A N E M I A

SYMPTOMS AND SIGNS OF ANEMIA

* Symptoms:
-Shortness of breath (particularly on exercise)
-Weakness
-Lethargy
-Palpitation
-Head aches
* In Older Subject:
-Cardiac failure
-Angina pectoris
-Confusion
-Intermittent claudication
SYMPTOMS
* General:
-Pallor of mucous membrane (less than 9 d/dl)
-Tachycardia
-Cardiomegali
-Syst flow murmur (especially at the apex)
-Retinal hemorhages (unusual)
-In the elderly: congestive hearth failure
* Specific:
-Koilonychia (spoon nails) iron def.
-Jaundice hemolytic or megaloblastic anemia
-Leg ulcers sickel cell A
-Bone deformities thalasssemia major
-Neugopathy vit. B12 def.
Classification based on red cell indices
Normocytic, normochromic
Macrocytic
Microcytic, hypochromic
Microcytic, hypochromic
MCV < 80 fl
MCH < 27 pg
Clinically:
- Iron def.
- Thalassemia
- Anemia of chronic disease (some cases)
- Lead poisoning
- Sideoblastic anemia (some cases)

Normocytic, Normochromic
MCV : 80 - 95 fl
MCH : > 26 pg
Clinically:
- Hemolitic Anemia
- Anemia of chronic disease (some cases)
- After acut blood loss
- Renal disease
- Mixed deficiencies
- Bone marrow failure

Macrocytic
MCV : > 95 fl
Hypersegmented Neutrophil
Five Lobes
Clinically:
- Megaloblastic : vit B12 or folate def.
- Non megaloblastic:
^ Alcohol
^ Liver disease
^ Myelodysplasia
^ Aplastic anemia
Anemia with the varation in size
(anysocytosis) and Shape (poikilocytosis)
( 1 )
Red cell abnormalities Causes
-Macrocyte - liver disease
- alcoholism
-Target cell - iron def. , liver dis
- hemoglobinopathy
- post splenectomy
-Stomotocyte - liver disease, alcoholism
-Pencil cell - iron def.
-Ecchinocyte - liver disease
- post splenectomy

Anemia with the varation in size
(anysocytosis) and Shape (poikilocytosis)
( 2 )
Red cell abnormalities Causes
-Microspherocyte - hereditary spherocytosis
- AIHA, septicemia
-Fragments - DIC, microangiopati
HUS,TTP Burs,cardiac valve
-Elliptocyte - hereditary elliptocytosis
-Tear drop - Myelofibrosis, extramedullary
hemopoiesis
-Basket cell - Oxydant damage e.g. G6PD
-Sickle cell - Iron deficiency
-Microcyte - Hemoglobinopathy

Reticulocyte count
Normal : 0.5 - 1.5 %
reticulocyte :
Anemia
Hemolytic anemia
After an acut major hemorrhagic
Within 2 3 days
Reaches a maximum in 6 10 days
Remains raised until th Hb returns to normal level
Factor impairing the normal
reticulocyte response to anemia
Marrow disease
Hipoplasia
Infiltration by carcinoma
Lymphoma, myeloma, acut leukemia
Deficiency of iron, Vit. B12, Folic acid
Lack of erythropoietin eg. Renal disease
Reduced tissue O2 consumption e.g mixooedema, protein def.
In effective erythropoiesis, thalassemia nyelodisplasia
Chronic inflammatory or malignant disease
Leukocyte and Platelet Count
Measurement of these help to distingguish pure
anemia from pancytopenia (marrow hypoplasia,
hypersplenisme)
Biopsi
1. Site : posterior iliac crest
2. Stains : haematoxylin and eosin, reticulin (silver stain)
3. Indication:
- Suspicion of polycythemia vera
- Nyelofibrisis and other myeloproliferative disorders
- Aplastic anemia
- Malignant lymphoma
- Secondary carcinoma
- Cases of splenomegali or pyrexia of undetermined
- Any case where aspiration give cause a dry tap
4. Special test : Immunophenotyping

Assesment of erythropoiesis
Normal erythropoiesis
Decrease erythropoiesis (eg. Aplastic anemia)
Increase erythropoiesis (eg. Hemolytic anemia)
In effective erythropoiesis (Megaloblastic anemia)


T h e r a p y
Underlying disease
Hematinic :
- Ferrum
- Vit. B
12
- Folic Acid