Anaemia paj sir lec note

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Anaemia paj sir lec note

  1. 1. ANAEMIA2012.12.06Paj sir’s lecture note jumbz
  2. 2.  Anaemia- british style Anemia – american style Acording to WHO(1960) proposed a cut off value for hb content for anaemia.It is 12% How ever excluded from this group are 1.pregnant(15-49years) 2.children(6-59 months) For srilanka today,peak or the maximum apears around to 9-11 months in children
  3. 3.  If you want to look at anaemia in pregnant, you find it 35% In children 6-60months – 33% anaemia At the time of birth we have sufficient iron storage . It lasts at in 6th month Breast milk is poor source of iron only help untill 6th month.iron in breast milk is in the form of heme iron. There are two types of iron 1.mainly inorganic iron 2.heme iron
  4. 4.  Of these two iron is absorbed through carrier system..The percentage of absorption is depend on body state. In anaemic condition it willl increase absorption.those people who are normal will absorb low amount relative to anaemic patients. So absorption is governed by body state. Iron is carried by a protein- transferrin,not as ferus state,but as
  5. 5.  When it is absorbed to enterocyte once,it is converted to Fe3+ by a protein,-ceruloplasmin. Fe2+ Fe3+ Ceruloplasmin is a beautiful blue colour protein. So iron in ferus state absorbs and is converted to feric state and is loaded to transferin.(a protein)
  6. 6.  Apo-transferin-produce in liver Fe3+ loaded. Can loaded 2 atoms,then it transported to sites where iron is required; principal site is bone marrow.liver is also a site. Erythroblast ae born in bone marrow,iron for synthesis of heme and then corperated into hemoglobin Also goes to other places where heme proteins are produced.
  7. 7.  1.myoglobin-in muscle. 2.cytochroms-in mitochindria,electrone transport system on inner surface of mitochondria. (Mitochondria originates from maternal side,so genatic disorders from mother) Excess iron stored in liver as feritin.another form is hemosidarin.but most is in the form of feritin. Everyday on an average we relase 1mg of iron to iron pool.
  8. 8.  Fe2+ Fe3+ why is this reaction is so important??? If you have iron in ferrus state it will be more active and begins to produce oxygen free radicles. Oxygen free radicles are sometime important as to attack invading pathogens. Free radicles are caused to oxidation of sevarel components 1.oxidation of nucleic acids-cause to cancer 2.phospholipids-reduction in cell membrane function. 3.protein-make an inactive condtion.
  9. 9.  Skin-wrinkling of the skin.in skin abundantly present protein is collagen. In wrinkling 2 sulper amino acids are oxidized forming disulfied linkage -SH- -S-S- Free radicles oxidise protein,PUFA,nucleic acids.so they are toxic.ceruloplasmin is a protective agent makinf it less toxic. Iron is transported by apo-transferrin. what happen in iron deficiency??? The body will try to bring as much as
  10. 10.  But we release only 1mg.so in growing child,adolecent and pregnant 1mg is insufficient.so become anaemia. Howrcome do we overcome this??? 1.liver starts to produce more an more apotransferrin.so in iron deficiency anaemia apotransferrin is increased. What about iron we put out into blood.they are carried by ferritin.infact level of ferritin in blood plasma is an indicator of iron store. What about heme??? Maximum percentage of heme iron absorption is 30%.absorption of inorganic iron is 10%. Heme iron from animal sources.(liver o,organ meats).
  11. 11.  Fish – almost black colour is due to lot of heme iron. Myoblobin present in red colour. If you are a vegiterian maximum absorption is 10%.but average value is 3%-5%.so have to provide vit.c. Iron deficiency is found in all over the world. Special reasons, 1.iron is found in richly surface on the earth. 2.plant-iron in ferric state.so it is unavailable. We can only absorb iron only in Fe2+ form.so bioavailability is low. If you are a vegan-no iron come from heme.so vitamin c should be 60mg per day.smokers should get 100mg per day,due to produce oxygen free radicles by components such as CO,arsenic.
  12. 12.  We usualy use in curries surviving agents(tamerin,lime,goraka,bilin). These agents give acidic ph helping in iron absorption. Never ever use aluminium pots.otherwise aluminium jump into them.So use clay pots. In green leaves vegitables also in legums iron is bound to phytic acid.so they are not bioavailable. How do we release them??? Soaking them wtare absorbs.It triggers growth of seeds.(germination).so trace elmants are released.Bound to phytic acid is a self defence. There is an enzyme called phytase to release
  13. 13.  Are there any form of anaemias??? Yes! But the main thing is iron deficiency anaemia. If you have malaria,those parasite enter your body having a luxury day :D But people who are in anaemic condition,parasites can not grow. In addition toirion deficiency ther are also folate def and vit b 12 def. folate and vit.B12 are involve I DNA synthesis.when deficiency (one or both) dna replication will be affected.Without DNA replication no cell division. So reducing cell division.
  14. 14.  So what will happen??? Number of enterocyte will be reduced and affect in absorption of nutrients. Malabsorption accures. So not only anaemia but also undernutrition condition occures. How do you know it??? 1.take a blood sample from finger pit. 2.get a blood picture.can be seen macrocytic and microcytic RBCs.This says number of RBCs and Hb content is less.
  15. 15.  Clinical feature-involve with nerve transmission. In vit B12 deficiency.Dismatching signals through nerves.It will damage the nerve covering- mayalin sheath.So what will happen??? -Not proper covering the nerve fiber -signal will become weak and leak. Vitamin B 12 is most stable.can be in 125c’ Folic acid- 50% of iron deficiency are also in folic acid deficiency. Folic acid deficiency is caused mainly due to poor processing. Folic acid is heat unstable.So it is called labile.acidic pH is good for it.
  16. 16.  What are the other bad affects??? 1.growth retardation folate & 2.malabsorption B12 defi. Anaemic women placenta is large.But small fetus.Small for date babies. How do we define- infant is less than 2.5kg These infant ,in their middle and old age will be affected in 1.DM 2.hypertension. Their imunity is reduced
  17. 17.  Children and workers as tea pluckers and ruber tappers-increased absence of days and reduced work output. School children-increased absence of school is due to illness. 1.common cold 2.cough low immunity 3.diarrhoea Fe- 1.Need to transport oxygen.They require O2 and also for production in heme protein .Need for mitochondria for production of citochromefor energy production.
  18. 18.  2. mayoglobin in red muscle. Darker red in muscle. What is the reason??? Continuos 24hr energy rquirement. In anaemia growth rate is reduced. Any other form of anaemia??? Yes ! Thalassemia – commmonest form is beta thalassemia.Their Hb A amount is low.So how do they overcome-by Hb A2 and Hb F. Also they will have alfa-4.they are not functional Hbs.Abnormal proteins. ‘’heinz bodies’’-dark pigment
  19. 19.  Sickle cell anaemia-sickling of RBCs giving hypoxia. Normally RBCs are rolled over and creeped through blood vessels.but due to sickle shape it damage blood vessles and blocks the blood flow. Sickling can be seen only in oxygen deficinecy. Maleria - patasites enter good helath peoplefor their multiplication.they would finaly burst RBCs.leading hemolysis anaemia.-hemolytic anaemia.
  20. 20.  Iron is something that retains in body strongly. How do we loss it??? Skin,feces…. No in urine no in bile. Only through removed of cells.dead cells.
  21. 21.  Synthesis of heme. 1.succinyl CoA+glycine rate limitting step Delta.amino lenolenic acid inhibited by heme (surplace free) Porphobilinogen There is a feedback type inhibition Transferrin – loaded with iron.maximux is 2 atoms of iron. There is a normal saturated rate of transferrin.In iron deficiency this rate will be reduced.

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