Hematology hot topics and morphology
Download
1 / 35

HEMATOLOGY Hot Topics and Morphology - PowerPoint PPT Presentation


  • 239 Views
  • Updated On :

HEMATOLOGY Hot Topics and Morphology. BCSLS Telehealth Broadcast June 16, 2005 Kin Cheng [email protected] 76 year old female Previously well Acute back pain and vomiting after mowing the lawn. CASE # 1. Physical (10:00 PM): Afebrile P-108; BP 139/69

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'HEMATOLOGY Hot Topics and Morphology' - Patman


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Hematology hot topics and morphology l.jpg

HEMATOLOGYHot Topics and Morphology

BCSLS Telehealth Broadcast

June 16, 2005

Kin Cheng

[email protected]


Case 1 l.jpg

76 year old female

Previously well

Acute back pain and vomiting after mowing the lawn

CASE # 1


Slide7 l.jpg

Physical (10:00 PM):

  • Afebrile P-108; BP 139/69

  • Alert and oriented but “deathly ill looking”

  • Soft, non-tender abdomen with bowel sounds


Mchc 365 l.jpg
MCHC >365

  • Hematocrit: RBC x MCV

  • MCH = Hgb / RBC

  • MCHC = Hgb / Hct

  • 3 x RBC = Hgb

  • 3 x Hgb = Hct


Mchc 365 handling l.jpg
MCHC >365 Handling

  • Cold agglutinin : Warm sample

  • Lipemic, icteric, hemolysed: Saline replacement

  • Protein: Warm specimen, rerun

  • Spherocytes





Manual differential l.jpg
Manual Differential

  • Neuts: 5.0

  • Lymphs: 2.7

  • Eos: 0.1

  • NRBC: 5 / 100 WBC




Slide22 l.jpg

Intubated at 01:30

Hypotensive post-intubation

ICU bed found at referral centre (04:00)

Arrested in transit (04:30)


Slide23 l.jpg

  • Autopsy:

  • green discoloration of skin with skin slippage and advanced organ autolysis

  • No identifiable source of sepsis


Clostridial gas gangrene l.jpg
Clostridial Gas Gangrene

  • 6/150 species capable of causing gas gangrene

  • Toxin and gas producing bacteria

  • Lethal

  • Necrotize soft tissues

  • Clostridial myonecrosis: Common surgical infection if poor surgical technique


Clostridial gas gangrene25 l.jpg
Clostridial gas gangrene

  • Anerobic, gram pos bacilli (Hematology stain is NOT gram stain)

  • Spore forming bacteria

  • Found in soil, contaminated raw meat and poultry, normal skin, colon flora


Clostridial infection l.jpg
Clostridial infection

  • 80% caused by C. perfringens

  • 20%:

    • C. novyi

    • C. septicum

    • C. bifermentans

    • C. histolyticum

    • C. fallax


Clostridium perfringens welchii l.jpg
Clostridium perfringens (welchii)

  • Produce 12 types of toxins (lecithinase)

  • Extraordinary spectrum of clinical manifestations from transient bacteremia to gas gangrene or sepsis with hemolysis

  • Rate of myonecrosis: 2 cm/hr

  • Fatal within 12 hours.


C perfringens l.jpg
C. perfringens

  • Introduction of bacteria into tissues

  • Bacterial proliferation in low (<30%) oxygen environment

  • Incubation period: 1 – 12 hrs

  • Release exotoxin


C perfringens29 l.jpg
C. perfringens

  • >17 Exotoxins:

    • Lecihinase

    • Collagenase

    • Hyaluronidase

    • Fibrinolysin’hemolysin


C perfringens30 l.jpg
C. perfringens

  • Alpha toxin: lecithinase

    • Destroys red cell membranes, muscle cells, platelets and WBC

    • Induces platelet aggregation and clot formatioin

  • Kappa toxin: destroys connective tissues

  • Theta toxin: Destroys WBC and disarms inflammatory responses.



C perfringens32 l.jpg
C. perfringens

  • Massive intravascular hemolysis

  • Hb-emia, Hb-uria, hyperkalemia

  • Renal failure, coagulopathy

  • Often fully conscious with normal BP

  • Shock and death 70-100% mortality

  • Survival measured in hours


C perfringens33 l.jpg
C. perfringens

  • Elderly and immunocompromized

  • Cancer patients with mucosal disruption

    • Chemotherapy & radiotherapy

    • Tumor infiltration

    • Malnutrition

  • Hepatobilliary disease, liver abscess, colonic perforation, trauma or surgery

  • Septic abortion / ruptured ectopic pregnancy


Case 134 l.jpg
Case # 1

  • Despite absence of effective RBC mass patients transiently maintain normal BP and mentation presumably due to free Hb

    • Maintenance of intravascular oncotic pressure

    • Maintenance of adequate tissue oxygenation



ad