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EXPERT LECTURE

SUB MODULE 1:

ANEMIA

FACULTY OF MEDICINE

UNIVERSITY OF BRAWIJAYA MALANG

MODULE HEMATOLOGY

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No. 1Describe in brief erythropoiesis

(red blood cell formation) and

morphological red blood cell !

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Morphology of red blood cell :

- The diameter is 8 m able to pass through themicrocirculation

- 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

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No. 2Describe in brief the etiology &

pathophysiology of anemia !

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The etiology and pathophysiology of anemia :

A. Disorders of effective red blood cell productionB. 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

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B. Disorders of increased red blood cell destruction

1. Defect of hemoglobin2. 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 erythrocyte7. 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

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No. 3Describe clinical features and

laboratory findings to diagnosis the

etiology of anemia !

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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)

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B. Laboratory findings :

I. Complete blood count (CBC)

1. RBC count : Hb, hematocrit, reticulocyte count2. 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

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Algorithms of anemia

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ad smangat..ad smangat

Belajar..

Doa

Tawakkal

Semangat.

Dr. ruly rizQ!!!!!!