Hematology Learning Objectives
Describe cellular and plasma components of the blood.
Cellular components of blood: RBC (red blood cells/erythrocytes), WBC (white blood cells/leukocytes),
platelets
Plasma components of blood: accounts for 50-55% of blood, mixture of inorganic & organic substances
o Plasma proteins (albumin 54% = main, fibrinogen 7%, & globulin 48%), H2O (90%), other solutes
Identify the main functions of the 3 different types of blood cells and what signs and symptoms to look for if they
are abnormal.
RBC/erythrocytes: most abundant cells of blood, responsible for tissue O2 (hemoglobin)
o Circulate for 120 days, dependent on erythropoietin, bioconcave disc shape
o Cell membrane, no organelles packed with hemoglobin, flexible for gas exchange,
o Abnormal S &S: Anemia
Leukocytes: (WBC) defend body against infections
o Remove dead or injured cells, Circulate for 4-8 hours
o Granulocytes: contain small enzyme filled cytokines (under microscope have granules)
o Agranulocytes: no granules in cytoplasm and contain large nucleus, lymphocytes
o Abnormal S & S: Elevated = infections, Low WBC = chemotherapy
Platelets: used in blood clotting (coagulation), stop blood loss in hemostasis
o Count = 150k – 400k / L, bleeding time is 3.6 min, stick to site and form a plug/clot by fibrin
Primary step (clot formation) & secondary Step (clot process)
o Control of bleeding & circulate from 7-10 days
o Abnormal S & S:
Name the components of the CBC – especially RBC, HB and HCT and WBC -and their normal values. Relate
to names of disorders of blood cells.
RBC: males (4.2 mil – 5.4 mil), females (3.6-5 mil), AVERAGE (3.5-5)
o Elevated RBC = polycythemia
o Low RBC = anemia
HGB/HB: 14-16.5 g/dl males……12-15 females g/dl -Anemia
HCT: 40-50% male…..37-47% female
WBC: differential which examine different types of active WBCs AVERAGE (4,400-11,300)
o Elevated WBC = leukocytosis
o Low WBC = leukopenia
o Differentials: similar to blood drawn, neutrophils are first responders, gives us info about types of
WBC found in sample,
Bands – baby neutrophils, increase in band leads to new immune response
Segments: mature neutrophils
Platelets: 150,000 – 450,000
o Elevated= thrombocytosis
o Low platelets = thrombocytopenia
Name the 5 types of leukocytes and the functions of each. (Memorize)
Neutrophils: granulocytes Fight infection that signaled to develop change & first responders
Eosinophils: granulocytes help control allergic reactions, fight parasites
Basophils: granulocytes release histamine & other inflammatory mediators
Lymphocytes: Agranulocytes Immune response cells (T cells- attack infected cells/ help other immune cells &
B cells- Make antibodies, memory cells)
Monocytes/macrophages: Agranulocytes antigen-presenting cells, create inflammatory response (chronic)
Name the triggers for differentiation of stem cells in the bone marrow –specifically for erythrocytes.
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Growth factors / Cytokines – e.g., Erythropoietin (EPO), Granulocyte colony-stimulating factor
(G-CSF), Granulocyte-macrophage CSF (GM-CSF), Thrombopoietin (TPO).
Transcription factors – e.g., GATA-1, PU.1, RUNX1.
Cell–cell interactions / microenvironment (niche signals) – via stromal cells, extracellular
matrix.
Hormones – e.g., thyroid hormone, glucocorticoids.
Name the relationship of erythropoietin to the bone marrow and RBC production.
Erythropoietin (EPO) is a hormone made by the kidneys in response to low oxygen. It stimulates the bone
marrow to produce more red blood cells (RBCs), increasing oxygen delivery in the blood. (example: hypoxia)
Name the most common clinical signs of anemia.
Reduced O2 carrying capacity = tissue hypoxia
Hemodilution: low levels of RBCs lead to low blood volume, (body tries to compensate by increasing tissue
fluid/volume)
Hypoxemia: causes vasodilation, tachycardia, increase respiration rate, blood shunting
Reduced blood flow & O2 to important organs causing fatigue, headache, temperature change, weakness, pale
skin
Discuss the pathophysiology of sickle cell anemia and the cause of a painful crisis
Sickle cell anemia is caused by a β-globin mutation that produces hemoglobin S, making red blood cells
sickle-shaped and fragile. These cells block blood vessels, causing tissue ischemia, pain crises, and chronic
anemia. Change in RBC behavior, result in low O2 within blood (sickling process), lifelong disease = no cure
More common among African Americans
Sickle Cell Crisis: Hypoxia (high altitude, exercise), Dehydration, Infection, Cold exposure
State the significance between neutrophil bands and segs.
Neutrophil bands: known as immature neutrophils
o Increased bands indicate acute infection or inflammation (shift to the left), high bands also indicate the
body’s need for more neutrophils than bone marrow can mature
o Appear when demand exceeds supply of mature segments
Neutrophil segments: categorized as mature neutrophils, more effective during phagocytosis,
o Normally present in circulation
Neutrophil bands & segments make up Absolute neutrophil count (ANC)
o Respond quickly to infection, have short lifespans
Name several conditions which can cause neutropenia
Cancer related: chemotherapy & radiation treatments, leukemia
Immunosuppressed therapy individuals
Bone marrow transplants
Metabolic diseases, HIV i2nfection, autoimmune disorders
Define leukemia. Name the 4 types of leukemia. Which one is the most common in children?
Leukemia: cancer of the blood & bone marrow
o Overproduction of immature WBC (abnormal blast cells which alter RBC production)
o Leukemia leads to decreases RBC (anemia), Decreased platelets (thrombocytopenia), decrease in
WBC function (neutropenia/low # of WBC or neutrophils)
4 types of Leukemia
o Acute lymphoblastic Leukemia (ALL): MOST COMMON IN CHILDREN & 85 percent of a
five-year survival rate within children, involves immature B-cells or T-cells (lymphoblasts), treated
with combination chemotherapy
o Acute Myeloid (Most Common): involves myeloid cell mutations (chromosomal changes & gene
fusions), most difficult to treat, involves combo chemotherapy & potential stem cell transplant
o Chronic Myeloid: occurs in less than 5% of child cancers, usually treated with TKIs
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