MODULE 3

HEMATOLOGY
Tutor:
 GROUP 9B
● 11020200167 Andi Fahira Chaidir
● 11020200174 Lulu Luqyana Amirah Salsabila
● 11020200187 Nurul Ainun Annisa
● 11020200190 Andi Fitri Nurul Khazanah T.D
● 11020200198 Ratna Febirianti
● 11020200203 Andi Mappaita El Firman
● 11020200211 Salma Umarella
● 11020200219 Regina Lestari
● 11020200224 Mega Alfima
● 11020200238 Nirwana
● 11020200247 Rahmatillah
 Scenario 3
A 53-year-old man came to the general practitioner with complaints of weakness for the past 1 month.
Complaints accompanied by feeling easily tired, nausea, vomiting, decreased appetite, a little
tightness, and swollen legs. The patient has been diagnosed with kidney failure since 3 months ago
and has been receiving regular treatment. Physical examination revealed anemic conjunctiva, spoon
nails, and edema in both legs. In the laboratory results obtained MCV 75, MCHC 28

Dificult Word
● MCV (Mean Corpuscular Volume) is a measurement of the volume or average size of red blood
cells.
● MCHC (Mean Corpuscular Haemoglobin Concentration) is calculation of the average
concentration of hemoglobin in one red blood cell

Laloan,R.J. et al. 2018. RELATIONSHIP OF SMOKING WITH ERRYTHROCYTE INDEX VALUE (MCV, MCH, MCHC) IN STUDENT smokers.
Journal of Medicine and Rehabilitation. Vol 1 No 2.
 Key sentences

1. 53 years old man

2. Complaints off weakiness since last 1 month
3. Easly tired , nausea , vomiting, decreased appetite, a litle tightness , and swallen feet
4. Diagnosed with kedney failure 3 month ago and has been receiveng reguler treatment
5. Physical examination of anemic conjungctiva , spoon nails , and edema in both leg .
6. Laboratory results obtained MCV 75 , MCHC 28
QUESTION

1. Explain the basic hematologi in general?

2. What is the definition and etiology of anemia ?
3. Explain the classification of anemia !
4. Explain the differential diagnosis related to the scenario?
5. What the interpretion of MCV and MCHC ?
6. Explain the diseases associated with the scenario !
7. What is relation between the patients signs and symptoms and the
diagnosi ?
8. Explain the diagnostic step from scenario !
9. Explain the islamic perspective according to the scenario !
 Basic Hematologi In General

Hudnall,S,D.2012. Hematology. Elsevier Inc.

 Definition and Etiology of Anemia

Anemia is defined as a reduction of the hemoglobin concentration or red blood cell (RBC) volume
below the range of values occurring in healthy persons. ―Normal‖ hemoglobin and hematocrit (packed
red cell volume) vary substantially with age and sex .

Anemia may result from a variety of intrinsic red cell defect, as well as extrinsic causes. Based upon
physiologic mechanism, the anemias can be broadly classified into those due to blood loss,decreased
red cell production , or increased red cell destruction.

Thornburg,C,D. 2020. Nelson Textbook of Pediatrics. Elsevier Inc.

Classification of Anemia
CATEGORY CLASSIFICATION DISEASE PROCESS
Decreased RBC production (hypoproliferative) Microcytic Iron deficiency,Thalassemia,Sideroblastic, Chronic
disease (neoplasm, infection, diabetes, uremia, thyroid
disease, cirrhosis)
Normocytic Primary bone marrow problem (aplastic, myeloid
metaplasia, myelofibrosis, myelophthisic anemia,
Diamond-Blackfan anemia)
Secondary bone marrow problem (uremia, liver disease,
endocrinopathy, chronic inflammation)
Macrocytic Folic acid deficiency
Liver disease
Vitamin B 12 deficiency
Scurvy
Hypothyroidism
Chemotherapy, immunosuppressive therapy
Increased RBC destruction (hemolytic) Intrinsic Membrane disorder (spherocytosis, sickle cell, stem cell
disorder, elliptocytosis, spur cell)
Extrinsic Hemoglobin disorder (thalassemia, autoimmune,
hemoglobinopathies)
Infections (hepatitis and cytomegalovirus, Epstein-Barr
virus, typhoid fever, Escherichia coli )
Medications (penicillin, antimalarials, sulfa drugs, or
acetaminophen)
Leukemia or lymphoma
Enzyme defect (G6PD)
RBC loss (hemorrhagic) Acute or chronic Gastrointestinal tract
Traumatic
Intraperitoneal
Extraperitoneal
Gynecologic
Urinary
Pelvic

Ezenkwele,U,A. 2013. Emergency Medicine Second Edition. Elsevier Inc

 Differential Diagnosis

Janz,T,G.,Dupre,A,A. 2018. Rosen’s Emergency Medicine: Concepts and Clinical Practice Ninth Edition. Elsevier,Inc.
 Differential Diagnosis
A. Iron deficiency anemia

Symptoms may reflect hypoxic functioning (as with any

Iron deficiency anemia classically presents with decreased
anemia) or may be more specific to iron deficiency (eg,
hemoglobin; microcytic, hypochromic RBCs; and
pagophagia)..
decreased iron stores.
Treatment,An oral iron supplement

B. Anemia of chronic disease

The anemia of chronic disease, or anemia of inflammation, is a

Treating the underlying disease, when possible, should correct
multifactorial anemia that occurs in a wide spectrum of
or improve the anemia. In the other cases, symptomatic anemia
disorders, including chronic infections, rheumatologic diseases,
should be treated. Iron and erythropoiesis-stimulating agents
chronic kidney disease (CKD), inflammatory bowel diseases,
(ESAs) may be used in selected cases. The widest experience in
hematologic and solid cancer, chronic heart failure, and chronic
their use is derived from treatment of CKD patients.
obstructive pulmonary disease.

Clinical Overview,2021.Iron Deficiency Anemia. Elsevier,BV.

Lee,G. & Andrew,S. 2020. Goldman-Cecil Medicine, Twenty Sixth Edition. Elsevier,Inc.
 C. Thalassemia

The thalassemias, or more comprehensively the
thalassemia syndromes, are a heterogeneous group of
inherited hemolytic anemias characterized by
deficient or absent production of one of the globin
chains of hemoglobin.
In the presence of anemia with thalassemic red cell changes, the next
step is the evaluation of hemoglobin fractions (HbA, HbA 2 , HbF, or
hemoglobin variants) by electrophoresis on cellulose acetate at
alkaline pH or, even better, by high-performance liquid
chromatography that enables the precise measurement of HbA 2 ,
HbF, and HbA and the provisional identification of a large number
of hemoglobin variants, including HbE.

Conventional Treatment
No specific treatment is required for α- or β-
thalassemia heterozygotes (carriers, thalassemia
minor), but they should receive appropriate
genetic counseling.

Lee,G. & Andrew,S. 2020. Goldman-Cecil Medicine, Twenty Sixth Edition. Elsevier,Inc.
 Interpretion od MCV and MCHC
Age Hb (g/dL) a HCT (%) a MCV (fL) a MCHC (g/dL Reticulocyte WBCs Platelets
RBC) a s (×10 3 /mL) b (10 3 /mL) b
26–30 13.4 (11) 41.5 (34.9) 118.2 (106.7) 37.9 (30.6) — 4.4 (2.7) 254 (180–
weeks 327)
gestation c
28 weeks 14.5 45 120 31.0 (5–10) — 275
32 weeks 15.0 47 118 32.0 (3–10) — 290
Term d (cord 16.5 (13.5) 51 (42) 108 (98) 33.0 (30.0) (3–7) 18.1 (9–30) e 290
)
1–3 days 18.5 (14.5) 56 (45) 108 (95) 33.0 (29.0) (1.8–4.6) 18.9 (9.4–34) 192
2 weeks 16.6 (13.4) 53 (41) 105 (88) 31.4 (28.1) — 11.4 (5–20) 252
1 month 13.9 (10.7) 44 (33) 101 (91) 31.8 (28.1) (0.1–1.7) 10.8 (4–19.5) —
2 months 11.2 (9.4) 35 (28) 95 (84) 31.8 (28.3) — — —
6 months 12.6 (11.1) 36 (31) 76 (68) 35.0 (32.7) (0.7–2.3) 11.9 (6–17.5) —
6 months–2 12.0 (10.5) 36 (33) 78 (70) 33.0 (30.0) — 10.6 (6–17) (150–350)
years
2–6 years 12.5 (11.5) 37 (34) 81 (75) 34.0 (31.0) (0.5–1.0) 8.5 (5–15.5) (150–350)
6–12 years 13.5 (11.5) 40 (35) 86 (77) 34.0 (31.0) (0.5–1.0) 8.1 (4.5– (150–350)
13.5)
12–18 Years
Male 14.5 (13) 43 (36) 88 (78) 34.0 (31.0) (0.5–1.0) 7.8 (4.5– (150–350)
13.5)
Female 14.0 (12) 41 (37) 90 (78) 34.0 (31.0) (0.5–1.0) 7.8 (4.5– (150–350)
13.5)
Adult
Calihan,J. 2021. Harriet Lane Handbook Twenty Second Edition. Elsevier, Inc.
 Diseases Associated With the Scenario

● Koilonychia (spoon nails),The nail plate is thinned and flattened with upward
eversion of its lateral and distal edges, leading to a concave spoon-like shape
Koilonychia.
● Conjunctiva is an indentation in the eye, normally the conjunctiva is reddish in color,
in certain circumstances (eg in anemia) the conjunctiva will be pale in color which is
called anemic conjunctiva.
● Chronic Kidney Failure is a disease due to a gradual decline in kidney function that
causes an imbalance of fluids, electrolytes, and waste disposal in the body.
Symptoms no appetite accompanied by eating disorders, and swollen feet.

1. Tosti,A.Piraccini B,M. 2018. Dermatology Fourth Edition. Elsevier Limited

2. Qalbi, Muhammad Nur. 2019. Jurnal Indikator Antropometri dan Gambaran Konjungtiva Sebagai Prediktor Status Anemia Pada Wanita. Universitas
Hasanuddin.
3. Yurian Prabowo.2017.Implementasi Sistem Pakar Untuk Diagnosis Penyakit dengan Gejala Awal Kaki Bengkak.Jurnal Teknik Informatika dan Sistem
Informasi. Vol 3, No 3.
Diagnostic Step From Scenario

● The diagnosis of anemia and the assessment of its severity are best made by measuring the Hb
concentration rather than the hematocrit (Hct).
● In addition to the Hb value, the evaluation of anemia in CKD patients should include a complete blood
count with RBC indices (mean corpuscular Hb concentration [MCHC], mean corpuscular volume [MCV]),
white blood cell count (including differential), and platelet count.
● Renal anemia is typically normochromic and normocytic, deficiency of vitamin B 12 or folate may lead
to macrocytosis, whereas iron deficiency or inherited disorders of Hb formation (such as thalassemia)
may produce microcytosis

Macdougall.L.C & Eckardt.K.U. 2019. Comprehensive Clinical Nephrology Sixth Edition. Elsevier,Inc.
 Islamic Perspective According to the Scenario
QS. Al-Hadid Verse 25
Meaning:
And We created iron which has strength,
great power and many benefits for
mankind, and that Allah may know who
helps (religion) Him and His messengers
even though (Allah) does not see.
Surah Al-Baqarah (2) verse 173:
Meaning:
Verily, Allah has only forbidden to you carrion,
blood, pork, and animals slaughtered in the name
of other than Allah. However, whoever is in a
state of necessity, does not intend to be
disobedient, and nor transgress, then there is no
sin for him. Truly Allah is Most Forgiving and Most
Merciful.