Samenvatting BB
Inhoud
Ziekteleer................................................................................................................................................6
Anemie...............................................................................................................................................6
Pathofysiologie van anemie................................................................................................................6
Verschijnselen.................................................................................................................................6
Bloedverlies....................................................................................................................................6
Hemolyse........................................................................................................................................7
Gestoorde erytropoëse...................................................................................................................8
Secundaire non-generatieve anemie..............................................................................................8
Aanpak van anemie in de praktijk.......................................................................................................8
Anamnese.......................................................................................................................................8
Lichamelijk onderzoek....................................................................................................................8
Diagnostiek.....................................................................................................................................9
Differentiële diagnose....................................................................................................................9
Therapie..........................................................................................................................................9
Aandoeningen die gepaard gaan met bloedverlies............................................................................9
Rund...............................................................................................................................................9
Kleine herkauwers..........................................................................................................................9
Varken..........................................................................................................................................10
Paard............................................................................................................................................10
Hond.............................................................................................................................................10
Aandoeningen die gepaard gaan met hemolyse..............................................................................10
Hemotrope mycoplasma-infecties................................................................................................10
Babesiose (hond)..........................................................................................................................10
Piroplasmose................................................................................................................................10
Infectieuze anemie.......................................................................................................................10
Isoerytrolysis neonatalis...............................................................................................................11
Idiopathische immuungemedieerde hemolyse............................................................................11
Intoxicatie.....................................................................................................................................11
Koperstapeling..............................................................................................................................11
Aandoeningen als gevolg van een gestoorde erytropoëse...............................................................11
IJzergebrekanemieën....................................................................................................................11
Infectieuze anemie bij pluimvee...................................................................................................11
1
, Leishmaniose bij de hond.............................................................................................................12
Hemorragische diathese.......................................................................................................................12
Fysiologie van de hemostase............................................................................................................12
Het stollingsmechanisme..............................................................................................................13
De pathofysiologie van de hemostase..............................................................................................14
Storingen in de primaire hemostase.............................................................................................14
Storingen in de secundaire hemostase.........................................................................................15
Storingen in de primaire en secundaire hemostase.....................................................................15
De klinische gevolgen van hemorragische diathese.........................................................................15
Leukocytenafwijkingen.........................................................................................................................17
Fysiologie..........................................................................................................................................17
De granulo(cyto)poëse.................................................................................................................17
De monocytopoëse.......................................................................................................................17
De lymfopoëse..............................................................................................................................18
Invloed van stress en glucocorticoïden.........................................................................................18
Aandoeningen van de lymfoïde organen..............................................................................................18
Lymfeknopen....................................................................................................................................18
Bouw en functie van de gezonde lymfeknoop..............................................................................18
Reactiepatroon van lymfeknopen.................................................................................................18
Aanvullende diagnostiek bij lymfadenopathie..............................................................................19
Differentiële diagnose van lymfadenopathie................................................................................20
Infectieziekten die gepaard gaan met een lymfadenitis...............................................................20
Milt...................................................................................................................................................22
Miltvergroting – splenomegalie....................................................................................................23
Miltruptuur...................................................................................................................................24
Ontwikkelingsstoornissen van de milt..........................................................................................24
Neoplasieën van de milt...............................................................................................................24
Bursa Fabricius..................................................................................................................................24
Thymus.............................................................................................................................................25
Reactiepatroon van de thymus.....................................................................................................25
Neoplasieën van de thymus..........................................................................................................25
Beenmerg.........................................................................................................................................25
Neoplasieën van de lymfoïde organen.............................................................................................25
Leukemieën..................................................................................................................................25
Maligne lymfoom (lymfosarcoom)...............................................................................................26
Histiocytaire aandoeningen bij hond en kat.................................................................................26
2
, Plasmaceltumoren bij hond en kat...............................................................................................26
Tumoren van het hemopoëtisch systeem.....................................................................................27
Neoplasieën lymfoïdesysteem kip................................................................................................27
WC 1 voorbereiding..............................................................................................................................29
Functies van bloed............................................................................................................................29
Samenstelling van bloed...................................................................................................................29
Transport en opslag van zuurstof.....................................................................................................29
Stofwisseling erytrocyt.....................................................................................................................30
WC 2.....................................................................................................................................................31
EPO...................................................................................................................................................31
IJzerhuishouding...............................................................................................................................31
Tellen van bloedcellen......................................................................................................................31
Opdrachten.......................................................................................................................................32
WC 3.....................................................................................................................................................32
Zelfstudie-opdrachten......................................................................................................................32
PR1.......................................................................................................................................................32
PR 4 voorbereiding...............................................................................................................................33
Hematocrietbepaling........................................................................................................................33
Reticulocytentelling..........................................................................................................................33
Bloeduitstrijkje.................................................................................................................................33
Beoordeling rode bloedbeeld...........................................................................................................34
HC 6a....................................................................................................................................................35
Leukocytose......................................................................................................................................35
Immuunpathogenese...........................................................................................................................35
Transplantaten.................................................................................................................................35
Afstoting...........................................................................................................................................35
Voorkomen van afstoting.................................................................................................................36
Tumorimmunologie..........................................................................................................................36
Overgevoeligheidsreacties................................................................................................................36
Auto-immuniteit...............................................................................................................................36
PR 2 en 3...............................................................................................................................................37
Immuunelektroforese.......................................................................................................................37
Coombs test......................................................................................................................................37
Dubbele immunodiffusie..................................................................................................................37
ELISA.................................................................................................................................................38
PR 5......................................................................................................................................................38
3
, Analysemethoden.............................................................................................................................38
Microcapillair................................................................................................................................38
Coulter Counter............................................................................................................................38
Laser Cell Counter/Scatterplot......................................................................................................38
WC 8.....................................................................................................................................................38
Hematogene pigmenten...................................................................................................................39
Hemosiderine...............................................................................................................................39
Bilirubine......................................................................................................................................39
Hemoglobine................................................................................................................................39
Porfyrine.......................................................................................................................................39
WC 12 (farmacologie)...........................................................................................................................39
Farmaca die hemostase en fibrinolyse beïnvloeden.........................................................................39
Heparine.......................................................................................................................................39
Coumarine derivaten....................................................................................................................39
Aspirine.........................................................................................................................................40
Clopidogrel...................................................................................................................................40
Middelen die de fibrinolyse bevorderen.......................................................................................40
Farmaca met immunomodulerende en/of anti-inflammatoire werking...........................................40
Cytostatica....................................................................................................................................40
Glucocorticosteroïden..................................................................................................................40
NSAID’s.........................................................................................................................................41
WC 12 (opdrachten).............................................................................................................................42
Secundaire hemostase.........................................................................................................................45
Hemostase............................................................................................................................................45
DDx Anemie..........................................................................................................................................46
Hemolyse..........................................................................................................................................46
Bloedverlies......................................................................................................................................47
Gestoorde erytropoëse....................................................................................................................47
DDx Hemorragische Diathese...............................................................................................................48
DDx Splenomegalie...............................................................................................................................48
DDx Lymfadenopathie (vergroting lymfeknopen)................................................................................49
Lymfeknoop..........................................................................................................................................49
Leukopoëse..........................................................................................................................................50
Granulopoëse...................................................................................................................................50
Referentiewaarden...............................................................................................................................52
Hond.................................................................................................................................................52
4
Inhoud
Ziekteleer................................................................................................................................................6
Anemie...............................................................................................................................................6
Pathofysiologie van anemie................................................................................................................6
Verschijnselen.................................................................................................................................6
Bloedverlies....................................................................................................................................6
Hemolyse........................................................................................................................................7
Gestoorde erytropoëse...................................................................................................................8
Secundaire non-generatieve anemie..............................................................................................8
Aanpak van anemie in de praktijk.......................................................................................................8
Anamnese.......................................................................................................................................8
Lichamelijk onderzoek....................................................................................................................8
Diagnostiek.....................................................................................................................................9
Differentiële diagnose....................................................................................................................9
Therapie..........................................................................................................................................9
Aandoeningen die gepaard gaan met bloedverlies............................................................................9
Rund...............................................................................................................................................9
Kleine herkauwers..........................................................................................................................9
Varken..........................................................................................................................................10
Paard............................................................................................................................................10
Hond.............................................................................................................................................10
Aandoeningen die gepaard gaan met hemolyse..............................................................................10
Hemotrope mycoplasma-infecties................................................................................................10
Babesiose (hond)..........................................................................................................................10
Piroplasmose................................................................................................................................10
Infectieuze anemie.......................................................................................................................10
Isoerytrolysis neonatalis...............................................................................................................11
Idiopathische immuungemedieerde hemolyse............................................................................11
Intoxicatie.....................................................................................................................................11
Koperstapeling..............................................................................................................................11
Aandoeningen als gevolg van een gestoorde erytropoëse...............................................................11
IJzergebrekanemieën....................................................................................................................11
Infectieuze anemie bij pluimvee...................................................................................................11
1
, Leishmaniose bij de hond.............................................................................................................12
Hemorragische diathese.......................................................................................................................12
Fysiologie van de hemostase............................................................................................................12
Het stollingsmechanisme..............................................................................................................13
De pathofysiologie van de hemostase..............................................................................................14
Storingen in de primaire hemostase.............................................................................................14
Storingen in de secundaire hemostase.........................................................................................15
Storingen in de primaire en secundaire hemostase.....................................................................15
De klinische gevolgen van hemorragische diathese.........................................................................15
Leukocytenafwijkingen.........................................................................................................................17
Fysiologie..........................................................................................................................................17
De granulo(cyto)poëse.................................................................................................................17
De monocytopoëse.......................................................................................................................17
De lymfopoëse..............................................................................................................................18
Invloed van stress en glucocorticoïden.........................................................................................18
Aandoeningen van de lymfoïde organen..............................................................................................18
Lymfeknopen....................................................................................................................................18
Bouw en functie van de gezonde lymfeknoop..............................................................................18
Reactiepatroon van lymfeknopen.................................................................................................18
Aanvullende diagnostiek bij lymfadenopathie..............................................................................19
Differentiële diagnose van lymfadenopathie................................................................................20
Infectieziekten die gepaard gaan met een lymfadenitis...............................................................20
Milt...................................................................................................................................................22
Miltvergroting – splenomegalie....................................................................................................23
Miltruptuur...................................................................................................................................24
Ontwikkelingsstoornissen van de milt..........................................................................................24
Neoplasieën van de milt...............................................................................................................24
Bursa Fabricius..................................................................................................................................24
Thymus.............................................................................................................................................25
Reactiepatroon van de thymus.....................................................................................................25
Neoplasieën van de thymus..........................................................................................................25
Beenmerg.........................................................................................................................................25
Neoplasieën van de lymfoïde organen.............................................................................................25
Leukemieën..................................................................................................................................25
Maligne lymfoom (lymfosarcoom)...............................................................................................26
Histiocytaire aandoeningen bij hond en kat.................................................................................26
2
, Plasmaceltumoren bij hond en kat...............................................................................................26
Tumoren van het hemopoëtisch systeem.....................................................................................27
Neoplasieën lymfoïdesysteem kip................................................................................................27
WC 1 voorbereiding..............................................................................................................................29
Functies van bloed............................................................................................................................29
Samenstelling van bloed...................................................................................................................29
Transport en opslag van zuurstof.....................................................................................................29
Stofwisseling erytrocyt.....................................................................................................................30
WC 2.....................................................................................................................................................31
EPO...................................................................................................................................................31
IJzerhuishouding...............................................................................................................................31
Tellen van bloedcellen......................................................................................................................31
Opdrachten.......................................................................................................................................32
WC 3.....................................................................................................................................................32
Zelfstudie-opdrachten......................................................................................................................32
PR1.......................................................................................................................................................32
PR 4 voorbereiding...............................................................................................................................33
Hematocrietbepaling........................................................................................................................33
Reticulocytentelling..........................................................................................................................33
Bloeduitstrijkje.................................................................................................................................33
Beoordeling rode bloedbeeld...........................................................................................................34
HC 6a....................................................................................................................................................35
Leukocytose......................................................................................................................................35
Immuunpathogenese...........................................................................................................................35
Transplantaten.................................................................................................................................35
Afstoting...........................................................................................................................................35
Voorkomen van afstoting.................................................................................................................36
Tumorimmunologie..........................................................................................................................36
Overgevoeligheidsreacties................................................................................................................36
Auto-immuniteit...............................................................................................................................36
PR 2 en 3...............................................................................................................................................37
Immuunelektroforese.......................................................................................................................37
Coombs test......................................................................................................................................37
Dubbele immunodiffusie..................................................................................................................37
ELISA.................................................................................................................................................38
PR 5......................................................................................................................................................38
3
, Analysemethoden.............................................................................................................................38
Microcapillair................................................................................................................................38
Coulter Counter............................................................................................................................38
Laser Cell Counter/Scatterplot......................................................................................................38
WC 8.....................................................................................................................................................38
Hematogene pigmenten...................................................................................................................39
Hemosiderine...............................................................................................................................39
Bilirubine......................................................................................................................................39
Hemoglobine................................................................................................................................39
Porfyrine.......................................................................................................................................39
WC 12 (farmacologie)...........................................................................................................................39
Farmaca die hemostase en fibrinolyse beïnvloeden.........................................................................39
Heparine.......................................................................................................................................39
Coumarine derivaten....................................................................................................................39
Aspirine.........................................................................................................................................40
Clopidogrel...................................................................................................................................40
Middelen die de fibrinolyse bevorderen.......................................................................................40
Farmaca met immunomodulerende en/of anti-inflammatoire werking...........................................40
Cytostatica....................................................................................................................................40
Glucocorticosteroïden..................................................................................................................40
NSAID’s.........................................................................................................................................41
WC 12 (opdrachten).............................................................................................................................42
Secundaire hemostase.........................................................................................................................45
Hemostase............................................................................................................................................45
DDx Anemie..........................................................................................................................................46
Hemolyse..........................................................................................................................................46
Bloedverlies......................................................................................................................................47
Gestoorde erytropoëse....................................................................................................................47
DDx Hemorragische Diathese...............................................................................................................48
DDx Splenomegalie...............................................................................................................................48
DDx Lymfadenopathie (vergroting lymfeknopen)................................................................................49
Lymfeknoop..........................................................................................................................................49
Leukopoëse..........................................................................................................................................50
Granulopoëse...................................................................................................................................50
Referentiewaarden...............................................................................................................................52
Hond.................................................................................................................................................52
4
