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ANAEMIA

ANAEMIA. The term is derived from ancient Greek ” bloodlessness “ it is defined as a low haemoglobin concentration that is below the normal range appropriate for age and sex. which is <13.5g/dl for male and <11.5g/dl for female. CLASSIFICATION. Anaemia may be due to

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ANAEMIA

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  1. ANAEMIA The term is derived from ancient Greek ” bloodlessness“it is defined as a low haemoglobin concentration that is below the normal range appropriate for age and sex. which is <13.5g/dl for male and <11.5g/dl for female.

  2. CLASSIFICATION Anaemia may be due to DECREASED MARROW PRODUCTION lack of iron,vitB12,folate. Hypoplasia invasion by malignant cells. PERIPHERAL CAUSESblood loss haemolysis hypersplenism

  3. MICROCYTIC iron deficiency thalassemia sideroblastic anaemia of chronic disease • MACROCYTIC megaloblastic normoblastic liver disease hypothyroidism hyperlipidaemia

  4. Alcohol pregnancy cytotoxic drugs reticulocytosis(haemolysis) MDS,marrow infiltration • NORMOCYTIC anaemia of chronic disease acute blood loss hypothyroidism hemolytic aplastic

  5. HAEMOLYTIC CONGENITAL hereditary spherocytosis hereditary elliptocytosis .thalassemia .sickle-cell G-6-PD deficiency pyruvate kinase deficiency • ACQUIRED IMMUNE autoimmune, warm/cold alloimmune (transfusion reaction, organ transplantation)

  6. NON IMMUNE PNH mechanical(prosthetic heart valve,march & microangiopathic haemoglobinuria) Infection;falciparum malaria,sepsis Chemicals,drugs(dapsone.sulphonamide) sec to other disease e.g renal or liver failure Extra-vascular;sickle-cell,hereditary spherocytosis intra-vascular;G6PD,acquired haemolytic anaemias

  7. CLINICALFEATURES • SYMPTOMS Fatigue dyspnoea palpitations headache dizzines angina

  8. SIGNS mucous membrane pallor tachypnoea postural hypotension high volume pulse severe anaemia<8g/dl tachycardiasystolic flow murmurs raised JVP ankle oedema heart failure

  9. SPECIFIC CLINICAL FEATURES IRON DEFICIENCY koilonychia atrophic glossitis rarely post-cricoid webs.

  10. Thalassemia • Thalassemic facies, bossing of skull, prominent malar eminence, skeletal deformities. Hepatosplenomegaly growth retardation intermittent fever haemochromatosis resulting in cirrhosis,cardiac failure, endocrinopathies.

  11. MEGALOBLASTIC ANAEMIA sore mouth smooth tongue angular cheilosis vitiligo grey hair weight loss pyrexia paresthesia ,dorsal column loss, subacute combined degeneration of cord

  12. HAEMOLYTIC mild jaundice hepatosplenomegaly (extravascular hemolysis) haemosiderinuria (intravascular haemolysis)

  13. SICKLE CELL ANAEMIA Early features; anaemia jaundice painful swelling of hand &feet splenomegaly<10yrs after that autosplenectomy

  14. ACUTE SYNDROMES. Precipitated by infection ,hypoxia, dehydration and acidosis. • Vaso-occlusive crises. acute severe bone pain. tachycardia, sweating, fever • sequestration crises sudden splenomegaly/hepatomegaly. aplastic crises. sudden lethargy,pallor

  15. CONGENITAL HAEMOLYSIS HEREDITARY SPHEROCYTOSIS • mostly asymptomatic with chronic compensated haemolytic state • there may be acute crisis. • Haemolytic crisis • Megaloblastic crisis • aplastic crisis • pigment gallstones in 50% causing cholecystitis

  16. PAROXSYSMAL NOCTURNAL HAEMOGLOBINURIA Haemoglobinuria only at night. Venous thrombosis at unusal sites(hepatic,mesenteric,cerebral) may have thrombocytopenia,neutropenia

  17. GLUCOSE-6-PHOSPHATE DEHYDROGENASE.DEFICIENCY. • Acute drug induced haemolysis presenting with haemoglobinuria, with analgesics.aspirin.phenacetin antimalarials antibiotics,sulphonamide,ciprofloxacin misc.vit K.quinidine. • Chronic compensated haemolysis. • Infection or acute illness.

  18. Low Hb High MCV>96fl Low MCV<76fl Normal MCV

  19. Low/norm MCV Hh retic(haemolysis) Blood film & retic count Norm/low retic Low MCH Target cells, dimorphic Ferritin norm/high Basophilic stippling Bone marrow Low ferritin Hb electrophoresis ACD sideroblastic Iron deficiency Bone marrow High HbA2 Norm HbA2 Iron stores adequate? B-thalassemia Alpha-thalassemia

  20. HAEMOLYTIC ANAEMIA Blood film spherocytes No spherocytes fragmentation DCT + DCT _ autoimmune Hereditary Hereditary microangiopathic spherocytosis haemolysis enzymopathies traumatic malaria clostridium

  21. FERRITIN is increased in A)iron deficiency anaemia B)sideroblastic anaemia C)anaemia of chronic disease D)thalassemia

  22. Ans) sideroblastic anaemia

  23. Following conditions can give macrocytic or normocytic picture except; • A)hypothyroidism B)pregnancy C)haemolysis D)anaemia of chronic disease

  24. Ans) anaemia of chronic disease

  25. Anaemia and splenomegaly is present in following conditions except • thalassemia • Leukemia • Infective endocarditis • sickle cell anaemia

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