anemia - lecture-notes.tiu.edu.iq
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ANEMIA
Definition
Reduction of RBCS volume or Hb
concentration below the normal range for a
particular age and sex of the patient . For men,
anemia is typically defined as hemoglobin
level of less than 13.5 gram/100ml and in
women as hemoglobin of less than 12.0
gram/100ml
What are the symptoms of anemia?
• tired, fatigue easily, appear pale,
palpitations , short of breath.
• hair loss, malaise.
• Tinnitus, Headache, Sense of taste is
affected, Sore tongue.
• Dysphagia
Classification of anemia
Morphologic
Normocytic: MCV= 80-100fL
Macrocytic: MCV > 100 fL
Microcytic : MCV < 80 fL
Hypochromic
Normochromic
Blood film (Hypochromic RBC)
Microcytic anemias
• Iron deficiency anemia
• Thalassemia
• Lead poisoning
Megaloblastic Macrocytic Anemias
• Vit B12 deficiency
• Folic acid deficiency
What is the type of anemia?
• History and physical exam.
• CBC
• Red cell morphology ( peripheral smear)
• Other Lab. investigations
Investigation of anemia(1)
• WBC count and differential
• Platelet count and morphology
• Biochemistry
• Bone marrow exam.
Investigation of anemia(2)
• Serum values of
• Iron
• TIBC
• Ferritin
• Bilirubins
• LDH
• Vit B12 and /or Folic acid
Investigation of anemia(3)
• Red cell enzymes
• Coombs tests
• Liver, renal, endocrin functional tests
IRON DEFICENCY ANEMIA
ETIOLOGY
• Increased demand for iron
• Increased iron loss
• Decreased iron intake or absorption
CLINICAL FEATURE
1. General feature of anemia.
2. Brittle nail and nail cracking are common but koilonychias may be present .
3. Angular stomatitis .
4. Atrophy of the papillae of the tongue.
5. Pica.
koilonychias
Atrophy of the papillae of the
tongue
Diagnosis
• Hemoglobin(Hb)- low
• Hematocrit (PCV)- low
• Microcytic (MCV-low )
• Serum ferritin-low
• Serum iron-low and iron binding capacity-high
• The gold standard investigation is BM iron store
Management
• Treat the cause.
• Iron replacement.
Iron can be supplemented by the oral or parenteral
iron therapy
Dental aspects
Local anaesthesia is usually satisfactory for pain
control.
Conscious sedation may be given only if there is
supplemental oxygen. Deeper levels of sedation are
more likely to lead to hypoxia.
When GA is given, it is vital to ensure full oxygenation.
Whenever possible, therefore, the anaemia should be
corrected pre-operatively and the haemoglobin level
must be raised, if necessary by transfusion.
The patient should be stabilized at least 24 h pre-
operatively
Some anaemias can also cause oral lesions such as
ulcers, glossitis or angular stomatitis
MEGALOPLASTIC ANEMIA
B12 DEFICIENCY
• Food Sources
• Vitamin B12 is found in:
• Eggs
• Fortified foods such as soymilk
• Meat
• Milk and milk products
• Organ meats (liver and kidney)
Causes of B12 deficiency
• Nutritional
– Rare
• Malabsorption
– Gatsric Disease
• Gastrectomy
• Pernicious Anaemia
– Terminal ileal disease
Ulcerative colitis
Ileal resections
Vitamin B-12 deficiency of any cause will result in
anemia and neurologic symptoms.
• Feelings of numbness
• tingling
• weakness
• lack of coordination
• impaired memory
• personality changes
Diagnosis
• A complete blood cell count (CBC)
• Hemoglobin(Hb)- low
• Hematocrit (PCV)- low
• Macrocytic (MCV-high )
• Examination of a blood smear
• Blood vitamin B-12 level measurements
• Finally, bone marrow aspiration or bone
marrow biopsy
Blood smear (macrocytic RBC)
Treatment
• Treatment of the cause.
• B12 replacment.
• Patients with B12 deficency anemia are
treated with parentral therapy.
vitamin B12
Sickle cell anaemia
It has no problem with simple dental care and
LA.
Patients Should be investigated if GA is to be
given. if the haemoglobin is less than 11 g/dl it
presents a hazard for GA.
Aspirin is best avoided as, in large doses, it may
cause acidosis and precipitate a crisis;
paracetamol and codeine are effective
alternatives.
Conscious sedation with relative analgesia can
be used safely. Benzodiazepines are best
avoided.
Elective surgery should be carried out in
hospital and during a phase when haemolysis is
minimal. Anaemia should be corrected before
GA and the haemoglobin brought up to at least
10 g/dl.
Exchange transfusion is occasionally required
for major surgery but only in selected patients.
Hepatitis B or C, or HIV carriage, may be a
complication in repeatedly transfused patients.
Since splenectomy results in an immune defect,
it may be prudent to cover surgical procedures
with prophylactic antimicrobials.
Local anaesthesia is safe.
β Thalassaemia
β Thalassaemia usually results from point
mutations within the β globin gene cluster, β thalassaemia can be classified according to the
severity of their symptoms into three groups:
1- β thalassaemia minor (or trait)
2- β thalassaemia major
β Thalassaemia minor
It's the mildest form, which arises from the
inheritance of a single abnormal β globin gene. Typically, the affected individual exhibits no
significant signs of the disease and generally live
a normal lifespan.
Investigation:
Microcytic hypochromic anaemia
β Thalassaemia major
β Thalassaemia major results from the inheritance of two b thalassaemia genes.
In the absence of treatment, the condition is
characterized by :
1- sever anaemia
2- Retarted growth
3- Facial mongoloid appearance
5- Rarely live beyond the second decay.
peripheral blood
• Sever haemolytic anaemia with Hb< 7.0 g/dl
• Microcytic hypochromic
Treatment:
Blood transfusion
Iron chelating agent
stem cell transplant
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