1.. introduction to blood

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1.. introduction to blood

  1. 1. BLOODBLOODPROF. RAFI AHMED GHORIPROF. RAFI AHMED GHORIPROFESSOR & CHAIRMANPROFESSOR & CHAIRMANDEPARTMENT OF MEDICINEDEPARTMENT OF MEDICINELIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCELIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCEJAMSHOROJAMSHORO
  2. 2. BLOODBLOODINTRODUCTIONINTRODUCTIONBLOOD CONSISTS OF:BLOOD CONSISTS OF: Red CellsRed Cells White cellsWhite cells PlateletsPlatelets Plasma, in which above elements arePlasma, in which above elements aresuspended.suspended.
  3. 3. BLOODBLOODFORMATION OF BLOOD:FORMATION OF BLOOD: 22ndndweekweek→blood islands in yolk sac.→blood islands in yolk sac. 33rdrdweek→migrate to liver and spleen chiefweek→migrate to liver and spleen chiefsites of erythropoisissites of erythropoisis 55ththmonth → bone marrow-MED.month → bone marrow-MED.Haemopoisis. (erythropoisis).Haemopoisis. (erythropoisis). At birth→ marrow of nearly every bone.At birth→ marrow of nearly every bone. At adult life→ confined to end of longAt adult life→ confined to end of longbones→axial skelaton, ribs and skull.bones→axial skelaton, ribs and skull.
  4. 4. BLOODBLOODFORMATION OF BLOOD:FORMATION OF BLOOD: Path. processesPath. processes→ extramedullary→ extramedullaryhaemopoisis in liver & spleen.haemopoisis in liver & spleen.NB.NB.All peripheral blood cells are derived fromAll peripheral blood cells are derived fromsingle stem cell (pleuripotent steam cell),single stem cell (pleuripotent steam cell),Stems cellsStems cells Self renerwalSelf renerwal Diff. Into mature cellsDiff. Into mature cells
  5. 5. BLOODBLOODNB.NB.Ist detectable CFU IS CFU-S(colonyIst detectable CFU IS CFU-S(colonyforms unit spleen, which gives rise toforms unit spleen, which gives rise toCFU-GEMM (i.e. Granulocyte, ErythroidCFU-GEMM (i.e. Granulocyte, Erythroidcells, Monocytes, Megakaryocytes).cells, Monocytes, Megakaryocytes).
  6. 6. BLOODBLOODHaemopoietic growth factors:Haemopoietic growth factors: All factors are glycoproteinAll factors are glycoprotein Factors include:Factors include:- Erythropoietin- Erythropoietin- Colony Stimulating factors (CSF)- Colony Stimulating factors (CSF)- Interleukins (IL)- Interleukins (IL)Gene for most of them is 5 chromosome.Gene for most of them is 5 chromosome.And many growth factors are producedAnd many growth factors are producedby recombinant DNA tech. e.g. GM-CSFby recombinant DNA tech. e.g. GM-CSFafter B.M. transplantation to accelerateafter B.M. transplantation to accelerateneutrophil recovery.neutrophil recovery.
  7. 7. B. lymphocyteNproerythoblastPre BTotipotent stem cellPluripotent myeloid stem cellsPre IMegakeryoblastBlast cellsMyeloblastPromytocyteMonoblastT. lymphocyteEarly normoInt.NormoLat.NormoRecti.RectRed cellProliferative phaseMaturation phaseReleased B. marrowE M Plat BErythroiten used for anemia in CRF
  8. 8. BLOODBLOODANEMIA:ANEMIA: Defined as a state in which the blood HbDefined as a state in which the blood Hblevel is below the normal range for thelevel is below the normal range for thepatient’s age and sex.patient’s age and sex.CLASSIFICATION OF ANEMIA:CLASSIFICATION OF ANEMIA: Blood lossBlood loss- Acute- Acute- Chronic inadequate production of- Chronic inadequate production ofnormal RBC by Bone Marrownormal RBC by Bone Marrow(hypoplasia, aplasia)(hypoplasia, aplasia)- Excessive destruction of RBCS- Excessive destruction of RBCS(Haemolysis)(Haemolysis)
  9. 9. BLOODBLOODMORPHOLOGICAL CLASSIFICATIONMORPHOLOGICAL CLASSIFICATION::Normocytic (N.MCV)Normocytic (N.MCV)Microcytic (Microcytic (↓↓MCV)MCV)Macrocytic (Macrocytic (↑MCV)↑MCV)
  10. 10. BLOODBLOODCLASSIFICATION OF RED CELL APPEARANCECLASSIFICATION OF RED CELL APPEARANCEMICROCYTES (SMALL CELL)MICROCYTES (SMALL CELL) ↓↓MCV(>80f L)MCV(>80f L)Iron Deficiency AnemiaIron Deficiency Anemia Fe content reducedFe content reduced Normal Fe. contentNormal Fe. content-- Thallesemia-SiderrobalsticThallesemia-Siderrobalsticanemiaanemia
  11. 11. BLOODBLOODCLASSIFICATION OF RED CELL APPEARANCECLASSIFICATION OF RED CELL APPEARANCEMACROCYTES (LARGE CELLS)MACROCYTES (LARGE CELLS) ↑↑MCV(>96fl)MCV(>96fl)MegalobalasticMegalobalastic- B 12- B 12- Folate- FolateNormoblasticNormoblastic- Liver D. Alcohol Haemlysis- Liver D. Alcohol Haemlysis
  12. 12. BLOODBLOODCLASSIFICATION OF RED CELL APPEARANCECLASSIFICATION OF RED CELL APPEARANCENORMAL CELLSNORMAL CELLS MCVMCVNormoblastNormoblastAc blood lessAc blood lessAnemia of Ch.Anemia of Ch.Disease e.g.Disease e.g.InfectionInfectionR.F.R.F.C.T. Dis.C.T. Dis.Malig.Malig.Endo.Endo.
  13. 13. BLOODBLOODCLASSIFICATION OF RED CELL APPEARANCECLASSIFICATION OF RED CELL APPEARANCEUNUSUAL CELLSUNUSUAL CELLS SpherocyteSpherocyte Sickle cellSickle cell SchistocytesSchistocytes Burr cellsBurr cells Howell jolly bodiesHowell jolly bodies PoikilocytesPoikilocytes Blister cellsBlister cells
  14. 14. BloodBloodSYMPTOMS & SIGNS OF ANEMIASYMPTOMS & SIGNS OF ANEMIASYMPTOMSSYMPTOMS LassitudeLassitude FatigueFatigue Breathlessness on exertionBreathlessness on exertion PalpitationPalpitation Throbbing in head & earsThrobbing in head & ears DizzinessDizziness TinitusTinitus
  15. 15. BLOODBLOODSYMPTOMS & SIGNS OF ANEMIASYMPTOMS & SIGNS OF ANEMIASYMPTOMSSYMPTOMS HeadacheHeadache Diminish of visionDiminish of vision InsomniaInsomnia Paraesthesia of finger & toesParaesthesia of finger & toes AnginaAngina
  16. 16. BLOODBLOODSYMPTOMS & SIGNS OF ANEMIASYMPTOMS & SIGNS OF ANEMIASIGNSSIGNS Pallor ofPallor of- Skin- Skin- Mucous membrane- Mucous membrane- Palm of hands- Palm of hands- Conjunctive- Conjunctive TachycardiaTachycardia Cardiac dilatationCardiac dilatation Systolic flow murmurs edema.Systolic flow murmurs edema.
  17. 17. BLOODBLOODAnemia due to inadequate production ofAnemia due to inadequate production ofRed cells:Red cells:CAUSES:CAUSES: Deficiency of essential factors:Deficiency of essential factors:- Iron, vit.12- Iron, vit.12 Folate.Folate. Toxic factors:Toxic factors:- Inflammatory disease, Hepatic or Renal- Inflammatory disease, Hepatic or Renaldis.,Dgs.dis.,Dgs. Endocrine Diseases:Endocrine Diseases:- Hypo or Hyperthyroidism, hypopittutism- Hypo or Hyperthyroidism, hypopittutismhypogonad:hypogonad:↓↓erythryroitin.erythryroitin.
  18. 18. BLOODBLOODAnemia due to inadequate production ofAnemia due to inadequate production ofRed cells:Red cells:CAUSES:CAUSES: Invasion of Bone MarrowInvasion of Bone Marrow- Leukemia, sec. ca., fibrosis.- Leukemia, sec. ca., fibrosis. Disorders of developing Red cells.Disorders of developing Red cells.-- Sideroblastic anemia, NeoplasticSideroblastic anemia, Neoplasticdisorders of erythropoisic, otherdisorders of erythropoisic, otheriodiopathic refactory anemia,iodiopathic refactory anemia,heridatory disorders of Hb. Synthesisheridatory disorders of Hb. Synthesis(Thallasemia)(Thallasemia) Failure of stem cells.Failure of stem cells.- Hypoplastic & aplastic anemia.- Hypoplastic & aplastic anemia.
  19. 19. BLOODBLOODIRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIACAUSES:CAUSES:1.1. Poor intakePoor intake2.2. Decreased absorptionDecreased absorption3.3. ↑↑ demandsdemands4.4. Blood lossBlood loss
  20. 20. BLOODBLOODIRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIACLINICAL FEATURES:CLINICAL FEATURES: Symptomatology of iron deficeincy isSymptomatology of iron deficeincy ismainly that of anemia. However theremainly that of anemia. However thereare charachteristic features, these areare charachteristic features, these aremainly epitelial changes produced bymainly epitelial changes produced byinadequate iron in the cells.inadequate iron in the cells.-- Brittle nailsBrittle nails-- Spoon-shaped nails (koilonychias)Spoon-shaped nails (koilonychias)-- Atrophy of the papillae of the tongue.Atrophy of the papillae of the tongue.
  21. 21. BLOODBLOODIRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIACLINICAL FEATURES:CLINICAL FEATURES: Angular stomatitisAngular stomatitis Brittle hairsBrittle hairs A syndrome of dysphagia and glossitisA syndrome of dysphagia and glossitis(Plummer-Vinson ro Peter-Brown-Kelly(Plummer-Vinson ro Peter-Brown-Kellysyndrome).syndrome). Rarely in severe deficiency parotidRarely in severe deficiency parotidenlargement, spleenomegaly and failureenlargement, spleenomegaly and failureto grow.to grow.
  22. 22. BLOODBLOODGOOD CLINICAL HISTORYGOOD CLINICAL HISTORY Dietary intakeDietary intake Self Medication –NSAIDS.Self Medication –NSAIDS. Blood in faeces (Haemrrhoid or ca.Blood in faeces (Haemrrhoid or ca.lower Bowl)lower Bowl) P/R examination.P/R examination.
  23. 23. BLOODBLOODORALORAL Fe sulphate 200 mg/100Fe sulphate 200 mg/100PARENTERALPARENTERAL Iron sorbital 1.5mgIron sorbital 1.5mg Per kg/body wt dailyPer kg/body wt daily l/m, never give.l/m, never give.

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