2. Anemia

3. Anemia means deficiency of hemoglobin in blood either due to few RBCs in blood or too little hemoglobin in the cells.

4. Anemia
anemia is a functional inability of the blood to supply the tissue with adequate O2 for proper metabolic function.
anemia is not a disease, but rather the expression of an underlying disorder or disease.

5. Anemia Quantitative and/or qualitative deficiency of RBC ↓ No of RBCs
↓ Amount of Hb
↓ O2 carrying capacity

6. Anemia Anemia may develop:
When RBC loss or destruction exceeds the maximal capacity of bone marrow RBC production
When bone marrow production is impaired

7. Anemia
Various diseases and disorders are associated with anemia include:
Nutritional deficiencies
External or internal blood loss
Increased destruction of RBCs
Ineffective or decreased production of RBCs
Abnormal hemoglobin synthesis
Bone marrow suppression by toxins, chemicals, radiation, Infection
Bone marrow replacement by malignant cells

8. Normal RBCs

9. Types of Anemia Blood loss anemia Aplastic anemia Megaloblastic anemia
Hemolytic anemia

10. Classification of Anemia
Nutritional anemia
Pernicious anemia
Aplastic anemia
Renal anemia
Blood loss anemia
Hemolytic anemia
Congenital anemia

11. Classification of anemias
Anemias may be classified morphologically based on the average size of the cells and the hemoglobin concentration into:
Macrocytic
Normochromic, normocytic
Hypochromic, microcytic

12. Nutritional Anemia Iron deficiency anemia ↓ intake of iron
↓ absorption of iron
Chronic blood loss
↑ demand of iron (e.g. pregnancy)
No of cells may be normal
↓ iron → ↓ Hb → ↓ size of cells (microcytic)
↓ iron → ↓ Hb → ↓ colour (Hypo chromic)
(brittle spoon shaped nails- koilonychias- is a common feature)

13. Microcytic RBC

14. Micocytic Hypochromic anemia

15. Nutritional Anemia Magaloblastic anemia ↓ dietary Vitamin B12
↓ intrinsic factor
↓Folic acid
Maturation failure
Cells- bigger ( megaloblasts)
Cell membrane – fragile → easy rupture
Hb contents - normal

16. Pernicious Anemia Maturation failure anemia
↓ Vit. B12 due to poor absorption from GIT
↓ intrinsic factor in the stomach
Autoimmune destruction of parietal cells
Atrophy of gastric mucosa
Gastrectomy
Megaloblastic anemia
Cell membrane fragile → easy rupture

17. Macro ovalocyte

18. Aplastic Anemia Failure of bone marrow to produce RBCs
Aplasia of the bone marrow
Bone marrow may be destroyed
Radiation e.g X-rays, gamma rays, nuclear bomb explosion
Chemicals e.g.benzene, arsenic, chloramphenicol. quinine, gold salts, benzene, radium etc
Bacterial toxins
Tuberculous invasion
HIV infections
Invasion of bone marrow by cancer cells
Chemotherapy for cancer

19. Renal Anemia Renal diseases (CRF) → ↓ Erythropoietin
↓ Erythropoietin → → ↓ Production of erythrocytes

20. Hemorrhagic Anemia Acute blood loss anemia Chronic blood loss anemia
Normocytic
Normochromic
↓ RBC count
↓ Hb/cmm of blood
Chronic blood loss anemia
Microcytic
Hypochromic

21. Normocytic RBC

22. Normochromic & Hypochromic cells

23. Hemolytic Anemia Erythroblastosis Fetalis Sickle cell anemia
Congenital spherocytosis
Hemolysis due to
Infections like malaria, septicemia
Chemicals like lead, hemolysins
Agglutinins
(Jaundice is common feature in hemolytic anemia)

24. Erythroblastosis fetalis
Rh negative mother
Rh positive fetus
Mother exposed to positive cells during first delivery
Antibodies formed against positive cells
Severe anemia in subsequent fetus
Blast cells in the blood

25. Erythroblastosis fetalis

26. Erythroblastosis fetalis

27. Sickle cell anemia
Sickle-cell anemia – results from a defective gene coding for an abnormal hemoglobin called hemoglobin S (Hb S)
Alpha chains are normal, beta chain is defective
Hb S has a single amino acid substitution in the beta chain
Valine is substituted for Glutamic acid at position 6
Low oxygen → Precipitation and crystallization of Hb S → Sickling & hemolysis of RBC
Sickle cell disease crises – a vicious cycle
Hb S precipitate and cells aggregate may block small blood vessels leading to necrosis

28. Sickle cells

29. Hereditary spherocytosis
One of the congenital anemia
RBC are spherical instead of being biconcave
Decreased deformability
Cannot withstand compression
Hemolysis in tight vascular beds

30. Spherocytes

31. Thalassemia Cooley’s anemia or Mediterranean anemia
Impaired α or β chain synthesis due to genetic abnormality
α thalassemia
Decreased, defective or absent α chain
β thalassemia (more common)
Decreased, defective or absent β chain

32. Effects of anemia ↓ viscosity Easy flow of blood
↑ blood flow in all the tissues
↓O2 →vasodilatation
↑ COP
↑ work load on heart
May → cardiac failure

33. Common clinical features in anemia
Pale skin, lips, conjunctiva, mucous membrane, koilonychias etc
Increased HR, COP, murmurs
Increased Respiration rate, breathlessness
Anorexia, nausea , vomiting,
Headache, lack of concentration, irritability, lethargy, lack of energy, fatigue
Menstrual disturbances, menorrhagia, oligomenorrhea, amenorrhea

34. Polycythemia
An increase in RBC mass is called polycythemia and it may lead to an increase in blood viscosity.
Polycythemia
Relative polycythemia due to decreased plasma volume e.g. in dehydration.
Absolute polycythemia due to actual increase in RBC mass.
This may occur in disorders that prevent adequate tissue oxygenation

35. Polycythemia Secondary polycythemia
Individuals living at high altitudes have increased RBC levels because of the decreased partial pressure of O2 at high altitudes which leads to decreased O2 saturation.
Polycythemia vera
Uncontrolled proliferation/production/cancer of RBC

36. Choose the best response, During the middle trimester of gestation, which is the main organ for production of RBCs a)Bone marrow b)Spleen c)Liver d)Lymph nodes

37. Each gram of pure hemoglobin combines with a)15 ml of oxygen 2)1
Each gram of pure hemoglobin combines with a)15 ml of oxygen 2)1.34 ml of oxygen 3)20 ml of oxygen 4)2.24 ml of oxygen

38. Among Plasma proteins 80% of osmotic pressure is exerted by
Albumin
Globulin
fibrinogen

39. After 20 years of age, red cells are produced in the
Marrow of long bones
Liver
Vertebrae, sternum and ribs

40. Chronic blood loss leads to which type of anemia a) megaloblastic anemia b)microcytic hypochromic anemia c) normocytic, normochromic anemia

41. Megaloblastic anemia is due to which of the following a) folic acid deficiency b) Iron deficiency c)Vitamin C deficiency

42. In sickle cell anemia, a)Alpha chains are faulty b)Beta chains are faulty c)Gamma chains are faulty