Scribd Logo
Upload

Welcome to Scribd!

  • Hematopatholdentistry

    Uploaded by

    Abbi Yanto Art
    20 views49 pages

    Original Title

    hematopatholdentistry.ppt

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    20 views49 pages

    Hematopatholdentistry

    Uploaded by

    Abbi Yanto Art

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 49

    Hematopoietic and

    lymphoid systems

    • main entities - disorders

    • exam questions and very concise


    text - www.lfhk.cuni.cz/patanat
    Hematopoietic and lymphoid
    systems - exam questions
    • Posthemorrhagic and hemolytic anemias
    • Anemias of diminished erythropoiesis; pernicious anemia
    • Polycythemia
    • Bleeding disorders
    • DIC
    • Lymph node pathology - review
    • Spleen pathology - review
    • Thymus pathology - review
    • Non-Hodgkin’s lymphomas
    • Hodgkin’s disease
    • Acute leukemias
    • Chronic leukemias
    • Myeloproliferative disorders
    • Plasma cell dyscrasias
    • Histiocytoses
    • Storage diseases
    Anemia - causes

    • posthemorrhagic
    • hemolytic
    • impaired red cell production
    Blood loss -
    posthemorrhagic anemias
    • acute - hypovolemia, shock, rapid
    hemodilution, slowly increasing
    hematopoesis (sufficient amount of
    iron)
    • chronic - GIT, female genital tract -
    iron loss (increased hematopoesis)
    Hemolytic anemias - general
    features
    • increased rate of RBCs destruction
    • increased amount of iron
    • hypercellular bone marrow
    • reticulocytes in peripheral blood
    Hemolytic anemias - RBCs
    destruction

    • intracorpuscular (intrinsic) -
    hereditary, acquired are rare
    • extracorpuscular (extrinsic) -
    acquired, immunity, mechanical
    trauma, infections
    Intracorpuscular anemias

    • hereditary

    • acquired
    Hereditary

    • spherocytosis
    • sickle cell anemia
    • thalassemia - T. maior, T. minor
    • glucose-6-phosphate dehydrogenase
    deficiency
    Acquired

    • paroxysmal nocturnal
    hemoglobinuria
    Extracorpuscular anemias

    • immunity related
    • mechanical trauma
    • infections
    Immunity related
    • autoimmune anemias
    • Erythroblastosis fetalis (hemolytic disease of the
    newborn) - related mainly to Rh system (D- antigen), less
    to AB0 systém. Passage of fetal RBCs through the placenta
    during last trimester (no cytotrophoblast) or during
    childbirth. Mother antibodies cross the placenta.
    • Concurent AB0 incompatibility protects the
    mother against Rh immunization - RBCs removed
    from maternal circulation. The blood dose - 1 ml. IgG
    response - cross the placenta, IgM - does not cross, the
    response faster in 2nd or 3rd gravidity (faster IgG response).
    Mechanical trauma
    • prostethic valves - more in metallic
    or plastic prostheses than in
    bioprostheses

    • microangiopathic hemolytic anemia -


    squeezed RBCs in narrowed vessels
    - DIC, SLE, malignant hypertension
    Infections

    • malaria - 4 subtypes of plasmodia,


    Asia, Africa - Anopheles (mosquito)

    • Plasmodium falciparum - malignant


    tertian malaria
    Anemias of diminished
    erythropoiesis

    • lack of
    – iron
    – folic acid
    – vitamin B12
    – less frequently - pyridoxin, thiamin
    Iron deficiency anemia
    (sideropenic)
    • lack of iron in the food - veggies;
    malabsorption - sprue
    • increased demand - gravidity
    • chronic loss - GIT, menstrual
    bleeding
    • morphology - microcytosis, low
    RBCs volume, pallor, spoon-shaped
    nails
    Folic acid and vitamin B12
    (Cobalamin) deficiency
    anemia (megaloblastic)

    • folic acid deficiency - gravidity,


    severe alcoholics, drug abusers.
    Sometimes celiakia, malabsorbtion.
    • B12 - like folic acid deficiency, in
    addition - peripheral nerves and
    spinal chord demyelinization
    Aplastic anemia

    • pancytopenia, erythrocytopenia,
    agranulocytosis, thrombocytopenia
    • in half number of cases - idiopatic
    • sometimes after irradiation,
    myelotoxic drugs
    Myelophtisis

    • bone marrow metastases - breast,


    lungs, prostate

    • multiple myeloma, TBC


    Bleeding disorders -
    hemorrhagic diatheses

    • vascular fragility - vitamin C


    deficiency - scurvy
    • DIC, thrombocytopenia,
    coagulopathies
    DIC
    • Blood clotting - starts from soft tissue
    (tissue thromboplastin) or endothelial
    damage (factor XII.)
    • Causes: 1/ release of clotting factors -
    amniotic fluid embolization, cytoplasmic
    granules - promyelocytic leukemia, mucus
    - Ca, Gram-negative sepsis
    2/ extensive endothelial damage,
    burns, SLE
    DIC - morphology

    • fibrin microthrombi within capillaries


    - kindeys, brain, heart, lungs, adrenal
    gland (Waterhouse - Friderichsen sy),
    hypophysis (Sheehan sy)
    • acute DIC - bleeding, chronic -
    thrombotic
    Thrombocytopenia

    • Idiopathic thrombocytopenic purpura


    (ITP)
    • Thrombotic thrombocytopenic
    purpura (TTP) (m. Moschowitz) -
    microthrombi composed of platelets
    Coagulation disorders

    • acquired - prothrombin, f. VII., IX.,


    and X. - hepatic damage
    • hereditary -
    • hemophilia A
    • hemophilia B
    Leukemias

    • leukemic form
    • aleukemic form
    • leukemic infiltration of the liver,
    spleen, lymph nodes
    • primary site - bone marrow
    Leukemias - classification

    • maturation:
    • acute leukemias
    • chronic myeloproliferative disorders

    • cell types:
    • lymphatic
    • myeloid
    Acute leukemias
    • clinical course
    – sudden onset
    – anemia, fever, infections, hemorrhagic
    diathesis
    – bone pain (bone marrow expansion)
    – generalized lymphadenopathy (ALL),
    splenomegaly, hepatomegaly
    – CNS symptoms - headache, vomitus,
    paralysis
    ALL (acute lymphoblastic
    leukemia)
    • 80 % of childhood leukemias
    • 5 - 10 % Philadelphia chromosome (22 
    9)
    • prognosis - relatively good, 90 % -
    remission, if translocation  worse
    prognosis
    AML (acute myeloid
    leukemia)

    • adult middle age


    • prognosis bad, 5-year survival - 10 -
    15 %
    • hiatus leukemicus
    • bone marrow transplantation
    Chronic myeloproliferative
    disorders
    • CML
    • CLL
    • polycytemia vera
    • HCL
    • myeloid metaplasia with
    myelofibrosis
    • essential thrombocytemia
    CML (chronic myeloid
    leukemia)

    • adults middle or younger age


    • “pyoid” bone marrow
    • Philadelphia chromosome - 90 %
    patients
    • bad prognosis
    CLL (chronic lymphatic
    leukemia)
    • older age
    • long asymptomatic period, non-
    characteristic symptoms
    • course and prognosis variable
    • related to malignant lymphomas
    Polycytemia vera
    • proliferation of erythroid, myeloid
    and megakaryocytic line
    • increased blood viscosity, blood
    volume
    • borne marrow highly cellular
    • hypertension, thromboses, bleeding
    Hairy cell leukemia
    • chronic B-cell line leukemia
    • fine cytoplasmic projections -
    immunohistochemistry, phase
    contrast, EM
    • hepatomegaly, splenomegaly
    • therapy - purine analogues
    Myeloid metaplasia with
    myelofibrosis
    • bone marrow fibrotic, hypocellular
    • neoplastic stem cells within the
    spleen
    • unknown ethiology of bone marrow
    fibrosis
    • splenomegaly, trilinear
    hematopoiesis in the spleen,
    prominent megakaryocytes
    Leukemias - general
    morphology

    • bone marrow soft - “pyoid” (CML)


    • splenomegaly - CML
    • lymph nodes enlargement - CLL
    • hepatomegaly - CML, CLL
    • sometimes other organs infiltrated
    Non-neoplastic white cells
    disordes
    • leukopenia - neutropenia
    (agranulocytosis)
    – impaired granulopoiesis - bone marrow
    failure
    – destruction of granulocytes - immunity,
    drugs
    • reactive leukocytosis - infections
    • infectious mononucleosis - EBV
    Plasma cell dyscrasias
    • multiple myeloma
    • localized plasmacytoma
    • Waldenström’s macroglobulinemia
    • heavy-chain disease
    • primary amyloidosis
    • monoclonal gammopathy of
    undetermined significance
    Multiple myeloma
    morphology

    • osteolytic lesions - prominent mainly


    in the scull
    • histologically - diffuse infiltration by
    neoplastic plasma cells
    • kidney - myeloma nephrosis -
    neoplastic plasma cells, casts within
    distal tubules
    Histiocytoses X

    • acute disseminated Langerhans’ cell


    histiocytosis (Letterer - Siwe)
    • unifocal and multifocal - eosinophilic
    granuloma
    • multifocal histiocytosis (Hand-
    Schüller-Christian disease)
    Malignant lymphomas

    • non-Hodgkin’s lymphomas

    • Hodgkin’s lymphoma
    Non-Hodgkin’s lymphomas

    • nodular
    • diffuse

    • Working Formulation, Kiel


    Classification, REAL, WHO
    Malignant lymphomas -
    some entities

    • ML of CLL type
    • follicular centre ML
    • diffuse large cell ML
    • Burkitt’s lymphoma
    Extranodal ML

    • mycosis fungoides

    • Sézary’s syndrome

    • MALToma
    Hodgkin’s ML

    • nodular lymphocyte predominance


    Hodgkin’s lymphoma
    • classical Hodgkin’s lymphoma
    – lymphocyte rich
    – nodular sclerosis
    – mixed cellularity
    – lymphocytic depletion
    Hodgkin’s ML - staging
    • I. Single lymph node region or single
    extralympatic organ.
    • II. Two or more lymph node regions or limited
    contiguous extralymphatic organ on the same
    side of diaphragm.
    • III. Two or more lymph node regions or limited
    contiguous extralymphatic organ on both sides of
    diaphragm.
    • IV. Multiple, disseminated foci of involvement,
    both sides of diaphragm + bone marrow.
    Lymph nodes -non-
    neoplastic diseases

    • reactive lymphadenitis
    – acute non-specific
    – chronic non-specific
    • speciphic lymphadenitis
    – TBC (BCG)
    – Cat Scratch Disease
    Spleen - overview

    • enlargement
    – massive
    – moderate
    – mild
    • rupture
    • necrosis
    Thymus - overview

    • thymic hyperplasia
    • tumors
    • thymoma
    » benign thymoma - 90 %
    » thymic carcinoma
    Thymomas
    • epithelial predominance
    • lymphocyte predominance
    • mixed

    • appendant disease - myasthenia


    gravis

    You might also like