Haematopoesis

Rosita Juwita Sembiring

ZAT BESI DALAM TUBUH

PERAN FISIOLOGIS
Hemoglobin Myoglobin

Total Besi dalam tubuh 4 5 gr

Reaksi

redox enzimatik

CADANGAN Ferritin Tansferin Hemosiderin

HEMOGLOBIN MYOGLOBIN ENZIM : SITOKROM, KATALASE, PEROKSIDASE

HEME IRON

BESI (IRON)

NON HEME IRON

Ferritin Hemosiderin Transferrin

ZAT BESI DALAM TUBUH .

1. SERUM IRON, TERIKAT PADA
TRANSFERIN . 2. KAPASITAS IKATAN BESI TOTAL (TIBC) . 3. FERRITIN . 4. SERUM TRANSFERIN RESEPTOR . 5. SATURASI TRANSFERIN . 6. PROTOPORFIRIN ERITROSIT BEBAS (

FEP) .

Anemias red cell mass

Erythropiesis

Megaloblastic B12,Folate,

Iron deficiency

Anemia of Chronic disease (Renal Disease & Liver Disease)

Marrow failure Aplastic anemia Pure red cell aplasia Others

KLASIFIKASI ANEMI
I . W.H.O .
1. ANEMI DEFISIENSI .
2. ANEMI HEMOLITIK .

3. ANEMI POST HEMORRHAGIK .

4. ANEMI APLASTIK .

Anemia In Family Practice

Classification of Anemia (Mean Corpuscular volume):

Microcyctic

MCV < 80 fL
MCV > 100 fL MCV 80

Macrocytic Normocytic 100 fL

II . STATUS ZAT BESI .

1. SERUM IRON, N = 50 150 ug / L . An. Def. Fe = < 50 ug / L . 2. TIBC, N = 250 450 ug / L . 10 An. Def. Fe = > 450 ug/L . 3. SI . : RATIO SI / TIBC X 100 % = % IRON DEF. ANEMI = < 15 % . 4. FERRITIN ( EIA ) : AN. DEF. Fe < 10 15 ug/L

Iron Deficiency Anemia

Anemia In Family Practice

Hemoglobin below the normal reference level for the age and sex of the individual Reference range:
1-3 days: 14.5 - 22.5g/dl 6 months to 2 years: 10.5 - 13.5g/dl Adult Men: 13-18 g/dl Adult Women: 11.5-15.5g/dl

Anemia In Family Practice

Clinical Features
(symptoms):
Infants Irritability, restlessness Anorexia, sleepiness Behavioral changes
School going children

Anemia In Family Practice

Clinical Features
(symptoms):
Common Fatigue/Muscle weakness Headache/Lack of concentration Faintness/dizziness

Exertional dyspnoea/palpitation
Angina/intermittent claudication

Anemia In Family Practice

Clinical Features
(signs):
Non-specific pallor, tacycardia, flow mummer

Specific koilonychia, angular stomatitis, glossitis neuropathy, dementia, paraplegia jaundice, bone deformities, leg ulcer

Anemia In Family Practice

History:
Physiological

Inadequate intake Blood loss Malabsorption

Comorbids

Drug history Family history

Anemia In Family Practice

Consequences of iron deficiency:

Children with Hb < 10g/dl have reduced cognitive & psychomotor function despite a return to normal hematological status Reduced immunity and growth failure Deficiency in dopamine receptors

Anemia In Family Practice

Consequences of iron deficiency:

Children with Hb < 10g/dl have reduced cognitive & psychomotor function despite a return to normal hematological status Reduced immunity and growth failure Deficiency in dopamine receptors

Anemia In Family Practice

Microcytic Anemia

Iron deficiency

Hemoglobinopathy Sideroblastic

Lead poisoning
Occasionally chronic

disease

 If no obvious cause
Serum Ferritin:
< 15ug/l : Iron deficiency

Normal or : Serum Iron / Increased Total Iron binding capacity(TIBC)

Anemia In Family Practice

Serum TIBC Iron Iron Decrease Increased deficiency d ThallasemiaIncreased Normal Increased

Evaluation continued..

Peripheral smear
Hypochromi c

Target cells
Basophilic stippling Diamorphi

Siderobla Increased Normal st c Chronic Decrease Decrease Hypo/normo chromic disease d d

Evaluation Anemia In Family Practice continued..

Thallesemia
Mentzer index: MCV/RBC count. <13 Hb Electrophoresis

Sideroblastic anemia
Bone marrow exam

Iron deficiency anemia in men/post menopausal women

Gastro-intestinal endoscopy Barium studies

Anemia In Family Practice

Children

Rx of iron deficiency:

Elemental iron 3-6mg/kg/day, contd.. 4-6 months Check Hb at 4 weeks

Adults
Ferrous sulphate/gluconate/fumarate Iron polymaltose complex Elemental iron 200mg/day

Parental Iron

Anemia In Family Practice

Diet for Iron Deficiency:

In adults, limit milk intake - 500 mL/day Avoid excess caffeine Eat iron-rich foods Protein foods Vegetables
Meats Fish & Shelfish Eggs

Greens Dried peas & beans

Fruits
Dried fruit Juices Most fresh fruits

Grains

Iron-fortified breads Dry cereals Oatmeal cere

Anemia In Family Practice

Macrocytic anemia (evaluation):

Peripheral film & Reticulocyte count Macrocytes absent Normal reticulocyte
artifactual (hyperglycemia/natremia, cold agglutinin, and extreme leucocytosis)

High reticulocyte
hemolysis, bleeding or nutritional response to folate/B12/iron

Anemia In Family Practice

Evaluation continued...
Macrocytes present
With megaloblast MCV>120

B12 deficiency, Folic acid deficiency Drugs (cytotoxic, anticonvulsant, antibiotic

Without megaloblast MCV 100-120

Liver disease, Alcoholism Hypothyroidism, Myelodysplastic disorder

Anemia In Family Practice

Vitamin B12 deficiency (causes) Nutritional

Malabsorption states
food bound (prolonged use of gastric acid blockers) lack of intrinsic factor/parietal cells (pernicious anemia,atrophic gastritis, gastrectomy) Ileal disease (crohns, bacterial overgrowth, tape worm)

Anemia In Family Practice

Vitamin B12 deficiency (Rx)

Oral: 1000-2000 mcg/day for 2 weeks 1000 mcg/day for life

Intramuscular:1000 mcg alternate days to a total of 3-5 mg 1000 mcg every 3 months Intranasal: Nascobal

Cell Megaloblastic .

UNITED NATIONS GENEVA