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Haematology for Dental Students - RBC Disorders

Haematology for Dental Students - RBC Disorders

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Haematology for Dental Students - RBC Disorders

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  1. Any fool can know. The point is to understand ! -- Albert Einstein Without Pathology, Medicine is quackery…!

  2. DS3102: Clinical Haematology Pathology of RBC disorders (anemia) Dr. Shashidhar Venkatesh Murthy A/Prof. & Head of Pathology Less  More

  3. RBC Hb + Enz Membrane Anemia Introduction: O2 in - CO2out “Anemia is, decreased red cell mass affecting tissue oxygenation”  Low Hb* or Low HCT *  Types: • Failure of production – Deficiency anemia (iron) • Excess destruction – Hemolytic anemia. (immune)  What is ‘polycythemia’ ? ( RBC)  What is spurious / false anemia? ( Plasma) 3

  4. Normal Blood Film: RBC RBC Hb + Enz + Membrane WBC RBC WBC WBC

  5. Anemia diagnosis: Plasma WBC & PLT 120 Haemoglobin – 150 - 140 ±25 g gm/L PCV / HCT Packed Cell Volume 45 PCV/HCT - 0.47 ±0.07, 0.42 ±0.05 % lit/lit (%) RBC count - 5.5 ±1, 4.8 ± 1 x1012/L Mean Cell Hb30 MCH - Hb/RBC - 30 ± 3 pg/RBC pg picogram (wt) • Average Hb in RBC Mean Cell Vol90 MCV - PCV/RBC 90 ±10 – fl fl femto litres (vol) 5

  6. When your thinking is brilliant, you will be brilliant, but if your thinking is not brilliant you will not be brilliant, no matter how brilliant you may think you are….! -- Christian D. Larson Fake it until you make it…! -- Mohd. Ali. Boxer.

  7. Clinical Features of Anemia & their Pathogenesis.

  8. Anemia: Clinical Presentation  Extreme fatigue (tiredness) Decreased oxygen supply to tissues.  Chest pain (only in severe anemia) Myocardial ischemia. 8

  9. Anemia: Clinical Presentation RBC: Bring in O2, Take out CO2  Pale skin Less Hb / RBC  Dizziness or lightheadedness Decreased oxygen supply to Brain. 9

  10. Anemia Clinical Presentation:  Shortness of breath, light headedness. Decreased O2, Increased Co2.  Fast heart rate (tachycardia) Tissue hypoxia – Hypothalamus – sympathetic stimulation. 10

  11. Epithelial damage:  Brittle nails Fast dividing cells (epith) also need iron / nutrition Cytochrome enzymes  Stomatitis, Glossitis, Esophagitis. 11

  12. The mind uncontrolled and unguided will drag us down; and the mind controlled and guided will save us, free us. -- Swami Vivekananda

  13. Classification of Anemia: Pathogenesis  Decreased Production: • Nutrient Deficiency. • Iron def., Megaloblastic (B12/Folate) • Stem cell Deficiency : • Anemia of chronic disorders (ACD). • Aplastic anemia – bone marrow defect.  Increased loss / destruction: • Blood loss anemia – Acute / Chronic - bleeding. • Hemolytic anemia – Congenital / Acquired. • Acquired – Immune Haemolytic anemia (AIHA) • Congenital – Sickle, thalassemia etc. Top 5 Anemias 1. Iron Deficiency. 2. Megaloblastic. 3. An. of Chronic Dis. 4. Aplastic. 5. Haemolytic - AIHA 13

  14. Anemia Pathogenesis: B12, Folate DNA: Megaloblastic Anemia BLAST Early Intermediate Late  Retic.  RBC Aplastic anemia Hemolytic anemia Immune Proerythroblast (Pronormoblast) Polychromatophilic Normoblast Reticulocyte Basophilic Normoblast Orthochromatophilic Normoblast Erythrocyte Iron Deficiency anemia Hb: Iron 14

  15. Laboratory Diagnosis: Normal WBC Scattergram Neutrophil Neutrophil RBC Lymphocyte 15 RBC Histogram

  16. Classification of Anemia: Top 5 Anemias 1. Iron Deficiency. 2. Megaloblastic.  Decreased Production: • Nutrient Deficiency. • Iron def., Megaloblastic (B12/Folate) • Stem cell Deficiency : • Anemia of chronic disorders (ACD) – Iron transfer defect. • Aplastic anemia – bone marrow defect.  Increased loss / destruction: • Blood loss anemia – Acute / Chronic - bleeding. • Hemolytic anemia – Congenital / Acquired. • Acquired / External RBC defect – Immune AIHA (Warm/Cold), Mechanical, Drugs & Parasites • Congenital / Internal RBC defect – E.g. Sickle cell anemia, Thalassemia. Most common anemias 16

  17. Haemopoiesis in deficiency anemias Macrocytic, pancytopenia Megaloblastic Microcytic hypochromic Iron Deficiency Normal 17

  18. Iron Deficiency - Megaloblastic  Causes: • Bleeding, Nutrition, Increased needs.  Pathogenesis: •  Iron - Hb - MCV  Morphology: • Microcytic, Hypochromic • Pencil cells.  Clinical Features: • koilonychia, glossitis, stomatitis.  Causes: • Nutrition, gastritis, intestinal disorders, Cancer therapy.  Pathogenesis: • Abn. DNA*  all cells.  Morphology: • Macrocytic, Normochromic • Pancytopenia*  Clinical Features: • Jaundice mild, glossitis, chelitis, stomatitis. 18

  19. Whatever you think, that you will be. If you think yourselves weak, weak you will be. If you think yourselves strong, strong you will be! -- Swami Vivekananda

  20. Microcytic Anemia (IDA) Normal 20

  21. Iron Deficiency Anemia: L 1.Microcytic, Hypochromic – excess cell division, low Hb. 2.Anisopoikilocytosis. – varying supply, abnormal hemopoiesis. 3.Pencil forms. - ? cause 21

  22. Macrocytic Anemia (Meg.): H H N Normal 22

  23. Megaloblastic Anemia: Megaloblastic Bone Marrow Normal Macrocyte Megaloblast Hypersegmented Neutrophils 1. Oval Macrocytes, Pancytopenia – Less cell division. 2. Anisopoikilocytosis – Ineffective hempoiesis, Hemolysis. 3. Hypersegmented neutrophils. - Megaloblasts (in marrow). 23

  24. Anemia of Chronic Disease:  Causes: • Chronic Infections, inflammations, malignancy & anemia of renal disease*.  Pathogenesis: • Inflammatory mediators (IFN, TNF) block iron transfer from store to RBC • Also decrease erythropoietin prod.  Morphology: • Mild Microcytic, Hypochromic.  Clinical Features: • Mild anemia, resistant to iron… IDA ? IDA / ACD ACD 24

  25. “No doubt knowledge is valuable, but above it is Character” Knowledge without character is dangerous!

  26. Aplastic A: BM Failure: immune, drugs, cancer.. Stem cell damage • Drugs, Immune • Viral Infections. Dysplasia Normal BM Aplasia Leukemia Clinical Features: Anemia, Infections & Bleeding. 1. RBC - Anemia, 2.  WBC - Leukopenia 3.  PLT - Thrombocytopenia Normocytic Pancytopenia 26

  27. Our destiny is in our hands, What we think and do in the present determines what shall happen to us in the future. -- Christian D. Larson

  28. Mechanism & Types of Anemia :  Decreased Production: • Nutrient Deficiency. • Iron, B12 / Folate • Hemopoietic cell defect: • Anemia of chronic disorders (ACD) – low erythropoietin. • Aplastic, Hypoplastic – Drugs, Disease, Destruction. • Dysplastic & Neoplastic proliferative anemias.  Increased loss / destruction: • Blood loss anemia – bleeding, parasites, • Hemolytic anemia – Congenital / Acquired. • Acquired / External RBC defect – Immune (Warm/Cold), Mechanical, Drugs & Parasites • Congenital / Internal RBC defect – Defective Membrane (HS), Hb (Sickle, Thal) or Enzyme (G6PD) 28

  29. Hemolytic anemia (acquired): COLD  Causes: • Antibody to RBC – commonest (cold / warm) • Idiopathic, Drugs, infections, malaria, trauma.  Pathogenesis: • Damage  Hemolysis  Jaundice.  Morphology: • Spherocytes (warm) / RBC clumps (cold).  Clinical Features: • anemia, Jaundice. Splenomegaly in chronic. • Diagnosis: Coomb’s test (detects Ab on RBC) WARM IgG IgM COLD WARM 29

  30. Thalassemia Congenital Hemolytic An.: RBC Cell Mem. Enzymes Hemoglobin Hemolysis Jaundice • • • Clinical Features 1. Membrane Disorders • Hereditary Spherocytosis (HS) 2. Enzyme Deficiencies. • G6PD Def. 3. Hemoglobin Disorders • Globin deficiency: Thalassemia • Globin abnormal: Sickle cell an. 30

  31. Reticulocyte: Immature RBC Spherocyte RNA network within RBC – stained by methylene blue. Reticulocyte Polychromatophil RBC Nucleated RBC (Bluish, Large, high MCV) Reticulocytes (Immature RBC)  Increased RBC production Reticulocytosis  Hemolytic anemia/bleeding 5-7 days 31

  32. Never say No, never say, ‘I cannot’, for you are infinite. Even time and space are as nothing compared with your nature. You can do anything and everything. -- Swami Vivekananda

  33. Anemia Diagnosis:

  34. Anemia Clinical Diagnosis MCV Microcytic Normocytic Macrocytic Measure Ferritin Measure B12 + folate Normal/high Low Low Normal Anemia of chronic disease/ Congenital Hb dis. Iron def Anemia Megaloblastic anemia Reticulocyte count Anemia of chronic disease Renal failure Marrow failure high low Hemolytic anemia or blood loss 34

  35. If you need help, contact me… 1. Office location – MS 39-136 (Townsville) 2. Office Tel: 4781 4566 3. Email: venkatesh.shashidhar@jcu.edu.au Need personal guidance? Email me for an appointment.

  36. The power of thought is not a compelling force. It is a building force, and it is only when used in the latter sense that desirable results can be produced. -- Christian D. Larson

  37. The pessimist waits for better times, and expects to keep on waiting; the optimist goes to work with the best that is at hand now, and proceeds to create better times. -- Christian D. Larson

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