PhD., Viktoriya Piliponova Vinnytsya National Pirogov Memorial Medical University Pathophysiology Department PATHOLOGY OF RED BLOOD PhD., Viktoriya Piliponova

In norm The number of erythrocytes: in female - 3,9-4,7·1012/l in male - 4,5-5,0·1012/l Hemoglobin in female - 120-140g/l in male - 140-160g/l Color index(CI) - 0,85-1,15 Globular value = 3 x Hb / the first 3 figures of erythrocytes. Reticulocytes - 0.5-2%, 0,5-2%0

Anemia -is a syndrome or disease which is characterized by the decrease of erythrocytes and hemoglobin amount in the unite of blood volume and accompanied by qualitative changes of erythrocyte.

Classification of anemia I. According to etiology: Hereditary and acquired II. According to pathogenesis : Diserythropoietic Hemolytic Posthemorragic

IІІ. According to type of hematopoesis: 1. with erythroblastic 2. with megaloblastic ІV. According to color index (globular value): 1. normochromic 2. hypochromic 3. hyperchromic

Color index(CI) - 0,85-1,15 Globular value = 3 x Hb (g/l) / the first 3 figures of erythrocytes. ІV. According to color index (globular value): 1. normochromic 2. hypochromic 3. hyperchromic

V. According to ability of bone marrow to regeneration: regenerative hyperregenerative hyporegenerative aregenerative

Qualitative (degenerative) changes of red blood cell - poikilocytosis - different shape of erythrocytes; - anisocytosis - different size of erythrocytes; - anisochromia - different saturation of red blood cells by hemoglobin

- pathological inclusions in the erythrocytes : Cabot rings Jolly bodies

Relative (in case of plasma volume decrease). Erythrocytosis – it is increase of the erythrocytes number in one unit of blood volume   Absolute : 1). Primary 2). Secondary Relative (in case of plasma volume decrease).

Vaquez disease Erythremia (true polycythemia) - chronic leukemia with the defect of cells of precursor of mielopoesis with unlimited proliferation hematopoetic cells. Blood picture: Hemoglobin (over 180g/l) Erythrocyte (over 6x1012/l) Platelets (over 400x109/l) Leukocyte (over 10x109/l) Hematocrit ↑

Anemia -is a syndrome or disease which is characterized by the decrease of erythrocytes and hemoglobin amount in the unite of blood volume and accompanied by qualitative changes of erythrocyte.

Iron-deficiency anemia Reasons: blood loss chonic low initial level of Fe high requirement of Fe alimentary disorder of absorption transferrin insufficiency

Iron-deficiency anemia Blood picture : Erythrocyte number ↓ Reticulocyte number ↓ Hemoglobin amount ↓ Color index (globular value) ↓ Smear: microcytes, anulocytes In the serum : the amount of iron is reduced (in norm: 12,5 - 30,4 mcmol/l).

PALENESS OF SKIN BRITTLE HAIR CRACKED LIPS BRITTLE NAILS

PRINCIPLES OF TREATMENT : !!! Before taking of iron supplements to determine the Fe level in the blood

Etiotropic treatment: balanced diet

Pathogenetic treatment : Oral and parenteral Iron therapy: Iron supplements intake (Fe bivalent!) in combination with vitamin C (vitamin C improves absorption of Fe in the blood) Replacement therapy : According to indications – red cell transfusion.

IRON REFRACTORY is anemia which arises up as a result of the violation of iron including into hemoglobin, at the activity decrease or absence of enzymes which are needed for the hemoglobin synthesis (protoporphyrin ІX deficiency) Reasons:   1. Hereditary   2. Lead poisoning, alcoholism.

Iron-refractory anemia Blood picture : - Hemoglobin amount ↓ - Erythrocyte number ↓ - Color index (globular value) ↓ Sideroblasts ↑ In the blood serum the number of iron increases!!!!. In marrow the sideroblasts number increases.

PRINCIPLES OF THERAPY: Normalization of porphyrin metabolism (vitamins B6) Removal of Fe from the tissues

insufficient intake with food pathology of the stomach В12-deficiency anemia Reasons: insufficient intake with food pathology of the stomach pathology of the intestine transcobalamin deficiency hepatitis pregnancy

В12-deficiency anemia Erythrocyte number ↓ Hemoglobin amount ↓ Blood picture Erythrocyte number ↓ Hemoglobin amount ↓ Color index (globular value) ↑ ↑ Leukopenia, hypersegmentation of neutrophils Thrombocytopenia In the smear of blood: megalocytes, megaloblasts; Jolly's bodies; Cabot's rings.

Glossitis – inflammation with depapillation of the tongue dorsal surface Atrophic gastritis Funicular myelosis Pancytopenia

PRINCIPLES OF THERAPY : Etiotropic treatment : balanced diet Pathogenetic treatment : cyanocobalamin and folic acid

Hypoplastic (aplastic) - anemia which affects bone marrow erythrocyte sprout on the background of a deep bone marrow suppression and sharply reduced production of red blood cells and granulocytes and platelets (pancytopenia).

Causes: Ionizing radiation, infectious, chemicals - drugs: [sulfonamides, levomycetin, cytostatics, anti-TB drugs], benzol and its derivatives, pesticides; Blood Picture: Number of Hb ↓ Erythrocyte number ↓ Color index - normochromic Pancytopenia (↓ leukocytes, platelets).

Hemolytic is anemia which arises up as a result of increased hemolysis when destruction of erythrocytes prevails above their production. Classification : І. Hereditary – Membranopathy Haemoglobinopathy Enzymopathy ІІ. Acquired

Classification of hemolytic anemia І. Hereditary Membranopathy Haemoglobinopathy Enzymopathy ІІ. Acquired

Classification: After the mechanism of hemolysis hemolytic anemias are divided into: anemias with intravascular hemolysis; anemias with intracellular hemolysis.

Reasons and mechanisms of the intracellular hemolysis: inherited or acquired defect of erythrocytes; antibody-dependent [cell- mediated];

microspherocytosis or Minkowsky-Shauffard disease [hereditary spherocytosis].   Blood picture : 1. The number of hemoglobin decreases. 2. The number of erythrocytes is decreases. 3. CI is normal - normochromic anemia. 4. The reticulocytes number increases - hyperregenerative anemia. 5. Decrease of erythrocytes osmotic resistance takes place. 6. Increase mean concentration of hemoglobin in the red blood cell (МСНС) more than 36%. 6. The number of unconjugated [indirect] bilirubin increases.

Enzymopathy-deficiency of the enzyme Gl-6-FDG Blood picture : 1. Erythrocyte number ↓ 2. Hemoglobin amount ↓ 3. Color index (globular value) – normochromic. 4. Reticulocyte number ↑ 5. Erythrocytes osmotic resistance ↓ 6. Indirect bilirubin ↑

Hemoglobinopathys are the anemias related to the violation of hemoglobin synthesis. Types of hemoglobinopathys : The 1st – is the hemoglobin chains synthesis violations; The 2nd – is the hemoglobin chains structure violations.

α-thalassemia Blood picture : 1. Erythrocyte number ↓ ↓ Hemoglobinopathy α-thalassemia Blood picture : 1. Erythrocyte number ↓ ↓ 2. Hemoglobin amount ↓ 3. Color index ↓. 4. Reticulocyte number ↑ 5. Erythrocytes osmotic resistance ↓ 6. Indirect bilirubin ↑ 7. Target erythrocytes (codocytes)

Sickle-cell anemia Blood picture : Erythrocyte number ↓ Hemoglobin amount ↓ Color index (globular value) – normochromic Indirect bilirubin ↑ Smear - Sickle-cell