Anemia ANEMIA any condition in which the number of red cells, the amount of hemoglobin - PowerPoint Presentation

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Anemia

ANEMIA

any condition in which the number of red cells, the amount of hemoglobin or the volume of packed red blood cells per unit volume is less than normal.

a pathophysiological condition in which the body cannot meet its demands for oxygen.

M:

Hb

<13.5

Hct

<41

F

:

Hb

<12

Hct

<36

Erythrocyte Indices

Hgb

M: 14.0-18.0

g

/

dL

F

: 12.0-16.0

g

/

dL

Hct

M: 42-52%

F

: 37-47%

MCV [=

Hct

(%) / RBC

count

(x106/

μL

)/10] 80-100μ3(

or

fL

)

MCH [=

Hgb

(

g

/

dL

) / RBC

count

(x106/

μL

)/10] 27-33

pg

MCHC [=

Hgb

(

g

/

dL

) /

Hct

(%)/100] 32-36

g

/

dL

classification of anemia by color

1. hypochromic(

decreasedcolor

) • increased central pallor

2. normochromic(

normalcolor

)

• central pallor ~1/3 of the RBC diameter

3. hyperchromic(increased color) (~spherocytosis)

• loss of central pallor

Classification based on cause:



Hemorrhagic anemia

♣ Excessive loss of RBC through

bleeding,stomach

ulcers,menstruation



Hemolytic anemia

♣  RBC plasma membrane ruptures.

♣  may be due to

parasites,toxins,antibodies

.



Thalassemmia

♣ Less synthesis of hemoglobin .Found in population of Mediterranean sea.



Sickle cell anemia

♣ Hereditary blood disorder, characterized by red blood

cells that assume an abnormal, rigid, sickle shape.



Aplastic anemia

♣ destruction of red bone marrow .

♣ caused by

toxins,gamma

radiation.

pathophysiologic classification

I

RBC loss

1. blood loss : a. acute : trauma, massive hemorrhage b. chronic : GI lesion, GYN lesion

2. ↑ RBC destruction

a.

Intrinsic Abnormality

;

membrane disorder : hereditary spherocytosis

–  enzyme disorder :

pk

def

, g6pd

–  

Hgb

synthesis disorder :

thalessemia,sickle

cell

–  acquired

memb

. defect :

pnh

b.

Extrinsic Abnormality

: mechanical trauma

chemical injury

iii. infection

iv. immunologic injury

II

↓RBC production

1. stem cell abnormality

2. erythroblast abnormality

3. unknown/multiple mechanism

↓ RBC production

1. stem cell abnormality :

applastic

2. erythroblast abnormality

megaloblastic

anemia

iron deficiency anemia (defective

Hb

synthesis)

Symptoms

Easy fatigue and

lossof

energy

• Unusually

rapid heart beat, particularly

with exercise

• Shortness of breath, particularly

with exercise

• Pale skin

• Leg cramps

• Coldness in the hands and feet

• Insomnia

• Light-headedness

• Faintness

• Signs of heart failure

symptoms: anemia caused by iron deficiency

• A hunger for strange substances such as paper, ice, or dirt (a condition called pica)

Upward curvature of the nails, referred to as koilonychias

Soreness of the mouth with cracks at the corners

symptoms: anemia caused by vitamin B12 deficiency:

A tingling, "pins and needles" sensation in the hands or feet

Lost sense of touch

A wobbly gait and

difficulty walking

Clumsiness and stiffness of the arms and legs

• Dementia

symptoms: anemia caused by chronic lead poisoning:

• A blue-black line on the gums referred to as a lead line

Abdominal pain

Constipation

Vomiting

symptoms: anemia caused by chronic red blood cell destruction)

Jaundice (yellow skin and eyes)

Brown or red urine

Leg ulcers

Failure to thrive in infancy

Symptoms of gallstones

History

Obtain a family history for anemia, jaundice,

cholelithiasis

, splenectomy, bleeding disorders, and abnormal

Hbs

• Document the patient's occupation, hobbies, prior medical treatment,

drugs (including over-the-counter medications and vitamins),

household exposures to potentially noxious agents (insecticides, paints, solvents, hair dyes)

h/o

blood loss, carefully document pregnancies, abortions, and menstrual loss ,bleeding

pr

Seek a history of gastrointestinal (GI) complaints that may suggest gastritis, peptic ulcers, hiatal hernias, or diverticula

• Abnormal urine color can occur in renal and hepatic disease and in hemolytic anemia

• A dietary history must include foods that the patient eats and those that he/she avoids, as well as an estimate of their quantity

Changes in body weight are important with regard to dietary intake and can suggest the presence of

malabsorption

or an underlying wasting disease of infectious, metabolic, or neoplastic origin

• Obtain a history of fever or identify the presence of fever, because infections, neoplasms, and collagen vascular disease can cause anemia

The occurrence of

purpura

,

ecchymoses

, and

petechiae

suggest the occurrence of either thrombocytopenia or other bleeding disorders; this may be an indication either that more than 1

bone marrow lineage

is involved or that coagulopathy is a cause of the anemia because of bleeding

physical examination

Examine optic fundi carefully

conjunctivae and the

sclerae

, which can show pallor, icterus, splinter hemorrhages,

petechiae

,

Perform systematic examination for palpable enlargement of lymph nodes for evidence of infection or neoplasia

• Carefully search for hepatomegaly and splenomegaly

A

rectal and pelvic examination

-tumor or infection of these organs can be the cause of anemia

The neurologic examination should include tests of position sense and vibratory sense, examination of the cranial nerves, and testing for tendon reflexes

Diagnostic algorithm

*HARRISONS TEXT BOOK OF INTERNAL MEDICINE

Thanks