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Anemias

Anemias. 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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Anemias

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  1. Anemias

  2. 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.

  3. 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.

  4. 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

  5. Chest pain (angina or heart attack) • Intermittentclaudication • Lossofsexualdrive • Abdominal pain • Weight loss Signs and symptoms

  6. 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

  7. Reticulocyte count • Retic count = % immature RBC • Normal 0.5-1.5% (for non-anemic) • <1% Inadequate production • >=1% Increased production (? adequacy)

  8. Classification according to mechanism • Blood loss acute and chronic • Excessive destruction of rbcs • Impaired production of rbcs

  9. Iron • B12 • Folate Decreased ProductionNUTRITIONAL DEFICIENCY

  10. 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

  11. Microcytic Anemia • MCV <80 • Reduced iron availability • Reduced heme synthesis • Reduced globin production

  12. Microcytic AnemiaREDUCED HEME SYNTHESIS • Lead poisoning • Acquired or congenital sideroblastic anemia • Characteristic smear finding: Basophylic stippling

  13. Microcytic AnemiaREDUCED GLOBIN PRODUCTION • Thalassemias • Smear Characteristics • Hypochromia • Microcytosis • Target Cells • Tear Drops

  14. 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

  15. koilonychia

  16. Lab tests of iron deficiency of increased severity

  17. 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

  18. 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

  19. Smear • Macro-ovalocytic • Polychromasia • Hypersegmented neutrophil Megaloblastic Anemia

  20. Normocytic Anemia (MCV 80-100 fl)

  21. 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

  22. Hemolytic Anemia

  23. Hemolytic Anemia

  24. TTP-HUS / DIC

  25. Spherocytes. One arrow points to a spherocyte; the other, to a normal RBC with a central pallor.

  26. Schistocytes (thrombotic thrombocytopenic purpura).

  27. Peripheral blood smear with sickled cells

  28. Clinical Presentation: Signs and Symptoms http://www.ornl.gov/sci/techresources/Human_Genome/posters/chromosome/sca.shtml

  29. 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

  30. Sickling of red blood cells leads to: • Vaso-occlusive complications • Severe anemia • Chronic hyperbilirubinemia

  31. Vaso-occlusive complications • Occur in areas with: • Prolonged, low oxygen tension • Decreased pH • Inflammation • Low blood flow Source: Robbins

  32. 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

  33. Thank you for attention!

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