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Hematoimmunology System, Coagulation cascade, Gambar CBC, Gambar serum,…

- - - - Location
        
        Superolateral left upper quadrant/Left hypochondrium abdomen
        
        gambar Spleen
      - Function
        
        Prenatally
        
        Hematopoietic organ
        
        RBC filtering
        
        Immune system
        
        Platelets storing
        
        Iron recycling by macrophages
    - - Location
        
        Right hypochondrium
        
        Upper epigastrium
        
        Left hypochondrium
      - Anatomy
        
        gambar Liver
      - Function
        
        Menghancurkan RBC yang sudah tua
        
        Membersihkan darah
        
        Menyimpan cadangan energi dan nutrisi
        
        Memproduksi protein
        
        Memproduksi kolesterol dan hormon
    - - Location in Adults
        
        Flat bones of pelvis (34%)
        
        Vertebrae (28%)
        
        Cranium & mandible (13%)
        
        Sternum & ribs (10%)
        
        Proximal portions of humerus & femur (4-8%)
      - Function
        
        Hematopoiesis
      - Types
        
        Red bone marrow
        
        Yellow bone marrow
        
        gambar Perbedaan
  - - - Membutuhkan 2 spesimen yang terpisah
      - site
        
        Tulang manapun (lahir)
        
        Anterior medial tibial area (young children)
        
        Sternal
        
        Anterior iliac crest (adult)
    - - Platelets analysis
        
        Platelets Counts
        
        ↑ Trombositosis
        
        ↓ Trombopenia
      - RBC analysis
        
        Hemoglobin
        
        Hemoglobin Concentration
        
        Spectrophotometer 540 nm
        
        Hematocrit
        
        Erythrocytes Counts
        
        ↓ Anemia
        
        ↑ Polycythemia
        
        Erythrocytes Indices
        
        MCV
        
        MCH
        
        MCHC
        
        Reticulocyte Counts
        
        Red Cell Distribution Width
      - WBC analysis
        
        Leukocyte Counts
        
        ↓ Leukopenia
        
        ↑ Leukositosis
        
        Normal: 4500-11.000
        
        Leukocyte DIfferential Counts
    - - gambar
    - - Normal value
        
        Wanita: 0-20mm/h
        
        Pria: 0-15mm/h
  - - - 92% Water
      - 7% Protein
        
        Contains
        
        Albumin
        
        Globulins
        
        Fibrinogen
        
        Regulatory proteins
      - <1% Other solutes
        
        Contains
        
        Electrolytes
        
        Nutrients
        
        Respiratory gases
        
        Waste Product
    - - Life span
        
        120 days
      - Normal concentration
        
        3.9-5.5 million/microliter
        
        woman
        
        4.1-6 million/microliter
        
        man
      - Fungsi
        
        Transport Hemoglobin
        
        Mengandung anhidrase karbonat
        
        Buffer asam basa
      - no nukleus, no mitokondria, no ATP
        
        gambar eritrosit
      - Morphology
        
        Biconcave
        
        Ukuran
        
        Diameter: 7.5 mikrometer
        
        Tebal tepi: 2.6 mikrometer
        
        Tebal tengah: 0.75 mikrometer
        
        Plasmalema
        
        40% lipid
        
        10% karbohidrat
        
        50% protein
      - Hemolysis
        
        Intravascular
        
        Ekstravascular
    - - Platelets
        
        Structure
        
        Fragmel sel bermembran
        
        2-4 mikrometer
        
        Tidak bernukleus
        
        Concentration
        
        150.000-400.000 mikroliter
        
        Fungsi
        
        Proses pengumpalan darah dan membantu memperbaiki luka kecil pada dinding dari pembuluh darah
        
        Regio
        
        Regio Hyalomere
        
        Regio Granulomere
        
        Hemostasis
        
        Vasoconstriction
        
        Platelet activation & aggregation
        
        Activation of clotting factors & formation of fibrin
        
        Clot resorption
      - Leukocyte
        
        Concentration
        
        4500-11.000/mikroliter
        
        Granule
        
        Specific granule
        
        Azurophilic granule
        
        Gelatinase granule
        
        gambar
        
        Granulosit Polimorfonuklear
        
        Neutrophils
        
        57-67%
        
        1-4 days
        
        12-15 mikrometer
        
        2-5 lobus
        
        fagosom
        
        Eosinophils
        
        1-3%
        
        1-2 weeks
        
        12-15 mikrometer
        
        2 lobus
        
        Granula merah
        
        Modulate inflammation & Fagositosis
        
        Basophils
        
        <1%
        
        Several month
        
        12-15 mikrometer
        
        2 lobus
        
        Mediator inflamasi, Platelet activating factor, Eosinophilic chemotacic factor, Heparin, Histamine, Fosfolipase A, dan Receptor IgE
        
        Agranulosit Mononuklear
        
        Monocyte
        
        5.3%
        
        10-20 hours - years
        
        12-15 mikrometer
        
        Oval/U/C
        
        Immune system
        
        Lymphocyte
        
        20-40%
        
        6-15/7.5-18 mikrometer
        
        Lymphocyte Class
        
        B lymphocyte
        
        T helper lymphocyte (CD4+)
        
        Cytotoxic (CD8+)
        
        Natural killer cells
        
        T regulatory (CD4+CD25+)
  - - - Def. Fungsional
        
        Penurunan kapasitas oksigen darah
      - Def. Operasional
        
        Pengurangan kadar Hb darah karena penurunan eritrosit, Hb, dan Hct di bawah interval referensi
      - Epidemiology
        
        Riskesdas 2013: prevalensi 21.07%
        
        Riskesdas 2018: prevalensi 32%
      - Clinical Manifestation
        
        Symptoms
        
        Sesak nafas, kelelahan, jantung berdebar, pusing
        
        Sign
        
        Pucat: Hb = 9-10 g/dL, tachycardia, cardiomegaly, systolic murmur
        
        Khusus
        
        Koilonychia (IDA)
        
        Icterus (hemolitik, megaloblastik)
        
        Ulkus tungkasi (sickle cell, hemolitik)
        
        Deformitas tulang (thalassemia)
        
        Akut
        
        pernapasan pendek, kegagalan fungsi organ, syok
        
        Kronik
        
        Pucat, lesu, lelah
        
        Hemolisis: jaundice & batu kandung empedu
        
        ↓ eritropoiesis: ↑Fe, gagal jantung & endokrin
      - Etiologi
        
        Perdarahan
        
        Hemolisis yang meningkat
        
        Eritropoiesis menurun
      - Morphology
        
        Microcytic
        
        Macrocytic
        
        Normocytic
      - Classification
        
        Hemolytic
        
        Sferositosis Herediter
        
        Sickle Cell Anemia
        
        Thalassemia
        
        α-thalassemia
        
        β-thalassemia
        
        Deficiency G6PD
        
        Malaria
        
        Berkurangnya umur eritrosit, peningkatan eritropoiesis, tertahannya komponen dari kerusakan eritrosit
        
        dimished erythropoiesis
        
        Iron Deficiency Anemia
        
        Kekurangan dari penyimpanan besi dalam tubuh
        
        Etiology
        
        Low intake
        
        Menstruating women
        
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        Increased iron loss
        
        Increased demand
        
        Decreased absorption
        
        Epidemiology
        
        Riskesdas 2018: 48.9%
        
        Kurang Edukasi IDA
        
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        Penerima TTD 80.9%
        
        Konsumsi <52 butir: 98.6%
        
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        Konsumsi >52 butir: 1.4%
        
        WHO: prevalensi 40%
        
        Indonesia: IDA peringkat 4 dari 25 pada kelompok WUS & remaja putri
        
        Pathogenesis & Pathophysiology
        
        gambar
        
        Stages
        
        Stage 1
        
        Stage 2
        
        Stage 3
        
        Clinical Manifestation
        
        Koilonychia
        
        Glossitis
        
        Dysphagia
        
        Pica
        
        Other symptoms: pallor, shortness of breath, headache, fatigues
        
        Laboratory Findings
        
        Bone Marrow
        
        High cellularity, erythroid hyperplasia, absence of macrophage
        
        Blood smear
        
        Anulocyte, microcytic, hypochromic, pencil shape
        
        Iron Therapy
        
        Oral
        
        Parenteral
        
        Pharmacological Properties of Oral Iron Preparation
        
        Pharmacokinetics
        
        Via intestine
        
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        Pharmacodynamic
        
        iron supply
        
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        Side effect
        
        Manajemen IDA
        
        Iron sulfate peroral 3 tablet/hari
        
        Complication
        
        komplikasi kehamilan
        
        Gagasan
        
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        Anemia of Chronic Inflammation
        
        Megaloblastic Anemia
        
        Aplastic Anemia
        
        Myelophthisic Anemia
        
        Kekurangan konsumsi nutrisi (iron, folic acid, vit B12), bone marrow failure, inflmasi sistemik, infiltrasi bone marrow
        
        Sideroblastic Anemia
      - Treatment
        
        Suplemen vitamin B12 & folat
        
        Suplemen zat besi
        
        Blood transfusion
        
        Chemotherapy/bone marrow transplantation
      - Blood Test
        
        CBC
        
        RBC count: menurun
        
        Hb COunt: menurun
        
        MCV: naik, normal, turun
        
        MCH: naik, turun
        
        MCHC: naik, turun
        
        Reticulocyte: naik, turun, normal
        
        WBC
        
        Dapat naik atau normal
        
        Differential count: pada infeksi terdapat peningkatan neutrophil
        
        Platelet
        
        pneingkatan platelet pada anemia hemolysis
  - - - Gambar
    - - gambar
  - - - Memberi warna
      - Menjaga bentuk
      - Mengikat O2
      - Mengikat CO2
    - - Gambar
    - - Gambar
    - - Formation
        
        Hemoglobin (70%)
        
        Myoglobin
        
        Sytochrome
      - Body avarages 4 to 5 grams
      - Iron Absorption, Storage, and Transport
        
        gambar
      - Iron Recycle
        
        erytropoiesis
      - Iron Deficiency
      - Iron Excretion
        
        Physiology: feces, mestrual
        
        Phatology: bleeding
      - Iron Uptake
        
        gambar