RBC Disorders <ul><li>Two Types </li></ul><ul><li>Anemia </li></ul><ul><li>Polycythemia </li></ul>
Anemia <ul><li>Definition </li></ul><ul><li>Clinical features </li></ul><ul><li>Diagnosis </li></ul><ul><li>Lab </li></ul>...
Classification of Anemia
<ul><li>Morphological </li></ul><ul><li>Etiological </li></ul>
Morphological <ul><li>Macrocytic (Megaloblastic )MCV>100 fl </li></ul><ul><li>Macrocytic (Non megaloblastic) </li></ul><ul...
Etiological <ul><li>Excessive destruction or loss of red cells </li></ul><ul><li>1) Blood loss </li></ul><ul><li>a) acute ...
<ul><li>3)Intra corpuscalr hemolytic disease </li></ul><ul><li>Various acquired and hereditary causes of hemolytic anemia ...
<ul><li>Inadequate production f mature red cells  </li></ul><ul><li>1) Deficiency of essential substances like iron , foli...
<ul><li>3) Infiltration of bone marrow </li></ul><ul><li>leukemia, lymphoma, carcinoma, myelofibrosis </li></ul><ul><li>4)...
Microcytic Hypochromic Anemia Iron deficiency Anemia
Iron metabolism <ul><li>Amount  </li></ul><ul><li>Total body iron= 2-5 </li></ul><ul><li>Distribution </li></ul><ul><li>He...
<ul><li>Transport protein – transferrin (beta globulin) One mol binds one or two atomsof ferric iron </li></ul><ul><li>nor...
IRON <ul><li>Functions as electron transporter; vital for life </li></ul><ul><li>Must be in ferrous (Fe +2 ) state for act...
IRON Body Compartments - 75 kg man 3 mg Absorption < 1 mg/day Excretion < 1 mg/day Stores 1000mg Tissue 500 mg Red Cells 2...
IRON   CYCLE Fe Fe Fe Fe Fe Ferritin Hemosiderin slow Fe Fe Fe Fe Fe Fe Fe Fe Fe Ferritin Ferritin Transferrin Receptor RB...
Iron absorption <ul><li>Duodenum </li></ul><ul><li>Proximal jejunum </li></ul><ul><li>Influenced by rate of erythropoiesis...
Factors affecting Iron Absoption <ul><li>Form of iron  </li></ul><ul><li>Acids </li></ul><ul><li>Amount of iron </li></ul>...
Iron balance <ul><li>Normal – absorption exceeds excretion </li></ul><ul><li>Plasma iron pool maintained at a constant </l...
 
GI ABSORPTION OF IRON Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Ferritin Fe Fe Fe Fe Fe Fe Fe TRANSFERRIN
IRON Causes of Iron Deficiency <ul><li>Blood Loss </li></ul><ul><ul><li>Gastrointestinal Tract </li></ul></ul><ul><ul><li>...
IRON STORES Iron Deficiency Anemia Stores 0 mg 3 mg Absorption 2-10 mg/day Excretion Dependent on Cause Tissue 500 mg Red ...
IRON DEFICIENCY Symptoms <ul><li>Fatigue - Sometimes out of proportion to anemia </li></ul><ul><li>Atrophic glossitis </li...
 
 
Laboratory Findings <ul><ul><li>Blood  </li></ul></ul><ul><li>Hb </li></ul><ul><li>RBC </li></ul><ul><li>WBC </li></ul><ul...
<ul><li>Blood picture </li></ul><ul><li>anisocytosis, poikilocytosis, microcytosis and hypochromia  </li></ul><ul><li>Bone...
<ul><li>Biochemical test </li></ul><ul><li>a) Serum iron – Reduced </li></ul><ul><li>b) TIBC – Increased  </li></ul><ul><l...
Differential Diagnosis <ul><li>Thalassemia ß minor </li></ul><ul><li>Anemia of chronic disorders </li></ul><ul><li>Siderob...
N HB A 2  increase N N HB electro Ring form present absent absent Blast iron present present Present Absent BM Iron I N N ...
Treatment <ul><li>Oral  </li></ul><ul><li>Parenteral </li></ul><ul><li>Blood transfusion </li></ul><ul><li>Response to tre...
Plummer Vinson Syndrome   (Patterson Kelly Syndrome) <ul><li>Characterized by iron deficiency, dysphagia with glossitis </...
Iron overload  <ul><li>Hemosiderosis </li></ul><ul><li>Hemochromatosis </li></ul><ul><li>Treatment of iron overload </li><...
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Classification Of Anaemia & Ida

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Transcript of "Classification Of Anaemia & Ida"

  1. 1. RBC Disorders <ul><li>Two Types </li></ul><ul><li>Anemia </li></ul><ul><li>Polycythemia </li></ul>
  2. 2. Anemia <ul><li>Definition </li></ul><ul><li>Clinical features </li></ul><ul><li>Diagnosis </li></ul><ul><li>Lab </li></ul><ul><li>Normal values </li></ul>
  3. 3. Classification of Anemia
  4. 4. <ul><li>Morphological </li></ul><ul><li>Etiological </li></ul>
  5. 5. Morphological <ul><li>Macrocytic (Megaloblastic )MCV>100 fl </li></ul><ul><li>Macrocytic (Non megaloblastic) </li></ul><ul><li>Microcytic (MCV <80 fl ) </li></ul><ul><li>Normocytic (81-99 fl) </li></ul>
  6. 6. Etiological <ul><li>Excessive destruction or loss of red cells </li></ul><ul><li>1) Blood loss </li></ul><ul><li>a) acute </li></ul><ul><li>b) chronic </li></ul><ul><li>2)Extra Corpuscular hemolytic disease </li></ul><ul><li>a) antibodies </li></ul><ul><li>b) infection eg. Malaria </li></ul><ul><li>c) Drugs chemicals </li></ul><ul><li>d) Trauma to red cells </li></ul>
  7. 7. <ul><li>3)Intra corpuscalr hemolytic disease </li></ul><ul><li>Various acquired and hereditary causes of hemolytic anemia </li></ul>
  8. 8. <ul><li>Inadequate production f mature red cells </li></ul><ul><li>1) Deficiency of essential substances like iron , folic acid, vit B 12 , protein and other elements like copper,cobalt etc </li></ul><ul><li>2) Deficiency of erythroblasts </li></ul><ul><li>a)Aplastic anemia </li></ul><ul><li>b)Pure red cell aplasia </li></ul>
  9. 9. <ul><li>3) Infiltration of bone marrow </li></ul><ul><li>leukemia, lymphoma, carcinoma, myelofibrosis </li></ul><ul><li>4) Endocrine abnormalities </li></ul><ul><li>Myxoedema, addison’s disease, pitutary insufficiency </li></ul><ul><li>5) Chronic renal disease </li></ul><ul><li>6) Chronic inflammatory disease </li></ul><ul><li>7)Cirrhosis of liver </li></ul>
  10. 10. Microcytic Hypochromic Anemia Iron deficiency Anemia
  11. 11. Iron metabolism <ul><li>Amount </li></ul><ul><li>Total body iron= 2-5 </li></ul><ul><li>Distribution </li></ul><ul><li>Hemoglobin – 2-3gm </li></ul><ul><li>Storage iron ( ferriin & hemosiderin ) -1gm </li></ul><ul><li>Essential (non available) tissue iron -0.5gm </li></ul><ul><li>Plasma or transport iron - 3-4 mgm </li></ul>
  12. 12. <ul><li>Transport protein – transferrin (beta globulin) One mol binds one or two atomsof ferric iron </li></ul><ul><li>normal value – 1.2 – 2 g/l </li></ul><ul><li>Serum iron </li></ul><ul><li>normal value – 100ug/dl </li></ul><ul><li>TIBC –It is the amount of transferrin available to bind with iron normal value – 300ug/dl </li></ul><ul><li>TIBC is normally 3 times that of serum iron </li></ul><ul><li>% saturation is about 335 </li></ul>
  13. 13. IRON <ul><li>Functions as electron transporter; vital for life </li></ul><ul><li>Must be in ferrous (Fe +2 ) state for activity </li></ul><ul><li>In anaerobic conditions, easy to maintain ferrous state </li></ul><ul><li>Iron readily donates electrons to oxygen,  superoxide radicals, H 2 O 2 , OH• radicals </li></ul><ul><li>Ferric (Fe +3 ) ions cannot transport electrons or O 2 </li></ul><ul><li>Organisms able to limit exposure to iron had major survival advantage </li></ul>
  14. 14. IRON Body Compartments - 75 kg man 3 mg Absorption < 1 mg/day Excretion < 1 mg/day Stores 1000mg Tissue 500 mg Red Cells 2300 mg
  15. 15. IRON CYCLE Fe Fe Fe Fe Fe Ferritin Hemosiderin slow Fe Fe Fe Fe Fe Fe Fe Fe Fe Ferritin Ferritin Transferrin Receptor RBC PRECURSOR CIRCULATING RBCs Fe Fe TRANSFERRIN MONONUCLEAR PHAGOCYTES
  16. 16. Iron absorption <ul><li>Duodenum </li></ul><ul><li>Proximal jejunum </li></ul><ul><li>Influenced by rate of erythropoiesis and state of iron stores. </li></ul>
  17. 17. Factors affecting Iron Absoption <ul><li>Form of iron </li></ul><ul><li>Acids </li></ul><ul><li>Amount of iron </li></ul><ul><li>Rate of erythropoiesis </li></ul>
  18. 18. Iron balance <ul><li>Normal – absorption exceeds excretion </li></ul><ul><li>Plasma iron pool maintained at a constant </li></ul>
  19. 20. GI ABSORPTION OF IRON Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Fe Ferritin Fe Fe Fe Fe Fe Fe Fe TRANSFERRIN
  20. 21. IRON Causes of Iron Deficiency <ul><li>Blood Loss </li></ul><ul><ul><li>Gastrointestinal Tract </li></ul></ul><ul><ul><li>Menstrual Blood Loss </li></ul></ul><ul><ul><li>Urinary Blood Loss (Rare) </li></ul></ul><ul><ul><li>Blood in Sputum (Rarer) </li></ul></ul><ul><li>Increased Iron Utilization </li></ul><ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>Infancy </li></ul></ul><ul><ul><li>Adolescence </li></ul></ul><ul><ul><li>Polycythemia Vera </li></ul></ul><ul><li>Malabsorption </li></ul><ul><ul><li>Tropical Sprue </li></ul></ul><ul><ul><li>Gastrectomy </li></ul></ul><ul><ul><li>Chronic atrophic gastritis </li></ul></ul><ul><li>Dietary inadequacy (almost never sole cause) </li></ul><ul><li>Combinations of above </li></ul>
  21. 22. IRON STORES Iron Deficiency Anemia Stores 0 mg 3 mg Absorption 2-10 mg/day Excretion Dependent on Cause Tissue 500 mg Red Cells 1500 mg
  22. 23. IRON DEFICIENCY Symptoms <ul><li>Fatigue - Sometimes out of proportion to anemia </li></ul><ul><li>Atrophic glossitis </li></ul><ul><li>Pica </li></ul><ul><li>Koilonychia (Nail spooning) </li></ul><ul><li>Esophageal Web </li></ul>
  23. 26. Laboratory Findings <ul><ul><li>Blood </li></ul></ul><ul><li>Hb </li></ul><ul><li>RBC </li></ul><ul><li>WBC </li></ul><ul><li>Platelets </li></ul><ul><li>Red cell indices </li></ul><ul><li>MCV MCH MCHC </li></ul><ul><li>RDW </li></ul>
  24. 27. <ul><li>Blood picture </li></ul><ul><li>anisocytosis, poikilocytosis, microcytosis and hypochromia </li></ul><ul><li>Bone marrow </li></ul><ul><li>Hypercellular with erythroid hypercelluar.Micronormoblast </li></ul><ul><li>Iron stain (PERL’s) – absent or minimal </li></ul>
  25. 28. <ul><li>Biochemical test </li></ul><ul><li>a) Serum iron – Reduced </li></ul><ul><li>b) TIBC – Increased </li></ul><ul><li>c) % Saturation – Decreased </li></ul><ul><li>d) Serum ferritin – Decreased </li></ul><ul><li>e) Red cell protoporphyrin increased </li></ul>
  26. 29. Differential Diagnosis <ul><li>Thalassemia ß minor </li></ul><ul><li>Anemia of chronic disorders </li></ul><ul><li>Sideroblastic anemia </li></ul>
  27. 30. N HB A 2 increase N N HB electro Ring form present absent absent Blast iron present present Present Absent BM Iron I N N D Ferritin Normal Normal D I TIBC Inc Normal D D Serum Iron D D D decrease MCHC D D D “ MCH Decrease Decreas e Low/N decrease MCV Sidero Thal ACD Fe Def Investigation
  28. 31. Treatment <ul><li>Oral </li></ul><ul><li>Parenteral </li></ul><ul><li>Blood transfusion </li></ul><ul><li>Response to treatment? </li></ul>
  29. 32. Plummer Vinson Syndrome (Patterson Kelly Syndrome) <ul><li>Characterized by iron deficiency, dysphagia with glossitis </li></ul><ul><li>Occurs in middle aged or elderly women </li></ul><ul><li>Anemia tend to be severe –spleen palpable </li></ul><ul><li>Dysphagia due to spasm at the esophageal entrance due to fine web/band formation </li></ul><ul><li>Mucosal change may lead to carcinoma </li></ul>
  30. 33. Iron overload <ul><li>Hemosiderosis </li></ul><ul><li>Hemochromatosis </li></ul><ul><li>Treatment of iron overload </li></ul><ul><li>Desferrioxamine </li></ul><ul><li>Bronze diabetes? </li></ul>
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