Hematopathology

Dr Manjiri Karandikar

Professor of Pathology
B.V.D.U.M.C. Pune
 Composition of blood
• Cells + plasma
• Cells RBCs, WBCs, Platelets
• Function of RBCs – to carry Oxygen to the
tissues & bring back CO₂ to the lungs
• Function of WBCs – to fight infections
• Function of platelets – clotting
• Plasma contains clotting factors & proteins
Blood cells & Plasma
 Function of RBCs

• To carry Oxygen to the tissues & bring back CO₂ to the

lungs with the help of Hemoglobin

Hb = Heme +Globin
Heme = Iron + protoporphyrin
Disorders of RBCs

• Anemia

• Polycythemia
 Anemia Definition

Definition

Decreased hemoglobin concentration below the

normal range for age & sex of the individual.
Hb values Normal Range

• Adult Male 13 -17.2 g/dl

• Adult Female 11.5 – 15 g/dl
 Classification of Anemias

• Due to blood loss

• Due to increased destruction of RBCs

• Due to decreased production of RBCs

Nutritional deficiency anemias

• Iron deficiency anemia

• Vitamin B 12 deficiency anemia

• Folic acid deficiency anemia

 Iron Deficiency Anemia

Most common nutritional disorder in the world

Prevalence higher in developing countries

Infants, Toddlers
Adolescent girls
Women of childbearing age
Impoverished
Elderly
Causes of Iron Deficiency

(1) Dietary lack

(2) Increased requirement

(3) Impaired absorption

(4) Chronic blood loss

 Iron Metabolism
Daily requirement 7 -10 mg adult men
7 - 20 mg adult women

Absorption
20%- 25 % of iron from non vegetarian food
< 5 % of iron from vegetarian food

Total body iron content

2 g in women and 6 g in men
 Clinical Features
• S/S common to all anaemias
• Pallor, weakness, breathlessness on exertion, easy
fatigability, palpitations, lethargy

• S/S related to the underlying cause of the anemia,

e.g. gastrointestinal or gynecologic disease,
malnutrition, pregnancy, and malabsorption
Pallor
Platynuchia & Koilonychia
Koilonychia in IDA
 In infants and young children

Irritabily Slower rate of growth

Poor appetite
and development
Pica - unusual craving for non-food items
e.g. ice, sand, paint, mud etc.
 Lab Diagnosis of IDA
• Hb Moderate reduction
• PBS Microcytic, hypochromic anaemia

• Sr. Iron Low < 50 μg/L (N- 40 -140 μg/dl)

• Sr. Ferritin Low < 12 μg/L (N- 30-250 μg/L)
Lab Diagnosis of IDA
PBS Normal & IDA
 Megaloblastic Anemia

Aetiology

• Vitamin B12 Deficiency

• Folic acid Deficiency

 Vitamin B12
• Sources: kidney, liver, heart, eggs, cheese, milk
No vegetarian source
• Daily Need: 2-4 µG

• Body Stores: 2-4 mg

• Absorption: actively through ileum

• Tissue stores: liver, kidney, brain

Vitamin B12 Deficiency
 FOLIC ACID

• Sources: kidney, liver, heart, eggs, cheese,

milk, leafy vegetables, fruits
• Daily Need: 200 - 400 mg

• Body Stores: 2 - 4 g

• Absorption: actively through ileum

• Tissue stores: liver, kidney, brain

FOLIC ACID DEFICIENCY
 Clinical signs & symptoms
• Anaemia , Pallor
• Glossitis -- beefy, red tongue
• loose motions

• Neurological manifestations – peripheral

neuropathy, tingling, numbness
 Megaloblastic anaemia

 Peripheral Blood Smear

Macrocytic anaemia
Bone marrow examination - Megaloblasts

• Sr. Vitamin B 12
• Sr. Folate
PBS-Megaloblastic Anemia
Pernicious anemia
• CNS lesions found in three fourths of all cases of
florid pernicious anemia.
• Principal alterations in spinal cord
• Demyelination of the dorsal and lateral tracts,
sometimes followed by loss of axons.
• Spastic paraparesis, sensory ataxia, and severe
paresthesias in the lower limbs.
• Less frequently, degenerative changes occur in the
ganglia of the posterior roots and in peripheral
nerves
Q. Define Anemia. Discuss different types of
Anemia.
Anemia Definition
Decreased hemoglobin concentration below the
normal range for age & sex of the individual.
Hb values Normal Range
• Adult Male 13 -17.2 g/dl
• Adult Female 11.5 – 15 g/dl
Classification of Anemias

1. Due to blood loss e.g. Acute Road traffic accidents,

Intra-operative blood loss

2. Due to increased destruction of RBCs i.e. Hemolytic

anemias
e.g. Thalassemia, sickle cell anemia

3. Due to decreased production of RBCs

e.g. Hypoplastic anaemia ,Aplastic anaemia

Iron Deficiency Anemia

Most common nutritional disorder in the world.

Prevalence higher in developing countries.
Most common in Women of childbearing age.

Causes of Iron Deficiency

1. Dietary deficiency 2. Increased requirement

3.Impaired absorption 4.Chronic blood loss

Dietary sources – Meat, green leafy vegetables
Absorption
Iron from nonvegetarian food is better absorbed
than iron from vegetarian food .
• Clinical Features
• S/S common to all anaemias
• Pallor, weakness, breathlessness on exertion, easy
fatigability, palpitations, lethargy
• S/S related to the underlying cause of the anemia

• Lab Diagnosis of IDA

• Hb Moderate reduction
• PBS Microcytic, hypochromic anaemia
• Sr. Iron Low
• Sr. Ferritin Low
 Megaloblastic Anemia
Aetiology
• Vitamin B12 Deficiency
• Folic acid Deficiency
• Combined Vitamin B12 & Folic acid Deficiency
• Dietary Sources of Vit B12 – meat ,eggs,
cheese, milk, No vegetarian source
• Dietary Sources of Folic acid – meat, eggs,
cheese, milk, leafy vegetables, fruits
Causes of Vitamin B12 & Folic acid deficiency

Clinical features
Anaemia , Pallor, oral ulcers,
Neurological manifestations e.g.
Tingling, numbness of extremities
Lab Diagnosis
Hb – low ,
Peripheral Blood Smear - Macrocytic anaemia
Bone marrow examination - Megaloblasts

• Sr. Vitamin B 12 assay - decreased level

• Sr. Folate assay - decreased level