Hematologic System

I. Blood

Description: specialized organ that differs from other organs in that it exists in a fluid state

Composition:

• Plasma- fluid portion of blood which contains various proteins (albumin, globulin, fibrinogen
and other factors necessary for clotting) as well as electrolytes, waste products and nutrients

• Various types of cell- White blood cell (leukocyte), Red blood cell (erythrocyte) and platelet
(thrombocyte)

Sites of production –where blood is produced

1. Bone marrow

Description: site of hematopoiesis or blood formation

Composition:

• Red marrow- islands of cellular components

• Yellow marrow- fats

Location: skeletal system (bone)

2. Stem cell

Description: primitive cell which produces specific types of blood cells

Differentiates into:

• Lymphoid stem cells- produces either T or B lymphocytes

• Myeloid stem cells- differentiates into three broad cell types: erythrocyte, leukocyte and
platelet

3. Spleen – major source of hematopoiesis in fetal life

RES (Reticulo Endothelial System)

Description: complex system of cells, throughout the body capable of phagocytosis

Composition: special tissue macrophages which are derived from monocyte

Location: SPLEEN- site of activity for most MACROPHAGES

II. Types of Blood

1. Erythrocyte (RBC)- biconcave disk that resembles a soft ball compressed between 2 fingers
with a diameter of 8µm; consists of hemoglobin which contains iron

Function: transport oxygen and carbon dioxide

Physiology of production:

Pluripotential Stem Cell

Myeloid stem cell

BFU-E

CFU-E

Reticulocyte

Red blood cell (erythrocyte)

Normal values:
Male- 4.2-5.6 M/µL
Female- 3.8-5.1 M/µL
Child- 3.5-5.0 M/µL
2. Leukocyte (WBC)- protects the body against infection and tissue injury
Two general categories:

A. GRANULOCYTES- defined by the presence of granules in the cytoplasm of the cell

Three main subgroups:

a) Eosinophil- have bright-red granules

Function:involved in allergic reaction; digest foreign protein

b) Basophil- have deep blue granules

Function: contains histamine; integral part of hypersensitivity reactions

c) Neutrophil- with granules that stain a pink to violet hue

Function: prevents or limits bacterial infection via phagocytosis

B. AGRANULOCYTES

a) Monocyte- a single-lobed nucleus; largest leukocyte;

Function: highly phagocytic, esp. against fungus; immune surveillance

b) Lymphocyte- integral component of immune system

  T lymphocyte- responsible for cell-mediated immunity; recognizes
material as “foreign”

 B lymphocyte- responsible for humoral immunity; many mature into

plasma cells to form antibodies

 Plasma cell- secretes immunoglobulin; most mature form of B

lymphocyte.

Normal Values:
WBC
Male- 3.8-11.0 K/mmᵌ
Female- 3.8-11.0 K/ mmᵌ
Child- 5.0-10.0 K/ mmᵌ
Differential count
Neutrophil- 50-81%
Lymphocyte- 14-44%
Monocyte- 2-6%
Eosinophil- 1-5%
Basophil- 0-1%
3. Thrombocyte (platelet)- plays an essential role in the control of bleeding.

Physiology of production

Pluripotential stem cell

 Myeloid stem cell

CFU-Meg

Megakaryocyte

Proplatelets

Platelets

Normal Value: 150,000-400,000/ml

III. Assessment of client with hematologic disorder

Normal values (Hematology)

RBC
Male- 4.2-5.6 M/µL
Female- 3.8-5.1 M/µL
Child- 3.5-5.0 M/µL
Hemoglobin
Male- 14-18g/dL
Female-11-16g/dL
Child- 10-14g/dL
Newborn-15-25g/dL
Hematocrit
Male- 39-54%
Female- 34-47%
Child- 10-14%
MCV- 78-98 fL
MCH- 27-35 pg
MCHC- 31-37%
WBC
Male- 3.8-11.0 K/mmᵌ
Female- 3.8-11.0 K/ mmᵌ
Child- 5.0-10.0 K/ mmᵌ
Differential count
Neutrophil- 50-81%
Lymphocyte- 14-44%
Monocyte- 2-6%
Eosinophil- 1-5%
Basophil- 0-1%
Platelet- 150,000-400,000/ml
 Physical Assessment

Assess for:

With decreased RBC production:

-pallor

-tachycardia

-fatigue (frequent resting)

-muscle weakness

-systolic heart murmur

-frontal bossing

Increased RBC destruction

-jaundice

-dark urine

-spleenomegaly

-hepatomegaly

-decreased BP

-icteric sclera

Increased RBC loss

-pallor

-fatigue

-muscle weakness

-decreased peripheral pulse

-cool skin

-tachycardia

Diagnostic Tests

• CBC (complete blood count)- identifies the total number of blood cells as well as hemoglobin,
hematocrit (percentage of blood volume consisting of RBC), and RBC indices

• Peripheral blood smear

• Bone marrow aspiration and biopsy

- needed to assess how a person’s blood cells are being formed and to assess the
quantity and quality of each type of cell produced w/in the marrow

- also used to document infection or tumor within the marrow