Anemia

Anemia

1. Definition

   • A reduction in the total circulating erythrocyte mass

2. Classification

   • On the basis of cause
     • blood loss
     • Inadequate production of normal blood cells
     • Excessive destruction of blood cells
   • On the basis of morphology
     • Normocytic
     • Microcytic
     • Macrocytic

3. Blood cells

   • Types
     • Red blood cells - Erythrocytes
       • Structure
         • Anucleated
         • Biconcave
       • Function
         • Gas exchange
       • Erythropoiesis
     • White blood cells
     • Platelets

4. Types

   • Aplastic anemia
     • Disorder of hemopoietic stem cells
     • Results in pancytopenia
     • Inherited
   • Anemia with chronic renal failure
     • Normocytic normochromic anemia
     • Normal bone marrow
   • Megaloplastic anemia
     • Impaired DNA synthesis
       • Causes
         • Vitamin B12 deficiency (pernicious anemia)
         • Folic acid
   • Pernicious anemia
     • Causes
       • Vitamin B12 deficiency
       • Poor diet
       • Low absorption
         • Gastrocectomy
         • Defective intestinal absorption
         • Neoplasm in ileum
   • Folic acid deficiency
     • Causes
       • inadequate dietary intake
       • Pregnancy
       • Alcoholics
   • Iron deficiency anemia
     • Causes
       • Decreased iron intake
       • Excessive loss
         • Menstrual bleeding
       • Increased iron demand
     • Management
       • Iron supplements
         • Ferrous sulfate
           • Absorption
             • Duodenum
             • Upper jejunum
           • Excretion
             • Urine
             • Sweat
             • Sloughing of intestinal mucosa
             • Menses in women
         • Ferrous gluconate
           • Adverse reactions
             • Diarrhea
             • Constipation
             • Vomiting
             • Nausea
             • Epigastric pain
         • Ferrous fumarate
           • Orally absorbed
           • Excretion
             • Feces
             • Urine
             • Bile
             • Sweat

5. Clinical presentation

   • Symptoms
     • Iron deficiency anemia
       • Fatigue
       • Pica
       • Spoon nails
       • Palpitations
     • Vitamin B12 deficiency
       • Early graying of the hair
       • Burning sensations in the tongue
     • Aplastic anemia
       • Fatigue
       • Malaise
       • Pallor
       • Mucosal bleeding
       • purpura
       • Petechiae
     • Sickle cell anemia
       • Fatigue
       • Arthritis
       • Swelling of peripheries
   • Physical examination
     • Systemic examination
       • Cardiomegaly
       • Tenderness
       • Splenomegaly
       • Hepatomegaly
     • The skin and mucosal membrane
       • Conjuctiva
       • Nail defects
       • Jaundice
       • Ulcerations
       • Angiomas
       • Purpura
       • Abnormal pigmentations
       • Pallor
     • General appearance
       • Chronic illness
       • Underdevelopment
       • Malnutrition

6. Diagnosis

   • Red blood cell indices
     • Mean corpuscular volume
       • Definition
         • The Average volume of RBC in a specimen
       • Normal range
         • 80-100fL
       • Interpretation
         • If low: Microcytic
           • Microcytic anemia
         • If high: Macrocytic
           • Macrocytic anemia
         • if Normal: Normocytic
     • Mean corpuscular hemoglobin
       • Definition
         • Amount of hemoglobin in an average RBC
       • Normal range
         • 27-33 pg/cell
     • Mean corpuscular hemoglobin concentration
       • Definition
         • Average concentration of hemoglobin in an average RBC
       • Normal range
         • 33-36 g/dL
       • Interpretation
         • If low: Hypochromic
         • If high: Hyperchromic
         • If normal: Normochromic
     • Red cell distribution width
       • Definition
         • Measures the variation in RBCs size or RBC volume
       • Normal range
         • 11-15%
       • Interpretation
         • If elevated: Anisocytosis
   • Iron studies
     • Ferritin
       • Intracellular storage form of iron
       • Normal range: 10-120μg/L
     • Serum iron
       • Refers to ferric ions bound to serum transferrin
       • Normal range: 9-30 μmol/L
     • Transferrin
       • iront transport protein in the plasma
       • Normal range: 2-4 g/L
     • Transferrin saturation
       • Value of serum iron/by the total iron-binding capacity
       • Normal range: 25-50%
   • Peripheral smear
     • Procedure
   • Red cell folate
     • Normal range: 317-1422 nmol/L packed cells
   • Vitamin B12
     • Normal range:148-616 μmol/L
   • Diagnostic tests
     • Sensitivity
     • Specificity
     • Positive predicted value
     • Negative predicted value

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