anemia new

By:.

Amit Kr. Singh

AnemiaAnemia

DefinitionDefinition

TypesTypes

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Anaemia =Anaemia = reduction of O reduction of O2 2 carrying capacity carrying capacity

of the blood with inadequate Oof the blood with inadequate O22 supply to supply to

tissue .tissue .

Anaemia is diagnosed when there isAnaemia is diagnosed when there is a a

reduction of (RBCs number or PCV) below reduction of (RBCs number or PCV) below

the reference range for age and sex of the the reference range for age and sex of the

individual .individual .

More More accurately is defined as is defined as reduction in reduction in

the red cell massthe red cell mass

AnemiaAnemia

DefinitionDefinition

TypesTypes

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Mineral deficiency: iron, zinc, selenium, cupper

Vitamin deficiency: B12, folic acid ; Vit C&

pyridoxine

Hormonal deficiency: anaemia of renal

diseases, pituitary, thyroid or suprarenal

deficiency.

Protein deficiency : high class

ETIOLOGICAL CLASSIFICATION

I- Decrease red cell production.

AnemiaAnemia

TypesTypes

II- Haemolytic anaemia:II- Haemolytic anaemia:

Short life-span of RBCsShort life-span of RBCs

III- Acute post hemorrhagic anaemia:III- Acute post hemorrhagic anaemia:

Loss of RBCsLoss of RBCs

IV- Mixed anaemia.IV- Mixed anaemia.

eg. Megalobastosis associated with haemolysis eg. Megalobastosis associated with haemolysis

ETIOLOGICAL CLASSIFICATIONETIOLOGICAL CLASSIFICATION

AnemiaAnemia

TypesTypes

MORPHOLOGICAL CLASSIFICATION

A. Microcytic-hypochromic anaemias:

Thalassaemia.

Iron deficiency anaemia.

Anaemia of chronic disease.

AnemiaAnemia

TypesTypes

MORPHOLOGICAL CLASSIFICATION

B-Normocytic-normochromic anaemias:

Acute post –haemorrhagic anaemia.

Hemolytic anaemia.

Aplastic anaemia.

C- Macrocytic- normochromic anaemias:

Megaloblastic anaemia.

AnemiaAnemia II- GENERAL SYMPTOMS OF ANAEMIA:II- GENERAL SYMPTOMS OF ANAEMIA:

1-Neurological

Dizziness, fainting, lack of concentration

Blurred or diminished vision

Headache,

Paraesthesia in the fingers and toes

Insomnia, irritability.

2-CVS:

Angina, dyspnea, palpitation and intermittent

claudication by exertion

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AnemiaAnemia II- GENERAL SYMPTOMS OF ANAEMIA:II- GENERAL SYMPTOMS OF ANAEMIA:

4-GIT:4-GIT:

Dyspepsia and anorexia Dyspepsia and anorexia

5-Genital5-Genital

Loss of libido & impotence Loss of libido & impotence

Menstrual abnormalities as amenorrhea. Menstrual abnormalities as amenorrhea.

6-May be polyuria.6-May be polyuria.

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AnemiaAnemia III- PHYSICAL SIGNS:III- PHYSICAL SIGNS:

Pallor of the skin and mucous membranes

Fever :

Mild fever may occur in sever anaemia but

other causes should be excluded

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Microcytic Microcytic AnemiaAnemia

Basic nutritional features and metabolism of iron Basic nutritional features and metabolism of iron

Dietary sources :

Red meat and liver, bread, eggs and green

vegetables, mainly in ferric form,

Daily minimum requirement 10-12mg of which

about 1mg is absorbed.


Factors enhancing iron absorption

Pregnancy

Iron deficiency anaemia

Increased erythropoiesis

Vit. C.


Storage :

About two-thirds of the total body iron is in

the circulation as haemoglobin.

Iron loss: (0.5 mg/day). Via

Hair and nail growth

Epithelium of the skin and mucus membrane.

body excreta : stool and urine


General manifestations of anaemia GIT manifestations

Angular stomatitis.• Atrophic glossitis (red, glazed, smooth

tongue) Koilonychia; spoon-shaped nails in severe cases: Brittle hair

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AetiologyAetiology

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Features of special types:

1- Plummer-Vinson –syndrome: Common in middle aged female Postcricoid esophageal web cause

dysphagiaC/PC/P


A.A.To diagnose iron deficiency anaemia To diagnose iron deficiency anaemia

CBC: The red cells are microcytic, (MCV<80f1)

and hypochromic (MCH < 27pg) and

poikilocytosis (variation in size and

shape).

Bone Marrow: Absent iron store, Normoplastic hyperplasia, ↓ Hb in maturely erythroblasts.

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A.A.To diagnose iron deficiency anaemia To diagnose iron deficiency anaemia

Serum iron study Decreased serum iron (n=70-170 mg%). Increased total iron binding capacity

(TIBC).(n=250-450mg%). Decreased transferrin saturation (n=25-

50%)

LabLab


The aim of the treatment is to correct the The aim of the treatment is to correct the

anemia and build up iron stores anemia and build up iron stores Correction of underlying cause if Correction of underlying cause if

possiblepossible Iron replacement Iron replacement

Oral iron: Oral iron: 200 mg anhydrous ferrous sulphate three 200 mg anhydrous ferrous sulphate three

times daily.times daily. The response is a rise in Hb The response is a rise in Hb

concentration of 1 gm/dl per week, concentration of 1 gm/dl per week, Side effects Side effects nausea, abdominal pain, nausea, abdominal pain,

diarrhea or constipation. diarrhea or constipation.

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AetiologyAetiology

Macrocytic Macrocytic AnemiaAnemia

MEGALOBLASTIC ANAEMIA

This anaemia in which DNA syntheses is impaired with delayed nuclear maturation. This will lead to formation of megaloblast i.e. large cells with large immature nucleic ( cellular gigantism). The cells affected are those rapidly developing: haematopoietic cells, GI mucosa, and skin.

Megaloblastic changes occur in

1- Vitamin B12 deficiency or abnormal vit. B12 metabolism

Macrocytic Macrocytic AnemiaAnemia •VITAMIN B12

Vit B12 is synthesized by certain micro-organism.

*Sources: meat, fish, eggs, and milk but not

plants

*It is not destroyed by cooking . *Daily requirement is 1-2 mg / day.

*Storage : the average adult stores 2-3 mg in the liver, ).

Macrocytic Macrocytic AnemiaAnemia Absorption: Vit. B12 is liberated in the

stomach, bound by intrinsic factor (IF) and absorbed through the terminal ileum.

It is essential for:

1-haematopoiesis 2-GIT mucosa integration

3-Formation of myelin of nervous system.

Macrocytic Macrocytic AnemiaAnemia

CAUSES OF VIT. B12 DEFICIENCY

I- True deficiency: (Decreased intake) -Poor socioeconomic status. -Vegetarians, alcoholic

II-condition deficiency A-Decreased absorption .

Treatment :Hydroxycobalamin as intramuscular injection 100 mg for 3 weeks and oral folic acid 5mg tablets daily for 4 months

HAEMOLYTIC HAEMOLYTIC AnemiaAnemia

Definition : An abnormal excessive destruction of red cells that overwhelms the compensatory capacity of the bone marrow.

{normally ,RBCs are being regularly destroyed after 120 days ,but haemolytic anaemia does not develop because of compensation by the BONE MARROW}

HAEMOLYTIC ANAEMIA

Haemolytic Haemolytic AnemiaAnemia

ETIOLOGY:

1.Conginital (intra -corpuscular) or

2.Acquired (extra –corpuscular(

2.Acquired (extra –corpuscular(

Autoimmune. Infections (colestridia,malaria(.

Drugs.

Haemolytic Haemolytic AnemiaAnemia 1.Conginital (intra -corpuscular(

a. Abnormalities of red cell membrane.b. Disorder of haemoglobin (himoglobinopathy(

Lack of Hb synthesis. Abnormal Hb. (sickle cell(

c. Red cell enzyme defects. Glucose 6 phosphate dehydrogenase(G-6-PD(

Haemolytic Haemolytic AnemiaAnemia Clinical feature:


1- Short life span of RBCs:Measured by radioactive barium labeled RBCs

2-Bone marrow* Hypercellular normabloastic marrow.* Hypocellular in a plastic crisis.* Megaloblastic in folate deficiency.

3-Increased serum LDH

4-Incresesd serum biliurbin and urinary urobilinogen.

INVESTIGATIINVESTIGATIONON


SICKLE CELL ANAEMIASICKLE CELL ANAEMIA

Symptoms vary from a mild asymptomatic disorder to severe haemolytic anaemia and recurrent severe painful crises.


CLINICAL FEATURES :

1) The disease is more common among negros.

2) General manifestations of haemolytic anaemia

3) In the older patients, vaso-occlusive problems occur owing to sickling in the small vessels of any organ, typical infarctive sickle crises include


COMPLICATIONSCOMPLICATIONS

1) Susceptibility to infections

2) Chronic leg ulcers due to ischemia

3) Gall stones pigment stones from persistant haemolysis

4) A septic necrosis of bone particularly of the femoral heads

5) Blindness due to retinal detachment and / or proliferative retinopathy

6) Chronic renal disease.

Haemolytic Haemolytic AnemiaAnemia Investigations:

1) CBC

The level of Hb is in the range 6-8gm/dl with high reticulocytic count (10-20%).

2) Hb electrophoresis:

* There is no Hb A, 80-85% Hb S and 2-20% HbF. * The parents of the affected child will show features of

sickle cell trait


TREATMENT :TREATMENT :

a) prophylaxis

* Genetic counseling * Prenatal diagnosis * Prevent exposure to hypoxia * Vaccination

b) Active treatment

1) The “steady state” anaemia requires no treatment

2) Acute attacks require supportive therapy intravenous fluids, oxygen, antibiotics and adequate analgesia.

3) Folic acid (5mg/day) is given to prevent megalobastosis.

AnemiaAnemia

anemia new

Health & Medicine

iron deficiency anaemia

hemolytic anaemia

aplastic anaemia

iron loss

anaemia of chronic disease

typesii haemolytic anaemia

anaemia of renal diseases

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