Blood, Immunity and Inflammation Module 01
III Module of Semester 1
First Year MBBS
Duration Three Weeks
Sindh Medical College
Rationale: To understand the functioning of the body in its whole, it is crucial to know about a component that affects every single cell of it, the blood . Knowledge of blood, immunity and inflammation is essential. Blood is responsible for the supply of micronutrients , O2 delivery to the tissues and maintenance of homeostasis. Immunity comprises of body responses and defense mechanisms against injurious agents and various diseases encountered in daily life. Inflammation being the first response to most of these processes.
Terminal Objective:
Medical graduate after completion of 5 years training program should be able to recognize the clinical presentations of common hematological , immunological and inflammatory disorders . Should be able to diagnose these disorders on the basis of history, examination and investigations. Should be well versed with the basic principles of managing these diseases . Medical graduate must be confident enough in the era of counseling and assessing the prognosis of various diseases .
Enabling Objectives:
The students should be able to:
1. Recognize the structure of haematopoietic tissues and mechanism of hematopoiesis
2. Relate utilization and metabolism of micronutrients( iron, vitamin B12, folic acid and B6) with normal and abnormal hematopoiesis
3. Justify that the basic structure of Hemoglobin is essential for RBCs normal function
4. Explain the Mechanism of corpuscular and extra corpuscular Hemolytic anemia
5. Understand the mechanism of hemeostasis, explain the role of platelets in homeostasis and coagulation
6. Differentiate the different blood groups on the basis of antigens expressed on cells
7. Comprehend the requirements of transfusion and its complications
8. Define Inflammation and the mechanism of phagocytosis
9. Recognize the mechanism of inflammatory process and host responses to inflammation
10. Differentiate the mechanism of cellular and humoral immunity, hypersensitivity and immunological disorders
11. Relate the consequences and patho-physiology of inflammation, allergic and immune responses.
Sindh Medical College
Weekly Schedule of Blood, Inflammation and Immunity
Time Table: First Week
January 2010
8:30- 9:30 / 9:30-10:30 / 11:-12:45 / 1:30-3:00Mon
Day 01
4/1 / Dean / Physiology
Introduction to the Blood, Inflammation and Immunity Module
Dr. Tariq Kamal
Fourth Floor Lecture Hall / Anatomy
Embryological development of blood elements (angiogenesis).
Dr. Sarwar Qureshi
First Floor Lecture Hall / Anatomy
Cassification & components of connective tissue
Dr. Talat Yasmeen
Fourth Floor Lecture Hall / Practical
GP C: Physiology: methods of blood sample collection, PCV and Blood film
Mrs. Takreem (Physio Lab)
GP A:Anatomy: Histology of Blood (Part of Connective tissue histology) Dr. Tasneem (Histo Lab)
GP B : Over view of Blood Biochemistry in Labs(visit to Clinical lab to see how blood tests, with which method are performed to produce blood reports )
Dr. Beenish (Bio. Lab)
Tues
Day 02
5/1 / Biochemistry
Composition of blood: plasma Components and Proteins
Dr. Saleem
Fourth Floor Lecture Hall / Physiology
Composition of Blood: Cellular Components
Dr. Aijaz Qureshi
Fourth Floor Lecture Hall / Practical
GP A: Physiology: methods of blood sample collection, PCV and Blood film
Mrs. Takreem (Physio Lab)
GP B:Anatomy: Histology of Blood (Part of Connective tissue histology)
Dr. Tasneem (Histo Lab)
GP C : Over view of Blood Biochemistry in Labs(visit to Clinical lab to see how blood tests, with which method are performed to produce blood reports )
Dr. Beenish (Bio. Lab) / Community Medicine
Historical Development of public Health
Dr. Shaheen Agha (Third Floor Lecture Hall)
Wed
Day 03
6/1 / Physiology
Maturation of RBCs, Regulation of erythropoiesis
Dr. Tariq Kamal
Fourth Floor Lecture Hall / Biochemistry
Iron Metabolism
Dr. Surriya
Fourth Floor Lecture Hall / Practical
GP B Physiology: methods of blood sample collection, PCV and Blood film
Mrs. Takreem (Physio Lab)
GP C:Anatomy: Histology of Blood (Part of Connective tissue histology) Dr. Tasneem (Histo Lab)
GP A : Over view of Blood Biochemistry in Labs(visit to Clinical lab to see how blood tests, with which method are performed to produce blood reports )
Dr. Beenish (Bio. Lab) / BEHAVIORAL SCIENCES
Dr. Zafar Haider
Fourth Floor Lecture Hall
Thurs
Day 04
7/1 / Biochemistry
Vit B12 / Folic Acid/ B6
Prof. Raisa Anjum
Fourth Floor Lecture Hall / Hematologist /Physiology
classification of anemia and significance of red cell indices
Dr. Tariq Kamal
Fourth Floor Lecture Hall / Tutorial
GP B: Physiology; Effects of Anemia on body
Dr. Iqbal Ghatta (Physio. Lab)
GP C: Biochemistry: Interpretation of biochemistry reports for the diagnosis of anemia (Hb conc;, CBC,S. TIBC, S. Ferritin Levels, Vit: B12)/ Hb estimation and RBC
Dr. Beenish (Bio. Lab)
GP A: Self Study -Digital Library, skill lab A2( vital signs) 55 / Clinical Faculty
History &: clinical findings in an anemic patient
Fri
Day 05
8/1 / Biochemistry
Synthesis ,Structure and functions of Hemoglobin
Time: 08:30 to 10:00
Mr. Akhtar Makhdoom
Fourth Floor Lecture Hall / Tutorial
Time: 10:30 to 12:00
GP C: Physiology; Effects of Anemia on body
Dr. Iqbal Ghatta (Physio. Lab)
GP A: Biochemistry: Interpretation of biochemistry reports for the diagnosis of anemia (Hb conc;, CBC, S. TIBC, S. Ferritin Levels, Vit: B12)/ Hb estimation and RBC Dr. Beenish (Bio. Lab)
GP B1: Self Study -Digital Library, Skill lab B2 ( vital signs) 55
Sat
Day 06
9/1 / Biochemistry
Abnormalities of Hb synthesis: porphyria ad its different types Variants of hemoglobin
Mr. Akhtar Makhdoom
Fourth Floor Lecture Hall / Physiology
BLOOD GOUPS
ABO/Rh system
Dr. Aijaz Qureshi
Fourth Floor Lecture Hall / Tutorial
GP A: Physiology; Effects of Anemia on body
. Dr. Iqbal Ghatta (Physio. Lab)
GP B: Biochemistry: Interpretation of biochemistry reports for the diagnosis of anemia (Hb conc;, CBC, S. TIBC, S. Ferritin Levels, Vit: B12)/ Hb estimation and RBC Dr. Beenish (Bio. Lab)
GP C1: Self Study -Digital Library, skill lab C2( vital signs) 55 / CBL: Case 1
Time Table: Second Week
8:30- 9:30 / 9:30-10:30 / 11:00-12:45 / 1:30-3:00Mon
Day 07
11/1 / Biochemistry
Hemoglobinopathies and Thalassemia
Dr. Surriya
Fourth Floor Lecture Hall / Anatomy
Introduction to lymphoid tissue and immune system,
10:45 to 12:00
Dr. Talat Yasmeen
Third Floor Lecture Hall / Anatomy
Histology of Spleen and Lymph Node
Dr. Talat Yasmeen
Fourth Floor Lecture Hall / Practical
GP A- Physiology: Fragility of RBC, MCH , MCHC
Dr. Takreem (Physio. Lab)
GP B - Histology: Histology of Spleen,/ lymph node
Dr. Tasneem (Histo Lab)
GP C – Biochemistry
Haemoglobin electrophoresis
Dr. Aneela (Bio. Lab)
Tues
Day 08
12/1 / Physiology
Define Polycythemia, and its effects on the body
Dr. Tariq Kamal
Fourth Floor Lecture Hall / Pathology
Indications of Blood Transfusion and Transfusion Reactions
Dr. Khursheed Hashmil
Fourth Floor Lecture Hall / Community Medicine
Health System 1
Dr. Kiran Mehtab
Third Floor Lecture Hall / Practical
GP B - Physiology: Fragility of RBC, MCH, MCHC
Mrs. Takreem (Physio. Lab)
GP C – Histology: Histology of spleen/LYMPH NODE
Dr. Tasneem (Histo Lab)
GP A – Biochemistry
Haemoglobin electrophoresis
Dr. Aneela (Bio. Lab)
Wed
Day 09
13/1 / Biochemistry
Heme Degradation and related disorders and hyperbilirubinemia
Dr. Saleem
Fourth Floor Lecture Hall / Physiology
Hemolysis and hemolytic anemias
Dr. Aijaz Qureshi
Fourth Floor Lecture Hall / Presentation by studentsIn Physiology Department.
1-Effect of Anemia on the body.
2-Investigation of patients with
anemia.
3-Transfusion reactions.
DR. IQBAL GATTA & DR. TARIQ KAMAL
Third Floor Lecture Hall / Practical
GP C- Physiology: Fragility of RBC , MCH, MCHC
Mrs. Takreem (Physio. Lab)
GP A-Histology: Histology of spleen/lymph node
Dr. Tasneem (Histo Lab)
GP B – Biochemistry
Haemoglobin electrophoresis
Dr. Aneela (Bio. Lab)
Thurs
Day 10
14/1 / Physiology
Hemostasis and Role of thrombocytes
Dr. Aijaz Qureshi
Fourth Floor Lecture Hall / Biochemistry
Vitamin K and its disorders
Prof. Raisa Anjum
Fourth Floor Lecture Hall / Tutorial
GP A- Physiology: Fibrinolytic mechanism
Dr. Iqbal Ghatta (Physio. Lab)
GP B - Biochemistry: Interpret lab
investigation of electrophoresis of thalassemic
Pts. Mrs. Fatima Baloch (Bio. Lab)
GP C2 – Self Study -Digital Library, skill lab C1(
vital signs) 55 / Clinical Faculty
History, Examination and Management of a patient with bleeding Disorder
Fri
Day 11
15/1 / Physiology
Clotting cascade and bleeding disorders
Dr. Tariq Kamal
Fourth Floor Lecture Hall / Pharmacology
Coagulants and Anticoagulants
Dr. Naseem Karim
Fourth Floor Lecture Hall / Tutorial
Time: 10:45 to 12:00
GP B- Physiology: Fibrinolytic mechanism
Dr. Iqbal Ghatta (Physio. Lab)
GP C - Biochemistry: Interpret lab investigation of electrophoresis of thalassemic Pts Mrs. Fatima Baloch (Bio. Lab)
GP A2 – Self Study -Digital Library, skill lab A1( vital signs) 55
Sat
Day 12
16/1 / Physiology
Heamorrhagic and thromboembolic conditions
Dr. Tariq Kamal
Fourth Floor Lecture Hall / Blood Banking / Tutorial
GP C- Physiology: Fibrinolytic mechanism
Dr. Iqbal Ghatta (Physio. Lab)
GP A - Biochemistry: Interpret lab investigation of electrophoresis of thalasemic Pts Mrs. Fatima Baloch (Bio. Lab)
GP B2 – Self Study -Digital Library, skill labB1( vital signs) 55 / CBL: Case 2
Time Table: Third Week
8:30- 9:30 / 9:30-10:30 / 11:00-1:15 / 1:45-3:00Mon
Day 13
18/1 / Pathology
Acute and chronic inflammatory response.
Dr. Yasmeen Hashim
Third Floor Lecture Hall / Community Medicine
Health System 2
Dr. Kiran Mehtab
Third Floor Lecture Hall / Practical
10:40 to 12:00
GP A- Physiology: Blood grouping and cross matching/ERYTHROBLASTOSIS FETALIS Mrs. Takreem (Physio Lab)
GP B- Histo and pathology Lab: Histology of lymphoid System and Slides of acute and chronic inflammatory conditions Dr. Tasneem (Histo Lab)
GP C- Histology Practical: Histology of Thymus and tonsils,
(Histo Lab) / Students Presentation
Anatomy Gp A
Functions of Blood Elements
Dr. Rais
ADH
Physio Gp B
1. Hemostasis
2. Erythroblastosis Fetalis
Dr. Iqbal Gatta
Phys. Lab
Bio Gp C
1. Vitamin K and its disorders
2. Heme Degradation and related disorders.
Dr. Beenish
Bio.Lab
Tues
Day 14
19/1 / Behavioral Sciences)
Dr. Zafar Haider
Fourth Floor Lecture Hall / Anatomy
Histology of Thymus and tonsils
Dr. Talat Yasmeen
Fourth Floor Lecture Hall / Practical
GP B- Physiology: Blood grouping and cross matching/ERYTHROBLASTOSIS FETALIS Mrs. Takreem (Physio Lab)
GP C- Histo and pathology Lab: Histology of lymphoid System and Slides of acute and chronic inflammatory conditions. Dr. Tasneem (Histo Lab)
GP A- Histology Practical: Histology of Thymus and tonsils,
(Histo Lab) / Students Presentation
Anatomy Gp A
Functions of Blood Elements Dr. Rais
ADH
Physio Gp B
1. Hemostasis
2. Erythroblastosis Fetalis
Dr. Iqbal Gatta
Phys. Lab
Bio Gp C
1. Vitamin K and its disorders
2. Heme Degradation and related disorders.
Dr. Beenish
Bio.Lab
Wed
Day 15
20/1 / Physiology
Genesis and general characteristics of white blood cells
Dr. Aijaz Qureshi
Fourth Floor Lecture Hall / Biochemistry
Immunoglobulin
Dr. Surriya
Fourth Floor Lecture Hall / Tutorial
GP – A Physiology: Cellular and humoral Immunity
Dr. Iqbal Ghatta (Physio. Lab)
GP -B Pathology: (Leukopenia / leukocytosis) Dr. Tazeen Shah (Patho. Seminar)
GP - C Biochemistry: estimation of immunoglobulins (Electrophoresis) Biochemical Interpretation of Immune-deficient disorder Dr. Beenish (Bio. Lab) / Practical
GP 3- Physiology: Blood grouping and cross matching/ERYTHROBLASTSIS FETALIS
GP 1- Histo and pathology Lab: Histology of lymphoid System and Slides of acute and chronic inflammatory conditions
GP 2- Histology Practical: Histology of Thymus and tonsils,
(Histo Lab)
Thurs
Day 16
21/1 / Physiology
Function of WBC and monocyte macrophage cell system ( RES).
Dr. Tariq Kamal
Fourth Floor Lecture Hall / Pathology
Hemodynamic and cellular phases. Types of exudates. .(Role of Chemical mediators in inflammation)
Dr. Yasmeen Hashim
Third Floor Lecture Hall / Tutorial
GP – B Physiology: Cellular and humoral immunity
Dr. Iqbal Ghatta (Physio. Lab)
GP - C Pathology: Leukopenia/ leukocytosis
Dr. Tazeen Shah (Patho. Seminar)
GP – A Biochemistry: Biochemical Interpretation of Immune-deficient disorder
Dr. Beenish (Bio. Lab) / Students Presentation
Anatomy Gp A
Functions of Blood Elements
Dr. Rais
ADH
Physio Gp B
1. Hemostasis
2. Erythroblastosis Fetalis
Dr. Iqbal Gatta
Phys. Lab
Bio Gp C
1. Vitamin K and its disorders
2. Heme Degradation and related disorders.
Dr. Beenish
Bio.Lab
Fri
Day 17
22/1 / Pathology
Define Immunity and its types
Dr. Khursheed Hashmil
Fourth Floor Lecture Hall / Physiology
types and functions of lymphocytes
Dr. Aijaz Qureshi
Fourth Floor Lecture Hal / Tutorial
GP -C Physiology: Cellular and humoral Immunity Dr. Iqbal Ghatta (Physio. Lab)
GP - A Pathology Leukopenia/ leukocytosis
Dr. Tazeen Shah (Patho. Seminar)
GP – B Biochemistry: Biochemical Interpretation of Immune-deficient disorder
Dr. Beenish (Bio. Lab)
Sat
Day 18
23/1 / Physiology
Allergy and hypersensitivity
Dr. Tariq Kamal
Fourth Floor Lecture Hall / Pathology
Antigen –Antibody reactions.
MHC molecules.
Dr. Rizwana Barakzaii
Fourth Floor Lecture Hall / Pathology
Presentation by students
1. Acute and chronic inflammatory response
2. Immunity and its types
3. Immune-deficient disorder
Dr. Tazeen Shah
First Floor Lect. Hall / CBL: Case 3
Notice:-
The dates given against the days are tentative. In case of college closure due to Holidays, the day would automatically shift to the next working date.
Clinical Case1
A 28-years-old professional lady, resident of Karachi , is in the second trimester of her first pregnancy . Though her pregnancy has been progressing uneventfully, recently she has noticed that she gets tire very easily and is short of breath on even slight exertion. She also has experienced periods of light-headedness, though not to the point of fainting. Further she has noticed cramps in her legs, a desire to crunch on ice, and that her tongue has become sore. She is concerned so she makes an appointment to see her physician.
On examination the physician finds that her heart rate is 120/ minute, BP is 100/ 56mmHg, she has pallor, pale gums and nail beds, and her tongue is swollen. Given her history and the findings on her physical exam, the physician orders some blood tests. The results are shown below:
Table 1. Blood Sample ResultsRed Blood Cell Count / 3.5 million/mm3
Hemoglobin (Hb)
Hematocrit / 7 g/dl
26
Mean corpuscular volume ( MCV) / 62fL
Mean Corpuscular Hb Concentration (MCHC) / 30g/dl
Mean Corpuscular Hb (MCH)
White blood cell count
Platelet count
Reticulocyte count / 19.0pg/cell
5,300/uL
5,50,000/L
1.4
Serum Iron / 43
Total Iron Binding Capacity in the Blood (TIBC) / 500
Serum ferritin / 10
LEARNING OBJECTIVES: The student will be able to: