Any fool can know.

The point is to understand !

-- Albert Einstein

Know Pathology you know medicine.

Without Pathology, Medicine is
quackery!
 Shashidhar Venkatesh Murthy
A/Prof & Head of Pathology
College of Medicine & Dentistry
.. foundation of clinical medicine

Clinical Pathology:
RBC Disorders: Introduction

CPC : Term2 Week1 - Haem 1/2.

System : Haematology - RBC Disorders.
Topic : 1: Anemia Intro 2: IDA & ACD 3: MBA 4: Haemolytic 5: Others.
 CPC 2.1: Tired woman...
63y Ayr Increasing lethargy, dyspnea, edema - 1year
Difficulty walking weakness & unsteadiness. - 2week
Initially treated with iron tablets.
Increasing lethargy, SOB, dyspnea, ankle swelling
Palpitations, chest pain on exertion, relieved on rest.
Fever some times. Loss of appetite, some loss of weight
Hypothyroidism- thyroxine, NSAID for osteoarthritis.
Bruises easily, Pale, mild jaundice. Differntial Diagnosis:
Stomatitis, glossitis, Megaloblastic anemia
PNS: 4/5 lower limb, Romberg +ve, Pernicious anemia
Hypothy. macro. An.
Reflexes , Babinski +ve, sensation Malignancy, Aplastic,
Refractory anemia.
GI bleeds,
3
 CPC scenarios:
2014: I.H. 16 year old girl from Bamaga; attending boarding school in
Charters Towers Presents to GP: Im feeling very short of breath
when I play netball. Accompanied by boarding house teacher
(female)
2012: Mrs. IS, 68y old pensioner, rural near Ingham. Husband, a
butcher. She is on warfarin for 10y, for atrial fibrillation. HPTN on
Aldomet. She feels tired and is pale yellow and gets angina while going
for a regular evening walk.
What if The patient is a ?
64y woman (occult GI loss, hypothyroidism, chronic disease)
40y woman (mennorhagia)
40y man (occult malignancy, haematological malignancy)
65y man with Stage 4 renal failure (discuss renal anaemia)
74y man with no PMH of note (B12 def., occult GI malignancy) 4
CPC2.1: Tired woman: Lab results:

1. Where is the primary pathology (diagnosis?)

2. What psychiatric symptoms in Vit B12 deficiency?
3. FBC in Haemolytic?, Folate def.?, ACD? Acute / Chronic blood loss?
Success is going from failure to
failure without loss of enthusiasm !
Winston Churchill
 CPC 2.1: RBC disorders
2014 Title: Haematopoetic 1/2 Anaemia
Term 2
CPC 1 MB2:HRM: Week 2&3 RBC
System: Haematopoietic system
Aim: To educate students in:
Clinical, pathological & population studies of
patients with anaemia (RBC disorders)
Objectiv 1. Demonstrate competency in history taking &
es: clinical examination of patients with anaemia
and related illnesses.
2. Describe the pathophysiology of the acute
anaemic process and the common causes
and important other rare causes of anaemia,
particularly in the tropics and Indigenous
populations.
3. Outline the basic sciences relating to bone
marrow, red blood cell production and
turnover of iron, routine blood test
parameters, measurement of iron stores, and7
 Learning Objectives: Diseases of RBC
Anaemia: Overview, Classification, pathogenesis,
diagnosis, clinical features & complications.
Study TOP 10 ANEMIA
Major (detailed)
1. Iron Deficiency anemia.
2. Megaloblastic anemia.
3. Imm. Hemolytic (Warm/Cold)
4. Anemia of Chronic Disease.
5. Aplastic Anemia
Minor (brief note)
6. Myelodysplastic/Refractory An
7. Sickle Cell Anemia
8. Thalassemia syndromes.
9. G6PD deficiency anemia.
10.Hereditary Spherocytosis.
Whatever you think, that you will be.
If you think yourselves weak,
weak you will be.
If you think yourselves strong,
strong you will be!
-- Swami Vivekananda
Shashidhar Venkatesh Murthy
A/Prof & Head of Pathology
College of Medicine & Dentistry
.. foundation of clinical medicine

RBC & Anemia: Pathophysiology

 Reticulocyte
Normal RBC (immature)
MCV >100
8
Persisting RNA 8
Retic.

Band
8
L
12-14

Capillary 5-10
Only healthy elastic
RBC can squeeze
through capillary.

RBC Histogram
 Definition of Anemia:

Anemia is decreased red cell mass affecting tissue

oxygenation

Diagnosed using Hematocrit or Hb. levels

(Low Hb* or Low HCT)

Types:
Decreased production Deficiency anemia.
Increased loss/destruction Hemolytic anemia.

12
 Pathogenetic Classification of Anemia:
Decreased Production: Top 6 Anemias:
1. Iron Def. A
Nutrient Deficiency.
2. Megaloblastic
Iron def (IDA) / Megaloblastic (MBA) 2 3. Anem. Of Chronic Dis.
Hemopoietic cell defect: 4. Aplastic An.
Anemia of chronic disorders (ACD) 5. Immune Hemolytic Warm
Aplastic anemia (AA). 2 6. Immune Hemolytic - Cold
Dysplastic anemia. Myelodysplastic Syndromes
Increased loss / destruction:
Blood loss anemia Acute / Chronic - bleeding.
Hemolytic anemia Congenital / Acquired.
Acquired / External injury.
Immune AIHA (Warm/Cold) Mechanical, Drugs & Parasites
2
Congenital / Internal RBC defect
Defective Membrane (Spherocytic an) Cell Mem
Defective Hemoglobin (Sickle cell an.) Hb.
Deficient Enzyme (G6PD) Enzymes
13
 RBC development: MCV MCV
110 90

Bone Marrow

14
 Anemia Pathogenesis:

DNA: B12, Folate Megaloblastic anemia

BLAST Early Intermediate Late Retic. RBC

Aplastic anemia
Aplastic anemia
Dysplastic anemia
Dysplastic anemia
Hemolytic anemia
Immune
Proerythroblast Polychromatophilic Reticulocyte Mechanical
Infection
(Pronormoblast) Normoblast
Drugs
Basophilic Defective*
Orthochromatophilic Erythrocyte
Normoblast Normoblast
Iron Deficiency anemia Hb: Iron Iron Metabolism: limited,10%,
Recycle, Ferritin, Transferrin,
Hepcidin, forms Hb in cytoplasm. 15
We are here for you.

venkatesh.shashidhar@jcu.edu.au (Shashi)
Daisy.mehra@jcu.edu.au (Daisy)

Need personal help?

Email us for an appointment or call,
Office Tel: 4781 4566 (Shashi)
Office Tel: 4781 5626 (Daisy)
When your thinking is brilliant, you will be
brilliant, but if your thinking is not brilliant
you will not be brilliant, no matter how
brilliant you may think you are.!
-- Christian D. Larson

Fake it until you make it!

-- Mohd. Ali. Boxer.