OVERVIEW

FACULTY OF MEDICINE UNIVERSITY OF BRAWIJAYA MALANG

CONTRIBUTORS TEAM

MODULE HEMATOLOGY(SYMPTOMATOLOGY)

AREA OF COMPETENCY 3rd of the Doctor Competencies Standard

from Indonesian Medical Council

MODULE HEMATOLOGY(SYMPTOMATOLOGY)

MODULE CONTENTS

SUB MODULES :1. Anemia2. Polycythemia3. Bleeding Disorders4. Thrombosis5. Granulocytes Disorders

HISTORY TAKING

LEARNING METHODS

Active learning (3 hrs)

Group discussion (2 hrs)

Expert lecture (1 hrs)

History taking : check list(last programme)

All sub modules

EVALUATION

1. Middle exams at the end of module programmes multiple choice

2. Final exams at the end of semester OSCE

COMPETENCY COMPONENTS To apply concept & principles of anemia

as sign or symptom (see outline of lecture contents)

SUB MODULE 1: ANEMIA

….. ANEMIA (cont’d)

CLINICAL COMPETENCIES

1. Student can describe :The RBC formation (erythropoiesis)Morphological of RBCEtiology & pathophysiology of anemia

2. Student can diagnose the etiology of anemia based on clinical features & lab. findings

….. ANEMIA (cont’d)

DEFINITION & OVERVIEW

Anemia is a reduction in Hb concentration of the blood accompanied by a fall in RBCs and packed cell volume (PCV)

Anemia is not diagnosis but it is only symptom

It must be established the etiology of anemia based on clinical features & lab. findings

….. ANEMIA (cont’d)

OUTLINE OF LECTURE CONTENTSA. ERYTHROPOIESIS :

- Erythrocyte differentiation- Regulation of erythropoiesis

B. RED BLOOD CELLS (RBCs) : morphologyC. ANEMIA :

- Definition, classification & etiology- Diagnosis : clinical features &

lab.findingsD. APPROACH TO DIAGNOSE

COMPETENCY COMPONENTS To apply concept & principles of definition,

classification and clinical approach to diagnose the etiology of polycythemia;

(see outline of lecture contents)

SUB MODULE 2: POLYCYTHEMIA

….. POLYCYTHEMIA (cont’d)

CLINICAL COMPETENCIES

1. Student can describe definition, classification and etiology of polycythemia

2. Student can diagnose polycythemia (rubra) vera, secondary and relative polycythemia

….. POLYCYTHEMIA (cont’d)

DEFINITION & OVERVIEW

Polycythemia (erythrocytosis) is an increase in the Hb concentration above the upper limit of normal for the patient’s age and sex

Classified according to its pathophysiology

The major subdivision : - absolute polycythemia: primary & secondary - relative/pseudopolycythemia

….. POLYCYTHEMIA (cont’d)

OUTLINE OF LECTURE CONTENTSA. DEFINITION B. CLASSIFICATION AND ETIOLOGYC. POLYCYTHEMIA (RUBRA) VERA :

- criteria for diagnosis- clinical features and laboratory findings

D. SECONDARY POLYCYTHEMIAE. RELATIVE/PSEUDOPOLYCYTHEMIAF. APPROACH TO DIAGNOSE

COMPETENCY COMPONENTS To apply concept & mechanism of hemostasis,

pathophysiology, and clinical approach to diagnose the etiology of bleeding disorders

(see outline of lecture contents)

SUB MODULE 3: BLEEDING DISORDERS

….. BLEEDING DISORDERS (cont’d)

CLINICAL COMPETENCIES

1. Student can describe :The mechanism of hemostasisEtiology & pathophysiology of bleeding disorders

2. Student can diagnose the etiology of bleeding disorders based on clinical features & lab. findings

….. BLEEDING DISORDERS (cont’d)

DEFINITION & OVERVIEW

Hemostasis is series of physiological processes which arrest bleeding at the site of injury and initiate repair of the blood vessel

An efficient and rapid mechanism for stoping bleeding is clearly essential for survival

Bleeding disorders may result from defective of vascular, platelets or coagulation

…..BLEEDING DISORDERS (cont’d)

OUTLINE OF LECTURE CONTENTSA. MECHANISM OF HEMOSTASIS

1. Vascular factor2. Platelets3. Coagulation factor

B. ETIOLOGY & PATHOPHYSIOLOGY OF BLEEDING DISORDERS

C. DIAGNOSIS : clinical features & lab. findingsD. APPROACH TO DIAGNOSE

COMPETENCY COMPONENTS To apply concept & principles of vascular-bed-

specific hemostasis, pathophysiology of thrombus formation, pathogenesis & risk

factors of thrombosis (see outline of lecture contents)

SUB MODULE 4: THROMBOSIS

….. THROMBOSIS (cont’d)

CLINICAL COMPETENCIES

Student can describe :vascular-bed-specific hemostasispathophysiology of thrombus formation on atherosclerotic lesionspathogenesis & risk factors of arterial & venous thrombosis

….. THROMBOSIS (cont’d)

DEFINITION & OVERVIEW

Thrombi are solid masses or plugs formed in the circulation from blood constituents.

Their clinical significance results from ischemia from local vascular obstruction or distant embolization.

Thrombi are involved in the pathogenesis of myocardial infarction, cerebrovascular disease, peripheral arterial disease & deep vein occlusion.

…..THROMBOSIS (cont’d)

OUTLINE OF LECTURE CONTENTS

A. VASCULAR-BED-SPECIFIC HEMOSTASISB. HYPERCOAGULABILITY STATESC. PATHOPHYSIOLOGY OF THROMBUS FORMATION

ON ATHEROSCLEROTIC LESIONS- The Virchow Triad- Local substrates for thrombosis

D. ARTERIAL & VENOUS TROMBOSIS - Pathogenesis- Risk factors

COMPETENCY COMPONENTS To apply concept & principles of granulopoiesis,

the morphology and the function of granulocytes, and clinical approach to

diagnose granulocytes disorders(see outline of lecture contents)

SUB MODULE 5: GRANULOCYTES

DISORDERS

….. GRANULOCYTES DISORDERS (cont’d)

CLINICAL COMPETENCIES

1. Student can describe :granulopoiesisthe morphology & function of granulocytescauses of granulocytes disorders

2. Student can do clinical approach to diagnose causes of granulocytes disorders

DEFINITION & OVERVIEW

Granulocytes, which include 3 types of cell: neutrophils (polymorphs), eosinophils and basophils, together with monocytes comprise the phagocytes.

The function of phagocytes and immunocytes in protecting the body against infection is closely connected with two soluble protein systems of the body, immunoglobulins and complement. These proteins, which may also be involved in blood cell destruction in a number of diseases.

….. GRANULOCYTES DISORDERS (cont’d)

OUTLINE OF LECTURE CONTENTS

A. GRANULOCYTES- Neutrophils (polymorph)- Neutrophil precursors- Monocytes- Eosinophils- Basophils

B. GRANULOPOIESISControl of granulopoiesis: myeloid growth factors

C. THE FUNCTION OF GRANULOCYTES:Chemotaxis, Phagocytosis, Killing &

Digestion

….. GRANULOCYTES DISORDERS (cont’d)

D. DEFECTS OF PHAGOCYTIC CELL FUNCTION Chemotaxis, Phagocytosis, Killing &

DigestionE. LEUCOCYTOSIS AND MONOCYTOSIS

- Neutrophil leucocytosis- The leukemoid reaction- Eosinophilic leucocytosis- Basophilic leucocytosis- Monocytosis

F. NEUTROPENIA

….. GRANULOCYTES DISORDERS (cont’d)