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Hematology and Immunology

Hematology is the medical specialty


that studies the anatomy and
physiology of the blood and uses
diagnostic tests, medical and surgical
procedures, and drugs to treat blood
diseases.

Hematology and Immunology


Immunology is the medical specialty
that studies the anatomy and
physiology of the lymphatic system
and uses diagnostic tests, medical
and surgical procedures, and drugs
to treat lymphatic and immune
response diseases.

Figure 6-1 Lymphatic system

Anatomy and Physiology (contd)


The Blood
Contains blood cells, blood cell
fragments, water, and other substances
(proteins, clotting factors, etc.)
Transports oxygen, carbon dioxide,
nutrients, and waste products
Contains cells that also function as part
of the immune system

Anatomy and Physiology (contd)


The Lymphatic System
Consists of the lymphatic vessels, lymph
fluid, lymph nodes, lymphoid tissues,
and lymphoid organs
Forms a pathway throughout the body
that is separate from that of the
cardiovascular system that contains the
blood
Defends the body against
microorganisms and cancerous cells

Anatomy of the Blood


Plasma
Clear, straw-colored liquid (about 90%
water) that makes up 55% of the blood.
The formed elements of the blood
(erythrocytes, leukocytes, and platelets)
are suspended in the plasma.

Anatomy of the Blood (contd)


Plasma (contd)
Contains substances the body produces
itself such as: albumin, bilirubin,
hormones, complement proteins, and
clotting factors.
Contains creatinine and urea, which are
waste products of cellular metabolism.

Figure 6-2 Plasma

Anatomy of the Blood (contd)


Erythrocytes
Most numerous of the formed elements
in the plasma
Red blood cell that is a round, somewhat
flattened, red disk
Unique because, unlike other body cells,
they have no cell nucleus when they are
mature

Figure 6-3

Hematopoiesis.

Figure 6-4 Erythrocytes


Andrew Syred/Photo Researchers, Inc.

Anatomy of the Blood (contd)


Erythrocytes (contd)
Contain hemoglobin, a red, ironcontaining molecule that binds to
oxygen molecules to form
oxyhemoglobin.
Hemoglobin carries oxygen from the
lungs to every cell in the body, and
carries carbon dioxide from the cells
back to the lungs.
Hematopoiesis, the process by which all
blood cells are formed, occurs in the red

Anatomy of the Blood (contd)


Erythrocytes (contd)
Very immature cells are known as stem
cells.
Erythrocyte stem cells mature to
become erythroblasts and then
normoblasts.

Anatomy of the Blood (contd)


Erythrocytes (contd)
Do not have a nucleus, so they cannot
divide or repair themselves.
Last 120 days before they begin to
deteriorate.
Specialized cells (macrophages) break
down erythrocytes hemoglobin into
heme and globins.

Anatomy of the Blood (contd)


Erythrocytes (contd)
Iron stripped from heme molecules is
stored in the liver and the spleen; the
remainder of heme molecules is
converted to bilirubin.
Bilirubin plays an important role as an
antioxidant, protecting body cells from
damage by free radicals.

Anatomy of the Blood (contd)


Leukocytes
White blood cells that include five types
of cells (neutrophils, eosinophils,
basophils, lymphocytes, and monocytes)
Can be identified by the presence or
absence of granules in their cytoplasm
and the shape of their nucleus

Anatomy of the Blood (contd)


Leukocytes (contd)
Leukocytes with large granules in their
cytoplasm are categorized as
granulocytes, which include neutrophils,
eosinophils, and basophils.
Leukocytes with few or no granules in
their cytoplasm are categorized as
agranulocytes, which include
lymphocytes and monocytes.

Anatomy of the Blood (contd)


Neutrophils
Most common leukocyte, making up 40
to 60% of leukocytes in blood
Categorized as granulocytes
Nucleus has many segments or lobes, so
they are also known as
polymorphonucleated leukocytes
(PMNs), polys, segs, or segmenters

Anatomy of the Blood (contd)


Neutrophils (contd)
Develop in the red marrow
Engulf and destroy bacteria
(phagocytosis)
Live only a few days or even just a few
hours if they are actively destroying
bacteria

Figure 6-5 Neutrophil

Anatomy of the Blood (contd)


Eosinophils
Make up just 1 to 4% of leukocytes
Categorized as granulocytes; also
known as eos
Nucleus has two lobes
Develop in the red marrow
Engulf and destroy foreign cells (pollen,
animal dander, etc.)
Release chemicals that kill parasites

Figure 6-6 Eosinophil

Anatomy of the Blood (contd)


Basophils
Least common leukocyte, making up 0.5
to 1% of leukocytes
Categorized as granulocytes; also
known as basos
Nucleus has more than one lobe
Develop in the red marrow
Release histamine at the site of tissue
injury
Release heparin, an anticoagulant

Figure 6-7 Basophil

Anatomy of the Blood (contd)


Lymphocytes
Make up 20 to 40% of leukocytes.
Categorized as agranulocytes and are
the smallest leukocytes; they are also
known as lymphs.
Nucleus is round and nearly fills the cell.
Some lymphocytes live for just a few
days, while others live for many years.

Anatomy of the Blood (contd)


Lymphocytes (contd)
Begin development in red marrow; some
become B cells or natural killer cells;
others migrate to the thymus to become
T cells
Present in the blood and lymph nodes;
destroy viruses and produce antibodies

Figure 6-8 Lymphocyte

Anatomy of the Blood (contd)


Monocytes
Make up 2 to 4% of leukocytes
Categorized as agranulocytes and are
the largest leukocytes; also known as
monos
Have a large amount of cytoplasm, and
nucleus is large and kidney bean shaped
Develop in the red marrow

Anatomy of the Blood (contd)


Monocytes (contd)
Are phagocytes that engulf and destroy
microorganisms, cancerous cells, dead
leukocytes, and cellular debris.
Monocytes in the lymph nodes,
intestine, liver, pancreas, thymus,
spleen, bone, and skin are known as
macrophages.

Figure 6-9 Monocyte

Table 6-1 Leukocyte Types and Characteristics

Table 6-1 (continued) Leukocyte Types and Characteristics

Anatomy of the Blood (contd)


Thrombocytes
Different from other blood cells because
they are only cell fragments
Active in the blood-clotting process
Begin in the red marrow as stem cells
that then become megakaryoblasts, and
then mature into megakaryocytes, a very
large cell
Cytoplasm of the megakaryocyte breaks
away at the edges to form cell fragments
(thrombocytes) that are released into the
blood

Anatomy of the Blood (contd)


Blood Type
Most important blood types are the ABO
and Rh blood groups
ABO blood group contains A, B, AB, and
O antigens

Table 6-2 ABO Blood Group

Anatomy of the Blood (contd)


Blood Type (contd)
Rh blood group has 47 different antigens
Rh is positive when antigens are present
on erythrocytes
Rh is negative when antigens are not
present on erythrocytes

Figure 6-10 A unit of blood


Shout Pictures/Custom Medical Stock Photo, Inc.

Physiology of Blood Clotting


Platelet aggregationThrombocytes
form clumps to decrease blood loss
CoagulationBlood clot forms
HemostasisCessation of bleeding
When clotting factors in the plasma
are activated to form a blood clot,
the fluid portion of plasma that
remains is known as serum.

Figure 6-11 Blood clot


Susumu Nishinaga/Photo Researchers, Inc.

Table 6-3 Blood Clotting Factors

Table 6-3 (continued) Blood Clotting Factors

Anatomy of the Lymphatic System


Lymphatic Vessels, Lymph, and
Lymph Nodes
Lymphatic vessels are similar in
structure to blood vessels, but with
several important differences.
Begin as tiny lymphatic capillaries in the
tissues.

Anatomy of the Lymphatic System


(contd)
Lymphatic Vessels, Lymph, and
Lymph Nodes (contd)
End in ducts that empty into large veins
in the neck.
Tissue fluid enters a lymphatic capillary
and becomes lymph, the fluid that
circulates through the lymphatic system.

Anatomy of the Lymphatic System


(contd)
Lymphatic capillaries have large
openings in their walls that allow
microorganisms and cancerous cells
to enter.
Lymphatic capillaries become larger
lymphatic vessels that bring lymph to
the lymph nodes.
Valves keep the lymph flowing in one
direction.

Anatomy of the Lymphatic System


(contd)

Lymphoid Organs (contd)


Grouped together in chains in areas
where there is a high risk of invasion
by microorganisms or cancerous cells.
Lymphatic vessels end at ducts in the
thoracic cavity: right lymphatic duct
and thoracic duct.
Both lymphatic ducts then empty into
large veins in the neck.

Figure 6-12

Lymphatic system

Anatomy of the Lymphatic System


(contd)
Lymphoid Tissues
Contain lymphocytes and macrophages
that are active in the immune response
Tonsils and adenoids in the oral cavity
Appendix and Peyers patches in the small
intestine

Anatomy of the Lymphatic System


(contd)
Lymphoid Organs
Thymus is located within the
mediastinum and helps lymphoblasts
mature into T lymphocytes
Spleen is located on left side of
abdominal cavity and is the largest
organ in the lymphatic system
Spleen removes old erythrocytes from
the blood

Anatomy of the Lymphatic System


(contd)
Lymphoid Organs
Spleen also acts as storage area for
whole blood, which is released into the
circulatory system during times of
danger or injury

Diseases and Conditions


Blood
Blood dyscrasia
Hemorrhage
Pancytopenia
Septicemia

Diseases and Conditions (contd)


Erythrocytes
Abnormal red blood cell morphology
Anemia

Aplastic anemia
Folic acid deficiency anemia
Iron deficiency anemia
Pernicious anemia
Sickle cell anemia

Figure 6-13 Microcytic, hypochromic erythrocytes


Joaquin Carillo Farga/Photo Researchers, Inc.

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Figure 6-14 Sickle cell


Eye of Science/Photo Researchers, Inc.

Figure 6-15 Sickle cells in a capillary

Diseases and Conditions (contd)


Erythrocytes (contd)
Anisocytosis
Poikilocytosis
Polycythemia vera
Thalassemia
Transfusion reaction

Diseases and Conditions (contd)


Leukocytes
Acquired immunodeficiency syndrome
(AIDS)
Leukemia
Mononucleosis
Multiple myeloma

Figure 6-16 Human immunodeficiency virus


Chris Bjornberg/Photo Researchers, Inc.

Figure 6-17 Acute lymphocytic leukemia


Peres/Custom Medical Stock Photo, Inc.

Diseases and Conditions (contd)


Thrombocytes
Coagulopathy
Deep venous thrombosis (DVT)
Disseminated intravascular coagulation
(DIC)
Hemophilia
Thrombocytopenia

Figure 6-20 Deep venous thrombosis

Diseases and Conditions (contd)


Lymphatic System
Graft-versus-host disease (GVHD)
Lymphadenopathy
Lymphedema
Lymphoma
Hodgkins lymphoma
Non-Hodgkins lymphoma

Splenomegaly
Thymoma

Figure 6-19 Lymphadenopathy


Custom Medical Stock Photo, Inc.

Diseases and Conditions (contd)


Autoimmune Disorders
Diabetes mellitus, type 1
Graves disease
Hashimotos thyroiditis
Inflammatory bowel disease
Multiple sclerosis

Diseases and Conditions (contd)


Autoimmune Disorders (contd)
Myasthenia gravis
Psoriasis
Rheumatoid arthritis
Scleroderma
Systemic lupus erythematosus

Laboratory and Diagnostic Procedures


Blood Cell Tests
Blood type
Complete blood count (CBC) with
differential
Peripheral blood smear

Table 6-4 Complete Blood Count (CBC) with Differential

Table 6-4 Complete Blood Count (CBC) with Differential

Laboratory and Diagnostic Procedures


(contd)
Coagulation Tests
Activated clotting time (ACT)
Partial thromboplastin time (PTT)
Prothrombin time (PT)

Laboratory and Diagnostic Procedures


(contd)
Other Blood Tests
Blood chemistries
Ferritin

Figure 6-20 Blood chemistry analyzer


Alvis Upitis/Jupiter Images PictureArts Corporation/Brand X Pictures Royalty
Free

Laboratory and Diagnostic Procedures


(contd)
Other Blood Tests (contd)
Human immunodeficiency virus (HIV)
tests
ELISAFirst screening test done for HIV
Western blotUsed to confirm a positive
ELISA and make a diagnosis of HIV infection
Viral RNA load testMeasures tiny amounts
of HIV RNA and monitors progression of the
disease and response to antiretroviral drugs

Laboratory and Diagnostic Procedures


(contd)
Other Blood Tests (contd)
Human immunodeficiency virus (HIV)
tests (contd)
p24 antigen testDetects the protein p24 in
HIV
CD4 countUsed to monitor the progression
of the disease and response to antiretroviral
drugs

Total iron-binding capacity (TIBC)

Laboratory and Diagnostic Procedures


(contd)
Saliva Test
OraSure
Quick screening test that is done in the
doctors office or clinic. It uses the same
technology as the ELISA blood test.

Laboratory and Diagnostic Procedures


(contd)
Serum Tests
Electrophoresis
Monospot

Laboratory and Diagnostic Procedures


(contd)
Urine Tests
Bence Jones protein
Schilling test

Laboratory and Diagnostic Procedures


(contd)
Radiologic Procedures
Color flow duplex ultrasonography
Lymphangiography

Medical and Surgical Procedures


Medical Procedures
Bone marrow aspiration
Phlebotomy
Vaccination

Figure 6-21 Phlebotomy


Getty Images Photodisc-Royalty Free

Medical and Surgical Procedures (contd)


Blood Donation and Transfusion
Procedures
Blood donation
Blood transfusion

Medical and Surgical Procedures (contd)


Blood Donation and Transfusion
Procedures (contd)
Bone marrow transplantation (BMT)
Plasmapheresis
Stem cell transplantation

Figure 6-22 Stem cell


Dr. Yorgos Nikas/Photo Researchers, Inc.

Medical and Surgical Procedures (contd)


Surgical Procedures
Lymph node biopsy
Lymph node dissection
Splenectomy
Thymectomy