Haematology

actualy

hematology is the science that deals with blood elements

Blood elements
RBCs , WBCs and coagulation
science of investigation not science of clinical diagnosis
investigations
yolk sac

3rd week

IntraUterina

hematologist

RBCs

physiology

RBC

liver and spleen

BoneMarrow

fourth month

Bone marrow
hemolytic anemia

limited to end of long bones and flat bones

RBCs

liver & spleen

shaft

hepatosplenomegaly

undifferentiated

replace

proliferating

shaft

proliferate

and bone marrow expansion

stem cells

BM

RBCs

RBCs

cells
RBCs

bone marrow

stage

rbcs , wbcs or platlets

pleuripotent cells

nucleus

nucleus
reticulocytes

stem cell

RBCS
Mature RBCs

%2

maximum 2 %

RBCs

haemolysis

reticulcytes

immature

anemia

reticulcytes

reticulcytes

iron

reticulcytosis

bone marrow

RBCs

bone marrow

iron

RBCS

reticulocytes

Mature RBCs

medical treatment

nucleas

RBCs

Bone marrow

success of treatment

haemolysis and haemorhhage

iron deficnecy anemia

reticulcytes

pan

bone marrow failure

reticulcytes

hypersplenism or bone marrow failure

reticulocyte

spleen

reticulcytes

hypersplenism

cytopenia

bone marrow failure

bone marrow activity

reticulocytes
reticulocyte

RBCs

Reticulocytosis

COUNT

reticulocytes

large cells in blood

Macrocytosis
RBCs

stimulate

Androgen

=D

female
35 ml

male =D
Androgen

Male : 4-6 Mil

Female : 3.5 to 4.5 Mill
Male
female

androgen

menstrual cycle
androgen

production of RBCs

Female

Bone marrow failure

stimulate production of RBCs

polycythemia

RBCs

sicke cell ad spherocytes

biconcave

packed cell volume

centrifuge
011

Hemtaocrite

centrifuge
55

011
55

RBCs

shape

hematocrite
011
, 55

hematocrite
plasma
packed RBCs

Count

RBCs

55

hypervolemia

anemia

hypervolemia

anemia

hematocrite
diluted

hematocrite

dehydration or polycythemia

hypervolemia
2

21

01

mean corpuscular volyme

mean corps volume

RBC

RBC

RBC

count
69 86

range

macrcyte

range

69

hematocrite
90 U

5 million

Microcyte

69

RBcs
,

Microscope
megalo

diameter of RBC
02

RBC

macro
megalo

45 ml

mcq

normocyte

size

microcyte 97.

macor

macro

micron 97.6

megalo

megaloblastic Macrocytic
macrocytic non megaloplastic

haemoglobin
Male : 14-16
Female 13.5-14
polycythemia
0

01

RBCs
5

anemia

hemoglobin
05

01

RBC

15gm

mean corpuscular haemoglobin

RBC

heamoglobin

hyperchromic
mean

haemoglobin
RBC

02

hemoglobin

26

range

RBC

hemoglobin

hypochromic

RBC

hypo , hyper or normochromic

hematocrite

30 Pg

hemoglobin

corpuscular haemoglobin

mean corpuscular hemoglobin concentration

the value of blood film in diagnosing anemia
size , shape , count , mean corpuscular volume

the value of blood

01

items
smear

infection , inflammation and malignancy

3

ESR

Capillary tube
RBCs

RBCs

RBCs

blood
5

ESR

2 hours

RBCs should be attached

RBCs

Repulsion
negative

ESR

negative charge
albumin

RBCs

RBCs

to eacth other

nephrotic syndrome
negative charges

negative charge

albumin

albumin

ESR

charges
ESR

infection and

globulin

negative charges from RBCs

globulin and fibrinogen

inflammation
ESR
ESR

negative charges

pregnancy

fibrinogen

and malignancy , Infection and inflammation , pregnancy and nephrotic syndrome

antibodies

MCQ

Malignancy , TB

ESR

malignancy
Charges

collagen disease

RBCs

ESR

011

ESR

MCQ

abnormal shape of rbcs

Value of blood film in diagnosin anemia

General Rules

general rules
general rules
anemia

General rules

anemia is the decrease in RBCs or hemoglobin or hematocrite in same age sex

adult

09

02
Caucasian

actually am not

female

low hemoglobin

05

anemic

anemic ?
polycythemia

and race

hemoglobin 14 is abnormal

male

diluted

Anemia by definition

0.

02
dehydrated

negros

Sex
Race

sex , age and race

RBCs

is it possible to do this ?
RBC

01

anemic

RBCs

IV

technetium labeled RBCs

chromium or technetium

gamma camera

RBCs
hypervolemia

hypervolemia

anemia

RBCs

RBCs
not practical

acc to morphology

acc to etiology

classification of anemia
Acc to etiology

etiological
enough

hemoglobin deficiency anemia

anemia of bone marrow

Bone marrow

RBCs

hemorrhage and hemolytic anemia

failure

Deficiency anemia , Anemia of bone amrrow failure , hemorrhage and

according to etiology
hemolytic anemia

normocytic normochromic anemia

hypo chromic

69

morphology
microcytic

microcytic hypochromic
28
Microcytic hypochromic anemia
Microcytic hypochromic anemia

heme and
iron

heme

globulins

heme

iron +

heme

globulin

deficiency anemia
thallassemia
acute

RBCs

globulin

Normocytic normochronic anemia

bone marrow failure , acute hemolysis ,hemorrhage

5

megaloblastic

02

reticulocytosis

non megaloblastic

02

megaloblastic

liver cell failure

Macrocytic anemia

non megaloblastic

macrocytic anemia

Vb12 and folic acid

reticulocytosis

RBCs
reticulocytes

liver cell failure , alcoholism and reticulocytosis

Macrocytic non megaloplastic

classification of anemia
etiology

physiology

etiology

general rules

physiology of iron

etiology

HCL

iron deficiency anemia

absorbtion

iron

HCL

of iron deficiency anemia

FOG P

Clinical picture
decrease of o2 delivery to tissue

retinal edema

vasodilatation

hypoxia

Fatigue F

fundus

blurring of vision
tissue hypoxia
Heart

acute anemia

vaso dilatation

edema

Oedema

sever anemia and long standing

anemic HR
failure

consent
Heart failure

075

hemoglobin
Heart failure

vasodilatation GIT

vasodilatation peripheral
hypoprotenemia

anorexia

acute

edema

malabsorbtion

Git congestion

GIT Congestion
CNS , CVS , Respiratory , Renal
headache

cerebral edema

CNS

General systems

Vasodiltation

CNS

hypoxia of nerve , peripheral neuritis

tumor

headache , anorexia and bluring of vision

pseudo tumor cerebri

Heart

severe long standing anemia

, palpitation , tachycardia

Nocturia

it has similar features like a brain tumor

hyperdynamic circulation
CVS

Renal blood flow

specific features
haemolytic
6

jaundice

anemia

FOG P

VD

failure
polyurea Renal

specific
spooning

FOG P

C/P of the cause

epigastria pain and constipation

iron deficiency anemia

etiology
C/P of the cause
2

ESR

specific feature
of nails

C/P of the cause

specific feature

hematocrite

FOG P

RBCs

MCV & MCH

microcytic hypochromic or macrocytic
hemoglobin
iron deficncy

specific investigation
microcytic hypochromic

thalassemia

.9

iron deficncy

61

MCV

MCV

iron level

thalassemia

hemoglobin

Bone marrow failure

hematocrite
anemia

specific investigation

reticulocyte

hemolytic or hemorrhage

BM failure

Investigation of the cause

iron

microcytic anemia

.0

MCV

stool analysis for parasite

iron deficncy anemia

Treatment
Tratemnt of cause
Blood transfusion if HB<7 or there is HF

0
2

Iron deficiency anemia

rules
physiology
physiology
Diet
duodenum

ferrous

ferric

HCL

duodenum
regulate absorbtion
1mg

absorption of iron
apoferritin

iron
iron
absorption

absorbtion of iron

absorbtion

duodenum
absorbtion only to 1 mg

Mucosal block theory

7

1mg

absorbtion

apoferritin

transferring

transferrin

blood

iron

Iron
, Transferrin saturated

iron

iron

01
% 01

total binding capacity

transferrin saturation

iron deficncey

iron

transferrin

total iron binding capacity

myoglobin

catalase

iron

enzymes

enzymes

ferrtitin

Muscles

tissue

liver
physiology

Etiology

Starvation , malnutrition *
milk

9
9

diminced HCl

iron

female

iron deficiency
gastrc carcinoma

atrophic gastritis , gatsrectomy

stomack

malabsorbtion duodenum

HCL
rare

Iron deficiency anemia

congenital

chronic blood loss

parasite and menstrual irregularity
anclystoma

cancer colon

iron deficiency anemia

peptic ulcer virus hemoptysis

parasite

parasite

51
colonoscopy
hematuria

clinical picture
affect metabolism
proliferate

tissue

FOG P
specific

enzymes

tissue proliferating

proliferate

metabolism

tissues

0
2
0

skin an GIT
loss of hair and

iron deficiency

proliferation and replacement

SKIN
spooning of nails

proliferation and

papillae
red glazed tongue

GIT

proliferation

replacement

clinical picture of the cause

gatsrectomy
epigastria pain constipation and pellagra

diminished absorption
parasite manifestations
Plummer Vinson syndrome ?

splenomegaly dysphagia

ESR

female

cancer esophagus

hematocrite

Investigations

RBCs

Type of anemia : microcytic hypochromic anemi

MCV & MCH

total iron binding capacity

transferring saturation

ferrtitin
reticulocytosis

iron

Investigation of cause
female

esinophilia
infertility
esinophilia

worm or ova

Stool analysis

hemoglobin

anclystoma

worm or ova
coloncopy

stool analysis

51

Treatment
iron

ferrous sulphate

ferrous sulphate & ferrous gluconate

absorbtion
gastritis

Ferrous

iron

acid
dark stool stool

absorption

iron

malabsorbtion

ferrous

vein

acid

rapid correction
parentral

parentral and oral have the same rate of correction

thrombophlebitis

capsule

oral iron

rapid correction

acid

iron

acid

parentral iron

iron

Iron

oral

gastric irritation

malabsorbtion
mg 0

parentral

IV

parentral

vein
vein

MCQ

acid IV ?
dilution

acid

ferrous
vein

thrombosis

IM
proton pumb inhibitor

peptic ulcer

mebendazole

anclystoma
Iron deficncey anemia
Discuss Iron deficncey anemia
anemia of chronic hemorrhage
discuss anklystoma duednalis
etiology

Anemia of chronic illness

chronic infection- chronic inflammation- and malignancy

chronic illness
tb

chronic infection

Inflammation : collagen disease

Tumor Malignancy
inflammatory mediators cytokines
.1

021

suppression of BoneMarrow
normocytic

Kidney

suppression erythropoietin
transferritin

cytokines
serum

RBC

Iron Bone marrow

iron

cytokines

normochromic anemia
iron release to the tissue

iron

iron

shortening life span of RBC

iron deficncy anemia

iron

BM
BM
iron

microcytic hypochromic

normochromic normocytic

ferrritin

inhibition of iron release to the tissue

serum iron
ttt of underlying

anemia of choronic illness

investigation

iron

Microcytic hypochromic

iron deficny anemia

clinical picture

total binding capacity

cause

iron

cytokines

failure to utilize iron

anemia of choronic illness

iron
sideroplastic anemia

iron and protoporphyrin

heme

heme + globin

10

MCQ

Sideroblastic anemia
siderblastic anemia
glycine

gamma amino levulinic acid

aminoacid

1h :36
folic acid

VIT B6

enzyme

Gamma amino levilunic synthetase

synthesis
sideroblastic anemia
congenital

VIT B6 metabolism

INH

Not present *

VIt B 6 deficncy , folic acid deficncy

protoporphyrin

inhibition

siderblastic anemia

lead poisiong

protoporphyrin

iron

RBCs
-

cases

Vitamine B12 deficiency

Vit B12
Vit B12
intrinsic

parietal cells

blood

B12

GIT

stomach
absorbtion

CNS

RBCs

Oral

Vb12 is only animal sources

terminal ileum

Bone maroow

B12

plasma

.. factor

transcobalamine -2

2 years

liver

=D

animal source Source

excess Vit B12

under basal condition

Function *

division

cells

cytoplasm

DNA

nucleas

vit B12

b12

double

cytoplasm and nucleas

DNA

double

cytoplasm

B12

divide

double

Nucleas

megaloblasts
RBCs , WBCs

cells

Megaloblasts

stem cells

proliferate
anemia

Bone
11

cells

bilirubin

divide

bone marrow
B12

proliferate

cells

and platlet

anemia
bilirubin

normoblast

stage

marrow
erythroblast

mature

at variable stage of development

nucleas

WBCs

thrombocytopenia

platelet

RBCs
serum muramidase

multinucleated

enzyme

immature

6 lobes

3 lobes

WBCs

nucleas

multilobated nuclueas
mylination of Nerve fibers
Vit B12

Vit B 12

proliferate

GIT
proliferation

etiology
Diminshed intake
=D vegetarian

vegetarian Egyptian

Starvation, vegeterians
American vegetarian

=D

=D

, vegeterians

Starvation

Diminshed intake

diminished absorbtion

intrinsic factor
automimmune disease

Addissonian pernicious anemia

gatsrectomy, gastritis.

Antibodis against parietal cells

0

antibodies

antibodies against intrinsic factor

antibodies against terminal ileum

high incidence against gastric carcinoma
,

against parietal cells

European female

disease

blue eye fair head females

illeal disease
2 , 2 infection , 2 inflammation ,
TB & regional ileitis 2 infection ,
crohns and ulcerative colitis 2 inflammati
contents

peristalsis

Intestine

blind loop syndrome

proliferation of bacteria

12

2
stagnant

Transcobalamine deficiency congenital

malignancy

B12

proliferating

pregnancy

bone marrow

hemolytic anemia

increase requirement

V B12

proliferate

cells

B12

Clinical picture
FOG P
purpra

hepatosplenomegaly

jaundice

red glaze tonge

specific

sub acute combined degeneration

demylination
Cp of the cause

Diminshed intake
examination

Addisoninan pernicious
investigation

Investigations
ESR

RBCs

Type Megaloblastic normochromic anemia

MCHC

MCV

Specific nvestigations
anisocytosis , poikilocytosis , cabbot rings
specific
muramidase

mulitlobated WBCs
BM

thrombocytopena

serum LDH

High bilirubin

No reticulcytes
reticulocytosis

TTT

Inv of the cause

endoscopy

stomach
antibodies 0

obsolete

Intestine

B12

Vit B12

chilling test

UG

urine

perniciose anemia

IM

urine

Vit B12
absorbtion

intestine
test
test

urine
intrinsic factor
bacterial over growth

13

aborbtion
intrinsic factor
antibiotic

B12

vit b 12
HCL and pepsin

pernicious anemia

tb

underlying cause
HF

HB

Blood transfusion

Discuss vit b 12 deficency

Discuss subacute combined degeneration
discuss addisonian pernicious anemia

Folic Acid deficiency

carrier
GIT and

intestine

absorption

tetra hydro foliate

liver

vegetables source

activation
CNS

inactive

Vit B12

bone marrow
0

Etiology
Deficient Intake 0

anorexia and alcoholism

anti epileptics
b12

anticonvulsant

dialysis

malabsorbtion syndrome

dialysis

folic acid
activation

drugs

carrier

Blood

dialysis

drugs

tetrahydrofolate

Deficient absorbtion

2
0

carrier
activation

folic acid

malignancy , pregnancy and hemolytic anemia

requirements
CNS

B12

5
Clinical picture
Investigations

aminoacid

absolete

folic acid
glutamic

glutamic acid
FIGLU

FIGLU test
FIGLU

Histidine

chilling test

FIGLU

B12

Histidine

folic acid deficnecny

Urine

FIGLU
treatment
folic acid
underlying cause

B12
14

MCQ

Folic acid

=D

751

151

MCQ

Bone marrow failure Aplastic anemia

=D
Unipotent and pleuripotent
platelet and WBCs

RBCs

diamond blackfan syndrome

in one element
congenital

RBCS

phalanges 0
Renal failure

anti erythropoietin
TAR

BM

thumb

erythropoietein

Unipotent

Thumb

acquired

bronchogenic carcinoma or thymoma

wisckot Aldrich syndrome

platlet
syndrome
idiopathic

WBCs

.
Unipotent

BM

BM failure

Pleuripotent
failure
% 61

Idiopathic and drugs

corticosteroids
b cells
BM

idiopathic

B cells

autoimmune
T

T Cells

antibodies

anti emetic , antithyroid , antibiotic , antidiabetic

Antis

Drugs

infection , immunological, irradtion

tb and hepatitis
SLE

Infection

Immunological

leukemia and lymphoma Infiltration

myetophthitic anemia
=D

Infiltration of BM
benzene

chemicals
BM failure
Clinical picture
BM

FOG P
15

RBCs

bleeding tendency
severe up to septic shock

organisms

already

platlet

Infection

WBCs

CP of the cause
investigations
ESR

hematocrite

RBCs

normocytic normochromic
MCV & MCH normal

WBCs and platlets Inv of the cause

BM biopsy
biopsy

aspiration

Under local anaesthia

fibrosis of bone

aspiration

aspiration
fibrosis

BM aspiration

iliac crest

BM cavity

biopsy

marrow

Treatment
RBCs

platlets

WBCs

packed RBCs
platlet
WBCs

=D

WBCs

anti fungal , antibiotic and antiviral

antigen

androgen or erythropoietin

RBCs
danazol

granulocyte GCSF

stimulate BM
platlet

side effects

lithium

wbcs
stimulating factor
idiopathic

cyclosporine
0.5

stimulate BM

MCQ

Hemolytic anemia
021
proliferate

RBCs Normal
BM

S
Hemolytic anemia

shortening life span of RBCS

hemolysis

IF RBCs are destroyed before 120 day this called hemolysis

021
rbcs

hemolysis

Replace damaged cells

replacement but no anemia

BM

replacement and no anemia

.1
60
40

maximum capacity
replacement

bone marrow

LIFE span

replacement
hemolysis only 021

16

05

05

proliferate
anemia

05

life span

% 65

extra vascular

spleen and liver

RBCs
intravascular

RBCs

disease

% 65

hemolytic anemia

Extravascular

intravascular hemolysis

disease

Liver and spleen

RBCs

hepatosplenomegaly
ESR

RBCs

damage extravascular

RBCs extravascular

HT

FOG P

anemia

Bone marrow expansion

hair on end appearance wide medulla and thin cortex

heme

heme + globin
TIBC

iron

RBCs

BM

RBC s

XRay

hemeoglobin

iron

disease

LDH
Mongloid features

extravascular ,

iron

iron and protophorphyrin

Transferring saturation
neuritis

CNS

hemosiderosis

tissue

cardiomyopathy

CVS

abdomen
liver cirrhosis liver
interstitial lung fibrosis
renal tubular disfunction
damage testies , suprarenal and pituitary

urine

ID bilirubin

indirect bilirubin

urobilinogen

indirect

endocrine

lung
Kidney

genetalia

biliverdin

protoporphyrin

cinically jaundice , gall bladder stones

stercobilinogen in stool

hemolytic

disease extravscular

hepatosplenomegaly .. jaundice ,
LDH

ESR

extravascular
HT

RBCs
0

inv
urobilinogen ,

extravascular
0

Hematology
17

extravascular

disease
hemosidern
stercobilinogen

18

+.41q
Haematology

Hemolytic Anemia
Clinical picture
FOG P
crisis 3
hemolysis

hypoxia

hemolytic anemia

hemolysis

specific

1
2

Hemolytic crisis

sickle cell anemia

jaundice
BM

hemolytic anemia

megaloblastic crisis

megaloblastic crisis
depletion folic acid

folic acid ,

parovirus infection

hemoltic anemia
proliferating

Aplastic crisis

BM

BM
c.p of cause

Investigations
ESR

RBCs ,Hematocrite

MCV & MCH norml

2

Specific

Investigation of cause

Treatment

blood transfusion
megaloblastic crisi

B12

iron chelating agent

BM transplant
general rule
general rules
19

hemolytic anemia
approach to diagnose a patient with hemolytic anemia

RBCs

corpuscular and extracorpuscular

enzymes
hemoglobin

cell wall & hemoglobin

enzyme

hemolytic anemia
RBCs

corpuscular

cell wall

RBC

hemolysis

hereditary eliptocytosis PNH

hereditary spherocytosis

RBCs

cell wall

Hereditary Spherocytosis
RBCs

ankyrin and spectrin

NA

protein

NA-K ATPase pump

pump

Cell wall
wall RBC

squeeze and extend

RBCs

cell wall protein

defect

defect

hereditary spherocytosis
rigid

2ATP

At high Energy
High energy

ATP 4

energy production

spleen

ATP
rigid

pump

energy production

RBCs

hypoxia

wall

sinusoids

NA

pump
rupture

% 05

Autosomal dominant

disease

Clinical picture
FOG P
1
hemolytic , megalobasltic and aplastic crisis
positive family history
positive family

crisis 3

1
2
3

Cp of the cause

spontenous mutation
history

Investigation
ESR

RBCs ,Hematocrite

sphero and sicklecell anemia

Hyperchromic
hemolytic
stercobilinogen

serum iron

MCV

hyperchromic

heptaomegaly
spherocytes

20

ESR

specific

Treatment
Blood transfusion , folic acid, vit b 12
Iron chelating agent, splenectomy , BM transplantation
MCQ

spherocytosis

Paroxysmal nocturnal hemoglobinuria

paroxysmal nocturnal hemoglobinuria
complment
activate

Inactive

protein 9

antibody

activation

C3

Immune system

complement

C5,6,7,8,9

cell wall

activate C3

antigen
c4

Activate C4

antigen
pathway

classic pathway

activation

C3

activate C3

macrophage

acidosis

altenative pathway

C3

pypass

activated
wbcs

BM

GPI

stem cells

inhibitors

RBCs
surface

paroxysmal nocturnal hemoglobinuria

complement

activation

disease

WBcs RBCs platlet

complment activation
acidosis

hemolysis
hemolysis

hemolytic anemia

acidosis

severe exertion

nocturnal
ketoacidosis

hemoglobin daily

WBCs
thrombosis

starvation

hemolysis daily

iron deficncy
liable for infection

hemolysis

respiratory rate

hemolysis

iron deficincey

GPI

infection

CO2

lactic acidosis

acidosis

C5,6,7,8,9

complement
WBCs

GPI

activate C2

opsonization

RBCs

cells

C2

C1
C1

membrane attacking unit

C1&2
bacteria

activation

hemosiderosis

RBCs
platlets

Etiology
21

its a disease in which bone marrow is producing RBCs WBCs and platlet without GPI

ClinicalPicture
FOG P
Intravascular

Bony pain , fever , abdominal pain , jaundice

associated with 3 crisis

1
2
3

hemolysis on exposure to infection or acidosis

Specific

Clinical picture of the cause

.. leukemia % 20 .. Bone marrow failure % 20

liable for infection and thrombosis

investigation
ESR

RBCs ,Hematocrite

heptoglobin and hemopexin

+Ve schumms test

hemolysis

acid

sucrose

Ham test

RBCs

sucrose

Specific investigations

acid

hemolysis

acid

anaerobic metabolism

antigen
CD

Cluster of differentiation

CD

antigen

GPI
flow cytometry

detection

CD55 & CD59

antigen

CD

CD

PNH

CD55 & CD59

Treatment
anticoagulatns

hemolysis

acidic

splenectomy ?

injection

acidic

immune system

Blood transfusion , folic acid *

iron

iron or heparin IV

suppress

corticosteroids

G6PD deficiency
cell wall
G6PD enzymes
physiology
RBCs
damage
radicals

Oxygen free radicals

damage
RBCs

RBCs

body guard

Oxgen free radicals

cell wall protected by glutathione

RBCs

22

RBCs

RBCs

to RBCs cells wall

glutathione body guard

hydrogen

glutathione

hydrogen

NADPH

radicals

Hydrogen
NADPH

wall of

RBCs

RBCs
Glucose-6-phosphate dehydrogenase

oxygen free radicals

Intravascular

Glutathione will remain oxidized

Hydrogen

Heinz bodies

disease

damaged

females carriers
=D

NADPH

males affected

rBCs

X Linked

disease
x

Clinical picture
FOG P

1
2

Specific

crisis 3
male are affected
antimalarial drugs

Infection

oxygen free radicals

hemolysis
vit D injection

aspirin

3
severe hemolysis

fava beans

oxygen free radicals

favism

severe defiecney in enzyme Mediterranean type

mild deficiency so mild hemolysis Negros type

has 2 defect Favism

gene defect

G6PD deficncy

G6PD deficncy

G6PD deficncy

favism

Investigations
ESR
G6PD
deficiency

Heinz bodies

0 10 RBCs

RBCs ,Hematocrite

last attack at least

0

upnormal RBCs

Normocytic normochromic
inv of the cause

0
RBCs

Treatment
Vit b 12 and folic acid

Avoid pPt factor

Blood transfusion
Hepatosplenomegaly
G6PD

iron

intermittent hemolysis

Hemoglobinopathies
23

hemoglobin
heme + globin
alphe beta gamma and delta

polypeptide chain 4

adult hemoglobin
hemoglobin F

beta 2

alpha 2

gamma 2

alpha 2

hemoglobin A2
fetal hemoglobin to adult

globin

delta 2

alpha 2

Hemoglobin F
fetal

Intrauterine
hemoglobin
% 1 adult 97% of hemoglobin

Thalassemia
deficient in

semia

beta

alpha chain deficient

beta thallasemia

thalla

thallassemia

beta chain deficient

disease
one of the chains
thallasemia

beta thalaseemia
6

Intrauterine

alpha
hemoglobin f
gamma

beta chain
gamma chain

beta chain
gamma chain

hemoglobin F

gamma

microcytic hypochromic anemia

alpha chain >>
extravascular
,

precipitation
RBCs

alpha chain

RBCs
extravascular

Etiology
Clinical picture
FOG P

3 crisis
Cp of the cause
characterstic

Investigation
ESR

RBCs ,Hematocrite
Type : Microcytic hypochromic

24

hemoglobin adult

hemoglobin F & A2

Treatment
blood transfusion , BM transplantation , folic acid , gene therapy
thalassemia

serum

Microcytic hypochromic

2 genes

Beta chain

Thalassemia minor

Gene

.. % 2 1?

major

A2

iron

Sickle cell anemia

sickle cell
absent or deficient beta chain
valine

thallasemia

glutamic acid
6

aminoacid

IntraUterine

on exposure to

hemoglobin S

Abnormal beta structure *

adult hemoglobin

abnormal hemoglobin

sickle shape
liver and

sickle cell is abnormal beta chain

abnormal beta

alpha

traction on wall of rbc

hypoxia

occlusion BV

sickle cell
spleen

ClinicalPicture
FOG P
3 crisis
sequestration crisis

vasoocclusive

Infarction

crisis 2

sickle cell

retinak detachment

Vaso occlusive crisis

retina
stroke CNS

Heart

lUNg

splenic infarction Spleen

Myocardial infarction
lung infarction
autosplenectomy
by usual organism in unsual site
salmonella
thrombocytosis

Pnemococal peritonitis
autosplectomy

infection
pneumonia
salmonella ostomylitis

pnemococci
typhoid
platlet

25

CP of cause

microcirculation

renal

renal infarction

Diabetius inspedius

Diabetius inspedius
vasoocclusive crisis

antidiuretic hormone

avascular necrosis

sequestration crisis
we have

hypotension

GIT

Infarction neck of femur *

crisis

sudden pooling of blood to splanchnic area

no idea

Investigation
ESR

RBCs ,Hematocrite

Normocytic normochromic
slide

HbS

Hemoglobin electrophoresis
sickle cells

Hypoxia

Treatment

sequestration
gamma chain

azycitidne
gamma

crisis 2
fluids

blood

A2

gamma

sicke

6
alpha

gamma

thallasemia

sequestration

thallasemia

analgesics

MCQ

BM Transplant

beta abnormal
sickle

Blood transfusion
B12 & folic acid
Splenectomy ?

vasoocclusive crisis

essay

PNH

sickle

extracopuscular
hypersplenism

RBCs
autoimmune & alloimmune
malaria , gas gangrene

hypertension , microangiopathic hemolytic anemia

RBCs
immunological

infection
prothetic valve

mechanical

hypersplenism and immunology

Mechanical and microangipopathic .. M & M

Infection , lead poisning , snake venom ,
45

=D
45

26

RBCs
march hemoglobinura

15
RBCs

extracorpuscular hemolysis

antibodies against his own RBCs

RBCs

immune system

autoimmune warm and autoimmune

autoimmune

immune system

Antibodies against his own antigen

autoimmune
cold
Autoimmune warm

immune

leukemia , lymphoma and collagen disease

immune system
syphilis , mycoplasma
liver and spleen

antigen
EBV

RBCs

infection antigen

RBCs

immune system

IgG

idiopathic

system

idiopathic

cold

RBCs
IgG

Antigen

antigen
warm autoimmune

warm At normal body temp

IgM

complment system

RBCs

autoimmune cold

IgM
cold

RBCs

IgM

complment

RBCs

complment

IGM
warm
under normal tempruture >>

Clinical picture

FOG P

CP of underlying cause
extravascular hemolysis
thrombocytopenia
exposure to cold

warm hemolytic anemia

platlets

Antibodies

renauds phenomena

Warm

COLD

evans syndrome
spasm of vessels

Investigations
ESR

RBCs ,Hematocrite

In both

normocytic normochromic
detect antibodies aganst RBCs

combs test

test
cooling

27

IgG

IgM
positive

test

Treatment

blood transfusion and ttt of underlyin cause 2

cold

cold

corticosteroids

warm

immunosupressant

splenctomy
warm

hemolytic

erythropoietin

Polycythemia
polycythemia

polythycemia
6

RBCs

00

hematocrite
HB

36 ml/kg

male

ml/kg 32

3
RBCs

18 mg

155

increase in total red cell mass

% 32 polycythemia

Hemoglobin

dehydrated

female

3255
655

polycythemia

155

male

Blood

polycythemia vera

primary

RBCs

255

primary and secondry

Primary polycythemia polycythemia vera

skin proliferate until wound is healed

proliferating is proliferating under control

leukoocytosis

infection
proliferation under control

malignancy

apoptosis

proliferation

proliferate
RBCs , WBCs and platlets

apoptosis

mechanism
stem cells

apoptosis

malignancy

proliferate

mechanism

defect

B cell leukemia
Defect in apoptosis

28

mutation in JAK 2

apoptosis

Polycythemia vera
Bcl-XL

apoptosis

gene
JAK 2

stem cell without control

platlet

WBCS

proliferation

RBCs

proliferation is not under control

disease

viscosity of blood and blood volume

RBCs
Clinically

viscosity

pseudotumor cerebrii

retinal infarction

viscosity

MYocardial infarction

Brain edema

retinal edema
Viscosity

pulmonary infarction

BloodVolume

CNS
infarction
Eye

retinal vessel engorged

Hypertension and HF

volume

Heart

pulmonary edema

volume

Lung

Viscosity

Malabsorbtion and occlusion , hepatosplenomegaly GIT

cyanosis Skin ;
platlets

platlets

RBCs

viscosity

non functioning

DIC

bleeding

nucleas
purities

RBCs
non functioning

thrombosis ,

basophils

histamine

WBCs

basophils

proliferate with no

gout

peptic ulcer

uric acid

DNA

H2

H1

Invade tissue

leukemia

control

Investigations
ESR

Hematocrite

RBCs ,

WBCS Uric acid

Platelets
Histamine
Erthyropiotin

feed back inhibition

Treatment
dilution
anticoagulant

saline

Dextran

thrombosis

Venesection

non functioning

RBCS
platlet
cautiously

H1 Blocker

peptic ulcer

H2 blocker

gout

Allopurinol

WBCs

cryoheptidine
=D

chemotherapy

leukemia

symptomatic
buslphan

hydroxyl urea
phosphate

chemotherapy

leukemia
phosphate

radioactive phosphate IV

leukemia
29

11

control

radioactive phosphate

polycythemia vera
primary polycythemia or polycythemia vera

secondry
20 % Liver & 80 % kidney

kidney and liver

hypoxia

erythropoietin
hypoxia kidney

erythropoietin

erythropoietin

High altitude, COPD , congenital cyanotic heart disease ,

hypoxia kidney
hypoxia

erythropoietin

High altitude, COPD , congenital cyanotic heart disease ,

erythropoietin
RBCs

appropriate erythropoietin release

erythropoietin

kindey

hypoxia

hepatoma

renal artery stenosis

tumor in kidney

hypernephroma
polycythemia

erythropoietin

bronchogenic carcinoma and cerbellar hemangioblastoma

inappropriate erythropoietin release

secondry

erythropoietin
RBCs

primary
secondry

dehydration
A&B

RBCs WBCs platlets

false polycythemia

criteria of primary polycythemia

2A+2B

3A

Hematology
30

primary and secondry

polycythemia vera

primary

41q
Haematology

Drug induced anemia

RBCS

item

Drug induced anemia

Inumerate drug induce anemia
anemia
iron deficiency anemia
proton pump inhibitors , H2 blockers ,

drugs

iron deficiency
HCL

absorbtion

iron

achlorhydria

iron deficiency
iron

hemorrhage

over dose of anticoagulant

anticoagulant

bleeding
deficiency anemia

B6 metabolism
methotrexate

absorption

Inh
drugs

sideroblastic
folic acid

sulphonamide

antis

B12 & folic acid

activation

antibiotic antiepileptic antidiabetic antithyroid

aspirin , antimalarial or sulphonamides

anemia

and antiepileptic

Bone marrow failure

G6PD

hemolytic anemia
hemolysis

iron parentral
amphotercin

alpha methyl dopa

PNH

induce autoimmune hemolytic actions

B
by themselves can induce autoimmune hemolytic anemia

antigen
RBCs

incomplete antigen
antigen

immune system

HAptin

penicillin

antigen

Mention mechanism of anemia in the following disease

Liver cell failure
Leukemia
Renal failure

RBCs

Coagulation or homeostasis
coagulation or homeostasis
Mechanism by which the body stops bleeding

Mechanism

bleeding
hemorrhage

hemorrhage
platlets

BloodVessels

clotting system

BloodVessel
vasoconstriction

vasoconstriction

blood vessels

activated

BloodVessel

blood clotting system

stasis

bleeding

vasoconstriction
injury

sympathetic fibers nerve supply

injury

blood vessels

injury

Local axonal reflex

reflex vasoconstriction

irritation

serotonin

serotonin & Local axonal reflex

VC

response

platelets
platlets

megakryocytes

megakryocytes

BoneMarrow

budding
alpha and dense

granules

nucleas

Platelets

megakryocytes

granules
5

11
platelets

011

111

platlets

which means
Platelets

Platelets

wall of blood vessels

factor 8

VWbrandfactor

adhesions
wall

Injury

Glycoprotein receptor

receptor

endothelium
platelet
Platelets

platlet aggregatons

step

GP2b/3a

protein
fibrin

Prostaglandin
TXA2

ThromboxaneA2

aggregations

Prostaglandin

antiplatlet

aspirin
platelets aggregations

granules

granules

platelets

step of secretions

serotonin

VC

serotonin

aggregations
coagulation factors

clot

activation

wall

contents

ADP

Platelets

platelet factor 3

secretions

blood clot
clot

step

retractozyme
retractozyme
function of platelet

coagulation
not all of them

liver

factor 13

11 7 9 2
activation

1792

liver

not activated

endothelium

in contact with collagen

11 activate 7

7 activate

11

injury
activate 11

liver

activation

is lined be endothelium

endothelium

ca
vit k

?
collagen

coagulation

12

CoagulationFactors

blood vessels

endothelium

collagen

12 activate

collagen
calcium + Platelets factor 3 & 8
intrinsic pathway
component

3 9

11

3 9

tissues

Extrinsic pathway

not present in blood tissue factor

pathway

11

trauma
3

extrinsic

brain , prostate , placenta

very rich in tissue factor

common pathway
fibrinogen into

thrombin

pathway 2
prothrombin to thrombin
RBCs wbcs and platelet

tissue of the body

11
11

common pathway
fibrin

intrinsic and extrinsic and common pathway

fibrin

Anticoagulant system
anti- coagulation system

coagulation system

balamce
blood

extend

balance

thrombus

coagulation system
thrombus

anti coagulation

anti coagulant
vasoconstriction

antagonize

endothelium

vasodilatation

platelets

intrinsic pathway

extrinsic pathway

anti coagulation

prostacyclin

wall of bv
collagen

vessels

inhibition

endothelium

activation

endothelium

tissue factor inhibitor

endothelium

antithromibn 3

endothelium

common pathway

pathway 3

endothelium

fibrinolysis

tPA

anti coagulant
anti coagulant

coagulation factors

coagulation factor

liver

VIT K

liver

anti coagulant

VIT K

protein C & S

balance

anticoagulation factor

activated

factor activated
injury

liver

active factor

active

Basics
general rules

General Rules
coagulation
blood vessels , Platelets or coagulation factors

disease

etiology

purpra

blood vessels or Platelets

raised ,

color

red spots

Clinical picture
petechaie

red then brown the disappear

change

color changes
Platelets

bv
, bleeding gums perifollicular hemorrhage
hair follicles
without

spontenous

external hemorrhage
hemorrhage
hemorrhage

perifollicular hemorrhage epistaxis,

cerebral hemorrhage
Hemorhhage

petechie

anemia

trauma


disease

picture

ecchymosis and hematoma

anemia

coagulation

raised

ecchymosis

hemotpysis hematuria whatever

hematoma

petchiea more than 3 ml

external hemorrhage
internal hemorrhage

Internal hemorrhage

hemophilia

coagulation congenital

joint and muscles

hemoarthrosis

joint

congenital

hemorrhage

external and internal hemorrhage

hemorrhage

congenital

trauma

bleeding

hemorrhage

cutting umbilical cord

umbilical cord

detected

supplying baby
cp

bv and Platelets

epistaxis

hemoptysis and bleeding gum

clinically

overlap

bv and Platelets

hematoma

investigations not cp

petechie

hematologist

Investigations

blood vessels , coagulation or platelets or anatomical

ICU
tube

Open heart

ICU

011

pericardium

tube

011
medical
medical

suture

medical or surgical

complications
investigations

blood vessels , coagulation or platelets

bleeding time

1
bleeding time

=D
bleeding

platelet

same effect

Bleeding
blood vessels or Platelets
abnormal

prolonged
platelet count function

bleeding time

2- 4 minuits

blood vessels or Platelets

blood vessels

clotting time

clotting time

prolonged

bleeding time

in 5 10 minuits

surgical

anatomical ,

7 clotting time

coagulation

9 bleeding time
bV

2 bed side test

Platelets

blood vessels

Platelets

11
common

extrinsic

Intrinsic

collagen
7

coagulation

PTT

, , 7 activate 11

, 11 activate 12 activate 12

fibrinogen into fibrin

thrombin

coagulation

PT

PTT

collagen

intrinsic

ptt

3 9

blood clot

11

extrinsic and common

PT

3 9

brain
extrinsic

thrombin

prothrombin to thrombin

clotting time
PT abnormal

ptt

PT normal
common pathway

, intrinsic

clotting

PTT abnormal

Abnormal

PT normal

PTT abnormal

12

1221127
11
deficiency

test normal

11
50 mg

mg 11

ratio between PT
brain tissue
rabit

second 16
rabit

intrinsic

12

PT

rabit

activate

15 seconds

intrinsic

11

pathway

pathway

extrinsic

test

11 activate
blood clot

tissue factor

fibrinogen into fibrin

abnormal

11

PT

brain placenta and prostate

11

activate

30 seconds

brain tissue of rabbit

11

pathway

prothrombin to thrombin

intrinsic and common

pt and ptt

INR
12

PT

variable tissue factor

content

rabbit
brain tissue

tissue

brain tissue
10 PT

Tissue

11

11 PT
Tissue variable from one to another

41

Brain tissue

10

ratio

16

32

PT
12

20
2 INR

2
PT control

PT

=D 125 INR
2-3 times

PTT

INR

12

INR 2

3
20

PT

heparin

:D

Adjust heparin dose

PTT

Anticoagulant
fibrinogen le fibrin

PT

thrombin

normal

tesathrombin
fibrinogen bs
obsolete

clot

hess capillary fragilty test

Treatment
Bleeding tendency
Avoid trauma , avoid injury
Avoid unnecessary surgeries
Avoid aspirin

Vascular purpra
vascular purpra

blood vessels

Platelets

blood vessels

vascular purpra and platelet purpra

congenital or acquired

Platelets

purpra

blood vessels

vascular purpra

congenital
congenital weakness in wall of blood
features
blood vessels dilated

ehler danlos and marfan syndrome

ehler

telengectasia
vasoconstriction in response to trauma
GIT hemorrhage

marfan

typical

vessels

herediatary hemorrhagic telengectasia

blood vessels
response to trauma is vasoconstriction

Acquired
I M
blood vessels
vit c deficnecy

scurvy

acquired

hypertension
collagen

acquired

Mechanical

Mesenchymal weakness

scurvy , perifollicular
old age

hemorrhage
steroid ttt and cushing

fast food
I
plague

Infections

SLE

collagen disease

Inflammation

henoch schonlein purpura

Immunological

very common in female

Idiopathic

Henoch schonlein purpura

Henoch schonlein purpura
Antibodies

rheumatic fever

upper airway infection

story of

immune complex

blood

blood vessels
antigen

heart

Antibodies

complex

against organism

Rheumatic fever

rheumatic fever

vasculitis
IgA
it doesnt take that

11 3

Henoch schonlein

IgG& IgM

Henoch schonlein

vessels

Rheumatic fever

Rheumatic fever
long time

Clinical picture
3

petechie

Purpra

blood vessels

buttocks

color changes

cerebral hemorrhage

internal and external hemorrhage

external hemorrhage
periarticular
arthritis

Internal and external hemorrhage

internal hemorrhage

D.D of intusseption

red hot tender

joint

GIT
joint

hemorrhage

rheumatic fever
spontenous without trauma
glomeruli

blood vessels

glomerulonephritis

hemorrhage

characterstic

nephritic syndrome and renal failure

Investigations
Bleeding time
Normal PT,PTT, Platelet count
RBCs cast in urine
specific

Treatment
corticosteroids
Platelets

blood vessels

Platelets defect
3
Thrombocytopenia
Thromboasthenia
Thromobcytosis
decrease in Platelets count

Thrombocytopenia

defect in function

Thromboasthenia
Thromobcytosis

212111

1112111

Platelets

Thrombocytopenia
Platelets

count

Platelets

1112111
Platelets

Platelets
surgery

pooling

Bone marrow failure

Platelets < 60.000

enough above 50.000

1112111

512111
dilution

712111
Platelets

minor surgery

destruction

1112111

production

Platelets
Platelets

production

production

drugs

pancytopenia

b12 & Folic acid deficiency

diuretic

immunological

splenomegaly

destruction

autoimmune or alloimmune
against

AB

autoimmune

thiazide

incompatible blood transfusion

antibodies

immunological
AB

Alloimmune

my own platelets
evan syndrome , alpha methyl dopa ,
Platelets

ITP
AB

warm hemolytic anemia Autoimmune

%9 0

allergy
platelets

Heparin induced thrombocytponea

IgG

heparin

population

Thrombosis

thrombosis

alpha methyl dopa , ITP and evan syndrome

thrombotic thrombocytopenic purpra , hemolytic uremic syndrome
destruction
BM

DIC

AUtoimmunie and alloimmune

increase destruction

destruction

reticulcytes

decr prod

BM
platlets

destruction

decrease productin

Platelets

platelets

incr or dec

BM

low Platelets count

decrease production

pooling
211 at any moment Platlet

pooling
311

311
splenomegaly

incr or decr

pooling

spleen

Platelets

211
211

spleen

blood

91

spleen

splenomegaly

91
Platelets

platelets

131

spelnomegaly

hypothermia

111

count actually normally

hypothermia

pooling

spleen

we have no idea

splenomegaly or hypothermia

spleen

pooling

dilution
fresh flood
dilution of

Platelets

Platelets

5
ca

platelet thrombocytopenia

2 units of platelets

massive blood transfusion

plaltlet
platelets

dilution of platelets

massive blood transfusion

Causes of thrombocytopenia
ITP

ITP Idiopathic thrombocytopenic purpra

idiopathic
Budding of megakayocytes
complex

BM
receptors

ITP
IgG

ITP

IgG Antibodies

macrophage

spleen
platelets

IgG

Platelets

macrophage

Platelets

budding

AB

Clinical picture
CP
petechia <3 ml doesnt blanch , not raised
cerebral hemorrhage

external hemorrhage and internal hemorrhage

spontenous

children

acute

within 3

acute and chronic ITP

specific

spontenous remission
mild

mild

severe thrombocytopenia

middle age

females

remission and excarebation

chronic ITP
Mild :D

month

thrombocytopenia

remission and exacerbation

Investigation
Bleeding time
Platelets count
normal clotting time PT ,PTT
IgG
Specific inv

megakaryocytes wth defective budding

Treatment
Avoid trauma , avoid injury
Avoid unnecessary surgeries
corticosteroids

mild hemorrhage
cerebral hemorrhage
Antibodies

Platelets

bleeding

temporary we are just buying time

you are just buying time

receptors of macrophages

permenant treatment
danazole

fever

Ab

ITP
lymphoma and leukemia

pooling

aplastic anemia

spleen

splenomegaly or Lymphadenopathy or
IgG

Plasma pharesis
splenectomy

budding

Ab

Antibodies

cyclosporine

ITP

IV immunoglobulins

ITP

ITP

splenomegaly

exclusion
splenomegalo

lyphadenopathy
platelet

ITP

splenomegaly
splenomegaly
ITP

Thromboasthenia
Platelets

function
VWBF

function

defect

Thromboasthenia

glycoptn recptor

Platelets

adhesions
adheiosn

deficeny
inhibition

congenitally

endothelium

toxins

VWB disease
RenalFailur

VWBF

failure

congenital or uremia
adhesion

Bernard

release VWBF
congenitally

congenitally

receptors

VWBF

platelet

thromboxane and adenosine

aggregations

aggregation

VWBF

receptors

aggregations

fibrin

2B

receptor

aggregations
fibrinogen

congenital afibrinogenia

diphosphate
Afibrinogenmia

fibrin

fibrinogen
congenitally

glanzman disease

1911

receptors

congenital

Dysphybrinogenima

receptors

congenital

receptor

Aspirin
antiplatlet

aggregation

fibrin

thromoxane A2

clopidogrel

ADP
angina

platelets
granules

afibrinogenima

BM

Tirofiban

angina and myocardial infarction

glanzman disease

3 adhesions

toxins prevent its release

glycoptn

defect

storage disease
secretions

granules

secretions
secreting stage

angina :D

granules

Thrombocytosis
primary ya secondry

Platelets

thrombocytosis

chronic myelocytic leukemia

polycythemia vera

primary
leukemia

essential hypertension
primary thrombocytosis
Platelets primary

essential thrombocytosis

Platelets

bleeding tendency

non functioning

bleeding tendency
hemorrhage hemolysis bonemarrow irritation

Platelets
non functioning

splenectomy

secondry
Platelets are function

thrombocytosis
ITP causes of asthenia

just causes

causes of thrombocytopenia causes of thrombocytosis

decr production

Platelets

destruction of platelet

Coagulation defect Hemophilia A

hemophilia a , b , parahemophilia,

congenital

congenital and acquired

coagulation
7 . 9 .11.13

Hemophilia A
VWB 1

factor 8 antihemophilic globulin

activate 7

7 activate

11

Platelets adhesion

< 11 activate

1
endothelim

12 intrinsic pathway

Liver
ca & factor 8

VWBF

antihemophilic globulin ,

liver

intrinsic

11
factor 8

disease

urine
antihemophilic globulin
Intrinsic pathway
males affected , females carrier

VWBF
hemophilia a

X linked

antihemophilic deficecny is hemophilia a

Clinical picture
joint

red , hot and tender

Ecchymosis , hematoma external hemorrhage *

joints
congenital
Hemorrhage

joint

ankylosis and fixation of joint

nerve

calcification

hematoma in muscles

cut of umbilical cord or circumcision >>

following trauma

Hemorrhage

family history

carrier

female

paternal uncle

maternal uncle

Investigations
ptt

intrinsic

Bleeding time normal

Clotting time prolonged
pt or ptt

pathway
211 51

1
mild

specific
01 25
moderate

5-25

sever

1-5

very severe

<1

DNa analysis

intrauterine

Treatment
Avoid truma

Avoid unnecessary operations

:D
hemophilic

31

15ml/kg

plasma

051

12

risk of hepatitis and

volume overload

1
051

15X30 ..

711
infections

factor 8 resistance

antibodies

antigen

active bleeding

factor 8 resistance

cryoperciptate
IV

room tempreture
=D

31

1
volume overload

volume

genetic engineering
bleeding

periceptate

cryo

crypoerciptate

hepatitis and aids and factor 8 resistance

thrombin

thrombin

compression

externally

thrombin

Thrombin

VonwilleBrand Disease
urine

factor 8 VWB

VWB disease
actually

platelet count normal

prolonged bleeding time

investigations

plasma and cryo

endothelium

ADH
MCQ
hemophilia A

Hematology

ptt prolonged

ADH

desmopressin

Hemophilia

VWB disease
7