anemias - semmelweis universityxenia.sote.hu/depts/pathophysiology/.../anemia_en.pdf · iron...
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ANEMIAS
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Anemia is usually a symptom, that is associated with another disease, e.g. with chronic inflammation or with malignancy.
Definition: Red Blood Cell Count (RBC), or other laboratory parameters (HGB, PCV) are lower than normal.
Female:RBC: < 3.8 T/lHGB: < 120 g/lPCV: < 0.37 l/l
Male:RBC: < 4.4 T/lHGB: < 135 g/lPCV: < 0.40 l/l
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Classification of Anemias
I. BLOOD LOSS:a. acute: traumatic shock,b. chronic: gynecological or gastrointestinal
diseases.II. HEMOLYTIC ANEMIAS:
a. intrinsic (intracorpuscular) abnormalities:1. abnormalities of cytoskeleton,2. enzyme deficiencies,3. disturbances of hemoglobin synthesis.
b. extrinsic (extracorpuscular) abnormalities:1. antibody mediated,2. mechanic traumas of RBCs,3. infections.
III. ABNORMAL RBC DEVELOPMENT
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Thalassemia Peripheral Blood
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Classification of Anemias
Megaloblastic Anemias
HyperchromicMacrocytic
Iron deficiency Anemia
HypochromicMicrocytic
Hemolytic anemias
Anemia due to Acute Blood Loss
Aplastic Anemias
NormochromicNormocytic
Regenerative Anemias
Hypo-Aregenerative Anemias
Hb Content of RBC
(MCH)
Size of RBC
(MCV)
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Laboratory Diagnosis of Anemias
RBC: 3.8-5.5 T/l WBC: 4-10 G/l
MCV: 80-95 fl PLT: 150-400 G/l
MCH: 28-33 pg
MCHC: 320-360 g/l
HGB: 120-180 g/l
PCV: 0.37-0.52 l/l
Reticulocyte count (relative to RBC): 0.5-2.0 %
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Blood Chemistry
Serum Iron: 10-36 μmol/l
TIBC: 45-80 μmol/l
Transferrin saturation: 0.2-0.5
(Quotient of serum iron and TIBC)
Haptoglobin concentration: 6-28 μmol/l
(its level decreases during hemolysis)
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Examinations Medical history, Symptoms and Findings:
a. Medical History: nutritional habits, dyscoloration of urine and stool, gynecological history, previous diseases: chronic inflammation, malignancy.
b. Symtoms: weakness, fatigue, short of breath, palpitation, angina pectoris, headache, sleeping problems, flattened nails, dry skin, hair loss, digestive disorders, motivelessness (DD: depression).
c. Findings: pallor (conjunctiva, nail bed), systolic murmur, tachycardia, jaundice, splenomegaly, paresthesia, glossitis.
Symptoms and findings depend on the type of anemia and its duration.
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Laboratory examinations I.Basic:• Blood test, thrombocyte- and reticulocyte count,
BSR, • Urine test, • Serum: creatinine, bilirubin, LDH, iron, ferritin,
haptoglobin, hemopexin,• Blood in stools.
If cause of anemia is not clear:• Gastroscopy, colonoscopy, gynecological
examination,• Special laboratory tests: Schilling-test, direct and
indirect Coombs test, Hgb-electrophoresis in thalassemia and sickle cell anemia,
• Bone marrow smear.
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Laboratory examinations II.
In vivo examinations:1.) Schilling test,2.) Life span of RBCs .
In vitro examinations:1.) serum ferritin level,2.) serum vitamin B12 level,3.) serum and RBC folic acid level,4.) erythropoietin level.
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Laboratory Diagnosis of Hypochromic Anemia
normalemptyBone marrow iron storages
decreasedelevatedTIBC
decreaseddecreasedSerum iron
MCHC
MCH
At the lowest level of the normal range or decreased
Decreased, depending on the severity of anemia
MCV
Anemia due to Chronic Inflammation or Malignancy
Iron deficiency Anemia
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Iron Deficiency Anemia Peripheral Blood
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Causes of Iron Deficiency Anemia1. Chronic Blood Loss
gynecological bleeding,gastrointestinal bleedingrarely hematuria, hemoglobinuria.
6. Increased Needspreterm neonates,puberty,pregnancy.
11. Nutritional Habits
13. Malabsorptiongastrectomy, celiac disease.
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Causes of Vitamin B12 Deficiency
1. Nutritional:vegetarianism
2. Malabsorption:a. Gastric origin:
lack of IF, pernicious anemia,gastrectomy.
b. Bowel origin:diverticulosis, blind loop syndrome, bowel resection, inflammatory bowel diseases.
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Folic acid deficiency1. Nutritional:
alcoholism, starvation, elderly patients, nutritional habits.2. Malabsorption:
gastrectomy, bowel resection, inflammatory bowel diseases, celiac disease.
3. Increased consumption:pregnancy, brest feeding, preterm neonates,inflammatory diseases: rheumatoid arthritis, psoriasis,hematological diseases,malignant diseases.
4. Medical treatmentantiepileptics,
5. Others:active liver disease, heart failure.
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Megaloblastic Anemia Peripheral Blood
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Megaloblastic Anemia Bone Marrow