"I am careful not to confuse excellence with perfection' Excellence is what I can reach for Perfecti - PowerPoint PPT Presentation

1 / 51
About This Presentation
Title:

"I am careful not to confuse excellence with perfection' Excellence is what I can reach for Perfecti

Description:

... anemia, pancytopenia. Pernicious anaemia. autoimmune, ... Intrinsic factor Ab - Pernicious anemia. Gastrectomy, Ileal resection. Inflammatory bowel disease ... – PowerPoint PPT presentation

Number of Views:131
Avg rating:3.0/5.0
Slides: 52
Provided by: it868
Category:

less

Transcript and Presenter's Notes

Title: "I am careful not to confuse excellence with perfection' Excellence is what I can reach for Perfecti


1
"I am careful not to confuse excellence with
perfection. Excellence is what I can reach
forPerfection is God's business Michael J.
Fox
2
HEMATOLOGY Part-I RBC disorders
  • Dr. Venkatesh M. Shashidhar
  • Senior Lecturer in Pathology
  • Fiji School of Medicine

3
Introduction
  • Yolk sac Placenta ? Liver Spleen ? B.marrow.
  • Haemopoietic marrow ? fatty marrow.
  • RE system can take over hemopoiesis.
  • 50 fat in adult marrow.
  • Stem cell ? Progenitor cells ? Mature cells
  • Growth factors Erythropoietin, thyroxine,
    Androgens.
  • Iron, Vit B12, Folate, Zinc, Vit-C, B6, E,
    thiamine, riboflavin, other metals, aminoacids

4
Introduction
  • low O2 ? Kidney ? Erythropoietin ?
    Erythropoiesis.
  • 1 blast ? 16 RBC, 1 week, 1-2 day in spleen ?
    mature
  • Hb formation and DNA essential for maturation.
  • Immature RBC RNA/DNA remnant polychr.. lt2
  • RBC cannot use oxygen only glycolysis why?

5
Haemopoiesis
6
Bone Marrow Cellularity
Normal Hypercellular Hypocellular
7
Erythropoiesis
8
C.B.C
  • Haemoglobin - 152.5, 14 2.5 - g/dl
  • PCV - 0.47 0.07, 0.42 0.05 - l/l ()
  • Haematocrit, effective RBC volume - better
  • RBC count - 5.5 1, 4.8 1 x1012/l
  • MCHC - Hb/PCV - 30-36 - g/dl
  • Hb synthesis within RBC
  • MCH - Hb/RBC - 29.5 2.5 pg/l
  • Average Hb in RBC
  • MCV - PCV/RBC 85 8 - fl

9
Blood Smear - Normal
10
White Blood Cells
11
RBC disorders (Anemias)
Anemia is decreased red cell mass affecting
tissue oxygenation Low Hb lt13.5 (males), lt11.5
(females) Polycythemia ? High Hb.
12
Anemia Classification
  • Acquired
  • Decreased production
  • Increased loss
  • Congenital
  • Increased loss/Hemolytic
  • Decreased production
  • Nutritional
  • Marrow suppression
  • Marrow infiltration
  • Increased loss
  • Blood loss
  • Hemolytic
  • Immune
  • Non immune

13
Acquired RBC disorders
  • Decreased Production
  • Aplastic, Hypoplastic anemias
  • Deficiency anemias Iron, B12, Folate etc.
  • Lack of erythropoiesis - Kidney disease
  • Marrow disease, malignancy, radiation
  • Increased loss/destruction
  • Blood loss anemias - parasites, bleeding
  • Hemolytic anemias - Autoimmune (cold warm
    antibody) mechanical, drugs toxins.

14
Iron Deficiency Anemia
  • Most abundant metal but most common deficiency..!
  • Common in developing world,
  • Worm infestation, chronic blood loss, poor diet.

15
Low HbAnemia MCV
Low microcytic
Normal normocytic
High macrocytic
Measure Ferritin
Measure B12 folate
Normal/high
Low
Low Megaloblastic anemia
Normal
Anemia of chronic disease/ Congenital Hb dis.
Iron def Anemia
Reticulocyte count
Anemia of chronic disease Renal failure Marrow
failure
high
low
Hemolytic anemia or blood loss
16
Iron Metabolism
  • Limited absorption and no excretory mech.
  • Recycling of iron dead cells to new cells
  • 1mg/day ? 3-6G body ? 1mg/day
  • 10 of the 10 to 20 mg of dietary iron.
  • Iron is absorbed in Jejunum.
  • Stored as Ferritin Hemosiderin.
  • Laboratory tests
  • Serum iron(1mg/l)
  • Serum iron binding capacity (3mg)
  • Serum ferritin (gt20ug)

17
IDA - Etiology
  • Blood loss bleeding, parasites
  • Poor diet malnutrition (greens meat)
  • Increased need Pregnancy, children

18
IDA - Pathogenesis
  • Decreased Iron stores
  • Decreased Hb Synthesis
  • Delayed maturation of erythroblasts (cytopl)
  • Decreased cell size (microcytes)
  • Decreased hb content (hypochromia)
  • Decreased RBC number
  • Anemia.

19
Microcytic Anemia (IDA)
20
Clinical Features
  • Anemia
  • Pallor, Weakness, Lethargy
  • Breathlessness on exertion
  • Palpitations may lead to heart failure - edema
  • IDA
  • Angular cheilosis, atrophic glossitis,
  • dysphagia, koilonychia, gastric atrophy.

21
Angular cheilitis Glossitis
22
Iron Deficiency Anemia
23
IDA on Treatment
24
Megaloblastic anemia
  • Vitamin B12/Folic acid deficiency
  • Second most common type of anemia.
  • Multi System disease All organs with increased
    cell division.
  • Macrocytic anemia, pancytopenia.
  • Pernicious anaemia
  • autoimmune, Gastric atrophy, VitB12 def.

25
Megaloblastic anemia - Etiology
  • Malnutrition
  • Intrinsic factor Ab - Pernicious anemia
  • Gastrectomy, Ileal resection
  • Inflammatory bowel disease
  • Malabsorption syndromes - Sprue
  • Blind loop syndrome

26
Megalobl - Pathogenesis
  • Decreased Vit B12 / Folate
  • Decreased DNA Synthesis
  • Delayed maturation of erythroblasts (Nucleus)
  • Increased cell size (macrocytes)
  • Normal hb content (Normochromia)
  • Decreased RBC number
  • Decreased WBC number (pancytopenia)
  • Anemia Pancytopenia.

27
Macrocytic Anemia (Meg.)
28
Megaloblastic Anemia
29
CWM-20353-Meg.An
30
CWM- ?
31
CWM - ?
32
Hemolytic Anemia - Types
  • Immune lysis
  • Warm Cold Ab types.
  • Mechanical Damage
  • Microangiopathy (DIC), prosthesis, march
  • Hereditary Defects
  • Membrane, Hb Enzyme defect
  • Infection induced
  • Clostridia, malaria, septicemia

33
Clinical Features
  • Pallor mild mucosal
  • Jaundice - Mild fluctuating
  • Splenomegaly
  • No bile in urine (dark on standing-UBG)
  • Pigment gall stones in chronic forms
  • Crisis aplastic, hemolytic, vascular
  • Ankle ulcers

34
Polychromasia - Hemolytic An.
35
CBC Analyzer Report
36
Congenital RBC Disorders
  • Membrane Disorders
  • Spherocytosis, Elliptocytosis
  • Hemoglobin Disorders
  • Hemoglobinopathies - Sickle cell, HbC etc.
  • Thalassemia Syndromes - ?, ?, ?
  • Enzyme disorders
  • G6PD, PK deficiency

37
Thalassemia Trait
38
Thalassemia Major
39
Blood Smear Interpretation
Normal Micro/hypo Macro Target Sphero Heinz
body Schistocyte nRBC Polychrom Teardrop
A B C D E F G H I J
40
Basophilic Stippling
41
Polychromasia - Hemolytic An.
42
ß Thalassemia Major
43
Sickle Cell Disease
44
Microangiopathy / DIC
45
Her. Spherocytosis /AIHA
46
Cold Hemagglutinin Disease
47
Anemia with Low MCV and Low Retics
  • Differential diagnosis
  • Iron deficiency
  • Sideroblastic anemia
  • Thalassemia trait
  • Anemia of chronic disease
  • Laboratory evaluation
  • Iron, iron-binding capacity, and ferritin
  • Blood smear - Target cells, stippling, etc.
  • Hb electrophoresis for Thalassemia
  • Bone marrow iron stores, ring sideroblasts

48
Anemia with High MCV, Low Retics
  • Differential diagnosis
  • Megaloblastic anemia
  • B12, Folate deficiency
  • Myelodysplastic syndrome
  • Nonmegaloblastic anemia
  • Liver disease , Hypothyroidism
  • Laboratory evaluation
  • Serum B12, RBC folate levels.
  • Examination of peripheral smear
  • Bone marrow examination.

49
Anemia with Normal MCV,Low Retics
  • Differential diagnosis
  • Primary bone marrow failure
  • Aplastic anemia, drugs, chemotherapy
  • Secondary bone marrow failure
  • Uremia, Endocrine disorders, AIDS,
  • Anemia of chronic disease
  • Laboratory evaluation
  • Blood smear Iron, TIBC, Ferritin.
  • Bone marrow smear and iron stores
  • Kidney, Thyroid liver function tests, Cortisol
    levels
  • Erythropoietin level

50
Anemia with high Retics - Hemolysis
  • Differential diagnosis
  • Immune Warm Cold Ab, Auto Allo immune
  • Mechanical - Valve, Microangiopathy (DIC)
  • Hereditary hemolytic anemias Hb, Enzyme mem
  • Infection-related hemolysis Clostridia, malaria.
  • Laboratory evaluation
  • Blood smear morphology, nRBC, Parasites, Retics.
  • Evidence of Hemolysis Bilirubin, Haptoglobin,
  • Direct and indirect Coombs test
  • Hemoglobin electrophoresis, G6PD screen etc.

51
Causes of High Hct/polycythemia
  • Relative or spurious erythrocytosis
  • Hemoconcentration secondary to dehydration
  • (diarrhea, diaphoresis, diuretics, deprivation
    of water, emesis, ethanol, etc.)
  • Absolute erythrocytosis (True )
  • Tissue hypoxia - High altitude, Pumonary disease,
    respiratory def. Right to left cardiac shunts,
    Carbon monoxide intoxication, High
    oxygen-affinity Hb.
  • High EPO - Renal disease, Tumors eg. HCC.
  • Androgen therapy
  • Primary - Polycythemia vera
Write a Comment
User Comments (0)
About PowerShow.com