Beruflich Dokumente
Kultur Dokumente
in Geriatric Patients
Sahyuddin
Tutik Harjianti
A. Fachruddin Benyamin
SubDiv of Hematology & Medical Oncology
Dept of Internal Medicine, Medical Faculty
Hasanuddin University
I. Introduction :
a. Genetic process
b. Somatic mutation error in
transcription & translation process
c. Immune system defect
d. Free radicals cell destruction
tissue destr organ destr.
Sel Normal
Gain of function
mutations of tyrosine
kinases
eg. AML1-ETO
CBF-SMMHC
PML-RAR
enhanced
Normal
proliferation
enhanced
Normal
differentiati
on
Suppressio
Normal
apoptosis
n
apoptosis
GgnImun
Sistem
surveilence
imun
ALL
CLL
nave
Lymphomas
MM
germinal center
B-lymphocytes
Lymphoid
progenitor
AML
Hematopoietic
stem cell
Myeloid
progenitor
Plasma
cells
T-lymphocytes
Myeloproliferative disorders
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
B-cell development
CLL
stem
cell
lymphoid
progenitor
mature
naive
B-cell
memory
germinal B-cell
center
B-cell
MM
progenitor-B
ALL
pre-B
immature
B-cell
Bone marrow
DLBCL,
FL, HL
plasma cell
Lymphoid tissue
2. Megaloblastic Anemia
Deficiency
Cyanocobalamin
Deficiency
Cyanocobalamin
An important
sign :
3. Level of Vit B12 <100 pg/ ml
1. macrocytic Anemia
sign
Macrocytic
Division of Hematology & Medical Oncology Dept. of Internal Medicine
Normocytic
The Cause
1.
2.
2.
3.
4.
Physiology
Phatogenesis
Need : 3 5 ug / hari
Example :
3. Leukemia
AML : 80 % adult age
Median age : 55 y.o.
Increase of incidence = age
Problem : - Poor prognosis
- Low remission rate
(low tolerance to chemotx, infection etc)
5. Myelodysplastic Syndromes
MDS :
74,1 y.o
78,2 y.o
6. Multiple Myeloma
MM :
4. Supressed normal Ig production
5. Bone destruction bone-pain etc.
6. Kidney function disorder
* Gbr. klinis
_________________________________
Peny. lanjut usia (median : 60 th)
Anemia, LED tinggi
Nyeri tulang : costa, vertebra
Fraktur patologik : colum femoris
Ggl ginjal, kompresi med.spinalis
* Laboratorium
_________________________________
Anemia ( normokrom )
LED sangat tinggi ( mis. 150 / 160
)
Hiperkalsemia ( Ca >> )
Proteinuria (Bence Jones protein)
Elektroforesis protein serum
abnormal
(spike monoclonal pd beta atau
Serum Protein
Electrophoresis
Normal
Kyle RA and Rajkumar SV. Cecil Textbook of Medicine, 22nd Edition, 2004
Thank You