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Anemia dr.

Bertha- by: Huei, Elsya, Yuli, Aurora, Nagisa Page 1



Anemia -dr.Bertha- by: Huei, Elsya, Yuli, Au, Nagisa
Development of the hematopoietic system
Mesoblastic : yolk sac, 10 14
th
days of gestation
Hepatic : liver, 6-8 weeks to 24 weeks of gestation, 85% erythroid
Myeloid : bone marrow, 40% erythroid
Pluripotent stem cells : capable of self renewal and clonal maturation into all blood
cell lineages
Eritropoietin (EPO)
Glikoprotein 30-39 kd
Berikatan dengan reseptor spesifik yang terdapat pada permukaan prekursor eritroid
stimulasi diferensiasi, maturasi klonal hingga terbentuk eritrosit matur
Produksi EPO sangat dipengaruhi oleh konsentrasi O
2

o Hipoksia, anemia stimulasi produksi EPO stimulasi eritropoiesis
Hemoglobin
O
2
-carrying protein
Complex protein consisting:
Heme iron containing
tetramer (2 pairs of peptide chains)
Globin (protein)
HbA 22 (adult)
HbF 22 (fetal)
Hb embrionik : Gower-1, Gower-2, Portland
Anemia
Reduction of RBC volume or Hb concentration below the normal values
Reduction in the amount of Hb decrease O
2
-carrying capacity
Few clinical disturbances occur 7-8 g/dL
Normal value
Age Hb (g/dL) Ht (%)
Cord blood 16.8 (13.7-20.1) 55 (45-65)
2 wk 16.5 (13-20) 50 (42-66)
3 mo 12.0 (9.5-14.5) 36 (31-41)
6 mo 6 yr 12.0 (10.5-14) 37 (33-42)
7-12 yr 13.0 (11-16) 38 (34-40)
Adult:
Female 14 (12-16) 42 (37-47)
Male 16 (14-18) 47 (42-52)

Classification

Anemia dr. Bertha- by: Huei, Elsya, Yuli, Aurora, Nagisa Page 2

Inadequate production
o Defisiensi
Fe, folic acid, vit. B12, vit. C, protein, vit. B6
o Bone marrow failure
congenital vs acquired
including : chronic disease, renal failure (Fe, eritropoeitin, IFN-, IFN-)
Blood loss
Hemolytic process
o Cellular defect (corpuscular)
membrane defect
enzyme deficiency
hemoglobinopathy
o Ekstracellular defect (extracorpuscular)
autoimmune
hypersplenism

Clinical Manifestations

Pallor (skin and mucous membrane)
Physiologic adjustments
o cardiac output
o O
2
extraction ( A-V O
2
difference)
o Shunting of blood flow towards vital organs & tissues
o 2,3-DPG within the RBC
When moderate-severe anemia develops slowly few signs and symptoms
dissapear
Weakness, tachypnea, tachycardia, cardiac dilatation, CHF
Diagnosis
History and PE
Initial lab examination
Advance lab examination
Approach to common causes of anemia in children
Is anemia associated with other hematologic abnormalities?
Yes aplastic anemia, anemia, other bone marrow replacement disorders
Is anemia associated with reticulocytosis?
Yes bleeding, hemolysis
Is there associated hyperbilirubinemia? (or increased serum lactase
dehydrogenase?)
Yes hemolysis
Is anemia associated with reticulocytopenia?
Yes assess RBC size
Are red blood cells microcytic?
Yes hemoglobinopathy, Fe deficiency, lead poison
Are red blood cells macrocytic?
Anemia dr. Bertha- by: Huei, Elsya, Yuli, Aurora, Nagisa Page 3

Yes
o Is there neutrophil hypersegmentation?
Yes folate def, vit B12 def, inborn error metabolism
No Diamond Blackfan anemia, Pearson Syndrome
Are red blood cells normocytic?
Yes chronic disease, renal failure, hypothyroidism

Initial Laboratory Examination

1. Hb
2. Ht
3. WBC
4. Diff count
5. Platelet
6. MCV
7. MCH
8. MCHC
9. Reticulocyte count
10. Peripheral blood smear
Advance Laboratory Examination
1. Bone marrow aspiration
2. Feritin, folat, vit B12
3. Hb electrophoresis
4. Enzyme analysis
5. Biopsy
6. Etc
Management
Supportive
O
2
Nutrition
Blood transfusion if necessary


Causative
Physiologic anemia of infancy
Normal newborn higher Hb & Ht, larger RBC
Within 1
st
week progressive decline in Hb level begins and persists for 6-8 weeks
Physiologic anemia
Normally reached between 8-12 weeks old (Hb 9-11 g/dL)
Preterm infants occur by 3-6 weeks, Hb level of 7-9 g/dL