hempopoiesis nurses

8/14/2019 Hempopoiesis Nurses

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Blood cellsBlood cells

&&

HemopoieticHemopoietic

SystemSystem


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Composition of BloodComposition of Blood

Blood consists of:Blood consists of:


Red blood cellsRed blood cells

PlateletsPlatelets

White blood cellsWhite blood cells

PlasmaPlasma


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PlasmaPlasma

Carries cellsCarries cells

Transport gasesTransport gases

Aid in body defenseAid in body defense

Prevent blood lossPrevent blood loss


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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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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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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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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
http://www.emedicine.com/med/images/197800-207575-1823.jpg


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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

hempopoiesis nurses

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