ANEMIA

Khristy C
Tjiang kelvin
Steven matuali

07120100107
07120110030
07120110055

Anemia from the Greek (an-amia) meaning "without blood/lack of

blood from - an-, "not" + haima, "blood".
Definition :
Condition in which characterized:
Hb concentration decrease below the normal value.
Usually is followed by a decrease in hematocrit value or
decrease erythrocyte count.
Hb concentration depends on :
Sex
Age
Altitude
Method used for Hb determination.
Anemia may also be diagnosed where there is decreased oxygenbinding ability of each hemoglobin molecule due to deformity or lack in
numerical development as in some other types of hemoglobin deficiency.

ETIOLOGI OF ANEMIA
1. BLOOD LOSS / Erythrocyte loss
a. Acute : HEMORRHAGE
b. Chronic : LOW-VOLUME LOSS
2.EXCESSIVE BLOOD CELL DESTRUCTION /HEMOLYSIS
a.Hereditary abnormalities : erythrocyte membrane,
hemoglobinopathy
b.Aquired abnormalities : immunologic defect, obstetric infection, chemistry,
physic, mechanic abnormality.
3.DEFICIENT RED BLOOD CELL PRODUCTION
(ineffective hematopoiesis).
a. Nutritrional anemia : protein, folic acid, Fe, vit B12 def
b. Bone marrow failure : aplastic anemia, anemia in malignancy
c. low erythropoietin or Decreased marrow response to erythropoietin

FUNCTIONAL CLASSIFICATION OF ANEMIAS

Anemias may also be classified functionally into:

Hypoproliferative (when there is a proliferation defect)
Ineffective (when there is a maturation defect)
Hemolytic (when there is a survival defect)

MORPHOLOGICAL CLASSIFICATION OF ANEMIAS

Anemias may be classified morphologically based on the average size of the cells and
the hemoglobin concentration into:
Macrocytic
Normochromic, normocytic
Hypochromic, microcytic

CLINICAL EVALUATION :
The causes anemia suggested from history and physical examination :

HISTORY
- blood loss : obvious and dramatic clue to the causes anemia.
- History of anemia reaches back to childhood is highly suggestive of a
hereditary disorder ---especially congenital hemolytic anemia.
- sudden onset pancytopenia in healthy individual may be explain with
history of exposure to toxic chemicals or new medication.
-TRANFUSION HISTORY
- PAST BLOOD COUNT MEASUREMENTS
-NUTRITIONAL HABIT
-ACUTE OR CHRONIC ILLNES : WEIGHT LOSS, FEVER, NIGHT
SWEATS .
SYMPTOMS: weakness or fatigue in general or during exercise, malaise
and poor concentration , headache, dizziness .
Severe anemia -dyspnoe (shortness of breath) on exertion.

PHYSICAL EXAMINATION :
PHYSICAL SIGN DEPEND ACUTE OR CHRONIC OF ONSET :
ACUTE BLOOD LOSS SHOW SIGNS HYPOXIA AND HYPOVOLEMIA
(FOR EXAMPLE TACHYCARDIA AND HYPOTENSI ORTHOSTATIC ) --LOSS 40 % BLOOD WILL EXHIBIT IN SIGN AND SYMTOMPS
HYPOVOLEMIC SHOCK
ANEMIA DEVELOPS GRADUALLY BODY HAS TIME TO INCREASE
PLASMA VOLUME :
--- IN YOUNGER INDIVIDUAL SIGNS AND SYMTOMS NOT
APPEAR UNTIL Hb 7 8 g/dL
--- IN OLDER : Hb 10 g/dL CAN BE SYMTOMPMATIC
(EXSPECIALLY PATIENT CVD OR ATHEROSCLEROTIC).
GENERAL : SKIN AND MUCOUS MEMBRANE PALLOR
( LESS REALIBLE INHEAVILY PIGMENTED PATIENTS)

Measurements Lab of Anemia

Hemoglobin = grams of hemoglobin per 100 mL of whole
blood (g/dL)
Hematocrit = percent of a sample of whole blood occupied by
intact red blood cells
RBC = millions of red blood cells per microL of whole blood
MCV = Mean corpuscular volume
MCHC = Mean corpuscular Hemoglobin corpuscular
concentration
MCH = Mean corpuscular Hemoglobin
RDW = Red blood cell distribution width
Reticulocyt
Bone marrow Examination:
To know about productivity of erythrocyte .
To know cellularity of sources

Measurements Lab of Anemia

Hemoglobin concentration in grams/deciliter - the RBCs are lysed and the
hemoglobin is measured spectrophotometrically, or ( manual: Sahli)
At birth the normal range is 13.5-20 g/dl
The normal range for males is 13.5-17.5 g/dl
The normal range for females is 12-16 g/dl
Note that the normal ranges may vary slightly depending upon the patient
population.
RBC indices these utilize results of the RBC count, hematocrit, and
hemoglobin to calculate 4 parameters:
Hematocrit (Hct) or packed cell volume in % or (L/L)
At birth the normal range is 42-60% (.42- .60)
The normal range for males is 41-53% (.41-.53)
The normal range for females is 38-46% (.38-.46)
Note that the normal ranges may vary slightly depending upon the patient
population.

Measurements Lab of Anemia

Lab investigation. A complete blood count, CBC, will include:
An RBC count:
At birth the normal range is 3.9-5.9 x 10 6/ul (1012/L)
The normal range for males is 4.5-5.9 x 10 6/ul
The normal range for females is 3.8-5.2 x 10 6/ul
Note that the normal ranges may vary slightly
depending upon the patient population.

Mean corpuscular hemoglobin (MCH) is the average weight of

hemoglobin/cell in picograms (pg= 10-12 g)
Hgb (in g/dl)/RBC(x 1012/L) x 10
At birth the normal range is 31-37
In adults the normal range is 26-34
This is not used much anymore because it does not take into
account the size of the cell.

Measurements Lab of Anemia

Mean corpuscular volume (MCV) is the average volume/RBC in
femtoliters (10-15 L)
Hct (in %)/RBC (x 1012/L) x 10
At birth the normal range is 98-123
In adults the normal range is 80-100
The MCV is used to classify RBCs as:
Normocytic (80-100)
Microcytic (<80)
Macrocytic (>100)

Measurements Lab of Anemia

Mean corpuscular hemoglobin concentration (MCHC) is the
average concentration of hemoglobin in g/dl (or %)
Hgb (in g/dl)/Hct (in %) x 100
At birth the normal range is 30-36
In adults the normal range is 31-37
The MVHC is used to classify RBCs as:
Normochromic (31-37)
Hypochromic (<31)
Some RBCs are called hyperchromic, but they dont really have a
higher than normal hgb concentration, they just have decreased
amount of membrane.

Macrocytic Anemia
Etiologi
1.Megaloblastic anemia, the most common cause of macrocytic anemia
(due to a deficiency of either vitamin B12, folic acid (or both).
Deficiency in folate and/or vitamin B12 (inadequate intake or insufficient
absorption)
Folate deficiency normally does not produce neurological symptoms, while
B12 deficiency does.
2.Pernicious anemia is an autoimmune condition-- decrease intrinsic factor
produced by the parietal cells of the stomach. Intrinsic factor is required to
absorb vitamin B12 from food-- destruction of intrinsic factor --- poor absorption
of vitamin B12.
3. Removal of the functional portion of the stomach--- during gastric bypass
surgery, leading to reduced vit B12/folate absorption.
4. Hypothyroidism
5. Alcoholism , liver Disease coomonly causes a macrocytosis, although not
specifically anemia.
6 Methotrexate, zidovudine, and other drugs that inhibit DNA replication.

Vitamin B12 Deficiency Versus Folate Deficiency

Vitamin B 12
Deficiency

Folate Deficiency

MCV

> 100

> 100

Smear

Macrocytosis with
hypersegmented
neutrophils

Macrocytosis with
hypersegmented
neutrophils

Pernicious anemia

Yes

NO

Homocystine

Elevated

Elevated

Methylmalonic Acid

Elevated

NORMAL

NORMOCYTIC ANEMIA
Normocytic anaemia occurs when the overall hemoglobin
levels decreased, but the red blood cell size (MCV)
remains normal.
Causes :
Acute blood loss
Anemia of chronic disease
Aplastic anemia (bone marrow failure)
Hemolytic anemia
HEINZ BODY ANEMIA
Heinz Bodies are an abnormality that form on the cells in
this condition.
This form of anemia may be brought on by taking certain
medications; acetaminophen (Tylenol).

MICROCYTIC ANEMIA
Microcytic anemia is primarily a result of hemoglobin synthesis failure/insufficiency,
Etiologies:
1.HEME SYNTHESIS DEFECT
Iron deficiency anemia
Anemia of chronic disease (more commonly presenting as normocytic anemia)
2.GLOBIN SYNTHESIS DEFECT
alpha-, and beta-thalassemia
HbE syndrome
HbC syndrome
3.SIDEROBLASTIC DEFECT
Hereditary sideroblastic anemia
Acquired sideroblastic anemia, including lead toxicity
Reversible sideroblastic anemia

Iron-Deficiency Anemia
An iron deficiency inhibits Hb synthesis, leading to hypochromic microcytic
anemia: MCH "26 pg, MCV "70 fL, Hb "11 g/L.
The primary causes are:
blood loss (most common cause); 0.5mg Fe are lost with each mL of blood;
insufficient iron intake or absorption;
increased iron requirement due to growth, pregnancy, breast-feeding, etc.;
decreased iron recycling (due to chronic infection);

Iron-Deficiency Anemia

Clinical Manifestations
Most common: pallor
Second most common: inflammation of the tongue
(glossistis)
Cheilitis=inflammation/fissures of lips
Sensitivity to cold
Weakness and fatigue

Diagnostic Studies
CBC
Iron studies Diagnostics:
Iron levels: Total iron-binding capacity (TIBC), Serum Ferritin.
Endoscopy/Colonscopy

Sources

of

Physical Manifestation :
Spoon Nails in Iron
Deficiency

iron

to
make
hemoglobin
1.iron
supplement
2.
meat
red meat, such as beef or liveras well as chicken, pork, fish, and shellfish.
3.Nonmeat
foods
sources
of
iron
include:
Spinach
and
other
dark
green
leafy
vegetables
Peanuts, peanut butter, and almonds , Eggs ,Peas; lentils; and white, red, and
baked

beans

Measurements of Anemia
Red cell distribution width (RDW) is a measurement of the variation
in RBC cell size
Standard deviation/mean MCV x 100
The range for normal values is 11.5-14.5%
A value > 14.5 means that there is increased variation in cell size
above the normal amount (anisocytosis)
A value < 11.5 means that the RBC population is more uniform in
size than normal.

Measurements Lab of Anemia

Blood smear examination using a Wrights or Giemsa stain. The
smear should be evaluated for the following:
Poikilocytosis describes a variation in the shape of the RBCs. It
is normal to have some variation in shape, but some shapes are
characteristic of a hematologic disorder or malignancy.

Treatment anemia
Goals of Treatment
1.to increase the red blood cell count and/or
hemoglobin level.
2.to treat the underlying condition or cause of the
anemia.

Depends on the type, cause, and severity of the

condition include
1.dietary changes or supplements
2.medicines
3. procedures.

Depends on the type, cause, and severity of the condition include:

1. Dietary Changes or Supplements
Low levels of vitamins or iron in the body can cause some types of anemia---low
levels hb may be due to poor diet or certain diseases or conditions.
Common vitamin supplements are vitamin B12 and folic acid/folate and iron
supplement
2.
Medicines
goal : increase the number of red blood cells and delete underlying cause of anemia.
Some

3.
severe

of

these
medicines
include:
*Antibiotics
to
treat
infections.
*Hormones to treat adult and teenaged women who have heavy
menstrual
bleeding.
*erythropoietin to stimulate body to make more red blood
cells.
*Chelation
therapy
for
lead
poisoning.
anemia

medical

procedure
1.blood
2.blood and marrow stem cells transplants.

Procedures
to
treat
it
transfusions

Cobalamin (Vitamin B12) Deficiency

Clinical manifestations

General symptoms of anemia

Sore tongue
Anorexia
Weakness
Parathesias of the feet and hands
Altered thought processes
Confusion dementia

Diagnostic Studies

RBCs appear large

Abnormal shapes
Structure contributes to erythrocyte
destruction
Schilling Test: a medical investigation
used for patients with vitamin B12
deficiency. The purpose of the test is to
determine if the patient has pernicious
anemia.

VITAMIN B12 ABSORPTION

Mucosal cell

Folic Acid Deficiency

Folic acid, a vitamin found in large amounts in leafy plants, yeast, and liver, is
required for synthesis of the nucleotide base thymine. It is, therefore, essential for
the formation of DNA and thus for normal cell division.
When this vitamin is not present in adequate amounts, impairment of cell
division occurs throughout the body but is most striking in rapidly proliferating cells,
including erythrocyte precursors. Thus, fewer erythrocytes are produced when folic
acid is deficient.

Clinical manifestations are similar to those of cobalamin deficiency

Insidious onset: progress slowly
Absence of neurologic problems
Treated by folate replacement therapy
Encourage patient to eat foods with large amounts of folic acid
Leafy green vegetables
Liver
Mushrooms
Oatmeal
Peanut butter
Red beans

Aplastic Anemia

19/04/2011

Clinical Manifestations
Gradual development
Symptoms caused by suppression of any or all bone marrow
elements
General manifestations of anemia
Fatigue
Dyspnea
Pale skin
Frequent or prolonged infections
Unexplained or easy bruising
Nosebleed and bleeding gums
Prolonged bleeding from cuts
Dizziness
headache

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