Hematologic and
Immunologic Problems
Facilitating Learning Session
with
Year III Medical Students
Southwestern University College of
Medicine
Cebu City
July 29, 1999
Glenda Caballero, Leevaneigh Digdigan, Ruben
Gador, Jr., Herbert Libres, Roland Madrona, Obriz Paglinawan, Louire
Grace Paypa, Claudelle Montano,
Ronnie Dan Salazar
Facilitator: Reynaldo O.
Joson, MD
Outputs
Overview
Patient with
Pallor
Learning
Issues
Overview of Hematologic and Immunologic Problems
1. Concept
"Hematologic" - "Blood" System
"Immunologic" - "Defense" System
Parts of the Systems
|
|
Hematologic (Blood) System |
Immunologic (Defense) System |
|
Factory |
Spleen/liver - children |
Thymus - T cells |
|
Products |
Cells |
Cells |
|
Vessels |
Blood vessels |
Lymph vessels |
|
Natural History - Place of Destruction |
Liver |
Spleen? |
|
Function |
Oxygenation |
"Defense" |
These problems can affect the biopsychosocial well-being of the individuals as well as the socioeconomic productivity of affected individuals, families, and communities.
2. Common Types of Problems
|
Types of Problems |
Hematologic (Blood) System |
Immunologic (Defense) System |
|
Production |
|
|
|
Transportation |
|
|
|
Destruction |
|
|
3. Common Causes
|
Causes of Problems |
Hematologic (Blood) System |
Immunologic (Defense) System |
|
Genetic |
|
|
|
Autoimmune |
|
|
|
Infection |
|
|
|
Chemicals |
|
|
|
Tumors |
|
|
|
Radiation |
|
|
4. Common complaints of patients with hematologic and immunologic problems
|
Hematologic Problems |
Immunologic Problems |
|
Pallor |
Hypersensitivity/Allergy |
|
Bleeding/Hematoma |
|
|
Recurrent Infection |
|
|
Splenomegaly/Hepatomegaly |
|
5 Magnitude of Hematologic and Immunologic Problems (independent study)
6. Personal Perspective on How To Solve the Problems in the
Community (independent study)
Overview
Patient with Pallor
Learning Issues
A hypothetical child patient with pallor was discussed from clinical diagnosis to paraclinical diagnostic procedure to treatment.
Excerpt of discussion:
Trigger 1: A patient with pallor.
Concept of Pallor
Pale, anemia, decreased in red blood cells
Clinically detected by physical examination:
generalized pallor of the skin supported by pale nail beds and conjunctivae
Laboratory finding:
Decreased red blood cell count in peripheral blood smear
2. Common Types of Anemia
Morphologic
|
Types based on morphology |
Causes |
|
Hypochromic, microcytic |
Iron deficiency |
|
Normochromic, normocytic |
Blood loss |
|
Macrocytic |
Vitamin B6 and B12 deficiency |
3. Common Causes of Anemia
Problems in Production
Problems in Destruction
Nutritional - very common
Blood Loss - very common
Bone Marrow Failure
Problems in Spleen - least common
Congenital
Acquired
Trigger 2: A 10-year-old boy with pallor with no associated symptoms. Pallor was noted by mother 2 weeks prior to consult. Physical examination: pale pink conjunctivae. No other unusual findings.
Primary clinical diagnosis:
Secondary clinical diagnosis
Bases:
Do you need a paraclinical diagnostic procedure? If yes, why? If no, why?
If you need a paraclinical diagnostic procedure, which one will you choose based on benefit-risk-cost-availability analysis?
How do you interpret the result of the paraclinical diagnostic procedure you have chosen?
Trigger 3. The CBC shows Hemoglobin of 10 gm%.
Trigger 4. Suppose the diagnosis is aplastic anemia. How do you treat this patient? Compare options using benefit-risk-cost-availability factors?
How do you advice the mother on the diagnosis and how to prevent it and maintain health for the child?
Reticuloendothelial System - concept and function
Microcytic - macrocytic - mechanism
Will there be cyanosis with decrease in red blood cells?
Where is/are the places of destruction of hematologic/immunologic cells? Spleen?
Do all bones have bone marrow?
Magnitude of Hematologic and Immunologic Problems
Personal Perspective on How to Solve the Problems in the Community
Overview
Patient with Pallor
Learning Issues