Samenvatting Hematologie - MLT2 - HoGent

Hematologie 1
Inhoud
H1. Inleiding tot hematologie..........................................................................................................................................3
1.1. Functies................................................................................................................................................................3
1.2. Samenstelling van het bloed.................................................................................................................................3
1.2.1. Bloedcellen....................................................................................................................................................3
1.2.2. Bloedplasma..................................................................................................................................................3
1.2.3. Verdeling van bloedcellen in bloed................................................................................................................4
1.3. Bloedafname........................................................................................................................................................4
H2. Morfologie van de bloedcellen..................................................................................................................................5
2.1. Rode bloedcellen of erytrocyten..........................................................................................................................5
2.1.1. Morfologie.....................................................................................................................................................5
2.1.2. Bloedgroepensysteem...................................................................................................................................5
2.2. Witte bloedcellen of leukocyten...........................................................................................................................6
2.2.1. Neutrofielen...................................................................................................................................................7
2.2.2. Eosinofielen...................................................................................................................................................7
2.2.3. Basofielen......................................................................................................................................................8
2.2.4. Monocyten....................................................................................................................................................8
2.2.5. Lymfocyten....................................................................................................................................................8
2.2.6. Bloedplaatjes of trombocyten.......................................................................................................................9
Referentiewaarden volwassene...............................................................................................................................9
H3. Tellen van de verschillende bloedcellen..................................................................................................................10
3.1. Referentiewaarden.............................................................................................................................................10
3.2. Hemato-morfologie............................................................................................................................................10
3.3. Hemocytometrie.................................................................................................................................................11
3.3.1. Microscopisch..............................................................................................................................................11
3.3.2. Elektronisch.................................................................................................................................................11
H4. Hematopoëse..........................................................................................................................................................14
4.1. Stamcellen..........................................................................................................................................................14
4.2. Algemeen schema van hematopoëse.................................................................................................................15
4.3. Groeifactoren......................................................................................................................................................16
4.3.1. Werking groeifactoren.................................................................................................................................17
4.3.2. Signaaloverdracht........................................................................................................................................18
4.4. Plaats van hematopoëse.....................................................................................................................................19
4.4.1. Rode beenmerg...........................................................................................................................................20
4.4.2. Stamceltransplantatie..................................................................................................................................22
H5. Ontwikkeling en functie van erytrocyten................................................................................................................23
5.1. Erytropoëse; ontwikkeling erytrocyten...............................................................................................................23

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, 5.1.1. Ontwikkeling erytrocyten – alle tussenstadia..............................................................................................24
5.1.2. Erytropoëtine...............................................................................................................................................28
5.1.3. Bouwstenen voor RBC.................................................................................................................................28
5.2. Biochemie van erytrocyten.................................................................................................................................28
5.2.1. Embden-Meyerhof pathway........................................................................................................................29
5.2.2. Hexose monofosfaat shunt..........................................................................................................................29
5.2.3. Leubering-Rapoport shunt...........................................................................................................................29
5.3. Functie van erytrocyten......................................................................................................................................29
5.3.1. Structuur van hemoglobine.........................................................................................................................30
5.3.2. Normale varianten van Hb...........................................................................................................................30
5.3.3. Synthese van Hb..........................................................................................................................................31
5.3.4. Functie van Hb.............................................................................................................................................31
5.3.5. Hemoglobinederivaten................................................................................................................................32
5.4. Veroudering en afbraak erytrocyten...................................................................................................................32
5.5. Laboratoriumonderzoeken i.v.m. erytrocyten.....................................................................................................32
H6. Ontwikkeling en functie van leukocyten..................................................................................................................33
Granulopoëse........................................................................................................................................................33
Monopoëse...........................................................................................................................................................34
Lymfopoëse...........................................................................................................................................................34
Functie leukocyten.................................................................................................................................................34
H7. Ontwikkeling en functie trombocyten.....................................................................................................................35
H8. Hemostase of bloedstolling.....................................................................................................................................35
8.1. Primaire hemostase............................................................................................................................................36
8.1.1. Bloedvatwand..............................................................................................................................................36
8.1.2. Trombocyten................................................................................................................................................37
8.1.3. Mechanisme van primaire hemostase.........................................................................................................37
8.1.4. Remming van primaire hemostase..............................................................................................................38
8.1.5. Samenvattend..............................................................................................................................................39
8.2. Secundaire hemostase........................................................................................................................................41
8.2.1. Stollingsfactoren..........................................................................................................................................41
8.2.2. Initiatiefase..................................................................................................................................................44
8.2.3. Amplificatiefase...........................................................................................................................................45
8.2.4. Propagatiefase.............................................................................................................................................46
8.2.5. Stabilisatiefase.............................................................................................................................................47
8.2.6. Extrinsiek vs instrinsiek systeem..................................................................................................................47
8.3. Remmers van de secundaire hemostase.............................................................................................................48
8.4. Fibrinolyse (7d-10d)............................................................................................................................................49




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,H1. Inleiding tot hematologie
Hematologie = bestuderen van samenstelling en eigenschappen van bloed, bloedvormende organen
(hematopoëtische organen) en bloedziekten

VOLWASSEN: 60-70 ml bloed per kg lichaamsgewicht

 MAN: 5-6L bloed
 VROUW: 4-5L bloed


1.1. Functies
1. Weefsels voorzien van O2 en CO2 verwijderen

2. Transport:
- suikers, mineralen, vitamines, hormonen, eiwitten,
vetten...
- afvalstoffen naar nieren en longen

3. Afweersysteem: bescherming indringers

4. Water en zouthuishouding

5. Regulatie van lichaamstemperatuur

6. Herstel bij verwondingen

1.2. Samenstelling van het bloed
Volwassen: 55% vloeibare fractie 45% vaste bestanddelen
= PLASMA = BLOEDCELLEN
= water met opgeloste stoffen

1.2.1. Bloedcellen
Rode bloedcellen of erytrocyten
 Geen kern in de bloedbaan
 41% van het bloedvolume
 Zuurstof transport

Witte bloedcellen of leukocyten
 4% van bloedvolume
 Functie in afweersysteem

Bloedplaatjes of trombocyten
 0,1% van bloedvolume
 Functie in homeostase (=bloedstolling)


1.2.2. Bloedplasma
 Water: 91%
 EW: albumines, globulines, fibrinogeen, stollingsfactoren,…
 Zouten (ionen)
 Voedingsstoffen: suikers, vetten, aminozuren, vitamines,…
 Hormonen
 Afvalstoffen: ureum, urinezuur, koolsotfdioxide, bilirubine,…


 Functies:

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, 1. Transport van voedingsstoffen, afvalstoffen, hormonen,…

2. Regulatie lichaamstemperatuur

3. Water-en zouthuishouding van cellen



1.2.3. Verdeling van bloedcellen in bloed
Gelijkmatige verdeling door…

- beweging
- afstoting door negatief geladen celoppervlak bij fysiologische pH (7,34)

 pH daling: minder afstoting: rouleauxvorming




1.3. Bloedafname
SERUM
Bloedafname  bloedstolling  fibrine netwerk aanmaak  bloedcellen zitten vast

PLASMA

Bloedafname  in buis met antistolling
middel  centrifuge  zie foto voor
resultaat


 Serum buizen  geen antistolling
 Rest van de buizen  antistolling middel geschikt voor
de analyse die uitgevoerd moet worden




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