Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.

Hematological disorders

hematological disorders in relation to occupations

  • Soyez le premier à commenter

Hematological disorders

  1. 1. OCCUPATIONAL HAEMATOLOGICAL DISORDERS Dr. Dalia Abdallah El-Shafei Lecturer, Community medicine department, Zagazig University
  2. 2. #Haem synthesis (Pb) # cell production (Benzene) ++ leukemia (IR) Haemolysis (As + Naphthalen+ others) # O2 delivery (MetHb, SulfHb, COHb)
  3. 3. ScreeningHistory Physical examination Blood examination Bone marrow examination Other studies
  4. 4. HISTORY  Usually, Non-specific symptoms. • Anemia. • Jaundice. • Pica. • Infections. • Thrombocytopenia. • Drug history.  Detailed work history
  5. 5. PHYSICAL EXAMINATION  Pallor, jaundice, cyanosis.  Abnormal bleeding.  Infections.  Bone tenderness (sternum)
  6. 6. BLOOD EXAMINATION  HB, Hematocrit value  MCV, MCHC, MCH  Peripheral blood smear ( RBCs morphology)  Leucocytes differential count.  Reticulocytes.
  7. 7. BONE MARROW EXAMINATION  Iliac crest or sternum. • Tumor cells • Abnormal hematopoietic cells • Chromosomal studies (proto- oncogenes- philadelphia chromosome)
  8. 8. OTHER STUDIES  Bleeding disorders (platelet count + PT + PTT)  Iron stores estimation (serum iron + TIBC + serum ferritin)  Hemolysis (LDH, Indirect bilirubin).  Rapid cell turnover → ↑ serum Uric acid
  9. 9. INHIBITION OF HB SYNTHESIS LEAD POISONING
  10. 10. "Lead makes the mind give way." ANCIENT AWARENESS Greek Dioscerides - 2nd BC
  11. 11. 150 10 20 30 40 50 100 Death Encephalopathy Nephropathy Frank Anemia Colic Hemoglobin Synthesis Vitamin D Metabolism Encephalopathy Frank Anemia Decreased Longevity Hemoglobin Synthesis Nephropathy Peripheral Neuropathies Infertility (MEN) Systolic Blood Pressure (MEN) Hearing Acuity Erythrocyte Protoporphyrin (Women) Hypertension (?) Nerve Conduction Velocity Erythrocyte Protoporphyrin Vitamin D Metabolism(?) DEVELOPMENTAL TOXICITY IQ HEARING GROWTH Transplacental Transfer Blood Lead (ug Pb/dl) - Low birth weight - Miscarriages, Stillbirth - Premature birth CHILDREN ADULTS
  12. 12. #HB synthesis #Globin synthesis #Pyrimidine 5”- nucleotidase enz. Iron accumulation Basic Defects
  13. 13. ANEMIA AND LEAD TOXICITY (90%)  Normochromichypochromic, normocyticmicrocytic  Reduced RBCs survival time  Compensatory reticulocytes production  reticulocytosis  Basophilic stippling (70%)  ↑ urinary excretion of ALA + Coproporpherine III +Uroporphyrin +lead
  14. 14. MICROCYTIC ANEMIA WITH BASOPHILIC STIPPLING
  15. 15. LEAD PROVOCATION TEST  CaEDTA infusion “1g in 500ml 5%dextrose” over 6 hs → 24-hs urinary lead. • Normally < 0.5 mg • Lead toxicity → ≥ 1 mg
  16. 16. INHIBITION OF CELL PRODUCTION BENZENE POISONING
  17. 17. DESCRIPTION  Colorless or light yellow liquid  Sweet odor (Conc. Below threshold of smell associated with toxicity)  Highly flammable.  Evaporates into the air very quickly. Its vapor is heavier than air and may sink into low-lying areas.
  18. 18. Glues, Paints, Furniture wax, Detergents Tobacco smoke, Gas stations, MV exhaust, Industrial emissions
  19. 19. HIGH-RISK BENZENE EXPOSURE JOBS  Adhesive production  Aircraft engine & fuel workers  Automotive mechanics  Brake technicians  Chemical plant workers  Engine & turbine workers  Gasoline distribution workers  House painters  Newspaper press workers  Painters  Paper and pulp  Pesticide manufacturing  Pipefitters  Printers & print shop  Refinery workers  Shoe / leather workers  Solvent workers  Synthetic rubber  Tankermen  Truck drivers
  20. 20. MECHANISM OF TOXICITY  Benzen induces pancytopenia by disrupting cell production from the pluripotent stem-cell stage to the functional stage.  There is good evidence that benzene is cancerogenic.
  21. 21. GENETIC SUSCEPTIBILITY Genetic variations of Myeloperoxidase & NADPH quinine oxidoreductase
  22. 22.  Euphoria,  Dizziness,  Headache,  Blurring of vision,  Mucous membrane irritation,  Tremor,  Chest tightness,  Respiratory depression,  Cardiac arrhythmia,  Coma  Convulsion.  Direct skin contact → Marked irritation due to defeating action of the solvent. ACUTE POISONING
  23. 23.  # BM cell proliferation:  Anemia (including aplastic anemia), leucopenia, thrombocytopenia, pancytopenia; CHRONIC EXPOSURE
  24. 24.  Mutagenic effect:  Leukemia (particularly of the myelomonocytic type),  Chromosomal abnormalities  A dry, scaly dermatitis may developed on prolonged or repeated skin exposure to liquid benzene.
  25. 25. BM ASPIRATION
  26. 26.  Hypocellular with lymphocyte predominance  + Immature cells  No fibrosis  Acute myelogenous leukemias (AML)  Myeloma, CLL, CML
  27. 27. MANAGEMENT  Blood transfusion  Neutrophil transfusion  Stem-cell transplantation from HLA identical siblings:  Sever aplastic anemia  Young pt.  Need immunosuppression
  28. 28. OTHER AGENTS # BM GROWTH Aplastic anemia Insecticides “lindane” Solvents “glues, kerosesn, ”TNT, CCL4 IR
  29. 29. INDUCTION OF LEUKEMIA IONIZING RADIATION
  30. 30. TYPES OR PRODUCTS OF IONIZING RADIATION   or X-rayNeutron
  31. 31. COSMIC RADIATION
  32. 32. 2ry ionizing effects Indirect ionization Direct ionization • Neutrons • x, rays • α, • Cosmic rays
  33. 33. Radiation interacting with cell molecules
  34. 34. IONIZING RADIATION AT THE CELLULAR LEVEL  Causes breaks in one or both DNA strands or;  Causes Free Radical formation
  35. 35. OH . (hydroxyl radical) H . Radiation Damage water molecule -ray 2 OH .  H2O2 What happens when the water molecule is struck by the gamma ray?
  36. 36. PENETRATION ABILITIES OF DIFFERENT TYPES OF RADIATION Alpha Particles Stopped by a sheet of paper Beta Particles Stopped by a layer of clothing or less than an inch of a substance (e.g. plastic) Gamma Rays Stopped by inches to feet of concrete or less than an inch of lead Radiation Source Neutrons Stopped by a few feet of concrete:: 1:100:10,000
  37. 37. DOSE RESPONSE TISSUE Very High White blood cells (bone marrow) Intestinal epithelium Reproductive cells High Optic lens epithelium Esophageal epithelium Mucous membranes Medium Brain – Glial cells Lung, kidney, liver, thyroid, pancreatic epithelium Low Mature red blood cells Muscle cells Mature bone and cartilage
  38. 38. MYELODYSPLASTIC SYNDROME Cytomenia + remarkably cellular BM Dyserthropoiesis Rigid sideroblasts Variable no. of blasts (<leukemia) MDS “pre-leukemic”
  39. 39. ACUTE RADIATION SYNDROME (A SPECTRUM OF DISEASE)
  40. 40. ACUTE HEALTH EFFECTS  Changes in the blood cells  Vascular changes  Skin irritation  Gastrointestinal effects  Radiation sickness: • Diarrhea • Nausea • Vomiting • High fever  Hair loss  Burns
  41. 41. 58 MONITORING INSTRUMENTS  Personal monitoring: Film badges, bracelet, rings Pocket dosimeter
  42. 42. Alpha Survey Meter Detecting Radiation Beta & Gamma Survey Meter
  43. 43. LABORATORY FINDING  CML, CLL.  BM →↑ cellularity “ mainly Neutrophils”  Chromosomal analysis: Philadelphia chromosome  Auer rods.
  44. 44. “King of Poisons, Poison of Kings” HEMOLYTIC DISEASE ARSINE POISONING
  45. 45. Industrial processes  Semiconductor manufacturing (gallium arsenide)  Fossil fuels  Wood treated with arsenic preservatives  Metallurgy  Smelting (copper, zinc, lead) & refining of metals & ores  Glass manufacturing  Commercial products  Wood preservatives  Pesticides  Herbicides  Fungicides  Food  Seafood and fish  Others  Antiparasitic drugs  Folk remedies
  46. 46. OTHER HEMOLYTIC DISEASES
  47. 47. MARCH HEMOGLOBINURIA “FOOTSTRIKE HEMOLYSIS” “RUNNER’S ANEMIA” Repeated force (trauma) to the foot cause the breakdown of RBCs in blood vessels. CAUSES Hard surfaces, long distances, Worn out shoes, Inherited RBCs problem (hereditary spherocytosis).
  48. 48. IMMUNE MEDIATED HEMOLYTIC ANEMIA
  49. 49. AGENTS INTERFERE WITH O2 DELIVERY
  50. 50. METHEMOHLOBINEMIA
  51. 51. SULFHEMOGLOBINEMIA
  52. 52. CARBOB MONOXIDE

×