Make your own free website on Tripod.com

Hematologic and Immunologic Problems


Problem-based Learning Session

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
Bone marrow - adults

Thymus - T cells
Spleen/bone marrow - B cells
Reticuloendothelial system

Products

Cells
Fluid - plasma

Cells
Fluid - lymph (humoral factors)

Vessels

Blood vessels

Lymph vessels

Natural History - Place of Destruction

Liver
Spleen

Spleen?

Function

Oxygenation
Nutrition
Defense
Homeostasis

"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


Patient with Pallor

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
Lead poisoning
Copper poisoning

Normochromic, normocytic

Blood loss
Protein-calorie deficiency
Vitamin E deficiency

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?


Learning Issues

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


SWU-MHAM-CM