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Hematology (1) The blood and bone marrow, abnormal blood count, anemias: an overview
 

Hematology (1) The blood and bone marrow, abnormal blood count, anemias: an overview

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    Hematology (1) The blood and bone marrow, abnormal blood count, anemias: an overview Hematology (1) The blood and bone marrow, abnormal blood count, anemias: an overview Presentation Transcript

    •  
    • Hematology Course: an overview of Clinical Hematology Dr. Ahmed Elshebiny , MD Lecturer of Internal Medicine Faculty of Medicine, Menoufyia University Former Clinical Research Fellow, Joslin Diabetes Center, Harvard University
    • Course includes
      • Hematology an Overview : The blood and bone marrow
      • Clinical Hematology : The full blood count
      • Anemia : a Clinical approach
      • Deficiency anemias
      • Hemolytic anemia : Acquired
      • Hemolytic anemia : inherited
      • Bone marrow failure syndromes ( aplastic, myeloysplastic, PNH)
      • Hypoproliferative anemias (of chronic disease)
      • Myeloproliferative disorders
      • Leukemias
      • Lymphomas & Myelomas
      • Porphyria & Hemochromatosis
      • Leukocyte disorders
      • Interpretation of standard hematologic tests
    • Structure and Function The blood and bone marrow
    • Blood as a circulatory fluid
      • A protein rich fluid called plasma in which cellular elements are suspended
      • Carrier of O 2 and CO 2
      • Carries nutrients
      • Carries waste
      • Hormones
      • Immunity
      • Hemostasis
    •  
    • Blood is continuously renewed
    • The Bone Marrow is the blood Factory May be exposed to damage or failure
    • Spleen?
      • Blood filter
      • Immunity
    • Red blood cells
      • A nucleated
      • Diameter and thickness
      • Membrane
      • Metabolism
    • Red cell membrane
      • Phospholipid bilayer
      • Intracellular protein network
      • 50% cholestrol
      • Membrane proteins
        • ( glycophorin c and band 3)
      • Reticuloproteins
        • ( spectrin , actin, ankyrin)
    • Hemoglobin
      • Tetramer of 4 globin chains (proteins)
      • Each with a heme group containing iron
      • Can be distinguished by electrophoresis
      • Chain types
        • Alpha
        • Beta
        • Gamma
        • Delta
        • Zeta and epsilon are embryonic
    •  
    • Fetal and neonatal hemoglobins
    • HB and MCV values with age & sex
    • Haemopooiesis
      • Yolk sac ( 3 rd week)
      • Liver and spleen ( 6 wk to 7 months)
      • Bone marrow
      • Red marrow & yellow marrow
      • Extramedullary ---- When?
    •  
    • Aplastic Anemia
    • Bone marrow aspiration and biopsy
    • Bone marrow aspiration
    • P.N.H
    • Hematology Course (2): Clinical Hematology Abnormal Blood count
    • Manifestations of blood diseases
      • Anemia
      • High hemoglobin
      • Bleeding
      • Thrombosis
      • Infections
      • Lymphadenopathy
      • Splenomegaly
    • Full blood count
      • Common investigation
      • Can point to hematological disorders
      • Cornerstone of hematological diagnosis
      • Manual or automated
      • Automated counting and sizing by different methods e.g. ( Aperture impedance)
      • They also measure the hemoglobin by spectrophotometry
      • Some other parameters are calculated ( MCH, MCHC)
      • The automated analyzers can diffrentiate leukocyte
    • N.B.
      • 5% of the normal population lie outside the normal range
      • Race may affect the CBC
      • Be careful of artifacts
    • Anemia
      • Definition
      • Morphological approach
      • Etiological( kinetic ) approach
      • RBCs in the blood film
    • Polycythemia
      • True Polycythemia( Primary and secondary)
      • Relative ( decreased plasma volume)
    • Leucocytosis
      • Examine the differential count
      • Examine a blood film
      • Commonest is neutrophilia
    • WBCs
      • 5 WBCs line ( diffrential)
        • Neutrophils
        • Lymphocytes
        • Monocytes
        • Eosinophils
        • Basophils
    • Neutropenia
      • Clinically evident when ANC < 500
      • Congenital and acquired
        • Congenital ( e.g Kostman;s syndrome and cyclic neutropenias)
        • Most cause of acquired neutropenia is drugs
    • Drugs associated with neutropenia
      • Anticonvulsants ---- phenytoin
      • Antithyropid ------- carbimazole
      • Phenothiazines ------ carbamazepine
      • Antibacterial -------- phenylbutazone
      • Anti-inflammatory ------ co trimoxazole
      • Cytotoxic
      • Others ----- gold, penicillamine, imipramine
    • Neutrophil disorders
      • Infections( viral, salmonella, protozoal, malaria)
      • Drugs
      • Autoimmune
      • Alcohol
      • Congenital
      • Infections ( bact, fungal)
      • Surgery, Burns
      • Infarctions
      • Inflammation ( gout, RA, IBD)
      • Malignancy (CML)
      • Physiological
      Neutroppenia Netrophilia
    • Lymphocytic count disorders
      • Infections( recent viral)
      • (immunosuppressive, cortisone)
      • Autoimmune & CT diseases
      • Sarcoidosis
      • Chronic renal failure
      • Congenital : severe combined immunodifficiency
      • Infections ( viral, pertussis, glandular fever)
      • Lymphoproliferative ( CLL, lymphoma )
      • Post splenectomy
      Lymphopenia Lymphocytosis
    • Eosinophils
      • Acute inflammation
      • Steroids
      • Catecholamines
      • Allergy ( asthma, eczema)
      • Infections ( Helminths, viral)
      • Skin disease
      • C.T disease e.g PAN
      • Malignancy ( solid tumors and lymphomas)
      • Gold therapy
      Eosinopenia Eosinophilia
    • Basophils
      • Hyperthyroidism
      • Inflammation ( Acute hypersensitivity, IBD)
      • Iron difficiency
      • Myeloproliferative disorders ( Polythycemia, CML)
      basopenia Basophilia ( rare)
    • Monocytosis
      • Viral and fungal infections
      • T.B infection
      • C.T diseases
      • Inflammatory bowl disease
      • Myeloproliferative
      • Chronic Myelomonocytic leukemia ( one of MDS)
      • Malignancy e.g solid tumors
    • Platelets (thrombocytopenia)
      • Spurious
      • Increased consumption
      • Decreased production
    • Platelets (thrombocytosis)
      • Reactive
      • Primary
    • Blood film
      • Abnormal shape ( poikilocytosis)
      • Spherocytes
      • Target cells
      • Polychromasia
      • Dimorphic film
      • Lobulation and toxic granulation
      • A typical cells
      • Blast cells
      • Malaria
      • others
    • Hematology Course (3): Clinical Hematology Anemia : a clinical approach!
    • Anemia is operationally defined as a reduction in one or more of the major RBC measurements: hemoglobin concentration, hematocrit, or RBC count Keep in mind these are all concentration measures … most accurately measured by obtaining a RBC mass via isotopic dilution methods. Definition:
    • Kinetic approach to anemias
      • Decreased erythrocyte production
        • Decreased erythropoietin production
        • Inadequate marrow response to erythropoietin
      • Erythrocyte loss
        • Hemorrhage
        • Hemolysis
    • Normal blood film
    • Morphological approach
    • Reticulocytes
      • Increased reticulocytes (greater than 2-3% or 100,000/mm3 total) are seen in blood loss and hemolytic processes, although up to 25% of hemolytic anemias will present with a normal reticulocyte count due to immune destruction of red cell precursors.
      • Retic counts are most helpful if extremely low (<0.1%) or greater than 3% (100,000/mm3 total).
    • Reticulocytes
    • Low MCV
      • Iron Deficiency
      • Thalassemia
      • Lead poisoning
      • Sideroblastic Anemia
      • Anemia of chronic disease
    • Iron difficiency anemia Thalassemia
    • Thalassemia
    • Sickle cell anemia
    • Spherocytosis
    • Hemolytic anemia
    • Normocytic anemia
      • Causes
      • Approach
      • Reticulocytic count
      • Coomb’s test
    • Macrocytic anemia
    • B 12 and folate deficiency
    • References
      • Merck manual : online textbook
      • E-medicine , online textbook ,
      • specialties,.
      • Bethesda Handbook of Clinical Hematology
      • Problem solving in Hematology
      • Essential Revisoin notes for MRCP 2009
      • Kumar & Klark : Clinical Medicine 2009
      • Davidson’s : Clinical and practice of Medicine 1999
      • Ganong’s physiology 2010
      • Other Web Resources & books
    • THANK YOU