Lecture 1: Hematology (Theoretical)

Hematology

Shukur wasman smail

PhD student in Immunology

Pathological Analysis Department

Paitaxt Technical Private Institute
2020-2021
 INTRODUCTION

The word hematology comes from the Greek haima

(means blood) and logos (means discourse); therefore,
the study of hematology is the science, or study, of
blood. Hematology encompasses the study of blood
cells and coagulation. Included in its concerns are
analyses of the concentration, structure, and function of
cells in blood; their precursors in the bone marrow;
chemical constituents of plasma or serum intimately
linked with blood cell structure and function; and function
of platelets and proteins involved in blood coagulation.

The study of blood has a very long history. Mankind

probably has always been interested in the blood, since
primitive man realized that loss of blood, if sufficiently
great, was associated with death. And in Biblical
references, “to shed blood” was a term used in the
sense of “to kill”.

Before the days of microscopy only the gross

appearance of the blood could be studied. Clotted
blood, when viewed in a glass vessel, was seen to form
distinct layers and these layers were perceived to
constitute the substance of the human body. Health and
disease were thought to be the result of proper mixture
or imbalance respectively of these layers.

Microscopic examination of the blood by Leeuwenhoek

and others in the seventeenth century and subsequent
improvements in their rudimentary apparatus provided
the means whereby theory and dogma would gradually
be replaced by scientific understanding.

Currently, with the advancement of technology in the

field, there are automated and molecular biological
techniques enable electronic manipulation of cells and
detection of genetic mutations underlying the altered
structure and function of cells and proteins that result in
hematologic disease.
 Hematology

CHAPTER ONE
BLOOD
Chapter One: 1.Composition blood
Blood is a circulating tissue composed of fluid plasma and cells. It is composed
of different kinds of cells (occasionally called corpuscles); these formed
elements of the blood constitute about 45% of whole blood. The other 55% is
blood plasma, a fluid that is the blood's liquid medium, appearing yellow in color.
The normal pH of human arterial blood is approximately 7.40 (normal range is
7.35-7.45), a weak alkaline solution. Blood is about 7% of the human body
weight, so the average adult has a blood volume of about 5 liters, of which 2.7-3
liters is plasma. The combined surface area of all the red cells in the human
body would be roughly 2000 times as great as the body's exterior surface.

confined to blood are called plasma proteins. These

proteins play a role in maintaining proper blood osmotic
pressure, which is important in total body fluid balance.
Most plasma proteins are synthesized by the liver,

2
Hematology

including the albumins (54% of plasma proteins),

globulins (38%), and fibrinogen (7%). Other solutes in
plasma include waste products, such as urea, uric acid,
creatinine, ammonia, and bilirubin; nutrients; vitamins;
regulatory substances such as enzymes and hormones;
gasses; and electrolytes.

Formed elements
The formed elements of the blood are broadly classified
as red blood cells (erythrocytes), white blood cells
(leucocytes) and platelets (thrombocytes) and their
numbers remain remarkably constant for each individual
in health.

I. Red Blood Cells

They are the most numerous cells in the blood. In
adults, they are formed in the in the marrow of the bones
that form the axial skeleton. Mature red cells are non-
nucleated and are shaped like flattened, bilaterally
indented spheres, a shape often referred to as
”biconcave disc” with a diameter 7.0-8.0m and
thickness of 1.7-2.4m. In stained smears, only the
flattened surfaces are observed; hence the appearance
is circular with an area of central pallor corresponding to
3
Hematology

the indented regions.

They are primarily involved in tissue respiration. The red

cells contain the pigment hemoglobin which has the
ability to combine reversibly with 02. In the lungs, the
hemoglobin in the red cell combines with 02 and
releases it to the tissues of the body (where oxygen
tension is low) during its circulation. Carbondioxide, a
waste product of metabolism, is then absorbed from the
tissues by the red cells and is transported to the lungs to
be exhaled. The red cell normally survives in the blood
stream for approximately 120 days after which time it is
removed by t h e phagocytic cells of t h e
reticuloendothelial system, broken down and some of its
constituents re utilized for the formation of new cells.

II. White Blood Cells

They are a heterogeneous group of nucleated cells that

are responsible for the body‟s defenses and are
transported by the blood to the various tissues where
they exert their physiologic role, e.g. phagocytosis.
WBCs are present in normal blood in smaller number
than the red blood cells (5.0-10.0  103/l in adults).
Their production is in the bone marrow and lymphoid
tissues (lymph nodes, lymph nodules and spleen).
4
Hematology

There are five distinct cell types each with a

characteristic morphologic appearance and specific
physiologic role. These are:
 Polymorphonuclear leucocytes/granulocytes
o Neutrophils
o Eosinophils
o Basophiles
 Mononuclear leucocytes
oLymphocytes
oMonocytes

 Fig. 1.1 Leucocytes

5
Hematology

Polymorphonuclear Leucocytes

Polymorphonuclear Leucocytes have a single nucleus

with a number of lobes. They Contain small granules in
their cytoplasm, and hence the name granulocytes.
There are three types according to their staining
reactions.

Neutrophils

Their size ranges from 10-12m in diameter. They are

capable of amoeboid movement. There are 2-5 lobes to
their nucleus that stain purple violet. The cytoplasm
stains light pink with pinkish dust like granules. Normal
range: 2.0-7.5 x 103/l. Their number increases in acute
bacterial infections.

Eosinophils

Eosinophils have the same size as neutrophils or may

be a bit larger (12-14m).There are two lobes to their
nucleus in a "spectacle" arrangement. Their nucleus
stains a little paler than that of neutrophils. Eosinophils
cytoplasm contains many, large, round/oval orange pink
granules. They are involved in allergic reactions and in
combating helminthic infections. Normal range: 40-400/
l. Increase in their number (eosinophilia) is associated
with allergic reactions and helminthiasis.
6
Hematology

Basophils

Their size ranges from 10-12m in diameter. Basophiles

have a kidney shaped nucleus frequently obscured by a
mass of large deep purple/blue staining granules. Their
cytoplasmic granules contain heparin and histamine that
are released at the site of inflammation. Normal range:
20-200/l. Basophilia is rare except in cases of chronic
myeloid leukemia.

Mononuclear Leucocytes
Lymphocytes
There are two varieties:
 Small Lymphocytes
Their size ranges from 7-10m in diameter. Small
lymphocytes have round, deep-purple staining
nucleus which occupies most of the cell. There is
only a rim of pale blue staining cytoplasm. They
are the predominant forms found in the blood.

 Large Lymphocytes
Their size ranges from 12-14m in diameter.
7
Hematology

Large lymphocytes have a little paler nucleus than

small lymphocytes that is usually eccentrically
placed in the cell. They have more plentiful
cytoplasm that stains pale blue and may contain a
few reddish granules. The average number of
lymphocytes in the peripheral blood is 2500/l.
Lymphocytosis is seen in viral infections especially
in children.

Monocytes

Monocytes are the largest white cells measuring 14-

18m in diameter. They have a centrally placed, large
and „horseshoe‟ shaped nucleus that stains pale violet.
Their cytoplasm stains pale grayish blue and
contains reddish blue dust-like granules and a few clear
vacuoles. They are capable of ingesting bacteria and
particulate matter and act as "scavenger cells" at the
site of infection. Normal range: 700-1500/l.
Monocytosis is seen in bacterial infections. (e.g.
tuberculosis) and protozoan infections.

III. Platelets

These are small, non nucleated, round/oval cells/cell

fragments that stain pale blue and contain many pink
granules. Their size ranges 1-4m in diameter. They

8
Hematology

are produced in the bone marrow by fragmentation of

cells called megakaryocytes which are large and
multinucleated cells. Their primary function is
preventing blood loss from hemorrhage. When blood
vessels are injured, platelets rapidly adhere to the
damaged vessel and with one another to form a platelet
plug. During this process, the soluble blood coagulation
factors are activated to produce a mesh of insoluble
fibrin around the clumped platelets. This assists and
strengthens the platelet plug and produces a blood clot
which prevents further blood loss. Normal range: 150-
400 x 103 /l.

1.2 Function of blood

Blood has important transport, regulatory, and protective
functions in the body.

 Transportation
Blood transport oxygen form the lungs to the cells of the
body and carbon dioxide from the cells to the lungs. It
also carries nutrients from the gastrointestinal tract to
the cells, heat and waste products away from cells and
hormones form endocrine glands to other body cells.

9
Hematology

 Regulation
Blood regulates pH through buffers. It also adjusts body temperature through
the heat-absorbing and coolant properties of its water content and its variable
rate of flow through the skin, where excess heat can be lost to the environment.
Blood osmotic pressure also influences the water content of cells, principally
through dissolved ions and proteins.

 Protection
The clotting mechanism protects against blood loss, and certain phagocytic
white blood cells or specialized plasma proteins such as antibodies, interferon,
and complement protect against foreign microbes and toxins.

10