41q

“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