BLOODBLOOD

PROF. RAFI AHMED GHORIPROF. RAFI AHMED GHORIPROFESSOR & CHAIRMANPROFESSOR & CHAIRMAN

DEPARTMENT OF MEDICINE DEPARTMENT OF MEDICINE LIAQUAT UNIVERSITY OF MEDICAL & HEALTH LIAQUAT UNIVERSITY OF MEDICAL & HEALTH

SCIENCE JAMSHOROSCIENCE JAMSHORO

BLOODBLOODINTRODUCTIONINTRODUCTION

BLOOD CONSISTS OF:BLOOD CONSISTS OF: Red Cells Red Cells White cellsWhite cells PlateletsPlatelets Plasma, in which above Plasma, in which above elements are suspended. elements are suspended.

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FORMATION OF BLOOD:FORMATION OF BLOOD: 22ndnd week week→blood islands in yolk sac.→blood islands in yolk sac. 33rdrd week→migrate to liver and spleen week→migrate to liver and spleen

chief sites of erythropoisis chief sites of erythropoisis 55thth month → bone marrow-MED. month → bone marrow-MED.

Haemopoisis. (erythropoisis).Haemopoisis. (erythropoisis). At birth→ marrow of nearly every At birth→ marrow of nearly every

bone.bone. At adult life→ confined to end of long At adult life→ confined to end of long

bones→axial skelaton, ribs and skull.bones→axial skelaton, ribs and skull.

BLOODBLOODFORMATION OF BLOOD:FORMATION OF BLOOD: Path. processesPath. processes→ extramedullary → extramedullary

haemopoisis in liver & spleen.haemopoisis in liver & spleen.

NB.NB.

All peripheral blood cells are derived All peripheral blood cells are derived from single stem cell (pleuripotent from single stem cell (pleuripotent steam cell),steam cell),

Stems cellsStems cells Self renerwal Self renerwal Diff. Into mature cellsDiff. Into mature cells

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NB.NB.Ist detectable CFU IS CFU-Ist detectable CFU IS CFU-S(colony forms unit spleen, S(colony forms unit spleen, which gives rise to CFU-GEMM which gives rise to CFU-GEMM (i.e. Granulocyte, Erythroid (i.e. Granulocyte, Erythroid cells, Monocytes, cells, Monocytes, Megakaryocytes). Megakaryocytes).

BLOODBLOODHaemopoietic growth factors:Haemopoietic growth factors: All factors are glycoproteinAll factors are glycoprotein Factors include:Factors include:

- Erythropoietin - Erythropoietin

- Colony Stimulating factors (CSF)- Colony Stimulating factors (CSF)

- Interleukins (IL) - Interleukins (IL)

Gene for most of them is 5 Gene for most of them is 5 chromosome. And many growth chromosome. And many growth factors are produced by recombinant factors are produced by recombinant DNA tech. e.g. GM-CSF after B.M. DNA tech. e.g. GM-CSF after B.M. transplantation to accelerate transplantation to accelerate neutrophil recovery.neutrophil recovery.

B. lymphocyte

N

proerythoblast

Pre B

Totipotent stem cell

Pluripotent myeloid stem cells

Pre I

Megak eryoblast

Blast cells

Myeloblast Promytocyte

MonoblastT. lymphocyte

Early normo

Int.NormoLat.Normo

Recti.

Rect

Red cell

Proliferative phaseMaturation phase

Released B. marrow

E M Plat B

Erythroiten used for anemia in CRF

BLOODBLOODANEMIA:ANEMIA: Defined as a state in which the blood Hb Defined as a state in which the blood Hb

level is below the normal range for the level is below the normal range for the patient’s age and sex.patient’s age and sex.

CLASSIFICATION OF ANEMIA:CLASSIFICATION OF ANEMIA: Blood lossBlood loss

- Acute - Acute

- Chronic inadequate production of - Chronic inadequate production of normal RBC by Bone Marrow normal RBC by Bone Marrow (hypoplasia, aplasia) (hypoplasia, aplasia)

- Excessive destruction of RBCS - Excessive destruction of RBCS (Haemolysis)(Haemolysis)

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MORPHOLOGICAL MORPHOLOGICAL CLASSIFICATIONCLASSIFICATION::

Normocytic (N.MCV)Normocytic (N.MCV)

Microcytic (Microcytic (↓↓MCV) MCV)

Macrocytic (Macrocytic (↑MCV) ↑MCV)

BLOODBLOOD CLASSIFICATION OF RED CELL CLASSIFICATION OF RED CELL

APPEARANCEAPPEARANCE

MICROCYTES (SMALL MICROCYTES (SMALL CELL)CELL) ↓↓MCV(>80f L)MCV(>80f L)

Iron Deficiency AnemiaIron Deficiency Anemia Fe content reducedFe content reduced Normal Fe. contentNormal Fe. content

-- Thallesemia-Thallesemia-Siderrobalstic anemiaSiderrobalstic anemia

BLOOD BLOOD CLASSIFICATION OF RED CELL CLASSIFICATION OF RED CELL

APPEARANCEAPPEARANCE

MACROCYTES (LARGE MACROCYTES (LARGE CELLS)CELLS) ↑↑MCV(>96fl)MCV(>96fl)

Megalobalastic Megalobalastic - B 12- B 12- Folate - Folate

NormoblasticNormoblastic- Liver D. Alcohol Haemlysis - Liver D. Alcohol Haemlysis

BLOODBLOOD CLASSIFICATION OF RED CELL CLASSIFICATION OF RED CELL

APPEARANCEAPPEARANCENORMAL CELLSNORMAL CELLS MCVMCV

NormoblastNormoblastAc blood lessAc blood lessAnemia of Ch.Anemia of Ch.Disease e.g.Disease e.g.InfectionInfectionR.F.R.F.C.T. Dis.C.T. Dis.Malig.Malig.Endo.Endo.

BLOODBLOOD CLASSIFICATION OF RED CELL CLASSIFICATION OF RED CELL

APPEARANCEAPPEARANCE

UNUSUAL CELLSUNUSUAL CELLS SpherocyteSpherocyte Sickle cellSickle cell SchistocytesSchistocytes Burr cellsBurr cells Howell jolly bodiesHowell jolly bodies Poikilocytes Poikilocytes Blister cellsBlister cells

BloodBloodSYMPTOMS & SIGNS OF SYMPTOMS & SIGNS OF

ANEMIAANEMIA

SYMPTOMS SYMPTOMS Lassitude Lassitude Fatigue Fatigue Breathlessness on exertionBreathlessness on exertion PalpitationPalpitation Throbbing in head & earsThrobbing in head & ears DizzinessDizziness Tinitus Tinitus

BLOODBLOODSYMPTOMS & SIGNS OF ANEMIASYMPTOMS & SIGNS OF ANEMIA

SYMPTOMSSYMPTOMS HeadacheHeadache Diminish of vision Diminish of vision Insomnia Insomnia Paraesthesia of finger & toes Paraesthesia of finger & toes AnginaAngina

BLOODBLOODSYMPTOMS & SIGNS OF ANEMIASYMPTOMS & SIGNS OF ANEMIA

SIGNSSIGNS Pallor ofPallor of

- Skin- Skin- Mucous membrane- Mucous membrane- Palm of hands - Palm of hands - Conjunctive - Conjunctive

Tachycardia Tachycardia Cardiac dilatationCardiac dilatation Systolic flow murmurs edema.Systolic flow murmurs edema.

BLOODBLOODAnemia due to inadequate Anemia due to inadequate production of Red cells:production of Red cells:

CAUSES:CAUSES: Deficiency of essential factors:Deficiency of essential factors:

- Iron, vit.12 - Iron, vit.12 Folate. Folate. Toxic factors:Toxic factors:

- Inflammatory disease, Hepatic or Renal - Inflammatory disease, Hepatic or Renal dis.,Dgs.dis.,Dgs.

Endocrine Diseases:Endocrine Diseases:

- Hypo or Hyperthyroidism, - Hypo or Hyperthyroidism, hypopittutism hypopittutism hypogonad:hypogonad:↓↓erythryroitin.erythryroitin.

BLOODBLOODAnemia due to inadequate Anemia due to inadequate production of Red cells:production of Red cells:CAUSES:CAUSES:

Invasion of Bone MarrowInvasion of Bone Marrow- Leukemia, sec. ca., fibrosis.- Leukemia, sec. ca., fibrosis.

Disorders of developing Red cells.Disorders of developing Red cells.- - Sideroblastic anemia, Sideroblastic anemia,

Neoplastic disorders of Neoplastic disorders of erythropoisic, other iodiopathic erythropoisic, other iodiopathic refactory anemia, heridatory refactory anemia, heridatory disorders of Hb. Synthesis disorders of Hb. Synthesis (Thallasemia)(Thallasemia)

Failure of stem cells.Failure of stem cells.- Hypoplastic & aplastic anemia.- Hypoplastic & aplastic anemia.

BLOODBLOODIRON DEFICIENCY IRON DEFICIENCY

ANEMIAANEMIA

CAUSES:CAUSES:

1.1. Poor intake Poor intake

2.2. Decreased absorptionDecreased absorption

3.3. ↑ ↑ demands demands

4.4. Blood loss Blood loss

BLOODBLOODIRON DEFICIENCY IRON DEFICIENCY

ANEMIAANEMIACLINICAL FEATURES:CLINICAL FEATURES: Symptomatology of iron deficeincy Symptomatology of iron deficeincy

is mainly that of anemia. However is mainly that of anemia. However there are charachteristic features, there are charachteristic features, these are mainly epitelial changes these are mainly epitelial changes produced by inadequate iron in the produced by inadequate iron in the cells.cells.-- Brittle nailsBrittle nails-- Spoon-shaped nails (koilonychias) Spoon-shaped nails (koilonychias) -- Atrophy of the papillae of the Atrophy of the papillae of the tongue.tongue.

BLOODBLOODIRON DEFICIENCY IRON DEFICIENCY

ANEMIAANEMIACLINICAL FEATURES:CLINICAL FEATURES:

Angular stomatitis Angular stomatitis Brittle hairsBrittle hairs A syndrome of dysphagia and A syndrome of dysphagia and glossitis (Plummer-Vinson ro glossitis (Plummer-Vinson ro Peter-Brown-Kelly syndrome).Peter-Brown-Kelly syndrome).

Rarely in severe deficiency Rarely in severe deficiency parotid enlargement, parotid enlargement, spleenomegaly and failure to spleenomegaly and failure to grow.grow.

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GOOD CLINICAL HISTORYGOOD CLINICAL HISTORY Dietary intakeDietary intake Self Medication –NSAIDS.Self Medication –NSAIDS. Blood in faeces (Haemrrhoid Blood in faeces (Haemrrhoid

or ca. lower Bowl)or ca. lower Bowl) P/R examination.P/R examination.

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ORALORAL Fe sulphate 200 mg/100Fe sulphate 200 mg/100

PARENTERAL PARENTERAL Iron sorbital 1.5mgIron sorbital 1.5mg Per kg/body wt dailyPer kg/body wt daily l/m, never give. l/m, never give.