Anemia 1 PDF

Lecture 20 HPS Anemia(1) Presented by Dr Sarah Abusham  Learning objectives Know the definition of anemia List the causes of anemia Identify the causes of microcytic hypochromic anemia. Know the causes , clinical and laboratory findings in IDA....

Lecture 20 HPS Anemia(1) Presented by Dr Sarah Abusham  Learning objectives Know the definition of anemia List the causes of anemia Identify the causes of microcytic hypochromic anemia. Know the causes , clinical and laboratory findings in IDA. Know the causes of Anemia of chronic disease and the laboratory findings. Define sideroblastic anemia and identify the lab findings. www.vision.edu.sa  Anemia occurs when the body doesn't have enough healthy red blood cells to carry adequate oxygen to tissues. The causes of anemia can be broadly categorized into three main groups: ❖Decreased Red Blood Cell Production ❖ Increased Red Blood Cell Destruction (Hemolysis) ❖ Blood Loss (acute or chronic) ❖Other Causes ( infection, alcoholism, drugs) www.vision.edu.sa  Decreased Red Blood Cell Production Nutritional Deficiencies: Iron deficiency (most common cause of anemia worldwide) Vitamin B12 deficiency (pernicious anemia) Folate (vitamin B9) deficiency. Chronic Diseases: Chronic kidney disease (insufficient erythropoietin production) Chronic inflammatory diseases (e.g., rheumatoid arthritis, lupus) Cancer www.vision.edu.sa  Continue Endocrine Disorders: Hypothyroidism Hypopituitarism Bone Marrow Disorders: Aplastic anemia (failure of bone marrow to produce blood cells) Myelodysplastic syndromes Leukemia or lymphoma Genetic Disorders: Thalassemia (reduced or defective hemoglobin production) www.vision.edu.sa  Hypochromic microcytic anaemia Anaemia characterized by low MCV & low MCH & MCHC. Differntial diagnosis: 1-Iron deficiency anaemia 2-Anaemia of chronic diseases. 3-Thalassemia. 4-Sideroblastic anaemia &lead poisoning. www.vision.edu.sa  Definition Iron deficiency is defined as a decreased total iron body content. Iron deficiency anemia occurs when iron deficiency is sufficiently severe to diminish erythropoiesis and cause the development of anemia. Iron deficiency without anemia are more common www.vision.edu.sa  Iron deficiency is the commonest cause of anemia in every country of the world. Also it is the most important cause of microcytic hypochromic anemia. IDA characterized by reduction in all three red cell indices. (MCV,MCH,MCHC) and PBF shows microcytic hypochromic red cells due to defect in Hb synthesis. www.vision.edu.sa  Causes of IDA 1-Chronic blood loss; usually uterine or GI bleeding and rarely urinary bleeding. 2-Increased demands; pregnancy, growth, prematurity and child bearing. 3-Malabsorption; gastrectomy or coeliac disease. 4-Poor diet. www.vision.edu.sa  When IDA is developing the RE stores (ferritin and haemosiderin) become completely depleted before anemia occurs. In early stage Pt usually have no symptoms. Symptoms are those of low Hb like palpitations, dyspnea, headache, and dizziness. Pt can show painless glossitis, angular stomatitis, brittle spoon nails (Koilonychia). A curious but characteristic neurobehavioral complication is pica, the compunction to consume non-foodstuffs such as ice or clay. All these epithelial cell changes are due to reduction in iron containing enzymes www.vision.edu.sa  angular stomatitis (A) / koilonychia (D) www.vision.edu.sa  Lab findings: CBC; low Hb, low MCV. PBF; shows hypochromic, microcytic cells with target cells, pencil shaped cells. Platelets is often moderately raised. Bone marrow aspirate is not essential to assess IDA except in complicated cases, iron stores www.vision.edu.sa www.vision.edu.sa IDA PBF www.vision.edu.sa www.vision.edu.sa  Serum iron and total iron binding capacity (TIBC); serum iron is low, and TIBC is high. Serum ferritin; very low. Serum transferrin: low Prussian blue-stained specimen of bone marrow confirms iron depletion. Investigation for the causes of IDA; clinical history, physical and rectal examination, upper GIT endoscopy ,sigmoidoscopy, searching for hook worm ova, urine for haematuria www.vision.edu.sa  Investigation for the causes of IDA; clinical history, physical and rectal examination, upper GIT endoscopy , sigmoidoscopy, searching for hook worm ova, urine for haematuria www.vision.edu.sa  Anemia of chronic diseases Features ; 1-normochromic normocytic or mildly hypochromic microcytic RBCs 2-mild and non progressive anaemia. (Hb not less than 9g/dl) 3-Serum iron is reduced. 4-serum ferritin is normal or raised. 5-BM storage is normal. www.vision.edu.sa  Pathogenesis of this anemia is due to; 1-decrease release of iron from MQ to plasma. 2-reduce RBC life span. 3-inadequate erythropoietin response to anemia. The anemia does not response to iron therapy. treatment by treating the underlying cause, it may response to erythropoietin. Chronic diseases like RA, chronic renal failure….. www.vision.edu.sa  Sideroblastic anemia A group of blood disorders characterized by impaired incorporation of iron into hemoglobin, despite adequate iron stores. This results in the accumulation of iron in the mitochondria of developing red blood cells, forming ringed sideroblasts. It could be congenital or acquired. Key Features Presence of ringed sideroblasts in the bone marrow Microcytic or normocytic anemia, often with hypochromia Elevated serum iron and ferritin, low transferrin saturation. www.vision.edu.sa Sideroblastic anemia www.vision.edu.sa Thank You [email protected] 00966510148225 www.vision.edu.sa