ANAEMIA

1. ANAEMIA

2. Synopsis • Definition of anaemia. • Causes of anaemia. • Clinical feature of anaemia. • symptoms • signs • Classification of anaemia. • Iron deficiency anaemia • Megaloblastic anaemia or macrocytic anaemia • Parnicious anaemia or addisonian anaemia. • Aplastic anaemia. • Haemolytic anaemia. • Sickle cell anaemia • Thalesemia or cooleys anaemia.

3. 5. Investigation of anaemia 6. management of anaemia 7. Case Record

4. Definaton:-Anaemia is defined as a state in which blood haemoglobin level is below the normal range for the patients age , sex and altitude of resistance. • Normal Hb. Level – • In males - 13 -18gm% • In females - 11-5 -16.5 gm% • Children10-12 years – 11.5- 14 gm% • Childern 1year – 11.0 -13.0 gm% • Childern 3months- 9.5 -12.5gm% • Infants13.6 – 19.6gm%

5. Blood cell

6. Causes of Anaemia:--- • Due to Inadequate production of normal RBC • Deficiency – of Iron &vit B12 folate. • Endocrine deficiency– hypothyrodisum, hypopituitarism hypoadrenalism, hypogonadism, Reduced erythropoietin • Marrow failure- Hypoplastic, aplastic anaemia Marrow invasion - Leukemia, secondary CA • Maldevelopment - Sideroblastic A, Haemoglobinopathies.

7. Toxic Factors- Renal failure, hepatic failure drugs. • Due to excessive distruction of red cells (haemolytic). • congenital/ Genetic – Hb. Or enzyme deficiency. • Aquired - infections e.g. malaria • 3)Due to excessive blood loss – • accute blood loss –e.g. trauma, post partum bleading. • Chronic blood loss- e.g. peptic ulcers, worm infection, menorrhagia.

8. Clinical feature of anaemia:- • 1.Symptoms :- • Weakness • Irritability, lack of concentration sleep disturbances. • Dizziness, headache, syncope, vertigo, lassitude. • Throbing in head, ears. • Fatigueness, paraesthesia in finger, toes • Anorexia nausia, indigestion bowel disturbances. • Dyspnoea on Exertion.

9. Palpitation angina, symptoms of cardiac failure. • Amenorrhoea, polymernorrhoea. • 2.Signs :- • Pallor of skin, oral mucosa mambrane, tongue, nail beds, palpebral conjunctiva. • Oedema. • Tachycardia ,wide pulse pressure . • Koilonychia Brittleness amd longitudinal ridging on nails. • Sign of cadiac failure. • Murmure.

10. SYMPTOMS Headach

11. Abdomen – spleenomegaly. • Classification of anaemia:-------- • 1. Based on the aetiopathology. • 2. Based on the morphology of cell. • 1. Morphologiical classification • Macrocytic or megoloblastic Anaemia. • Microcytic anaemia – Mcv more than 100 fl. • Normocytic Normochromic anaemia or Aplastic Anaemia. • Hypochromic microcytic anaemia or IDA –MCV less than 78fl.

13. 2. Aetiopathological classification • Dyshaemopoietic – These are due to a deficiency in one of essential factors for the synthesis off Hb. Or. Normal RBC • For e.g. :- Deficiency of Vit. B12, Deficiency of iron, of thyroxin, of vit.c. • Haemolysis or H/g. • .

14. Due to excessive distruction of RBC. • Congenital e. g. sickle cell or thalesemia. • Aquired e.g. infection • B.Postmorrhagicanaemia. • For e.g. – Bleading piles , malena,peptic ulcers, menorrhagia. • Due to mismatchod blood transfusion and RH incompatibility

15. Iron deficiency Anaemia:-------- Iron deficiency anaemia is the commonest form of anaemia. It is also called as hypochromic microcytic anaemia because in this type of anaemia chromatin material is in the less amount and the size of the RBC small. Cause:------- Increased Blood loss Increased requirement Inadequate Dietary intake Decreased Absorption

16. C/F :---- • Angular Stomatitis • Glossitis (Bald tongue) • Nails – thin , fragile,platynychia, koilonychia. • PICA- indicates a craving for strange items like coal, earth,tomatoes, starch, ice, rice. • PLUMMER VINSON SYNDROME or Sideropenic Dysphagia or Patterson kelly syndrome :--- This is occurs in long standing anaemia and characterised by I.D.A., dysphagia, koilonychia and glossitis.

17. Megaloblastic anaemia Megaloblastic anaemia is a disorder caused by the impaired DNA synthesis and is charecterized by distnictive abnormality in the haemopoitic precursors cells in bone marrow in which the nucleous maturation is delayed as compare to that of cytoplasm. Normally the cell division occurs and cytoplasm grow and hence the nucleated precursor red cells grows enormously which are abnormal both in morphology and function. Hence these large cells are called megaloblasts and the RBC formed and released in circulation from these megaloblasts are also abnormal with increased size hence C/d macrocytes the impairment of the DNA is caused due to the defciency of vit. B12 or folic acid.

18. C/F:--------- • All c/f of anaemia. • glossitis, Angular cheilosiss. • jaundice – Due to intramedullary breakdown of Hb. • Neurological manifestation. • e.g.- degeneration of spinal cord. • Numbness. • Sterility.

19. Parnicious anaemia:----- This is a megaloblastic macrocytic anaemia resulting from a failure of secretion of the intrinsic factor by the stomach. In the abscence of intrinsic factor dietary vit. B12 is not absorbed & results in vit B12 deficiency. • C/F:--- • All c/f of anaemia. • C/F of megaloblastic anaemia.

20. Aplastic anaemia:------ It is defined as a condition of inhibition of the process of haemopiosis in which an acelluar or markedly in pancytopaenia i.e. anaemia granulocytopaenia, thrombocytopaenia. • C/F:--------------- Pancytopaenia. • Anaemia . • Granulocytopaenia – leads to infections. • Thrombocytopaenia – leads to haemorrhage. • Haemolytic anaemia:-- Haemolytic anaemia mean a premature distruction and increased rate of the distruction of the RBC’s.

21. Normal life span of RBC’s = 120 days • C/F:---- • 1 All c/f of anaemia. • 2 H/O :- • Jaundice. • Black urine with haemoglobinuria. • Urine is normal in colour on passing but on standing black. • Cholilithiasis • Spleenic pain. • Infections.

22. 3. Physical findings :- • Signs of anaemia. • Jaundice. • Spleenomegaly. • Chronic leg ulcers. • Skeleton hypertrophy – enlargement of the maxillary bones & frontal. • Signs of cholilithiasis.

23. Sickle cells anaemia:---- This is a haemolytic of a intrinsic type due to the haemoglobinopathies in structure, of the chain. • Sickle cell anaemia results from an abnormal haemoglobin known as haemoglobin S(Hb-s) or sickle cell haemoglobin. • Clinical features:---- 1. In children • Clinical manifetations are absent in the first 6 months of life because high. Hb f level protects the red cell sicllings. • Infections are common. • HAND foot syndrome – micro infection of carpal and tarsal bones.

25. Spleenic sequestration syndrome - sudden pooling of blood within the spleen resulting in spleenomegaly, hypovolaemia sock. • Spleenomegaly present throughout the early childhood But later spleenic atrophy. By about &year of age, spleen is no longer palpable. • 2. In adults :--- • Clinical feature of anaemia. • C/F of haemolytic anaemia. • INFARCTION CRISIS :--- • Occlusion of microvascular circulation by the sickle cells leading to tissue ischaemic and infarction, charactrised by .

26. Sudden attack of bone & ab. Pain. • Spleenic infarctioon. • Cerebral infarction – hemiplegia. • Pulmonary infarction – accute chest syndrome. • Renal infection - haematuria . • Retinal infection – loss of vision • Aplastic crisis :-- • HAEMOLYTIC CRISIS :-- Hb.deacreases And hepatospleenomegaly.

27. Thalesemia / cooleys’s anaemia • This is a haemolytic anaemia of a intrinsic type due to the haemoglobinopathies in synthesis of Hb. • The fundamental defect in the thalessemia is a reduction or absence of synthesis of one of the globin chains. • Clinical features:----- General c/f of anaemia • Skeleton deformities – frontal bossing cheek & low bone protrusion – pathological fractue of long bone. • Progressive hepatospleenomegaly.

28. Investigation :- • total blood count – Hb, Tand D, DLC, E.S.R.,platelate,reticulocyte count. • Coombs test (for investigation of Hb). • Hb electrophoresis . • B.T. ,C.T. • Ab. Test .

29. Management :- accor. To cause and severity. • correction of dietary deficiency • administration of specific lacking substances. • Removal of toxic chemical agent or drugs. • T/t of cause . • B.T.