贫血和再障(英文PPT)
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ANEMIA
Tian jin Medical University, College of Nursing
1
Introduction
Anemia is a commonly encountered clinical symptom that is caused by an acquired or hereditary abnormality of red blood cells (RBC) or its precursors, or may be a manifestation of an nonhematologic disorder hematologic hematology adj. n.
Decresed RBC production
Anemia
1. BM stem cells abnormality AA 2. BM injured by abnormal tissues/cells Leukemia 3. Cell dysmaturity (1). DNA dyssynthesis Megaloblastic anemias (2). Hb dyssynthesis IDA 4. Abnormality in haematopoiesis modulation AA
13
Classification: according to etiology/pathogenesis
etiology/pathogenesis
Decreased RBC production Increased RBC destruction Blood loss
14
Classification: according to etiology/pathogenesy
Anemia
PNH hereditary spherocytosis G6PD deficiency hemoglobinopathy porphyrinopathy
immunologic, chemical, biological, or phisical factors 16
Classification: according to etiology/pathogenesy
2
Definition
Anemia is defined as a decrease in the circulating RBC or hemoglobin and a corresponding decrease in the oxygencarrying capacity of the blood. Normal values of the hemogram: TEST HCT (%) Hb (g/L) RBC Count(1012/L) HCT:Haematocrit WOMEN 37-43 11.3-13.5 3.83-4.83 Hb:hemoglobin MEN 42-49 12.7-15.3 4.29-5.58
＞100 80～100 ～ anemia ＜80
MCV：mean corpuscular volume ； MCHC：mean cell hemoglobin concentration
8
Macrocytic anemia
•Megaloblastic anemias ( folic acid and vitamin B12 deficiency) •Alcoholism •Drugs •Liver diseases •Primary bone marrow disorder •Hypothyroidism •Splenectomy
1. RBC Loss without RBC destruction 2. Deficient RBC production 3. Increased RBC destruction over production
5
RBC loss without RBC Destruction
Hemorrhage Due to trauma Due to disorders: e.g.cancer, ulcers, tuberculosis, diverticular disease, and irritable bowel syndrome (including ulcerative colitis and Crohn’s disease) Menstrual flow Gynecological disorders (e.g. endometriosis, fibroids) Pregnancy, especially at gestation Parasitism Hookworms
9
Normocytic anemia
•Chronic disease anemia (hepatic, renal or endocrine disorders) •Primary bone marrow disorders (aplasia, myelodisplasia, myelofibrose, hematologic and solid tumors, HIV infection, granulomas •Hemolytic anemia
12
Classification: according to Bone marrow proliferative degree
Bone marrowFra Baidu bibliotek
anemia
hyperplasia IDA, hemolytic anemia, blood loss anemia Hypoplasia AA, PRCA Dysmaturity(ineffective erythropoiesis) myelodysplastic syndrome(MDS) Megaloblastic anemias
18
Clinical manifestation
1、nervous system： 、 ： headache、dizzy、dispirited、faint、ear noises、dim eyesight 、 、 、 、 、 、 memory impairment、impaired concentration；acroanesthesia , 、 ； intelligence development abnormality 2、skin and mucosa：pallor；rough ；ulcer, stained yellow, 、 ： ； Koilonychia 3、espiratory apparatus：accelerated breathing ；short breath、 、 ： 、 4、digestive system：abdominal distention、anorexia, bowel 、 ： 、 disturbance, swallow foreign body sensation；Decreased food appetite; ； mirror surface tongue
10
Microcytic anemia
•Iron Deficiency •Thalassemia
11
Classification according to severity
Degree
Hb g/L Hb（g/L）
Mild anemia 90～120 ～ Moderate anemia 60～90 ～ Severe anemia ＜60 Very Severe anemia ＜30
Blood loss 1. Acute blood loss 2. Chronic blood loss
17
Clinical manifestation
Related factor; 1. cause of anemia 2. Degree of decrease of oxygen carrying capacity 3. Degree of decrease of blood volume 4. Speed of anemia genesis 5. Compensation and tolerance of blood and other
6
Deficient RBC Production
Neoplasia Leukemia Metastasis to bone marrow Osteogenic sarcoma Myelofibrosis Pernicious anemia Iron Deficiency anemia Aplastic anemia Chloramphenicol administration Renal disease (lack of erythropoietin production) Increased RBC destruction over erythropoiesis
19
Clinical manifestation
5、urinary system：bilirubinuria 、hemoglobinuria、 、 ： 、 urinary siderosis；ARF ；
6、circulating system：peripheral vaso-constriction， 、 ： ， Palpitation, congestive heart failure 7、endocrine system： endocrine functional abnormality 、 ： 8、immune system： 、 ：
15
Classification: according to etiology/pathogenesis
Increased RBC destruction 1. RBC internal defect (1)RBC membrane defect acquired: hereditary : (2) enzyme deficiency: (3) Hb abnormality (4) porphyrin metabolism 2. Exopathic
21
Diagnosis
complete diagnosis 1. anemia 2. Degree of anemia 3. Classification of anemia 4. Cause of anemia
20
Clinical manifestation
9、hematological system： 、 ： peripheral blood: blood cell count, appearance and biochemical component； ； plasma ,serum hematopoietic organ :BM , liver , spleen, lymph node 10、genital system ： 、
7
cell morphological classification
cell morphological type
MCV（fl） MCHC (%)
32～35 ～ 32～35 ～ ＜32
Macrocytic anemia Normocytic anemia
Microcytic hypochromic
They can be altered by the plasmatic volumes . Difference between women and men values are due to androgen hormones. For pregnant women, Hb＜100g／L
4
There are several causes of anemia
3
Definition
A decrease in any of these values (HCT, Hb, RBC count) is called anemia.
TEST HCT (%) Hb (g/L) RBC Count(1012/L) WOMEN ＜ 37 ＜ 110 ＜ 4.0 MEN ＜ 42 ＜ 120 ＜ 4.5
Tian jin Medical University, College of Nursing
1
Introduction
Anemia is a commonly encountered clinical symptom that is caused by an acquired or hereditary abnormality of red blood cells (RBC) or its precursors, or may be a manifestation of an nonhematologic disorder hematologic hematology adj. n.
Decresed RBC production
Anemia
1. BM stem cells abnormality AA 2. BM injured by abnormal tissues/cells Leukemia 3. Cell dysmaturity (1). DNA dyssynthesis Megaloblastic anemias (2). Hb dyssynthesis IDA 4. Abnormality in haematopoiesis modulation AA
13
Classification: according to etiology/pathogenesis
etiology/pathogenesis
Decreased RBC production Increased RBC destruction Blood loss
14
Classification: according to etiology/pathogenesy
Anemia
PNH hereditary spherocytosis G6PD deficiency hemoglobinopathy porphyrinopathy
immunologic, chemical, biological, or phisical factors 16
Classification: according to etiology/pathogenesy
2
Definition
Anemia is defined as a decrease in the circulating RBC or hemoglobin and a corresponding decrease in the oxygencarrying capacity of the blood. Normal values of the hemogram: TEST HCT (%) Hb (g/L) RBC Count(1012/L) HCT:Haematocrit WOMEN 37-43 11.3-13.5 3.83-4.83 Hb:hemoglobin MEN 42-49 12.7-15.3 4.29-5.58
＞100 80～100 ～ anemia ＜80
MCV：mean corpuscular volume ； MCHC：mean cell hemoglobin concentration
8
Macrocytic anemia
•Megaloblastic anemias ( folic acid and vitamin B12 deficiency) •Alcoholism •Drugs •Liver diseases •Primary bone marrow disorder •Hypothyroidism •Splenectomy
1. RBC Loss without RBC destruction 2. Deficient RBC production 3. Increased RBC destruction over production
5
RBC loss without RBC Destruction
Hemorrhage Due to trauma Due to disorders: e.g.cancer, ulcers, tuberculosis, diverticular disease, and irritable bowel syndrome (including ulcerative colitis and Crohn’s disease) Menstrual flow Gynecological disorders (e.g. endometriosis, fibroids) Pregnancy, especially at gestation Parasitism Hookworms
9
Normocytic anemia
•Chronic disease anemia (hepatic, renal or endocrine disorders) •Primary bone marrow disorders (aplasia, myelodisplasia, myelofibrose, hematologic and solid tumors, HIV infection, granulomas •Hemolytic anemia
12
Classification: according to Bone marrow proliferative degree
Bone marrowFra Baidu bibliotek
anemia
hyperplasia IDA, hemolytic anemia, blood loss anemia Hypoplasia AA, PRCA Dysmaturity(ineffective erythropoiesis) myelodysplastic syndrome(MDS) Megaloblastic anemias
18
Clinical manifestation
1、nervous system： 、 ： headache、dizzy、dispirited、faint、ear noises、dim eyesight 、 、 、 、 、 、 memory impairment、impaired concentration；acroanesthesia , 、 ； intelligence development abnormality 2、skin and mucosa：pallor；rough ；ulcer, stained yellow, 、 ： ； Koilonychia 3、espiratory apparatus：accelerated breathing ；short breath、 、 ： 、 4、digestive system：abdominal distention、anorexia, bowel 、 ： 、 disturbance, swallow foreign body sensation；Decreased food appetite; ； mirror surface tongue
10
Microcytic anemia
•Iron Deficiency •Thalassemia
11
Classification according to severity
Degree
Hb g/L Hb（g/L）
Mild anemia 90～120 ～ Moderate anemia 60～90 ～ Severe anemia ＜60 Very Severe anemia ＜30
Blood loss 1. Acute blood loss 2. Chronic blood loss
17
Clinical manifestation
Related factor; 1. cause of anemia 2. Degree of decrease of oxygen carrying capacity 3. Degree of decrease of blood volume 4. Speed of anemia genesis 5. Compensation and tolerance of blood and other
6
Deficient RBC Production
Neoplasia Leukemia Metastasis to bone marrow Osteogenic sarcoma Myelofibrosis Pernicious anemia Iron Deficiency anemia Aplastic anemia Chloramphenicol administration Renal disease (lack of erythropoietin production) Increased RBC destruction over erythropoiesis
19
Clinical manifestation
5、urinary system：bilirubinuria 、hemoglobinuria、 、 ： 、 urinary siderosis；ARF ；
6、circulating system：peripheral vaso-constriction， 、 ： ， Palpitation, congestive heart failure 7、endocrine system： endocrine functional abnormality 、 ： 8、immune system： 、 ：
15
Classification: according to etiology/pathogenesis
Increased RBC destruction 1. RBC internal defect (1)RBC membrane defect acquired: hereditary : (2) enzyme deficiency: (3) Hb abnormality (4) porphyrin metabolism 2. Exopathic
21
Diagnosis
complete diagnosis 1. anemia 2. Degree of anemia 3. Classification of anemia 4. Cause of anemia
20
Clinical manifestation
9、hematological system： 、 ： peripheral blood: blood cell count, appearance and biochemical component； ； plasma ,serum hematopoietic organ :BM , liver , spleen, lymph node 10、genital system ： 、
7
cell morphological classification
cell morphological type
MCV（fl） MCHC (%)
32～35 ～ 32～35 ～ ＜32
Macrocytic anemia Normocytic anemia
Microcytic hypochromic
They can be altered by the plasmatic volumes . Difference between women and men values are due to androgen hormones. For pregnant women, Hb＜100g／L
4
There are several causes of anemia
3
Definition
A decrease in any of these values (HCT, Hb, RBC count) is called anemia.
TEST HCT (%) Hb (g/L) RBC Count(1012/L) WOMEN ＜ 37 ＜ 110 ＜ 4.0 MEN ＜ 42 ＜ 120 ＜ 4.5