BLOOD

55%
plasma

45%
cells

Red Blood Cells- RBC ((Erythrocytes))

White Blood Cells-WBC (( Leucocytes))
Platelets (( thrombocytes))

These are the blood cells

which we need to synthesize
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Hemopoiesis

- ?Q 3.&4. Where & When

A. Prenatal (i.e. Fetus) :Up to 6 weeks ( yolk sac)

6 weeks -- 6 months ( Liver & spleen)
6 9 months ( bone
marrow )

B. Postnatal :*. Infants: Bone marrow ( practically all

bones)
*. Adults: Bone marrow (central skeleton )
sternum, vertebrae, ribs, skull,
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sacrum , pelvis
& proximal ends of

Remember
Under special abnormal conditions
in post-natal life ( e.g. B.M. failure )
#.

Liver & spleen may resume

their fetal hemopoiesis i.e.

( extra-medullary Hemopoiesis)
#. Fatty marrow(Long bones) may
reverse to hemopoiesis leading to
expansion of hemopoiesis down the long
bones ( B. M. expansion )
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--?Q5.How
Hemopoietic stem Cells (HSC) (CD34+ CD38-)
Pluri-potent SC in bone marrow

Myeloid SC

Lymphoid SC
RBC

Other WBC

LYMPHOCYTES

One HSC is capable of producing

mature blood cells 6 10 ~

PLATELET

. Myeloid: Erythroid ratio [M:E ratio] in B.M

Reference range
~ 3:1
Myeloid
Stem Cells

-Pro
normoblast
Early
normoblast
Intermediate

Myeloblast
-Mono
blast

normoblast
Late
normoblast
Reticulo
cyte

RBC

Pro
-mono
cyte
-Mono
cyte

Pro-myelocyte

Myelocyte

-Mega
-Karyo
blast
-Mega

-karyo
cyte

Meta-myelocyte

Band
Granulocytes

Platelet
Pls refer to
haemostasis

Pro-normoblast

The earliest recognizable erythroid cell

S.: diameter 163 m
N/C ratio: 4 / 1
C.: Deep blue basophilic (?) & no granules
N.: large round nucleus with red-purple
finely stippled chromatin & 1-2 nucleoli
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Why
Cytoplasm of pronormoblast
stains
?deep blue basophilic

The deep blue basophilic

cytoplasm reflects the RNA
activity needed to produce the
protein ( i.e. globin ) needed for
haemoglobin synthesis.
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Early normobl.

Interm normobl

Late normobl.

S.

142 m

13 2 m

112 m

N/C

3/1

1/1

1/3 or less

C.

still basophilic

start of
Hb. synthesis

increasing
Hb--ization

N.Ch. Condensed

forming
coalescent clumps

(basophilic)

more clumped

(polychromatic)

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N. is smaller,
darker
& eccentric

(orthochromic)

Reticulocytes
C Routine stain

S.: diam. 8 1 m

No nucleus

supra-vital stains
e.g. new methylene blue stain

Polychromasia characteristic reticular appearance

dt remaining RNA

Normal
Reticulocyte Count

to 2.5 % of RBCs in adults & children 0.5

to 6.0 %
in infants & cord 2.0
blood

It ripens in the spleen & PB (through loss of its

remaining RNA to
become RBC). Normal maturation
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 Fully- hemoglobinized,
biconcave , flexible &
squeezable hard-working
mature cells
Life-span 1207 days
##Diameter
~71 m
##Volume (MCV) 8610 fl
Hb (MCH) 302 pg
Stains deep at periphery &
pale in the center.
This area of central pallor is
~ one third of diameter.
fl (femtolitre) =10-15 L
pg (picogram)=10-12 g
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Normal

RBC

Normocytic
Normochromic

Cell

##IMP

15 m
N/C 5/1
C: pale blue
N chromatin: fine
<5% of normal marrow
Usually larger
N/C 4/1or less
N chrom.: denser
Gr. Specific (neutrophil,
eosinophil or basophil)
N chrom.: thick strands
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Myeloblast

Ni Gr.
C.
N

+ 1-5

Promyelocyte

+ +
1-3

Myelocyte

1ry

- +
2ry

Cell

##IMP

N: Kidney-shaped
or indented
N.Chr.: more condensed
Smaller
N. U-shaped
N.Chr.: coarse & clumped
N Neutroph - (2 to 4 seg.)
Eosino- & Basoph - bi- lobed
Gr Eosinoph - (orange)
Basoph (deep blue)
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Meta-myelocyte

Band form

Segmented

Monocyte
##The largest WBC in the normal PBS
##predominant cell Neutrophil
C. ground-glass &voluminous with vacuoles
fine azuro-philic granules
N. folded with thready chromatin
Turns into macro-phage in tissues
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L/Group12

Stromal cells r major source of growth factors except for:

a. Erythropoietin, 90 % of which is synthesized in kidney.
b. Thrombopoietin, made

largely in
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liver.

Remember

In Stem Cell Transplantation

(SCT)

Stem cells from

B.M.donor
r injected in patient [B.M.
recipient]

I.V. ( just like Blood Transfusion )

& by their receptors they r
directed to
migrate to B.M. looking for their
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CBC
Peripheral
Blood smear
(PBS)

Q7.Routine

Diagnostic Tools
in
Hematology

bone marrow
aspiration
bone marrow
trephine biopsy

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CBC

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fl (femtolitre) = 10-15 L

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pg (picogram) =1 0-12 g

Peripheral Blood Smear (PBS)

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Peripheral Blood Smear (PBS)

Bone Marrow Aspiration

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Bone Marrow
Trephine Biopsy

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##Absolute
count

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L/Group12

L/Group12

Anemia (s)
Reduction in Hb.Conc.
Red Cell count
below normal
for age and sex
Is a Hb conc. of 12 g/dL anemia?

Hb

(g/dL)
Male
13-17
(152)

Female
12-15
(13.5 1.5)
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Anemias
di-phospho- 2,3
glycerate

O2

DPG 2,3

Anemia
HYPOXIA
Re-distribution

Delivery

COMPENSATORY
MECHANISMS

.C.O
cardiac
output

Plasma
PATHOPHYSIOLOGY
OF ANEMAIS

For specific
features
Pls, refer to different
types
of anemia in text
Gastro-intestinal
System

Central Nervous System

General

Cardio-Respiratory
System

Genito-urinary
System

Anemias
ETIOLOGIC
Classification
ACUTE
normocytic normochromic

CHRONICrefer to IDA
microcytic hypochromic

Hemorrhagic
anemia (s)

II
Dys-hemopoietic
Anemia (s)
Deficiency

Non
deficiency

III
Hemolytic
anemia (s)

Abnormalities of
RC

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Abnormalities of
RC
environment

Anemias

MORPHOLOGIC
Classification
I
Normocytic
Normochromic

II
Microcytic
Hypochromic
anemia (s)

IDA
Thalassemi
as
1/3 ACD

anemia (s)

2/3 ACD

III
Macrocytic
anemia (s)

Megaloblastic
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