ANEMIAReduction of Hb concentration/RBC volumebelow the range of normal values according to age & sexThe lowest limit of Hb concentration: 6 mo - 6 yr: 11,0 g/dl> 6 yr: 12,0 g/dlThe normal value of Hb concentration (g/dl):Cord blood: 13,5 - 20,51st day: 15,0 - 23,52 - 3 mo: 9,0 - 12,56 mo - 6 yr: 11,0 - 14,56 yr - 14 yr: 12,0 - 15,5

CLASSIFICATION OF ANEMIA- MCV (VER) - MCHC (KHER- MCH (HER)- RDW

Based on EtiologyPost-hemorrhagic Anemia Deficiency Anemia3. Aplastic AnemiaHemolytic AnemiaAnemia in malignancyBased on MorphologySize of cell: - normocytic anemia : MCV 80 - 96 3 (fl)- microcytic anemia : MCV < 80 3 (fl)- macrocytic anemia : MCV > 96 3 (fl)

Hemoglobin Concentration:- normochromic anemia: MCHC 32 - 38 % / MCH 27 - 32 pg- hypochromic anemia : MCHC < 32 % / MCH < 27 pg

CLINICAL MANIFESTATIONS OF ANEMIAEarly onset of Anemia :

Massive acute bleeding RBC decrease 30% shock death Massive & acute hemolysis acute anoxia (severe hypoxia)Late onset of anemia: mild symptoms:- Latent anoxia - Adaptation & compensation mechanism Onset of anemia

Anemia is not a diagnosis syndrome (symptom)

Clinical symptom: primer disease & anemiaAnemia dysfunction of tissue & compensation mechanisms:1. Oxygen transport decrease & vasoconstriction: fatigue, irritable, pale, dyspnea

2. Decrese of blood volume: hypotension (shock), pale 3. Increase of cardiac output: tachycardia, pulse pressure , murmur, heart enlargement

PRINCIPLE OF ANEMIA TREATMENTAnemia as a symptom (syndrome)Therapy causal / etiologyBlood transfusion Substitution 1. Massive & acute bleeding life threatening2. Congenital anemia periodic blood transfusion has strict conditions3. Signs of severe & acute anoxiaIndication:

- RBC volume 30 cc/kg bb Hb 15 g/dl 2 cc RBC/kg bw equal Hb 1g/dl

- Whole blood from Department of Blood Transfusion 30% RBC. three folds 3 X 2 = 6 cc/kg bb to increase Hb 1 g/dl

- PRC contain 60- 70% RBC to increase Hb 1 g/dl 3 cc/kg bw

BASIC CALCULATION