Professional Documents
Culture Documents
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3
RBCs
WBCs
platelets
2/3 hematology
, bleeding disorder 1/3
: points 4
Definition
(causes(etiology
C/P
Investigations
................................................................................
....
Pallor
anemia
Pallor
Pallor
Pallor
Pallor Anemia
pallor
anemic pale
pallor anemic
CBC
......
defintion of anemia
11 % dl /
gram /dl 11
definition
11 Per dl
anemic male or female
regardless age or sex
pallor
2
................................................................................
....
pallor anemia
complete blood count CBC
gram / dl 11
target
extermities
18
neonatal period
Infant period
childhood period 12 10
adlocent
adult
target
Phsiology
hematology
fetus Intra utrine
placenta
placenta good source for oxygen supply
lung
................................................................................
....
oxygen supply
Lung
fetus
fetal hemoglobin
Hb F
Hb F
oxygen dissociation
fetus
net result
Intra utrine cells fetus
Partial hypoxia
hemoglobin
gram / dl 18-22
Polycythemia
................................................................................
....
) blood
18 ........
... stimulus ...
hypoxia
18 ....
............ 9
....
9
Normal
adult -14
15 Puberity 15 15
72 15
Lung
hypoxia
erythropiotein stimulation of RBCs synthesis
5
................................................................................
....
hemoglobin
... hemoglobin gram / dl 9
physiological anemia of the neoborn
MCQ
phsiologyical anemia of the neoborn
hemolysis of the RBCs (a
Nutritional anemia (b
bleeding tendency (c
(d erythropiotein level
D erythropiotein level
weeks 6 Hemoglobin
erythropiotein
stimulation of the RBCs
Etiology of anemia
RBCs count
) (
synthesis
excess loss
................................................................................
....
synthesis
Decrease synthesis of the RBCs
(a bone marrow
bone marrow failure
requirement of the bone marrow (b
RBCs
stem cells
Mother cells
platelets WBCs RBCs
Vit. E
anti oxidant
7
................................................................................
....
synthesis
RBCs free radicals
RBCs Hemolysis
enumerate causes of nutritional anemia and discuss how to
diagnose one of them
Nutritional anemia
nutritional anemia
Iron deficiency
cupper deficiency
vit. B6 deficiency
protien deficiency
Vit. E deficiency
Vit. D deficiency
vit. B12 and folic acid deficiency
How to diagnose one of them
the most common cause
Most common type of nutritional anemia
Iron deficiency anemia
Nutritional anemia
iron deficiency anemia
title nutritional anemia
8
................................................................................
....
Nutritional anemia
anemia
nutritional anemia
anemia
exception
Pancytopenia
pancytopenia
pancytopenia
RBCs
RBCs WBCs Plateles
stem cells
stem cells
RBCs WBCs Platelets
nutritional anemia
anemia
Vit B1 Vit B12 folic acid
pan cytopenia
bone marrow failure
bone marrow failure
bone marrow failure
bone marrow
stem cells
un differniated cells
stem cells un differentiated cells
................................................................................
....
Un differeniated cells
Organ
stem cell
RBCs
WBCs platelets
receptors
stem cells
receptors erythropiotein hormone
erythropiotein hormone receptor
erythropiotein hormone receptor
erythropiotien
stem cells
RBCs
RBCs
erythropioesis
receptor
thrombopiotein
erythropiotein
thrombopiotein
thrombopiotein receptor
stem cells
Platelets
Megakaryocytes
Mother cells of the platelets
plateletes
receptor
inflammatory cytokines
10
................................................................................
....
interlukin tumor necrosis factor
receptor
Interlukin
cytokines
receptor stem cells
stem cells
receptor
Inflammatory process
interlukin
cytokines
Inflammatory process
WBCs
iron deficiency anemia
daily requirement of iron mg/kg /day 3-2
sources of iron
animal plant
Plant very complex
simple formula
................................................................................
....
breast feeding
deficient in iron
acidic alkaline
absorption
artificial milk
deficient in iron
alkaline
absorption
iron
breast feeding
iron PH stomach
antacid
... ... gastric erosion antacids
ulcers stomach
alkaline iron absorption
Iron
iron ferric ferrous
ferrous iron upper part of the duodenum
2nd and 3rd part of the duodenum
PH alkaline
absorption
mucosa of the duodenum
carrier protien apoferritin
iron
iron ferritin
carrier protien blood
blood transferrin
stores
12
................................................................................
....
Liver
6
???? why iron has carrier protein in the blood
Iron free in the blood
deposition inside the tissues
hemosidrosis
| |
apoferritin Iron Lumen of the duodenum
lumen duodenum
stores enough 6
stores
7th, 8th, and 9th months
stores
:
1/3
: gram 2500
stores
intra utrine growth retardation
.N.B
iron deficiency anemia
breast feeding
13
................................................................................
....
teeth
breast milk iron
suppose 2 mg /kg /day
breast feeding 1mg /kg /day
iron breast feeding absorption
stores
2mg /kg /day
Stores 6
6 iron deficiency anemia
iron
"
"
causes of iron deficiency anemia
decrease intake
delayed weaning
breast feeding only
absorption of iron
absorption of iron
a- alkaline media in the stomach and duodenum
b- other content of food
Positive or negative
absorption of iron
Positive absorption of iron
vitamin C acidity
protiens amino acids
14
................................................................................
....
negative iron absorption
chemical reaction with iron
decrease absorption of iron
...
phytate and oxalate
oxalate
phytate catch iron
absorption of iron
oxalate
oxalate iron absorption of iron
oxalate
excess loss of iron
Iron RBCs
RBCs
chronic blood loss
RBCs iron
iron deficiency anemia
.N.B
(:
15
................................................................................
....
some infants
sensitive to cow milk
something like dysentry
diarrhea, mucous and blood
clinical manifestations of iron deficiency anemia
:Symptoms of anemia*
FAHM general symptoms
headache, dizziness and syncopal attack
easy chest pain Palpitations chest pain
fatigability
intermittent claudication
specific symptoms *
anorexia
feeding centre brain
centres
cytochrome system
main component of cytochrome system
(iron like RBCs (HB
iron
feeding centre signals
.N.B
problem
):
signals cytochrome system
Pica
16
................................................................................
....
true pica and pseudo pica
pseudo pica
true pica
sever iron deficiency anemia
atrophy of the tongue
Nails
atrophy of the nail bed
spooning of the nails
as caused by atrophy of the nail bed
ischemia sever anemia
abdomen
splenomegaly % 15-10
investigations
CBC
micro cytic hypochromic anemia
hemoglobin gram /dl 11
) MCV ( MCV
mean corpscular volume
femtoliter 60 Microcytic
MCH picogram 26
iron deficiency anemia synthesis
zero
17
................................................................................
....
blood film
no abnormal cells
serum ferritin of serum iron
iron binding capacity
free
transferrin 3 iron
normal iron
transferrin
...
iron deficiency anemia
serum iron
iron binding capacity
serum iron serum ferritin
serum iron serum ferritin
serum ferritin acute phase reactant
acute phase reactant
iron deficiency anemia
acute follicular tonsillitis
CRP ... serum ferritin
iron deficiency anemia Infection serum
ferritin serum ferritin Normal high iron
deficiency anemia
serum ferritin Infection
iron
serum iron serum ferritin
iron ferritin
... iron component Iron
ferritin protien carrier iron
18
................................................................................
....
serum ferritin protein Kwashiorkor
iron deficiency anemia
serum ferritin
Pan hypoprotienemia
serum ferritin serum iron
iron binding capacity
iron binding capacity serum iron
iron binding capacity
.......
heme globin
heme Iron protoporphrin
globin
megaloblastic anemia
notes
Megaloblastic anemia
defect in RBCs synthesis due to B12 and folic acid
etiology
Vit. B12 and folic acid
Vit. B12 and folic acid deficiency
sources of Vit. B12
animal only
B12 micro gram per day 1
.N.B
19
................................................................................
....
in neonates .... stores in liver
15 full term
stomach
parietal cells
carrier protien ) ( Intrinsic factor
B12 Intestine
terminal ileum
receptors
receptors Intrinsic factor
B12 intrinsic factor circulation
Intrinsic factor
B12
Intrinsic factor
stool
B12 deficiency
megalobalstic anemia pernicious anemia
20
................................................................................
....
deficiency of intrinsic factor perinicious anemia
perinicious anemia
megaloblastic anemia
perinicious anemia megaloblastic anemia
autoimmune
parietal cells antibody
common in adult
adult type of perinicious anemia
Stores
Liver
Folic acid
plant animal
gram / day 1 daily requirement
liver absorption
21
................................................................................
....
liver can store folic acid
active form of folic acid is folinic acid
folic acid reductase enzyme
decrease absorption
absorption
malabsorption syndrome
MCQ
patient take methotrexate after 2 weeks manifestations of anemia
+ petichea + purpura and there is history of repeated infection the
: main line of treatment is
packed RBCs (a
folic acid (b
B12 (c
folinic (d
folinic folic acid d
active form acid
22
................................................................................
....
methotrexate block reductase
folic acid folinic
folinic
mitosis brain cell germ cell
clinical presentation
Mitosis
Mitosis total number of cells
parallel
mitosis
promotor gene
Organ
order
cytoplasm nucleus
cytoplasm transcript
Nucleus polymerase
polymerase active
methyl group
Methyl group
folic acid
methyl group
methyl group folic acid
B12
.N.B
Mitosis
DNA transcriptase
23
................................................................................
....
RNA
duplication of cyoplasm
cytoplasm
DNA
neucleus
total number
.N.B
megaloblastic anemia
megalo
blast malignant
)
Hematology
(:
blast
blast
blast
notes (
mitosis
hematological cells
clinical pictures
pan cytopenia
24
................................................................................
....
degeneration of Schwann cells
brain cells mitosis
glossitis
failure to thrive
stomatitis
Notes Investigations
megaloblast
CBC
pancytopenia
synthesis
MCV
femtoliter 100
macrocytic anemia
MCH MCHC normal
(:
total number of RBCs
blood film
WBCs
hyper segmented
mitosis
platelets
immature
to be sure of your diagonsis
bone marrow
Mitosis
25
................................................................................
....
hypocellular
megaloblastic
causes
folic and B12
serum B12 and folic
neurological
folic acid deficiency
folic acid
B12 deficiency
mg B12 250
B12 B12
methyl folic acid
3
!!!!!!!!
26
................................................................................
....
iron deficiency anemia
hemolytic anemia
enumerate causes of microcytic hypochromic anemia and discuss
how to diagnose one of them
anemia
27
................................................................................
....
differential diagnosis
blood
diagnosis
diagnosis ....
clinical pictures Investigations
clinical diagnosis laboratory diagnosis
..... management
management treatment
........
Management
clinical picture investigations treatment
management clinical pictures investigation
treatment
diagnosis treatment
Undergraduates
disturbance mood
100
:
treatment !!!!
28
................................................................................
....
diagnosis treatment
diagnosis management ....
definition etiology ...... Pathogenesis
management diagnosis
definition Pathogenesis etiology
discuss
iron deficiency anemia
patient CBC
microcytic hypochromic anemia
blood film
no abnormal cells
serum iron
iron binding capacity
iron deficiency anemia
thalassaemia
hemolysis
Loss of the blood
hyperactive bone marrow
blood film thalassaemia
RBCs
29
................................................................................
....
anisocytosis
Hemoglobin electrophoresis
Hb F
lead pisoning
RBCs
lead deposit
RBCs
basophilic stibling of RBCs
sidroblastic anemia
cupper and B6 protoporphrin
sidroblastic anemia
Sidroblastic anaemia
sidroblastic anaemia MCQ
... bone marrow
normoblast
Normoblast reticulocyte mature RBCs
Normoblast normoblast
.... iron protopophyrin
protoporphyrin Iron haem ...
defect
protoporphyrin
iron normoblast bone marrow protoporphyrin
sidroblast
iron granules normoblast
protoporphyrin
30
................................................................................
....
sidrosis
normoblast sidroblast
sidroblast normoblast
protoporphyrin
(
treatment of iron deficiency anemia
screening for hypothyrodism
breast feeding
proper weaning
preterm
Iron supplmentation
| |
iron supplemention
full term
................................................................................
....
artificial milk
..
delayed weaning
.
iron therapy
Oral Parental
parental
Hyperpigmentation
coma
Parental
sever gastritis
Iron
iron parental
gastritis oral iron
dose
dose
elemental iron therapy
mg/ kg/ day 6
elemental iron
acutally absorbed
dose
3
3
cm / 3times per day 4
time
32
................................................................................
....
absorption iron
between meals
72
reticulocytic count
3 %5
bone marrow
hemoglobin
6-4
stores
6-4
| |
common side effect
stool
stool
iron absroption
Hyper pigmentation
packed RBCs
33
................................................................................
....
patient with iron deficiency anemia packed RBCs
gram / dl 6
anemic heart failure
Packed RBCs
hemoglobin gram /dl 10
iron therapy
gram/ dl 5
anemic heart failure
packed RBCs
surgical emergency
acute appendicitis
pallor
CBC gram / dl 8
) (
packed RBCs
Hemolytic anemia
written, clinical, X-ray and oral
34
................................................................................
....
diagnostic investigation of hemolytic anemia
subtypes
.N.B
bone marrow
life span RBCs days 60
total count of RBCs
hypoxia
kidney
erythropiotein
erythropiotein stem cell of bone marrow
erythropioesis
RBCs
reticulocytes
Hemolytic anemia
life span of RBCs
days 30
count of RBCs
bone marrow
Life span
RBCs 15
bone marrow
35
................................................................................
....
8
bone marrow
life span RBCs
15
manifestations of hemolytic anemia
.N.B
hemolytic anemia
anemia due to short life span of RBCs
hemolytic anemia
clinically presented
Life span of RBCs
15
etiology
hemolytic anemia
RBCs
acquired malaria
merozyte RBCs
merozyte
RBCs
RBC
cell membrane
spherocytosis
36
................................................................................
....
hemoglobin
abnormal hemoglobin
hemoglobin
quantity thalassaemia
qualitive sickle cell anemia
enzymes RBCs
G6PD deficiency
pyruvate kinase deficiency
RBCs
extra corpuscular
toxins
plamsa
toxins RBCs
toxins
snake venom
DIC sever infection
toxins
non immune causes immune causes
antibody
transplacental
Iso immune
Intra utrine Rh +ve
Rh negative
placenta
B
A
Anti B placenta
auto immune
antibody RBCs isolated
SLE multi system affection
37
................................................................................
....
enumerate 3 different types of anemia caused by 3 different
parasites
iron deficiency anemia
bilharzial and ancylostoma
megaloblastic anemia
diphylopothrium latum
hemolytic anemia
malaria
chronic
38
................................................................................
....
G6PD deficiecny
Metabolism
free oxygen radicals
H2O2
39
................................................................................
....
RBCs Glucose
glucose kinase
glucose 6 phosphate
glucose 6 phosphate dehydrogenase
phospho gluconate 6
glucose 6 phosphate
phospho gluconate 6
glucose 6 phosphate dehydrognase enzyme
reaction
NADP
NADP glutathione
reduced glutathione
reduced glutathione cell membrane
cell membrane
free oxygen radicals
.N.B
RBCs free oxygen radicals
RBCs
G6PD deficiency
acute hemolysis of RBCs
free oxygen radicals
free oxygen radical
metabolism
40
................................................................................
....
free oxygen radical
free oxygen radical
(:
free oxygen radical
drugs
.N.B
G6PD deficiency
antipyretic
sulpha
G6PD deficiency
free oxygen radical
41
................................................................................
....
free oxygen radical
G6PD deficiency
G6PD deficiency
gene X chromosome
general population typer B+ gene
X chromosome
drak races
type A+ gene
+
G6PD B-ve and A-ve
MCQ
gene of G6PD in dark races
Type A
gene X chromosome
common in males
male XY
female XX
common in males
females
42
................................................................................
....
clinical pictures
G6PD deficiency
clinically presented
history of exposure to oxidizing agent
free oxygen radical
hemolysis RBCs
intracellular content RBCs
hemoglobin
free in plasma
intra cellular
extracellular
pyrogenic effect
fever and rigor
RBCs
3
manifestation of anemia
sever pallor
headache, syncopal attack
Manifestation
hemoglobin
free in plasma
hemoglobin
hemoglobin
molecular weight
glomerulus of the kidney
filtration
filtration
acute tubular necrosis & acute renal failure
43
................................................................................
....
Liver
high molecular weight
Urine
hemoglobin Hemoglobin
kidney
haptoglobin (a
hemopexin (b
macro protien
Hb Kidney
spleen
spleen
spleen filter
haptoglobin hemopexin
hemoglobin spleen
spleen hemoglobin
hemoglobin extra cellular
very toxic
spleen
hemoglobin
globin and heme
globin
indirect bilirubin
fat soluble
Liver
uptake
liver
direct bilirubin
44
................................................................................
....
bile secretion
stool
bilirubin
bilirubin
bilirubin RBCs
hemoglobin haem
RBCs hemolysis of hemoglobin
haem bilirubin bilirubin
haem bilirubin
unconjugated bilirubin ) -1
-2 (
.
kidney liver
kidney
kidney
kidney
liver
unconjugated bilirubin liver liver
unconjugated bilirubin
Liver Liver
, Liver Unconjugated bilirubin
receptors Liver Y & Z receptors
unconjugated
bilirubin Liver
Liver uptake
unconjugated bilirubin
conjugation
Liver unconjugated conjugated
45
................................................................................
....
conjugated bilirubin ) -1 -2 (
conjugated bilirubin
Urine
secretion
bile bile
intestine intestine
stercobilinogen
intestine
stercobilin
brown stool
stercobilinogen
Liver Liver Liver
Liver
entero-hepatic circulation
kidney Kidney
stercobilinogen urine
urine stercobilinogen
) urobilinogen
( jaundice
urobilinogen
Urine
jaundice
Hemolytic jaundice hemolysis RBCs
hemoglobin unconjugated bilirubin
Kidney
Liver uptake
unconjugated bilirubin Uptake
conjugated bilirubin Liver
46
................................................................................
....
intestine stercobilinogen
stercobilin urobilinogen
-1 bilirubin
-2 stercobilinogen
-3 stercobilin
-4 urobilinogen
hemolytic jaundice sever
hemolysis bilirubin
hemolytic jaundice
bilirubin hemolysis
Liver bilirubin
urine urobilinogen
stool stercobilinogen
stercobilin stercobilin stool
jaundice Urine
stool
/ Jaundice urine
/ hemolytic jaundice stool
Urine stool
Hepato-cellular jaundice Obstructive jaundice
................................................................................
....
conjugated bilirubin Obstructive
unconjugated normal conjugated bilirubin
urine urine
conjugated bilirubin Urine
obstructive stercobilinogen
Intestine stercobilin
stool urobilinogen stercobilinogen
obstructive jaundice
-1 conjugated bilirubin urine
-2 stercobilinogen urobilinogen
bile bilirubin
bile salts
bile salts
itching bradycardia
itching prostaglandins
Itching unknown
bile intestine
vitamins
cholesterol
jaundice cholesterol
alkaline phosphatase
Hepatocellular jaundice
48
................................................................................
....
Obstructive jaundice
Hemolytic jaundice
conjugated unconjugated bilirubin
Liver uptake
Unconjugated
Unconjugated bilirubin Uptake
Unconjugated Liver conjugation
conjugation liver excretion
excretion hepatocyte
excretion conjugated bilirubin
conjugated Unconjugated
/ conjugated liver
excretion uptake
conjugated bilirubin bile intestine
stercobilinogen stercobilin
urobilinogen xxxxxxxxxxxx
urobilinogen stercobilinogen
urobilinogen Hepatocellular jaundice
hemolytic obstructive hemolytic
Urobilinogen stercobilinogen
obstructive Hepatocellular
stercobilinogen urobilinogen
stercobilinogen intestine
stool stercobilin
Entero hepatic circulation
kidney urobilinogen
49
................................................................................
....
Hepatocellular jaundice stercobilinogen stool
stercobilin Liver Liver
Hepatocellular jaundice excretion
urobilinogen
stercobilin urobilinogen
indirect bilirubin Liver
indirect bilirubin
Indirect bilirubin
Jaundice
free oxygen radical
hemoglobin
hemopexin and haptoglobin
hemoglobin
hemoglobin blood
filtration kidney
chemical tubular necrosis
so early
bilateral
unilateral
hemoglobin urine
hemoglobinuria
Urine
red colored urine
50
................................................................................
....
differential diagnosis
oral
Pallor, high grade fever, jaundice, irritable and red colored urine
Irritable Pain
abdominal examination
examination
Kidney
G6PD deficiecny
UTI
tenderness bilateral
G6PD deficiency
unilateral
acute pyelonephritis G6PD deficiency
urine red in color
hematuria
Hemoglobinuria
51
................................................................................
....
Urine
Hemoglobinuria G6PD
(Hematouria ( RBCs opaque
acute pyelonephritis
Investigations
CBC
complete blood count
hemoglobin gram /dl 11
RBCs count
MCV
MCH
normocytic normochromic anemia
blood film
abnormal cells
urine analysis
hemoglobinuria
52
................................................................................
....
complications
sever hemolysis
hemoglobin Kidney
massive tubular necrosis
acute renal failure
hemoglobin
gram/dl 5
false screening
HIV hepatitis
treatment G6PD
antibiotic Infection
Packed RBCs
anemic heart failure
acute tubular necrosis
washing kidney
Hyper volemia
congested heart failure
lasix
mannitol diuresis
Urine
Urine output
washing of the kidney
Oral
53
................................................................................
....
G6PD deficiency
sever hemolysis
free oxygen radicals
:
destruction of the RBCs
!!!!!!!!!!
G6PD deficiency
resistant
RBCs
Hexose monophosphate pathway
pentose shunt
Pathway glucose 6 phosphate dehydrognase
deficiency
RBCs
hexose monophosphate pathway
text anti malarial drugs
sever hemolysis G6PD
immune modulator
collagen disease
lupus rheumatoid arthritis
54
................................................................................
....
G6PD deficiency
Infection
fava beans
metabolism
free oxygen radical
hemolysis
G6PD
free oxygen radical
free oxygen radical
hemolysis
favism G6PD deficiency
G6PD deficiency favism
)
(:
.A smile is a language that even a baby understands
( ):
months 7
clinical manifestation
55
................................................................................
....
G6PD deficiency
G6PD deficiency
CBC
diagnostic enzyme assesment
G6PD Normal
enzymatic assay 6
6 G6PD normal
normal
NADP
normal
glutathione
glutathione deficient
................................................................................
....
heme globin
heme spleen
Iron
protoprophrin indirect bilirubin
globin
spleen
indirect bilirubin
fat soluble
fat soluble
Liver
Liver Indirect direct bilirubin
Liver
direct bile secretion
GIT
bacterial flora
bacterial flora
stercobilinogen
pathwaies 3
enterohepatic circulation
stool oxidation in GIT
stercobilin
stool
absorped
sysmtemic
stercobilinogen
water soluble
water soluble
Kidney
urobilinogen
urobilinogen
stercobilinogen
57
................................................................................
....
kidney
splenomegaly
indirect bilirubin
Liver
Liver
indirect bilirubin
Liver
jaundice mild
lower fornices
sclera
liver bilirary system
once jaundice
Liver
Liver hepatomegaly
58
................................................................................
....
splenomegaly hepatomegaly
liver spleen
chronic hemolytic anemia
spleen Liver
chronic hemolytic anemia
direct bilirubin
liver 6 direct bilirubin
6
stercobilinogen 6
stool
dark stool
stercobilinogen GIT
oxidation
Stercobilin
stool
dark stool
Urine normal
urobilinogen
urine
bone marrow 8
marrow cavity
skull circumference
zygoma Marrow cavity
Upper jaw
upper jaw
59
................................................................................
....
widely seperated teeth
Lower jaw
white marrow
Marrwo
Mongoloid facies of thalassaemic facies
causes of thalassaemic facies
Hyper active bone marrow
60
................................................................................
....
stool analysis
lab investigation stercobilinogen
lab clinical dark stool
urine analysis
urobilinogen
bone X-ray
manifestations of hyperactive bone marrow
chronic hemolytic anemia
diagnosis
investigation clinical presentation
specific investigation
general
complications
complication of blood transfusion
HIV hepatitis
spleen
filter spleen
channels
Normal cells
abnormal phagocytic
RBCs Normal cells
splenomegaly phagocytic cells
phagocytic cells
phagocytic cells
splenomegaly
61
................................................................................
....
Phagocytic cells
trabeculi spleen
( channels ( tunnel
normal cells
RBCs
phagocytic cells
normal RBCs or abnormal RBCs
frequent blood transfusion
RBCs WBCs
RBCs spleen
trabeculi
cells
WBCs platelets
phagocytic cells
thrombocytopenia Leukopenia
bleeding tendency
frequency of infection
hypersplenism
size phagocytic cells
spleen
trabeculi
normal
frequent blood transfusion
bleeding tendency
repeated infection
Pancytopenia
62
................................................................................
....
Liver spleen diaphragm
ribs and throacic cage
normally Liver
spleen
ribs liver spleen
spleen 3 costal margin
chronic hemolytic anemia
spleen
umblicus
abdominal wall
complication
Hemochromatosis
)(Bronze diabetes
63
................................................................................
....
4
hemosidrosis
hemochromatosis
Organs
Organ liver
liver
hemochromatosis
carcinogenic
intestine Mucosal block
64
................................................................................
....
deficit mucosal block
6 clinical picture of
hemochromatosis
mental
disturbances
hemochromatosis
65
................................................................................
....
Investigations
investigation for the cause-1
Binding capacity
Investigation for the liver cell failure -2
investigation of portal hypertension -3
Treatment
500 250
250
hemochromatosis
60
56
56 12
66
................................................................................
....
hepatoma hemochromatosis 30%
Iron
Pituitary gland
pan hypopituitrism
GH TSH FSH
LH
heart
deposit for cardic muscle
cardiomyopathy
.H.F
Iron phagocytic cells
spleen
Liver
6
Pancreas
islets cells
receptor
receptors
glucose metabolism of glucose
inside the cells
hemosidrosis
iron Islets cells
diabetes
normal
diabetes
receptor
gonadal cells
67
................................................................................
....
delayed puberty
Infertility
pituitary
skin
Lower limbs
stgnation of the blood
skin Iron
necrosis
ulcers
hemosidrosis
histamine
Itching
ulcers
6 Liver
direct bilirubin
viscosity of bile
biliary stones
gall stone
biliary obstruction
Heart failure
hemosidrosis
anemic heart failure anemia
heart failure myocarditis repeated infection
cirsis
bone marrow
8
inquirement
folic acid B12 iron
iron
68
................................................................................
....
B12
stores folic acid
folic acid
megaloblastic anemia
Crisis
megaloblastic crisis
Over consumption of folic acid
hyepr activity bone marrow
aplastic crisis
thalassaemia
G6PD deficiency
hyper hemolytic crisis
acute hemolytic anemia
on top of chronic hemolytic anemia
Hemolytic crisis
Infection thalassaemia
hyperactive of the spleen
spleen
Phagocytic cells
splenomeglay
complications
repeated infections
WBCs
pancytopenia
heart failure
left sided heart failure
chest infection stgnation of the blood in the lung
hypersplenism
69
................................................................................
....
splenoectomy
meningeococcal hemophilus
splenoectomy infection
phagocytosis
chemotaxsis organism
immune system
immune system Phagocyte Organism
cell migration
phagocyte organism
cell adhesion
phagocytosis
enzyme
intra cellular killing of organsims
capsulated organism
phagocyte
capsulated organsim
chemotaxsis
phagocyte Organism
capsulated oragnism
capsule
very smooth
surface
Phagocyte
70
................................................................................
....
glu like material
specific for capsulated organsim
complications
Pathological fracture
pathological fracture
trauma
fracture
cortex
medulla
trauma fracture
complications
stunted growth
short stature why
hormones
.G.H
hypopituitrism
hemosidrosis
somatomedin
TSH
T3 and T4
Insulin
One of the main growth factor
repeated infection
growth hormone
receptor
receptor
Somatomedin
71
................................................................................
....
receptor .G.H Somatomedins
treatment of anemia
bone marrow abnormal cells
spleen
bone marrow transplantation
packed RBCs
ordinary transfusion
gram /dl 6
hemosidorosis
hemoglobin gram /dl 8
dysmorphic features
hyper active bone marrow
hypertransfusion
hemoglobin gram / dl 10
hemoglobin 3 4
hemosidrosis
72
................................................................................
....
dysmorphic features
supertransfusion
hemoglobin gram /dl 12
oxygen supply
folic acids
Hyperactive bone marrow
................................................................................
....
9/1/2011
say 12
12000
40
12000/40
ml /kg per year 300
sever hypersplenism
hyper splenism
spleen
spleen capsulated organsim
74
................................................................................
....
long acting penicillin
spherocytosis
RBCs
biconcave in shape
small capillary
small trabeculi of the spleen
RBCs Life span
120
spleen
spleen RBCs 120
RBCs ATP
Pump 120
120 ATP
Na pump
RBCs spherical in shape
RBCs trabeculi spleen
trabeculi
phagoctytic cells
RBCs biconcave
) (
RBCs
Na mainly
75
................................................................................
....
extracellular
!!!!
main gates
spectrin
neutral protien
positive charges
protien
RBCs
small gates amino acids
glucose
Main gates
RBCs
Na pump
active pump
ATP
Na pump ATP RBCs
RBCs
spherocytosis
spherocytosis autosomal dominant gene
gene defect
Positive family history
76
................................................................................
....
autosomal
male female
no sex difference
dominant
spectirn
main gates
RBCs
Main gates
side gates
Na pump
ATP
Pump
RBCs spherical in shape
spleen
phagocytic
hemolysis so early
channel
pump main gates
................................................................................
....
bilirubin
bilirubin
neonatal jaundice
Indirect bilirubin
fat soluble
blood brain barrier
kerniectrus bilirubin encephalopathy
kernicterus
cerebral palsy
complication of spherocytosis
complications of chronic hemolytic anemia
gall stones
78
................................................................................
....
chronic hemolytic anemia
Investigations
general invetigations
CBC
Anemia
normocytic normochromic anemia
MCV MCH Normal
spherical in shape
poly chromisia
RBCs
RBCs
blood film
RBCs
spherical
RBCs
RBCs
serum iron
iron binding capacity
indirect bilirubin
liver consumption
Neonatal period
stool analysis
stercobilinogen
urine analysis
urobilinogen
79
................................................................................
....
X-ray bone
chronic hemolytic anemia
diagnostic investigations
Osmotic fragility test
test tubes
variable concentration of Na
Normal saline 0.9
0.9
RBCs
RBCs saline
spherocyte
0.2-0.3-0.4-0.5-0.6-0.7-0.8
RBCs
RBCs
RBCs
Biconcave RBCs Na 0.9
0.8
RBCs 0.9
) saline ) 0.8
RBCs
0.6
normal 0.5
hemolysis
80
................................................................................
....
0.3
No cells
deposit
hemolysis complete
0.5 complete hemolysis 0.3
spherocytosis
RBCs
0.9 RBCs
0.8 RBCs
0.7 deposit start hemolysis
0.5 No cell
hemolysis
autohemolysis spherocytosis
81
................................................................................
....
spherocytosis
glucose 24
RBCs
RBCs
diabetes spherocytosis
packed RBCs
folic acid 5 mg/day
iron chelating agent therapy
cholecystomy
gall stones
spleen
spherocytosis
spleen spherocytosis
hemolysis
RBCs 120
other reticuloendothelial system
trabeculi
spleen hemolysis
CBC
blood film
spherocytosis
clinical
laboratory
splenoectomy !!!!
spleen
82
................................................................................
....
is the main mature part of the reticuloendothelial system in the
first 5 years of age
lymph nodes immature
Maturation
Lymph node Mature
spleen
booster dose
spleen
spleen
frequent blood transfusion
folic acid
complications
spherocytosis
RBCs
ATP
spectrin
spectrin
Indirect bilirubin
fat soluble
83
................................................................................
....
golden yellow
Liver
Urine
Urine
Urine
indirect hyperbilirubinemia
urine
direct hyperbilirubinemia
RBCs spherical
spleen trabeculi lymph nodes
phagocytic cells
, RBCs
spherocytosis
spleen
thalassaemia bone marrow transplantation
sickle cell
84
................................................................................
....
thalassaemia
thalassaemia
quantitative defect
In chain synthesis
in protien part of hemoglobin
alpha chain thalassaemia
alpha thalassaemia
alpha thalassaemia clinical
.i
deletion 3
alpha chain silent carrier
gene maping
.ii
2gene defect
.iii
alpha chain
85
................................................................................
....
.iv
defect
alpha chain
hemoglobin
sever heart failure
2chains
Hemoglobin
chain 2
gama chains
alpha and 2 gama 2
( fetal hemoglobin ( Hb F
fetus
chain chromosomes
11
Genes 2
Gama synthesis
Beta chains
Hb A adult hemoglobin
Beta chain gene 2 11
dominant
thalassaemia
Beta thalassaemia
delta chain
Alpha chain
adult hemoglobin
Hb A2
11
86
................................................................................
....
blood
PNH
PNH blood element blood
elements RBCs platelets WBCs
cell
membrane RBCs platelets WBCs
in activation active
complement complement activation blood
activated complement blood RBCs
WBCs platelets
cells
complement
In activation
RBCs active complement
complement activation complement
activation Hypoxia
hypoxia ... partial hypoxia
Hypo ventilation
... respiratory rate shallow
breathing
respiratory rate adult 18 10
...... Hypoxia hypoxia PH
7.35
PH activation for the complement
activation for the
complement
blood elements
hypoxia
PH 7.4 7.35
PH ... complement activation
activation
fever Loin
pain Intravascular hemolysis
hemoglobinuria
87
................................................................................
....
paroxysmal attack
nocturnal Hemoglobinuria
paroxysmal nocturnal hemoglobinuria
CBC pan cytopenia
acidosis acidosis
metabolic or respiratory acidosis
acidosis complement activated
pancytopenia
PNH
PNH Ham test
Ham test acidic media
acidic media complement activation
blood elements .... Ham test
acidosis acidic media
diagnostic for PNH
**** !!!!!
"..... ,
" *****
88