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Anemias (part 1)

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on 4 December 2013

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Transcript of Anemias (part 1)

Anemias


Anemia: definition & mechanisms
What is anemia?
Mechanisms
Explained by erythropoiesis

Occurs in the bone marrow

Stimulus for erythropoiesis?

“RBCs lost must be replaced” ineffective ?

Purpose of erythropoiesis?

insufficient?
Clinical & Laboratory Findings
> Medical History & Physical Examination
Signs and Symptoms (regardless of etiology)
INTEGUMENTARY
RESPIRATORY
NEUROMUSCULAR
GASTROINTESTINAL
GENITOURINARY
METABOLIC
OTHER SIGNS
SUMMARY
Anemia: manifest as consequence of underlying condition

Values depend on age, gender, race under similar environmental condition

Evaluation depend on clinical & laboratory findings

Anemia classification may be based on:
A. lab parameters: ARC,MCV, RDW
B. Pathophysiology

Joy P. Calayo, RMT, MSMT
Decrease in O2 – carrying capacity of blood
Hb non-functional
Hb too little
Reduction from baseline value of:
Total RBC count
Red cell mass
Amount of circulating Hb
Baseline values may vary
Subsequent hypoxia results

Physiological adaptations
Slowly developing anemia:
Relatively symptomatic in chronic conditions

EPO production
More rapid delivery of blood w/ low O2 content
HR, RR, CO

In persistent & marked anemia-- heart failure
In tissue hypoxia: increased 2,3-BPG


R shift of the O2-Hb dissociation curve
Lab Findings
CBC
RDW
Reticulocyte count (absolute, relative)
PBS examination
BM examination

Other tests: Se iron, TIBC, Se Ferritin, Folate, Vit. B12, DAT, Hb electrophoresis

Based on clinical and lab findings
Evaluation of Anemia
What other tests can be performed to evaluate anemia??
Basis: ARC & MCV
A. LOW Absolute reticulocyte count
Decreased RBC production
Classification based on MCV:
Low (microcytic)
Normal (normocytic)
High (macrocytic)

see p. 226
see p. 228 Fig. 18-3
Basis: ARC & MCV
B. HIGH Absolute reticulocyte count
Classification based on shortened RBC survival
Hemolytic (various causes*)
Acute blood loss

Hemolytic anemias: causes
Immune-mediated (perform DAT)
Membrane defects
Hemoglobinopathies
RBC enzyme deficiencies
Infections
Intravascular destruction (microangiopathic HA)

Basis: MCV & RDW
* Low MCV,
Normal
RDW
Microcytic homogenous
Heterozygous thalassemia
Chronic inflammation

*Low MCV,
High
RDW
Microcytic heterogenous
IDA
S-Beta thalassemia
Hb H
RBC fragmentation
Basis: MCV & RDW
*Normal MCV, Normal RDW
Normocytic homogenous
Chronic inflammation (e.g., RA)
Non-anemic hemoglobinopathy (e.g. AS, AC)
Transfusion
Chemotherapy
Hemorrhage
Hereditary spherocytosis

Basis: MCV & RDW
*Normal MCV, High RDW
Normocytic heterogenous
Mixed deficiency
Early Fe or Folate deficiency
Anemic hemoglobinopathy (e.g., SS, SC)
Myelofibrosis
Sideroblastic

Basis: MCV & RDW
*High MCV, Normal RDW
Macrocytic homogenous
Aplastic anemia

*High MCV, High RDW
Macrocytic heterogenous
Folate deficiency
Vit. B12 deficiency
Reticulocytosis
Cold agglutinins
MDS
Pathophysiologic Classification
*Anemia caused by decreased RBC production

*Anemia caused by increased RBC destruction or loss (HA)

*Intracorposcular abnormality (Intrinsic)

*Extracorposcular abnormality (Extrinsic)

See p. 229

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