13. www.freelivedoctor.com Blood Loss Acute: trauma Chronic: lesions of gastrointestinal tract, gynecologic disturbances. The features of chronic blood loss anemia are the same as iron deficiency anemia, and is defined as a situation in which the production cannot keep up with the loss
35. www.freelivedoctor.com Decreased intake Inadequate diet, vegetarianism Impaired absorption Intrinsic factor deficiency Pernicious anemia Gastrectomy Malabsorption states Diffuse intestinal disease, e.g., lymphoma, systemic sclerosis Ileal resection, ileitis Competitive parasitic uptake Fish tapeworm infestation Bacterial overgrowth in blind loops and diverticula of bowel Increased requirement Pregnancy, hyperthyroidism, disseminated cancer
36.
37. Please remember that ALL megaloblastic anemias are also MACROCYTIC (MCV>94 or MCV~100), and that not only are the RBC’s BIG, but so are the neutrophils, and neutrophilic precursors in the bone marrow too, and even more so, HYPERSEGMENTED!!! www.freelivedoctor.com
Classical RBC’s and platelets, as in in the lab or your office with WRIGHT’s stain.
Classical features of peripheral white cells
Bone marrow biopsy stained with H&E (left), and smear stained with Giemsa (right). BOTH have special advantages!
This is a very intense slide, you may have to write a lot of stuff down and listen well!
This is also a very INTENSE slide!
Platelet analogy.
Note lack of a central pallor and a microcytosis, i.e., low MCV
G6PD converts glucose-6-phosphate into 6-phosphoglucono-δ-lactone and is the rate-limiting enzyme of the pentose phosphate pathway .
Heinz bodies, precipitated hemoglobin are seen quite well on a methylene blue stain.
At first the spleen may be enlarged (left) because of HYPERPLENISM due to hemolysis, later it may infarct itself due to small vessel occlussive disease and be quite small (right), perhaps only 1/10 its normal size.
H= High affinity
PIGA makes GPI, defective PIGA makes defective or inadequate GPI. Why does the term hemoglobinuria imply hemolysis? What does “paroxysmal” mean” Ans: Sudden, UN-controllable
What is the difference between an “agglutinin” and a “hemolysin”? Ans: “-lysis” implies complement fixation
The Coombs is a routine test used in the workup of just about ALL kinds of hemolytic anemias
Anemias of diminished erythropoesis. Doesn’t this just really boil down to three items?
Megaloblasts on top, macrocytes on bottom. What is the difference between a megaloblast and a macrocyte? What is the difference between a megaloblast and an erythroblast?
This is the HARD way to remember megaloblastic anemias
This is the EASY way
A great diagram of the iron cycle. Know what heme, transferrin, ferritin, and hemosiderin are in the iron cycle
Relate hypochromia, microcytosis, anisocytosis to the Wintrobe indices: Ans: MCHC, MCV, RDW, respectively
Most are hypochromic (low MCHC), and microcytic (low MCV) like Fe deficiency anemias but have NORMAL iron stores (i.e., hemosiderin).
Fanconi syndrome and Fanconi anemia are two completely different disorders, but named after the same guy, even though the “syndrome was NOT described by him. Fanconi’s Anemia is characterized by short stature , skeletal anomalies, increased incidence of solid tumors and leukemias, bone marrow failure ( aplastic anemia ), and cellular sensitivity to DNA damaging agents such as mitomycin C . If you understand the cell differentiation concept, why would an aplastic anemia be less likely to involve lymphocytes?
The NORMAL adult RED bone marrow in the axial skeleton should be about 50% cells and 50% fat. What is this? Perhaps around 90:10?
Does this sound like the usual suspects again?
What do you think the most serious consequence might be for a person with increased RBCs and platelets?
Doesn’t this really boil down to TWO things? 1) Reduced platelet function, and 2) everything else?
Normal platelets, but DAMAGED vessel walls
At what platelet count level does SPONTANEOUS bleeding generally occur? Ans: 20K Platelets normally 150K-300K
Note the last three items are ALL in the same category
At what platelet count level does SPONTANEOUS bleeding generally occur? Ans: 20K Platelets normally 150K-300K
Any thrombocytopenia of increased destruction should have INCREASED megakaryocytes in the marrow! JUST LIKE a hemolytic anemia has an erythroid HYPER-plasia, same principle!
For all practical purposes, the same as Hemophilia A. How to differentiate? Factor assays! Note the AMAZING similarities between Hemophilia A and B
What is a “consumptive” coagulopathy? Ans: the platelets and many clotting factors are “consumed”, i.e., used up!
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