pleno blok 2.2 minggu 2

7/25/2019 Pleno Blok 2.2 Minggu 2

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PLENARY DISCUSSION

By : Group 2A Addina Fitri Islami Amelia Yendra

Dilla Ariyani Frissia Dwi Agseptya Joshua Roberto Pratama Ari !urul Ramadhani Rahma A"ah #u$i Ramadhani


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%earning &b'e$ti(e

)* Anemia +emoliti$

2*

Post , +aemorrhage Anemia-* %aboratory .ests or Anemia

/* Anti0Anemia Drugs


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A!1IA +1&%I.I3


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3%A#IFI3A.I&!

)* +erediter +emolity$ AnemiaA* Dee$ts 1n4yme51n4imopaty

a* Dee$ts o 1mbden eyerho lines

0 De"$ien$y pyru(ate 6inase0 De"$ien$y glu$ose phospat isomerase

0 De"$ien$y phospogli$erate 6inase

b* Dee$ts +e7ose oniphospat

0 De"$ien$y Glu$ose 8 Phospatdehydrogenase

0 de"$ien$y glutation redu$tase


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B* +emoglobinopaty

a* .halassemiab* #i$6le $ell anemia

3* Dee$ts embrane 9embranopaty

a* #erositosis +erediterb* 1liptosis herediter

2* A$;uired +emolyti$ Anemia

A* Autoimmune +emolyti$ Anemia

B* !on Autoimmune +emolyti$Anemia


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1!


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Diagnosis: en4ymati$ .est

.herapy : most don>t need therapy= but in

se(ere hemolyti$ anemia is gi(en oli$ a$id )mg5day

2* +e7ose onophpspate lines

glu$ose is metaboli4ed by G8PD to produ$e

glutation that prote$t hemoglobine anderitro$yte rom o7idants*

.his line will be a$ti(ed when eritro$yte e7poseby drug or to7ine that orm o7ygen radi$als*

.he drug are: asetanilid= u4olidon= nataen=e$t


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D1F13.# 1BRA!1

#erositosis herediter is eritro$ytedisorder show the eritro$yte is roundli6e a donuts with in$reased ragility*

Dominan autosome disorder* It is$aused by de"$ien$y o protein thatorm membrane

1lipsitosis herediter = the disorder thatshow the shape o eritro$yte is o(al orelips $aused by de"$ien$y o protein

spe$trin*


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A3?@IR1D +1&%Y.I3 A!1IA


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A@.&I@!1 +1&%Y.I3 A!1IA

Autoimune hemoliti$ anemia is adisorder that in sura$e eritro$yte we$an "nd antibody* #o that the term o

eritro$yte sir$ulation is shorter*it o$$ure throught a$ti(ation o$omplement=a$ti(ation $elluler

me$anism= or both o them*


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Diagnosis : 3oomb>s .est

)* Dire$t 3oomb>s .est2* Indire$t 3oomb>s .est

arm Autoimmune +emolyti$ Anemia

C AI+A is warm0type* .heautoantobody rea$t at -E3

#ymptom: Anemia= 'aundi$e= e(er= the

$olour o urine is dar6=splenomegali= and hepatomegali


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.herapy:

)* 3orti$osteroid: )0)= mg56gBB5hari2* #plene$tomy

-* Imunosupressan

/* Blood transusion therapy


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3old Autoimmune +emolyti$ Anemia

+emolysis is $aused by $old antibody

#ymptom : anemia +b 90)2g5dl=

a$rosianosis and splenomegali*

.herapy: a(oid $iold region that $an

in$reased hemolysis* 3lorambusil 20/mg5day


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Drug indu$ed hemolyti$ Anemia

It happen throught:)* Absorption o the drug in(ol(ing

drug dependent antibody

2* .he ormation o a ternary $omple7-* Indu$tion o antibody

/* &7idation o hemoglobin


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!&! I@!1 +1&%Y.I3 A!.IB&DY

+emolysis o$$ure without in(ol(ement oAntibody but be$ause o mole$ulardee$ts= abnormality o membrane=

hipersplenisme= mi$roangiopaty andine$tion

#ymptom: wea6= di44y= 'aundi$e= and the$olour o the urine is brown


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i$roangiopati$ +emolysis

1ritro$yte membrane rupture in blood$ir$ulation be$ause o "brin ormi$rotombi trombo$yte in arteriole*1ritro$yte is $aught in "brin mesh and

$ause ragmentation o eritro$yte

o$$ur in abnormality o the blood(essel walls= su$h as maligna

hypertension= e$lampsi= DI3= tromboti$thrombo$ytopenia purpura 9..P=+emolyti$ @remi$ #yndrome 9+@#


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+ypersplenisme

17$essi(e destru$tion o erytro$yteby spleen* It>s happen when the si4eo spleen in$rease*

Ine$tion o mi$roorganism

i$roorganism has (arious way to

ine$ting the eritro$yte* Dire$tine$tion to eritro$yte li6e alaria=dri(ing out the to7in li6e 3lostridiumper"ngens*


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THALASSEMIA


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B1.A .+A%A##1IA

3lini$al symptoms :1. Failure to thri(e2. 1ating diH$ulty3. Re$urrent ine$tions


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B1.A .+A%A##1IA

B1.A thalassemia :

---> transusion---> without transusion


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B1.A .+A%A##1IA

-growth and de(elopment is ;uite good- not ound splenomegaly

- i transusion therapy should ollow

$helation therapy

Prognosis

ithout the transusion will result in death atthe ageo 2 yearsBy low hbwill die from infection


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P. , +A1&RR+AG1 A!1IA


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is a $ondition in whi$h the number ored blood $ells or hemoglobin 9 theo7ygen0$arrying protein in red blood$ells is below normal as a result obleeding a lot *


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ETIOLOGI blood loss ;ui$6ly pulls water rom tissues

outside the blood (essels to 6eep blood (esselsthat remain un"lled blood $onse;uentlybe$ome watery and the per$entage o red blood$ells *

Impro(ement and red blood $ell ormation will$ompensate or anemia

But at the (ery se(ere anemia = espe$ially i itarises immediately due to loss o blood abruptlyas it did = a$$ident = $hildbirth = surgery = andrupture o blood (essels a$tion should be

ta6en *


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Bleeding $ontinuous and unending =whi$h $ould o$$ur in parts o thebody bleeding that o$$urs in the nose= bleeding o$$urs in the smallintestine and $olon $an$er = and itmay not be seen $learly be$ause o

the amount o blood a little bit andalso $alled hidden hemorrhage*

Bleeding due to 6idney tumors or

$ontent o urine and the urine is(isible on the patient = (ery mu$hbleeding during menstruation*


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SYMPTOM

.he loss o large amounts o blood suddenly $an $ause two problems:

Blood pressure de$reased as the amount o Kuid in the blood (essels

diminish

.he bodyLs o7ygen supply de$reases be$ause the number o red blood

$ells redu$ed o7ygen transport* Both o these problems $an $ause heart atta$6 = stro6e or death * Anemia

$aused by bleeding $an be mild to se(ere = and symptoms (ary * Anemia maynot $ause symptoms or may $ause :

Fainting Di44y

.hirsty #weating ea6 pulse and ast Rapid breathing


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CLINICAL MANIFESTATIONS OF ANEMIA DUE TOBLEEDING

InKuen$es that arise immediately Due to rapid blood loss o$$urs $ardia (as$ular

reKe7es are physiologi$al orm orteiola $ontra$tion =redu$tion o blood Kuid or its $omponents to a less

(ital organs 9 brain and heart * .he symptoms depend on the ast and the amount

o blood lost and whether the body is still able tohold $ompensation *

2CC ml blood loss in adults who happen ;ui$6ly more dangerous than -CCCml blood loss in a longtime *


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#low inKuen$e A ew hours ater the bleeding a shit o e7tra$ellular

Kuid and intra(as$ular iontra(as6uler namely that

the $ontents and the osmoti$ pressure $an bemaintained but resulting in hemodilati *

#ymptoms ound are leu6o$ytosis 9 )=CCC02C=CCC 5mm- (alue o hemoglobin = erythro$ytes and

hemato$rit modestly due to hemodilasi * .o maintain metabolism = as $ompensation

eritropoeni6 system be$omes hypera$ti(e =sometimes (isible symptoms o heart ailure *

+emodelasi $ir$umstan$es in adults $an $ause

abnormalities o $erebral and myo$ardial inar$tiondue to hypo7emia*

Beore returning to normal 6idney will be oundoliguria or anuria as a result o redu$ed Kow to the

6idneys *


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TREATMENT OF ANEMIA DUE TO BLEEDING

I the bleeding is slow: &(er$ome $ause bleeding body $an $ompensate

9 'ust gi(e Fe supplements to in$rease the ormationo new blood

I the bleeding is ;ui$6 and a lot :

Gi(e blood transusions to repla$e blood loss ando(er$ome the $ause then gi(e mineral supplementsto repla$e blood $omponents that go missing *


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A!1IA +1&%I.I3


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LABORATORY TEST

1. Hb2. LED3. Reticulc!te". Hel#et cell$ %&it%it #ic'()*i+(t,ic

,e#l!tic-. %+e'%it cell ,e'eit('! %+e'%it%i%

/ E'!t,'c!te 0 / )'#&'# )'#%iti& / ()i%%it%i%

/ +i&il%it%i%


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T,(l(%%e#i( 0/ E'!t,'c!te 0

/ #i&'%iti& ,i+&'#

/ ()i%%it%i%$ +i&il%it%i% / t('*et cell

/ e'it'%it cell it, )ucleu%

/ te(''+ cell

/ +li&'# cell +li&'#(ti)

/ '(*#e)t%it cell


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S+i)(l c' / Cellul('it! ,!+e'celule' / E'it'+eti& ,!+e'(ctie$

+'e#i)()t i% 'ub'i%it / Miel+eti& little %u++'e%%e / T'#b+eti& Me*(&('i%it

e(%! t 4) / 'e%e'e Fe )'#(l5


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L(b'(t'! te%t

1. C#b%6te%t

/i'ect T 4) ()! ()tib! '

c#+le#e)t i) %u'(ce e'it'%it

/ i)i'ect t ete'#i)e ()! ()ti/RBC 'ee ()tib! i) ci'cul(ti).


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2.LDH te) i) i)t'((%cul(' ()e7t'((%cul(' ,e#li%i%

3.Bili'ubi) i)i'e&

".H(+t*lbi)

-.He#%ie'i) () Hb u'i)


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LABORATORY TESTS FORBLEEDING


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LABORATORY TEST

1.Hb

2.Leu&c!te% )'#(l /

3.LED

".Neut'+,ili(

-.Reticulc!te


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/ E'!t,'c!te )'#%iti&)'#&'#

/ A)i%c!t%i%/ +i&il%it%i%

/ Leu&c!te% Neut'+,ili( / Pl(telet% T,'#bc!t%i%

/ Pli&'#(ti) 89:


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SPINAL CORD / Cellul('it!

/ E'it'+eti& (ctie $ (ll t!+e

4)$+'e#i)()t i% 'ub'i%it/ Miel+eti& (ll t!+e 4)

/ T'#b+iti& #e*(&('i%it

e(%! t 4) it, e)u*, t'#b%it*u%,


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A!.I0A!1IA DR@G#


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A!.IA!1IA +IP&MR&IM

1. Fe

; P'e+('(ti)

&ral :

0 in the orm o (arious errous salts o sulate =

umarate = glu$onate = su$$inate =glutamate and

la$tate*

0 preparations are widely used and ine7pensi(eis errous sulate hydrate 9 Fe#&/* +2& -CC mg $ontaining 2C Fe * For se(ereanemia typi$ally administered - times daily

-CC mg o errous sulate or 8 months

Parenteral :


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Parenteral :

0 'usti"ed only when oral administration is notpossible*

0 &ld Iron 0 de7tran 9 imeron $ontaining C mg Feper ml 9 solution or use % or IN*

0 to use I total dose re;uired is $al$ulated based

on the se(erity o anemia = namely 2C mg Fe per

gram o hemoglobin de"$ien$y * &n the "rst dayin'e$ted C mg = ollowed by )CC02C mg e(ery day

or se(eral days*

0 to use the beginning o the IN dose should not

e7$eed 2 mg = ollowed by a gradual in$rease to 20 -hari to a$hie(e a dose o )CC mg 5 day

*

!atural #our$e:


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!atural #our$e:

0 Foods that $ontain high le(els o Fe9greater than mg 5 L O CC g is theheart= li(er = egg yol6s = yeast =shell"sh = nuts and $ertain dried ruits *

0 Foods that $ontains moderate

le(els o Fe 9 )0 mg 5 )CC are meat= "sh = poultry = green (egetables andgrains *

0 Foods that $ontain iron in low;uantities 9 less than ) mg 5 )CC g mil6 or its produ$ts = and (egetables

are less green

;EFFECTS OF NON THERAPY


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EFFECTS OF NON THERAPY

F' '(l (#i)i%t'(ti) 0

0 depending on the amount o soluble Feand

absorbed in ea$h administration* 0 symptoms may in$lude nausea andstoma$h pain 9 )02C =$onstipation 9 )C = diarrhea 9 and $oli$ *

I) t,e +('e)te'(l (#i)i%t'(ti)0


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I) t,e +('e)te'(l (#i)i%t'(ti)0 systemi$ rea$tions may also o$$ur = namely : at C*0C* o $ases * .he rea$tion $an o$$ur

within )C minutes ater in'e$tion were heada$he= mus$le and 'oint pain = hemolysis = ta$hy$ardia= Kushing = sweating = nausea = (omiting =bron$hospasm = hypotension = di44iness and

$ir$ulatory $ollapse

rea$tions more oten happend in ) 5 202/ hours

ater the in'e$tion or e7ample syn$ope = e(er =$hills = rash = urti$aria = $hest pain = pain in thewhole body and systemi$ ensealopatia*Rea6siis more $ommon in IN administration = as well as

sho$6 or $ardia$ arrest *

2. OTHER DRUGS


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2. OTHER DRUGS Rib


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A!.IA!1IA 1GA%&B%A#.IM

1. SIANO?OBALAMIN; P'e+('(ti)

&ral :

.he oral dosage $an be useul as a dietarysupplement = but a small bene"t or patients whola$6 intrinsi$ la6tor or patients with impaired ileum= due to absorption by diQusion unreliable as aneQe$ti(e therapy

Parenteral :


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a e e a $yano$obalamin solution that is powered )C0)CCC

m$g 5 ml * In'e$tion o a solution o$yano$obalamin rarely $ause allergi$ rea$tionsand irritation at the in'e$tion site *

%i(er e7tra$t solution in water * Bene"ts o li(ere7tra$t solution to perni$ious anemia $aused by(itamin B)2 $ontained therein * @se o this li(ere7tra$t in'e$tions $an $ause allergi$ rea$tions lo$aland general = and rom mild to se(ere *

Depot in'e$tions o (itamin B)2 * .he intended useo depot in'e$tions o (itamin B)2 is to redu$e there;uen$y o in'e$tions * +owe(er= the bene"ts othe use o these preparations is still underresear$h *

!atural #our$e:


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!atural #our$e: resour$es to meet human needs areanimal oods = be$ause the plants donot $ontain (itamin B)2

oods ri$h in (itamin B)2 are organmeats 9 li(er = 6idney = heart andshell"sh * 1gg yol6s= at0ree driedmil6 and ood rom the sea9 sardines = $rabs $ontaining (itaminBre in moderation *

2. FOLIC ACID


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2. FOLIC ACID

;P'e+('(ti)

O'(l 0 In the orm o tablets o C*) C*/ / )C or 2C mg *

In addition = lolat a$id $ontained in (ariousmulti(itamin preparations or in $on'un$tion with otherantianemia *

For diagnosti$ purposes is used a dose o C*) mgorally or )C days only $ause hematologi$ response inpatients with olate de"$ien$y

Initial therapy in olate de"$ien$y without$ompli$ations begins with C*0) mg a day orally or )Cdays * .reatment was $ontinued with a dose osupport whi$h usually ranges between C*)0C* mgdaily *

Parenteral :


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Parenteral :

0 in a solution o a$id in'e$tion lolat mg 5 ml *

0 Foli$ gi(en % or de$ree i the$ir$umstan$es do not allow *

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