Hematology

Hematology
Cellular Components Components of Blood
Red Blood Cells White Blood Cells Inflammatory process Coagulation

Hemorrhage Blood Typing Clotting disorders Transfusion Medicine

Hematopoiesis

Extramedullary hematopoiesis

Medullary hematopoiesis

Cellular Components

Bone Marro

Circulation

Blood component

Components of Blood
!lasma
Transport mechanism
"#$"%& ater' ($)& proteins %$*&
+ats Car,ohydrates -glucose. Electrolytes /ases -0%1 C0%. Chemical messengers
Other 3% Protein 7%

Plasma Components
Water 90%

Components of Blood
Red Blood Cells
Erythrocyte
Hemoglo,in 0% ,earing molecule
Comprised of 2 su,units3 4 /lo,in -,inds to 5 0% molecule. 4 Heme -iron. 5##& saturation 6 2 glo,in su,units carrying 0% 4 Each gram of hemoglo,in 6 5'*2 ml 0%

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Components of Blood
Red ,lood cell production
Erythropoiesis
Erythropoietin

Hemolysis 8e9uestration :a,oratory analysis of red ,lood cells

Red ,lood cell count Hematocrit Hemoglo,in

Components of Blood
!latelets -Throm,ocytes.
Mega;aryocytes
Throm,opoietin

Throm,ocytopenia Throm,ocytosis

+unctions of Blood
5' <istri,ution
$ $ $ $ $ $ $ <eli7er oxygen and nutrients to cells Remo7e meta,olic aste Transport hormones to targets Maintain ,ody temp distri,ute heat Maintain pH = fluid 7olume Restrict loss at in>ury -clotting. !re7ent infection -leu;ocytes.

5' Regulation

5' !rotection

Characteristics of Blood
5' pH )'2 %' Temperature *?C/100.4F 3. Total volume 4-6 Liters Estimate your own blood volume !" body wei#$t in %# & blood in Liters 1%# & '.'lb (wei#$t lb/'.') * 0.0! & blood in

Composition of Blood
+ractionation 6 !rocess of separating hole ,lood into plasma and formed elements Blood matrix 6 +lasma
, -.." (water / soluble 0roteins)

1 2lood 3ells 4ormed elements

1 Eryt$ro3ytes -4."5 trans0ort o*y#en 1 Leu%o3ytes 6 1"5 de4ense 1 +latelets 6 1"5 3ell 4ra#ments and 4or 3lottin#

!lasma
"#& ater @ dissol7ed solutes
Autrients1 gasses1 hormones1 astes1 ions1 proteins

!lasma !roteins --7" o4 total 0lasma)

, !.6#/100ml o4 0lasma , .* more 0roteins t$an interstitial 4luid , +roteins remain in 0lasma5 not absorbed by 3ells 4or nutrients

* Classes of !lasma !roteins

Bl,umins -(#&. /lo,ulins -*C&. +i,rinogen -2&.
Constitute )$"& of plasma * types of plasma proteins3 al,umins1 glo,ulins1 and fi,rinogen
Bl,umin accounts for (#$?#&
Creates colloid osmotic pressure that dra s H%0 from interstitial fluid into capillaries to maintain ,lood 7olume and pressure

/lo,ulins carry lipids

/amma glo,ulins are anti,odies

+i,rinogen ser7es as clotting factor

Con7erted to fi,rin 8erum is fluid left hen ,lood clots

!lasma !roteins
5' Bl,umins -(#& of plasma proteins.
$ $ !roduced ,y the li7er +unctions3
5' Bct as pH ,uffer for ,lood %' Contri,ute to osmotic pressure of ,lood $ Deep ater in ,lood 5' Transport fatty acids %' Transport Thyroid hormones *' Transport 8teroid hormones

!lasma !roteins
%' /lo,ulins -*C& of plasma proteins.
5' /amma glo,ulins E Bnti,odies E Immunoglo,ulins3
$ $ !roduced ,y plasma cells in the lymphatic system +unction to attac; foreign su,stances

%' Blpha and Beta glo,ulinsETransport glo,ulins3

$ $ !roduced ,y the li7er +unction to transport small or insolu,le compounds to pre7ent filtration loss ,y the ;idney

!lasma !roteins
*' Clotting +actors -2& plasma proteins.
$ $ $ $ !roduced ,y the li7er 55 total1 fi,rinogen most a,undant Bll function to promote or form a clot +i,rinogen produce long1 insolu,le strands of fi,rin

FF8erum 6 plasma -$. minus fi,rinogen

!lasma !roteins
2' 0ther -5& of plasma proteins.
$
$

+rom :i7er3
Meta,olic enGymes and anti,acterial proteins

$
$

+rom endocrine organs3

Hormones

F:i7er disease 6 leads to ,lood disorders ,Ec plasma proteins are produced ,y the li7er

Figure 191b

Trombosit (platelets)

!latelets -Throm,ocytes.
Cell fragments in7ol7ed in clotting +lattened discs1 no nucleus %$2Hm diameter1 5Hm thic; Constantly replace
"$5% days in circulation !hagocytosed ,y cells in spleen

*C#1###EHl ,lood 5E* of total platelets held in reser7e in spleen1 mo,iliGed for crisis

Karakteristik Trombosit Terdapat Dihasilkan bentuk umur inti Dalam pembuluh darah

Sumsum tulang Berbentuk bulat, bulat lonjong atau spindle, cakram 5-9 hari Tidak memiliki inti

!latelet Counts
5C#1### to C##1### per microliter Throm,ocytopenia3 I ?#1###EHl
a,normally lo platelet count Results in ,leeding

Throm,ocytosis3 J 5 millionEHl
a,normally high platelet count <ue to cancer or infection Results in a clotting ris;

* +unctions of !latelets
5' Transport clotting chemicals1 and release important clotting chemicals hen acti7ated %' Temporarily form patch -platelet plug. o7er damaged 7essel alls *' Bcti7ely contract ound after clot formation
$ Contain actin and myosin

!latelet !roduction
Blso called throm,ocytopoiesis3 occurs in ,one marro 5' Induced ,y throm,opoietin from ;idney and C8+ of leu;ocytes %' Mega;aryocyte in ,one marro ,rea;s off mem,rane enclosed cytoplasm to ,lood *' Each mega;aryocyte can produce K21### platelets

Mechanism that controls blood loss after injury, and the reaction sequence in blood clotting.

Hageman factor -LII.

L
inacti7e

acti7e

C:0T M

Hemostasis
The cessation of ,leeding3
7ascular phase platelet phase coagulation phase

The Nascular !hase

B cut triggers 7ascular spasm *#$minute contraction

Figure 1911a

* 8teps of the Nascular !hase

5' Endothelial cells contract3
expose ,asal lamina to ,loodstream

%' Endothelial cells release3

chemical factors3
B<!1 tissue factor1 and prostacyclin

*' Endothelial cell mem,ranes ,ecome Ostic;yP3

seal off ,lood flo

local hormones stimulate smooth muscle contraction and cell di7ision

The !latelet !hase

Begins ithin 5C seconds after in>ury

Figure 1911b

The !latelet !hase

!latelet adhesion -attachment.3
to stic;y endothelial surfaces to ,asal laminae to exposed collagen fi,ers

!latelet aggregation -stic; together.3 forms platelet plug closes small ,rea;s

Bcti7ated !latelets Release Clotting Compounds

Bdenosine diphosphate -B<!. Throm,oxane B% and serotonin Clotting factors !latelet$deri7ed gro th factor -!</+. Calcium ions

The Coagulation !hase

Begins *# seconds or more after the in>ury

Figure 1912a

The Coagulation !hase

Blood clotting -coagulation.3
In7ol7es a series of steps con7erts circulating fi,rinogen into insolu,le fi,rin

Blood Clot
+i,rin net or; Co7ers platelet plug Traps ,lood cells 8eals off area

The Common !ath ay

EnGymes acti7ate +actor L +orms enGyme prothrom,inase Con7erts prothrom,in to throm,in Throm,in con7erts fi,rinogen to fi,rin

+unctions of Throm,in
8timulates formation of tissue factor
forms positi7e feed,ac; loop accelerates clotting

!lasma Clotting +actors

Table 194

Clotting <isorders
Throm,ocytosis and Throm,ocytopenia
Throm,ocytosis
Bn a,normal increase in the num,er of platelets

Throm,ocytopenia
Bn a,normal decrease in the num,er of platelets
8e9uestration <estruction -IT!. <ecreased production

Management
!ro7ide supporti7e care and follo general treatment guidelines'

Clotting <isorders
Hemophilia
<eficiency or a,sence of a ,lood clotting factor
<eficiency of factor NIII causes hemophilia B' <eficiency of factor IL causes hemophilia B' <eficiency is a sex$lin;ed1 inherited disorder'
<efecti7e gene is carried on the L chromosome'

8igns = 8ymptoms
Aumerous ,ruises1 deep muscle ,leeding1 and >oint ,leeding'

Clotting <isorders
Hemophilia -cont'.
Management
Treat the patient similarly to others'
Bdminister supplemental oxygen' Esta,lish IN access'

Be alert for recurrent or prolonged ,leeding1 and pre7ent additional trauma'

Non Wille,randQs <isease

<eficient component of factor NIII
/enerally results in excessi7e ,leeding' /enerally is not seriousR pro7ide supporti7e care'

Clotting <isorders
<isseminated Intra7ascular Coagulation
8ystem acti7ation of coagulation cascade' Results from sepsis1 hypotension1 0B complications1 se7ere tissue or ,rain in>ury1 cancer1 and ma>or hemolytic reactions'

Multiple Myeloma
Cancerous disorder of plasma cells' !athologic fractures are common'

Blood type= AB !"h

History

PRINSIP PENGGOLONGAN DARAH

/olongan darah adalah ciri ;husus darah dari suatu indi7idu ;arena adanya per,edaan >enis ;ar,ohidrat dan protein pada permu;aan mem,ran sel darah merah /olongan darah manusia ditentu;an ,erdasar;an >enis antigen dan anti,odi yang ter;andung dalam darahnya'
BB0 Rhesus -fa;tor Rh.

History /0:0A/BA <BRBH

8ecara ;linis golongan darah dihu,ung;an dengan transfusi hanya * gol'darah R 5'/olongan darah BB0 %'/olongan darah Rhesus *'/olongan darah MA'

<asar penemuan golongan darah 3 5' Bdanya antigen yg terdapat pada permu;aan eritrosit %' Bdanya Gat anti -anti,odi. yg terdapat dalam plasmaEserum

Bntigen Bda 2## antigen diturun;an1 menurut Hu;um Mendel Bntigen yang terpenting pada transfusi darah Contoh 3 antigen B dan B pada sistem golongan darah BB0 antigen Rhesus pada +a;tor Rhesus dise,ut se,agai aglutinogen

Bnti,odi E Gat anti merupa;an protein yg dihasil;an oleh tu,uh1 ,ai; secara alamiah ataupun se,agai rea;si terhadap masu;nya antigen merupa;an protein yg mempunyai stru;tur mole;ul imunoglo,ulin Contoh 3 anti B1 anti B dan anti BB pada sistem BB0 dise,ut se,agai aglutinin Menurut cara pem,entu;annya 5' Sat anti alamiah -natural anti,odi. Terdapat dalam tu,uh secara alamiah tanpa adanya stimulus dari antigen asing yang masu; ;edalam tu,uh' Ter,entu; ,u;an ;arena rea;si imunologi;

 Biasanya merupa;an Ig M -anti,odi leng;ap. 8udah ada se>a; lahir contoh 3 anti B 1 anti B dan merupa;an Gat anti terpenting pada transfusi darah' %' Sat anti didapat 6 anti,odi imun -Bc9uired anti,odi. ter,entu; a;i,at masu;nya antigen asing ;e dalam tu,uh -setelah transfusi1 ;ehamilan. ,iasanya merupa;an Ig / -anti,odi ta; leng;ap. contoh 3 anti Rhesus -anti <. Menurut ;eadaan rea;si 5' Bnti,odi leng;ap Merupa;an anti,odi yang dpt mengaglutinasi;an sel dalam ling;ungan salin %' Bnti,odi ta; leng;ap Merupa;an anti,odi yang hanya dapat mengaglutinasi;an sel dalam ling;ungan tinggi protein -high protein.1 misalnya dengan u>i Com,s Bnti,odi ini ditemu;an pertama ;ali dalam sistem Rhesus misal ,ayi yang ,aru lahir mengalami OTaundiceP'

GOLONGAN DARAH ABO

!enemuan Darl :andsteiner tentang golongan darah BB0 R +a;tor yang terdapat di permu;aan eritrosit -antigen. R Gat yang menentu;an golongan darah manusia' +a;tor yang terdapat dalam plasma E serum -anti,odi. R Gat anti yang dapat menghancur;an antigan yg men>adi la annya' Macam$macam golongan darah ,erdasar;an hasil penelitian 3
A0 5 % * 2 C ( ) ? " 5# 55 8I8TEM /0:' <BRBH ABO MA8s ! Rhesus :utheran Dell :a is <uffy Didd Nel Wright BATI/EA B1 B1 0 M1 A1 8s !51 !% C1 <1 E1 c = e :u a1 :e , D1 ; :e a1 :e , +y a1 +y , T; d1 T; , <I Wr a THA !EA 5"## 5"%) 5"%) 5"2# 5"2C 5"2( 5"2( 5"C# 5"C5 5"C% 5"C* A0 5% 5* 52 5C 5( 5) 5? 5" 8I8TEM /0:' <BRBH <iego I Ut 8utter /er,ich Bu,erger :an Lg BATI/EA <i I1 i Ut a1 Ut , Ts a1 Ts , /e Bu a :an Lg a THA !EA 5"CC 5"C( 5"C( 5"C? 5"(# 5"(5 5"(5 5"(%

o Menurut Mandel pem,entu;an antigen dia asi oleh gen ma;a segala sifatnya a;an di aris;an' o /en B1 B1 0 merupa;an pasangan ;romosom yang dapat me aris;an ;epada ;eturunannya' o Misalnya R
Byah gol' darah B 1 genotifnya B0 dan I,u gol' darah B1 genotifnya B01 Demung;inan ana;nyaR
Byah I,u B 0 BB B0 B0 00 B 0

Byah gol' darah BB 1 genotifnya BB dan I,u gol' darah 01 genotifnya 001 Demung;inan ana;nyaR
Byah B B0 B0 B B0 B0

I,u 0 0

Byah gol' darah B 1 genotifnya1 B0 dan I,u gol' darah BB1 genotifnya 001 ;emung;inan ana;nya R
AYAH A iBU B B BB BB B0 B0 O

/olongan <arah Rhesus

o <itemu;an oleh R :ansdsteiner dan Weiner o Rhesus 6 Rh o Bntigen rhesus ini ,erasal dari ;era dinama;an Macaca rhesus ' o Dira$;ira ?C& ditemu;an orang ;ulit putih di Bmari;a 8eri;at ,ersifat Rh -neg. dan ;ulit hitam dinegara yang sama le,ih "5&' o !ersentase Rh @ -pos.J Rh negatif' o !ada transfusi darah penting di;enali fa;tor rhesus pada pasien dan donor' o Bntigen Rhesus ada C macam R
Bntigen Rh < C c E e Sat anti Rh Bnti < Bnti C Bnti c Bnti E Bnti e

B:00< TU!E8 B1 B1 BB1 0

There are % ;inds of antigens B and B If antigen B is present1 the ,lood type is B If antigen B is present1 the ,lood type is B Blood type BB1 has ,oth antigen B and B Blood type 01 has no antigens

BATIB0<IE8 BA< B:00< TU!E8

Bnti,odies found in plasma are B:WBU8 opposite the antigen on RBC +or example3
Blood type B has antigen B on the RBC so plasma ould ha7e anti,odies for antigen B Type BB ,lood ha7e no anti,odies Type 0 ,lood ha7e ,oth B and B anti,odies

Rh@ERh$
Rh@ means that have protein Rh$ means that lack protien The dominant gene is The recessi7e gene is !

Blood !roducts and Blood Typing

Compatibility Among ABO Blood Groups
Rea tion !ith serum o" Re ipient #onor Cells

82 2 8 9 $6 no reaction
@ 6 reaction

82 -

2 / / -

8 / / -

9 / / / -

Blood !roducts and Blood Typing

BradyR !aramedic Care !rinciples and !ractice

 <alam ;eadaan normal 1 serum atau plasma orang tida; mengandung anti Rh a;an tetapi orang dapat distimuler -dipacu. untu; mem,entu; anti,odi rhesus 1 yaitu dgn >alan R 5' Transfusi misal R >i;a seorang perempuan Rh neg ;arena sesuatu hal harus ditolong dengan trans fusi dan ;e,etulan darah yg diterimanya ,erasal dari donor Rh pos sehingga perem$ puan terse,ut distimuler untu; mem,entu; anti Rh' B;i,atnya serum darah perempuan yg semula ,ersih dari anti Rh1 se;arang mengandung anti Rh' :e,ih$le,ih >i;a transfusi dila;u;an le,ih dari se;ali1 ma;a ,anya; anti Rh a;an ,ertam ,ah' %' !er;a inan
Byah Rhesus -@.

I,u Rhesus -$. Bayi !ertama Rhesus -@. Bayi ;e dua dst Rhesus -@.
plasenta Eritrosit ,ayi masu; ;edalam 8ir;ulasi darah i,u ter,antu; Sat anti rhesus

I;terus E Eritro,lastosis fetalis E H<A Dematian Tanin dalam ;andungan

Tes Coom,s
Tes ini >uga di;enal tes anti glo,ulin E BH/ -anti$human glo,ulin. V!ada tahun 5"2C Coom,s1 Mourant dan Race menemu;an tes antiglo,uin Tes ini gunanya untu; untu; mendapat;an tes yang sensiti7e dalam mendete;si Rh anti,odi E mendete;si anti,odi ta; leng;ap atau ;omplemen pada permua;aan sel darah merah 1. %' *' 2' Hasil !ositif di indi;asi;an 3 Hemolytic Disease of the Newborn -H<A. Bnemia hemoliti; auto$imun Bnema hemoliti; imun ;arena o,at Rea;si hemoliti; pada transfusi darah'

Caranya ada % macam R 5' Tes Coom,s dire; -langsung. 3 ut; mendeta;si anti,odi ta; leng;ap pada permu;aan sel erit' 8el yg telah diliputi Sat anti ta; leng;ap

8erum Coom,s -serum antiglo,ulin.

Bglutinasi

%' Tes Coom,s indire; -ta; langsung. 3 ut; mencari anti,odi tida; leng;ap yang terdapat dalam serumEplasma' 8el darah merah golongan 0 Rhesus -@. @ Sat anti tida; leng;ap dalam serumEplasma 8el diliputi Gat anti td; leng;ap @ 8erum Coom,s -serum antiglo,ulin.

Bglutinasi

Transfusion Reactions continued

If ,lood types incompati,le1 recipientQs anti,odies agglutinate donorQs RBCs Type 0 is Ouni7ersal donorP ,ecause lac;s B and B antigens RecipientQs anti,odies onQt agglutinate donorQs Type 0 RBCs Type BB is Ouni7ersal recipientP ,ecause doesnQt ma;e anti$B or anti$B anti,odies WonQt agglutinate donorQs RBCs
13-19

8EM0/B BERMBA+BBT