Hematology PSL 222

Anemia
Medicine L3.
PSL 222
Lecture 3

Dr. S.Bashir

Anemia : Definition

Reduction in the total number of RBC,

hemoglobin and/or hematocrit below normal
for age and sex.
Functionally : Impaired oxygen delivery.
Consequences:
Secondary to tissue hypoxia ?
Compensatory mechanisms for correction?
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Dr. S.Bashir

General Clinical Features

Weakness, malaise, easy
fatigability.
Dyspnea on mild exertion.
Pallor
Headache, faintness,
dimness of vision
Palpitations, why?
..
Angina, heart failure ..
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Dr. S.Bashir

Laboratory Diagnosis of anemia

Hb conc.?
RBC count?
Hematocrit?
RBC Indices?
Blood smear?
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Dr. S.Bashir

Normal Hb concentration
Men:
15 + 2 gm% (per 100mls).

Women:
13.5 + 1.5 gm% (per 100mls).
How is it different in Abha?
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Dr. S.Bashir

:Effect of high altitude

Acclimatization to high altitude :
The decrease in atmospheric pressure

decreased O2 partial pressure

stimulation of erythropoisis.
increased RBC count and Hb conc.
Condition called physiological polycythemia.
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Dr. S.Bashir

Hematocrit : PCV
Men 45 + 5.
Women 41 + 5

Dr. S.Bashir

:RBC Indices
Laboratory calculation of:
Mean RBC volume (MCV).
Micro/macro or normocytic RBC?

Mean RBC Hb . Concentration (MCHC).

-Hyper / normo/ hypochromic RBC?
Mean RBC Hb content (MCH)

Dr. S.Bashir

MCV
Total RBC volume / number of RBC
MCV=

PCV x10
RBC count

Normal = 86+ 10 fL
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Dr. S.Bashir

.Mean Cell Hb. Conc

Hb

MCHC

g/dL

Ht. (PCV)
X 100

= ---------------------

15
45 = 33.3 g/dL
X 100

NORMAL MCHC =
10

= ----------

33 1.5 g/dL

Dr. S.Bashir

Mean Cell Hemoglobin:

MCH
Hb

X 10

RBCC

gm/dL

= ---------------------x 106/L

15 gm/dL

= -----------

X 10 5=x 10 /L30 pg
6

NORMAL MCH =
11

30 2 pg

Dr. S.Bashir

Morphologic Classification

Normocytic
normochromic

MCV 86 + 10

Microcytic
hypochromic .

MCV <76

Macrocytic
hypochromic

MCV > 96

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MCHC 33 + 1.5

MCHC < 31.5

MCHC < 31.5

Dr. S.Bashir

Morphologic Classification:
Blood film
Microcytic
hypochromic
Iron def.
Macrocytic :
Folate def.
Vitamin B12 def.
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Dr. S.Bashir

RETICULOCYTE COUNT
What are reticulocytes?
Slightly immature RBC at
the stage of maturation
between the extrusion of
the nucleus and the mature
erythrocyte. They still
contain mitochondria and
ribosomes.
What conditions cause
increase in their numbers
in peripheral blood?
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Dr. S.Bashir

to 2.0% 0.2

to 10,000=
100,000/L
(Adults & Children )

Hematology
Anemia
Medicine .
PSL 222
Lecture 4
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Dr. S.Bashir

?Anemia: causes
Functional
Classification :
- Decreased
production.
- Increased
destruction
or loss.
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Dr. S.Bashir

Decreased production

1-Deficiency of 2- Lack of Erythropoietin?

nutrients:
Iron
3- Damage to bone marrow?
Folic acid
B-12
4- Chronic disease ?
Proteins.

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Dr. S.Bashir

?Lack of Erythropoietin
Possible causes?
1-?
2- In extremely premature babies.

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Dr. S.Bashir

?Damage to bone marrow

Causes?
1 2-

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Dr. S.Bashir

Commonest types of anemia

Iron (Fe) def anemia is the commonest type
world wide. Less common are folate and B12
deficiencies.
In Saudi Arabia sickle cell anemia is also
common.

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Dr. S.Bashir

Fe Dietary sources
Best dietary sources are liver and red
meat because of high iron content and
easy absorption (Heme iron).
Plant sources include nuts, beans, dates
and some vegetables but absorption from
these sources is poor (Non-heme iron).

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Dr. S.Bashir

Iron absorption
A good source of vitamin C (ascorbic acid) - i.e.,
oranges, grapefruits, tomatoes, broccoli, and
strawberries, eaten with a NON-HEME food will
enhance absorption.
The following factors will decrease non-heme iron
absorption: Large amounts of tea or coffee consumed with a
meal.
Excess consumption of high fiber foods or bran
supplements (the phytates in such foods inhibit
absorption).
High intake of calcium
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Dr. S.Bashir

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Dr. S.Bashir

Iron homeostasis
Iron is transported with transport protein as
transferrin.
Iron is stored in the liver and bone marrow as
ferretin.
Iron from destroyed old RBC is recycled.
Small amount of Fe is lost in sheded skin &
intestinal cells.
Women lose more Fe during menstrual cycle
and pregnancy.
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Dr. S.Bashir

Causes of Fe Deficiency
Poor diet:
Poor and elderly.
Increased requirements:
Infants, children, pregnancy.
Chronic blood loss:
GI bleeding
Impaired absorption:
Gastrectomy. Why?
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Dr. S.Bashir

Clinical features of Fe
Deficiency anemia
Signs and symptoms of
anemia ?
Koilonychia?
Splenomegaly.
RBC: Microcytic &
hypochromic.
Treatment?

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Dr. S.Bashir

Clinical features of Fe
Deficiency anemia

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Dr. S.Bashir

Folate & Vitamin B-12 Deficiencies

:anemia's
Deficiency of either folate or B-12 cause
macrocytic (megaloblastic) anemia.
RBC in the blood appear large (macrocytes), MCV.

In the bone marrow the RBC precursors are also

large called ( megaloblasts).

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Dr. S.Bashir

Folate

B-12

Dietary sources :
Leafy green
vegetables,
some fruits &liver,.
Causes of def.?

Diet sources :
meat, liver &
kidney.
Causes of def?
Vegetarian diet
Pernicious
anemia?

?
?

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Dr. S.Bashir

Absorption of vitamin B-12

Requires the
intrinsic factor
secreted by the
stomach.
Also requires the
acidity of the
stomach.
Absorption occurs at
the terminal ileum
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Dr. S.Bashir

Auto-immune Pernicious anemia

A rare cause of B-12
deficiency is autoimmune
atrophy of gastric mucosa
lack of intrinsic factor
inability to absorb vitaminB12
Macrocytic anemia that
does not respond to
treatment with oral
vitamin B-12
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Dr. S.Bashir

Clinical signs of Macrocytic anemia

Signs and symptoms of
anemia, yellow
discoloration of skin,
dyspepsia, glossitis?
The tongue becomes
very red and painful
and the papillae
atrophy, leaving a
shiny, smooth surface.
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Dr. S.Bashir

Aplastic Anemia
Destruction of red bone
marrow by bacterial
toxins, drugs or radiation.
Affects all blood cells,
leading to?
Anemia.
Leucopenia ( WBC).
Thrombocytopenia (
platelets).

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Dr. S.Bashir

Increased destruction
1-Hemorrhage :
Acute ?
Chronic?
2-Hemolysis ?
Premature lyses
of RBC.
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Dr. S.Bashir

Hemolytic anemia
RBC rupture (lyses) prematurely.
Can be due to ?

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Dr. S.Bashir

Hemolytic anemia's:
Infections.
malaria
Genetic membrane defects
(spherocytosis, elptocytosis)
Genetic Hb abnormalities.
(Sickle cell disease, thalasemia)
Genetic enzyme defects.
(G6PD)
Auto-immune diseases
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Dr. S.Bashir

Hemolytic anemia :
Clinical Features

Symptoms of anemia
Jaundice. Why?
Too much bilirubin

Gall bladder stones

Dark or red urine
Bone pain & thinning
of cortical bone
Splenomegaly .
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Dr. S.Bashir

Sickle Cell Disease

A mutation in the gene for
the beta chain of Hb
results in an abnormal
hemoglobin called HbS.
Under low-oxygen
conditions, the beta chains
link together and become
stiff rods - this gives the
RBC a sickle shape.
Sickled RBCs block and
clog small blood vessels.
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Dr. S.Bashir

Sickle Cell Disease

Autosomal recessive.
HbS: Glutamic acid instead
of Valine at Beta 6 position
Disease: refers to
homozygous state HbSS.
Trait: refers to
heterozygous state HbAS.
Crisis? An acute episode of
hemolysis.
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Dr. S.Bashir

Thalassemia Syndromes
Heterogeneous group of mandelian disorders,
all characterized by:
Lack of or decreased synthesis of either the
alpha or beta globin chain of HbA1
Alpha or beta thalassemia
Decreased HbA1 and relative excess of other
chains
Ineffective erythropoiesis and/or hemolysis
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Dr. S.Bashir

Anemia of Chronic Disease

Chronic infection, chronic renal disease,
malignancy, immune disorders
Insufficient erythropoiesis, block in release of
iron from RES to erythroid precursors and
decreased RBC survival.
Normochromic normocytic or microcytic
hypochromic
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Dr. S.Bashir

Polycythemia
Abnormal increases in
the RBC.
Physiological?
Adaptation to High altitude

Pathological?
Idiopathic

Increases blood viscosity

?
Thrombosis and emboli.
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Dr. S.Bashir

Polycythemia

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Dr. S.Bashir

THANK YOU

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Dr. S.Bashir