pathological physiology of blood system. pathophysiology of blood system.… · posthemorrhagic...
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Pathological
physiology of blood
system
Department of pathological physiology– 2017
Azerbaijan Medical
University
The types of pathological
changes of blood system
Blo
od
syst
emThe changes of general
volume of blood
The changes of physical-chemical properties of blood
Quantitative and qualitative changes of blood cells,
disturbances of hemostasis.
The changes of general volume of
bloodNormovolemy
Hypovolemy
Hypervolemy
Formed elements
Plasma
Simple normovolemy
Oligocythemic normovolemy
Polycythemic normovolemy
Simple hypovolemy
Oligocythemic hypovolemy
Polycythemic hypovolemy
Simple hypervolemy
Oligocythemic hypervolemy
Polycythemic hypervolemy
The changes of general volume of blood
Hypervolemy
Simple Oligocythemic
Hypovolemy
Polycythemic
The changes of physical-chemical
properties of blood
• Special mass of blood
• Viscosity of blood
• Osmotic pressure of blood
• Resistance of erythrocytes
• Erythrocyte sedimentation rate(ESR)
Erythrocyte sedimentation rate
Increases
During increased concentration of
the high molecular proteins
Alkalosis
Anemia
Hydremia
Decreases
During increased concentration of low
molecular proteins artması
Acidosis
Erythrocytosis
Dehydration
Pathology of erythrocyte
system
Quantitative changes:
• Absolute and relative
Erythrocytosis
Erythropenia
Qualitative changes:
Regenerator forms of erythrocytes
Degenerative changes in erythrocytes
Cells of pathological regeneration
Erythrocyte indexes
MCV (mean corpuscular volume) – 80-98 fl
MCH (mean corpuscular hemoglobin) – 26-33 pq
MCHC (mean corpuscular hemoglobin concentration)
CLASSIFICATION OF ANEMIA
POSTHEMORRHAGIC DYSHEMOPOIETIC
HEMOLYTIC
Classification of anemia
According to the color index
normochrome
hypochrome
hyperchrome
According to the regenerator
ability
regenerator
hyporegenerator
hyperregenerator
According to the course
acute
chronic
According to the type of
erythropoiesis
normoblastic
meqaloblastic
Posthemorrhagic anemia
Stages of the acute posthemorrhagic anemia
Vascular-reflex stage
First 8-12 hour
Hydremicstage
1-2 days after
Medullarystage
4-5 days after
Iron deficiency anemia
Hematological signs:
• Hyperchrome anemia
• hyporegenerator anemia
• microcytosis, poikilocytosis
• Decreased level of iron(1000 mkq/l in norm),ferritin (12–32 mkM/l in norm), transferrin and increasing of general iron-binding ability of plasma
Anemia of chronic diseases
B12 deficiency
anemia
Hemotological signs:
• Megaloblasts and megalocytes
• Decreased amount of erythrocytes and
concentration of hemoglobin
• hyperchromia
• anisocytosis (makrocytosis), poikilocytosis
(especially oval-shape cells), pathological
derivatives (Jolly body, Kebot rings)
• Decreased amount of leukocytes and
thrombocytes, hypersegmented giant
neutrophiles.
• bilirubinemia
Food
R-protein
Parietal cells of
mucous membrane of
stomach
R-B12 complex
Intrinsic
Castle factor
Pancreas
ProteasesDegradation
of R-B12
complex
Gastromucopr
otein-B12
complex
Ileum
Portal
vein
Receptor for
intrinsic Castle
factor
Transcobalamin
The types of aplastic anemia
Total (hereditary)
• Fanconi anemia, Estren-
Dameshec anemia
• pancytopenia (decreasing
of amount of all blood
cells),
• panmyelopathy (decreasing
of amount of all cellular
elements in bone marrow)
Partial (hereditary)
• Deficiency of only
erythroid cells in blood
and bone marrow
• Blekfend-Daymond
anemia, partial red-
cellular aplasia
Hemolytic anemia
Signs of hemolysis The types of hemolysis
intravascular extravascular
Localization Vessels MFS
Yellowness of skin and
mucous membrane
a little Significantly
Enlargement liver and
spleen
a little Significantly
Laboratory indices Normochrome anemia, reticulocytosis, hypersideremia,
hyperplasia of erythrocytic cells in bone marrow
Hyperbilirubinemia
Hemoglobinemia
Hemoglobinuria
Hemosiderinuria
Hyperbilirubinemia
Hereditary membranopathy:
hereditary spherocytosis
Spherocyte
Macrophage of
spleen
Spectrin
Lipid layer
Hereditary
enzymopathies:
glucose-6-phosphate-
dehydrogenase
deficiency hemolytic
anemia
Glucose-6-
phosphate
6-phosphoglucanate
Glutathione
reductase
Glutathione
peroxidase
Hereditary hemoglobinopathies:
sickle-cell anemia
Thalassemiaα
-thal
asse
mia α-thalassemia
major
α-thalassemia intermedia
α-thalassemia minor
α-thalassemia minimum β
-thal
asse
mia
β0-thalassemia
β+-thalassemia (major və minor)
Extravascular hemolysis during
β-thalassemia
Immune hemolytic anemia: rhesus
incompatibility
Pathology of leukocyte system
Quantitative changes
• Leukocytosis: physiological and pathological
• Leukopenia
Qualitative changes
• Hypersegmentation
• Vacuolization
• Botkin-Qumprext shadow
• Toxic granularity
• Knyazkov-Dele bodies
• Auer sticks
• Ridder forms
• Nuclear shift and etc.
Hemopoiesis
(formation of blood cells)
HEMOBLASTOSES
LEUKEMIAS
(LEUKOSES) HEMATOSARCOMAS
(LYMPHOMAS)
Leukoses
Acute leukoses
No-differentiated leukoses
Myeloblast leukoses
Lymphoblast leukoses
Monoblast leukoses
Plazmoblast leukoses
Erithromyeloblast leukoses
Megacaryoblast leukoses
Chronic leukoses
Myelocytic origin: chronic
myeloleukoses, erithromyeloz
(erithremia)
Lymphocytic origin: chronic
lympholeukoses,
paraproteinemic (myeloma,
Valdenstrem
macroglobulinemia)
Monocytic origin: histiocytoses
Difference between
acute and chronic
leukoses
Normal bone
marrowLeukosic
tissue
Myeloblast
Hiatus
leukaemicus
Metamyelocyte
Stick-nuclear neutrophil
Segmented-nuclear neutrophil
LYMPHOMAS
HODGKIN
LYMPHOMAS
NON-HODGKIN
LYMPHOMAS
PATHOLOGY OF
HEMOSTASIS
The types of hemostasis pathology
Pathology connected with damage of vascular wall
Pathology connected with quantitative and qualitative changes of
thrombocytes
Pathology connected with disturbance of coagulation cascade
Willebrand disease and Bernard
Soulier syndrome
COAGULATION CASCADE
Pathology
connected with
damage of
vascular wall
Randyu-Osler
syndrome
Shenleyn-Genochdisease
ScorbutusEhlers-Danlos
syndrome
Pathology connected with quantitative and
qualitative changes of thrombocytes
Thrombocytopenia
Verlhof disease
trombotic-
trombocytopenic
purpura
hemolytic-uremic
syndrome, ets.
Thrombocytopathy
Willebrand disease
Bernard-Sulye
disease
Qlansman-Negeli
thrombostenia, etc.
Coagulopathy
Hemophilia
Prouer-Stuart
disease
Afibrinogenemia
Disseminated intravascular
coagulation syndrome (DIC)