MODULE HEMATOLOGY

EXPERT LECTURE

SUB MODULE 1: ANEMIA

FACULTY OF MEDICINE UNIVERSITY OF BRAWIJAYA MALANG

No. 1 Describe in brief erythropoiesis (red blood cell formation) and morphological red blood cell !

Erythropoiesis (RBC formation)

Notes : BFUE = burst-forming unit erythroid CFUE = colony-forming unit erythroid

Morphology of red blood cell : - The diameter is 8 m able to pass through the microcirculation - The RBC have a biconcave disc shape and flexible - The RBC membrane comprises a lipid bilayer, integral membrane proteins and membrane skeleton - The RBC contain Hb to carry O2 to the tissues and to return CO2 from tissues tu the lungs

No. 2 Describe in brief the etiology & pathophysiology of anemia !

The etiology and pathophysiology of anemia : A. Disorders of effective red blood cell production B. Disorders of increased red blood cell destruction C. Blood loss A. Disorders of effective red blood cell production 1. Marrow failure 2. Impaired erythropoietin 3. Abnormalities of cytoplasmic maturation 4. Abnormalities of nuclear maturation 5. Primary dyserythropoietic anemias 6. Erythropoietic protoporphyria 7. Refractory sideroblastic anemia

B. Disorders of increased red blood cell destruction 1. Defect of hemoglobin 2. Defect of the red cell membrane 3. Defect of red cell metabolism 4. Antibody-mediated 5. Mechanical injury to the erythrocyte 6. Thermal injury to the erythrocyte 7. Oxidant-induced red cell injury 8. Infectious agent-induced red cell injury 9. Paroxysmal nocturnal hemoglobinuria 10. Plasma-lipid-induced abnormalities of the RBC membrane C. Blood loss 1. Acute 2. Chronic

No. 3 Describe clinical features and laboratory findings to diagnosis the etiology of anemia !

A. Clinical features : I. Symptoms : - shortness of breath particularly on exercise - weakness - lethargy - palpitation - headaches

II. General signs : - pallor of mucous membrane (if Hb level < 9-10 g/dl) - hyperdynamic circulation : tachycardia, a bounding pulse, cardiomegaly, and a systolic flow murmur especially at the apex - congestive heart failure (in elderly patient) - retinal hemorrhages (unsual sign)

III.

Specific signs are associated with particular types of anemia : - koilonychia/spoon nails (iron deficiency anemia) - jaundice (hemolytic or megaloblastic anemias) - bone deformities (thalassemia major and other severe congenital hemolytic anemias)

B. Laboratory findings : I. Complete blood count (CBC) 1. RBC count : Hb, hematocrit, reticulocyte count 2. RBC indices : MCV, MCH, MCHC, RDW 3. WBC count : cell differential, neuclear segmentation of neutrophils 4. Platelet count 5. Blood film can assess cell morphology : cell size, Hb content, anisocytosis, poikilocytosis, polychromasia II. Iron suplly studies 1. Serum iron (SI) 2. Total iron binding capacity (TIBC) 3. Serum ferritin III. Marrow examination 1. Aspirate 2. Biopsy

No. 4 Describe practical algorithms of anemia !

Algorithms of anemia

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