affect RBC production?

Hemolytic process → ↑ destruction → ↓ red blood cells

what are the functions of the hematologic system?

transportation, regulation, protection

what is the hematologic system responsible for transporting?

1. Oxygen (from lungs to L heart to cells)

2. Carbon dioxide (from cells to R heart to lungs)

3. Proteins (albumin, clotting factors)

4. Hormones (from endocrine glands to cells)

5. Waste products ( to the kidneys and liver)

6. Nutrients (from GI tract to cells)

7. Immunoglobulins

what is the hematologic system responsible for regulating?

1. H2O content

2. pH/acid base balance

3. Osmotic Pressure (albumin)

4. Temperature

what does the hematologic system protect against/with?

1. Clotting factors (to prevent excessive blood loss)

2. Antibodies (to fight infections)

what would be tested to see if a person was anemic, polycythemia, or neither?

levels of

hemoglobin

hematocrit

MCV

MCH

MCHC

what can anemia be due to?

↓ production or ↑ loss/destruction

what are the signs and symptoms of anemia?

fatigue, heart and pulmonary symptoms, pallor

what can polycythemia be due to?

↑ RBCs (absolute polycythemia) or ↓ plasma volume (relative polycythemia)

what are the signs and symptoms of polycythemia?

ruddy complexion, headache, dizziness, fatigue

what is the treatment for polycythemia?

phlebotomy

why do both anemia and polycythemia cause fatigue?

in anemia, you dont have enough RBC for sufficient energy, in polycythemia, flow is so heavy and slow so it tires you out

what does anemia cause?

reduced ability to deliver oxygen

how does the slow onset of anemia present?

tiredness, weakness, SOB, headaches, exercise intolerance, DOE

how does the rapid onset of anemia present?

confusion, syncope, LOC, increased thirst

anemia can be caused by either decreased production or increased loss of RBC. if it is by decreased production, what are the three possibilities?

↓Hb production

↓Nuclear maturation

↓Bone marrow activity

anemia can be caused by either decreased production or increased loss of RBC. if it is by increased loss, what are the two possibilities?

destruction of hemorrhage

what is the cause of microcytic anemia?

↓Hb production

what is the cause of macrocytic anemia?

↓nuclear maturation

what is the cause of normocytic anemia?

↓ bone marrow activity

↑ destruction

↑ loss

normocytic anemia can be cause by ↓ bone marrow activity , ↑ destruction , or ↑ loss. which will cause ↑reticulocyte count?

↑ destruction

↑ loss

what is the most common type of microcytic anemia?

iron deficiency anemia

what are the microcytic anemias?

"Its Time to Scan for Life Threatening Anemia"

Iron deficiency

Thalassemia

Sideroblastic

Lead Poisoning

Anemia of chronic disease (inflammation)

or L-Tics if you like that better :)

what is sideroblastic anemia?

anemia with very uniquely formed RBCs

who usually gets lead poisoning anemia?

kids

what are the macrocytic anemias?

(B12 and folate deficiencies)

Folic acid deficiency anemia

pernicious anemia

vitamin B12 deficiency anemia

what may folic acid deficiency anemia be caused by?

pregnancy, not eating greens, alcoholism

what are some causes of the macorcytic anemias?

alcoholism

liver disease

hypothyroidism

medications

where can normocytic anemias from ↓cell production originate from?

the kidney or the bone marrow

what are the normocytic anemias from ↓cell production?

MACA

Medication (that destroys bone marrow)

Aplastic Anemia

Chronic Kidney disease

Anemia of chronic disease

what is the most effective way of determining effective erythropoiesis?

reticulocyte count

what are the normocytic anemias caused by ↑cell destruction?

think hemolysis!!!

Sickle cell

Hereditary spherocytosis

Hemolytic process

Medications

what are the causes of loss that cause normocytic anemia?

acute loss: hemorrhage

hypersplenism (spleen is overactive so catches cells and destroys them)

what is the classic sign of iron deficiency anemia?

PICA - craving an eating non food items like ice, clay, paint chips, dirt or soil

what is pernicious anemia caused by? where?

INTRINSIC factor not allowing for absorption of vitamin B12

in gastric + small intestine

what can lead poisoning be caused by?

exposure to paint

what does alcoholism cause the deficiency of?

folate and B12

which anemias are inherited disorders?

Thalassemia, G6PD deficiency, Sickle cell

does thalassemia have a high reticulocyte count? why or why not?

yes, because cells are being destroyed prematurely, therefore more young cells are being produced to make up for them

does sickle cell have a higher or lower reticulocyte count?

higher because there is hemolysis so the bone marrow tries to compensate

does G6PD have high reticulocyte count?

yes because there is hemolysis early so the bone marrow compensates with reticulocytes