study guide hematologic tayang 9 september 2014

8/9/2019 Study Guide Hematologic Tayang 9 September 2014

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Study Guide Hematologic System & Disorders &Clinical Oncology

Hematology system & clinical oncology is an expanding science with new concepts andideas appearing in the literature almost daily.In this block, we will learn about the basic of hematology, disorder of blood cell whichoccurred in the hemopoiesis process, or during circulation process and during thedestruction process of the cell, and management therapy of blood disorder. In this block, wealso will learn about the basic of malignancy, epidemiology, early detection of cancer,diagnosis of cancer and management therapy of cancer including surgery, radiotherapy, andsystemic therapy for better quality of life of patient with cancer.

This block will take 2 meeting to be completed, each meeting consist of introductorylecture continued by indi!idual learning, single group discussion and self assessment,student pro"ect and ending with plenary session. In each topic there will be a list of tasks todiscuss which some of them are based on a case that commonly find in clinical practice.There will also a simple clinical problem that you need to discuss and respond, each partwill be gi!en a cut of clinical information for you to be responded.

#!aluation in this block will be formati!e and summati!e. The formati!e e!aluation isdirecti!e and will take as checklist and peer assessment, while summati!e will be conductedat the end of this block.

$e belie!e that the basic of hematology and clinical oncology that you will learn in this blockwill impulse you to learn more about it to help you dealing with hematology problems inpatients.

%ood luck,

lanner team

'dayana 'ni!ersity (aculty of )edicine, )#' *

1. PREFACE


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*. reface+++++++++++++++++++++++++++++++++. *

2. ist of -ontents++..++++++++++++++++.++++++++++... 2

. lanners Team & ecture+++++++++++++++++++++++++

/. (acilitators +++++++++++++++++++++++++++++. /

. 0e!en %eneral -ore -ompetency ++++++++..++++++++++..

1. -urriculum lock3 The Hematology 0ystem &4isorder & -linical 5ncology ..+. 1

6. Time Table

7 8egular class++.+++++++++++++++++++++++++++.. 6

7 #nglish class++..++++++++++++++++++++++++++.. 6

9. )eeting of student representati!es+++++++++++++++++++++.. */

:. ;ssessment method+++++++++++++++++++++++++++.. */

*


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No. NAME DEPARTEMENT PHONE

*. 4r. dr. =etut 0uega, 0p 4 =H5)>Head? Internal )edicine secretary?

-linical athology


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REGULAR CLASSNO NAME GROUP DEPT PHONE VENUE

* dr. @i =adek )ulyantari , 0p. = * -linicalathology


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1. . Patient ca e4emonstrate capability to pro!ide comprehensi!e patient care that is compassionate,

appropriate, and effecti!e for the management of health problems, promotion of healthand pre!ention of disease in the primary health care settings.

2. Me!ica" #no$"e!%e &a'e)astery of a core medical knowledge which includes the biomedical sciences,beha!ioral sciences, epidemiology and statistics, clinical sciences, the social aspect of medicine and the principles of medical ethics, and apply them

3. C"inica" '#i"" 4emonstrate capability to effecti!ely apply clinical skills and interpret the findings in the

in!estigation of patient.

4. Co(()nication4emonstrate capability to communicate effecti!ely and interpersonally to establishrapport with the patient, family, community at large, and professional associates, thatresults in effecti!e information exchange, the creation of a therapeutically and ethicallysound relationship.

*. In+o (ation (ana%e(ent

4emonstrate capability to manager information which includes information access,retrie!al, interpretation, appraisal, and application to patientDs specific problem, andmaintaining records of his or her practice for analysis and impro!ement

,. P o+e''iona"i'( 4emonstrate a commitment to carrying out professional responsibilities and to personal

probity, adherence to ethical principles, sensiti!ity to a di!erse patient population, andcommitment to carrying out continual self7e!aluation of his or her professional standardand competence

-. Co(()nit /&a'e! and health system7 based practice4emonstrate awareness and responsi!eness to larger context and system of healthcare, and ability to effecti!ely use system resources for optimal patient care

'dayana 'ni!ersity (aculty of )edicine, )#'

*. THE SEVEN GENERAL CORE COMPETENC0


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Ai('

*. -omprehend the erythropoiesis, granulopoiesis, thrombopoiesis, basicprinciples of haemostasis and transfusion medicine

2. ;pply and interpret physical examination, laboratory, and imaging diagnosis of hematology system disorders.

. ;pply general principles of approach and management of patient withmalignancy.

/. 4iagnose and manage patient with common forms of anemias and to recogniEeor identify common forms of white blood cell disorders.

. 4iagnose and manage common forms of hemostatic or coagulation disorder.1. 4iagnose and refer special patients with hematology system disorders6. lan patient, family, and necessary community education about hematology

system disorders and clinical oncology.

0ub thema * 3 Hematologic system and disorders.0ub thema 2 3 %eneral and clinical oncology.

S)& t e(a 1

LEARNING OUTCOMES*. 4escribe the biology of the hemopoetic system and its clinical implications2. 4escribe the general principles and mechanisms of hemostasis and coagulation

. ;pply the general principles of transfusion medicine/. 8ecogniEe or identify common forms of thrombotic and thromboembolic disorders

. 8ecogniEe or identify common forms of splenic disorders >hypersplenism,splenomegaly, and spleen rupture?

1. 4ifferentiate and diagnose common form anemia6. 4ifferentiate acute and chronic leukemias, and myelodysplastic syndrome9. 4ifferentiate HodgkinDs and non HodgkinDs lymphoma

S)& t e(a 2

LEARNING OUTCOMES*. 4escribe the general principles of cancer genetic and cancer cell biology and

immunology of cancer

2. ;pply general principles of pre!ention and early detection of cancer . ;pply general principles -linical and athological approach to patient with cancer /. 4escribe general principles of cancer therapy

. ;pply general principles of follow up, rehabilitation, palliati!e care, ethic andpsychosocial to cancer patient.

'dayana 'ni!ersity (aculty of )edicine, )#' 1

,. CURRICULUM LOC THE HEMATOLOGIC S0STEM AND DISORDERS AND

CLINICAL ONCOLOG0


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Da Date To5ic Lea nin%

'it)ation

Re%)"a

C"a''

En%"i'

C"a''

PIC

* Tuesday0ept, :,2


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0%4 *


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deficiency anemia Ind. earning


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*2 $ednesday0ep, 2/,2


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Ind. earning


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5ct, ,2


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2 (riday5ct, *


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In the middle of each block curriculum, a meeting is held among the studentrepresentati!es, facilitators, and resource person of the block. The meeting is to discussabout the effecti!eness of on going teaching and learning processes, facilitators andlectures as a feedback to impro!e process. This meeting is held on+ > schedule to bead!ise?.

;ssessment in this thema consists of30%4 3 F0 >re!iew article? 3 * F(inal exam 3 9< F.

Fo (at Pa5e 7A tic"e Re8ie$9TITLE

7')&:ect;to5ic c oo'e + o( co(5entenc "i't9

@ame@I)

(aculty of )edicine 'dayana 'ni!ersity

2


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2 ;cute ympoblatic eukemia 2

*2 4eficiency ;nemia

/ -hronic )yeloblatic eukemia /;quired Hemolytic ;nemia

1 Interpretation of -omplete lood -ount 8esult 1

6 olycytemia 6

9 aboratory 0creening for Hemostasis 9

: )ultiple )yeloma :

*< Hemophilia *<

** romotion and re!ention of Iron 4eficiency ;nemia **

*2 Transfusion 8eaction *2

ENGLISH CLASSNO TOPIC GROUP

* )anagement of Iron 4eficiency ;nemia *

2 ;cute )yeloblatic eukemia 2

-hronic ympoblatic eukemia

/ (olic ;cid 4eficiency ;nemia /

#pidemiologi, 0creening and diagnositic 5f -ancer

1 -ongenital Hemolytic ;nemia 1

6 Hemophilia ; 6

9 imphoma 9

: ;nemia on -hronic 4isease :

*< Idiopatic Thrombocytopenia urpura >IT ? *<

** ;plastic JHypoplastic ;nemia **

*2 Aon $ilebrands 4isease *2T e Sc e!)"e +o St)!ent P o:ect P e'entation

NO Date To5ic Lea nin%Sit)ation

Re%)"a C"a'' En%"i'C"a''

Lect) e

'dayana 'ni!ersity (aculty of )edicine, )#' *


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*. $ednesday 5ct, *,2regular class?

olycytemia >regularclass?

0tudentro"ect

*2. < K */.regular

class?)ultiple )yeloma>regular class?

0tudentro"ect *2. < K */.


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I!io5aticT o(&oc to5eniaP) 5) a 7ITP97en%"i' c"a''9

A5"a'tic ;H 5o5"a'tic Ane(ia7en%"i' c"a''9

Von Bi"e& an!'Di'ea'e 7en%"i'c"a''9

1. Thursday5ct, :,2reguler class?

aboratory screening

for hemostasis>reguler class?

romotion andpre!ention of irondeficiency anemia>reguler class?

Transfusion reaction>reguler class?

0tudentro"ect

*2. < K */.


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LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LL

lock 3 Hematology systems & disorders and clinical oncology@ame 3 LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL 0tudent @o. >@I)? 3 LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL (acilitator 3 LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL Title 3 7

LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL



Time table of consultationoint of discussion $eek 4ate Tutor sign

*. Title *2. 8efferences 2

. 5utline of paper /. -ontent /

. (inal discussion ;ssessment

;. aper structure 3 6 9 : *<. -ontent 3 6 9 : *<

C. 4iscussion 3 6 9 : *<

Total point 3 > ; M M - ? 3 N LLLLLLLLLLLLL

4enpasar, LLLLLLLLLLLLLLLLLLLLLL

(acilitator,

;ssessment will be carried out on >day, date?. There will be *)-O? and some other types of questions. The minimal

passing score for the assessment is 6


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Lecture 1.Introduction ofHematologic System and Disorders

and General Oncology


DA0 I 7T)e'!a < Se5t< t 2=149

0ub topic 3 Introduction of Hematologic0ystem and 4isorders

rof.4r. dr. =etut 0uega, 0p 4 =H5)

A&'t actHematologic 0ystem and 4isorders is the discipline that studies the normal and abnormalconditions of the blood and is components. lasma component of the blood consists of se!eral proteins which are instrumental in the process of coagulation, anti7coagulation, as

well as fibrinolytic reactions. 5ne of the most particular characteristics of the hematopoieticsystem is the perpetual regeneration process of blood cells throughout the lifespan of theorganism.

luripotent hematopoietic stem cell >H0-? is the precursor of blood cells. The componentsof blood from H0- that acti!ely circulate are erythrocytes, leukocytes, and thrombocytes.

ymphocytes are among the components produced by H0-, and thus the field of hematology also includes in it the studies of reticuloendothelial system and lymph nodes.@o indi!idual organ can be specifically linked to hematology disordersG the problems couldmanifest themsel!es at the bone marrows, lymphatic organs, intra!ascular compartmentswhere the red blood cells circulate, or endothelial cells along the blood !essels and theproteins in the plasma component.

0ub theme %eneral 5ncology is the discipline that studies the general aspect of tumor Jmalignancy J cancer describe epidemiology, cancer pre!ention, therapy of cancer rehabilitation patient with cancer.

;t the end of this program, medical students are expected to3*. 'nderstand medical doctorDs approaches toward anemia and se!eral erythrocytes

disorders.2. e able to e!aluate complete blood check >complete hematology check?

. 'nderstand how to design screening tests to detect bleeding disorders.

e able to apply them to appropriately classify the patients with cellular or protein damagerelated to bleeding.

*. 0tudy clinical profiles, proteins, and genetic factors instrumental in the process of thrombosis.

2. -apable to identify the patient with hematological disorders who should bereferred to the hematological expert for further assessmentsP

Lea nin% ta'#*. earn how to understand what is hematologyQ2. How to e!aluate lood -elluler (unctionQ

. $hat is the physical stage of bloodQ/. #xplain what are the hematology disordersQ

Se"+ a''e''(ent*. 'nderstand what is hematology consisting of.2. 'nderstand the physical stage of blood as well as cellular element of the blood.

'dayana 'ni!ersity (aculty of )edicine, )#' *:


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Lecture 2.Introduction of HematologicSystem and Disorders and General

Oncology

Sub topic : Introduction of ClinicalOncology

Dr. Wayan Sudarsa, Sp On!

La&o ato 5ict) e o+ 5atient $it &"oo! ce""' !i'o !e


. 'nderstand in general hematology disorders.

A&'t act5ncology is a study of -ancer. -ancer arises from a series of genetic alterations thatpromote self sufficiency in growth, escape from cell cycle exit, resistance to apoptosis,cellular immortaliEation, and ultimately the acquisition of properties that facilitateangiogenesis, in!asion, and metastasis.

The scope of 5ncology are basic sciences of oncology and clinical oncology. asicscience of oncology are mainly consist of molecular biology and immunology. -linical5ncology is a multidisciplinary area of medicine, which means that se!eral medicaldisciplines are in!ol!ed in the pre!ention, screening and early detection of people with riskof cancer, and diagnosis, staging and treatment of indi!idual patients with cancer as well

Lea nin% Ta'#*. ;t the le!el of molecular biology point of !iew, what is the definition of

-ancerQ

2. $ould you elaborate what are the causes of -ancerQ. -an you define the ten most common cancer that affected of the human bodyaccording of %lobal -ancer 0tatistics Q >www.I;8-.org?./. 5n your opinion, is cancer can be pre!entedQ

DA0 2 7Be!ne'!a < Se5t 1= t 2=149

dr. 0ianny Herawati, 0p. =

The differential diagnosis of anemia is broad. The likely cause of anemia in an indi!idualpatient can be narrowed by systematic e!aluation. -ritical information includesmeasurements of the erythropoietic response and measurement of8 - siEe. These datapro!ide a framework that guides the selection of more specific studies to establishunderlying diagnosis.The complete blood count >- - is a laboratory report of the cellular elements of the blood.- - is now routinely performed with an automated instrument.0e!en !alues relating to 8 - are reported in - -, including Hb, 8 - count, )-A, )-H,)-H- and 84$.

Hb is direct measure ofthe concentration of Hb in grams per deciliter.



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Lecture 1. HematopoesisSub topic : Leukopoesis


Hct is the !olume 8 -s expressed as a percentage of whole blood!olume. 8 - count is direct measure of the numher of8 -)-A is direct measure of mean 8 - !olume in femtoliters >fl?)-H is calculated by di!iding the Hb by the 8 - count and isexpressed in picograms >pg?

)-H- is !alue calculated by di!iding the Hb by the Hct and isexpressed in grams per deciliter.84$ is a statistical !alue describing the coefficient of !ariation ofthe)-A

The way to measure erythropoietic response is doing the reticulocyte count. 8eticulocytecount pro!ides a rapid method to differentiate between anemia due to defecti!e productionof 8 - and anemia due to decrease sur!i!al of 8 -s from bleeding or hemolysis

Lea nin% Ta'#*. 4escribe preanalytical factors in hematology testP2. 4escribe laboratory examination should be done in hematology disorderP

. #xplain about complete blood count interpretationP

Se"+ a''e''(ent*. 4escribe source of biologic !ariation in hematology testP2. #xplain about the parameter in complete blood count examinationP

. #xplain about reticulocyte count and interpretation of the resultP/. 4escribe interpretation of blood smear e!aluationP

DA0 3 7T ) '!a < Se5t 11 t 2=149

dr. I $ayan 0ugiritama, ).=es

eukopoiesis is the process by which white blood cells form and de!elop. eukopoiesisresult in the formation of cells belonging to the % an)"oc te and a% an)"oc te series.G an)"oc te includes neutrophil, basophil and eosinophil, whereas A% an)"oc te' includelymphocytes and monocytes.

%ranulocytopoiesisEo'ino5 i"< a'o5 i" an! Ne)t o5 i" are deri!e from unipotential stem cell ,respecti!ely,CFU@Eo< CFU@ a, and CFU@G. #ach of these stem cells is descendant of pluripotentialstem cell CFU@S. Thus, CFU@Eo< CFU@ a and CFU@G undergo mitosis gi!ing rise to( o&"a't' . M o&"a't undergo mitosis gi!ing rise to 5 o( e"oc te' , which in turn di!ide toform ( e"oc te' . 5n this step the specific granules are present and three granulocyte linesmay be recogniEed. The subsequent stage of maturation is (eta( "oc te then to thegranulocyte with a band7shaped nucleus, and finally to the mature granulocyte > ne)t o5 i"<eo'ino5 i"< an! &a'o5 i" ?.

)onocytopoiesis

'dayana 'ni!ersity (aculty of )edicine, )#' 2*


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Lecture 2. HematopoesisSub topic: !rombopoesis


Monoc te is deri!e from the bipotential stem cell, CFU@GM, whose undergoes mitosis andgi!es rise to two unipotential stem cells, CFU@G and CFU@M >(ono&"a't' ?. The next stageof maturation is 5 o(onoc te' and finally to the mature (onoc te . #!ery day, thea!erage adult forms more than *< *< monocytes, most of which enter the circulation. $ithin aday or two, the newly formed monocytes enter the connecti!e tissue spaces of the body anddifferentiate into (ac o5 a%e' .

ymphopoiesisThe multipotential stem cell CFU@L di!ides in the bone marrow to form the two unipotentialprogenitor cells, CFU@L and CFU@L T, neither of which is immunocompetent. CFU@Lmigrates to a &) 'a@e )i8a"ent "ocation in the bone marrow, di!ides se!eral times andgi!ing rise to immunocompetent lymphocytes. CFU@" T cells undergo mitosis, formingimmunocompetent T cells, which tra!el to the co te? o+ t ()' . 5n thymus -('7lyTproliferate, mature and begin to express cell surface markers. ;s these surface markersappear on T7cell plasmalemma, the cell become immunocompetent T " (5 oc te' .

Lea nin% Ta'#'

*. #xplain the classification, structure and function of leucocyte P2. #xplain the formation of the leucocytesP. #xplain the regulation of the leucocytes formationP

/. #xplain the maturation of lymphocyteP. 4iscuss in your group the definition, sign and symptom, causes, diagnosis and

treatment of the a% an)"o'ito'i' P1. 4iscuss in your group the abnormality of leucocyte formationP

Se"+ A''e''(ent *. 4escribe the structure of the leucocytes P2. 4escribe the %ranulocytopoiesis, )onocytopoiesis, and ymphopoiesis P

dr. 0ianny Herawati, 0p. =

Lea nin% Ta'#*. 4escribe about trombopoiesis

2. 4escribe about the mechanism of platelet release.. 4escribe about thrombocyte maturation

/. 4escribe regulation of trombopoiesis

Se"+ a''e''(ent*. #xplain the characteristics of the thrombocyte2. #xplain about thrombopoietin

. #xplain the ultrastructural of thrombocyte/. #xplain the characteristics of megakaryocyte

. #xplain role of the spleen in platelet production.1. #xplain platelet life span and turno!er of platelet

DA0 4 7F i!a < Se5t 12 t 2=14



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Lecture 1. HematopoesisSub topic : "ryt!ropoesis

Lecture 2. HematopoesisSub topic : Synt!esis of !emoglobin# function of

blood and blood cells metabolismrof. dr. @yoman ;gus agiada,0p iok


dr. @I =adek )ulyantari, 0p. =>=?

A STRACT'nder physiologic condition, the red7cell mass is maintained in equilibrium by appropriatead"ustments of red7cell production. The erythropoiesis results from the action of erythropoietin on colony7forming unit Kerythroid >-('e?. #rythropoietin is produce by theaction of renal erythropoietic factor >8#(?, which is deri!ed from the kidneys under thesecondary influence of hypoxic condition.In !i!o, the mature erythrocyte is a biconca!e disk with a surfact7to7!olume ratio thatenables optimal gaseous interchange. The cells also is deformed easily and, consequently,can pass through small !essels and capillary without rupture.The re7cells membrane is composed of matrix formed from a double layer of phospholipids.The main fuction of red7cells membrane are to maintain cell7shape deformability for osmoticbalance between plasma and cell cytoplasm, to help in the tranfostation of essential cellular ions and gases.)aturation entails changes in the nucleus and the cytoplasm of cells. ;s maturationprogress, the nuclei became smaller, and their structure becomes denser and more coarse.@ormal red7cell maturation 3 ronormoblast >rubriblast?7 asophilic normoblast K

olychromatic normoblast K 5rthochromatic normoblast Kreticulocyte K mature erythrocyte.The a!erage life of a red cell approximates *2< days, and fewer than 2 F of the circulatingcells are newly produce and released from the bone marrowas reticulocytes.

Lea nin% Ta'#' *. #xplain the erythropoesis process and normal red7cell maturationP2. $hat is the erythrocyte functionQ

. )ention the nutritional requirement of erythropoesis process P/. In normal condition, what kind of erythrocytes series can we find in peripheral blood

and in bone marrowQ. 4escribe the structure of erythrocyte if lack of this nutrient 3 !itamin *2 and iron

during the erythrocytopoesisP Se"+ A''e'(ent

*. 'nderstand the erythropoesis process and normal red7cell maturation.

2. 'nderstand the erythrocyte function. 'nderstand about the factors that influence of erythropoesis process



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Ca'e 1.$omen patient years old, !isiting her family physician complaining tired and feeling weakafter deli!ery one week ago. The baby weight / kg. 0he got stitches on perineum.

hysical examination showed that the heart rate *Hb?

concentration. The normal range for Hb is established by measuring the !alues from alarge sample of healthy indi!iduals and !aries as a function of age and gender*. )ales and females ha!e equi!alent Hb !alues until puberty.

'dayana 'ni!ersity (aculty of )edicine, )#' 2/

Lecture 1. $nemiaSub topic : %at!op!ysiologi and &lassi'cation

of anemiaDr. "etut #ria$ati, Sp# %"


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2. The increase in Hb that occurs in men is largely attributed to the effect of an! o%en' on the release of erythropoietin ># 5? and the responsi!eness of redblood cell >8 -? precursors to # 5.

. The gender disparity in the normal range for Hb concentration is less significant inelderly indi!iduals.

. ;nemia is defined as Hb concentration more than to standard de!iations below thenormal range for age and gender. 'sing this definition, there is less than a F chancethat a Hb concentration below the normal range is a RnormalS !alue for the indi!idual.$orldwide, almost one7third of the population is anemic.

The first step in diagnosis of anemia is to establish whether the abnormality is isolated to asingle cell line >red blood cells only? or whether it is part of a multiple cell line abnormality>red cells, white cells and platelets?. ;bnormalities of to or three cell lines usually indicateone of the following 3

• bone marrow in!ol!ement, >e.g., aplastic anemia, leukemia?, or • an immunologic disorder >e.g., connecti!e tissue disease or immunoneutropenia,

idiopathic thrombocytopenic purpura IT or immune hemolytic anemia singly or incombination? or

• sequestration of cells >e.g., hypersplenism?.

The blood smear is !ery helpful in the diagnosis of anemia. It establishes whether theanemia is hypochromic, microcytic, normocytic, macrocytic or show speEcific morphologicabnormalities suggesti!e of red cell membrane disorders >e.g., spherocytes, stomatocytosisor elliptocytosis? or hemoglobinopathies >e.g., sickle cell disease, thalassemia?.The mean corpuscular !olume >)-A? confirms the findings on the smear with reference tothe red cell siEe, e.g., microcytic > 6< fl?, macrocytic >U9 fl? or normocytic >6276: fl?. Themean corpuscular hemoglobin >)-H? and mean corpuscular hemoglobin concentration>)-H-? are calculated !alues and generally of less diagnostic.

Lea nin% ta'#atient of 2 years, girl with pale since 2 month ago, without fe!er and bleeding. Hemoglobin

le!el is 1 gJd , )-A is 19 fl. ;nswer the following question 3

*. 4iscuss what are steps you can perform on this patient >anamnesis, physicalexamination, other laboratorium?.

2. $hat the differential diagnosis of this patient Q

Se"+ A''e''(ent

a. 4efined of anemia Pb. 4escribe the classification of anemia based on etiologi Pc. $hat is the differential diagnosis of patients microcytic anemia Qd. $hat is the differential diagnosis of patients normocytic anemia Qe. %i!e the differential diagnosis of macrocytic anemia Pf. 4escribe of historical factors of importance in e!aluating patients with anemia



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(utritional $nemia !e diagnostic of iron de'ciency anemia

4r.dr. =etut 0uega, 0p 47=H5)

(utritional $nemiaSub topic General Information Nutritional AnemiaSub topic Patofisiology of Iron Deficiency Anemia


Lea nin% ta'#*. $hat is definition of polisitemiaQ2. #xplain the pathophysiology of polisitemiaQ

. )ention the sign and symptom of polisitemiaP/. $hat are laboratory finding in polisitemiaQ

DA0 , 7T)e'!a < Se5t 1, t 2=149

4r.dr. =etut 0uega, 0p 4 =H5)

Lea nin% ta'#

; 1 years old male, come with chief complain palpitation and feel !ery weak. 0e!eral daysago, he frequently had his stool with black color. He also suffered from nausea, !omiting,and pain on epigastrial. aboratory findings are 3 Hb 6,1 grJdl, )-A 62 fl, )-H 2 pg ,)-H- 29F, 0I < ngJdl, TI - 2 ngJ 4l. hysical examination found with angular cheilitis, li!er and spleen without any abnormality.

1. $hat is the type of anemia the patient suffered fromQ2. #xplain how is the patomechanism of the case abo!eP

Se"+ A'e''(ent*. 'nderstand the iron metabolism in the body2. 'nderstand the absorbtion of the iron in the body

. 'nderstand the function and cycle of iron in the body

DA0 - 7Be!ne'!a < Se5t 1- t 2=149


Lect) e 2. POLISITEMIA

dr. T"okorda %de 4harmayuda, 0p 4 =H5)


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(utritional $nemiaSub topic %at!op!ysiology and management diagnostic of

folic acidand )12 de'ciency anemia

Sub topic !e diagnostic of folic acid and )12 de'ciencyanemia

4r. @i )ade 8enny ;nggreni 8ena, 0p 4


Lea nin% Ta'# ; 1 years old male, come with chief complain palpitation and feel !ery weak. 0e!eral daysago, he frequently had his stool with black color. He also suffered from nausea, !omiting,and pain on epigastrial. aboratory findings are 3 Hb 6,1 grJdl, )-A 62 fl, )-H 2 pg ,)-H- 29F, 0I < ngJdl, TI - 2 ngJ 4l. hysical examination found with angular cheilitis, li!er and spleen without any abnormality.

*. $hat are the supporting examinations needed to confirm the dignosis abo!eQ2. #xplain the blood smear and bone marrow examinations finding will found at the

patient abo!eP. $hat is the other possibility diagnosis of the caseQ #xplain your answerP

/. $hat are the possible etiology caused the anemic condition of the caseQ

Se"+ A'e''(ent*. 'nderstand clinical manifestation of I4;2. 'nderstand the way to make diagnosis of I4;

. 'nderstand how to pre!ent the I4;

DA0 6 7T ) '!a < Se5t 16 t 2=149

A STRACT

The macrocytic anemias are a morphological classification of anemias that ha!e an)-A of greater than *


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$cute LeukemiaSubtopic $*L# $LL


The megaloblastic anemias show striking similarities in their clinical andhematological presentations. 0e!eral tests are used to confirmed the diagnostic of *2 or folic acid deficiency anemia. They include serum *2, folic acid, or red cell folatedetermination by radioimmunoassay.

Lea nin% Ta'#*. How is the metabolism of *2 and folic acid in the bodyQ2. #xplain the possible etiology of *2 and folic acid deficiency anemiaP

. #xplain the way of diagnostic *2 and folic acid deficiency anemiaP

Se"+ A''e''(ent*. 'nderstand the metabolism of *2 and folic acid in the body.2. )ention the etiology of *2 and folic acid deficiency anemia.

. )ention the clinical presentation of *2 and folic acid deficiency anemia./. 'nderstand the laboratorium examinations that supporting thr diagnostic of *2 and

folic acid deficiency anemia.

DA0 7F i!a < Se5t 1 t 2=149

dr. osen ;dnyana, 0p 4 =H5)dr. ;; $idnyana, 0p;

A&'t act ;cute leukemia is defined as the malignant accumulation of transformed hematopoieticprogenitor cells. eukemic blast cells retain the capability of self renewal, but unlike normalhematopoietic stem cells >H0-s?, they ha!e limited or no potential for terminaldifferentiation. eukemic infiltration of the marrow space ultimately leads to bone marrowfailure, so most patient present with consequences of cytopenias. The acute leukemias canbe classified by morphology, histochemical staining, and immunophenotype into two broadcategory 3 acute myelocytic leukemia >;) ? and acute lymphocytic leukemia >; ?. Thedistinction between the two acute leukemias in clinically important because the treatmentsand prognoses are different.

Lea nin% Ta'#

=adek, six years old girl came to pediatric emergency at 0anglah Hospital with cheapcomplaint pale, hematoma at femur, gum bleeding, limfadenopati and hepatosplenomegali.4octors at hospital do examination - -.

ab data 3 #rythrocyte and hemoglobin count are below normal eucocyte total count 9 x *< : J eucocyte distribution on differential count is as follows

last form 91 Frolymphocyte Fymphocyte : F

latelet count is !ery low

An'$e t e +o""o$in% )e'tion'*. $hat diagnosis is most likely for this case Q



29/49

Lect) e 1. N)t itiona" Ane(iaS)& to5ic Mana%e(ent t e a5 o+ i on !e+icienc <

S)& to5ic Mana%e(ent t e a5 o+ Fo"ic aci! an! Vit 12 De+icienc4r. dr. agus =omang 0atriyasa, ).8epro

4rs. I )ade ;dioka , ;pt, ).0i

$plastic $nemia + $nemia of &!ronicDiseases


2. $hat additional test can be performed Q. $hat is the prognosis of the case Q

Se"+ A''e''(ent*. $hat are the symptoms and sign of acute leukemia Q2. 4o you know the general classification for leukemia Q

. $hen would it be suitable to forward a leukemia patientQ

Lea nin% Ta'#1. How do you define malignant hematologyQ2. @ame the types of malignant hematology3. $hat are the prognostic factors for acute myeloblastic leukemiaQ4. 5utline the classification for acute myeloblastic leukemia5. #xplain the principles for treating acute myeloblastic leukemia.

How would you educate an acute myeloblastic leukemia patientQ

DA0 1= 7Mon!a < Se5t 22t

2=149

Lea nin% ta'#* 4escribe the normal mechanism of regulation of iron absorption in the body

2. 4escribe the normal mechanism of regulation of iron storage in the body. 4escribe the acute and chronic toxicity of iron/. 0ketch and explain the enEymatic reaction that use folates

. 4escribe the clinical applications of !itamin *2 and folic acid

Se"+ a''e''(ent*. #xplain role of iron in the body2. 4escribe the clinical applications of iron

. $hey iron should not gi!en in hemolytic anemiaQ/. #xplain role of !itamin *2 and folic acid in the body

DA0 11 7T)e'!a < Se5t 23 t < 2=149

'dayana 'ni!ersity (aculty of )edicine, )#' 2:


30/49


dr. osen ;dnyana, 0p 4 =H5)

A5"a'tic Ane(iaA&'t act

;plastic anemia is one type of anemia with incidence worldwide is 2 to casesJmillionpopulation per year in industrial countries. -haracteriEed by pancytopenia and markedlyhypocelluler marrow. The pathogenesis underlying anemia aplastic could be an immunesuppression of marrow, toxic in"ury to stem and J or progenitor cells, and inherited instrinsicstem cell defect. -linical features of aplastic anemia shown anemic syndrome, bleeding or infection as a consequences of cytopenias. 0upporting examination recommended arecomplete blood count, and bone marrow aspiration.

Lea nin% Ta'#*. ; 2 years old woman gi!es a month history of progressi!ely increasing tiredness

with bruising, malaise and menorrhagia. 5n examination she is anemic and hasmultiple bruises. ; full blood count shows H% 1.: gJd , $ - *.* x *< : Jl >;@-


31/49

%latelet function and disorderSub topic trombositosis

Sub topic trombositopenia48 4r =etut 0uega,0p 47=H5)

4r @i )ade 8enny ;nggreni 8ena,0p 4


six months. hysical examination3 lood pressure **


32/49

HemostasisSub topic %rinciple of !emostasis

Sub topic DI $%S48 4r =etut 0uega,0p 47=H5)



2. 'nderstand the etiology of thrombocytopenia.. 4escribe the clinical manifestation and how to confirm diagnosis and to treat IT .

DA0 13 7T ) '!a < Se5< 2*t

2=14""""""9

A STRACT

-ellular systems and biochemical processes related to the bleeding pre!ention or blood coagulation mechanism of humans are !ery complex. The syntheses of the influentialcomponents >proteins, cells and blood !essels? constantly interact in balance so as to makesure that neither bleeding nor coagulation happen within the blood !essels throughout life.

In this opportunity we will discuss approaches to patients with bleeding and thosewith abnormal blood coagulation as well as se!eral situations that may happen to thepatient as the result of the process disorders.

Lea nin% Ta'#

*. earn how to make diagnosis and treat 4I- patientCa'e St)!

; patient with decrease of consciousness after had snake bite. He got hematome in thebitten area and abdomen. He also had red color of urine.

*. #xplain what are clinical features supporting 4I- on that caseP2. $hat kinds of laboratory test are needed for the diagnosisQ

. How to manage this patientQ #xplain your answerP/. $hat is -onsumpti!e coagulopathyQ #xplain your answerP

Se"+ A''e''(ent*. 'nderstand the principle of hemostasis2. 4escribe the possible etiology, clinical features, laboratory findings of 4I-

. )ention the clinical features, laboratory findings of ; 0

DA0 14 7F i!a < Se5 2, t 2=149



33/49

Lecture 1. Hemo'lia

4r ;; $idnyana,0p;

*alignan Lymp!oma and Diagnostic %at!ology

Lecture 2. ,on -illebrand s disease



Lea nin% Ta'#ayu, ; se!en years old man came to the pediatric emergrncy at 0anglah Hospital with

hematoma at hand and femur with diameter 6 cm x cm , / cm x / cm. Hematomadisappear after trauma four days ago. $hat do you do to diagnosis the patiens Q> anamnesis, physical examination, laboratory e!aluation ?

Se"+ A''e''(ent*. How the patterns of clinical bleeding in disorders of hemostasis > primary hemostasis

and secondary hemostasis ? Q2. $hat the bleeding manifestation in hemophilia Q

. -lassify hemophilia ; and according to the degree of se!erity Q

A STRACTAon $illebrandDs 4isease >A$4? is a bleeding disorder inherited in an autosomal

dominant, characteriEed by an abnormal platelet adhesion with or without a low factor AIIIacti!ity. A$( promotes platelet adhesion and is also the carrier for factor AIII, protecting thelatter from premature destruction. This explains the combination of defecti!e plateletadhesion and reduced le!els of factor AIII. There are !aries of A$4, from mild to se!eretype. 0e!eral supporting examinations needed to confirmed the diagnostic of A$4.

Lea nin% Ta'#*. earn how the pathophysiology of A$4.2. How is the clinical manifestation and type of A$4Q

. $hat are the laboratory e!aluation needed as a diagnostic tools for A$4Q

Se"+ A''e''(ent

*. 4escribe the pathophysiology and classification of !on $illebrand diseaseP2. 4escribe the bleeding manifestation in !on $illebrand diaseaseP

. 'nderstand the laboratory examination support the A$4.

DA0 1* 7Mon!a < Se5 2 t 2=149



34/49

Lect) e 1. He(o" tic Ane(ia

S)& to5ic Con%enita" e(o" tic ane(ia< e(o%"o&ino5ati


! . T:o#o !a G!e D a (a )!a< S5PD HOMdr. @i utu #kawati,).8epro, 0p.;

Lea nin% Ta'#

Ca'e

;n 97year7old female with lymph node enlargement of right neck region. The nodes areconfluent, without tenderness or redness of the skin abo!e the nodes. There are also fe!er,weight loss, pruritus and pain. -omplete blood test results are within normal limit. -hest x7ray shows enlargement of mediastinal nodes.

;nswer the following questions31. $hat diagnosis is most possible for this caseQ2. $hat additional test can be performed to support the diagnosisQ3. $hat is the prognosis of the caseQ

Se"+ a''e''(ent

*. )ention the base of classification of lymphoid malignancies and what are thepurposes of the classification

2. $hy Hodgkin lymphoma is a distinct entity. )ention the clinical differences between H and @H

/. )ention the ;nn ;rbor staging system of ymphoma. )ention the grouping lymphomas by clinical beha!ior

DA0 1, 7 T)e'!a < Se5t 3= t 2=149

4r. =etut ;riawati, 0p;>=?

A&'t act-ongenital hemolytic anemias result from mutations that quantitati!ely or qualitati!elyinfluence the function of red !lood cell proteins. These mutations can be broadly groupedinto three categories 3 membrane defects, enEymatic defects, and hemoglobin defects.$hile many mutations ha!e been described in each category, only a small number arecommonly encountered in clinical practice.-linical findings and specialiEed laboratory studies are often required to precisely define theunderlying disease process. This general approach is true especially in the case of congenital hemolyitic anemias 3In all patients with hemolytic anemia, a careful history and physical examination areimportant.

*. The history should explore the chronicity of the problem, ethnic and racial

background, family history, underlying or associated medical conditions, and newmedications.

'dayana 'ni!ersity (aculty of )edicine, )#' /


35/49

Lect) e 2. He(o" tic Ane(ia

S)& to5ic Ac )i e! e(o" tic ane(ia

dr. T"okorda %de 4harmayuda, 0p 4 =H5)


2. Baundice is a common finding. 0plenomegaly may also be associated with a wide!ariety of hemolytic disorders.

Aarious "a&o ato a&no (a"itie' are associated with hemolysis.*. ;n ele!ated reticulocyte index is typical , consistent with a compensatory bone

marrow response to anemia. one marrow examination is not necessary for mostpatients.2. Increased lactate dehydrogenase, unco"ugted bilirubin, and depressed or absent

haptoglobin are also obser!ed with hemolysis.. The red blood cell >8 -? morphology is frequently abnormal and pro!ides an

important clue to the underlying disease process./. The peripheral blood smear is rarely pathognomic.

Lea nin% ta'#atients of 2 years, male with pale since 2 month ago, not history of bleeding, and fe!er.

The abdominal became more bigger since * months. History of transfusion X six month agobecause pale. Hemoglobin le!el is gJd , )-A is 19 fl, reticulocyte is F.

;nswer the following questions 3*. $ould you like to explain what kind the abnormalities in patient abo!e.2. $hat the laboratorium test you need to confirm this disease Q

. $hat the differential diagnosis in patient abo!e Q

Se"+ a''e''(ent*. 4escribe classification of congenital hemolytic anemia.2. #xplain clinical presentation and laboratory e!aluation of congenital hemolytic

anemias

. #xplain the principle management of congenital hemolytic anemias

A&'t act

Hemolytic anemias result from a shortened red blood cells >8 -? sur!i!al rate as aresult of an increased rate of 8 - destruction. Hemolytic disorders are generally limited toconditions in which the rate of 8 - destruction is increased while the ability of the bonemarrow to respond to the anemia remains intact. one marrow can increase its productionrate 179 times normalG therefore, hemolytic disordes can be present in the absence of anemia. $hen bone marrow erythropoesis cannoyt keep up with the shortened length of 8 - sur!i!al, hemolytic anemia result.

Lea nin% Ta'# *. Coung female come with complain of yellowish eyes, feeling weak and diEEy since

around days before admitted to hospital. 5n physical examination found icteric oneyes, and pale on hand and foot. atient without history of bleeding before.



36/49

)lood transfusion and)lood banking

D . Ni a!e# M)" anta i< S5.P 7 9


aboratory results H% 9. mgJd , eukosit :


37/49

Lecture 1. *ultiple myeloma4r. osen ;dnyana, 0p 4 =H5)


2. If you work in the lood ank, what will you doQ. If you know that the patientDs blood type was ; 8h positif and the ; blood is empty

in the lood ank, what will you doQ/. $hat is your ad!ice to the clinicianQ

. Two day latter the patient need some more blood and in the lood ank the ;blood type was allready a!ailable. If you are clinician what is your decision use the

; blood or still asking the same blood type as beforeQ %i!e your explanationP

DA0 16 7T ) '!a < Oct 2 n! 2=149

)ultiple meyloma is characteriEed by the proliferation and accumulation of clonal plasmacells. The presence of somatic mutations in the complementarity determining regions >theantigen7binding portion? of the clonal immunoglobulin indicates the transforming e!entoccurred in a postgerminal center cell or a plasma cell itself.The commonest chromosomal abnormality in!ol!es the hea!y chain locus on chromosome*/, but there is no single cytogenetic abnormality that is characteristic of the disease.-hromosome * abnormalities are also common and are associated with poor prognosis.

;t the gene7expression le!el, monoclonal gammopathy of unknown significance >)%'0?cannot be distinguished from multiple myeloma. Howe!er, normal plasma cells can beclearly distinguished from plasma cells of both )%'0 and myeloma. The clinical features of the disease result from bene marrow infiltration by the malignant clone, secretion of osteoclast7acti!ating factors and cytokines, high le!els of circulating immunoglobulin andJor free light chains, and depressed immunity.The most common presenting symptom is bone pain, present in 1H0-T? as compared with con!entional chemotherapy, and newer agentssuch as thalidomide and borteEemib are effecti!e in a significant percentage of patients withthis relapsed or refractory disease. The management of myeloma has become morecomplicated with this expanding set of therapeutic alternati!es, but the lack of o!erlappingtoxicities means that many patients e!en with ad!anced disease can be managed

effecti!ely as outpatients with reasonable quality of life. 0ur!i!al from diagnosis hasincreased significantly o!er the past decade, particularly in patients under age 1


38/49

Lecture 2. *DS# Langer!ans cell tumor

dr. osen ;dnyana,0p 4


-ase(emale 16 years old come with pain on !ertebra since 2 years ago and she also complainabout body weakness and diEEiness. yshical examination *


39/49

Lecture 1. &!ronic LeukemiaSubtopic &LL# &*L


marking therapies on one type of )40 less optimal than the others. %i!en lack of precisepathophysiologic understanding of more than few )40 subtypes, designing truly targetedtherapies is impossible.

(emale, 1 years old came with body weakness and headache. yshical examination **


40/49


1. 4escribe the clinical presentation of -2. 4escribe the hematology manifestation of -3. )ention how to diagnose -

CMLA&'t act-) is a hematopoietic malignancy originating from transformation of primiti!ehematopoietic cell. -) progresses from an initial chronic phase characteriEed by marrowhyperplasia and increased numbers of circulating differentiated myeloid cells followed byad!anced phases of disease >accelerated phase and blast crisis? marked by block indifferentiation, accumulation of blasts and depletion of normal hematopoietic cells,especially white blood cell and platelets.

#xposure to high7dose ioniEing radiation increases the incidence of -) with amode of increased incidence that ranges / to ** year in different exposed population.-hemical agents, including cytotoxic drugs ha!e not been established as a couse.

-) is the result of an acquired genetic abnormality that induces a malignant

transformation of single pluripoten lymphohematopoietic cell. -) is generally belie!ed tode!elop from transformation of primiti!e hematopoietic stem cell by the -87; fusiongen. The -87; gen that characteriEes -) results from a chromosomal translocationthat results in the fusion of the ; gene on chromosome : and the -8 gene fromchromosome 22.

;pproximately


41/49

"pidemiology and screening of cancer


DA0 2= 7Mon!a < Oct , t 2=149

! . Ba an S)!a 'a< S5 On#

A&'t act-ancer is a ma"or public health problem in the de!eloped countries. -urrently, cancer is thesecond leading of death after cardio!ascular disease. $H5 ha!e had established priorityprogram for cancer control. 5ne of these priority program is -ancer screening, whether there is a indi!idual or mass screening program.

0creening test is performed on asymptomatic indi!idual to determine that cancer might be present and that further e!aluation is necessary. )any tests ha!e both screeningand diagnostic uses, and it is only the context in which these are used that determineswhether they are screening or diagnostic. ; screening test is done on indi!iduals whorecei!e the test principally because they are of the age or sex at risk for the cancer. ;diagnostic test is done on an indi!idual because of clinical suspicion of disease. 0creeningmust find disease earlier and lead to an efficacious treatment, so earlier use of theefficacious treatment must offer better outcome.

The ultimate purpose of cancer screening is to reduce mortality. Howe!er, there arese!eral biases of cancer screening program that can suggest benefit to e!en the mostastute clinician when there is none. These biases are selection, lead7time, and length bias.

E5i!e(io"o% o+ Cance Lea nin% ta'#

a. #xplain the main purpose of studying -ancer #pidemiology

b. #xplain what you know about -ancer incidence rate, -ancer mortality rate, 8elati!e8isks and 5dds 8atio of cancerc. #xplain why globally, cancer incidents tend to increase.d. @ame fi!e types of cancer most common in the world for men and womene. based on incidence rate.f. @ame the highest cancer mortality rate in the world for men and women.g. @ame and explain the cancer etiology factorsh. @ame and explain the types of epidemiology studies intended to find out about

cancer etiology.

Cance Sc eeni% an! Ea " DetectionLea nin% ta'#

#xplain what you know about -ancer 0creeninga. #xplain what is meant by rimary, 0econdary, and Tertiary -ancer re!entionsb. $hat is the main purpose of performing screening for cancerQc. $hat conditions are imperati!e to perform an effecti!e cancer screening programQd. #xplain what is meant by -ritical point, ead Time ias, and ength time bias .e. In cancer screenmgf. #xplain about ap Test as the screening test for -er!ical -ancerg. #xplain about )ammography as the screening test for reast -ancerh. #xplain about screening program for -olorectal -ancer.i. #xplain about screening program for rostate -ancer

". #xplain the relationship between smoking and ung -ancerk. #xplain the relationship between breast cancer and colorectall. #xplain the relationship between H A infection and cer!ical uterine cancer.m. #xplain about (amilial reast -ancer and (amilial -olorectal -ancer

'dayana 'ni!ersity (aculty of )edicine, )#' /*


42/49

Lecture 1. *olecular )iology and immunology ofcancer

Lecture 1. *anagement diagnostic# t!erapy and referal

cancer patient


n. $hat is meant by -hemopre!ention on -ancer, and name some examples.

Se"+ A''e''(ent

a. 0creening for the cancers below ha!e !ery strong e!idence based, except3b. )ammography to screen for breast cancer on women abo!e 8efer To3 4e Aita3 -ancer. rinciples ;nd ractice 5f 5ncology 2


43/49


A&'t act-ancer is often considered to be a difficult and complex field of medicine. -ancer

encompasses o!er one hundred different malignant diseases, each of which may present inan early or late stage, and with different tumor characteristics. )ost of the patient may comeat the first of his or her !isit to the hospital with late stage of disease. 5!er *. millionindi!iduals in the 'nited 0tate are diagnosed with in!asi!e cancer each year. -urrently, * in/ deaths in 'nited 0tate is due to cancer rank second only to heart disease as the leadingcause of mortality.

In generally, there are two important classification of tumors, first is solid tumor andsecond is non7solid tumor. This simple classification according to the implementation of treatment. 0olid tumors mostly be treated by surgery and non solid tumors be treated bymedical. -linical diagnosis of tumor whether malignant or benign is confirmed by !ariousways. The procedure of diagnosis is started from anamneses, physical in!estigation and

followed by imaging and histopathology examination. ;namnesis based on se!en sacred or fundamental four procedures. The right anamnesis and physical examination may lead tothe right management on cancer patient. There are six basic cancer patient managementinclude >*? -linical diagnosis completion, >2? 0taging establishment, > ? erformance statusdetermination, >/? lanning therapy, > ? Therapy implementation >1? (ollow up.

-ytology and or histo7pathology in!estigation is one important in!estigation toconfirm diagnosis of neoplasm. ; tissue diagnosis is critical to the care of all cancer patients. 4epending on the type of tumor and its location, the method of biopsy will !ary.-ommon diagnostic techniques use included needle aspiration biopsy, core needle biopsy,incisional biopsy and excisional biopsy. -linical diagnosis of cancer patient is !eryimportant be confirmed quickly. In oncology management no treatment may apply for anyindi!idual patient with cancer before diagnosis confirmed. There are many crucial questionsin focused for diagnosis and treatment of cancer patients such as3

*. $hen do I ha!e to be on the alert for a malignant diseaseQ2. $hat can I seeQ

. How do I ha!e to examine the patientQ/. $hich rele!ant in!estigations are requiredQ

. $hat are the doDs and donDtsQ1. $hat should be my pattern of referralQ6. $hat is going to happen to the patient and whyQ9. How to take care of the patient at homeQ

5ncology is a multidisciplinary area of medicine, which means that se!eral medicaldisciplines are in!ol!ed in the diagnosis, staging and treatment of indi!idual patients withcancer. This multidisciplinary approach is reflected in cancer education. ;n 5ncology teamusually includes a 0urgeon, a athologist, a 8adiotherapist, and an internist-hemotherapist, anesthesiologist as well. 0urgery is still as the first modality therapy onsolid cancer. 5thers modalities therapy are chemotherapy, radiotherapy, hormonal therapy,immunotherapy, targeting therapy. Treatment planning for the indi!idual patient with cancer depends on tumor factors, patient factors, and doctor factors. There are two goals intreatment of patient with cancer, one for curati!e intent and other for non curati!e intent.

Lea nin% ta'#

$omen, year old, with a huge tumor on the left breast. 0he comes to the hospital, whereyou are working. The photograft was shown as below.



44/49

Lecture 1. Diagnostic pat!ology# tumor markers andstaging of cancers


#;0# ;@0$#8 ;@4 4I0-'00 TH#0# O'#0TI5@0 ;0 # 5$

*. $hat are the principles of cancer patient management Q lease mention itP2. How should diagnosis be done in abo!e patientQ

. 4o you need imaging in!estigationQ lease explain of each imaging if neededP/. #xplain all things that you obser!e in physical in!estigationQ Is this breast tumor

malignant or benignQ lease gi!e the reasonP. 4o you need cytology or histopathology in!estigationQ lease mention itP1. How do you communicate to the patient, his family to explain what ha!e you found

and what will you plan to doQ6. $hat treatment should you suggest to performQ9. $hat is the goal of surgery to be expectedQ:. $hat alternati!e treatment do you suggest, if patient re"ect surgeryQ*


45/49

Lecture 2. Diagnostic imaging and strategy t!erapy ofcancer

D . E" 'anti D$i Ma ta!iani< S5Ra!


;bstract3

#!ery year the approach to laboratory diagnosis of cancer becomes more complex,more sophisticated and more specialiEed. Two con!entional methods used are cytologic andhistopathologic examination. The cytologic method is di!ided into exfoliati!e cytology >papsmear, urine, sputum, body fluid, etc.? and non exfoliati!e cytology >(@;?. $hilehistopathologic method requires sample from excision or biopsy of the lesion. y bothcytologic and histopathologic methods, the pathologists determine malignancymorphologically. )orphologic sign of malignancy is called anaplasia. -ytologic andhistopathologic diagnosis of cancer is, in most instances, not difficult. Hence they becomethe most widely used methods until recently. Howe!er, new techniques are being constantlyadded to the tools of the surgical pathologist, i.e. immunohistochemistry, flow cytometry andmolecular diagnosis.

Tumor markers are biochemical indicators of the presence of a tumor. They includecell surface antigens, cytoplasmic proteins, enEymes and hormones. In clinical practice,howe!er, the term usually refers to a molecule that can be detected in plasma or other bodyfluid. 0ome examples of tumor markers are -#;, ;( , 0;, etc.

rognosis of cancer disease depends on grading and staging. %rading of a cancer isbased on the degree of differentiation of the tumor cells and the number of mitoses withinthe tumor as presumes correlates of the neoplasm aggressi!eness. The staging of cancer isbased on the siEe of the primary lesion, its extent of spread to regional lymph nodes and thepresence or absence of blood borne metastases. The higher the grading and the staging of the tumor, the poorer is likely the prognosis.

Lea nin% ta'#

*. Two most widely used methods in pathologic diagnosis of cancer are cytology andhistopathology. 4ifferentiate their purposes and the way to collect and handle thesample to the laboratoryP

2. 4ifferentiate the pathologic sign of benign and malignant tumor >macroscopy andmicroscopy?P

. @ow day immunohistochemichal examination has been used in many cases of cancer in clinical setting. #xplain about their purposesP

/. #xplain about tumor marker and its examplesP. 4ifferentiate between grading and staging of cancerP #xplain it with examplesP

Se"+ a''e''(ent

*. y both cytologic and histopathologic methods, the pathologists determinemalignancy morphologically. )orphologic sign of malignancy is called anaplasia.#xplain about RanaplasiaSP

2. ; 1< year old man complains about right upper abdominal mass since * month ago.5n palpation, the mass shows irregular surface and hard consistency. Coususpected it as a malignancy of the li!er. $hat kind of tumor marker do you chooseto confirmQ

. ; malignant tumor, histopathologically consists of small round cell that can not bedistinguish whether it is a carcinoma, sarcoma or lymphoma. $hat examination doyou suggest for confirmationQ

/. #xplain about T@) staging systemP. ; breast cancer shows marked nuclear pleomorphia, few tubular formation and large

amount of mitosis. ;s conclusion, the tumor is in ad!anced stage. Is the conclusioncorrectQ #xplain it with reasonP



46/49

)asic &linical Skills /&linical %at!ology0


;bstract

The role of imaging in oncology include screening of the primary tumor, radiologicaldiagnostic of the primary tumor, e!aluate tumor extension and metastatic of the tumor radiologically >radiological staging?, treatment planning, and follow up >e!aluation of thetreatment result and detection of the recurrence tumor?. There are many kind of imagingmodality that can be use in oncology field. Those imaging modality including con!entionalradiography >plain or contrast study?, ultrasonography, computed tomography >-T? scan,magnetic resonance imaging >)8I?, also radioisotope scanningJ nuclear medicine. (or oncologic imaging manner, those imaging modality can be combine each other, depend onthe indication of each disease. $hile choosing imaging modality, we should be alwaysconsidered about indication, weakness and ad!antage of each imaging modality, so that theradiological examination will gi!e optimal benefit for the patient.

earning task*. ; 2 7years woman complained about ha!ing a mobile lump at her left breast since

one month ago.Ouestion 3

a. $hat the diagnosis possibility Qb. $hat kind of imaging examination that can be used for helping establish the

diagnosis Q

2. ; age U < year?, what kind of breast

cancer radiological screening that should be performed by this patientQ. ; young health man has a family history of colon cancer. $hat kind of imaging

examination that can be use for screening Q

0elf ;ssessment 3*. #xplain about the role of imaging in oncology.2. )ention about type of imaging modality for e!aluating malignancy process of the

bone, li!er, brain, spinal cord, lung, breast and large bowel >colo7rectal?.

earning resources 34eAita. -ancer 3 rinciples and ractice of 5ncology >1 th edition?. ippincott $illiams &$ilkins. -hapter 2/3 ;d!anced imaging )ethods. age 9:71**.

0utton 4. 8adiology and Imaging for )edical 0tudents >6 th edition?. -hurchilli!ingstone. *::9.

DA0 24 7Mon!a < Oct 13 t 2=149

! . Siann He a$ati< S5P! . Ni a!e# M)" anta i< S5.P

'dayana 'ni!ersity (aculty of )edicine, )#' /1


47/49

)asic &linical Skills /%at!ology $natomy0


DA0 2* 7T)e'!a < Oct 14 t 2=149

! . Ni Ba an Bina ti< S5PA

& 33I& L * *$%

Smstr Program or curriculum blocks

10 Senior Clerkship


Da 2, 7Be!ne'!a < Oct< 1* t 2=149 Si"ent Da

Da 2- 7T ) '!a < Oct< 1, t 2=149 E8a")ation


48/49


9 Senior Clerkship

8 Senior clerkship

7

MedicalEmergency(3 weeks)

CS (1 weeks)

Special !opic"-!ra#el medicine(2 weeks)

Elec$i#e S$%dy &&&(' weeks)

Clinic rien$a$ion(Clerkship)(' weeks)

6

!he espira$orySys$em and*isorders(4 weeks)

CS (1 weeks)

!heCardio#asc%larSys$em and*isorders(4 weeks)

CS (1 weeks)

!he +rinarySys$em and*isorders(3 weeks)

CS (1 weeks)

!he eprod%c$i#eSys$em and*isorders(3 weeks)

CS (1 weeks)Elec$i#e S$%dy&&

(1 weeks)

,limen$ary hepa$o-

iliary sys$ems disorders

(4 /eeks)

CS (1 weeks)

!he EndocrineSys$em0

Me$a olism and*isorders(4 weeks)

CS (1 weeks)

Clinical %$ri$ionand *isorders

(2 weeks)

CS (1 weeks)

Special !opic "- allia$i#e

medicine-Complemen$ary ,l$erna$i#eMedicine- orensic(3 weeks)

Elec$i#eS$%dy &&

(1 weeks)

!

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11. 3"44"3"(&"S


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#le!ent edition. Aol *. 2. 2

study guide hematologic tayang 9 september 2014

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