HEMATOLOGY: NONMALIGNANT DISORDERS

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"Strength does not come from winning. Your
struggles develop your strength. When you go
through hardship and decide not to surrender,
that is strength."
Arnold Schwarzenegger
Bodybuilder and Actor
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HEMATOLOGYRBC Disorders

• Dr. VM Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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Blood Smear - Normal
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White Blood Cells
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Megaloblastic anemia

• Vitamin B12/Folic acid deficiency
• Low DNA synthesis Nuclear immaturity - less
  division more cell size - Macrocytosis
• Megaloblasts Abnormal destruction - ?RBC
• DNA defect all cell lines affected
  -pancytopenia
• Multi System disease ?cell division -
  Epithelia.
• Pernicious anaemia
• autoimmune, VitB12 absorption deficiency -
  Gastric atrophy CNS damage.

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Megaloblastic anemia

• Vitamin B12/Folic acid deficiency
• Second most common type of anemia.
• Vit B12 Synthesised only by microorganisms
  animal food dairy Pr
• Folate only in Plant foods uncooked.
• Vegetarianism ..?

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Megaloblastic Anemia
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Megalobl - Pathogenesis

• Decreased Vit B12 / Folate
• Decreased DNA Synthesis
• Delayed maturation of erythroblasts (Nucleus)
• Increased cell size (macrocytes)
• Normal hb content (Normochromia)
• Decreased RBC number
• Decreased WBC number (pancytopenia)
• Anemia Pancytopenia.

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Macrocytic Anemia (Meg.)
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Megaloblastic Anemia
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Megaloblastic Anemia
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Megaloblastic Anemia
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CWM-20353-Meg.An
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CWM-20353-Meg.An
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Clinical Case

• History
• A 48 year old male has become progressively more
  fatigued at the end of the day. This has been
  going on for months. In the past month he has
  noted paresthesias with numbness in his hands. A
  CBC demonstrates the findings shown below. A
  peripheral blood smear (the slide is
  representative of this condition) shows red blood
  cells displaying macro-ovalocytosis and
  neutrophils with hypersegmentation.

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CBC Result
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Blood Film
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Quiz

• Describe RBC Morphology. - M/N, OM, HSP, APC
• Describe The WBC in the field.
• What is the diagnosis from these findings? MBA
• Which of the following tests would be most useful
  to determine the etiology
• A. Hemoglobin electrophoresis Cong hemolytic
  anemia
• B. Reticulocyte count Hemolytic anemia
• C. Stool for occult blood - parasites
• D. Vitamin B12 assay - MBA
• E. Bone marrow biopsy - Malignancy

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Schilling test

• Radiometric test of cobalamin absorption. (3
  parts)
• First - radioactive cyanocobalamin is given
  orally. Unlabeled cyanocobalamin is given
  intramuscularly
• Next, the urinary secretion of radioactive
  cobalamin is measured .
• Second - test is performed in the same manner,
  except that IF is given orally along with
  radioactive cyanocobalamin.
• Third - Patient is treated with antibiotics
  prior. (Blindloop syndrome)
• Problem Inadequate collection of urine samples

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Folate Estimation

• Serum folate is low - folate deficiency during
  the previous 2-3 days. A single meal with normal
  folate content can change to normal.
• The RBC folate level is usually low in patients
  with folate deficiency and levels do not
  fluctuate during the lifespan of the RBC.
• The RBC folate level may not be low in persons
  with rapidly developing acute folate deficiency.
• RBC folate levels are low in more than 50 of
  patients with cobalamin deficiency.

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People can be divided into two classes those who
go ahead and do something, and those who sit
still and inquire, 'Why wasn't it done the other
way? - Oliver Wendell Holmes