Hematology

General Director at Baidoa District Hospital

 Haemoglobin: Normal adults values,
o Male: 13.5-17.5 gm/dl
o Female: 12-16 gm/dl
 Anaemia:
o Male: <13 gm/dl
o Female: <12 gm/dl
o Pregnant Female: < 11 gm/dl

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 RBCs: -
o Shape: biconcave disc. –
o Average diameter: 7.2 micron. –
o Nucleus: absent.
o Life span: is approximately 120 days.
o Count: Male: (4.5-5.5 million/mm3).
Female: (3.8-4.8 million/mm3).

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Haematopoiesis:
It is the process relating to the formation of
blood cells. In the embryo this occurs
initially in the yolk sac, followed by the
liver and spleen, by 5 months in utero
haematopoiesis is established in the bone
marrow (BM).
Stages of development of RBCS
Stem cell → Proerythroblast → Erythroblast→
Normoblast → Reticulocyte →Mature RBC

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 It is composed of four globin chains, each
containing an iron containing protoporphyrin
pigment termed haem.
 Fe ++

Haem
 Protoporphyrin

 Four globin Polypeptide chains

 The globin chains are a combination of two

alpha and two non alpha chains.

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 Types of Hb in nonnal adults: (according to
the type of globin chains):
1. - Hb A: comprises about 97% (2 a & 2 B chains).
2. - Hb F : < 1% (2 a & 2 y chains).
3. - Hb A2: 1.5-3.2% (2 a & 2 ychains) .

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 It is the rate of sedimentation of RBCs in
mm/hr when anticoagulated blood is allowed
to stand. This is due to its ability for rouleaux
formation . . It is sensitive but a non specific
test for inflammation and tissue damage
(measure of the acute phase response). .

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 Factors promoting rouleaux formation
- Fibrinogen. - Immunoglobulins.

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 Methods of determination:
1. Westergren method: Blood + Na citrate Normal
values: o < 13 mm/hour S? < 20 mm/hour
2. wintrobe method· Blood +dried anticoagulant
(EDTA) • The anticoagulant is dried with no dilution
of blood. • So we can also calculate haematocrit
value.

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 Causes of moderate rise of ESR: •
o Anaemia. •
o Myocardial infarction. •
o Inflammatory diseases e.g rheumatoid disease, collagen diseases, or
rheumatic fever •
o Infections e.g pyogenic, TB.
 Causes of high ESR (> 100 mm/hr):
o Malignancy e.g leukaemia, lymphoma. •
o Collagen disease e.g SLE. •
o Multiple myeloma. •
o Active TB, severe pyogenic infections
 Normal or low ESR:
o Polycythaemia. •
o Hypofibrinogenemia (DIC or partially clotted blood sample). •
o Sickle cell anaemia or hereditary spherocytosis.
Q Anaemias with low ESR (inability of rouleaux formation) •
o Sickle cell anaemia
o Hereditary spherocytosis

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 Abnormal blood film (value of blood film)
o Microcytosis iron deficiency anaemia
o Macrocytosis megaloblastic or non-megaloblastic anaemia.
o Hypochromia diminished Hb concentration e.g in cases of iron
deficiency anaemia.
o Anisocytosis(variation in the size of red cells) e.g in megaloblastic
or iron deficiency anaemia. It is non specific.
o Poikilocytosis (variation in shape of RBCs). It is also non specific
and present in many conditions.
o Punctuate a or il n (basophilic stippling) of RBCs in lead poison.
o Howel joily bodies (small round nuclear remnants) e.g in
dyshaemopoiesis e.g megaloblastic anaemia and post-
splenectomy.
o Pappenheimer bodies in sideroblastic anaemia.
o Polychromasia corresponds to reticulocytosis e.g in haemolysis.
Parasites in RBCs e.g malaria.

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 Shapes of RBCs in different diseases:
o Burr cell (Echinocyte) RBCs with scalloped border uraemia. •
o Stomatocyte (Mouth cell) Inherited. •
o Target cell (Codocyte) Thalassaemia, iron deficiency, liver
disease.
o Acanthocyte (Spur cell) Splenectomy, advanced liver disease.
o Elliptocyte (Oval cell) Inherited.
o Sickle cell (Lancet cell) Sickle cell anaemia.
o Spherocytes : inherited, acquired spherocytosis.
o Schistoytes or schizocytes (Helmet cell) Mechanical haemolysis.
o Tear drop cell(Dacrocyte) Myelofibrosis.

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 This is by ferrous sulfate 200 mg tab or ferrous
gluconate 300 mg tab.

Dose (About 150 mg elemental iron is usually required)
◦ Ferrous sulfate 200 mg tab/8hr gives (120 mg
elemental iron/d), or ferrous gluconate 300 mg/12
hour (70 mg elemental iron/d).

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◦ It is best absorbed if given one hour before meals,
it is irritant causing nausea. The dose should be
lowered until tolerable or the medication should be
discontinued until symptoms resolve and then
restarted at a lower dose.
◦ Nausea can be avoided by taking iron with food,
ascorbic acid can be given to improve absorption.
Slow release formulations of iron cause fewer GIT
side effects.

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Preparations :
o Iron dextran (cosmofer) 100 mg/2 ml (1M, IV).
o Iron sorbitol (ferrlecit ) 50 mg /ml IM only .

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 Anaemia is present when there is reduction in number of
RBCs & Hb content of blood with decreased 0 2 carrying
capacity of blood in relation to age & sex.
 Other factors including pregnancy and altitudes also affect
haemoglobin levels and must be taken into account when
considering whether an individual is anaemic.

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 Treatment:
a) Treatment of the cause: e.g. oesophageal varices-
peptic ulcer - ankylostoma.
b) Iron therapy as before.
c) Blood transfusion.
d) Multivitamins to correct other associated
deficiencies.

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