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ID:20770286
大小:822.50 KB
页数:50页
时间:2018-10-16
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1、徐运孝内科学多媒体教案HEMOLYTICANEMIAS一、GeneralInformation●HbStructure●DefinitionofHemolyticAnemias1、HbStructureHbA(22)HbA2(22)HbF(22)ProtoporphyrinHematinHbFe2Haptoglobinnon-22、DefinitionofHemolyticAnemiasHemolyticanemiaisonekindofanemiainwhichthedestructionofredcellisincreasedwhilethec
2、ompensatoryfunctionofmarrowhematopoisisisinsufficient。HemolyticdisordersHemolyticjaundice二、ClassificationandPathogenesis1、Hemolyticsites:ExtravascularhemolysisIntravascularhemolysisHemolysisinsitu2、HereditaryTendency:HereditaryAcquired3、PathogenesisIntrinsicabnormitiesofredcells:re
3、dcellmembranedisorders;enzymedefects;hereditaryHbdisease.Extrinsicabnormitiesofredcells:Immune;Physicalandmechanical;chemical;infections。(二)Distinguishwhetherthereishemolyticanemiaornot1、Evidenceofexcessivedestructionofredcells(1)Examinationsabouttheshortenedlifespanandtheexcessive
4、destructionoftheredcells.(2)Evidenceoftheimprovedfreehemoglobinlevel.(3)Examinationsabouttheabnormalmetabolismofserumbilirubin(1)examinationabouttheshortenedlifespanandexcessivedestructionoftheredcells.Thelifespanoftheredcellsisshortened.32P-DFPorH-DFPT1/215d(normal25-32d)cha
5、ngesofredcellmorphology:spherocyte,ellipotocyte,stomatocyte,helmetcell,sicklecell.LDH2、Evidenceofcompensatoryaccelerationoferythropoiesis(2)ExaminationabouttheincreasedplasmafreehemoglobinmoderatehemolysiscombinewithHpHpsmallpartcombinewithhemopexinhemopexinfreeHbalbuminsevereh
6、emolysissomeconverttomethemoglobinmethemalbuminrenalreabsorptionepithliummajorporthemoglobinuriabyrenaltubuleurinehemosiderinhemosiderineuriadesquamationafreeHbbHpcmethemalbumindHburineeurineroustest(+)(3)ExaminationaboutabnormalmetabolismofbilirubinIndirectbilirubinUrineurobilin
7、ogen,urinebilirubin(-)Stoolbilinogen2、Evidencesofcompensatoryaccelerationoferythropoiesis(1)Reticulocytosis(2)Bloodsmearanisocytosis,polychromatophiliaofredcells.Howoll-Jollybody.Cabotring,nucleatedredcells.(3)Hyperplasiabonemarrow(三)FindtheetiologyofhemolysisanemiaExaminations
8、about
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