教学ppt课件贫血

教学课件贫血第一页，共39页。教学课件贫血教学课件贫血教学课件贫血DefinitionADefinitionA reduction below normal in the concentration of hemoglobin,the mass of red blood cells and/or the hematocrit in the blood.In men Hb 120g/L RBC 4.51012/L HCT 0.42 In women Hb 110g/L RBC4.0 1012/L HCT0.37 2021/1/122第二页，共39页。DefinitionAreductionbelownoFactors influencing Hb concentrationSexAgeAltitudeAlterations in plasma volume2021/1/123第三页，共39页。FactorsinfluencingHbconcentClassification Morphologic classificationTypeMCV(um)MCH(PG)MCHC(%)DiagnosisMacrocytic1003232-35MegaloblasticanemiaNormocytic80-10026-3232-35AA,HA,AcuteposthemorragicanemiaMicrocytic802632IDA,SideroblasticanemiaThalassemias2021/1/124第四页，共39页。ClassificationMorphologicKinetic classification(Classifiedaccordingtoetiologyandpathogenesis)一、一、Decreased erythropoiesisDecreased erythropoiesis1Proliferation and differentiation 2 abnormalities of SCHSC:AA,Fanconisanemia,MDSErythrocytic progenitors:Pure red cell aplasia,Anemiascausedbykidneyfailureandendocrinedisorders2021/1/125第五页，共39页。Kineticclassification(Classi2Marrow infiltrationleukemiascarcinomamultiplemyelomamyelofibrosisMalignanthistocytosis2021/1/126第六页，共39页。Marrowinfiltrationleukemi3Production and maturation blockages of differentiating cellsDNAsynthesisblockage:VitB12,falicaciddifficiencies,嘌呤和嘧啶嘌呤和嘧啶metabolicdefectsMegaloblasticanemiaHbsynthesisblockage:Hemeproductiondefect:IDAHeptoglobinproductiondefect:Thalassemias2021/1/127第七页，共39页。Productionandmaturationbloc4 Unknown reason or several mechanismsSideroblasticanemiaChronicdiseaseanemias(chronicinflummation,infections,尿毒症尿毒症,Hepaticdisorders,neoplasm,connectivetissuedisease,endocrinedisorders)2021/1/128第八页，共39页。4Unknownreasonorseveralm二、二、Accelerateddestructionofredcells1Endogenous(intra-erythrocytedefects)1.Membranedefectsoferythrocytes:Hereditary:Hereditaryspherocytosis(HS)Hereditasyelliplocytosis(HE)Acquired:PNH2.EnzymedefectsGlucose-6-PhosphateDehydrogenase(G6PD)deficiencyPyruvatekinasedeficiency3.Abnormalhaptogllbinsynthesis:Sicklecellanemia,HemoglobinopathiesThalassemias2021/1/129第九页，共39页。二、Accelerateddestructionofr2)Extragenous1.Immune HA:AIHA,neonatalHA,mismatchedtransfusion,drug-inducedHA2.2.Mechanical:marchhemoglobinuria,cardiacvalvesprostheses,microangiopathichemolyticdisorders.3.3.Due to chemical,physical or microrganisms:Chemicaltoxin-anddrug-inducedhemolysis,largescaleburnedpatient(severeburnedpatient)Infection-induced,benzene,radiation4.microrganisms:Malaria,virus,etc.5.4.Increased damage of monocyte-macrocyte system:Hypersplenism2021/1/1210第十页，共39页。2)ExtragenousImmuneHA:AIHA,三三.BloodlossAcuteposthemorrageanemiaChronicbleedingIDA2021/1/1211第十一页，共39页。三.BloodlossAcuteposClassifiedaccordindtotheproliferativesituationsofBMHyperplasticanemias(增生性贫血增生性贫血):HemolyticanemiaAnemiacausedbybloodlossMegaloblasticanemia,IDAHypoplasticanemias(增生减低性贫血增生减低性贫血):AA2021/1/1212第十二页，共39页。ClassifiedaccordindtotheprClinicalmanifestationsFactors influencing symptoms:SeverityofanemiaHb8090g/LsymptomsRapidityofanemiaAbruptlossof20%ofthecirculatingbloodvolumemarkedpallor,posturalhypotensionandtachycardia(心动过速心动过速)Thelossof50%severeshockevendealth.2021/1/1213第十三页，共39页。ClinicalmanifestationsFactorIncontrast,thegradualloss(evenHb3040g/L)ofthecirculatingredcellmassinapatientwithperniciousanemiamayoccurwithoutanysymptomsatall.2021/1/1214第十四页，共39页。Incontrast,thegraduallossWhy?Redcell2,3DPG(RBC内内2,3-二磷酸甘油酸二磷酸甘油酸Inanemiatheoxyhemoglobindissociationcurveusuallyshifts(右右移移)inamannertoincreasethequantityofoxygenreleasedintissueswithoutoppeciablyalteringthequantityofosygenboundinthelungs.Redcell2,3diphophoglycerate(2,3DPG)regularlyincreasesinanemicpatientstomediatethiseffect.MaximumelevationofRBC2,3DPGincreasesoxygendeliveryonlyabout30percent,butthisisahighlyefficientformofcompensationrequiringnosignificantexpenditureofenergy.2021/1/1215第十五页，共39页。Why?Redcell2,3DPG2021/1/Theagedpatientsorpatientswithvascularorcardiacdiseasesmaynotstandtomilderanemia.2021/1/1216第十六页，共39页。TheagedpatientsorThelevelofanemiaatwhichsymptomsoccurishighlyvariableamongindividualsaswouldbeexpectedfromthewidelydifferingdegreesofphysicalactivity,physicalconditioning,circulatoryadequacy,andsensitivityorstoicismofthepopulation.2021/1/1217第十七页，共39页。ThelevelofanemiaatwhichsGeneralmanifestations:(Nonspecific and reflect tissue hypoxia)Tiredness,fatiguethemostcommon,theearliestsymptomPallorofskinandmucosasharedchracteristicCardiovascularsystems:Palpitationsanddyspneaonexertion,breathlessnesscommonsymptomsValvulaemurmursHb3mAnemiccardicdisease2021/1/1218第十八页，共39页。Generalmanifestations:(Non3Neurologicsystem:Headache,Dizziness,Confusion,decreasedmentalacuity(记忆力衰退记忆力衰退),晕厥，注意力不集晕厥，注意力不集中，失眠，耳鸣中，失眠，耳鸣severeanemiaComa4Digestivesystem:Anorexia(食欲不振食欲不振)，厌食，厌食earlymegaloblasticanemiaNausea(恶心恶心)，flatulence(胀气胀气)，diarrhoea(腹腹泻泻)orconstipation(便秘便秘)lingualabnormalities(舌的改变舌的改变)：common2021/1/1219第十九页，共39页。3Neurologicsystem:Heada5Genitourinarysystem:severeanemiapolyurea(多尿多尿),hypobaricurine(尿比重低尿比重低),proteinuria(蛋白尿蛋白尿):肾小球滤过功能和小管肾小球滤过功能和小管分泌及回收功能障碍分泌及回收功能障碍female:disturbedmenstruation(月经紊乱月经紊乱),性功能减退多见性功能减退多见6Other:7.Manifestationsofunderlyingdisease:2021/1/1220第二十页，共39页。5Genitourinarysystem:severeTheprocessofcorrectdiagnosisistheoneofdifferentialdiagnosis.Steps:1.ToEstablishthetypeofanemia2.TofindoutthecauseorunderlyingdiseasesofanemiaDiagnosis2021/1/1221第二十一页，共39页。Theprocessofcorrectdiagnos1.1.Cause or inducer of anemia:Cause or inducer of anemia:Nutrition,specialhabitsforfoodchangeinstoolhabits:stoolGuaiacsinallprofessioninfluationofsurroundingenvironmentchronicdiseasesmenstruation,marriage一一History2021/1/1222第二十二页，共39页。Causeorinducerofanemia:N2.Developing processes,severity 2.Developing processes,severity&complications of anemias&complications of anemiasDurationandonsetofsymptoms3.Important laboratory results,3.Important laboratory results,diagnosis,treatments and their diagnosis,treatments and their effects.effects.2021/1/1223第二十三页，共39页。2.Developingprocesses,seskinandmucosa:pallor,jaundice,petechiaehairandnailsadenopathy(淋巴结肿大淋巴结肿大)hepatomegaly-splenomegalyneurologicabnormalities肛门及妇科盆腔检查肛门及妇科盆腔检查二二Physical examination2021/1/1224第二十四页，共39页。skinandmucosa:pallor,jaund、The hemogram The hemogram 血像血像Routine blood exam(Hb,RBC)Routine blood exam(Hb,RBC)The reticulocyte count(RC)The reticulocyte count(RC)RC:hyperplasticRC:hyperplasticRC:hypoplasticRC:hypoplastic三、三、Laboratory findings2021/1/1225第二十五页，共39页。、Thehemogram血像RoutinebReticulocyte CountIsrequiredintheevaluationofallpatientswithanemiaasitisasimplemeasureofproductionYoungRBCthatstillcontainsasmallamountofRNANormallytake1dayforreticulocytetomature.Underinfluenceofepotakes2-3days1/120thofRBCnormally2021/1/1226第二十六页，共39页。ReticulocyteCount2021/1/1226第Absolute Retic countReticcountsarereportedasapercentage:RBCcountxRetic%=Absoultereticcountnormal:(77+23)x109/LAbsoluteReticcountsneedtobecorrectedforearlyrelease(Ifpolychromasiaispresent)Absoluteretic/2(forhctinmid20s)Absoluteretic/3(hct20)2021/1/1227第二十七页，共39页。AbsoluteReticcountReticcounMCV(themeancorpuscularvolume):themostusefuloftheRBCindices.MCH,MCHC:arerarelyashelpfulastheMCVTheleukocyteandplateletcount:Anemiawithadiminishedleukocyteandplateletcount-pancytopenia-suggestseitherprimarymarrowdisease,megaloblasticanemia,orhypersplenism.Examinationoftheperipheralbloodsmear:2021/1/1228第二十八页，共39页。MCV(themeancorpuscularvolum2.Examination of bone marrow2.Examination of bone marrow骨髓涂片检查：主要观察骨髓涂片检查：主要观察BM增生程度，各系统细胞分类计数，增生程度，各系统细胞分类计数，异常细胞，正常异常细胞，正常BM组织有核细胞与脂肪组织各占组织有核细胞与脂肪组织各占1/2，前者增，前者增多尤其是红系见于增生性贫血，后者增多代表多尤其是红系见于增生性贫血，后者增多代表BM增生低增生低下，见于下，见于AA，骨髓小粒是血液稀释与否的一个重要标志。，骨髓小粒是血液稀释与否的一个重要标志。Examinationofaspiratedsmearsingeneralgivessuperiorcytologicinformationwhilethecorebiopsyprovidescrucialinformationconcerningtheoverallcellularity,aswellasthepresenceoffibrosis,tumor,orgranulomas.Bothproceduresarecomplemantaryandarebestperformedtogetherwhenthediagnosisisindoubt.Bonemarrowironstaining2021/1/1229第二十九页，共39页。2.Examinationofbonemarrow3.Some useful ancillary tests3.Some useful ancillary tests1)Stoolsforoccultblood2)TestsforhemolyticanemiasuchasCoombstest3)Testsfornutritionalanemiasuchasserumfolicacid,serumVitaminB12,SI,SF,etc.4)Liverandkidneyfunctiontests5)Immunologictests6)影像学检查：钡餐透视，钡灌肠影像学检查：钡餐透视，钡灌肠2021/1/1230第三十页，共39页。3.SomeusefulancillarytestsTreatment一、一、TreatmentofthecausesThepurposeisthetreatmentoftheunderlyingdisease.GastriccancerPerniciousanemia恶性贫血恶性贫血megaloblasticanemia2021/1/1231第三十一页，共39页。Treatment一、Treatmentofthec二、二、Drugs明确病因之前且忌乱投药明确病因之前且忌乱投药Ironagents;calculationofdosefalicacid,VitB12VitB6Corticosteroids:AIHA，AA,PNHAndrogens:maypromatereythropoiesis:1.)刺激刺激EPO分泌。分泌。2增强增强BM对对EPO的的效应。效应。EPO:AnemiacausedbykidneydiseasesImmunosuppressionagentsALG(antilymphocyteglobulinCsA:AcuteandsevereAA2021/1/1232第三十二页，共39页。二、Drugs明确病因之前且忌乱投药2021/1/1232三、三、TransfusionsAvoidofcomplicationsashepatitisandAIDSWholebloodFrozedredcellsWashedredcellsLeukocytepoorpackedcells浓缩浓缩RBCChronicanemia:Hb300)lowAnemia of Chronic DxlowlowNormal to highAplastic anemia HighExtremely highNormal to high2021/1/1236第三十六页，共39页。LabEvaluationofHypoproliferLaboratory findings in anaemiaDrs Shepherd,Dexter,and Rapson Spring 20012021/1/1237第三十七页，共39页。LaboratoryfindingsinanaemiaScanning Electron microscopy:normal red cell2021/1/1238第三十八页，共39页。ScanningElectronmicroscopy:2谢谢大家！结结 语语第三十九页，共39页。谢谢大家！结语第三十九页，共39页。