An autoimmune disease is a condition in which your immune system mistakenly attacks your body. The immune system normally guards against germs like bacteria and viruses. When it senses these foreign invaders, it sends out an army of fighter cells to attack them. Normally, the immune system can tell the difference between foreign cells and your own cells. In an autoimmune disease, the immune system mistakes part of your body — like your joints or skin — as foreign. It releases proteins called autoantibodies that attack healthy cells. Some autoimmune diseases target only one organ. Type 1 diabetes damages the pancreas. Other diseases, like lupus, affect the whole body.

1. HEMOLYTIC
ANEMIA AND
DIABETES

2. AUTOIMMUNITY
INTRODUCTION
Antigens present in one’s own cell are called
auto Antigens or self antigen. When they are
altered by some bacteria, chemicals, viruses
etc then they elict the production of Ab in the
own body is called auto Antibodies.
Autoimmune disease is defined as
humoral or cell mediated immune response
against the constituents of the body’s own
tissues.

3. Autoimmune diseases are defined as a
group of disorders in which tissue injury
is caused by humoral or cell mediated
immune response to self antigens.
Autoimmunity was first observed by
metalnikoff in 1900 in guinea pigs.
Definition

4. AUTOIMMUNE DISEASE
In these disease, destruction of one’s own tissues
causing disease. There is immune response due to
reaction of self antigens.
1. Autoimmune disease are caused by autoimmune
response.
2. The auto antigen which produces autoimmune
disease in one individual, will cause the same disease
in an experience animal when the same disease in an
experimental animal when the same antigen is
injected.

5. 3. In auto immune disease an elevated amount of
immunoglobulin.
4. Lymphocytes and plasma cells accumulate at the
sites of lesions.
Causes of autoimmune disease
1.Sequestered antigens
2.Neoantigens
3.Cross reacting antigens
4.Cessatio of tolerance
5.Loss of immunoregulation

6. Classification of
autoimmune diseases
1.Haemolytic autoimmune
disease
2.Localised autoimmune
disease
3.Systemic autoimmune
disease

7. Hemolytic Anemia
Hemolytic anemia is a condition in which there are
not enough red blood cells in the blood, due to the
premature destruction of red blood cells. There are a
number of specific types of hemolytic anemia, which
are described individually
 Hemolytic anemia (HEE-moh-lit-ick uh-NEE-me-uh)
is a condition in which red blood cells are
destroyed and removed from the bloodstream
before their normal lifespan is over.

8. Red blood cells are disc-shaped and look like
doughnuts without holes in the center. These cells
carry oxygen to your body. They also remove carbon
dioxide (a waste product) from your body.
Red blood cells are made in the bone marrow.
They live for about 120 days in the bloodstream
and then die.
When blood cells die, the body's bone marrow
makes more blood cells to replace them. However, in
hemolytic anemia, the bone marrow can't make red
blood cells fast enough to meet the body's needs

9. Hemolytic anemia occurs when the bone marrow is
unable to increase production to make up for the
premature destruction of red blood cells. If the bone
marrow is able to keep up with the early destruction,
anemia does not occur (this is sometimes called
compensated hemolysis).
There are many types of hemolytic anemia, which
are classified by the reason for the premature
destruction of red blood cells.The defect may be in
the red blood cell itself (intrinsic factors), or outside
the red blood cell (extrinsic factors).

10. Intrinsic factors are often present at birth
(hereditary).They include:
Abnormalities in the proteins that build normal red
blood cells
Differences in the protein inside a red blood cell that
carries oxygen (hemoglobin)
Extrinsic factors include:
Abnormal immune system responses
Blood clots in small blood vessels
Certain infections
Side effects from medications

11. Types of hemolytic anemia include:
Hemoglobin SC disease (similar in symptoms to
sickle-cell anemia)
Hemolytic anemia due to G6PD deficiency
Hereditary elliptocytosis
Hereditary spherocytosis
Idiopathic autoimmune hemolytic anemia
Malaria
Paroxysmal nocturnal hemoglobinuria (PNH)
Secondary immune hemolytic anemia
Sickle-cell anemia
Thalassemia

13. Signs and tests
These are tests for red blood cell destruction
(hemolysis). Specific tests can identify the types of
hemolytic anemia. They are usually performed when
hemolysis is suspected or has been determined.
In general, signs of anemia (pallor, fatigue,
shortness of breath, and potential for heart failure)
are present. In small children, failure to thrive may
occur in any form of anemia. Certain aspects of the
medical history can suggest a cause for hemolysis,
such as drugs, consumption of fava beans, the
presence of prosthetic heart valve, or other medical
illness.

14. Sickle cell anemia (sickle cell disease) is a disorder
of the blood caused by an inherited abnormal
hemoglobin (an oxygen-carrying protein within the
red blood cells).The abnormal hemoglobin causes
distorted (sickled) red blood cells.
The sickled red blood cells are fragile and prone to
rupture. When the number of red blood cells
decreases from rupture (hemolysis), anemia is the
result.This condition is referred to as sickle cell
anemia.The irregular sickled cells can also block
blood vessels causing tissue and organ damage and
pain.
Sickle cell anemia

15. Sickle cell anemia is one of the most common
inherited blood anemias.The disease primarily
affectsAfricans and AfricanAmericans.
It is estimated that in the United States, some
50,000 AfricanAmericans are afflicted with the most
severe form of sickle cell anemia.Overall, current
estimates are that one in 1,875 U.S. AfricanAmerican
is affected with sickle cell anemia.

16. Normal Red Blood Cells and Sickle Cells
Normal Red Blood Cells and Sickle Cells

18. Sickle cell anemia is caused by an abnormal type of
hemoglobin called hemoglobin S. Hemoglobin is a
protein inside red blood cells that carries oxygen.
Hemoglobin S changes the shape of red blood cells,
especially when the cells are exposed to low oxygen
levels.The red blood cells become shaped like
crescents or sickles.
The fragile, sickle-shaped cells deliver less oxygen
to the body's tissues.They can also get stuck more
easily in small blood vessels, and break into pieces
that interupt healthy blood flow.
Causes

19. Sickle cell anemia is inherited from both parents. If
you inherit the hemoglobin S gene from one parent
and normal hemoglobin (A) from your other parent,
you will have sickle cell trait.
People with sickle cell trait do not have the
symptoms of sickle cell anemia.
Sickle cell disease is much more common in people of
African and Mediterranean descent. It is also seen in
people from South and Central America, the
Caribbean, and the Middle East.

20. Symptoms usually don't occur until after age 4
months.
•Almost all patients with sickle cell anemia have
painful episodes (called crises), which can last from
hours to days.These crises can affect the bones of
the back, the long bones, and the chest.
•Some patients have one episode every few years.
Others have many episodes per year.The crises can
be severe enough to require a hospital stay.
Symptoms

21. Common symptoms include:
Attacks of abdominal pain
Bone pain
Breathlessness
Delayed growth and puberty
Fatigue
Fever
Paleness
Rapid heart rate
Ulcers on the lower legs (in adolescents and adults)
Yellowing of the eyes and skin (jaundice

22. The goal of treatment is to manage and control
symptoms, and to limit the number of crises.
•Patients with sickle cell disease need ongoing
treatment, even when they are not having a painful
crisis.
•Folic acid supplements should be taken. Folic acid is
needed to make red blood cells.
Treatment

23. •Other treatments for sickle cell anemia may include:
Hydroxyurea (Hydrea), a medicine that may help
reduce the number of pain episodes (including chest
pain and difficulty breathing) in some people
Antibiotics to prevent bacterial infections, which are
common in children with sickle cell disease
Treatment for a sickle cell crisis includes:
Blood transfusions (may also be given regularly to
prevent stroke)
Pain medicines
Plenty of fluids

24. Treatments for complications of sickle cell anemia
may include:
Kidney dialysis or kidney transplant for kidney
disease
Drug rehabilitation and counseling for psychological
complications
Gallbladder removal in those with gallstone disease
Hip replacement for avascular necrosis of the hip
Treatments, including surgery, for persistent, painful
erections (priapism)
Surgery for eye problems
Wound care, zinc oxide, or surgery for leg ulcers

25. Diabetes

26. Introduction to Diabetes-
•Diabetes mellitus is characterized by abnormally
high levels of sugar (glucose) in the blood.
•When the amount of glucose in the blood increases,
e.g., after a meal, it triggers the release of
the hormone insulin from the pancreas.
•Insulin stimulates muscle and fat cells to remove
glucose from the blood and stimulates the liver to
metabolize glucose, causing the blood sugar level to
decrease to normal levels.

27. 1. Insulin is a hormone produced by the pancreas to
control blood sugar. Diabetes can be caused by too
little insulin, resistance to insulin, or both.
To understand diabetes, it is
important to first understand the normal process by
which food is broken down and used by the body for
energy.
Several things happen when food is digested:
-A sugar called glucose enters the bloodstream.
Glucose is a source of fuel for the body.

28. An organ called the pancreas makes insulin. The role
of insulin is to move glucose from the
bloodstream into muscle, fat, and liver cells,
where it can be used as fuel.
3. People with diabetes have high blood sugar
because their body cannot move sugar into fat, liver,
and muscle cells to be stored for energy. This is
because either Their pancreas does not make
enough insulinTheir cells do not respond to insulin
normally.

29. FIG-1 Insulin production and diabetes

30. There are three main types of diabetes-
1. Type 1 diabetes – Insulin
dependent diabetes.
2. Type 2 diabetes – Non-insulin
dependent diabetes
3.Gestational diabetes

31. Type 1 and Type 2 diabetes impede a person’s
carefree life. When breakdown of glucose is stopped
completely, body uses fat and protein for producing
the energy.
Due to this mechanism symptoms like
polydipsia, polyuria, polyphegia and excessive
weightloss can be observed in a diabetic. Desired
blood sugar of human body should be between 70
mg/dl -110 mg/dl at fasting state. If blood sugar is less
than 70 mg/dl, it is termed as hypoglycemia and if
more than 110 mg /dl, it’s hyperglycemia.

32. Type 1 diabetes – occurs when there is a
severe lack of insulin due to the destruction of
most or all of the beta cells in the islets of
Langerhans .
This type of diabetes develops rapidly, usually
appearing before the age of 35, and most often
between the ages of 10 and 16. Regular insulin
injections are required to survive.

33. This diabetes can occur at any age, but it is most
often diagnosed in children, teens, or young adults.
In this disease, the body makes little or no insulin.
Daily injections of insulin are needed. The exact
cause is unknown.
Type 1 diabetes is typically treated with a
combinations of regular and NPH insulin, or
synthetic insulin analogs.

34. FIG-1 Insulin is a hormone secreted by the pancreas in
response to increased glucose levels in the blood.

35. FIG-3In response to high levels of glucose in the blood, the insulin-
producing cells in the pancreas secrete the hormone insulin.Type I
diabetes occurs when these cells are destroyed by the body’s own
immune system.

36. Type 2- diabetes makes up most of diabetes cases.
It most often occurs in adulthood, but teens and
young adults are now being diagnosed with it
because of high obesity rates.
Many people with type 2 diabetes do not know
they have it.
Diabetes affects more than 20 million Americans.
Over 40 million Americans have pre-diabetes
(early type 2 diabetes).

37. Non-insulin-dependent diabetes occurs when the
body does not produce enough insulin, and the
insulin that is produced becomes less effective.
This type of diabetes usually appears in people over
the age of 40, and tends to have a more gradual
onset. In most cases, glucose levels in the blood can
be controlled by diet, or diet and tablets, although
sometimes insulin injections may be needed.
About 90 per cent of diabetics are
non-insulin dependent.

38. A rare form of type 2 diabetes is maturity onset diabetes of
the young
[MODY]. MODY occurring in adolescents and teenagers, is
found to have
A genetic basis. A gene, synthesizing the enzyme
glucokinase , located
On chromosome 7, is found to be defective in MODY
patients.
Glucokinase is a key enzyme in glucose metabolism. Besides
its invovlement in the metabolism, glucokinase in the
pancreatic
Cells serve as a detector for glucose concen tration in the
blood.

39. This detection stimulates beta-cells of the pancreas
to secret insulin.
A gene modification that results in a defective or an
altered glucokinase
hampers pancreatic insulin secreation . Later work
has shown that
Glucokinase gene is defective in the common form
of type-2 diabetes.

41. Diabetic emergencies
People (usually with type 1 diabetes) may also
present with diabetic ketoacidosis, a state of
metabolic dysregulation characterized by the smell
of acetone; a rapid, deep breathing known as
Kussmaul breathing; nausea; vomiting and
abdominal pain; and altered states of consciousness.

42. A rarer but equally severe possibility is
hyperosmolar nonketotic state, which is more
common in type 2 diabetes and is mainly the
result of dehydration.
Often, the patient has been
drinking extreme amounts of sugar-containing
drinks, leading to a vicious circle in regard to
the water loss.

43. Complications
All forms of diabetes increase the risk of long-term
complications. These typically develop after many
years (10–20), but may be the first symptom in those
who have otherwise not received a diagnosis before
that time. The major long-term complications relate
to damage to blood vessels.
Diabetes doubles the risk of cardiovascular
disease.The main "macrovascular" diseases (related
to atherosclerosis of larger arteries) are ischemic
heart disease (angina and myocardial infarction),
stroke and peripheral vascular disease.

44. Causes-
The cause of diabetes depends on the type-
Type 1 diabetes is partly inherited and then triggered
by certain infections, with some evidence pointing at
Coxsackie B4 virus.
There is a genetic element in
individual susceptibility to some of these triggers
which has been traced to particular HLA genotypes
(i.e., the genetic "self" identifiers relied upon by the
immune system). However, even in those who have
inherited the susceptibility, type 1 diabetes mellitus
seems to require an environmental trigger.

45. Type 2 diabetes is due primarily to lifestyle
factors and genetics-
Following is a comprehensive list of other causes of
diabetes-
1.Genetic defects of β-cell Function
2.Maturity onset diabetes of the young (MODY)
3.Mitochondrial DNA mutations
4.Genetic defects in insulin processing or insulin
action
5.Defects in proinsulin conversion
6.Insulin gene mutations
7.Insulin receptor mutations

47. Symptoms
High blood sugar levels can cause several
symptoms, including:
1.Blurry vision
2.Excess thirst
3.Fatigue
4.Frequent urination
5.Hunger
6.Weight loss
-period of time. People may be very sick by the time
they are diagnosed.

48. Because type 2 diabetes develops slowly, some
people with high blood sugar have no symptoms.
-Symptoms of type 1 diabetes develop over a short
Signs and tests-
A urine analysis may be used to look for high blood
sugar. However, a urine test alone does not
diagnose diabetes.

49. Your health care provider may suspect that you have
diabetes if your blood sugar level is higher than 200
mg/dL. To confirm the diagnosis, one or more of the
following tests must be done.
Blood tests:
Fasting blood glucose level -- diabetes is diagnosed if
it is higher than 126 mg/dL twice. Levels between
100 and 126 mg/dL are called impaired fasting
glucose or pre-diabetes. These levels are risk factors
for type 2 diabetes.

51. Treatment-
There is no cure for diabetes. Treatment
involves medicines, diet, and exercise to
control blood sugar and prevent symptoms and
problems.
For more information on how to take care of
your diabetes, see also:
Diabetes diet
Diabetes foot care

52. Treatments aim to keep the level of blood glucose
as normal as possible.
For type 1 diabetes, this involves regular injections
of insulin, a regulated diet and the careful
monitoring of blood glucose levels.
As people with type 2 diabetes still produce some
insulin, diet alone is often effective, although oral
antidiabetic drugs and insulin injections may also
be required. Regular exercise is usually
recommended as it helps the body to use blood
glucose.

53. Prevention-
-Keeping an ideal body weight
and an active lifestyle may
prevent type 2 diabetes.
There is no way to prevent type 1
diabetes

54. THANK YOU