Anaemia’s

1. Anaemia’s Shannon and Rick

2. Anaemia • A Hb deficit of whole-body circulating blood volume • Dependant on age and gender • Creates the risk of tissue hypoxia

3. Classifying Anaemia • Cause • Failure of RBC production • Loss/destruction of RBC’s • Morphology • Cell Size • Microcytic • Normocytic • Macrocytic • Cell Shape • Poikilocytes • Sickle cell • Cell Colour • Normochromic • Hypochromic

4. Anaemia of Blood Loss • Acute • Blood loss + IV therapy  anaemia of dilution • ↓PCV • Normochromic, normocytic  macrocytic, hypochromic (reticulocytes from ↑ EPO) • Chronic • Rate of blood loss > erythropoeisis or iron stores depleted

5. Haemolytic Anaemia • Intravascular (vessels) vs. Extravascular (spleen) • Premature RBC destruction • ↑EPO  ↑erythropoeisis marrow erythroid hyperplasia + Reticulocytosis • ↑ Hb degradation products  mild jaundice • Splenomegaly

6. Hereditary Spherocytosis • Protein defect  lipid destabilization and membrane fragility  membrane loss  altered shape to accommodate volume  Spleen food • Spherical, normochromic • ↑MCHC due to dehydration • Tx.: Splenectomy, folate, genetic counselling, transfusinon (w. iron-chelator), bone marrow transplant

7. G6PD Deficiency • Oxidant damage • Recessive X-linked trait + infection (stress) • Intra/extravascular • Normochromic, normocytic • Tx. : stop offending drugs, treat infection, transfusion as required.

8. Thalassemia • Varying types, symptoms dependent. • Reduced or absent α/βglobin chains due to recessive inherited genetic traits. Unimpaired chain gets put into overdrive. • Ineffective erythropoesis (apoptosis in marrow), haemolysis, decreased O2 carrying capability • Hypochromia, microcytic

9. Sickle Cell anaemia • Abnormal Hb that crystallizes once offloaded the oxygen: point mutation in βglobin • Changed shape leads to removal in spleen or impairment of circulation • Reversible. • Normochromic, sickle-shaped cells due to fibres.

10. Immunohemolytic Anaemia • Type II hypersensitivity (Ab and complement attach on  lysis/phagocytosis) • Normochromic, normocytic • Tx. : remove offending source (drug, chemical, environment), splenectomy, corticosteroids.

11. Paroxysmal Nocturnal Hemoglobinuria • Mutation in gene for an enzyme essential for cell membrane synthesis. • Complement (more active at night) says “whats up with this cracker?” and takes him out • Tx. : Immunosuppressive drugs, bone marrow transplant.

12. Anaemia’s of Diminished Erythropoiesis • Megaloblastic (Pernicious) Anaemia • Megaloblastic (folate Deficiency) Anaemia • Iron Deficiency Anaemia • Anaemia of Chronic Disease • Aplastic Anaemia

13. Pernicious Anaemia and Folate Deficiency Anaemia • Vit B12 deficiency (potentially due to lack of parietal cells. Vit B9 deficiency. • Megaloblastic (normochromic, macrocytic – due to disabling of mitosis) • Tx. B12/B9

14. Iron Deficiency Anaemia • Hypochromic, microcytic anaemia. • Hb is not made, hence no O2 transport. • Lots of common signs and symptoms • Check iron tests • Tx: iron! Beware haemochromotosis.

15. Anaemia of Chronic Disease • Cytokines  ↑hepatic hepcidin inhibit ferriportin.no iron delivered to developing RBC’s • Normochromic/normocytic or hypochromic/microcytic • Ferritin should be normal/ high (diff. to iron deficiency), TIBC low or normal

16. Aplastic Anaemia • Bone marrow not having enough RBC progenitors to replenish aged RBC’s. • Autoimmune destruction, drugs, cancer. • Pancyopenia symptoms • Tx. : immune suppression + marrow transplant and supportive therapy

17. Symptoms • Glossitis • papillae atrophy due to high turn over of mucosal cells, is very sensitive to nutritional deficiencies. Reveals vasculature below, and can lead to inflammation. • Easily fatigued/Tiredness • Lack of O2 carrying ability of the blood due to lack of circulating Hb means not enough O2 available for aerobic metabolism to occur. • Tachypnea • due to above, therefore resp rate is increased in an effort to accommodate for this and ‘get more O2 in” • Tachycardia • as above again, in an effort to ‘deliver’ more O2 to O2 starved sites. • Koilonychia • no idea why we get this, we just do.