anemia introduction dr. sachin kale, md. asso. prof, dept. of pathology in charge, central...
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Anemia Introduction
Dr. Sachin Kale, MD.Asso. Prof, Dept. of pathology
In charge, Central Laboratory, MGM.
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Outline• Introduction to hematology and
hematopoiesis
• Introduction to anemias• Iron deficiency anemias• Megaloblastic anemia.• Sickle cell anemia
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Anemias• Signifies a decrease in Hb or Hct and
represents underlying disease than a specific diagnosis
• Accepted definitions -• Male: < 13.5 g/dl• Female: < 12.5 g/dl• Pregnancy & Children - ( 6 m – 8 yrs): <
11 g/dl• Preterm infants: < 14 ; Full term infant: <
13.5
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Anemias
• SaO2 ( % of heme groups occupied by O2) and PaO2 ( amount of O2 dissolved in plasma) are normal; since O2 exchange in lungs are normal.
• However oxygen content (total amt of O2 available) is decreased owing to reduction in Hb concentraion.
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Mature RBC
• Anucleate cells• Devoid of mitochrondria – lack citric acid
cycle, beta oxidation of fatty acid, oxidative phosphorylation
• Metabolize glucose by anerobic glycosylation – lactate is the end product.
• Generate glutathione via pentose phosphate shunt.
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Mature RBC
• Reduce heme iron from ferric (+3) to ferrous (+2) state using methemoglobin reductase system Synthesizes 2,3 bisphosphoglycerate via Rappapor-Luebering shunt. ( used for right shifts in O-D curve)
• ABO & Rh antigens on membranes.
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Mature RBC
• Senescent RBCs are removed mainly by extravascular hemolysis – endproduct is lipid soluble unconjugated bilirubin.
• Lesser extent – intravascular hemolysis.
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Basic pathophysiological categories of anaemia
• Blood loss
• Impaired red cell production• Inadequate supply of nutrients essential for
eythropoiesis, such as: .– iron deficiency– vitamin B 12 deficiency– folic acid deficiency– protein-calorie malnutrition– other less common deficiencies
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Impaired red cell production
• Depression of erythropoietic activity• Anaemia associated with chronic disorders. such as:
– infection– connective tissue disorders– inflammatory disorders– disseminated malignancy– Anaemia associated with renal failure
• Aplastic anaemia• Anaemia due to inherited disorders, such as
thalassaemia
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Impaired red cell production
• Anaemia due to replacement of normal bone marrow by:– Leukaemia– Lymphoma– myeloproliferative disorders– Myeloma– myelodysplastic disorders
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Excessive red cell destruction
• Due to intrinsic defects in red cells• Due to extrinsic effects on red cells
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General evidence of hemolysis
• Evidence of increased HB breakdown:– Jaundice and Hyperbilirubinemia
• Evidence of compensatory erythroid hyperplasia:– Reticulocytosis
• Evidence of damage to red cells:– Spherocytosis– Fragmentation RBCs– Heinz bodies
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Classification of anemias
• Microcytic anemias: ( MCV < 80 fl)
• Iron deficiency (most common)• Thalassemia• Anemia of chronic disease• Sideroblastic anemia
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Classification of anemias
• Macrocytic anemia (MCV > 100 fl)
• B12 deficiency• Folate deficiency• Alcoholic liver disease• Hypothyroidism
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Normocytic anemia ( MCV 80 – 100 fl)
• Reti count: (< 2%)• Acute blood loss• Early iron deficiency• Aplastic anemia• Anemia of chronic disease• Renal disease
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Normocytic anemia ( MCV 80 – 100 fl)
• Reti count: (> 3%) ( Intrinsic RBC defect)• Membrane defects
– Congenital spherocytosis/elliptocytosis– Paroxysmal Nocturnal Hemoglobinuria (PNH)
• Abnormal hemoglobins:– Sickle cell disease variants
• Enzyme deficiencies– G6PD & Pyruvate kinase deficiency.
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Normocytic anemia ( MCV 80 – 100 fl)
• Reti count: (> 3%) ( Extrinsic RBC defect)• Autoimmune hemolytic anemias ( warm and
cold)• Paroxysmal cold hemoglobinuria• Microangiopathic hemolytic anemia
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Work up of anemic patient
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Chipmunk facies
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RBCs in health and disease
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Understanding CBC: the complete blood count
• Haematocrit is 3 times the HB value: Rule of 3.• RBC count usually parallels HB and Hct, • In thallasemias RBC count is normal to
increased even though Hb is low.• RDW: Red cell distribution width• WBC count: Total and differential• Blood film:
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RBC indices
• MCV: volume of average red cell (fl or um3)MCV = Hctx1000/RBC count ( in millions per ul)
• MCH: content (wt) of Hb of average red cellMCH = Hb (g/l)/RBC ( in millions per ul)
• MCHC: average concentration of Hb in given volume of packed cells.MCHC: Hb(g/dl)/Hct
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X’s Edition
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Question 1
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Iron deficiency anemia
Thalasemia
Alcoholic liver disease
Anemia of chronic disease
All of the following cause microcytic anemia except
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Iron deficiency anemia
Thalasemia
Alcoholic liver disease
Anemia of chronic disease
All of the following cause microcytic anemia except
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Question 2
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Aplastic anemia
Hereditary spherocytosis
Acute blood loss
Anemia of renal disease
All of the following cause normocytic anemia with reti
count < 2%, except
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Aplastic anemia
Hereditary spherocytosis
Acute blood loss
Anemia of renal disease
All of the following cause normocytic anemia with reti
count < 2%, except
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Question 3
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MCV = Hctx1000/RBC count
MCH = Hb (g/l)/RBC
MCHC: Hb(g/dl)/Hct
All of the above
Which of the following is True
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MCV = Hctx1000/RBC count
MCH = Hb (g/l)/RBC
MCHC: Hb(g/dl)/Hct
All of the above
Which of the following is True
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Question 4
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26 yr, female, routine Check up. CBC = Low
MCV, Low Hb, WBCs: N
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Positive Sickle screen
Increased HbA2 & F
Normocytic ane. Increased reti
Low Sr. Ferritin
You expect further studies to reveal
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Positive Sickle screen
Increased HbA2 & F
Normocytic ane. Increased reti
Low Sr. Ferritin
You expect further studies to reveal
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Question 5
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Low Ferritin concentration
Microcytic RBC Indices
Abnormal Hb electrophoresis
All of the above
Which of the following is present in both IDA & Thalassemia
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Low Ferritin concentration
Microcytic RBC Indices
Abnormal Hb electrophoresis
All of the above
Which of the following is present in both IDA & Thalassemia
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• A well executed CBC followed by its proper interpretation has its worth in gold and a shrewd clinician make use of this simple and cheap test for diagnosing hematological and even non-hematological disorders..
Dr. M. B Agrawal.
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Thank you!