ANAEMIA

Outi Vehviläinen, MDIlembula 14.12.2012

I DefinitionII PathofysiologyIII Aethiology

Aenemia

Anaemia is defined as a condition in which the Hb concentration in peripheral blood is lower than normal for age, sex and pregnancy state of the subject.

I Definition

Newborn infants 1406 months – 6 years1106-14 years 120Adult males 130Adult females non pregnant 120 pregnant 110

I Definition: normal haemoglobin

Anaemia reduces the oxygen-carrying capacity of the blood.

The body compensates this:◦ 1.increasing the release of oxygen from Hb to the tissues◦ 2.increasing cardiac output◦ 3.enhancing blood flow to vital tissues◦ 4.increasing respiration

Severity of anaemia is passing through three stages◦1.compensated◦2.decompensated◦3.lifethreatening anaemia

II Pathophysiology

The major compensatory mechanism in mild to moderate anaemia is the increase of oxygen release to tissue by up to 40%.

Cardiac output is raised by an increase in stroke volume at rest

Exaggerated tachycardia on exertionVasodilation

PATIENT:breathlessness on exertion

1. Compensated anaemia

Hb below 70 g/lIncreased cardiac outputStroke volume and heart rate are raised at

restPeripheral vasodilation

PATIENT: breathlessness at rest, tachycardia

2. Decompensated anaemia

Respiratory distress with tachypneaOxygen supply to the myocardium is

insufficient and no further increase in cardiac output is possible

High output cardiac failure develops

PATIENT: severely breathless, may complain of angina

Cardiomegaly,pulmonary oedema, hepatomegaly,peripheral oedema,sometimes ascites

3. Life-threatening anaemia

1. Blood loss a. Acute b. Chronic (hookworms, schistosomiasis)

1.Decreased red cell production a. Nutritional deficiencies b. Depressed bone marrow

funtionIron Secondary anaemiasFolate HIV/AIDSVitamin B 12 tuberculosisVarious other chronic infections protein-energy chronic hepatic disease vitamin A chronic renal disease vitamin C carcinomatosis vitamin E, riboflavin, pyridoxine, Cu Aplastic anaemia

drugs and chemicalsinfiltrationidiopathicirradiationcongenital

Thalassaemiasalfa thalassaemiasbeta thalassaemias

3.Increased red cell desctrutiona. Abnormalities of red cells b. Abnormal haemolysis Haemoglobin Immune haemolysis sickle-cell disease autoimmune Enzymes fetomaternal G6PD deficiency incompatibility

Membrane incompatible blood transfusion elliptocytosis Non-immune haemolysis ovalocytosis infections (e.g. malaria)

spherocytosis hypersplenism drugs and chemicals venoms burns mechanical

III Aetiology of anaemia

1) Blood loss 2) Decreased red cell

production3) Increased red cell

desctrution

III Aetiology of anaemia

1. Blood loss a. Acute haemorragia

b. Chronic -hookworms,

-schistosomiasis- menorrhagia- peptic ulcers

III Aetiology of anaemia

2.Decreased red cell production a. Nutritional deficiencies b. Depressed bone marrow function

Iron Secondary anaemiasFolate HIV/AIDSVitamin B 12 tuberculosisVarious other chronic infections protein-energy chronic hepatic

disease vitamin A chronic renal disease vitamin C carcinomatosis vitamin E, riboflavin, pyridoxine, Cu

Aplastic anaemiadrugs and chemicalsinfiltrationidiopathicirradiationcongenital

Thalassaemiasalfa thalassaemiasbeta thalassaemias

III Aetiology of anaemia

3.Increased red cell desctrutiona. Abnormalities of red cells b. Abnormal haemolysis Haemoglobin Immune haemolysis sickle-cell disease autoimmune Enzymes fetomaternal incompatibility G6PD deficiency incompatible blood transfusion Membrane

elliptocytosis Non-immune haemolysis ovalocytosis infections (e.g. malaria)

spherocytosis hypersplenism drugs and chemicals venoms burns mechanical

III Aetiology of anaemia

Inadequate intakeChronic blood loss:

◦Hookworm◦Schistosomiasis causing hematuria

(S.haematobium) and ulcers and polyps in the colon (S.mansoni).

HAEMATOLOGY: Anaemia with microcytic hypochromic red cells (MCV reduced)

III Aetiology2. Decreased red cell production: Nutritional

deficiencyIron deficiency

Clinical signs:◦ increased suspectibility to infections◦mild splenomegaly◦depression of mood◦glossitis and angular cheilosis◦sterility◦ retarded growth and development in childhood◦ in pregnancy: fetal growth retardation,

premature delivery and low birthweight

HAEMATOLOGY: Anaemia with macrocytosis (MCV increased)

PHYSIOLOGICAL HIGH DEMANDS: IN PREGNANCY PATHOLOGICALLY HIGH DEMANDS: IN MALARIA

HEMOLYSIS

III Aetiology2. Decreased red cell production: Nutritional deficiency

Folate deficiency

1. Blood loss a. Acute b. Chronic (hook worms, schistosomiasis)

1. Decreased red cell production a. Nutritional deficiencies b. Depressed bone marrow funtion

Iron Secondary anaemias

Folate HIV/AIDSVitamin B 12 tuberculosisVarious other chronic infections protein-energy chronic hepatic disease vitamin A chronic renal disease vitamin C carcinomatosis vitamin E, riboflavin, pyridoxine, Cu Aplastic anaemia

drugs and chemicalsinfiltrationidiopathicirradiationcongenital

Thalassaemiasalfa thalassaemiasbeta thalassaemias

3. Increased red cell desctrutiona. Abnormalities of red cells b. Abnormal haemolysis Haemoglobin Immune haemolysis sickle-cell disease autoimmune Enzymes fetomaternal G6PD deficiency incompatibility

Membrane incompatible blood transfusion elliptocytosis Non-immune haemolysis

ovalocytosis infections (e.g. malaria) spherocytosis hypersplenism

drugs and chemicals venoms burns mechanical

III Aetiology of anaemia

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