Anaemia
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Transcript of Anaemia
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• Definition
1) It is a pathological condition in which the
haemoglobin level of the blood goes down below thelower limit of the normal range of the age and sex ofthe individual.
OR
2) It is a pathological condition in which the RBC charring capacity of blood is decrease.
OR
3) It is a pathological condition in which the RBC count or haemoglobin concentration or both goes down.
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CLASSIFICATION
Mainly two types :
1. Morphological anaemia :-
based on absolute indices of morphological changes seen in RBC in peripheral blood smeared .
Which is follow by pathologist.
2. Etiological anaemia:-
based on cause of anaemia . Which is follow by clinician to know the cause so that can be treated.
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Morphological Anaemia• Based on the value of absolute indices of
morphological changes in RBC. like change in size , shape and concentration of Hb.
• On the base of change in RBC ; three subtypes of morphological anaemia is there:-
1. Normocytic normochromic2. Microcytic hypochromic 3. Macrocytic normocromic
• Absolute indices are three:1. M.C.V = Mean corpuscular volume.2. M.C.H =Mean corpuscular haemoglobin.3. M.C.H.C=Mean corpuscular haemoglobin
concentration.
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ATEOLOGICAL ANAEMIA This classification is based on the etiology (cause) of anaemia.
1. Due to blood loss(post haemorrhagic)• acute blood loss :
Like in accident, surgery ,APH ,PPH , etc…• Chronic blood loss:
Eg. Piles ,peptic ulcer , hook-warm infection, etc….
2. Due to deficiency of haemopoatic factor OR Nutritional anaemiaeg: Fe –deficiency anaemia
Vit-B12 or folic acid deficiency anaemai.
3. APLASTIC ANAEMIAcaused by bone marrow failure
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4. Haemolytic anaemia:
It is divided in to two subtypes
A) Intracorpuscular : thalassaemias , haemoglobinopthis
B)Extracorpuscular: malaria, haemolytic disease of new born, incompatible blood
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Clinical feature of Anaemia
Lassitude FatiguePalpitationBreathlessness on exertionDimness of visionInsomniaAnginaTingling sensationPallorness of skin , mucous membrane, conjunctivaTrechycardia
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Systolic murmur
oedema
Amenorrhea
Menorrhagia
Attacks of giddiness
Headache
Drowsiness
Flatulence of abdomen after eating
( In mild anaemia there may not be any symptoms)
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Anisocytosis : Increase variation in size of RBC.
normal size of RBC= 6.7-7.7 µ (normocyte)
o average -7.2 µ
• Larger than 8µ is
called- Macrocyte.
• Smaller than 6µ is
Called- Microcyte.
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Poikilocytosis : increase variation in shape of RBC.
eg. Sickle shaped or oval shaped.
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Hypochromasia :central pallor area of RBC is increased more than 1/3rd . seen in Fe deficiency anaemia, thalassaemias , sideroblastic anaemia.
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Most common type of anaemia.
More common in vegetarian people than non-veg people.
because non-vegetarian food is rich in iron.
• Contain heam-Fe which is ferrous form of iron does not need HCL of gastric juice and vitamin for absorption.
• Easily absorbed.
• Absorbed in duodenum and upper jejunum.
In vegetarian Fe is in ferric form.
Need HCL of gastric juice and vitamin to convert into ferrous form.
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Source of iron :-
Non –vegetarian food rich in iron :
liver , kidney , egg-yolk, meat , fish fat.
Vegetarian food rich in iron:
cereal pulse base diet is rich in iron.
dark green vegetable like spinach , leafy vegetables , dry fruits , whole pulses like channa, rajma , bajra etc… , jiggery , dates , banana , apple etc..
Daily requirement= 18 mgm/day ( in adult)
Daily loss = 0.5 to 1.0 mgm/day
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Body iron store in hair , nails , sweat etc..
Absorption :-
-> depend upon need of body.
-> controlled by mucosal block.
-> in anaemic person more absorption.
-> increased by vit-C , gastric juice,
-> decreased by milk , antacids , phylates , tannin etc..
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AETIOLOGY
1. Blood loss.
Acute chronic
-accident - piles
-APH - hook warm infection
-PPH - bleeding from peptic ulcer
-menorrhagia - intestinal malignancy
- apistexis
In India malaria and hook worm infection are most common cause for chronic blood loss
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2. Increase requirement of iron:
eg. Growing age , pregnancy , lactation etc..
3. Inadequate dietary intake:eg. Due to poverty , anorexia(in TB, cancer) , vegetarian diet
4. Decrease absorption of iron:eg. Partial or total gastectomy, achlohydria ,
intestinal malabsorbtion in coeliac disease
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Lab Diagnosis1) Hb – decreased
2) RBC count – decreased
3) PCV – decreased
4) Absolute indices-
M.C. V
M.C.H ALL are decreased
M.C.H.C
5) P.s – anisocytosis and Poikilocytosis.
microcytic hypochromic RBC
6) Reticulocyte count – may be normal , decreased or slightly increased(normal in adult->0.2-2% , in infants 2-6%, total 24000-48000/cumm)
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7) WBC count - normal
8)Differential count – normal
9)Platelet count – normal or slightly increased in case of bleeding.
10)Bone marrow biopsy – hyper cellular due to erytheiod hyperplasia
11)Parssian blue stain – Negative.(shows absence of iron store in REcell of bone marrow)
12)Biochemical findings –A. Serum iron level -> decreased(normal 18-
180µgm/day)
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DifferenceHeam iron
It is in ferrous form
Can be easily absorbed
Soluble
Vit-C and HCL is not needed.
High bio availability
Found in non-veg food i.e red meat
NON HEAM IRON
It is in ferric form.
Has to be converted in to ferrous form and then absorbed
Insoluble
Gastric HCL make is soluble & vit-C convert it in ferrous form.
Low bio availability
Found in vegetarian food.
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Etiology & Pathogenesis:-
Deficiency of vit-B12(cobalamine) & / or folic acid
Impaired DNA synthesis
Delayed maturity of nucleus of RBC precursor
Slow division of cell.
(the cytoplasmic development progress normally)
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• It leads to formation of large nucleated RBC precursor : Megalobasts.
• Megaloblastas are morphologically & functionally abnormal so that RBCs are formed from them released into the peripheral blood is also abnormal in size(macrocyte ).
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Cause
B-12 deficiency.
due to:
1. inadequate dietary intake- more common in vegetarian and breast feed baby.
2. Malabsorption – due to lack of intrinsic factor , gastractomy , disease of small intestine like Clohn’s disease.
3. Increase demand – eg.pregnancy , lactation , infancy etc…
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source
• Non-veg food like kidney, liver, heart , muscle meat etc are rich in B12.
• Fish , egg , cheese & milk also rich in B12.• Vegetable are poor in source(B12)
Daily requirement : 2-4µg Absorption : in distal Ilium. Storage : Mainly in liver -> 2mgm Kidney Heart 2mgm Brain
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function
• DNA synthesis.
• Myelination of peripheral nerves , spinal cord and cerebrum.
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(same as B-12 deficiency)
due to:
1. inadequate dietary intake- more common in vegetarian and breast feed baby.
2. Malabsorption – due to lack of intrinsic factor , gastractomy , disease of small intestine like Clohn’s disease.
3. Increase demand – eg.pregnancy , lactation , infancy etc…
Folic acid deficiency
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Diet : Non-veg food is rich in folic acid than vegetarian food .
Daily requirement :100 – 200 mg/ day
Absorption :whole of small intestine
Nervous manifestation : numbness , weakness , ataxia , diminished reflexes
Atrophic gastritis in stomach is seen.
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Lab diagnosis
RBC count : decreased
PCV : decreased
Absolute indices :-
• M.C.V → increased
• M.C.H → increased
• M.C.H.C → normal or slightly decreased
Reticulocyte count → decreased
P.S → anisocytosis & poikilocytosis.
• RBCs shows 2 characteristic changes
a) Macrosytosis
b) Ovalocytosis
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e• Tear drop cells may be seen.
• Basophilic stipping of RBC.
WBC count : TLC ( total leukocyte count) slightly decrease
D.C ( differential count)
• Neutrophils → hyper segmented nucleus )
(lobes more than 5)
Platelet : slight thrombocytopenia with
Megathrombocytes.
Pancytopaenia is characteristic feature.
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Biochemical findings :
• Serum B-12 level are decreased : >100 ng/litter
(normal 200-900 ng/litter )
• Serum iodate : >4 µg/litter
(normal 6-12 µg/litter)
• Megaloblastic erythroid hyperplasia.
• This abnormality of RBC , destroy in bone marrow and seen in 2 forms
a) Abnormal mitosis
b) Degenerated giant mitocyte(wbc)
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Bone marrow finding
• Bone marrow is hypercellular due to megaloblastic erythroid hyperplasia.
• They may shows abnormal mitosis.
• Giant metamylocytes are also seen
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• Also known as Addison’s megaloblastic
anaemia.
• Uncommon in India
• Age incidence :- middle and old age people
• When occur in children called - juvenile
pernicious anaemia.
• Both sex are similarly affected.
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aetiology• Deficiency of intrinitsic factor.• Atrophy of gastric mucosa due to
prodenetion of autoimmune antibodies against parietal cell and intrinsic fator
• Antibodies are found in serum and gastric juice of the patient
Pathological changes in gastric mucos :
Certain mucosal atrophy affecting acid and pepsin secreting cells of stomach.
Result : deficiency of intrinsic factors leads to megaloblastic anaemia and subsentcombined degeneration of spinal cord and peripheral neuropathy.
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Classification ( according to cause)
Haemolytic anaemia
Intracorpuscular Extracorpuscul- thalassaemia - Infection- enzymatic deficiency - drugs & chemical
in RBC -miscellaneou-Defect in cell mambrane
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Aetiology – pathogenesis Increase haemolysis of RBCs
Decrease life span of RBC
Increased destruction of RBC
Increased release of haem
Increased formation of bilirubin(uncongugated)
goes to liverCongugated bilirubin
Goes to intestine
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CAUSES :
1. Intracorpuscular cause
Mainly three intacorpuscular causesA. Thalassaemia and haemoglobinopathyB. Enzymatic deficiency in RBCs . Eg -> G-6PD deficiency &
P.K deficiency & haemoglobinopthisisC. Defect in cell-membrane eg. Hereditory sperocytosis & hereditory
eliptocytosis. It is a qualitative disorder of HB . Decreased of HB
synthesis leads to abnormal HB.
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• Defect in the popypeptide chain of HB.
• over 100 abnormal Hbs are known. Hb-S, Hb-C Hb-D, Hb-E etc..
• Out of all this Hb-s is most common. Which cause sickle cell anaemia.
THALASSAEMIA
Quontative defect of haemoglobin.
Hereditary disorder.
Defect : reduced ret of synthesis of one or more of globin peptide chains.
Two types: α & β
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Lab diagnosis• Hb : decreased • RBC :decreased • PCV : decreased• MCV• MCH normal• MCHC • Peripheral blood smear :• normocytic normochromic.• Polychorm cell is may seen.• RBC lies much apart from each other WBC : normal Platelets : normal
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• Reticulocyte : increased up to 20-30 %
• Bone marrow : hyper cellular of erythroidhyparplasia
• Electrophoresis : separation of Hbs. Abnormal Hbs may be detected (Hb-s)
• Osmotic fragility of RBC – increased
• Sickle cell for Hb-S may be positive.
• G-6PD deficiency may be seen.
• Blood bilirubin level : increased.
• Urobilinogen in urine : increased
• Sterkobilirogen in stool : increased.
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Characterised by pancytopaenia
Anaemia
Leucopaenia
Thrombocytopaenia
Cause atrophy of bone marrow
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classification
-
chemical - infection drugsinsect killer - AIDS Eg.cytotoxic drugs
- aersenic cals - hepatitis -Like methotexaticChloramphenico ;
Aplastic Anaemia
PRIMARY SECONDARY
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Clinical featurs• Anemia
• Haenmorrhages : of thrombocytopaeniableeding from gums , vagina ,bowels etc..
• Infections of leukopaenia
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Lab diagnosisHb : decreased
P.S : normocytic normochromic .
RBC : decreased
PCV : decreased
MCV : increased
MCH : normal
MCHC : increased
Rticulocyte : nil
Leukopaenia : neutrophils decreased, relative lymphocytosis
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• Platelet : increased (thrombocytopaenia)• Bone marrow : dry tap• Tryphling biopsy : hypocellular
Bone marrow is aplastic . Replaced by fat with patchy areas of cell
Sever decreased f myeloid cellsMegakareyocyte and erythroid cells.Pancytopaenia : marrow consist chiefly of
lymphocytes and plasma cells….