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ERYTHROCYTES, HEMOGLOBIN & ANEMIAS By Dr.M.Anthony David MD Professor of Physiology NOMAD:2006: BP: HBANEM
NOMAD:2006: BP: HBANEM
<ul><li>25 Trillion in an average 70 kg adult man. </li></ul><ul><li>Men have about   4.5 to 5.5 Millions/cu.mm </li></ul>...
POLYCYTHEMIA <ul><li>Increase in the number of Erythrocytes </li></ul><ul><li>Is of two types </li></ul><ul><li>Primary Po...
ERYTHROCYTE MORPHOLOGY <ul><li>They are biconcave discs in shape about 7.5 Microns in diameter </li></ul><ul><li>They are ...
HEMOGLOBIN <ul><li>A  CHROMO PROTEIN  MOLECULE. </li></ul><ul><li>IS PRESENT EXCLUSIVELY  WITHIN THE ERYTHROCYTE. </li></u...
HEMOGLOBIN MOLECULE NOMAD:2006: BP: HBANEM
SYNTHESIS OF HEMOGLOBIN <ul><li>REQUIRES: </li></ul><ul><ul><li>Nutrients such as Proteins, Vitamins & Minerals. </li></ul...
HEME <ul><li>Iron containing Porphyrin. </li></ul><ul><li>Iron-Protoporphyrin IX </li></ul><ul><li>Porphyrin is formed fro...
NOMAD:2006: BP: HBANEM
HEMOGLOBIN CATABOLISM <ul><li>Macrophages, mainly the Kupffer cells in the liver  phagocytose Hemoglobin. </li></ul><ul><l...
<ul><li>Fe ++  + TRANSFERRIN TO BONE MARROW FOR REUSE. </li></ul><ul><li>Fe ++  + PORPHYRIN    HEME </li></ul><ul><li>(In...
HEMOGLOBIN:NORMAL LEVELS <ul><li>MALES: 14 – 18 Gm% </li></ul><ul><li>FEMALES: 12 – 15 Gm% </li></ul><ul><li>AT BIRTH: 23 ...
<ul><li>1 Gm OF HEMOGLOBIN, WHEN FULLY SATURATED, COMBINES WITH  1.34 ml OF OXYGEN. </li></ul><ul><li>HEMOGLOBIN CONCENTRA...
HEMOGLOBIN FORMATION: FACTORS <ul><li>1. PROTEINS: </li></ul><ul><ul><li>HIGH POTENCY: ANIMAL PROTEINS LIKE LIVER, SPLEEN ...
<ul><li>2. IRON: HEMOGLOBIN HAS 2.5 Gms OF THE TOTAL BODY IRON OF 4 - 5 Gms IN AN AVERAGE HEALTHY ADULT. </li></ul>HEMOGLO...
HEMOGLOBIN: STRUCTURE <ul><li>HAS FOUR POLYPEPTIDE CHAINS OF TWO TYPES: EACH IN DUPLICATE. </li></ul><ul><li>HbA: ADULT HE...
STRUCTURE & FUNCTION <ul><li>Hb A =  α 2   β 2 </li></ul><ul><li>HEMOGLOBIN COMBINES LOOSELY & REVERSIBLY WITH OXYGEN. </l...
<ul><li>   2,3 DPG       AFFINITY OF Hb TO O 2 </li></ul><ul><li>THIS CAUSES THE OXYGEN TO BE FREELY DISSOCIATED. </li>...
HEMOGLOBIN: VARIETIES <ul><li>HEME IS THE SAME </li></ul><ul><li>VARIETIES ARE DUE TO CHANGES IN THE PEPTIDES OF THE GLOBI...
Hb:PHYSIOLOGICAL VARIETIES <ul><li>2. FETAL HEMOGLOBIN: </li></ul><ul><li>Hb F :  α 2   γ 2   </li></ul><ul><li>γ  : GAMMA...
Hb: PATHOLOGICAL : SICKLE CELL DISEASE <ul><li>CAUSE:  </li></ul><ul><ul><li>ABNORMAL POLYPEPTIDES DUE TO SUBSTITUTION OF ...
NOMAD:2006: BP: HBANEM
SICKLE CELL DISEASE <ul><li>WHEN Hb S IS REDUCED, IT BECOMES LESS SOLUBLE &  ‘GELS’ </li></ul><ul><li>THIS CHANGES THE SHA...
A SICKLED ERYTHROCYTE NOMAD:2006: BP: HBANEM
Hb: PATHOLOGICAL : THALASSEMIAS <ul><li>DEFECT IN THE SYNTHESIS OF EITHER ALPHA & BETA CHAINS OF GLOBIN. </li></ul><ul><li...
BETA THALASSEMIA <ul><li>ERYTHROCYTES ARE ABNORMAL: HAVE LESS Hb A AND MORE OF Hb A 2  & Hb F. </li></ul><ul><li>RAPID HEM...
NOMAD:2006: BP: HBANEM  Let's take a break!
NOMAD:2006: BP: HBANEM  BACK TO WORK NOW!
IRON METABOLISM & ANEMIAS By Dr.M.ANTHONY DAVID, MD Professor of Physiology  NOMAD:2006: BP: HBANEM
IRON IN THE BODY NOMAD:2006: BP: HBANEM  BIOCHEMICAL FORM SITE CONC. % OF TOTAL HEMOGLOBIN Erythrocytes 2.5 Gms 60-65 STOR...
IRON BALANCE <ul><li>ADULT MEN: </li></ul><ul><li>DIET :    5 – 10 mg/day </li></ul><ul><li>LOSS: </li></ul><ul><li>0.4 m...
<ul><li>HAVE MORE IRON LOSS: </li></ul><ul><li>Monthly Menstrual Periods: 50 – 80 ml </li></ul><ul><li>Child Bearing & Rea...
IRON ABSORPTION <ul><li>SITE: Duodenum/Upper Jejunum via brush border. </li></ul><ul><li>Ferrous form better absorbed than...
ANEMIAS Deficiency of Hb in the blood caused by either:  RBC Count or    Hb in the RBCs NOMAD:2006: BP: HBANEM
NOMAD:2006: BP: HBANEM
ANEMIAS: CLASSIFICATION <ul><li>HEMORRHAGIC ANEMIA </li></ul><ul><li>APLASTIC ANEMIA </li></ul><ul><li>MEGALOBLASTIC ANEMI...
1. HEMORRHAGIC ANEMIA (BLOOD LOSS)  <ul><ul><li>ACUTE : Sudden loss of blood </li></ul></ul><ul><ul><li>RBC Count decrease...
2. APLASTIC ANEMIA: <ul><li>Lack of functioning Red Bone Marrow, the hemopoietic tissue. </li></ul><ul><li>Caused by expos...
3. MEGALOBLASTIC ANEMIA: <ul><li>Deficiency of Vit B 12  and or Folic Acid. </li></ul><ul><li>Intrinsic Factor can also be...
MEGALOBLASTIC ANEMIA: <ul><li>Intestinal Sprue or Malabsorption Syndrome can also cause this. </li></ul><ul><li>Megaloblas...
NOMAD:2006: BP: HBANEM  MEGALOBLASTS
4. HEMOLYTIC ANEMIAS <ul><li>Mostly heriditary. </li></ul><ul><li>Cells are  fragile, rupture easily as they move through ...
5. SICKLE CELL ANEMIA <ul><li>Affects 0.3 to 1% of West African & African blacks. </li></ul><ul><li>The Beta chains of Hem...
NOMAD:2006: BP: HBANEM
ERYTHROBLASTOSIS FETALIS <ul><li>Rh Isoimmunisation causes this disease </li></ul><ul><li>Antigen antibody reaction causes...
IRON DEFICIENCY ANEMIA <ul><li>The most common type of anemia . </li></ul><ul><li>Caused by nutritional deficiency of Iron...
IRON RICH DIETS NOMAD:2006: BP: HBANEM
SECONDARY ANEMIA(RENAL) <ul><li>Renal Diseases can cause decreased  Erythropoietin . </li></ul><ul><li>Erythropoietin is e...
REVIEW <ul><li>Erythrocytes: </li></ul><ul><ul><li>4.5 – 5.5 Million/cc of blood in Males </li></ul></ul><ul><ul><li>4 – 5...
REVIEW <ul><li>Hemoglobin is a chromoprotein present exclusively within the erythrocytes. </li></ul><ul><li>Hb synthesis t...
<ul><li>Normal blood levels of Hemoglobin: </li></ul><ul><ul><li>Males  : 14 – 18 Gm% </li></ul></ul><ul><ul><li>Females  ...
<ul><li>Anemia is a decrease in either Hb or RBCs. </li></ul><ul><li>Types of Anemia: </li></ul><ul><ul><li>Hemorrhagic </...
NOMAD:2006: BP: HBANEM  THANKS FOR LISTENING!
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Hemoglobin & Anemias - the basics by Dr.M.Anthony David MD

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A brief description of Erythrocytes, hemoglobin and Anemias for Health professional students

Transcript of "Hemoglobin & Anemias - the basics by Dr.M.Anthony David MD"

  1. 1. ERYTHROCYTES, HEMOGLOBIN & ANEMIAS By Dr.M.Anthony David MD Professor of Physiology NOMAD:2006: BP: HBANEM
  2. 2. NOMAD:2006: BP: HBANEM
  3. 3. <ul><li>25 Trillion in an average 70 kg adult man. </li></ul><ul><li>Men have about 4.5 to 5.5 Millions/cu.mm </li></ul><ul><li>Women have about 4 to 5 Millions/cu.mm </li></ul><ul><li>Decrease in the Erythrocyte Count is called Anemia </li></ul><ul><li>Increase is called Polycythemia </li></ul>
  4. 4. POLYCYTHEMIA <ul><li>Increase in the number of Erythrocytes </li></ul><ul><li>Is of two types </li></ul><ul><li>Primary Polycythemia </li></ul><ul><li>Secondary Polycythemia </li></ul>NOMAD:2006: BP: HBANEM
  5. 5. ERYTHROCYTE MORPHOLOGY <ul><li>They are biconcave discs in shape about 7.5 Microns in diameter </li></ul><ul><li>They are about 2 – 3 Microns thick </li></ul><ul><li>They have no nuclei. </li></ul><ul><li>Why? </li></ul><ul><li>They make place for Hemoglobin </li></ul><ul><li>Hemoglobin takes up a third of the volume of each erythrocyte </li></ul>NOMAD:2006: BP: HBANEM
  6. 6. HEMOGLOBIN <ul><li>A CHROMO PROTEIN MOLECULE. </li></ul><ul><li>IS PRESENT EXCLUSIVELY WITHIN THE ERYTHROCYTE. </li></ul><ul><li>ROUGHLY ONE THIRD OF THE VOLUME OF THE ERYTHROCYTE IS OCCUPIED BY HEMOGLOBIN. </li></ul><ul><li>IS A COMPLEX PROTEIN WITH TWO MOIETIES: HEME + GLOBIN. </li></ul>NOMAD:2006: BP: HBANEM
  7. 7. HEMOGLOBIN MOLECULE NOMAD:2006: BP: HBANEM
  8. 8. SYNTHESIS OF HEMOGLOBIN <ul><li>REQUIRES: </li></ul><ul><ul><li>Nutrients such as Proteins, Vitamins & Minerals. </li></ul></ul><ul><li>TAKES PLACE ONLY WITHIN THE NORMOBLASTCELLS.(INTRACELLULAR) </li></ul><ul><li>HEMOGLOBIN = HEME + GLOBIN </li></ul><ul><li>HEME = PIGMENT </li></ul><ul><li>GLOBIN = PROTEIN </li></ul>NOMAD:2006: BP: HBANEM
  9. 9. HEME <ul><li>Iron containing Porphyrin. </li></ul><ul><li>Iron-Protoporphyrin IX </li></ul><ul><li>Porphyrin is formed from 4 Pyrrole rings joined by four methane bridges. </li></ul><ul><li>The side chains 1,3 5, & 8 are Methyl. </li></ul><ul><li>The side chains 2 & 4 are Vinyl. </li></ul><ul><li>The side chains 6 & 7 are Propionic Acid. </li></ul>NOMAD:2006: BP: HBANEM
  10. 10. NOMAD:2006: BP: HBANEM
  11. 11. HEMOGLOBIN CATABOLISM <ul><li>Macrophages, mainly the Kupffer cells in the liver phagocytose Hemoglobin. </li></ul><ul><li>HEMOGLOBIN = HEME + GLOBIN </li></ul><ul><li>HEME  Fe ++ + PORPHYRIN </li></ul><ul><li>PORPHYRIN  BILVERDIN + CO. </li></ul><ul><li>CO  TO THE LUNGS AND OUT. </li></ul><ul><li>BILVERDIN REDUCED TO BILIRUBIN AND SENT TO BLOOD & LIVER FOR EXCRETION. </li></ul>NOMAD:2006: BP: HBANEM
  12. 12. <ul><li>Fe ++ + TRANSFERRIN TO BONE MARROW FOR REUSE. </li></ul><ul><li>Fe ++ + PORPHYRIN  HEME </li></ul><ul><li>(In the presence of the enzyme, Heme Oxidase .) </li></ul><ul><li>HEME + GLOBIN  HEMOGLOBIN </li></ul>HEMOGLOBIN CATABOLISM NOMAD:2006: BP: HBANEM
  13. 13. HEMOGLOBIN:NORMAL LEVELS <ul><li>MALES: 14 – 18 Gm% </li></ul><ul><li>FEMALES: 12 – 15 Gm% </li></ul><ul><li>AT BIRTH: 23 Gm% </li></ul><ul><li>FALLS TO 10.5Gm% BY THIRD MONTH </li></ul><ul><li>RISES GRADUALLY TO 12.5 Gm% AT 1 YEAR OF AGE. </li></ul>NOMAD:2006: BP: HBANEM
  14. 14. <ul><li>1 Gm OF HEMOGLOBIN, WHEN FULLY SATURATED, COMBINES WITH 1.34 ml OF OXYGEN. </li></ul><ul><li>HEMOGLOBIN CONCENTRATION IS THEREFORE AN INDEX OF THE OXYGEN CARRYING CAPACITY OF THE BLOOD. </li></ul>HEMOGLOBIN LEVELS : SIGNIFICANCE NOMAD:2006: BP: HBANEM
  15. 15. HEMOGLOBIN FORMATION: FACTORS <ul><li>1. PROTEINS: </li></ul><ul><ul><li>HIGH POTENCY: ANIMAL PROTEINS LIKE LIVER, SPLEEN KIDNEY & HEART MOST POTENT </li></ul></ul><ul><ul><li>MUSCLE PROTEINS MEDIUM POTENT </li></ul></ul><ul><ul><li>LEAST POTENCY: CEREALS, DAIRY PRODUCTS, VEGETABLES & FRUITS </li></ul></ul>NOMAD:2006: BP: HBANEM
  16. 16. <ul><li>2. IRON: HEMOGLOBIN HAS 2.5 Gms OF THE TOTAL BODY IRON OF 4 - 5 Gms IN AN AVERAGE HEALTHY ADULT. </li></ul>HEMOGLOBIN FORMATION: FACTORS NOMAD:2006: BP: HBANEM
  17. 17. HEMOGLOBIN: STRUCTURE <ul><li>HAS FOUR POLYPEPTIDE CHAINS OF TWO TYPES: EACH IN DUPLICATE. </li></ul><ul><li>HbA: ADULT HEMOGLOBIN HAS: </li></ul><ul><ul><li>2 α CHAINS AND </li></ul></ul><ul><ul><li>2 β CHAINS. </li></ul></ul><ul><li>EACH CHAIN IS ASSOCIATED WITH ONE HEME GROUP. </li></ul><ul><li>THUS THERE ARE FOUR HEMES TO THE MOLECULE, A TETRAMER OF MW 68,000 </li></ul>NOMAD:2006: BP: HBANEM
  18. 18. STRUCTURE & FUNCTION <ul><li>Hb A = α 2 β 2 </li></ul><ul><li>HEMOGLOBIN COMBINES LOOSELY & REVERSIBLY WITH OXYGEN. </li></ul><ul><li>IT’S AFFINITY TO OXYGEN IS DECREASED IN THE PRESENCE OF 2,3, DIPHOSPHO GLYCERATE (2,3 DPG) </li></ul><ul><li>2,3 DPG IS A PRODUCT OF GLUCOSE METABOLISM. </li></ul>NOMAD:2006: BP: HBANEM
  19. 19. <ul><li> 2,3 DPG   AFFINITY OF Hb TO O 2 </li></ul><ul><li>THIS CAUSES THE OXYGEN TO BE FREELY DISSOCIATED. </li></ul><ul><li>THIS HAPPENS AT THE TISSUE LEVEL. </li></ul><ul><li>ENSURES FREE AVAILABLITY OF O 2 TO THE TISSUES. </li></ul><ul><li>THUS OXYGEN DELIVERY IS A BASIC FUNCTION OF HEMOGLOBIN </li></ul>STRUCTURE & FUNCTION NOMAD:2006: BP: HBANEM
  20. 20. HEMOGLOBIN: VARIETIES <ul><li>HEME IS THE SAME </li></ul><ul><li>VARIETIES ARE DUE TO CHANGES IN THE PEPTIDES OF THE GLOBIN MOIETY. </li></ul><ul><li>PHYSIOLOGICAL VARIETIES: </li></ul><ul><li>1. ADULT Hb: Hb A: </li></ul><ul><ul><li>Hb A: α 2 β 2 : PREPONDERANT FORM: 68,000 </li></ul></ul><ul><ul><li>Hb A2: α 2 δ 2 : A MINOR COMPONENT </li></ul></ul>NOMAD:2006: BP: HBANEM
  21. 21. Hb:PHYSIOLOGICAL VARIETIES <ul><li>2. FETAL HEMOGLOBIN: </li></ul><ul><li>Hb F : α 2 γ 2 </li></ul><ul><li>γ : GAMMA CHAINS HAVE MORE AFFINITY TO OXYGEN. </li></ul><ul><li>THIS HELPS THE FETUS TO ACQUIRE OXYGEN FROM THE MOTHER. </li></ul>NOMAD:2006: BP: HBANEM
  22. 22. Hb: PATHOLOGICAL : SICKLE CELL DISEASE <ul><li>CAUSE: </li></ul><ul><ul><li>ABNORMAL POLYPEPTIDES DUE TO SUBSTITUTION OF AMINO ACIDS </li></ul></ul><ul><ul><li>SUPRESSION OF SYNTHESIS OF POLYPEPTIDE CHAINS. </li></ul></ul><ul><li>Hb S: </li></ul><ul><ul><li>OCCURS IN 0.3 to 1 % OF WEST AFRICAN & AMERICAN BLACK PEOPLE </li></ul></ul><ul><li>VALINE IS SUBSTITUTED FOR GLUTAMIC ACID AT 6 POSITION OF BETA CHAIN. </li></ul>NOMAD:2006: BP: HBANEM
  23. 23. NOMAD:2006: BP: HBANEM
  24. 24. SICKLE CELL DISEASE <ul><li>WHEN Hb S IS REDUCED, IT BECOMES LESS SOLUBLE & ‘GELS’ </li></ul><ul><li>THIS CHANGES THE SHAPE OF THE ERYTHROCYTES. </li></ul><ul><li>THEY BECOME ‘SICKLE’ SHAPED </li></ul><ul><li>THEY INCREASE THE BLOOD VISCOSITY AND UNDERGO HEMOLYSIS. </li></ul><ul><li>THIS IS A SERIOUS CONDITION, CAN BE FATAL BY MIDDLE AGE. </li></ul>NOMAD:2006: BP: HBANEM
  25. 25. A SICKLED ERYTHROCYTE NOMAD:2006: BP: HBANEM
  26. 26. Hb: PATHOLOGICAL : THALASSEMIAS <ul><li>DEFECT IN THE SYNTHESIS OF EITHER ALPHA & BETA CHAINS OF GLOBIN. </li></ul><ul><li>OCCURS IN HOMOZYGOUS OFFSPRING OF HETEROZYGOUS PARENTS. </li></ul><ul><li>BETA THALASSEMIA IS MORE COMMON. BETA CHAIN NOT FORMED. </li></ul>NOMAD:2006: BP: HBANEM
  27. 27. BETA THALASSEMIA <ul><li>ERYTHROCYTES ARE ABNORMAL: HAVE LESS Hb A AND MORE OF Hb A 2 & Hb F. </li></ul><ul><li>RAPID HEMOLYSIS OCCURS IN VIVO. </li></ul><ul><li>CAUSES HYPOCHROMIC ANEMIA. </li></ul><ul><li>CHILDREN FAIL TO THRIVE. </li></ul><ul><li>THEY DIE YOUNG. </li></ul>NOMAD:2006: BP: HBANEM
  28. 28. NOMAD:2006: BP: HBANEM Let's take a break!
  29. 29. NOMAD:2006: BP: HBANEM BACK TO WORK NOW!
  30. 30. IRON METABOLISM & ANEMIAS By Dr.M.ANTHONY DAVID, MD Professor of Physiology NOMAD:2006: BP: HBANEM
  31. 31. IRON IN THE BODY NOMAD:2006: BP: HBANEM BIOCHEMICAL FORM SITE CONC. % OF TOTAL HEMOGLOBIN Erythrocytes 2.5 Gms 60-65 STORAGE Fe (ferritin & hemosiderin) Phagocytes & Hepatic Parenchymal cells 1 – 1.5 Gms 25 -30 MYOGLOBIN Myohemoglobin Red Muscle Fibres 0.2 Gms 150-200mg 4 Trace Heme Tissue enzymes Tissue Cells < 0.1 Gms 1
  32. 32. IRON BALANCE <ul><li>ADULT MEN: </li></ul><ul><li>DIET :  5 – 10 mg/day </li></ul><ul><li>LOSS: </li></ul><ul><li>0.4 mg : Urine </li></ul><ul><li>0.8 mg : Bile </li></ul><ul><li>Traces : Mucosa of GI tract. </li></ul>NOMAD:2006: BP: HBANEM
  33. 33. <ul><li>HAVE MORE IRON LOSS: </li></ul><ul><li>Monthly Menstrual Periods: 50 – 80 ml </li></ul><ul><li>Child Bearing & Rearing : 15 Months: 900 mg (2mg/day) How? </li></ul><ul><ul><li>Fetal Iron Content : 400mg. </li></ul></ul><ul><ul><li>Iron in Placenta/Uterus : 150mg. </li></ul></ul><ul><ul><li>Blood loss in Parturition:170mg. </li></ul></ul><ul><ul><li>Iron in Breast milk : 180mg. </li></ul></ul><ul><ul><li>TOTAL : 900mg. </li></ul></ul>IRON BALANCE: women NOMAD:2006: BP: HBANEM
  34. 34. IRON ABSORPTION <ul><li>SITE: Duodenum/Upper Jejunum via brush border. </li></ul><ul><li>Ferrous form better absorbed than Ferric form </li></ul><ul><li>Ascorbic Acid (Vit C) helps absorption. </li></ul><ul><li>Phosphates/Phytates reduce ionic Iron absorption by forming insoluble salts. </li></ul><ul><li>Heme in diet is directly absorbed </li></ul><ul><li>Iron deficiency states enhance Iron absorption. </li></ul>NOMAD:2006: BP: HBANEM
  35. 35. ANEMIAS Deficiency of Hb in the blood caused by either:  RBC Count or  Hb in the RBCs NOMAD:2006: BP: HBANEM
  36. 36. NOMAD:2006: BP: HBANEM
  37. 37. ANEMIAS: CLASSIFICATION <ul><li>HEMORRHAGIC ANEMIA </li></ul><ul><li>APLASTIC ANEMIA </li></ul><ul><li>MEGALOBLASTIC ANEMIA </li></ul><ul><li>PERNICIOUS ANEMIA </li></ul><ul><li>HEMOLYTIC ANEMIA </li></ul><ul><li>SICKLE CELL ANEMIA </li></ul><ul><li>IRON DEFICIENCY ANEMIA </li></ul><ul><li>SECONDARY ANEMIA (RENAL) </li></ul>NOMAD:2006: BP: HBANEM
  38. 38. 1. HEMORRHAGIC ANEMIA (BLOOD LOSS) <ul><ul><li>ACUTE : Sudden loss of blood </li></ul></ul><ul><ul><li>RBC Count decreased for 1 – 3 days </li></ul></ul><ul><ul><li>RBCs are restored in 3 – 6 weeks </li></ul></ul><ul><ul><li>CHRONIC BLOOD LOSS : </li></ul></ul><ul><ul><li>They cannot absorb Fe enough to form Hb </li></ul></ul><ul><ul><li>Have Hypochromic, Microcytic Anemia. </li></ul></ul>NOMAD:2006: BP: HBANEM
  39. 39. 2. APLASTIC ANEMIA: <ul><li>Lack of functioning Red Bone Marrow, the hemopoietic tissue. </li></ul><ul><li>Caused by exposure to gamma ray radiation (Nuclear Bomb Blast) </li></ul><ul><li>Excessive exposure to X rays </li></ul><ul><li>Exposure to certain industrial chemicals. </li></ul>NOMAD:2006: BP: HBANEM
  40. 40. 3. MEGALOBLASTIC ANEMIA: <ul><li>Deficiency of Vit B 12 and or Folic Acid. </li></ul><ul><li>Intrinsic Factor can also be deficient. </li></ul><ul><li>Production of Erythrocytes becomes slow. </li></ul><ul><li>They remain large, have odd shapes and are called ‘Megaloblasts’ </li></ul><ul><li>Atropy of Stomach mucosa can cause loss of Intrinsic factor & this anemia is called Pernicious Anemia. </li></ul>NOMAD:2006: BP: HBANEM
  41. 41. MEGALOBLASTIC ANEMIA: <ul><li>Intestinal Sprue or Malabsorption Syndrome can also cause this. </li></ul><ul><li>Megaloblasts are over sized, anisocytic. </li></ul><ul><li>They have fragile membranes and rupture easily. </li></ul><ul><li>TREATMENT: Vitamin B12 Folic Acid if it is nutritional. </li></ul>NOMAD:2006: BP: HBANEM
  42. 42. NOMAD:2006: BP: HBANEM MEGALOBLASTS
  43. 43. 4. HEMOLYTIC ANEMIAS <ul><li>Mostly heriditary. </li></ul><ul><li>Cells are fragile, rupture easily as they move through the capillaries. </li></ul><ul><li>The life span of erythrocytes is reduced. </li></ul><ul><li>HERIDITARY SPHEROCYTOSIS: </li></ul><ul><li>Small spherical erythrocytes. </li></ul><ul><li>Cannot be compressed even slightly </li></ul><ul><li>Rupture and are lysed very easily. </li></ul>NOMAD:2006: BP: HBANEM
  44. 44. 5. SICKLE CELL ANEMIA <ul><li>Affects 0.3 to 1% of West African & African blacks. </li></ul><ul><li>The Beta chains of Hemoglobin are defective. </li></ul><ul><li>They have Hb S </li></ul><ul><li>Sickling occurs when Hb loses Oxygen. </li></ul><ul><li>A vicious circle of events occurs:  Oxygen tension  Sickling  Rupture of Erythrocytes  </li></ul><ul><li> Further  Oxygen tension </li></ul><ul><li>This is called a crisis in sickle cell disease. </li></ul>NOMAD:2006: BP: HBANEM
  45. 45. NOMAD:2006: BP: HBANEM
  46. 46. ERYTHROBLASTOSIS FETALIS <ul><li>Rh Isoimmunisation causes this disease </li></ul><ul><li>Antigen antibody reaction causes lysis of erythrocytes. </li></ul><ul><li>Seen in Neonates and is also called Icterus Gravis Neonatorum. </li></ul><ul><li>Excess Bilirubin enters the brain, causing ‘kernicterus’ </li></ul><ul><li>Can become fatal. </li></ul>NOMAD:2006: BP: HBANEM
  47. 47. IRON DEFICIENCY ANEMIA <ul><li>The most common type of anemia . </li></ul><ul><li>Caused by nutritional deficiency of Iron. </li></ul><ul><li>Erythrocytes are smaller and have less Hb. </li></ul><ul><li>So they are called Microcytic & Hypochromic. </li></ul><ul><li>Treated by taking Iron rich diets. </li></ul><ul><li>Dark green leafy vegetables: esp Drumstick leaves. </li></ul><ul><li>Meats like Liver & spleen. </li></ul>NOMAD:2006: BP: HBANEM
  48. 48. IRON RICH DIETS NOMAD:2006: BP: HBANEM
  49. 49. SECONDARY ANEMIA(RENAL) <ul><li>Renal Diseases can cause decreased Erythropoietin . </li></ul><ul><li>Erythropoietin is essential for proper production of erythrocytes (Erythropoiesis) </li></ul><ul><li>Renal disease thus causes Anemia. </li></ul>NOMAD:2006: BP: HBANEM
  50. 50. REVIEW <ul><li>Erythrocytes: </li></ul><ul><ul><li>4.5 – 5.5 Million/cc of blood in Males </li></ul></ul><ul><ul><li>4 – 5 Million/cc of blood in females </li></ul></ul><ul><li>Biconcave discs </li></ul><ul><li>7.5 Microns X 2.5 Microns </li></ul><ul><li>No nucleus </li></ul><ul><li>Hemoglobin takes up a third volume </li></ul>NOMAD:2006: BP: HBANEM
  51. 51. REVIEW <ul><li>Hemoglobin is a chromoprotein present exclusively within the erythrocytes. </li></ul><ul><li>Hb synthesis takes place within the normoblasts. </li></ul><ul><li>Hemoglobin = Heme + Globin. </li></ul><ul><li>Heme is an Iron containing Porphyrin. </li></ul><ul><li>Iron is present in the Ferrous form. </li></ul><ul><li>Oxygen can be loosely attached to Hb. </li></ul>NOMAD:2006: BP: HBANEM
  52. 52. <ul><li>Normal blood levels of Hemoglobin: </li></ul><ul><ul><li>Males : 14 – 18 Gm% </li></ul></ul><ul><ul><li>Females : 12 – 15 Gm% </li></ul></ul><ul><li>1 Gram of Hemoglobin combines with 1.34 ml of Oxygen. </li></ul><ul><li>Varieties of Hemoglobin include: Hb A, Hb F </li></ul><ul><li>Hb S, Hb A 2 </li></ul>REVIEW NOMAD:2006: BP: HBANEM
  53. 53. <ul><li>Anemia is a decrease in either Hb or RBCs. </li></ul><ul><li>Types of Anemia: </li></ul><ul><ul><li>Hemorrhagic </li></ul></ul><ul><ul><li>Aplastic </li></ul></ul><ul><ul><li>Megaloblastic </li></ul></ul><ul><ul><li>Pernicious </li></ul></ul><ul><ul><li>Hemolytic </li></ul></ul><ul><ul><li>Sickle Cell </li></ul></ul><ul><ul><li>Iron deficiency </li></ul></ul><ul><ul><li>Secondary (Renal) </li></ul></ul>REVIEW NOMAD:2006: BP: HBANEM
  54. 54. NOMAD:2006: BP: HBANEM THANKS FOR LISTENING!
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