Anemia Caused by Decreased RBC Production<br />1<br />
Nutrients necessary for RBC maturation are<br />Deficient<br />Megaloblastic Anemia<br />Iron Deficiency Anemia<br />Aplas...
Megaloblastic ANEMIA<br />3<br />
Pathogenesis:<br />4<br />
Causes :<br />5<br />
Vit B12 & Folate absorption<br />6<br />
Decreased intake<br />Inadequate intake, Vegetarians<br />Increased Requirement<br />Pregnancy<br />Hyper thyroidism<br />...
Impaired Absorption<br />Intrinsic Factor Deficiency<br />PERNICIOUS<br />GASTRECTOMY<br />Malabsorption states<br />Diffu...
Biochemical function of vit. b12<br />9<br />
Neurological Complication<br />10<br />
More in Scandinavian & English Speaking <br />Blacks & Hispanics in US<br />Common in OLD Age 50’s-80’s<br />Maybe Strong ...
Pernicious Anemia<br />Immune – mediated destruction of gastric mucosa<br />Autoreactive T-cell response initiates autoAbp...
Insidious onset<br />Progressive anemia <br />Atrophic glossitis & Gastric atrophy<br />Seen in pernicious anemia<br />Int...
Moderate – Severe Megaloblastic Anemia<br />Leukepenia & Thrombocytopenia<br />Mild Jaundice – peripheral hemolysis of rbc...
Folate deficiency<br />Manifestation same as B12 Deficiency<br />Except Neurological s/s<br />Folic acid is sensitive to h...
16<br />
Pancytopenia- intramedullary destruction of precursor( apoptosis )<br />Macrocytes (+) – high MCV but not MCHC<br />Thicke...
Iron deficiency anemia<br />18<br />
Most common nutritional disorder in the world.<br />Prevalence of iron deficiency anemia is<br />Higher in the developing ...
Balance : 1 mg iron absorbed / day<br />Daily iron requirement :<br /> 7-10mg (men )	7-20mg ( women )<br />Ascorbic acid ,...
Iron absorbed by duodenum & Jejunum  transported by Transferrin  Liver & BM  Incorporated to Developing rbc in BM<br />...
Inadequate dietary iron<br />Pregnancy , Lactation<br />Chronic blood loss – GIT bleeding or tumors<br />Most common cause...
Features:<br />Morphology:<br />Clinical Manifestation:<br />BM – mild to moderate erythroid hyperplasia<br />Dxtic : Disa...
Aplastic anemia<br />24<br />
Disorder of Pleuripotential stem cell<br />Lead to BM failure  Pancytopenia<br />Most are Idiopathic<br />Other Causes:<b...
Pathogenesis:<br />Immunologically mediated suppression <br />Stem cells drugs, infectious agent								        environmen...
Pathogenesis:<br />	2. Give rise to clonal population with reduced proliferative capacity<br />Either pathway <br />APLAST...
28<br />
Unpredictable<br />Recovery if w/draw toxic drugs in some<br />Allogenic BM transplant <br />Immunosuppressive therapy<br ...
30<br />
31<br />
POLYCYTHEMIA<br />32<br />Abnormally high rbc and Hgb<br />Type:<br />1. RELATIVE – HEMOCONCENTRATION<br />DEHYDRATION<br ...
POLYCYTHEMIA<br />33<br />2. ABSOLUTE<br />Primary <br />A.  Intrinsic Abn of myeloid stem cells<br />Polycythemiavera<br ...
POLYCYTHEMIA<br />34<br />Secondary<br />High eryhtropoietin<br />Appropriate - Adaptive<br />Inappropriate secretion of h...
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Rbc Patho B 2

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Rbc Patho B 2

  1. 1. Anemia Caused by Decreased RBC Production<br />1<br />
  2. 2. Nutrients necessary for RBC maturation are<br />Deficient<br />Megaloblastic Anemia<br />Iron Deficiency Anemia<br />Aplastic Anemia<br />Anemia of Renal Disease<br />Anemia of Chronic Disease<br />Myelopthisic Anemia<br />Anemia Caused by Lead Poisoning<br />Anemia Caused by Decreased RBC Production<br />2<br />
  3. 3. Megaloblastic ANEMIA<br />3<br />
  4. 4. Pathogenesis:<br />4<br />
  5. 5. Causes :<br />5<br />
  6. 6. Vit B12 & Folate absorption<br />6<br />
  7. 7. Decreased intake<br />Inadequate intake, Vegetarians<br />Increased Requirement<br />Pregnancy<br />Hyper thyroidism<br />Disseminated Cancer<br />Vit. B12 Deficiency<br />7<br />
  8. 8. Impaired Absorption<br />Intrinsic Factor Deficiency<br />PERNICIOUS<br />GASTRECTOMY<br />Malabsorption states<br />Diffuse Intestinal Disease<br />Ileal resection, ileitis<br />Parasites – hook/tapeworms<br />Bactrial overgrowth in Blind Loops <br />Vit. B12 Deficiency<br />8<br />
  9. 9. Biochemical function of vit. b12<br />9<br />
  10. 10. Neurological Complication<br />10<br />
  11. 11. More in Scandinavian & English Speaking <br />Blacks & Hispanics in US<br />Common in OLD Age 50’s-80’s<br />Maybe Strong Genetic predisposition <br />Incidence<br />11<br />
  12. 12. Pernicious Anemia<br />Immune – mediated destruction of gastric mucosa<br />Autoreactive T-cell response initiates autoAbprod’n.<br />Result to Chronic atrophic gastritis<br />Types of AutoAb<br />75%Type I – Blocks binding of B12 to IF<br />Type II – Prevent Binding of IF - B12 to Ileal Receptor<br />Type III – Not specific, common in elderly not R/T pernicious<br />12<br />
  13. 13. Insidious onset<br />Progressive anemia <br />Atrophic glossitis & Gastric atrophy<br />Seen in pernicious anemia<br />Intestinalization of gastric epithelium  Gastric Ca<br />CNS in ¼ of cases<br />Spastic paraparesis Sensory ataxia<br />Severe paresthesia in the L.E. <br />Tx by giving oral / parenteral B12<br />Halt progression of Neuro s/s but not GI changes<br />Clinical course:<br />13<br />
  14. 14. Moderate – Severe Megaloblastic Anemia<br />Leukepenia & Thrombocytopenia<br />Mild Jaundice – peripheral hemolysis of rbc<br />Neurological – Posterolateral spinal tracts <br />Schillings test – Decreased uptake of radioactive B12<br />Low B12<br />Elevated Homocysteine & Methylmalonic acid<br />More Sensitive than B12<br />Diagnostic:<br />14<br />
  15. 15. Folate deficiency<br />Manifestation same as B12 Deficiency<br />Except Neurological s/s<br />Folic acid is sensitive to heat, boiling, frying, steaming <br />Brocolli, lettuce, asparagus, lemons, banana<br />Casues:<br />1. Decreased intake<br />2. Increased requirement<br />3. Impaired use<br />15<br />
  16. 16. 16<br />
  17. 17. Pancytopenia- intramedullary destruction of precursor( apoptosis )<br />Macrocytes (+) – high MCV but not MCHC<br />Thicker , Well – Hemoglobinized<br />No Central pallor<br />Retic – Low<br />Large & HypersegmentedNeutrophils<br /> BM markedly Hypercellular with Asynchronous maturation of N/C<br />Morphology:<br />17<br />
  18. 18. Iron deficiency anemia<br />18<br />
  19. 19. Most common nutritional disorder in the world.<br />Prevalence of iron deficiency anemia is<br />Higher in the developing countries, <br />Toddlers & adolescent girls<br />Women of childbearing age<br />Features:<br />19<br />
  20. 20. Balance : 1 mg iron absorbed / day<br />Daily iron requirement :<br /> 7-10mg (men ) 7-20mg ( women )<br />Ascorbic acid , Citric acid, Amino acids enhance absorption<br />20<br />Nutritional Iron requirement<br />
  21. 21. Iron absorbed by duodenum & Jejunum  transported by Transferrin Liver & BM  Incorporated to Developing rbc in BM<br />Iron is stored as Hemosiderin( aggregates ) or Ferritin ( complexed with Apoferittin )<br />21<br />Iron absorption<br />
  22. 22. Inadequate dietary iron<br />Pregnancy , Lactation<br />Chronic blood loss – GIT bleeding or tumors<br />Most common cause in Western countries<br />Impaired absorption <br />Menstrual , parturition, Vaginal Bleeding<br />Causes:<br />22<br />
  23. 23. Features:<br />Morphology:<br />Clinical Manifestation:<br />BM – mild to moderate erythroid hyperplasia<br />Dxtic : Disappearance of stainable iron in macrophages in BM ( Prussian Blue Stain )<br />MicrocyticHypochromicrbc<br />Pencil rbc<br />Anisopoikilocytosis<br />No Reticulocytosis<br />Low Serum Ferritin<br />High TIBC<br />Anemia<br />Severe Cases:<br />GLOSSITIS, ANGULAR STOMATITIS, KOILONYCHIA<br />Treatment:<br />Iron Supplement<br />Treat the cause<br />23<br />
  24. 24. Aplastic anemia<br />24<br />
  25. 25. Disorder of Pleuripotential stem cell<br />Lead to BM failure  Pancytopenia<br />Most are Idiopathic<br />Other Causes:<br />Radiation – whole body, dose dependent<br />Chemotx<br />Immune reaction due to viral infxn<br />Idiosynchratic reactions- dose independent <br />Chloramphenicol<br />Features:<br />25<br />
  26. 26. Pathogenesis:<br />Immunologically mediated suppression <br />Stem cells drugs, infectious agent environmentalinsultsGenetically Altered stem cell<br />1. Evokes a T cell-mediated immune response (IFN-gamma and TNF-alpha)<br />POTENT INHIBITOR OF STEM CELL FUNCTION<br />26<br />
  27. 27. Pathogenesis:<br /> 2. Give rise to clonal population with reduced proliferative capacity<br />Either pathway <br />APLASTIC ANEMIA<br />27<br />
  28. 28. 28<br />
  29. 29. Unpredictable<br />Recovery if w/draw toxic drugs in some<br />Allogenic BM transplant <br />Immunosuppressive therapy<br />Antithymocyte Globulin<br />Cyclosporine<br />Prognosis & TREATMENT:<br />29<br />
  30. 30. 30<br />
  31. 31. 31<br />
  32. 32. POLYCYTHEMIA<br />32<br />Abnormally high rbc and Hgb<br />Type:<br />1. RELATIVE – HEMOCONCENTRATION<br />DEHYDRATION<br />STRESS ( Gaisbock syndrome)<br />Patient is Obese, hypertensive , anxious <br />
  33. 33. POLYCYTHEMIA<br />33<br />2. ABSOLUTE<br />Primary <br />A. Intrinsic Abn of myeloid stem cells<br />Polycythemiavera<br />B. Mutation in erythropoietin receptor <br />Cause Hyperresponsiveness to eryhtropoietin<br />
  34. 34. POLYCYTHEMIA<br />34<br />Secondary<br />High eryhtropoietin<br />Appropriate - Adaptive<br />Inappropriate secretion of hormone<br />Liver/ Renal Cell Ca<br />

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