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Patients with
Anemia
Prof. Dr / Nabil Lymon
Blood Cells
and
Hemoglobin
structure
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:Definitions
: Anemia -
is defined as the lowering of hemoglobin
concentration below the established normal
:levels
.In male < 13.5 gm/dl & In female < 11.5 gm / dl
Anemia is a clinical sign not a diagnostic -
.entity
:)Hematocrit )Hct -
is the proportion, by volume, of the blood
occupied by red blood cells. The hematocrit
(Hct) is expressed as a percentage, normal
: levels are
in Adult male & 0.37 - 0.47 in Adult 0.54 - 0.4
:Definitions
Red Cell Indices
Are measurements that indicate the size
:and hemoglobin content of red cells
)M.C.V )Mean Corpuscular Volume
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M.C.H.C
Mean Corpuscular Hemoglobin)
:)Concentration
: Neurological -
H eadacheT innitus
Dizziness
Signs &Symptoms of
Anemia
: Skin -
P.allor of skin , mucous membranes, nail beds and palms
: Gastrointestinal -
A norexiaN ausea
Constipation
Diarrhea
: Respiratory -
Increased Respiratory Rates
: Genitourinary -
M enstrual irregularityA menorrhea
Menorrhagia
Loss of libido or potency
: Fundus Examination -
Is the patient Anemic or
not ?
Anemic means single or
total decrease in :
- Hb
- Hct
- RBCscount
in?…But
millions
Normocytic Microcytic
Normochro
mic Anemia Increased Hypochromi
c Anemia
Macrocytic
Anemia
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Anemia
It may be due to :
- Acute Blood Loss
- Aplastic Anemia
- Hemolytic Anemia ( Except
Thalasemia)
- A.O.C.D (Anemia Of Chronic
Which of
(Diseases
Which ….?
Do Reticulocytic Count
Normal Low or High
A.O.C.D Absent Acute Blood -
:.e.g B.M.F Loss
TB, SLE, Aplastic“ search for )
Malignancy, Rh. evidence of
Arthritis ”Anemia
(the cause
:Note BM biopsy or BM
Evidence of the - aspiration Hemolytic -
cause : show
- low Hb &/or Hct & /or RBCs count
- Normal RBCs indices
- Reticulocytosis
Unconjugated Hyper-
billirubinemia
“
jaundice”
- Hemoglobinuria - Hemoglobinemia
(increased free Hb)
- Decreased Haptoglobin.
Microcytic
Increased Hypochromi
c Anemia
Macrocytic
Anemia
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Microcytic Hypochromic
Anemia
- The Commonest Cause is:
Iron Deficiency Anemia
-Other Causes: - Thalasemias
- Sedroplastic Anemia
- Lead Poisoning
- A.O.C.D
Which of Which ….?
:Do Iron Studies
Serum Iron -
Serum Ferritin -
(Total Iron Binding T.I.B.C -
(Capacity
Transferrin Saturation -
According to Iron Studies
Iron Thalasse Sideropla A.C.O.D
Deficienc mia stic
y Anemia Anemia
Serum
Fe
Serum Normal N or
Ferritin
T.I.B.C Normal
Transferr
in
Saturatio
Iron Deficiency Anemia
Iron Deficiency Anemia
Iron :Notes
Studies Search For The -
Serum Fe :Cause
:.e.g
Serum Chronic Blood Loss
Ferritin
Ankylostoma
T.I.B.C
Cancer Colon
Nutritional causes
Transferri
n Severe Aniso-cytosis -
Saturatio :and Poikilo-cytosis
n Increased R.D.W(N ≤
(13%
Anisocytosis with
hypochromia and
microcytes((IDA
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Spoon Nails:
If nails look scooped out, like a
spoon, it could be a sign of iron-
.deficiency anemia
Plummer Vinson Syndrome
Left : Spoon shaped finger nails
Right :Showing angular cheilitis, and
dry skin
Plummer Vinson
Syndrome
Iron Deficiency Anemia
Thalassemia
Iron :Notes
Studies Hb Electrophoresis -
Serum Fe :will show
Persistence of
Serum ]Hb]f
Ferritin
Specific Clinical -
T.I.B.C Features of
:Thalasemia
Transferri
Huge Spleen
n
Saturatio Mongoloid Faces
n Hemosedrosis
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Thalassemia minor
is an inherited form of hemolytic anemia that
is less severe than thalassemia major .This
blood smear from an individual with
thalassemia shows small(microcytic), pale
(hypochromic), variously-shaped
(poikilocytosis )red blood cells .These small
red blood cells(RBCs )are able to carry less
oxygen than normal RBCs
Thalassemia, being a genetic disease, runs in
a family .Most are silent carriers or suffer
mild anemia .Severe cases such as the
Hemoglobin H disease with enlarged spleen,
small body and malnourished look shows
more prominent symptoms .[Pic below:
[Enlargement of spleen, small body
Sideroplastic Anemia
Iron :Notes
Studies Sedroplastic Anemia
Serum Fe :is due to
B6 Deficiency -
Serum Norma Drugs e.g.: INH -
Ferritin l Inherited -
T.I.B.C Norma
:Blood film show
l
Transferri RBCs contain Iron
n Granules
Saturatio :Treated by
n B6 supply
Many rounded sideroblasts are present
in this field .This is the hallmark
feature ofsideroblastic anemia
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Lead Poisoning
:Notes
.History is Suggestive -
.Elevated Serum Lead level -
Purely Motor Neuropathy (foot and -
(wrist drop
:Blood Film show -
Basophilic Stippling of RBCs
Basophilic Stippling of
RBCs
Basophilic stippling appears as round, dark-
blue granules in red blood cells on smears
stained with supra vital stains such as
brilliant cresyl blue.
They may be observed inlead poisoning,
exposure to some drugs, severe burns,
anemia, or septicemia. The granules are
precipitated ribosomes and mitochondria
Red Cell Indices
According to MCV & MCH
Increased
Macrocytic
Anemia
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Macrocytic
Anemia
- In Which :
- low Hb &/or Hct & /or RBCs count
- Increased RBCs indices
- Causes :
# Folic Acid Deficiency # B12 Deficiency