بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. BLOOD

3. Composition: suspension of cells in a complex liquid (plasma) Plasma:* H2O + organic molecules + mineral salls * After coagulation (- Fibrinogen) = serum Blood Cells: * R.B. C * W. B. C. * platelets. Origin: Site: *In the embryo (Liver, Spleen, Bone marrow) * After birth (only in the Bone marrow) * Lymmphoid tissues (B.M., L.N., Spleen, Payer's patches)

5. HEMOPOIESIS • 1-Erythropoiesis: • The erythroblastic line represents 10 -30% of the bone marrow cells. • 2-Steps of maturation: It take 7 days under normal condition. • 1- Erythroblast (pronormoblast) • 2-Basophilic Normoblast • 3- Polychromatic normoblast. • 4-Orthochromatic normoblast. • 5-Reticulocyte • 6- R. B. C

7. 4-In Cases or Urgent Blood Loss: E.g.: - after haemolytic attack - after Hge 1- Hypersecretion of erythropoietin 2- Augmentation of no. of erythroblasts in B. M. resulting in: 3- Acceleration of Hb. synthesis normal corpuscular conc. or Hb. occurs early decrease the number of cell divisions between stage of erythroblast and reticulocytes -- reduction of duration of erythropoiesis to 3-4 days. N.B as a result of Hyper secretion of the erythropoietin and acceleration of Hb. synthesis. Hypererythropoiesis occurs.

8. HYPERERYTHROPOIESIS a- Increase in number or reticulocytes in the peripheral blood b- presence of immature R.B.CS (polvchromatophilia ) c- Macrocytosis. (duo to reduction of number of mitoses between proerthroblasts and Reticulocytes) d- Some orthochromatic normoblasts may be found in the peripheral Blood

9. 5-Exogenous Factors necessary for Erythropoiesis: 1-Iron 2-Folic acid and Vitamin B12

10. EXAMINATION OF THE BLOOD: COMPLETE BLOOD PICTURE (C.B.C.) A-QUANTITATIVE EXAMINATION: 1-Quantitative Exam. of the RBCS with its constituents: a- R.B.Cs no./mm3: Male 4.5 – 6.2 x 106 Female & Child: 4 – 5.4 x 106 Infant 3.6 – 5 x 106 at Birth 5 – 6 x 106

11. b-Hematocrite: (relative volume of R.B.CS in the blood) - By centrifugation of a small column of blood in a standard tube: Male40 - 54 % Female35 - 47 %

12. c- Hb. Content of 100 cc blood: Male13 - 18 gm/100cc Female & Child: 12 - 16 gm/100cc Infant 12 - 16 gm/100cc at Birth 14 - 20 gm/100cc

15. f- Reticulocytic count: - Normal life span of RBCs = 120 days - Reticulocytes are the newly fabricated RBCs within the 1st 24 hours (still containing cytoplasmic organelles) i.e. --- by special stain --- counting the no. of RBCs containing such organells among 1000 RBCs in %. - Absolute no. of reticutocytes: = RBCs count X reticulocytic %. * normal 25.000 ----- 100.000/mm3 (l-2 %) For Hb content within the normal range. * with anaemia increase in no. of the reticulocytes , if there is a normal ability of the B.M. to synthesis RBCs i.e., If Hb <= 8 gm in regenerative anaemia (e.g., haemolytic or post Hgic) -- reticulocytic count must be > 100.000 . If < 100.000 this means aregnerative, i.e., ( hypoplastic or aplastic ) anaemia.

16. 2 - Quantitative Exam. of WBCS: Normal 4.000 --- 10.000/mm3 in adults Infants 1st year 5.000 - 20.000 /mm3 2nd year 6.000 – 17.000 / mm3 10 years 5.000 --- 13.000/mm3 N.B. In adult. * > 11.000 indicates leucocytosis­ * < 4.000 indicates leucopenia.

17. 3-QUANTITATIVE ESTIMATION OF PLATELETS: Normal l50.000 - 450. 000/mm3 < 150,000 indicates thrombocytopenia. >450.000 indicates thrombocytosis

18. B- MORPHOLOGIC EXAMINATION: RBCs Morphological exam. of RBCs. WBCS Differential white cell count. I- Morphologic Examination of RBCs: Normally : RBCs are of * same form * same colour * same diameter. Any abnormality Pathological condition: * in size : anisocytosis * in form: poikilocytosis

19. II- Differential white cell Count: -The absolute no. more important than the %

20. Polymorphonuclear Neutrophils: * 40 – 70% of WBCS (1700 - 7000) * Function: The main Function is phagocytosis of foreign bodies esp. Bacteria

21. Granulopoiesis: It takes 10 days under normal conditions 50 -70 % of B. M. cells - Myeloblasts 2.3 % - Promyelocytes 4-8% - Myelocytes 10-15% - Metamyelocytes15-20% - Polynuclearcells20-30% * Life span: in the circulation is very short within 12 hours . 50% of formed neutrophils leave the blood to the tissues and don't turn back again.

22. In cases of excess demand: Rapid passage of neutrophils to the blood from the marrow resulting in the release of band forms, even metamyelocytes and myelocytes.

23. Polymorphonuclear leucocytosis: Due to increase polymorphonuclear neut. i.e.> 7000/ mm3 1- Reactional: a- physiologic: - Neonates - Severe exercise - Menestruation - Pregnancy

24. b- Pathologic: - Bacterial infections - Inflammatory diseases : (Arthritis - Allergic ) - Tissue necrosis e.g., rnyocardial Infraction, pancreatitis - Heavy smokers. - Acute hemorrhage or hemolysis - Intoxication (radiation, benzene) - Start of chronic myeloid leukemia - Without cause

25. 2- Myeloproliferative disorders: as Chronic Myeloid 1eukemia Neutropenia: means that Neutrophils < 1700 / mm3, It is due to either: 1- Insufficient production (central): A- As a part of Pancytopenia: e.g., aleukemic leukemia or aplastic amenia B- Isolated: 1- Hereditary form. 2- Allergy to certain drugs 3- Direct central inhibition e.g., henothiazine 4- Constitutional agranulocytosis.

26. 2- Hyperdestruction (peripheral): - Auto immunisation - Lupus Erythromatosis . Usually with thrombocytopenia - Felty's syndrome # But espe. in moderate cases (i.e. 800- 1700) we must exclude : -Some parasitic infections (kala Azar) - Some bacterial infections (typhoid, Brucellosis) - Some viral infections (Viral hepatitis) - May be normal esp. in black races.

27. Eosinophiles: * Functions: (not exactly known) - phagocytosis : Ag- Ab complex - Transport the plasminogen - Play a role in destruction of certain larvae - Has a role in allergy

28. Eosinophilia: means eosinophils > 300/mm3 but more significant if > 500/mm3 causes: 1- Allergic conditions: - Asthma, - Allergy to certain drugs as penicillin's. 2- parasitic infections: Filariasis, Ascaris, Oxyuris, Taeniasis. 3- Polyarteritis nodosa 4- Dermatosis­ 5- Malignancy: - H.D - certain cancers (Liver, Ovary)

29. Basophils: * Function: - Unknown. - Rich in histamine and heparin - Play a role in delayed hypersensitivity reaction If >1 % = pathologic conditions: 1- Myeloproliferative syndromes esp. C.M.L 2-Severe hyperlipidaemia 3- Hypothyroidism

30. Monocytes: - The largest circulatory blood cells, have: * characteristic Nuclear shape, * Longer life span than other WBCs (2-3 days) Function: 1- phagocytosis : Play a role in defence mechanism In tissues --- Macrophages 2- Play a role in immunologic reactions

31. Monocytosis: means monocytes > 1000 /mm3: 1- reactional: - infections: (bacteria, virus parasites) - At the recovery of agranulocytosis 2- Acute monocytic leukemia, chronic myelomonocytic leukemia 3- Isolated chronic Monocytosis : ­rare as in refractory anaemias at the start of acute monocytic Leukemia, and chronic myelomonocytic eukemia.

32. Lymphocytosis: • Means increased number of lymphocytes above the upper limit of normal (> 4000 – 4500/cumm in adults , > 6000- 7000 , cu mm in neonates and infants. • Causes: • Viral infections : hepatitis, measles, infective mononucleosis • Bacterial infections : brucellosis , T.B., whooping cough. • Malignant lymphocytosis : Chronic lymphatic leukemia and Waldestron’s macroglobulinemia.

33. Thank you