Upload
alvin-arif
View
232
Download
0
Embed Size (px)
Citation preview
7/25/2019 kp 2.4.1.2
1/28
APLASTIC ANEMIA
Dr dr H IRZA WAHID SpPD KHOM FINASIM
SUBDIVISION OF HEMATOLOGY & MEDICAL ONCOLOGY
DEPARTEMENT OF INTERNAL MEDICINE
FACULTY OF MEDICINE ANDALAS UNIVERSITY
09-02-2015
7/25/2019 kp 2.4.1.2
2/28
7/25/2019 kp 2.4.1.2
3/28
Hema!"!#$ Da% O%!"!#$ Me'$Hema!"!#$ ( I"m) * Da+a,
Hem!!e.$. (S)m-.)m )"a%# --------------------------------/ Da+a, e$
E+$+!!e.$. e+$+!.$ A%em$a P!"$.$em$a Me#aa+$!!e.$. +!m!.$ T+!m!.$!.$. T+!m!.$!e%$a
G+a%)"!!e.$. "e)!.$ Le)!e%$a Le)!.$!.$.
M!%!.$!!e.$. m!%!.$ M!%!.$!e%$a M!%!.$!.$.
L$m3!!e.$. "$m3!.$ L$m3!.$!e%$a L$m3!.$!.$.
E4+ame')"a+--------------------------------------- / Ha$ L$ma
O%!"!#$ Me'$ ( I"m) * T)m!+ * N!% S)+#e+
7/25/2019 kp 2.4.1.2
4/28
7/25/2019 kp 2.4.1.2
5/28
7/25/2019 kp 2.4.1.2
6/28
7/25/2019 kp 2.4.1.2
7/28
ANEMIAPARAMETER ( 6a'a+ ,em!#"!$% Me!'e Sa,"$
P+$a 'e7a.a ( 8a%$a 'e7a.a ( Ham$" ( H 1: ( 12 ( 11 #+ ;
GE,+!%$> '$.ea.e
7/25/2019 kp 2.4.1.2
8/28
A#eSe4 +. Hem!#"!$% #'L Hema!>+$ ;
C,$"'+e% 05- 110 ::
C,$"'+e% 5-12 115 :5
C,$"'+e% 12-15 120 :
A')" Me% 1:0 :9
N!%-+e#%a%8!me%
120 :
P+e#%a% 8!me% 110 ::
Anemic Ranges of Hemoglobin and Hematocrit Values
WHO. Worldwide Prevalence of Anaemia 1993-!!"."
#$%ese are onl& guidelines and some '%&sicians feel t%e t%res%olds s%ould be %ig%er for adults.
7/25/2019 kp 2.4.1.2
9/28
De3$%$$!%
Pe+$,e+a" Pa%>!e%$a A%em$a Le)>!e%$a T,+!m!>!e%$a
Re$>)"!>!-e%$a
A"a.$> !%e ma++!7 H!>e"")"a+ 7$, a""
e"eme%. '!7% m!." 3aa%' .+!ma
Re.$')a" ,ema!!$e$>
>e"". a+e %!+ma" N! ma"$#%a%> !+ 3$+!.$. N! me#a"!"a.$>
,ema!!$e.$.
7/25/2019 kp 2.4.1.2
10/28
Se=e+$ !3 D$.ea.e
Se=e+e A"a.$> A%em$a SAA
Ma++!7 !3 "e.. ,a% 25; %!+ma" >e"")"a+$
2 !3 : a%!+ma" e+$,e+a" "!!' =a")e.
A.!")e +e$>)"!>e >!)% 0000
ANC500
P"ae"e. 20000
Ve+ Se=e+e A"a.$> A%em$a VSAA A!=e 7$, ANC 200
7/25/2019 kp 2.4.1.2
11/28
H$.!+ !3 A"a.$> a%aem$a
Pa)" E,+"$>, 1@5-1915 'e.>+$e'
,e 3$+. >a.e !3 a"a.$> a%aem$a $% a
+e#%a% 7!ma% 7,! '$e' !3 ma++!73a$")+e $%1@@@
T,e e+m a"a.$> a%aem$aJ 3$+.).e' A%a!"e C,a)33a+' $% 190
7/25/2019 kp 2.4.1.2
12/28
A"a.$> A%em$a e$'em$!"!#
a%%)a" $%>$'e%>e $% E)+!e a%' US - 2 >a.e. e+
m$""$!% !)"a$!% ) >a.e. $% Ba%#! $%
T,a$"a%' a%' 1 $% $a" +e'$.!.$$!% e4$.. $% ,e U%$e'Sae. ,!7e=e+ +e=a"e%>e $. $%>+ea.e' $% ,e
Fa+ Ea.
T,e ma"e-!-3ema"e +a$! $. a+!4$mae" 1(1
A"a.$> a%em$a !>>)+. $% a"" a#e #+!).
a .ma"" ea $% $%>$'e%>e $% >,$"',!!'
a ea $%>$'e%>e $% e!"e a#e' 20-25 ea+. a%' a
ea $% e!"e !"'e+ ,a% 0 ea+.
7/25/2019 kp 2.4.1.2
13/28
A"a.$> A%em$a - E$!"!#
C!%#e%$a"$%,e+$e' 20;
Pa$e%. ).)a"" ,a=e '.m!+,$> 3ea)+e. !+
,.$>a" .$#maa O>>a.$!%a"" ma++!7 3a$")+e ma
e ,e $%$$a" +e.e%$%# 3ea)+e
Fa%>!%$ a%em$a
D.e+a!.$. >!%#e%$a
S,7a>,ma%-D$am!%' .%'+!me
Fam$"$a" a"a.$> a%em$a
A>K)$+e'
7/25/2019 kp 2.4.1.2
14/28
A"a.$> A%em$a( C!%
A>K)$+e'( D+)#.
- C!!4$> '+)#. - A%$$!$>.
- C,"!+am,e%$>!" - A%$-$%3"amma!+
- A%$->!%=)".a% - S)",!%am$'e.
- 2-: m!%,. ).)a"" e7ee% e4!.)+e a%' ,e 'e=e"!me% !3 a"a.$> a%em$a
Ra'$a$!%.
C,em$>a". e# Be%e%e a%' e.$>$'e.
V$+).e.( Hea$$. B C
He+e. .$m"e4
E-B =$+).
HIV Imm)%e( SLE RA +,e)ma!$' a+,+$$.
P+e#%a%>
PNH
I'$!a,$> P+$me+ ( 5;
7/25/2019 kp 2.4.1.2
15/28
Pa,!#e%e.$.
Imm)%e me>,a%$.m +e.!%.$"e 3!+
m!. !3 ,e >a.e. !3 I'$!a,$>
a>K)$+e' a"a.$> a%em$a A>$=ae' C!!4$> T >e"". $% B"!!'
& B!%e ma++!7 B!%e ma++!7
3a$")+e
7/25/2019 kp 2.4.1.2
16/28
7/25/2019 kp 2.4.1.2
17/28
C"$%$>a" Fea)+e.
A%em$a
B"ee'$%#( E>>,m!.e. B"ee'$%#
#)m. E$.a4$.
I%3e>$!%.( Fe=e+M!), )">e+.
7/25/2019 kp 2.4.1.2
18/28
D$a#%!.$.
B"!!' e+$,e+a" .mea+ (Pancytopenia and reticulocytopenia
B!%e ma++!7 a.$+a$!% & $!. (Hypocellular / aplastic bone arro!!it" increased #at spaces
Te.. 3!+ )%'e+"$%# >a).e $iral titers
7/25/2019 kp 2.4.1.2
19/28
BM Aspiration BM
Biopsy
7/25/2019 kp 2.4.1.2
20/28
7/25/2019 kp 2.4.1.2
21/28
BM $!.
"ypocellular %increased #at spaces
7/25/2019 kp 2.4.1.2
22/28
Ot"er causes o# Pancytopenia&
S$#% !3 >!%#e%$a" '$.ea.e
D+)#. V$+a"
Me#a"!"a.$> a%em$a
B!%e Ma++!7 $%3$"+a$!% !+ Re"a>eme%(
SLE RA
D$..em$%ae' TB
PNH
Se.$.I3 -
$'$!,a$> !+ +$ma+ a>K)$+e' a"a.$>
a%em$a
7/25/2019 kp 2.4.1.2
23/28
A"a.$> A%em$a - T+eame%
8$,'+a7a" !3 e$!"!#$>a" a#e%.
Ma%a#eme% !3 )%'e+"$%# '$.e.a.e
S)!+$=e
Re.!+a$!% !3 ma++!7 a>$=$( B!%e ma++!7 +a%."a%
Imm)%!.)+e..$=e +eame%- P+e'%$.!"!%e - A%$"m,!>e #"!)"$%
- C>"!.!+$%
- S"e%e>!m
A%'+!#e%.
G+!7, 3a>!+.
7/25/2019 kp 2.4.1.2
24/28
APLASTIC ANEMIA +eame%
S)!+$=e >a+e
T+a%.3).$!%T+eame% !3 a%em$a
T+eame% !3 "ee'$%#
P+e=e%$!% a%' +eame% !3
$%3e>$!%
7/25/2019 kp 2.4.1.2
25/28
Hema!!$e$> .em >e""
+a%."aa$!% $% .e=e+e a"a.$>
a%em$a1 A'=a%a#e.
- >!++e>$!% !3 ,ema!!$e$> 'e3e>
- "!%#-e+m .)+=$=a"( @0; - 90; HLA-ma>,e' .$"$%#
'!%!+- ma?!+$ !3 ,e a$e%. aea+ ! e >)+e'
2 Re.+$>$!%.- a#e e"!7 0
- .)$a"e '!%!+ a=a$"a"e $% "e.. ,a% :0; .$"$%#
- 25-0; +$. !3 GVHD
- 5-15; +$. !3 #+a3 3a$")+e $% m)"$+a%.3).e' a$e%.
- ,$#, m!+a"$ a3e+ MUD-HSCT
- .!"$' )m!+. 12;
7/25/2019 kp 2.4.1.2
26/28
Imm)%!.)+e..$!%
Imm)%!.)+e..$!% $. NOT >)+a$=e G!a" $. .).a$%e' +em$..$!%
20-:; ,a=e +e>)++e% a"a.$> a%em$a
20-:; 'e=e"! >"!%a" '$.!+'e+ PNH MDS !+ a>)e"e)em$a
C!m$%a$!% ,e+a $. e. A%$,m!>e #"!)"$% ATG 3$+. >,!$>e
T!4$> .$'e e33e> $. .e+)m .$>%e.. 4 7$, .e+!$'
Ca% "!7e+ "ae"e >!)%. +a%.3).e +%
C>"!.!+$%e 3$+. >,!$>e H$#, '!.e >!+$>!.e+!$'. ae+$%# !33
A"em))ma
Aa,$!+$%e
M>!,e%!"ae m!3e$"
7/25/2019 kp 2.4.1.2
27/28
7/25/2019 kp 2.4.1.2
28/28