Download - Hematology 3
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“Haematology
item RBCS
Drug induced anemia
Inumerate drug induce anemia
drugs anemia
iron deficiencyiron deficiency anemia
achlorhydria iron absorbtion HCL proton pump inhibitors , H2 blockers ,
iron deficiency
bleeding anticoagulantover dose of anticoagulant hemorrhage iron
deficiency anemia
anemia sideroblasticInhB6 metabolism
B12 & folic acid folic acid drugs absorption methotrexate
and antiepileptic activation sulphonamide
Bone marrow failure antis antibiotic antiepileptic antidiabetic antithyroid
hemolytic anemia G6PD aspirin , antimalarial or sulphonamides
hemolysis
PNH iron parentral
induce autoimmune hemolytic actions alpha methyl dopa amphotercin
B
by themselves can induce autoimmune hemolytic anemia
penicillinHAptinincomplete antigenantigen
antigenimmune systemantigenRBCs
Mention mechanism of anemia in the following disease
Liver cell failure
Leukemia
Renal failure
Drug induced anemia
RBCs
coagulation or homeostasis
Mechanism by which the body stops bleeding Mechanism
bleeding
hemorrhage 3hemorrhage
platlets
BloodVessels
clotting system
BloodVessel
injuryBloodVessel vasoconstriction vasoconstriction
bleeding stasis blood clotting system activated blood vessels
injuryvasoconstriction
1 Local axonal reflex blood vessels nerve supply sympathetic fibers injury
irritationreflex vasoconstriction
2 serotonin
response VCLocal axonal reflex &serotonin
platelets
BoneMarrow megakryocytes megakryocytesplatlets
budding
megakryocytes Platelets nucleas granules alpha and dense
granules
platlets 111011115
which means 5platelets
Platelets
Injury adhesionswall of blood vessels Platelets
receptor Glycoprotein receptorwall VWbrandfactor factor 8
endothelium
step platlet aggregatonsplatelet
proteinGP2b/3a Platelets
fibrin
Coagulation or homeostasis
aggregations A2hromboxaneT Prostaglandin
aspirinantiplatletProstaglandinTXA2
platelets aggregations
step step of secretionsplatelets granulesgranules
contents serotoninVCserotonin
Platelets ADP aggregations
secretions platelet factor 3 activation coagulation factors
retractozyme blood clot wall clot
retractozyme clot
function of platelet
coagulation
coagulation13factor liver not all of them
ca liver 179229711
liver vit knot activated activation
actors FoagulationC ation activ?
blood vessels is lined be endothelium endothelium collagen
collagen endothelium injury endothelium in contact with collagen
collagen activate 1212 activate 11 11activate 7 7activate 11
calcium + Platelets factor 3 & 8
pathway intrinsic
component
pathway athwayxtrinsic pE 93 1193
113tissue factornot present in blood tissues
trauma
extrinsic33
tissue of the body3very rich in tissue factor brain , prostate , placenta
112pathway common pathway
common pathway 11prothrombin to thrombin thrombin fibrinogen into
fibrin fibrinRBCs wbcs and platelet
intrinsic and extrinsic and common pathway
coagulation system anti- coagulation system
balance balamce
coagulation system thrombus extend blood
vessels anti coagulationthrombus
anti coagulationendothelium anti coagulant
1 prostacyclin vasodilatation antagonize vasoconstriction
2 endothelium platelets wall of bv
3 endotheliumactivation intrinsic pathway collagen
0 endotheliumtissue factor inhibitor inhibitionextrinsic pathway
5 endotheliumantithromibn 3 common pathway
endothelium3pathway
6 tPAfibrinolysis
anti coagulant
anti coagulantliver coagulation factors anti coagulant
protein C & SVIT K VIT K liver coagulation factor
anticoagulation factor balance
liver factor activated activated
active active factor injury
Basics
general rules
disease coagulation
1 etiology blood vessels , Platelets or coagulation factors
2 Clinical picture blood vessels or Platelets purpra
petechaie red spots 3, raised color
change red then brown the disappear
color changes
Platelets bv
petechie external hemorrhage , bleeding gums perifollicular hemorrhage
epistaxis, perifollicular hemorrhage hemorrhagehair follicles
cerebral hemorrhage hemorrhage spontenouswithout
trauma anemia Hemorhhage
Anticoagulant system
General Rules
anemia picture disease
coagulation hematomaecchymosis and
petchiea more than 3 ml hematoma ecchymosis raised
external hemorrhage hemotpysis hematuria whatever
internal hemorrhage
coagulation congenital hemophilia Internal hemorrhage
joint hemoarthrosis joint and muscles
hemorrhage congenital
external and internal hemorrhage
hemorrhage trauma congenital hemorrhage
cutting umbilical cord bleeding
supplying baby detected umbilical cord
cp
bv and Platelets hemoptysis and bleeding gum epistaxis bv and Platelets
petechie hematoma overlap clinically
hematologist investigations not cp
Investigations blood vessels , coagulation or platelets or anatomical
ICU
ICU Open hearttube
tube pericardium 011
011
suture medical
complications medical or surgical medical
blood vessels , coagulation or plateletsinvestigations
1 bleeding time
bleeding time
same effect =D
Bleeding bleeding
2- 4 minuits bleeding time prolonged blood vessels or Platelets
blood vessels or Platelets platelet count function abnormal platelet
blood vessels
timebleeding clotting timeclotting time
in 5 – 10 minuits prolonged
coagulation anatomical ,surgical
2 bed side test bleeding time 9 clotting time 7
Platelets blood vessels Platelets bV
11
coagulation coagulation Intrinsic extrinsic common
pt and pttPTT PT PTT ncollage
activate pathway intrinsic collagen activate 12 12activate 11 , 11activate 7 , , 7
activate 1111prothrombin to thrombin thrombin fibrinogen into fibrin
blood clot 30 seconds ptt intrinsic and common
PT PT brain tissue of rabbit
3braintissue factor brain placenta and prostate
activate pathway extrinsic 93 11931111
prothrombin to thrombin thrombin fibrinogen into fibrin blood clot
15 seconds pathway extrinsic and common
clotting time abnormal
clotting ptt PT abnormal extrinsic
PTT abnormal PT normal intrinsic
Abnormalcommon pathway
PTT abnormal PT normal intrinsic ,
intrinsic 122112712test
121111
11test normal deficiency
11mg50 mg PT
INR ratio between PT
PT 1216second brain tissue
rabbit tissue factor variable rabit rabit rabit
brain tissue content
brain tissue tissue
PT 11Tissue PT 10
Tissue variable from one to another 11
10Brain tissue 41
ratio
PT 3216
2012
INR 2
INR 2 2
3INR PT PT control
:D PT2012INR 125=D
PTT Adjust heparin dose heparin PTT 2-3 times
normal PT Anticoagulant
tesathrombin thrombin fibrinogen le fibrin
clot fibrinogen bs
hess capillary fragilty test obsolete
Treatment Bleeding tendency
Avoid trauma , avoid injury
Avoid unnecessary surgeries
Avoid aspirin
blood vessels blood vessels vascular purpra
purpra Platelets vascular purpra and platelet purpra Platelets
vascular purprablood vessels congenital or acquired
congenital
ehler danlos and marfan syndrome congenital weakness in wall of blood
vessels 2typical marfan ehler 2features
herediatary hemorrhagic telengectasia telengectasiablood vessels dilated
blood vessels vasoconstriction in response to trauma
response to trauma is vasoconstriction GIT hemorrhage
Vascular purpra
Acquired
acquired M I
Mechanical hypertension blood vessels
Mesenchymal weakness collagen acquired scurvy vit c deficnecy
scurvy , perifollicular
hemorrhage old age
fast food steroid ttt and cushing
I
Infectionsplague
Inflammation collagen disease SLE
Immunological henoch schonlein purpura
Idiopathicvery common in female
rheumatic fever Henoch schonlein purpura
blood vessels upper airway infection Antibodies
against organism Antibodies antigen immune complex story of
rheumatic fever Rheumatic fever complex heart blood
vessels vasculitis
Rheumatic feverIgG& IgM Henoch schonleinIgA
Rheumatic fever3 Henoch schonlein311it doesn’t take that
long time
Clinical picture blood vessels Purpra petechie 3
color changes buttocks
internal and external hemorrhage cerebral hemorrhage
Internal and external hemorrhage external hemorrhage
GIT D.D of intusseption internal hemorrhage periarticular
hemorrhage joint joint red hot tender arthritis
rheumatic fever
hemorrhage spontenous without trauma
characterstic glomerulonephritis blood vessels glomeruli
nephritic syndrome and renal failure
Henoch schonlein purpura
Investigations Bleeding time
Normal PT,PTT, Platelet count
specific RBCs cast in urine
Treatment’ corticosteroids
blood vessels Platelets
3
Thrombocytopenia
Thromboasthenia
Thromobcytosis
Thrombocytopenia decrease in Platelets count
Thromboasthenia defect in function
Thromobcytosis
ThrombocytopeniaPlatelets 1112111 212111
Platelets
1112111Platelets count
712111Platelets
Platelets < 60.000 Platelets
Platelets 1112111enough above 50.000 surgery
Platelets 1112111minor surgery 512111
Platelets production destruction pooling dilution
production production Bone marrow failure
b12 & Folic acid deficiency 2pancytopenia drugs
thiazide diuretic
* ndestructiosplenomegaly immunological
immunological antibodies autoimmune or alloimmune
Alloimmune ABincompatible blood transfusion autoimmune AB against
my own platelets
ITP alpha methyl dopa , ,evan syndrome
Autoimmune warm hemolytic anemia ABPlatelets
Platelets defect
Heparin induced thrombocytponea allergy 09%
population heparin IgG platelets
thrombosis Thrombosis
alpha methyl dopa , ITP and evan syndrome
hemolytic uremic syndrome ,thrombotic thrombocytopenic purpra
AUtoimmunie and alloimmune DIC destruction
decr proddestruction increase destruction BM
BM reticulcytes
BM platelets decrease productin platlets
low Platelets count incr or dec Platelets destruction
decrease production
pooling incr or decr pooling pooling
Platelets spleen 311Platletat any moment 211
111spleen 211311
splenomegalyspleen blood 211splenomegaly
1319191
count actually normally spelnomegaly Platelets
pooling hypothermia hypothermia platelets
spleen we have no idea spleen
pooling splenomegaly or hypothermia
dilution2
9fresh flood
Platelets Platelets dilution of
plaltlet platelet thrombocytopenia 5
platelets massive blood transfusion 2 units of platelets ca
massive blood transfusiondilution of platelets
Causes of thrombocytopenia
ITP
ITP ITP idiopathic
spleen IgG Antibodies IgG BM Budding of megakayocytes
platelets macrophage receptors complex
Platelets IgG
ITP “ Idiopathic thrombocytopenic purpra “
AB budding Platelets macrophage
Clinical picture CP
petechia <3 ml doesn’t blanch , not raised
external hemorrhage and internal hemorrhage cerebral hemorrhage
spontenous
specific acute and chronic ITP acute children
severe thrombocytopenia spontenous remissionwithin 3
month chronic ITP females middle age mild
thrombocytopenia Mild :D remission and excarebation mild
remission and exacerbation
Investigation Bleeding time
Platelets count
PT ,PTT normal clotting time
Specific inv IgG megakaryocytes wth defective budding
Treatment
Avoid trauma , avoid injury
Avoid unnecessary surgeries
corticosteroids
mild hemorrhage
cerebral hemorrhage
bleeding Platelets Antibodies
temporary we are just buying time
IV immunoglobulins receptors of macrophages you are just buying time
Plasma pharesis Antibodies permenant treatment
splenectomy cyclosporine danazole
aplastic anemia budding
spleen Ab ITP
splenomegaly ITP splenomegaly or Lymphadenopathy or fever Ab
exclusionITP IgG
splenomegaly ITP splenomegalopoolingITP
splenomegaly lyphadenopathy lymphoma and leukemia
ITP platelet
Thromboasthenia defect functionfunctionPlatelets
adhesions Platelets glycoptn recptor VWBF
defect adheiosn
1 VWBF VWB disease congenitallydeficeny
failure RenalFailur toxins endotheliuminhibition
VWBF release congenital or uremia
2 receptors congenitally Bernardhesionad
adhesions3VWBF congenitally
VWBF toxins prevent its release
receptors
aggregationsaggregations platelet glycoptn
receptor 2B fibrin aggregation thromboxane and adenosine
diphosphate aggregations
fibrinAfibrinogenmia congenital afibrinogenia fibrinogen
Dysphybrinogenima fibrinogen
receptors congenital glanzman disease congenitally
Tirofibanreceptors1911
3angina and myocardial infarction
aggregationreceptor congenital glanzman disease
fibrin afibrinogenima
thromoxane A2 Aspirin
ADP clopidogrel antiplatlet
angina :D angina
secretionsstorage disease platelets BM
granules secreting stage granules secretions granules
Thromboasthenia
thrombocytosis Platelets primary ya secondry
primary polycythemia verachronic myelocytic leukemia
leukemia
ntial thrombocytosisesseessential hypertension
Platelets primary thrombocytosis
Platelets non functioning bleeding tendency primary Platelets
non functioning bleeding tendency
secondry splenectomy hemorrhage hemolysis bonemarrow irritation
Platelets are function
just causes thrombocytosis
causes of thrombocytosis causes of thrombocytopeniacauses of asthenia ITP
destruction of platelet Platelets decr production
coagulation congenital and acquired congenital hemophilia a , b , parahemophilia,
7 . 9 .11.13
a AHemophili
111VWB
endothelim Platelets adhesion factor 8 antihemophilic globulin
Liver intrinsic pathway 12 activate 11 <11activate 77activate
11ca & factor 8
factor 8 intrinsic liver antihemophilic globulin ,VWBF
urine
VWBF antihemophilic globulin
disease hemophilia a Intrinsic pathway
antihemophilic deficecny is hemophilia a X linked males affected , females carrier
Thrombocytosis
Coagulation defect “ Hemophilia A “
Clinical picture Ecchymosis , hematoma external hemorrhage *
Hemorrhage congenital joints joint red , hot and tender joint
ankylosis and fixation of joint
hematoma in muscles calcification nerve
Hemorrhage following trauma cut of umbilical cord or circumcision >>
family history Y
X female carrier
maternal uncle paternal uncle
Investigations
Bleeding time normal
Clotting time prolonged
pt or pttpathway intrinsic ptt
specific 151211
2501mild
5-25 moderate
1-5 sever
<1 very severe
DNa analysis
intrauterine
reatmentT 1 Avoid truma
:D
hemophilic
2 Avoid unnecessary operations
3 1plasma 15ml/kg 31
..15X30 051112051
711volume overload risk of hepatitis and
infections
1antigen antibodies factor 8 resistance
factor 8 resistance active bleeding
1cryoperciptate
31room tempreture IV
=D
1
crypoerciptatecryo periceptate volume volume overload
hepatitis and aids and factor 8 resistance genetic engineering
0 externally compression thrombin bleeding
Thrombin thrombin thrombin
VWB disease factor 8 VWB urine
actually
investigations prolonged bleeding time platelet count normal
ptt prolonged plasma and cryo 1
desmopressinADH ADH endothelium
VWB disease Hemophilia MCQ
A B 7hemophilia A
Hematology
VonwilleBrand Disease