SlideShare a Scribd company logo
1 of 33
ANEMIA
Anemia is operationally defined as a
reduction in one or more of the major RBC
measurements: decreased amount of
circulating blood or low levels of
haemoglobin, low haematocrit.
hemoglobin concentration, hematocrit, or
RBC count
Keep in mind these are all concentration
measures
Definition:
Hemoglobin??
Hemoglobin
• Hemoglobin is the protein molecule in RBC that carries O2
from the lungs to the body's tissues and returns carbon CO2
from the tissues back to the lungs.
• Hemoglobin maintains the shape of RBC also.
α
β
β
α
Fe⁺⁺
Fe⁺⁺
Fe⁺⁺
Fe⁺⁺
Globin chain
Haem
Prophyrin ring
Iron atom
O2
O2
O2
O2
Hemoglobin structure
Dr. Aljabry
CD33-Sialic acid binding
Ig-like lectin 3
Colony forming unit –
Granulocyte,
Erythrocyte, Monocyte,
Megakaryocyte
Stem cell Factor
Burst forming unit E
Hematopoietic stem cell:
1- Self renewal
2- Cell differentiation
Hematopoiesis
Myeloid SC Erythroid Precursors
Transcriptional
Factor
Erythropoietin
GATA1
8
8
Late
Normoblast
Reticulocyte Erythrocyte
Basophilic
Normoblast
Erythroblast
Intermediate
Normoblast
+ ++ +++ ++ + -
Synthesis of
Hemoglobin
Erythropoiesis
The “Bone Marrow” is the major site with the need of:
Folic acid – Iron “Ferrous” – Vit B12 – Erythropoietin -Amino acids
minerals - other regulatory factors
Classification of
Anemia
Classification of anaemia
Female
Male
Indices
11.5-15.5
13.5-17.5
Hemoglobin(g/dL)
36-48
40-52
Hematocrit (PCV) (%)
3.9-5.6
4.5-6.5
Red Cell Count (×10¹²)
80-95
Mean Cell Volume (MCV) (fL)
30-35
Mean Cell Hemoglobin (MCH)
(pg)
Hb
Macrocytic
Normocytic
Microcytic
MCV
Normochromic
Hypochromic
MCH
Normal Ranges
HCT
• An (without) -aemia (blood)
• Reduction of Hb concentration below the normal
range for the age and gender
• Leading to decreased O2 carrying capacity of
blood and thus O2 availability to tissues (hypoxia)
ANEMIA
Clinical Features
Presence or absence of clinical feature depends on:
1-Speed of onset :
Rapidly progressive anemia causes more symptoms than slow onset
anemia due to lack of compensatory mechanisms:
(cardiovascular system, BM &O2 dissociation curve
2-Severity:
• Mild anemia: no symptoms usually
• Symptoms appear if Hb less than 9g/dL
3- Age:
• Elderly tolerate anemia less than young patients
• Weakness
• Headache
• Pallor
• Lethargy
• Dizziness
• Palpitation (tachycardia)
• Angina
• Cardiac failure
Related to anemia
Related to compensatory
mechanism
Clinical Features
1-General features of anemia
Specific signs are associated with particular types of anemia :
 Spoon nail with iron deficiency,
 Leg ulcers with sickle cell anemia
 Jaundice with hemolytic anemia
 bone deformities in thalassemia major
2-Specific features
Classification of
Anemia
Hypochromic
microcytic
anemia
Hemoglobin
Porphyrin
Iron
Globin chain
Thalassemia
Iron def.
anemia
Sideroblastic
anemia
DNA
DNA
synthesis
Megaloblastic
anemia:
-B12 def.
-Folate def.
MDS
Macrocytic
anemia
RBC count
Hemolysis
RBC production
Acute
bleeding
Autoimmune
Enzymopathy
Membranopathy
Mechanical
Sickle cell anemia
BM failure:
-Chemotherapy
-Aplastic anemia
-Malignancy
Anemia of chronic
disease
Blood loss
Normocytic
normochromic
anemia
• Iron is among the abundant minerals on earth (6%).
• Iron deficiency is the most common disorder( 24%).
• Limited absorption ability :
1-Only 5-10% of taken iron will be absorbed
2- Inorganic iron can not be absorbed easily.
• Excess loss due to hemorrhage
Iron Deficiency Anemia
!
20/03/1445 18
Daily absorption ≈1 mg
Circulating
hemoglobin
(2.5g)
Bone marrow
erythroblast
(150mg)
Daily loss ≈1 mg
Liver and muscle
myoglobin (650mg)
Urine
faeces
Skin
nail
hair
Transferrin (4mg)
menstrual loss
(hemorrhage)
Macrophage (1g)
Storage forms:
Ferritin
Haemosiderin
Hepcidin
BM macrophage
- ve
IL6
Tfr2
+ve
Hypoxia
Iron for
erythropoeisis
Factor reducing absorption
Factors favoring absorption
Inorganic iron
Haem iron
Ferric iron Fe+++
Ferrous Iron (Fe++)
Alkalines
Acid
Iron overload
Iron def
Tea
Pregnancy
Increased hepcidin
Hemochromatosis
Precipitating agent(phenol)
Solubilizing agent (Sugar)
Iron Absorption
1-Body Iron status:
Increased demands
(iron def.,pregnancy..)
Low iron stores high absorption
Iron overload Full iron stores Low absorption
2- Content and form of dietary iron
More Iron
Heam Iron
More
absorption
3- Balance between dietary enhancers&Inhibitory factors:
Meat (haem iron)
Fruit (Vitamin C)
Sugar (Solubilizing agent )
Acids
Dairy foods (calcium)
High fiber foods (phytate)
Coffee &tea (polyphenoles)
Anti -Acids
Enhancers Inhibitors
Iron Absorption
Ferrous Iron
1-Chronic blood loss:
• GIT Bleeding: peptic ulcer, esophageal varices , hookworm cancer
• Uterine bleeding
• Hematuria
2- Increased demands:
• Immaturity
• Growth
• Pregnancy
• EPO therapy
3-Malabsorption:
• Enteropathy
• Gastrectomy
4-Poor diet: Rare as the only cause (rule out other causes)
Causes of IDA
4
Iron def.
anemia
3
Latent
2
Pre-latent
1
Normal
Low
Low
Low
Normal
Stores
Low
Low
Normal
Normal
MCV/MCH
Low
Normal
Normal
Normal
Hemoglobin
Development of IDA
Signs of
anemia
24
Beside symptoms and signs of anaemia +/- bleeding patients present with:
(a): Koilonychia (spoon-shaped nails)
(b): Angular stomatitis and/or glossitis
(c): Dysphagia due to pharyngeal web (Plummer-Vinson syndrome)
Signs and symptoms of IDA
a
c
b
Investigation
Microcytic hypochromic anemia with:
• Anisocytosis( variation in size)
• Pokiliocytosis (variation in shape)
normal
Iron Studies
TIBC*
• Serum Iron
• Serum ferritin
• Transferrin
saturation
• Low serum iron
• Low serum ferritin
• Low transferrin
saturation
high TIBC
Normal IDA
TIBC : total iron binding capacity of transferrin
Iron Studies
Low TIBC*
• High Serum Iron
• High Serum ferritin
• High Transferrin
saturation
• Low serum iron
• Low serum ferritin
• Low transferrin
saturation
high TIBC
Thalassemia IDA
Normal
BM Iron stain (Perl’s stain): The gold standard but invasive procedure
Normal IDA: reduced or absent iron stores
(hemosiderin)
Investigation
Treatment of IDA
• Treat the underlying cause
• Iron replacement therapy:
Oral :( Ferrous Sulphate OD for 6 months)
Intravenous:( Ferric sucrose OD for 6 months)
Hb should rise 2g/dL every 3 weeks
PREVENTION OF IDA
• Dietary modification
Meat is better source than vegetables.
• Food fortification (with ferrous sulphate)
• GIT disturbances ,staining of teeth & metallic taste.
• Iron supplementation:
For high risk groups.
Anemia of chronic disease
•Normochromic normocytic (usually) anemia caused by
decreased release of iron from iron stores due to raised
serum Hepcidin .
•Associated with
- Chronic infection including HIV, malaria
- Chronic inflammations
-Tissue necrosis
-Malignancy
Hepcidin
BM macrophage
IL-6
IL-1
TNF
no Iron for
erythropoeisis
+ve
Tuberculosis
SLE
Carcinoma
Lymphoma
- ve
33
Management:
Treat the underlying cause
Iron replacement +/- EPO
• Normocytic normochromic or mildly microcytic anaemia
• Low serum iron and TIBC
• Normal or high serum ferritin ( acute phase reactant)
• High haemosiderin in macrophages but low in normoblasts
Work-up and treatment

More Related Content

Similar to Anaemia4.pptx

Similar to Anaemia4.pptx (20)

Anemia
AnemiaAnemia
Anemia
 
Anemia
AnemiaAnemia
Anemia
 
Classification of different types of anemia
Classification of different types of anemiaClassification of different types of anemia
Classification of different types of anemia
 
Anemia; causes, types, laboratory investigations
Anemia; causes, types, laboratory investigationsAnemia; causes, types, laboratory investigations
Anemia; causes, types, laboratory investigations
 
Approach to hypochromic microcytic anemias.pptx
Approach to hypochromic microcytic anemias.pptxApproach to hypochromic microcytic anemias.pptx
Approach to hypochromic microcytic anemias.pptx
 
ANAEMIA
ANAEMIAANAEMIA
ANAEMIA
 
hematology.pptx
hematology.pptxhematology.pptx
hematology.pptx
 
Approach to anemia
Approach to anemiaApproach to anemia
Approach to anemia
 
Approach to Anemia.pptx
Approach to Anemia.pptxApproach to Anemia.pptx
Approach to Anemia.pptx
 
Normocytic Anemias.pdf
Normocytic Anemias.pdfNormocytic Anemias.pdf
Normocytic Anemias.pdf
 
Iron deficiency anemia
Iron deficiency anemia  Iron deficiency anemia
Iron deficiency anemia
 
Unit 3 rbc disorders
Unit 3 rbc disordersUnit 3 rbc disorders
Unit 3 rbc disorders
 
Microcytic hypochromic anaemia
Microcytic hypochromic anaemiaMicrocytic hypochromic anaemia
Microcytic hypochromic anaemia
 
Microcytichypochromicanaemia 111208111013-phpapp02 (1)
Microcytichypochromicanaemia 111208111013-phpapp02 (1)Microcytichypochromicanaemia 111208111013-phpapp02 (1)
Microcytichypochromicanaemia 111208111013-phpapp02 (1)
 
SEM.pptx
SEM.pptxSEM.pptx
SEM.pptx
 
APPROACH TO ANAEMIA
APPROACH TO ANAEMIAAPPROACH TO ANAEMIA
APPROACH TO ANAEMIA
 
Hematinics
HematinicsHematinics
Hematinics
 
Anemia
AnemiaAnemia
Anemia
 
Anemia
AnemiaAnemia
Anemia
 
Micro cytic hypochromic ...
Micro cytic hypochromic ...Micro cytic hypochromic ...
Micro cytic hypochromic ...
 

More from ssuser504dda

Palliative care presentation slide4.pptx
Palliative care presentation slide4.pptxPalliative care presentation slide4.pptx
Palliative care presentation slide4.pptxssuser504dda
 
Palliative class presentation slid3.pptx
Palliative class presentation slid3.pptxPalliative class presentation slid3.pptx
Palliative class presentation slid3.pptxssuser504dda
 
Palliative care presentation slide2.pptx
Palliative care presentation slide2.pptxPalliative care presentation slide2.pptx
Palliative care presentation slide2.pptxssuser504dda
 
Palliative care presentation slides.pptx
Palliative care presentation slides.pptxPalliative care presentation slides.pptx
Palliative care presentation slides.pptxssuser504dda
 
Development studies - presentation .pptx
Development studies - presentation .pptxDevelopment studies - presentation .pptx
Development studies - presentation .pptxssuser504dda
 
Group Reproductice health Coursework.ppt
Group Reproductice health Coursework.pptGroup Reproductice health Coursework.ppt
Group Reproductice health Coursework.pptssuser504dda
 
Mortality Audit presentation - slid.pptx
Mortality Audit presentation - slid.pptxMortality Audit presentation - slid.pptx
Mortality Audit presentation - slid.pptxssuser504dda
 
Examinating the Resipiratory System.pptx
Examinating the Resipiratory System.pptxExaminating the Resipiratory System.pptx
Examinating the Resipiratory System.pptxssuser504dda
 
crush-injury-and-crush-syndrome-191.pptx
crush-injury-and-crush-syndrome-191.pptxcrush-injury-and-crush-syndrome-191.pptx
crush-injury-and-crush-syndrome-191.pptxssuser504dda
 
Male Reproductive System ......... .pptx
Male Reproductive System ......... .pptxMale Reproductive System ......... .pptx
Male Reproductive System ......... .pptxssuser504dda
 
Antenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptxAntenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptxssuser504dda
 
Student Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptxStudent Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptxssuser504dda
 
Intravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptxIntravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptxssuser504dda
 
IVU contrasted studies - lecture....pptx
IVU contrasted studies - lecture....pptxIVU contrasted studies - lecture....pptx
IVU contrasted studies - lecture....pptxssuser504dda
 
Cranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptxCranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptxssuser504dda
 
HEPATITIS IN Children a case study.pptx
HEPATITIS IN Children  a case study.pptxHEPATITIS IN Children  a case study.pptx
HEPATITIS IN Children a case study.pptxssuser504dda
 
children. palliative care.pptx
children.     palliative       care.pptxchildren.     palliative       care.pptx
children. palliative care.pptxssuser504dda
 
PALLIATIVE CARE (GROUP2) BME3 2023.pptx
PALLIATIVE CARE (GROUP2)  BME3 2023.pptxPALLIATIVE CARE (GROUP2)  BME3 2023.pptx
PALLIATIVE CARE (GROUP2) BME3 2023.pptxssuser504dda
 
Group pharmacology uuuuu. .pptx
Group pharmacology   uuuuu.        .pptxGroup pharmacology   uuuuu.        .pptx
Group pharmacology uuuuu. .pptxssuser504dda
 
Group 5_ Year 3 Pharmacology 2023.pptx
Group 5_   Year 3 Pharmacology 2023.pptxGroup 5_   Year 3 Pharmacology 2023.pptx
Group 5_ Year 3 Pharmacology 2023.pptxssuser504dda
 

More from ssuser504dda (20)

Palliative care presentation slide4.pptx
Palliative care presentation slide4.pptxPalliative care presentation slide4.pptx
Palliative care presentation slide4.pptx
 
Palliative class presentation slid3.pptx
Palliative class presentation slid3.pptxPalliative class presentation slid3.pptx
Palliative class presentation slid3.pptx
 
Palliative care presentation slide2.pptx
Palliative care presentation slide2.pptxPalliative care presentation slide2.pptx
Palliative care presentation slide2.pptx
 
Palliative care presentation slides.pptx
Palliative care presentation slides.pptxPalliative care presentation slides.pptx
Palliative care presentation slides.pptx
 
Development studies - presentation .pptx
Development studies - presentation .pptxDevelopment studies - presentation .pptx
Development studies - presentation .pptx
 
Group Reproductice health Coursework.ppt
Group Reproductice health Coursework.pptGroup Reproductice health Coursework.ppt
Group Reproductice health Coursework.ppt
 
Mortality Audit presentation - slid.pptx
Mortality Audit presentation - slid.pptxMortality Audit presentation - slid.pptx
Mortality Audit presentation - slid.pptx
 
Examinating the Resipiratory System.pptx
Examinating the Resipiratory System.pptxExaminating the Resipiratory System.pptx
Examinating the Resipiratory System.pptx
 
crush-injury-and-crush-syndrome-191.pptx
crush-injury-and-crush-syndrome-191.pptxcrush-injury-and-crush-syndrome-191.pptx
crush-injury-and-crush-syndrome-191.pptx
 
Male Reproductive System ......... .pptx
Male Reproductive System ......... .pptxMale Reproductive System ......... .pptx
Male Reproductive System ......... .pptx
 
Antenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptxAntenatal Care -REPRODUCTIVE HEALTH.pptx
Antenatal Care -REPRODUCTIVE HEALTH.pptx
 
Student Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptxStudent Academic - PLACEMENT REPORT.pptx
Student Academic - PLACEMENT REPORT.pptx
 
Intravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptxIntravenous Urography lecture detai.pptx
Intravenous Urography lecture detai.pptx
 
IVU contrasted studies - lecture....pptx
IVU contrasted studies - lecture....pptxIVU contrasted studies - lecture....pptx
IVU contrasted studies - lecture....pptx
 
Cranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptxCranial nerves - esson presentation.pptx
Cranial nerves - esson presentation.pptx
 
HEPATITIS IN Children a case study.pptx
HEPATITIS IN Children  a case study.pptxHEPATITIS IN Children  a case study.pptx
HEPATITIS IN Children a case study.pptx
 
children. palliative care.pptx
children.     palliative       care.pptxchildren.     palliative       care.pptx
children. palliative care.pptx
 
PALLIATIVE CARE (GROUP2) BME3 2023.pptx
PALLIATIVE CARE (GROUP2)  BME3 2023.pptxPALLIATIVE CARE (GROUP2)  BME3 2023.pptx
PALLIATIVE CARE (GROUP2) BME3 2023.pptx
 
Group pharmacology uuuuu. .pptx
Group pharmacology   uuuuu.        .pptxGroup pharmacology   uuuuu.        .pptx
Group pharmacology uuuuu. .pptx
 
Group 5_ Year 3 Pharmacology 2023.pptx
Group 5_   Year 3 Pharmacology 2023.pptxGroup 5_   Year 3 Pharmacology 2023.pptx
Group 5_ Year 3 Pharmacology 2023.pptx
 

Recently uploaded

CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsNaveen Gokul Dr
 
Tips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES examTips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES examJunhao Koh
 
Drug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptxDrug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptxMohammadAbuzar19
 
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Health Kinesiology Natural Bioenergetics
 
The Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsMedicoseAcademics
 
Unit 4 Pharmaceutical Organic Chemisty 3 Quinoline
Unit 4 Pharmaceutical Organic Chemisty 3 QuinolineUnit 4 Pharmaceutical Organic Chemisty 3 Quinoline
Unit 4 Pharmaceutical Organic Chemisty 3 QuinolineAarishRathnam1
 
JOURNAL CLUB PRESENTATION TEMPLATE DOCUMENT
JOURNAL CLUB PRESENTATION TEMPLATE DOCUMENTJOURNAL CLUB PRESENTATION TEMPLATE DOCUMENT
JOURNAL CLUB PRESENTATION TEMPLATE DOCUMENTThomas Onyango Kirengo
 
Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?bkling
 
How to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw materialHow to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw materialSherrylee83
 
Sell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stockSell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stocktammysayles9
 
duus neurology.pdf anatomy. phisiology///
duus neurology.pdf anatomy. phisiology///duus neurology.pdf anatomy. phisiology///
duus neurology.pdf anatomy. phisiology///sofia95y
 
Top 10 Most Beautiful Russian Pornstars List 2024
Top 10 Most Beautiful Russian Pornstars List 2024Top 10 Most Beautiful Russian Pornstars List 2024
Top 10 Most Beautiful Russian Pornstars List 2024locantocallgirl01
 
Varicose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas HospitalVaricose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas HospitalGokuldas Hospital
 
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...Neelam SharmaI11
 
Lachesis Mutus- a Homoeopathic medicinel.pptx
Lachesis Mutus- a Homoeopathic medicinel.pptxLachesis Mutus- a Homoeopathic medicinel.pptx
Lachesis Mutus- a Homoeopathic medicinel.pptxMUHAMMADZAHID314
 
Histopathological staining techniques used in liver diseases
Histopathological staining techniques used in liver diseasesHistopathological staining techniques used in liver diseases
Histopathological staining techniques used in liver diseasesPHARMA IQ EDUCATION
 
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose AcademicsHistology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose AcademicsMedicoseAcademics
 
Storage of Blood Components- equipments, effects of improper storage, transpo...
Storage of Blood Components- equipments, effects of improper storage, transpo...Storage of Blood Components- equipments, effects of improper storage, transpo...
Storage of Blood Components- equipments, effects of improper storage, transpo...DrShinyKajal
 
Overview on the Automatic pill identifier
Overview on the Automatic pill identifierOverview on the Automatic pill identifier
Overview on the Automatic pill identifierNidhi Joshi
 

Recently uploaded (20)

CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
 
Tips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES examTips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES exam
 
Drug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptxDrug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptx
 
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
 
The Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - Subconscious
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
 
Unit 4 Pharmaceutical Organic Chemisty 3 Quinoline
Unit 4 Pharmaceutical Organic Chemisty 3 QuinolineUnit 4 Pharmaceutical Organic Chemisty 3 Quinoline
Unit 4 Pharmaceutical Organic Chemisty 3 Quinoline
 
JOURNAL CLUB PRESENTATION TEMPLATE DOCUMENT
JOURNAL CLUB PRESENTATION TEMPLATE DOCUMENTJOURNAL CLUB PRESENTATION TEMPLATE DOCUMENT
JOURNAL CLUB PRESENTATION TEMPLATE DOCUMENT
 
Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?
 
How to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw materialHow to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw material
 
Sell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stockSell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stock
 
duus neurology.pdf anatomy. phisiology///
duus neurology.pdf anatomy. phisiology///duus neurology.pdf anatomy. phisiology///
duus neurology.pdf anatomy. phisiology///
 
Top 10 Most Beautiful Russian Pornstars List 2024
Top 10 Most Beautiful Russian Pornstars List 2024Top 10 Most Beautiful Russian Pornstars List 2024
Top 10 Most Beautiful Russian Pornstars List 2024
 
Varicose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas HospitalVaricose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas Hospital
 
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
 
Lachesis Mutus- a Homoeopathic medicinel.pptx
Lachesis Mutus- a Homoeopathic medicinel.pptxLachesis Mutus- a Homoeopathic medicinel.pptx
Lachesis Mutus- a Homoeopathic medicinel.pptx
 
Histopathological staining techniques used in liver diseases
Histopathological staining techniques used in liver diseasesHistopathological staining techniques used in liver diseases
Histopathological staining techniques used in liver diseases
 
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose AcademicsHistology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
 
Storage of Blood Components- equipments, effects of improper storage, transpo...
Storage of Blood Components- equipments, effects of improper storage, transpo...Storage of Blood Components- equipments, effects of improper storage, transpo...
Storage of Blood Components- equipments, effects of improper storage, transpo...
 
Overview on the Automatic pill identifier
Overview on the Automatic pill identifierOverview on the Automatic pill identifier
Overview on the Automatic pill identifier
 

Anaemia4.pptx

  • 2. Anemia is operationally defined as a reduction in one or more of the major RBC measurements: decreased amount of circulating blood or low levels of haemoglobin, low haematocrit. hemoglobin concentration, hematocrit, or RBC count Keep in mind these are all concentration measures Definition:
  • 4. Hemoglobin • Hemoglobin is the protein molecule in RBC that carries O2 from the lungs to the body's tissues and returns carbon CO2 from the tissues back to the lungs. • Hemoglobin maintains the shape of RBC also.
  • 6. CD33-Sialic acid binding Ig-like lectin 3 Colony forming unit – Granulocyte, Erythrocyte, Monocyte, Megakaryocyte Stem cell Factor Burst forming unit E
  • 7. Hematopoietic stem cell: 1- Self renewal 2- Cell differentiation Hematopoiesis Myeloid SC Erythroid Precursors Transcriptional Factor Erythropoietin GATA1
  • 8. 8 8 Late Normoblast Reticulocyte Erythrocyte Basophilic Normoblast Erythroblast Intermediate Normoblast + ++ +++ ++ + - Synthesis of Hemoglobin Erythropoiesis The “Bone Marrow” is the major site with the need of: Folic acid – Iron “Ferrous” – Vit B12 – Erythropoietin -Amino acids minerals - other regulatory factors
  • 11. Female Male Indices 11.5-15.5 13.5-17.5 Hemoglobin(g/dL) 36-48 40-52 Hematocrit (PCV) (%) 3.9-5.6 4.5-6.5 Red Cell Count (×10¹²) 80-95 Mean Cell Volume (MCV) (fL) 30-35 Mean Cell Hemoglobin (MCH) (pg) Hb Macrocytic Normocytic Microcytic MCV Normochromic Hypochromic MCH Normal Ranges HCT
  • 12. • An (without) -aemia (blood) • Reduction of Hb concentration below the normal range for the age and gender • Leading to decreased O2 carrying capacity of blood and thus O2 availability to tissues (hypoxia) ANEMIA
  • 13. Clinical Features Presence or absence of clinical feature depends on: 1-Speed of onset : Rapidly progressive anemia causes more symptoms than slow onset anemia due to lack of compensatory mechanisms: (cardiovascular system, BM &O2 dissociation curve 2-Severity: • Mild anemia: no symptoms usually • Symptoms appear if Hb less than 9g/dL 3- Age: • Elderly tolerate anemia less than young patients
  • 14. • Weakness • Headache • Pallor • Lethargy • Dizziness • Palpitation (tachycardia) • Angina • Cardiac failure Related to anemia Related to compensatory mechanism Clinical Features 1-General features of anemia Specific signs are associated with particular types of anemia :  Spoon nail with iron deficiency,  Leg ulcers with sickle cell anemia  Jaundice with hemolytic anemia  bone deformities in thalassemia major 2-Specific features
  • 16. Hypochromic microcytic anemia Hemoglobin Porphyrin Iron Globin chain Thalassemia Iron def. anemia Sideroblastic anemia DNA DNA synthesis Megaloblastic anemia: -B12 def. -Folate def. MDS Macrocytic anemia RBC count Hemolysis RBC production Acute bleeding Autoimmune Enzymopathy Membranopathy Mechanical Sickle cell anemia BM failure: -Chemotherapy -Aplastic anemia -Malignancy Anemia of chronic disease Blood loss Normocytic normochromic anemia
  • 17. • Iron is among the abundant minerals on earth (6%). • Iron deficiency is the most common disorder( 24%). • Limited absorption ability : 1-Only 5-10% of taken iron will be absorbed 2- Inorganic iron can not be absorbed easily. • Excess loss due to hemorrhage Iron Deficiency Anemia !
  • 18. 20/03/1445 18 Daily absorption ≈1 mg Circulating hemoglobin (2.5g) Bone marrow erythroblast (150mg) Daily loss ≈1 mg Liver and muscle myoglobin (650mg) Urine faeces Skin nail hair Transferrin (4mg) menstrual loss (hemorrhage) Macrophage (1g) Storage forms: Ferritin Haemosiderin
  • 20. Factor reducing absorption Factors favoring absorption Inorganic iron Haem iron Ferric iron Fe+++ Ferrous Iron (Fe++) Alkalines Acid Iron overload Iron def Tea Pregnancy Increased hepcidin Hemochromatosis Precipitating agent(phenol) Solubilizing agent (Sugar) Iron Absorption
  • 21. 1-Body Iron status: Increased demands (iron def.,pregnancy..) Low iron stores high absorption Iron overload Full iron stores Low absorption 2- Content and form of dietary iron More Iron Heam Iron More absorption 3- Balance between dietary enhancers&Inhibitory factors: Meat (haem iron) Fruit (Vitamin C) Sugar (Solubilizing agent ) Acids Dairy foods (calcium) High fiber foods (phytate) Coffee &tea (polyphenoles) Anti -Acids Enhancers Inhibitors Iron Absorption Ferrous Iron
  • 22. 1-Chronic blood loss: • GIT Bleeding: peptic ulcer, esophageal varices , hookworm cancer • Uterine bleeding • Hematuria 2- Increased demands: • Immaturity • Growth • Pregnancy • EPO therapy 3-Malabsorption: • Enteropathy • Gastrectomy 4-Poor diet: Rare as the only cause (rule out other causes) Causes of IDA
  • 24. 24 Beside symptoms and signs of anaemia +/- bleeding patients present with: (a): Koilonychia (spoon-shaped nails) (b): Angular stomatitis and/or glossitis (c): Dysphagia due to pharyngeal web (Plummer-Vinson syndrome) Signs and symptoms of IDA a c b
  • 25. Investigation Microcytic hypochromic anemia with: • Anisocytosis( variation in size) • Pokiliocytosis (variation in shape) normal
  • 26. Iron Studies TIBC* • Serum Iron • Serum ferritin • Transferrin saturation • Low serum iron • Low serum ferritin • Low transferrin saturation high TIBC Normal IDA TIBC : total iron binding capacity of transferrin
  • 27. Iron Studies Low TIBC* • High Serum Iron • High Serum ferritin • High Transferrin saturation • Low serum iron • Low serum ferritin • Low transferrin saturation high TIBC Thalassemia IDA Normal
  • 28. BM Iron stain (Perl’s stain): The gold standard but invasive procedure Normal IDA: reduced or absent iron stores (hemosiderin) Investigation
  • 29. Treatment of IDA • Treat the underlying cause • Iron replacement therapy: Oral :( Ferrous Sulphate OD for 6 months) Intravenous:( Ferric sucrose OD for 6 months) Hb should rise 2g/dL every 3 weeks
  • 30. PREVENTION OF IDA • Dietary modification Meat is better source than vegetables. • Food fortification (with ferrous sulphate) • GIT disturbances ,staining of teeth & metallic taste. • Iron supplementation: For high risk groups.
  • 31. Anemia of chronic disease •Normochromic normocytic (usually) anemia caused by decreased release of iron from iron stores due to raised serum Hepcidin . •Associated with - Chronic infection including HIV, malaria - Chronic inflammations -Tissue necrosis -Malignancy
  • 32. Hepcidin BM macrophage IL-6 IL-1 TNF no Iron for erythropoeisis +ve Tuberculosis SLE Carcinoma Lymphoma - ve
  • 33. 33 Management: Treat the underlying cause Iron replacement +/- EPO • Normocytic normochromic or mildly microcytic anaemia • Low serum iron and TIBC • Normal or high serum ferritin ( acute phase reactant) • High haemosiderin in macrophages but low in normoblasts Work-up and treatment