NCM 106 = 5 concepts/6 lecture units

1 concept = 22 lecture hours

ABC
ER
IVFT
HEMATOLOGY
ONCOLOGY
GRADING SYSTEM

FinaL Exam 40%

Quizzes 30%
SCA 10%
Attitude 10%
Attendance 10%
TOTAL 100%
 Classroom Rules and Regulations
• Using of gadget is not allowed
• Late =1-15mins
• More than 15 mins late will be marked absent
• 3days late = 1 absent
• Incomplete uniform = absent
• No special quiz
 PRE TEST
1-3 ORGANS INVOLVE IN BLOOD FORMATION
4-10 IDENTIFY SPECIFIC BLOOD CELLS

5.

6.
4.

7.

10.

8.
9.
HEMATOLOGY
 OBJECTIVES
• At the end of the lecture the students
– Will know how blood is formed
– Will know lineage of cellular components of blood
– Will be able to identify composition of blood and
its functions
REVIEW OF BLOOD FORMATION
REVIEW OF BLOOD FORMATION
REVIEW OF BLOOD FORMATION
 BLOOD

• Overview
• Functions of blood
• Plasma
• Erythrocytes
• Leukocytes
• Platelets
 COMPOSITION OF BLOOD
• Blood is a fluid connective tissue composed
of:
– Plasma
– Formed elements
• Erythrocytes
• Leukocytes
• Platelets
 FUNCTIONS OF BLOOD
• Transport
– O2, CO2, nutrients, wastes, hormones, etc
• Protection
– WBC, antibodies, platelets, compliment CHON
• Regulation
– Fluid and temperature, regulation and buffering
– 37 degrees
– pH – 7.35 – 7.45.
 BLOOD VOLUME
• Adults have 4-6 L of blood (7-10%)
• Plasma, a clear extracellular fluid
• Formed elements (blood cells and platelets)
 PLASMA
• Plasma – liquid portion of blood
– Serum remains after plasma clots
• 3 major categories of plasma proteins
– Albumin
– Globulin
– Fibrinogen
OTHER COMPONENTS OF PLASMA
• Nitrogenous by-products of metabolism
– Lactic acid, urea, crea, CHON etc
• Nutrients – glucose, carbohydrates, amino
acids
• Electrolytes – Na, K, Cl, HCO3
• Repiratory gases – O2 and CO2
• Hormones.
 ERYTHROCYTES
OVERVIEW
• Biconcave disc, anucleated, essentially no organelles
• 7-8 microns
• 5-7days
• Have a flexible cytoskeleton that allows them to move
through narrow spaces
• Cytoplasm is filled with hemoglobin for gas transport
• Are the major factor contribution to blood viscosity
• 175B/day
• 1-2% reticulocytes
• 5M/microliter (mm3)
• 120 days.
ERYTHROCYTE IMAGE
 ERYTHROCYTE FUNCTIONS
• Gas transport – major function
– Due to loss of organelles during maturation
– Increase surface area/volume ratio
• 26-33% of cytoplasm is hemoglobin
– O2 delivery to tissue and CO2 transport to lungs
• Important role in gas transport and pH
balance
HEMOGLOBIN STRUCTURE OVERVIEW
• Protein globin: 2 alpha chain and 2 beta chain
– Heme pigment centrally bonded to each globin
• Iron atom in each heme can bind to 1 O2
molecule
• Each Hb molecule can transport 4 O2
molecule
• Men 14-16g/dl
• Women 12-14g/dl
HEMOGLOBIN STRUCTURE
 HEMATOCRIT
• RBC count and hemoglobin concentration
indicate an O2 carrying capacity of blood
• Hematocrit (packed cell volume) - % of blood
composed of cells
• Men 42-52%
• Women 37-48%
 ERYHTROCYTE DISORDERS

• Increased – Eryhtrocytosis/Polycythemia
• Decreased – Anemia
 LEUKOCYTES
• 5,000 - 10, 000 WBC/microliter
• Conspicous nucleus
• Travel in blood before migrating to connective
tissue and lymphatic tissues tissue
• Protects against pathogens
• Less than RBC
• Stored in RBM
• RES
 LEUKOCYTE CLASSES
• Granulocytes
– Neutrophils 50 - 70%
– Eosinophils 2 - 4%
– Basophils 0.5-1%
• Agranulocytes
– Lymphocytes 25 - 45%
– Monocytes 3-8%
LEUKOCYTE FUNCTIONS
NEUTROPHILS

• 9-12microns
• 50-70%
• 3-5 lobes
• 1-2days/6 hours
• Blue & pink granules
BASOPHILS

• 9-12 microns
• 0.5-1%
• Few hrs-few days
• Blue stain
EOSINOPHILS

• 10-14microns
• 2-4%
• 5days
• 2 lobes
• Bright red
LYMPHOCYTE

• 5-10/10-18microns
• 25-45%
MONOCYTE

• Kidney shaped
• 16-25microns
• 3-8%
• Months - years
RETICULO ENDOTHELIAL SYSTEM
 LEUKOCYTE DISORDERS
1. Leukopenia – low WBC count – damaged RBM
Causes: radiation, poisons
2. Leukocytosis: high WBC count
Causes: infection, allergy and disease
3. Leukemoid reaction –
Uncontrolled WBC reaction/overproduction
4. Leukemia ???
 PLATELETS
• Small fragments of megakaryocytes cytoplasm
• Sticky, circulate in clumps
• 150,000 - 400,000/ml
• 2-3 µm, contain granules
• Secrete clotting factor and growth factors for
vessel repair
• Initiate formation of clot (HEMOSTASIS)
PLATELETS
PROPERLY ID WHAT YOU SEE
 ERYTHROPOIESIS
• Production of erythrocytes
• Regulated by:
– Balance in erythrocytes production and
destruction
– Blood oxygen levels
– Hormonally controlled (EPO and testosterone)
**blood doping**
• Excessive effects: blood viscosity
• Decreased effects: O2 carrying capacity
HEMATOPOEISIS
ERYTHROPOIESIS
 LEUKOPOEISIS
• Chemically regulated
by other WBC’s and
other physiologic
functions
• Colony Forming Units
(CFU) stimulate
production of specific
leukocytes
LEUKOPOEISIS
THROMBOPOIESIS
 NUTRITIONAL REQUIREMENTS
• Adequate protein intake
• Adequate iron intake
• Adequate vitamin intake
 NORMAL
CELLS SIZE/µm NUCLEUS LIFESPAN COLOR VALUES/µL

RBC 7 to 8 anucleated 120 days red 4to 5M /mm3

Hb/Hgb 12-16mg/dl

Hct 40-50%

WBC 4,000 – 11,000/mm3

6h/1-2
Neutrophils 9 to 12 2 to 5 days pink to violet 1800 -7300 50-70%

Eosinophils 10 to 14 bilobed 5 days bright red 0-700 2-4%

few
Basophils 9 to 12 bilobed hrs/days deep blue 0-150 0.5-1%

Lymphocytes 5 to 10 large hrs/yrs 1500-4000 25-45%

10 to 18

Monocytes 16 to 25 K shaped mos to yrs pale blue 200-950 3-8%

5 to 10
Platelets 2 to 3 fragments days deep purple 150,000-400,000 <1%
COMPLETE BLOOD COUNT
 POST TEST
• IDENTIFY WHICH OF THE FOLLOWING COUNT
IS ABNORMAL
• MAKE A TABLE LIKE THIS. eg
TYPE OF CELL RESULT OR INTERPRETATION

Platelet 105689345 Bacterial

infection/
Prone to infection