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Anemia. Actuality of theme:. Anemia is very often met in 20% women of the developed countries and in 50% women of the non-developed countries; More than 50% patients with chronic diseases and tumors; Considerably worsens quality of life and capacity. Definition of anemia.
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Actuality of theme: • Anemia is very often met in 20% women of the developed countries and in 50% women of the non-developed countries; • More than 50% patients with chronic diseases and tumors; • Considerably worsens quality of life and capacity.
Definitionofanemia Anemiais the decreasing of hemoglobin and red blood cells level in the unit of blood volume Reduction in one or more of the major red blood cell (RBC) measurements:Hemoglobin Hematocrit RBC countFrom data of WHO:a hematocrit less than 40 in men and 37 in women, or hemoglobin less than 130 g/l in men and less than 120 g/l in women.
Weaknessandfatiguearethemostcommonsymptomsofanemia. • Decreased energy • Shortnessofbreathonexertion (dyspnea) • Palpitations (feeling of the heart racing or beating irregularly) • Cold hands or feet • Headache • Lightheadednessordizziness • Dizziness and passing out, especially upon standing • Ringingintheears (tinnitus) • Irritabilityandothermooddisturbances • Mentalconfusion • Lethargy Signs and symptoms
Chest pain (angina or heart attack) • Intermittentclaudication • Lossofsexualdrive • Abdominal pain • Weight loss Signs and symptoms
The skin and mucous membranes are pale (however, healthy-looking skincolordoesnotruleoutanemiaif a patienthasriskfactorsandothersymptomsofanemia) • Rapidheartbeat - tachycardia, • Heart murmur - systolicflowmurmur, • heartfailure • tachypnea • Low blood pressure (hypotension) PhysicalExamination
Reticulocyte count • Retic count = % immature RBC • Normal 0.5-1.5% (for non-anemic) • <1% Inadequate production • >=1% Increased production (? adequacy)
Classification according to mechanism • Blood loss acute and chronic • Excessive destruction of rbcs • Impaired production of rbcs
Iron • B12 • Folate Decreased ProductionNUTRITIONAL DEFICIENCY
Microcytic anemia (MCV less than 80) • - Usually hypochromic as well • Iron-deficiency anemia • Anemia of chronic diseases(rare) • Sideroblastosis • Hereditary anemia (thalassemia) • Lead poisoning • Deficit of copper, poisoning by zinc
Microcytic Anemia • MCV <80 • Reduced iron availability • Reduced heme synthesis • Reduced globin production
Microcytic AnemiaREDUCED HEME SYNTHESIS • Lead poisoning • Acquired or congenital sideroblastic anemia • Characteristic smear finding: Basophylic stippling
Microcytic AnemiaREDUCED GLOBIN PRODUCTION • Thalassemias • Smear Characteristics • Hypochromia • Microcytosis • Target Cells • Tear Drops
Thalassemia • Normal to inc. RPI • Normal RDW • Target cells • Mentzer index <13 =MCV/RBC • Youden’s index - using RDW & Mentzer index - sensitivity = 82% - specificity = 80% • confirm w/ Hgb electrophoresis
Makrocytic anemia (MCV more than 100 fl) - Megaloblastic anemia (vitamin В12 or folic acid deficiency ) - Toxic effect of chemotherapeutic agents (methotrexate) or other medications (zidovudine (AZT), phenytoin) - Pathology of bone marrow - Chronic abuse by alcohol (toxic effect) - Liver disease
Folate • Inadequate intake • Synthesized by plants and micro-organism • Green leafy vege’s • Fruits • Absorbed in jejunum B12 • Inadequate absorption • Synthesized by bacteria • Meat, fish, dairy (strict vegans) • Absorbed as B12-IF complex in ileum (gastrectomy) • Ca++ and pH dependant (PPI) MegaloblasticAnemia
Smear • Macro-ovalocytic • Polychromasia • Hypersegmented neutrophil Megaloblastic 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
Spherocytes. One arrow points to a spherocyte; the other, to a normal RBC with a central pallor.
Clinical Presentation: Signs and Symptoms http://www.ornl.gov/sci/techresources/Human_Genome/posters/chromosome/sca.shtml
A prolonged environment of low oxygen leads to aggregation and polymerization of hemoglobins into long chains of rod-like fibers, causing the RBC to form the shape of a crescent or sickle. • Donut-shaped • Soft and malleable • Able to pass through small spaces • Lifespan ~120 days • Sickle-shaped • Hard and rod-like • Gets stuck in narrow spaces • Lifespan ~20 days http://www.humanillnesses.com/original/images/hdc_0001_0003_0_img0235.jpg
Sickling of red blood cells leads to: • Vaso-occlusive complications • Severe anemia • Chronic hyperbilirubinemia
Vaso-occlusive complications • Occur in areas with: • Prolonged, low oxygen tension • Decreased pH • Inflammation • Low blood flow Source: Robbins
Irreversibly sickled cells end up in the spleen. • Hemolysis occurs at the splenic cords. • Decreased RBCs and increased bilirubin • Infarction and fibrosis causes autosplenectomy. Severe Anemia and Chronic Hyperbilirubinemia Source: Robbins