Hematology

1. Anemia & Polycythemia
Dr. Sai Sailesh Kumar G
Associate Professor
Department of Physiology
RDGMC
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2. Case study
 The blood peripheral smear report of 42 years old female
suffering from polymenorrhoea showed microcytic
hypochromic anemia. Diagnose the condition. Describe
signs and symptoms of the disease.
 Iron deficiency anemia
 signs
1. Dry, soft, spoon shaped nails with longitudinal
striations
2. Angry red tongue
 Symptoms
1. Breathlessness
2. Palpitations
3. Tiredness
4. Generalized weakness
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3. Learning objectives
 Define anemia
 Classify anemia on the basis of morphology and
etiology
 Describe megaloblastic anemia
 Describe effects of anemia on circulatory system
 Define polycythemia
 Describe the effects of polycythemia on circulatory
system
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4. Anemia
 Anemia means deficiency of hemoglobin in the
blood
 This can be caused by either too few red blood
cells or too little hemoglobin in the cells
 Some types of anemia and their physiological
causes classified on the basis of the red cell
morphology
1. Normocytic anemia
2. Macrocytic anemia
3. Microcytic anemia
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5. Normocytic anemia
 Post hemorrhagic
 Endocrine disorders
1. Hypothyroidism
2. Addison disease
3. Hypo-pitutarism
 Anemia of chronic disorders
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6. Microcytic anemia
 Iron deficiency anemia
1. Dietary deficiency
2. Inhibitory diet (high phytate)
3. Hookworm
4. Chronic bleeding
5. infection
 Thalassemia
 Hemoglobinopathies
1. HbS
2. HbC
3. HbE DR Sai Sailesh Kumar G 6

7. Macrocytic anemia
 Vitamin B12 deficiency anemia (megaloblastic)
1. Dietary deficiency
2. Pernicious anemia
3. Gastric resection
4. Ileal disease
5. Tropical sprue
 Folate deficiency
1. Dietary deficiency
2. Pregnancy
3. Drug induced DR Sai Sailesh Kumar G 7

8. Alcoholism & Anemia
 Antifolate action of ethanol, is the most common
cause of a low hematocrit in hospitalized
alcoholics.
 It is more often due to direct toxicity of the
alcohol on the marrow.
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9. DR Sai Sailesh Kumar G 9

10. Sideroblastic anemia
 Sideroblastic anemia is a group of blood disorders
characterized by an impaired ability of the bone marrow
to produce normal red blood cells.
 In this condition, the iron inside red blood cells is
inadequately used to make hemoglobin, despite normal
amounts of iron.
 As a result, iron accumulates in the red blood cells,
giving a ringed appearance to the nucleus (ringed
sideroblast).
 signs and symptoms of this condition may include
fatigue, breathing difficulties, weakness, and
enlargement of the liver or spleen
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11. Sideroblastic anemia
 There are many potential causes of sideroblastic
anemia.
 Depending on the cause, it can be classified as
hereditary (sometimes called congenital), acquired,
and idiopathic (cause unknown).
 The treatment for this condition differs depending
on the underlying cause.
 If acquired, avoidance and or removal of the toxin
or drug can lead to recovery.
 Vitamin B6 (pyridoxine) may be useful in some
circumstances. DR Sai Sailesh Kumar G 11

12. Blood loss anemia
 Can be acute (rapid) or chronic
 After rapid hemorrhage, the body replaces the
fluid portion of the plasma in 1-3 days.
 But this leaves a low concentration of RBCs.
 If a second hemorrhage does not occurs, the
RBC concentration usually returns to normal
within 3-6 weeks.
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13. Blood loss anemia
 Can be acute (rapid) or chronic
 In chronic blood loss, person frequently can not
absorb adequate amounts of iron from the
intestines to form hemoglobin as rapidly as it is
lost
 Smaller RBCs with less Hb are produced.
 Causes microcytic hypochromic anemia
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14. Aplastic anemia
 Lack of functioning of bone marrow
 For instance, a person exposed to high dose
radiation or chemotherapy for cancer treatment can
damage stem cells of bone marrow
 Followed in a few weeks by anemia
 Similar effect is caused by high doses of certain
chemicals such as insecticides
 In autoimmune disorders such as lupus
erythematous, immune system attacks stem cells in
bone marrow DR Sai Sailesh Kumar G 14

15. Aplastic anemia
 In half of aplastic anemia cases, the cause is
unknown – idiopathic aplastic anemia
 People with severe aplastic anemia usually die
unless treated with blood transfusions or bone
marrow transplantation
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16. Megaloblastic anemia
 Deficiency of Vitamin B12 or folic acid and intrinsic
factor lead to slowdown reproduction of erythroblasts in
the bone marrow.
 As a result, the red cells grow large, with odd shapes,
and are called megaloblasts.
 Thus, atrophy of stomach mucosa, as occurs in
pernicious anemia, or loss of entire stomach after
surgical total gastrectomy can lead to megaloblastic
anemia.
 Also, patients who have intestinal sprue, in which folic
acid, vitamin B12 and other compounds are poorly
absorbed, often develop megaloblastic anemia.
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17. Megaloblastic anemia
 Because, in these states, erythroblasts can not
proliferate rapidly enough to form normal
number of RBCs.
 Those RBCs formed are usually over sized, have
bizarre shapes, and have fragile membranes.
 These cells rupture easily, leaving the person in
dire need of an adequate number of red cells.
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18. Hemolytic anemia
 Different abnormalities of RBCs, make the cells
fragile, so they rupture easily as they go through the
capillaries
 Especially through the spleen
 Even though the number of red cells formed may be
normal, or much greater than normal in some
hemolytic diseases,
 the life span of fragile red cell is so short that the
cells are destroyed faster than they can be formed
 Severe anemia results
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19. Hemolytic anemia
 Hereditary spherocytosis
 Red cells are very small and spherical
 These cells can not withstand compression forces
 Because they do not have normal loose, bag like
cell membrane structure of the biconcave disc
 On passing through the splenic pulp and some other
tight vascular beds,
 They are easily ruptured even by slight compression
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20. Hemolytic anemia
 Sickle cell anemia
 Cells have abnormal type of hemoglobin HbS
 Faulty beta chains in hemoglobin molecule
 When this hemoglobin exposed to hypoxia
 It precipitates into long crystals inside RBC
 These crystals elongate the cell and give it the
appearance of sickle rather than a biconcave disc
 The precipitated Hb also damages the cell
membrane
 Cells become highly fragile
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21. Hemolytic anemia
 Sickle cell anemia
 Such patients frequently experience a vicious
circle of events called a sickle cell disease
 “Crisis”
 Once, the process starts, it progress rapidly,
eventuating in a serious decrease in the red cells
within a few hours and in some causes death.
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22. Effects of anemia on circulatory system
 Viscosity of blood depends largely on the blood
concentration of red blood cells
 In severe anemia, blood viscosity fall to as low as
1.5 times that of water rather than the normal value
of about 3.
 This decrease the resistance to the blood flow in the
peripheral blood vessels
 So far greater than normal quantities of blood flow
through the tissues and return to the heart
 Thereby greatly increasing the cardiac output
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23. Effects of anemia on circulatory system
 Further, due to hypoxia, there is dilation of the
peripheral tissue blood vessels
 Further increase in the return of the blood to the
heart
 Increase in the cardiac output to a still higher level
 Some times 3-4 times normal
 Thus, one of the major effects of anemia is greatly
increased cardiac output as well as increased
pumping workload on the heart.
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24. Effects of anemia on circulatory system
 Increased cardiac output in anemia partially
offsets the oxygen carrying effect of the anemia
 Each unit quantity of blood carries only small
quantities of oxygen
 Rate of blood flow increased enough that almost
normal quantities of oxygen is delivered to
tissues.
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25. Effects of anemia on circulatory system
 What happens if a person with anemia does
exercise
 Heart is not capable of pumping of much greater
quantities of blood than it is already pumping
 Consequently, during exercise, which greatly
increase tissue demand for oxygen, extreme
tissue hypoxia results and acute cardiac failure
may ensue
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26. Secondary Polycythemia
 Hypoxia – high altitudes
 Failure of oxygen delivery to tissues – cardiac
failure
 Too little oxygen in breathed air
 Tissues become hypoxic
 Blood forming organs usually produce large
quantities of extra red blood cells
 This condition is called secondary polycythemia
 Red cell count raises to 6-7 millions per cubic mm
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27. Secondary Polycythemia
 A common type of secondary polycythemia,
called physiological polycythemia occurs in
natives who live at altitudes of 14,000-17,000 feet
 At this height, atmospheric oxygen is very low
 In these persons, normal blood count is 6-7
millions/cubic mm
 This allows to perform reasonably high levels of
continuous work even in rarefied atmosphere
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28. Polycythemia Vera
 Pathological condition
 Red cell count is 7-8 millions/cubic mm
 Hematocrit may be 60-70% instead of normal 40-45%
 Total blood volume increases
 Viscosity of blood increases
 Polycythemia Vera caused by a genetic aberration in
the hemoblastic cells
 The blast cells no longer stop producing red cells
when too many cells are already present
 Excess production of RBC
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29. Effect of Polycythemia on circulatory
system
 Viscosity greatly increases
 Resistance to blood flow increases
 Blood flow is sluggish through peripheral blood vessels
 Decrease in venous return
 Conversely, due to high blood volume in polycythemia
that tends to increase the venous return
 That’s why cardiac output in polycythemia is not far from
normal
 Because these two factors almost neutralize each other
 The arterial pressure is also normal in most people with
polycythemia
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30. Effect of Polycythemia on circulatory
system
 A person with polycythemia ordinarily has a ruddy
complexion with a bluish (cyanotic) tint to the skin
 The quantity of blood in skin subpapillary venous
plexus is greatly increased
 Blood flows sluggish in the skin capillaries before it
enter venous plexus
 So larger hemoglobin is deoxygenated than normal
 Blue color of all this deoxygenated hemoglobin
masks the red color of the oxygenated hemoglobin
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32. THANK YOU
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