Hematologic Disorders

Blood cells originate from Stem Cells

Classification of Disorders • Benign – non life threatening • Anemias • Coagulation • Platelet disorders • Malignant • Leukemias and Lymphomas

Normal RBC RBCs • Hgb=amount of hemoglobin or O2-carrying capacity • Hct=volume of packed cells • Reticulocyte count number of immature (Reticulocyte count) , MCV (Mean Corpuscular Volume - increased with B12 and Folate deficiency; decreased with iron deficiency and thalassemia elevated for alcholism, liver, anemias, MCHC = Mean Corpuscular Hemoglobin - May be decreased when MCV is decreased; increases limited to amount of Hgb that will fit inside a RBC • Normal values differ by gender - Why? Testosterone male hormone stimulates bone marrow

RBC = most common, concave disc, can change shape, Decreased with anemia; increased when too many made and with fluid loss due to diarrhea, dehydration, burns

HgB molecule - carry's oxygen

The percentage of blood that is comprised of red blood cells.(volume of packed cells)

Recipe for Making RBCs • Adequate # stem cells • Healthy stem cells • Erythropoietin – produced by the kidneys and stimulates the bone marrow à RBC’s • Vitamins - B12, folate (Gastric Bypass needs B12 – shots) • Iron RBCs break down à phagocytes à Bilirubin I Iron

Erythropoiesis = Production of RBC (dialysis is hard on the RBC’s) • Bone Marrow (vertebrae, sternum, ribs, skull, pelvis, proximal long bones) • tissue hypoxia (increase RBC’s and in high altitude) • RBC formation = 3-5 days; life span = 120 days • Breakdown RBC; amino acids & iron reused • heme - low hemoglobin a production problem or a blood loss problem bilirubin liver bile • Bilirubin accumulation = jaundice = yellow

Normal RBC Indices • Normal RBC=Male 4.2-5.4, Female 3.6-5.0 • Hct= 3 x Hgb • Hgb • Male 14-16 g/dL • Female 12-15 • Reticulocyte count -1-1.5% • MCV - 85-100 • MCHC - 31-35

Anemia - Low Red Blood Cell Count Production Problem • Bone marrow problem • Lack of raw materials • Iron; B12; Folate Taking Thymine – could be alcohol problem Blood Loss or Destruction Problem • Hemolysis • Bleeding

Production or Blood Loss

Effects of Anemia • _O2 carry capacity _ tissue Hypoxia (resp rate increases, blood pressure increases, pulse goes up) (possible angina)

Production Problem: Iron Deficiency • Iron (Fe) – Iron is added with Vitamin C to help with absorbing, 2/3 of the world have parasite, spoon shape nails, irregular heart beat, crack in sides of mouth (cheilosis), pica – eating things that …. • Deficiency – give iron, cause black dark stools hypochromic (low MCH); microcytic (low MCV) RBC • Males - blood loss - GI bleed, surgery • Females - menses; GI bleed, surgery, pregnancy

Production Production: B12 Deficiency (Pernicious Anemia) (vegetarians could have problems) • Intrinsic factor (IF) • B12 binds IF • Dietary • Dairy products, liver, shrimp, eggs • Inadequate absorption • Pernicious Anemia - lack intrinsic factor • Ileal resection, loss of pancreas, gastrectomy

Manifestations of B12 Deficiency – Synthesis of DNA, cell maturing, absorbtion problem (intrinsic and parietal cells) • Symptoms: pallor, weakness, sl. jaundice, smooth sore, beefy tongue, diarrhea • Neurologic - neuropathy • B12 level part of every neuropathy work-up • Replacement