Hematology - Asrar 2006 - REV - Formatted - 1 Col

Al Azhar medical school
Hematology
hematology

Hematology :
anemia
bleeding
blood
transfusion
.... leukemia Lymphoma neutrophils neutrophils
oral
anemia
Anemeias
anemia
Anemia Anemia

... anemia anemia
... anemia
Anemia
..... decrease production of the RBCs RBCs
Excess loss of RBCs
RBCs loss of RBCs
anemia decrease production of RBCs Excess loss

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Pediatrics / Abo El-Asrar Revision

Decrease production of RBCs
RBCs production
requirement of the bone marrow bone marrow RBCs
requirement
Bone marrow bone marrow failure Hypo plastic
anemia
excess loss RBCs
RBCs Hemolytic anemia
RBCs hemorrhage bleeding
tendency

.... decrease production excess loss

...
focus
decrease production reticulocytic count
low
reticulocytic count ...... normal reticulocytic count 1-2 %
Loss of RBCs reticulocytic count
decrease production
excess loss of RBCs

enumerate .....
enumerate causes of anemia with low reticuloctyic count

enumerate causes of anemia with reticulocytopenia
reticulocytic count
discuss one of them
written
... hemolysis fatal mistake

with reticulocytopenia Low reticulocytic count
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anemia with high reticulocytic count reticulocytosis hemolysis
hemorrhage

anemia High or low reticulocytic count

decrease production of RBCs Low reticulocytic count

decrease requirement of the bone marrow
requirement of the bone marrow
requirement of the bone marrow extrinsic
RBCs Intrinsic
Intrinsic RBCs
extrinsic causes
Iron
, folic acid
, B12
, vitamin B1,
vitamin B6,
vitamin E ......... E
vitamin E RBCs ... RBCs free

oxygen radicals

vitamin E .... antioxidant antioxidant free oxygen radicals
RBCs G6PD deficiency
.... cupper

enumerate causes of nutritional anemia

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nutrition anemia Kwashiorkor Marasmus rickets
nutritional anemia Nutrient RBCs
nutritional anemia
:
iron deficiency anemia

folic acid deficiency
B12 deficiency
B1 B6
vitamin E
RBCs
discuss one of them
iron deficiency megalo blastic
iron deficiency most common type Nutritional anemia

anemia with low reticulocytic count
anemia with high reticulocytic count
nutritional anemia
nutritional anemia

nutritional anemia iron deficiency
anemia
..... extrinsic factor
Intrinsic factor
erythropoietin
cortisone stimulant bone marrow
growth hormone stimulation for the bone marrow
thyroxin
.... androgen androgen effect

....
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bone marrow erythopioesis RBCs

) .... , , ....
(

enumerate types of anemia secondary to organ failure

secondary to organ failure Organ failure
anemia
.1 erythropoietin
.... erythropoietin mainly form kidney
Liver
.2 supra renal cortex
.3 growth hormone Pituitary
.4 thyroxin thyroid gland
anemia organ failure

anemia secondary to organ failure Organ anemia
renal failure
renal failure

Liver disease anemia
.1 erythropoietin
.2 liver disease bleeding tendency
) hepatology (

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bleeding tendency blood loss

anemia
... cortisone Addison disease anemia cortisone
stimulant ..... bone marrow
Addison ) (
triad Addison
Hypoglycemia
Hyponatermia hyperkalemia hypotension

Addison anemia stimulation bone
marrow
growth hormone
... Pituitary dwarfism growth hormone ... mild
manifestation of anemia growth hormone Main stimulant for erythopoiesis
erythopoiesis
thyroxin
endocrine cretinism ...
thyroxin stimulation of the bone marrow
decrease requirements

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reticulocytopenia
bone marrow failure
bone marrow failure
bone marrow stem cells
receptors 3
receptor
erythropoietin .1
Liver thrombopoietin hormone receptor thrombopoietin receptor .2
Inflammatory reaction interleukin interleukin .3
stem cells colony receptor
erythroblast stem cells erythropoietin receptor
RBCs
megakaryocyte stimulation thrombopoientin receptor
platelets
Interleukin WBCs colonies stem cells stimulation interleukin
Organism

Organism neutrophils Lymphocyte Interleukin
Interleukin
bone marrow failure

stem cells hereditary defect
stem cells
autosomal stem cells gene defect gene defect stem cell
recessive disease
erythropoietin receptor .... receptors

Interleukin receptors thrombopoietin receptor defect
defect receptors

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sensitivity
colonies

........... Pancytopenia pancytopenia Hematology

Pancytopenia blood elements

Fanconi anemia
Fanconi syndrome
autosomal recessive disease ... Fanconi anemia receptor stem cell
skeletal deformities thumb radius
thumb radius completely absent deformed
... renal anomalies
Caf-au-lait patches
Hereditary disease Mode of inheritance autosomal recessive ...

erythropoietin receptor
erythropoietin receptor sensitivity
pancytopenia

Pure red cell aplasia

Diamond black fan anemia Pure red cell aplasia
erythropoietin receptor stem cells sensitivity

Hereditary factors
suppression bone marrow
drugs
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drugs chloramphenicol
suppression stem cells
Salmonella suppression stem cells
sulphonamide suppression bone marrow
.. cyto-toxic drugs immune therapy ... immune suppressant
.... suppression bone marrow
irradiation
septicemia toxins suppression bone marrow
viral bone marrow Marrow element
bone marrow bone marrow tropic virus ...
bone marrow tropic virus
bone marrow tropic viruses virus target bone marrow
. Epstein Barr virus bone marrow
. Human parvovirus
. Hepatitis B virus
viruses bone marrow

bone marrow infiltrated
bone marrow
bone marrow
Leukemia Lymphoma Malignancies
inborn error of metabolism
mechanism hepatomegaly
inborn error bone marrow
Lipid storage disease Infiltration bone marrow

marble bone disease deposit bone marrow
histocytosis X tumor Infiltration bone marrow

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Infiltration bone marrow

multiple myeloma
... bone marrow infiltration
infiltration bone marrow Pancytopenia
anemia with reticulocytopenia requirement of the bone marrow

defect
bone marrow failure

anemia with reticulocytosis

hemolysis RBCs hemorrhage

. hemolysis of the RBCs
hemolytic anemia
... RBCs hemolytic anemia
RBCs ... intrinsic causes RBCs
RBCs extrinsic cause
Intrinsic causes RBCs .... .... RBCs ) (
acquired congenital
acquired
erythrocytic phase hepatic phase
erythrocytic phase RBCs replication RBCs 8 ....
8 RBCs
infiltration RBCs
RBCs
congenital defect in RBCs
congenital defect RBCs cell membrane
spherocytosis elliptocytosis acanthocytosis RBCs
cell membrane
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cell membrane RBCs RBCs stream engagement
spleen
spleen
paroxysmal nocturnal hemoglobinuria )

paroxysmal nocturnal hemoglonbiuria
(

enzymatic defect RBCs G6PD deficiency pyruvate kinase deficiency

thalassemia sickle cell anemia
Intrinsic causes
extrinsic causes
RBCs RBCs
RBCs
extrinsic causes :
RBCs immune mediated ..... Antibody
toxins
RBCs antibody toxin
anti body RBCs

placenta Intra utrine ....placenta ...... Ig G
placenta separation of placenta
Neonatology Rh and ABO incompatibility

) .... .... ...
(! ...
sever hemolysis anti B or anti A or anti D
auto antibody antibody .... RBCs
idiopathic type of autoimmune hemolytic anemia ...
SLE systemic lupus multi antibodies against multi organs
... auto immune hemolytic anemia .... thrombocytopenia Leucopenia
11

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.... toxins toxins RBCs

toxins snake venom ...
diaphragmatic paralysis hemolysis
intrinsic toxins septicemia hemolysis
infection bone marrow failure
Infection Hemolysis
excessive bleeding
anemia with reticulocytosis
reticulocyte
bleeding tendency bleeding tendency
anemia

anemia in general
requirement bone marrow failure hemolysis hemorrhage
anemia with reticulocytosis ... anemia with reticulocytopenia
nutritional anemia anemia secondary to organ failure

diagnosis and management of chronic hemolytic anemia
how to diagnose and to treat chronic hemolytic anemia management

diagnosis
diagnosis .... clinical pictures Investigations
clinical diagnosis laboratory diagnosis
..... management management treatment ........
Management clinical picture investigations treatment
management clinical pictures investigation treatment
diagnosis treatment
Undergraduates
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disturbance mood

100

:
treatment !!!!

diagnosis treatment
diagnosis management .... definition
etiology ...... Pathogenesis
management diagnosis definition Pathogenesis
etiology

discuss

management of chronic hemolytic anemia
) (
diagnostic approach of chronic hemolytic anemia

management of chronic hemolytic anemia
diagnostic approach treatment
chronic hemolytic anemia
3
clinical presentation of chronic hemolytic anemia in general
Investigation of chronic hemolytic anemia
treatment of chronic hemolytic anemia

13

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clinical manifestation of chronic hemolytic anemia
RBCs bone marrow 120 120
spleen
..... hemoglobin globulin heam
heam protoporphyrin iron indirect bilirubin
indirect billirubin Liver liver
) bilirubin
( /http://www.facebook.com/groups/dr.tafreegh
liver indirect bilirubin direct bilirubin
bile secretion gut
GIT bacterial flora stercobilinogen
.... stool oxidation stercobilin stool dark in color
entero-hepatic systemic circulation Urine Urobilinogen
urobilinogen
chronic hemolytic anemia cycle 120

RBCs
7 8
hemolytic anemia short life span of the RBCs
hemolytic anemia
life span of RBCs 15
..... hemolytic anemia clinically present Life span 15
..... life span 120 hemolytic anemia
15
15
bone marrow 8 Normal
bone marrow RBCs
RBCs number
manifestation of anemia in general
manifestation of anemia
... Pale Pale iron therapy
...... Iron folic acid ..... B12 ..... multi vitamins
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.... anemia not responding to hematinic
hematinics bone marrow

bone marrow
vitamins tonics

spleen
function of the spleen
spleen ... splenomegaly

RBCs indirect bilirubin
indirect bilirubin liver

Indirect bilirubin capacity of the liver
Liver normal
Liver Normal
Indirect bilirubin ... Jaundice

jaundice tinge
tinge Liver good compensation Indirect bilirubin
deep jaundice
thalassemia jaundice deep jaundice

chronic hemolytic anemia jaundice tinge
jaundice deep hemolytic anemia liver
affection
jaundice Liver compensation Normal
Liver ... hepatomegaly

spleen Liver

chronic hemolytic anemia hepatomegaly splenomegaly
splenomegaly hepatomegaly
15

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Normal Liver
Normal direct bilirubin
dark stool Normal stool sterecobilinogen
urine
normal color urine

marrow activity normal 8 bone marrow
cortex widening of the medulla

... skull medullary cavity flat bone of the skull
Hyperactive marrow lateral part zygomatic bone maxilla
Prominent zygoma
Prominent upper jaw
Most common type of chronic faces of thalassemia face
Mongoloid face hemolytic anemia
Hyper active marrow

general clinical manifestations of chronic hemolytic anemia
anemia not responding to hematinics
splenomegaly with or without hepatomegaly
tinge of jaundice
dark colored stool
normal color urine
Mongoloid faces Long standing cases
clinical manifestations
clinical picture of hemolytic anemia in general ...
clinical pictures Onset of chronic hemolytic anemia
neonatal since birth since birth presentation spherocytosis
jaundice
neonatal jaundice since birth alpha thalassemia
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Beta thalassemia
sickle cell Beta chain Beta chain

Onset of disease spherocytosis
alpha thalassemia
sickle cell
beta thalassemia
)
(.
investigation
laboratory diagnosis
investigation chronic hemolytic anemia
in general
. CBC
CBC comment component of the CBC
comment
.
. blood film specific abnormal cells
CBC Other component WBCs platelets

Normocytic normochromic
.... normocytic MCV 70 80 plus or minus ten

Normochromic Mean corpuscular hemoglobin 32 33

Normocytic normochromic anemia thalassemia Microcytic
hypochromic anemia
chronic hemolytic anemia Normocytic normochromic anemia except thalassemia
microcytic hypochromic
hemolytic anemia
17

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reticulocytic count
blood film
blood film spherocytes spherocytosis
target cells anisocytosis
sickle shaped RBCs sickle cell anemia
CBC normocytic normochromic thalassemia Microcytic
hypochromic anemia

blood film spherocytes target cells sickle shaped cells
WBCs Platelets chronic hemolytic anemia Normal
...

serum iron
serum iron
serum iron iron binding capacity
iron iron binding capacity

indirect bilirubin

Liver
Liver exceed 5 mg/dl compensation

stool analysis
stool analysis dark in urine Investigation
stercobilinogen stercobilin stool
urine analysis
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urobilinogen
bone survey
skull x- hair on end appearance mosaic pattern of the bone bone X-ray
chronic hemolytic anemia ray

chronic hemolytic anemia in general investigations
specific investigations
specific general clinical presentation
specific investigation
specific investigation
diagnostic test for spherocytosis osmotic fragility test
osmotic fragility test spherocytosis
hemoglobin electrophoresis ... hemoglobin electrophoresis
Minor major, intermediate thalassemia
s hemoglobin electrophoresis sickle cell ...
sickle cell anemia sickling test :
sickling test sickling test hemoglobin electrophoresis available
sodium
RBCs
sickling test Sickle cell RBCs
anti body coomb's test auto immune hemolytic anemia

HAM test PNH
paroxysmal nocturnal hemoglobinuria
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PNH

mood ... ... full mark under zero

topic
treatment chronic hemolytic anemia
management clinical pictures investigations
treatment

treatment
.... Hereditary anemia

packed RBCs packed RBCs transfusion 15 ml/ kg 15 ml/
kg

Level Heart failure Level

heart failure 6
RBCs
11
10 Packed RBCs
hyper transfusion
12
super transfusion
iron chelating
.... .... ... iron
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load hemosidrosis ... Iron chelating therapy
anemic hear failure

10 whatever ....12
Iron chelating
.. .. tissue
.... hypoxia tissue hypoxia IQ ... bone marrow
Hyper active mongoloid face thalassemic face

thalassemia
completely normal
Liver spleen
anemia Hyper active bone marrow
Hyper active bone marrow

Iron ... hemosidrosis
Iron load iron chelating therapy iron chelation
therapy Parental Oral
Parental desferal desferoxamine
Oral Historical ....
Oral L1 very effective effect
Parental

Hyper active bone marrow
bone marrow 8 normal
8 normal requirement
requirement
B12 iron
storage folic acid
folic acid one week
folic acid supplementation
folic acid
21

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folic acid tablet
folic acid ..... folic acid crisis
megalobalstic crisis

treatment of treatment of complications
complications
treatment of complications
complications

treatment of the complications
complications of chronic hemolytic anemia
...
complications complications of blood transfusion complications
infection Hepatitis B, C HIV

hyper active bone marrow medulla cortex cortex
cortex bone Liable for pathological fracture

pathological fracture

spleen ... more soft
Left hypochondrium
spleen spleen traumatic rupture spleen
traumatic rupture spleen spleen
spleen phagocytic function
phagocytic function spleen ... hypersplenism

iron Hemosidrosis iron Heart
Liver spleen Islets cells of langerhans diabetes
peripheral nerves peripheral neuritis .. skin dark coloration
endocrinal glands
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normal Liver direct bilirubin
gall stone ... viscosity of the bile
spherocytosis gall stones Hemolytic anemia

Heart failure ... Heart failure
anemic heart failure .... anemia Heart failure .
Heart failure iron .... hemosiderosis .
heart failure toxic myocarditis Infection .
toxic Infection anemia , heamosidrosis heart failure
myocarditis

repeated infection repeated infection ... repeated infection
chest Lung congestion .... lung congestion heart failure .... heart failure
infection
Hypersplenism traumatic rupture spleen spleen
spleen splenoectomy ........ splenoectomy
incidence of infection by capsulated organisms capsulated organisms specific spleen
salmonella , meningeococci , H.influenza and pnumococci .....

WBCs repeated infection
... folic acid WBCs crisis WBCs
megaloblastic anemia folic acid folic acid
megaloblastic crisis Hemolytic anemia
pan cytopenia megalobalstic anemia
virus infection bone marrow
a Hypo plastic anemia Hypo plastic anemia bone marrow
plastic crisis
Megaloblastic ..... folic acid deficiency
WBCs WBCs a plastic crisis
WBCs hypersplenism
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WBCs
repeated infection WBCs
Megaloblastic crisis a plastic crisis hypersplensim
complication
crisis
hemolytic crisis
hemolytic crisis Hemolytic crisis chronic hemolytic anemia Infection
Infection Hemolytic function of the spleen phagocytic of the spleen
RBCs

Hyper hemolytic crisis chronic hemolytic anemia acute on top
G6PD thalassemia combination hyper hemolytic crisis

complications
... stunted growth
hemosiderosis growth hormone pituitary somatomedins
liver affection
hemosiderosis somatomedins Liver
hemosiderosis growth hormone Pituitary
pathological fracture stunted growth
anemia stunted growth oxygen
repeated infection stunted growth
) (

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. . ! . . ! . .
! . . ! .
. ! . . ! .
. . ! . .
. . ! . . .
. . ! .
. . " . " :
. " .
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: : - : - :

chronic hemolytic anemia clinical thalassemia
.... thalassemia Investigations
CBC
WBCs platelets megaloblastic crisis a plastic crisis
Hypersplenism

) (
) (
PNH
PNH
blood element blood elements RBCs platelets WBCs
cell
membrane RBCs platelets WBCs
inactivation active complement
complement activation blood
activated complement blood RBCs WBCs platelets

cells
complement
Inactivation
RBCs active complement
complement activation complement activation
Hypoxia
hypoxia ... partial hypoxia
Hypo ventilation
... respiratory rate shallow breathing
respiratory rate adult 18 10
25

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......Hypoxia hypoxia PH 7.35
PH activation for the complement
activation for the complement
blood elements

hypoxia
PH 7.4 7.35
PH ... complement activation
activation

<
fever Loin pain Intravascular hemolysis
< hemoglobinuria
paroxysmal attack
nocturnal Hemoglobinuria
paroxysmal nocturnal hemoglobinuria

CBC pan cytopenia
acidosis acidosis metabolic or respiratory
acidosis
acidosis complement activated pancytopenia
PNH
PNH Ham test
Ham test acidic media acidic media
complement activation blood elements .... Ham test
acidosis acidic media
diagnostic for PNH
) ( 2006
pan cytopenia
.... pan cytopenia pan cytopenia
component of the blood elements bi cytopenia component

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pan cytopenia
skeleton
< ... production blood elements
< ... excessive destruction blood elements
decrease of production Pan cytopenia

decrease production decrease production requirement
megalobalstic anemia B1 deficiency B1 deficiency hypo plastic anemia
megaloblastic anemia Pan cytopenia B1 deficiency Hypo plastic anemia
stem cells
bone marrow
bone marrow hypo plastic anemia hypo plastic anemia
pure red cell a plasia
bone marrow failure Pure red cell
pure red cell pure anemia pan cytopenia
bone marrow failure pure red cell a plasia

... spleen Hypersplenism

Hypersplenism pan cytopenia
DIC disseminated intravascular coagulaopathy platelets count
DIC DIC vascular thrombosis ... ... intravascular thrombus

thrombus fibrinolytic system
fibrinolytic system intravascular thrombus
thrombus
thrombus fibrinolytic system
.... .....
Consumption coagulation factors and

platelets thrombus
thrombus platelets coagulation factor
.... platelets coagulation factors
27

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thrombocytopenia Platelets
coagulation factors
ecchymotic patches DIC
bleeding tendency
anemia bleeding tendency
bone bone marrow suppression toxins infection infection DIC
Pan cytopenia marrow suppression

pan cytopenia DIC
roughness of the endothelium of the blood vessel Infection .... Infection .... DIC***
vessel Intra vascular thrombosis endothelium roughness
thrombus

hemolytic uremic syndrome
bi cytopenia pan cytopenia hemolytic uremic syndrome
gastroenteritis Intestine certain strains E.coli hemolytic uremic
blood toxins entero toxins toxins gastroenteritis ....
Hemolysis of the RBCs
.... intra vascular hemolysis
thrombocytopenia thrombocytopenia platelets toxins
immune complexes
immune complexes
nephritis
anemia thrombocytopenia

E.coli gastroenteritis hemolytic uremic syndrome
gastroenteritis Intestine E.coli
toxins entero toxins toxins certain strains gastroenteritis
hemolytic anemia RBCs blood
thrombocytopenia platelets

28
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immune complexes nephritis
nephritis pan cytopenia
pan cytopenia
Hypo plastic anemia Hypo plastic anemia

clinical manifestations of pan cytopenia
pan cytopenia clinically
. pan cytopenia RBCs anemia
. platelets Petechiae , ecchymosis , bleeding , purpura etc.
. WBCs recurrent infection
clinical manifestations of the underlying etiology
hypo plastic anemia
hypo plastic anemia
Investiagations
Investigatioins
CBC
CBC pan cytopenia
blood elements RBCs WBCs Platelets
pan cytopenia anemia
megalobalstic RBCs macrocytic normochromic anemia MCV 100
macro cytic anemia megalobastic
) ... (
pan cytopenia excessive destruction PNH
CBC anemia
thrombocytopenia leucopenia
... normocytic normochromic
Normocytic normochromic megalobalstic anemia macrocytic
normochromic anemia
Normocytic normochromic anemia megaloblastic
29

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reticulocytic count

decrease production .... bone marrow failure
Megaloblastic B1
hypersplenism DIC PNH
excessive destruction
reticulocytic count

bone marrow aspiration highly indicated bone
marrow aspiration ... marrow bone marrow
hypocellular ....
Megalobastic megaloblastic anemia ...
Infiltration leukemia Lymphoma bone marrow aspiration
bone marrow hyper cellular, hype active bone
marrow
excessive destruction
) gall stone spherocytosis
thalassemia ........ gall stone spherocytosis ...... thalassemia
thalassemia spherocytosis onset of hemolysis thalassemia
spherocytosis
spherocytosis thalassemia
indirect bilirubin

thalassemia microcytic RBCs
spherocytosis ... normocytic RBCs
normochromic
RBCs thalassemia spherocytosis
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RBCs spherocytosis thalassemia
bilirubin RBCS spherocytosis thalassemia
gall stones spherocytosis
spherocytosis hemolysis
bilirubin hemolysed spherocytes hemolysis
of thalassemia

bleeding
bleeding tendency
bleeding tendency
bleeding tendency general
bleeding tendency
bleeding
bleeding tendency
bleeding tendency bleeding under the skin Petechiae
purpura ecchymosis
bleeding epistaxis hematuria
Hematuria bleeding per rectum
prolonged bleeding after minor truma tooth extraction circumcision
bleeding
bleeding from one orifice explanation local cause

epistaxis systemic causes of bleeding
bleeding tendency exclusion of local causes
bleeding tendency

bleeding tendency bleeding tendency
bleeding tendency
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bleeding tendency :
blood vessel
:
vascular
phases
coagulation factors
vascular causes
vascular casues allergic casuses clinical
Henoch Schonlien purpura
Henoch Schonlien purpura vascultitis skin purpuric
eruption buttocks lower limbs extensor surface of the forearm distribution

Purpura Purpura raised above the level of the skin itchy

arthritis Nephritis GIT bleeding bleeding per rectum abdominal
colic intussusceptions
) :

(

vitamin C deficiency ) scurvy (
vitamin C collagen fibers supporting the blood vessel
vitamin C collagen fibers support blood vessel
skeleton of the vessel liable to bleed
steroid
steroid media collagen fibers
cortison ... musclosa vessel
muscle layer of the vessel collagen support catabolic effect cortison
wall of the vessel
cushing stria rubra Lower abdomen breast
upper part of the thigh, etc.. lysis of supporting layer of the vessel
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meningeococcemia septicemia septicemia
sever vasculitis meningeo coccal toxins

collagen diseases
SLE lupus lupus collagen diseases
platelets defect
thrombocytopenia number of the platelets
thromboasthenia function of the platelets
thrombocytopenia
400,000 cell /mm3 150,000 normal platelets count
100,000 platelets count thrombocytopenia
thrombocytopenia
decrease production of the platelets
pure red cell bone marrow failure decrease production of the platelets
erythropoietin receptor pure red cell aplasia aplasia
thrombocytopenia
thrombocytopenia
TAR syndrome )TAR syndrome Pure red cell aplasia
( thromboycopenia with absent radius
thrombopoietin erythropoietin pure red cell aplasia
receptor
thrombopoietin stem cells thrombopoietin receptor
Platelets count Megakaryocytes ... hormone

absent radius
Thrombocytopenia Absent Radius syndrome
excess destruction thrombocytopenia
excess destruction
excess destruction of the platelets
non immune ( immune ) anti body
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Immune thrombocytopenia
antibody placenta platelets
trans placental
anti body platelets ) ITP (immune thrombocytopenic purpura
anti body placenta
immune thrombocytopenia
permanent transient transient placenta
Iso immune placenta

Rh D antigen Rh +ve antigen
Rh ve
Platelets platelets antigen P antigen
P antigen
P antigen P antigen 15 %

Rh
P antigen P antigen
P antigen
anti P anti body
anti P ... anti P placenta
thrombocytopenia hemolysis platelets

Rh incompatibility
Iso immune incompatibility
trans placental antibody
antibody
ITP anti body
antibody RBCs Evan's syndrome auto immune hemolytic
anemia
Evan's syndrome RBCs platelets
Systemic lupus non specific antibody
Post transfusion thrombocytopenia
post transfusion thrombocytopenia Platelets P antigen P
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antigen positive
P antigen positive
Platelets count 400,000 Normal
) ( blood transfusion

blood
anti P plasma transfusion blood tansfusion anti P

thrombocytopenia
thrombocytopenia Iso immune incompatibility
P antigen

anti P
P antigen positive
non immune
non immune anti body
spesis Hypersplenism
hypersplensim spleen
consumption of the platelets
consumption of the platelets thrombosis
thrombus ... thrombus ...
DIC thrombotic thrombocytopenic purpura TTP
hemolytic uremic platelets toxins antibodies
giant hemangioma Hemangioma bone
Hemangioma stagnation ..... .... thrombosis thrombus ...
.... DIC
consumption of the platelets
thrombocytopenia
thromboasthenia
thromboasthenia
thromboasthenia
35

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wall of the blood vessel blood vessel Injury
platelets aggregations
wall of the blood vessel Von willbrand ) (
Von willbrand factor receptors receptors wall of the vessel

glycoprotein 1b receptor glycoprotein 1b receptor Von willbrand factor
wall of the vessel adhesion
glycoprotein 1b receptor Von willbrand factor stimulation enzyme
platelets cyclo-oxygenase
cyclo-oxygenase platelets arachidonic acid prostaglandins A2
... thromboxane A2 ... prostacycline coagulation cathcade
cyclo-oxygnase phosphate
phosphrus ATP ADP phosphate group
ADP platelets receptor
glycoprotein 2b
Platelets receptor glycoprotein 3a receptor
two platelets ) (
ADP collagen
ADP collagen ) platelets ( platelets
aggregation
adhesion aggregation
thromboasthenia
thromboasthenia Platelets number adhesion
aggregation
Von willbrand factor
glycoprotein 1b receptor Bernard-Soulier Disease
) spelling

(
cyclo-oxygenase .... suppression suppression uremia
renal failure thromboasthenia
glycoprotien IIb IIIa
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coagulation factor defect bleeding disorder
intrinsic pathway factor 7 coagulation factors
factor 8 factor 9 factor 11 .... factor 12 .... factor 8
()
fibrin clot factor 1 factor 1 factor 2 factor 10 common pathway
Intrinsic pathway coagulation factor defect

Intrinsic pathway .. hemophilia hemophilia
Hemophilia A factor 8
Hemophilia B factor 9
Hemophilia C factor 11
fibrinogen congenital defect congenital defect in factor 7
congenital ...hereditary
congenital defect in fibrinogen
afibrinogenemia finbrinogen
non functional
acquired causes
Liver acquired causes
Liver cirrhosis
vitamin K
factor 10 factor 9 factor 7 factor 2 vitamin K
( 1972)
thrombotic thrombocytopenic DIC coagulation factors consumption
purpura
thrombus consumption
coagulation factors consumption
clinical manifestation of bleeding tendency

ecchymotic bleeding clinical manifestations
hemoartharosis joint hemorrhage patches
sever bleeding truma after
.')$%&'"# !

37

what ever ... Petechiae and purpura
Petechiae and purpura bleeding paragraph
Petechiae and purpura bleeding oral orifice hematuria

enumerate to detect the cause
Petechiae and purpura and discuss one of them

) (
Petechiae and purpura vascular and platelets
Petechiae and purpura vascular causes and platelets causes

coagulation factor defect Petechiae and purpura
coagulation factor defect minus
bold
.....
Petechiae and purpura coagulation factor defect
once Petechiae and purpura vascular and platelets

presented by ecchymotic patches ecchymosis major hemorrhage
under the skin
Major hemorrhage vascular platelets coagulation factor defect
ecchymosis

ecchymosis Petechiae and purpura ecchymosis without
Petechiae and purpura
ecchymosis Petechiae and purpura
ecchymosis Petechiae and purpura vascular + platelets

ecchymosis without Petechiae and purpura coagulation factor
"/!0,-.+"- 31.2"467+5"'9;1&:
38

defect
full mark
70 %

Petechiae and purpura vascular or platelets
coagulation
) (
coagulation factor defect Petechiae or purpura

diagnostic approach laboratory investigation

diagnosis investigations

. vascular
. thrombocytopenia
. thromboasthenia
. coagulation factor defect

... CBC CBC Platelets count
platelets count thrombocytopenia
CBC thrombocytopenia
thrombocytopenia production excess destruction
: bone marrow aspiration
bone marrow
megakaryocyte
megakaryocyte marrow ... Marrow ...
decrease production
megakaryocyte ... excess destruction
39

! )'$%&'"#.

platelets count normal

platelets count normal thrombocytopenia
platelets count normal thrombocytopenia
vascular thromboasthenia coagulation factor

bleeding time
bleeding time

Minor leak
normal bleeding time 5
bleeding time normal
bleeding time normal minor leak
Minor leak Platelets platelets function
ecchymosis
bleeding time Normal
coagulation factor defect
bleeding time Prolonged
bleeding time ... prolonged vascular thromboasthenia
) thrombocytopenia ... thrombocytopenia platelets count (
bleeding time prolonged
platelets function test
platelets function test Impaired thromboasthenia
platelets function normal vascular casue

bleeding time normal platelets count normal coagulation factor defect
PT PTT
PT extrinsic common pathway
PTT intrinsic common
"/!0,-.+"- 31.2"467+5"'9;1&:
40
PT normal PTT prolonged intrinsic pathway

hemophilia
PTT normal PT prolonged extrinsic factor 7
PTT PT prolonged common pathway
... vitamin K afibrinogenemia ... Liver cirrhosis
G6PD deficiency
G6PD deficiency
G6PD deficiency X-linked recessive gene genetic defect
X-chromosome
common common
presented clinical presentation
clinical presentation pathogenesis acute hemolytic anemia
G6PD deficiency free oxygen radicals
free oxygen radicals O3 H2O2
O3 H2O2 free oxygen radicals RBCs
..... oxygen
G6PD enzyme
free oxygen radicals

free oxygen radicals lipolysis lipid part of the cell membrane of the RBCs lipid
part cell membrane RBCs
Lipid part cell membrane
cell membrane lipo protein
Lipid part cell membrane
cell membrane

RBCs blood vessel
RBCs blood vessel
41

! )'$%&'"#.

RBCs
RBCs .... manifestations of anemia
marked easy fatigability

syncopal attack

RBCs ... Intra cellular content
intra cellular content Pyrogenic effect
Pyrogenic effect
fever and crisis

RBCs ...
.... Liver
haptoglobin hemopexin
haptoglobin hemopexin chemical reaction

haptoglobin globin part
hemopexin haem part

hemopexin hemopexin haem part
Haptoglobin globin part

macro protein
... ... renal tubules
acute tubular necrosis
spleen
spleen Bilirubin
indirect bilirubin
Indirect bilirubin liver
jaundice
"/!0,-.+"- 31.2"467+5"'9;1&:
42

jaundice tinge
tinge Liver
tinge of jaundice
stauration level haptoglobin hemopexin
haptoglobin Hemopexin

free circulation
free in circulation filtration glomeruli tubular reaction
tubular reaction
bilateral loin pain
bilateral loin pain

.... ...... urine urine ........ hemoglobinuria
hemoglobinuria
red color urine
free oxygen radicals
history of exposure to oxidizing agent
Oxidizing agent free oxygen radicals

anti pyretic Paracetamol
anti malarial drugs
Ambilhar anti Bilharzial drug
chloramphenicol
insectcide ... sever hemolysis

clinical manifestations of G6PD deficiency
history of exposure to oxidizing agent
manifestations of anemia
fever and rigors
bilateral loin pain red colored urine
tinge of jaundice
43

! )'$%&'"#.

clinical manifestations G6PD deficiency
give an account on
give an account on
clinical manifestations complications
complications G6PD deficiency
complications
acute hemolysis
17-16 ... 16 8
level 8 anemic heart failure

rapid reduction rapid reduction heart compensation
.....
heart compensation
8 Gallop rhythm heart manifestations of
congested heart failure
thalassemia 8
.... chronic hemolytic anemia very gradual heart good
compensation
compensation
anemic heart failure
complications
complications
hemolysed RBCs
free hemoglobin
urinary tubules
acute tubular necrosis acute renal failure
"/!0,-.+"- 31.2"467+5"'9;1&:
44

acute renal failure
anemic heart failure anemic heart failure urgent
blood transfusion

... .... screening hepatitis
HIV
complications of blood transfusion
HepatitisHIV
complications G6PD deficiency
complications of blood transfusion Hepatitis& HIV
Investigations
investigations G6PD deficiency

G6PD deficiency ... CBC
CBC Normocytic normochromic anemia

blood film Heinz bodies

urine analysis
urine analysis urine analysis hemoglobinuria
urine
consumed
consumed spleen
haptoglobin Hemopexin
renal function
renal function renal function Kidney
45

! )'$%&'"#.
diagnostic test
G6PD deficiency G6PD assay
G6PD assay
G6PD assay CBC normocytic normochromic
Heinz bodies
Urine hemoglobinuria
haptoglobin and hemopexin
renal function acute tubular necrosis

. free oxygen radicals
. Heart packed RBCs transfusion anemic
heart failure
. IV fluid + osmotic diuretics washing renal tubules effect of
hemoglobin renal tubules

packed RBCs IV fluids osmotic diuretics

give an account on laboratory diagnosis of iron deficiency anemia
laboratory diagnosis
etiology
clinical manifestations

laboratory diagnosis of iron deficiency anemia

Investigations Iron deficiency anemia
:
"/!0,-.+"- 31.2"467+5"'9;1&:
46

:
Investigations iron deficiency anemia
Iron deficiency anemia


CBC
CBC RBCs WBCs platelets
RBCs
WBCs platelets normal

CBC
) ( microcytic hypochromic anemia
MCV 60
MCH 25 25%
thalassemia minor microcytic hypochromic anemia

laboratory

low zero
thalassemia microcytic hypochromic

Iron deficiency anemia thalassemia minor
CBC
microcytic hypochromic
iron thalassemia

aplastic crisis thalassemia
thalassemia
aplastic crisis bone marrow
bone marrow activity
47

! )'$%&'"#.

aplastic crisis bone marrow

iron deficiency anemia CBC
CBC
Blood film
blood film abnormal cells
no abnormal cells

no abnormal cells ... CBC

Microcytic hypochromic anemia
o thalassemia
blood film anisocytosis target cells
o lead poisoning
lead poisoning microcytic hypochromic anemia
lead poisoning blood film RBCs basophilic stippling of the RBCs
iron deposit
o microcytic hypochromic anemia sidroblastic anemia
sidroblastic anemia sidroblastic abnormal cells peripheral blood
sidroblast
)
Sidroblastic anaemia

sidroblastic anaemia MCQ
... bone marrow normoblast
Normoblast reticulocyte mature RBCs
Normoblast normoblast .... iron protopophyrin
protoporphyrin Iron haem ...
defect
protoporphyrin
iron normoblast bone marrow protoporphyrin
"/!0,-.+"- 31.2"467+5"'9;1&:
48

sidroblast
iron granules normoblast
protoporphyrin
sidrosis
normoblast sidroblast
sidroblast normoblast protoporphyrin
(
sidroblast peripheral blood
No abnormal cells
thalassemia sidroblastic anemia lead poisoning
abnormal cells

serum iron serum ferritin


serum ferritin acute phase reactant
acute phase reactant
acute follicular tonsillitis
CRP ... serum ferritin
iron deficiency anemia Infection serum ferritin serum ferritin
Normal high iron deficiency anemia
serum ferritin Infection
iron
iron ferritin
49

! )'$%&'"#.

Iron ... iron component
iron protien carrier ferritin
Kwashiorkor protein serum ferritin
serum ferritin
Pan hypoprotienemia

iron binding capacity
iron binding capacity

chronic blood loss o
stool analysis
ankylostmoa stool analysis o
occult blood in the stool stool analysis
malabsorption syndrome in undigested food stool anaylsis
general

endoscopy o
lower GIT endoscopy Upper GIT endoscopy
varices
oozing of the blood Peptic ulcer
chronic blood loss
endoscope
50
1&:;9'"7+564"- 31.2"/!0,-.+"

Malabsorption syndrome
malabsorption syndrome Investigation of malabsorption syndrome
Under graduates
Investigation of malabsorption syndrome
investigation according to the suspected underlying etiology

enumerate
enumerate causes of pallor and hepato splenomegaly
hepatomegaly splenomegaly hepato splenomegaly pallor

pallor
enumerate causes and discuss how to diagnose one of them
clinical and investigation diagnosis
pallor hepato splenomegaly

chronic hemolytic anemia pallor hepato splenomegaly
Hepato splenomegaly tinge of jaundice pallor
thalassemia spherocytosis
sickle cell

tumor malignant
tumor
bone marrow infiltration
anemia
hepato splenomegaly spleen Liver Infiltration

pallor and hepato splenomegaly stage 4 lymphoma lymphoma
.')$%&'"# !

51
Pallor hepato splenomegaly

inborn error of metabolism
marble bone osteopetrosis bone diseases
disease
pan cytopenia excess Ca deposit in the bone marrow osteopetrosis
bone marrow
bone marrow spleen Liver
extramedullary hemopoiesis
spleen liver extramedullary hemopoiesis
Inborn error of metabolism
hepatomegaly mechanism
Nieman-Pick disease Gaucher's disease
Liver Infiltration bone marrow infiltration lipid storage disease
spleen
Liver spleen Gaucher's disease
spleen liver Nieman-Pick disease

hepatomegaly mechanism
Wilson disease
spleen liver deposit cupper Wilson

hemolytic anemia cell membrane of the RBCs deposit cupper
hepato splenomeglay hemolytic anemia Wilson
CNS renal affection

hepatic affection
liver affection inbron error ........inborn error
Liver affection anemia liver affection
erythropoietin Liver anemia liver affection
portal hypertension liver cirrhosis
hypersplenism spleen Portal hypertension
52
1&:;9'"7+564"- 31.2"/!0,-.+"
bleeding liver cirrhosis

chronic blood loss
anemia chronic blood loss
tyrosinemia
glycogen storage diseases Liver affection
liver affection
Hepato megaly Liver
liver cirrhosis hepato splenomegaly
portal hypertension hypersplenism anemia
bleeding liver affection erythropoietin
Inborn error of metabolism
chronic liver disease
chronic liver affection hepato splenomegaly hepatomegaly

chronic active hepatitis
virus B and C

chronic Bilharziasis of the liver
portal hypertension .... fibrosis
cirrhosis
spleen portal hypertension
hypersplenism spleen
terminal hematuria urinary tract chronic bilharziasis
malaria
Liver hepatocytic phase anemia RBCs erythrocytic phase

.')$%&'"# !

53

Rickets generalized lypmphadenopathy
splenomegaly hepato splenomegaly
nutrition Kwashiorkor
Kwashiorkor anemia iron folic B12
anemia Kwashiorkor hepato splenomegaly

Iron deficiency anemia 15 % splenomegaly
hepato splenomegaly
.... chronic infection chronic infection
Cytomegalo virus EPV brucellosis organo megaly
anemia
enumerate causes of anemia with hepato splenomegaly

outline enumerate
outline the commonest types of anemia
anemia in general

what are the commonest causes of iron deficiency anemia in school children in Egypt and what is the
??? treatment

iron deficiency anemia in school children
clinical manifestations Investigations
"/!0,-.+"- 31.2"467+5"'9;1&:
54

treatment
anemia in general
causes of anemia
commonest causes of iron deficiency anemia in school children
school children
iron deficiency anemia in school children delayed weaning
Intrautrine growth retardation storage in liver
preterm !!!!!! ) (

iron deficiency anemia preterm

antiacid iron absorption
iron absorption
) (
vitamin K vitamin K
malabsorption syndrome
chronic blood loss

absorption malabsorption syndrome
epistaxis hematuria
bleeding per rectum menorrhagia
chronic blood loss
Liver affection
Liver cirrhosis iron deficiency anemia decline in the store
inborn error of metabolism Liver cirrhosis

Liver cirrhosis very common inborn error of metabolism
55

! )'$%&'"#.

mention causes of anemia in 2years child

Beta thalassemia sickle cell anemia

how to manage 3yrs old with pallor

iron deficiency anemia Megaloblastic Hemolytic anemia

enumerate causes of chronic hemolytic anemia and how to diagnose and treat one of them
chronic hemolytic anemia hemolytic anemia
cell membrane PNH
cell membrane spherocytosis elliptocytosis chronic hemolytic
anemia
.... PNH PNH Intravascular hemolysis
abnormal hemoglobin thalassemia sickle cell anemia
enzymatic defect
) : G6PD chronic haemolysis (
intrinsic cause
extrinsic causes
auto immune type
auto immune hemolytic anemia acute or chronic


"/!0,-.+"- 31.2"467+5"'9;1&:
56

most prominent Beta thalassemia
clinical manifestations Investigations treatment

ecchymotic patches
A and B
what are the suspected causes
how to manage one of them
how to manage clinical picture, investigations and treatment

ecchymosis
Petechiae and purpura
Petechiae and purpura vascular or platelets causes
coagulation factor defect See above
blood
57

! )'$%&'"#.

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Al Azhar medical school

Pediatrics / Abo El-Asrar Revision

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Al Azhar medical school

vitamin E RBCs ... RBCs free

Pediatrics / Abo El-Asrar Revision

iron deficiency anemia

cortisone stimulant bone marrow

growth hormone stimulation for the bone marrow

.... androgen androgen effect

" /!0,-.+"- 31.2"467+5"'9;1&:

Al Azhar medical school

enumerate types of anemia secondary to organ failure

Pediatrics / Abo El-Asrar Revision

bleeding tendency blood loss

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Al Azhar medical school

bone marrow failure

erythropoietin receptor .... receptors

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Pediatrics / Abo El-Asrar Revision

Hereditary disease Mode of inheritance autosomal recessive ...

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Al Azhar medical school

Pediatrics / Abo El-Asrar Revision

Infiltration bone marrow

anemia with reticulocytopenia requirement of the bone marrow

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Al Azhar medical school

enzymatic defect RBCs G6PD deficiency pyruvate kinase deficiency

anti body RBCs

Pediatrics / Abo El-Asrar Revision

.... toxins toxins RBCs

" /!0,-.+"- 31.2"467+5"'9;1&:

Al Azhar medical school

Pediatrics / Abo El-Asrar Revision

chronic hemolytic anemia cycle 120

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Al Azhar medical school

Pediatrics / Abo El-Asrar Revision

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Pediatrics / Abo El-Asrar Revision

Level Heart failure Level

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Al Azhar medical school

Pediatrics / Abo El-Asrar Revision

cortex bone Liable for pathological fracture

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Al Azhar medical school

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Pediatrics / Abo El-Asrar Revision

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Al Azhar medical school

Pediatrics / Abo El-Asrar Revision

fever Loin pain Intravascular hemolysis

" /!0,-.+"- 31.2"467+5"'9;1&:

Al Azhar medical school

decrease of production Pan cytopenia

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