o hemograma
DESCRIPTION
O HEMOGRAMA. Maria Cristina Purini de Melo Hematologista Centro de Hematologia de São Paulo. Componentes do Sangue. 55% plasma 45% celulas: 99% EritrócitosTRANSCRIPT
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O HEMOGRAMA
Maria Cristina Purini de MeloHematologista
Centro de Hematologia de São Paulo
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Componentes do Sangue
55% plasma45% celulas: • 99% Eritrócitos • <1% leucócitos e
plaquetas
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Elementos do Sangue Eritrócitos Leucócitos
Granulares oneutrófilosoeosinófilosobasófilos
Agranulares o Linfócitos = T, B, natural killer o Monócitos
Plaquetas
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Hematopoese
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• Glóbulos vermelhos– Transporte de oxigênio
• Glóbulos brancos– Defesa do organismo
• Plaquetas
coagulação
FUNÇÕES
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O HEMOGRAMA
ERITROGRAMA• NÚMERO DE ERITRÓCITOS(milhões/µL)• HEMOGLOBINA(g/dL)• HEMATRÓCRITO: E x VCM (%)• VCM: Ht x 10/E(fL)• HCM: Hb x10/E(pG)• CHCM:Hb/Ht(%)• RDW(%)• HISTOGRAMA• CONTAGEM DE ERITROBLASTOS • RETICULÓCITOS• ALARMES
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HEMOGRAMA/VALORES DE REFERÊNCIA
Plaquetas: 140.000-400.000/mm3
Idade Hb HtRN 17 3,5 51 93-6m 11,5 2 35 66m-5a 12 1 36 36a-10a 12,5 1 38 311a-15a 13 1 39 3Fem. 13,5 1,5 41 5Masc. 15 2 45 2Gest. 12 1 36 3
LEUCOGRAMA 4000-11000/mm3
Pmc: 0 Mc :0 Mn:0Bastonetes:1-3%- 45-330Segm.: 40-70%- 1800-8140Eos : 7% 770Bas. : 1,5% 165Linf. : 19-48% 855-5280Monoc. :3,4-9% 153-990
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O HEMOGRAMA
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O HEMOGRAMA
VOLUME CORPUSCULAR MÉDIO: 80 - 98 fL
•MACROCITOSE : ACIMA DE 98
•MICROCITOSE : ABAIXO DE 80
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MACROCÍTICA
Normocítica/Normocrômica
Microcítica /Hipocrômica
MORFOLOGIA
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HEMÁCIAS NORMAIS
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RDW/ GRAU DE ANISOCITOSE
• 11-14%
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ANISOCITOSE/POIQUILOCITOSE
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RETICULÓCITOS
REFLETEM O ESTADO REGENERATIVO DA MEDULA
0,5-2% DO TOTAL DE ERITÓCITOS:50000-200000/uL
CORREÇÃO: 10x Ht nl/ Ht pac X /2(dias)
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POLICROMASIA
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RETICULOCITOSE
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ANEMIAS
DIAGNÓSTICO DIFERENCIAL
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DIAGNÓSTICO DIFERENCIAL DAS ANEMIAS
Eritropoese: eficaz ineficaz
MorfologiaMecanismoLaboratório
Suspeita Clínica
Confirmação: Hb/Ht
RETICULÓCITOS
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Doenças dos Eritrócitos
Anemias Microcíticas = VCM <82
Anemias Macrocíticas = VCM >98
Anemias Normocíticas = VCM >82 e <98
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Anemias Microcíticas
• Anemia Ferropriva - Talassemia Menor- Talassemia Maior• Doença da Hb H• Anemia Sideroblástica
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Ferropriva
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Talassemia
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Anemias Normocíticas
Anemia de Doença Crônica
• Doenças Inflamatórias
• Neoplasias
• Infecção
• Hipotireodosmo
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Anemias Macrocíticas
• Anemia Megaloblástica
• Anemia Associada ao Alcoolismo e `as Doenças Hepáticas
• Fármacos antivirais e antineoplásicos
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Megaloblástica
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Megaloblástica
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Alcoolismo
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•DEFEITO NA PRODUÇÃO
Estimulo inadequado Defeito na Stem –cell Alteração no microambiente
•DEFEITO NA MATURAÇÀO Nuclear Citoplasmático
•DIMINUIÇÃO NO TEMPO DE VIDA DA HEMÁCIA Hemorragia Hemólise
PATOFISIOLOGIA
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DEFEITOS NA PROLIFERAÇÃO
• ALTERAÇÃO NO MICROAMBIENTE
ESTÍMULO INADEQUADO Deficiência de Ferro Doença Crônica Insuficiência Renal Doenças Endocrinológicas
DEFEITO NA STEM CELL Aplasia Doenças clonais
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MATURAÇÃO ANORMAL
Alteração na síntese de Hb
Def Ferro Anemia De Doença Crônica
Anormalidades Nucleares Deficiência B12 Folato
Anormalidades Citoplasmáticas
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Hemólise Adquirida Hereditária
DIMINUIÇÃO DA VIDA MÉDIA DAS HEMÁCIAS
Hemorragias
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• PERFIL DO FERRO
• DOSAGEM DE B12 /FOLATOS
• TESTES DE HEMÓLISE
• ESTUDO DA MEDULA ÓSSEA
• ELETROFORESE DE Hb
LABORATÓRIO
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Hemoglobinopatias
• Anemia Falciforme• S--Talassemia• Hemoglonopatia C• S-C• C--Talassemia
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Falciforme
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Anemias Hemolíticas
Hereditárias
• Esferocitose
• Eliptocitose
• Estomatocitose
• Piropoiquilocitose
• Deficiência de G6PD
Adquiridas
• Anemia Hemolítica Auto-Imune
• Anemia Hemolítica por Anticorpo Frio
• Anemias Hemolíticas Microangiopáticas
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Anemia hemolítica microangiopática
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INCLUSÕES
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Pontilhado Basófilo
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BORRELIA
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Cândida
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Malária
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POLIGLOBULIAS
• Hct >56% e Hb >19g/dl - Homens• Hct >52% e Hb >17,5g/dl - Mulheres• Causas: -Altitudes elevadas;
-Fumo; -DPOC; -Hipernefroma (tumor secretor de eritropoetina); -Policitemia Vera.
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REGULAÇÃO DA PRODUÇÃO
FEEDBACK NEGATIVO
Anemia, Altitude, Insuficiência Cardíaca Doenças Pulmonares
HEMATÓCRITO VOLUME TOTAL DE SANGUE TRANSPORTE de O2 aos TECIDOS
HIPÓXIAERITROPOETINA MEDULA ÓSSEA
PRODUÇÃO de ERITRÓCITOS
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O HEMOGRAMA
LEUCOGRAMA :• NÚMERO TOTAL • DIFERENCIAL : Granulócitos Neutrófilos:
Bastonetes Segmentados Eosinófilos Basófilos
Monócitos Linfócitos
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SEG
BAST
EOS
BAS
LINF
MONO
45-70
20-45
4-8
51-4
LEUCOGRAMA
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LEUCOGRAMA• Leucocitose = aumento de leucócitos• Leucopenia = diminuição de leucócitos• Causas de neutrofolia: Doenças
infecciosas, Doenças inflamatórias agudas, IAM, Acidose diabética, Intoxicações exógenas, Picadas de artrópodos e ofídios, Corticóides, Lítio, etc.
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Medula óssea
6 a 10 dias
Sangue
6-10 hs
Estroma
Pool mitótico
Pool pós mitótico
Neutrófilos circulantes
Pool marginal
IL-3
GM-CSF
IL-5
G-CSF
IL-8
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LEUCOGRAMA
• Neutropenia: < 1600 - raça branca; < 1200 raça negra.
• Causas: Infecções; Agranulocitose (fármacos antitireóideos, fenotiazinas e clozapina); Tricoleucemia; Leucemia de Grandes Linfócitos Granulares, Artrite Reumatóide; LES; Neutropenia Crônica Benigna.
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Eosinófilos
• Função = não inteiramente esclarecida– Fagocitose
• Eosinofilia– alergias– Parasitoses
1-4 %
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Basófilos
•Ricos em histamina, heparina•Importantes na resposta Aguda• 0.25-0.5%
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Monócitos
• ~5 – 10%• Precursores dos
macrófagos nos tecidos– Fagocitose:
bactérias, fungos, vírus, debris
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MONÓCITOS
• Monocitose: -Endocardite sub-aguda, -Tuberculose (doença cavitária pulmonar e forma ganglionar), -Brucelose, - Leucemia Mielomonocítica Crônica.
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Linfócitos
T-= approx 2/3
Responsáveis pela imunidade celular
B-Responsáveis pela imunidade humoral
– anticorpos – 25-70%
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LINFÓCITOS
• Linfocitose: > 4000/microlitro
• Causas: Esplenectomia; Infecções virais; Infecções bacterianas; Síndromes linfoproliferativas.
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LINFÓCITOS
• Linfopenia: < 1000/microlitro• Causas: -Transitórias: após
vacinação, Doenças inflamatórias/infecciosas graves, estresse.
• -Duradouras: Pós Rxt, drogas imunossupressoras, Dç. de Hodgkin, LES, AIDS.
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Plaquetose
• Doenças Mieloproliferativas Crônicas
• Pós -Hemorragia• Infecção /Inflamação cronicas• Lesões Teciduais• Esplenectomia • Hemólise • Anemia ferropriva
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Plaquetopenia• EDTA• Gravidez• Medicamentos • Hiperesplenismo• Infecções• PTI• PTT• Doenças Hematológicas
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