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بسم الله الرحمن الرحيم

بسم الله الرحمن الرحيم. ANEMIA Dr Mokarian ICM 83/2/7. Dr mokarian. PROPERTIES OF THE HUMAN HEMOGLOBINS. HEMOGLOBIN STRUCTURE: 1- a tetramer of globin polypeptide chains A pair of a-like chains 141 amino acids long A pair of b-like chains 146 amino acids long HbA( a2b2)

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بسم الله الرحمن الرحيم

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  1. بسم الله الرحمن الرحيم

  2. ANEMIA Dr Mokarian ICM 83/2/7

  3. Dr mokarian PROPERTIES OF THE HUMAN HEMOGLOBINS • HEMOGLOBIN STRUCTURE: • 1- a tetramer of globin polypeptide chains • A pair of a-like chains 141 amino acids long • Apair of b-like chains 146 amino acids long • HbA( a2b2) • HbF (a2g2) • HbA2 (a2d2) • 2-single heme moiety / every globin chain heme=protoporphyrin IX ring +a single iron atom in the ferrous state (Fe2+): • every molecule of hemoglobin can thus transport up to four oxygen molecules

  4. Dr mokarian PROPERTIES OF THE HUMAN HEMOGLOBINS FUNCTION OF HEMOGLOBIN: hemoglobin must bind O2 efficiently at the partial pressure of oxygen (PO2) of the alveolus, retain it, and release it to tissues at the PO2 of tissue capillary beds.

  5. Dr mokarian

  6. Dr mokarian The Bohr effect arises from the stabilizing action of protons on deoxyhemoglobin, which binds protons more readily than oxyhemoglobin because it is a weaker acid. HbA has a reasonably high affinity for 2,3-BPG. HbF does not bind 2,3-BPG, so it tends to have a higher oxygen affinity in vivo.

  7. Dr mokarian HEMOGLOBIN STRUCTURE:

  8. Dr mokarian • DEVELOPMENTAL BIOLOGY • first appearing at about 6 weeks after conception • HbPortland (z2g2), Hb Gower I (z2e2), and Hb Gower II (a2e2) • At 10 to 11 weeks, fetal hemoglobin (HbF; a2g2) becomes predominant. • The switch to nearly exclusive synthesis of adult hemoglobin (HbA; a2b2) occurs at about 38 weeks • Fetuses and newborns therefore require a-globin but not b-globin for normal gestation.

  9. CLINICAL PRESENTATION OF ANEMIA Anemia is most often recognized by abnormal screening laboratory tests. the gradual onset of anemia,particularly in young patients,may not be associated with signs or symptoms until the anemia is severe [Hemoglobin <70 to 80 g/L (7 to 8 g/dL)] DIFINATION : MALE Hb< 14-16 Mg/dl FEMALE Hb< 12-14 Mg/dl

  10. CLINICAL PRESENTATION OF ANEMIA • SYMPTOM: • FATIGUE • SKIN • NEUROLOGIC • CARDIOLOGIC • RESPIRATORY • GASTROINTESTINAL • GUT

  11. CLINICAL PRESENTATION OF ANEMIA • SIGN • Weakness • Skin • Neurologic • Cardiovascular • Respiratory • Gastrointestinal • GUT

  12. Primary Labortory Test For Anemia • CBC –PLT • HB • HCT • RBC • MCV 80-100fl HCT(G//L) / RBC (* 1000,000,000,000/L) • MCH 30-34 PG HB(G/L) /RBC (*1000.000,000,000) • MCHC 30-36G/DL) HB( G/L) / HCT ( L/L) • RDW 12 - 14 • WBC & DIF • PERIPHERAL BLOOD SMEAR • RET% • BUN/CR

  13. Labortory test for anemia RETICULOCYTE PRUDUCTION INDEX (RPI) RPI=RET%*PHCT/NHCT/ SI

  14. EXAMPLE FOR RPI CALCULATION 35 YEARS AGED MALE WITH : HB=8 G/DL MCV=105 fl RET%=3% CRC=24 / 45 * 3=1.6 RPI=1.6 / 2 = 0.8

  15. CALCULATTION USED FOR INTERPRETING RBC INDECES IN MICROCYTIC ANEMIA

  16. Labortory test for anemia • IRON RESERVE TESTS • SERUM IRON • TIBC • TRANSFERIN SATURATION • FERITIN • FREE ERYTROCYTIC PROTOPURPHIRIN • BMB STAINING

  17. Labortory test for anemia • EVALUTION FOR HEMOLYSIS • RETICULOCYTE PRODUCTION INDEX • LDH • HAPTOGLUBULIN • HEMOPEXIN • HEMALBUMIN • URIN HEMOCIDERIN • HEMOGLUBINUREA

  18. APPROUCH TO ANEMIA RPI LOW RPI INCREASED RPI <2 > OR = 2 MCV HEMOLYTIC ANEMIA POST TREATMENT DECREASED NORMAL INCREASED FE TIBC FERITIN MEGALOBLASTIC ANEMIA IDA NO IDA & MDS HB ELECTEROPHERESIS & AA R/O ANEMIA OF CHRONIC DISEASE

  19. 36 YRS MALE WITH ANEMIA HB=12 MCV=65 RBC =5600000 MCH=23 28 FEMALE WITH ANEMIA HB=9 MCV=76 RBC= 4800000 14 YRS BOY HB=7 MCV=108 RET=15% RBC=45000000

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