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Пульмонология, гематология (англ,рус)

d.      digestive system


Answers to tests:

1.      b

2.      d

3.      a

4.      a, c, d




1.     Therapy: Manual. The course of lectures/V. M. Fedosyeyeva, A. A. Chrenov. – Simferopol, 2003. – 326 - 375 p.

2.     Davidson’s Principles and practice of medicine (nineteenth         edition)/Christopher Haslett, Edvin R. Chilvers and others. – Edinburgh, 2002.

3.     Harrisons Principle if internal medicine (seventeenth Edition)/Fauci, Braunwald, Hasper and other. – Part 6, section 2, Chapter 98. 100 - 102.

4.     The Merck Manual of Diagnosis and Therapy (seventeenth Edition)/ Robert Berkow, Andrew J. Fletcher and others. – published by Merck Research Laboratories, 1999.







Short theoretic material


Anemia - is the decreasing of hemoglobin and red    blood cells amount in the unit of blood volume. From data of WHO: a hematocrit less than 40 in men and 37 in women, or hemoglobin less than 130 g/l in men and  less than 120 g/l in women.

Blood & Lymphocyte Development


Actuality of theme:

lAnemia is very often met in 20% women of the developed countries and in 50% women of the non-developed countries;

lMore than 50% patients with chronic diseases and tumors;

lConsiderably worsens quality of life and capacity.


Clinical classification of anemia is based on morphological prinsiple - determination of mean corpuscular volume (MCV) of red blood cells


MСV- is determined by automatic laboratory analyzers or by such formula: MСV = (hematocrit x10) / amount of  RBC (in mln/l).



In the morphological approach, anemia is classified by the size of red blood cells; this is either done automatically or on microscopic examination of a peripheral blood smear.

The size is reflected in the mean corpuscular volume (MCV):

•         If the cells are smaller than normal (under 80 fl), the anemia is said to be microcytic;

•         if they are normal size (80-100 fl), normocytic;

•         and if they are larger than normal (over 100 fl), the anemia is classified as macrocytic.


Normocytic anemia

 (MCV -  80-100)

•         A loss or destruction of RBC is increased

•         Decreasing of RBC synthesis

•         Pathology of bone marrow (for example, action of medications, infection, aplastic anemia, myelodysplastic syndrome, plural mieloma and other infiltrative diseases).

Causes of Normocytic anemia

•         acute blood loss

•         anemia of chronic disease

•         aplastic anemia (bone marrow failure).


Microcytic anemia  (MCV less than 80)

Microcytic anemia is primarily a result of hemoglobin synthesis failure/insufficiency, which could be caused by:

• Heme synthesis defect

• Globin synthesis defect

• Sideroblastic defect


Makrocytic anemia

 (MCV more than 100 fl)

- Megaloblastic anemia (vitamin В12 or folic acid deficiency )

- Toxic effect of chemotherapeutic agents (methotrexate) or other medications (zidovudine (AZT), phenytoin)

- Pathology of bone marrow

- Chronic abuse by alcohol (toxic effect)

- Liver disease


Anemia during pregnancy

Anemia affects 20% of all females of childbearing age in the United States and Europe. Because of the subtlety of the symptoms, women are often unaware that they have this disorder, as they attribute the symptoms to the stresses of their daily lives. Possible problems for the fetus include increased risk of growth retardation, prematurity, intrauterine death, rupture of the amnion and infection.

During pregnancy, women should be especially aware of the symptoms of anemia, as an adult female loses an average of two milligrams of iron daily. Therefore, she must intake a similar quantity of iron in order to make up for this loss. Additionally, a woman loses approximately 500 milligrams of iron with each pregnancy, compared to a loss of 4-100 milligrams of iron with each period.


Depends on the level of hemoglobin in the blood anemia is divided on:

- mild degree (Hb  110-90 g/l),

- moderate degree (Hb  89-70 g/l),

- severe degree (Hb less than 69 g/l).


Depends on the size of RBC and their saturation by hemoglobin (from data of colour index - CI) anemia is divided on:

-Normocytic normochromic   anemia: colour of RBC is normal and CI is 0,86-1,1;

-Microcytic anemia (can be hypo- or normochromic): microcytosis ,   anizopoykilocytosis,   hypochromia, CI < 0,8;

-Makrocytic anemia: makrocytosis, even megalocytosis, CI > 1,1.



•         External bleeding: Loss of blood through heavy menstrual bleeding, wounds, as well as stomach ulcers can cause anemia.

•         Iron deficiency: The bone marrow needs iron to make red blood cells.

•         Anemia of chronic disease: Any long-term medical condition can lead to anemia.