Anemia

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Anemia

• Presented by M.A. Kaeser, DC
• Fall 2009

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Definition

• Reduction in hemoglobin and hematocrit values
  below the normal range

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Signs and Symptoms

• Fatigue
• Dyspnea
• Pallor
• Tachycardia
• Degree of symptomatology depends on magnitude and
  rapidity of fall, adequacy of physiologic
  corrective mechanisms and presence of associated
  diseases

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Diagnostic Classification System

• Types of anemia
• Microcytic hypochromic
• Macrocytic
• Normochromic normocytic

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Microcytic Hypochromic

• Causes impairment of hemoglobin synthesis
  within the developing RBC which leads to
  hypochromic cells due to decreased hemoglobin and
  smaller than normal cells due to an increase in
  cell division
• Examples
• Iron deficiency lack of total body iron
• Thalassemia production of globin is impaired
• Sideroblastic production of porphyrin is
  impaired
• Remember hemoglobin consists of heme moieties
  attached to a globin molecule the heme moiety
  consists of iron attached to a porphyrin if the
  RBC lacks iron or cant synthesize the porphyrin
  or the globin properly, it cant produce
  hemoglobin
• Index
• Low MCV (Mean corpuscular volume) and MCHC (Mean
  corpuscular hemoglobin concentration)

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Iron Deficiency Anemia

• Can be confirmed by TIBC (total iron binding
  capacity)
• Also confirmed by trial of iron therapy
• Should increase the reticulocyte count within
  approx. 4 days
• Causes
• Pregnancy insufficient dietary iron to supply
  the rapidly expanding red cell mass as iron
  shifts to the fetus
• Dietary deficiency is extremely rare except in
  children under 4 years
• Menstrual blood loss (M/C cause) with flow in
  excess of 100 mL
• GI bleeding postmenopausal women and adult
  males
• Malabsorption

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Thalassemia

• A low MCV (mean corpuscular volume) coupled with
  a normal serum iron level
• Thalassemia major is rare
• Thalassemia minor is relatively common
• Cause
• Defective synthesis of the globin molecule

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Sideroblastic Anemia

• Least common microcytic hypochromic anemia
• Porphyrin synthesis is deficient and iron
  accumulates within the mitochondria
• May occur as a rare congenital disorder, acquired
  idiopathic bone marrow disorder or in association
  with alcoholism, lead poisoning, isoniazid
  therapy, RA, carcinoma and other disorders

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Macrocytic

• Causes
• Megaloblastic
• B12 deficiency
• Folate deficiency
• Chemotherapy
• Normoblastic (nonmegaloblastic)
• Some hemolytic and acute blood loss anemia due to
  increased reticulocytosis
• Liver disease
• Hypothyroidism
• Index
• Increased MCV above 100

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Megaloblastic Macrocytic Anemia

• Impaired maturation of the nucleus
• B12 deficiency
• Daily requirement is 1 mg
• Body stores large amounts
• Available in all animal foods (including dairy
  products)
• Takes 3 - 4 years to exhaust the bodys stored
  supple
• Malabsorption is M/C reason for deficiency
• Pernicious anemia-atrophic gastritis diminishes
  production of intrinsic factor and causes
  malabsorption of B12
• Sprue, regional enteritis, disease of the
  terminal ileum, fish-tapeworm infestation, blind
  loop syndrome
• Shilling Test detects vitamin B12 malabsorption
• Folic acid deficiency
• More common than B12 deficiency
• Sources are green vegetables and liver
• Exhausted in 2 3 months
• Common in malnourished individuals and alcoholics

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Normoblastic Macrocytic Anemia

• Mild degrees of macrocytosis are associated with
  this group
• Liver disease
• Hypothyroidism
• Aplastic anemia
• Refractory anemia

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Normochromic Normocytic-Underproduction

• Causes
• Chronic disease
• Renal failure
• Liver disease
• Hypothyroidism
• Myelophthisic anemia-due to replacement of marrow
  by malignant lesions or by myelofibrosis
• Aplastic anemia-increase in cellular elements in
  the bone marrow and increased fat in the bone
  marrow
• Refractory anemia-bone marrow is hyperplastic
  with failure of cells to mature properly and
  subsequently die- sometimes represents
  preleukemic states
• Index
• Normal or low reticulocyte count

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Normochromic Normocytic-Increased Red Cell
Destruction (Hemolysis)

• Causes
• Hereditary hemolytic anemias
• Acquired hemolytic anemias
• Index
• Elevated reticulocyte count

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Hereditary Hemolytic Anemias

• M/C is hemoglobinapathies
• Abnormal hemoglobins, S and C
• M/C in blacks
• Sickle cell anemia homozygous SS disease
• Milder sickle cell anemia heterozygous SC
  disease
• Hereditary Spherocytosis
• Severe to mild anemia
• Splenomegaly
• Hereditary Nonspherocytic hemolytic anemia
• Due to red cell enzyme deficiencies
• G6PD (glucose-6-phosphate dehydrogenase)
  deficiency and pyruvate kinase deficiency

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Acquired Hemolytic Anemias

• Hypersplenism
• Splenic hyperfunction
• Coombs-positive anemia
• Microangiopathic hemolytic anemia
• Large numbers of red cell fragments
  (schistocytes)
• Causes collagen vascular disease, disseminated
  intravascular coagulation, kidney desease assoc.
  with malignant hypertension
• Paroxysmal nocturnal hemoglobinuria