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lymphoid systems
• posthemorrhagic
• hemolytic
• impaired red cell production
Blood loss -
posthemorrhagic anemias
• acute - hypovolemia, shock, rapid
hemodilution, slowly increasing
hematopoesis (sufficient amount of
iron)
• chronic - GIT, female genital tract -
iron loss (increased hematopoesis)
Hemolytic anemias - general
features
• increased rate of RBCs destruction
• increased amount of iron
• hypercellular bone marrow
• reticulocytes in peripheral blood
Hemolytic anemias - RBCs
destruction
• intracorpuscular (intrinsic) -
hereditary, acquired are rare
• extracorpuscular (extrinsic) -
acquired, immunity, mechanical
trauma, infections
Intracorpuscular anemias
• hereditary
• acquired
Hereditary
• spherocytosis
• sickle cell anemia
• thalassemia - T. maior, T. minor
• glucose-6-phosphate dehydrogenase
deficiency
Acquired
• paroxysmal nocturnal
hemoglobinuria
Extracorpuscular anemias
• immunity related
• mechanical trauma
• infections
Immunity related
• autoimmune anemias
• Erythroblastosis fetalis (hemolytic disease of the
newborn) - related mainly to Rh system (D- antigen), less
to AB0 systém. Passage of fetal RBCs through the placenta
during last trimester (no cytotrophoblast) or during
childbirth. Mother antibodies cross the placenta.
• Concurent AB0 incompatibility protects the
mother against Rh immunization - RBCs removed
from maternal circulation. The blood dose - 1 ml. IgG
response - cross the placenta, IgM - does not cross, the
response faster in 2nd or 3rd gravidity (faster IgG response).
Mechanical trauma
• prostethic valves - more in metallic
or plastic prostheses than in
bioprostheses
• lack of
– iron
– folic acid
– vitamin B12
– less frequently - pyridoxin, thiamin
Iron deficiency anemia
(sideropenic)
• lack of iron in the food - veggies;
malabsorption - sprue
• increased demand - gravidity
• chronic loss - GIT, menstrual
bleeding
• morphology - microcytosis, low
RBCs volume, pallor, spoon-shaped
nails
Folic acid and vitamin B12
(Cobalamin) deficiency
anemia (megaloblastic)
• pancytopenia, erythrocytopenia,
agranulocytosis, thrombocytopenia
• in half number of cases - idiopatic
• sometimes after irradiation,
myelotoxic drugs
Myelophtisis
• leukemic form
• aleukemic form
• leukemic infiltration of the liver,
spleen, lymph nodes
• primary site - bone marrow
Leukemias - classification
• maturation:
• acute leukemias
• chronic myeloproliferative disorders
• cell types:
• lymphatic
• myeloid
Acute leukemias
• clinical course
– sudden onset
– anemia, fever, infections, hemorrhagic
diathesis
– bone pain (bone marrow expansion)
– generalized lymphadenopathy (ALL),
splenomegaly, hepatomegaly
– CNS symptoms - headache, vomitus,
paralysis
ALL (acute lymphoblastic
leukemia)
• 80 % of childhood leukemias
• 5 - 10 % Philadelphia chromosome (22
9)
• prognosis - relatively good, 90 % -
remission, if translocation worse
prognosis
AML (acute myeloid
leukemia)
• non-Hodgkin’s lymphomas
• Hodgkin’s lymphoma
Non-Hodgkin’s lymphomas
• nodular
• diffuse
• ML of CLL type
• follicular centre ML
• diffuse large cell ML
• Burkitt’s lymphoma
Extranodal ML
• mycosis fungoides
• Sézary’s syndrome
• MALToma
Hodgkin’s ML
• reactive lymphadenitis
– acute non-specific
– chronic non-specific
• speciphic lymphadenitis
– TBC (BCG)
– Cat Scratch Disease
Spleen - overview
• enlargement
– massive
– moderate
– mild
• rupture
• necrosis
Thymus - overview
• thymic hyperplasia
• tumors
• thymoma
» benign thymoma - 90 %
» thymic carcinoma
Thymomas
• epithelial predominance
• lymphocyte predominance
• mixed