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  Blood disorder

Hematology is the branch of clinical pathology that is concerned with the study of the formed cellular and non-cellular elements of the blood, blood-forming organs like the bone marrow and blood diseases. The formed elements of the blood are the white blood cells (WBCs), red blood cells (RBCs) and platelets. Plasma is the acellular or the fluid portion which comprises about 55% of the blood. Suspended in the plasma are the albumins (the most abundant plasma protein), immunoglobulins (antibodies), enzymes, coagulation factors and hormones.

Anemia Blood disorder
Blood disorder


Blood disorders are classified according to the following categories: hemoglobinopathies, anemias, decreased or increased number of cells, malignancies and coagulopathies.

Hemoglobinopathies refers to a disease involving the rate of hemoglobin synthesis. It is a congenital abnormality of the hemoglobin molecules which often results to increase rate of hemolysis. The common disorders under this category are: sickle cell disease, methemoglobinemia and thalassemia. Sickle-cell disease is a general term for a group of genetic disorders caused by formation of sickle hemoglobin in the form of Hgb S/Hb S. Due to the distorted shapes of the red blood cells because of the abnormal sickle hemoglobin, oxygenation of tissues is impaired.

Thalassemia, also known as "Cooley's anemia", is another inherited disease involving the red blood cells. This genetic defect results in the synthesis of an abnormal hemoglobin molecule leading to formation of very vulnerable red blood cells to any form of mechanical injury. The red blood cells in this genetic problem rupture and die easily as evidenced by an abnormal result in the osmotic fragility tests. The last disorder is methemoglobinemia, also known as "met-H", defined as a genetic disease characterized by the presence of an increase levels of methemoglobin in the bloodstream.

Anemia is a general term for deficiency or lack of red blood cells or hemoglobin. The most common etiology is the iron-deficiency anemia. When the dietary intake or absorption of iron is not enough, then iron-deficiency anemia occurs. Without iron, hemoglobin, the oxygen carrying protein cannot be formed. Although, some individuals may have poorer compensatory mechanisms especially during an infection, pregnancy and other chronic debilitating conditions which make them at risk for developing iron deficiency anemia. Another type of anemia is the megaloblastic anemia resulting from lack of vitamin B12 (also known as pernicious anemia) and folic acid. As compared to the iron-deficiency anemia wherein the red blood cells are smaller than normal, megaloblastic anemia is a macrocytic type of anemia. The red blood cells in this type of anemia are bigger than the normal size. Pregnant women may have this type of anemia hence, during the pre-natal period, intake of supplements in the form of folic acid and B complex vitamins aside from ferrous sulfate are important to prevent this blood disorder. Another type of anemia due to the abnormal breakdown of red blood cells either intravascularly (inside the blood vessels) or extravascularly (anywhere else in the body) is known as hemolytic anemia. Lastly, a more serious condition is the aplastic anemia, a type of pancytopenia in which the bone marrow itself is not functioning very well in replenishing the dying old red blood cells to compensate for the decreasing number of red blood cells in the bloodstream. Usually patients have decreasing reticulocyte count, indicating that the bone marrow is not producing enough cells to replace the old worn-out red cells. Some causes of bone marrow failure are due to repeated exposure to radiation and chemicals. Patients diagnosed with anemia usually complain of shortness of breath, easy fatigability, pallor and or cyanosis and sometimes with hepatosplenomegaly.

Other disorders that can lead to decreasing number of formed cellular elements are the following: myelodysplastic syndromes (MDS, previously known as "preleukemia") a group of hematological conditions due to ineffective production of blood cells and has varying risks of transforming into a malignant condition known as acute myelogenous leukemia (AML); myelofibrosis, one of the myeloproliferative diseases in which the bone marrow is gradually replaced by connective tissue; neutropenia, below than normal count of a type of granular leukocyte; agranulocytosis which actually means literally as lack of granulocytes, an acute condition involving a severe and life threatening reduction in the number of leukocytes (white blood cells), provides defense against infection in the body ; Glanzmann's thrombasthenia, an extreme rare blood disorder , in which there is normal platelet count but with impaired clotting function due to deficiency of the glycoprotein IIb/IIIa and lastly, the thrombocytopenia in which there is a deficiency or below than normal levels of platelet count in bloodstream leading to bleeding problems.

Disorders with associated increased number of cells in the blood are: polycythemia vera, which is a net increase of the red blood cells mass in the circulation; leukocytosis, an increase white blood cell count usually seen during infections; and thrombocytosis, elevated platelet counts in the circulation.

Common hematological malignancies are: lymphoma, multiple myeloma and leukemia. Lymphoma is a general term for a malignancy in which the origin of the tumor is lymphocytes or, more rarely, from histiocytes. Generally, these cell types are actually part of the reticuloendothelial system (RES) and circulate in the lymphatic vessels. There are two common lymphomas, the hodgkin lymphoma (with presence of Reed-Sternberg cells histologically) a radiosensitive tumor and the non-hodgkin lymphoma, radioresistant tumor. Multiple myeloma also known as MM, myeloma, plasma cell myeloma, or as Kahler's disease named after Otto Kahler is a malignancy derived from plasma cells. Plasma cells are members of the immune system cells that produce large amount of antibodies. Leukemia is a general term for malignancy or cancer of the blood or bone marrow characterized by an abnormal proliferation of white blood cells either mature or immature leukocytes in the peripheral circulation. Patients with leukemia presents with weak immune system, recurrent infections and lymphadenopathy.

Coagulopathies include thrombocytosis and recurrent thrombosis. Thrombocytosis, is the presence of abnormally elevated platelet counts in the blood, and can be either reactive or primary. Although often symptomless but still it predisposes the patient to thrombus formation. (especially when it is a secondary reaction) Recurrent thrombosis is the formation of a clot (thrombus) inside the lumen of a blood vessel, hence; obstruction of the blood flow may occur through the circulatory system. The main complication of thrombus formation is embolisation, (thromboembolism) a clot that has been disloged.

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