haematology for dental students - rbc disorders
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Haematology for Dental Students - RBC DisordersTRANSCRIPT
Any fool can know. The point is to understand !
-- Albert Einstein
Without Pathology, Medicine is quackery…!
Pathology ofRBC disorders (anemia)
Dr. Shashidhar Venkatesh MurthyA/Prof. & Head of Pathology
DS3102: Clinical Haematology
Less More
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Anemia Introduction:
“Anemia is, decreased red cell mass affecting tissue oxygenation” Low Hb* or Low HCT *
Types:• Failure of production – Deficiency anemia (iron)• Excess destruction – Hemolytic anemia. (immune)
What is ‘polycythemia’ ? ( RBC)
What is spurious / false anemia? ( Plasma)
O2 in - CO2 out
RBCHb + Enz
Membrane
Normal Blood Film:
Hb + Enz + Membrane
RBC
WBC
WBC
RBC
WBC
RBC
Anemia diagnosis:
Haemoglobin – 150 - 140 ±25 g gm/L
PCV/HCT - 0.47 ±0.07, 0.42 ±0.05 % lit/lit (%)
RBC count - 5.5 ±1, 4.8 ± 1 x1012/L
MCH - Hb/RBC - 30 ± 3 pg/RBC pg picogram (wt)
• Average Hb in RBC
MCV - PCV/RBC 90 ±10 – fl fl femto litres (vol)
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Mean Cell Hb 30
Mean Cell Vol 90
120
Packed Cell Volume 45
Plasma
WBC & PLT
PCV / HCT
When your thinking is brilliant, you will be
brilliant, but if your thinking is not brilliant
you will not be brilliant, no matter how
brilliant you may think you are….! -- Christian D. Larson
Fake it until you make it…! -- Mohd. Ali. Boxer.
Clinical Features of Anemia & their Pathogenesis.
Anemia: Clinical Presentation
Extreme fatigue (tiredness)
Chest pain (only in severe anemia)
Decreased oxygen supply to tissues.
Myocardial ischemia.
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Pale skin
Dizziness or lightheadedness
Anemia: Clinical Presentation
Less Hb / RBC
Decreased oxygen supply to Brain.
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RBC: Bring in O2, Take out CO2
Shortness of breath, light headedness.
Fast heart rate (tachycardia)
Anemia Clinical Presentation:
Decreased O2, Increased Co2.
Tissue hypoxia – Hypothalamus –sympathetic stimulation.
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Epithelial damage: Brittle nails
Stomatitis, Glossitis, Esophagitis.
Fast dividing cells (epith) also need iron / nutrition Cytochrome enzymes
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The mind uncontrolled and unguided will drag us down; and the mind controlled and guided will save us, free us.
-- Swami Vivekananda
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Classification of Anemia: Pathogenesis
Decreased Production:• Nutrient Deficiency.
• Iron def., Megaloblastic (B12/Folate)
• Stem cell Deficiency :• Anemia of chronic disorders (ACD).• Aplastic anemia – bone marrow defect.
Increased loss / destruction:• Blood loss anemia – Acute / Chronic - bleeding. • Hemolytic anemia – Congenital / Acquired.
• Acquired – Immune Haemolytic anemia (AIHA)• Congenital – Sickle, thalassemia etc.
Top 5 Anemias1. Iron Deficiency.2. Megaloblastic.3. An. of Chronic Dis.4. Aplastic.5. Haemolytic - AIHA
Proerythroblast(Pronormoblast)
BasophilicNormoblast
PolychromatophilicNormoblast
OrthochromatophilicNormoblast
Reticulocyte
Erythrocyte
BLAST Early Intermediate Late Retic. RBC
Anemia Pathogenesis:
DNA: Megaloblastic Anemia
Hb: Iron
B12, Folate
Iron Deficiency anemia
Hemolytic anemiaImmune
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Aplastic anemia
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Laboratory Diagnosis: Normal
RBC Histogram
WBC Scattergram
Neutrophil
RBC
Lymphocyte
Neutrophil
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Classification of Anemia:
Decreased Production:• Nutrient Deficiency.
• Iron def., Megaloblastic (B12/Folate)
• Stem cell Deficiency :• Anemia of chronic disorders (ACD) – Iron transfer defect.• Aplastic anemia – bone marrow defect.
Increased loss / destruction:• Blood loss anemia – Acute / Chronic - bleeding. • Hemolytic anemia – Congenital / Acquired.
• Acquired / External RBC defect– Immune AIHA (Warm/Cold), Mechanical, Drugs & Parasites
• Congenital / Internal RBC defect– E.g. Sickle cell anemia, Thalassemia.
Top 5 Anemias1. Iron Deficiency.2. Megaloblastic.
Most common anemias
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Haemopoiesis in deficiency anemias
Macrocytic, pancytopeniaMicrocytic hypochromic
Iron Deficiency Normal Megaloblastic
Iron Deficiency - Megaloblastic Causes:
• Bleeding, Nutrition, Increased needs.
Pathogenesis:• Iron - Hb - MCV
Morphology:• Microcytic,
Hypochromic • Pencil cells.
Clinical Features:• koilonychia, glossitis,
stomatitis.
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Causes:• Nutrition, gastritis,
intestinal disorders, Cancer therapy.
Pathogenesis:• Abn. DNA* all cells.
Morphology:• Macrocytic,
Normochromic• Pancytopenia*
Clinical Features:• Jaundice mild, glossitis,
chelitis, stomatitis.
Whatever you think, that you will be. If you think yourselves weak,
weak you will be. If you think yourselves strong,
strong you will be!
-- Swami Vivekananda
Microcytic Anemia (IDA)
Normal
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Iron Deficiency Anemia:
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1.Microcytic, Hypochromic – excess cell division, low Hb.
2.Anisopoikilocytosis. – varying supply, abnormal hemopoiesis.
3.Pencil forms. - ? cause
L
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Macrocytic Anemia (Meg.):
NormalHN
Megaloblastic Anemia:
1. Oval Macrocytes, Pancytopenia – Less cell division.
2. Anisopoikilocytosis – Ineffective hempoiesis, Hemolysis.
3. Hypersegmented neutrophils. - Megaloblasts (in marrow).
Megaloblastic Bone Marrow Normal
Hypersegmented Neutrophils
Macrocyte
Megaloblast
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Anemia of Chronic Disease: Causes:
• Chronic Infections, inflammations, malignancy & anemia of renal disease*.
Pathogenesis:• Inflammatory mediators (IFN,
TNF) block iron transfer from store to RBC
• Also decrease erythropoietin prod.
Morphology:• Mild Microcytic, Hypochromic.
Clinical Features:• Mild anemia, resistant to iron…
24IDA ? IDA / ACD ACD
“No doubt knowledge is valuable,but above it is Character”
Knowledge without character is dangerous!
Aplastic A: BM Failure: immune, drugs, cancer..
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Dysplasia Normal BM Aplasia
Clinical Features:Anemia, Infections & Bleeding.1. RBC - Anemia,2. WBC - Leukopenia3. PLT - Thrombocytopenia
Stem cell damage• Drugs, Immune• Viral Infections.
Leukemia
Normocytic Pancytopenia
Our destiny is in our hands, What we think and do in the present
determines what shall happen to us in the future.
-- Christian D. Larson
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Mechanism & Types of Anemia : Decreased Production:
• Nutrient Deficiency. • Iron, B12 / Folate
• Hemopoietic cell defect:• Anemia of chronic disorders (ACD) – low erythropoietin.• Aplastic, Hypoplastic – Drugs, Disease, Destruction.• Dysplastic & Neoplastic proliferative anemias.
Increased loss / destruction:• Blood loss anemia – bleeding, parasites, • Hemolytic anemia – Congenital / Acquired.
• Acquired / External RBC defect– Immune (Warm/Cold), Mechanical, Drugs & Parasites
• Congenital / Internal RBC defect– Defective Membrane (HS), Hb (Sickle, Thal) or Enzyme (G6PD)
Hemolytic anemia (acquired): Causes:
• Antibody to RBC – commonest (cold / warm)• Idiopathic, Drugs, infections, malaria, trauma.
Pathogenesis: • Damage Hemolysis Jaundice.
Morphology:• Spherocytes (warm) / RBC clumps (cold).
Clinical Features:• anemia, Jaundice. Splenomegaly in chronic.• Diagnosis: Coomb’s test (detects Ab on RBC)
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IgG
WARM
IgM
COLD
WARM
COLD
Congenital Hemolytic An.:
1. Membrane Disorders• Hereditary Spherocytosis (HS)
2. Enzyme Deficiencies.• G6PD Def.
3. Hemoglobin Disorders• Globin deficiency: Thalassemia• Globin abnormal: Sickle cell an.
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RBC• Cell Mem.• Enzymes• Hemoglobin
HemolysisJaundice
Clinical Features
Thalassemia
Reticulocyte: Immature RBC
Reticulocyte
RBC
Reticulocytes (Immature RBC) Increased RBC productionReticulocytosis Hemolytic anemia/bleeding 5-7 days
(Bluish, Large, high MCV)
RNA network within RBC – stained by methylene blue.
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Polychromatophil
Spherocyte
Nucleated RBC
Never say No, never say, ‘I cannot’, for you are infinite. Even time and space are as nothing compared with your
nature. You can do anything and everything.
-- Swami Vivekananda
Anemia
Diagnosis:
MCV
Microcytic Normocytic Macrocytic
Measure Ferritin
Low Normal/high
Iron def Anemia
Anemia ofchronic disease/
Congenital Hb dis.
Reticulocyte count
high low Anemia of chronic diseaseRenal failure
Marrow failure
Hemolytic anemia or blood loss
Measure B12 + folate
Megaloblasticanemia
Normal Low
Anemia Clinical Diagnosis
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The power of thought is not a compelling force. It is a building force, and it is only when used in
the latter sense that desirable results can be produced.
-- Christian D. Larson
The pessimist waits for better times, and expects to keep on waiting; the optimist goes to work with the best
that is at hand now, and proceeds to create better times.
-- Christian D. Larson