Lecture notes
Phase 3 - Haematology
- Module
- MED3004 (MED3004)
- Institution
- University Of Glasgow
Notes based on haematology week covering haematopoiesis, anaemia, malignant haematology and bleeding disorders.
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🩸Week 2: Haematology
Date @25/09/2022 → 02/10/2022
Week Lead Prof Edward Fitzsimons
Additional Notes
Glossary of Terms
Haematopoiesis
Anaemia
Iron Deficiency Anaemia
🔗📽 Haematology Virtual GP Tutorial
Anaemia of Chronic Disease (ACD)
Megaloblastic Anaemia
Haemolytic Anaemia
Haemoglobinopathies
Thalassaemias
Sickle Cell Disease
Clinical Diagnosis of Anaemia
Malignant Haematology
Myeloma
Lymphoma
Hodgkin’s Lymphoma
Non-Hodgkin’s Lymphoma
Leukaemia
Pre-Leukaemic Conditions
Acute Leukaemia
Chronic Leukaemia
Bleeding Disorders
, White Cells and Platelets Bon
The WBC differential may be obtained from Aspi
Bone marrow aspirate
inspection of the blood film or directly from cellu
the haematology FBC analyser. This
WBC Differential Rem
determines the number of polymorphs, Bone marrow trephine biopsy prov
lymphocytes and monocytes in the total
infilt
WBC.
The
Circulating phagocytic cells will become foun
Monocytes
tissue macrophages
Leukaemic blasts in th
The polymorphonuclear leucocyte and
(Granulocyte) cells with 2-5 nuclear lobes synd
and granules in the cytoplasm. Staining
Acut
characteristics of the granules identify: AML
Polymorph com
Neutrophils - neutral staining granules in
(Granulocyte) Acut
cytoplasm Basophils - basophilic granules ALL
which migrate to the tissues to become com
mast Cells. Eosinophils - eosinophilic CML Chro
granules
CLL Chro
Neutrophilia Increased neutrophils
Des
Neutropenia Decreased neutrophils whe
Myelodysplatic syndromes
Lymphocytosis Increased lymphocytes occu
MDS
Activated
Often seen in viral infection Des
lymphocytes
marr
Atypical reactive (CD8) lymphocytes in Myeloproliferative appe
Atypical
certain infections such as glandular fever esse
mononuclear cells
and viral hepatitis mye
Thrombocytopenia Reduced platelets Mali
Thrombocytosis Increased platelets the b
Myeloma
lymp
Red Blood Cells mye
MCV Mean corpuscular volume (RBC size)
Haemostasis
Mean corpuscular haemoglobin content
MCH Prothrombin time - test of ex
(RBC colour) PT
to warfarin and liver disease
Large RBCs (↑MCV) seen in B12/folate
INR International normalised rati
Macrocytes deficiency, hepatic disease,
hypothyroidism Partial thromboplasm time -
PTT and KCCT (Kaolin Cephalin
Poorly haemoglobinised and small RBCs
Hypochromic pathway sensitive to IV hepa
(↓MCH ↓MCV) seen in iron deficiency,
microcytic
chronic disease and thalassaemia trait Term to describe the coagula
(extrinsic and intrinsic) that l
Immature RBCs; Normally <2% of
Coagulation to fibrin; Do not confuse wit
RBCs; No nucleus but some persisting
Reticulocytes describes RBCs being stuck
RNA; Polychromatic (blue-purple)
antibodies
appearance in the blood film
Pin point bleeding on skin an
RBC columns seen in samples with Purpura/
thrombocytopenia or, less co
raised globulin or raised fibrinogen levels Petechiae
Rouleaux purpura does not blanch on
ie myeloma, chronic
inflammation/infection Ecchymoses Bruises
, Red Blood Cells Blood Bank
Direct Coombs test Test to detect the presence
Indirect Coombs
(DCT)/ Direct Test to detect presence of antibody on is the basis of the cross ma
test
antiglobulin test RBC surface; Positive in AIHA, HDN and screen
(DAGT)
Haematopoiesis
✅
Haematopoiesis
Learning Outcomes
Many million blood cells die Haematopoi
Introduction to haemopoietic stem and are replaced every day
cell disorders and this procelss happens
Appreciate importance of bone throughout ones’s life.
marrow microenvironment Haematopoiesis is the
Develop basic understanding of process of blood cell
clonal disorders of haemopoietic production.
stem cells Sites of Haematopoiesis
Understand over-production –
Foetus: 0-2
myeloproliferative disorder (example Yolk sac Liver
months 2-7 It starts w
– Jak2 positive ET) and spleen
months 5-7 divide int
Bone marrow
months
Consequences of under-production Both mye
– aplastic anaemia (example Bone marrow of
Infants capable o
Falconi’s anaemia) all bones
types req
Bone marrow of
Appreciate how abnormal cells are vertebrae, ribs, Stem cel
produced – myelodysplasia, sternum, skull, process c
leukaemia (example – Refractory Adults sacrum, pelvis able to re
anaemia with excess blasts and and ends of
monosomy 7) femurs (axial
bones)
Understand basic concepts of stem
cell mobilisation and stem cell
transplant
Haematopoietic Stem Cells
Characteristics Fate - one of three things can
happen to them
Self renewal capacity
Self-renewal - identical copy is
Unspecialised
made
Ability to differentiate into mature functional
Apoptosis - programmed cell
cells
death
Rare - 1 in 10,000 to 1 in 1 million in bone
Differentiation - maturation and
, stem cell transplant from self or donor The balance between these is
cells. influenced by a complex
interplay of micro-environmental
Umbilical cord blood
signals (the niche) and internal
cues
Bone Marrow
Haematopoiesis is a function of the bone marrow.
Bone Marrow Microenvironment Bone Marrow Architecture
Stroma is the bone marrow microenvironment that supports the
developing haemopoietic cell
Rich environment for growth and development of stem cells
Stromal cells within the marrow are supported by an extracellular
matrix
A number different cells
myelocytes, mature neut
Trephine of the bone ma
shows bony trabeculae,
For bone marrow testing
posterior iliac crest is sa
the bone marrow using l
Diagram shows how stem cells might interact with the different cells
within the bone marrow and with the extracellular matrix.
This interaction can be done through adhesion molecules, growth
factors (cytokines and chemokines) and their receptors.
Scanning Electron Mic
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