Features of childrens` blood. The semiotics of major hematological syndromes презентация

Содержание

The blood creations or hemogenesis is a process of origin and subsequent ripening of blood cells in the so-called organs of blood creations. The cells of blood pass whole row stages

Слайд 1

Features of childrens` blood. The semiotics of major hematological syndromes.

Слайд 2The blood creations or hemogenesis is a process of origin and

subsequent ripening of blood cells in the so-called organs of blood creations. The cells of blood pass whole row stages in the organs of before abandoning them forever.

Слайд 3
The single cell that gives life to all blood cells is

the polypotentic trunk cell of bone marrow hemogenesis. The cells-predecessors of blood cells (blastic cells) must not abandon the organs of hemogenesis. Otherwise speaking about unrestrained growth of number of cells-predecessors as a process it corresponds to the malignant tumour and is named leukemia in fact.

Слайд 4


About the blood condition we can judge on the base

of peripheral blood composition making blood tests. About the condition of hemogenesis it is the most exactly possible to judge basing on composition of marrow.

Слайд 5 Functions of blood and its formed elements.


The

functions of blood and its formed elements are varied.
A blood is an original liquid organ and one of the basic reservoirs of extracellular water. The liquid part of blood (plasma, serum) simultaneously is an object and mean to keep up constancy of organism’s internal environment (homeostasis). The chemical composition of plasma is very composite and counts the thousands known substances.

Слайд 6Using blood circulation the nutrients and oxygen are delivered to the

tissues and the final metabolites are excreted. A blood is a transporting highway, by means of which the humoral regulation is carried out. Thus from the moment of mediator or hormone throwing in the blood to subsequent adaptive reaction from a few seconds to a few minutes pass.

Слайд 7The blood cells also execute the great number of functions. The

long-living (to 100 days) red cells execute the transport of oxygen. The leucocytes (to 10 days) participate in the specific (immunity) and unspecific protective reactions. Their trophic function is additional.

Слайд 8The leucocytes disintegrating feed intensively proliferative tissues by the products contained

in their kernels. The platelet cells (they live hours, days) participate in maintenance of blood coagulability. Also they constantly renew the endothelium of blood vessels including capillaries and also carry out a trophic function for other tissues.

Слайд 9 The concept of embryonic hemogenesis.
In the period of

prenatal life of fetus 3 periods of hemogenesis are marked off. However its stages are not strictly differentiated and each other changes gradually.

Слайд 10
The first stage of hemogenesis is revealed in a 19-th daily

aged embryo in the bloody islets of yolkbag. The initial priextraemmitive blood cells containing hemoglobin and kernels appear. They are megaloblasts. This first brief period of hemogenesis or erythropoesis predominantly is called extra- embryonic hemogenesis.

Слайд 11The second (hepatic-splenic) period begins after 6 weeks of intrauteral development

and achieves its maximum at the 5-th month of prenatal human life. At first the hemogenesis takes place in a liver and erythropoesis is the most expressed among processes of hemogenesis. The leuko- and trombocytopoesis are considerably weaker in this period. The megaloblasts are gradually substituted by erythroblasts. On the 3—4-th months of prenatal life the spleen includes into the hemogenesis. Like the most active organ of hemogenesis the spleen functions from 5-th till the 7-th month of ontogenesis. The erythro-, granulocyto- and megacaryocytopoesis are carried out in it. The active lymphopoesis arises up in spleen later — from the end of 7-th month of prenatal development.

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The third or bone marrow period of hemogenesis which gradually

becomes determinative in the production of blood cells begins on the 4—5-th months of development in utero.

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According to the different periods of hemogenesis (extraembryonic, hepatic and bone

marrow) there are three different types of hemoglobin: the embryonic (HbP), fetal (НbF) and hemoglobin of adult (HbA). The types of normal hamoglobin differ among themselves by amino- acid composition and affinity to oxygen.

Слайд 14 The embryonic hemoglobin (HbP) can be found only in the

earliest stages of embryo’s development. On 8 —10-th week of gestation the fetus has the red blood cells containing about 90 — 95% НЬF. At the same period the HbA (5 — 10%) begins to appear. At birth the amount of fetal hemoglobin varies from 45 to 90%. So the HbF is gradually substituted for HbA within period of gastation.

Слайд 15In children aged one year the common hemoglobin level remains about

15% of НЬF and in a 3 years old toddlers the amount of HbF should not exceed 2%.

Слайд 16Hemogenesis after the birth.

Newborns’ marrow is the

general source of all blood cells production. At this time both the flat and tubular bones are filled by the active in regard to hemogenesis red marrow. However already since the first year of life the partial transformation of red marrow in most tubular bones into the fatty (yellow) marrow begins to be set. In 12—15 years old children as well as in adult persons the hemogenesis is saved in bone marrow of only flat bones.

Слайд 17The rapidly exhausted marrow is incident to the neonatal period of

life. After an unfavorable influences such as infections and intoxications provoking anemia the children of early age can have a return to the embryonal type of hemogenesis. In this situations in children the so-called extramedullary centers of hemogenesis in liver, spleen and even skin can appear.

Слайд 18 The features of blood in newborns.

The common

amount of circulatory blood in newborns differs and depends on body mass and maturity, time of umbilical cord clumbing. In common situations in newborns the average volume of blood is about 80 ml per 1 kg of body mass. In adult persons this is 50—60 ml per kg.

Слайд 19 The level of hemoglobin (Hb) in the peripheral blood of

well newborns is higher than in infants and adult persons. Always it is 145—200 g/L and 10 - 55% of it are formed by HbA. The content of red corpuscles corresponds to 4,5 • 10E12/l — 7 • 10E12/l. The hematocrit (Ht) which reflects correlation between the volume of formed elements (mainly red cells) and plasma after blood centrifugation is about 42 - 60%. In these condition a color coefficient (CC) (it uses only in our national practice) varies from 0,9 to 1,3 reflecting the erythrocytes` saturation by hemoglobin.

Слайд 20

From the first hours after birth the disintegration of red cells

begins. This process clinically causes the appearance of physiological jaundice and declines declines of red cells concentration in blood.

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The range of normal variations of general leucocytes count (WBC)

at birth is wide enough and makes up 10x10E9/L - 30х10E9/L. In subsequent days and weeks of life the amount of leucocytes gradually goes down up to 5 – 15х10E9/L.

Слайд 22The leukocytes formula (or differential count or homograph) in newborns has

features. For the first days after birth the neutrophyles prevail and arrive at approximately 60% from the common number of white blood cells. Thus the white cells formula at the moment of birth looks like such in adult persons. During the days after the birth the physiological prevalence of neutrophyles cells gradually disappear while the percent number of lymphocytes grows up. On the 5 — 6th day of life the percentage of neutrophyles and lymphocytes in blood evens.

Слайд 23The physiological prevalence of lymphocytes in comparison with other white cells

is being the normal phenomenon in children until the age of 5 years and is called the physiological lymphocytosis.

Слайд 24The content of other white blood elements comparatively less differs from

the indexes of adults’ blood.
The number of platelet cells (PLT) in the neonatal period is 150 • 10E9/L — 400 • 10E9/L.
The bleeding time does not differ from such one within other periods of childhood and is equal to 2—4 min. In newborns the bleeding time and the time of blood coagulation can be prolonged especially in children with neonatal jaundice.
ESR is low comparing with the results of adult persons and makes 1 — 3 mm/hour.

Слайд 25The blood in infants.

In infants next to

the neonatal period the gradual decline of number of red cells, their sizes, hematocrit, level of general hemoglobin and content of hemoglobin in one erythrocyte are the main features of babies’ peripheral blood composition. In term born infants there are the lowest values of them in age of 2-6 months. This important phenomenon is not characteristic to any other age period of human life. So, many well-children in this age have general hemoglobin level less then 110 g/L. The minimum possible normal level in 2 months is 95 g/L and 5% of normal infants have so low hemoglobin. In this age the hematocrit makes up 30-35% and amount of red cells about 3,5 • 10E12/L.

Слайд 26The average volume of one erythrocyte in children in this age

is equal to 75 - 100 fl, average content of hemoglobin in 1 red cell makes up 25-30 picograms that corresponds to the colour index less than 1 unit. It is the physiological state reminding hypochromic and microcytic feature of red blood cells and is observing in many children. It is conditioned by some disparity between a large necessity in iron which is needed for erythropoesis and by rapid growth of child’s body mass, his or her bloods` volume increasing and difficulties to obtain enough iron with a milky food. Since the second year of life the children begin to get the compound feeding enriched by iron (eggs and meat). Most of them overcame the deficit of iron and their level of hemoglobin gradually approach to the adult one.

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The amount of leucocytes in healthy infants vary in limits since

5 • 10E9/L until 15• 10E9/L. The high number of leucocytes count in well-infants unusual for adult persons can be explained by predisposition to digestive leukocytosis in infants. Besides in the leukocytes formula of healthy children till the 5 years the physiological lymphotcytosis is prevailing always.

Слайд 28 Second and subsequent years of child’s life

Since the beginning of the second year of life until to the pubertal period the morphological composition of peripheral blood gradually acquires traits characteristic for adults. In boys and boy-teens the general hemoglobin makes up 135-165 g/L. In girls it is 115- 145 g/L. The content of red cells respectively is 4.2-5.5 and 3.7 – 5.0 х 10E12/L. The hematokrit is 36-48%. The volume of red cells is 80 -100 fl and average hemoglobin in one erythrocyte 28 – 35 picograms.

Слайд 29 In a leukocytic formula in children aged 3-4 years there

is the tendency to gradual growth of neutrophyles` percentage and diminishment of lymphocytes. Between the fifth and sixth year of life the 2-nd cross of neutrophyles and lymphocytes amount in formula happens. In this moment the content of them in a peripheral blood is evened. The further increasing of neurophiles` percentage proceeds after 5 years upto the stable level and the leukocytical formula becomes such as in adult persons.

Слайд 30 Semyotics of blood changes.
The modern blood test includes:
- Research of

blood cellular composition.
- Assay of chemical composition of blood serum.
- Conclusion about coagulative properties of blood.
Investigation of
biophysical properties
of blood (ESR).

Modern hematological analyzer

Слайд 31 red blood cells

Слайд 32The state of red blood cells is characterized by next clinical

and laboratory parameters.
1. The content of common hemoglobin (Hb) in blood is measured in g/L. Before measure of common Hb the whole blood passes procedure of red cells destruction. The lower acceptable value of normal hemoglobin in blood below which the anemic symptoms appear and it is possible to diagnose anemia in patient is 110 g/L.

Слайд 33There are some exceptions. This value is necessary to increase up

to 135 g/L in newborns because they usually have higher Hb in comparison with other age groups of people (see above the physiological features of newborns) and to decrease up to 95 g/l in children aged 2-3 months passing nadir of physiological iron - deficiency.
Average content of hemoglobin in one red corpuscle can be also measured by the modern automatic cytometry and this parameter is widely used in current clinical practice.

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If the average content of Hb (Mean corpuscular hemoglobin concentration MCH)

in one red cell is less than 25 pg it is a symptom of hypochromia. The normal value is 25-35 pg of Hb in one erythrocyte and this condition corresponds to normochromia.
When the Hb is more than 35 pg in mean erythrocyte it corresponds to sign called red cells hyperchromia.

Слайд 35With high accuracy the hematocryt (Ht, %) reflects a volume which

is occupied by red cells in analyzed sample of blood without taking into account their individual size (or mean volume of red cells).

Слайд 36The amount of red cells (RBC) can be also calculated. The

content of red cells less than 3х10E12/L and hematocrit less than 30% testify the deficiency of erythrocytes. On the other hand the red cells amount which exceeds 6 х 10E12/L and Ht more than 60% almost for certain must suggest the existence in patient red cell polycytaemia.

Слайд 37The average volume of one red cell (Mean corpuscular volume –

MCV) can be also measured by the cytometry. Usually it makes up 80 – 100 ft. This sort of red cells with normal size is named a normocytes. The small red cells with a mean volume less than 80 ft are nominated as a microcytes. At application of common microscopic technique the pattern of microcytes in blood is characterized by phenomenon of anyzocytosis (by the variety of sizes) and poikylocytosis (by the variety of form). The red cells having an average volume more than 100 fl are named macrocytes.

Слайд 38There is the extra - systematic value of erythrocytes system called

color coefficient. In proper measure it reflects content of hemoglobin in one red cell, but without taking into account its size and/or volume. It is calculated by the division of hemoglobin content on the number of red cells. If the value of coefficient is less than 0.9 un this condition corresponds in majority cases to the hypochromia of red cells, 1 (0.9-1.1) to the normochromia, and more than 1.1 to the hyperchromia.

Слайд 39
Morphologic abnormalities of the red blood cell.
A.(left above) Normal.
B.(right

above etc.) Macrocytes (folic acid or vitamin B12 deficiency).
C. Hypochromic microcytes (iron deficiency).
D. Target cells (Hb CC disease).
E.(below) Schizocytes (hemolytic-uremic syndrome).

A

B

C

D

E

Слайд 40 The anemic syndromes.
The anemic syndrome is defined as a deficit

of hemoglobin and/or red cells with characteristic performance of clinical symptoms.

The common clinical symptoms of anemia are the pallor of skin and mucous and easy fatiguability, somnolence in patients. The last symptoms display systemic hypoxia. The low viscosity of blood due to deficiency of red cells seldom provokes the anemic murmur in anemia on a pulmonary artery during the heart auscultation. Also the anemia can be accompanied with various skin disorders.

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According laboratory data all cases of anemic syndrome or anemia

can be divided into a several group having individual sings and features. This groups also differ on their causative mechanisms. Dialing with laboratory data, symptoms and anamnesis in majority situation the well educated physician can make accurate diagnosis of anemia.

Слайд 42Iron - deficiency anemia and anemia, caused by deficit of other

components necessary for the Hb synthesis in erythrocyte.

It is necessary to emphasize that in routine practice the pediatrician very often has to deal exactly with anemia of this type, and, especially, with cases linked by iron-deficiency state. Without exaggeration the iron-deficient anemia should be nominated as the commonest disease in children.

Слайд 43For iron-deficient anemia it is typical of:
The general hemoglobin is below

than age dependant normal level;
There is always red cell hypochromia (the average content of hemoglobin in red cells is below than normal and/or a colour value is below 0.9);
The erythrocytes usually are mycrocytic (the mean volume of red cells is less then normal). Very often the anizocytosis, poikylocytosis should be revealed by microscopic technology.
The hematockrit is moderate low.
The common content of red cells in blood can be normal.
Because the cause of this anemia is the deficit of iron there is a low level of elementary iron in blood serum.

Слайд 44Koilonychia associated with iron deficiency anemia.

Слайд 45The symptoms of promoted fatigueability in children can look like as

diminished motor activity. The pallor which can be named as «waxen» is the most important symptom of iron-deficient anemia. In girls-teenagers with severe iron-deficiency anemia on a background of difficult menstruations with considerable big chronic losses of blood the pallor can have a greenish tint. This state is called a juvenile chlorosis. Sometimes the deficit of iron in children provoke the original symptom of pica (clorotica). It means a perverted appetite. The children with pica can eat unsuitable things. The involuntary desire to eat earth is complicated by ascariasis and the iron- deficiency in this children can worse.

Слайд 46The cause of anemia can be a deficit in the child’s

organism of vitamin В12 and folic acid. The number of red cells and level of hemoglobin go down below than age dependant normal level. The most important diagnostic sign of this type anemia is the macrocytic and hyperchromic characteristics of red blood cells in this patients.


megaloblastyc pathway

Diphyllobothrium latum (diphylobothriosis).

Слайд 47



The anemia due to bleeding first of all is attributed to

them. The fact of the occult, internal or obvious bleeding is the characteristic sign of this anemic type.

The largest group of anemias is formed by normochromic and normocytal cases.

Слайд 48 As a result of red cells haemolysis also the normochromic,

normocytal anemias develop. A jaundice (yellowish discoloration of skin and mucouses as a result of serum indirect hyperbilyrubinemia more then 50micromoles/litre) is important incriminative sign. As a clinical example of this sort of anemia the neonatal haemolytic disease due to incompatibility by Rh- and blood group between expectant mother and her fetus can be done. Also a lot of hereditary form of hemolytic anemias exist in pediatric practice.

Слайд 49 Finally, the normochromic and normocytal anemias develop as a result

of red cells making lack in the red marrow. They are hypo- and aplastyc anemias. The anemias of this group can be innate and acquired. The important additional symptoms of their diagnostics are: the decline of reticulocytes (PTC) (young form of red cells) number – less then 1 % of all red cells in peripheral blood) and the aplasia of bone marrow with insufficient content of erythroblasts in it.

Слайд 50 The semyotics of red cells number increase

1. Typically the abnormally high numbers of red cells in a peripheral blood is wide spread sign of chronic hypoxemia, first of all in congenital heart disease.
2. The development of seeming erythrocytosis is possible in dehydration because of blood concentration. The blood concentration shows up the increase of other, so-called concentration values. For example, in dehydrated patients the serum protein shows up elevated.
3. The true polycytemia (erythremia) is connected with neoplasmic (tumors`) proliferation of red cells in bone marrow.

Слайд 51 Leucocytes

Слайд 52
The characteristics of leukocytes are:
1)

The value of leucocytes count (WBC) in unit of blood volume (in liter);
2) The composition of hemograph (or differential count or leukocytes formula) as a correlation between the number of leucocytes types shown in absolute count (AC) in unit of volume (1 liter) or in percents in relation to all leucocytes.
The leukocytosis and leukopenia appear as concomitant reactions in various diseases or even physiological states of human body. The unrestrained proliferation of leucocytes known as a type of malignant tumor process – leukemia (Blast cells) or severe insufficiency of leukocytes production – bone morrow aplasia are being an independent diseases.

Слайд 53 Leukocytosis

The leukocytes count (WBC) is defined

as a content of leucocytes of all types. Except for the cases considered in connection with the discussion of newborns and infants in all other periods it is accepted to consider that normal white blood cells count is not less than 2.5x10E9/l and above 13.5 х 10E9/l.

Слайд 54 The leukocytes count (WBC) exceeding 20 х 10E9/L is named

hyperleukocytosis or leukemoid reaction because this condition can remind a leucosis. In difficult cases the truth leukemia can be distinguished from leukemoid reaction only on the basis of the bone marrow investigation. The benign leukemoid reaction does not show malignant cell proliferation in opposite to the leukemia.

Слайд 55Neutrophylic leukocytosis (ANC) and leukemoid reaction of neutrophylic type appear in

festering-inflammatory processes. The appearance in the hemograhp of white cells called band neutrophyles (the stick-nuclear and other young forms) facilitates a judgment about microbial-inflammatory character of hyperleukocytosis. Also the toxic graininess of their cytoplasm helps in it diagnostics.

NEU

Слайд 56Eozynophilia (over 5% from numbers of leukocytes formula or AEOSC
0,5 х

10E9 cells in 1 L of blood) is observed in various allergic diseases and also in parasitic worms infections.

EOS

Слайд 57Lymphocytosis. The amount of lymphocytes considerably increases in viral diseases like

the infectious lymphocytosis and whooping cough. Diling with a leukemoid lymphocytic reaction in a child usually it is necessary to think out about a possibility of lymphoblastic leucosis (leukemia) which is the typical malignant disease in childhood fortunately can
be considered won now.

LYM

Слайд 58Monocytosis is characteristic for infectious mononucleosis caused by the Ebstain-Barr viral

disease.

MON

Слайд 59Leukopenia
The leukopenia (the abnormal decline of leucocytes

in peripheral blood less then 2,5х10^9/L) is observed in such infections, as typhoid fever, measles and German measles, viral hepatitis, at hypersplenism. The sensitive lack (less 1,5х10^9/L) of granulocytes number (neutrophyles, eozynophyles) is named as neutropenia and it can be caused by influence of radio-active matters, x-rays, use of some medicinal matters (sulfonamides, antipyretics and many other), in condition of individual sensitiveness to them. Almost the complete disappearances of granulocytes defined as agranulocytosis takes place in some cases and is represented as an independent disease. Sometimes there is complete exhaustion of bone marrow — panmyelophtysis. This patients suffer from the severe recurrent microbial infections. The lymphopenia less then 0,25х10^9/L is specific for a few immunodeficiency diseases including for AIDS (acquired immunodeficiency syndrome).

Слайд 60

coagulative properties of blood

Слайд 61




The adequate to the trauma early bleeding is beginning right away

after the damage of vessel and it is selected as a normal.

Слайд 62The components of haemostasis are:

- vascular wall
- thrombocytes (platelet cells)
- plasma

factors of blood coagulation

Chart of haemostasis:

Trauma---------thromboplastin
↓
Prothrombin----thrombin
↓
Fibrinogen ------fibrin ---------- blood clot

Слайд 63
For the hemorrhagic syndrome the inadequate easy bleeding and also late,

deferred from a moment of trauma bleeding arising up in a few hours after a trauma or operation are characteristic. Usual easy and late bleedings develop in cases if a child suffers from the disease in which the changes in system of blood coagulation-haemostasis are present.

Easy bleeding (hemorrhagic syndrome).


Слайд 64

The damage of any component of hemostasis causes haemorrhagic syndromes

which subdivide on:

- vasopathy (vessel pathology),
- thrombocytopenia, thrombocytopathy,
- coagulopaty.

Слайд 65In accordance of represented factors of hemorrhagic disease 3 clinical types

of pathologic bleeding are:

1. petechial (vasculitical) purpure,
2. echymosical –spotted purpure,
3. haematomical .

Слайд 66 The vascular purpuric type of bleeding shows up as the

small-spotted hemorrhagic rash (skin eruptions) sometimes confluent, with the possible hearths of necrosis on the skin and on the mucous membranes of oral cavity, gastrointestinal tract and in the glomerulas of kidneys. The bleeding into the gastrointestinal tract and from kidneys therefore is possible. The traumas by promoted bleeding are not accompanied. In children this type of bleeding is typical of blood vessel inflammation (anaphylactoid vasculitis), periarteriitis, vitamin C deficiency (scurvy).

Слайд 67 vascular purpuric type of bleeding

Слайд 68The petechial-spotted type of bleeding is also wide spread in pediatric

practice. On a skin spontaneously or after insignificant traumas the small-punctated haemorrhages (petekhias) and big sized - ekchymosises («bruises») appear. Also there are the nose-bleeds and bleeding from the gums. In girls the severe and prolonged vaginal bleeding happens. The laboratory assay of bleeding time is usually prolonged. This type of bleeding appear due to deficiency of platelet cells. Idiopathic thrombocytopenic purpure is one of the most frequent hemorrhagic diseases in childhood characterizing by marked decline of thrombocytes number in a peripheral blood.

Слайд 69petechial-spotted type of bleeding

Слайд 70The hematoma-predisposed type. There are large, deep, very painful intermuscular haemorrhage

and bleeding in to the joints. Such hematomas arise up after insignificant traumas or causelessly. They should be so severe that even squeeze on nervous trunks and large vessels that results in development of peripheral pulsy. The hematomic type of bleeding is strictly characteristic of inherited coagulopaty hemophilia A.

Слайд 71







Facial hematoma in a 1-year-old boy with hemophilia A.
The hematoma-predisposed

type of bleeding

Слайд 72 biophysical properties of blood

(ESR)

Слайд 73ESR (erythrocytes sedimentation reaction).

The spontaneous

(not to mix up with hematocrit) concretion of red cells takes place because of their greater relative density as compared to blood plasma. The red cells spontaneously moving downward oust plasma upwards. In a norm ascending and descending influences on red cells are almost balanced, therefore concretion of these cells is minimum. The changes of erythrocytes sedimentation reaction (ESR) are very significant in a different pathological states especially chronic.

Слайд 74

ESR increases due to raise of serum fybrinogen, immunoglobulines, gaptoglobin, cholesterol

concentrations. It elevates also in alkalosis, anemia.

Слайд 75 The normal values of ESR depend on persons` age and

sex. In children ESR is lower (1—8 mm/h) than in adult persons. In newborns it is rarely higher then 2 mm/h. In old men ESR is below (1—10 mm/h, the average is 5 mm/h) than in women (from 2 to 15 mm/h, the average is 9mm/h).
The ESR increases in the pathological states which can be conditioned by inflammation disease especially hidden such a connective tissue diseases and malignant tumors. The important conclusion is seemed quite obvious that it is necessary to use ESR for chronic diseases diagnostics and making their prognosis.

Слайд 76At what age in childhood the hematocrit has the lowest normal

level?

A. 1 hour
B. 1 week
C. 1 month
D. 3 months
E. 3 years

Слайд 77At what age in childhood the hematocrit has the lowest normal

level?

A. 1 hour
B. 1 week
C. 1 month
D. 3 months
E. 3 years

Слайд 78Tiny, flat, round, red or purple spot on skin caused by

minute submucosal or intradermal hemorrhage is:

Ecchymosis
Petechia
Purpura
Macula
Roseola

Слайд 79Tiny, flat, round, red or purple spot on skin caused by

minute submucosal or intradermal hemorrhage is:

Ecchymosis
Petechia
Purpura
Macula
Roseola

Слайд 80The microcytic anemia is associated with:

hemolytic disorders
folic acid

deficiency
due to bleeding
chronic inflammation
iron deficiency

Слайд 81The microcytic anemia is associated with:

hemolytic disorders
folic acid

deficiency
due to bleeding
chronic inflammation
iron deficiency

Слайд 82A 8-year-old male is brought to the emergency department with an

allergic reaction to a bee sting. Which leukocytes respond to an allergic reaction?

monocytes
neutrothils
eosinophils
lymphocytes
basophils

Слайд 83A 8-year-old male is brought to the emergency department with an

allergic reaction to a bee sting. Which leukocytes respond to an allergic reaction?

monocytes
neutrothils
eosinophils
lymphocytes
basophils

Слайд 84Normal hemoglobin (Hb) values to neonate is:

70 to 110 g/l
110 to

130 g/l
140 to 150 g/l
170 to 220 g/l
220 to 240 g/l

Слайд 85Normal hemoglobin (Hb) values to neonate is:

70 to 110 g/l
110 to

130 g/l
140 to 150 g/l
170 to 220 g/l
220 to 240 g/l

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