PATHOLOGY OF RED BLOOD

1. VinnytsyaNational Pirogov Memorial Medical University Pathophysiology Department PATHOLOGY OF RED BLOOD PhD.,ViktoriyaPiliponova

2. In norm The number of erythrocytes: • in female - 3,9-4,7·1012/l • in male - 4,5-5,0·1012/l Hemoglobin • in female - 120-140g/l • in male - 140-160g/l • Color index(CI) - 0,85-1,15 • Globular value = 3 x Hb / the first 3 figures of erythrocytes. • Reticulocytes - 0.5-2%, 0,5-2%0

3. Anemia -is a syndrome or disease which is characterized by the decrease of erythrocytes and hemoglobin amount in the unite of blood volume and accompanied by qualitative changes of erythrocyte.

4. Classificationof anemia • I. According to etiology: • Hereditary and acquired • II. According to pathogenesis : • Diserythropoietic • Hemolytic • Posthemorragic

5. IІІ. According to type of hematopoesis: • 1. with erythroblastic • 2. with megaloblastic ІV. According to color index (globular value): • 1. normochromic • 2. hypochromic • 3. hyperchromic

6. Color index(CI) - 0,85-1,15 • Globular value = 3 x Hb (g/l) / the first 3 figures of erythrocytes. ІV. According to color index (globular value): • 1. normochromic • 2. hypochromic • 3. hyperchromic

7. V. According to ability of bone marrow to regeneration: • regenerative • hyperregenerative • hyporegenerative • aregenerative

8. Qualitative (degenerative) changesof red blood cell • - poikilocytosis- differentshapeof erythrocytes; • - anisocytosis- differentsizeof erythrocytes; • - anisochromia- different saturationof red blood cells by hemoglobin

9. - pathological inclusions in the erythrocytes : Cabot ringsJolly bodies

11. Erythrocytosis – it is increase of the erythrocytes number in one unit of blood volume • Absolute: 1). Primary 2). Secondary • Relative(in case of plasma volume decrease).

12. Vaquez disease Erythremia (true polycythemia) - chronic leukemia with the defect of cells of precursor of mielopoesis with unlimited proliferation hematopoetic cells. Blood picture: • Hemoglobin (over 180g/l) • Erythrocyte (over 6x1012/l) • Platelets (over 400x109/l) • Leukocyte (over 10x109/l) • Hematocrit↑

14. Anemia -is a syndrome or disease which is characterized by the decrease of erythrocytes and hemoglobin amount in the unite of blood volume and accompanied by qualitative changes of erythrocyte.

17. Iron-deficiency anemia • Reasons: • blood loss chonic • low initial level of Fe • high requirement of Fe • alimentary • disorder of absorption • transferrin insufficiency

18. Iron-deficiency anemia • Blood picture : • Erythrocyte number ↓ • Reticulocyte number ↓ • Hemoglobin amount ↓ • Color index (globular value) ↓ • Smear: microcytes, anulocytes • In the serum : the amount of iron is reduced (in norm: 12,5 - 30,4 mcmol/l).

21. PALENESS OF SKIN BRITTLE HAIR CRACKED LIPS BRITTLE NAILS

23. PRINCIPLES OF TREATMENT : • !!! Before taking of iron supplements to determine the Fe level in the blood

24. Etiotropic treatment: balanced diet

25. Pathogenetic treatment : • Oral and parenteral Iron therapy: • Iron supplements intake (Fe bivalent!) in combination with vitamin C (vitamin C improves absorption of Fe in the blood) • Replacement therapy : According to indications – • red cell transfusion.

26. IRON REFRACTORY is anemia which arises up as a result of the violation of iron including into hemoglobin, at the activity decrease or absence of enzymes which are needed for the hemoglobin synthesis (protoporphyrin ІXdeficiency) Reasons: •   1. Hereditary • 2. Lead poisoning, alcoholism.

27. Iron-refractory anemia • Blood picture : - Hemoglobin amount ↓ - Erythrocyte number ↓ - Color index (globular value) ↓ • Sideroblasts ↑ • In the blood serum the number of iron increases!!!!. • In marrow the sideroblasts number increases.

28. PRINCIPLES OF THERAPY: • Normalization of porphyrin metabolism (vitamins B6) • Removal of Fe from the tissues

29. В12-deficiencyanemia Reasons: • insufficient intake with food • pathology of the stomach • pathology of the intestine • transcobalamin deficiency • hepatitis • pregnancy

31. В12-deficiencyanemia • Blood picture • Erythrocyte number ↓ • Hemoglobin amount ↓ • Color index (globular value)↑ ↑ • Leukopenia, hypersegmentation of neutrophils • Thrombocytopenia • In the smear of blood:megalocytes, megaloblasts; Jolly's bodies; Cabot's rings.

33. Glossitis – inflammation with depapillation of the tongue dorsal surface Atrophic gastritis Funicular myelosis Pancytopenia

34. PRINCIPLES OF THERAPY : • Etiotropic treatment : balanced diet • Pathogenetic treatment : cyanocobalamin and folic acid

35. Hypoplastic (aplastic) - anemia which affects bone marrow erythrocyte sprout on the background of a deep bone marrow suppression and sharply reduced production of red blood cells and granulocytes and platelets (pancytopenia).

36. Causes:Ionizing radiation, infectious,chemicals - drugs: [sulfonamides, levomycetin, cytostatics, anti-TB drugs], benzol and its derivatives, pesticides; • Blood Picture: • Number of Hb ↓ • Erythrocyte number ↓ • Color index - normochromicPancytopenia (↓ leukocytes, platelets).

37. Hemolytic is anemia which arises up as a result of increased hemolysis when destruction of erythrocytes prevails above their production. • Classification : • І. Hereditary– • Membranopathy • Haemoglobinopathy • Enzymopathy • ІІ. Acquired

38. Classification of hemolytic anemia • І. Hereditary • Membranopathy • Haemoglobinopathy • Enzymopathy • ІІ. Acquired

39. Classification: • After the mechanism of hemolysis hemolytic anemias are divided into: • anemias with intravascular hemolysis; • anemias with intracellular hemolysis.

40. Reasons and mechanisms of the intracellular hemolysis: • inherited or acquired defect of erythrocytes; • antibody-dependent [cell-mediated];

41. microspherocytosis or Minkowsky-Shauffard disease [hereditary spherocytosis]. Blood picture : • 1.The number of hemoglobin decreases. • 2. The number of erythrocytes is decreases. • 3. CI is normal - normochromic anemia. • 4. The reticulocytes number increases - hyperregenerative anemia. • 5. Decrease of erythrocytes osmotic resistance takes place. • 6. Increasemean concentration of hemoglobin in the red blood cell (МСНС) more than 36%. • 6. The number of unconjugated [indirect] bilirubin increases.

43. Enzymopathy-deficiency of the enzyme Gl-6-FDG Blood picture : • 1.Erythrocyte number ↓ • 2. Hemoglobin amount ↓ • 3. Color index (globular value)– normochromic. • 4. Reticulocyte number ↑ • 5. Erythrocytes osmotic resistance ↓ • 6. Indirect bilirubin ↑

44. Hemoglobinopathys are the anemias related to the violation of hemoglobin synthesis. Types of hemoglobinopathys : • The 1st – is the hemoglobin chains synthesis violations; • The 2nd – is the hemoglobin chains structure violations.

45. Hemoglobinopathy • α-thalassemia Blood picture : • 1. Erythrocyte number ↓ ↓ • 2. Hemoglobin amount ↓ • 3. Color index ↓. • 4. Reticulocyte number ↑ • 5. Erythrocytes osmotic resistance ↓ • 6. Indirect bilirubin↑ • 7. Target erythrocytes (codocytes)

48. Sickle-cell anemia Blood picture : • Erythrocyte number ↓ • Hemoglobin amount ↓ • Color index (globular value)– normochromic • Indirect bilirubin ↑ • Smear - Sickle-cell