Saleh ahmed 86 years old mele saudi from oneiza
unembloyed, feeling severe pain tightness of chest
started since 3 years, every two months come to
hospital to transfute 3 to 4 blood units his chest
pain sudden not continuous and not radiated ,sharp
relieved by blood transfusion.
His past history
medical: hypertension, DM2, since 4 years, heart
attack, edema due to nephropathy, develop episodes of mild
surgical: left eye lazer.
medications: all orally for hypertension, DM2,
Family history: informant is his son 68 years old with DM2
and his dauter and most of family members have DM2 and
that’s why should we alwaysadvice
avoid mariage from relatives.
social history: 1 packet
half of packet
review of systems:
Respiratory: due to his last episode most doctors to make sure
of lungs by auscultation. Due to multiple chest pain shortness of
breath and hypoxia.
GI: little neausea, no vomiting, no loss of wieght, urination is
normal. There is change in bowel habit 1 to 2 per day.
dark bloody feces with mucus.
GE: vital signs and alarm signs.
Abdominal examination and respiratory
Elaboration:DD: colon polyp, diverticulitis and
investigation: CBC, ECG, stool,
to look for UGI bleeding
elaboration:blood transfusion, hydroxycarbamide,
learning goals: anemia complications.
Blood consist of
erythrocytes 120 days.
Platelets 2 days.
blood formation where does it occur(hematopoeisis)?
Lymph nodes. Thymus.
what occur in patient of anemia? Which is affect in
hemoglobin performs the main function of RBCs by carrying
oxygen to tissues and returning CO2 from the tissues to lungs.
the convave shape allow the RBCs to uptake O2 and release CO2.
Normal value of hemoglobin is ………………….
Anemia:is present when there is decrease
level of hemoglobin in blood depending on
the sex and age of the individual.
Common is fatigue, headache and
After complication or long term
Male: 5-6 L.
hemog Female: 12-16 g/dl.
lobin Male:13-18 g/dl.
pallor of extremeties, face, conjuctive.
Central cyanosis of tongue and lips.
Cholinychia (spoon shape of nails).
Systolic flow murmur.
TYPE AND CAUSES OF ANEMIA
most cause is iron deficiency due to
1- limited ability of body to absorb iron.
2- frequent loss of iron due to hemorrhage.
chronic disease ex: infection tuberculosis, chronic inflammatory
disease chron’s disease.
Sideroblastic anemia: inherited or acquired.
anemia: seen in chronic disease such as
1- endocrine disorders( hypopituitarism, hypothyroidism and
2- hematological disorders(aplastic anemia wether primary
congenital or secondary due to chemical or certain drugs.
3- seen acutely following blood loss.
defect in DNA synthesis in bone marrow
thereby affecting: B12 metabolism or causeing
deficiency leading to perncicious anemia
. Folic acid dificiency or abnormal folate
2- non-megaloblastic anemia:
single base mutation of adenine to thymine.
Mostly in african population.
Inherited from both parents.
COMPLICATIONS OF ANEMIA
Long term problems lead to complications:
every organ is involved.
growth and development: children below normal
weight > delayed sexueal maturation > hormone
Bones: hip joint replacement may be required due
to vaso-occlusion episodes leading to chrinic
Infection: more common in the tissues which vasoocclusion occur ex: bones, lungs and kidney.
Respiratory: shortness of breath, chest pain and
hypoxia > death
Cardiac problems: cardiomegaly.
arrhythmias and iron
myocardial infarction due to thrombotic
episodes not secondary to atheroma.
neurological: in 25% of patients.
Cholelithiosis: pigment stones occur as a result of
Liver: chronic hepatomegaly.
Renal: chronic tubulo-interstitial nephritis
Priapism: unwanted painful erection due to vasoocculsion.
Eye: retinopathy > yearly eye check is required.
Pregnancy: impaired placental blood flow causes
intrauterine growth retardation.
preclampsia and fetal death
Sickle solubity test
Hb electrophoresis: always needed to confirm the
MANAGEMENT AND TREATMENT
Patient survive longer with better treatment.
Blood transfusion should be given only for clear
indications. Ex: surgery, heart failure , painful
episodes without complications and in cases of
Hydroxycarbamide is first drug for sickle anemia to
reduce the episodes of pain.
Bone marrow transplantation.
Some patients with Hb SS die in the first few years
There is indivisual variation in the severity of the
Some patients have normal lifespan with few