Anemias Overview Flashcards
When can you say that a person has anemia
If hemoglobin level low for what is expected for (based on gender, age, geographical location)
Global prevalence of anemia worlwide
32.9%
Normal Hb for men
> 13g/dl
Normal Hb for women
> 12g/dl
Pregnant women Hb
> 11g/dl
Infants from 2-6months Hb
> 9.5g/dl
Children from 6-24 months Hb
> 10.5g/dl
2yrs - 11yrs Hb
> 11.5g/dl
Children over 12yrs Hb
> 12g/dl
What happens when Hb decreases ?
Less O2 carrying capacity
Hypoxia
Hypoxia induced effect on organ function
Signs and symptoms of anemia
2 bases of classification of anemia
Etiologic classficaion
Morphologic classification
Anemia types based on etiology
Impaired RBC production
Excessive destruction of red cells
Blood loss
Type of anemia based on morphologic classification
Macrocytic anemia
Microcytic hypochromic anemia
Normocytic normochromic anemia
Causes of red blood cells production impairment
Inadequate supply of nutrients essential for eryhtropoeisis Depression of erythropoeitic activity Chronic disorders Aplastic anemia Replacement of bone marrow
What are some causes of inadequate supply of nutrient
Iron deficiency
Vit b12 deficiency
Folic acid deficiency
Protein calorie malnutrition
Chronic disorders that can lead to anemia
Infection
Connective tissue disorders
Disseminated malignancy
Renal disease
Disorder leading to replacement of bone marrow
Leukemia
Lymphoma
Myeloproliferative disroders like myelofibrosis
Myelodysplastic syndrome
Causes of excessive red cell destruction (hemolytic anemia )
Intrinsic defects in RBCs - red cell membrane defect -hemoglobin defects - enzyme defects Extrinsic defects - immune mechanism - Non immune mechanism - miscellaneous
What are some disorders of red cell membrane defects
Hereditary spherocytosis
Herditory elliptocytosis
Disroders linked to Hemoglobin defect
Sickle cell disease
Unstable hemoglobin disease
Thalassemia
Disease linked to enzyme defects
Pyruvate kinase deficiency
G6PD deficiency
Paroxysmal nocturnal hemoglobinuria
Immune mechanism leading to anemia
Autoimmune acquired hemolytic anemia
Hemolytic disease of the newborn
Drug induced hemolytic anemia
Extrinsic Non immune mechanism leading to anemia
Microangiopathic hemolytic anemia
March hemolytic anemia
Extrinsic miscellaneous disorder leading to anemia
Hemolytic anemia due to chemical and drugs
Hemolytic anemia due to infections
Hemolytic anemia due to bruns
Lead poisoning
Basis of morphological classification of anemia
Based on size of red cell
Based on hb content of red cell
Normal red cell diameter
8 microns
What can you compare size of red cell to in blood film
Nuleus of mature lymphocyte
What is MEAN CELL VOLUME (MCV)
Average volume of red blood cell
Mcv formula
Hematocrit / RBC
Mean cell hemoglobin MCH
Average weight of hemoglobin in the RBC
MCH formula
Hb/RBC
Mean cell hemoglobin concentration
MCHC
MCHC
Hb/ hematocrit
What is hematocrit
Fractional volume of blood that the erythrocytes occupy
Normal hematocrit for male
46%
Normal hematocrit for female
42%
What does it mean when the red cell distribution width is low
Mean that there’s uniformity in size of red blood cells
What does a large value in the red cell distribution
Mixed populations of small and large RBC
Immature RBC are large
Anisocytosis
High variation in RBC size
Poikilocytosis
Variation in shape of RBC
Formula for MCV
Hematocrit x 10/RBC count
Normal range mcv
81-100 fL
MCH formula
Hemoglobin x 10/RBC count
Normal range MCH
26-34 pg
MCHC formula
Hemoglobin x 100/hematocrit
Normal range of MCHC
31-36%
RDW formula
Standard deviation of MCV/MCV x100
RDW normal range
11.5% - 14.5%
Blood characteristic of normocytic normochromic anemia
Normal MCV
Normal MCHC
Normal MCH
Causes of normocytic normochromic anemia
Blood loss Increased plasma volume in pregnancy or over hydration Hemolytic anemia in certains causes Aplastic anemia Kidney disease Anemia of chronic disease
Microcytic hypochromic anemia MCV, MCHC, MCH
Low everything
Causes of Microcytic hypochromic anemia
Iron deficiency anemia
Thalassemia
Sideroblastic anemia
Lead poisoning
MCV of Macrocytic anemia
Raised MCV
Causes of Macrocytic anemia
Megaloblastic anemia Due to Folic acid deficiency and vit b12 deficiency
History to take in anemia
Diet especially for children pregnant and lactating mothers
Unusual bleeding or bruising
Blood in stools
Ménorraghia
Number / frequency of pregnancy
Bleeding hemorrhoids
Dark urine -> Intravascular hemolysis
Family history of anemia
Comorbidities like acute infections, chronic inflammatory diseases, CKD, surgeries
Physical examination
Pallor of mucous membranes
Mouth for glossitis , stomatitis , gum disease
Nails for koilonychia
Pedal edema for heart failure
Jaundice for hemolysis
Masses in Abdomen , pelvis, spleen, uterus
Rectal, scrotal and vaginal examination when appropriate
Essential hematological test
Test to know type of anemia Test to know cause of anemia Reticulocyte count Blood film Sickling test Hb electrophoresis ESR CRP Thick and thin blood film G6PD defiance screening test Coombs test
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