SlideShare una empresa de Scribd logo
1 de 55
Hemolysis and Hemolytic Anemias Dr. Sabir
Hemolytic Anemias-Introduction ,[object Object],[object Object],[object Object]
General Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hemolytic Anemias - Classification Schemes ,[object Object],[object Object],[object Object]
Hemolytic Anemias -  Sites of Red Cell Destruction ,[object Object],[object Object],[object Object],[object Object]
Laboratory Evidence for Presence of Hemolysis ,[object Object],[object Object]
Evidence for increased red cell production ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Polychromatophilic cell  on Wright-Giemsa staining Reticulocytes (supravital staining)
Erythroid Hyperplasia ,[object Object],[object Object],[object Object]
Frontal Bossing Results from increased erythropoietic activity and marrow space expansion
Evidence for Increased Red Cell Destruction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Biochemical consequences of hemolysis in general ,[object Object],[object Object],[object Object],[object Object]
Biochemical Consequences of  Intravascular  Hemolysis ,[object Object],[object Object],[object Object],[object Object]
Hemolytic Anemias - Classification by Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Congenital Hemolytic Anemias- Membrane Defects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hereditary Spherocytosis ,[object Object],[object Object]
Hereditary Spherocytosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HEREDITARY SPHEROCYTOSIS Osmotic Fragility
Osmotic Fragility Normal Abnormal- HS cells lyse more readily at low ionic strength
Congenital Hemolytic Anemias Enzyme Defects
Red Cell Enzyme Defects ,[object Object],[object Object],[object Object]
RBC Metabolism Simplified  Glucose Anaerobic glycolysis Aerobic metabolism Glucose-6-P G6PD ,[object Object],[object Object],F-6-P
G6PD Deficiency Pathophysiology ,[object Object],[object Object],[object Object]
G6PD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
G6PD Deficiency  Agents to avoid ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Blister cell
Favism ,[object Object],[object Object],[object Object]
G6PD Deficiency Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Congenital Hemolytic Anemias Hemoglobinopathies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acquired Hemolytic Anemias Immune-Mediated Hemolysis
Pathophysiology ,[object Object],[object Object],[object Object]
Immune hemolytic anemias - Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Auto-Immune Hemolytic Anemias ,[object Object],[object Object],[object Object],[object Object]
Coomb’s Test ,[object Object],[object Object]
Direct Coomb’s Test Patient’s RBCs coated with IgG or C3 Antibodies to human IgG/C3 (Coomb’s reagent) Agglutinationin the test tube
Indirect Coomb’s Test Agglutinationin the test tube Patient serum containing anti RBC Abs Normal RBCs and Coomb’s reagent
Warm-Antibody Hemolytic Anemias ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spherocyte Formation Progressive loss of membrane, loss of surface area, more spherocytic shape
Warm-Antibody Hemolytic Anemias Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Warm Autoimmune Hemolytic Anemia - spherocytes
Warm-Antibody Hemolytic Anemias Treatment ,[object Object],[object Object]
Warm-Antibody Hemolytic Anemias Immunosuppressive Treatment ,[object Object],[object Object],[object Object],[object Object]
Cold Agglutinin Disease ,[object Object],[object Object],[object Object]
Cold Agglutinin Disease ,[object Object],[object Object],[object Object]
Digital ischemia from cold-agglutinin disease
Cold Agglutinin Disease Clinical features ,[object Object],[object Object],[object Object],[object Object],[object Object]
Paroxysmal Nocturnal Hemoglobinuria ,[object Object],[object Object],[object Object],[object Object]
Paroxysmal Nocturnal Hemoglobinuria - Clinical features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Non-Immune Hemolytic Anemia Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Microangiopathic Hemolytic Anemias ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MAHA - Schistocytes
Macroangiopathic Hemolytic Anemias ,[object Object],[object Object],[object Object],[object Object]
March Hemoglobinuria ,[object Object],[object Object],[object Object]
Hemolysis from Infections ,[object Object],[object Object],[object Object],[object Object]
Hemolysis Associated with Chemical and Physical Agents ,[object Object],[object Object],[object Object],[object Object],[object Object]

Más contenido relacionado

La actualidad más candente (20)

Acute leukemias
Acute leukemiasAcute leukemias
Acute leukemias
 
Von willebrand's disease
Von willebrand's diseaseVon willebrand's disease
Von willebrand's disease
 
Aplastic anemia
Aplastic anemiaAplastic anemia
Aplastic anemia
 
Megaloblastic anemia
Megaloblastic anemiaMegaloblastic anemia
Megaloblastic anemia
 
Acquired hemolytic anemia
Acquired hemolytic anemiaAcquired hemolytic anemia
Acquired hemolytic anemia
 
Myeloproliferative disorders
Myeloproliferative disordersMyeloproliferative disorders
Myeloproliferative disorders
 
Macrocytic anemia
Macrocytic anemiaMacrocytic anemia
Macrocytic anemia
 
Megaloblastic anemia
Megaloblastic anemiaMegaloblastic anemia
Megaloblastic anemia
 
Pernicious Anemia
Pernicious  AnemiaPernicious  Anemia
Pernicious Anemia
 
pathology of Anemia
pathology of Anemia pathology of Anemia
pathology of Anemia
 
Iron deficiency anemia pathogenesis and lab diagnosis
Iron deficiency anemia  pathogenesis and lab diagnosisIron deficiency anemia  pathogenesis and lab diagnosis
Iron deficiency anemia pathogenesis and lab diagnosis
 
Haemolytic anemia
Haemolytic anemia Haemolytic anemia
Haemolytic anemia
 
Haemolytic anaemias
Haemolytic anaemiasHaemolytic anaemias
Haemolytic anaemias
 
Von Willebrand Disease
Von Willebrand DiseaseVon Willebrand Disease
Von Willebrand Disease
 
Hereditary spherocytosis
Hereditary spherocytosisHereditary spherocytosis
Hereditary spherocytosis
 
AMYLOIDOSIS
AMYLOIDOSISAMYLOIDOSIS
AMYLOIDOSIS
 
Hemolytic anemia
Hemolytic anemiaHemolytic anemia
Hemolytic anemia
 
Anaemia pathology ppt
Anaemia pathology pptAnaemia pathology ppt
Anaemia pathology ppt
 
sideroblastic anemia
sideroblastic anemiasideroblastic anemia
sideroblastic anemia
 
Pancytopenia
PancytopeniaPancytopenia
Pancytopenia
 

Similar a Medicine 5th year, 8th lecture/part one (Dr. Sabir)

ANEMIA HEMOLITICA-INDIA.ppt
ANEMIA HEMOLITICA-INDIA.pptANEMIA HEMOLITICA-INDIA.ppt
ANEMIA HEMOLITICA-INDIA.pptRuben Silva Ames
 
Hemolytic anemia
Hemolytic anemiaHemolytic anemia
Hemolytic anemiaFatima Avci
 
hemolytic anemia (cell membrane defect)
hemolytic anemia (cell membrane defect)hemolytic anemia (cell membrane defect)
hemolytic anemia (cell membrane defect)Afrina Qureshi
 
Child with pallor & jaundice (hemolytic anemia)
Child with pallor & jaundice (hemolytic anemia)Child with pallor & jaundice (hemolytic anemia)
Child with pallor & jaundice (hemolytic anemia)Safia Sky
 
Hemolytic anemia (1)
Hemolytic anemia (1)Hemolytic anemia (1)
Hemolytic anemia (1)vvyvi
 
Hemolytic Anemia Investigation - By Mohan kumar
Hemolytic Anemia Investigation - By Mohan kumarHemolytic Anemia Investigation - By Mohan kumar
Hemolytic Anemia Investigation - By Mohan kumarSchin Dler
 
Approach to Autoimmune hemolytic anemia
Approach to Autoimmune hemolytic anemiaApproach to Autoimmune hemolytic anemia
Approach to Autoimmune hemolytic anemiaKumar Abhinav
 
PLASMA PROTEINS
PLASMA PROTEINSPLASMA PROTEINS
PLASMA PROTEINSYESANNA
 
7 Anemia full lecture notes for preparing exam
7 Anemia full lecture notes for preparing exam7 Anemia full lecture notes for preparing exam
7 Anemia full lecture notes for preparing examRAFIULLAHRAFI14
 
5thsembloodtransfusion
5thsembloodtransfusion5thsembloodtransfusion
5thsembloodtransfusionTanuj Bhatia
 
Approach to a patient with hemolytic anaemia
Approach to a patient with hemolytic anaemiaApproach to a patient with hemolytic anaemia
Approach to a patient with hemolytic anaemiasunil bhatt
 
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore KashmirAnaemias By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore KashmirProf Dr Bashir Ahmed Dar
 

Similar a Medicine 5th year, 8th lecture/part one (Dr. Sabir) (20)

ANEMIA HEMOLITICA-INDIA.ppt
ANEMIA HEMOLITICA-INDIA.pptANEMIA HEMOLITICA-INDIA.ppt
ANEMIA HEMOLITICA-INDIA.ppt
 
Hemolytic anemia
Hemolytic anemiaHemolytic anemia
Hemolytic anemia
 
Haemolytic disorders
Haemolytic disordersHaemolytic disorders
Haemolytic disorders
 
Hemolytic anemia
Hemolytic anemiaHemolytic anemia
Hemolytic anemia
 
hemolytic anemia (cell membrane defect)
hemolytic anemia (cell membrane defect)hemolytic anemia (cell membrane defect)
hemolytic anemia (cell membrane defect)
 
Child with pallor & jaundice (hemolytic anemia)
Child with pallor & jaundice (hemolytic anemia)Child with pallor & jaundice (hemolytic anemia)
Child with pallor & jaundice (hemolytic anemia)
 
Hemolytic anemia (1)
Hemolytic anemia (1)Hemolytic anemia (1)
Hemolytic anemia (1)
 
Hemolytic Anemia Investigation - By Mohan kumar
Hemolytic Anemia Investigation - By Mohan kumarHemolytic Anemia Investigation - By Mohan kumar
Hemolytic Anemia Investigation - By Mohan kumar
 
Approach to Autoimmune hemolytic anemia
Approach to Autoimmune hemolytic anemiaApproach to Autoimmune hemolytic anemia
Approach to Autoimmune hemolytic anemia
 
Haematology notes
Haematology notesHaematology notes
Haematology notes
 
G6PD disease.pptx
G6PD disease.pptxG6PD disease.pptx
G6PD disease.pptx
 
PLASMA PROTEINS
PLASMA PROTEINSPLASMA PROTEINS
PLASMA PROTEINS
 
Anaemia
AnaemiaAnaemia
Anaemia
 
AIHA -Autoimmune Haemolytic Anaemias
AIHA -Autoimmune Haemolytic AnaemiasAIHA -Autoimmune Haemolytic Anaemias
AIHA -Autoimmune Haemolytic Anaemias
 
Hemolytic Anemia
Hemolytic Anemia Hemolytic Anemia
Hemolytic Anemia
 
7 Anemia full lecture notes for preparing exam
7 Anemia full lecture notes for preparing exam7 Anemia full lecture notes for preparing exam
7 Anemia full lecture notes for preparing exam
 
5thsembloodtransfusion
5thsembloodtransfusion5thsembloodtransfusion
5thsembloodtransfusion
 
Approach to a patient with hemolytic anaemia
Approach to a patient with hemolytic anaemiaApproach to a patient with hemolytic anaemia
Approach to a patient with hemolytic anaemia
 
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore KashmirAnaemias By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
 
Anemia And Its Classification
Anemia And Its ClassificationAnemia And Its Classification
Anemia And Its Classification
 

Más de College of Medicine, Sulaymaniyah

Más de College of Medicine, Sulaymaniyah (20)

Pediatrics 6th year, Tutorial (Dr. Tara Husain)
Pediatrics 6th year, Tutorial (Dr. Tara Husain)Pediatrics 6th year, Tutorial (Dr. Tara Husain)
Pediatrics 6th year, Tutorial (Dr. Tara Husain)
 
Pediatrics 6th year, Tutorial (Dr. Adnan)
Pediatrics 6th year, Tutorial (Dr. Adnan)Pediatrics 6th year, Tutorial (Dr. Adnan)
Pediatrics 6th year, Tutorial (Dr. Adnan)
 
Tubes, Suture Materials, IV Fluids photos
Tubes, Suture Materials, IV Fluids photosTubes, Suture Materials, IV Fluids photos
Tubes, Suture Materials, IV Fluids photos
 
Surgery 6th year, Tutorial (Dr. Aram Baram)
Surgery 6th year, Tutorial (Dr. Aram Baram)Surgery 6th year, Tutorial (Dr. Aram Baram)
Surgery 6th year, Tutorial (Dr. Aram Baram)
 
Surgery 6th year, Tutorial (Dr. Aram Baram)
Surgery 6th year, Tutorial (Dr. Aram Baram)Surgery 6th year, Tutorial (Dr. Aram Baram)
Surgery 6th year, Tutorial (Dr. Aram Baram)
 
Surgery 6th year, Tutorial (Dr. Hamid)
Surgery 6th year, Tutorial (Dr. Hamid)Surgery 6th year, Tutorial (Dr. Hamid)
Surgery 6th year, Tutorial (Dr. Hamid)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. Ali A. Nabi)
Surgery 6th year, Tutorial (Dr. Ali A. Nabi)Surgery 6th year, Tutorial (Dr. Ali A. Nabi)
Surgery 6th year, Tutorial (Dr. Ali A. Nabi)
 
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
 
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. Bakhtyar Rasul)
Surgery 6th year, Tutorial (Dr. Bakhtyar Rasul)Surgery 6th year, Tutorial (Dr. Bakhtyar Rasul)
Surgery 6th year, Tutorial (Dr. Bakhtyar Rasul)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
 
Surgery 6th year, Tutorial (Dr. Sarwar Noori)
Surgery 6th year, Tutorial (Dr. Sarwar Noori)Surgery 6th year, Tutorial (Dr. Sarwar Noori)
Surgery 6th year, Tutorial (Dr. Sarwar Noori)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. Bakhtyar Baram)
Surgery 6th year, Tutorial (Dr. Bakhtyar Baram)Surgery 6th year, Tutorial (Dr. Bakhtyar Baram)
Surgery 6th year, Tutorial (Dr. Bakhtyar Baram)
 
Surgery 6th year, Tutorial (Dr. Aso Omar)
Surgery 6th year, Tutorial (Dr. Aso Omar)Surgery 6th year, Tutorial (Dr. Aso Omar)
Surgery 6th year, Tutorial (Dr. Aso Omar)
 

Último

♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...astropune
 
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...Dipal Arora
 
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore EscortsVIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escortsaditipandeya
 
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...narwatsonia7
 
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...Taniya Sharma
 
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...chandars293
 
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...narwatsonia7
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...Arohi Goyal
 
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service AvailableCall Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service AvailableDipal Arora
 
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...narwatsonia7
 
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Dipal Arora
 
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Gwalior Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...parulsinha
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...vidya singh
 
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 

Último (20)

♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
 
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
 
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore EscortsVIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
 
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
 
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
 
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
 
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
 
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service AvailableCall Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 8617370543 Top Class Call Girl Service Available
 
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
 
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
 
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Gwalior Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Gwalior Just Call 9907093804 Top Class Call Girl Service Available
 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
 
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
 
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
 

Medicine 5th year, 8th lecture/part one (Dr. Sabir)