Anemia
Anemia; is a decreased red blood cells and deficiency in oxygen and body tissues hypoxia.
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Anemia is usually diagnosed with a decrease in Hematocrit and Hemoglobin values.
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Three types red cell size; Normocytic (Hypochromic), Microcytic, Macrocytic
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Microcytic hypochromic anemias are caused by disorders; Hemoglobin synthesis and iron deficiency
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Macrocytic Anemia abnormalities in Bone marrow
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Clinical findings:
Eyes; Yellowing
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Central; Fainting
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Muscular; Weakness
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Heart; Heart Attack
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Skin; Yellowing
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Anemias of Blood loss
1) Acute blood loss; occurs due to loss of intravascular blood volume; may result in shock and/or death.
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Symptoms; tachycardia, Hypotension
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2) chronic blood loss; occurs when iron reserves and iron deficiency are depleted
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Symptoms; weakness and Anorexia
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Hemolytic anemias
A shortened life span (
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Elevated erythropoietin with increased erythropoiesis
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Accumulation of hemoglobin (Process of red cell hemolysis)
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1) Extravascular hemolysis; occurs in macrophages of the spleen.
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Clinical; Anemia, splenomegaly and Jaundice
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2) Intravascular hemolysis; occurs when red blood cells are ruptured by mechanical injury,
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complement fixation, intracellular parasites or extracellular toxins.
Clinical;Anemia, hemoglobinemia and Jaundice. splenomegaly Is not seen.
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causes of Hemolytic anemia;
Hereditary Spherocytosis; is caused by cytoskeletal or red cell membrane protein defects.(morp;
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central zone of pallor, splenomegaly,)
Glucose-6-phosphate dehydrogenase; This enzyme functions in the hexose monophosphate
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shunt or glutathione metabolism to reduce NAPD to NADPH with against oxidative injury.
Sickle Cell Disease; This is a hereditary hemoglobinopathy resulting from substitution of valine
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for glutamic acid at the sixth position of the Beta-globin to generate HbS. (Chronic hemolysis ,microvascular
occlusion and Tissue damage).
Morphology; target cells, reticulocytosis.
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Clinic; reticulocytosis, hyperbilirubinemia, hemolytic anemia (Lung, bones, liver, brain, spleen)
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Symptoms; anemia, renal disease, eye involvement, bone marrow, leg ulcers, GI tract symptoms
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Thalassemia Syndromes; it is a heterogeneous group of inherited disorders caused by
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mutations that reduce alpha or beta global chain synthesis. (Chromosome 16 and Chromosomes 11)
Beta thalassemia; are characterized by deficient synthesis of which global B.
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Beta-thalassemia major; manifests between 6-9 months after birth as hemoglobin synthesis moves
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from HbF to HbA.
Beta thalassemia minor; heterozygotes are usually asymptomatic due to sufficient Beta global
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synthesis.
Beta thalassemia intermedia;
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Alpha thalassemia; is due to reduced alpha global synthesis; gene deletion is the most
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common genetic cause.

Silent carrier state; has one deletion.
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Alpha thalassemia trait; has two deletions
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hemoglobin H disease; has three deletions
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Hydrops fetalis; has 4 deletions
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Immunohemolytic anemias; is caused by antibodies that bind to red blood cells and
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cause their premature destruction.
Warm antibody type; Most commonly, immunoglobulin G (IgG) anti-RBC antibodies coat the RBC and
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act as opsonins, and are eventually destroyed completely in the spleen.(systemic lupus, lymphoid neoplasms)
Cold agglutinin type; is caused by IgM antibodies that agglutinate RBCs at low temperatures. It can be
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acute (viral etiology) or chronic (setting of B-cell neoplasms).
Cold hemolysin type; occurs in paroxysmal cold hemoglobinuria and is capable of causing substantial
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intravascular hemolysis.(IgG) (viral infection)
trauma; Prosthetic heart valves - mechanical prosthetics, Microangiopathic hemolytic anemia with diffuse
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microvascular narrowing owing to fibrin or platelet deposition.
anemias of diminished eryropoiesis; Megaloblastic anemias, Iron Deficiency anemia, Anemia of
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Chronic disease, Pure Red Cell aplasia, Other forms of marrow failure
Megaloblastic anemias; is due to a deficiency of vitamin B12 or folate and results in
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abnormally large RBCs and erythroid precursors (megaloblasts).
Anemias vitamin B12 deficiency; Pernicious anemia so caused by autoimmune gastritis and
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attendant loss of intrinsic factor production.
Atrophic glossitis; (shiny, glazed, red tongue), and a virtual absence of parietal cells. ( pale skin, memory
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loss, Depression, muscle weakness)
Achlorhydia - impairs vitamin B12 release from R bindersj, Gasterectomy - causes loss of intrinsic factor,
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Pernicious anemia, Resection is distal ileum - prevents intrinsic factor-vitamin B12 absorption, Malabsorption
syndromes, Increased requirements - pregnancy
Anemia of Folate Deficiency; Deficiency induces a megaloblastic anemia hematological
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indistinguishable from that seen in B12 deficiency; gastric atrophy and CNS defects do not occur
Causes; decreased intake, increased requirements, impaired utilization.
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Neural tube defects; Malformations of brain and spinal cord , Occurs early in uterine development.
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Causes; Genetic and environmental components and Folic acid.
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Types; Encephalocele, Anencephaly, Spina Bifida)
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