Active bone marrow contain:-

Erythroid cells ………………...give RBCsMyeloid cells ………................give WBCs

Megakaryocytic cells ……….. produce platlets

Normally : myeloid \ erythroid ratio is 2\1In erythroid hyperplasia ( eg. Heamolytic anemia ) this ratio

become less than 2l1

HEAMATOlogyErythropoiesis

Site:

1 ST 8 WEEKS

FROM 8 WEEK UP TO 6 MONTHS

FROM 6 MONTHS AND ONWARDS

IN YOLK SAC

IN LIVERIN BONE MARROW

In infants & young children red & white marrow are involved in hematopoiesis.

In adults red marrow only.

Very important :--

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Factors affecting erythropoiesis:

1- The factory healthy bone marrow

2- primitive material nutrional element

3- manager of factory erythropitin hormone

4- secrtary other hormones

5- workers healthy organs such as liver

Hemoglobin:

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.

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

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). d) Chronic infection

b) Thalassemia. e) CRF.

c) Sideroblastic anemia f) Lead poisoning.

ii. Normocytic normochromic anemia:

(a) Hemolytic anemia (except Thalassemia). (c) Aplastic anemia

(b) Hemorrhagic anemia (d) Leukemia

iii. Macrocytic anemia:

A) Anemia of newborn (excluded by age).

B) Megaloblastic anemia.

(4) Classification of normocytic normochromic anemia:

Reticulocytic count

(Normal: 1-2% of RBCs count)

High count low count

Hemorrhagic hemolytic Aplastic leukemia

Coombs test

+ve -ve

Immune non- immune

Iso-immune auto immune congenital Acuired

Blood indices:

1) Mean Corpuscular volume (MCV ):

MCV =

MCV Microcytosis (< 70 fl).

MCV Macrocytosis (>100 fl).

2) Mean corpuscular hemoglobin (MCH):

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.