anemia1-case introduction
TRANSCRIPT
Any fool can know. The point is to understand !
-- Albert Einstein
Know Pathology – you know medicine.
Without Pathology, Medicine is quackery…!
CLINICAL PATHOLOGYThe foundation of Clinical Medicine.
Shashidhar Venkatesh MurthyA/Prof & Head of Pathology
College of Medicine & Dentistry
RBC Disorders: Introduction
CPC 2.1: Tired woman...
Increasing lethargy, SOB, dyspnea, ankle swelling… Palpitations, chest pain on exertion, relieved on rest. Fever some times. Loss of appetite, some loss of weight Hypothyroidism- thyroxine, NSAID for osteoarthritis. Bruises easily, Pale, mild jaundice. Stomatitis, glossitis, PNS: 4/5 lower limb, Romberg +ve,
Reflexes , Babinski +ve, sensation
63y Ayr – Increasing lethargy, dyspnea, edema - 1year Difficulty walking – weakness & unsteadiness. - 2weekInitially treated with iron tablets.
Differntial Diagnosis: Megaloblastic anemiaPernicious anemiaHypothy. – macro. An.Malignancy, Aplastic, Refractory anemia.GI bleeds,
CPC scenarios:
2014: I.H. 16 year old girl from Bamaga; attending boarding school in Charters Towers Presents to GP: “I’m feeling very short of breath when I play netball”. Accompanied by boarding house teacher (female)
2012: Mrs. IS, 68y old pensioner, rural near Ingham. Husband, a butcher. She is on warfarin for 10y, for atrial fibrillation. HPTN on Aldomet. She feels tired and is pale yellow and gets angina while going for a regular evening walk.
What if “The patient” is a …?• 64y woman (occult GI loss, hypothyroidism, chronic disease)• 40y woman (mennorhagia)• 40y man (occult malignancy, haematological malignancy)• 65y man with Stage 4 renal failure (discuss renal anaemia)• 74y man with no PMH of note (B12 def., occult GI malignancy)
CPC2.1: Tired woman: Lab results:
1. Where is the primary pathology (diagnosis?)2. What psychiatric symptoms in Vit B12 deficiency? 3. FBC in AHA, MBA, IDA, ACD, Acute / Chronic blood loss?
“Success is going from failure to failure without loss of enthusiasm” !
– Winston Churchill
CPC 2.1: RBC disorders2014 Term 2 CPC 1
Title: Haematopoetic 1/2 Anaemia
System: Haematopoietic system Aim: To educate students in:
Clinical, pathological & population studies of patients with anaemia (RBC disorders)
Objectives:
1. Demonstrate competency in history taking & clinical examination of patients with anaemia and related illnesses.
2. Describe the pathophysiology of the acute anaemic process and the common causes and important other rare causes of anaemia, particularly in the tropics and Indigenous populations.
3. Outline the basic sciences relating to bone marrow, red blood cell production and turnover of iron, routine blood test parameters, measurement of iron stores, and precursors important for red cell production.
4. Demonstrate an understanding of the complications of anaemia and anaemia as a presentation for other pathologies and as an illness in itself.
MB2:HRM: Week 2&3 RBC
Learning Objectives: Diseases of RBC
Anaemia: Overview, Classification, pathogenesis, diagnosis, clinical features & complications.
Study TOP 10 ANEMIAMajor (detailed)
1. Iron Deficiency anemia.2. Megaloblastic anemia.3. Imm. Hemolytic (Warm/Cold)4. Anemia of Chronic Disease.5. Aplastic Anemia
Minor (brief note)6. Myelodysplastic/Refractory An7. Sickle Cell Anemia8. Thalassemia syndromes.9. G6PD deficiency anemia.10. Hereditary Spherocytosis.
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
CLINICAL PATHOLOGYThe foundation of Clinical Medicine.
Shashidhar Venkatesh MurthyA/Prof & Head of Pathology
College of Medicine & Dentistry
RBC & Anemia: Pathophysiology
Normal RBC
RBC Histogram
8 μ8 μ
Capillary 5-10 μOnly healthy elastic RBC can squeeze through capillary.
L8 μ
Band
N
12-14μ
Reticulocyte(immature)MCV >100
Retic.Persisting RNA
Definition of Anemia:
“Anemia is decreased red cell mass affecting tissue oxygenation”
Diagnosed using Hematocrit or Hb. levels (Low Hb* or Low HCT)
Types: Decreased production – Deficiency anemia. Increased loss/destruction – Hemolytic anemia.
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Pathogenetic Classification of Anemia: Decreased Production: Nutrient Deficiency.
Iron def (IDA) / Megaloblastic (MBA) Hemopoietic cell defect:
Anemia of chronic disorders (ACD) Aplastic anemia (AA). Dysplastic anemia. Myelodysplastic Syndromes
Increased loss / destruction: Blood loss anemia – Acute / Chronic - bleeding. Hemolytic anemia – Congenital / Acquired.
Acquired / External injury. Immune AIHA (Warm/Cold) Mechanical, Drugs & Parasites
Congenital / Internal RBC defect Defective Membrane (Spherocytic an) Defective Hemoglobin (Sickle cell an.) Deficient Enzyme (G6PD)
2
2
2
•Cell Mem•Hb.•Enzymes
Top 6 Anemias:1. Iron Def. A2. Megaloblastic3. Anem. Of Chronic Dis.4. Aplastic An.5. Immune Hemolytic – Warm6. Immune Hemolytic - Cold
RBC development:
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Bone Marrow
MCV90
MCV110
Proerythroblast(Pronormoblast)
BasophilicNormoblast
PolychromatophilicNormoblast
OrthochromatophilicNormoblast
Reticulocyte
Erythrocyte
BLAST Early Intermediate Late Retic. RBC
Anemia Pathogenesis:
DNA: B12, Folate
Hb: Iron Iron Metabolism: “limited”,10%, Recycle, Ferritin, Transferrin, Hepcidin, forms Hb in cytoplasm.
Megaloblastic anemia
Iron Deficiency anemia
Hemolytic anemiaImmuneMechanicalInfectionDrugsDefective*
Aplastic anemia Dysplastic anemia
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