Hematology Lab Rotation

By
Dr. Gulzar Alam
Ph.D. (Pathology & Pathophysiology)
 Hematology
• Hematology is a branch of medicine concerning the study of blood, blood-
forming organs such as bone marrow, and blood-related disorders and
diseases.
• Hematologic analysis is often used for the diagnosis and treatment of animal
diseases
• Hematologists and hematopathologists are highly trained healthcare
providers who specialize in diseases of the blood and blood components.
These include blood and bone marrow cells.
• Four major areas of study within hematology include hemoglobinopathy,
hematologic malignancies, anemia and coagulopathy.
 Blood
• Blood is a liquid connective tissue that consists of cells surrounded by a liquid
extracellular matrix.
• The extracellular matrix is called blood plasma, and it suspends various cells and
cell fragments
• It has a slightly alkaline pH ranging from 7.35 to 7.45.
• The color of blood varies with its oxygen content. When saturated with oxygen, it
is bright red. When unsaturated with oxygen, it is dark red.
• Blood constitutes about 20% of extracellular fluid, amounting to 8% of the total
body mass.
• The blood volume is 5 to 6 liters (1.5 gal) in an average sized adult male and 4 to
5 liters (1.2 gal) in an average-sized adult female.
 Functions of Blood

1. Transportation.
• Blood transports oxygen from the lungs to the cells of the body and carbon
dioxide from the body cells to the lungs for exhalation.
• It carries nutrients from the gastrointestinal tract to body cells and hormones from
endocrine glands to other body cells.
• Blood also transports heat and waste products to various organs for elimination
from the body
 2. Regulation
• Circulating blood helps maintain homeostasis of all body fluids.
• Blood helps regulate pH through the use of buffers (chemicals that convert strong
acids or bases into weak ones).
• It also helps adjust body temperature through the heat absorbing and coolant
properties of the water in blood plasma and its variable rate of flow through the
skin, where excess heat can be lost from the blood to the environment.
• In addition, blood osmotic pressure influences the water content of cells, mainly
through interactions of dissolved ions and proteins.
 3. Protection

• Blood can clot (become gel-like), which protects against its excessive loss from
the cardiovascular system after an injury.
• In addition, its white blood cells protect against disease by carrying on
phagocytosis.
• Several types of blood proteins, including antibodies, interferons, and
complement, help protect against disease in a variety of ways
 Components of Blood
Whole blood has two components:
• (1) Blood plasma, a watery liquid extracellular matrix that contains dissolved
substances, and
• (2) Formed elements, which are cells and cell fragments. If a sample of blood is
centrifuged (spun) in a small glass tube, the cells (which are more dense) sink to the
bottom of the tube while the plasma (which is less dense) forms a layer on top
• Blood is about 45% formed elements and 55% blood plasma. Normally, more than
99% of the formed elements are cells named for their red color—red blood cells
(RBCs). Pale, colorless white blood cells (WBCs) and platelets occupy less than 1% of
the formed elements.
Components of Blood in a Normal Adult
 Blood Plasma
• When the formed elements are removed from blood, a straw-colored liquid called blood
plasma (or simply plasma) is left.
• Blood plasma is about 91.5% water and 8.5% solutes, most of which (7% by weight) are
proteins
• Hepatocytes (liver cells) synthesize most of the plasma proteins, which include the
albumins (54% of plasma proteins), globulins (38%), and fibrinogen (7%).
• Certain blood cells develop into cells that produce gamma globulins, an important type
of globulin. These plasma proteins are also called antibodies or immunoglobulins
• Besides proteins, other solutes in plasma include electrolytes, nutrients, regulatory
substances such as enzymes and hormones, gases, and waste products such as urea, uric
acid, creatinine, ammonia, and bilirubin
 Formed Elements
• The formed elements of the blood include three principal components: red blood cells
(RBCs), white blood cells (WBCs), and platelets .
• RBCs and WBCs are whole cells; platelets are cell fragments.
• RBCs and platelets have just a few roles, but WBCs have a number of specialized
functions.
• Several distinct types of WBCs
• Granular WBCs (contain conspicuous granules that are visible under a light microscope
after staining) which are neutrophils, eosinophils and basophils
• Agranular WBCs(no granules are visible under a light
• microscope after staining) which are Monocytes, T and B lymphocytes and natural killer
(NK) cells
• The percentage of total blood volume occupied by RBCs is called the hematocrit. The
normal range of hematocrit for adult females is 38–46% for adult males, it is 40–54%
because of testosterone hormone,
Formed Elements of Blood.
Structure and Gross Anatomy Bone marrow
• Bone marrow itself is a spongy, jelly-like material found in the center of bones, in a space
called the medullary cavity.
• The cavity is surrounded and protected by a hard layer called the periosteum,
• It is separated into a vascular section and non-vascular sections.
• Vascular section: contains blood vessels that supply the bone with nutrients and transport
blood stem cells and mature blood cells away from the bone and into circulation.
• Non-vascular section: where hematopoiesis (blood cell formation) occurs.
 Function of Bone Marrow
• Bone marrow serves a crucial function for the body, producing bone marrow stem cells
and blood products.
• There are two main types of bone marrow, and they each perform specific roles.
• Red bone marrow, also called myeloid tissue, is made up of fibrous tissue that contain
hematopoietic cells, or blood-forming stem cells.
• All red blood cells and platelets in adults are formed within red bone marrow, as well as
60% to 70% of white blood cells. lymphocytes, begin formation in red bone marrow and
then become fully mature in other parts of the body like the thymus, spleen, and lymph
nodes
• White blood cells have a lifespan of hours to days, platelets must be replaced after about
10 days, and red blood cells can last for roughly 120 days
• Yellow bone marrow is fattier and is home to mesenchymal or marrow stromal cells.
These are the stem cells that produce the body's connective tissues like fat, cartilage,
muscle, and bone cells.
• Yellow bone marrow also stores fat and nutrients for red bone marrow to use and to
maintain body functions.
Abnormal Conditions Associated with Bone Marrow
• When there is a problem with the production of or function carried out by bone
marrow, the effects are widespread. Here are some of the problems that can
arise within bone marrow:
• Leukemia: Leukemia is a cancer of the blood, where the bone marrow
produces abnormal white cells.
• Aplastic anemia: In this disease, the bone marrow does not produce red blood
cells.
• Myeloproliferative disorders: These include chronic myelogenous leukemia
(CML), polycythemia vera, primary myelofibrosis, essential thrombocytopenia,
chronic neutrophilic leukemia, and chronic eosinophilic leukemia.
• Lymphoma: Lymphoma is a cancer of the immune cells that begins in the
lymphocytes.
 Formation of Blood Cells or Hematopoiesis
• Blood cell formation, also called hematopoiesis or hemopoiesis.
• Blood cells are divided into three groups: the red blood cells (erythrocytes), the
white blood cells (leukocytes), and the blood platelets (thrombocytes).
• Before birth, hemopoiesis first occurs in the yolk sac of an embryo and later in the
liver, spleen, thymus, and lymph nodes of a fetus.
• Red bone marrow becomes the primary site of hemopoiesis in the last 3 months
before birth, and continues as the source of blood cells after birth and throughout life
• In the human adult, the bone marrow produces all of the red blood cells, 60–70
percent of the white cells (i.e., the granulocytes), and all of the platelets.
• The lymphatic tissues, particularly the thymus, the spleen, and the lymph nodes,
produce the lymphocytes (comprising 20–30 percent of the white cells).
• The reticuloendothelial tissues of the spleen, liver, lymph nodes, and other organs
produce the monocytes (4–8 percent of the white cells).
• The platelets, which are small cellular fragments rather than complete cells, are
formed from bits of the cytoplasm of the giant cells (megakaryocytes) of the bone
marrow.
 Regulation of Hematopoiesis
• Normal hematopoiesis is a well-regulated process in which the generation of mature
blood elements occurs from a primitive pluripotent stem cell in an ordered sequence of
maturation and proliferation.
• Regulation occurs through the generation of specific hormones and cytokines:
• Erythropoietin
• Interleukin 3
• Granulocyte-monocyte colony-stimulating factor (GM-CSF)
• Monocyte-macrophage colony-stimulating factor (M-CSF)
• Granulocyte colony-stimulating factor (G-CSF)
• Interleukin 5
• Interleukin 4, and other less well-defined factors, including the megakaryocyte growth
factors
• These hematopoietic growth factors may represent a significant new group of
therapeutic reagents for patients with hematological and oncologic disease.
Hematopoietic Growth Factors
Origin, Development, and Structure of Blood cells
 Blood Composition
❖Whole blood includes erythrocytes, leukocytes, platelets, and
plasma.
❖When a specimen is centrifuged, leukocytes and platelets
make up the buffy coat (small white layer of cells lying
between the packed red blood cells and the plasma).
❖Plasma is the liquid portion of unclotted blood.
❖Plasma normally appears hazy and pale yellow (contains all
coagulation proteins)
❖Serum is the fluid that remains after coagulation has occurred
and a clot has formed.
❖Serum normally appears clear and straw colored (lacks
fibrinogen group coagulation proteins)
Basic Hematology Terminology
Formed Elements and Sizes
 Red Blood Cell(RBC) Indices
MCV (mean corpuscular volume):
❖ Reference range (Si/conventional units) is 80-100 femtoliters (fL), and it is
an indicator of the average/mean volume of erythrocytes (RBCs)
❖ Calculate using the hematocrit (Hct) and RBC count:

❖Increased in megaloblastic anemia, hemolytic anemia with reticulocytosis,

liver disease, and normal newborn
❖Decreased in iron deficiency anemia, thalassemia, sideroblastic anemia,
and lead poisoning
 MCH (Mean Corpuscular Hemoglobin)
❖Reference range (Si/conventional units) is 26-34 picograms (pg), and
it is an indicator of the average weight of hemoglobin in individual
RBCs

❖Increased in macrocytic anemia

❖Decreased in microcytic, hypochromic anemia
 MCHC (Mean Corpuscular Hemoglobin
Concentration)
❖Reference range (conventional units) is 32-37 g/dL (SI units 320-370 g/L),
and it is a measure of the average concentration of hemoglobin in grams
per deciliter

❖32-37 g/dL MCHC indicates normochromic RBCs

❖Lesser than 37 g/dL MCHC indicates a possible error in RBC or hemoglobin
measurement, or the presence of spherocytes
 RDW (RBC Distribution Width)
❖It is included in the complete blood count test as it measures the
variation in size and volume of red blood cells.
❖The regular size of RBC is 6-8 (µm) in diameter.
❖If it is reported as coefficient of variation, the test is called RDW-CV
❖Normal value is between 10.2% and 14.5%
 Hct (Hematocrit)
❖Hematocrit is the percentage of RBCs in a given volume of
whole blood
❖Reference range for males (conventional units) is 41-53%
❖Reference range for females (conventional units) is 36-46%
❖Hematocrit is calculated by many automated cell counters using
the MCV and RBC count
Thanks