ANEMIA

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Published on March 18, 2014

Author: abhijitgg25

Source: authorstream.com

ANEMIA: ANEMIA Dr.ABHIJIT GOGOI UNIUVERSITY OF FIJI Anemia: Anemia Anemia is qualitative or quantitative decrease in hemoglobin content or RBCs count, or both of them below the normal range. Anemia leads to a decrease in blood ability to transport oxygen to tissue cells. Low RBC count(<4million/cmm): Low RBC count(<4million/cmm) Anaemia is labelled when Hb Conc is less 13 gm/dl in adult males 11.5 gm/dl in adult females 15 gm/dl in newborns 9.5 gm/dl at 3 month of age Gradings of Aneamia Mild Aneamia - Hb 8-10 Gm% Moderate Aneamia - 6-8 Gm% Severe Aneamia – Hb <6 Gm% Anemia: Anemia Types & causes of anemia: I-Blood loss anemia: A-Acute blood loss anemia : Due to severe hemorrhage. Plasma volume is replaced rapidly by the fluids present in tissue spaces. This leads to marked dilution of the blood. RBCs are replaced within 2-3 weeks. Sufficient iron gives normocytic cells but insufficient iron will produce microcytic RBCs. Anemia: Anemia Types & causes of anemia: I-Blood loss anemia: B-Chronic blood loss anemia : Due to repeated loss of small amounts of blood over a long period e.g.: -Gastrointestinal bleeding (peptic ulcer)/piles -Excessive menstruation. -Hemorrhagic diseases. Due to depletion in iron stores the newly formed RBCS are microcytic . Anemia: Anemia Types & causes of anemia: II- Aplastic anemia: It results from destructione of bone marrow. Diminished erythropoisis It may result from: 1-Excessive exposure to x-rays or gamma rays. 2-Chemical toxins e.g. cancer therapy & prolonged exposure to insecticides or benzene. 3-Invasion of bone marrow by cancer cells. 4-Following infection by hepatitis. Damaged bone marrow don ’ t produce any RBCs, so in aplastic anemia RBCS are normocytic . It is associated with decrease in WBCs & platelets. Aplastic Anemia:  Aplastic Anemia Fanconi anemia – congenital Direct stem cell destruction – external radiation Drugs - chloramphenicol , gold, sulfonamides, felbamate Other Toxins - Solvents, degreasing agents, pesticides Viral infection - parvovirus B19, HIV, other Idiopathic Aplastic Anemia: Aplastic Anemia Should be suspected from an inappropriately low reticulocyte count. Diagnosis can be confirmed by bone marrow examination. Anemia: Anemia Types & causes of anemia: III-Hemolytic anemia: It results from increased rate of destruction of RBCs inside the vascular system. Causes of hemolytic anemia: A-Hereditary:( intracopuscular defects) 1-Membrane abnormalities.e.g .- hereditary spherocytosis , hereditary elliptocytosis 2-Enzyme deficiency e.g. G-6-P Dehydrogenase .( Oxidation vulnerability) 3-Hemoglobin abnormalities.- sickle cell syndromes, unstable hemoglobins,methemoglobinemia 4Glycolytic defects: pyruvate kinase deficiency, 5 Thalassaemia III-Hemolytic anemia: : III-Hemolytic anemia: B-Acquired:( extracorpuscular defects) 1-Incompatible blood transfusion.(Ag- Ab reaction), erythroblastosis foetalis 2-Parasitic infection e.g. malaria. 3-Toxic agents e.g. snake venom & insect poisons. 4-Thermal e.g. several burns. 5 -  Microangiopathic:Prosthetic valve 6 - Hypersplenism –anemia caused by splenomegaly Anemia : Anemia Types & causes of anemia: IV- Dyshemopoietic anemia: Deficiency anemia's-Which may be due to: 1-Iron deficiency anemia. 2-Maturation failure ( megaloblastic ) anemia:- a-Vitamin B 12 deficiency. b-Folic acid deficiency. 3-Anemia of endocrine disorders. 4-Protein deficiency anemia. 5-Anemia of renal failure. Morphological Classification of Anemia: Morphological Classification of Anemia Morphological Approach Red blood cell size(MCV) Microcytic (Cells Smaller than normal size i.e. MCV< 80 fl) Normocytic (Cells Normal sized i.e. MCV = 80-100 fl) Macrocytic (Cells bigger than normal size i.e. > 100 fl) Concentration of Hb (MCHC) Normochromic (Normal Hb Concentration) Hypochromic (Decreased Hb Concentration- cells paler than normal) PowerPoint Presentation: Normochromic=RBC with normal amount of hemoglobin. Hypochromic=RBC with low level of hemoglobin. No hyperchromic RBC. Morphological Classification of Anemia: Morphological Classification of Anemia Normocytic Normochromic Anemia. Microcytic Hypochromic Anemia. Macrocytic Hypochromic Anemia. MORPHOLOGICAL CLASSIFICATION OF ANEMIA(wintrobes): MORPHOLOGICAL CLASSIFICATION OF ANEMIA(wintrobes) PATHOLOGY, SYMPTOMS, AND SIGNS OF ANEMIA : PATHOLOGY, SYMPTOMS, AND SIGNS OF ANEMIA Megaloblastic anemia:: Megaloblastic anemia: Vitamin B12/Folic acid deficiency Second most common type of anemia. Macrocytic anemia, pancytopenia . Pernicious anaemia – autoimmune, Gastric atrophy, VitB12 def. Megalobl - Pathogenesis:: Megalobl - Pathogenesis: Decreased Vit B12 / Folate Decreased DNA Synthesis Delayed maturation of erythroblasts (Nucleus) Increased cell size ( macrocytes ) Normal hb content ( Normochromia ) Decreased RBC number Decreased WBC number ( pancytopenia ) Anemia & Pancytopenia . Macrocytic Anemia (Meg.):: Macrocytic Anemia (Meg.): CWM-20353-Meg.An: CWM-20353-Meg.An Megaloblastic Anemia : : Megaloblastic Anemia : Maturation factors: Maturation factors Vitamin B12 and Folic acid: Essential for DNA synthesis ( Thymidine triphosphate ) Abnormal and diminished DNA Failure of division and maturation Macrocytic / Megaloblastic anemia Megaloblastic Aneamia: Megaloblastic Aneamia The presence of macro- ovalocytes having an MCV >115 fl, anisocytosis , poikilocytosis and hypersegmented neutrophils suggests a megaloblastic disorder associated with a nutritional deficiency, i.e., vitamin B12 or folate deficiency. Vitamin B12 Deficiency : Vitamin B 12 Deficiency Essentials of Diagnosis Macrocytic anemia. Macro- ovalocytes and hypersegmented neutrophils on peripheral blood smear. Serum vitamin B 12 level less than 100 pg/ mL. PowerPoint Presentation: Other Lab tests Homocysteine – Folate def. Methylmalonic acid – B12 def. Intrinsic Factor Ab test – very specific for pernicious anemia but only 50% sensitive Parietal cell AB test – quite sensitive (90%) but not specific Schilling test PowerPoint Presentation: The bone marrow is hypercellular , showing evidence of abnormal proliferation and maturation of multiple myeloid cell lines. These abnormalities are most evident in the erythroid precursors with large megaloblastic erythroblasts present in increased numbers throughout the marrow. Bone Marrow Cellularity:: Bone Marrow Cellularity: Normal Hypercellular Hypocellular PowerPoint Presentation: Similar morphologic abnormalities can be seen in the other myeloid elements, e.g., large or giant metamyelocytes and other granulocytic precursors. This ineffective erythropoiesis is accompanied by intramedullary hemolysis causing an elevated lactate dehydrogenase and indirect bilirubin in the serum. However, the reticulocyte count is low due to the abnormal maturation process. Vitamin B12 Absorption: Vitamin B 12 Absorption Parietal cells - produce IF IF B 12 B 12 B 12+IF IF Stomach IF Ileum - IF receptors B 12 B 12 CAUSES OF MEGALOBASTIC ANEMIA: CAUSES OF MEGALOBASTIC ANEMIA PowerPoint Presentation: Methylmalonic Acid (MMA) and Homocysteine Serum Concentrations Cobalamin and folate are cofactors in several important metabolic pathways in the cell. The hydroxylated form of cobalamin plays an important role in the metabolism of homocysteine and MMA. The conversion of homocysteine to methionine requires both vitamin B12 and folate as cofactors. PowerPoint Presentation: However, the metabolism of L- methylmalonyl CoA to succinyl CoA , an enzymatic pathway involved in oxidative phosphorylation reactions within the cell, only requires vitamin B12. PowerPoint Presentation: Differentiating cobalamin deficiency from folate deficiency by measuring serum MMA and homocysteine levels. Both of these metabolites are elevated in cobalamin deficiency, PowerPoint Presentation: In folate deficiency patients, serum homocysteine levels are markedly increased, while serum MMA levels are not elevated Vitamin B12 Absorption: Vitamin B 12 Absorption Parietal cells - produce IF IF B 12 B 12 B 12+IF IF Stomach IF Ileum - IF receptors B 12 B 12 COMPARISON OF FEATURES OF VITAMIN B12 AND FOLIC ACID DEFICIENCY STATES : COMPARISON OF FEATURES OF VITAMIN B12 AND FOLIC ACID DEFICIENCY STATES

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