HAEMATOLOGY

ANAEMIA

 In Anaemia, the periferal resistance is reduced because of hypoxia  causing increased cardiac output. This increased output is at times 3- 4 times normal. This increased output compensates for the hypoxic effect of anaemia by increasing the rate of blood flow to the tissues.

HYPOXIA

In days/ weeks acclimatization occurs by increasing ventilation, increased diffusion through pulmonary capillaries, by increase in pulmonary collateral capillarity, increase in RBC production as well as increased vascularity of tissues ( periferal) and increased ability of tissue cells to use oxygen and increasing the mitochondria.

CELLULAR ELEMENTS

1)       A gradual fall in RBC count or in Hb till 5g/ lt  can be tolerated without resulting in CCF.

2)       Neutropenia is defined as an absolute count below 2500/ cubic mm but the count has to fall below 1000 for increased risk of Bacterial infection.

3)       Though platelet count is normally 1.5 lac to 3.5 lac / cubic mm platelet count has to fall below 10,000 to 20,000 for spontaneous and serious haemorrhage.

LEUKEMIA

In Acute Leukemia , the average survival is from 6 weeks to 5 years with 30% patients reaching 5 years.

In Chronic Leukemia average survival is 6 years.

 The decision to give specific Chemotherapy is dependent on the patients age, personal wish, presence of other serious diseases ,etc as treatment is generally aggressive and has a number of sideeffects.

Supportive treatment can effect considerable improvement in well being .

Chemotherapy causes severe bone marrow hypoplasia causing

i)                     Anaemia and bleeding requiring repeated transfusion.

ii)                   Septicemia and systemic fungal and viral infections .

iii)                  Renal and Hepatic failure.

However life is comfortable until the RBC, WBC & Platelets fall under the bare minimum to cause CCF, infection , or Hemorrhage.

     Relapse rate continue to be high despite treatment and it is difficult  to decide whether the remissions are spontaneous or chemotherapy induced.

Since around 80% of adut patients with acute Leukemia achieve initial remissions . Hence an effort has to be made in not making the treatment of disease more grievous than its endurance.