Lecturer /Sulaimani College of Medicine/ Dept.of Pathology

Slides:



Advertisements
Similar presentations
Anemia Introduction Dr. Sachin Kale, MD.
Advertisements

HEMATOLOGY WHAT IT IS : Study & measurement of individual elements of Blood. WHAT IT’S COMPOSED OF. SHOW SLIDES FROM PERIPHERAL BLOOD TUTOR CD OR USE PLATE.
Approach to Anemia - Summary
Clinical pathology department SCU
Anemia Dr. Meg-angela Christi M. Amores. What is Hematopoeisis? It is the process by which the formed elements of the blood are produced Erythropoeisis:
ANEMIA DEFINITION & CLASSIFICATION
Lecture – 3 Dr. Zahoor Ali Shaikh
MLAB Hematology Keri Brophy-Martinez
Red Cells Prof. K. Sivapalan. June 2013Red Cells2 ERYTHROCYTE- RBC Biconcave disc. 7.2 μ x 2.2 μ No nucleus. PCV – 45, 35 % Hb% - –14.5 g/dL. - Males,
Differential diagnosis of Anemia:
Course title: Hematology (1) Course code: MLHE-201 Supervisor: Prof. Dr Magda Sultan Outcome : The student will know : -The types of hemolytic anemias.
ANEMIA. Functions of erythrocytes Transport of respiratory gases Large surface area : volume ratio Flexible biconcave disc Haemoglobin for exchange of.
Introduction to Hemolytic Anemias
Laboratory diagnosis of Anemia
Physiology Presentation Roll No.# 218, 224, 230, 236, 242, 248 Muhammad Mohsin Ali Dynamo.
Anaemia By Jeeves.
INTRODUCTION TO ANEMIA Definition. Age, Sex and other factors. Causes of Anemia. Clinical diagnosis. Classification of Anemia. Laboratory Tests in the.
Laboratory diagnosis of Anemia
 The term is derived from ancient Greek ” bloodlessness “it is defined as a low haemoglobin concentration that is below the normal range appropriate.
Introduction to Haematology! Elliot Catchpole PCMD Starting with anaemias!
Anaemia. Definition decreased haemoglobin concentration a decrease in normal number of red blood cells decreased haematocrit.
Course title: Hematology (1) Course code: MLHE-201 Supervisor: Prof
Hemolytic Anemias Defined as those anemias result from an increased in the rate of red cell destruction. The red cell destruction is usually removed extravascular.
Course title : Hematology (1)
MLAB 1415-Hematology Keri Brophy-Martinez Chapter 14: Introduction to Hemolytic Anemias.
1 Approach to Anemia in Children Dr.Hekmati Moghaddam.
Lecture 2 Red Blood Cells, Anemias & Polycythemias
Haematology Group C Wedyan Meshreky Helen Naguib Sharon Naguib.
Hemolytic anemia Excessive destruction of red cells Acute Hemolytic anemia Chronic Hemolytic anemia Congenita l Acquired : Immune Non-immune.
Anemias-continuation
Haemolytic anaemias Dr. Suhair Abbas Ahmed.
Erythrocytic Morphology and Associated Diseases(Size and Shape)
Laboratory evaluation of erythrocyte RBC Haemoglobin Packed cell volume MCV MCH MCHC RDW Reticulocyte Blood film Quantitative description of erythropoiesis.
Nada Mohamed Ahmed , MD, MT (ASCP)i
Acquired haemolytic anaemias
Hemolytic anemias.
 The term is derived from ancient Greek ” bloodlessness “it is defined as a low haemoglobin concentration that is below the normal range appropriate.
بسم الله الرحمن الرحيم.
HEMOLYTIC ANEMIAS.
Hemtology Lecture 10. Definition the study of blood, the blood-forming organs, and blood diseases. Hematology includes Etiology Diagnosis Treatment Prognosis.
ERYTHROCYTE II (Anemia Polycythemia)
CLASSIFICATION OF ANEMIA
Red Cell Turnover and Life Span 2.5 million red cells are removed from the circulation every second. BM produces 200 billion new red cells (reticulocytes)
HEMOLYTIC DESORDERS Red Cell Turnover and Life Span 2.5 million red cells are removed from the circulation every second. BM produces 200 billion new red.
Diagnostic Approaches To Anemia 1. Is the patient anemic ? 2. How severe is the anemia ? 3. What type of anemia ? 4. Why is the patient anemic? 5. What.
Approach to Anemia Sadie T. Velásquez, M.D.. Objectives.
Anemia Presented by M.A. Kaeser, DC Fall 2009
Nada Mohamed Ahmed, MD, MT (ASCP)i. Objectives Intoduction Definition Classification Intravascular &extra vascular hemolysis Signs of hemolytic anemias.
Anaemias Polycythaemia.
AN APPROACH TO THE ANEMIC PATIENT. Prevalence and causes of anemia world-wide Blood 2014;123:615 Us More common in women Iron deficiency most common cause.
MLAB Hematology Keri Brophy-Martinez
Classification of Anaemia
1 COLLEGE OF HEALTH SCIENCES, DEPARTMENT OF BIOMEDICAL LABORATORY SCIENCE Chapter 20. Erythrocytic disorders.
MLAB Hematology Keri Brophy-Martinez
MLAB Hematology Keri Brophy-Martinez
ANAEMIA- BASIC ASPECTS
Introduction To Medical Technology
AN INTERESTING AUTOMATED HEMOGRAM FOR DISCUSSION
Dr. M. A Sofi MD; FRCP (London); FRCEdin; FRCSEdin
Anemia By: Dr Sunita Mittal.
HEMOLYTIC DISORDERS Red Cell Turnover and Life Span 2.5 million red cells are removed from the circulation every second. BM produces 200 billion new.
Objective To know different hematological diseases. To study the pathology of different hematological disorders.
Dr. M. A Sofi MD; FRCP (London); FRCEdin; FRCSEdin
MLAB 1415-Hematology Keri Brophy-Martinez
CLASSIFICATION OF ANEMIAS
Approach to Haemolysis
Anemia March ,12,2019.
CLASSIFICATION OF ANAEMIA By GEORGE. CLASSIFICATION OF ANAEMIA.
RED BLOOD CELLS (RBCs) Prof. Dr. Salwa Saad.
Presentation transcript:

Lecturer /Sulaimani College of Medicine/ Dept.of Pathology Anemia Dr.Sana Delawer Jalal Lecturer /Sulaimani College of Medicine/ Dept.of Pathology M.B.Ch.B, F.I.C.M.S.

Red Cell Indices Mean Cell Volume (MCV) It is calculated from PCV and red cell count as follows: MCV = PCV/RBC ( fl) Normal value: 80-95 fl It decrease in iron deficiency anaemia and haemoglopinopathies It is increase in megaloblastic anaemia and chronic haemolytic anemia

Mean Cell Haemoglobin Concentration (MCHC) It is calculated from the haemoglobin and PCV as follows: MCHC = Hb/PCV g/dl Normal value: 32-35.5 g/dl It is usually decreased in iron deficiency anaemia (microcytic hypochromic anaemia)

Mean Cell Haemoglobin (MCH) It is calculated from the haemoglobin and erythrocyte count as follows: MCH = Hbx10/RBC pg Normal value: 27-32 pg It is decrease in iron deficiency anemia and thalassaemia (microcytic hypochromic anemia) It is recognized by the pale colour of the red cell in the peripheral blood film It is increase in macrocytic anemia (vitamin B 12 and folic acid)

Red Cell Distribution width (RDW) RDW reflects the variation of RBCs volume it is usually performed by modern analysers Normal RDW varies between 12 to 17 Severe iron deficiency anemia is associated with increased RDW Thalassemia and anemia of chronic disease are associated with normal RDW

Definition Anemia is a decrease in the number of RBCs, Hb content, or Hematocrit below the lower limit of the normal range for the age and sex of the individual In adults, the lower extreme of the normal haemoglobin is taken as 13.0 g/ dl for males and 11.5 g/dl for female Newborn infants have higher haemoglobin level and, therefore, 15 g/dl is taken as the lower limit at birth

Classification of Anemia Several types of classifications of anemia's have been proposed Two of the widely accepted classifications are based on : The pathophysiology The morphology

The Pathophysiological Classification Depending upon the pathophysiologic mechanism, anemias are classified into 3 groups: I. Anemia due to increased blood loss. II. Anemias due to impaired red cell production. III. Anemias due to increased red cell destruction .(Haemolytic )

The Morphological Classification Based on: Red cell size, Haemoglobin content Red cell indices Anaemias are classified into 3 types: I. Microcytic, hypochromic II. Normocytic, normochromic III. Macrocytic, normochromic

Simplified Classification Of Anemias 1. Deficiency anemias 2. Aplastic anemia 3. Hemolytic anemias 4. Secondary anemias

The Pathophysiological Classification

Impaired Red Cell Production A. Disturbance of proliferation and differentiation of stem cells ( aplastic anemia, pure red cell aplasia) B. Disturbance of proliferation and maturation of erythrocytes: 1.Defective DNA synthesis (megaloblastic anemias) 2.Defective Hb synthesis: a/. Deficient heme synthesis (iron deficiency) b/. .Deficient globin synthesis (thalassemia) 3. Unknown or multiple mechanisms (anemia of chronic disease, anemia of marrow replacement)

Increased Rate Of Destruction Intrinsic abnormalities Hereditary 1. Red cell membrane defects (Hereditary spherocytosis, Hereditary eliptocytosis) 2. Red cell enzyme deficiencies a/. Glycolytic enzymes: pyruvate kinase, hexokinase b/. Enzymes of hexose monophosphate shunt: G-6PD, glutathione synthetase. 3. Disorders of globin synthesis a/. Deficient globin synthesis (thalassemia) b/. Structurally abnormal globin synthesis (sickle cell anemia, unstable hemoglobins) Acquired 1. Membrane defect: paroxysmal nocturnal hemoglobinuria

Increased Destruction Extrinsic Abnormalities 1. Antibody Mediated a/. Autoantibodies (idiopathic, drug-associated, SLE, malignancies) b/. Alloantibodies (transfusion reactions, erythroblastosis fetalis) 2. Mechanical Trauma of RBCs a/. Microangiopathic hemolytic anemias (thrombotic thrombocytopenic purpura,hemolytic –uremic syndrome ) b/. Cardiac traumatic hemolytic anemia 3. Chemicals and Micro organisms 4. Sequestration in mononuclear phagocytic system - hypersplenism

Morphologic Classification Of Anemias Type MCV MCHC Common cause ____________________________________________________ Macrocytic anemia increased normal Vitamin B12 deficiency Folic acid deficiency Microcytic anemia - hypochromic decreased decreased Iron deficiency Thalassemia - normochromic decreased normal Spherocytosis or normal Normocytic anemia normal normal Aplastic anemia - normochromic Chronic renal failure Some hemolytic anemia

Classification of anemias using MCV

Thalassemia Microcytic Anemia MCV<80 fl Iron Deficiency Sideroblastic Anemia Thalassemia Microcytic Anemia MCV<80 fl Anemia of Chronic Disorder Lead Poisoning

Reduced Erythropoiesis Stem cells defects/ Reduced Erythropoiesis Normocytic Anemias 80-95 fl Intrinsic Extrinsic Hemolytic Anemias Extrinsic Causes Intrinsic Defects

Drugs Myelodysplastic Alcoholism syndrome Macrocytic Anemias Megaloblastic anemia Macrocytic Anemias MCV> 95 fl Hypothyrodisim Liver Disease Drugs

Hypochromic Microcytic

Normochromic Normocytic

Laboratory Investigation Anemia is not a diagnosis, but a sign of underlying disease The objective of the laboratory is to : determine the type of anemia as an aid in discovering the cause

Laboratory Investigation-cont. Screening is usually done with the CBC or "complete blood count" Most laboratories now use automated, multiparameter instruments which will provide results for the following parameters: Hemoglobin Hematocrit Red cell count MCV , MCH ,MCHC RDW White cell and platelet count Differentia WBC count. l

Laboratory Investigation of Hemolytic anemia These are dividing into 4 groups: I-Tests show increased red cell breakdown II- Tests show increased red cell production III- Tests show damage to red cells IV- Tests show shortened red cell life span

Tests Show Increased Red Cells Breakdown Serum bilirubin-unconjugated (indirect)bilirubin is raised Urine Urobilinogen is raised Faecal Stercobilinogen is raised Serum haptoglobin ( α globulin binding protein) is reduced or absent Plasma lactic acid dehydrogenase is raised Evidence of intravascular haemolysis in the form of haemoglobinaemia, haemoglobinuria, haemosiderinuria

Tests Show Increased Red Cells Production. Reticulocyte count reveals reticulocytosis which indicate marrow erythroid hyperplasia Routine blood film shows macrocytosis, polychromasia, and normoblasts Bone marrow show erythroid hyperplasia X ray of bones shows evidence of expansion of marrow spaces especially in tubular bones and skull

Tests Revealing Damages To RBCs Routine blood film shows a variety of abnormal morphological appearances of red cells Osmotic fragility is increased Autohaemolysis test Coomb's antiglobulin test Electrophoresis for abnormal haemoglobin Estimation of HbA2

Tests Show Shortened Red Cell Life Span Tested by Cr51 labeling method normal RBC life span of 120 days is shortened to 20-40 days in moderate haemolysis and 5-20 days in severe haemolysis

Special Investigations Biochemical Tests biochemical tests are aimed to identifying: 1-Depleted cofactors necessary for normal hematopoiesis (iron, ferritin, folate, B12). 2-Abnormally functioning enzyme (glucose-6-phosphate dehydrogenase, pyruvate kinase), or 3-Abnormal function of the immune system (the direct antiglobulin [Coombs'] test).

Thank you