HEMATOLOGY - Pécsi Tudományegyetem
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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