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it covers the hematopoietic system, Lecture notes of Clinical chemistry

Centro Escolar University (CEU)Clinical chemistry

disease associated with abnormal rbc, wbc, and platelets

Typology: Lecture notes

2022/2023

Uploaded on 01/26/2023

RashiGallardo
RashiGallardo 🇵🇭

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Hematopoiesis
HEMATOLOGY II
BS Medical Laboratory Science | SEM 2 2023
Hematopoietic System
• blood, spleen, kidneys, liver, bone
marrow
cellular components
pluripotent stem cell
Components of Blood
• Plasma
Transport mechanism
• 90%-92% water
• 6-7% proteins
• 2-3%: fats, carbohydrates,
electrolytes, gases, chemical
messengers
• Red Blood Cell
Erythrocyte
• Hgb- O2 bearing molecule
4 subunits:
• Globin- binds to one O2 molecule
• Heme (iron)
100% saturation=4 globin subunits
carrying O2
• each gram of hgb→ 1.34 ml 02
red cell production
• erythropoiesis
➔ erythropoietin
• hemolysis
• sequestration
• laboratory analysis of rbc
➔ rbc count
➔ hematocrit
➔ hemoglobin
Platelets
• megakaryocytes
➔ thrombopoietin
• thrombocytopenia
• thrombocytosis
Hemorrhage
class l
class ll
class lll
class lV
Blood loss (ml)
<750
750-1500
1500-2000
>2000
Blood loss (vol
%)
<15%
15-30%
30-40%
>40%
Pulse
<100
>100
>120
>140
BP
normal
normal
decreased
decreased
Pulse pressure
normal/
increased
decreased
decreased
decreased
Resp. rate
14-20
20-30
30-40
>35
Urine output
(ml/hr)
>30
20-30
5-15
negligible
Mental status
slightly
anxious
mildly
anxious
anxious,
confused
confused,
lethargic
Fluid
replacement
crystalloid
crystalloid
crystalloid
& blood
crystalloid
& blood
Blood Products & Blood Typing
Blood typing
Antigens: A, B, AB, O
Rh factors: Rh+ 85%, Rh- 15%
compatibility among ABO groups
Donor cells
AB
B
A
AB
-
+
+
B
-
-
+
A
-
+
-
O
-
-
-
Types of Transfusions
Type
Contents
Use
whole blood
all cells, platelets,
clotting factors,
plasma
replace blood loss
from hemorrhage
packed rbc
rbc/ some plasma
replace rbc in
anemic patients
platelets
thrombocytes/
some plasma
replace platelets in
patients wt
thrombocytopenia
fresh
frozen
plasma
(FFP)
plasma, a
combination of
fluids, clotting
factors, and
proteins
replace vol. in a burn
px or hypovolemia
secondary to low
oncotic pressure
clotting
factors
specific clotting
factors needed
for coagulation
replace factors
missing due to
inadequate
production as in
hemophilia
reaction wt serum of
recipient
- no reaction
+ reaction
myeloid multipotent stem cells
common lymphoid stem cells
lymphocytes
unipotent progenitors
lymphocytes
thrombocytes
basophils
eosinophils
neutrophils
monocytes
erythrocytes
erythropoietin
pf3
pf4
pf5

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HEMATOLOGY II

BS Medical Laboratory Science | SEM 2 2023

Hematopoietic System

  • blood, spleen, kidneys, liver, bone marrow cellular components pluripotent stem cell Components of Blood
  • Plasma Transport mechanism
  • 90 %- 9 2% water
  • 6 - 7 % proteins
  • 2 - 3%: fats, carbohydrates, electrolytes, gases, chemical messengers
  • Red Blood Cell Erythrocyte
  • Hgb- O2 bearing molecule 4 subunits:
  • Globin- binds to one O2 molecule
  • Heme (iron) 100 % saturation= 4 globin subunits carrying O
  • each gram of hgb→ 1.34 ml 0 2 red cell production
  • erythropoiesis ➔ erythropoietin
  • hemolysis
  • sequestration
  • laboratory analysis of rbc ➔ rbc count ➔ hematocrit ➔ hemoglobin Platelets
  • megakaryocytes ➔ thrombopoietin
  • thrombocytopenia
  • thrombocytosis Hemorrhage class l class ll class lll class lV Blood loss (ml) <^750 750 -^1500 1500 -^2000 > Blood loss (vol %) <15% 15 - 30% 30 - 40 % >40% Pulse <100 >100 >120 > BP normal normal decreased^ decreased Pulse pressure normal/ increased decreased (^) decreased decreased Resp. rate 14 - 20 20 - 30 30 - 40 > 35 Urine output (ml/hr)

30 20 - 30 5 - 15 negligible Mental status slightly anxious mildly anxious anxious, confused confused, lethargic Fluid replacement crystalloid crystalloid crystalloid & blood crystalloid & blood Blood Products & Blood Typing Blood typing Antigens: A, B, AB, O Rh factors: Rh+ 85 %, Rh- 1 5% compatibility among ABO groups Donor cells AB B A O AB - + + + B - - + + A - + - + O - - - - Types of Transfusions Type Contents Use whole blood all cells, platelets, clotting factors, plasma replace blood loss from hemorrhage packed rbc rbc/ some plasma replace rbc in anemic patients platelets thrombocytes/

some plasma replace platelets in patients wt thrombocytopenia fresh frozen plasma (FFP) plasma, a combination of fluids, clotting factors, and proteins replace vol. in a burn px or hypovolemia secondary to low oncotic pressure clotting factors specific clotting factors needed for coagulation replace factors missing due to inadequate production as in hemophilia reaction wt serum of recipient

  • no reaction
  • reaction myeloid multipotent stem cells common lymphoid stem cells unipotent progenitors lymphocyteslymphocytes thrombocytes basophils eosinophils neutrophils monocytes erythrocytes erythropoietin

HEMATOLOGY II

BS Medical Laboratory Science | SEM 2 2023

Diseases of Erythrocytes

  1. Anemias
  • sign, not a separate disease process
    • signs/symptoms may not be present until the body is stressed
    • differentiate chronic anemia from acute episode
  • treat signs and symptoms:
    • maximize oxygenation and limit blood loss
    • establish IV therapy Types of Anemia Inadequate production of rbc:
  • aplastic- failure to produce rbc
  • iron deficiency- iron is primary component of hemoglobin
  • pernicious- vit B12 is necessary for correct rbc division during its development
  • sickle cell- genetic alteration causes production of a hgb that changes shape of rbc to a C, or sickle in a low oxygen state Increased red blood cell destruction:
  • hemolytic- body destroys rbc at greater rate than production, rbc parts interfere with blood flow Blood cell loss or dilution:
  • chronic disease- hemorrhage leads to cell loss while excessive fluid leads to a dilution of rbc concentration
  1. Sickle Cell Disease
  • hgb polymers form in the sickle cells with oxygen release, causing them to deform→ deformed cells block the flow of cells and interrupt the delivery of oxygen to the tissues (lower panel) note: normal red cells maintain their shape as they pass through the capillaries and release O2 to the peripheral tissues (upper panel) sickle cell crises
  • vaso-occlusive
  • musculoskeletal/abdominal pain
  • priapism
  • renal/cerebral infarction
  • hematological
  • lowered hgb
  • splenic sequestration
  • infections
  • management
  • follow general treatment and guidelines prn
  • consider analgesics
  1. Polycythemia
  • overproduction of erythrocytes
  • occurs in patients > 50 y/o or with secondary dehydration
  • most deaths due to thrombosis
  • results in bleeding abnormalities
  • epistaxis, spontaneous bruising, GI bleeding
  • management
  • follow general treatment guidelines Diseases of Leukocytes
  1. Leukopenia
  • too few white blood cells or neutrophils
  1. Leukocytosis
  • an increase in the number of circulating white blood cells, often due to infection → leukemoid reaction
  1. Leukemia
  • cancer of hematopoietic cells
  • initial presentation
  • acutely ill, fatigued, febrile, and weak anemic
  • thrombocytopenia
  • often have a secondary infection

HEMATOLOGY II

BS Medical Laboratory Science | SEM 2 2023

Platelet structure Platelets in Smears

  • on a stained wright stain:
    • dark purple spots, about 20% the diameter of red blood cells.
    • smear is used to examine platelets for size, shape, qualitative number and clumping
    • ratio of platelets to red blood cells in a healthy adult is 1 :10 to 1: Platelets in the Endothelium
  • main function: hemostasis
  • gather at the site and unless the interruption is physically too large, they plug the hole Hemostasis
  • adhesion: platelets attach to substances outside the interrupted endothelium
  • activation: platelets change shape, turn on receptors and secrete chemical messengers
  • aggregation : platelets connect to each other through receptor bridges primary hemostasis
  • formation of platelet plug associated with activation of the coagulation cascade with resultant fibrin deposition and linking [secondary hemostasis]
  • PLT are responsible for stopping the bleeding of unnoticed wear and tear of the skin note: once the platelet plug is formed by the platelets, clotting factors begin creating the clot overlapping of events
  • process of hemostasis may overlap; the spectrum is from a predominantly platelet plug or “white clot” to a predominantly fibrin clot or “red clot” or the more typical mixture→ final result: clot additional: Platelets are stimulated by the hormone thrombopoietin , they break off the megakaryocytes and enter blood stream→ circulating for about 10 days before ending their short lives in the spleen
  • thrombopoietin helps to maintain the count of platelets at a normal level (150-450 X10^9/L) collagen
  • should one receive a cut or bruise, blood’s ability to coagulate occurs
  • platelets provide the necessary hormones and proteins for coagulation
  • collagen is released when the lining of a blood vessel is damaged; the platelet recognized collagen→ begins to coagulate blood by forming a kind of stopper (they clump to form a clot): further damage to the blood vessel is prevented platelet membrane
  • contains several phospholipids
  • phos- phatidylinositol
  • phosphatidylcholine
  • phosphatidylserine (PS) and phos-phatidylethanolamine that play a major role in platelet function

HEMATOLOGY II

BS Medical Laboratory Science | SEM 2 2023

phosphatidylserine (PS)

  • negatively charged expressed in the inner membrane leaflet of the resting platelet; on a platelet activation
  • translocates to the outer leaflet : an essential step in the formation of a procoagulant platelet surface that is critical in several blood coagulation mechanisms basic hemostasis
  • process that causes bleeding to stop, keeps blood within a damaged blood vessel
  • opposite: hemorrhage
  • first stage of wound healing
  • involves coagulation, blood changing from a liquid to a gel intact blood vessels are central to moderating blood’s tendency to form clots
  • hemostasis is triggered by factors such as a direct injury to vascular smooth muscle, chemicals released by endothelial cells and platelets and reflexes initiated by local pain receptors
  • vascular spasm: more effective in smaller blood vessels 3 major steps of hemostasis 1. Vascular spasm
  • is the blood vessel’s first response to injury; damaged vessels constrict (vasoconstrict)→ reduces the amount of blood flow through the area and limits the amount of blood loss 2. Platelet Plug Formation
  • platelets adhere to damaged endothelium to form a platelet plug (primary hemostasis) and then degranulate→ regulated through thromboregulation
  • plug formation: activated by a glycoprotein called Von Willebrand factor (vWF) , found in plasma platelets adhere to collagen: as they adhere to collagen fibers of a wound, platelets become spiked and much stickier → they release chemical messengers i.e., adenosine diphosphate (ADP), serotonin and thromboxane A 2 , **causing more platelets to stick to the area, release their contents, and enhance vascular spasms
  1. Aggregation**
  • platelet clump together in a blood smear
  • begins after activation and occurs as a result of turning on the GPllb/llla receptor, allowing these receptors to bind vWF or fibrinogen
  • 60 ,000 receptors per platelet
  • when any one or more of at least nine diff platelet surface receptors are turned on during activation, intraplatelet signaling pathways cause existing GPllb/llla receptors to change shape - curled to shape→ becomes more capable of binding