anemia - 2 dr. shaikh mujeeb ahmed assistant professor almaarefa college ims 423 block
TRANSCRIPT
Anemias of Deficient Red Cell Production
• Deficiency of – Iron– Vitamin B12– Folic acid
• Bone marrow failure
Iron-Deficiency Anemia
• Dietary deficiency• Loss of iron through bleeding• Increased demands• Daily dietary requirement of iron – Male 1 mg – Adolescents 2-3 mg – Female (15 to 45 years) 2-3 mg – Pregnancy 3-4 mg – Infancy 1 mg
Hepcidin - the Iron Regulatory Hormone
• Hepcidin as the main regulator of systemic iron homeostasis.
• Hepcidin synthesis is induced by– iron loading and inflammation and
• suppressed by – erythropoiesis.
Causes of iron deficiency anemia
• Chronic blood loss– Peptic ulcer– Itestinal polyps– Hemorrhoids – Malignancy
• Excessive aspirin intake – undetected blood loss
• Menstruation – 1.5mg iron /day
Characterstics
• Low hemoglobin • Low Hematocrit, • Low serum iron and ferritin levels. • RBC count• Microcytic and hypochromic • Poikilocytosis (irregular shape)• Anisocytosis(irregular size) • MCHC and MCV.
Management
• Preventaion • In infants & children– Iron supplimentation after 4-6 months of age in
breastfed infants– Iron fortified formulas & cereals in <1 yr. age– Above 1 yr – iron rich diet + iron fortified vitamins
• Control chronic blood loss• Supplemental iron – ferrous sulphate
Megaloblastic Anemias
• Impaired DNA synthesis• MCV > 100fL• Vitamin B12 & Folic acid deficiency• Slow progress
Vitamin B12–Deficiency Anemia
• Essential for DNA synthesis and nuclear maturation• Found in all foods of animal origin• Absorbed by a unique process• Daily B12 requirement • Adults - 1.0 μg• Pregnancy - 1.4 μg• Lactation - 1.3 μg• Infants - 0.1 μg• Children (1-10 years) - 0.04 μg /kg • Children (11-16) - 1.0 μg
Cause
• pernicious anemia, resulting from an atrophic gastritis
• immunologically mediated, possibly autoimmune, destruction of the gastric mucosa.
• Gastrectomy• Ileal resection • Inflammation or neoplasms in the terminal ileum • Malabsorption syndromes
Clinical Features
• Glossitis• Anorexia• Diarrhea• Demyelination of the dorsal and lateral
columns of the spinal cord causes symmetric paresthesias of the feet and fingers, loss of vibratory and position sense, and eventual spastic ataxia.
Folic Acid–Deficiency Anemia
• Folic acid is also required for DNA synthesis and red cell maturation
• Increased MCV and normal MCHC• Folic acid is readily absorbed from the
intestine. • It is found in vegetables (particularly the green
leafy types),fruits, cereals, and meats.
Dietary requirement for folate (µg/24h)
• Adult males - 200 • Adult females - 170 • Pregnancy - 370-470 • Lactation - 270 – Children 1-6 years - 50 – 7-12 years - 102 – 13-16 years - 170
Causes of deficiency• Pregnancy• Malnutrition• Alcoholism• Total body stores of folic acid amount to 2000 to 5000 µg, • Daily requirement - 50µg• Malabsorption of folic acid in
– Celiac disease– Drugs
• Phenobarital, phenytoin, primidone• Diuretic• Methotrexate – anti cancer
Aplastic Anemia• Disorder of pluripotential bone marrow stem cells that results
in a reduction of all three hematopoietic cell lines—red blood cells, white blood cells, and platelets
• The cells that remain are of normal size and color• Features
– weakness, – fatigability, – Pallor– Petechiae (i.e., small, punctate skin hemorrhages)– Ecchymoses (i.e., bruises) often occur on the skin,– and bleeding from the nose, gums, vagina, or gastrointestinal tract
due to decreased platelet levels. – increases susceptibility to infection - neutrophils .
Causes
• Exposure to – Radiation,– Chemicals– Toxins
• Complication of infections– Viral hepatitis– Mononucleosis, – other viral illnesses, including acquired
immunodeficiency syndrome (AIDS).– In 2/3rd cases, no known cause as idiopathic aplastic
anemia
Management
• Stem cell replacement by bone marrow or peripheral blood transplantation
• Immunosuppressive therapy• Blood transfusion• Corticosteroid therapy
Photomicrographs show hypocellular bone marrow before (a) bone marrow transplantation and regenerating hematopoeisis and normal cellularity after bone marrow transplantation (b).
A
B
Anemia of Chronic Disease
• As a complication of – Chronic infections– Inflammation– Cancer– Chronic kidney disease
• Treatment for the underlying disease• Short-term erythropoietin therapy• Iron supplementation• Blood transfusions