Diseases Of The Blood

Transcription

1 Diseases Of The Blood DR. Associate Professor Of Pathology Faculty Of Medicine Ain Shams University

2 Red Blood Cells and Anemia

3 RBC=4-6 million/mm 2 Hb=12-18 g/dl Oxygen Carrying Molecule Hemoglobin Tetramer: 2 alpha chains and two beta chains ( 2 2 ) attached to Heme pocket Heme: protoporphyrin ring and iron

4 Anemia Reduction in Oxygen Carrying Capacity of Blood Reduction in RBCS &/or haemoglobin/unit volume of blood with low or normal blood volume Not enough production by Bone Marrow Too much peripheral destruction

5 PATHOLOGY, SYMPTOMS, AND SIGNS OF ANEMIA

6 Classification of Anemia 1. Deficiency anaemia 2. Bone Marrow hypofunction anaemia 3. Acute post Haemmorhagic anaemia 4. Haemolytic anaemia d.t: RBC destruction Hereditary (Intra corpuscular defect) Acquired (Extra corpuscular defect)

7 Classification of Anemia Microcytic iron deficiency anemia thalassemia Macrocytic Megaloblastic anemia Normocytic Anemia of chronic disease Blood loss BM failure Haemorrhagic anemia

8 Iron Deficiency Anemia

9 Plummer- Vinson syndrome Middle aged women with iron deficiency anaemia 1. Glossitis 2. Atrophy of filiform papillae of the tongue 3. Atrophy of pharyngeal mucosa & dysphagia. 4. Stomatitis 5. Post-cricoid carcinoma

10 Megaloblastic Anemia

11 POLYCYTHEMIA Polycythemia is the increased number of RBCs/unit volume of blood in the presence of increased blood volume. POLYCYTHEMIA rubra vera (Primary) bone marrow neoplasm POLYCYTHEMIA (Secondary) 1. Hypoxia: as in high 2. Renal disease: due to secretion of an erythropoietin-like substance.

12 Polycythemia rubra Vera All cell lines increased, NOT just RBC The red blood cell 10 million/mm 2 The Hb percentage is increased Leucocytosis (increased number of leucocytes) Thrombocytosis (increased number of platelets).

13 White Blood Cells and Leukaemia

14 Neutrophilia Suppuration Infection Intoxications as lead poisoning. Metabolic disorders as diabetic ketosis, uremia. Bone marrow neoplasia as polycythemia vera. After acute haemorrhage. Anaphylactoid shock.

15 Neutropenia 1. Infections as typhoid, tuberculosis, influenza, malaria. 2. Intoxications as benzene. 3. Hypersplenism. 4. Aplasia of bone marrow.. 5. Anaphylactic shock 6. Radiation.

16 Lymphocytosis a- Certain acute infections as whooping cough, chronic infections as tuberculosis and syphilis. b- Infectious mononucleosis (EBV). c- Infections in children. Eosinophilia: a- Parasite. Monocytosis: tuberculosis severe suppuration b- Allergy. malaria leukaemia.

17 Causes: 1. Viruses. 2. Chemical agents as benzene. 3. Ionizing radiation. 4. Chromosomal abnormalities. Leukaemia Definition: malignant proliferation of WBC s in bone marrow. count + immature cells. aleukaemic leukemia: normal count + immature forms in the peripheral blood.

18 Classification: 1. Acute leukaemia 2. Chronic leukaemia Total WBC: 4,500-10,000/mm 2

19 Acute leukaemia: young children rapid and fulminating course. 1. high remittent fever 2. necrosis in mouth and throat 3. rapid anaemia 4. bleeding 5. enlargement of lymph nodes, HSM. Haematological findings: WBC s 100,000/mm 2. Mostly: immature (blast cells) Marked normocytic, normochromic anaemia. Thrombocytopenia.

20 Chronic Myeloid Leuk. "CML" Chronic Lymphocytic leuk. "CLL" 1- Incidence Common Less common. 2- Age yr yr. 3- Haematologic finding. a- WBC's up to /mm 2 - Neutrophils (myelocytic series) - eosinophils, basophils + their precusor /mm 2 - lymphocytes - lymphoblasts - Late absolute leucocytic b- Normocytic Normochromic anaemia d.t haemolysis or inadequacy of Bone marrow. c- Thrombocytopenia. d- Bone marrow hypercellular +blasts 4- Fate : Rapidly fatal. Slow course 5- Death d.t: Acute exacerbation Intercurrent infection

21 Chronic Myeloid Leuk "CML" a) Lymph nodes: Late. b) Spleen : Marked enlargement dark + infarction Mic : Atrophic lymphoid follicles. Leukemic infiltrate in red pulp. Myeloid metaplasia. 6- Pathological Findings: Chronic Lymphocytic leuk. "CLL" a) Lymph nodes: Marked GLA+ diffuse infiltration by lymphocytes b) Spleen: slightly enlarged hyperplasia lymphoid follicle. c) Liver : enlarged. d) Haemorrhages : d.t thrombocytopenia. e) Anaemia + fatty change of parenchymatous organs. f) Secondary bacterial infection. g) Skin & mucous membranes : nodules (leukaemic deposits).

22 GOOD LUCK