Anaemia Basics PDF

Lecture 8: [PATH] Anemia Basics Dr. M Khan Unit of Pathology AIMST University  Lecture 8: [PATH] Anaemia Basics Objectives The objective of the lecture is to discuss the workup of a case of anaemia. Topic outcomes At the end of the lecture, students should...

Lecture 8: [PATH] Anemia Basics Dr. M Khan Unit of Pathology AIMST University  Lecture 8: [PATH] Anaemia Basics Objectives The objective of the lecture is to discuss the workup of a case of anaemia. Topic outcomes At the end of the lecture, students should be able to 8.1. diagnose anaemia by applying essential steps in the diagnostic workup process. 8.2. explain the compensatory mechanisms and clinical presentation of anaemia. 8.3. identify the type of anaemia based on the underlying mechanism and based on RBC indices (classify) 8.4. identify the causes of aplastic anaemia and pancytopenia  Anemia Anemia is defined as a clinical condition where capacity of blood to transport oxygen to tissues is compromised due to reduced haemoglobin concentration or RBC count In adults, the lower extreme of the normal haemoglobin is taken as 13.0 g/dl for males and 11.5 g/dl for females Anaemia: Etiological Classification Anemia: Morphologic Classification  Diagnostic Approach in Anemia 1. History: Menstrual bleeding, chronic blood loss 2. Clinical Examination: signs and symptoms of anemia 3. Lab Investigation: A. Haemoglobin estimation and CBC B. Peripheral Blood Film Examination i. Variation in size (Anisocytosis) ii. Variation in shape (Poikilocytosis) iii. Inadequate haemoglobin formation (Hypochromasia) C. Red Cell Indices D. Leucocyte and Platelet Count E. Reticulocyte Count F. Bone Marrow Examination 4. Biochemical Test: Serum iron, folate or vitamin B12 level Anaemia: Diagnostic Workout  History Acute, subacute or chronic onset? Menstrual history History of trauma, injury, blood loss Evidence of hemolysis, urine color? Dietary habit and nutritional status Systemic/chronic/inflammatory disease Is the patient taking any medication, alcohol? Is the patient, iron, vitamin B12 deficient? If so, why? History of transfusion Family history  Clinical Presentation: Symptoms The presenting features of anemia are: Tiredness Easy fatiguability Generalized muscular weakness Lethargy and headache In older patients, there may be symptoms of Cardiac failure Angina pectoris Intermittent claudication Confusion Visual disturbances.  Clinical Presentation: Signs 1. Pallor: the most common and characteristic sign seen in mucous membranes, conjunctivae and skin. 2. Cardiovascular system: tachycardia, collapsing pulse, cardiomegaly, murmur, dyspnoea on exertion, congestive heart failure. 3. Central nervous system: faintness, giddiness, headache, tinnitus, drowsiness, numbness and tingling sensations of the hands and feet. 4. Reproductive system: amenorrhoea and menorrhagia 5. Gastrointestinal system: Anorexia, flatulence, nausea, constipation and weight loss may occur. 6. Ocular manifestations: Retinal haemorrhages may occur if there is associated vascular disease or bleeding diathesis. 7. Lymphatic system: Enlargement of spleen and Lymph nodes Clinical Presentation in Anemia  Lab Investigation 1. Estimation of Hb 2. Red Cell Indices (RCIs)  PBS (Peripheral Blood Smear) Examination In PBS, Red Blood Cell morphology is investigated though following parameters 1. Variation in size (Anisocytosis) 2. Variation in shape (Poikilocytosis) 3. Inadequate haemoglobin formation (Hypochromasia) 4. Compensatory erythropoiesis RBC Morphology in Anemia  Bone Marrow Examination Normal Bone Marrow Biochemical Test Compensatory Mechanisms in Anaemia BPG:2,3-Bisphosphoglycerate Compensatory Mechanisms in Anaemia  Compensatory Mechanisms in Anaemia Non-haemodynamic Haemodynamic Compensatory Mechanisms in Anaemia  Aplastic Anaemia Aplastic anemia is a syndrome of bone marrow failure characterized by peripheral pancytopenia and marrow hypoplasia  Pancytopenia is a clinical condition in which there is significant reduction in the number of almost all blood cells (red blood cells, white blood cells, and Platelets Causes of Pancytopenia Thank You