Salman Bin AbdulAziz University College Of Pharmacy PATHOPHYSIOLOGY II anemia is decrease number of RBC or count of hemoglobin or both. What is anemia ? What is classification of anemia ? What is characterizes of each type ? APPLIED THERAPEUTICS I IRON DEFICIENCY ANEMIA 1. D.G., a 35-year-old woman, is seen in the clinic. Her chief complaints include weakness, dizziness, and epigastric pain. She has a 5-year history of peptic ulcer disease, a 10-year history of heavy menstrual bleeding, and a 20-year history of chronic headaches. She has two children who are 1 and 3 years of age.D.G. is currently taking tetracycline (250 mg BID) for acne, ibuprofen (400 mg PRN) headaches, and daily esomeprazole (40 mg). A review of her systems is positive for decreased exercise tolerance. Physical examination reveals a pale, lethargic, white woman appearing older than her stated age. Her vital signs are within normal limits; her heart rate is regular at 100 beats/min. are planned to evaluate her persistent epigastric pain. Her examination is notable for pale nail beds and splenomegaly. Signicant laboratory results include the following: Hgb,8 g/dL (normal, 14 to 18); Hct, 27% (normal, 40% to 44%); platelet count, 800,000/mm3(normal, 130,000 to 400,000); reticulocyte count, 0.2% (normal, 0.5% to 1.5%); mean corpuscular volume (MCV), 75 m3 (normal, 80 to 94); mean corpuscular hemoglobin (MCH), 23 pg (normal, 27 to 31); mean corpuscular hemoglobin concentration (MCHC), 30%(normal, 33%to 37%); serumiron, 40g/dL (normal, 50 to 160); serumferritin, 9 ng/mL(normal, 15 to 200); total iron-binding capacity (TIBC), 450 g/dL (normal, 250 to 400); and 4+ guaiac stools (normal, negative).Iron deciency is determined to be the cause of D.G.s anemia. An upperGI serieswith a small bowel follow- through What factors predispose D.G.to iron deciency anemia? ANSWER Several factors predispose D.G. to iron deciency anemia.Her history of : I.heavy menstrual bleeding II.chronic use of nonsteroidal anti-inammatory drugs III.recurrent peptic ulcer disease, or both. IV.Many women of childbearing age have a borderline iron deciency that becomes more evident during pregnancy because of the increased iron requirements. V. use of proton pump inhibitors and tetracycline that effect to absorption of iron. 2. What subjective or objective signs, symptoms, and laboratory tests are typical of iron deciency in D.G.? constitutional symptoms of weakness and dizziness could be a result of her severe anemia. increased heart rate, decreased exercise tolerance, and pale appearance are consistent with tissue anoxia detected by measuring ferritin. inammatory disorders and liver disease.serum ferritin level 70% of patients with AIDS and correlates with the severity of the clinical syndrome. In this patient population, anemia is a risk factor for early death. Common symptoms such as : 1.Fatigue 2.Breathlessness 3.difculties in mental concentration may contribute to this patient populations decreased quality of life. Approximately 1% of all AIDS-related anemias are related to parvovirus and can be treated and reversed with IV gammaglobulin. Enhanced production of cytokines, such as TNF-, also may be correlated with hematologic abnormalities. As illustrated by J.M., HIV-associated anemia has a characteristic RBC morphology, which is normochromic and normocytic. Treatment with rhEPO What factors can contribute to J.M.s anemia?