Anemias幻灯片.ppt
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参见附件(573kb)。
Anemias
CUF-S (造血干C、红系祖C)
↓
proerythroblast (原始RBC)
↓
Basophilic normoblast ( 早幼RBC)
↓
Polychromatic mormoblast(中幼RBC)
↓
Orthrochromatic normoblast (晚幼RBC)此阶段脱核进入血循环
↓
Reticulocyte (网织RBC)
经特殊染色见到丝状或网状结构, 保留残余线粒体和核糖，仍有继续合成Hb的能力(从早幼RBC开始)
↓
erythrocyte
Definition
? A reduction below normal in the concentration of hemoglobin , the mass of red blood cells and/or the hematocrit in the blood.
Factors influencing Hb concentration
Sex
Age
Altitude
Alterations in plasma volume
★Classification
Morphologic classification
Kinetic classification
(Classified according to etiology and pathogenesis)
一、Decreased erythropoiesis
? Proliferation and differentiation
abnormalities of SC
HSC: AA, Fanconis anemia, MDS
Erythrocytic progenitors : Pure red cell aplasia, Anemias caused by kidney failure and endocrine disorders
? Marrow infiltration
leukemias
carcinoma
multiple myeloma
myelofibrosis
Malignant histocytosis
? Production and maturation blockages of differentiating cells
DNA synthesis blockage : Vit B12, falic acid difficiencies, 嘌呤和嘧啶 metabolic defects→Megaloblastic anemia
Hb synthesis blockage :
Heme production defect : IDA
Heptoglobin production defect : Thalassemias
4 Unknown reason or several mechanisms
Sideroblastic anemia
Chronic disease anemias (chronic inflummation, infections, 尿毒症, Hepatic disorders, neoplasm, connective tissue disease, endocrine disorders)
二、Accelerated destruction of red cells
1)Endogenous (intra-erythrocyte defects) 1.Membrane defects of erythrocytes :
Hereditary :Hereditary spherocytosis (HS)
Hereditasy elliplocytosis (HE) Acquired : PNH
2.Enzyme defects
Glucose--6--Phosphate Dehydrogenase (G6PD) deficiency
Pyruvate kinase deficiency
3.Abnormal haptogllbin synthesis :
Sickle cell anemia, Hemoglobinopathies
Thalassemias
2)Extragenous
? Immune HA : AIHA, neonatal HA,mismatched transfusion, drug-induced HA
2. Mechanical : march hemoglobinuria , cardiac valves prostheses, microangiopathic hemolytic disorders.
3. Due to chemical, physical or microrganisms :
Chemical toxin-and drug-induced hemolysis, large scale burned patient (severe burned patient)
Infection-induced , benzene, radiation
microrganisms: Malaria, virus, etc.
4. Increased damage of monocyte-macrocyte system : Hypersplenism
三. Blood loss
◆Acute posthemorrage anemia
◆Chronic bleeding →IDA
Classified accordind to the proliferative situations of BM
Hyperplastic anemias (增生性贫血):
Hemolytic anemia
Anemia caused by blood loss
Megaloblastic anemia, IDA
Hypoplastic anemias (增生减低性贫血): AA
Clinical manifestations
Factors influencing symptoms:
Severity of anemia Hb<80~90g/L→symptoms ......
Anemias
CUF-S (造血干C、红系祖C)
↓
proerythroblast (原始RBC)
↓
Basophilic normoblast ( 早幼RBC)
↓
Polychromatic mormoblast(中幼RBC)
↓
Orthrochromatic normoblast (晚幼RBC)此阶段脱核进入血循环
↓
Reticulocyte (网织RBC)
经特殊染色见到丝状或网状结构, 保留残余线粒体和核糖，仍有继续合成Hb的能力(从早幼RBC开始)
↓
erythrocyte
Definition
? A reduction below normal in the concentration of hemoglobin , the mass of red blood cells and/or the hematocrit in the blood.
Factors influencing Hb concentration
Sex
Age
Altitude
Alterations in plasma volume
★Classification
Morphologic classification
Kinetic classification
(Classified according to etiology and pathogenesis)
一、Decreased erythropoiesis
? Proliferation and differentiation
abnormalities of SC
HSC: AA, Fanconis anemia, MDS
Erythrocytic progenitors : Pure red cell aplasia, Anemias caused by kidney failure and endocrine disorders
? Marrow infiltration
leukemias
carcinoma
multiple myeloma
myelofibrosis
Malignant histocytosis
? Production and maturation blockages of differentiating cells
DNA synthesis blockage : Vit B12, falic acid difficiencies, 嘌呤和嘧啶 metabolic defects→Megaloblastic anemia
Hb synthesis blockage :
Heme production defect : IDA
Heptoglobin production defect : Thalassemias
4 Unknown reason or several mechanisms
Sideroblastic anemia
Chronic disease anemias (chronic inflummation, infections, 尿毒症, Hepatic disorders, neoplasm, connective tissue disease, endocrine disorders)
二、Accelerated destruction of red cells
1)Endogenous (intra-erythrocyte defects) 1.Membrane defects of erythrocytes :
Hereditary :Hereditary spherocytosis (HS)
Hereditasy elliplocytosis (HE) Acquired : PNH
2.Enzyme defects
Glucose--6--Phosphate Dehydrogenase (G6PD) deficiency
Pyruvate kinase deficiency
3.Abnormal haptogllbin synthesis :
Sickle cell anemia, Hemoglobinopathies
Thalassemias
2)Extragenous
? Immune HA : AIHA, neonatal HA,mismatched transfusion, drug-induced HA
2. Mechanical : march hemoglobinuria , cardiac valves prostheses, microangiopathic hemolytic disorders.
3. Due to chemical, physical or microrganisms :
Chemical toxin-and drug-induced hemolysis, large scale burned patient (severe burned patient)
Infection-induced , benzene, radiation
microrganisms: Malaria, virus, etc.
4. Increased damage of monocyte-macrocyte system : Hypersplenism
三. Blood loss
◆Acute posthemorrage anemia
◆Chronic bleeding →IDA
Classified accordind to the proliferative situations of BM
Hyperplastic anemias (增生性贫血):
Hemolytic anemia
Anemia caused by blood loss
Megaloblastic anemia, IDA
Hypoplastic anemias (增生减低性贫血): AA
Clinical manifestations
Factors influencing symptoms:
Severity of anemia Hb<80~90g/L→symptoms ......
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