IT-3 Anemia Normositer
IT-3 Anemia Normositer
Macrocytic
Gejala umum:
Sindroma anemi :
lemas, pusing, cepat lelah , mata berkunang, tinitus, mual,
kaki dingin dan sesak nafas, jantung berdebar-debar.
Timbul pd setiap anemia apapun penyebabnya
Pemeriksaan Laboratorium:
Darah rutin : Hb, WBC, Trombosit, LED, Ht, RBC
Darah lengkap :
Darah rutin, MCH, MCV,MCHC, apusan darah tepi, RDW,
Diff count
Pemeriksaan sumsum tulang:
Mengetahui keadaan hemopoesis
• Intracorpuscular factor
• Extracorpuscular factor
. Intracorpuscular factor
Red cell abnormality
A. Hereditary
1. Membrane defect (spherocytosis, elliptocytosis)
2. Metabolic defect (Glucoze-6-Phosphate-Dehydrogenaze (G6PD)
deficiency, Pyruvate kinase (PK) deficiency)
3. Hemoglobinopathies (unstable hemoglobins,
thalassemias, sickle cell anemia )
B. Acquired
1. Membrane abnormality-paroxysmal nocturnal hemoglobinuria (PNH)
Mechanisms of hemolysis /
Pathogenesis:
1. Intra vascular
2. Extra vascular
Hemolysis - RBC destruction
Serum
Heme Globin Hgb + haptoglobin
haptoglobin
2. Blood smear
- Anisopoikilocytosis, spherocytes
- Erythroblasts
- Schistocytes
Treatment:
- Steroids
- Splenectomy
- Immunosupressive agents
- Transfusion If needed
Paroxysmal Nocturnal Hemoglobinuria (PNH)
1. Pathogenesis
2. Symptoms
- Passage of dark brown urine in the morning
3. PNH –laboratory features:
- Pancytopenia
- Chronic urinary iron loss
- Serum iron concentration decreased
- Hemoglobinuria
- Hemosiderinuria
Lab Tests for PNH
• Acidified serum lysis test (Ham’s test)
• Sugar water (sucrose hemolysis) test
• Flow cytometry: lack of CD59 on RBCs, or lack of
CD59 or CD55 on granulocytes
Treatment
• Megaloblastic erythropoesis
• Bone marrow rich in cells,
• Giant metamyeolcytes
• Giant bands
• Many Howell-Jolly’es bodies
• Cabot’s rings
Biochemical findings in MA
• Serum indirect (unconjugated) bilirubin
• Serum LDH (principally LDH-1)
• Serum iron
– (unless the anemia is complicated with iron
deficiency)
• Vitamin B12 concentration ↓
• Folic acid concentration ↓
The diagnosis of megaloblastic anemia
Mucosal cell
Folate/B12 DNA Synthesis
Clinical Feature
Sympton and sign Vit B12 Def :
• Severe : anemia, neuropathy
• Other symptom : sore mouth,loss of taste, atropy
mucosa of the tongue.
• Disorder of the central nervous system :
paresthesias of the hands & feet, unsteadiness of
gait, memory loss etc.
Folate deficiency
• Reduced intake ( nutritional & malabsorpsi)
• Increased utilisation (pregnancy, malignancy,
hyperthytoidsm)
• Defective utilisation : drugs (anticonvulsant, oral
contraceptive), alcoholism.
• Reduced hepatic stores
alcohosm, hepatoma
FOLATE DEFISIENSI
Cause , Sypmtom & Sign folic acid def
1. Aplastic anemia
2. Hypoplastic myelodysplastic syndrome or
hypoplastis AML
3. PNH
4. Hypoplastic antecedent phase of acute
lymphocytic leukemia
5.Hypoplastic antecedent of hairy cell leukemia
6. Idiopathic myelofibrosis
7. Pure red cell aplasia
8. Agranulocytosis.
Diagnosis Criteria for Severe AA