anemia Flashcards
a condition in which number
of RBC or Hgb concentration is lower than the normal.
is a manifestation of a certain disease associated with a
decrease in the red blood cell, decrease in hematocrit and
a decrease in hemoglobin.
Anemia
decrease in the oxygen carrying capacity of the blood.
functional
reduction from the baseline value for the total
number of RBCs, amount of circulating hemoglobin,
and RBC mass for a particular patient.
operational
decrease in RBCs, Hb and Hct below the previously
established reference values for healthy individuals of
the same age, gender, and race and under similar
environmental conditions.
conventional
Clinical Findings of Anemia
- history
- physical examination
- signs and symptoms
- laboratory procedures
History of Patient
Diet
Bleeding history
Drug ingestion
Occupation
Exposure to chemicals
Travel
Previous medication
Ethnic group
Family history of disease
Hobbies
Neurologic symptoms
Physical Examination
- skin
- eyes
- mouth
- Sternal tenderness
- Lymphadenopathy
- Cardiac murmurs
- splenomegaly
- hepatomegaly
General causes of Anemia
- Decreased red blood cell production
- Increased red blood cell destruction
- Blood loss
Anemia due to decreased production of RBC
- Iron Deficiency Anemia
- Anemia due to Chronic Inflammation
- Sideroblastic Anemia
- Megaloblastic Anemia
- Aplastic Anemia
- Thalassemia
- Anemia due to Chronic Renal Failure
- Anemia due to Endocrine Disorder
- Anemia due to Marrow Infiltration
Anemia due to increased destruction of RBC
- Intracorpuscular Abnormality (Intrinsic)
- Extracorpuscular Abnormality (Extrinsic)
Intracorpuscular Abnormality
- Membrane Defect
- Enzyme deficiency
- Paroxysmal Nocturnal Hemoglobinuria
- Globin abnormality
Extracorpuscular Abnormality
- Mechanical
- Infection
- Chemical and Physical Agents
- Antibody-mediated Anemia (AMA)
Anemia due to blood loss
- Acute post hemorrhagic anemia
- Chronic post hemorrhagic anemia
Laboratory test for Anemia assessment
- complete blood count
- reticulocyte count
- Peripheral smear
- bone marrow examination
- Iron studies
- Blood Chemistry
- Urinalysis
- Fecalysis
- Hematological special test procedures
Morphological Classification of Anemia
- Microcytic hypochromic anemia (found in SIGA)
- Macrocytic normochromic anemia
- Normocytic normochromic anemia
Causes of Iron Deficiency Anemia
Inadequate intake of iron
Increased need of iron
Chronic blood loss
Stage I of iron deficiency
Iron Depletion
Iron depletion
Hemoglobin - normal
Serum Iron - normal
Total Iron Binding Capacity - normal
Ferritin - low
Stage II of Iron deficiency
Exhaustion of the storage pool of iron
Stage III of Iron deficiency
– Frank Anemia
Exhaustion of the storage pool of iron
Hemoglobin - normal
Serum Iron - decreased
Total Iron Binding Capacity - increased
Ferritin - decreased
Frank Anemia
Hemoglobin - decreased
Serum Iron - decreased
Total Iron Binding Capacity - increased
Ferritin - decreased
Blood Features of IDA
decreased normal retic
decreased serum iron
decreased serum ferritin
increased total iron-binding capacity (TIBC)
decreased in osmotic fragility test
Microcytic hypochromic type of Anemia
Anisocytosis
Poikilocytosis
Treatment for IDA
Ferry sulfate supplement with vitamins C
CATEGORIES OF LAB DIAGNOSIS FOR ANEMIA
- screening
- diagnostic
- specialize
Screening for anemia
- cbc
- rbc indices
Diagnostic for anemia
- Iron studies
Specialize for anemia
Hb electrophoresis
SEVERE TYPE OF IRON DEFICIENCY
- Smooth tongue
- koilonychia
- PICA
Iron deficiency can result in a painless, smooth, shiny, and reddened tongue
Smooth tongue
a condition also referred to as
“spoon-shaped nails,” is associated with iron deficiency in which the fingernails are thin, brittle, and concave with raised edges
koilonychia
Condition where there’s a craving for uncertain food.
Ex: dirt, clay, chalk
Craving for non-edible food
PICA
develop when the incorporation of iron into heme is blocked
SIDEROBLASTIC ANEMIA
2 types of SIDEROBLASTIC ANEMIA
- Hereditary Sideroblastic Anemia
- Primary Acquired Sideroblastic Anemia
due to a congenital enzyme defect delta amino-levulinic acid
synthetase or heme synthetase
Hereditary Sideroblastic Anemia
due to somatic mutation of the erythroid progenitor cells that
cause either defects in heme synthesis or defects in DNA
synthesis
Primary Acquired Sideroblastic Anemia
Lead interferes with iron storage in the mitochondria
Lead damages the activity of enzymes used for heme
synthesis
Lead poisoning
second most common type of anemia
ANEMIA DUE TO CHRONIC INFLAMMATION
inherited disorders caused by genetic alterations that reduce
or preclude the synthesis of the globin chains of hemoglobin
tetramer
THALASSEMIA
predominant in Mediterranean, African and Asian ancestry.
THALASSEMIA
Who first described THALASSEMIA?
COOLEY and LEE in 1925
Types of Thalassemia
- Beta (β) Thalassemia
- Alpha (α) Thalassemia
- Hereditary Persistence of Hb F (HPHF)
- Hemoglobin Lepore
- Hemoglobinopathy + Thalassemia
which chromosome beta chain is found?
chromosome 11
other name for alpha Thalassemia
minor
Heterozygous thalassemia
Cooley’s trait
Rietti-Greppi Micheli disease
hemoglobin range for thalassemia minor
10-13 mg/dL
other name for Intermediate B-thalassemia
Thalassemia
Intermedia
results when one of
the 2 genes that
produce beta globin
is defective
Thalassemia minor
more severe
anemia than minor
B-thalassemia but
do not require
regular transfusion
Intermediate B-thalassemia
Other name for beta Thalassemia
major
Homozygous thalassemia
Cooley’s anemia
Mediterranean anemia
Target cell anemia
decrease or
complete lack of
beta globin
production
Thalassemia
major
which chromosome alpha chain is found?
chromosome 16
deletion of one α globin
gene, leaving 3 functional α
globin genes
Silent Carrier
deletion of two α globin
gene
α Thalassemia Trait
homozygous
caused by the presence of
only one gene producing α
chains.
Hemoglobin H Disease
results in the absence of all
α chains synthesis
Hydrops Fetalis
thalassemia with increased levels of fetal hemoglobin
Hereditary Persistence of Hb F (HPHF)
a rare class of thalassemia caused by crossing over of beta
and delta genes
Hemoglobin Lepore
is a double heterozygous abnormality
Hemoglobin S- Thalassemia
co-inherited of Hemoglobin E and β thalassemia that results
to a marked reduction of β chain production.
Hemoglobin E-Thalassemia
LABORATORY FINDINGS OF THALASSEMIA
- CBC
- Peripheral smear
- . increased reticulocyte count
- . bone marrow examination
- . decreased OFT
- supravital stain
- electrophoresis
- Mass spectrophotometry
- DNA analysis (sophisticated test)
- . increased indirect bilirubin
disorder in the DNA synthesis of RBC
the maturation of nucleus is delayed relative to that of
cytoplasm
Megaloblastic anemia
Causes of Megaloblastic Anemia
- dietary deficiency
- increased need during pregnancy and lactation
- impaired absorption in the intestine
- impaired use due to drugs
- excessive loss during renal dialysis
Laboratory Findings of Megaloblastic Anemia
- cbc
- peripheral smear
- Decreased in absolute reticulocyte count
- . Chemistry Analysis
- Schilling Test
- hypersegmented neutrophil
used to distinguish malabsorption of vitamin B12 from
other causes of malabsorption
Schilling Test
anemia caused by conditions such as
a. alcoholism
b. chronic liver disease
Non-megaloblastic anemia
characterized by premature RBC destruction caused by
autoantibodies that bind the RBC surface.
Autoimmune Hemolytic Anemia
- responsible for approximately 70% of Immune hemolytic cases
- mediated by antibody with maximum binding affinity at 37°C
Warm-Reactive Autoimmune Hemolytic Anemia
mediated by antibody with maximum binding
affinity at 4°C or below 32°C
Cold-Reactive Autoimmune Hemolytic Anemia
a rare acute form of cold-generated hemolysis
- hemolysis occurs when blood is warmed after
previous exposure to chilling
Paroxysmal Cold Hemoglobinuria (PCH)
self-limiting, but severe even fatal following the administration of
drug that can cause immune hemolytic anemia
Drug-Induced Immune Hemolytic Anemia
usually occurs in newborns following the transplacental passage
of maternal anti-fetal red cells antibody.
Alloimune Hemolytic Anemia
2 Causes Alloimune Hemolytic Anemia
- Erythroblastosis fetalis
- Isoimmune HDN due to ABO incompatibility
