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MINISTRY OF PUBLIC HEALTH OF UKRAINE
BUKOVINIAN STATE MEDICAL UNIVERSITYÂ
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Approval on methodological meetingÂ
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department
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pathophisiology                           Â
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Protocol â„–
Chief of department of the pathophysiology,
professor                             Â
          Yu.Ye.Rohovyy
“___― ___________ 2008 year.
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Methodological Instruction
to Practical Lesson
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Ðœodule 2 : PATHOPHYSIOLOGY OF THE ORGANS AND SYSTEMS.
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      Contenting module 4. Pathophysiology of blood system.
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Theme 6: Final control - 4.
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Chernivtsi – 2008
     1.Actuality of the theme. Anemia appear on the base of various
diseases, intoxycations, bloodloss. Therefore clinicists of various specialities often
find them in the practical activity.  The quantitative changes erythrocytes and
hemoglobin are one of the most important parameters, on the basis of which
diagnostics of anemia is carried out. On changes of these parameters also judge about
the efficiency of treatment. Using the quantitative characteristics of erythrocytes and
hemoglobin, it is possible to define one more clinicaly important parameter - colour
index. Basing on a colour index one can judge about the saturation of erythrocytes
by hemoglobin. The value of a colour index (norm, decrease, increase) has
diagnostic mean.
    The qualitative features of erythrocytes of peripheral blood and bone
marrow allow to determine a kind of anemia, to make submission about regenerative
ability of bone marrow and to inspect efficiency of treatment. For example,
erythrocytes with the distinctive morphological characteristics are peculiar for irondeficiency anemia (hypochromic erythrocytes), B12Â (folic)-deficiency anemia
(megaloblastes and megalocytes), sickle-cell anemia (sickle-shape erythrocytes),
thalassemia (target like erythrocytes), Minkovskyi-Shoffar’s anemia
(microspherocytes). The increase of amount reticulocytes in peripheral blood
testifies for good compensator possibility of bone marrow. The availability in
blood of anisocytes,poikilocytes and other degenerative forms show the
heavy disorder of erythropoiesis.
Leucocytosis are considered as a reaction hematopoietic system due to action
of physiological and pathological irritations. Leucocytosis is a pathological
symptom of many diseases. In a basis of leucocytosis lay pathophysiological
mechanisms connected with proliferation, maturation going out of leucocytes and
their flow into vessels and redestribution. Different kinds of leucocytosis may be the
additional criteri for establish the diagnosis. Eosinophilia, for example, is
characterized for allergy reactions, neutrophile leucocytosis - for acute inflamation
processes.
  Leucopenia may depend upon oppressive influence of some toxines on the
maturation and outflow of leucocytes from the bone-marrow. Often these
phenomenas are observed during the infectious diseases. They have significanse for
the differential diagnostic. If for the disease is characterised leucocytosis, the
availability of leucopenia testifies on depression of hemopoietic system. It is
regarded as a criteri weakenes of reactivity of the body on action of pathological
factors.Directness and character of changes of white blood cells due to various
diseases - significant for the diagnosis and control of the treatment.
Steady growth of number of leucosis among the population of many countries of
the world and high lethality demand steadfast attention to the given pathology.
Preventive measures have the large significance in struggle with leucosis. Therefore
it is important for the future doctor to acquire existing submissions about etilogy of
leucosis (chemical cancerogens, ionizating radiation, virus infection). Each form of
leucosis differs by characteristic shifts of cytostructure of peripheral blood and bone
marrow. On these features differential diagnostics of leucosis is constructed. It is
necessary to mark that the therapy of leucosis mainly pathogenetic. The deepening
of our submissions about separate chains of pathogenesis will promote perfecting of
purposeful treatment.
The liquid state of blood is provided with difficult interaction of three systems –
coagulative, ancoagulative and fibrinolytic. Alteration each of them can cause to
decrease or increase of coagulation of blood. The decrease of
coagulation(hypocoagulation) appears like hemorrhagic syndrome. It’s appears
as results of alteration thrombocytous-vessels hemostatic (thrombocytopenia and
thrombocytopathia) or disturbance of various stages of coagulation of blood
(hemophilia A, B, C, afibrinogenemia). The increase of coagulation of blood
(hypercoagulation) is considered as major mechanism formation of thrombus. One
of the most serious consequences alteration of hemostasis, which includes both
hyper- and hypocoagulation, is syndrome of disseminated intravascular coagulation
of blood – DIC-syndrome. It develops as complication in traumatic, anaphilaxic
or cardiogenic shock, malignant tumours, acute kidney insufficiency, exfoliation of
placenta, septicemia, massive hemolysis. The consequences of disturbances
coagulation of blood quite often acquire menancing character and demand
emergency measures from the medical staff.
              2.Length of the employment – 2 hours.
3.Aim:
To khow: pathology of the anemia, leukocytosis, leucopenia, leukemia,
hemostasis.
To be able: to analyse the pathogenesis of the anemia,
leukocytosis, leucopenia, leukemia, hemostasis.Â
To perform practical work: To analyse the tests, clinical-pathophysiological
schemes, tables with pathology of the anemia, leukocytosis, leucopenia,
leukemia, hemostasis.
Control questions of the theme:
1.     Anemia, definition of concept, hematological indexes.
2.                Regenerative forms of erythrocytes.
3.            Classifications of anemias.
4.            Acute posthemorrhagic anemia.
5.            Chronic posthemorrhagic anemia.
6.            Irondeficiency anemia.
7.            B12-(folate)deficiency anemia.
8.            Hypoplastic anemias
9.            Metaplastic anemias.
10.        Dysregulative anemias.
11.        The characteristic of hemolytic anemias.
12.        Mechanical hemolysis of erythrocytes.
13.        Immune hemolytic anemias.
14.        Toxic hemolytic anemia.
15.        Acquired membranopathy.
16.        Hereditary membranopathies.
17.        Hereditary enzymopathies.
18.        Hereditary hemoglobinopathies.
19.        Iron refractory anemia.
20.        What is leukocytosis?
21.        Classification of the leukocytosis.
22.        Etiology of the leukocytosis.
23.        The mechanisms of leucocytosis.
24.        Blood picture under the leukocytosis.
25.        What is leukopenia?
26.        Classification of the leukopenia.
27.        Etiology of the leukopenia.
28.        The mechanisms of leucopenia.
29.        What is aleukia ?
30.        Blood picture under the leukopenia.
31.        Leucocyte degeneration in blood.
32.        What is leukemia ?
33.        Classification of the leukemia.
34.        Etiology of the leukemia.
35.        The pathogenesis of leukemia.
36.        Blood picture under the leukemia.
37.        Leucocyte degeneration in blood.
38.        What is hemostasis pathology.
39.        Classification of pathology of hemostasis.
40.        Normal hemostasis.
41.        The classical coagulation cascade.
42.        Virchow's triad in thrombosis.
43.        Decreasing of blood coagulation ability.
44.        Thrombocytopenia and thrombocytopathy.
45.        Increasing of blood coagulation ability.      Â
46.        Generalized (disseminated) intravascular blood coagulation
(DIC-syndrome).
Literature:Â
1. Gozhenko A.I., Makulkin R.F., Gurcalova I.P. at al. General and clinical
pathophysiology/ Workbook for medical students and practitioners.-Odessa, 2001.
2. Gozhenko A.I., Gurcalova I.P. General and clinical pathophysiology/ Study guide
for medical students and practitioners.-Odessa, 2003.
3. Robbins Pathologic basis of disease.-6th ed./Ramzi S.Cotnar, Vinay Kumar,
Tucker Collins.-Philadelphia, London, Toronto, Montreal, Sydney, Tokyo.-1999.
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