PLENO 1

FIRST SCENARIO
HEMATOIMMUNOLOGY BLOCK
GROUP 8
Ajeng Amalia Insani 1318011007
Analia Refsi Yusnita 1318011010
Bella Yanita 1318011033
Firza Syailendra 1318011073
Intan Fajar Ningtyas 1318011086
Melly Setiawati 1318011103
Muhammad Jyuldi Prayoga 1318011110
Nuzuluthfiana 1318011126
Sayyidatun Nisa 1318011150
Setiawan Prayogi 1318011153
Shessy Syahaya 1318011155
Stevi Erhadestria 1318011160
PALE AND WEAK

Ms. Kinara, 23 years old, came to the doctor

because of fatigue and headache. W months earlier,
she felt weak, fatigue, and headache. She rarely
eats meat. Four months ago, she got
menometrorhagia and the ilness has recovered
about 3 weeks ago. Physical examination result
showed Hb 10gr/dL, MCV 73fl, MCH 24pg,
peripheral blood film showed microcytic
hypochrome anemia, leucocyte and thrombocyte
are normal.
Learning Objective

1. Explaining haematopoiesis
2. Anemia classification based on etiology
and eritrocyte morphology and the
differences
3. Nutritional aspect of anemia patient
1. Haematopoiesis

a. Definition:
the process of production, multiplication,
and specialization of blood cells in the
bone marrow. The process begins with
the pluripotent stem cell.
b. Divided into two:
1). Prenatal
• Mesoblastic phase
• Hepatic phase
• Myeloid phase
2). Postnatal
c. 3 process of blood cells formation
1). Proliferation/Multiplication
The number of the cells is increased from one
pluripotent haematopoietic cell becoming some
blood cells.
2). Maturation
The cells growth and getting mature.
3). Differentiation
Causing blood cells that have been formed have
some different specific characters.
Erythropoiesis (1)

Erythropoiesis is the pathway that produces

mature red blood cells from haematopoietic
stem cells. During mammalian development,
erythropoiesis occurs successively in the yolk
sac, the foetal liver and the bone marrow.

Steps:
1. the different stages of erythropoiesis can all be
defined by phenotypic markers;
2. erythroid diseases are well-characterised and in
many cases their molecular causes have now
been found
Erythropoiesis (2)

3. terminal erythroid differentiation depends on only

one exogenous growth factor, erythropoietin;
4. most if not all the transcription factors that
regulate erythropoiesis are known.

Many features differentiate primitive and foetal

erythropoiesis from adult erythropoiesis both at
the cellular and molecular levels. This review will
focus on the late stages of adult erythropoiesis
starting from the common erythro/megakaryocytic
precursor and ending with the mature red blood
cells.
Picture 1. Hematopoiesis
(Source: Robbins & Cotran
pathologic basis of disease 7th
ed 2005)
2. Anemia Classification

a. Based on Etiology
1). Fe defficient anemia
2). Aplastic anemia
3). Haemolitic anemia
4). Anemia caused by chronical bleeding
b. Based on Eritrocyte Morphology
1). Macrocytic normochromic anemia
2). Microcytic hypochromic anemia
3). Normocytic normochromic anemia
Based on Etiology (1)

1. Fe Defficient Anemia
Peripheral blood smear showed hypochromic
anemia mikrositer, anisocytosis, and
poikilositosis . The more severe the degree of
anemia even closer degree of hypochromia.
2. Aplastic Anemia
This type of anemia is normokrom normositer .
Sometimes found macrocytosis , anisocytosis ,
and poikilositosis . the presence of young
erythrocytes or leukocytes in peripheral blood
indicates young bekan aplastic anemia
Based on Etiology (2)

3. Haemolytic Anemia
Usually normositi . and MCV increased and
there reticuloses reflecting the presence of
erythroid hyperplasia in the bone marrow
4. Anemia caused by Chronical Bleeding
Generally it is normokrom normositer although
many patients had hypochromic picture with
MCHC < 31 g / dL and a few have macrocyter
cells with MCV < 80 fl . Absolute reticulocyte
values ​in the normal range or slightly increased .
changes in leukocytes and platelets are
inconsistent.
Picture 2. Anemia Aplastic Picture 3. Iron-Defficient Anemia

Picture 4. Anemia Haemolytic Picture 5. Anemia caused by

Chronical Bleeding
Based on Erythrocyte Morphology

Macrocytic Microcytic Normocytic

Normochromic Hypochromic Normochromic
Anemia Anemia Anemia

Hb normal normal

Eryth. Size normal

MCV normal

MCHC normal normal

 3. Nutritional Aspect

a. Fe Defficient Anemia
There are two forms of dietary iron: heme and nonheme.
Heme iron is derived from hemoglobin, the blood
protein that delivers oxygen to cell tissue. Accordingly,
heme iron is found in animal foods that contain
hemoglobin (7-22%).

Nonheme iron is essentially plant-derived (1-6%).

b. Folate (folic acid)-deficient Anemia
Folic acid is a B vitamin necessary for the growth
of healthy new cells and especially blood cells.
Good food sources of folic acid are:
• Asparagus
• Bananas
• Beef liver
• Black-eyed peas or dried beans
• Bread
• Broccoli
• Cereal
• Eggs, etc
c. Other Vitamin-deficient Anemias (“Pernicious Anemia”)
• Vitamin B12 is considered important in building and
fortifying blood cells. Good sources include:
Breakfast cereals fortified with B12, milk, yogurt, cheese,
beef, liver, poultry, fish, shellfish
• Vitamin B6 performs a variety of functions in the body,
notably, red blood cell production and enhancement of
hemoglobin function. Common foods rich in Vitamin B6
include: Fish (salmon, tuna), Chicken, Bananas, Beans
• Vitamin C helps the body absorb iron.. Highest levels of
Vitamin C can be found in: Citrus, Apricots, Kiwi fruit
REFERENCES

Abdulsalam, Maria, dkk. 2012. Hematologi-Onkologi

Anak. Jakarta: EGC.

Arif, Mansjoer, dkk. 2000. Kapita Selekta Kedokteran

Edisi III. Jakarta: FKUI.

Sudoyo, Aru W, dkk. 2009. Buku Ajar Ilmu Penyakit

Dalam Jilid III Edisi V. Jakarta: Interna Publishing.
THANK YOU
FOR YOUR ATTENTION