Anemia

Anemia

Reduction in the Red cell mass
2. Erythropoiesis
  2. Occur in
    1. very early embryo: Yolk Sac
    2. NEWBORN: Liver, Spleen
    3. CHILDHOOD: axial skeleton & appendicular skeleton both have red (active) marrow
    4. ADULT: axial skeleton red marrow, appendicular skeleton yellow marrow
    5. EXTRA medullary
      1. LIVER AND SPLEEN
3. Hemoglobin formation
  1. Types of hemoglobin
  2. heme synthesis
    1. Iron
      1. Transport
    2. protoporphyrin
  3. Globin Synthesis
History Taking for Anemia
1. Diet
2. family history
3. environmental exposures
4. symptoms
  1. 1. causes of palpitations
      1. Strong emotional responses
      2. Strenuous exercise
      3. Caffeine
      4. Nicotine
      5. Fever
    2. causes of tiredness
      1. Lifestyle factors
      2. Anxiety
      3. Cancer
      4. Emphysema
5. age and sex
6. onset, duration& progress
7. Drug Ingestion
Types of anemia
1. Microcytic
  1. Iron deficiency
    1. Caused by
      1. Blood Loss
        to rule out blood loss
        do a
        Colonoscopy
        if there is pouches or polyps, GI bleeding
        Fecal Occult Blood Test
        check stool samples for hidden (occult) blood
      2. dietary deficiency
        Effect of food on iron absorption
        Reduce absorption
        1. Cheese and yogurt
        2. Eggs
        3. Milk
        4. Tea or coffee
        Increase Absorption
        Vitamin C
    2. Treated By
      1. iron supplementation
        Iron is absorbed the best on an empty stomach
      2. Oral vs. IV
        Oral iron has the advantage of being simple and cheap
        Oral iron is limited by poor compliance, poor absorption & low efficacy.
  2. Anaemia of chronic disease
  3. Sideroblastic anaemia
  4. Thalassaemia
  5. MCV<80 fl
2. Normocytic
  1. MCV 80-100 fl
  2. Hemolytic Anemia
    1. Intracorpuscular defects
      1. G6PD deficiency
      2. Hereditary spherocytosis
      3. PNH
    2. Extracorpuscular defects
      1. Sickle Cell Anemia
3. Macrocytic
  1. Megaloblastic
    1. Vitamin B12 Deficiency
      1. In vegeterians
        Increased risk of colorectal cancer
        Lower bone mineral density
        Insufficient levels of omega-3 fatty acids
    2. Folate deficiency
  2. Non-megaloblastic:
  3. MCV>100 fl
Investigations
1. 1. red cell size
  1. Microcytosis
  2. Macrocytosis
  3. Anisocytosis
    1. 6. red cell distribution width
      1. The degree of variation in RBC size
2. 2. red cell shape
3. 3. red cell colour
  1. Hypochromia
  2. Hyperchromia
4. 4. Polychromasia vs Anisochromasia
5. 5. mean corpuscular volume
  1. This is the average volume of one red cell
6. 7. Packed cell volume
8. Gel Electrophoresis
  1. movement of molecules by an electric current.
  2. used to separate mixtures of DNA, RNA, or proteins according to molecular size.
  3. Can know the type of Hb present
9. Blood film
  1. A thin layer of blood smeared on a microscope slide
  2. to allow the various blood cells to be examined microscopically.
10. 8. Serum ferritin
11. 9. Serum iron
12. 11. Total Iron Binding Capacity (TIBC)
13. 10. %saturation
Physical Examination
1. Inspection
  1. 1. Hands
    1. Kilonychia
    2. Tachycardia
  2. 2. Arms
    1. Scratch Marks
    2. Ecchymosis
  3. 3. Eyes
    1. Pallor
    2. Jaundice
2. Palpation of LN
3. Other Examinations
  1. Neurological Examination
  2. Pelvic and rectal examination
  3. Bone tenderness
  4. Abdominal examination
syndrome rather than a disease
Pathophysiologial Classification
1. Hypoproliferative
2. Blood loss
3. overdestruction

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	Created by Alshaima Yousef over 8 years ago