You are on page 1of 44

Hematology PSL 222

Anemia Medicine L3.

PSL 222

Lecture 3

Hematology PSL 222 • Anemia • Medicine L3. • PSL 222 • Lecture 3 1 Dr.

Anemia : Definition

Reduction in the total number of RBC, hemoglobin and/or hematocrit below normal for age and sex.

• Functionally : Impaired oxygen delivery.

• Consequences:

– Secondary to tissue hypoxia ?

– Compensatory mechanisms for correction?

General Clinical Features

• Weakness, malaise, easy fatigability. • Dyspnea on mild exertion. • Pallor • Headache, faintness, dimness of vision • Palpitations, why? ……… .. • Angina, heart failure … ..

General Clinical Features • Weakness, malaise, easy fatigability. • Dyspnea on mild exertion. • Pallor •

Laboratory Diagnosis of anemia

• Hb conc.?

• RBC count?

• Hematocrit? • RBC Indices? • Blood smear?

Normal Hb concentration

Men:

15 + 2

gm% (per 100mls).

Women:

13.5 + 1.5 gm% (per 100mls). How is it different in Abha?

:Effect of high altitude

• Acclimatization to high altitude :

– The decrease in atmospheric pressure decreased O2 partial pressure stimulation of erythropoisis. increased RBC count and Hb conc. – Condition called physiological polycythemia.

Hematocrit : PCV

Men 45 + 5.

Women 41 + 5

Hematocrit : PCV • Men 45 + 5. • Women 41 + 5 7 Dr. S.Bashir
Hematocrit : PCV • Men 45 + 5. • Women 41 + 5 7 Dr. S.Bashir

:RBC Indices

Laboratory calculation of:

• Mean RBC volume (MCV).

– Micro/macro or normocytic RBC?

• Mean RBC Hb . Concentration (MCHC). -Hyper / normo/ hypochromic RBC? • Mean RBC Hb content (MCH)

MCV

Total RBC volume / number of RBC

MCV=

PCV x10

RBC count

Normal = 86+ 10 fL

..Mean

Mean Cell

Cell Hb.

Hb. Conc

Conc

MCHC
MCHC
 

Hb

g/dL

 
 
 

X 100

Ht. (PCV)

%

= ---------------------

15
15
45
45
  • X 100 =

33.3 g/dL

= ----------

NORMAL MCHC =

33 ± 1.5

g/dL

Mean Cell

Mean

Cell Hemoglobin:

Hemoglobin:

MCH

MCH

 

Hb

gm/dL

 
 

X 10

RBCC

x 10 /µL

6

= ----------------------

15 gm/dL

X 10 =

5 x 10 6 /µL

30 pg

= -----------

NORMAL MCH = 30 ± 2 pg

Morphologic Classification

Normocytic normochromic

Microcytic hypochromic .

Macrocytic ± hypochromic

MCV 86 + 10

MCHC

33 + 1.5

MCV <76

MCHC < 31.5

MCV > 96

MCHC < 31.5

Morphologic Classification:

Blood film

• Microcytic hypochromic Iron def.

• Macrocytic :

–Folate def. –Vitamin –B12 def.

Morphologic Classification: Blood film • Microcytic hypochromic – Iron def. • Macrocytic : –Folate –Vitamin –B12

RETICULOCYTE COUNT

What are reticulocytes?

Slightly immature RBC at the stage of maturation between the extrusion of the nucleus and the mature erythrocyte. They still contain mitochondria and ribosomes.

RETICULOCYTE COUNT • What are reticulocytes? • Slightly immature RBC at the stage of maturation between

to 2.0% 0.2

What conditions cause increase in their numbers in peripheral blood?

to 10,000=

100,000/L

(Adults & Children )

Anemia Medicine . PSL 222 Lecture 4

Hematology

?Anemia: causes

• Functional Classification :

  • - Decreased production.

  • - Increased destruction or loss.

Decreased production

• 1-Deficiency of nutrients:

– Iron –Folic acid

–B-12

–Proteins.

2- Lack of Erythropoietin?

• 3- Damage to bone marrow?

• 4- Chronic disease ?

?Lack of Erythropoietin

Possible causes?

1-?

2- In extremely premature babies.

?Damage to bone marrow

Causes?

1-

2-

Commonest types of anemia

• Iron (Fe) def anemia is the commonest type world wide. Less common are folate and B12 deficiencies.

• In Saudi Arabia sickle cell anemia is also common.

Fe Dietary sources

• Best dietary sources are liver and red meat because of high iron content and easy absorption (Heme iron).

• Plant sources include nuts, beans, dates and some vegetables but absorption from these sources is poor (Non-heme iron).

Iron absorption

A good source of vitamin C (ascorbic acid) - i.e., oranges, grapefruits, tomatoes, broccoli, and strawberries, eaten with a NON-HEME food will enhance absorption.

The following factors will decrease non-heme iron

absorption:-

Large amounts of tea or coffee consumed with a meal.

Excess consumption of high fiber foods or bran supplements (the phytates in such foods inhibit absorption).

High intake of calcium

Dr. S.Bashir
Dr. S.Bashir

23

Iron homeostasis

• Iron is transported with transport protein as transferrin.

• Iron is stored in the liver and bone marrow as ferretin.

• Iron from destroyed old RBC is recycled.

Small amount of Fe is lost in sheded skin & intestinal cells.

• Women lose more Fe during menstrual cycle and pregnancy.

Causes of Fe Deficiency

Poor diet:

Poor and elderly. Increased requirements:

Infants, children, pregnancy. Chronic blood loss:

GI bleeding Impaired absorption:

Gastrectomy. Why?

Clinical features of Fe

Deficiency anemia

• Signs and symptoms of anemia ?

• Koilonychia? • Splenomegaly.

• RBC: Microcytic & hypochromic.

• Treatment?

Clinical features of Fe Deficiency anemia • Signs and symptoms of anemia ? • Koilonychia? •

Clinical features of Fe

Deficiency anemia

Clinical features of Fe Deficiency anemia 27 Dr. S.Bashir
Clinical features of Fe Deficiency anemia 27 Dr. S.Bashir

Folate & Vitamin B-12 Deficiencies :anemia's

• Deficiency of either folate or B-12 cause macrocytic (megaloblastic) anemia.

RBC in the blood appear large (macrocytes), MCV.

• In the bone marrow the RBC precursors are also large called ( megaloblasts).

 

Folate

Dietary sources :

Leafy green vegetables, some fruits &liver,. Causes of def.?

?

?

Folate • Dietary sources : Leafy green vegetables, some fruits &liver ,. • Causes of def.?

B-12

Diet sources :

meat, liver & kidney.

Causes of def? Vegetarian diet Pernicious anemia?

Absorption of vitamin B-12

Requires the intrinsic factor secreted by the stomach.

Also requires the acidity of the stomach.

Absorption occurs at the terminal ileum

Auto-immune Pernicious anemia

A rare cause of B-12 deficiency is autoimmune atrophy of gastric mucosa lack of intrinsic factor inability to absorb vitamin- B12

Macrocytic anemia that does not respond to treatment with oral vitamin B-12

Auto-immune Pernicious anemia • A rare cause of B- 12 deficiency is autoimmune atrophy of gastric

Clinical signs of Macrocytic anemia

Clinical signs of Macrocytic anemia • Signs and symptoms of anemia, yellow discoloration of skin, dyspepsia,

• Signs and symptoms of anemia, yellow discoloration of skin, dyspepsia, glossitis?

• The tongue becomes very red and painful and the papillae atrophy, leaving a shiny, smooth surface.

32

Dr. S.Bashir

Aplastic Anemia

Destruction of red bone marrow by bacterial toxins, drugs or radiation.

Affects all blood cells, leading to?

Anemia. Leucopenia (WBC). Thrombocytopenia (platelets).

Increased destruction

• 1-Hemorrhage :

–Acute ? – Chronic?

• 2-Hemolysis ? –Premature lyses of RBC.

Increased destruction • 1-Hemorrhage : –Acute – Chronic? • 2-Hemolysis ? –Premature of RBC. 34 Dr.
Increased destruction • 1-Hemorrhage : –Acute – Chronic? • 2-Hemolysis ? –Premature of RBC. 34 Dr.

Hemolytic anemia

• RBC rupture (lyses) prematurely.

• Can be due to ?

Hemolytic anemia's:

Infections. malaria

Genetic membrane defects

(spherocytosis, elptocytosis) Genetic Hb abnormalities.

(Sickle cell disease, thalasemia) Genetic enzyme defects.

(G6PD)

Auto-immune diseases

Hemolytic anemia :

Clinical Features

• Symptoms of anemia • Jaundice. Why?

Too much bilirubin

• Gall bladder stones • Dark or red urine

• Bone pain & thinning of cortical bone

• Splenomegaly .

Hemolytic anemia : Clinical Features • Symptoms of anemia • Jaundice. Why? – Too much bilirubin
Hemolytic anemia : Clinical Features • Symptoms of anemia • Jaundice. Why? – Too much bilirubin

Sickle Cell Disease

A mutation in the gene for the beta chain of Hb results in an abnormal hemoglobin called HbS.

Under low-oxygen conditions, the beta chains link together and become stiff rods - this gives the RBC a sickle shape.

Sickled RBCs block and clog small blood vessels.

Sickle Cell Disease • A mutation in the gene for the beta chain of Hb results

Sickle Cell Disease

• Autosomal recessive.

• HbS: Glutamic acid instead of Valine at Beta 6 position

• Disease: refers to homozygous state HbSS.

• Trait: refers to heterozygous state HbAS.

• Crisis? An acute episode of hemolysis.

Thalassemia Syndromes

• Heterogeneous group of mandelian disorders, all characterized by:

• Lack of or decreased synthesis of either the alpha or beta globin chain of HbA1

• Alpha or beta thalassemia

• Decreased HbA1 and relative excess of other chains

• Ineffective erythropoiesis and/or hemolysis

Anemia of Chronic Disease

• Chronic infection, chronic renal disease, malignancy, immune disorders

• Insufficient erythropoiesis, block in release of iron from RES to erythroid precursors and decreased RBC survival.

• Normochromic normocytic or microcytic hypochromic

Polycythemia

Abnormal increases in

the RBC. Physiological?

– Adaptation to High altitude

Pathological?

– Idiopathic

Increases blood viscosity

?

Thrombosis and emboli.

Polycythemia • Abnormal increases in • the RBC. Physiological? – Adaptation to High altitude • Pathological?
Polycythemia • Abnormal increases in • the RBC. Physiological? – Adaptation to High altitude • Pathological?

Polycythemia

Polycythemia 43 Dr. S.Bashir

THANK YOU

THANK YOU 44 Dr. S.Bashir
THANK YOU 44 Dr. S.Bashir