5. Función Eritrocitica
• Transporte de gases respiratorios
Gran área de Superficie : volume ratio
Disco Biconcavo Flexible
Moleculas de hemoglobina en su
estructura
Capacidad de glucolisis
6. Hemograma - 7
Dr. Lezama
INDICES ERITROCITARIOS
1. Volumen corpuscular medio: (VCM)
(Hto x 10)/(recuento de eritrocitos x 106
)
V.N. = 90 ±8 fL
2. Hemoglobina corpuscular media: (HCM)
(Hb x 10)/(recuento de eritrocitos x 106
)
V.N. = 30 ±3 pg
3. Concentración media de hemoglobina corpuscular: (CMHC)
(Hb x 10)/Hto, o HCM/VCM
V.N. = 33 ±2 %
4. Amplitud de distribución eritrocitaria:
V.N. = 11,5 – 14,5%
7. Hemograma - 8
Dr. Lezama
SERIE ROJA
HEMOGLOBINA
- Adulto: a) mujeres: 12-16 g/100 mL.
b) hombres: 13-17 g/100 mL
- Gestante: > 11 g/100 ml
- Niños. De acuerdo a Edad
HEMATOCRITO
- Adulto: a) mujeres: 36-46%.
b) hombres: 39-52%
- Gestante: >33 %
- Niños: Según edad
HEMATIES
- Adulto: a) mujeres: 3,5 – 5,0 millones/mm3
b) hombres: 4.0 – 5,5 millones/mm3
- R/N: 5,0 - 6,5 millones/mm3
13. NEUTROPENIA
• Neutropenia – reducción en número
Drogas/Quimioterapia/irradiación
Infección Viral
Inherited disorders
Incrementa el riesgo de infección bacteriana
28. Hemograma - 29
Dr. Lezama
SERIE PLAQUETARIA
Rango de normalidad:
150.000-450.000 PLAQ/mm3
Trombocitosis: Sds. Mieloproliferativos
Esplenectomía
Infección
Tumores
Ferropenia, hemorragias
Trombocitopenia: PTI,PTT
Aplasia medular
Leucemias agudas
Notas del editor
Normal lifespan in circulation is 120 days approximately, the cell is then sequestered in the spleen and ‘recycled’ Cell is derived from early erythroblast in BM, in which haemoglobin is gradually synthesised. The nucleus is extruded from the cell in the BM, then the slightly immature cell termed a reticulocyte is released into the circulation where maturation is completed in a couple of days. Production is mainly controlled by erythropoietin, which is induced by the kidney in response to tissue hypoxia. Many other components must also be available such as iron, cobalt, vitamins B12, C, E, B6, thiamine and riboflavin The mature red cell or erythrocyte is enclosed in a membrane which comprises a cytoskeleton, overlaid by a lipid bilayer. The cytoskeleton consists of specialised proteins forming a lattice which supports and maintains the red cell shape and the lipid bilayer acts as a hydrophobic barrier. The major component of the red cells is haemoglobin, which comprises four globin chains , linked to a haem molecule. The normal shape of the red cell is a biconcave disc of approximately 7-8 microns in diameter and about 1.7 microns in thickness
The role of theHb contained in the red cell is to reversibly bind to oxygen and release it to the tissues and then to carry carbon dioxide away from the tissues. The cell is well designed to promote gaseous exchange with high surface area, allowing maximum gaseous uptake The flexibility of cell enables it to reach smallest capillaries. Structure of haemoglobin is dynamic, promoting release of oxygen. ATP and NADH are generated by the glycolytic pathway, providing energy to maintain the cellular integrity and activity
Leucocytes comprise three major types. The lymphocyte makes up about 20% of the total wbcs, in the normal adult. A higher proportion is seen in children. Monocytes comprise about 5-10% of the total Granulocytes form the largest group, with about 60-70% of the total. Of these the majority are neutrophils, with small populations of eosinophils and basophils.
Neutrophils form the major cell type in the peripheral blood, although they only spend about 12-24 hours before migrating to the tissues. They are highly motile cells, which rapidly migrate to the site of infection, in response to factors released by bacteria and activated cells already present at the site. They readily phagocytose and destroy bacteris etc, utilising enzymes and hydrogen peroxide
Markedly neutropenic (<0.5 x10 9 /l) are at severe risk of bacterial infection and this is a major cause of concern in patients receiving chemotherapy.
Neutrophilia or neutrophil leucocytosis is a common finding, as it represents a rapid response to many conditions. Neutrophils in the peripheral blood consist of two ‘pools’. Some are freely circulating, representing the count measured by the analyser, but a further large marginal pool is also present in the circulation, adherent to the vessel walls. This population can be rapidly mobilised causing a very dramatic increase in the total count. In the longer term, a large reserve pool is also present in the bone marrow, which can be mobilised if required. This slide shows less mature neutrophils showing fewer lobes than usual this is called left shift. The granules are also very marked in response to infection, this is called toxic granulation.
Lymphocytes can be split into different functional groups by their antigenic makeup The major types are B and T cells and these cannot be differentiated from the blood film alone. The majority of lymphocytes are small cells with little cytoplasm and well condensed nucleus. A small proportion are larger with more abundant cytoplasm and may show a few azure granules. A small but significant group are the Natural Killer cells, which have a cytotoxic action, these may be the large lymphs seen in the blood film
An increase in the age related reference range is termed lymphocytosis. The most common cause is viral infection especially Infectious Mononucleosis (Glandular Fever), which is associated with these large basophilic cells, showing abundant cytoplasm. These cells represent normal T cells which have been activated by the viral infection.
A malignant proliferation of lymphocytes is seen in lymphatic leukaemia and occasionally in lymphoma. The cells are mature and appear relatively normal. They are more fragile however, so smear cells may be seen in the blood film. CLL is a fairly benign condition, usually seen in older patients and is often a chance finding, Proliferation of early primitive lymphoid cells is also be seen, this is described as acute leukaemia and carries a less good prognosis.
A reduction of lymphocytes can be associated with severe problems of immunity and in certain cases can be life threatening. Eg HIV infection is primarily associated with a reduction in T lymphocytes, leading to severely compromised immune status Severe Combined Immunodeficiency Disease (SCID) is associated with almost complete absence of lymphocyte function and has a very poor outcome.
Monocytes only pass transiently through the peripheral blood and most of their lifespan occurs as macrophages in the tissues. They are large cells with a bean or horseshoe shaped nucleus and a greyish cytoplasm. They have a major role in the immune response, where they process and present antigens to the T lymphocytes. They are also major producers of cytokines. They are motile cells which are able to phagocytose foreign material.
Mild monocytosis is frequently seen, usually in conjunction with a raised neutrophil count in bacterial infection. In CMML, the monocyte count may be quite high and atypical cells may be seen. Acute leukaemia of monocytoid origin is also recognised, in which very early cells may be seen.
Examples of allergic conditions whre eosinophils are commonly raised are asthma, eczema and hay fever. Parasitic infections associated with eosinophilia include intestinal and blood borne worms
An immune thrombocytopenia can occur following viral infection or as an apparently spontaneous event. In some cases it is transient and resolves quickly, in others it may become a chronic condition. Patients receiving high dose chemotherapy, may have severely decreased platelets and often require platelet transfusion until their counts have improved.