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Outlines

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Title: Outlines


1
? ? ? ?
  • ???
  • ????
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2
Outlines
  • ?? ??
  • ????? ??
  • ??? ??
  • ??? ??
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  • ????

3
Think of????
  • ??????????
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  • ???
  • ?????

4
????????
  • ????? (BC 384322)
  • ????
  • ????????
  • ????????BC???????
  • ??????????? (?17??)
  • ???????,?????,????????

5
?? (William Harvey, 15781657)
  • 1628 A.D.?????
  • ????????????????
  • ???????,??????????
  • ??????????,??????????
  • ?????????????
  • ???????1661?
  • ??????????,????????

6
???? (Circulation)
  • ????
  • ????
  • ????????
  • ????????
  • ??????
  • ????????
  • ????
  • ??? ? ??? ? ??

7
???? (Circulation)
?
???
???
CO2
O2
LA
RV
??
LV
RA
????
??
??????
???
??
??
????
??
??
???
????
8
Outlines
  • ?? ??
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  • ??? ??
  • ??? ??
  • ??? ??
  • ????? ??
  • ????

9
??????? ??
  • ??
  • ??? ?? 2 ??
  • ??? ??? ?? 6 ??10???
  • ?? ?? 24 ?? ? ??
  • ?????? ( 20 ??? )
  • ??
  • ??
  • ????
  • ?????

10
????
  • Stem cell (???) self-renewal
  • Totipotent (??) pluripotent (??) ???
  • CD34 (1 of BM 0.01 of PB)
  • PPSC (1 of CD34 )
  • Committed (??)stem cell
  • Progenitor ???? mitosis maturation
  • Precursor ???? maturation

11
????
  • ??
  • ??? 7
  • 3500cc /50Kg 5000cc/ 70kg.
  • ?? 45 volume
  • ???? 5,000K/ul (95)
  • ???? 5K/ul (0.1)
  • ???? 250K/ul (5)
  • ?? 55 volume

12
????
RBC ??? Neutrophil ??? Monocyte
??? Eosinophil ??? Basophil ??? Platelet
???
Myeloid Stem cell
Stem Cell
BM
THYMUS
T/NK T ?? stem cell NK
?? B ?? Plasma ??
Lymphoid Stem cell
LN
13
(No Transcript)
14
????????
15
Outlines
  • ?? ??
  • ????? ??
  • ??? ??
  • ??? ??
  • ??? ??
  • ????? ??
  • ????

16
???
  • ??? Biconcave, 882m , ??90 fL
  • No nucleus, no mitochondria.
  • RBC 500 ?/ ul
  • Reticulocyte (???) 1?,?Golgi, mitochondria
  • Cytoplasm ?Hemoglobin (Hb) ???
  • The major protein (34 of RBC ??)
  • Life 100-120d ? macrophage ??.
  • Energy glucose ? 2,3-DPG, ATP
  • NADPH??? ??

17
RBC Series
  • Pronormoblast
  • Basophilic normoblast
  • Polychromaphilic
  • Orthrochromic
  • Reticulocyte, RBC

BM PB (1day)
18
???????
?????
?????
?????
?????
?????
?????
19
?????
  • ???? O2 ???
  • Hb (15 g/100cc) x 1.34 (cc/g) 20 cc/100 cc
  • ????? ??? - ???
  • ?????? (O2 dissociation curve)
  • (Hb) ??????,??????
  • ?H, DPG, temp ??
  • ????? CO2

20
???? (O2 delivery)
  • O2 delivery CO Hb 1.34 SaO2
  • CO (L/min) cardiac output ?????
  • Hb (g/dL) hemoglobin ?????
  • 1.34 (mL/g) O2 / Hb ??????????
  • SaO2 () ???????????

21
Erythropoietin (??)
  • EPO ??????
  • 34 Kd ???
  • Kidney 80-90
  • Liver 10-20
  • ??? O2 ??
  • Artery O2 (?)
  • Anemia
  • Poor blood flow
  • Low blood volume

22
?????
  • ????? ??
  • ???????
  • ??????
  • ???????

23
(No Transcript)
24
?? (anemia)
  • ????? (???) ???
  • Hb g/dL
  • Hb lt13.5 (male) or lt12 (female)
  • RBC (/uL) Hb / 3
  • Hct (hematocrit, ???? ) Hb 3
  • ???? compensation
  • ???? acute 3 folds chronic 5-8 folds
  • O2DC (??????)

25
Normal Hb MCV
26
Diagnosis of Anemia Important Tools
  • History
  • FH, diet, ??, MC, Pb, ?, ??, ?, ??
  • Physical examination
  • ? (chipmunk), ?, ?, nail, LN, L/S, DRE
  • Blood routine ????
  • PB smear ???
  • Reticulocyte ???

27
Red Cell Index
  • RBC ( M/ul M/cumm ) ????
  • Hb ( g/dl ) ???
  • Hct ( ) MCV x RBC x 0.1 ( Hb x 3 ) ??
  • MCV ( fl u3 ) Hct / RBC x 10 ????

28
Anemia MCV ???
  • Microcytic ?? Hb ?? ? dec cytoplasm
  • IDA, thalassemia
  • Macrocytic ?? Nu ????, reticulocyte
  • Megaloblastic, hemolysis, aplastic anemia
  • Normocytic ?? stem cell (Nu, Hb ??)
  • Hemolysis, acute blood loss, aplastic anemia

microcytic
macrocytic
normocytic
29
IDA Blood Loss
  • The most common cause of anemia.
  • Acute blood loss trauma, GI, MC
  • Iron deficiency anemia ?????
  • Chronic blood loss MC, ??
  • Diet, diarrhea

30
Hemolytic anemia ????? (1)
  • G6PD (??? 6-?????) deficiency
  • ?????????
  • ??, ??, ?? ? ???? ? ??
  • ?????? aspirin, ???, ???, ???, ??? C,K

31
Hemolytic anemia ????? (2)
  • Thalassemia (?????)
  • alfa ? 4, beta ? 2 in Taiwan
  • decrease globin ? ab imbalance ? HA
  • decrease MCV HbA
  • increase HbA2 (a2d2), HbF (a2g2), target cells,
    N-RBC
  • transfusion, ??, ??
  • Sickle cell anemia ??(8),????
  • Hb S (b6glu?val) ? sickling (when hypoxemia)
  • splenic hemolysis, ???? ? ?????

32
????? Megaloblastic Anemia
  • ??
  • B12, ?? ? DNA??? ???, ??
  • ??????, ?????RNA?????
  • ???? alcohol, ??, ??, TPN
  • ???? (?????, B12????????)
  • pernicious a. (????), ???, ????
  • ???? ??, ??
  • ??????(??)?B12?????
  • ???? B12???

33
Aplastic Anemia
  • ???????
  • ?? 80 ??
  • ????????
  • Anemia
  • Leukopenia
  • Thrombocytopenia

34
??????
  • ??? ??????
  • ??? ???????
  • ?? ? ???????????
  • Polycythemia vera
  • ??? 10x water ? ?????
  • ???
  • Secondary polycythemia
  • ??(4km)???????? ? tissue hypoxia
  • ??????? ? EPO activity

35
Outlines
  • ?? ??
  • ????? ??
  • ??? ??
  • ??? ??
  • ??? ??
  • ????? ??
  • ????

36
??? - ????
  • ??? (granulocyte, PMN) ??
  • ??? neutrophil 60 - ????? 6h
  • ??? eosinophil 3 - ??????
  • ??? basophil 1 - ?????
  • ???? mast cell nil
  • ??? (lymphocyte) 30 mo-yrs
  • B cell (15) - ???? antibody
  • T cell (70) - ???????
  • Natural Killer cell (15) - ??
  • ??? (monocyte) 6 - ???? 15h
  • ???????-???????

37
PMN Series
Myeloblast
Myelocyte
Promyelocyte
?????
?????
Band form
Metamyelocyte
Segment form
38
??????
sIg
DR
DR
DR
DR
CD19
CD19
CD19
CD19
Plasma cell
TdT
TdT
B
TdT
Cu
CD34
CD10
CD10
CD21 CD22
CD20
CD20
DR
Precursor B
Pre-B
B Plasmacyte
TdT
Early Thymocyte Common Mature
CD3
CD34
CD2
CD8
CD4
T8
CD5
CD5
CD2
CD2
CD2
CD5
CD8
TdT
TdT
TdT
TdT
CD3
CD4
CD2
CD34
CD34
CD1
CD1
T4
CD7
CD7
CD7
T
39
Monocyte Series
Monoblast
Promonocyte
?????
?????
Monocyte
Macrophage / Histiocyte
???? / ??????
????
40
?????
  • ???? (7000 - 3500/ul)
  • ??????????
  • ????????????????
  • ????
  • ??? (??)
  • ?????
  • ???????
  • ???????
  • ???????????????

41
Outlines
  • ?? ??
  • ????? ??
  • ??? ??
  • ??? ??
  • ??? ??
  • ????? ??
  • ????

42
???
  • 2-3 u, ??????
  • ????, ????????, ????????????

43
Hemostasis system
vessel or cell injury
COAGULATION
TFPI, AT3, PC/PS
Thrombin
CLOT
PLATELET
FIBRINOLYSIS
Fibrin
Plasmin
Plug
Tm, PL, VWF
ENDOTHELIUM
VASOCONSTRICTION
44
Hemostasis System
45
Coagulation Cascade
46
Platelet Series
?????
????
Megakaryoblast
Promegakaryocyte
???
Megakaryocyte
Platelet
47
?????
  • ?????
  • ?????????????????
  • (?12-5)
  • ?????
  • NSAID (non-steroid anti-inflammatory drug)
  • aspirin
  • ?????

48
Outlines
  • ?? ??
  • ????? ??
  • ??? ??
  • ??? ??
  • ??? ??
  • ????? ??
  • ????

49
???? (Circulation)
?
???
???
CO2
O2
LA
RV
??
LV
RA
????
??
??????
???
??
??
????
??
??
???
????
50
????
51
????
  • ????
  • Primary ??? ?????
  • ??????
  • Secondary ??? ?????
  • ???????????? (MALT)
  • ??????????? (thoracic duct)
  • ???
  • ????????
  • ???B?T?NK

52
1o ?????????
B NK T
53
2o ??????????
B
RC Ma DC
T
T
54
Superficial Lymph Nodes
55
???????
  • ?? ( gt5000/ul )
  • Virus, TB, syphilis, pertussis, stress.
  • ?? ( lt1500/ul )
  • Dec. production adv cancers or Hodgkin disease,
    AA, congenital Ig deficiency
  • Inc. destruction steroid, cytotoxic therapy
  • ??????????????????
  • AIDS ??????????? miliary TB ?SLE

56
???????
  • ??????
  • ??, ??
  • ??????????
  • ????
  • ?????
  • ?????
  • ??????????

57
Immunity ????
  • ?? innate immunity
  • WBC, tissue macrophage
  • ???????Skin
  • Lysozyme, ????, complement, NK cells
  • ?? acquired immunity lymphocyte
  • Cellular T cell
  • Humoral B cell ? Ab -- antigen (gt8Kd)
  • Hapten ??? (lt8Kd) protein ? Ag

58
Inflammation (??)
  • Vasodilatation, increase permeability,
    coagulation, WBC infiltrate, cell swelling
  • Local tissue macrophage in 1hr
  • Blood neutrophil infiltration in hrs
  • Blood monocyte-macrophage after 8hrs
  • BM myeloid hyperplasia after 3-4 days

59
Phagocytosis
60
Immune Interactions
APC
Th
mT
CTL
mB
NK
61
Antibody
  • IgG 75 secondary response
  • IgA mucosal protection
  • IgM primary response
  • IgD ?
  • IgE allergy
  • mast, basophil

variable
LC
HC
62
???????
Complement lysis ADCC (NK, PMN, Ma)
B
Th2
Ab
?
APC Mo
B7/ICAM
Ag
MHC2
Self MHC1
Th1
CTL
Non-self MHC1
IFN, IL2
NK
63
Stress and Immune
64
Outlines
  • ?? ??
  • ????? ??
  • ??? ??
  • ??? ??
  • ??? ??
  • ????? ??
  • ????

65
?? (???)
  • ????300?
  • ??????????? glycolipid
  • ????ABO(????) Rh(???)

66
Blood Components
67
Blood Components
  • Whole blood (WB)
  • RBC packed red blood cell (PRBC)
  • Leukocyte-reduced RBC 3rd generation (adhesion)
    filter remove 99.9 WBC.
  • Washed RBC plasma washed off by NS.
  • Frozen, deglycerolized RBC up to 10y (65C),
  • Irradiated RBC 25Gy x 4w.
  • Platelets
  • RDP (random donor platelet ) platelet
    concentrate (PC)
  • SDP (single donor platelets) apheresis (PH)

68
Plasma Components
  • FFP, plasma derived volume expanders (albumin)
  • Coagulants
  • Cryoprecipitate
  • F8 concentrates
  • F9 concentrates
  • AT3 concentrates
  • Recombinant F7a, Fibrin Sealants
  • Ab
  • Immune Globulins, Rh IG

69
Acute transfusion reactions
  • Acute hemolytic transfusion reactions
  • Febrile nonhemolytic reactions
  • Transfusion-related acute lung injury (ARDS)
  • Allergic reaction, anaphylaxis
  • Hyper-volemia
  • Non-immune hemolysis
  • Complications of massive transfusion
  • Transfusion-transmitted disease

70
Acute hemolytic transfusion reactions
  • Very severe, esp. ABO incompatibility.
  • 1/6001/250k
  • Hemolysis
  • Intravascular A, B, Kell, Kidd, Fya ? C9
  • Extravascular Rh.
  • S/S C/F gt N/V, SOB, chest pain, back pain
  • Mx stop BT, report, blood/urine test, check
    blood bag set, IVF, diuretics (keep UO
    gt100ml/h)

71
Febrile nonhemolytic reactions
  • Def rise of BT gt 1C.
  • 0.5 per component.
  • Usually in late 1/3 of BT.
  • Mechanism Ab to WBC, lymph, platelet.
  • S/S transient diastolic HTN, C/F, headache.
  • Mx stop BT, use pre-storage WBC reduction.

72
Transfusion-transmitted disease
  • Hepatitis B 1/63-233k C 1/263k (in US)
  • HIV HTLV 1/1M
  • CMV IUBT, preterm lt1200g in CMV- mother, organ
    transplantation, pregnancy.
  • Spirochete syphilis not viable in 4C x 1-4d.
  • Parasite malaria, babesiosis, Trypanosoma
    cruzi..
  • Creutzfeldt-Jacob (mad cow) disease 1980-1996
    stay in UK gt6mo, family history.

73
THANKS !!
  • ???
  • ????
  • ??????
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