FACULTY OF MEDICINE AND HEALTH SCIENCES

MBBS PROGRAM
2017 - 2018

Systemic Pathology

PRACTICAL GUIDE BOOK

Prepared by:

Dr. Shwe Sin

Part 1: Anaemias of Diminished Erythropoiesis

Learning Objectives

At the end of the class, students should be able to:

1. Identify Iron Deficiency Anaemia (IDA)

2. Identify Megaloblastic Anaemia

Part 2: Haemolytic Anaemias

Learning Objectives

At the end of the class, students should be able to:

1. Identify Thalassemia
2. Identify Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency
3. Identify sickle cell anaemia
4. Identify immune mediated haemolytic anaemias
I. Iron Deficiency Anaemia (IDA)
Iron Deficiency Anaemia: Nail changes

Iron Deficiency Anaemia: Peripheral blood film changes

Magnification: High power

A 35-year-old woman complained of malaise, fatigue and palpitation of one month

duration. She had a history of abnormal heavy menstruation for 4 months. She looked pale,
glossitis and nail changes (Photograph) on examination
Q. Describe the gross nail changes shown in the photograph.

The nail becomes change into spoon-shaped and it is also known as

KOILONYCHIA.

Q. Describe the peripheral blood film changes shown in photomicrograph.

Markedly reduced red cell population, anisocytosis with microcytes,

poikilocytosis with pencil-shaped cells & few target cells.

Q. State the causes of IDA.

Chronic blood loss

Increased demand (e.g. pregnance, infancy)
Poor diet
Malabsorption

Q. What do you understand the meaning Anaemia of Diminished

Erythropoiesis.

Q. List the examples of Anaemia of Diminished Erythropoiesis.

IDA
Megaloblastic anaemia
Aplastic anaemia
Myelophthisic anaemia

Q. Describe the pathogenesis of Anaemia formation in Chronic diseases

Due to production of pro-inflammatory cytokines in chronic diseases resulting

sequestration of iron in mononuclear phagocytes will lead to anaemia formation.
 II. Megaloblastic Anaemia
Megaloblastic Anaemia: Peripheral blood film changes and showing
hypersegmented neutrophil

Magnification: High power

A 56-year-old woman complained of malaise, fatigue and palpitation of 3 weeks duration. She
looked pale, angular stomatitis and glossitis on examination. Serum Vitamin B12 levels are
reduced.

Q. Describe the peripheral blood film changes shown in photomicrograph.

There are oval-shaped macrocytes, anisopoikilocytosis and hypersengmented

neutrophil.

Q. What is the MOST likely diagnosis.

Megaloblastic anaemia

Q. Describe the pathogenesis of megaloblastic anaemia.

 Both Vitamin B12 and folic acid are coenzymes required for DNA synthesis.
Deficiency of Vit B12 and folic acid lead to disturbances in derangement of DNA
synthesis which in turn results in delayed nuclear maturation and cell division.
This results in enlargement of erythroid precursors (megaloblasts) and thus
abnormally large rbc.
III. Thalassemia

Photograph: 7 year old girl

-thalassemia major; x-ray shows hair-on-end appearance

 -thalassemia major; Hepatosplenomegaly

-thalassemia major; Peripheral Blood film changes

The photograph shows a 7 year old girl with pallor and abnormal facial appearance. She had a
history of regular blood transfusion.

Q. Based on the patients history and physical appearance, what is the most likely
diagnosis?

Thalassaemia syndrome

Q. Describe the pathogenesis of thalassemia syndrome.

Mutations in the or globin genes result in reduced haemoglobin synthesis

causing hypochromic microcytic anaemia

Q. Describe the peripheral blood film changes of thalassemia major.

Reduced red cell population, increased central pallor, anisocytosis with

microcytes, poikilocytosis with target cells and numerous nucleated rbc

Half dry eye

Q. State the complications of thalassaemia.

Growth retardation, Prone to infection, Iron overload, Cardiac failure

IV. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency
G6PD deficiency: Heinz bodies

Q. Describe the pathogenesis of G6PD deficiency.

This is sex-linked inheritance disease in which deficiency of glucose-6-phosphate

dehydrogeneae enzyme causing the red blood cells susceptible to oxidant stress.

Q. State the etiologic agents that can cause haemolysis in G6PD deficiency.

Infections
Drugs (e.g. antimalarias, sulphonamides etc)
Miscellaneous (e.g. naphthalene, fava beans etc)

Q. Name the inclusion bodies that can be seen in G6PD deficiency.

Heinz bodies (due to oxidized denatured Hb)

V. Sickle Cell Anaemia
Sickle cell anaemia: Dactylitis

Sickle cell anaemia: Peripheral blood film changes

Q. What is the diagnosis?

Sickle cell anaemia

Q. Describe the pathogenesis of sickle cell anaemia.

It is a haemoglobin disorders resulting from the inheritance of the sickle-b globin

gene formation of abnormal HbS.

Q. State the most common serious complication of sickle cell anaemia.

Vaso-occlusive or pain crisis

VI. Immune Mediated Haemolytic Anaemias

Autoimmune haemolytic anaemia (AIHA) : Peripheral Blood Film changes

Q. State the types of AIHA.

Warm AIHA
Cold AIHA

Q. Describe the pathogenesis of AIHA.

There is production of alloantibodies or autoantibodies to red blood cells.