hom dr.

uswa
 darah dan pembuluh darah
Pembuluh darah

{
plasma

Plasma Sel

air, protein, faktor pembekuan darah eritosit, leukosit, trombosit

self
↳
ALBUMIN 99101341117 ↳ 1=1-5×111

HB : lk : 13 - 16 gr % phletora lkemeahan

I
/ Hb on : polisitiemialeñtrositosis →

t pucat
pr : 12 - 15 gr%
→
Hbt
Pansitopenia : Hb + leukosit + trombosit
beri wanna : anemia
→ anemia

leukosit : 4000 - 11.000 aplastic

Koko leukositosis
\
R : →
inpeksi bakteri
Koko to
↳ sist.im on :
leukopeni infeksi virus
Trombosit : 150.000 - 450.000
→

- tromboritrombositos.is →
trombosis
itrombositopeni perdarahan
↳
hentikanperdarahan-otromb.us trombo I →

\ mcv If
: mean corpuscular volume : 80 - 100 : normositer
ukuran I
< 80 : mikrositer → Kecil ukuran normal

> 100 : makrositer → besar

. mch .
: mean corpuscular hemoglobin :

I : 27 - 33 : normokrom
t
normal wtarna
< 27 : hipokorom
warna
→
pucat

> 33 : hiperkrom
✗
I
×
mchc : mean corpuscular hemoglobin concentrate : 32 - 36
 ykmah.letihlesuilvnglai.lemasy.MN/vMCHt
5L + konjungtiva anemis

anemia
) MCHCN)
→
MCVCN
TMNT MCHINI

anemia mikrositik hipokrom anemia normositik normokrom anemia makrositer

-

Kafetasik Retikulosit > 1.5% Retikulosit < 1.5%

.

anemia hemolitik anemia

perdarahan
Anemia Anemia Thalasemia Anemia akut
Anemia Anemia anemia anemia
penyakit kronis defisiensi fe sideroblastik renalis aplastik Def vit b12 Def asam folat
imun non imun
Autoimun Anemia
hemolitik anemia g6pd
( AIHA )
 → Anemia Perry . kronis

5L 1-
perry
.
kronis ( TB .
keganasanl
Px ferritin / atasi
: N R
,
Tx :
penyakitdasar

→ Anemia Def Fe

• Anak ' ,
cacingan ,
hamil ,
perdarahankroni 's • > MDT : set
cigar lcerutu ,
/ pencil

(mens ,
hemoroid ) . > Gold standar : profit besi : serum iron t
Ferritin I
• 5L + koilonikia + atrofipapillidah /glossitis +
TIBC on

stomatitis angolan's + pica → Tx : Non medikamentosa

tab 1325mg hati ayam
NB : i SF =
200mg
-

Konsumsidaging .

elemental
itab SF = 60
-65mg besi - rabsorb.si : asam ( vitcljusjenk)
Anemia mikrositik
-

tabsorbsi : basa ( ppl antasida ) Kopi Heh

.

Hipokrom Thalassemia Medikamentosa

phamil
→

( kafetasik ) • Autosomal resesif →

genetic .
> SF 3 ✗
200mg 1325mg → beri 3-
ymgg
organomegali ikterik facies Cooley /
t
• 5L + + +

Jksudah -
lanjvt terapi ← Hb naik >
Zgrldl
5T rodent face / mukatikus normal sampai Abnormal
I

Thalasemia • MDT : set target , teardrop spin

3- 6 bln

Pikus Foto schaedel hair end

/as askorbat
on
• :
app vite 3×50
on
, .

-100mg

Target
• Gold standar : Hbelektroforesa
Talasemia B : HbAzP HBFR
Mayor gejala 1+1 transfuse ( ) t

Transpusi
,
,
: .

Teardrop
Talasemia ✗ : Hb At
, gejala E) itranpusi f)
Minor :

• Tx :
Rujuk ( transfuse PRC + kelasi besi →
deperoxamin )
• Bolak batik mascle
- Rs untuk transfers i

→ Anemia Sideroblastik
5L + BMP ( ring sideroblastik / papen
heimer bodies )

Tx : Rujvk
 anemia mikrositik hipokrom

anemia defisiensi besi anemia sideroblastik anemia penyakit kronik thalasemia

Fr : anak, hamil, cacingan, vegetarian Etio : gang. Pengikatan Etio : penyakit kronik yg mendasari Etio : defek pembentukan rantai globin
perdarahan kronik : hemoroid mutasi genetik terkait kromosom x tb & keganasan Autosomal resesif - RPK sama
Dx : 5L + koilonikia, glositis, stomatitis angularis, pica Dx : 5L Dx : 5L + RPT Dx : 5L + jaundice + organomegali + facies coley/Rodent face
Lab : MDT : sel pencil, cigar cell Px : BMP : ring sideroblastik Px : feritin n//T Px : mdt : sel target, tear drop
gold : profil besi : si K/, feritin /, tibc / Th : rujuk Th : terapi penyakit yg mendasari lab : BI /, si n//, tibc n//,
µ feritin /
-1
^ -1 -1
V

Th foto Schaedel : hair on end

Non medikamentosa gold : Hb elektrofesa : hba2 /, hbf /, hba L/
^ ^

/ asupan besi : daging, hati ayam

T
that aseiniap thalassemia ✗

/ absorpsi fe : VIT c, jus jeruk Th : transfusi PRC + kelasi besi (deferoxamine)

T

hindari : ppi, antasida, teh, kopi

-
Hemosiderosis : - Mengikat & ekskresi besi
besi numpuk di tubuh
medikamentosa
ay
Sf 3 x 200 mg/325 mg (60 mg fe elemental)
Smart w

5t
TAlsemia
2,3 mgg - Hb normal - lanjutkan 3 - 6 bulan/4 - 6 mgg TEar drop
TArget cell
TIkus
transfusi PRC jika Hb < 7 g% + gang. Hemodinamik
Transfusi berulang
 I t
mikrositik
TB
hipokrom

Dx :

normokrom
penyakitkronis.in
Anemia

Hipokrom
dwdl ←
nomositer
-01
mikrositer
"J°t

→ Gold stand ar : profit besi

 turun Dx : ADB
→ →
town

↳ naik

Dx : ADB

Tx :
SF 3×200/325 → 3- 4m99
t
SF 1×1
←
lanjutst-o-Hb.tn > zyr
3- 6 bln hb normal

→
autosomal resesif
 €
1- 3%
Dx :
Thalasemia B mayor

thalasemia B → Hbf on ,
Hb Azt mayor
→ gejalalttxtranofusilt)
thalassemia ✗ → Hb At minor →
gejalact transfused
,

Px BMP
penunjang :
 Anemia Perdarahan Aleut
• 7 5L

""" "" "

•
> Perdarahan akut lcepat

Anemia hemolitik
•
5L +
organomegali + ikteñk
• Coomb test

Anemia GGPD / Anemia Hemolitik Autoimun

Glucose 6 Phosphat Dehidroginase ( AIHA )
• > Coomb test G) . > Coomb test 1+1
0 batmalaria ( prima /win I
2-
,
Setelah transfuse Hb tetap / turun
dapsonckusta )
•

cotrimoxazole ,
•
> →

riwobat + ikteñk
Anemia nomokrom normositer o
> 5L +
organomegalitikteñk + .
> 5L
torganomegali
• > MDT : heinz body / bite cell .
> Tx :
awal → transfuse washed red cell

→ Tx : hentikanobat tepat → KS /prednisone

→ Anemia renalis

Def eritropoeitin ec gagalginjal

5L + Ur / Cr R t USG : ginjal Kecil + GFR t

Tx : atasi penyakit ginjal + beri eritropoietin

→
Retikulosit Nlt

→
Anemia aplastic
→ Gg sum sum
tulang :
primer Cidiopatik ) selander ( obat :/doramfenicol)

→ Pansitopeni : leukosit I =
demamlinpeksi °
> BM : hiposelular / hipoplastik /
trombo I = perdarahan dominasi se / Cemal
,

Hb t = 5L

Tx : rujvk →
transplant asi sumsumtulang
?⃝
 anemia normositik normokrom
Retikulosit > 1.5% Retikulosit < 1.5%

anemia hemolitik anemia aplastik anemia renalis

Etio Etio : Def eritropoietin ec penyakit gagal ginjal
primer : gg produksi sel darah di sumsum tulang Dx : 5L + ureum cr /T + USG : ginjal mengecil
Imun Non imun
sekunder : riw obat obatan : kloramfenikol Th : atasi penyakit ginjal + eritropoietin
Dx : 5L + infeksi & perdarahan berulang
AIHA G6pd
Penunjang :
anak : inkompatibilitas ABO-RH Malaria pansitopenia
Obat BMP : hiposeluler/hipolastic + didominasi sel lemak
Th : rujuk - transplantasi sumsum tulang

AIHA Anemia g6pd

Dx : 5L + jaundice, organomegali Etio :
Penunjang : coomb test radikal bebas
Th : kortikosteroid - rujuk rpo : primakuin (malaria), cotrimoksazol, gol.sulfa, dapson
/
prednison 3 x 5 mg Dx : 5L + jaundice + organomegali + rpo
Smart way
Penunjang : mdt : heinz body/bite Cell ikterik

mikrositer normositer

Smart way
Begah thalasemia AIHA G6PD

Bite g6pd heinz body

→ awal

Dx Anemia Hemolitik Autoimun →

coomb test G)
:

GGPD → Tx : hentikanobat

Dx : Anemia renalis → Tx : atasi perry .

ginjal
+

eñtropoeitin
→ Pansitopeni

Px : BMP →
dominasi set lemak / hiposelular
→

↳ primer

Dx : Anemia aplastic
 Anemia makrositik / megaloblastik
MDT :
hipersegmentasineutropil

Anemia def B12 / Anemia

def Bg /
-

cyanocobalamin /
pernisiosa
ds .

polat
hamil obatepilepsi.at/cohol
lambungan gastrektomi.ir/kusgaster)
?
•
7 FR : ( PPI ,
7 FR : ,

•
> 5L +
atropipapillidah + kesemutanlkebas .
> 5L + atnpipapilidah
•
> Gold standar : Kadar BR /
uji sliding ° > Gold stander : Kadar
Bg
Tx B12 / hari injeksi " Tx Ias polat 5mg /hair Ctdk hamil)
:
1mg → :
Bg .

Ibu hamil → 4000

mcglqmg-oriwmelahirkananencef-a.li/
\
spina
bifida / palatoskisis
400 meg / normal
0,4mg
→
 anemia makrositik
mdt : hipersegmented neutrofil

anemia Def VIT b12/sianokobalamin anemia defisiensi asam folat/b9

Fr : penyakit lambung, gastrektomi Fr : hamil, alkohol, rpo : Pirimetamin (obat tokso)
Dx : 5L + glositis, kesemutan, kebas Dx : 5L + Fr
Penunjang : uji schiling, gold : kadar b12 serum rendah Penunjang : gold : kadar b9 serum rendah
Th : inj sianokobalamin 1 mg/hari selama 6-7 hari Th : as.folat 5 mg/hari (1-4 bulan)
lanjutan : 100 mcg tiap 2 hari (7x), 100 mcg tiap 3-4 hari (3 mgg)
 0

B12 lambing ( ppl gastritis)

Def
,
-
→

( Def ✓
-

Bg
0

- Px :
Kadar B12 /ujischiling Tx : Biz
1mg
/Kari →
injeksi

→
ADB Dx : Anemia B12
→ anemia hemolikikimvn

→
thalassemia

normal :
400 mcg
to,ymg
Hamil →
→ C- lnonrmal /
: 4000 Mcg
4mg
 Hb on >
16mg / dl
/ I
""

t
100C

Polisitemialeritrositosis
A B
7-
grgar.am 2gr garam

Absolut Relatif
• sseldarah merah Seldarahmerah
benar ?
naik sealant naik
→ Volume cairn t
t

Dehidrasi
Primer /vera Selander
Pcrdarahan
lvkabakar
°
>
Sumsumtulang " C)
sumsumtulang
t hanya Hb R Obat ? → diuretic

Hb on Tx :
awalltepat → rehidrasi
leukoon
Patologis Fisiologis
trombotn
Penyakit paru >
Tinggal di

}°↳9
→
.

"

Tx : aural : rehidra.si .
> Keracunanco pegunungan /
chronic mountain
tepat donordarah /
: Tx : awal : rehidasi sickness
lmonges
Flebotomi
tepat :
atasipenyakit disease
 Hb > 16 mg/dl atau eritrosit > 6 juta

polisitemia
Absolut Relatif eat N
/ sel darah merah / volume plasma - / kons. Eritrosit
- ,
,

primer sekunder Dehidrasi

Perdarahan
Luka bakar

Kelainan Patologis Fisiologis

sumsum tulang Peny. Paru kronik Chronic mountain sickness/
Peny ginjal monges disease
Keracunan co - tinggal di pegunungan
Kongenital (mutasi gen)

Dx
sakit kepala, nyeri di bag tubuh, telinga berdenging, mudah lelah, sesak, plethora (kemerahan)
+ Hb > 16 mg/dl atau eritrosit > 6 juta
Th
rehidrasi
Phlebotomi - donor darah rutin
 -

-
-

Senora naik → sum sum

tiling

rehidasi
'

→
aural :

tepat plebotomi
:

t
f) sums um
talang

o f
obat diuretic → Tx : rekidn.si

-
-

Sumsumtulang
Dx : Polisitemia vera → aural →
retudr si
 Perdarahan sulit berhenti
Ptekie, Purpura
Mimisan, gusi berdarah

carahentikan
Gangguan hemostasis →

perdarahan
BT
e-
: fungsi trombosit
-

vasokonstriksi

lp.cm/outuhdarah.- -Eoagulasi- o8-l2kec:l0

CT
PT : f II, f VII
TT : f V, f X
aPTT : f VIII, IX, XI, XII

dtrah
Gang. Vasokonstriksi Gang. Trombosit Gang. Koagulasi
pain

Gang pemecahan fibrin

-
.

→
-
trombosit
↳ pen .
darah ,
t.coagula.si

HSP ITP Von willebrand APCD Hemofilia DVT DIC

(Henoch scholein purpura) (Def VIT k) (Deep Vein trombosis) (Disseminated intravascular coagulation)
(Idiopatic trombositopenia purpura) disease

BT
t t
BT BTtzci-F.si ¥+
 →
Henoch sihonlein purpura
• > Autoirniin → askulitis
•
> Hematuria
small child Tx : Ks /prednisone .

Palpable purpura

Abdominal pain / IgA

→ Imune Trornbositupenic Purpura ( ITP !

Tromkositt
prednisone
Riw / dare /
}
• > . Is PA → Tx Ks
:

Ptekie / purpura BT
. >
memanjang o >

→ Von willebrand disease

Def fakitor willebrand G- trombosit F. ☒ rawal desmopresin

4T¢
I :

Gg Hemostasis
→ von __→
g.
.

.
.

( Perdarahanl → BT
memanjang . CT
rnemanjang ,
apt:# rnemanjang . tesristosetin (t ) I tep±t : vonwillebran

kriopresipitat

→ VKBD / APCA

Def vitk . : anak < ith ,

riw.C-ldiberivitksa.at tahir ( duk.vn/;susuporrnul .

• PT.me manjang ,
APTT normal lmernanjang
Tx : wit k 1mg

→
Hemofilia
✗ linked i-esesiffh-anyalaki-lat.it ,
hamartrosis ( perdarahansen.fi/.sirkums:isidarI.rhC-lhenti

PT normal APTT
,
nemanjang

A :
Def .
F- 8 ( klasik) → Tx : 1=8 / kriopresipitast

B : Def Fg ( christmast disease) → Tx Fg

}
.
:

Epp
( Tx
:
Def - Fll → : Fit

→
Beep Vein Trembosis € DVT )
• > Riw imobilisasi : stroke I:# rjatananjauh.in/--lamasiC+)

°
> Homan sign fit ,
D- dinner I

→ Disseminated Intravascular Coagulation ( Dlc )

-

•
2
Keganasan .
sepsis , postpartum
trombosit
•
> BT act memanjang ,
to .
D
-
- dimer on .
Fibrinogen
Tx :
Njuk
 Perdarahan sulit berhenti
Ptekie, Purpura
Mimisan, gusi berdarah

Gangguan hemostasis
BT : fungsi trombosit
vasokonstriksi
CT
PT : f II, f VII
TT : f V, f X
aPTT : f VIII, IX, XI, XII

Gang. Vasokonstriksi Gang. Trombosit Gang. Koagulasi Gang pemecahan fibrin

HSP ITP Von willebrand APCD Hemofilia DVT DIC

(Henoch scholein purpura) (Def VIT k) (Deep Vein trombosis) (Disseminated intravascular coagulation)
(Idiopatic trombositopenia purpura) disease
 gangguan hemostasis
gang vasokonstriksi gang. trombosit

hsp itp Von willebrand

Henoch scholein purpura
Dx : ptekie + palpable purpura
Lab : BT / + trombosit normal
-1
Idiopatic trombositopenia
purpura disease
Etio : jumlah trombosit rendah - autoimun Dx : gg perdarahan sulit berhenti

Th : prednison Dx : ptekie/purpura + riw ispa/diare/vaksin (anak) Lab : BT /, trombosit n, vwf ,/, aptt /, ristocetin (+)
-1 ^

Lab : BT / trombosit 1/ Th : rujuk - faktor VW, faktor viii

-1
,

Th : rujuk - prednison Desmopresin

Fungsi VW
Smart way Melekatkan trombosit ke jar rusak
bt memanjang
Mengikat fviii
Palpable
Menjaga fviii agar tidak terdegradasi
purpura

trombosit

normal ///
LLL

hsp vwf itp

 gangguan hemostasis

gang. Koagulasi gang pemecahan fibrin

APCD Hemofilia dvt dic

Def VIT k - fk II Deep Vein trombosis Disseminated intravascular coagulation
Etio : BBl (-) inj. VIT k Etio : x linked resesif Dx : edema tungkai unilateral, nyeri Komplikasi penyakit : keganasan, sepsis, post partum
Dx : perdarahan sulit berhenti + hematom (+/-), / tik Kla Homans sign (nyeri dorsofleksi), d dimer /T Dx : trombosit 1-//n, ct /(semua Fr koagulasi /)
T T
T

Lab : PT memanjang, tt, aptt normal/aptt memanjang A : def. F viii : hemofilia klasik Gold : USG doppler d dimer /, fibrinogen 1-/
-1

Th : VIT k 1 mg/hari (3 hari berturut) B : Def f. IX : critmas disease Th : antikoagulan : heparin, warfarin Th : transfusi ffp, Tc (trombosit concentrate)
Rujuk C : Def f. XI
Dx : perdarahan sulit berhenti
hemarthrosis (perdarahan sendi - bengkak lutut)
Lab : Aptt memanjang
Gold : kadar viii, ix, xi
Th : A : kriopresipitat
B/C : FFP (fresh frozen plasma)
 prednisone
Tx : Ks /

Tx : Ks

€
Tx vile K
:
1mg
 Tx : aural →
desmopresir .

tepals
.
→ VWB

k-r-iopnesipit.at

☐* : Vat B
X
X
×

→ hemoifilia A ( Kla sik)

1.
Sepsis
 Smart way
-

Leukosit > 30.000

⑧nak ④ ki ④ ki
leukemia
A- Mel tutup aurrod
punya
-

gang tinggal di Philadelphia Kobi

main basket
→ CML Etio : benzena (SPBU, tambang), karsinogenik → Px : BMP
t
ELL

Kla

i.pe 'M Tipe M

f.
.

akut kronik →
'

Tipel Tipe 1-
sel blast > 20% sel blast < 20%
it / (-) organomegali (+) organomegali

AML ALL CML CLL

acute myeloblastic leucemia acute lymphoblastic leucemia chronic myelositic leucemia chronic lymphositic leucemia

Aver Rod
.

dewasa muda 90% anak mutasi bcr - abl Px : smudge Cell/

Px : myeloblast (+) Px : limfoblast (+) Px : myelosit (+) basket Cell
Auer rod Kromosom philadelpia (9:22)

Th : rujuk
 leukemia

Aleut ikronik

blast > 20-1 .

blast <
20%

M L
M :L
.
.

! neut segmen
basofi ;
-

→ it
/ 5/20,180/20 / zo→tr
→
Diff tell
,
"☐
→
to

f I I Tipem ( myeloid )
eosinofil neut
.

monosit
.

rievtrofil
lirnposit
"

batang
.
. ,

it , b
eosin
opil
I

20--40 Tipel ( limpoid )

→ limfosit
Blast -1 Akut

}
→
: so .

# ME
2/3 / ☒ 0/60/30 /¥0
t
N →
tipe M
--

I
Akut

'

¥ blast imatur
'

- → chronic
I
akut
✗

→ aurrod
 pembesaran kgb

Nyeri + demam (-) nyeri

limfadenitis
BB d. anemia

(+) alarm sign

y
(-) alarm sign
Limfadenopati Limfoma maligna

Limfoma Limfoma
→ EBV
Non Hodgkin Hodgkin
selpolimorp.it/ Sel uniform/homogen/benjolan multiple Sel reedstenberg (+)
Cth : limfoma burkit : starry sign Owl eyes
Benjolan tunggal
 t
reed stenberg

non

itt

D. × : limpoma hodg#in
 hipersensitivitas
Kla menurut coombs + gel

Tipe 1 Tipe 2 Tipe 3 Tipe 4

reaksi cepat/anafilaksis - igE/sel mast sitotoksik - ig m, ig G kompleks ag-Ab/kompleks imun - komplemen reaksi lambat/delayed - sel t helper

Cth Cth Cth Cth

syok anafilaksis, rhinitis alergi, d atopi, alergi makanan / AIHA/inkompabilitas, itp, rx transfusi darah sle, ra, gnaps dka, tb paru, uji tuberkulin
urticaria ,
asma
konj alergi
, .
I
dash ?an
I
Px : skin prick test

Syok anapilaktik → Tx : *
Epinepñn /adrenalin 013mg Ibb 1 : 1000 1M , clang 3x
* resvsitasi caiman

*
Inj antihistamine : dimenhidrinat ,
ranitidin
*
Inj kortikosteroid hidrocortison
. :
lmetylprednisolon
 Dx : syokanafilaktik

Dx :
syokanapilaktik
→
Ig E

D ✗ : TB pan

→ set 1- helper