1. Objective
To know different hematological diseases. To study the pathology of different hematological disorders.

2. Anaemia

3. Definition :defined as a hemoglobin concentration in the blood less than 130 g/l .in adult males (NR g/L) and less than 120 g/l(NR g/L) in adult females.

4. Morphological classification
Normochromic Normocytic Anaemias
Hypochromic Microcytic Anaemias
Normochromic Macrocytic Anaemias
Dimorphic Anaemias

5. Aetiological Classification
1) Anaemia of inadequate red cell production : ( Low Retics )
Stem cell Failure ( Hypoplastic )
Building units deficiency ( Iron, B12, folate……etc deficiencies )
Marrow infiltration ( Leukamias, marrow deposits, fibrosis & macrophage filtration )
Dyserythropoiesis ( Thalass., CDA & MDS )

6. 2) Anaemias of excessive red cell destruction (Haemolytic Anaemias) (High retics)
A) Intrinsic red cell defects :
I. Membrane defects : ( H.S , H.O & PNH ) .
II. Hb-Synthesis defects : (Haemoglobinpathies )
III. Metabolic defects : ( Enzymopathies )

7. B) Extrinsic red cell defects :
Immune red cell destruction :
Autoimmune : Warm & Cold antibody types
Alloimmune : Incompatible blood trans . & HDN
Drug related immune haemolysis

8. Non- immune haemolysis :
Infections : Malaria , haemorrhagic fever, gas gangrene …. Etc .
Chemicals : Oxidants
Physical agents : Burns ,
Mechanical haemolysis : MAHA , Cardiac haemolysis & March Hb-uria

9. 3.Blood loss

10. Iron Deficiency (ID)
A reduced iron supply to the erythron can be absolute due to reduced body iron leading to IDA or functional due to defective iron utilization such as anaemia associated with chronic illnesses.

11. Causes of IDA
Dietary deficiency of Iron (important only when associated with other causes) may arise due to poverty, religious trends and among vegetarians.
Malabsorption of iron : this occurs in gluten enteropathy and after gastrectomy.
Increased demands:
Infancy aggravated by prematurity, infections and delayed mixed feeding.
Adolescence
Pregnancy : emberyo requirements is around 300 mg mg .
Blood loss: this is the most important cause of IDA, in females it is most commonly from the genital tract while in males from GIT usually.

12. Absorption
Duodenum .
Jejunum .

13. Iron absorption Favoured by
Increased haem iron
Increased animal food
Ferrous iron salt
Gastric acid PH
Vit C
Iron deficiency
Haemorrhage
Ineffective erytropoiesis
Pregnancy and hypoxia

14. Iron absorption reduced by
Decreased haem iron
Ferric salt
Alkalis
Tannate in tea
Iron overload
Inflammatory disorders

15. Haematological features:
Reduction in all red cell indices ( Hb, PCV, MCV, MCH & MCHC )
Peripheral blood:
Hypochromia + microcytosis with mild to moderate anisopoikilocytosis
Platelets are usually increased but may be normal, WBCs are normal usually.

17. Bone marrow
BM is usually hypercellular
Normoblastic erythroid hyperplasia, normoblasts show shaggy outlines and vacuolated cytoplasm with pyknotic nuclei.
Other haematopoietic cells are normal.
Absent marrow iron both in erythroid cells and macrophages with iron stain.

18. Diagnisis of IDA In most cases: Clinical data.
Typical red cell morphology
Reduced serum iron &increased TIBC
Reduced transferrin saturation
S. Ferritin
B.M iron assessment (Iron stain)

19. Iron requirement Vary with age and sex .
Its highest in pregnancy and adolescent .
Adult male: – 1 mg /day
Female :
Menopause: mg/d
Menstruation: mg/d
Pregnancy: mg/d
Female ( y ): mg/d
Child: mg /d