Pria Wanita Sel darah merah / Red Blood Cell, RBC (10 6 /ul) 5,4 4,8 Hematokrit (Hct) % Vol RBC -------------- X 100 vol darah 47 42 Hemoglobin/ Hb (g/dL) 16 14 Volume eritrosit rata-rata/ Mean Corpuscular Volume/MCV (fL) Hct X10 = ---------------- RBC(10 6 /uL) 87 87 Hemoglobin eritrosit rata-rata/ Mean Corpuscular Hemoglobin/MCH (pg) Hb X10 =---------------- RBC(10 6 /uL) 29 29 Konsentrasi hemoglobin eritrosit rata- rata/ Mean Corpuscular Hemoglobin Concentration /MCHC (g/dL) Hb X10 =---------------- Hct 34 34 Diameter sel rata-rata/ mean cell diameter, MCD (um) =diameter rata-rata 500 sel pada sediaan hapus 7,5 7,5 Tabel Karakteristik RBC Manusia (indikator kapasitas pembawaan O2) Normal Blood Cells: Haemopoiesis: Pembentukan eritrosit, sebagian besar lekosit, dan trombosit dewasa di sumsum tulang belakang (sel multipoten);
Janin: di hati dan limpa Anak-anak di rongga sumsum tulang seluruh tulang ad 20 tahun, kecuali tulang humerus atas dan femur.
Sumsum tulang seluler aktif = sumsum merah. Sumsum tulang inaktif = sumsum kuning (diinfiltrasi lemak). Proerythroblast (Pronormoblast) Basophilic Normoblast Polychromatophilic Normoblast Orthochromatophilic Normoblast Reticulocyte Erythrocyte Early Intermediate Late Steps in Erythropoisis RED CELL DISORDERS ANEMIA ERYTHROCYTOSIS Anemia is decreased red cell mass affecting tissue oxygenation Practical - Low Hb* or Low Hematocrit* Anemia A reduction below normal in the concentration of hemoglobin or red blood cells in the blood.
Hematocrit (<40% in men,<36% in women)
Hemoglobin (13.2g/dl in men, 11.7g/dl in women) CAUSA
Acquired disorders: Decreased production Increased loss
Enzyme disorders: G6PD deficiency Anemia with Low MCV (Microcytic Hypochromic) Differential diagnosis Iron deficiency Thalassemia
Laboratory evaluation Iron, iron-binding capacity, and ferritin Hb electrophoresis for Thalassemia Anemia with High MCV (Macrocytic anemia) Differential diagnosis Megaloblastic anemia Nonmegaloblastic anemia
Laboratory evaluation Serum vitamin B12, RBC folate Examination of peripheral smear Anemia with Normal MCV (Normocytic anemia) Differential diagnosis Primary bone marrow failure Aplastic anemia Secondary bone marrow failure Uremia, HIV infection etc.
Laboratory evaluation Blood smear for morphology Erythropoietin level Bone marrow aspirate and biopsy Anemia aplastik Pansitopenia (DT) Deplesi BM cell & replacement BM with fat Occur at any age, more frequent in age 50 Etiologi : 1, Primer : congenital, idiopathic 2, sekunder : chemical, drugs, radiation. Infectius,imunologic
Iron Deficiency Anemia (IDA) Katabolisme iron Eritrosit (100-120 hari)
Difagositosis oleh sistem makrofag
Globin heme
Porfirin iron
Biliverdin utk sistesis Hb baru
bilirubin Ekskresi (empedu) IDA - Etiology Blood loss Bleeding Parasites, Gynecologic, ulcers Increased need Pregnancy, children Poor diet / poor absorption Malnutrition (greens & meat), malabsorption, intestinal surgery, gastric atrophy. IDA - Pathogenesis: Decreased Iron stores Decreased Hb Synthesis Delayed maturation of erythroblasts (cytoplasmic) Decreased cytoplasm, more division (microcytes) Decreased hb content (hypochromia) Anemia. Laboratory tests:
Hematologi rutin Serum iron Serum iron binding capacity Serum ferritin
Microcytic Anemia (IDA) Symptoms of Anemia Nonspecific and reflect tissue hypoxia:
Fatigue Dyspnea on exertion Palpatations Headache Confusion, decreased mental acuity Skin pallor Clinical Features: General features of Anemia Pallor, Weakness, Lethargy, Breathlessness on exertion Palpitations heart failure pedal edema
Special features in IDA: Angular cheilitis, atrophic glossitis, Oesophageal atrophy/web dysphagia, Koilonychia, brittle nails, gastric atrophy. Angular cheilitis Angular cheilitis & Glossitis Koilonychia in Iron def. Koilonychia in Iron def. Iron Deficiency Anemia: IDA on Treatment : Megaloblastic anemia: Vitamin B12/Folic acid deficiency Second most common type of anemia. Macrocytic anemia, pancytopenia. Pernicious anaemia: autoimmune, Gastric atrophy, Vit B12 def. Megaloblastic anemia - Etiology Malnutrition Intrinsic factor Ab - Pernicious anemia Gastrectomy, Ileal resection Inflammatory bowel disease Malabsorption syndromes - Sprue Blind loop syndrome
Megalobl - Pathogenesis: Decreased Vit B12 / Folate Decreased DNA Synthesis Delayed maturation of erythroblasts (Nucleus) Increased cell size (macrocytes) Normal hb content (Normochromia) Decreased RBC number Decreased WBC number (pancytopenia) Anemia & Pancytopenia. Vitamin B 12 Absorption Parietal cells - produce IF IF B 12
B 12
B 12+IF IF Stomach IF
Ileum - IF receptors B 12
B 12 Macrocytic Anemia (Meg.): Macroovalocytes & Macropoly Megaloblastic Anemia : Differential diagnosis of Anemia Low Hb=Anemia MCV Low microcytic Normal normocytic High macrocytic Measure Ferritin Low Normal/high Iron def Anemia Anemia of chronic disease/ Congenital Hb dis. Reticulocyte count high low Anemia of chronic disease Renal failure Marrow failure Hemolytic anemia or blood loss Measure B 12 + folate
Low Megaloblastic anemia Normal Causes of High Hct/polycythemia Relative or spurious erythrocytosis Hemoconcentration secondary to dehydration (diarrhea, diaphoresis, diuretics, deprivation of water, emesis, ethanol, etc.)
Absolute erythrocytosis (True ): Tissue hypoxia Smoking (Co), High altitude, Pumonary disease, respiratory def. Cardiac shunts, High oxygen-affinity Hb. High EPO - Tumors eg. Renal cell Ca, hepatoma Androgen therapy Primary - Polycythemia vera
Association of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS) Part 2 - Prevention and Monitoring