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Rbc Patho B 2
 

Rbc Patho B 2

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    Rbc Patho B 2 Rbc Patho B 2 Presentation Transcript

    • Anemia Caused by Decreased RBC Production
      1
    • Nutrients necessary for RBC maturation are
      Deficient
      Megaloblastic Anemia
      Iron Deficiency Anemia
      Aplastic Anemia
      Anemia of Renal Disease
      Anemia of Chronic Disease
      Myelopthisic Anemia
      Anemia Caused by Lead Poisoning
      Anemia Caused by Decreased RBC Production
      2
    • Megaloblastic ANEMIA
      3
    • Pathogenesis:
      4
    • Causes :
      5
    • Vit B12 & Folate absorption
      6
    • Decreased intake
      Inadequate intake, Vegetarians
      Increased Requirement
      Pregnancy
      Hyper thyroidism
      Disseminated Cancer
      Vit. B12 Deficiency
      7
    • Impaired Absorption
      Intrinsic Factor Deficiency
      PERNICIOUS
      GASTRECTOMY
      Malabsorption states
      Diffuse Intestinal Disease
      Ileal resection, ileitis
      Parasites – hook/tapeworms
      Bactrial overgrowth in Blind Loops
      Vit. B12 Deficiency
      8
    • Biochemical function of vit. b12
      9
    • Neurological Complication
      10
    • More in Scandinavian & English Speaking
      Blacks & Hispanics in US
      Common in OLD Age 50’s-80’s
      Maybe Strong Genetic predisposition
      Incidence
      11
    • Pernicious Anemia
      Immune – mediated destruction of gastric mucosa
      Autoreactive T-cell response initiates autoAbprod’n.
      Result to Chronic atrophic gastritis
      Types of AutoAb
      75%Type I – Blocks binding of B12 to IF
      Type II – Prevent Binding of IF - B12 to Ileal Receptor
      Type III – Not specific, common in elderly not R/T pernicious
      12
    • Insidious onset
      Progressive anemia
      Atrophic glossitis & Gastric atrophy
      Seen in pernicious anemia
      Intestinalization of gastric epithelium  Gastric Ca
      CNS in ¼ of cases
      Spastic paraparesis Sensory ataxia
      Severe paresthesia in the L.E.
      Tx by giving oral / parenteral B12
      Halt progression of Neuro s/s but not GI changes
      Clinical course:
      13
    • Moderate – Severe Megaloblastic Anemia
      Leukepenia & Thrombocytopenia
      Mild Jaundice – peripheral hemolysis of rbc
      Neurological – Posterolateral spinal tracts
      Schillings test – Decreased uptake of radioactive B12
      Low B12
      Elevated Homocysteine & Methylmalonic acid
      More Sensitive than B12
      Diagnostic:
      14
    • Folate deficiency
      Manifestation same as B12 Deficiency
      Except Neurological s/s
      Folic acid is sensitive to heat, boiling, frying, steaming
      Brocolli, lettuce, asparagus, lemons, banana
      Casues:
      1. Decreased intake
      2. Increased requirement
      3. Impaired use
      15
    • 16
    • Pancytopenia- intramedullary destruction of precursor( apoptosis )
      Macrocytes (+) – high MCV but not MCHC
      Thicker , Well – Hemoglobinized
      No Central pallor
      Retic – Low
      Large & HypersegmentedNeutrophils
      BM markedly Hypercellular with Asynchronous maturation of N/C
      Morphology:
      17
    • Iron deficiency anemia
      18
    • Most common nutritional disorder in the world.
      Prevalence of iron deficiency anemia is
      Higher in the developing countries,
      Toddlers & adolescent girls
      Women of childbearing age
      Features:
      19
    • Balance : 1 mg iron absorbed / day
      Daily iron requirement :
      7-10mg (men ) 7-20mg ( women )
      Ascorbic acid , Citric acid, Amino acids enhance absorption
      20
      Nutritional Iron requirement
    • Iron absorbed by duodenum & Jejunum  transported by Transferrin Liver & BM  Incorporated to Developing rbc in BM
      Iron is stored as Hemosiderin( aggregates ) or Ferritin ( complexed with Apoferittin )
      21
      Iron absorption
    • Inadequate dietary iron
      Pregnancy , Lactation
      Chronic blood loss – GIT bleeding or tumors
      Most common cause in Western countries
      Impaired absorption
      Menstrual , parturition, Vaginal Bleeding
      Causes:
      22
    • Features:
      Morphology:
      Clinical Manifestation:
      BM – mild to moderate erythroid hyperplasia
      Dxtic : Disappearance of stainable iron in macrophages in BM ( Prussian Blue Stain )
      MicrocyticHypochromicrbc
      Pencil rbc
      Anisopoikilocytosis
      No Reticulocytosis
      Low Serum Ferritin
      High TIBC
      Anemia
      Severe Cases:
      GLOSSITIS, ANGULAR STOMATITIS, KOILONYCHIA
      Treatment:
      Iron Supplement
      Treat the cause
      23
    • Aplastic anemia
      24
    • Disorder of Pleuripotential stem cell
      Lead to BM failure  Pancytopenia
      Most are Idiopathic
      Other Causes:
      Radiation – whole body, dose dependent
      Chemotx
      Immune reaction due to viral infxn
      Idiosynchratic reactions- dose independent
      Chloramphenicol
      Features:
      25
    • Pathogenesis:
      Immunologically mediated suppression
      Stem cells drugs, infectious agent environmentalinsultsGenetically Altered stem cell
      1. Evokes a T cell-mediated immune response (IFN-gamma and TNF-alpha)
      POTENT INHIBITOR OF STEM CELL FUNCTION
      26
    • Pathogenesis:
      2. Give rise to clonal population with reduced proliferative capacity
      Either pathway
      APLASTIC ANEMIA
      27
    • 28
    • Unpredictable
      Recovery if w/draw toxic drugs in some
      Allogenic BM transplant
      Immunosuppressive therapy
      Antithymocyte Globulin
      Cyclosporine
      Prognosis & TREATMENT:
      29
    • 30
    • 31
    • POLYCYTHEMIA
      32
      Abnormally high rbc and Hgb
      Type:
      1. RELATIVE – HEMOCONCENTRATION
      DEHYDRATION
      STRESS ( Gaisbock syndrome)
      Patient is Obese, hypertensive , anxious
    • POLYCYTHEMIA
      33
      2. ABSOLUTE
      Primary
      A. Intrinsic Abn of myeloid stem cells
      Polycythemiavera
      B. Mutation in erythropoietin receptor
      Cause Hyperresponsiveness to eryhtropoietin
    • POLYCYTHEMIA
      34
      Secondary
      High eryhtropoietin
      Appropriate - Adaptive
      Inappropriate secretion of hormone
      Liver/ Renal Cell Ca