STEP 11. Erytrocyte disorder : abnormalities of size, shape, and colour of red blood cell cause by increasing or decreasing amount of Hbs rate in the erytrocyte.

2. Erytrocyte : red blood cell.

STEP 2

1. What is symptom of erytrocyte disorder ?

2. Identify and describe variety of erytrocyte disorder ?

3. What causes erytrocyte disorder ?

4. What are the test to diagnose blood disorder ?

5. What are physical examination of blood disorder ?

6. Whether if the number of erytrocyte is normal but there are decreasing of haemoglobin level includes in the erytrocyte abnormalities ?

7. What is the symptom of anemia ?

8. What are the various of anemia ?

9. What is the pathogenesis of anemia ?

STEP 3

1. Identify and describe variety of erytrocyte disorder ?

a. Red blood cell variation in shape :

Sperocyte : it has not central pallor.

Stomatocyte : shape of central pallor like mouth.

Eliptocis : its shape like elip.

Teardrop cell : the shape of cell is like a teardrop.

Pencil cell : the shape of cell is like a pencil.

Sickle cell : the shape of cell is like a moon or letter L.

b. RBC variation in size :

Microcytic cell : size of erytrocyte is less then lymfocyte central.

Macrocytic cell : size of erytrocyte is bigger then lymfocte central.

c. Based on colour of central pallor : Hypocromic : the diameter of central pallor is less then 1/3 erytrocytes diameter.

Hypercromic : the diameter of central pallor is bigger then 1/3 erytrocytes diameter.

d. Based on haemoglobin :

Anemia : the condition when the number of erytrocyte is decreasing.

Policitemia : the condition when the number of erytrocyte is increasing.

Thalasemia : the condition when the number of erytrocyte decreases based on abnormalities genetic.

2. What is symptom of erytrocyte disorder ?

Conjungtiva palpebra anemis.

Lack of concentration.

Tachycardy.

Headache.

Dispneu.

Dizzyness.

Hipoksia.

Sepalbia.

Exhausted.

Hypotensi.

Buzzing ear.

Cephalgia.

Anemia deficiency Fe : disfagia.

Anemia deficiency folat acid : red tounge.

Anemia hemolitic : icterus, hepatomegali.

3. What causes erytrocyte disorder ?

Hereditance.

Bleeding.

Unhealthy lifestyle.

Consuming heavy metal chemical.

Paracytes.

Menstruasi.

Pregnancy.

4. What are the test to diagnose blood disorder ?

Erytrocyte sedimentations rate.

Haemoglobin rate.

Hematokrit.

Counting amount of erytrocyte.

Counting amount of leucocyte.

Counting amount of thrombocyte.

Hematology routine.

Hematology specific.

5. What are physical examination of blood disorder ?

The palm is icteric or not.

The conjungtiva is pale or not.

The hair is easy to loss or not.

The colour of skin. Splenomegali.

The nail is spoon or not.

6. What are the various of anemia ?

Anemia caused by lossing blood : after experiencing bleeding which is so fast, the body will replace the blood.

Anemia aplastic : the bone marrow can not produce erytrocyte caused of radiation.

a. Primer congenital : it has hereditys pattern autocomal resesive.

b. Primer ideopatic : the mechanism has been not known yet.

c. Secunder : because of radiation.

Anemia hemolitic : the cell is easy to licis. Anemia based on etilogy :

a. Anemia pernisiosa : deficiency vit B12, bacause of instrinsic factor of gaster (mucose), the gasters mucose can not absorb properly.

7. Whether if the number of erytrocyte is normal but there are decreasing of haemoglobin level includes in the erytrocyte abnormalities ?

Anemia, because there is lack of haemoglobin in erytrocyte (hypocrom)

8. What is the pathogenesis of anemia ?

Bleeding -> darah kental -> tachycardy.

9. Variety and etiology of polisitemia ?

10. What is thalasemia ?

STEP 4

1. Identify and describe variety of erytrocyte disorder ?

Classified by checking MCV (mean corpusculer volume). MCV allows us to classify anemia as microcytic (MCV < 82 fL), normocytic (MCV = 82-98 fL) and macrocytic (MCV > 98 fL).

a. Microcytic anemia

Faced with microcytic anemia, the three main diagnostic possibilities include iron deficiency anemia (IDA), thalassemia, and anemia of chronic disorders (ACD).

b. Normocytic anemia

The fundamental question in normocytic anemia is to recognize the causes and susceptibility to treatment as soon as possible. Among the causes are nutritional deficiency, renal failure and hemolytic anemia

c. Macrocytic anemia

Macrocytosis is observed frequently using blood cell analyzers. Its prevalence is 1.7%-3.9%, but 60% of the patients with macrocytosis do not have anemia. On the other hand, macrocytosis can be physiological in some circumstances (infants, pregnancy, some families). Even keeping in mind the precedent data is convenient to make a careful evaluation of macrocytosis in every patient, to rule out any underlying pathology. In vitamin B12 and folic acid deficiency, as well as in other diseases, macrocytosis (blood) is accompanied by megaloblastosis (bone marrow). In such cases, both terms can be used interchangeably. The starting point in the diagnostic process for macrocytic anemia will be to rule out therapy with drugs that interfere with nucleic acid metabolism, such as hydroxyurea, methotrexate, trimethoprim, zidovudine or 5-fluorouracil, as well as habitual intake of alcohol

http://chealth.canoe.ca/channel_condition_info_details.asp?disease_id=280&channel_id=2022&relation_id=16451http://www.hem-aids.ru/system/files/attachments/646/anemii_anemii_pdf_008.pdf2. What is symptom of erytrocyte disorder ?

Anemia symptoms

Patients with anemia may present with fatigue, dizziness and dyspnea; however, mild anemia shows few clinical signs or symptoms. The signs of anemia include pallor of the conjunctivae, face, nail beds and palmar creases, although the absence of pallor does not rule out anemia

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754510/Symptoms (Polycythemia)

Polycythemia may not cause any symptoms. It's often discovered only if a hemoglobin test or a red blood cell count is done. Some people do experience symptoms that appear gradually. These may include itching following bathing, dizziness, and a flushing of the face and hands. Weakness, headaches, visual disturbances, and a sense of "fullness" in the head and in the left upper abdomen may also be associated with the condition. Some people may have high blood pressure.http://chealth.canoe.ca/channel_condition_info_details.asp?disease_id=280&channel_id=2022&relation_id=16451Thalasemia

A lack of oxygen in the bloodstream causes the signs and symptoms of thalassemias. The lack of oxygen occurs because the body doesn't make enough healthy red blood cells and hemoglobin. The severity of symptoms depends on the severity of the disorder.

Symptoms

Alpha thalassemia silent carriers generally have no signs or symptoms of the disorder. This is because the lack of alpha globin protein is so minor that the body's hemoglobin works normally.

http://www.nhlbi.nih.gov/health//dci/Diseases/Thalassemia/Thalassemia_Signs.html3. What causes erytrocyte disorder ?

TOXIC FORMS include plumbism. Here, lead salts attach to erythrocyte membranes making it more vulnerable to lysis or removal from circulation. Often we see a gingival "lead line" in plumbism.

BLOOD INCOMPATIBILITIES These forms include immune hemolysis such as from D or Rh antigens (maternal-fetal incompatibilities) or the ABO antigens (transfusion-related incompatibilities).

AUTOIMMUNE HEMOLYTIC ANEMIAS may be associated with tumors, infections and inflammatory conditions.

MECHANICAL HEMOLYSIS may be associated with artificial cardiac valveshttp://jan.ucc.nau.edu/prh/bio320/lecture_10.html4. What are the test to diagnose blood disorder ?

The reticulocyte countIncreased reticulocytes (greater than 2-3% or 100,000/mm3 total) are seen in blood loss and hemolytic processes, although up to 25% of hemolytic anemias will present with a normal reticulocyte count due to immune destruction of red cell precursors. faculty.washington.edu/rrichard 5. What are physical examination of blood disorder ?

6. What are the various of anemia ?

1. Morphological classification

Classified by checking MCV (mean corpusculer volume). MCV allows us to classify anemia as microcytic (MCV < 82 fL), normocytic (MCV = 82-98 fL) and macrocytic (MCV > 98 fL).

Microcytic anemia

Faced with microcytic anemia, the three main diagnostic possibilities include iron deficiency anemia (IDA), thalassemia, and anemia of chronic disorders (ACD).

Normocytic anemia

The fundamental question in normocytic anemia is to recognize the causes and susceptibility to treatment as soon as possible. Among the causes are nutritional deficiency, renal failure and hemolytic anemia

Macrocytic anemia

Macrocytosis is observed frequently using blood cell analyzers. Its prevalence is 1.7%-3.9%, but 60% of the patients with macrocytosis do not have anemia. On the other hand, macrocytosis can be physiological in some circumstances (infants, pregnancy, some families). Even keeping in mind the precedent data is convenient to make a careful evaluation of macrocytosis in every patient, to rule out any underlying pathology. In vitamin B12 and folic acid deficiency, as well as in other diseases, macrocytosis (blood) is accompanied by megaloblastosis (bone marrow). In such cases, both terms can be used interchangeably. The starting point in the diagnostic process for macrocytic anemia will be to rule out therapy with drugs that interfere with nucleic acid metabolism, such as hydroxyurea, methotrexate, trimethoprim, zidovudine or 5-fluorouracil, as well as habitual intake of alcohol

http://chealth.canoe.ca/channel_condition_info_details.asp?disease_id=280&channel_id=2022&relation_id=164517. Whether if the number of erytrocyte is normal but there are decreasing of haemoglobin level includes in the erytrocyte abnormalities ?

8. What is the pathogenesis of anemia ?

Berdasarkan patogenesisnya, anemia digolongkan dalam 3 kelompok

(Wintrobe at all, 1999) yaitu:

1. Anemia karena kehilangan darah

Anemia karena kehilangan darah akibat perdarahan yaitu terlalu

banyaknya sesl-sel darah merah yang hilang dari tubuh seseorang, akibat

dari kecelakaan dimana perdarahan mendadak dan banyak jumlahnya,

yang disebut perdarahan ekternal. Perdarahan dapat pula disebabkan

karena racun, obat-obatan atau racun binatang yang menyebabkan

penekanan terhadap pembuatan sel-sel darah merah. Selain itu ada pula

perdarahan kronis yang terjadi sedikit demi sedikit tetapi terus menerus.

Perdarahan ini disebabkan oleh kanker pada saluran pencernaan, peptic

ulser, wasir yang dapat menyebabkan anemia.

2. Anemia karena pengrusakan sel-sel darah merah

Anemei karena pengrusakan sel-sel darah merah dapat terjadi

karena bibit penyakit atau parasit yang masuk kedalam tubuh, seperti

malaria atau cacing tambang, hal ini dapat menyebabkan anemia

hemolitik. Bila sel-sel darah merah rusak dalam tubuh, zat besi yang ada di

dalam tidak hilang tetapi dapat digunakan kembali untuk membentuk selsel

darah merah yang baru dan pemberian zat besi pada anemia jenis ini

kurang bermaanfaat. Sedangkan asam folat dirusak dan tidak dapat

digunakan lagi oleh karena itu pemberian asam folat sangat diperlukan

untuk pengobatan anemia hemolitik ini.

3. Anemia karena gangguan pada produksi sel-sel darah merah

Sum-sum tulang mengganti sel darah yang tua dengan sel darah

merah yang baru sama cepatnya dengan banyaknya sel darah merah yang

hilang, sehingga jumlah sel darah merah yang dipertahankan selalu cukup

banyak di dalam darah, dan untuk mempertahakannya diperlukan cukup

banyak zat gizi. Apabila tidak tersedia zar gizi dalam jumlah yang cukup

akan terjadi gangguan pembentukan sel darah merah baru.

Anemia karena gangguan pada produksi sel-sel darah merah, dapat

timbul karena, kurangnya zat gizi penting seperti zat besi, asam folat, asam

pantotenat, vitamin B12, protein kobalt, dan tiamin, yang kekurangannya

biasa disebut anemia gizi. Selain itu juga kekurangan eritrosit, infiltrasi

sum-sum tulang, kelainan endokrin dan penyakit ginjal kronis dan sirosis

hati. Menurut Husaini (1998) anemia gizi yang disebabkan kekurangan

zat besi sangat umum dijumpai di Indonesia.www.library.upnvj.ac.id/pdf/s1keperawatan09/207314005/bab2.pdf9. Variety and etiology of polisitemia ?

Variety :

Polycythemia is an over-production of erythrocytes and blood plethora (may be 2-3X; RBC 6-10 million/mm3). Often characterized by liver enlargement and excessive thrombosis (elevated platelet levels). Also presents general circulation problems.

Secondary polycythemia such as from excessive erythropoietin, or subsequent to high-altitude training or to carbon monoxide poisoning.

Primary polycythemia (polycythemia vera) may be due to a benign tumor of the bone marrow.http://jan.ucc.nau.edu/prh/bio320/lecture_10.htmlEtiology :

Dehydration because of Shortage of water,prolonged vomiting, diarrhea(BA Pathology Kumar Robins, issue 7)

10. What is thalasemia ?

Thalassemia

Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form ofhemoglobin, the protein in red blood cells that carries oxygen. The disorder results in excessive destruction of red blood cells, which leads to anemia.

Causes, incidence, and risk factors

Hemoglobin is made of two proteins: Alpha globin and beta globin. Thalassemia occurs when there is a defect in a gene that helps control production of one of these proteins.

There are two main types of thalassemia:

Alpha thalassemia occurs when a gene or genes related to the alpha globin protein are missing or changed (mutated).

Beta thalassemia occurs when similar gene defects affect production of the beta globin protein.

Alpha thalassemias occur most commonly in persons from southeast Asia, the Middle East, China, and in those of African descent.

Beta thalassemias occur in persons of Mediterranean origin, and to a lesser extent, Chinese, other Asians, and African Americans.

There are many forms of thalassemia. Each type has many different subtypes. Both alpha and beta thalassemia include the following two forms:

Thalassemia major

Thalassemia minor

You must inherit the defective gene from both parents to develop thalassemia major.

Thalassemia minor occurs if you receive the defective gene from only one parent. Persons with this form of the disorder are carriers of the disease and usually do not have symptoms.

Beta thalassemia major is also called Cooley's anemia.

Symptoms

The most severe form of alpha thalassemia major causesstillbirth(death of the unborn baby during birth or the late stages of pregnancy).

Children born with thalessemia major (Cooley's anemia) are normal at birth, but develop severeanemiaduring the first year of life.

Other symptoms can include:

Bone deformities in the face

Fatigue Growth failure

Shortness of breath Yellow skin (jaundice)

Persons with the minor form of alpha and beta thalassemia have small red blood cells (which are identified by looking at their red blood cells under a microscope), but no symptoms.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001613/1. Giardina PJ, Forget BG. Thalassemia syndromes. In: Hoffman R, Benz EJ, Shattil SS, et al., eds.Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 41.

2. DeBaun MR, Frei-Jones M, Vichinsky E. Hemoglobinopathies. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 456.

Anemia

Sintesa

Jumlah

Erytrocyte disorder

Polisitemia

Thalasemia

primer

sekunder

relatif

alpha

betha

mayor

minor

-anemia sideroblastik

Anemia hipoblastik

Anemia megaloblastik