1. Fundamentals of Medicine: Haematology
Beth Harrison
Consultant Haematologist
University Hospitals Coventry and Warwickshire

2. What is Haematology about?
What is in the blood?
What do Haematologists do?
What do red cells do?
The outside of red cells
Why does blood clot?

3. Plasma: Cellular components: 55% of total blood volume
91% water % blood proteins: fibrinogen, coagulation factors, albumin, globulins % other: nutrients – amino acids, sugars, lipids hormones – Epo, Insulin electrolytes – Na+ K+ Ca++ etc
Cellular components:
White cell count=8x109/L
Platelet count=270x109/L
Red cell count=4.5x1012/L

4. Haematologists are: Pathologist: Clinician:
Investigate anaemia caused by inherited defects of Haemoglobin
Diagnose and treat leukaemia and other blood and lymph node cancers
Manage patients with bleeding disorders
Count cellular components in the blood
Monitor blood thinning therapies
Care for patients with inherited anaemias
Advise on use of blood products
Microscopic interpretation of blood and bone marrow smears
Measure coagulation using functional tests
Investigate and treat anaemia
Investigate bone marrow problems; diagnose leukaemia or myeloma from marrow
Crossmatch blood for transfusion
Advise on use of blood thinning medicines to prevent and treat blood clots
Investigate and treat bone marrow failure

5. What do red cells do?

6. What do red cells do?
Haemoglobin
Haem O2 O2
Globin O2 O2
Hb=13.0 g/dL

7. Counting Red Cells

8. Counting Red Cells Haematocrit Haemoglobin concentration
Red cell count
Mean cell volume

9. How do you know that I am anaemic?
Normal range
Normal range

10. The Outside of the Red Cell
The sugars expressed on these cell surface proteins determine the Blood Group
ABO Blood Groups
Being Blood Group A or B describes having one of the enzymes able to change the sugar patterns on the membrane proteins
Being Blood Group O describes having neither; Blood Group AB have both

11. The Outside of the Red Cell
All humans naturally form antibodies in childhood against ABO Blood Group Antigens we do not possess.
Blood for transfusion must be selected to be suitable by ABO Blood Group

12. How does blood clot?
Haemostasis: normal maintenance of integrity of blood vessels and prevention / limiting of blood loss
Thrombosis: blood clot, may be pathological
Clots in arteries and veins form by different mechanisms

13. How does blood clot? Venous Thrombosis RBCs and clotting factors
Warfarin
Arterial Thrombosis
Damaged vessel and platelets
Antiplatelet agents: aspirin
Mediators of clot formation:
Drugs to prevent / treat thrombosis:

14. Why does blood clot: Virchow’s Triad
Vascular injury / trauma Previous deep vein thrombosis Atherosclerosis Indwelling vascular catheter Phlebitis Abnormal heart valve
Bed rest, paralysis Venous obstruction Poor cardiac function Perioperative period Old age Obesity Trauma Severe illness
Vessel wall injury
Abnormal blood flow
Thrombosis
Increased coagulability
Cancer Pregnancy Oral contraceptive pill / other oestrogens Thrombophilia: abnormalities of normal anticoagulant systems Sickle cell disease Smoking Hyperviscosity conditions