HEMATOLOGY



HEMATOLOGY

Hematopoiesis

Fetus: liver, spleen, bones

sometimes regain heatopoietic activity in the adult: i.e. myelofibrosis

Child: long bones, skull, vertebrae etc.

Adult: vertebrae, sternum, ribs, pelvic bones

and long bones, skull - about 1 kg tissue

producing 1011 cells/day

Hematopoietic cells

Pluripotent stem cell compartment

relatively small, lymphocyte-like cells

Proliferating cells of committed lineage

myeloid, erythroid, megakaryocyte, lymphoid,

reticulum cell lines

(normal myeloid to erythroid ratio in the b.m. : 2-3:1)

Maturing (postmitotic) cells

Mature cells

circulating half life: pmn.leukocytes 6 hours

platelets: 8-10 days

erythroid cells: 120 days

Erythropoiesis

Stimulus: hypoxia erythropoietin

(in the kidney [and in the liver])

pluripotent stem cells

CFU-E

BFU-E

proerythroblasts

erythroblasts

normoblasts

mature red blood cells

Leukocyte production

Pluripotent stem cells

Myeloblasts (committed stem cells: CFU-C CFU-GM, stimulated by CSF-s)

Promyelocytes largest leukocytes, with non specific

granulation

Myelocytes specific granulation (Neu.,Eo., Bas.)

last proliferating cells

Metamyelocytes

Band-form

Mature polymorphonuclear granulocytes

Megakaryocyte line

Giant, multinucleated cells

Breaks up, releasing about 5000 platelets

Marrow lymphocytes

arising also in spleen and lymph nodes

lifetime: years

Bone marrow function

Haematopoiesis

Antibody producing plasma cell differentiation

Monitoring hematopoietic cell quality

Important key nutrients: iron

folic acid

vitamin B12

regulatory hormones

(EPO, CSF-s)

interleukins

Anemia

Decrease in red cell mass or hemoglobin content of blood below the physiologic need

Not a disease itself! A clinical sign!

Analysis of anaemia

seek the background mechanisms

loss of red blood cell - bleeding

lack of red blood cell production

excessive red blood cell damage

identify the cause of anaemia

morphological evaluation

History

Family history: anemia, splenomegaly, jaundice

Bleeding tendency in the family

Diet, alcohol intake

Menorrhagia (number of used tampons)

Drugs

Chronic diseases

Malnutrition, malabsorption

Transfusion, iron or other therapy against anemia

Anemia

Signs and symptoms vary with the rapidity of onset:

Rapid (bleeding or brisk hemolysis)

cardiovascular compensatory reactions:

tachycardia, postural hypotension, vasoconstriction

in the skin and extremities, dyspnea on exertion,

faintness, even shock

Slowly developing anemias (ie.nutritional deficiency, chr.bleeding, hemolysis etc.)

there is time for compensation

the patient remains asymptomatic for a long time

Anemia

Mild: often asymptomatic

Moderate: symptoms on exertion

Severe: symptoms on rest

heart failure

Anemia - symptoms

fatigue

dizziness, vertigo, headache, tinnitus

cold intolerance

increased irritability, difficult concentration

sleeping disturbancies

exertional intolerance

abnormal menstruation, loss of libido, impotence

Hb ................
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