Disorders of Blood Cells

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The Nature of DiseasePathology for the Health
Professions Thomas H. McConnell

• Chapter 7
• Disorders of Blood Cells
• Lecture 7

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Overview of Todays 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

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Blood Review
Figure from McConnell, The Nature of Disease,
2nd ed., LWW, 2014
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Blood Review
Figure from McConnell, The Nature of Disease,
2nd ed., LWW, 2014
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RBC Life Cycle
Figure from McConnell, The Nature of Disease,
2nd ed., LWW, 2014
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Laboratory Assessment of Formed Elements

• - Complete blood count (CBC)
• WBC count (cells/µl), WBC differential ( of each
  type)
• Platelet count (cells/µl)
• RBC count (cells/µl)
• Hematocrit (HCT RBC blood volume)
• Hemoglobin (HGB gm per 100 ml whole blood)
• 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)

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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

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Diagnosing Anemia
Figure from http//www.medicine.mcgill.ca/physio/
vlab/bloodlab/mcv-mchc_n.htm
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Overview of Anemia
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Anemia Blood Loss
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Anemia Increased RBC Destruction
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Anemia Increased RBC Destruction
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Sickle Cell Anemia
Figure from McConnell, The Nature of Disease,
2nd ed., LWW, 2014
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Anemia Increased RBC Destruction
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Anemia Increased RBC Destruction
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Anemia Insufficient RBC Production
Light Micrographs from McConnell, The Nature of
Disease, 2nd ed., LWW, 2014
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Anemia Insufficient RBC Production
Light Micrograph from McConnell, The Nature of
Disease, 2nd ed., LWW, 2014
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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

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Non-malignant Changes of Leukocytes
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Malignancies of WBCs - Overview
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Malignancies of WBCs - Overview
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Myeloproliferative/Myelodysplastic Disorders
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Lymphoproliferative Disorders - Leukemias
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Development of Lymphoid Malignancies
Figure from McConnell, The Nature of Disease,
2nd ed., LWW, 2014
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Lymphoproliferative Disorders Lymphomas

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