ANEMIASANEMIASLEUKEMIASLEUKEMIAS

Professor Yu.I. BondarenkoProfessor Yu.I. Bondarenko

ANEMIAANEMIA

SCHEME OF BLOOD SCHEME OF BLOOD FORMATIONFORMATION

DEFINITION OF ANEMIADEFINITION OF ANEMIA AnemiaAnemia is decrease of is decrease of

erythrocytes amount and erythrocytes amount and hemoglobin contents in unite hemoglobin contents in unite of of blood volume which is blood volume which is accompanied also with accompanied also with qualitative changes of qualitative changes of erythrocyteserythrocytes

Pathogenic classification of Pathogenic classification of anemiasanemias

1. 1. Posthemorrhagic anemiaPosthemorrhagic anemia

2. 2. Hemolytic anemiaHemolytic anemia

3. 3. Anemia as a result Anemia as a result insufficiency insufficiency of blood of blood formationformation

Acute posthemorrhagic Acute posthemorrhagic anemiaanemia ReasonsReasons::

1. 1. Wounding of vesselsWounding of vessels 2. 2. Gastro-intestinal Gastro-intestinal

bleedingbleeding 3. 3. DysmenorrheaDysmenorrhea 4. 4. Bleeding stomach ulcerBleeding stomach ulcer 5. 5. Lung tuberculosisLung tuberculosis

Chronical posthemorrhagic Chronical posthemorrhagic anemiaanemia

CausesCauses::1. 1. Stomach ulcerStomach ulcer2. 2. Stomach tumorStomach tumor3. 3. HemorrhoidHemorrhoid4. 4. Uterine bleedingUterine bleeding5. 5. Renal bleedingRenal bleeding6. 6. Nose bleedingNose bleeding By colour indexBy colour index - - hypochromichypochromic

Equired hemolytic anemiaEquired hemolytic anemia 1. 1. Toxic Toxic 2. 2. Immune Immune 3. 3. Mechanical Mechanical 4. Equired membranopathy4. Equired membranopathy

Toxic hemolyticToxic hemolytic anemiaanemia Poisoning by hemolytic poisonsPoisoning by hemolytic poisons:: ArsineArsine Acetic leadAcetic lead PhosphorusPhosphorus NitrobenzeneNitrobenzene PhenylhydrazinePhenylhydrazine Biliary acidsBiliary acids Mushroom poisonMushroom poison Snake venomSnake venom

ImmuneImmune hemolytic anemiahemolytic anemia1. 1. Autoimmune anemia Autoimmune anemia

2. 2. Posttrasfusion Posttrasfusion anemiaanemia а) а) transfusion oftransfusion of АВ0- АВ0-uncompatibleuncompatible

bloodblood б) б) transfusiontransfusion of Rhof Rh- - uncompatibleuncompatible bloodblood

3. 3. Hemolytic anemia of new-born Hemolytic anemia of new-born

Equired hemolytic anemiaEquired hemolytic anemia ReticulocytosisReticulocytosis

EquiredEquired hemolytichemolytic anemiaanemia ReticulocytosisReticulocytosis

HereditaryHereditary hemolytichemolytic anemiaanemia 1. 1. EnzymopathyEnzymopathy

2. 2. HemohlobinopathyHemohlobinopathy

3. 3. MembranopathyMembranopathy

EnzymopathiesEnzymopathies1. 1. Deficit ofDeficit of glucosoglucoso-6--6- dehydrogenasedehydrogenase

2. 2. Deficit ofDeficit of pyruvate pyruvate kinasekinase

Medicine drug causeMedicine drug cause hemolysehemolysein thein the GG-6--6-PhDGPhDG insuficiencyinsuficiency

SulfanilamidesSulfanilamides AntimalaricAntimalaric drugsdrugs Aminosalycilic acidAminosalycilic acid PhenacetinPhenacetin VitaminesVitamines CC andand KK Aspirin Aspirin in largein large dosesdoses

Hemolytic anemiaHemolytic anemia due todue to pyruvate kinasepyruvate kinase insefficiency.insefficiency.

ReticulocytosisReticulocytosis

HemohlobinopathiesHemohlobinopathies Sickle-cellSickle-cell anemiaanemia

ThalassemiaThalassemia:: αα--thalassemiathalassemia ßß--thalassemiathalassemia

Sickle-cellSickle-cell anemiaanemia - - bloodblood

Sickle-cell anemiaSickle-cell anemia – – bloodblood::at the leftat the left – – sicklesickle erythrocyteserythrocytesat the rightat the right – – testtest toto hypoxiahypoxia

MinorMinor ( (heterozygoticheterozygotic) ) thalassemiathalassemia – – bloodblood

Minor Minor ((HeterozygoticHeterozygotic) ) thalassemiathalassemia – – bloodblood

MajorMajor ( (HomozygoticHomozygotic) ) thalassemiathalassemia – – bloodblood

MajorMajor ( (homozygotichomozygotic)) Cooley’sCooley’s anemia anemia – – bloodblood

MembranopathiesMembranopathies HereditaryHereditary microspherocytosismicrospherocytosis HereditaryHereditary eliptocytosiseliptocytosis HereditaryHereditary pyropoikilocytosispyropoikilocytosis HereditaryHereditary stomatocytosisstomatocytosis HereditaryHereditary acanthocytosisacanthocytosis HereditaryHereditary echinocytosisechinocytosis

Membranopathy Membranopathy HereditaryHereditary microspherocytosismicrospherocytosis - -

bloodblood

MembranopathyMembranopathy HereditaryHereditary eliptocytosiseliptocytosis – – bloodblood

MegaloblastesMegaloblastes. . Megalocytes.Jolly’s bodiesMegalocytes.Jolly’s bodies. .

Cabot’s rings.Cabot’s rings.

LEUKEMIALEUKEMIA

Leukemia definitionLeukemia definitionLeukemiaLeukemia – – it is tumor it is tumor arisingarising from from bloodforming cells and bloodforming cells and primary lesionprimary lesion bone bone marrowmarrow

Classification of leukemiasClassification of leukemias Acute leukemiasAcute leukemias

myeloblasticmyeloblastic lymphoblasticlymphoblastic

ChronicalChronical leukemiasleukemias myeloidmyeloid lynphoidlynphoid

AcuteAcute myeloblasticmyeloblastic leukemiasleukemiasUndifferentiatedUndifferentiatedMyeloblasticMyeloblastic withoutwithout maturingmaturingMyeloblasticMyeloblastic withwith maturingmaturing PromyelocyticPromyelocyticMyelomonoblasticMyelomonoblasticMonoblasticMonoblasticErythroblasticErythroblasticMegacaryoblasticMegacaryoblastic

HistochemicalHistochemical signssigns of of differentiation ofdifferentiation of acute acute

leukemiasleukemias1. 1. Reaction for peroxidaseReaction for peroxidase 2. 2. Reaction for acidity phosphataseReaction for acidity phosphatase3. 3. Reaction for uncpecificReaction for uncpecific

esterasesesterases4. 4. Reaction for lipidesReaction for lipides5. 5. Reaction for Reaction for compoudcompoud

carbohydratescarbohydrates

ReactionReaction of myeloblastesof myeloblastes andand other of neutrophil cellsother of neutrophil cells for for

peroxidase peroxidase

Reaction of monoblastesReaction of monoblastes forfor αα--naphtylacetateestherasenaphtylacetateestherase

Reaction of myeloblastes and Reaction of myeloblastes and monoblastesmonoblastes forfor acidityacidity

phosphatasephosphatase

Acute lymphoblasticAcute lymphoblastic leukemialeukemia - - bloodblood

AcuteAcute В- В-lymphoblastosislymphoblastosis – – bone bone marrowmarrow

BigBig vacuolizedvacuolized lymphoblasteslymphoblastes

Acute lymphoblasticAcute lymphoblastic leukemialeukemia – – bone marrrowbone marrrow

Acute lymphoblasticAcute lymphoblastic leukemialeukemia – – bone marrrow. Initial stagebone marrrow. Initial stage. .

Acute lymphoblastosisAcute lymphoblastosis – – bone bone marrow.marrow. TotalTotal lymphoblasticlymphoblastic

metaplasiametaplasia

ChronicalChronical myeloidmyeloid leukemiasleukemias MyelocyticMyelocytic MonocyticMonocytic EosinophilicEosinophilic ErythroblasticErythroblastic MegacaryocyticMegacaryocytic

ChronicalChronical myelocytic leukemiamyelocytic leukemia – – bloodblood. . ChronicalChronical phasephase

ChronicalChronical myelocytic leukemiamyelocytic leukemia – – bloodblood..

ChronicalChronical myelocytic leukemiamyelocytic leukemia – – bloodblood

Stage of blastic crisisStage of blastic crisis

Chronical lymphoidChronical lymphoid leukemiasleukemias В-В-lymphocyticlymphocytic Т- Т- lymphocyticlymphocytic (1,5 %) (1,5 %) HaircellHaircell

ChronicalChronical В- В-cellcell lymphocyticlymphocytic leukemialeukemia - - bloodblood

ChronicalChronical lymphocyticlymphocytic leukemialeukemia – – blood. Gumprecht’s bodies.blood. Gumprecht’s bodies.

ChronicalChronical lymphocyticlymphocytic leukemialeukemia – – bone marrowbone marrow. . TotalTotal lymphoidlymphoid

metaplasia.metaplasia.

ChronicalChronical lymphocyticlymphocytic leukemialeukemia – – bone marrowbone marrow. . TotalTotal lymphoidlymphoid

metaplasia.metaplasia.

Chronical haircell leukemiaChronical haircell leukemia - - bloodblood

Chronical haircell leukemiaChronical haircell leukemia - - bloodblood

Haircell leukemiaHaircell leukemia - - bloodblood. . Reaction forReaction for acidityacidity phosphatasephosphatase

Chronical monocytic leukemiaChronical monocytic leukemia - - bloodblood

Mechanisms of cellular Mechanisms of cellular oncogenes activatingoncogenes activating

Point mutationsPoint mutationsChromosomal abnormalitiesChromosomal abnormalitiesVirualVirual transductiontransductionInsertionInsertion mutagenesismutagenesisGenesGenes amplificationamplification

ClinicalClinical manifestation ofmanifestation of leukemialeukemia

Metaplastic anemiaMetaplastic anemiaThrombocytopeniaThrombocytopeniaHemorrhagicHemorrhagic syndromesyndromeSecondarySecondary

immunedeficiencyimmunedeficiencyDecreaseDecrease of resistanceof resistance