FUNCTIONAL ANATOMY

AND PHYSIOLOGY
Blood flows throughout the body in the vascular system,
and consists of:
• red cells, which transport oxygen from the lungs to
the tissues
• white cells, which defend against infection
• platelets, which interact with blood vessels and
clotting factors to maintain vascular integrity and
prevent bleeding
• plasma, which contains proteins with many
functions, including antibodies and coagulation
factors.
In childhood, red marrow is progressively
replaced by fat (yellow marrow), so that, in
adults, normal haematopoiesis is restricted to
vertebrae, pelvis, sternum, ribs, clavicles, skull,
upper humeri and proximal femora. However,
red marrow can expand in response to
increased demands for blood cells.
 INVESTIGATION OF DISEASES OF THE BLOOD
The full blood count AND Blood film examination
 Bone marrow examination

In adults, bone marrow for examination is

usually obtained from the posterior iliac crest.
After a local anaesthetic, marrow can be sucked
out from the medullary space, stained and
examined under the microscope (bone marrow
aspirate). In addition, a core of bone maybe
removed (trephine biopsy), fixed and
decalcified before sections are cut for staining
 A bone marrow aspirate is used to assess the composition
and morphology of haematopoietic cells or abnormal
infiltrates. Further investigations may be performed, such as
cell surface marker analysis (immunophenotyping),
chromosome and molecular studies to assess malignant
disease, or marrow culture for suspected tuberculosis.
A trephine biopsy is superior for assessing marrow cellularity
marrow fibrosis, and infiltration by abnormal cells
such as metastatic carcinoma.
Investigation of coagulation / Bleeding disorders
 Clinical assessment
Investigations
Schemes for the investigation of
anaemias are often based on the size of
the red cells, which is most accurately
indicated by the MCV in the FBC.
Commonly, in the presence of anaemia:
• A normal MCV (normocytic anaemia)
suggests either acute blood loss or the
anaemia of chronic disease (ACD) .
• A low MCV (microcytic anaemia)
suggests iron deficiency or thalassaemia .
• A high MCV (macrocytic anaemia)
suggests vitamin B12 or folate deficiency
or myelodysplasia