Anaemia

Definition decreased haemoglobin concentration a decrease in normal number of red blood cells decreased haematocrit

Classification Mechanism –decreased production of Ery –increased destruction or loss of Ery –combined Size of red blood cells (MCV) –microcytic – i.e. iron deficiency anaemia –normocytic – i.e. haemolytic anaemia –macrocytic - megaloblastic anaemia Hb concentration in Ery (MCH) –hypochromic –normochromic –hyperchromic

Classification according to mechanism Decreased production of Ery –Iron deficiency anaemia (  synthesis of haem) –Sideroblastic anaemia (defect of heam synthesis) –Megaloblastic anaemia (  synthesis of DNA) Pernicious anaemia –Aplastic anaemia (defect of erythropoesis) –Anaemia of chronic diseases - inflammatory, kidney, endocrinology, liver (inhibition of erythropoesis) –Sicle cell anaemia, talasemia (defect of globin synthesis)

Increased destruction or loss of Ery –Posthemoragic anaemia chronic bleeding (menstruation, gastric ulcers...) –Hemolytic anaemia Congenital –Genetic conditions of RBC Membrane »Hereditary spherocytosis »Hereditary elliptocytosis –Genetic RBC enzyme defects »G6PD deficiency »Pyruvate kinase deficiency –Haemoglobinopathies »Sicle cell anaemia »Thalasemia

Spherocytes Eliptocytes Sicle cells

Glucose-6-phosphate dehydrogenase deficiency Favism Cause gene mutation (X linked) Manifestation after: foods (beans) drugs infection Effect oxidative stress  haemolysis

–Hemolytic anaemia Acquired –Immune mediated hemolytic anemia »Autoimmune hemolytic anemia »Warm (Cold) antibody autoimmune hemolytic anemia »Rh diesease »ABO hemolytic disease in newborn »Blood tranfusion reactions –Non-immune mediated hemolytic anaemia »Toxins (snake venom) »Trauma »Mechanical (heart valeves defects) »Infections »Membrane disorders (Paroxysmal nocturnal heamoglobinuria)

Combined –Talasemia –Sicle cell anaemia

Diagnosis haemoglobinmen g/lwomen g/l haematocritmen0,40 - 0,54women0,35 - 0,45 RBC countmen4,2 - 5,8 x /lwomen3,8 - 5,2 x /l Mean corpuscular volume (MCV) MCV = Htk/RBC count norm fl < 80 fl - microcytosis (i.e. iron def. anaemia) > 95 fl – macrocytosis (i.e. megaloblastic anaemia) Mean corpuscular Hb (MCH) MCH = Hb/RBC count norm pg < 27 pg - hypochromia > 32 pg - hyperchromia Mean corpuscular Hb concentration (MCHC) MCHC = Hb/Htk norm g/l < 320 g l - hypochromia Other tests: Erythrocyte sedimentation rate, ferritin, serum iron, total iron binding capacity, transferrin, folate level, serum vitamin B 12...)

Signs and symptoms decreased oxygen tranportation –dyspnea, fatique, lethargy, pale skin, mucosa, nail beds, angina pectoris (in patients with preexisting heart disease) decreased plasma volume –postural hypotension increased heart output –palpitations, murmurs, tachycardia Specific signs –jaundice – haemolytic anaemia –koilonychia – iron deficiency –pica (the consumption of non-food based items such as dirt, paper, wax, grass...) - iron deficiency

koilonychia clubbed fingernails

Iron deficiency anaemia – sideropenic anaemia Causes –dietary insuficiency (vegetarians) –malabsorption –chronic blood loss –loss of blood in the stool... Symptoms hypochromic, microcytic anaemia fatique, pale skin, tachycardia poor apetite, constipation, hair loss, nail deformities gingivitis, glossitis, gastritis

Sideroblastic anaemia hypochromic anaemia disorder of heme synthesis hereditary  -amino-levulinic acid synthetase deficiency acquired –lead intoxication –ethanol –inflammation –chemotherapy sideroblastic anaemia

Megaloblastic anaemia macrocytic anaemia Disorder of DNA synthesis deficiency of B 12 vitamine deficiency of folic acid after some drug application enzymopathies – rare Symptoms general GIT - glositis, anorexia, diarrhea neurological – disorders of sensitivity, parestesia, ataxia

Megaloblastic anaemia Cobalamin deficiency inadequate intake (vegetarians) malabsorption deficient intrinsic factor (athrophic gastritis) –Pernicious anaemia resorption disorders (after gastric surgery) biological competition –bacteria, parasites Folate deficiency inadequate intake alcoholism malabsorption increased need (pregnancy, infancy)

Aplastic anaemia inadequate red cell production (or all blood cells – pancytopenia) in bone marrow Cause idiopathic autoimmune disorder drugs ionizing radiation Symptoms general thrombocytopenia – bruising, petechiae leukopenia – risk of infection

Oral signs of anemia Oral leukoplakia in aplastic anemia Cheilosis