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ANEMIA www.freelivedoctor.com
ANEMIA ,[object Object],[object Object],www.freelivedoctor.com
Blood Reference Values WBC  4,800-10,800/mm 3 RBC  M: 4.7-6.1 mil/mm 3  F: 4.2-5.4 mil/mm 3  ( or x 10 6 /  L) Plt  130,000-400,000/mm 3 Hgb  M: 14.0-18.0 g/dL  F: 12.0-16.0 g/dL Hct  M:  42-52%  F: 37-47% MCV [= Hct(%) / RBC count(x10 6 /  L)/10]  80-100  3 (or fL) MCH [= Hgb(g/dL) / RBC count(x10 6 /  L)/10] 27-33 pg MCHC [= Hgb(g/dL) / Hct(%)/100]  32-36 g/dL RDW  8.5-11.5  % reticulocyte (absolute number)  40,000-100,000 /  L www.freelivedoctor.com
Erythrocyte Indices ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
RBC “rule of 3’s” ,[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
classification of anemia by color ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
anemia ,[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
ANEMIA morphologic classification microcytic MCV <80 normocytic MCV 80-100 macrocytic MCV >100 www.freelivedoctor.com
ANEMIA  classification by volume ,[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  classification by volume ,[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  classification by volume ,[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  classification by volume ,[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  classification by volume ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],hereditary spherocytosis hereditary elliptocytosis www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],pyruvate kinase def. G6PD def. www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Thalassemia sickle cell disease Hb C disease www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PNH www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Hereditary Spherocytosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Hereditary Spherocytosis www.freelivedoctor.com
Hereditary Spherocytosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Hereditary Elliptocytosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Embden-Meyerhof glycolytic pathway www.freelivedoctor.com
Pyruvate Kinase Deficiency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
X www.freelivedoctor.com
fluorescent spot test ,[object Object],www.freelivedoctor.com phosphoenol pyruvate pyruvate lactate PK ADP  ATP *NADH  NAD
www.freelivedoctor.com
G6PD Deficiency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
G6PD Deficiency bite cell Heinz bodies www.freelivedoctor.com
ANEMIA  pathophysiologic classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
hemoglobin molecule two    chains two    chains four   -globin genes two   -globin genes www.freelivedoctor.com
globin genes www.freelivedoctor.com CH16 CH11
Thalassemia Syndromes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Thalassemia Syndromes pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Thalassemia Syndromes pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
α -thalassemia  1  2  /   normal  1  2  /    + -thal heterozygote (mild)  1  2  /    0 -thal heterozygote (moderate) www.freelivedoctor.com
α -thalassemia  1  2  /    + -thal homozygote (moderate)  1  2  /    0 -thal x   + -thal (severe)  1  2  /    0 -thal homozygote (lethal) www.freelivedoctor.com
β -thalassemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
β -thalassemia promoter gene mutation: 75-80% reduction of transcription rate (  +  thal) chain termination mutation: premature termination of mRNA translation (  0  thal) splicing mutation: aberrant splicing (  0  &   +  thal) most common cause of thal www.freelivedoctor.com
“ Thalassemia Major” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
“ Thalassemia Major” www.freelivedoctor.com
“ Thalassemia Major” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
“ Thalassemia Minor” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
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Sickle Cell Disease ,[object Object],[object Object],www.freelivedoctor.com
Sickle Cell Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Sickle Cell Trait ,[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Paroxysmal Nocturnal Hemoglobinuria (PNH) ,[object Object],GPI-linked complement reg. Proteins CD55  (DAF) CD59 CD8 binding protein www.freelivedoctor.com
Paroxysmal Nocturnal Hemoglobinuria (PNH) ,[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
TTP / HUS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
TTP / HUS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Disseminated Intravascular   Coagulation (DIC) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Disseminated Intravascular   Coagulation (DIC) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Lead Poisoning ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Malaria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Immunohemolytic Anemia ,[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Immunohemolytic Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Immunohemolytic Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Immunohemolytic Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Drug-Mediated Injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Aplastic Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Aplastic Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Megaloblastic Anemia ,[object Object],[object Object],www.freelivedoctor.com
Vitamin B12 / Folate Deficiency ,[object Object],Methylcobalamin a coenzyme for tetrahydrofolate (FH 4 ) www.freelivedoctor.com
Vitamin B12 Absorption Vit B12:   absorbed in ileum   (with intrinsic factor) Intrinsic factor www.freelivedoctor.com
Vitamin B12 / Folate Deficiency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Vitamin B12 Deficiency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Vitamin B12 Deficiency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Vitamin B12 Deficiency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
folate deficiency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
folate deficiency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Iron Deficiency Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Iron Deficiency Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Iron Deficiency Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Iron Deficiency Anemia ,[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
sideroblastic anemia ,[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Sideroblastic Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Sideroblastic Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
Sideroblastic Anemia www.freelivedoctor.com
Sideroblastic Anemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
anemia work-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
anemia work-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
anemia work-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
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