Praktikum Histologi Alimentary System (2011)

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Penuntun Praktikum Histologi Alimentary System (2011)

Presentasi ini tentang penuntun praktikum histologi alimentary system. Dalam presentasi ini dibahas tentang cara mengenali struktur mikroskopis rongga mulut, bibir, lidah, esophagus, lambung (gaster), duodemun, jejenum, ileum, colon dan apendiks. Disusun dengan sangat praktis dan sangat mudah diterapkan. Presentasi ini disusun untuk kegiatan praktikum mahasiswa kedokteran universitas udayana pada blok alimentary system.

Penuntun Praktikum Histologi Alimentary System -

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Leukopoiesis and Agranulocytosis (2011)

Hematopoiesis (Leukopoiesis) -

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Blood Cells And Hematopiesis

Blood cells and hematopoesis

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Agranulocytosis ( Pathophysiology, Sign & Symptomps, and Treatment)

Agranulocytosis is characterized by a greatly decreased number of circulating neutrophils. Severe neutropenia is the term usually applied to patients with fewer than 500 neutrophils per microliter (μL) (including bands). Agranulocytosis usually refers to patients with fewer than 100 neutrophils/μL.

The reduced number of neutrophils makes patients extremely vulnerable to infection. Cardinal symptoms include fever, sepsis, and other manifestations of infection. Causes can include drugs, chemicals, infective agents, ionizing radiation, immune mechanisms, and heritable genetic aberrations.

PATHOPHYSIOLOGY

Agranulocytosis may be broadly divided into 2 groups: hereditary disease due to genetic mutations and acquired disease.

Hereditary disease due to genetic mutations
Many hereditary disorders are due to mutations in the gene encoding neutrophil elastase, or ELA2. Several alleles are involved. The most common mutations are intronic substitutions that inactivate a splice site in intron 4. Genes other than ELA2 are also involved.

A strong family history of recurrent infections, usually beginning in childhood, is strongly indicative of a genetic defect.

Acquired disease
Acquired agranulocytic disease may be due to drugs, chemicals, autoimmunity, infectious agents, or other causes.

Drugs or chemical is the most common cause of agranulocytosis. About one half of patients have a history of medication or chemical exposure. The patient's history must be carefully taken to elicit this information. (read : list of drugs causing agranulosytosis)

Bone marrow and peripheral blood are the organ systems affected. Agranulocytosis is characterized by inadequate production of neutrophils, excessive destruction of neutrophils, or both. The resulting infections tend to involve the oral cavity, mucous membranes, and skin. Systemic life-threatening sepsis may ensue. The most common infecting organisms are staphylococci, streptococci, gram-negative organisms, and anaerobes. Fungi are also commonly involved as secondary infective agents.

The occurrence of infection depends on the degree and duration of neutropenia. When the ANC (absolute neutrophil countis) persistently fewer than 100/µL for longer than 3-4 weeks, the incidence of infection approaches 100%.


EPIDEMIOLOGY

Frequency
The exact frequency of agranulocytosis is unknown. The estimated frequency of agranulocytosis is 1.0-3.4 cases per million population per year.

Race
Agranulocytosis has no racial predilection.

Sex
Agranulocytosis occurs slightly more frequently in women than in men, possibly because of their increased rate of medication usage. Whether this higher frequency is related to the increased incidence of autoimmune disease in women is unknown.

Age
Agranulocytosis occurs in all age groups.
The congenital forms are most common in childhood.
Acquired agranulocytosis is most common in the elderly population.

SIGN AND SYMPTOMS

History
Patients with agranulocytosis usually present with the following:

• Sudden onset of malaise
• Sudden onset of fever, possibly with chills and prostration
• Stomatitis and periodontitis accompanied by pain
• Pharyngitis, with difficulty in swallowing
• If treatment is not promptly instituted, the infection progresses to generalized sepsis, which may become life threatening.

• Patients often report a history of a new drug being used or a recent change in medication.

• Occupational or accidental exposure to chemicals or physical agents (eg, ionizing radiation) may have occurred.
• The patient may have experienced a recent viral infection, although such infections are rarely associated with severe neutropenia. Certain bacterial infections may also precede agranulocytosis.
• A history of periodically recurring infections is suggestive of cyclic neutropenia.
• A history of autoimmune diseases may be associated with antineutrophil antibodies. Such antibodies may also be the only manifestation of autoimmune disease. A number of test methods are available, but none is widely used.
• A strong family history of recurrent infections, usually beginning in childhood, is strongly indicative of a genetic defect.

Physical

• Fever may be present (temperature often 40 º C or higher).
• Rapid pulse and respiration may be evident.
• Hypotension and signs of septic shock if infection has been present
• Painful aphthous ulcers may be found in the oral cavity.
• Swollen and tender gums may be present.
• Usually, purulent discharge is not present, because not enough neutrophils exist to form pus.
• Skin infections are associated with painful swelling, but erythema and suppuration are usually absent.
  
  

DIFFERENTIAL DIAGNOSIS

• Large granular lymphocyte leukemia
• Autoimmune diseases
• Chronic myelomonocytic leukemia
• Congenital neutropenia
• Cyclic neutropenia
• Drug-induced neutropenia
• Large granular lymphocytic leukemia
• Pseudoneutropenia
  
  

TREATMENT

Medical care for patients with neutropenia is mostly supportive and based on the etiology, severity, and duration of the neutropenia. Fever and infections occurring as complications of neutropenia require specific treatment.

General Care:

• Removal of any offending drugs or agents is the most important step in most cases involving drug exposure; if the identity of the causative agent is not known, stop administration of all drugs until the etiology is established
• Use careful oral hygiene to prevent infections of the mucosa and teeth; control oral and gingival lesion pain with saline and hydrogen peroxide rinses and local anesthetic gels and gargles
• Avoid rectal temperature measurements and rectal examinations
• Administer stool softeners for constipation
• Use good skin care for wounds and abrasions; skin infections should be managed by someone with experience in the treatment of infection in neutropenic patients

Antibiotics
Start specific antibiotic therapy to combat infections. This often involves the use of third-generation cephalosporins or equivalents

Colony-Stimulating Factor Therapy
Myeloid growth factors—specifically, granulocyte colony-stimulating factors (G-CSFs) and granulocyte-macrophage colony-stimulating factor (GM-CSFs)—may shorten the duration of neutropenia

Granulocyte Transfusion
Neutrophil (granulocyte) transfusions have undergone a cycle of popularity followed by disfavor. These transfusions are accompanied by many complications, including severe febrile reactions. Their use is controversial.


PROGNOSIS
If agranulocytosis is untreated, the risk of dying is high. Death results from uncontrolled sepsis.
If the condition can be reversed with treatment, the risk of dying is low. Antibiotic and antifungal medications can cure the infection if the ANC rises.
Morbidity is entirely due to infections that complicate agranulocytosis. The infections may be superficial, involving mainly the oral mucosa, gums, skin, and sinuses, or they may be systemic, with life-threatening septicemia.

Reference
emedicine
medical-dictionary
medterm
medicineworld

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Agranulocytosis Powerpoint From Slideshare.net

Neutropenia, Agranulocytosis

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Drugs causing agranulocytosis

Many drugs can cause agranulocytosis and neutropenia. The mechanism of neutropenia can be varied depending on the drug. Many anti- neoplastic drugs cause agranulocytosis and neutropenia by bone marrow suppression. Neutropenia and agranulocytosis can also result from antibody or compliment mediated damage to the stem cells. Some drugs may cause increased peripheral destruction of white cells. About three fourth of all agranulocytosis in the United States is related to drugs. Procainamide, anti-thyroid drugs and sulfasalazine are at the top of the list of drugs causing this problem. Most agranulocytosis is related to the direct effect related to its dose. Phenothiazines, semi-synthetic penicillins, non-steroidal anti-inflammatory drugs (NSAIDs), aminopyrine derivatives, benzodiazepines, barbiturate, gold compounds, sulfonamides, and anti-thyroid medications are the most common causes of neutropenia and agranulocytosis.

List of drugs that causes agranulocytosis or neutropenia sorted as per probability
(Anti-neoplastic drugs are not included)

Dipyrone
Mianserin
Sulfasalazine
Co-trimoxazole
Anti-arrythmic agents
Procainamide
Ajmaline
Tocainide
Aprindine
Amiodarone
Penicillins
Amoxycillin
Aziocillin
Benzylpenicillin
Phenethicillin
Cloaxacillin and penicillin
Thiouracil derivatives
Methyl thiouracil
Propyl thiourcil
Phenylbutazone
Cimetidine
Penicillamine
Diclofenac
Carbamazepine
ACE-Inhibitors
Captopril
Enalapril
Hydrochlorothiazide with potassium sparing diuretics
Indomethacine
Cephalosporins
Cephalexin
Cepahazolin
Cefuroxime
Cefitaxime
Cephradine
Oxyphenbutazone
Nitrofurantoin
Salicylic acid derivatives
Clozapine
Carbimazone
Sulphonylurea derivatives
Glibenclamide
Tolbutamide
Methyldopa
Thiamazole
Nucleosides
Aminoglutethimide
Ibuprofen
Pentazocine
Levamizole
Promethazine
Chloramphinicol
Acetaminophen and combinations
Perazine
Mebhydrolin
Ranitidine
Imipramine
Miscellaneous drugs (relatively lower probability)
Phenytoin
Chlorthalidone
Sulphamethizole
Norfloxacin
Naproxen
Clomipramine
Trazodone
Omeprazole
Alimemazine
Pirenzepine
Ticlopidine
Ibopamine
Hydralazine
Nifedipine
Nalidixic acid
Doxycycline
Clindamycin
Gentamycin
Fusidic acid
Dapsone
Azapropazone
Propyphenazone
Sulindac
Piroxicam
Pirprofen
Niflumic acid
Allopurinol
Glafenine
Valproate
Levadopa with carbidopa
Chlorpramazine
Haloperidol
spironolactone
Zuclopenthixol
Zopiclone
Cinnarizine
Metronidazole
Pyrimethamine combinations
Thophylline

medicineworld

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Definition of Agranulocytosis

Definition of Agranulocytosis

Agranulocytosis /agran·u·lo·cy·to·sis/ (a-gran″u-lo-si-to´sis) a symptom complex characterized by decreased granulocytes and by lesions of the throat, other mucous membranes, gastrointestinal tract, and skin; most cases are complications of drug therapy, radiation, or exposure to chemicals.
(Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.)


An acute disease characterized by high fever, lesions of the mucous membranes and skin, and a sharp drop in circulating granular white blood cells.
(The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.)


An acute condition marked by severe depression of the bone marrow, which produces white blood cells, and by prostration, chills, swollen neck, and sore throat sometimes with local ulceration. Aalso called agranulocytic angina or granulocytopenia.
(Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved)


A severe reduction in the number of leukocytes (basophils, eosinophils, and neutrophils). Neutropenia results, whereby the body is severely depleted in its ability to defend itself. Fever, prostration, and bleeding ulcers of the rectum, mouth, and vagina may be present. The acute disease may be an adverse reaction to a medication or the result of the effect of radiation therapy or chemotherapy on bone marrow.
(Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier)


An acute disease in which there is a dramatic decrease in the production of granulocytes, so that a pronounced neutropenia evolves, leaving the body defenseless against bacterial invasion. A great majority of cases are caused by sensitization to drugs or chemicals that affect the bone marrow and depress the formation of granulocytes. Called also malignant or pernicious leukopenia and idiopathic or malignant neutropenia.
(Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.)

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