Anemia defisiensi

DR. EIFEL FAHERI,SPPD-KHOM

 ANEMIA

 Kriteria WHO
 Ringan

 Sedang

 Berat

 Hemoglobin : Hem + Globin

 OxyHb

 CarboxyHB

 MetHB
 HEMOGLOBIN AND HEMATOCRIT

► On basis of H&H, anemia can be classified as mild, moderate,

or severe.

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► On basis of duration of onset, anemia can be classified as
either chronic or acute.
► Rules of Three:
 RBC X 3 = Hemoglobin
 Hemoglobin X 3 = Hematocrit
► Ratio ofHb and Hct will vary with cause of anemia and affect
the RBC indices, particularly the MCV (Mean Corpuscular
Volume).
► Microscopic examination of peripheral blood smear is
required for evaluation of anemia. Bone marrow aspirates
and smear evaluation may also be needed.
MECHANISMS OF ANEMIA
 KLASIFIKASI ANEMIA

Quantitative
Clinical - Hematocrit
Blood loss - Hemoglobin

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Functional - Blood cell indices
- Decreased RBC Iron deficiency
Hemolysis - Reticulocyte count
production
- Increased RBC destruction Infection
- Combination of the two Nutritional deficiency
Metastatic BM replacement

Morphological
- Normochromic Normocytic
- Hypochromic Microcytic
- Normochromic Microcytic
- Normochromic Macrocytic
 KLASIFIKASI FUNGSIONAL ANEMIA
Anemia

Hipoproliferatif Gangguan maturasi Hemolitik

Marrow damage Defek sitoplasma Blood loss

-Thalassemia

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-Defisiensi besi
Hemolisis intravasculer
-Sideroblastik
Defisiensi Fe
Peny Autoimun
Defek maturasi inti sel
-Def asam folat Hb pathy
Stimulasi -Def vit B12
-Peny Ginjal -Anemia refrakter
-Inflamasi Defek membran
-Penyakit metabolik
ANEMIA DEFISIENSI

 Defisiensi besi
 Defisiensi asam folat
 Defisiensi vitamin B12
 Defisiensi G6PD
 DFISIENSI ASAM FOLAT DAN VITAMIN B
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 Penyebab utama anemia makrositik
 Sintesis DNA

 High turnover tissue  sumsum tulang

 Defisiensi  SST terganggu menganggu proses

diferensiasi sel darah merah dari awal (precursor),
pembelahan sel tidak lengkap (uncomplete).

in effective erythropoiesis

macrocytic red blood cell
JALUR METABOLIK ASAM FOLAT DAN
VITAMIN B12
ABSORBSI DAN TRANSPORT VITAMIN B12 DI
JARINGAN
 ANEMIA MIKROSITIK HIPOKROM

 Diagnostic:
 volumeerytrocyte (VER) < 80 fL and/or
 hemoglobin (HER) ≤ 27 pg/dL.
 etiology:
 Ineffective
iron metabolism
 Abnormal hemoglobin
 hemoglobinopati,
JALUR TRANSPORT BESI
ETIOLOGI DEFISIENSI BESI
FLOW CHART ANEMIA MIKROSITIK
HIPOKROM
Anemia
MCV<80fl &/or MCH ≤ 27 pg/dL

Indeks retikulosit <10‰ Indeks retikulosit 10-15‰ Indeks retikulosit >15‰

SI/IBC, Transferin, Feritin Elektroforesis hemoglobin

Normal Abnormal
Normal/Tinggi Defisiensi Fe

Dalam terapi Fe ? Hemoglobinopati

BMP Pasokan, Absorpsi ?

Hemolitik ? Thalasemia
Gangguan metabolisme Fe

Mielodisplasia (MDS)

Anemia of Chronic Diseases (ACD)

 DEFISIENSI G6PD
 G6PD ( glucosa 6 phospat dehydrogenase)
 Sel darah merah  enzim

 Enzim  mengkatalisis reaksi katabolisme :

metabolisme Karbohidrat
 2 jalur metabolisme :

- glikolisis (memasok energi)

- Hexose monophosphat shunt (HMS)  MetHb
 G6PD menghasilkan NADPH (niacin adenin
dinucleotide phosphat)
DIAGNOSIS

► Histori dari pasien

► Pemeriksaan fisik

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► Profil hematologi (CBC).

► Tanda dan gejala tidak spesifik : fatigue, weakness,

gastrointestinal symptoms (nausea, constipation and
diarrhea), sesak nafas terutama saat aktifitas
GEJALA DAN TANDA UMUM ANEMIA

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LABORATORIUM
► Hematologi lengkap
- retikulosit, MCV,MCH,MCHC, Eritrosit
RDW, Ht
► Gambaran darah tepi

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► SI/TIBC/Feritin

► Coomb’s test

► Ureum,kreatinin,SGOT,SGPT,Alb/Glob

► HbsAg, Anti HCV,HIV,ANA,helicobacter pylori

PEMERIKSAAN TAMBAHAN
► Saturasi transferin
► Bone marrow punction

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► Bone marrow biopsy

► USG Abdomen

► X-Ray

► Tes darah samar

► Elektroforesa HB
MCV

► Mean cell volume

► MCV is average size of RBC

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► MCV = Hct x 10
RBC (millions)
► If 80-100 fL, normal range, RBCs considered
normocytic
► If < 80 fL are microcytic
► If > 100 fL are macrocytic
► Not reliable when have marked anisocytosis
MCH

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► MCH is average weight of hemoglobin per RBC.
► MCH = Hgb x 10
RBC (millions)
MCHC
► MCHC is average hemoglobin concentration per RBC
► MCHC = Hgb x 100

Hct (%)

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► If MCHC is normal, cell described as normochromic
► If MCHC is less than normal, cell described as
hypochromic
► There are no hyperchromic RBCs
RDW

► Most automated instruments now provide an RBC

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Distribution Width (RDW)
► An index of RBC size variation

► May be used to quantitate the amount of anisocytosis on

peripheral blood smear
► Normal range is 11.5% to 14.5% for both men and women
NORMALS

COMPONENT NORMAL RANGES

WBC 4.8-10.8 x 103/μL
RBC Male 4.7-6.1 x 106/μL; Female 4.2-5.4 x 106/μL
Hgb Male 14-18 g/dL; Female 12-16 g/dL
Hct Male 42-52%; Female 37-47%
MCV 80-100 fL
MCH 27-31 pg
MCHC 32-36%
RDW 11.5-14.5%
Plt 150,000-350,000/μL
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Retic 0.5-2.0%
 RETIKULOSIT

Hitung Retikulosit
 Rasio retikulosit = Hitung Eritrosit
x 1000 ‰
 Indeks/koreksi retikulosit (Normal: 5-15 ‰.);
Ht
Pria : 42 x Rasio retikulosit
Ht
Wanita : 39 x Rasio retikulosit

Rasio Retikulosit (‰)

Hb Ht Pria Wanita
18 54 4.0 – 11.8 3.6 – 11.0
17 51 4.2 – 12.5 3.9 – 11.7
16 48 4.4 – 13.2 4.1 – 12.4
15 45 4.7 – 14.1 4.4 – 13.1
14 42 5.0 – 15.0 4.7 – 14.0
13 39 5.4 – 16.1 5.0 – 15.0
12 36 5.8 – 17.3 5.4 – 16.2
11 33 6.3 – 18.8 5.8 – 17.5
10 30 6.8 – 20.5 6.4 – 19.1
 MENTZER INDEX

MI  MCV
E

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MCV<80fL Thalasemia trait Def.Fe; Reutilisasi Fe Utilisasi Fe

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MCV≥80fL Def.Fe; Reutilisasi Fe Utilisasi Fe
 TREATMENT

 Blood Transfusion
 Iron suplemen

 Asam folat dan Vitamin B12

 Atasi Penyakit dasar

THANK YOU