1. “No doubt knowledge is valuable,
but above it is Character”
Knowledge without character is dangerous!
2. ….. foundation of clinical medicine
Shashidhar Venkatesh Murthy
A/Prof & Head of Pathology
College of Medicine & Dentistry
Clinical Pathology:
RBC Disorders: Deficiency Anemia
10. Megaloblastic Anemia:
10
1. Oval Macrocytes, Pancytopenia: cell division.
2. Anisopoikilocytosis: Hemolysis.
3. Hypersegmented neutrophils: Large cells / Megaloblasts
(in bone marrow).
Megaloblastic Bone Marrow Normal
Hypersegmented
Neutrophils
Macrocyte
Megaloblast
11. Pernicious Anemia: Vit B12
Autoimmune atrophic gastritis in aged.
IF & Parietal cell antibody (Type I,II,III)
Reduced Tetra-hydrofolate (FH4)
Decreased DNA synthesis.
Other causes of Vit B12 def. (not pernicious)
Gastrectomy
Achlorhydria
Chronic Pancreatitis
Ileal resection
Mal absorption syndromes.
Tapeworm infestation
Malignancy, pregnancy, hyperthyroidism etc.
Clinical:
MBA+ neurological deficits (spinal dorsal tract)
Loss of proprioception.
B12 Animal/bacteria
Folate Green Veg
12. Nothing can stop the man with the right
mental attitude from achieving his goal;
nothing on earth can help the man with the
wrong mental attitude!
-- Thomas Jefferson
13. Haemopoiesis in deficiency anemias
13
Macrocytic, pancytopeniaMicrocytic hypochromic
Iron Deficiency Normal Megaloblastic
14. Anemia of Chronic Disease:
Etiology:
Chronic Infections,
inflammations, malignancy
&
anemia of renal disease*.
Pathogenesis:
IFN, TNF, IL block iron
transfer from macrophage
store to RBC.
Erythropoietin*.
Morphology:
Mild Microcytic,
Hypochromic.
Clinical Features:
Mild anemia, resistant to
iron therapy.