SlideShare ist ein Scribd-Unternehmen logo
1 von 55
Hemolysis and Hemolytic Anemias Dr. Sabir
Hemolytic Anemias-Introduction ,[object Object],[object Object],[object Object]
General Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hemolytic Anemias - Classification Schemes ,[object Object],[object Object],[object Object]
Hemolytic Anemias -  Sites of Red Cell Destruction ,[object Object],[object Object],[object Object],[object Object]
Laboratory Evidence for Presence of Hemolysis ,[object Object],[object Object]
Evidence for increased red cell production ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Polychromatophilic cell  on Wright-Giemsa staining Reticulocytes (supravital staining)
Erythroid Hyperplasia ,[object Object],[object Object],[object Object]
Frontal Bossing Results from increased erythropoietic activity and marrow space expansion
Evidence for Increased Red Cell Destruction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Biochemical consequences of hemolysis in general ,[object Object],[object Object],[object Object],[object Object]
Biochemical Consequences of  Intravascular  Hemolysis ,[object Object],[object Object],[object Object],[object Object]
Hemolytic Anemias - Classification by Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Congenital Hemolytic Anemias- Membrane Defects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hereditary Spherocytosis ,[object Object],[object Object]
Hereditary Spherocytosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HEREDITARY SPHEROCYTOSIS Osmotic Fragility
Osmotic Fragility Normal Abnormal- HS cells lyse more readily at low ionic strength
Congenital Hemolytic Anemias Enzyme Defects
Red Cell Enzyme Defects ,[object Object],[object Object],[object Object]
RBC Metabolism Simplified  Glucose Anaerobic glycolysis Aerobic metabolism Glucose-6-P G6PD ,[object Object],[object Object],F-6-P
G6PD Deficiency Pathophysiology ,[object Object],[object Object],[object Object]
G6PD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
G6PD Deficiency  Agents to avoid ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Blister cell
Favism ,[object Object],[object Object],[object Object]
G6PD Deficiency Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Congenital Hemolytic Anemias Hemoglobinopathies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acquired Hemolytic Anemias Immune-Mediated Hemolysis
Pathophysiology ,[object Object],[object Object],[object Object]
Immune hemolytic anemias - Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Auto-Immune Hemolytic Anemias ,[object Object],[object Object],[object Object],[object Object]
Coomb’s Test ,[object Object],[object Object]
Direct Coomb’s Test Patient’s RBCs coated with IgG or C3 Antibodies to human IgG/C3 (Coomb’s reagent) Agglutinationin the test tube
Indirect Coomb’s Test Agglutinationin the test tube Patient serum containing anti RBC Abs Normal RBCs and Coomb’s reagent
Warm-Antibody Hemolytic Anemias ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spherocyte Formation Progressive loss of membrane, loss of surface area, more spherocytic shape
Warm-Antibody Hemolytic Anemias Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Warm Autoimmune Hemolytic Anemia - spherocytes
Warm-Antibody Hemolytic Anemias Treatment ,[object Object],[object Object]
Warm-Antibody Hemolytic Anemias Immunosuppressive Treatment ,[object Object],[object Object],[object Object],[object Object]
Cold Agglutinin Disease ,[object Object],[object Object],[object Object]
Cold Agglutinin Disease ,[object Object],[object Object],[object Object]
Digital ischemia from cold-agglutinin disease
Cold Agglutinin Disease Clinical features ,[object Object],[object Object],[object Object],[object Object],[object Object]
Paroxysmal Nocturnal Hemoglobinuria ,[object Object],[object Object],[object Object],[object Object]
Paroxysmal Nocturnal Hemoglobinuria - Clinical features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Non-Immune Hemolytic Anemia Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Microangiopathic Hemolytic Anemias ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MAHA - Schistocytes
Macroangiopathic Hemolytic Anemias ,[object Object],[object Object],[object Object],[object Object]
March Hemoglobinuria ,[object Object],[object Object],[object Object]
Hemolysis from Infections ,[object Object],[object Object],[object Object],[object Object]
Hemolysis Associated with Chemical and Physical Agents ,[object Object],[object Object],[object Object],[object Object],[object Object]

Weitere ähnliche Inhalte

Was ist angesagt? (20)

Hemolytic anemia
Hemolytic anemiaHemolytic anemia
Hemolytic anemia
 
Megaloblastic Anaemia - Vit B12 deficiency
Megaloblastic Anaemia - Vit B12 deficiencyMegaloblastic Anaemia - Vit B12 deficiency
Megaloblastic Anaemia - Vit B12 deficiency
 
Hereditary elliptocytosis
Hereditary elliptocytosisHereditary elliptocytosis
Hereditary elliptocytosis
 
Sickle cell disease
Sickle cell diseaseSickle cell disease
Sickle cell disease
 
Hemoglobinopathies
HemoglobinopathiesHemoglobinopathies
Hemoglobinopathies
 
Hematopoiesis
HematopoiesisHematopoiesis
Hematopoiesis
 
Hemolytic anemia
Hemolytic anemiaHemolytic anemia
Hemolytic anemia
 
Haemolytic anemia
Haemolytic anemia Haemolytic anemia
Haemolytic anemia
 
Bmfs
BmfsBmfs
Bmfs
 
Hemolytic anemia ppt presentation
Hemolytic anemia ppt presentationHemolytic anemia ppt presentation
Hemolytic anemia ppt presentation
 
Anemia
AnemiaAnemia
Anemia
 
Sickle cell anaemia
Sickle cell anaemiaSickle cell anaemia
Sickle cell anaemia
 
Leukemoid and lekoerythroblastic reaction
Leukemoid and lekoerythroblastic reactionLeukemoid and lekoerythroblastic reaction
Leukemoid and lekoerythroblastic reaction
 
Hemolytic anemia
Hemolytic anemiaHemolytic anemia
Hemolytic anemia
 
Wbc structure and functions
Wbc structure and functionsWbc structure and functions
Wbc structure and functions
 
Anemia And Its Classification
Anemia And Its ClassificationAnemia And Its Classification
Anemia And Its Classification
 
Hemolytic anemia (1)
Hemolytic anemia (1)Hemolytic anemia (1)
Hemolytic anemia (1)
 
Benign White blood cell (WBC) Disorders
Benign White blood cell (WBC) DisordersBenign White blood cell (WBC) Disorders
Benign White blood cell (WBC) Disorders
 
Hemoglobinopathy
HemoglobinopathyHemoglobinopathy
Hemoglobinopathy
 
Glomerular diseases
Glomerular diseases Glomerular diseases
Glomerular diseases
 

Ähnlich wie Medicine 5th year, 8th lecture/part one (Dr. Sabir)

ANEMIA HEMOLITICA-INDIA.ppt
ANEMIA HEMOLITICA-INDIA.pptANEMIA HEMOLITICA-INDIA.ppt
ANEMIA HEMOLITICA-INDIA.pptRuben Silva Ames
 
Hemolytic anemia
Hemolytic anemiaHemolytic anemia
Hemolytic anemiaFatima Avci
 
hemolytic anemia (cell membrane defect)
hemolytic anemia (cell membrane defect)hemolytic anemia (cell membrane defect)
hemolytic anemia (cell membrane defect)Afrina Qureshi
 
Child with pallor & jaundice (hemolytic anemia)
Child with pallor & jaundice (hemolytic anemia)Child with pallor & jaundice (hemolytic anemia)
Child with pallor & jaundice (hemolytic anemia)Safia Sky
 
Hemolytic Anemia Investigation - By Mohan kumar
Hemolytic Anemia Investigation - By Mohan kumarHemolytic Anemia Investigation - By Mohan kumar
Hemolytic Anemia Investigation - By Mohan kumarSchin Dler
 
Approach to Autoimmune hemolytic anemia
Approach to Autoimmune hemolytic anemiaApproach to Autoimmune hemolytic anemia
Approach to Autoimmune hemolytic anemiaKumar Abhinav
 
PLASMA PROTEINS
PLASMA PROTEINSPLASMA PROTEINS
PLASMA PROTEINSYESANNA
 
7 Anemia full lecture notes for preparing exam
7 Anemia full lecture notes for preparing exam7 Anemia full lecture notes for preparing exam
7 Anemia full lecture notes for preparing examRAFIULLAHRAFI14
 
5thsembloodtransfusion
5thsembloodtransfusion5thsembloodtransfusion
5thsembloodtransfusionTanuj Bhatia
 
Approach to a patient with hemolytic anaemia
Approach to a patient with hemolytic anaemiaApproach to a patient with hemolytic anaemia
Approach to a patient with hemolytic anaemiasunil bhatt
 
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore KashmirAnaemias By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore KashmirProf Dr Bashir Ahmed Dar
 
Anemia And Its Classification By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anemia And Its Classification By Dr Bashir Ahmed Dar Chinkipora Sopore KashmirAnemia And Its Classification By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anemia And Its Classification By Dr Bashir Ahmed Dar Chinkipora Sopore KashmirProf Dr Bashir Ahmed Dar
 

Ähnlich wie Medicine 5th year, 8th lecture/part one (Dr. Sabir) (20)

ANEMIA HEMOLITICA-INDIA.ppt
ANEMIA HEMOLITICA-INDIA.pptANEMIA HEMOLITICA-INDIA.ppt
ANEMIA HEMOLITICA-INDIA.ppt
 
Hemolytic anemia
Hemolytic anemiaHemolytic anemia
Hemolytic anemia
 
Haemolytic disorders
Haemolytic disordersHaemolytic disorders
Haemolytic disorders
 
Hemolytic anemia
Hemolytic anemiaHemolytic anemia
Hemolytic anemia
 
hemolytic anemia (cell membrane defect)
hemolytic anemia (cell membrane defect)hemolytic anemia (cell membrane defect)
hemolytic anemia (cell membrane defect)
 
Child with pallor & jaundice (hemolytic anemia)
Child with pallor & jaundice (hemolytic anemia)Child with pallor & jaundice (hemolytic anemia)
Child with pallor & jaundice (hemolytic anemia)
 
Hemolytic Anemia Investigation - By Mohan kumar
Hemolytic Anemia Investigation - By Mohan kumarHemolytic Anemia Investigation - By Mohan kumar
Hemolytic Anemia Investigation - By Mohan kumar
 
Approach to Autoimmune hemolytic anemia
Approach to Autoimmune hemolytic anemiaApproach to Autoimmune hemolytic anemia
Approach to Autoimmune hemolytic anemia
 
Haematology notes
Haematology notesHaematology notes
Haematology notes
 
G6PD disease.pptx
G6PD disease.pptxG6PD disease.pptx
G6PD disease.pptx
 
PLASMA PROTEINS
PLASMA PROTEINSPLASMA PROTEINS
PLASMA PROTEINS
 
Anaemia
AnaemiaAnaemia
Anaemia
 
AIHA -Autoimmune Haemolytic Anaemias
AIHA -Autoimmune Haemolytic AnaemiasAIHA -Autoimmune Haemolytic Anaemias
AIHA -Autoimmune Haemolytic Anaemias
 
Hemolytic Anemia
Hemolytic Anemia Hemolytic Anemia
Hemolytic Anemia
 
7 Anemia full lecture notes for preparing exam
7 Anemia full lecture notes for preparing exam7 Anemia full lecture notes for preparing exam
7 Anemia full lecture notes for preparing exam
 
5thsembloodtransfusion
5thsembloodtransfusion5thsembloodtransfusion
5thsembloodtransfusion
 
Approach to a patient with hemolytic anaemia
Approach to a patient with hemolytic anaemiaApproach to a patient with hemolytic anaemia
Approach to a patient with hemolytic anaemia
 
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore KashmirAnaemias By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anaemias By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
 
Anemia And Its Classification By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anemia And Its Classification By Dr Bashir Ahmed Dar Chinkipora Sopore KashmirAnemia And Its Classification By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
Anemia And Its Classification By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir
 
Anemia in Child
Anemia in ChildAnemia in Child
Anemia in Child
 

Mehr von College of Medicine, Sulaymaniyah

Mehr von College of Medicine, Sulaymaniyah (20)

Pediatrics 6th year, Tutorial (Dr. Tara Husain)
Pediatrics 6th year, Tutorial (Dr. Tara Husain)Pediatrics 6th year, Tutorial (Dr. Tara Husain)
Pediatrics 6th year, Tutorial (Dr. Tara Husain)
 
Pediatrics 6th year, Tutorial (Dr. Adnan)
Pediatrics 6th year, Tutorial (Dr. Adnan)Pediatrics 6th year, Tutorial (Dr. Adnan)
Pediatrics 6th year, Tutorial (Dr. Adnan)
 
Tubes, Suture Materials, IV Fluids photos
Tubes, Suture Materials, IV Fluids photosTubes, Suture Materials, IV Fluids photos
Tubes, Suture Materials, IV Fluids photos
 
Surgery 6th year, Tutorial (Dr. Aram Baram)
Surgery 6th year, Tutorial (Dr. Aram Baram)Surgery 6th year, Tutorial (Dr. Aram Baram)
Surgery 6th year, Tutorial (Dr. Aram Baram)
 
Surgery 6th year, Tutorial (Dr. Aram Baram)
Surgery 6th year, Tutorial (Dr. Aram Baram)Surgery 6th year, Tutorial (Dr. Aram Baram)
Surgery 6th year, Tutorial (Dr. Aram Baram)
 
Surgery 6th year, Tutorial (Dr. Hamid)
Surgery 6th year, Tutorial (Dr. Hamid)Surgery 6th year, Tutorial (Dr. Hamid)
Surgery 6th year, Tutorial (Dr. Hamid)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. Ali A. Nabi)
Surgery 6th year, Tutorial (Dr. Ali A. Nabi)Surgery 6th year, Tutorial (Dr. Ali A. Nabi)
Surgery 6th year, Tutorial (Dr. Ali A. Nabi)
 
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
 
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
Surgery 6th year, Tutorial (Dr. Khalid Shokor Mahmood)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. Bakhtyar Rasul)
Surgery 6th year, Tutorial (Dr. Bakhtyar Rasul)Surgery 6th year, Tutorial (Dr. Bakhtyar Rasul)
Surgery 6th year, Tutorial (Dr. Bakhtyar Rasul)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
Surgery 6th year, Tutorial (Dr. Ahmed Al-Azzawi)
 
Surgery 6th year, Tutorial (Dr. Sarwar Noori)
Surgery 6th year, Tutorial (Dr. Sarwar Noori)Surgery 6th year, Tutorial (Dr. Sarwar Noori)
Surgery 6th year, Tutorial (Dr. Sarwar Noori)
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Surgery 6th year, Tutorial (Dr. Bakhtyar Baram)
Surgery 6th year, Tutorial (Dr. Bakhtyar Baram)Surgery 6th year, Tutorial (Dr. Bakhtyar Baram)
Surgery 6th year, Tutorial (Dr. Bakhtyar Baram)
 
Surgery 6th year, Tutorial (Dr. Aso Omar)
Surgery 6th year, Tutorial (Dr. Aso Omar)Surgery 6th year, Tutorial (Dr. Aso Omar)
Surgery 6th year, Tutorial (Dr. Aso Omar)
 

Kürzlich hochgeladen

♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...astropune
 
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...narwatsonia7
 
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...Taniya Sharma
 
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...narwatsonia7
 
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service KochiLow Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service KochiSuhani Kapoor
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...narwatsonia7
 
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...jageshsingh5554
 
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiRussian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiAlinaDevecerski
 
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...astropune
 
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore EscortsVIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escortsaditipandeya
 
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls JaipurCall Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipurparulsinha
 
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...hotbabesbook
 
Lucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel roomLucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel roomdiscovermytutordmt
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Dipal Arora
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Call Girls in Nagpur High Profile
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 

Kürzlich hochgeladen (20)

♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
 
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
 
Russian Call Girls in Delhi Tanvi ➡️ 9711199012 💋📞 Independent Escort Service...
Russian Call Girls in Delhi Tanvi ➡️ 9711199012 💋📞 Independent Escort Service...Russian Call Girls in Delhi Tanvi ➡️ 9711199012 💋📞 Independent Escort Service...
Russian Call Girls in Delhi Tanvi ➡️ 9711199012 💋📞 Independent Escort Service...
 
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
 
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
 
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
 
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service KochiLow Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
 
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
 
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiRussian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
 
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
 
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore EscortsVIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
 
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls JaipurCall Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
 
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
 
Lucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel roomLucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel room
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
 

Medicine 5th year, 8th lecture/part one (Dr. Sabir)