Hematological System Disorders

Hemopoietic system includes bone marrow and cells derived from it i.e. Red blood cells (erythrocytes), platelets (thrombocytes), granulocytes (neutrophils, eosinophils, basophils), monocytes, lymphocytes and occasional plasma cells. Granulocytes, monocytes, lymphocytes and plasma cells are called white blood cells. It also includes lymphoid tissue consisting of thymus, lymph nodes and spleen.

Disorders of blood cells

Abnormalities of blood cells, either quantitative or qualitative are found only when blood examination is ordered, i.e. complete blood count (CBC). This is done in relation to number of diseases where one finds quantitative change rather than qualitative.

Leucopenia

It is an abnormal low white cell count. Viral infection, malnutrition, steroid therapy is the some of the frequently seen causes of leucopenia.

Neutropenia

Neutropenia means reduction of number of neutrophils in the blood. Most of the time it occurs with infections. If neutrophil count falls below 500 per mm it indicates some serious underlying disease.

Leucocytosis

It denotes increase in the number of white cells (leucocytes) in the blood. It occurs in number of conditions, especially as a response to infection. Infection induces response of various cytokines which in turn activates the production of leucocytes. Depending on the type of underlying disease leucocytes can be of different cell types.

Neutrophilia

It denotes increase number of neutrophils. It occurs in acute bacterial infection, infection caused by tissue necrosis for e.g. Myocardial infarction.

Eosinophilia

It denotes increase number of eosinophils. Noticed in allergic disorders such as asthma, skin allergy etc.

Basophilia

It denotes increase number of basophiles. It is rare and occurs only in certain rare disorders like Leukemia

Monocytosis

Chronic infections like tuberculosis, bacterial endocarditis, etc. cause increase in monocyte count.

Lymphocytosis

It denotes increase number of lymphocytes.

Most of the time it occurs in chronic infection, along with monocytosis especially those associated with immunological disturbances like hepatitis A.

Lymphadenitis

Circulating lymphocytes may lodge in lymph nodes, spleen, tonsils or payer’s patches under the influence of specific cytokines. Trivial injuries or infections cause subtle changes in lymph nodes without enlargement. More severe or chronic infection may cause lymph node enlargement called lymphadenitis.

Acute non specific lymphadenitis

Acute cervical, axillary or inguinal region lymphadenitis are very common. It occurs mostly in infection related to the region drained by that lymph node, e.g. cervical lymphadenitis in throat infection, mouth ulcers or tonsillitis. Viral infection sometimes caused generalized acute lymphadenitis which is short lived. Generally, the lymph nodes are tender. Sometimes it may progress to abscess formation.

Chronic lymphadenitis

Long standing lymph node enlargement needs careful study and investigation. Generally, lymph nodes are non-tender and may be firm or hard. Biopsy may be necessary. Most common cause is tuberculosis. However, other conditions including malignancies are to be ruled out.

Mention should be made of lymphomas and leukemia. Lymphoma denotes proliferation in various lymph nodes.

Red blood cells disorders

It is the most common disorder in practice. Anemia is defined as a reduction in circulating red cell mass or deficiency of hemoglobin in blood.

Iron deficiency anemia

This occurs when there is excessive loss or increased demand due to poor nutrition or disturbed absorption.

Loss of iron occurs in many gastric disorders like peptic ulcer, ulcerative colitis, sometimes even piles, etc. Certain drugs like NSAID’s can induce subtle blood loss. In women, menstrual bleeding if excessive may be a contributing factor. Iron demand is more in infancy and puberty age.

Weakness, pallor of mucus membrane, increased pulse rate, rarely ankle swelling if anemia is severe are some of the symptoms of anemia. Hemoglobin measurement is the commonest test to detect anemia.

Anemia associated with chronic disease

Many of the chronic diseases like chronic kidney disease, rheumatoid arthritis certain infections like tuberculosis are associated with anemia. Multiple factors contribute to Anemia of chronic disease. Therefore, the treatment is difficult.

Megaloblastic anemia

The major factor in megaloblastic anemia is an impairment of DNA synthesis wherein vitamin B12 and folic acid are necessary.

Deficiency of it leading to disturbed DNA synthesis is reflected in morphologic changes such as large size red cells.

Pernicious anemia

This is an autoimmune disorder wherein gastric mucosa becomes atrophic causing intrinsic factor deficiency. Absence of intrinsic factor affects absorption of vitamin B12. Besides anemia vitamin B12 deficiency causes neurological symptoms in few patients. They are related to focal demyelination in spinal cord, peripheral nerves, optic nerve and cerebrum. There may be sensory motor changes especially peripheral paresthesia and ataxic gait.

Sometimes vitamin b12 deficiency occurs in elderly individuals due to hypochlorhydria or following gastric surgery.

Folate deficiency

It results from poor intake of vegetables and can cause megaloblastic anemia.

There are number of other causes producing anemia. If anemia does not respond to therapy or if marked morphological abnormalities are noted in red blood cells it is better to investigate a patient further for proper diagnosis.