Introduction and Anemia 2007
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Introduction and Anemia 2007
![An Introduction ,[object Object],[object Object],[object Object],Gary Allegretta, MD](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Introduction and Anemia 2007
- 1. UNE HEMATOLOGY SECTION CLINICAL PEDIATRIC HEMATOLOGY December, 2008
- 4. The Evaluation Process Understand the System Where is it Broken? How is it Broken? Infection Toxic Trauma Metabolic Neoplastic Congenital Endocrine Immune Example
- 6. CTZ Cortical Other CNS Vagal GI Infection - Abscess Meningitis UTI Salmonella Toxic Chemo Mercury Lead - Pizza Trauma - CHI Subdural Chest Abdomen Metabolic - - DKA - Thyroid Neoplastic - Metastasis ICP; Mets Bladder Mass Obstruction Congenital - Anxiety Chiari - Dysmotility Endocrine - Thyroid Addison ’ s - Diabetes Immune - ADEM ADEM - IBD
- 7. RBC DEVELOPMENT [OxyHgb] & O 2 Delivery EPO RBC #
- 9. UNDERSTANDING THE SYSTEM -- IT ALL STARTS HERE
- 10. Marrow Components Microenvironment Red Cells Leukocytes Platelets
- 12. Cells of the Microenvironment Foam Cell – Fat-laden Macrophage Osteoblast Normal Macrophage
- 13. Cellular Development Deliver O 2 Clotting Infection Allergy & Infection
- 14. Hematopoietic Growth Factors Factor Age of Onset Production Site Target Cells Medication EPO 1 st & 2nd Trimester Liver Kidney CFU-E Epogen G-CSF 24 weeks Environment Cells CFU-G + GMM; Polys Neupogen GM-CSF 24 weeks Environment Cells Myeloid, Mono, RBC Leukine SCF 24 weeks Environment Cells Myeloid, Mono, RBC, Mast Cells -- IL-3 T-Cells Broad -- IL-11 Environment Cells Mature Platelets Neumega Thrombopoietin (TPO) Liver~platelet count All Platelets --
- 15. RBC FUNCTION [OxyHgb] & O 2 Delivery EPO
- 19. Globin Formation The Hemoglobin Tetramer
- 20. IRON PROCESSING Iron Processing Factors That Modify Iron Absorption Copper Development Fe Deficiency
- 22. Hemoglobin Function Hgb-Oxygen Dissociation Curve % O 2 Saturation Lung & Circulation Tissues Fetal Hgb High Altitude
- 25. Red Blood Cells - Shape
- 26. Normal vs. Sickle red cells
- 28. RBC MEMBRANE INTEGRITY RBC Membrane
- 29. RBC HYDRATION NEEDS RBC Cation Transporters
- 33. Bilirubin Metabolism Intravascular Extravascular Free Hgb + Haptoglobin Fe + Transferrin Free Hgb Red cells contain SGOT & LDH All Fe is recycled
- 35. Newborn Blood Values Age Hgb g/dl Hct% MCV Retic WBC Plts EPO Term 14.5-22.5 48-69 95-121 0.4-6 9-30 84-478 35.6 mU/ml 3 days Same 44-72 Gradual Change Gradual Change 150-400 2 weeks Gradual Change Gradual Change 1-1.2 No Change 1 month 1-2.4 5-19 2 months 9-14 28-42 0.1-2.9 Gradual Change 11.5 mU/ml 6 months 70-86 0.1-1.3 18.8 mU/ml
- 36. Fetal Marrow Development Primitive megaloblastic blood formation starts at 18th day - recurs with illness
- 37. Kleihauer-Betke Smear Adult (Maternal) RBC Fetal type RBC Acid removes adult hemoglobin, but not fetal hemoglobin
- 42. Hgb Chain Production Gestational Age 0 3 6 Birth 3 ß- Adult γ- Fetal (high O 2 affinity) є- Embryonic ά- Adult
- 43. Fetal Hemoglobin Oxygenated placental blood Lower extremity blood Fetal Brain Perfusion
- 44. Fetal Circulation Prenatal Fetal Circulation Video Postnatal
- 47. Severe anemia - Parvovirus
- 48. Blood Vessel Vascular Wall Cardiac Compensation to Hypoxia Hypoxia: Damaged RBC; Less RBC; Less Oxygen Delivery O 2
- 50. Pleural Effusion Normal Lung Cardiomegaly Hydrops Fetalis Radiograph
- 51. Infant with Hydrops Fetalis
- 52. Malignancy until proven otherwise after first week of life Leukoerythroblastic Blood Smear
- 57. Normal Infant Hgb Values Lower Normal - Term Lower Normal - Preterm
- 79. Evaluating an Anemia Destruction Production Loss Immune Not Immune GI Marrow Disease Marrow Invasion
- 80. Increased Destruction Immune Not Immune ABO Rh AIHA EBV SLE Intrinsic Extrinsic Enzyme Membrane HGB DIC & Sepsis Burns & Heat Toxins Heart Valve
- 81. Decreased Production Marrow Disease Marrow Invasion Nutritional Iron; Copper; Folate Metabolic Thyroid; B-12; Failure Aplastic Anemia Myelodysplasia Infection Congenital Fanconi; BFD Malignant Leukemia Neuroblastoma Lymphoma Solid Tumor Non-Malignant Histiocytosis Storage Disease
- 84. Glossitis
- 85. Angular Chelitis
- 86. Koilonychia
- 102. Basophilic Stippling
- 112. Osmotic Fragility [NaCl] % Lysis % Lysis 1.0% NS (plasma) 0 0 .75% NS 10 20 .50% NS 30 60 .25% NS 70 90 .00% NS (water) 100 100 • Normal •HS
- 123. Case Studies
- 125. Blood Smear
- 128. High Power Low Power
- 130. Management Options Dx: Fe Deficiency Consider Hospitalization Rx: Fe, 3-6 mg/kg/day Folate, 1 mg/day Retic in 3 Day Hgb in 1 Week ? Transfusion Continue Fe & Folate X 3 mos
- 138. Break Time! Grazing Horse, Freeport
- 139. Bilirubin Metabolism Intravascular Extravascular Free Hgb + Haptoglobin Fe + Transferrin Free Hgb Red cells contain SGOT & LDH All Fe is recycled
- 141. Blood Smear Normal