hempopoiesis nurses
TRANSCRIPT
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Blood cellsBlood cells
&&
HemopoieticHemopoietic
SystemSystem
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Composition of BloodComposition of Blood
Blood consists of:Blood consists of:
Blood cellsBlood cells
Red blood cellsRed blood cells
PlateletsPlatelets
White blood cellsWhite blood cells
PlasmaPlasma
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Composition of BloodComposition of Blood
PlasmaPlasma
Carries cellsCarries cells
Transport gasesTransport gases
Aid in body defenseAid in body defense
Prevent blood lossPrevent blood loss
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Composition of BloodComposition of Blood
When blood is removed fromWhen blood is removed fromcirculation, it clotscirculation, it clots
Clot consists of:Clot consists of: Blood cellsBlood cells Fibrin strands formed from conversion ofFibrin strands formed from conversion of
plasma protein Fibrinogenplasma protein Fibrinogen
Serum yellowish liquidSerum yellowish liquid
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Composition of BloodComposition of Blood
Blood is kept in fluid state byBlood is kept in fluid state by
Anticoagulants EDTA, Heparin, CitrateAnticoagulants EDTA, Heparin, Citrate
After Centrifugation separates into:After Centrifugation separates into:
Lower layer 42 47 % - Red cells Lower layer 42 47 % - Red cells
HematocritHematocrit
Intermediate layer 1% - Leukocytes Intermediate layer 1% - Leukocytes
Buffy coatBuffy coatTop layer 55% yellowish fluid Top layer 55% yellowish fluid
PlasmaPlasma
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Plasma ProteinsPlasma Proteins
Most abundant solutes in plasma.Most abundant solutes in plasma.Major proteins are albumin, globulins andMajor proteins are albumin, globulins andfibrinogenfibrinogenAlbuminAlbumin:: The most important protin;The most important protin;
Its functions like,Its functions like,1. Maintenance of blood volume,1. Maintenance of blood volume,
2. Plasma osmotic pressure2. Plasma osmotic pressure
3. carrier protein.3. carrier protein.GlobulinGlobulin:: The 2The 2ndnd most important proteinmost important protein
It comprises mainly of three types,It comprises mainly of three types,
1. alpha globulin1. alpha globulin
2. beta globulins2. beta globulins
3. gamma globulins3. gamma globulins
FibrinogenFibrinogen:: It has impotent role in clotting ofIt has impotent role in clotting of
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Blood cellsBlood cells
Erythrocytes (red blood cells)Erythrocytes (red blood cells)
Leucocytes (white blood cells)Leucocytes (white blood cells)
Thrombcytes (Platelets)Thrombcytes (Platelets)
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Site of haemopoiesisSite of haemopoiesis
first few weeks of gestation the yolkfirst few weeks of gestation the yolksac is the main site of haemopoiesis.sac is the main site of haemopoiesis.
Definitive haemopoiesis derives from aDefinitive haemopoiesis derives from apopulation of stem cells - firstpopulation of stem cells - firstobserved on the dorsal aorta termedobserved on the dorsal aorta termedthe AGM (aorta-gonads-mesonephros)the AGM (aorta-gonads-mesonephros)region.region.
These common precursors ofThese common precursors ofendothelial & haemopoietic cellsendothelial & haemopoietic cells(haemangioblasts) are believed to(haemangioblasts) are believed to
seed the liver, spleen and boneseed the liver, spleen and bonemarrowmarrow
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Sites of HemopoiesisSites of Hemopoiesis
Fetus 0 t0 2 months Yolk SacFetus 0 t0 2 months Yolk Sac
2 to 7 months Liver, Spleen2 to 7 months Liver, Spleen
5 to 9 months Bone marrow5 to 9 months Bone marrow
Infants Bone marrow ( All bones)Infants Bone marrow ( All bones)
Adults - Vertebrae, ribs, sternum, skull,Adults - Vertebrae, ribs, sternum, skull,
sacrum,sacrum,
Pelvis, Proximal end of femurPelvis, Proximal end of femur
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HEMATOPOISISHEMATOPOISIS
Bone marrow consists mainly of twoBone marrow consists mainly of two
portions;portions;
Red bone marrowRed bone marrow
Yellow bone marrowYellow bone marrow
In adults BM is restricted toIn adults BM is restricted to
- Pelvis- Pelvis
- Sternum- Sternum
- Vertebrae- Vertebrae
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Blood forming population of boneBlood forming population of bonemarrow is made up of three types ofmarrow is made up of three types ofcellscells Self renewing stem cellsSelf renewing stem cells
Differentiated progenitor cellsDifferentiated progenitor cells
Functional mature blood cellsFunctional mature blood cells
Blood cells precursorsBlood cells precursors
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HaematopoiesisHaematopoiesis
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Regulation ofRegulation of
HematopoisisHematopoisis Blood cells are produced by theBlood cells are produced by the
BM according to need &BM according to need &
regulatory factorsregulatory factors Cytokine family of glycoproteinsCytokine family of glycoproteins
stimulate stimulate
ProliferationProliferation DifferentiationDifferentiation
Functional activation of various BMFunctional activation of various BM
precursorsprecursors
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Regulation of HematopoisisRegulation of Hematopoisis Erythropoietin (EPO)Erythropoietin (EPO)
Thrombopoitin (TPO)Thrombopoitin (TPO)
Cytokines (CSFs)Cytokines (CSFs) G-CSFG-CSF
M-CSFM-CSF
GM-CSFGM-CSF
AndrogensAndrogens
Growth factorsGrowth factors Trace elements(iron,Cu)Trace elements(iron,Cu)
BB1212,Folic acid.,Folic acid.
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Regulation of HematopoisisRegulation of Hematopoisis
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Most numerous of the formedMost numerous of the formed
elementselements
Small,biconcave disk,large surfaceSmall,biconcave disk,large surface
area.area.
Contain hemoglobinContain hemoglobin Function is to transport oxygen.Function is to transport oxygen.
Total life in circulation isTotal life in circulation is
approximately is 120 days.approximately is 120 days.
ErythrocytesErythrocytes
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ErythrocytesErythrocytes
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ErythrocytesErythrocytes
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ErythrocytesErythrocytes
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1% of total blood volume.1% of total blood volume.
Function in inflammatory and inFunction in inflammatory and inimmune process.immune process.
They includeThey include
grannulocytes,lymphocytes andgrannulocytes,lymphocytes andmonocytes.monocytes.
LeucocytesLeucocytes
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Granulopoiesis
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Phagocytic cellsPhagocytic cells
They have identicalThey have identical
grannulation,spherical in shape andgrannulation,spherical in shape and
have distinctive multilobar nucleus.have distinctive multilobar nucleus.
Mainly these are of three types.Mainly these are of three types.
NeutrophilsNeutrophils
BasophilsBasophils
EosinophilsEosinophils
GrannulocytesGrannulocytes
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NeutrophilsNeutrophils 50-60%50-60% They get neutral stain with anThey get neutral stain with an
acidic and basic dye, so theyacidic and basic dye, so theycalled neutrophils.called neutrophils. Because they have multilabarBecause they have multilabar
neucleus (3-5),so they alsoneucleus (3-5),so they alsocalled Polymorphoneuclearcalled Polymorphoneuclear
leucocytes.leucocytes. Functions in defence mechnismFunctions in defence mechnism
against microorganisms.against microorganisms. Grannule of these cells containsGrannule of these cells contains
certain enzymes which havecertain enzymes which haveimportant role in these defenceimportant role in these defencemechanisms.mechanisms.
Total life in circulation is only 10Total life in circulation is only 10hours.hours.
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EosinophilsEosinophils
Granules stain redGranules stain redwith acidic dye (Eosin).with acidic dye (Eosin).
1-3% of total WBCs.1-3% of total WBCs.
Main role in allergicMain role in allergic
conditions and inconditions and in
parasitic infections.parasitic infections.
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BasophilsBasophils
Granules of these cellsGranules of these cells
stain blue with basic dye.stain blue with basic dye.
0.3-0.5% of total WBCs.0.3-0.5% of total WBCs.
Granules containGranules contain
heparin (anticoagulant)heparin (anticoagulant)
histamine (vasodilator).histamine (vasodilator).
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Monocytes and MacrophagesMonocytes and Macrophages
Largest cells of the WBCs series.Largest cells of the WBCs series.
3-8% of total WBCs.3-8% of total WBCs.
Total life Spain of these is 1-3 days, inTotal life Spain of these is 1-3 days, intissues survive for many days.tissues survive for many days.
Mainly these are phagocytic cells.Mainly these are phagocytic cells.
Many types due to their various locationsMany types due to their various locations- Histiocytes in tissue- Histiocytes in tissue
- Kupffer cell in liver- Kupffer cell in liver
- Microglial cells in brain- Microglial cells in brain
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Monocytes
Larger than other
peripheral blood cells
Nuecleus Centraloval or indented
Cytoplasm
Blue abundant
Fine granules Ground glass
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MonocytesMonocytes
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LymphocytesLymphocytes 20-30% of total WBCs20-30% of total WBCs No grannules in cytoplasms and alsoNo grannules in cytoplasms and also
called agrannulocytes.called agrannulocytes.
Two typesTwo types
B-cellsB-cells
T-cellsT-cells
Important role in immune responses.Important role in immune responses.
B-cells also produce antibodies.B-cells also produce antibodies.
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LymphocytesLymphocytes
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ThrombocytesThrombocytes
Originate from megakaryocytes.Originate from megakaryocytes.
They form platelet plug to controlThey form platelet plug to control
bleeding.bleeding.
In their cytoplasmic granules, certainIn their cytoplasmic granules, certain
mediators have important role inmediators have important role in
hemostasis.hemostasis.
They have no nucleus and can neverThey have no nucleus and can neverreplicate.replicate.
Total life is 8-9 days.Total life is 8-9 days.
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All blood cell precursors are derivedAll blood cell precursors are derived
from primitive cellsfrom primitive cells pluripotent stem cells.pluripotent stem cells.
Colony forming units (burst formingColony forming units (burst forming
units)units)
Disorders of the stem cells is theDisorders of the stem cells is theaplastic anaemia & leukemia'saplastic anaemia & leukemia's
Potential cures of these disorders isPotential cures of these disorders is
done by successful BM transplantationdone by successful BM transplantation
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Sources of stem cells for transplant areSources of stem cells for transplant are
Bone marrow,Bone marrow,
Peripheral blood andPeripheral blood and
Umbilical cord bloodUmbilical cord blood
BM and Peripheral blood transplant mayBM and Peripheral blood transplant may
bebe AutologousAutologous
AllogenicAllogenic
Umbilical cord transplants are the bestUmbilical cord transplants are the bestoption in children's, because less riskoption in children's, because less risk
factors of Graft-verses-Host disease.factors of Graft-verses-Host disease.
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Regulation of ErythropoiesisRegulation of Erythropoiesis
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Normal haemoglobins in adult bloodNormal haemoglobins in adult blood
d llR d ll
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Red cellRed cell
In order to carry haemoglobin into closeIn order to carry haemoglobin into closecontact with the tissues and for successfulcontact with the tissues and for successfulgaseous exchange, the red cell, 8gaseous exchange, the red cell, 8 m inm indiameter, must be able:diameter, must be able: to pass repeatedly through the microcirculationto pass repeatedly through the microcirculation
whose minimum diameter is 3.5whose minimum diameter is 3.5 m,m,
to maintain haemoglobin in a reduced (ferrous)to maintain haemoglobin in a reduced (ferrous)state andstate and
to maintain osmotic equilibrium despite theto maintain osmotic equilibrium despite thehigh concentration of protein (haemoglobin) inhigh concentration of protein (haemoglobin) inthe cell.the cell.
Its total journey throughout its 120-dayIts total journey throughout its 120-daylifespan has been estimated to be 480 km (300lifespan has been estimated to be 480 km (300miles).miles).
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Red cell metabolismRed cell metabolism
Embden-Meyerhof pathwayEmbden-Meyerhof pathway
In this series of biochemical reactions, glucoseIn this series of biochemical reactions, glucose
that enters the red cell from plasma by facilitatedthat enters the red cell from plasma by facilitated
transfer is metabolized to lactatetransfer is metabolized to lactate
This ATP provides energy for maintenance of redThis ATP provides energy for maintenance of redcell volume, shape and flexibility.cell volume, shape and flexibility.
The Embden-Meyerhof pathway also generatesThe Embden-Meyerhof pathway also generates
NADH - to reduce functionally deadNADH - to reduce functionally dead
methaemoglobin (oxidized haemoglobin)methaemoglobin (oxidized haemoglobin)
containing ferric iron to functionally active,containing ferric iron to functionally active,
reduced haemoglobin.reduced haemoglobin.
The Luebering Rapoport shunt - generates 2,3-The Luebering Rapoport shunt - generates 2,3-
DPG which forms a 1 : 1 complex withDPG which forms a 1 : 1 complex with
haemoglobin - is important in the regulation ofhaemoglobin - is important in the regulation of''
R d ll bR d ll b
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Red cell membraneRed cell membrane
The red cell membrane comprises a lipid bilayer,The red cell membrane comprises a lipid bilayer,
integral membrane proteins and a membrneintegral membrane proteins and a membrneskeletonskeleton
Approximately 50% of the membrane is protein,Approximately 50% of the membrane is protein,
20% phospholipids, 20% cholesterol molecules20% phospholipids, 20% cholesterol molecules
and up to 10% is carbohydrate.and up to 10% is carbohydrate. Carbohydrates occur only on the external surfaceCarbohydrates occur only on the external surface
while proteins are either peripheral or integral,while proteins are either peripheral or integral,
penetrating the lipid bilayer.penetrating the lipid bilayer.
The membrane skeleton is formed by structuralThe membrane skeleton is formed by structuralproteins:proteins:
andand spectrin,spectrin,
ankyrin,ankyrin,
protein 4.1 andprotein 4.1 and
Horizontal Lattice
maintain
Biconcave shape
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The structure of the red cell membrane. Some of the penetrating & integral
proteins carry carbohydrate antigens; other antigens are attached directly to the
lipid layer.
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Diagnostic testsDiagnostic tests
CBCCBC ESRESR
BoneBone marrow aspiration & Biopsymarrow aspiration & Biopsy
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Normal adult red cell values.Normal adult red cell values.
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Differential CountDifferential Count
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Differential CountDifferential Count
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Causes of Neutrophil LeukocytosisCauses of Neutrophil Leukocytosis
Bacterial infections Pyogenic bacterial, localized or
generalised Inflammation & tissue necrosis Neoplasms carcinoma or lymphoma
Acute haemorrhage Drugs corticsteroid therapy hronic myeloid Leukaemia
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ESRESR Screening testScreening test
Anticoagulated blood aggregates &Anticoagulated blood aggregates &sediments to the bottom of tubesediments to the bottom of tube
Rate of Aggregation increases inRate of Aggregation increases in
presence of fibrinogen & otherpresence of fibrinogen & otherproteinsproteins It is measured as distance in mm thatIt is measured as distance in mm that
red cell column travels in one hourred cell column travels in one hour
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Bone Marrow aspiration &Bone Marrow aspiration &
BiopsyBiopsy
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Supplies &EquipmentSupplies &Equipment
Supplies & equipmentSupplies & equipmentTray:Tray:
WoodenWooden
PlasticPlastic
SteelSteel
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Bone Aspiration Needle
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Positioning the PatientPositioning the PatientPatient is positioned dependingPatient is positioned depending
ononthe location of the procedure:the location of the procedure:
Posterior iliac crest (PIC)Posterior iliac crest (PIC)
patient is placed in a right orpatient is placed in a right or
left lateral position with theirleft lateral position with their
knees flexed, a pillow underknees flexed, a pillow undertheir head, and their eyestheir head, and their eyes
awayaway
Anterior iliac crest (AIC)Anterior iliac crest (AIC)
patient is placed in a supinepatient is placed in a supine
position, with their hips andposition, with their hips and
knees flexed, and eyesknees flexed, and eyes
averted away.averted away.
SternumSternum Supine position, Supine position,
head and eyes away, lighthead and eyes away, light
towel over face to keeptowel over face to keep
Diagram of Posterior pelvic bone position of
Right posterior iliac crest