Beruflich Dokumente
Kultur Dokumente
ancmias
.
Dr . Yenny Dian Andayani
SpPD
-([IOM
.
Divisicm l{matologicOncology Mcdic Dpr Intcrnrt Modicinc
Hmin Gmoal,HospkaU
Fmlty ofMcdicinc Sriwijrya Unireity
Moh
Palmbmg
( decreascd
MCV)
A!
hr.a 1;'A $i:mK.tfX <9 ( )
q-.
g,::n
(iltu.wdr
.MCV?
A!
,hnt^
{nn!*,
n{!
^krr
&d*r6*.e,61.
ar4..klrq&hF.'r.
.@.si.(,..h{bdl@
h'@@iart6t
,hr.i
l{.E-Gr.6H.n{o(r
rEFrdi,r,^*+
ll+!F't..rtu;.r{'
Gt.
iuir^^!
? . r,rilr
r.J
.
.
MCH?
Nilai normal
MCI{C
!, dhr*lakq
i-rrh
I'Icmogram
consist
Etiologry of anemia
'
'
'
.
Production
Dcstructiont
Loss
ofblood
Disturbance mctabolism
HEMOLYTIC ANEMIA
.
Anemia
of increased destuction
.
.
Intracorpuscular factor
Extracorpuscutnr factor
tr t iEsDA lr//"\DBooR
FIC-
oF
ct
6,7c1L
HEtilTAUX;|
d itfriFiE.
HEMOLYTIC A].{EMIA
l. lntracorpuscular factor
Causes
RGd
INTRACORPUSCULAR HEMOLYS$
Metabolic Abnormalities
Nonimrnunc
lnnmune
ccll tbnom.ltty
A. H.Edlttry
Mcmbrane Abnormalities
(G6pOl
Hemog!obinopathics
. EXTRACORPUSCULAR I{EMOLYSIS
B. Acquirud
l. Membrln..bnom.llty-p!.oxysh.l
Mechanisms of hemolysis /
Pathogenesis:
w.m+.c(c.ntibodieg
cold+.qliw lntibodica
hemo$ic anemlas
l. Ghcmlcrlt
Z Brqt"dal anfcctions. prrtsitlc lnfections (mal..lrl. Enons
!. Hcmolysl! due to phFic.l tnum.
- hcmolytic . urenh ryndrcm ltlusl
B. Nonlmmune
1. lntravascular
2. Extravascular
ITTPI
HEMOLYTICAHEMIA
lntravascula r Hemolysls
---..-
mri
.*tuffi
^*r.rfrf.'..l.wm
-E
'tt
-
ffiM
Blrtdury
frrEf.ltIocytsL
-r.aurpb..bcyrdo
Ltltc&b
<670
-tlwrh tlN*
r.l@holnd.h
-g
-Ud!bl6 hclrlobln
1d
nrrcfitta uc(om
!.
.o*'J*-
lr:::
nt tD
=-cE[
RBC LYSIS
I
HBG
**-\*"r".
a[rl,16k6'
zFF..t donrFffi
- ,t t , EIE , E
:H,ffiijffi"
-XAflA
'll?'llG
.[C
-hailql@
:. hHmf[oxlil
kkl+!!ffi:q
(spE
REMOVED BY UVER
HEMOGLOBINEMIA
I
,.F#
a- U6&
5. ttfl
-- -"'-
HAPTOGLOEIN
I
HEMOGLOBINURIA
ell)
liver)
Hgb
t\
Here
libffild
bl@d
rcsel
in
Gtobrn
./rl
./
\
Rcdilizsd
Prolopo.ptrfin
"l,uo* ,L".
lntravascular hemolysls :
celts dBtructlon coE ln vasculsr space
C.llnlql st8icr lsochi.d ytth ltrtnyEql!rhcmolFlc
- Red
-
E!umt
a.dcrt l HestloB
rnd
E!.travascular hemolysls :
clb deltrucllon occuE ln t llculoendothell.l sylt m (RESI
-Ctlnlcil states.!!ochl!dwlih.xtnyt.culrrh.molylh :
Autolmmune h.mobEb
Dcllycd h.molytlc lnn.fullon ructlotr3
Hlmogloblnoprlhlc!
- Red
Eqdhold hyprTph3rr
llcmgloDlnemh
Hctedltery rph!mcyt6h
Ht?er!plen13m
llclhcmo.lbu"ilafrla
l{emlyslB wlth
Xrmogloblnurlr
Abrcftr d trduced of
Hemosldcrlnurlr
llYor
dl..cse
lndlcct hyperblilrublnemh
lncrlrd excrcllon of blllrubln by b!le
Eq6hrold hypcrpl.rls
HemsldeE!lB
Anamnesa
. Fa(iguc
. Pallor
. Shortness of Breath
. Blccding/pctcchiac
. Joini s]mptotns
. Rash3g malar
. Fomily Histoty
. Mcdications
.
.
.
.
.
Laboratory f6atures:
Hem.tology test
,.
Lrborrtoryrertures
- Nomoc)4lcrf, .cGytlq rryperchrcmlc rrc61.
- Retlaloct/toalr
Tachycardia
Tachypnea
Jaundice
Splcnomcgaly
Signs olcongcsrive heart failurc in rapiclly
progressive ancmia
l.
ll.
l.
postalvc
Prlmary
Sc@ndary
1-Acue
.
2. Blood amar
- AnasopglkllcylGi3,
- Erythrcblest!
- Schistocytos
t.
spheGt tss
2.
Chrcnic
- dr?umatold ,nhdds, sfstomic lupur eMhemal6us
-
lylrphoprclifaEtlve dkordE
'
vir.l lnfections
drugs ( o-lilethyldop., prnlcillln, eulnine, euiotdine)
cold-reacllve antlbodles :
Treatment:
- Sterolds
. Splenectomy
-
lmmunosupressive agents
Transfuslon lf n@ded
-)
Penyaklt AH
A. Accqulred :
lntracorpuscular FACI'OR:
1nr,rxl
L P.lhogonc!lt
- An rcqulrcd clonrl
dl!o.!e, rrlllng
frdm
r tomallc
' Glyro.yl-photph
muteilon ln
!ilry
ofihr
ldocry{ccclcn(
- Ooncltrcy
htbno,
drrt brM
'
.
gcnc
proteins
. lJcmolysis is pH dcpcndent
. Thrombcsis can occur
.
.
.
- Hmoslderlnurl.
/L Trartmerlt:
of
lntracorpuscular Fact-or
B. Herediter ( defect)
.
.
Hemoglobinopathies
Mctabolic Machinery
-- G6PD dcficiency
raig Hemoglobin SC
Jrborutory felturcs:
- Hcmogloblnurl.
PNH
- P!ncylopcnl.
- Chronlc urln:ry lrcn lo$
- Scrum lrcn conccnlrllon dccrcascd
thcnpy
G6PD Deficiency
.
reaction'include:
sullonamide. aspirin
xposurc
Sign of anemra
.
.
.
.
Pale skin
Rapid pulse
Heart murmur
Enlarged sploen and
livcr
- Fever
-wcakress
-Dizziness, confution
-Intolerance to p.hysical activity
Treatment
Req-uired. test
Blood tests
are taken
to measure levels of
.
.
Comtrs test
Jmunosupresive
.
.
Change in
diet
Transfusion ifneeded
ln
Macrocytic Anemia
Ifrankyou
Ycnny Dian Andeyani
Oncology i\'lcdic Division
Dept.In(crnel Mcdicinc [{oh.llocsin Gencral
I{ospital
- /Fnculty of Mcdicinc Sriwijaye
Univeriitv Patembang
I Icmalology
.
.
MACROEYTIC ANEMIAS
Maciccyic anemias arc charactcrized by large
MEGALOBLASTIC ANEMTAS
RBCs
MEGALOBLASTIC ANEMI,AS
.
ii uwlly
duc
The bfochcmfccl
MEGALOBLASTIC ANEMIAS
to
'
.6E
taTorrd
6.d6rge
a B,l ir
ro
ric b@c
Em'
led io . ,.gdobhnic
for
E 66
thc
liv6
VITAMIN
DIFT.'ERENTIAL DIAGNO S IS
WTTH INCREASED MCV
B12
....
PF
tt
ABSORPTION
-''iL-,,)
\...ir"
.
.
.
9.57o
Dcficicncy of vitamin
are
ED
.r Llrzr.-..
hro'q}i.F
E a.rrryrm.:.Er<
^.rr-..
s4rrarB
or .vrn6h
.a.'
B.Ettxrd
nlt
- i.rryt:.oEn.n
^/.Et
or
o .E sFr^ta*
.!n ml..ryt.r.*
t - .+.6y.c.6lhD
1
a l,d
tutrtlilh.tl-<d.
!.c:l.rl-c
r<rc*rclr
lF tsi dl dltlNl..l.
a.l.
.lE
by ,lrr.llh.
a.l cr.^<r k Gl*ct.r.:.,
r.alcl.d!...:da.
..d rM.
'd.(.
rrd
'irr.d'
r..l t.rk.'
.
t.,tlT,tr<|.
.. *arh6-h
4h
ituF^dr
ro.^
3..otl
,l
NON-MEGALOBLASTIC MACROCYTIC
NON.MEGAI,OBLASTIC MACROCYTIC
ANEMIA
A}IEMIA
Notethat the macrocytic RBCs are not oval, but
are round.
Horvill-Jolly bodies
Folatle
.
.
.
.
.
.
Severe :
Feature
Sl,mpton and
of taste, utropy
ofthe tongue.
of
deficiency
Clinical
mgldl-
of
hyperlhytoidsm)
enteropatic cycle
fblate supply
alcoholic.
alcoho.sm, hepatoma
PERIPIIERAL SMEAR OF
MEGALOBLASTIC ANEMIA
10
Biochcmical findings in
'Anemi
. Mc4aloblastic erythropocsir
. Bone marrow rich in cclts,
. Giant metamycolcles
. Ciant bands
.
.
llowell-Joily'es bodies
Cabot's rings
Me-lrty
.
.
.
Senrm LDll
Semrn iron
.
.
normal
Diagnosis
tcst.
Dysplastic anemias;
Liver
(principally I-Dll-l)
MA
disease
Flemolysis
Schilling tcst
Treatment
11
Pernicious Anemia
Pernicious Anemia
.
Epidcmiologlr:
Pemicious Anemia
l.qE I hlctrddd
TpeA(artoimmune):
. fEBt irolvd in PrA. (d6 b.dMiDodi.r)
. brdc
rlc fundur
rd
bo4' sticlr
.dlabtir.nd
l.m./..
Clinical Fcatures:
- Megaloblasticanemia
- Scrum B-12 def
- Chronic atrophic gastritis
manifistations (F6r6a ili,b,E*, @ l*,
- Neurologic
-qrbldic
d Ftu :a Fh;
te!')
tffifty &Aq.bnhdftriq
glositis
Atrophic
- Achlorhydria Qack of HCI in gastric juice)
Elcvatcd.serum bilirubin aad I-DH rcflec-live of increascd
- RT-IC
breakdown due to ineffeitive erythropiesis.
d F*
hish
ffi
ffii.
8sh
rnd
ro
16tl..
TapcB:
Pernicious Anemia
.
k dfir-
Atrophic glossitis
Pernicious Anemia
of B-t2 ro IF
F*r&r4.rn
ClronicAtrophic Ga-slritis
Tsa gTE:
.'
Aulonniihody to lF
Pathophysiology
Clinical Fcatures:
- Mcgaloblastic anemia
- Senrm B- I 2 def
- Chronic atrophic gaslritis
Pernicious Anemia
. Schilling Test
-
- Notcommonly
used
lo dctect
def
12
Pemicious Anemia
Treatment
: IM
-
Pemicious Anemia
.
Response to Treatment
Rcticulocytosis in
34
days
Fall of scrum
2 days
13