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Samenvatting Hematologie - MLT2 - HoGent
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Hematologie 1Inhoud
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
1
, 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
2
,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:
3
, 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
4
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