Blood Disorders 1 PDF

 Blood disorders 1 Subtypes: - Red Cell Disorders (anemia, polycythemia) -White Cell Disorders (neoplastic and nonneoplastic) -Bleeding disorders (thrombocytopenia and coagulation) Red Cell Disorders Anemia *it’s is a sign of an underlying disease, not a disease itself...

 Blood disorders 1 Subtypes: - Red Cell Disorders (anemia, polycythemia) -White Cell Disorders (neoplastic and nonneoplastic) -Bleeding disorders (thrombocytopenia and coagulation) Red Cell Disorders Anemia *it’s is a sign of an underlying disease, not a disease itself ** ‫الجدول مطلوب‬ - Reduction in the oxygen-transporting capacity of blood, Anemia and erythropoietin: resulting from adecrease in the red cell mass, resulting in Hypoxia triggers increased erythropoietin (secreted tissue hypoxia. from the kidney). -(How to measure anemia? By complete blood count Compensatory erythroid hyperplasia in BM. (CBC) which will provide us with indices as Hct and Hg) In acute bleeding or hemolysis in healthy patient, Can be classified through (1-cause): increased production of red cells 5x to 8x. - Bleeding (blood loss). Increased numbers of newly formed red cells - Increased red cell destruction (hemolytic anemias) (reticulocytosis). - Decreased red cell production. In severe cases of anemia, EPO induces the production of extramedullary (outside bone marrow BM) hematopoiesis (liver, spleen, and lymph nodes). Exceptions (anemia of renal failure and chronic inflammation) -->So patient must be healthy to produce erythropoietin. Variation of size and shape of RBC. Higher RDW → high variation → disorder -Notice that female indices are less due to menstrual blood loss *‫*ا"رقام مش مطلوبة‬  RBC indices: Other blood tests to evaluate anemia - Hematocrit: percentage of RBCs in blood - MCV: average volume per RBC, in femtoliters (cubic What determines what tests I'm going to do for any patient who has anemia? 1. what the differential diagnosis is (micro?, macro?, normo? Cytic) microns) 2. associated foundings (ex: patients age) - MCH: average mass of hemoglobin per RBC, in -Microcytic anemia: Serum iron indices (iron levels, iron- picograms. binding capacity, transferrin saturation(iron is bonded to - MCHC: average concentration of hemoglobin in a transferrin) and ferritin concentrations-->Give us an idea given volume of packed RBCs, in grams per deciliter about iron storage) - RDW: variation of RBC volume. - Hemolytic anemia ( Plasma unconjugated bilirubin , - Reticulocytes: Aregenerative anemia haptoglobin -->carrier of free hemoglobin, and lactate dehydrogenase levels ). (reticulocytopenia number), hemolytic anemia - Megaloblastic anemia: (folate and vitamin B12 (reticulocytosis number). concentrations) - Indices are measured quantitatively or on blood film. - Abnormal hemoglobin (hemoglobin electrophoresis) Peripheral blood film RBCs We take a blood sample and swipe it (ex: sickled hemoglobin) on a slide, then we check this slide under the microscope, this gives us an Clinical Manifestations idea about RBCs, WBCs and platelets number, shape and size Lymphocyte Neutrophil. Type your text RBC palor Acute: shortness of breath, organ failure, shock (hypovolemic shock) ---> due to the blood loss. - Adaptive changes with slow onset anemia: RBC (no nucleus) a. Increased heart rate (tachycardia) b. Increased respiratory rate (tachypnea). Classification of anemia (2-morphology of c.Symptoms worse with pulmonary or cardiac disease. RBCs) Can be seen in peripheral blood smear Chronic -Size: reflected by MCV (normo, micro, macrocytic) - Pallor, fatigue. - Color: reflected by MCH (normo, hypochromic) ‫نسجة‬4‫ قليل ل‬O2 ‫بتعب بسرعة )نه توصيل‬ -With hemolysis: jaundice and gallstones - Shape: reflected by RDW (aniso-poikelocytosis: - With ineffective erythropoiesis (premature death of spherocytes, sickle, schistiocytes) Anisocytosis ---> variation in size. marrow erythroid progenitors) >> increase iron absorption Poikelocytosis ---> variation in shape. from gut >> iron overload, heart and endocrine failure (secondary hemochromatosis) (Accumulation of iron in the body) Morphology: -Microcytic: impaired Hg synthesis (iron deficiency, - If severe and congenital (thalassemia and sickle cell thalassemia) anemia): growth retardation, short stature,bone - Macrocytic: impaired maturation (folate or vitamin B12 deformities due to reactive marrow hyperplasia deficiency) Specially DNA maturation - Extramedullary hematopoiesis (splenomegaly, - Normocytic but with abnormal shapes (hereditary hepatomegaly) (increase in size for both) spherocytosis, sickle cell disease) Jaundice and gallstones with hemolytic anemia Chronic blood loss - Gastrointestinal bleeding (ulcer, hemorrhoids, cancer) and menstruation. - Iron stores are gradually depleted. Patient adapts-->tachycardia,fatigue,pallor - Iron deficiency leads to a chronic anemia of Skeletal deformities and cardiac hemochromatosis underproduction. - Microcytic, hypochromic, with low reticulocytes. Reticulocyte count is low because there is no iron and there is no increase in RBCs proliferation in bone marrow. Skeletal abnormalities, abnormal Due to the deposition ofiron, the heart shape of facial bones seems more brownish ANEMIA OF BLOOD LOSS: HEMORRHAGE (acute and chronic) Acute bleeding What we care about the most is Hypovolemic shock=cardiovascular collapse Death her is associated with the organic shock not anemia. - Massive loss of intravascular volume, leads to cardiovascular collapse, shock and death. - If blood loss exceeds 20% of blood volume, the immediate threat is hypovolemic shock rather than anemia. - Hemodilution achieves full effect 2 to 3 days (dilutional anemia) - Normocytic normochromic anemia with reticulocytosis( (due to induction of BM to produce more RBCs).). - Compensatory rise in erythropoietin level >>increased red cell production (5 to 7 days)after that hemoglobin return to its normal state..