RBC 3 Flashcards
Define anaemia
a group of disorders in which either hemoglobin concentration of blood or/and RBC count is below the normal range for the age and sex.
Anaemia =Hb concentration is less than:
* 13 g/dL in adult males
* 11.5 g/dL in adult females
* 15 g/dL in newborn
* 9.5 g/dL at 3 months of age.
Classifications of Anaemia
Morphology (Wintrobe’s) classification:
Normocytic normochromic anaemias.
Macrocytic normochromic anaemia
Microcytic hypochromic anaemias
Etiological (Whitby’s) classification:
Deficiency Anemia
Haemolytic Anemia
Blood loss Anemia
Anemia due to chronic disease
Aplastic Anaemia
Common Anaemia 4
Iron- deficiency Anemia (IDA)
Hereditary Spherocytosis
Sickle Cell Anaemia
Thalassemia
Normocytic normochromic anaemias
Normal MCV (78–94μm3) & normal MCHC (30–38%)
* Acute post-haemorrhagic anaemia
* Haemolytic anaemias
* Aplastic anaemias.
Microcytic hypochromic anaemias
Reduced MCV (<78μm3) & reduced MCHC (<30%)
* Iron deficiency anaemia
* Chronic post-haemorrhagic
anaemia
* Thalassaemia.
Macrocytic normochromic anaemia
Increased MCV (>94μm3) & normal MCHC (30–38%)
* Megaloblastic anaemia due to deficiency of vitamin B12
* Megaloblastic anaemia due to
deficiency of folic acid.
Deficiency Anemia
- Iron deficiency anaemia
- Megaloblastic anaemia –Vitamin B12 or folic acid deficiency
Blood loss Anemia
Acute post- haemorrhagic anaemia(accidents)
Chronic post- haemorrhagic anaemia.
Haemolytic Anemia
- Thalassemia
- Sickle cell anaemia
- Hereditary
spherocytosis - G6PD deficiency
- Microangiopathic
haemolytic anaemia - Toxic effects(malaria, snake venom)
- Splenomegaly
Aplastic Anaemia
It occurs due to the failure of bone marrow to produce RBCs
Anemia due to chronic disease
- Tuberculosis * Chronic
infections - Malignancies
- Chronic lung diseases
Iron Deficiency Anaemia
Total Iron :4 to 5 grams
-65% in form of Hb.
-1% in form of heme compounds-promote intracellular oxidation.
4% in form of myoglobin.
0.1% is combined with protein transferrin in blood plasma.
15%−30% stored for later use, mainly in RES of bone marrow and liver parenchymal cells, principally in form of ferritin.
Causes of Iron Deficiency
Inadequate dietary intake of iron
Increased loss iron
Increased demand of iron
Decreased absorption of iron
Inadequate dietary intake of iron
- Milk fed infants
- Poor economic status
individuals - Anorexia, e.g. in
pregnancy - Elderly individuals due
to atrophy and poor dentition.
increased loss iron
- Menses
- Acute blood loss
-Hook worm infestation
-Chronic blood loss
Increased demand of iron
- Pregnancy
-Rapid growth in infancy or adolescence - Erythropoietin therapy
Decreased absorption of iron
- Partial or total gastrectomy
- Achlorhydria
- Intestinal
malabsorption diseases.
Clinical Features of Iron Deficiency Anaemia
Symptoms
* irritability,palpitations,dizziness, breathlessness, headache and fatigue
* impair muscular performance, behavioral disturbances
Signs
* Pallor
* Nails: Flattening, Koilonychia
* Tongue: Soreness, Mild papillary
atrophy, Absence of filiform papillae
* Mouth : Angular stomatitis
Blood Smear: Iron Deficiency Anaemia
look at pic pg 11
Treatments of Iron Deficiency Anaemia
Oral
▪ Ferrous fumarate
▪ Ferrous gluconate
IV
-Sodium ferric gluconate
-Iron sucrose
-Iron dextran
Iron-Rich Diet
* Meat
* Poultry
* Fish
* Leafy greens
* Legumes
Blood Transfusion
* In Hb < 7–8 g/dL
* A unit of packed red cells increases the hemoglobin level by 1 g/dL
Megaloblastic Anaemia
-presence of abnormally large developing red cells in the bone marrow
- based on ineffective erythropoiesis.
Causes of Megaloblastic Anaemia
-Vitamin B12:Deficiency / abnormal metabolism
-Drugs interfering with synthesis of DNA
-Intrinsic Factor: Deficiency / defect
-Folate:Deficiency / abnormal metabolism / antifolate drug
-Arsenic poisoning
-Nitrous oxide inhalation
Megaloblastic anaemia due to vitamin B12 deficiency
cause:
Inadequate dietary intake
Malabsorption of vitamin B12 by GIT System
result:
Pernicious anaemia- failure of secretion of intrinsic factor by the stomach
Megaloblastic anaemia due to folate deficiency
Diet-Poor intake of vegetables
Increased demand in haemolysis & pregnancy
Malabsorption e.g. Coeliac disease
Drugs
* Certain anticonvulsants (e.g. phenytoin)
* Contraceptive pill
* Certain cytotoxic drugs (e.g. methotrexate)
Clinical Features of Megaloblastic Anaemia
Symptoms
* Malaise (90%)
* Breathlessness (50%)
* Paranesthesia (80%)
* Sore mouth (20%)
* Weight loss
* Altered skin pigmentation
* Grey hair
* Impotence
* Poor memory
* Depression
* Personality change
* Hallucinations
* Visual disturbance
Signs
* Smooth tongue
* Angular cheilosis
* Vitiligo
* Skin pigmentation
* Heart failure
* Pyrexia
Treatments of Megaloblastic Anaemia
Cobalamin
-Hydroxocobalamin is preferred because it is more highly protein- bound and therefore remains longer in the circulation (100–1000 mg)
Vitamin B12
-Oral doses of 1000 mg of vitamin B12 daily or injections to treat patients with pernicious anemia.
Folate
5-15mg; for 4 months
Polycythemia
Increase in all cell types of blood, usually it represents increase in number of red cells
-Primary Polycythemia(Polycythemia vera)
Cause:
clonal neoplastic disorder of hematopoietic stem cells
-Secondary Polycythemia (Secondary erythrocytosis)
Cause:
due to appropriate or inappropriate increase in secretion of erythropoietin.
-Apparent (relative) polycythemia
Cause:
not true polycythemia, but a spurious increase in red cells due to dehydration
Erythrocyte Sedimentation Rate (ESR)
- Rate at which red cells sediment when an anticoagulated blood is allowed to stand in a vertical tube
- Clinical significance – helps in understanding the prognosis of the disease.
- Methods:
❖Westergren’s method.
❖ Wintrobe’ s method.
Normal Values
-In Westergren‘s method:
Males : 3–5 mm/hr
Females : 5–12 mm/hr
-In Wintrobe’s method:
Males : 0–9 mm/hr
Females : 0–20 mm/hr
Factors Affecting ESR
-Rouleaux formation increases ESR
-Size of the red blood cells: Increase in ESR
-Number of red blood cells: When the number of RBCs increase the ESR
-Viscosity of blood: ESR is increased when the viscosity of blood is decreased
Physiological Variation of ESR
- Age: ESR is less in infants and old people.
- Sex: ESR is greater in females (5–9 mm) than males (3–7 mm).
- Pregnancy: ESR is raised in pregnancy from third month to parturition and returns to normal after 3–4 weeks of delivery
Pathological Variation of ESR
Increases ESR
* Tuberculosis
* Malignant diseases
* Collagen diseases
* All anaemias
except sickle cell
anaemia
* Chronic infections.
Decreases ESR
* Polycythaemia
* Decreased fibrinogen levels
* Sickle cell anaemia
* Allergic conditions
try practice SAQ
slide pg 24
