Patologi Darah dan Pmx Lengkap

 

Pemeriksaan

• Langkah-langkah dalam Penatalaksanaan Pasien (7)

  • Anamnesis
  • Pemeriksaan Fisik
  • Pemeriksaan Laboratorium
  • Pemeriksaan Penunjang lain : Radiologi, PA,dll
  • Diagnosis
  • Terapi
  • Evaluasi

• Manfaat Pemeriksaan lab

  1. Membantu diagnosa
  2. Menentukan prognosa (perkembangan penyakit pasien)
  3. Monitoring
  4. Screening
  5. Penelitian

• Biological Spesimen

   Blood  Urine  Saliva  Cerebrospinal Fluid  Amniotic Fluid  Duodenal Aspirate  Gastric Juice  Gall stone  Kidney Stone  Stools  Synovial Fluid  Tissue Specimen

• Laboratory Testing

  1. Clinical Chemistry = enzim
  2. Hematology: Hb
  3. Urine and body fluid : cairan usus, lambung, feses
  4. Immunology :alergi
  5. Microbiology: kultur bakteri
  6. Parasitology : cacing
  7. Biomolecular : gen (VCR?)

Hematology

• Cara Mengambil Darah : Flebotomi (Penyadapan Darah)
  • Kapiler
  • Vena
  • Arteri
• Function of blood
  • Transports oxygen, nutrients, metabolic waste products
  • Regulation of body temperature, signal transmission, acid-base homeostasis, and immune response
• Composition of blood
  • 60–80 mL blood/kg body weight ≅ 5 L blood for an adult weighing 70 kg/154 lbs
  • 45% cellular components (→ hematocrit), 55% plasma
• Production of blood
  • location
  • hematopoietic stem cells
  • disorder?

Pemeriksaan

• Lengka

  • Clinical Manifestation
  • Jumlah eritrosit
  • Jumlah leukosit

• Hematology autoanalyzer

  Hematology Autoanalyzer

  • Clinical manifestation
  • Masa perdarahan (BT / Bleeding Time)
  • Masa Pembekuan (CT / Clotting Time)
  • Plasma Prothrombin Time (PPT)
  • Activated Partial Thromboplastin Time (APTT)

RED CELL LINE- Erythrocytes

• Erythropoiesis (RBC)
  • production
  • physiology
• Diagnostic Parameter
  • Indeks
  • Hemoglobin (Hb)
  • Hematocrit (HCT)
  • Clinical significance
• Morphology
  • Normochromic : Red blood cell with a normal concentration of hemoglobin (MCH & MCHC = normal)
  • Hypochromic : Red blood cell with a decreased concentration of hemoglobin (MCH, MCHC < normal)
  • Normocytic : Normal size of RBC (MCV = normal )
  • Macrocytic : A larger than normal red blood cell (MCV > normal)
  • Microcytic : Decrease in the red cell size ( MCV < normal )
  • Anisositosis : variation in size
  • Poikilocytosis : variation in shape
• ↓ Anemia
  • what is it?
  • criteria?
  • patogenesis
  • Classification by morphology (MCV)
• ↑ Polisitemia vera
  • what is it?
  • laboratory finding?
  • increased risk?
  • differential diagnoses

WHITE CELL LINE - Leukocytes

• classified?

  

  • 1. Granulocytes - from the myeloid cell line
  • 2. Lymphocytes - from the lymphoid cell line

  

• ↓ leukopenia

  White cell count < 4,500/μL

  • causes

• ↑ leukocytosis- Leukemia

  White cell count > 10,000/μL

  Leukocytosis

  • what is it?
  • acute
  • chronic

PLATELET/ Thrombocytes

• production
  • Location: bone marrow
  • Duration: Production and maturation of platelets takes about 1 week.
  • Regulation: Thrombopoietin (secreted by the liver and kidneys) stimulates megakaryocyte proliferation and maturation in the bone marrow.
  • Stages of thrombopoiesis: myeloid precursor cell → megakaryoblasts → megakaryocytes → platelets
• physiology
  • Function: forms plug in bleeding vessel (primary hemostasis)
  • Lifespan: circulation for 8–9 days
  • Concentration: 150,000 to 450,000/μLcells
• ↑ Thrombocytosis
  • Increase in number of platelets to > 400,000/μL (absolute)
  • Causes
• ↓ Thrombocytopenia
  • Decrease in number of platelets to < 150,000/μL (absolute)
  • Causes
  • Penurunan produksi trombosit : Obat : kemotx, toxin (alcohol), diuretic thiazide Radiasi Aplasia sumsum tulang Keganasan yg menginfiltrasi sumsum tulang Defisiensi B12, asam folat Infeksi virus : HIV, hepatitis
    • Peningkatan destruksi trombosit : Autoimun disease, Cancer (CLL, Lymphoma), ITP, Obat (Metildopa, Heparin, Quinine), Inf. Virus (HIV, hepatitis), Sepsis, DIC
      • Sekuestrasi trombosit di spleen Splenomegali

Hemostasis

• Platelet and Coagulation

  Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The mechanism of coagulation involves activation, adhesion and aggregation of platelets, as well as deposition and maturation of fibrin.

  

  • Coagulation begins almost instantly after an injury to the blood vessel has damaged the endothelium lining the blood vessel. Exposure of blood to the subendothelial space initiates two processes:

• Coagulation Factor

  • Factor I - fibrinogen
  • Factor II - prothrombin
  • Factor III - tissue thromboplastin (tissue factor)
  • Factor IV - ionized calcium ( Ca++ )
  • Factor V - labile factor or proaccelerin
  • Factor VI - unassigned
  • Factor VII - stable factor or proconvertin
  • Factor VIII - antihemophilic factor
  • Factor IX - plasma thromboplastin component, Christmas factor
  • Factor X - Stuart-Prower factor
  • Factor XI - plasma thromboplastin antecedent
  • Factor XII - Hageman factor
  • Factor XIII - fibrin-stabilizing factor

• Bleeding disorder

  Bleeding disorders are characterized by defects in hemostasis that lead to an increased susceptibility to bleeding (also known as hemorrhagic diathesis).

• Caused by

  • (primary hemostasis defect),
  • (secondary hemostasis defect),

Peripheral Blood Histology

• image