教学课件贫血.ppt
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1、第一页,共39页。教学课件贫血教学课件贫血教学课件贫血D e f i n i t i o n A Definition A 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。D e f i n i t i o
2、 n A r e d u c t i o n b e l o w n oFactors influencing Hb concentrationSexAgeAltitudeAlterations in plasma volume2021/1/123第三页,共39页。F a c t o r s i n f l u e n c i n g H b c o n c e n tClassification Morphologic classificationTypeMCV(um)MCH(PG)MCHC(%)DiagnosisMacrocytic1003232-35Megaloblastic anemi
3、aNormocytic80-10026-3232-35AA,HA,Acute posthemorragic anemiaMicrocytic802632IDA,Sideroblastic anemiaThalassemias2021/1/124第四页,共39页。C l a s s i f i c a t i o n Mo r p h o l o g i c Kinetic classification(Classified according to etiology and pathogenesis)一、一、Decreased erythropoiesisDecreased erythropo
4、iesis 1Proliferation and differentiation 2 abnormalities of SCHSC:AA,Fanconis anemia,MDSErythrocytic progenitors:Pure red cell aplasia,Anemias caused by kidney failure and endocrine disorders2021/1/125第五页,共39页。K i n e t i c c l a s s i f i c a t i o n(C l a s s i2Marrow infiltration leukemiascarcino
5、mamultiple myeloma myelofibrosisMalignant histocytosis2021/1/126第六页,共39页。Ma r r o w i n f i l t r a t i o n l e u k e mi3Production and maturation blockages of differentiating cells DNA synthesis blockage:Vit B12,falic acid difficiencies,嘌呤和嘧啶嘌呤和嘧啶 metabolic defectsMegaloblastic anemiaHb synthesis b
6、lockage:Heme production defect:IDA Heptoglobin production defect:Thalassemias2021/1/127第七页,共39页。P r o d u c t i o n a n d ma t u r a t i o n b l o c4 Unknown reason or several mechanismsSideroblastic anemiaChronic disease anemias(chronic inflummation,infections,尿毒症尿毒症,Hepatic disorders,neoplasm,conn
7、ective tissue disease,endocrine disorders)2021/1/128第八页,共39页。4 U n k n o w n r e a s o n o r s e v e r a l m二、二、Accelerated destruction of red cells 1Endogenous(intra-erythrocyte defects)1.Membrane defects of erythrocytes:Hereditary:Hereditary spherocytosis(HS)Hereditasy elliplocytosis(HE)Acquired:P
8、NH2.Enzyme defects Glucose-6-Phosphate Dehydrogenase (G6PD)deficiency Pyruvate kinase deficiency 3.Abnormal haptogllbin synthesis:Sickle cell anemia,Hemoglobinopathies Thalassemias2021/1/129第九页,共39页。二、A c c e l e r a t e d d e s t r u c t i o n o f r2)Extragenous1.Immune HA:AIHA,neonatal HA,mismatch
9、ed transfusion,drug-induced HA2.2.Mechanical:march hemoglobinuria,cardiac valves prostheses,microangiopathic hemolytic disorders.3.3.Due to chemical,physical or microrganisms:Chemical toxin-and drug-induced hemolysis,large scale burned patient(severe burned patient)Infection-induced,benzene,radiatio
10、n4.microrganisms:Malaria,virus,etc.5.4.Increased damage of monocyte-macrocyte system:Hypersplenism2021/1/1210第十页,共39页。2)E x t r a g e n o u s I mmu n e H A :A I H A,三三.Blood lossAcute posthemorrage anemiaChronic bleeding IDA2021/1/1211第十一页,共39页。三.B l o o d l o s s A c u t e p o sClassified accordind
11、 to the proliferative situations of BMHyperplastic anemias(增生性贫血增生性贫血):Hemolytic anemiaAnemia caused by blood lossMegaloblastic anemia,IDA Hypoplastic anemias(增生减低性贫血增生减低性贫血):AA2021/1/1212第十二页,共39页。C l a s s i f i e d a c c o r d i n d t o t h e p rClinical manifestationsFactors influencing symptoms
12、:Severity of anemia Hb8090g/LsymptomsRapidity of anemia Abrupt loss of 20%of the circulating blood volume marked pallor,postural hypotension and tachycardia(心动过速心动过速)The loss of 50%severe shock even dealth.2021/1/1213第十三页,共39页。C l i n i c a l ma n i f e s t a t i o n s F a c t o rIn contrast,the gra
13、dual loss(even Hb 3040g/L)of the circulating red cell mass in a patient with pernicious anemia may occur without any symptoms at all.2021/1/1214第十四页,共39页。I n c o n t r a s t,t h e g r a d u a l l o s s Why?Red cell 2,3 DPG(RBC内内2,3-二磷酸甘油酸二磷酸甘油酸In anemia the oxyhemoglobin dissociation curve usually s
14、hifts(右右移移)in a manner to increase the quantity of oxygen released in tissues without oppeciably altering the quantity of osygen bound in the lungs.Red cell 2,3 diphophoglycerate(2,3 DPG)regularly increases in anemic patients to mediate this effect.Maximum elevation of RBC 2,3 DPG increases oxygen d
15、elivery only about 30 per cent,but this is a highly efficient form of compensation requiring no significant expenditure of energy.2021/1/1215第十五页,共39页。Wh y?R e d c e l l 2,3 D P G 2 0 2 1/1/The aged patients or patients with vascular or cardiac diseases may not stand to milder anemia.2021/1/1216第十六页
16、,共39页。T h e a g e d p a t i e n t s o rThe level of anemia at which symptoms occur is highly variable among individuals as would be expected from the widely differing degrees of physical activity,physical conditioning,circulatory adequacy,and sensitivity or stoicism of the population.2021/1/1217第十七页
17、,共39页。T h e l e v e l o f a n e mi a a t w h i c h sGeneral manifestations:(Nonspecific and reflect tissue hypoxia)Tiredness,fatigue the most common,the earliest symptom Pallor of skin and mucosashared chracteristicCardiovascular systems:Palpitations and dyspnea on exertion,breathlessnesscommon symp
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