Anaemia

Anaemia

1. Erythrocyte Regulation: Stimulus is hypoxia. Kidney detects reduced O2 levels in blood and releases erythropoietin, which stimulates Erythropoeisis (RBC production) in the bone marrow, O2 levels restored

   • Erythropoiesis: RBCs take 3-5 days to develop and exist for 120 days. Pluripotent stem cells take the myeloid line to become progenitor cells, which become RBCs
     • RBCs contain 4 chains of Haemoglobin, which transport O2 around the body

2. what is anaemia? A reduction in number or functionality of circulating RBCs

3. anaemia is not a disease itself, but a consequence of other conditions

   • loss or destruction of erythrocytes
     • blood loss
     • haemolysis
   • reduced production of erythrocytes
     • nutrient deficiency
     • bone marrow dysfunction
   • combination
     • chronic disease, renal failure

4. Classifications: Normacytic Normachromic Microcytic, Macrocytic, Hypochromic

   • microcytic hypochromic
     • iron deficiency anaemia
       • Iron Supplements
         • ferrous sulfate dried ferrous sulfate iron polymaltose ferrous fumarate ferric carboxymaltose
           • oral tablet, liquid, IV
           • AEs - drug interactions (iron forms complexes) black stools, diarrhoea, constipation, tooth staining.
   • macrocytic normochromic
     • B12 and Folic Acid deficiency anaemia
       • Treatment: B12 and Folic Acid supplements
         • B12
           • cyanocobalamin and hydroxocobalamin
             • Cyanocobalamin - cyanide moiety, synthetic, shorter half life, oral or IM
             • Hydroxocobalamin, hydroxyl group, naturally occurring, IM injection, longer half life
         • Folic Acid
   • normacytic normachromic
     • anaemia of chronic disease
       • Epo Agonists
         • mimic actions of erythropoietin to stimulate erhtyropoiesis in bone marrow, bind to Epo receptors on progenitor cells
         • rhEpo - alfa and beta, half life 6-9 hrs, human recombinant.
         • darbepoietin - synthetic, has two additional carbohydrate chains, longer half life, 25 hrs

5. Signs and Symptoms: fatigue, dizziness, fainting, difficulty concentrating, headaches, yellowing of mucosa, pale skin, cold extremities, heart palpitations, chest pain, ischaemia and heart failure in serious ongoing anaemia, shortness of breath, muscular weakness, pica, enlarged spleen in haemolytic anaemia