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Samenvatting 24-25 Hematologie 3 deel 1 : hematologie
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Samenvatting vak hematologie deel 1 : hematologie Gegeven in 3de jaar MLT
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HEMATOLOGIE 3:Deel 1 : Hematologie
Lector. Flies Reinoud
Academiejaar
2024 - 2025
,IN HOUD
Herhaling .................................................................................................................................................................. 2
Deel 1 : Afwijkingen van RBC .................................................................................................................................... 3
1. Anemie : inleiding ............................................................................................................................................. 3
2. Afwijkingen van ijzer- en heammetabolisme ................................................................................................... 6
3. Afwijkingen van het DNA-metabolisme ......................................................................................................... 10
4. Hemolytische anemie : Inleiding .................................................................................................................... 10
5. HA : Intracorpusculaire defecten.................................................................................................................... 12
6. HA : Extracorpusculaire defecten ................................................................................................................... 15
7. Hemoglobinopathiën ...................................................................................................................................... 19
8. Thalassemie .................................................................................................................................................... 21
DEEL 2 : Maligne afwijkingen van de WBC ............................................................................................................. 24
1. Inleiding .......................................................................................................................................................... 24
2. Indeling leukemie ........................................................................................................................................... 25
3. Myeloproliferatieve aandoeningen ................................................................................................................ 25
4. Chronische Myeloïde Leukemie ..................................................................................................................... 26
5. Polycythemia vera .......................................................................................................................................... 27
6. Essentiële trombocytemie.............................................................................................................................. 29
7. Myelofibrose (IMF) ......................................................................................................................................... 29
8. Myelodysplastisch syndromen ....................................................................................................................... 30
9. Acute leukemie ............................................................................................................................................... 31
10. Acute Lymfatische Leukemie (ALL) ............................................................................................................... 31
11. Acute Myeloïde Leukemie (AML) ................................................................................................................. 33
12. Lymfoïde Neoplasmata ................................................................................................................................. 34
13. Plasmacelaandoeningen ............................................................................................................................... 38
14. Laboratoriumdiagnostiek Leukemie ............................................................................................................. 40
1
Moons N / Vermeulen A
,HERHALING
REFERENTIEWAARDEN
Man Vrouw Eenheid
RBC 4,3 – 6,0 3,8 – 5,5 Miljoen / µl
HGB 14 – 18 12 – 16 g / dl
HCT 40 – 55 35 – 45 %
MCV 75 – 95 fl
MCH 27 – 32 pg
MCHC 30 – 35 g / dl
RDW < 15 %
WBC 4 000 – 11 000 / µl
TRO 140 000 – 450 000 / µl
RET 0,2 – 2,0 %
Absoluut # RET 60 000 – 100 000 (neonatie 400 000) / µl
RET index 0,4 – 2,22 %
ERYTROPOIESE
2
Moons N / Vermeulen A
, DEE L 1 : AFWIJKIN GEN VAN RBC
Cursus Hematologie : Deel 1: afwijkingen RBC
1. A NE MIE : I NLEIDI NG
1.1 A LGE MEE N
Anemie = bloedarmoede
→ gekenmerkte door daling van Hgb-gehalte
Definitie anemie
• Daling van O2-dragende capaciteit van bloed → komt tot uiting bij verlaagd Hgb-gehalte
• Vermindering van RBC, Hgb en RBC-massa (t.o.v. patiënt zijn basislijn)
22
20
18
Hgb
Hgb-gehalte = parameter voor O2-dragende capaciteit van het bloed 16
14
→ Laag Hgb-gehalte leidt tot weefselhypoxie* 12
10
8
6
Hct = parameter voor bloedvolume en viscositeit 4
2
0
j
m
d
v
2m
3m
4m
6m
1j
j
7
2-6
j
12
-18
s
lw
lw
atu
6-
12
vo
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on
*Weefselhypoxie gevolgen
Ne
• Onvoldoende O2-bevoorrading van omliggende weefsels
• Overconsumptie O2 : verhoogde cardiale en pulmonaire activiteit → Tachycardie
• Verhoogde RBC-productie : door stijging EPO (groeifactor)
Klinische symptomen
• Door weefselhypoxie: bleekheid, moe, syncope, vertigo, dyspnoe (kortademigheid)
• Door compensatie: tachycardie, hartruis, verhoogde RBC-productie (botpijn), A.pectoris
Aan- of afwezigheid klinische symptomen hangt af van 4 factoren
1. Snelheid van ontstaan → Snellere geeft ernstigere symptomen
2. Ernst v anemie → milde anemie : zelden symptomen
3. Leeftijd → Jongeren kunnen beter compenseren
4. Zuurstofdissociatiecurve → anemie geeft verhoogde 2,3-DPG productie
Left shift
Right shift
3
Moons N / Vermeulen A
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