- Review
- Blood
- Formed elements
- Plasma
- Hemopoiesis
- process of making the formed elements of blood
- stem cells
Stem Cell
Stem Cell Stem Cell Stem Cell
Progenitor Cell Progenitor Cell Progenitor cell
Any RBC Any WBC Platelet
- Erythropoiesis
- Formation of RBC’s
- Final maturation in blood (reticulocytes)
- Iron => Hemoglobin
Vitamin B12 => RBC maturation
- Controlled by erythropoietin (EPO)
Stem Cell
Erythrocyte progenitor Cell
GF EPO
Reticulocyte
EPO
Erythrocyte
- Leukopoiesis
- Formation of leukocytes (WBC’s)
- Neutrophil, Basophil, Eosinophil & Monocyte
- regulation depend on growth factors (GF)
Stem Cell
GF
Granulocyte/Monocyte progenitor
Granulocyte progenitor Monocyte progenitor
GF
GF
Neutrophil Basophil Eosinophil Monocyte
- Thrombopoiesis
- Formation of platelets
- Fragmentation
- lifespan = 3 days
- control by two growth factors
Stem Cell
Megakaryocyte progenitor cell
GF
Megakaryocyte
Thrombopoietin (IL-6)
Thrombocyte
- Coagulation
- hemostasis => process of stopping blood loss
- coagulation => convert fluid blood into a non-flowing gel
- Fibrin => protein filaments
- Thrombin => break fibrinogen into fibrin
Prothrombin XIIi
Fibrinogen Thrombin
XIIa
Fibrin Crosslinked
fibrin mesh
- Extrinsic Pathway
- Intrinsic Pathway
- Vitamin K => Synthesis of fibrinogen and prothrombin
- vonWillebrand Factor => Platelet plug
- Bleeding Disorders
- Platelet or clotting factor
- Platelet Disorders
- Thrombocytopenia
- insufficient circulating platelets
- Decrease production
- radiation/chemotherapy
- tumor
- alcohol
- folic acid, Vitamin B12 deficiencies
- Increased clearance
- non-immune
- Clotting Factor Disorders
- vonWillebrand’s Disease
- autosomal dominant
- transfusion with vWF
- Hemophilia
- X-linked
- transfusion of defective factor
- Hemophilia A => defect of factor VIII
- Hemophilia B => defect of factor IX
- Impaired Hepatic Synthesis
- liver damage => clotting factors made in blood
- lack of Vitamin K (absorption of Vitamin K is bile dependent)
- Erythrocyte Disorders
- polycythemia => increased # of RBC’s
- anemia => decreased Hg or decreased # of RBC’s
- Anemia
Hg
blood O2 transport capacity
arteriolar dilation cardiac output erythropoietin anaerobic metabolism
blood flow RBC production
- Impaired Erythrocyte Production : Marrow
- Pure Red Cell Aplasia
- Abnormal erythrocyte progenitor cells
- Aplastic Anemia
- pancytopenic disorder
- bone marrow transplant
- Impaired Erythrocyte Production : Deficiencies
- inadequate supply or excessive loss
- Iron Defieciency
- Vitamin B12 deficiency
- required for normal DNA synthesis (must get from diet!)
- pernicious anemia => decrease in intrinsic factor (IF)
- Folic acid deficiency
- Hemolytic Anemia : Intrinsic
- hereditary defects that promote hemolysis
- Sickle Cell
- abnormal hemoglobin (HgS)
- course variable
- sickle cell trait
- Thalassemia
- a
or b
- major => two defective alleles
- minor => one defective allele
- Polycythemia
- increase in red cell concentration
- Absolute Polycythemia
- overproduction of erythrocytes by the marrow
a) secondary polycythemia => due to response to EPO
1) Tumor
2) High Altitude exposure
3) Smoking
- primary polycythemia
- increase stem cell production with no increase in EPO
- benign tumor of the marrow
- polycythemia vera
- thickened blood
- increased coagulation
- Relative Polycythemia
- increased hematocrit but RBC # is normal
- decreased plasma
- dehydration, extensive skin burns
IV) Leukocyte Disorders
- Leukopenia => The general deficiency state
- Leukocytosis => non-neoplastic elevation of white cell numbers
- Leukemia => Neoplastic proliferation of leukocytes
- Lymphoma => Solid malignant tumors arising in the cells of lymphoid tissue
(lymphocytes & their precursors)
- Leukopenia
- most condition of WBC depletion involves neutropenia
Tumor Therapy Drug Immune Effects
Various Drugs Hypersplenism
Marrow Tumor Growth production clearance Autoimmune effects
B12/Folate
Neutropenia
Leukocytosis
- increased leukocyte count
Polymorphonuclear leukocytosis Acute inflammations
Basophilic leukocytosis Lung Malignancies
Eosinophilic leukocytosis Allergic disorders, skin disorders
Parasite/Fungal infections
Monocytosis Lupus, Rheumatoid Arthritis
TB, Crohn’s disease
Lymphocytosis Acute viral infections, TB
C) Leukemia
- aleukemic leukemia => when proliferation is confined to the marrow
- Pathogenesis
Neutropenia Infection
Disruption of normal Anemia Bleeding
marrow function
Thrombocytopenia Impaired
Hemostasis
Excessive leukocyte Local bone invasion Pain
precursor growth
Splenomegaly
Metastasis Hepatomegaly
Other systemic effects
- Classification
Leukemia
Acute Chronic
Myeloid Lymphocytic Myeloid Lymphocytic
(AML) (ALL) (CML) (CLL)
- Acute Lymphocytic Leukemia
- Acute Myeloblastic Leukemia
- Chronic Lymphocytic Leukemia
- Chronic Myeloblastic Leukemia
Stem Cell
Stem Cell Stem Cell Stem Cell
Progenitor Cell Progenitor Cell Progenitor cell
Any RBC Any WBC Platelet
Stem Cell
Erythrocyte progenitor Cell
GF EPO
Reticulocyte
EPO
Erythrocyte
Stem Cell
GF
Granulocyte/Monocyte progenitor
Granulocyte progenitor Monocyte progenitor
GF
GF
Neutrophil Basophil Eosinophil Monocyte
Stem Cell
Megakaryocyte progenitor cell
GF
Megakaryocyte
Thrombopoietin (IL-6)
Thrombocyte
Prothrombin XIIi
Fibrinogen Thrombin
XIIa
Fibrin Crosslinked
fibrin mesh
Hg
blood O2 transport capacity
arteriolar dilation cardiac output erythropoietin anaerobic metabolism
blood flow RBC production
Tumor Therapy Drug Immune Effects
Various Drugs Hypersplenism
Marrow Tumor Growth production clearance Autoimmune effects
B12/Folate
Neutropenia
Neutropenia Infection
Disruption of normal Anemia Bleeding
marrow function
Thrombocytopenia Impaired
Hemostasis
Excessive leukocyte Local bone invasion Pain
precursor growth
Splenomegaly
Metastasis Hepatomegaly
Other systemic effects
