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HEMATOLOGY: RBC Disorders

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Haematocrit, effective RBC volume - better. RBC count - 5.5 1, ... Angular cheilosis, atrophic glossitis, dysphagia, koilonychia, paraesthesia, gastric atrophy. ... – PowerPoint PPT presentation

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Title: HEMATOLOGY: RBC Disorders


1
HEMATOLOGYRBC Disorders
  • Dr. VM Shashidhar
  • Senior Lecturer in Pathology
  • Fiji School of Medicine

2
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

3
Blood Smear - Normal
4
Blood Smear - Normal
5
Blood Smear - Normal
6
RBC disorders (Anemias)
  • Anemia is decreased red cell mass affecting
    tissue oxygenation
  • Low Hb lt13.5 (males), lt11.5 (females)
  • Acquired disorders
  • Decreased production
  • Increased loss
  • Congenital disorders
  • Membrane, Hb enzyme disorders.

7
Acquired RBC disorders
  • Decreased Production
  • Aplastic, Hypoplastic anemias
  • Deficiency anemias Iron, B12, Folate etc.
  • Increased loss/destruction
  • Blood loss anemias - parasites, bleeding
  • Hemolytic anemias Immune, mechanical, drugs
    toxins.

8
Congenital RBC Disorders
  • Membrane Disorders
  • Spherocytosis
  • Hemoglobin Disorders
  • Sickle cell disease HbS
  • Thalassemias
  • Enzyme disorders
  • G6PD deficiency

9
Anemia with Low MCV(Microcytic Hypochromic)
  • Differential diagnosis
  • Iron deficiency
  • Thalassemia
  • Laboratory evaluation
  • Iron, iron-binding capacity, and ferritin
  • Hb electrophoresis for Thalassemia

10
Anemia with High MCV(Macrocytic anemia)
  • Differential diagnosis
  • Megaloblastic anemia
  • Nonmegaloblastic anemia
  • Laboratory evaluation
  • Serum vitamin B12, RBC folate
  • Examination of peripheral smear

11
Anemia with Normal MCV(Normocytic anemia)
  • Differential diagnosis
  • Aplastic anemia
  • Bone marrow inflitrations
  • Laboratory evaluation
  • Blood smear for morphology
  • Erythropoietin level
  • Bone marrow aspirate and biopsy

12
Anemia with high Retics(Hemolytic anemia)
  • Acute blood loss, Splenic sequestration
  • Hemolysis
  • Hemolytic anemia, enzyme deficiency
  • Laboratory evaluation
  • Blood smear for morphology.
  • Coombs test, Cold agglutinin titer
  • Hb electrophoresis

13
Iron Deficiency Anemia
  • Most abundant metal, common deficiency..!
  • Limited absorption and no excretory mech.
  • Recycling of iron dead cells to new cells
  • 1mg/day ? 3-6G body ? 1mg/day
  • Increased loss, demand, poor diet.
  • Deficiency ? reserves ?exhaustion ?def.synthesis
    ?anemia.
  • Angular cheilosis, atrophic glossitis, dysphagia,
    koilonychia, paraesthesia, gastric atrophy.

14
Microcytic Anemia (IDA)
15
Iron Deficiency Anemia
16
IDA on Treatment
17
Macrocytic anemia
  • Vitamin B12/Folic acid deficiency
  • Multi Systemic disorder Macrocytic an.
  • All organs with increased cell division
  • Delayed DNA synthesis less division
  • Nuclear size immature more cytoplasm
  • Megaloblasts, destruction, Few Large cells
  • Vit B12 also for myelin sheet nerve dis.
  • Pernicious anaemia

18
Megaloblastic Anemia
19
CWM-20353-Meg.An
20
CWM-20353-Meg.An
21
Iron Metabolism
  • 10 of the 10 to 20 mg of dietary iron is
    absorbed each day to balance the 1 to 2 mg daily
    loss.
  • Iron is absorbed in Jejunum.
  • Stored as Ferritin Hemosiderin.
  • Laboratory tests
  • Serum iron(1mg/l)
  • Serum iron binding capacity (3mg)
  • Serum ferritin (gt20ug)

22
Iron Deficiency Anemia
23
IDA on Treatment
24
IDA on Treatment
25
Megaloblastic Anemia
26
Macrocytic Anemia (Meg.)
27
Sickle Cell Disease
28
Microcytic Hypochromic RBC
29
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