General Aspects of

Blood and Hemopoietic

system

Lu, jizhou
Department of Blood
 Background knowleges
1. Blood system
(1) The composition of blood system
(2) The differentiation of blood cells
2. The types of blood diseases
 General view of normal hematopoiesis

Hematopoietic stem cell s

mixed myeloid progenitor cells lymphoid progenitors

pronormoblast monoblast myeloblast megakaryoblast lymphoblast

erythrocytes monocytes granulocytes platelets lymphocyte

 Properties of HSC
• High self-renew capacity
• Multiplotential precursor
Immunophenotype of HSC
 The classfication of blood diseases

1. Erythrocyte diseases
2. Leukocyte diseases
3. Hemorrhagic diseases
4. Thrombotic diseases
5. Blood Transfusion reaction
 Common Manifestations
• Anemia
• Hemorrhage
• Infections
• Others:You will meet anything in my
department.
 Lab Examinations
• Blood routine test
• Bone marrow test
• Phenotype test
• Chromosome test
 Anemia
• Definition
• Classifications
• Manifestations
• Diagnosis
• Therapy
 Definition
• The term anemia, as it generally is used
in clinical medicine, refers to a
reduction below normal in the
concentration of hemoglobin or red
blood cells in the blood.
 Important
Anemia is one kind of
‘syndrome’ rather than
‘disease’
 Normal range of RBC,Hb,Ht

• RBC Adults Male: 4.0~5.5×1012/L

Female: 3.5~5.0×1012/L
Infants 6.0~7.0×1012/L
• Hb Adults Male: 120~160g/L
Female: 110~150g/L
Infants 170~200g/L
• Hematocrit 0.40~0.50L/L
 WHO Criteria diagnosing anemia
• According to the diagnostic criteria of anemia
worked out by WHO, Hemoglobin concentration
of 130g/L, 120g/L considered the lower limits of
normal, at sea level, in adult men and women,
110g/L in 6 months old to 6 years old children,
120 g/L in 6 to 14 years old children, 110g/L in
pregnant women.
 Classification
(1) According to the progressive rate of anemia
①acute anemia
②chronic anemia
(2) According to the morphologic characteristic of red
cells, mainly according to MCV and
MCHC .(morphologic classification)
① macrocytic anemia
② normocytic anemia
③ microcytic anemia
 Classification
(3) According to the severity of anemia
①mild anemia
②moderate anemia
③severe anemia
④very severe anemia
(4) According to the cellularity of BM
①Hyper-cellular anemia
②Hypo-cellular anemia
 Classification
(5) According etiology of anemia .
① Impaired erythrocyte production
② More destruction of erythrocyte
③ Loss of blood
 Classification
(1)According to the morphologic characteristic of red
cells, mainly according to MCV and MCHC .
① Macrocytic anemia
MCV>100um3 Folic acid deficiency and VitaminB12 deficiency
anemia.
②Normocytic anemia
MCV=80~100um3 Aplastic anemia, the majority of hemolytic
anemia ,anemia with chronic disorders (such as chronic
inflammation , infection, hepatic diseases, connective diseases.
malignant tumors, etc.).
③Microcytic –hypochromic anemia
MCV<80um3 MCHC<32% Iron-deficiency anemia , Sideroblastic
anemia , thalassemia trait ,etc
 Classification
(2) According to the etiology and pathogen of anemia .
A. Impaired erythrocyte production
a. Insufficiency of hemopoietic materials
Iron-deficiency anemia
Megaloblastic anemia
b. Failure of hemopoietic function
Aplastic anemia
Anemia with chronic disorders
Sideroblastic anemia
 Classification
B. More destruction of erythrocyte (Hemolytic anemia)
a. Intrinsic-defect of erythrocyte
Hereditary: Hereditary spherocytosis
Enzyme –deficiency anemia
Thalassemias
Acquired: PNH(paroxysmal nocturnal hemoglobinuria)
b. Extrinsic-defect of erythrocyte
Immunohemolytic anemia
Mechanical trauma: microangiopathic hemolytic anemia
Hemolytic anemia result from physical, chemical or
biological
C. Loss of blood.
 Manifestations
The clinical manifestations of anemia depend on 3 factors:

a. The magnitude and rate of reduction in the oxygen-carrying

capacity of the RBCs.
b.The capacity of the cardiovascular and pulmonary systems to
compensate for the anemia.
c.The associated manifestations of the underlying disorders
that resulted in the development of anemia.
 Manifestations

The symptoms, signs of anemia can

involve all of the systems, as follows:
A. Weakness.
B. Skin. Pallor can be the most evident sign of anemia,
but many factors can affect the skin color.
 Manifestations
C. Cardiorespiratory system.
a. In many patients, respiratory and circulatory
symptoms are noticeable only after exertion or
excitement, however, when anemia is sufficiently
severe, dyspnea and awareness of vigorous or
rapid heart action maybe noted even at rest.
 Manifestations
b. When the anemia is very severe and prolonged,
the congestive heart failure may occur
c. The rate and depth of respiration often increase
d. Heart murmurs is a common cardiac sign
associated with edema.
e. Electrocardiographic changes. The most
common changes are ST junction depressed
 Manifestations
D. Central nerve system:
Headache, vertigo, tanintus, faintness, lack of mental
concentration, drowsiness, restlessness.
E. Gastrointestinal systems:
Anorexia, nausea, constipation, etc.
F. Genitourinary systems:
In the severe anemia, there maybe slight
proteinuria. The female patients may occur
excessive menstruation or hypomenorrhea. Both
in male and female, there will occur sexual desire
decrease.
G. Other signs:
such as fever, hemoglobinemia ,
hemoglobinuria.
济宁医学院附属医院血液科
 Diagnosis
• Diagnostic Steps of Anemia
Existence of anemia→Summary of the clinical and
laboratory charateristics →Clinical and morphologic
classification →Pathological classification→ （ If
necessary ） tentative treatment to definite the cause of
anemia 。
 Diagnosis

Diagnostic Clues:
• History.
• Physical examination.
• Adjuvant laboratory tests.
 Diagnosis
—— History
• The initial time, duration and manifestations of anemia
• Dietary habit, gastrointestinal conditions, nutritional conditions
• Acute and chronic hemorrhagic diseases, such as excessive
menstruation, hemorroids and melena
• Other chronic diseases, such as hepatic diseases, nephrotic
diseases, tuberculosis, chronic inflammation and tumor.
• Menstruation and pregnancy history
• Exposure to chemical, toxic substances and radiation
• Parasitic diseases
 Diagnosis
—— Physical Examinations
• Signs of malnutrional and deficieny of hematopoietic
materials
• Signs of hemolysis
• Signs of malignancy
• Signs of bone marrow failure
• Signs of function deficiency of various organs
 Diagnosis
—— Laboratory tests
• Blood Regular Test

① Hemoglobin and RBC

-----The most reliable index for diagnosing anemia

② MCV 、 MCHC 、 MCH

③ Reticulocyte

-----A very important index for diagnosing anemia

 Diagnosis
• Bone marrow
①Cellularity
②Percentage of various cell lines and
various cell stages
③Cell morphology
④Abnormal cells
⑤Parasites

★Multiple sites ， Bone marrow biopsy

 Diagnosis
• Other laboratory tests
Urine RT ， Stool OB 、 Stool parasite ， Liver and
kidney function 、 X-Ray 、 Endoscope ；

MICM for leukemia

Biochemistry ， Immunology ， Hemolytic tests.
 Therapy
• Eliminating the cause of anemia
• Correct anemia
 Key points
• The definition of anemia
• The diagnostic criteria of anemia worked
out by WHO
• The classification of anemia