1. بسم الله الرحمن الرحيم

2. ANEMIA
Dr Mokarian
ICM
83/2/7

3. PROPERTIES OF THE HUMAN HEMOGLOBINS
Dr mokarian
PROPERTIES OF THE HUMAN HEMOGLOBINS
HEMOGLOBIN STRUCTURE:
1- a tetramer of globin polypeptide chains
A pair of a-like chains 141 amino acids long
A pair of b-like chains 146 amino acids long
HbA( a2b2)
HbF (a2g2)
HbA2 (a2d2)
2-single heme moiety / every globin chain heme=protoporphyrin IX ring +a single iron atom in the ferrous state (Fe2+):
every molecule of hemoglobin can thus transport up to four oxygen molecules

4. PROPERTIES OF THE HUMAN HEMOGLOBINS
Dr mokarian
PROPERTIES OF THE HUMAN HEMOGLOBINS
FUNCTION OF HEMOGLOBIN:
hemoglobin must bind O2 efficiently at the partial pressure of oxygen (PO2) of the alveolus, retain it, and release it to tissues at the PO2 of tissue capillary beds.

5. Dr mokarian

6. HbA has a reasonably high affinity for 2,3-BPG.
Dr mokarian
The Bohr effect arises from the stabilizing action of protons on deoxyhemoglobin, which binds protons more readily than oxyhemoglobin because it is a weaker acid.
HbA has a reasonably high affinity for 2,3-BPG.
HbF does not bind 2,3-BPG, so it tends to have a higher oxygen affinity in vivo.

7. HEMOGLOBIN STRUCTURE:
Dr mokarian
HEMOGLOBIN STRUCTURE:

8. DEVELOPMENTAL BIOLOGY
Dr mokarian
DEVELOPMENTAL BIOLOGY
first appearing at about 6 weeks after conception
HbPortland (z2g2), Hb Gower I (z2e2), and Hb Gower II (a2e2)
At 10 to 11 weeks, fetal hemoglobin (HbF; a2g2) becomes predominant.
The switch to nearly exclusive synthesis of adult hemoglobin (HbA; a2b2) occurs at about 38 weeks
Fetuses and newborns therefore require a-globin but not b-globin for normal gestation.

9. CLINICAL PRESENTATION OF ANEMIA
Anemia is most often recognized by abnormal screening laboratory tests.
the gradual onset of anemia ,particularly in young patients,may not be associated with signs or symptoms until the anemia is severe [Hemoglobin <70 to 80 g/L (7 to 8 g/dL)]
DIFINATION : MALE Hb< Mg/dl
FEMALE Hb< Mg/dl

10. CLINICAL PRESENTATION OF ANEMIA
SYMPTOM:
FATIGUE
SKIN
NEUROLOGIC
CARDIOLOGIC
RESPIRATORY
GASTROINTESTINAL
GUT

11. CLINICAL PRESENTATION OF ANEMIA
SIGN
Weakness
Skin
Neurologic
Cardiovascular
Respiratory
Gastrointestinal
GUT

12. Primary Labortory Test For Anemia
CBC –PLT HB
HCT
RBC
MCV fl HCT(G//L) / RBC (* 1000,000,000,000/L)
MCH PG HB(G/L) /RBC (* ,000,000)
MCHC 30-36G/DL) HB( G/L) / HCT ( L/L)
RDW
WBC & DIF
PERIPHERAL BLOOD SMEAR
RET%
BUN/CR

13. Labortory test for anemia
RETICULOCYTE PRUDUCTION INDEX
(RPI)
RPI=RET%*PHCT/NHCT / SI
HCT
SHIFT INDEX 45 1 35
1.5 25 2 15
2.5

14. EXAMPLE FOR RPI CALCULATION
35 YEARS AGED MALE WITH :
HB=8 G/DL MCV=105 fl RET%=3%
CRC=24 / * 3=1.6
RPI=1.6 / = 0.8

15. IDA
B THAL MIN
MCV
DECREASE
VERY DECREASE
RBC/MCV
<13
>13
RBC
<
>

16. CALCULATTION USED FOR INTERPRETING RBC INDECES IN MICROCYTIC ANEMIA
CALCULATION
IDA
THAL NINOR
MCV-(5*HB)-RBC-3..4
>0
<0
MCV/RBC
>13
<13
MCH/RBC
>3..8
<3.8
RBC
<5000,000
>5000,000
MCH*(MCV)/100
>1530
<1530

17. Labortory test for anemia IRON RESERVE TESTS
SERUM IRON
TIBC
TRANSFERIN SATURATION
FERITIN
FREE ERYTROCYTIC PROTOPURPHIRIN
BMB STAINING

18. Labortory test for anemia EVALUTION FOR HEMOLYSIS
RETICULOCYTE PRODUCTION INDEX
LDH
HAPTOGLUBULIN
HEMOPEXIN
HEMALBUMIN
URIN HEMOCIDERIN
HEMOGLUBINUREA

19. APPROUCH TO ANEMIA RPI LOW RPI INCREASED RPI <2 > OR = 2
MCV HEMOLYTIC ANEMIA POST TREATMENT
DECREASED NORMAL INCREASED
FE TIBC FERITIN MEGALOBLASTIC ANEMIA
IDA NO IDA & MDS
HB ELECTEROPHERESIS & AA
R/O ANEMIA OF CHRONIC DISEASE

20. 36 YRS MALE WITH ANEMIA
HB=12 MCV=65 RBC = MCH=23
28 FEMALE WITH ANEMIA
HB=9 MCV=76 RBC=
14 YRS BOY
HB=7 MCV=108 RET=15% RBC=