1. بسم الله الرحمن الرحيم

2. آنمي ها:
تشخيص
انواع
Dr.Azarm

3. Anemia, one of the more common blood disorders, occurs when the level of healthy red blood cells (RBCs) in the body becomes too low.
Dr.Azarm

4. عوامل مؤثر در بروز علائم آنمي
1- ظرفيت حمل اكسيژن توسط خون
2 - درجة تغييرات حجم داخل عروقي
3- نسبت و شدت موارد 1و 2
4- بيماري زمينه اي يا اصلي
5- ظرفيت جبراني قلب و ريه
Dr.Azarm

5. Symptomatology 1- The speed of anemia onset
2- Other complicating Pathology
3- The underlying Cause
( causes for anemia )

6. ----------------------------------------------------
Changes in Hb concentration with age
Age Hb g/dl
First 3 days of life … …… 13-21
First month therafter …. …10-18
1-12 months ………………
1-12 years …………………
Adult males …….………… 13-18
Adult females ...…………

7. آندكسهاي خوني Hb : g/100 blood Hct : cells/plasma ( % )
MCV : Hct/RBC ( fl )
MCH : Hb/RBC ( Pg )
MCHC : Hb/HCT ( g/100cc RBC )
RDW : MCV/RBC ( million )

8. 1- شرح حال بيمار 2- معاينه فيزيكي 3-اقدامات لابراتواري 4-تشخيص بيماري
مراحل پنجگانه رسيد گي به بيمار
1- شرح حال بيمار
2- معاينه فيزيكي
3-اقدامات لابراتواري
4-تشخيص بيماري
5- درمان
Dr.Azarm

9. نكات مهم در شرح حاال بيمار
1- سابقه فاميلي
2- مدت شروع علائم آنمي
3 - سابقه مصرف دارو
4- سابقه بيماريهاي قبلي
5 - سابقه مسموميتها
6 - سابقه خونريزي
7 - عادات تغذيه اي
8 - سابقه تماس با اشعه
9 - بيماريهاي شايع منطقه
10- سايقه اختلالات مزمن
Dr.Azarm

10. 2- وجود زردي (ايكتر ) 3- وجود خونريري : 4- وجود اورگانومگالي
نكات مهم در معاينه فيزيكي
1- شدت رنگ پريدگي
2- وجود زردي (ايكتر )
3- وجود خونريري :
(پورپورا . ايكيموز . اپي ستاكسي . گوارشي)
4- وجود اورگانومگالي
5- تغييرات وزن بدن
6- تغييرات علائم حياتي

11. انواع كمخونيها :
ميكروسيتيك
نرموسيتيك
ماكروسيتيك

12. Microcytic Anemia
Iron deficiency anemia
Thalassemia Syndrome
Sidroblastic anemia

13. Macrocytic Anemia B12 & Folat deficiency Chemotherapy Liver disease
Hypothyroidism
Myeloma
Aplastic anemia

14. Normocytic Anemia (normal MCV)
Primary bone marrow failur
Aplastic anemia
Myelophthisic anemia
Secondary BM failur
Uremia
Endocrinopathy
HIV infection
Chronic disease anemia

15. Anemia with Elevated MCV
1- Megaloblastic anemia
- vitamin B12 deficiency
- Folate deficiency
- Myelodysplastic syndrome
- Drug-induced anemia
2- Non-Megaloblastic anemia
- Liver disease
- Hypothyroidism
- Reticulocytosis

16. Anemia with Low Reticulocytes
WBC & Platelet are Normal
Pure red cell Aplasia:
- Congenital , Aquiared
- Infection , Drugs
WBC & Platelet are decreased:
- Leukemia
- Aplastic anemia
WBC & P normal or decreased:
- Renal failure
- Infection
- Drugs
- Hypersplenism

17. Target Cells - Liver disease Thalassemia Post Splenectomy
Iron deficiency
Sickle cell anemia
Hemoglobinopathy C

18. Spherocytosis Autoimmune H.A. Hereditary Spherocytosis
Micro-angiopathic H.A.
Disseminated I.C.
Post Splenectomy

19. Reticulocytosis Bleeding Hemolysis Sudden Hypoxia Marrow Infiltration
Hematinic therapy

20. Heinz Bodies Enzymopathies ( G6PD deficiency) Oxidants (Sulphamides)
Unstable Hemoglubins
(Hb Leiden)
post Splenectomy

21. - Fatigue & Non-specific symptoms Cardio-vascular system
Clinical Manifestations of Anemia
- Fatigue & Non-specific symptoms
Cardio-vascular system
Neuro-muscular system
Gastro-Intestinal system
Epithelial Tissues
Immunity and Infection
Skeletal system and Growth
Genitourinary system
Mthabolic

22. Epithelial Tissues
Hair
Skin
Mocusa
Nail

23. Cardio-vascular System
Puls.
Blood P.
Heart.
murmure.

24. Castro-Intestinal System
Tongue and Mouth
Dysphagia
PICA
Stomach
Maldigestion
Malabsorption

25. Neuromuscular system Behavioral abnormality Depression Neuralgia pains
- Impair muscular performance
Behavioral abnormality
Depression
Neuralgia pains
Vasomotor disturbances
Numbness and tingling
Intracranial pressure
Papilledema
Pseudo-tumor cerebri

26. Normochrome N Acute inflamation
Hypochrome Mic ID-A ,Thalassemia S.
Sidroblastic A. , Chronic Inflamation
Macrocytic Folat & vit B12 deficiency
Target cell Thalassemia , Hb C,E & s
Post splenectomy
Abetalipoproteinemia
Basophilic Hemolytic A. , ID –A.
stippling Thalassemia , lead Poisoning

27. Basophilic……. Hemolytic A. , ID –A.
stippling Thalassemia , lead Poisoning
Heinz body ……G6PD d. Unstable Hb . post Splenectomy
Hawell-Jolly….. Post Splenectomy
bodies Megaloblastic A.
Tear drop ……. Myelofibrosis
Spherocyte ……Hereditery Sph. Imune H.A.
Hypophosphatemia ,G6PD d.
Schistocyte …...DIC , Thalassemia S.
NRBC …………Acute blood lose , Methaplasia

28. Anemia can be caused by many things, but the three main bodily mechanisms that produce it are:
excessive destruction of RBCs
blood loss
inadequate production of RBCs