ANEMIAKhristy C 07120100107Tjiang kelvin 07120110030Steven matuali 07120110055

Anemia from the Greek (an-amia) meaning "without blood/lack of blood from - an-, "not" + haima, "blood". Definition : Condition in which characterized:Hb concentration decrease below the normal value. Usually is followed by a decrease in hematocrit value ordecrease erythrocyte count. Hb concentration depends on :SexAge AltitudeMethod used for Hb determination. Anemia may also be diagnosed where there is decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency.

ETIOLOGI OF ANEMIA 1. BLOOD LOSS / Erythrocyte loss a. Acute : HEMORRHAGE b. Chronic : LOW-VOLUME LOSS

2.EXCESSIVE BLOOD CELL DESTRUCTION /HEMOLYSIS a.Hereditary abnormalities : erythrocyte membrane, hemoglobinopathy b.Aquired abnormalities : immunologic defect, obstetric infection, chemistry, physic, mechanic abnormality.

3.DEFICIENT RED BLOOD CELL PRODUCTION (ineffective hematopoiesis). a. Nutritrional anemia : protein, folic acid, Fe, vit B12 def b. Bone marrow failure : aplastic anemia, anemia in malignancy c. low erythropoietin or Decreased marrow response to erythropoietin

FUNCTIONAL CLASSIFICATION OF ANEMIASAnemias may also be classified functionally into:Hypoproliferative (when there is a proliferation defect)Ineffective (when there is a maturation defect)Hemolytic (when there is a survival defect)

MORPHOLOGICAL CLASSIFICATION OF ANEMIASAnemias may be classified morphologically based on the average size of the cells and the hemoglobin concentration into:MacrocyticNormochromic, normocyticHypochromic, microcytic

CLINICAL EVALUATION : The causes anemia suggested from history and physical examination : HISTORY - blood loss : obvious and dramatic clue to the causes anemia. - History of anemia reaches back to childhood is highly suggestive of a hereditary disorder ---especially congenital hemolytic anemia. - sudden onset pancytopenia in healthy individual may be explain with history of exposure to toxic chemicals or new medication. -TRANFUSION HISTORY - PAST BLOOD COUNT MEASUREMENTS -NUTRITIONAL HABIT -ACUTE OR CHRONIC ILLNES : WEIGHT LOSS, FEVER, NIGHT SWEATS . SYMPTOMS: weakness or fatigue in general or during exercise, malaise and poor concentration , headache, dizziness . Severe anemia -dyspnoe (shortness of breath) on exertion.

PHYSICAL EXAMINATION : PHYSICAL SIGN DEPEND ACUTE OR CHRONIC OF ONSET : ACUTE BLOOD LOSS SHOW SIGNS HYPOXIA AND HYPOVOLEMIA (FOR EXAMPLE TACHYCARDIA AND HYPOTENSI ORTHOSTATIC ) --- LOSS 40 % BLOOD WILL EXHIBIT IN SIGN AND SYMTOMPS HYPOVOLEMIC SHOCK ANEMIA DEVELOPS GRADUALLY BODY HAS TIME TO INCREASE PLASMA VOLUME : --- IN YOUNGER INDIVIDUAL SIGNS AND SYMTOMS NOT APPEAR UNTIL Hb 7 8 g/dL --- IN OLDER : Hb 10 g/dL CAN BE SYMTOMPMATIC (EXSPECIALLY PATIENT CVD OR ATHEROSCLEROTIC). GENERAL : SKIN AND MUCOUS MEMBRANE PALLOR ( LESS REALIBLE INHEAVILY PIGMENTED PATIENTS)

Measurements Lab of AnemiaHemoglobin = grams of hemoglobin per 100 mL of whole blood (g/dL)Hematocrit = percent of a sample of whole blood occupied by intact red blood cellsRBC = millions of red blood cells per microL of whole bloodMCV = Mean corpuscular volumeMCHC = Mean corpuscular Hemoglobin corpuscular concentrationMCH = Mean corpuscular HemoglobinRDW = Red blood cell distribution widthReticulocytBone marrow Examination: To know about productivity of erythrocyte . To know cellularity of sources

Measurements Lab of AnemiaHemoglobin concentration in grams/deciliter - the RBCs are lysed and the hemoglobin is measured spectrophotometrically, or ( manual: Sahli)At birth the normal range is 13.5-20 g/dlThe normal range for males is 13.5-17.5 g/dlThe normal range for females is 12-16 g/dlNote that the normal ranges may vary slightly depending upon the patient population.RBC indices these utilize results of the RBC count, hematocrit, and hemoglobin to calculate 4 parameters:

Hematocrit (Hct) or packed cell volume in % or (L/L)At birth the normal range is 42-60% (.42- .60)The normal range for males is 41-53% (.41-.53)The normal range for females is 38-46% (.38-.46)Note that the normal ranges may vary slightly depending upon the patient population.

Measurements Lab of AnemiaLab investigation. A complete blood count, CBC, will include:An RBC count:At birth the normal range is 3.9-5.9 x 106/ul (1012/L)The normal range for males is 4.5-5.9 x 106/ulThe normal range for females is 3.8-5.2 x 106/ulNote that the normal ranges may vary slightly depending upon the patient population.

Mean corpuscular hemoglobin (MCH) is the average weight of hemoglobin/cell in picograms (pg= 10-12 g)Hgb (in g/dl)/RBC(x 1012/L) x 10At birth the normal range is 31-37In adults the normal range is 26-34This is not used much anymore because it does not take into account the size of the cell.

Mean corpuscular volume (MCV) is the average volume/RBC in femtoliters (10-15 L)Hct (in %)/RBC (x 1012/L) x 10At birth the normal range is 98-123In adults the normal range is 80-100The MCV is used to classify RBCs as:Normocytic (80-100)Microcytic (100)Measurements Lab of Anemia

Measurements Lab of AnemiaMean corpuscular hemoglobin concentration (MCHC) is the average concentration of hemoglobin in g/dl (or %)Hgb (in g/dl)/Hct (in %) x 100 At birth the normal range is 30-36In adults the normal range is 31-37The MVHC is used to classify RBCs as:Normochromic (31-37)Hypochromic (

Macrocytic Anemia Etiologi 1.Megaloblastic anemia, the most common cause of macrocytic anemia (due to a deficiency of either vitamin B12, folic acid (or both). Deficiency in folate and/or vitamin B12 (inadequate intake or insufficient absorption) Folate deficiency normally does not produce neurological symptoms, while B12 deficiency does. 2.Pernicious anemia is an autoimmune condition-- decrease intrinsic factor produced by the parietal cells of the stomach. Intrinsic factor is required to absorb vitamin B12 from food-- destruction of intrinsic factor --- poor absorption of vitamin B12. 3. Removal of the functional portion of the stomach--- during gastric bypass surgery, leading to reduced vit B12/folate absorption. 4. Hypothyroidism 5. Alcoholism , liver Disease coomonly causes a macrocytosis, although not specifically anemia. 6 Methotrexate, zidovudine, and other drugs that inhibit DNA replication.

Vitamin B12 Deficiency Versus Folate Deficiency

Vitamin B 12 Deficiency Folate DeficiencyMCV> 100> 100SmearMacrocytosis with hypersegmented neutrophilsMacrocytosis with hypersegmented neutrophilsPernicious anemiaYesNOHomocystineElevatedElevatedMethylmalonic AcidElevatedNORMAL

NORMOCYTIC ANEMIANormocytic anaemia occurs when the overall hemoglobin levels decreased, but the red blood cell size (MCV) remains normal. Causes : Acute blood loss Anemia of chronic disease Aplastic anemia (bone marrow failure) Hemolytic anemia

HEINZ BODY ANEMIAHeinz Bodies are an abnormality that form on the cells in this condition. This form of anemia may be brought on by taking certain medications; acetaminophen (Tylenol).

MICROCYTIC ANEMIAMicrocytic anemia is primarily a result of hemoglobin synthesis failure/insufficiency, Etiologies:1.HEME SYNTHESIS DEFECT Iron deficiency anemia Anemia of chronic disease (more commonly presenting as normocytic anemia)

2.GLOBIN SYNTHESIS DEFECT alpha-, and beta-thalassemiaHbE syndrome HbC syndrome

3.SIDEROBLASTIC DEFECT Hereditary sideroblastic anemia Acquired sideroblastic anemia, including lead toxicity Reversible sideroblastic anemia

An iron deficiency inhibits Hb synthesis, leading to hypochromic microcytic anemia: MCH "26 pg, MCV "70 fL, Hb "11 g/L. The primary causes are: blood loss (most common cause); 0.5mg Fe are lost with each mL of blood; insufficient iron intake or absorption; increased iron requirement due to growth, pregnancy, breast-feeding, etc.; decreased iron recycling (due to chronic infection);

Iron-Deficiency Anemia

Iron-Deficiency AnemiaClinical ManifestationsMost common: pallorSecond most common: inflammation of the tongue (glossistis)Cheilitis=inflammation/fissures of lipsSensitivity to coldWeakness and fatigue

Diagnostic StudiesCBCIron studies Diagnostics:Iron levels: Total iron-binding capacity (TIBC), Serum Ferritin.Endoscopy/Colonscopy Sources of iron to make hemoglobin 1.iron supplement 2. meat red meat, such as beef or liveras well as chicken, pork, fish, and shellfish. 3.Nonmeat foods sources of iron include: Spinach and other dark green leafy vegetables Peanuts, peanut butter, and almonds , Eggs ,Peas; lentils; and white, red, and baked beans . Vitamin C is sometimes given to help the body absorb iron.Physical Manifestation : Spoon Nails in Iron Deficiency

Measurements of AnemiaRed cell distribution width (RDW) is a measurement of the variation in RBC cell sizeStandard deviation/mean MCV x 100The range for normal values is 11.5-14.5%A value > 14.5 means that there is increased variation in cell size above the normal amount (anisocytosis)A value < 11.5 means that the RBC population is more uniform in size than normal.

Measurements Lab of AnemiaBlood smear examination using a Wrights or Giemsa stain. The smear should be evaluated for the following:Poikilocytosis describes a variation in the shape of the RBCs. It is normal to have some variation in shape, but some shapes are characteristic of a hematologic disorder or malignancy.

Treatment anemia Goals of Treatment 1.to increase the red blood cell count and/or hemoglobin level. 2.to treat the underlying condition or cause of the anemia. Depends on the type, cause, and severity of the condition include 1.dietary changes or supplements 2.medicines 3. procedures.

2. Medicines goal : increase the number of red blood cells and delete underlying cause of anemia. Some of these medicines include: *Antibiotics to treat infections. *Hormones to treat adult and teenaged women who have heavy menstrual bleeding. *erythropoietin to stimulate body to make more red blood cells. *Chelation therapy for lead poisoning. 3. Procedures severe anemia - medical procedure to treat it 1.blood transfusions 2.blood and marrow stem cells transplants.Depends on the type, cause, and severity of the condition include:

1. Dietary Changes or Supplements Low levels of vitamins or iron in the body can cause some types of anemia---low levels hb may be due to poor diet or certain diseases or conditions. Common vitamin supplements are vitamin B12 and folic acid/folate and iron supplement

Cobalamin (Vitamin B12) DeficiencyClinical manifestationsGeneral symptoms of anemiaSore tongueAnorexiaWeaknessParathesias of the feet and handsAltered thought processesConfusion dementiaVITAMIN B12 ABSORPTION

Folic Acid Deficiency Clinical manifestations are similar to those of cobalamin deficiency Insidious onset: progress slowlyAbsence of neurologic problemsTreated by folate replacement therapyEncourage patient to eat foods with large amounts of folic acidLeafy green vegetablesLiverMushroomsOatmeal Peanut butterRed beans Folic acid, a vitamin found in large amounts in leafy plants, yeast, and liver, is required for synthesis of the nucleotide base thymine. It is, therefore, essential for the formation of DNA and thus for normal cell division. When this vitamin is not present in adequate amounts, impairment of cell division occurs throughout the body but is most striking in rapidly proliferating cells, including erythrocyte precursors. Thus, fewer erythrocytes are produced when folic acid is deficient.

Aplastic AnemiaClinical Manifestations Gradual developmentSymptoms caused by suppression of any or all bone marrow elementsGeneral manifestations of anemiaFatigueDyspneaPale skinFrequent or prolonged infectionsUnexplained or easy bruisingNosebleed and bleeding gumsProlonged bleeding from cutsDizzinessheadache

19/04/2011*

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