FSE Training - Basic Heamatology

Basic Heamatology

The average man has about 5 quarts of blood. This may be separated into 3 quarts of plasma and 2
quarts of cells.
The plasma is made up of water, foods, wastes, hormones, antibodies and enzymes.
The cells are classified as white cells, red cells and platelets.
Cells
Red Cell (Erythrocyte) 7.2 - 8.0u*
White Cell (Leukocyte) 10 - 25u
Platelets (Thrombocyte) 2 - 4u * 1 micron = 1 x 10-6 meter

In quantity, however, the red cells greatly predominate. For every 500 red cells there are
approximately 30 platelets and only 1 white cell.
 FSE Training - Basic Heamatology

The plasma is derived from the intestine and organs of the body. From the intestine comes water and
foods. And from the organs of the body comes wastes, hormones, antibodies, and enzymes.

The red cells, platelets, and most of the white cells are formed in the marrow of our bones. The most
common sources of supply are the ribs, breastbone, and pelvic girdle.

How are the blood cells formed?

In an effort to answer this question, two theories have been evolved:

The first theory states a single mother cell produces all blood cells. This theory is known as the
monophyletic theory.

The second theory states that several mother cells are involved, each mother cell producing its
own tribe of cells. This theory is known as the polyphyletic theory.

The blood carries food and oxygen to all the far-flung cells. It takes waste materials to the kidneys
and other organs of elimination. It helps to regulate the water content, temperature, and alkalinity of
the tissues.

The blood transports white cells and antibodies to battle infection and disease. It mends cuts - it
heals bruises. And it transfers hormones from the organs of production to the organs of
consumption.
 FSE Training - Basic Heamatology

1. RED Cells (RBC)

Normal Blood Count
- 5 x 106 /mm3 (male)
4 - 5 x 106 /mm3 (female)

if the person has a low RBC count, then the condition is known as Anemia.
If a greater than normal count is present, then the condition is Polycythemia.

To observe the details of all cells on the blood, they are firstly stained chemically using various type of stain.
Different cells exhibit different staining characteristics.

The two parameters that we are interested in are:

colour
intensity of stain

If we stain red cells, we can determine various cell disorders as follows.

Whenever the colour or intensity of a stained cell is being discussed:
The word Chromo is used. (Chromo - colour)
If the red cell being viewed have different amounts of staining
(I.e. some cells stained less than others)
The tern used to describe this condition is ANISOCHROMIA
This simply means different colours
If all the cells are stained uniformly less than normal, then - HYPOCHROMIA.
If all cells are over stained - HYPERCHROMIA
Normal staining = NORMOCHROMIA (colour is normal)
If different colours (red, green etc) are present within individual cells - POLYCHROMATOPHILIA
 FSE Training - Basic Heamatology

RBC - Shape

NORMOCYTES (Normal size cells)

8 1

2-3

A normal red cell should have an MCV (Mean Cell Volume)

between about 85 - 95u3

MACROCYTES > 10u in diameter

A typical Macrocyte is known as a Megalocyte and is always
associated with HYPERCHROMIA and ANAMIA.

>12 Football Shaped

We can also have a condition known as Target Cells - Caused by a Hemoglobin problem.

The Cell look like a Target

This is also associated with Anemia.

 FSE Training - Basic Heamatology

While we are talking about Haemoglobin (the Oxygen and Carbon Dioxide Transport
Mechanism) it is worth noting that there are several types known.

The first is HbF the F stands for FETAL HAEMOGLOBIN, in other words, all the Hb in a Fetus
is of this type, also it can be present in people of Mediterranean ancestry.

HbS (Sickle Cell Hb) is present only in the red cells of Negroid people. This lead to a severe
deformation of the red cell caused by the HbS being less soluble than other types of Hb. Thus
some HbS precipitates in the red cell and causes the deformation. This is a serious problem as
the oxygen carrying the efficiency of the cells is reduced

.
Sickle Cell Anaemia

HbA is the normal Hb present in the RBC of the majority of people.

All the previous types of red cells that we have discussed cause anaemias.

MICROCYTES < 7 in diameter

One type of Microcytes is known as SPHEROCYTE (because the cell is spherical).
 FSE Training - Basic Heamatology

Let us now look at the evolution of a red cell:

All blood cells originate in either in the bone marrow or various nodes within the body. They should reach
maturity where they are formed and only appear in the blood in adult form.

All cells originate from a STEM cell.

Nucleole
Granules

Cytoplasm

Membrane
Nucleus

Vacuole

STEM Cells (Larger cell) > 15 u

 FSE Training - Basic Heamatology

The lifetime of a red cell (upon reaching maturity) is about 120 days - it is interesting to calculate the
rate of production of RBC per second if we realize:

a) Lifetime of 120 days

b) 5 x 106 /mm
Formation of
c) Approx.. 6 liters of blood in average person
RBCs
STEM CELL
Division # 1

ERYTHROBLAST
Division # 2

ERYTHROBLAST
Maturation

ERYTHROBLAST POLYCHROMATOPHYL
Maturation

ERYTHROBLAST ACIDOPHIL (Evolution of Hb)

Maturation

RETICULOCYTE

Maturation
-----------------------------------------------------------
ERYTHROCYTE IN ACTUAL BLOOD

Note - Most immature cells are classified as BLAST cells.

 FSE Training - Basic Heamatology

PLATELETS (THROMOBOCYTES)

Platelets are involved in the blood clotting process. If for some reasons a small blood vessel is
ruptured, then platelets will stick to the wound and physically plug it.
Platelet size distribution is from about 1 1/2 u diameter to about 4u diameter.
Normal healthy individuals have between approx., 150,000 to 400,000 platelet/mm3.

If larger numbers are present the condition is known as THROMBOCYTOSIS.

If fewer than approx.. 150,000 / mm3 - then THROMBOPENIA Formation of

Platelets /
EVOLUTION OF PLATELET Thrombocytes

STEM CELL (25u)

Division

MEGA KARYOBLAST (25u) (Larger Nucleus)

Division

MEGAKARYOCYTE (50u) (Acidic)

META MEGA KARYOCYTE (50u)

Platelets

THROMBOCYTES ( Platelets)
 FSE Training - Basic Heamatology

WHITE CELLS (LEUCOCYTES) 4000 - 10,000/mm

White cells can be categorized into two basic groups.

LEUKOCYTE

Granulocytes Mono Nuclear

(or Polynuclears)

Neutrophil Eosinophil Basophil Lymphocyte Monocyte

Bacteria Virus

The GRANULOCYTES are concern with defending the body from bacterial invaders. The
MONONUCLEARS are activated by viruses.
The normal distribution in adults of the various types of LEUCOCYTES is as follows:

GRANULOCYTE NEUTROPHILS 50% - 70%

EOSINOPHIL 1% - 3%
BASOPHIL 0% - 1%

LYMPHOCYTE 20% - 40%

MONOCYTE 2% - 8%

For the children the main population of LEUKCOYTES is the LYMPHOCYTE (Reverse Differential).
 FSE Training - Basic Heamatology

NEUTROPHIL
When a Bacterial infection is present, the NEUTROPHIL population increases, at the expense of
the LYMPHOCYTES, this condition is known as LEUKOCYTOSIS or NEUTROPHILIA. This
condition is reached when the Neutrophil count is > 7000 /mm3.

If for some reason the Neutrophil count is < 3000/mm3, then we have a LEUKOPENIA or (in fact)
NEUTROPENIA.

GRANULOCYTE NEUTROPHILS 50 70% >15u

Granules

Nucleus

it will be noted that the Cytoplasm contains Granules.

There Granules contain an enzyme (Organic Catylist) called Peroxidase.

PEROXIDASE destroys Hydrogen Peroxide

Peroxidase
H2O2 H2O + O
 FSE Training - Basic Heamatology

EOSINOPHIL 1 - 3% >20u
EOSINOPHILS are associated with allergic reactions. If for any reasons the Eosinophils count is
raised, then the condition is known as EOSINOPHILIA.
EOSINIPHILIA is also associated with Parasitosis.
Eosinophils have a large amount of Peroxidase contained in the granules
.

Large Granules

Nucleus

BASOPHIL 0 - 1% >8u

The granules contained within the Basophil are areas where HERARIN and HISTAMINE are
found. The heparin is stsined dark blue to black by Alcian Blue.
Basophils main function is to combat allergies (allergic reaction). A rare form of Leukemia is
caused by an excess of Basophils. This is called Basophilia or Waldenstroem Disease.
Large Granules

Nucleus
 FSE Training - Basic Heamatology

LYMPHOCYTE 20-40% 8 10u

Lymphocytes are the virus killers.
Cytoplasm

Nucleus

There are two types of Lymphocyte, the small one (above) is most common. The nucleus is
almost as large as the cell and the Cytoplasm stains light to dark blue with Alcian Blue stain.
Where an increased population is noted, the condition is known as LYMPHOCYTOSIS (I.e. >
3,500/mm3).
The large Lymphocyte (or Viral or A typical Lymphocyte reacts with viruses, a typical condition is
known as MONONUCLEOSIS.
One of the more common Leukemia is LYMPHATIC LEUKEMIA. Formation
Where a decreased population occurs the condition is of
Lymphoctes
LYMPHOPENIA (i.e. < 1000/mm).

STEM CELL
Division

LYMPHOBLAST (25u) (Large Nucleus)

(No Granules)

LYMPHOCYE (No Granules)

 FSE Training - Basic Heamatology

MONOCYTES (MACROPHAGE) > 10u

Small Granules containing Esterase

Enzyme

Less dense Chromatin than Lymphocyte - Formation of

Cytoplasm Grey Moncytes

Nucleus

Increased population of Monocytes is called MONOCYTOSIS

STEM CELL

MONOBLAST

MONOCYTE (Large cell with Granules)

 FSE Training - Basic Heamatology

Formation of Granulocytes
 FSE Training - Basic Heamatology

Formation of Moncytes /
Lymphoctes
FSE Training - Basic Heamatology
FSE Training - Basic Heamatology
 FSE Training - Basic Heamatology

* Red cell 7.2 - 8.0 u

* Platelets 2.0 - 4.0 u
* White cell 10 - 20 u

* Lymphocyte >8u
* Monocyte > 12 u
* Basophil >8u
* Neutrophil >15 u
* Eosinophil > 20 u
* Large cell > 25 u
FSE Training - Basic Heamatology
FSE Training - Basic Heamatology
FSE Training - Basic Heamatology