Chapter 7 Disorders of Blood Cells Lecture 7 The Nature of Disease Pathology for the Health Professions Thomas H. McConnell

Overview of Today’s Lecture –Brief review of blood –Laboratory Assessment of Formed Elements –Anemia –Polycythemia –Leukopenia, leukocytosis, and lymphadenopathy –Malignancies of WBCs and Lymphoid tissue –Disorders of the spleen and thymus

Blood Review Figure from: McConnell, The Nature of Disease, 2 nd ed., LWW, 2014

Blood Review Figure from: McConnell, The Nature of Disease, 2 nd ed., LWW, 2014

RBC Life Cycle Figure from: McConnell, The Nature of Disease, 2 nd ed., LWW, 2014

Laboratory Assessment of Formed Elements - Complete blood count (CBC) 1.WBC count (cells/μl), WBC differential (% of each type) 2.Platelet count (cells/μl) 3.RBC count (cells/μl) 4.Hematocrit (HCT = RBC % blood volume) 5.Hemoglobin (HGB = gm per 100 ml whole blood) 6.Calculation of RBC indices using 4 and 5 above -Mean cell volume, MCV = HCT/RBC (normo-, macro-, or microcytic) -Mean cell Hgb concentration, MCHC = HGB/HCT (normo- or hypochromic) -Mean cell hemoglobin, MCH = not useful in regular practice -Other studies -% reticulocytes -Type of Hb (e.g, A - normal, S - sickle, F - fetal)

Anemia - Abnormally low Hb in blood (so decreased O2 carrying capacity) - Can be due to - Decreased # RBCs - Decreased amount of Hb in RBCs - Both - Always a sign of an underlying condition - Typical symptoms - Chronic fatigue - Shortness of breath - Pallor - Increased HR and respirations - If severe, fainting or comatose - Treatment - Replenish RBCs - Identify cause and treat/reverse it

Diagnosing Anemia Figure from: physio/vlab/bloodlab/mcv- mchc_n.htm

Overview of Anemia

Anemia – Blood Loss

Anemia – Increased RBC Destruction

Sickle Cell Anemia Figure from: McConnell, The Nature of Disease, 2 nd ed., LWW, 2014

Anemia – Increased RBC Destruction

Anemia – Insufficient RBC Production Light Micrographs from: McConnell, The Nature of Disease, 2 nd ed., LWW, 2014

Anemia – Insufficient RBC Production Light Micrograph from: McConnell, The Nature of Disease, 2 nd ed., LWW, 2014

Polycythemia (Erythrocytosis) Excess number of RBCs in blood Major symptoms/signs: red face, RBC count, HCT, and HB increased Relative –Increased concentration of RBCs (absolute # is unaffected) –Loss of fluid –Stress polycythemia Absolute – increase in # RBCs in body –Primary Polycythemia vera Due to BM malignancy A myeloproliferative syndrome –Secondary Something OUTSIDE BM causes problem Chronic hypoxia, e.g., smoking, lung disease, living at high altitude

Non-malignant Changes of Leukocytes

Malignancies of WBCs - Overview

Myeloproliferative/ Myelodysplastic Disorders

Lymphoproliferative Disorders - Leukemias

Development of Lymphoid Malignancies Figure from: McConnell, The Nature of Disease, 2 nd ed., LWW, 2014

Lymphoproliferative Disorders – Lymphomas *

Lymphoproliferative Disorders – Plasma Cell Disorders Figure from: McConnell, The Nature of Disease, 2 nd ed., LWW, 2014