CLINICAL PATHOLOGY

Hematology
Drh. Ahmad Fauzi, M.Sc
 Introduction
• Hematology: the study of blood and blood
forming tissues.
• Blood consists of 55% plasma and 45%
formed elements.
• Formed elements include erythrocytes,
leukocytes, and thrombocytes.
• PLASMA – Alb, Glob, Fibrin
• BUFFYCOAT - Formed
elements include leukocytes,
and thrombocytes.
• HEMATOKRIT - Eritrosit
PLASMA
Components of Blood
• Plasma Plasma Components
• Transport mechanism
• 90-92% water. Water
• 6-7% proteins (Albumin, 90%
globulin, fibrinogen)
• 2-3%
• Fats
• Carbohydrates (glucose)
• Electrolytes
• Gases (O2, CO2)
• Chemical messengers
Other Protein
3% 7%
Serum adalah plasma darah yang telah diambil
fibrinogennya.
Fibrinogen adalah protein yang esensial dalam
dalam proses pembekuan darah.
CELLULAR
Hematology
Spleen

Blood Kidneys
Hematopoietic
System

Bone
Liver
Marrow
Cellular Components
Pluripotent Stem Cell

Myeloid Multipotent Common Lymphoid

Stem Cells Stem Cells

Unipotent Lymphocytes
Progenitors

WBC’s
Basophils
RBC’s
Eosinophils
Thrombocytes Erythrocytes
Neutrophils
Monocytes
Platelets Erythropoietin
ERITROSIT
Erythrocytes
• Biconcave shape.
• Diameter 7
microns.
• Cells for transport
of O2 and CO2.
• Life span 120 days.
Components of Blood
• Red Blood Cells
• Erythrocyte
• Hemoglobin – O2 bearing
molecule
• Comprised of 4
subunits:
• Globin (binds to 1
O2 molecule)
• Heme (iron)
• 100% saturation = 4
globin subunits carrying
O2
• Each gram of Cellsalive.com

hemoglobin = 1.34
ml O2
Components of Blood
• Red blood cell
production
• Erythropoiesis
• Erythropoietin
• Hemolysis
• Sequestration
• Laboratory analysis of
red blood cells
• Red blood cell count
• Hematocrit
• Hemoglobin
Diseases of Erythrocytes
• Anemia ( RBC, Hb & Hematokrit)
• Anemias
• Anemia is a sign, not a separate disease process.
• Signs and symptoms may not be present until the body is
stressed.
• Differentiate chronic anemia from acute episode.
• Treat signs and symptoms.
• Maximize oxygenation and limit blood loss.
• Establish IV therapy if indicated.
ABNORMALITAS MORFOLOGI
ABNORMALITAS
MORFOLOGI
Diseases of Erythrocytes

Brady; Paramedic Care Principles and Practice

Diseases of Erythrocytes
• Sickle Cell Disease
• Normal red cells maintain
their shape as they pass
through the capillaries and
release oxygen to the
peripheral tissues (upper
panel). Hemoglobin polymers
form in the sickle rell cells
with oxygen release, causing
them to deform. The
deformed cells block the flow
of cells and interrupt the
delivery of oxygen to the
tissues (lower panel).
 Diseases of Erythrocytes
• Sickle Cell Disease (cont.)
• Sickle cell crises
• Vaso-occlusive
• Musculoskeletal/abdominal pain
• Priapism
• Renal/cerebral infarctions
• Hematological
• Lowered hemoglobin
• Splenic sequestration
• Infectious
• Management
• Follow general treatment guidelines prn.
• Consider analgesics.
Diseases of Erythrocytes
• Polycythemia
• Overproduction of erythrocytes.
• secondary dehydration.
• Most deaths due to thrombosis
• Results in bleeding abnormalities:
• Epistaxis, spontaneous bruising, GI bleeding.
• Management:
• Follow general treatment guidelines.
Hematokrit (HCT)/ Packed cell
volume (PCV)
• Hematokrit Adalah persentase sel darah merah
tehadap volume darah total.
• Penurunan nilai Hct merupakan indikator anemia
(karena berbagai sebab), reaksi hemolitik,
leukemia, sirosis, kehilangan banyak darah dan
hipertiroid.
• Peningkatan nilai Hct dapat terjadi pada
eritrositosis, dehidrasi, kerusakan paru-paru kronik,
polisitemia dan syok.
Know Normal Ranges!!!
WBC PLT
RBC MPV
HGB SEGS
HCT LYMPHS
MCV MONOCYTES
MCH EOSINOPHILS
MCHC BASOPHILS
Mean Corpuscular Volume (MCV)
(Volume korpuskuler rata – rata)
• MCV adalah indeks untuk menentukan ukuran sel darah merah.
• MCV menunjukkan ukuran sel darah merah tunggal apakah sebagai
Normositik (ukuran normal)
Mikrositik (ukuran kecil < 80 fL), atau
Makrositik (ukuran kecil >100 fL).
• Penurunan nilai MCV terlihat pada pasien anemia kekurangan besi,
anemia pernisiosa dan talasemia, disebut juga anemia mikrositik.
• Peningkatan nilai MCV terlihat pada penyakit hati, alcoholism, terapi
antimetabolik, kekurangan folat/vitamin B12, dan terapi valproat,
disebut juga anemia makrositik
Mean Corpuscular Hemoglobin Concentration (MCHC)
(Konsentrasi Hemoglobin Korpuskuler rata – rata)

• Indeks MCHC mengukur konsentrasi Hb rata-rata

dalam sel darah merah; semakin kecil sel, semakin
tinggi konsentrasinya.
• Perhitungan MCHC tergantung pada Hb dan Hct.
• Penurunan MCHC (hipokromik) terjadi pada pasien
kekurangan besi, anemia mikrositik, anemia karena
piridoksin, talasemia
• Peningkatan MCHC (hiperkromik) terjadi pada
sferositosis, bukan anemia pernisiosa.
Classifications of Anemias
Microcytic, Hypochromic
• Iron deficiency
• Sideroblastic
• Chronic disease, Inflammation
• Lead poisoning
• Thalassemia trait
Microcytic, Hypochromic
• Many RBCs smaller
than
nucleus of normal
lymphocytes,
increased central
pallor.
• Iron deficiency,
thalassemias,
anemia of chronic
disease.
Classifications of Anemias
Normochromic
• Hereditary Spherocytosis
• Hereditary Elliptocytosis
• PNH
• G6PD deficiency
• Aplastic anemia
• Acute blood loss
Classifications of Anemias

Macrocytic
• Vitamin B12 deficiency
• Folate deficiency
• Liver disease
Macrocytic RBCs
• Most RBCs larger
than nucleus of
normal
lymphocytes,
increased MCV.
• Folate or Vitamin
B12 deficiencies,
alcoholism, and
liver disease.
 Reticulocytes
• Immature RBCs.
• Contain residual
ribosomal RNA.
• Reticulum stains
blue using a
supravital stain
(new methylene
blue).
• Counted and
expressed as % of
total red cells.
LEUKOSIT
Components of Blood
• Leukocytes (cont.)
• White Blood Cell Count
• Normal 5-9 k WBC’s
• Leukopoiesis
• Granulocytes
• Neutrophil
• Basophil
• Eosinophil
• Monocytes
• Lymphocytes
Myelocytic
Maturation Series
Myeloblast
Promyelocyte
Myelocyte
Metamyelocyte
Band Neutrophil
Segmented Neutrophil
Leukocytes
• Five types.
• Size 8-20 microns.
• Involved in fighting
infection,
combatting allergic
reactions, and
immune responses.
Components of Blood
• White Blood Cells (Leukocytes)
• Margination
• Phagocytosis

The macrophage is using its internal

cytoskeleton to envelop cells of the fungus
Candida albicans.
Components of Blood
• Leukocytes (cont.)
• Immunity
• Subpopulation of lymphocytes known as T cells and B cells
• T cells develop cellular immunity.
• B cells produce humoral immunity
Components of Blood
• Leukocytes (cont.)
• Autoimmune disease
• May be specific or general
• Alterations in the immune process
• Immunosuppression
• HIV
• Anti-rejection medication
• Chemotherapy/Cancer
Components of Blood
• Inflammatory Process
• MAST CELLS.
• Immunoglobulin E antibody
IgE,
• Antigens
• Antigens stick to the mast cell IgE
antibodies, causing granules in the
mast cell to fire their contents into
the surrounding tissue.
• This releases a host of inflammatory
materials - leukotrienes, tumor
necrosis factor, interleukin-4 and
other cytokines that turn on other
inflammatory cells.
• These materials cause fluid to leak
from the capillaries and white cells
including neutrophils, T cells and
eosinophils to leave the circulation.
The end result is a "local
inflammatory response", a red, itchy Cellsalive.com
welt.
Diseases of Leukocytes
• Leukopenia/Neutropenia
• Too few white blood cells or neutrophils.
• Follow general treatment guidelines and provide
supportive care.
• Leukocytosis
• An increase in the number of circulating white blood
cells, often due to infection.
• Leukemoid reaction
 Diseases of Leukocytes
• Leukemia
• Cancer of hematopoietic cells
• Initial presentation
• Acutely ill, fatigued, febrile and weak, anemic.
• Thrombocytopenia
• Often have a secondary infection.
• Management
• Follow general treatment guidelines.
• Utilize isolation techniques to limit risk of infection.
Diseases of Leukocytes
• Lymphomas
• Cancers of the lymphatic system
• Hodgkin's
• Non-Hodgkins
• Presentation
• Swelling of the lymph nodes
• Fever, night sweats, anorexia, weight loss, fatigue, and pruritis
• Management
• Follow general treatment guidelines.
• Utilize isolation techniques to limit risk of infection.
 Toxic Granulation
• Increased basophilic
granules
in neutrophils.
• Seen in severe
infections, burns,
malignancies, and
pregnancy.
• Distinguish from
basophils.
 Dohle Bodies
• Sky blue inclusions
in cytoplasm of
neutrophils.
• Seen in infections,
burns,
myleproliferative
disorders, and
pregnancy.
• Composed of RER
and glycogen
granules.
TROMBOSIT
Thrombocytes

• Smallest cells in
the blood.
• Active role in
coagulation and
hemostasis.
Components of Blood
• Platelets (Thrombocytes)
• Megakaryocytes
• Thrombopoietin
• Thrombocytopenia
• Thrombocytosis
 Components of Blood
• Hemostasis- 3
mechanisms
• Vascular spasm
• Contraction of tunica
media
• Platelet plug
• Platelet aggregation
• Coagulation
• Formation of fibrin clot
This scanning electron micrograph shows the fine structure of
a blood clot. Platelets released from the circulation and exposed
to the air use fibrinogen from the blood plasma to spin a mesh
of fibrin.
Components of Blood
• Hemostasis (cont.)
• Fibrinolysis
• Lysis of clot (plasmin)
• Thrombosis
• Thrombolytics
• Medications affecting clot formation
• Alter the enzyme
on the platelet.
• Affect the coagulation cascade.
• Enhance clotting.
Coagulation Cascade - Synopsis
Clotting Disorders
• Thrombocytosis and Thrombocytopenia
• Thrombocytosis
• An abnormal increase in the number of platelets
• Thrombocytopenia
• An abnormal decrease in the number of platelets
• Sequestration
• Destruction (ITP)
• Decreased production
• Management
• Provide supportive care and follow general treatment
guidelines.
Clotting Disorders
• Hemophilia
• Deficiency or absence of a blood clotting factor
• Deficiency of factor VIII causes hemophilia A.
• Deficiency of factor IX causes hemophilia B.
• Deficiency is a sex-linked, inherited disorder.
• Defective gene is carried on the X chromosome.
• Signs & Symptoms
• Numerous bruises, deep muscle bleeding, and joint bleeding.
Clotting Disorders
• Hemophilia (cont.)
• Management
• Treat the patient similarly to others.
• Administer supplemental oxygen.
• Establish IV access.
• Be alert for recurrent or prolonged bleeding, and prevent
additional trauma.
• Von Willebrand’s Disease
• Deficient component of factor VIII
• Generally results in excessive bleeding.
• Generally is not serious; provide supportive care.
Clotting Disorders
• Disseminated Intravascular Coagulation
• System activation of coagulation cascade.
• Results from sepsis, hypotension, OB complications,
severe tissue or brain injury, cancer, and major
hemolytic reactions.
• Multiple Myeloma
• Cancerous disorder of plasma cells.
• Pathologic fractures are common.
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