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Anemias
By: Dr Asma Jabeen
Anemia
It is a common disorder in which the hemoglobin content of blood is decreasedbelow normal level.
▪ Decreased production of RBC▪ Increased destruction of RBC▪ Excess loss of blood from body
Classification of Anemia
❑ Morphological classification
❑ Etiological classification
Morphological classification
NormocyticNormochromic
MacrocyticNormochromic
MacrocyticHypochromic
Microcytic Hypochromic
Etiological Classification
HemorrhagicAnemia
Hemolytic anemia
Nutritionalanemia
Aplastic anemia
Anemia of chronic diseases
Hemorrhagic (Blood loss) anemia
▪ Anemia due to hemorrhage▪ Acute or chronic▪ normocytic, normochromic▪ plasma replaces in 1 to 3 days▪ RBC replacement takes 3 to 6 weeks▪ In chronic blood loss, microcytic,
hypochromic
Hemolytic anemia
Occurs due to excess destruction of RBC
▪ Congenital or acquired defect in RBC shape
▪ Liver failure▪ Renal disorder▪ Hypersplenism▪ Burns▪ Infections..malaria, septicemia▪ Agglutinins
➢ Sickle cell anemia
➢ Hereditary spherocytosis
➢ Erythroblastosis fetalis
Examples of hemolytic anemia
Nutritional deficiency anemia
▪ Iron deficiency
▪ Protein deficiency
▪ Vitamin B12 Deficiency
▪ Folic acid deficiency
Iron deficiency anemia
Due to iron deficiency; -in diet-or defect in absorption
RBCs are microcytic and hypochromic
Megaloblastic anemiaLoss of any one of :
Vitamin B12Folic acidIntrinsic factor
Effects: ▪ Slow reproduction of erythroblasts in
bone marrow▪ RBCs grow too large with odd shapes
called megaloblasts▪ Cannot proliferate rapidly to form
normal count
▪ RBCs are oversized, bizarre shapedfragile membranes so rupture easily
Pernicious anemia
➢ The atrophy of stomach mucosa leads to deficiency of vitamin B12 because of lack of intrinsic factor in gastric secretions.
➢ It is one form of megaloblastic anemia
➢ B12 deficiency leads to neurological symptoms
Aplastic anemia
Lack of functioning bone marrow.
▪ Excessive X- ray treatment▪ Gamma ray radiation ▪ Industrial chemicals , insecticides,
benzene in gasoline▪ Drugs , chemotherapy for cancer▪ Autoimmune disorders like lupus
erythematosus
Anemia of chronic disease
Characterized by short life span of redcells caused by
- Disturbance in iron metabolism- Resistance to erythropoietin action
▪ Inflammatory diseases - rheumatoidarthritis
▪ Chronic infections- tuberculosis▪ Cancers of lung and breast
Effects of anemia
Cardiovascular system:
Decreased viscosity of blood
Decreased resistance to flow
Increased blood flow
Increased cardiac output
Peripheralvasodilation due to hypoxia
Clinical features of anemia
Polycythemia
The increase in red blood cell count is
called polycythemia.
PrimaryPolycythemia vera
SecondaryPhysiologicalPathological
Polycythemia vera (Erythremia)
Cause: ▪ Genetic aberration in the hemocytoblasic
cells that produce blood cells▪ No longer stop producing cells even in
excess RBC▪ RBC count: 7 to 8 million/mm3
➢ Increased hematocrit, Increased blood volume
➢ Increased viscosity cause plugging of capillaries ..10 times more viscosity than water
➢ Excess production of WBCs and platelets
Physiological polycythemia
▪ In natives of 14,000 to 17,000 feet due to low atmospheric oxygen
▪ Blood count 6 to 7 millions/mm3
▪ Allow the people to perform high levels of continuous work in unfavorable environment
Secondary polycythemia
▪ Respiratory disorders like emphysema
▪ Chronic carbon monoxide poisoning
▪ Poisoning by chemicals
Effects of polycythemia
▪ Increased viscosity, sluggish blood flow, Decreased venous return but more blood volume - cardiac output almost normal
▪ Blood pressure almost normal
▪ Subpapillary venous plexus gives color to skin ruddy complexion with
bluish tint
PolycythemiaThree Pathophysiological Categories of Polycythemia
1.Relative Polycythemia (Red Blood Cell Mass Normal, Plasma Volume Decreased)
2.Secondary Polycythemia (Red Blood Cell Mass Increased)
3.Polycythemia vera (Red Blood Cell Mass Increased)
Polycythemia
Vera
Secondary Polycythemia
Pathophysiology Stem Cell
Disorder
Tissue hypoxia increasing EPO
production or due to renal or
hepatic disease causing
inappropriate increase in EPO
production
CBC Hct and often
WBC and
platelets are
increased
Only Hct is increased
EPO level Decreased or low
normal
Normal or increased
Treatment Phlebotomy Treatment not required
THANK YOU