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General Aspects of Blood and Hemopoietic system

Lu, jizhou Department of Blood

Background knowleges
1. Blood system (1) The composition of blood system (2) The differentiation of blood cells 2. The types of blood diseases

General view of normal hematopoiesis
Hematopoietic stem cell s
mixed myeloid progenitor cells lymphoid progenitors

pronormoblast monoblast myeloblast megakaryoblast lymphoblast

erythrocytes

monocytes

granulocytes

platelets

lymphocyte

Properties of HSC
• •

High self-renew capacity Multiplotential precursor

Immunophenotype of HSC

The classfication of blood diseases
1. Erythrocyte diseases 2. Leukocyte diseases 3. Hemorrhagic diseases 4. Thrombotic diseases 5. Blood Transfusion reaction

Common Manifestations
• • • •

Anemia Hemorrhage Infections Others:You will meet anything in my department.

Lab Examinations
• • • •

Blood routine test Bone marrow test Phenotype test Chromosome test

Anemia
• • • • •

Definition Classifications Manifestations Diagnosis Therapy

Definition

The term anemia, as it generally is used in clinical medicine, below refers in to a the reduction normal

concentration of hemoglobin or red blood cells in the blood.

Important
Anemia is one kind of ‘syndrome’ rather than ‘disease’

Normal range of RBC,Hb,Ht

RBC Adults Male: 4.0~5.5×1012/L Female: 3.5~5.0×1012/L Infants 6.0~7.0×1012/L

Hb

Adults Male: 120~160g/L Female: 110~150g/L Infants 170~200g/L

Hematocrit 0.40~0.50L/L

WHO Criteria diagnosing anemia

According to the diagnostic criteria of anemia worked out by WHO, Hemoglobin concentration of 130g/L, 120g/L considered the lower limits of normal, at sea level, in adult men and women, 110g/L in 6 months old to 6 years old children, 120 g/L in 6 to 14 years old children, 110g/L in pregnant women.

Classification
(1) According to the progressive rate of anemia ①acute anemia ②chronic anemia (2) According to the morphologic characteristic of red cells, mainly according to MCV and MCHC .(morphologic classification) ① ② ③ macrocytic anemia normocytic anemia microcytic anemia

Classification
(3) According to the severity of anemia ①mild anemia ②moderate anemia ③severe anemia ④very severe anemia (4) According to the cellularity of BM ①Hyper-cellular anemia ②Hypo-cellular anemia

Classification
(5) According etiology of anemia . ① Impaired erythrocyte production ② More destruction of erythrocyte ③ Loss of blood

Classification
(1)According to the morphologic characteristic of cells, mainly according to MCV and MCHC .
① Macrocytic anemia MCV>100um3 Folic acid deficiency and VitaminB12 deficiency anemia. ②Normocytic anemia MCV=80~100um3 Aplastic anemia, the majority of hemolytic

red

anemia ,anemia with chronic disorders (such as chronic inflammation , infection, hepatic diseases, connective diseases. malignant tumors, etc.). ③Microcytic –hypochromic anemia MCV<80um3 MCHC<32% Iron-deficiency anemia , Sideroblastic anemia , thalassemia trait ,etc

Classification
(2) According to the etiology and pathogen of anemia . A. Impaired erythrocyte production

a. Insufficiency of hemopoietic materials Iron-deficiency anemia Megaloblastic anemia b. Failure of hemopoietic function Aplastic anemia Anemia with chronic disorders Sideroblastic anemia

Classification
B. More destruction of erythrocyte (Hemolytic anemia) a. Intrinsic-defect of erythrocyte Hereditary: Hereditary spherocytosis Enzyme –deficiency anemia Thalassemias Acquired: PNH(paroxysmal nocturnal hemoglobinuria) b. Extrinsic-defect of erythrocyte Immunohemolytic anemia Mechanical trauma: microangiopathic hemolytic anemia Hemolytic anemia result from physical, chemical or biological C. Loss of blood.

Manifestations
The clinical manifestations of anemia depend on 3 factors: a. The magnitude and rate of reduction in the oxygen-carrying capacity of the RBCs. b.The capacity of the cardiovascular and pulmonary systems to compensate for the anemia. c.The associated manifestations of the underlying disorders that resulted in the development of anemia.

Manifestations
The symptoms, signs of anemia can involve all of the systems, as follows:
A. Weakness. B. Skin. Pallor can be the most evident sign of anemia,
but many factors can affect the skin color.

Manifestations
C. Cardiorespiratory system.
a. In many patients, respiratory and circulatory symptoms are noticeable only after exertion or excitement, however, when anemia is sufficiently severe, dyspnea and awareness of vigorous or rapid heart action maybe noted even at rest.

Manifestations
b. When the anemia is very severe and prolonged, the congestive heart failure may occur c. The rate and depth of respiration often increase d. Heart murmurs is a common cardiac sign associated with edema. e. Electrocardiographic changes. The most common changes are ST junction depressed

Manifestations
D. Central nerve system: Headache, vertigo, tanintus, faintness, lack concentration, drowsiness, restlessness. E. Gastrointestinal systems: Anorexia, nausea, constipation, etc. of mental

F. Genitourinary systems: In the severe anemia, there maybe slight proteinuria. The female patients may occur excessive menstruation or hypomenorrhea. Both in male and female, there will occur sexual desire decrease. G. Other signs: such as fever, hemoglobinemia , hemoglobinuria.
济宁医学院附属医院血液科

Diagnosis

Diagnostic Steps of Anemia
Existence of anemia→Summary of the clinical and laboratory charateristics →Clinical and morphologic classification →Pathological classification→ ( If necessary ) tentative treatment to definite the cause of anemia 。

Diagnosis
Diagnostic Clues:
• • •

History. Physical examination. Adjuvant laboratory tests.

—— History
• • •

Diagnosis

The initial time, duration and manifestations of anemia Dietary habit, gastrointestinal conditions, nutritional conditions Acute and chronic hemorrhagic diseases, such as excessive menstruation, hemorroids and melena

Other chronic diseases, such as hepatic diseases, nephrotic diseases, tuberculosis, chronic inflammation and tumor.

• • •

Menstruation and pregnancy history Exposure to chemical, toxic substances and radiation Parasitic diseases

Diagnosis
—— Physical Examinations

Signs of malnutrional and deficieny of hematopoietic materials Signs of hemolysis Signs of malignancy Signs of bone marrow failure Signs of function deficiency of various organs

• • • •

Diagnosis
—— Laboratory tests

Blood Regular Test
① Hemoglobin and RBC -----The most reliable index for diagnosing anemia ② MCV 、 MCHC 、 MCH ③ Reticulocyte -----A very important index for diagnosing anemia

Diagnosis

Bone marrow
①Cellularity ②Percentage of various cell lines and various cell stages ③Cell morphology ④Abnormal cells ⑤Parasites

★Multiple sites , Bone marrow biopsy

Diagnosis

Other laboratory tests
Urine RT , Stool OB 、 Stool parasite , Liver and kidney function 、 X-Ray 、 Endoscope ;

MICM for leukemia Biochemistry , Immunology , Hemolytic tests.

Therapy
• •

Eliminating the cause of anemia Correct anemia

Key points
• •

The definition of anemia The diagnostic criteria of anemia worked out by WHO

The classification of anemia