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Classification Of Anaemia & Ida
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Classification Of Anaemia & Ida

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