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HAEMATOPOIESIS AND CLASSIFICATION OF ANAEMIA

HAEMATOPOIESIS AND CLASSIFICATION OF ANAEMIA. BY DR. KAMAL E. HIGGY CONSULTANT HAEMATOLOGIST. “ leukaemogenesis”. Age. Normal CD34. CD34. Inflammatory micro –environment, ROS. Contributing elements: Th17, NK cells, Monocytes. Pro-inflammatory Cytokines eg; IFN- γ , IL- 1b, 2,6,7,15.

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HAEMATOPOIESIS AND CLASSIFICATION OF ANAEMIA

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  1. HAEMATOPOIESISANDCLASSIFICATION OF ANAEMIA BY DR. KAMAL E. HIGGY CONSULTANT HAEMATOLOGIST

  2. “leukaemogenesis” Age Normal CD34 CD34 Inflammatory micro –environment, ROS Contributing elements: Th17, NK cells, Monocytes. Pro-inflammatory Cytokines eg; IFN-γ, IL- 1b, 2,6,7,15 ... Apoptosis , proliferation pressure Oligoclonal CD8+ T cells AML Evolution IF=inhibitory factors eg TGF-β 6

  3. HAEMATOPOIESISNEUTROPHILS

  4. NeutrophiliaCauses-----------------------------------------------------------------------------------------------------------------------------------NeutrophiliaCauses----------------------------------------------------------------------------------------------------------------------------------- • Acute infections: Bacterial, viral, fungal, mycobacterial and rickettsial • Physical stimuli: Trauma, electric shock, anoxia, pregnancy • Drugs and chemicals: Corticosteroids, aetiocholanolone, adrenaline, lead, mercury poisoning, lithium • Hematological causes: Acute haemorrhage, acute haemolysis, transfusion reactions, post- splenectomy, leukaemia and myeloproliferative disorders. • Malignant disease: Carcinoma, especially of gastro-intestinal tract, liver or bone marrow • Miscellaneous conditions: Certain dermatoses, hepatic necrosis, chronic idiopathic leucocytosis

  5. LymphocytosisNon-Malignant causes----------------------------------------------------------------------------------------------------------------------------------- • Virus infections: Infectious mononucleosis Infectious lymphocytosis Cytomegalovirus infection Occasionally mumps, varicella, hepatitis, rubella, influenza • Bacterial Infections: Pertussis Occasionally cat-scratch fever, tuberculosis, syphilis, brucellosis • Protozoal infections: Toxoplasmosis occasionally malaria • Other rare causes: Hyperthyroidism, congenital adrenal hyperplasia

  6. MonocytosisCauses-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------MonocytosisCauses------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- • Chronic bacterial infections: Tuberculosis, subacute bacterial endocarditis, brucellosis • Other Specific Infections: Malaria, Kala-azar, trypanosomiasis, typhus, Rocky Mountain spotted fever • Malignant diseases: Hodgkin’s disease, carcinoma • Leukaemia: Acute myeloid leukaemia, chronic monocytic leukaemia • Neutropenias: Familial benign and severe neutropenia Cyclical neutropenia Drug-induced Agranulocytosis • Miscellaneous: Cirrhosis, systemic lupus erythematosus, rheumatoid arthritis

  7. EosinophiliaCauses • Allergic reactions: Asthma, hay fever, urticaria, angioneurotic oedema • Parasitic Infestation: Tissue parasites – trichinosis, filariasis, visceral larva migrans, etc.. Intestinal parasites – Ascaris, Taenia, etc. (less regularly) • Skin disorders: Pemphigus, pemphigoid, eczema, psoriasis, (dermatitis herpetiformis) • Drug hypersensitivity reactions: Especially iodides, penicillin, allopurinol, gold salts, tartrazine Loffler’s pulmonary syndrome and Loffler’s endomyocarditis Tropical eosinophilia (probably filarial)

  8. EosinophiliaCauses (Cont…) • Malignant diseases: Especially Hodgkin’s disease, carcinoma of ovary, lung stomach, angioimmunoblastic lymphadenopathy. • Following irradiation or splenectomy: Hypereosinophilic syndromes Eosinophilic leukaemia • Miscellaneous Conditions: Polyarteritis nodosa, ulcerative colitis, sardoidosis, scarlet fever, pernicious anaemia, chronic active hepatitis, eosinophilic granuloma, familial eosinophilia

  9. Leukaemoid Reactions or LeucoerythroblasticAnaemiaCauses • Severe infections, especially in children: a. Pneumonia, septicaemia, meningococcal meningitis b. Infectious mononucleosis, pertussis • Intoxications: Eclampsia, severe burns, mercury poisoning • Neoplasia: Especially with bone-marrow infiltration • Severe haemorrhage or haemolysis

  10. NeutropeniaCauses • Drugs: Selective neutropenia Agranulocytosis (Aplastic anaemia) • Infections: Viral – including hepatitis, influenza, rubella Bacterial – typhoid fever, brucellosis, miliary tuberculosis Rickettsial and protozoal infections (Sometimes) • Megaloblastic anaemia: Vitamin B12 or folate deficiency • Chronic neutropenia: Chronic idiopathic neutropenia Immune neutropenia Congenital neutropenias Cyclical neutropenia --------------------------------------------------------------------------------------------------------------------------------------------------------------

  11. NeutropeniaCauses (cont…) • Hypersplenism: Primary In association with cirrhosis, Felty’s syndrome, etc. • Ionizing radiation and cytotoxic drugs: Radiotherapy Alkylating agents, antimetabolites, others • Malignant disease: Acute leukaemia Leuco-erythroblastic anaemia due to metastatic carcinoma, multiple myeloma or lymphoma • Micscellaneous conditions: Systemic lupus erythematosus, myxoedema, hypopituitrism, iron deficiency, anaphylactic shock

  12. LymphopeniaSecondary Causes • Loss: Mostly from gut as in intestinal lymphangiectasia, Whipple’s disease and rarely Crohn’s disease Thoracic-duct fistula • Maturation: Primary, or secondary to gut disease Vit B12 or folate deficiency Zinc deficiency • Pharmacological agents: Antilymphocyte globulin Corticosteroids Cytotoxic drugs

  13. LymphopeniaSecondary Causes (Cont…) • Infections: Severe septicaemias Influenza, occasionally other virus infections Colorado tick fever Miliary tuberculosis • Other miscellaneous conditions: Collagen vascular diseases, especially SLE Malignant disease Other conditions with lymhocytotoxins Radiotherapy Graft-versus-host disease

  14. SIGNS AND SYMPTOMS OF ANAEMIA Initially, anaemia can be so mild it goes unnoticed. But signs and symptoms increase as the condition worsens. symptoms The main symptom of most types of anemia is fatigue. Other anemia symptoms include: Weakness Headache (Fatigue) Pale skin A fast or irregular heartbeat Palpitation exercise induced dyspnea (Shortness of breath) Chest pain Dizziness Cognitive problems Numbness or coldness in extremities

  15. Signs of Anaemia may include: Black and tarry stools (sticky and foul smelling) Maroon or visibly bloody s tools Tachycardia Tachypnea Pale or cold skin Jaundice low blood pressure Heart murmur Enlargement of the spleen Constipation syncope (particularly following exercise) bounding pulse syncope or postural hypotension tinnitus or vertigo irritability, restlessness (difficulty sleeping or concentrating more frequent in severe chronic anemia) Sweating, thirst and air hunger

  16. Hypochromic and/or Microcytic Anaemia Serum Fe Serum Fe Increased Hyperferraemia Serum Fe Reduced Hypoferraemia Serum Fe Normal Bone marrow Sideroblast Fe Increased Hemoglobin Electrophoresis, etc Bone Marrow Macrophage Iron Serum Ferritin OR Low Absent THLASSEMIA IRON DEFICIENCY SIDEROBLASTIC ANAEMIA Normal or Increased ANAEMIA OF CHRONIC DISORDERS Increased CONGENITAL HEMOGLOBINOPATHIES (S,C,D,E) ACQUIRED

  17. MACROCYTIC ANAEMIA BLOOD AND MARROW MORPHOLOGY NON-MEGALOBLASTIC MEGALOBLASTIC Clinical data; serum vitamins B12 DEFICIENCY NO DEFICIENCY FOLATE DEFICIENCY Congenital diseases Drugs RETICULOCYTES Schilling Test with intrinsic factor DIET Poor Normal or decreased corrected Not corrected Good increased Small bowel bacteria Drug-induced malabsorption Dietary Deficiency Hepatic Disease Hemolytic Anemia Pernicious anaemia Myxaedema Fish tapeworm Gastric resection Pregnancy Jejunal resection Hemorrhage Hypoplastic anemia Familial B12 malabsorption Ingestion of corrosives infancy Acq. Sideroblastic Anaemia Drug-induced malabsorption Certain Blood Diseases Tropical sprue, gluten sensitivity Inertintrinsic factor Myelophthisic Anemia Ileal Disease

  18. NORMOCYTIC, NORMOCHROMIC ANEMIA RETICULOCYTES Normal or Decreased Erythrocyte Production Increased Erythrocyte Production History, Course, Blood Smear, Bile Pigments Bone Marrow Aspirate and Biopsy Post hemorr-hagic Anemia Abnormal Marrow Normal Marrow Hemolytic Anaemia Serum Iron Test Liver Function Test Renal Function Test Endocrine Function Dyserythropoie-tic Anaemia Hypoplastic Anaemia Infiltration Leukemia Myxaedema Anaemia of renal failure Anemia of liver disease Anemia of chronic disorders Myeloma Addison’s Myelofibrosis eunuchoidism Early Fe deficiency Metastases Panhypopituitarism

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