7/21/2019 blood(2)

1/153

haemoglobin13male

12female

stages of RBCs development

stem cellsproerythroblasterythroblastnormoblastReticulocyte

mautre RBCs

normo blastnormo blastiron

Normoblastironreticulocyte

stagesperipheral blood

reticulocytemature RBCs

bone marrowperipheral bloodmature RBCs

reticulocyte

reticulocyteabout 0.2-2%Percent

Peripheral bloodreticulocytosis

bone marrowhyper activehyper activeRBCs

precursors

bone marrowRBCs

bone marrowRBCsReticulocytes

hemolysishemorrhagebone marrow

excessive production of RBCsReticulocytes

7/21/2019 blood(2)

2/153

iron deficiency anemiaB12

deficiency

bone marrowmature and

reticulocytes

iron deficiency anemiabone marrow

normoblastmature RBCs

Iron therapybone marrowreticulocytes

RBCS

Reticulocytosis

MCQ

reticulocytosis

MCQreticulocytesreticulocytosisbone marrow

activity

reticulocytosisaplastic anemia

bone marrow aplasiareticulocytosis

reticulocytosisiron deficiency anemia

hemolysis

hemorrhage

aplastic anemia

reticulocytesPeripheral blood

haemoglobin A

haemiron and prtoporphyrin

globinalphaBeta

alphahaemoglobin F

ESR

7/21/2019 blood(2)

3/153

anticoagulant

RBCs

column of plasma

RBCsColumn of plasma

factorsESR

RBCsrouleaux

RBCsrouleauximmunoglobulinsfibrinogen

fibrinogenimmunoglobulin

InfectionInflammatory

InflammatoryinfectionGamma globulin

fibrinogenRBCs

RBCsordersRBC

repulsionInflammation

InfectionimmunoglobulinfibrinogenESR

ESR

Westergren methodanti coagulantNa citrate

Wintrobe methodEDTA

haematocrit value

RBCs

7/21/2019 blood(2)

4/153

volume of RBCstotal blood volumehaematocrit value

haematocrit valueassesmentNa

citrate

trueaccurate

Westergren methodWintrobe method

Wintrobehaematocrit value

haematocrit valueRBCs in relation to blood volume

Na citratediluationfalse results

causes of moderate rise of ESR

infection , anemia , myocardial infraction

myocardial infractionESRpulmonary infraction

pulmonary embolismPulmonary infraction

rheumatoidESR

ESR

tuberculosisPyogenic infection

malignancyLeukaemiaLymphomaMultiple myeloma

pyogenic infection

ESR

leukaemiaLymphoma

ESRnormalpolycythaemia

7/21/2019 blood(2)

5/153

polycythaemia rubra vera

polycythaemiaRBCs

ESR

RBCs

2 anemiasESR

sickle cell and spherocytosis

RBCsspherocytessickle cellrouleaux

MCQ

haematocrit value

packed RBCs

Packed RBCsvolume of RBCsblood volume

RBCsvolumeplasma volume

RBCsvolumetotal blood volume

malefemale

polycythaemia

haematocrit valueMCQ

haematocrit value

normal

fluidsInterstitial tissues

Intravascular

7/21/2019 blood(2)

6/153

Interstitial tissueintravascular volume

haematocrit value

haematocrit valueImmediate haemorrhage

hamorrhage

peptic ulcervariceshematemesis

Haematocrit value

melena

haematocrit value

haematocrit value

patientrecurrent bleedingfollow up

how can you follow this patient

followpatienthaemoglobinRBCs

haematocrit value

providedbase linehaematocrit value

diluate

Blood indices

mean corpuscular haemoglobin

RBC

RBCRBCs

average27-32RBC

blood index

7/21/2019 blood(2)

7/153

mean corpuscular volume

packed cell volumepacked cell volumeRBCs

RBCRBCsRBCs

Mean corpuscular volume78-98

100macro

Mean corpuscular volumeblood index

normalnormocytic

macro cytic

microcytic

8problem

blood indices

anemic

mean corpuscular volume

normocytic , macrocytic and microcytic

morphological classificationaccording to blood indices

especiallymean corpuscular volume

microcytic anemia

iron deficiency anemia

normo cyticaplastic anemia , hemolytic

macrocytic

blood indices

7/21/2019 blood(2)

8/153

7/21/2019 blood(2)

9/153

blood film

blood filmOral

blood film

microcytosis , macrocytosis , hypochromia

anisocytosisvariation of the size of the RBCs

Poikilocytosisvariation of the shape of the RBCs

anisocytosispoikilocytosisnon specific

deficiency

deficiencyRBCsRBCs

variationsizeshape

punctuate basophiliabasophilicRBCslead

poison

Howell Jolly bodies

parasites in RBCsmalariaProblem solvingblood film

Infectionparasitemalaria

shape of the RBCs

written

Burr cellEchinocyte

uremiaBurr cells

Stomatocytes

target cellsCodocyteCodocyte

targetCodocyteiron deficiency , liver disease, Thalassaemia

AcanthocyteRBCschronic liver disease

RBCsRBCs

spleenRBCsRBCs

7/21/2019 blood(2)

10/153

spleen

post splenoectomyAcanthocyte

Acanthocyteadvanced chronic liver disease

Sickle celllancet cell

spherocytespherocytosis

SchistocytesRBCs fragmentedHelmet cellshcizocyte

Tear drop cellDacrocytemyelofibrosis

Red cell distribution width (RDW)

varitationsizeRBCs

variation

variation15%accepted

variation50%

variation80%

anisocytosisRBCsRBCsvariation

size

Red cell distribution width (RDW)

Red cell distribution width

variationnormally11.514.5 %variation

deficiencyiron deficiencyB12 deficiency

Iron therapy

ironferrous sulfate 200 mg tabferrous gluconate 300 mg tab

doses

ironnausea

nausea

7/21/2019 blood(2)

11/153

iron

absorption

irritation

ironLow concentrationiron

so irritant

iron absorptionascorbic acid

iron intolerancenauseavomiting

abdominal pain

plz

stooldarkstooldark

respond

reticulocytosis

bone marrowNormo blastreticuolcyte

RBCs

responseclinical

failure of oral iron

wrong diagnosisthalassaemia minor

thalassaemia minorhypochromic microcyticiron

deficiency anemia

female10iron therapy3

thalassaemia minor

thalassaemia minor9.5-

10

iron deficiencythalassaemia minorhaemoglobin electrophoresis

7/21/2019 blood(2)

12/153

malabsorptionchronic

infection

chronic infectionfailure of iron utilizationcytokinesInfection

cytokinesbone marrowiron

parenteral iron

IronSaccharated iron (ferrosac)

side effectsMinimalferrosac

iron dose

ironintermittent IV infusion

Iron deficiency anemia

ferrosac10050100

Intra venousevery other day

any rareanaphylaxis

ferrosachydrocortisone

Anaemiadefinition

decrease haemoglobin and RBCs count

in relation to age and sex

haemoglobin

adultchild

morphological

mainlyblood indices

7/21/2019 blood(2)

13/153

anaemiaoxygen carrying capacity

tissuesHypoxia

hypoxiatissues

compensatory mechanismvasodilationtissue

perfusioncardic output

2-3DPGhaemoglobin

8oxygentissues10

carrdic outputvaso dilation

chronic anaemia

7chronic anaemia

anaemicchronic anaemia

actue anaemia

anaemiaacutefew hourshemolytic crisis

G6PD

114

anaemic heart failure

symptomssignsanaemia

fatigueheadachehemic murmur

heart failureanaemic heart failureHeart failurehigh cardic

output failure

cardic output

tissueblood oxygenqualityoxygen

heart failure

digitalishaemoglobin

problem solving

anaemiaclinical examinationanaemia

anaemiairon deficiency

specific signs of different types of anaemias

koilonychias in iron deficiency anaemia

7/21/2019 blood(2)

14/153

Jaundicesplenomegalyhemolytic

neurologicalsubacute combined degenerationB12

deficiency

iron deficiency anaemia

iron10%iron

10iron1

iron kinetics

oral ironferricHCLferrousferrous

form of absorptionsmall intestine

small intestineapoferritinferritin systemapoferritinferritiniron

ferritinstoresdeliveryiron

transferrin

transferringlobuliniron

ironserum iron

serum ironserum irontransferrin

free ironblood

free iron in bloodinjurioustissueshaemoglobintransferrin

serum irontransferrin

iron binding capacitytransferrin

ironiron binding capacity

iron leveliron levelserum

irontransferrinratioiron binding capacity

transferrin

transferrin saturation

transferrin saturationirontransferrin

Most accurateiron

serum ironirontransferrin

7/21/2019 blood(2)

15/153

iron binding capacity

ratio

most accuratetransferrin saturation

Investigation

reflectiron

transferrinbone

marrowbone marrowreceptorbone

marrowRBC

normoblast

normoblastironreticulocytemature RBCperiphral

blood

serum ferritinreflect iron storesserum ferritin

accuratephase reactant

plateletsphase reactantserum ferritinphase reactant

plateletsInfectionInflammatory diseasesferritin

aetiology of iron deficiency anaemia

Iron deficiency anaemiaadultchronic blood loss

blood lossGIT bleedingGIT

vaginal bleedingutrine bleeding in femalemenstruation

problems

Ankylostoma anaemiairon deficiency anaemia

microcytic hypochromic

approach

microcytic hypochromiciron deficiency anaemiacommonest anaemia

thalassaemia

7/21/2019 blood(2)

16/153

Iron profilehaemoglobin electrophoresis

general featuresiron deficiency anaemia

koilonychiaspooning

Loss of luster

causeGIT bleedingutrine bleeding

diagnosis

anaemiaLow

mean corpuscular volumemicrocytic hypochromicmicrocytic hypochromiciron deficiency

anaemiairon profileserum iron

iron binding capacityserum ferritintransferrin

saturation

ironRBCbone marrowprotoporphyrin

haemoglobin

protoporphyrinfree protoporphyrinRBC

Iron deficiencyProtoporphyrin

bone marrow examination

bone marrow examinationdiagnosticconfirm

diagnosisbone marrow

anaemicmicrocytic hypochromiciron profile

bone marrow examinationabsolutely indicated

hyper plasiabone marrow

bone marrownormoblastnormoblast

bone marrowiron

anaemiahypochromic microcyticiron deficiency

Iron deficiency anaemia

upper GITendoscopeLower endoscope

7/21/2019 blood(2)

17/153

eosinophilia

occult blood in stoolnot reliable 100%occult blood

Moleculesstool

occult blood in stoolRBCsstooloccult blood in

stoolRBCschemical reaction

haemoglobinstool

iron lossblood loss

3false results

Occult blood in stoolpositiveGIT bleeding

occult blood in stoolPositivefalse

iron

megaloblastic Anaemia

mean corpuscular volume100115

B12

B12strictly vegetarian

liable

B12B12intrnisic factor

small intestine

terminal ileumterminal ileum

terminal ileumdeficiency

terminal ileumB12 deficiency

reaction

homocysteineamino acidsinjuryendothelium

coronary

lipid profilehypertensivediabeticrisk factor

7/21/2019 blood(2)

18/153

homocysteine

B12homocysteinemethionine

HomocysteineB12folic

folic acidB12atherosclerosis

antioxidantB12folic

acid

B12folicB12foliciron

calcium

quality of life

homocysteineatherosclerosis

folic

FIGLUtestclinical pathology

histidineFIGLUFIGLUglutamic acidfolic acid

folic acid deficiencyFIGLU

B12Folic acidserum

Causes of megaloblastic anaemia

causes of iron deficiency anaemia

adultchronic blood loss

B12 deficiencyB12 deficiency

intrinsic factorsmall intestine

B12 stores

B12

storesliver

folic acid

very easyIncrease demandiron

deficiencyfolic acid deficiencyB12

B12

7/21/2019 blood(2)

19/153

chronic gastritis

chronic gastritisA and B

Aauto immune

Bbacterial

auto immune

perniciousantibodyparietal cellsanti

bodyintrinsic factor

BHelicobacter pylori

small intestine

malabsorption

Diphyllobothrium latum

B12

folic acid deficiency

iron

anti folate

anti folatetrimethoprimantifolatesulpha

pernicious anaemia

B12 deficiencyauto immune disease

pernicious anaemiaB12 deficiencypernicious anaemiaB12 deficiencyauto immune disease

parietal cellsintrinsic factoranti parietal cell anti

bodyanti intrinsic factor anti body

associated with other auto immune diseasemyxoedema ,

thyroiditis , vitilligo

pathophysiology of megaloblastic anaemia

7/21/2019 blood(2)

20/153

folic acidB12maturationnucleuscell division

MiosisMitosis

nucleusdevelopmentcytoplasm

division

nuclear materialdivisionfolic

acid and B12

cytoplasmnucleus

RBCsbone marrowRBCsnucleuswell

developed

cytoplasmRNADNAbone marrow

bone marrowbone marrowmegaloblastic changes

megalobastic changesbone marrow

megaloblastic anaemia

Megaloblastic changesbone marrowdeficiencyfolic acid

B12RBCs

RBCsmegaloblastbone marrow

bone marrow

Peripheral bloodblood film

bone marrowintra medullary hemolysis

B12 deficiencyjaundice

jaundiceIntra medullary hemolysis

Jaundicebilirubin

platelets

RBCs

B12 deficiencyfolic acid deficiencypan cytopenia

7/21/2019 blood(2)

21/153

Non megaloblastic macrocytosis

RBCsperipheral bloodbone marrownormal

non megaloblastic

hypothyroidismalcohol excesschronic liver disease

RBCsLipidRBCs

RBCsRBCsmacrocyte

B12folic acid deficiencybone marrow

macrocytic non megaloblastic

anaemicmean corpuscular

volume120

macrocytosismegaloblasticnonmegaloblasticmegaloblastic

folic acidB12

non megalo blasticchronic liver disease

RBCsperipheral blood

reticulocytesmature RBCs

reticulocyte

reticulocytosishemolysismacrocytosis

hemolytic crisismacrocytosis

reticulocytosisreticulocyte

clinical pictures

B12

anaemiaGIT manifestationssubacute combined degeneration

iron deficiencyB12writtenproblem solving

7/21/2019 blood(2)

22/153

macrocytosismegaloblasticnon megaloblastic

neuroneuro

pallorfatiguemean corpuscular volume

examinationdata

glove and stock hypothesiabilateral exaggerated knee jerk

pyramidalglove and stock

glove and stockankle jerkLostperipheral

neuropathy

subacute combined degenerationbilateral pyramidal

hyper reflexiaperipheral neuropathylost ankle

knee jerkexaggerated

mean corpuscular volumeneurosub acute combined

degeneration

investigation

anaemiaanaemia

blood indicesmean corpscular volume

mean corpuscular volumeMacro cytic

megaloblasticnon megaloblastic

megaloblasticfolicB12

bone marrow examination mandatory

mandatory

bone marrowmegaloblast

non megaloblastRBCsperipheral blood

alcoholiccirrhotichypothyroidismreticulocytosis

B12

B12

stomachsmall intestine

7/21/2019 blood(2)

23/153

mean corpuscular volumeB12

intrinsic factorstomachsmall intestine

testSchilling test

Schilling test

vitamin B12 injectionstores

B12 oral

B12

digestion and absorptionbloodbloodstores

B12absorption

Intrinsic factorsmall intestine

B12oralintestine

intrinsic factorstomach

small intestine

other findings

MCQ

poikilocytosisanisocytosisnon specific

anisocytosisSvariation in size

poikilocytosispvariation in shape

Howell jolly bodiesnucleiwell developed

megaloblast

nuclear materialdevelopedremnantHowell jolly bodies

WBCsplatelets

bilirubin

reticulocyte

Hemolysismacrocytosis

7/21/2019 blood(2)

24/153

Hemolysismacrocytosis

folic acid deficiencyhemolysis

hemolysisbone marrowproliferatingconsume

folic acidfolic acid deficiency

hemolysisfolic acidB12

iron therapy

hemolyticiron over load

200-300

thalassaemiathalassaemia

supplement

folic acidB12ironcontra indicated

iron therapy

iron contra indicated

hemolysisdepletionfolic acid

macrocytosis

hemolytic crisisreticulocytosishemolytic crisis

reticulocytosis

reticulocytesmacrocytes

hemolytic anemia

megaloblastic anaemiahemolysisIntramedullary

7/21/2019 blood(2)

25/153

hemolytic anaemiafolic acidhemolysis

folic acid supplement

hemolytic anaemiacrisisreticulocytosis

reticulocyte

B12 deficiecnyIntra medullary hemolysis

bilirubin

WBCsshowing hypersegmented neutrophilsneutrophilshyper segmented

hyper segmentedWBCsdivisionnuclear

material

development of the neutrophilsnucleus hypersegmented

nucleus

nucleus.Hypersegmentation

hyper segmented neutrophilsMCQB12 or folic acid

deficiency

platelets

folic acidB12

Three parasites give different types of anaemia

Ankylostomairon deficiency anaemiaeosinophilia

Diphyllobothrium latumvit B12megaloblastic anaemia

malariahaemolytic anaemia

para sitesanaemiadiagnosis

treatment of each parasitedoseduration of the

drug

7/21/2019 blood(2)

26/153

ankylostomadiphyllobothrium latummalaria

pancytopeniawrittenwritten

anaemicdataplateletsRBCs

WBCscase of pancytopenia

pancytopenia

aplastic anaemia

hypersplenismB12folic acid deficiency

Sidroblastic anaemia

sidroblastic anaemiaMCQbone marrow

normoblast

Normoblastreticulocytemature RBCs

Normoblastnormoblastiron

protopophyrin

protoporphyrinIronhaem

defect

protoporphyrin

ironnormoblastbone marrowprotoporphyrin

sidroblast

iron granulesnormoblast

protoporphyrin

sidrosis

normoblastsidroblast

7/21/2019 blood(2)

27/153

sidroblastnormoblastprotoporphyrin

ironbone marrownormoblast

normoblastironprotoporphyrin

protoporphyrin

ironnormoblast

sidrosis

normoblastsidroblast

sidroblast

normoblastbone marrowiron granulesprecipitated

iron granulespericipitatedsidroblastbone marrow

sidroblast

normoblast

definite diagonis of sidroblastic anaemia

bone marrow examination

sidroblastic anaemiamicrocytic anaemia

RBCsironnormoblast

ironprotoporphyrinhaemoglobin

haemoglobin

RBCsbone marrowperipheral bloodhypochromic microcytic

iron deficiency anaemia

bone marrow

absolutelyprotoporphyrinironsidroblast

bone marrowbone marrow

bone marrowdefect partialironprotoporphyrinhaemoglobin

7/21/2019 blood(2)

28/153

RBCsbone marrowiron deficiencymicrocytic hypochromic

blood indiceshypochromic microcyticiron profileiron

deficiencyhaemoglobin electrophoresisthalassaemia minor

sidroblastic anaemia

bone marrow examination

sidroblast

RBCsperipheral bloodironprotoporphyrinhaemoglobin

iron

microscopeiron granules precipitatedRBCs

peripheral blood

iron granulespappenheimer bodies

causes

acquired

INH

ironprotoporphyrinvitamin B6

INHantagonize vit B6sidroblastic

INHvitamin B6

vitamin B12 and folic acidMegaloblastic anaemia

Vitamin B6sidroblastic anaemia

pappenheimer bodiesIron granulesperipheral blood

blood filmpappenheimeriron granulessidroblastic anaemia

stopdrugvitamin B6

Justsidrobalstic anaemia

7/21/2019 blood(2)

29/153

Normoblastiron moleculesbone marrowRBCs

peripheral bloodiron deficiency anaemia

pappenhemier bodies

patient with peptic ulcerGIT bleedingblack stool

melenairon therapy

peptic ulcer

DE-NOL

peptic ulcer

helicobacter

leucocyte

myeloid linelymphoid line

myeloid line

myeloid stem cells

Myeloid stem cellsmyeloblastpromyelocytemyelocyte

metamyelocyteneutrophils

blastbone marrowpromyelocyte , myelocyte and metamyelocytemore

developed

mature neutrophils

lymphoid stem cellslymphoblastprelymphocyte

lymphocyte

lecocytosis

Mature neutrophils

Mature lymphocyte

leukaemialeukaemiaproliferationImmature stages of

WBCs

Myeloid linemyeoblast

7/21/2019 blood(2)

30/153

Acute myeloid leukaemia

lymphoid lineneoplasmlymphoblastAcute

lymphoblastic leukaemia

leukaemiapre-lymphocytechronic lymphocytic leukaemia

leukaemiapromyelocytemetamyelocytechronic

myeloid leukaemia

acuteblastsproliferation mainly

chronicmatureblasts

blasts

aggressiveblasts

proliferationlymphoblastMyeloblast

bone marrowInfiltrationbone marrow failure

myeloblast

Acute myeloblastic leukaemiablastsbone marrow

neutrophilsneutrophils

blastsRBCsplateletsneutropenianeutrophils

anaemia , thrombocytopeniabone marrowblastsperipheral blood

blasts

Acute myeloid leukaemiaacute myeloblastic leukaemia

Acute lymphoblastic leukaemialymphoblast

bone marrowbone marrowlymphocyte mature

lymphoblastRBCsplateletsearly bonemarrow failure

acute leukaemia

bone marrow failure

blastsproliferation

bone marrownormal WBCsRBCs

platelets

chronic leukaemia

7/21/2019 blood(2)

31/153

bone marrow failurelate

chronicmore or less

bone marrow failure

so late

leucocytesbehavior

leucocytesproliferationbone marrowplatelets

RBCsmature WBCs

thrombocytopenicanaemicInfectionmature

WBCs

WBCsRBCsWBCsTissue invasioncirculationbone

lungLiverspleenlymph nodesskin

organsInfiltratedWBCs

disturbances

functions

Leukaemiamortality

AnaemiainfectionhemorrhageInflitrationvital organs

bone marrow failure

Acutechronic

immature WBCs normally3 %Immature WBCs

Immaturepromyelocyteblasts

blastbone marrow

shift to the leftLeucocytosisImmature WBCs

bone marrow

bone marrowWBCs

bone marrow

leucocytosisWBCsImmature

bone marrowWBCsinfection, bleeding and hemolysis

7/21/2019 blood(2)

32/153

bleedinghemolysisRBCs

bone marrow proliferate

platelets

WBCs

bone marrow emergency

Infectionemergencybone marrow

InfectionRBCs

WBCsplatelets

RBCsInfection

Infectioncytokinesbone marrow

RBCs

hemolysishemolysisleucocytesplateletsRBCsbone marrow

proliferation

hemolysishemorrhage

shift to the left

shift to the leftWBCs

immature

Immature WBCs

staffstaph aureus

staffs , t , a, double f

staff cellstaff cellsimmature neutrophils

staffimmature neutrophils

shift to the leftbone marrow

leucocytosis with shift to the left

shift to the right

shift to the rightfolic acid and

B12 deficiencyshift to the right

leucocytosis

Leucopenianeutrophilshyper segmented

7/21/2019 blood(2)

33/153

B12 and folic acid deficiencyshift to the right

leucopenianeutrophilshypersegmented

leucocytosisImmature

immature

staff cells

staff cells

immature neutrophils

character

nucleusnot well developednucleussegment

two segmentsneutrophilssegments

segmentsNeutrophilsstaff cellsimmature

hyper segmentedfolic acid and B12 deficiency

MCQclinical pathologyshift to the

leftleucocytosisimmature neutrophils

immature neutrophilsstaff cells

InfectionhemolysisBleeding

InfectionInfectionshift to the left

infectionbleeding or hemolysis

toxic granulations

toxic granulations

toxic granulationsignneutrophils

bloodblood

bloodclinical pathology7540blood

blood

blood

bloodbloooooooooood

infectiontoxic granulations

neutrophilssigntoxic granulations

7/21/2019 blood(2)

34/153

toxic granulaltionscytoplasmneutrophilsvacuoles

infectionsshift to the left

shift to the leftleucocytosisimmature WBCs

staff cells

neutrophilsInfectiontoxic granulations

toxic granulationsextremely specificinfection

Infection

leukaemiatoxic granulations

neutrophilsneuturophiliaNeutropenia

absolute countneutrophils2000-7000

percentabsolute count

take carepercentabsolute count

total leucocytic count10000neutrophils50%neutrophils

50%10000absolute countneutrophils5000

5000rangeNormal

neutrophilapyogenic infection

tissue damage

myocardial infractionpulmonary infractionleukaemias

Myeloproliferativerheumatoid

cortisone

neutrophilianeutrophilswallblood vessels

adhesionadhesion

Neutrophilsblood stream

neutrophilia

bone marrowWBCs

neutrophilsendotheliumblood vessels

Neutrophilia

neutrophiliafunctionneutrophilsImpaired

7/21/2019 blood(2)

35/153

eosinophils

eosinophiliaproblem

neutrophilswrittenoral

eosinophilswrittenoral

neutrophilswritten2008neutrophils

neutrophilianeutropeniashort

neutrophiliafull stop

eosinophilsspecific

eosinophiliaallergyparasite

Parasiteeosinophiliahydatid diseasefasciola

Liver diseaseeosinophilia

hydatid diseasefasciola

fasciola

fasciolahepatitis likehepatitis

liver enlargedtenderhepatitiseosinophilia

N.B.amoebic livereosinophila

eosinophilia

fasciola

fasciolafasciola

fasciola

amoebic liverparasiteliverLiver

amoebic liver

amoebic livereosinophilia

hydatid

fasciolabiliary systemLiver parenchyma

alkaline phophatasetransaminases

general

7/21/2019 blood(2)

36/153

parasite

addison's disease

addison'sAddison's

vasculitisStrug strauss vasculitis

primary hypereosinophilic syndrome

eosinophils very high

eosinophilsInfiltrationHeartLungvital organ

hypereosinophilic syndrome

eosinophils

steroid

allergycortisoneaddison'scortisoneHodgkin's

cortisonevasculitiscortisone

cortisone

cortisone

eosinophilslymphocytes

Basophils

myeloproliferative , chronic myeloid , myelosclerosis

polycythaemia rubra vera

basophils

lymphocyte

Infectionsore thoratlymphocytosis

lymphocytosis

viral

viral infectionT.B. , Brucella and typhoid

leukaemias

7/21/2019 blood(2)

37/153

Atypical lymphocytosis

infectious mononucleosis

Lymphocytosis

chronic lymphocytic leukaemia

infectious mononucleosis

male 65 yrs old . liver , spleen and lymph nodes

persistent lymphocytosis

chronic lymphocytic leukaemia

infectious mononucleosis

16 yrsliver , spleen and lymph nodes

LymphocytosisAtypical lymphocytosis

Lymphocyte

viral infectioninfectious mononucleosis

CMV

sore thoratinfectious mononucleosisvery common

Lymphopenia

HIV

Monocytes

bone marrowPeripheral bloodtissues

tissue macrophages

value of Bone marrow examination

diagnostic and confirmatory

diagnosticdiagnostic

bone marrow examination is mandatory

7/21/2019 blood(2)

38/153

bone marrow examination

multiple myelomaplasma cellsbone marrow

myelofibrosisfibrous tissuesbone marrow

A leukaemic leukaemiablastsbone marrowperipheral blood

aplastic anaemia

sidroblastic anaemia

confirmatory

leukaemiaPeripheral blood

A leukaemic leukaemialeukaemia

bone marrow

bone marrow

confirmcalssifications

iron deficiency

Megaloblastic

I.T.Pbone marrow examinationjust to confirmexclude similar

condition

I.T.Pidiopathic thrombo cytopenic

purpuraexclusion

bone marrow examinationconfirmexclude similar condition

A leukaemic leukaemia

A leukaemic leukaemiablastsbone marrowplatelets

thrombocytopenia

Idiopathic

bone marrow

I.T.PI.T.P

7/21/2019 blood(2)

39/153

bone marrow

almost sureI.T.Pbone marrow

sternumaspiration

dry tap

bone marrowfibrosis

trephine from iliac crestLocal anathesiaanterior

superior iliac spine

bone marrow

bone marrowfibrous tissuemyelofibrosis

dry tapMyelofibrosisfibrous tissuebone marrow

leukaemiaperipheral bloodLeucocytosisblasts

leukaemiaPeripheral blood

Acute leukaemia100,000total leucocytic countblasts

platelets

RBCs

leucocytosis40,000

leukaemia

leukaemia like

leukemoidoidlike

Leukaemia

Infection

leukemoid reaction

leukemoid reactionleukaemialeukaemiaabscess

total leucocytic count may exceed 50,000

usually50,000

total leucocytic count100,000Leukaemia

7/21/2019 blood(2)

40/153

leukemoid reaction

plateletsnormalRBCsalmost normally

bone marrownormally proliferation

blasts

leucocytesalkaline phosphatase

Normal leucocytesalkaline phosphatase

leucocytesleukaemialeucocytic alkaline phosphatase

Highleukemoid reaction

functioning WBCs

immature cellsnever exceed 5%blasts

leukaemiablood picture

leukaemia likeLeukemoidLeucocytoisplatelets

RBCs

blastsbone marrow

leucocytic alkaline phosphatase

blood picturefever

problemfeverblood picture

neutrophils

lymphocyteviral

leukaemiasLymphomas

leucocytosis due to infectionsteroid

infectiontoxic granulations

MCQ

leukoerythroblastic reaction

blastsWBCsbone marrow

blastsWBCsperipheral bloodleukaemia

blastsRBCsbone marrow

7/21/2019 blood(2)

41/153

leukaemiablastsRBCs

common

leukoerythroblasticblastsleucocytesblasts

RBCsPeripheral blood

bone marrowbone marrowblasts

Peripheral blood

bone marrow infiltrationmyeloma

leukaemialymphomaT.B.bone marrow infiltration

bone marrow infiltrationblastsRBCs

WBCs

leukoerythroblastic reactionoptionbone marrow

infiltrationleukaemia , lymphoma , T.B. , myeloma

leukoerythroblastic reaction

41

clinical pathology

leukaemia

Infiltrationbone marrowbone marrow failure

acute leukaemia

immune disorderWBCsantibodyauto immune

Infection

tissue infiltration

acute leukaemia

bone marrow failure

aetiology

geneticchemicalsionizing radiation

retrovirus

leukaemiaretrovirusHTLV1 ( human T-cell lymphotropic virus )

7/21/2019 blood(2)

42/153

Acute leukaemia

proliferationblasts

blastslymphcyteacute lymphoblastic leukaemia

blastsmyelocyteacute myeloid leukaemia

acute lymphoblastic leukaemia

acute myeloid leukaemiayoung adult

very aggressiveacute myeloid leukaemia

acute lymphoblastic leukaemiaALL85%commonadult

acute myeloid leukaemiavery aggressive

acute lymphoblastic leukaemia

lymphoblast

acute myeloidmyeloblastpromyelocyteMyelocyte

bone marrow

acute myeloid leukaemiaN0 to N7

very aggressive leukaemia

leukaemiaacute lymphoblastic leukaemia

myeloid

clinical pictures of acute leukaemia

feverinfection

sore thorat

pallorfatigueanaemia

Infectionneutrophilsmature

epistaxispurpuric eruption

fever , anaemia and bleeding

tissue infiltrationbone marrowPainsternum

tender sternum

liver , spleen and lymph nodes enlargement common with lymphoblastic leukaemiaMyeloid

7/21/2019 blood(2)

43/153

acute myeloidliver , spleenLymph nodes

13sore thorat , fever , liver , spleen and lymph node

enlargement

Infectious mononucleosisacute lymphoblastic

leukaemia

child , sore thorat , liver , spleen and lymph node enlargement

infectious mononucleosisacute lymphoblastic leukaemia

infectious mononucleosissore thorat

acute leukaemia

anaemicthrombocytopenicleukaemia

Investigations

total leucocytic count is variable

25%WBCs50,000

50%WBCs5,000-50,000

WBCs

acute leukaemiaexcessive blast in bone marrowblastsbone marrowperipheral blood

bone marrow

peripheral blood

blastsperipheral bloodblasts

acute leukaemia

blastsbone marrowbone marrow

A leukaemic leukaemia

blastsbone marrowperipheral blood

How can you suspect Aleukaemic leukaemia

blastsblastsbone marrow

infectionblastsbone marrow

neutrophils

feversore thorat

7/21/2019 blood(2)

44/153

RBCsbone marrowanaemia

plateletsthrombocytopenia

Infection , sore thoratblood pictures

thrombocytopenia

normocytic normochromic

hypochromic microcyticiron deficiency anaemia

female usuallyhaemoglobin

normocytic normochromicHypochromic

microcytic

very mild iron deficiency aneamia

Iron

neutrophilsPeripheral bloodneutropenia

peripheral bloodneutrophils

RBCsPlatelets

I.T.P.

thrombocytopeniaplateletsbone

marrow examination

blastsbone marrowbone marrow

Aleukaemic leukaemia

examinationRBCsplateletsbone marrow examination

Auer rods

blastslymphoblastmyeloblastAuer rods

differential diagnosis

fever with sore thoratacute leukaemiaInfectious

mononucleosis

7/21/2019 blood(2)

45/153

7/21/2019 blood(2)

46/153

vincristineleukaemia

dosehaematology

haematologydoseLeukaemia

Remission consolidation (4weeks )

cyclophosphamidecytosine arabinoside

consolidationCC

cyclophosphamidecytosine arabinoside

acute lymphoblastic leukaemialeukaemia

Meningesprophylaxis CNSCSF

methotrexate

cytotoxic drugsCSF

CNS prophylaxis

CNS prophylaxis

leukaemia

four dosescoursestextHaematology

Maintenance therapy

maintenanceMm

mercaptopurine and methotrexate

acute lymphoblastic leukaemia

7/21/2019 blood(2)

47/153

remission inductionvincristine , adriamycin, prednisolone and L-

asparaginase

signs of remission

clinical picture

blastsbone marrow5 %

blastsperipheral blood

consolidationconsolidationCC

cyclophosphamidecytosine arabinoside

prophylaxisCNSmethotrexateCSF

maintenanceMMmercaptopurine

methotrexate

Acute myeloid leukaemia

remissioncytosine arabinoside6-Thioguanine

cytosine arabinosideara-cara-cCara

6-Thioguanine

remissionconsolidationMedication

maintenance

remissionbone marrow transplantation

leukaemiavery aggressiveMaintenance

FAB classificationclinical pathology

FAB classification of acute lymphoblastic leukaemiaL1, L2,

L3

L1

L2

L3complication

PrognosisL3

acute myeloidacute myeloblastic leukaemiamyeloblastsacute lymphoblasticmyeloblast

7/21/2019 blood(2)

48/153

bone marrowacute myeloid

predominant cellmyelobalsts

M0Undifferentiated

M1myeloblastsMaturation

M3promyelocyticDIC

megakaryocyticbone marrow fibrosis

M5monocytichypertrphygum

calssificationacute myeloidM0

immunological classification

antigensMyeloid leukaemiaantigen

CDcluster differentiationantigen

CDleukaemias

Immune classificationcluster of differentiationantigen

Malignant cellsacute myeloid

chronic myeloid leukaemia

male middle age massive splenomegaly

malemiddle agemassive splenomegaly

myeloid

chronic myeloid leukaemialymphocyticLymphnode

spleen

spleenproliferationWBCschronic myeloid

leukaemiabone marrow failurelate

leukaemia

spleenbone marrow failure late

WBCsMature

plateletsleukaemiachronic

7/21/2019 blood(2)

49/153

myeloid leukaemiaspleen

spleen

obesespleen

anaemiabone marrow failurethrombocytopenia

WBCsmatureInfectionanaemia

accidently discoveredmalespleen

blood pictures

function of neutrophils and plateletsInfectionbleeding

huge spleenblast crisis

chronic myeloidacute

myeloidLeukaemia

chronic myeloidblast crisis

acute myeloid leukaemia

bone marrowblasts

blast crisis

chronic myeloidchronic myeloid

myeloid line

36myeloid linemyeloblastpromyelocyte

myelocytemetamyelocyteneutrophils

acute myeloid leukaemiablastsbone

marrow

chronic myeloidblastsbone marrowpromyelocyte

Myelocytebone marrow

spleenMyelocytepromyelocyteperipheral blood

mature neutrophils

platelets

bone marrow failure

suddenlybone marrowmyeloblastmyeloblast

plateletsRBCs

chronic myeloid leukaemiablast crisis

blast crisisaccelerated phase

7/21/2019 blood(2)

50/153

accelerated phasebone marrowInfiltrated

anaemicthrombocytopenic

blast crisis

blast crisisacute myeloid leukaemia

blood pictures

Total leucocytic count25,000100,000

chronic myeloid leukaemiaWBCs

acute leukaemia

acute leukaemia100,000

chronic

It is mainly of myeloid series, in the form of myelocytes ,

promyelocytes

Mature neutrophils

Myeloblasts

Myeloblastblast crisis

Basophilia and eosinophilia

leukaemia

investigations

uric acidhyper urcaemia

Philadelphia (ph) chromosomebone marrow

chromosomes9 and 22Philadelphia chromosome

Philadelphia

Philadelphia chromosomeproliferating

programmed cell deathrapidly dividing cellsbone

marrowGIT

tonguedesquamation

folic acid and B12GITBone marrow

Philadelphiachromosome

7/21/2019 blood(2)

51/153

WBCsmalignant

bone marrowleukaemiabone marrow

infiltration

leukaemiaWBCs

blast crisis

chronic myeloid

blast crisis

chronic myeloidRBCsplateletsneutrophils

mature

behavior

Leucocytic alkaline phosphatase is low

chronic myeloid leukaemia

WBCs

tissue infiltrationleucostasisblood vessel

HydroxyureaMyelosupressiveWBCs

200,000 or 300,00020,00015,000

Leukaemia

interferons

Radiotherapyspleen

leucopharesismalignant

hydroxyureaMyelosupressive

leukaemia

Imatinib

Interferonimatinib

hydroxyureaHydra

imatinib

blast crisisacute myeloid leukaemia

7/21/2019 blood(2)

52/153

Imatinibblast crisis

chronic myeloidspleenWBCs

proliferationplateletshaemoglobinbone

marrowfailure

WBCsfunctioning

spleen

WBCshydroxyurea

blast crisis

chronic myeloid leukaemiaImatinib

chronic lymphocytic leukaemia

LeukaeimalymphocyteproliferationLymphoid tissueliver, spleen

and lymph nodes

bone marrow failureLate

chronic myeloidleukaemiahydroxyurea

spleen

blast crisis

chronic lymphocyticlymphocyteantibody

Liable to infection

Lymphocytesauto antibodyRBCs

Infection

blast crisis

character

cell of originB-lymphocytesInfiltrationLiver , spleen

7/21/2019 blood(2)

53/153

immunoglobulinsInfection

abnormal immune reactionauto immune hemolytic

problem

maleliver , spleen and lymph node

Persistent lymphocytosisinfection

MRSA

stages

Stage Alymph nodeLymphocytes

Stage B

Stage Cbone marrow failure

Investigations

diagnosissustained absolute lymphocytosis

feverchest infection

antibiotic

investigationfeverishCBC

CBCLymphocytosis

viral infection

antipyreticinfection

virallymphocytosis

viralviralbacterial

antipyreticantibioticviral

lymphocytosis

chronic lymphocytic leukaemia

bone marrow failure

plateletsRBCsInfectionviral

bacterial infection

7/21/2019 blood(2)

54/153

investigations

Coomb's test

leukaemiaauto immune hemolytic

infectionantibiotic

bone marrow failure

Stage Cbone marrow failurePrednisolone

chemotherapyMore aggressive cases

cytoctoxic

Cchronic leukaemiachronicCChlorambucil

cyclophosphamide

episode

chronic myeloidleucocytesmyeloid

myelosuppressivehydroxyurea

chronic lymphocyticCchronicCChlorambucil

cyclophosphamide

Lymph nodes

auto immune hemolyticcortisone

Rituximab

Rituximabmonoclonal antibody70-80

chemotherapy

hairy cell leukaemia

leukaemiaMCQ

chronic lymphocyticbone marrow fibrosisleukaemiasplenomegalyerythema nodosum

7/21/2019 blood(2)

55/153

Bone marrow fibrosisWBCscytoplasmic projection

Interferon therapy

leukaemiainterferonChronic myeloid leukaemia

Interferon

Imatinib

Hairy cell leukaemiaviral retrovirus

interferondry tap

dry tapdry tapneedlebone

marrowbone marrow

Myelofibrosis

LeukaemiaHairy cell leukaemia

interferon

neutropenia and agranulocytosis

neutropeniaagranulocytosis

WBCsneutrophilsRBCs

normalplateletsNormalaplastic anaemia

viral infectionhypersplenismbone marrow

aplasiabone marrow aplasianeutrophils

hypersplenismneutrophils

HypersplensimMono cytopenia

HypersplenismPanmono cytopenia

Neutropeniathrombocytopenia

drugphenylbutazoneantithyroid

choloramphincol

clinical pictures

sore thorat

sore thoratulcersPus

dead polymorph

7/21/2019 blood(2)

56/153

PolymorphPus

Minimal signs of inflammationInflammationorgansim

neutrophils

.thorat ulcers

Hyperemiasigns of inflammationMinimalscanty pus

blood picture

neutrophilsPlateletsnormalRBCsNormal

bone marrow examination

antibiotic

blood disease presented with sore thorat and fever

acute leukaemiaacute

leukaemiablastsanaemiathrombocytopenia

blastsbone marrowPeripheral blood

anaemiathrombocytopenia

blood disease

agranulocytosis

neutropeniaplateletsRBCsNormal

aplastic anaemia

Pancytopenia

NeutropeniaRBCsplatelets

agranuloctyosis and aplastic anaemia

scanty pus and minimal signs of inflammation

thorat ulcers

throat ulcersminimal signs of inflammationscanty pus

Myeloproliferative disorders

myeloproliferativemyeloproliferative

7/21/2019 blood(2)

57/153

LeukaemiaproliferationWBCsplatelets

RBCs

Proliferationpanhyper cellularity of bone marrow

bone marrowhyper cellular

WBCsRBCsplateletsfibroblastHyper cellular

dominant

RBCsdominantpolycythaemia rubra vera

WBCsdominantchronic myeloid

plateletsdominantessential thromobocythemia

polycythemia rubra vera

polycythima rubra veraPan hyper cellularitybonemarrow

Hyper cellular

dominantRBCs

MCQpolycythima rubra veraRBCs

plateletsWBCs

RBCs

plethora

HyperviscosityRBCs

WBCsInvadetissue

Hyper viscositydizziness , vertigo

Hyper tensionHyperviscosity syndrome

spleensplenomegaly

retinaengorged veinsfundus examination

itching

Criteria

RBCsred cell massRBCspacked cell

volume

red cell mass

RBCsRed cell mass

haematocritRBCs mass

labled

7/21/2019 blood(2)

58/153

dilution

degree of dilutionRBCs

More accurateHaematocrit

haematocritvolume of RBCstotal blood volume

Red cell massRBCs mass

RBCsblood volume

haematocrit value

Red cell massMore accurate

secondary polythaemia

hypoxia

RBCsHypoxiaRBCschest

diseasesecondary to hypoxia

splenomegaly

Platelets

criteriaB1platelets400,000B2total leucocytic count

12,000

B3High leucocytic alkaline phosphataseWBCsmalignant

B4serum B12

Blood pictureRBCs

Bone marrowRBCsdominant

erythropoietin levelLowRBCserythropoietin

B12B12chronic myeloid

WBCschronic myeloidpolycythaemia rubra veraWBCs

transcoblamine

B12chronic myeloid

polycythemia rubra vera

7/21/2019 blood(2)

59/153

7/21/2019 blood(2)

60/153

fibroblastbone marrowbone marrowfibrous tissue

fibrous tissuemegakaryocyte

megakaryocytesMalignantmalignant megakaryocytesbone

marrowfibroblastgrowth factor

fibroblast

bone marrowfibrous tissue

anaemiaspleenextramedullary haematopoiesis

extra medullary haematopoiesisbone marrow

fibrosisbone marrow

stem cellsfibroblastfibrosisstem

cellsbone marrowspleenspleen

erythropoiesis

spleenRBCsextra medullary haematopoiesisthalassaemia

anaemiasplenomegaly

WBCschronic myeloid

leukaemiaanaemiahuge spleenleucocytosis

differential diagnosishuge spleen

chronic myeloid leukaemiachronic myeloid leukaemia

blood picturesbone marrow

writtenHuge spleen

on examinationspleen crossing the umbilicusHuge

myelofibrosisTear drop cellsdry

tap

chronic malariablood filmtropical

splenomegalytropical splenomegaly

syndrome

differential diagnosis

ParasiteKala azarleishmaniesisvisceral leishmaniesis

7/21/2019 blood(2)

61/153

specific drug for leishmania

amyloidosis spleen

nonhodgkin lymphoma

myelofibrosisleucoerythroblastic features

investigationbone marrowfibrous tissueprecursor

dry taptrephine from iliac crest

Tear drop cellsInvestigation

supportive

chapterHydroxyureahydra

splenoectomyspleenRBCshypersplenism

RBCs

bone marrow transplantation

Essential thrombocytosis

Platelets600,000

sustained

thrombocytosis

PlateletsPhase reactantrheumatic fever , rheumatoid

Thrombocytosis

essential thrombocytosissustained thrombocytosis

hydrahydroxyurea

7/21/2019 blood(2)

62/153

thrombocytosisreactive thrombocytosis

splenectomyspleenRBCs

spleen

bleedinghemolysischronic inflammationrheumatoid

plasma cell disorder (Gammopathies)

plasma cell disorder

plasma cell

plasma cellWaldenstrom's

Waldenstrom'splasma cellIg M

Ig MWaldenstrom's

plasma cellMalignantbone marrowIg G or Ig E or IgD

multiple myeloma

Multiple myelomapresentationmultiple myelomaIg G

multiple myelomaIg A

multiple myeloma

Waldenstrom'smono clonal hyper gamma globulinemia

multiple myelomaMono clonalWaldenstrom'smono clonal

7/21/2019 blood(2)

63/153

Multiple myelomaold male bony achesESR

bone painplasma cells

cytokinescytokinesstimulateosteoclastosteoporosis

verteberal collapse

vertebral collapsespinal cord compression

Para plegia

multiple myelomaneuro

Plasma cellblastsbone marrowbone marrow failure

anaemiathrombocytopenia

kidney

multiple myelomakidney

kidneymultiple myeloma

Haematological diseasediseasesrenalmultiple

myeloma

Leukaemia , lymphomatumor

lysis syndrome

cytotoxic drugsleukaemia , lymphomalysismalignant cells

multiple myelomaamyloid

light chain

light chainplasma cellMalignantbone marrowGamma

globulinslight chain

antibodytubulesvery toxictubules

contrast

LiablenephropathydiabeticMultiple myeloma

light chainreactioncontrast media

multiple myelomaLiable to contrast nephropathy

infection

bleeding tendency

7/21/2019 blood(2)

64/153

Plasma cellsbone marrowanaemia

thrombocytopeniaacute leukaemiaNo liver , no

splenomegaly and no lymph nodes

chronic lymphocyticliver , spleen and lymph nodes

Multiple myelomaLiverspleenlymph nodes

ESRplasma proteins electrophoresis showing monoclonal

bone marrowdiagnosticplsma cells

alkaline phosphataseosteoblast

osteoclastalkaline phosphataseNormal

light chainlight chainantibody

Light chainheavy chainfree light chain

Bence Jones proteins

Bence Jones proteinscan not be detected by deep stick

albumin

Bence Jones proteinsdetectionBence Jones proteinsspecific

80

clinical pathology

plasma protein electrophoresis

Normalalbuminalpha 1alpha 2Betagamma

abnormality

Gamma

gamma fraction

curvegamma

polyclonalmonoclonal

gamma globulinpoly clonal

gamma globulinmonoclonal

7/21/2019 blood(2)

65/153

curvecurve

myeloma Staging

supportive

pneumococcal vaccineAllopurinolgamma globulin

hypercalcemiaosteoclast

osteoclast inhibitorBisphosphonates

Malignant hyper calcemia

hyper calcemiamalignancyBisphosphonates

specific therapyVADvincristine , adriamycin and

dexamethasone

Thalidomide

Thalidomidethe most recent specific treatment for multiple myeloma

MCQlast minute of MRCP

Waldenstrom's macroglobulinemia

Ig M secreting tumor

Ig Mlarge molecular weight

Hyperviscosityslow in circulationcyanosisfingershyper

viscosity syndrome

hepatosplenomegaly and lymphadenopathymultiple myeloma

renal disease is not common

Lesionhypercalcemia

IgM

hyperviscosity syndrome

7/21/2019 blood(2)

66/153

K8 revision

lymphomas

LymphomaLeukaemiaLeukaemiatumorbone

marrowWBCsInfiltrationliverspleenLymph nodes

leukaemiabone marrow

InfiltrationleucocytesLiver , spleen and lymph nodes

lymphoma

Lymphoid tissue

malignant cellsPeripheral blood

malignant cellsPeripheral blood

Malignant cellsLymphoid tissue

malignant cellsLymphomaInvadebone marrowinvade

bone marrow

LymphomaHodgkin's lymphoma (HL)

lymphomawritten

lympho adenopathy

causes of lymph adenopathy

generalized lymphadenopathy

liver , spleen and lymph nodes

LeukaemiaHIVsarcoidosisBurcellaInfectious mononucleosis

Hodgkin's lymphomaReed-sternberg cells

nucleustwo kidneys

epidemiology

peak

Hodgkin's

lymphomaHodgkin's

no relation to Epstein Barr virus

clinical pictures

painless rubbery lymphadenopathy

7/21/2019 blood(2)

67/153

rubberyconsistencylymph nodeslymphoma

rubbery

Liver , spleen and lymph nodesextra nodal affection is minimal

fever and night sweat

lymphadenopathyT.B.

Lymphadenopathy

Lymphoma

leukaemia

infectious mononucleosis

Brucella

clinincal stages of Hodgkin's lymphoma

Stage 1one group of lymph node

Stage 2two groupslymph nodesidediaphragm

abovebelow the diaphragm

stage 3lymph nodesboth sides of the diaphragmabove and below

stage 4diffuse

lymphomastage A, B

Stage Asystemic

Stage Bsystemicsystemic symptomsfever

investigation

full blood countCBCcompletely normal

eosinophilia

eosinophiliaeosinophilia

ESRHigh

kidneyLymphomahyper urecaemiaLeukaemia

kidney

7/21/2019 blood(2)

68/153

definitive lymph node biopsy

management

radiotherapyStage 1,2Lymph nodespressure symptoms

chemotherapyStage 3,4

chemotherapyMOPP

recently ABVD(Adriamycin , bleomycin , vinblastine , Decarbazine )

recentEEACOPP therapyBelomycin, Etoposide ,

Adriamycin, cyclophosphamide , vincristine, procarbazine and prednisone

Non Hodgkin's lymphoma

mediastinal lymph node enlargement

mediastinal lymph node enlargement

sarcoidosislymphomaNon-Hodgkin's

T.B.

aetiologyrelationEpstein-Barr virus

infectious mononucleosisLong

runNon Hodgkin's lymphoma

Burkitt's lymphoma

Non Hodgkin'sHelicobacter pylori

Lymphoid tissueIntestine

Lymphoid tissueMALT

MALTMALT lymphoma

mucosal associated lymphoid tissue

Helicobacter pylorihelicobacterpeptic ulcer

incriminated in coronary heart diseaseIncreminatedlymphoma

pathogenesis

7/21/2019 blood(2)

69/153

classification

low grade, intermediate grade and high grade

clinical features

Hodgkin'sLiver , spleen and lymph nodestoxemia

fever

weight loss

systemic manifestations

extra nodal manifestations

Hodgkin'sNon-Hodgkin's

investigationsLymph node biopsy

Investigations

Hodgkin'sLymphomahyper calcemia

Lymphomainvestigationshyper urecemiahyper calcemia

Low grade Non-Hodgkin's lymphomaradio therapy

chemotherapyRituximabmonoclonal antibody therapy

high grade Non-Hodgkin's lymphomaCHOPR-CHOP

CHOP(Cyclophophamide, Doxorubicin, vincristin and

prednisolone )

R-CHOP)R, means Rituximab

Haemolytic anaemias

RBC life span120

Moderatesever

moderatelife span of RBCs

severlife span of RBCs

pathophysiology

RBCsbilirubinbilirubinindirect

7/21/2019 blood(2)

70/153

LiverUptake

RBCsLiverhealthyuptake

jaundice

Liver uptake8

Hemolysisjaundice

RBCsanaemicbone

marrow replication

replicationanaemiasever

Haemolytic anaemiahemolysisjaundice

anaemia

compensated hemolytic anaemia

RBCsRBCsbloodfree haemoglobin

free haemoglobinhaemoglobinemia

haptoglobinHemopexin

haptoglobinhemopexin

plasma proteingammabeta

globulinalphaBeta

alpha and Beta globulinscarriertransferrin

thyroxin binding globulins

globulinsLiver

Gamma globulinsLiver

haptoglobinshemopexinshaemoglobin

reticuloendothelial system

HaptoglobinHemopexinconsumedRBCsfree

haemoglobinshaemoglobinuria

general features of haemolytic anaemia

features of anaemiapallor

pallorfatiguedizzinessPalpitation

features of haemolytic jaundice

jaundicedjaundicejaundiceIndirect

bilirubin

Indirect bilirubinAcholuric jaundice

7/21/2019 blood(2)

71/153

Liver ,spleenhaemolytic anaemia

spleensite of RBCs destruction

extra medullary haematopoiesis

spleen , liverRBCs

thalassaemia major particularymyelofibrosis

thalassaemia majorbone marrow

bone marrow

Liver and spleenhaematopoesis

myelofibrosisbone marrowbone marrowfibrous

tissue

leg ulcershaemolytic anaemiaIron overload

Ironskinskin ulcers

skin ulcerssuggesthemolysissickle cell anaemia

gall stonespigment stones

Hemolytic anaemiapigment stonesspherocytosis

thalassaemia7spherocytosis

10RBCsspherocytosispigment

pigment loadgall bladderpigment stones

MCQ

hemolytic anaemiagall stonesspherocytosis

problem

jaundicedjaundicehemolysisIron

overloadliverhemosidrosis

viral hepatitisgall stone pigmentedintra hepatic biliary

dilatationstonecommon bile duct

viral hepatitisviral markerpositive

jaundice

hemolytic crisis

Hemolysishemolysisfeverrigorpallor

jaundice

bone achesbone marrowHyper activehemolytic crisis

7/21/2019 blood(2)

72/153

aplastic crisis

HemolysisRBCsblood

bone marrowHyper activebone marrowHyper active

bone marrowhyper activevitaminsB12folic acid

B12stores

folic acidstores

folic acid deficiency

folic acid

hemolytic anaemiafolic acidB12

iron supplementiron overload

RBCshaemoglobinhaptoglobinhemopexinhaemoglobinreticuloendothelial systemOrgans

Iron overloadIron overload

bone marrowfolic acid

virusparvovirus

parvovirus

erythemaface

slapped faceparvovirusbone marrowbone marrow3

RBCs

RBCsperipheral blood3

bone marrowRBCs

Haemolytic anaemia

haemolytic anaemiaseverRBCsLife span20

bone marrowRBCsbone marrow

hemolysiswhat is calledaplastic crisis

anaemiabone marrowcompensate

hemolytic crisispallorhaemolytic crisis

jaundice

aplastic crisisjaundice

blood picturesbone marrow hyper

activereticulocytosis

aplastic crisisnerver , everreticulocytosis

7/21/2019 blood(2)

73/153

megaloblastic crisis

folic acid

vaso-occlusive crisissickle cell anaemia

investigatios

blood pictureshaemolytic anaemiaNormochromic normocytic

anaemia

microcytic hypochromicthalassaemia

macrocyticmegaloblasticfolic acid deficiency

Hemolysis

megalobastic anaemiaintra medullary

hemolysisHemolysis

B12 deficiencyanaemicMegaloblasticbilirubin

manifestedhemolysiscirsis

thalassaemiaG6PD

leucocytosis , thrombocytosishemolysisbone

marrow emeregency

hemolysishemorrhageleucocytosis

thrombocytosis

Brisk reticulocytosisreticulocytosis

hemolysishyper active bone marrowhemolysis

reticulocytosishemorrhagehemolysis

impressedreticulocytosishemolysishyper

active bone marrowhemolysishyper active bone marrow

hemorrhage

bone marrowhaemolytic anaemiahyper active

7/21/2019 blood(2)

74/153

bone marrow hyper activenormoblast

bone marrowmegaloblastfolic acid

bone marrow aplasia

MCQ

bone marrow examination of valueHemolytic anaemia

hyper plasiaNormoblastMegaloblastfolic acid

hemolysisbone marrow

haptoglobinhaemopexinconsumed

bilirubin

Evidence of intravascular haemolysis

exampleintravascular hemolysisG6PD

intravascular hemolysis

RBCshaemoglobinRBCs

haemoglobinemiafree haemoglobin in peripheral blood

haemoglobinperipheral blood

haemoglobinuria

kidney tubules

Uptakehaemoglobin molecules

iron

ironkidney tubules

ironIrritantkidney tubules

kidney tubulesIronhaemosiderinurin

free haemoglobinkidney tubules

Uptakehaemoglobinhaemoglobintubules

Ironironkidney tubuleshaemosiderin

haemosiderinirritatekidney tubuleskidney tubules

haemosiderinUrinehaemosidernuria

rupture of RBCshaemoglobinaemiahaemoglobinuria

kidney tubuleshaemoglobinHaemosiderin

Kidney tubuleHaemosiderinuria

Haemosiderinuriaintravascular hemolysis

7/21/2019 blood(2)

75/153

Haemosiderinuriairon overloadhaemosidrosis

haemosiderinuriaintravascular hemolysis

haptoglobinhaemopexinconsumed

causes of haemolytic anaemia

Intrinsic and extrinsic

intrinsicRBCscorpuscular membrane

defectspherocytosis

defect in haemoglobin

extrinsicRBCsRBCsauto immune

mechanical hemolysis

sites of haemolysis

site of haemolysisextra vascularreticuloendothelial system

spleen

thalassaemiaspherocytosis

intravascularRBCsBlood streamG6PDmechanical

haemolysis

hereditary spherocytosis

problemwritten

membrane defect

membrane defectspectrin

spectrinRBCs wallpermeableRBCs

spherocyte

wallRBCs

RBCs

Spleenspleen

7/21/2019 blood(2)

76/153

spleenRBCs

RBCsATPNa pump120120ATPNa pump

RBCsspherical shapetrabeculispleen

phagocytic cells

RBCsbiconcave shape

RBCsextracellular

main gateselectron microscope

ptnspectrinneutral ptn

(+ve)insoluble ptn

RBCs

small gatesamino acidsglucoseMain gates

RBCSs

Na pumpactive pumpATP

Na pumpATPRBCs

RBCs

7/21/2019 blood(2)

77/153

spherocytosis

gene defectspectrin ptncharge+ve

main gates

RBCs

main gatesside gatesNa pump

ATP

Na pumpRBCs

spherical in shapespleenphagocytic cells

hemolysis so early.

blood

normal haemoglobinoxygenRBCs

RBCsspleen

bone marrowbone marrowproliferating

proliferation

spleen

thalassaemiaRBCs

bone marrow

bone marrow

spherocytosisbone marrowRBCsRBCs spherocyte

haemoglobin

spleen

mildconservativeseverspleen

7/21/2019 blood(2)

78/153

hereditary spherocytosisfeatures of anaemiaspleen

jaundiceanaemiahaemolyticjaundice

splenomegaly

family history positiveautosomal dominant

gall stones

Because the bone marrow capacity to increase erythropoiesis (6 to 8 folds

) exceeds the usual rate of haemolysis in the disease, anaemia is usually mild or

moderate and may even be absent

RBCspigment

spleen

thalassaemia

thalassaemiaspherocytosis

investigations

anaemic

spherocytosisblood filmspherocyte

RBCsbiconcave shape

RBCsspherocyte

shperocytemicro spheroctyeRBCs

normalRBCsmean

corpuscular haemoglobin concentration high

mean corpuscular haemoglobin concentration high

Hyper chromic

mean corpuscular volumemean corpuscular haemoglobin concentration

normalnormalvolume

relativelyconcentrated

osmotic fragility

serial diluationsaline

normal saline0.9

0.90.1

normally RBCs0.4

0.4RBCsdilution0.4

RBCsmembranefragile

7/21/2019 blood(2)

79/153

dilution0.7haemolysis

Increased fragilityfragility

RBCs

spleentest

10chromiumchromium

RBCs

RBCschromiumspleenspleen

spleenGamma camera

spleen

RBCs

testPositivespherocytosisPositiveHyper splenism

hyper splenismportal hyper tension

Hyper splenism

Pan cytopenia

RBCsspleenchromium RBCs

chromium

splenectomyblood transfusionsplenectomyfinal

not respondfamily history

spleenspleenliable

pneumococcal and meningococcal infectionpneumococcal vaccine

meningeococcal vaccine

recurrencespleens

spleensplenic tissue

implantationabdominal wall

spleens

recurrencedisease

problem

spherocytosis

pallorjaundicesplenomegalypalloranaemiajaundice

7/21/2019 blood(2)

80/153

and splenomegalyhaemolytic

Positvie family historyhaemolytic anaemiapositive family

history

splenectomy

spleenfeverneck rigidity

meningitis

spherocytosismeningitisMeningitis

original condition

spleenLiable

meningeococcal vaccinepneumococcal vaccine

Pneumonia

Hereditary elliptocytosis

spherocytosismild

hereditary stomatocytosis

Auto immune haemolytic anaemia (AIHA)

haemolytic anaemiaadult

auto immunestory

45jaundicedhistory and examinationjaundice and pallor

bilirubinHaemoglobinbilirubin

haemolysisBrisk reticulocytosis

anaemicjaundicereticulocytosisHaemolytic anaemia

45454025

haemolytic anaemia

testcoomb's test

haemoglobin electrophoresisacquired

coomb's testpositiveIndicateAuto immune haemolytic anaemia

coomb's testPositivenegative

antibodycoldwarm

cold antibodyIg M

warm antibodyIg G

for exampleantibodyRBCS

7/21/2019 blood(2)

81/153

antibodyRBCS

lupusauto immune haemolytic anaemia

chronic lymphocytic leukaemia

definite diagnosis

auto immune haemolytic anaemiaauto

immune haemolytic anaemia due to wtdue to lupusdue to leukaemia

definite diagnosis

thalassaemiadiagnosissickle celldiagnosis

shperocytosisdiagnosis

auto immune haemolytic anaemiapresentationindicates underlying disease

auto immune haemolytic anaemiaauto immune haemolytic anaemiawarm antibodywarm

antibodyantibodyantibodypositive in vitro

invitroactive37warm

auto immune haemolytic anaemiawarm antibody

Lleukaemia , lymphoma

lupus

alpha methyl dopa

manifestations of haemolytic anaemiajaundicePalloranaemiaspleen

Palpable

Investigations

coomb's testantibodyIg G

bloodspheroctye

Ig GRBCsspherocytesIg GRBCs

spherocyte

acquired spherocytosis

spherocytosisLupusauto immune

Leukaemiaacquired

spherocytosislupusLeukaemiaacquired

Evan's syndromeantibodyplatelets

ProblemproblemEvan's syndrome

Investigationscauseinvestigationscoomb's testIg G

7/21/2019 blood(2)

82/153

warmLupusLeukaemiaLupus marker

cortisone

splenectomyspherocytosis

spleenspleenextravascularblood stream

auto immune haemolytic anaemia

cold antibodyantibodycoldactive37in vitrocold

viral infectioninfectious mononucleosis

Infectious mononucleosis

sore thoratjaundicejaundice

auto immune haemolytic anaemiaEpstein Barr virus

hepatitis

coomb's testtransaminases

fever and sore thoratInfectious

mononucleosis

jaundicejaundiceauto immune haemolytic

coomb's testpositive

Epstein Barr virusviral hepatitis

anti bodyIg M

warm antibodyIg G

cold anti bodyIg M

Ig MM

MCQ

steroid

7/21/2019 blood(2)

83/153

cold antibodyintravascularextravascular

paroxysmal cold haemoglobinuria

haemolysismeaselesmumpschicken pox

coomb's testcoomb's testtest to detect

anti bodyRBCs

direct coomb's testdetect anti bodyRBCsRBCs

auto immuneanti

bodyRBCsRBCs

direct coomb's testdetect antibody coatingRBCs

RBCshuman serum

in direct coomb's test

RBCsPlasmaantibody

anti bodyRBCsRBCs

anti bodyRBCsRBCsplasma

coomb's testdirectindirect

Drugs causing haemolysis

alpha methyl dopa

Haptenpenicillinscephalosporinsincomplete antigen

RBCsRBCs..complete antigen

Quinidine type

7/21/2019 blood(2)

84/153

innocent by standerinnocent by stander

sulphasulpha

albuminsulphaalbuminantigenantibody

complementsulphasulpha

albuminantigenantigenantibody

complementcirculation

RBCs

Innocentby stander

antigenantibodycomplementcomplex

RBCs

complex

mechanism

antibodyRBCsalbumin

triggerImmune system

HaemolysisG6PD

antimalarial

drugs causing jaundice

hepatotoxic drugsliver cell failurecholestasis

haemolysisfungal

alpha methyl dopaHapten mechanismsulpha

innocent by stander

mechanical haemolysis

RBCsmechanically

haemolysissole

capillariesRBCssole

prolonged marching

7/21/2019 blood(2)

85/153

prosthetic valve

problem

double mitralvalve

replacementendocarditishaemolytic anaemia

mechanically

calcified aortic valveHaemolysis

Micro-angio-pathic haemolytic anaemia

micro-angio-pathic haemolytic anaemiamicroangioblood

vesselpathicdisease

blood vesselfibrin thrombus

fibrin thrombus

fibrin thrombus

RBCs

fibrin thrombus

mechanical haemolysis

fibrin thrombusDIC

haemolytic uraemic syndromeTTPthrombotic thrombocytopenic

purpurasclerodermascelrodermafibrous tissue

collagen depositionwallblood vesselsmalignant hypertension

MCQRBCsshistocytes

fragmented RBCshelmet

DIChaemolysisjaundice

Shistocytesshistocytes

blood film

toxic causes of haemolysis

malariaclostridiumsnake venom

7/21/2019 blood(2)

86/153

paroxysmal nocturnal haemglobinuria (PNH)

RBCs

acquired defectstem cellstem cellsmother cellsstem

cells

RBCsabnormalplateletsabnormalWBCsabnormal

abnormality in RBCsRBCsSpecific proteincell membrane

glycosoyl phosphatidyl inositol (GPI)

RBCsRBCs

(GPI)complement

Infection

complementPHbloodacidic side

stagnation of circulation

CO2 retentioncirculationPH

low PH

excitecomplement

complementRBCs

(GPI)complementRBCs

RBCs

complementRBCs

complementno antibody

Infection

plateletsaggregation

7/21/2019 blood(2)

87/153

WBCs

haemolysisrecurrent vascular occlusionInfection

sickle cell

haemolysisvascular occlusionInfection

sickle cellInfectionauto splenectomyspleen

Venous thrombotic episodes

hepatic veins

Budd chiari syndrome

problem

anaemicInfectionvascular occlusion

Budd chiari

Investigations

testHam's test (old test )

acidic media

flow cytometry

leukopeniathrombocytopenia

haemolytic anaemiaacquired

virus

stem cells

it may lead to aplastic anaemia

haemolytic anaemiaaplastic anemia

bone marrow aplasiahaemolytic anaemia

parvo virustransient

haemolytic anemiaaplastic anaemiaparoxysmal

7/21/2019 blood(2)

88/153

nocturnal haemoglobinuria

Investigation

coomb's testnegative

Intravascular

G6PD

steroid

Thalassaemia

Thalass

aemia

Beta thalassaemia

homozygous (Thalassaemia major )

heterozygous ( Thalassaemia minor) i.e. trait

thalassaemia minormild anaemiamicrocytic

hypochromic

iron deficiency anaemia

splenomegalyF

hypochromic microcyticiron

Ironironthalassaemia minorIron deficiencyresistance

haemoglobin electrophoresis

femaleIron deficiency

commonest cause of anaemia

iron

electrophoresisthalassaemia minor

diagnosis of thalassaemia minorfamily consuling

7/21/2019 blood(2)

89/153

thalassaemia minorthalassaemia minor

writtenthalassaemia minorthalassaemia major

thalassaemia minordifferential diagnosis

iron deficiencysidroblastic anaemia

thalassaemia minorclinicallysidroblasticiron deficiency

splenomegaly

Investigationselectrophoresis

thalassaemia minorMinor

10

thalassaemia minor

thalassaemia minorthalassaemia majorRBCs

thalassaemia intermedia

it includes patients who are symptomatic with moderate anaemia

710

it is more sever than thalassaemia trait

thalassaemia traitthalassaemia minor

thalassaemia intermediamilder than thalassaemia major

minormajorthalassaemia

intermedia

age of presentationlater in agelate childhood

15thalassaemiathalassaemia

minorthalassaemia majormajor

Presentedthalassaemia majorPresentedearly childhood

thalassaemia major

anaemiairon over load

sidroblastic anaemiaIronIron

protoporphyrinirondeposition

thalassaemia majoraplastic anaemia

7/21/2019 blood(2)

90/153

anaemia with iron over load

anaemias

tissue ironserum ferrittin

transferrin saturation

haemoglobinalphabeta chain

alphagamma

switchgammabeta

Normal haemoglobinalphabeta

alphagamma

gammaswitchbetaalphagammaswitch

beta

haemoglobin Falphagammafetal

haemoglobin

haemoglobin F

thalassaemia

Beta chain

alpha chainbeta chain

alphabetagamma

alphagammahaemoglobin F

alpha chaingammagamma

alpha chain

free alpha chain

free alpha chainRBCsbone marrow

haemoglobin FHaemoglobin Falpha chainsgamma

alpha chains

Beta chain

beta

free alpha chainlife span of RBCs

RBCsspleenHaemolysisspleen

spherocytosis

bone marrowHyperactivehaemolytic

RBCsFree alpha chain

7/21/2019 blood(2)

91/153

Free alpha chainbone marrow

bone marrowRBCs

free alpha chain

RBCsfree alpha chain

RBCsbone marrow

RBCsbone marrowperipheral bloodbone

marrowperipheral bloodspleen

free alpha chainchemical

RBCsspleenbone marrowHyper

activespherocytosis

spherocytosisbone marrow

thalassaemiabone marrow

ineffective erythropioesis

thalassaeimaspherocytosis

23

free alpha chainsRBCsspleenbone marrow

thalassaemiabone marrowineffective erythropoiesisbone

marrow

extra medullary haematopioesis

liverspleenRBCs

clinical pictures

6

Pictures of haemolytic anaemia

pallorjaundicesplenomegaly

Mongoloid featuresmongoloid featuresthalassaemiasperocytosis

iron over loadthalassaemia

PalejaundiceIron over loadskin

Iron overloadskinHyper pigmentation

skin

7/21/2019 blood(2)

92/153

by inspectionspherocytosisthalassaemia

color of the skin

Mongoloid features

investigations

anaemia

haemolysisHigh indirect bilirubinreticulocytosis

blood filmtarget cells

haemoglobin electrophoresishaemoglobin F

X-rayskullhair on end appearance

long bonesshowing thin cortex & wide medulla

mean corpuscular volumemicrocytichypochromic

normochomic

high serum ferritiniron over load

featus

biopsyplacentachorionic villus biopsy

thalassaemia

blood transfusion

folic acidbone marrowhyper active

desferal

bone marrow transplantation

spherocytosisspherocytosisbone marrowRBCs

spleenspleenbone marrow

thalassaemiabone marrowbone marrow

transplantation

Indicationsplenectomy

Indication of splenectomyhypersplenismhypersplenism

blood transfusion requirements250packed

RBCs/Kg/year

30bloodtransfusiondosespleenHypersplenism

7/21/2019 blood(2)

93/153

spleenextra medullary haematopoiesis

haemopoesishypersplenismspleendie

bone marrow transplantation

sickle cell anaemia

haemoglobin S

haemoglobin Fadult haemogobin

haemoglobin FOxygen delivery

haemoglobinadult

haemoglobin Sdelivery

hypoxiasickling

sickle cell traitsickle cell anaemia

2 abnormal genessickle cell anaemia

one abnormal geneheterozygoussickle cell trait

sickle cell anaemiaManifestations

sickle cell traithypoxiaanaesthesia

haemoglobin Shaemoglobin AJust one amino acid

glutamicvaline

haemoglobin Soxygen delivery

RBCshaemoglobin Shypoxiasickling

sicklemacro infractiondamagemicro infraction

small blood vesselspainful crises

features of anaemiaHaemolysis

without splenomegaly

spleenhaemolytic anaemia

7/21/2019 blood(2)

94/153

haemolytic anaemia without splenomegaly

sickle cell anaemiaspleenrepeated splenic

infarctionautosplenectomy

G6PDintra vascular haemolysis

spleen

paroxysmal nocturnal haemoglobinuria

complement

auto immune cold

mechanical haemolytic anaemia

intravascular haemolysis

haemoglobinuriahaemosiderinuria

extra vascular

spherocytosisthalassaemiaextra vascular

blood stream

vascular occlusionHigh mortality

DactylitisMesenteric occlusion

infractionnephrogenic diabetes insipidus

sicklinrenal medulla

sicklingRBCsplatelets

blood vesselischaemia

sicklingrenal medullaLess vascularcortex

hyper tonic

renal medullasicklingsicklingrenal

7/21/2019 blood(2)

95/153

medullaischaemiarenal medulla

tubulesrenal medullaloop of Henlecollecting tubules

anti diuretic hormone

Nephrogenic diabetes insipidus

sicklingrenal medullaischaemiaHyper

tonia medulla

ischaemiarenal tubulesmedulla

loop of Henle and collecting tubulesdiabetes insipidus

sickle cell

sickle celldiabetessickle celldiabetessickling

sickle

diabetes insipidusdiabetes mellitus

vascular occlusionchildren

sickle cell anaemia

vasculitisHenoch Schonlein purpura

vasculitisfar eastKawasaki

myocardial infraction

coronary care unit

coronaryKawasakisickle cell

myocardial infraction in child

myocardial infraction

vascular occlusion

retinablind

blood vessel

long term sequalae

7/21/2019 blood(2)

96/153

InfectionHyposplenism

Hyposplenismauto splenectomy

infectionpneumococcisalmonellameningeo

we can summarize the clinical manifestations of sickle cell anaemia

manifestations related to the haemolysis1-

2- manifestations related to the vaso occlusion painful crises and organ failure

3-manifestations related to infections with pneumococci and salmonella

General investigations

haemolysisHigh indirect bilirubinreticulocytosis

haemoglobin electrophoresisHaemoglobin SHigh

sickling test

RBCslideNa bisulphateNa bisulphate

hypoxiaRBCsHypoxiaslidesickling

slide

Positivesickle cell anaemiasickle cell trait

haemoglobin S very highsickle cell

anaemia

haemoglobin Svery highsickle cell trait

sickle cell beta thalassaemia

anaemicHigh level of haemoglobin Ssplenomegaly

problems

sickle cell anaemiaspleen

spleensickle cell Beta thalassaemia

sickle cell anaemiavascular occlusionsickling

sickle cell beta thalassaemiahaemoglobin Shaemoglobin F

7/21/2019 blood(2)

97/153

RBCs

haemoglobin Fsickling

haemoglobin ShypoxiaRBCssickling

haemoglobin SHaemoglobin Fsickling

Haemoglobin Shaemoglobin FRBCs

oxygenhaemoglobin F

haemoglobin ShypoxiasicklingRBCs

haemoglobin Shaemoglobin F

HypoxiasicklingRBCs

Haemoglobin Fhaemoglobin SOxygenhypoxiaoxygen

RBCshaemoglobin Fhaemoglobin S

haemoglobin SHypoxiahaemoglobinoxygen

Hypoxiahaemoglobin Fhaemoglobin Ssickling

sickle beta thalassaemiaLife spansickling

auto splenoectomy

spleen

sickle cell anaemiaspleen

sicklingsplenic veinsplenic veinspleencongested

blood transfusion

sickling crises (pain)

analgesicsNa HCO3Na HCO3

lactic acidosisvascular occlusionischaemiaLactic acidosis

fresh bloodfreshoxygen

7/21/2019 blood(2)

98/153

haemoglobin Shaemoglobin FHaemoglobin F

applied

cytotoxic drugshaemoglobin F

pneumococalinfluenzavaccines

bone marrow transplantation

Haemolytic anaemia

Gluose 6 phosphate dehydrogenase (G6PD) deficiencythalassaemiaspherocytosisG6PDproblemssickle cells

problems

clinical pathologyblood

hexose monophosphate shunt

NADPHH

HglutathionereducedRBCs

RBCsglutathione

glutathionereducedRBCsoxidizing agent

glutathionereducedHNADPH

NADPHhexose monophosphate shunt

shuntG6PD

G6PDhexose monophosphate shuntNADPH

HglutathionereducedRBCs

RBCs

oxidizing agentRBCs

very mild disease

oxidizing agent

chronic haemolysisaggrevatingoxidizing agent

favism

7/21/2019 blood(2)

99/153

favism

favismD6PDabnormal metabolism

beans

oxidizing agent

G6PD deficiencyfavismfavism

two abnormalitiesG6PDoxidizing

clinical presentationssyndromes of G6PD deficiency

1- Acute drug induced haemolysis

antimalarialsulpha

haemolysisIntravascular

no splenomegaly

2- chronic haemolytic anemia3-favism

4-neonatal jaundice

5- infections and acute illness will precipitate haemolysis

favismhaemolysis

haemolysisself limitedself limited

haemolysis

bone marrowhyperactivity

reticulocytosisreticulocytes rich

HaemolysisemergencyHaemolysis

acute12

reticulocytosis

reticulocytesvery richG6PDadult RBCs

Normallyadult RBCsG6PD

reticulocytes

bone marrowreticulocytes

7/21/2019 blood(2)

100/153

assasmentenzymes

enzymedeficientHaemolysis

G6PDadult mature RBCs

attackimmediatelyattackreticulocytosis

G6PD..normal or high

assessment

haemolytic crisesreticulocytosisblood picturesRBCs

matureenzymeMature RBCs

Hienz bodies

Hienz bodies

haemolysisintravascularblood film

Hienz bodies

oxidized haemoglobinRBCs

haemoglobinRBCs

Hienz bodies

Avoidcause

blood transfusion

splenectomy

anaemia

7/21/2019 blood(2)

101/153

reduction below normalbelow what is expected

below what is expectedNormal

normal haemoglobin100100

reduction below what is expected in one of the following parameter

parameterexpectedanaemia

percentageRBCs counthaematocrit

parameter

normalnormal

what is expected

definition

agesex

intrauterinerelatively hypoxic environment

Hypoxiamain stimulant for RBCs formation

relatively hypoxic environment

normalpolycythaemia

19Normal14

18stimulus

hypoxia

189

9

Normal

7/21/2019 blood(2)

102/153

adult14-15

Puberity1515

7215

N.B. reduction of haemoglobin in old age is adisease

15

189915

K9 revision

Haemostasis and bleeding disorders

haemostasisstopping of bleedingprevention of blood loss

bleeding

vasoconstriction

platelet plug

blood vesselvaso spasmblood vessel

blood vesselPlatelet plug

formation of blood clotcoagulationrepairdamaged blood vessel

Haemostasis

coagulation factorsplateletsblood vessel wall

blood vessel wall

plateletscoagulation

platelets

7/21/2019 blood(2)

103/153

150,000400,000

thrombocytopenia150,000significant thrombocytopenia

100,000

Platelets150,000

clinical haemorrhageplatelets

Platelets

10,00020,00010,000

Platelets

10,000cerebral haemorrhage

rate of drop of platelet count is very important

liver cirrhosis

Hyper splenismPlatelets40,000rate of drop of

plateletsvery gradual

thrombocytopeniaplateletsNormal

20,000

platelet count 80,000 to 100,000 is adequate for haemostasis

blood picturesnormal

platelets70,000

anti coagulant

component

anticoagulant

platelets consumption

splenectomyplateletsHypersplenism

HypersplenismLiver cirrhosisportal hypertension

splenectomy

bleeding time

ear lobule

neruse

7/21/2019 blood(2)

104/153

filter paper

filter paper8bleeding time

Platelets

blood clot

blood clotplatelets plug

Ivy's methodDuke's method

bleeding time

quantitive defect in plateletsplatelets

Plateletsnormalthromboastheniaplatelets dysfunction

uraemia

vascular defectvasculitisHenoch Scholein purpura

Platelets functions

thromboastheniaplatelets countNormal

bleeding time prolonged

mostly in plateletsvascular

platelets functions

platelets adhesionplateletswallblood vessel

blood vessel wallPlateletswallblood vesselplatelets adhesion

platelets aggregation

Platelets

adhesionaggregation

aggregationADP

ristocetin

7/21/2019 blood(2)

105/153

platelets aggregationristocetin

test

Hess capillary fragility test

Hess testtest

capillary fragility

Henoch Scholein purpura

systolicdiastolicsystolicdiastolic

capillary pressureforearm

Petichae

testno comment

vasculitis

vasculitisplateletsbleeding time

Normal

Henoch

Scholein purpura

vascular occlusion

blood vesselbleeding time may be

normal

Role of platelets in haemostasis

written5written

haemostasis

clinical pathology

59

blood vessel

traumaexposureblood vessel

endotheliumendotheliumcollagen fibersblood vesselendotheliumcollagen fibers

7/21/2019 blood(2)

106/153

InjuryreleaseVWFVWF

adhesionplatelets

adhesion

VWF diseaseadhesion defect

plateletsadhesionplatelets release

plateletsprostaglandinsADPstimulationplatelets

aggregation

platelets

platelets aggregationplatelets plug

traumavasoconstrictionnervous reflex myogenic contractionrelease of Thromboxyane A2

serotonin

platelets

vasoconstriction

Thromboxyane A2vasoconstriction

enhance platelet aggregation

traumareleasetissue thrombo-plastinenhance

coagulation

coagulationfibrin

platelets adhesionplatelets aggregation

vasoconstriction

coagulation

7/21/2019 blood(2)

107/153

vasoconstrictionplateletscoagulation

sequancesvasoconstrictionPlatelets adhesionplatelets plug

coagulationfibrinplatelets plug

Platelets plug

cement substancefibrincoagulation

platelet releasePlateletsenhancecoagulation

other function of platelets

plateletsfunctiongrowth factors

multiplicationgrowth of fibroblast

blood vessel wallplateletsgrowth factors

collagenwallblood vessel

7/21/2019 blood(2)

108/153

repairwall

vaso constrictionplatelet plugcoagulationblood vessel

collagenplateletsgrowth factors

Process of coagulation

coagulationcoagulation

Intrinsic pathwayextrinsic pathway

extrinsic pathway

coagulationfibrin

extrinsicextrinsictrauama

coagulationtissue thromboplastin

tissue thromboplastinactivationfactor

common pathway

vasoconstrictionplatelet adhesionplatelet plug

tissue thromboplastinfactor 7common pathwayfibrin

platelets

plateletsgrowth factorblood vessel

Intrinsic pathway

Intrinsic

coronary

DVTintrinsic pathway

rough surface

atheromaatherosclerosis

atheromarough surfaceIntrinsic pathway

extrinsic pathwayextrinsicemergency

intrinsicextrinsicProtection

Intrinsic

endotheliumatheroma

7/21/2019 blood(2)

109/153

activationfactor 12

factor 12activationactivationfactor 11factor 11active

activation of factor 9

factor 9activationactive 8common pathway

extrinsicIntrinsiccommon path way

sequances

common pathway

Intrinsicextrinsicfactor 10

factor 10prothrombinthrombinthrombinfibrinogenfibrin

common pathway

fibrinstabilization

factor 13fibrin stabilization factor

extrinsic pathway

tissuetissue thromboplastintissue thromboplastin

7factor

common pathway

Intrinsic pathway

rough surface

factor 12factor 11active factor 119

9factor 8factor 10Intrinsic

extrinsicfactor

factorIntrinsicextrinsiccommon pathway

prothrombinthrombinfibrinogenfibrin

traumaextrinsic pathwayintrinsic

intrinsic pathwaytraumaextrinsicintrinsic

7/21/2019 blood(2)

110/153

coagulation profile

Prothrombin timepartial thromboplastin time PPT

Prothrombin timeextrinsic pathwayPPTIntrinsic pathway

plateletsbleeding time

defectPlateletsplatelets countnormal

bleeding timePlatelets dysfunctiondysfunction

adhesionaggregationplatelets function test

plateletsdefect in coagulat