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Pathology 2
Chapter 9: Hematopoietic System
Hematopoietic System
 Goals
Acquaint the student radiographer with the pathophysiology and
radiographic manifestation off all common and some unusual
disorders of the hematopoietic system.
 Objectives
Understand, define and describe terms of the chapter.
Describe the physiology of the hematopoietic system.
Describe conditions affecting the system as well as their
radiographic manifestations.
Physiology of the Blood
 An adequate blood supply to all body tissues is necessary
to bring oxygen, nutrients, salts, and hormones to the cells
and to carry away the waste products of cellular
metabolism. The components of blood are also a major
defense against infection, toxic substances, and foreign
antigens.
Blood cont….
 Red bone marrow (found in vertebrae and flat bones such
as the sternum, ribs, skull, and proximal femur) and lymph
nodes are the blood-forming tissues of the body. Red
blood cells (erythrocytes) and platelets (thrombocytes) are
made in red bone marrow. White blood cells (leukocytes)
are produced in red marrow and lymphoid tissue.
Diseases of RBC’s
 Hemolytic anemias
 Sickle Cell anemia
 Megaloblastic Anemia
 Polycythemia (primary and secondary)
Anemia
 Anemia refers to the decrease in the amount of oxygen
carrying hemoglobin in the peripheral flow. Can be
contributed to
Improper formation of new red blood cells
Increased rate of red blood cell destruction
Loss of red blood cells from prolonged bleeding
 Patient may suffer from
Paleness
Fatigue, muscular weakness
Shortness of breath w/ increased respiratory rate
Hemolytic anemia
 Destruction of RBC’s
 Underlying abnormality is a shortened life span of the red
blood cells with resulting hemolysis and the release of
hemoglobin into the plasma.
 Most common cause is hereditary defect that may produce
abnormal red cells or abnormal hemoglobin.
 Radiographic appearance
Osteoporosis in the long bones, widened medullary spaces with
thinning of the cortex. Skull shows thinning of cortex with hair-onend appearance
Sickle Cell Anemia
 Hemoglobin is abnormal; RBC’s have crescent-shape. When red
blood cells are shaped like sickles or moons, they can get stuck
and die, especially inside smaller blood vessels. This keeps blood
from flowing properly in the body and it also causes a lot of pain.
Important organs like the brain, heart, and kidneys need constant
blood flow to work properly. A person's body knows that the sickle
cells aren't good, so it attacks and destroys them. But the body
can't make new blood cells fast enough to replace the old ones.
 Radiographic appearance
Bi-concave indentations on both the superior and inferior margins
of the softened vertebral bodies giving appearance of “fish
vertebrae.”
Another typical appearance localized steplike central depressions
vertebral end plates.
Megaloblastic Anemia
 Occurs as a result of deficiency of vitamin B12 and or folic
acid.
 Results in an overall decrease of RBC’s. Stomach
appears tubular with a decrease or absence of rugae.
Polycythemia
 primary (neoplastic) results from hyperplasia of bone marrow,
resulting in increased amounts of erythrocytes, granulocytes and
platelets. Chest films show prominent vascular markings without
cardiomegaly.
 Secondary (non-neoplastic) elevated hemoglobin concentration.
Normal chest film, but skull radiographs show hair-on-end
appearance on children with cyanotic heart disease.
Diseases of WBC’s
 Leukemia
 Lymphoma
 Infectious Mononucleosis
Leukemia
 Neoplastic proliferation of WBC’s.
 The term leukemia refers to cancers of the white blood
cells, which are also referred to as leukocytes or WBCs.
When a child has leukemia, large numbers of abnormal
white blood cells are produced in the bone marrow. These
abnormal white cells crowd the bone marrow and flood the
bloodstream, but they cannot perform their proper role of
protecting the body against disease because they are
defective.
Radiographic appearnace
 Skeletal radiographs display radiolucent bands at
metaphyses on long bones of children (moth-eaten
appearance). Commonly shows displacement or
obstruction of GI.
Lymphoma
 neoplasm of lymph system
 The term lymphoma refers to cancers that originate in the body's
lymphatic tissues. Lymphatic tissues include the lymph nodes (also
called lymph glands), thymus, spleen, tonsils, adenoids, and bone
marrow, as well as the channels (called lymphatics or lymph
vessels) that connect them. Although many types of cancer
eventually spread to parts of the lymphatic system, lymphomas are
distinct because they actually originate there.
Radiographic appearance
 enlargement of mediastinal lymph nodes produces
asymmetry on chest films, polypoid masses in the
stomach, thickening of rugae, as well as erosion of
thoracolumbar spine.
Infectious Mononucleosis
 viral infection of the lymph system that produces
lymphadenopathy and splenomegaly.
 commonly see enlarged hilar lymph nodes on chest
radiographs
Bleeding Disorders
 Hemophilia
 Purpura
Hemophilia
 inability of proper blood coagulation. Increased cloudy
densities displayed over soft tissues. Chronic cartilage
destruction with joint narrowing.
Purpura
 deficiency of number of platelets. Small bowel shows
thickening of mucosal folds
 splenomegaly