by dr.khlid hammasalih

1. HEAMATOlogy
Erythropoiesis
Site:
1 ST 8
WEEKS
FROM 8 WEEK UP TO 6
MONTHS
FROM 6 MONTHS AND
ONWARDS
IN YOLK
SAC
IN LIVER
IN BONE MARROW
 In infants & young children  red & white marrow are
involved in hematopoiesis.
 In adults  red marrow only.
------
 Very important :--
Active bone marrow contain:Erythroid cells ………………...give RBCs
Myeloid cells ………................give WBCs
Megakaryocytic cells ……….. produce platlets
Normally : myeloid erythroid ratio is 21
In erythroid hyperplasia ( eg. Heamolytic anemia ) this ratio become
less than 2l1
.
.
Factors affecting erythropoiesis:
1- The factory
healthy bone marrow
2- primitive material
nutrional element
3- manager of factory
4- secrtary
5- workers
Hemoglobin:
erythropitin hormone
other hormones
healthy organs such as liver

2.  It represents about 1/3 of RBC mass.
 It consists of a globin molecule attached to 4 heme groups.
 In normal adults  there are 3 types of Hb:
1. Hb A  adult Hb. (97%).
2. Hb F  Fetal Hb. (0.5%). Its production decreases after birth.
3. hb A2  (2- 2.5%).
4. at 3-6 th months ther is switching from gama to beta chain
hemoglobin so this is age of manifestation of thalassemia.
 RBC life span  120 days.
 RBC splits into: 1. Globin  which enters the protein
metabolic pool.
2. Heme  is converted into bilirubin which is excreted
by the liver
Anemia
Definition:
It means decrease of hemoglobin concentration below t he normal level for
age & sex.

3. Diagnosis:
A- History:
1)presentation & duration
2)history of presenting illness
3)prenatal natal post natal history: Infant and mother's blood type
History of exchange or intrauterine
transfusion, and a history of anemia
in the early neonatal period
Gestational age at birth is important,
as premature infants may have iron
or vitamin E deficiencies resulting in
anemia.
The presence of jaundice or need for
phototherapy may signify the
presence of an inherited hemolytic
anemia.
4)past medical history
a-Hemorrhage (acute or chronic)  e.g. Anklystoma, Accidents &
Menorrhagia.
b-Jaundice & dark urine (Hemolytic anemia
5)past surgical history.
6)Drug history  Drugs can cause anemia through:
-
B.M. depression (chloramphenicol & sufa).
-
Hemolysis through: G6PD deficiency & autoimmune hemolysis
(quinine).
7)nutritional history  Nutritional anemia
8) family history  Congenital anemia (e.g. thalassemia).
B- Clinical picture: (general C/P of all types of anemia).
Skin, mucosae – pallor, dryness, purpura
Hands – koilonychias, palmar crease pallor
Facies – skull bossing, maxillary hyperplasia
Eyes – jaundice, pallor

4. Mouth – glossitis, cheilosis, ulcers
Heart – tachycardia, functional murmurs, CCF
Lungs – breathlessness
Abdomen – hepatosplenomegaly
PR – bleeding, occult blood
Others – lymphadenopathy.
C- Investigations: (Steps)
(1) Is it a case of anemia or not? By
a- Hb (15gm%).
– In cases of anemia:
b- RBCs count (4-6 million/mm3).  the 3 parameters.
c- Hematocrit value (45%).
(2) What is the type of anemia? 3types according to RBCs size & Hb
content (blood indices).
a. Microcytic hypochromic.
b. Normocytic normochromic.
C. Macrocytic.
(3) What is the cause of anemia?
i.
Microcytic hypochromic anemia:
a) Iron deficiency anemia (IDA).
b) Thalassemia.
c) Sideroblastic anemia
ii.
d) Chronic infection
e) CRF.
f) Lead poisoning.
Normocytic normochromic anemia:
(a) Hemolytic anemia (except Thalassemia). (c) Aplastic anemia
(b) Hemorrhagic anemia
iii.
(d) Leukemia
Macrocytic anemia:
A) Anemia of newborn (excluded by age).
B) Megaloblastic anemia.
(4) Classification of normocytic normochromic anemia:
Reticulocytic count

5. (Normal: 1-2% of RBCs count)
High count
low count
Hemorrhagic
leukemia
hemolytic
Aplastic
Coombs test
+ve
-ve
Immune
Iso-immune
auto immune
non- immune
congenital
Acuired

7. Blood indices:
1) Mean Corpuscular volume (MCV):
MCV =
 MCV  Microcytosis (< 70 fl).
 MCV  Macrocytosis (>100 fl).
2) Mean corpuscular hemoglobin (MCH):

8. MCH =
(normal: 27- 32 picogram)
 MCH  Hypochromic (< 27 picogram).
3) Mean corpuscular hemoglobin concentration (MCHC):
(normal: 33- 37 gram%).
N.B.:
* Coombs' test:
> A test for detection of antibodies against RBCs.
> Either: 1. Direct  detects Abs on the surface of RBCs.
2. Indirect  detects Abs in plasma.
* Reticulocytic count:
> It is the single test to detect hemolytic anemia.