1

2

Dr. Jitendra Patel (MBBS, MD)

Medical Educator & Researcher

Associate Professor, Department of Physiology

Email: dr.jrpatel84@gmail.com Web: www.esphys.weebly.com

Competency

3

No. PY2.5 (Haematology; Blood & Immunity)

Competency Describe different types of Anemia & Jaundice

D/L/Core K/KH/Y

AM Written/Viva voce

Integration Biochemistry (HI) & Pathology (VI)

Concept Definition and classifications of anemia

E. knowledge Oxygen carrying capacity of the blood

OUTLINE OF LECTURE

Learning Objectives

1. Anemia:

1.1 Definition 1.2 Indicators

1.4 General Clinical Features 1.3 Classification

1.5 Types

2. Polycythemia:

2.1 Types 2.2 Clinical Features

Summary

Key Term & Concept

4

LEARNING OBJECTIVES

Define the Term “Anemia”.

List the Indicators of Anemia

Describe the Effect of Anemia on Function of Body

Describe the Classification of Anemia with Example

Describe the Types and Effect Of Polycythemia.

5

6

DEFINITION

Decrease oxygen carrying capacity of blood

• Either due to decrease RBC count

and/or

• Due to decrease Hb content or abnormal Hb in

the blood.

7

The main Problem…!!!

Decrease oxygen carrying capacity of blood

• OCC ml/dl =

(Hb in gm/dl * 1.34 ml) + (0.003 ml/mmhg

of PO2/dl)

8

Calculate Oxygen carrying capacity of the blood

in 23 year old healthy gentleman (Hb content is

15 gm/dl);

A. 20.1 ml/dl

B. 20.4 ml/dl

C. 50.1 ml/dl

D. Calculation not possible from given data

9

MCQ

Calculate Oxygen carrying capacity of the blood

in 23 year old healthy gentleman (Hb content is

15 gm/dl);

A. 20.1 ml/dL

B. 20.4 ml/dL

C. 50.1 ml/dL

D. Calculation not possible from given data

10

MCQ

INDICATORS

• RBC count

• Hb content

• PCV

• Blood Indices

11

Hb content

• Normal Hb content:

Male – 14 to 18 gm/dl

Female – 12 to 16 gm/dl

• Grading of Anemia

Mild – 8 to 10 gm/dl

Moderate – 6 to 8 gm/dl

Severe – below 6 gm/dl

12

Physiological varieties of Hb

13

Hb A Hb A2 Hb F Gower

I Gower

II Portland

Hb

a2b2 a2d2 a2g2 ζ2ε2 α2ε2 ζ2g2

Minor Hb F: Hb bart’s – γ4

Reaction of Hb

14

Oxy

Hb

Deoxy

Hb

Carbamino

Hb

Carboxy

Hb

Methamo

Hb

Sulf

Hb

Glycosylated

Hb

Hb+O2 Hb - O2 Hb + CO2 Hb+CO Hb-Fe+3 Hb+S HbA1C

Hemoglobinopathies

15

Glutamic acid is replaced by valine at 6th position of beta chain

β Thalassaemia Major

Less common

Homozygous transmission

Moderate to severe

Total absence of ß chain synthesis

HbF markedly increase

Life span: shorter, death occurs at 17th year

β Thalassaemia Minor

More common

Heterozygous transmission

Mild

Partial synthesis of ß chain

Normal or mild increase

Longer survival

16

Hemoglobinopathies

PCV (Hematocrit)

17

Mean Corpuscular Volume (MCV)

1. Mean Corpuscular Volume (MCV)

• The MCV is the average volume of the RBC

• Normal: MCV is 80-100 fL

• Microcytic; Normocytic; Macrocytic.

RBC Indices

MEAN CORPUSCULAR HEMOGLOBIN

• The MCH is the average weight of Hb in an RBC,

• The reference range for adults is 28-32 pg.

• The MCH is not generally considered in the classification of anemia.

RBC Indices…

MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC)

• The MCHC is the average concentration of Hb in each individual erythrocyte.

• Normochromic cells range from 30 to 38 g/dL,

• Hypochromic cells are less than 30 g/dL,

• MCHC will never > 38 g/dl, because cell can’t hold Hb beyond its saturation point.

RBC Indices…

21

General Clinical Features

Its Due to …….

• Tissue Hypoxia

Or

• Compensatory Mechanism

General Clinical Features...

24

Pallor

25

26

27

Based on …….

• Aetiology

Or

• Morphology

CLASSIFICATION

1. Deficiency anemia

Iron deficiency anemia

Megaloblastic anemia

Pernicious anemia

2. Blood loss

Acute

Chronic

3. Aplastic anemia

4. Haemolytic anemia

Sickle cell anemia

Thalassaemia

Heriditary spherocytosis

Due to toxic effect

5. Anemia due to chronic

diseases:

TB & Malignancies

Aetiological Classification (Whitby’s)

30

Normochromic

Hypochromic

Normocytic

Microcytic

Macrocytic

Morphological Classification (Wintrobe’s)

Normochromic

Hypochromic

Normocytic Acute haemorrhagic anemia Haemolytic anemia Aplastic anemia

Anemia of Chronic blood loss

Microcytic Anemia of chronic diseases

Iron deficiency anemia Thalassaemia

Macrocytic Megaloblasic anemia Pernicious anemia

Liver disease

Morphological Classification (Wintrobe’s)

33

• Commonest type of nutritional anemia

• Daily requirement of iron: 10-20 mg

• Causes:

1. Inadequate intake 2. Increased loss

3. Increased demand 4. Decreased absorption

• Specific features:

Nail: Koilonychia Tongue:Atrophic glossitis Mouth:angular stomatitis

Iron deficiency anemia

35

Iron deficiency anemia. Note microcytic hypochromic red cells in peripheral blood smear

and micronormoblasts in bone marrow with decreased iron store.

• Due to deficiency of Vit B12 or Folic acid

• Causes:

1. Inadequate intake

2. Malabsorption of vit B12

Gastric cause: pernicious anemia

Intestial cause

3. Incresed demand

4. Due to certain drugs or chemical

Megaloblastic anemia

37

General laboratory findings in macrocytic anemia, compared with the normal report.

38

39

40

Primary (Pathological):

Polycythemia Vera

Secondary:

Physiological

e.g. at high altitude

Pathological

e.g. cardiac failure

TYPES

• It is pathological condition

• In polycythemia vera the red blood cell count may be 7 to 8

million/cumm and the hematocrit may be 60 to 70 %.

• Polycythemia vera is caused by a genetic aberration in the

hemocytoblastic cells that produce the blood cells

Polycythemia Vera (Erythremia)

• Whenever the tissues become hypoxic, at high altitudes, or

as in cardiac failure, the blood-forming organs

automatically produce large quantities of extra red blood

cells. This condition is called secondary polycythemia.

• The red cell count commonly rises to 6 to 7 million/cumm

• PCV is about 30 per cent above normal.

Secondary Polycythemia

• Increased blood viscosity

• Increased blood volume

• May lead to hypertension

• A person with polycythemia vera ordinarily has a

bluish (cyanotic) tint to the skin.

EFFECT ON BODY FUNCTION

KEY TERM & CONCEPT

A n e m i a

H e m a t o c r i t

M i c r o c y t i c a n d m a c r o c y t i c

N o r m o c h ro m i c a n d hy p o c h ro m i c

H e m o g l o b i n o p a t h i e s

Po lyc y t h e m i a ve ra

45

SUMMARY

• Erythrocytes, which make up more than 99 percent of blood

cells, contain hemoglobin, an oxygen binding protein. Oxygen

binds to the iron in hemoglobin.

• Erythrocytes are produced in the bone marrow and destroyed in

the spleen and liver.

• Iron, folic acid, and vitamin B12 are essential for erythrocyte

formation.

• The hormone erythropoietin, which is produced by the kidneys

in response to low oxygen supply, stimulates erythrocyte

differentiation and production by the bone marrow.

46

SUMMARY

47

48

Why BMR is high in Anemia (mainly IDA)?

49

50

Assignment/SDL

1. Morphological classification of anemia with an example in tabular form.

2. Summary (SSS)

51

1. G K Pal - Textbook of Physiology

2. Indu Khurana - Medical Physiology for UG

3. Dir. Prof. A K Jain - Textbook of Physiology

4. Ganong's - Review of Medical Physiology

5. Guyton and Hall - Textbook of Physiology (International

Edition)

52

Suggested Reading

53

Just as the science and art of agriculture depend upon chemistry and botany, so

the art of education depends upon PHYSIOLOGY and psychology.

- Edward Thorndike