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2.anemia Class

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13 views

2.anemia Class

Uploaded by

Abdulmalik Al-harthy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Hematology II

Introduction to anemia
Definition of anemia
• Anemia from the Greek word (an-haîma) meaning
"without blood", is a deficiency of red blood cells (RBCs),
Hct% and/or hemoglobin below the normal values.
• Functionally, it is the inability of the blood to supply the
tissue with adequate O2 for proper metabolic function.
Normal Values:
Parameters Female Male
 RBC (x1012/L) 3.6- 5.0 4.2-5.4
 Hb (g/dL) 11.5- 16 13-17
 Htc (%) 37-47 42-52%

- Diagnosis of anemia is made by patient history, physical examination,


signs and symptoms, and hematological laboratory findings.
• Factors affecting Hb level:
Age, sex, race, altitude, Physical Health, Nutrition, life
style, occupation, customs of populations, etc.

Normal ranges of Hb at different ages:


Age or gender group Hb threshold (g/dl)
Newborns 14.0
Children (0.5–5.0 yrs) 11.0
Children (5–12 yrs) 11.5
Teens (12–15 yrs) 12.0
Women, non-pregnant (>15yrs) 11.5
Women, pregnant 11.0
Men (>15yrs) 13.0
Causes of Anemia
• Lack of required nutrients: iron, Vit. B12, folic acid, etc.

• Loss of blood: Hemorrhage, Hemolysis.

• Chronic Disease: Renal, liver, GIS, Endocrine, etc.

• Genetic Abnormalities: Thalassemia, Sickle cell anemia, etc.

• Inadequate production of red blood cells: aplastic anemia, acute


leukemia, etc.
Symptoms of anemia
• General symptoms of anemia:

• Weakness, malaise, tiredness and lethargy

• Pale skin and mucus membranes (pallor)

• Heart problems: (tachycardia, palpitation, etc.)

• CNS: (Headache, Faintness or dizziness, etc.)

• Loss of appetite (anorexia).

• Dyspnea

• Others
Other symptoms related to the type of
anemia
• Hair, mucus membranes, skin and/or nail
problems (in iron deficiency)
• Neural problems (in megaloblastic anemia due to ↓B12)
• Jaundice, Splenomegaly (in hemolytic anemia)
• Bone deformities (in thalassemia major)
• Leg ulcers, abdominal pain (in sickle-cell disease).
• Others
Classification of anemia
• Have a variety of ways - depending on criteria used:
• A- Morphologic classification:
1. Normocytic: MCV= 80-100fL
2. Microcytic : MCV < 80 fL
3. Macrocytic: MCV > 100 fL
• B- Pathogenic (clinical): (underlying mechanism)
1. Decreased RBC production (Hypoproliferation)
2. Increased RBC destruction (hemolysis)
3. Blood loss (bleeding)
4. Relative (increased plasma volume)
• C- Other classifications
A- Morphologic classification
1- Normocytic Anemias
• Acute post-hemorrhagic • Endocrin diseases
anemia • Renal failure
• Hemolytic anemia (except • Liver disease
some Hb disorders) • Chronic disease anemia (some
• Aplastic anemia diseases)
• Bone marrow infiltration • Protein malnutrition
A- Morphologic classification
2- Microcytic anemias
• Iron deficiency anemia
• Thalassemia
• Sideroblastic anemia
• Lead poisoning
• Anemia of chronic diseases (some diseases) &
inflammatory
A- Morphologic classification
3- Macrocytic anemias
• Megaloblastic: Vit B12 deficiency (Pernicious), Folic acid
deficiency, other.

• Non-megaloblastic: Liver diseases, Alcoholism, MDS, BM


diseases, some HA, acute bleeding, Hypothyroidism, others.
B- Pathogenic classification
(Causes of anemia)
1- Anemias caused by decreased RBC production
– A) Decreased Hb production:
– IDA, thalassemia, lead poisoning, sidroblastic anemia

– B) Defective DNA synthesis:


– Vit B12 deficiency, Folic acid deficiency, other.

– C) Stem cell defects:


 Pluripotent stem cell defects: Aplastic anemia, Leukemia or
MDS.
 Defective erythroid stem cell: Pure red cell aplasia, Anemia of
CRF, Endocrine disease anemia, etc.

– D) Other less defined reasons:


– Chronic diseases, BM infiltration, nutritional defects.
B- Pathogenic classification
(Causes of anemia)
Anemias caused by increased RBC -2
destruction (hemolytic anemias)
Can be classified as;
• Hemolysis due to intracorpuscular defects
• Hemolysis due to extracorpuscular defects
Or
• Hereditary hemolytic diseases
• Acquired hemolytic diseases
Or
• Intravascular hemolysis
• Extravascular hemolysis
B- Pathogenic classification
3. Blood loss anemia
a) Acute bleeding:
- Sudden hemorrhage, Trauma, surgery, vascular
disruption.
b) Chronic bleeding:
– Similar to iron deficiency anemia
– GI bleeding, hemorrhoids, menstrual blood loss, chronic
injury, etc.

4. Relative (increased plasma volume):


- Dilution: e.g. excessive intravenous fluids administration, pregnancy
C- Other Classifications of anemia
• According to Hb level (severity), anemia is classified as:

• According to duration, anemia is classified as:


o Acute: sudden
o Chronic: develop and last during months – years.
• Pathophysiological classification: (depending on Reticulocytes Production
Index (RPI)):
o Hypoproliferative: (when there is a proliferation defect), RPI < 2
o Ineffective: (when there is a maturation defect), PRI = 2-3
o Hyperproliferative: (when there is a survival defect) (Hemolytic or acute blood
RBC parameters
Reference values
• Parameter female male
• Red blood cells: RBC (x1012/L) 3.6 - 5.0 4.2-5.4
• Hemoglobin: Hb (g/dL) 11.5- 16 13-17
• Packed cell volume: PCV (Hematocrit: Htc) (%) 37-47 42-
52
• Male & female
• Mean cell volume: MCV (fl) 78-97
• Mean cell hemoglobin: MCH (pg) 27-32
• Mean cell hemoglobin concentration: MCHC (g/dL) 32-35
• Red cell distribution width: RDW (%) 11.5-14.5
• Reticulocytes: Ret (% / n) 0.5-2.5 % (50-100x109/L)
RBC morphology changes in anemia

• In peripheral blood smear, RBCs are studied


microscopically for:
1. Size: microcytic, normocytic, macrocytic, Anisocytosis,
Dimorphic.
2. Color (Hb content): Hypochromic, normochromic,
hyperchromic.
3. Shape: Ovalocytes, target cells, schistocytes, tear drops,
crenated cells, sickle cells, etc.
4. Inclusion bodies: Heinz B., Howell Jolly B., Cabot ring, etc.

• These changes in RBC morphology may assist in the


identification of the type & the cause of anemia.

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