9. Anaemia

10. Anemia is not a "disease" on its own rather it is the effect of another underlying reason which leads to anemia development. That is, something else has occurred first, which caused anemia to develop (as a consequence, or a feed back reaction). Anemia is not a "disease" on its own rather it is the effect of another underlying reason which leads to anemia development. That is, something else has occurred first, which caused anemia to develop (as a consequence, or a feed back reaction). In other words, anemia is a “sign” of another underlying pathologic process, which should be properly diagnosed and treated in order to treat the anemia. In other words, anemia is a “sign” of another underlying pathologic process, which should be properly diagnosed and treated in order to treat the anemia.

11. Anemia results whenever there is a decrease in the oxygen delivery capacity (by the red blood cells) to various tissue cells (medically referred to as "tissue hypoxia"). Anemia results whenever there is a decrease in the oxygen delivery capacity (by the red blood cells) to various tissue cells (medically referred to as "tissue hypoxia").

12. In general, there are two reasons for such disturbance in the red blood: In general, there are two reasons for such disturbance in the red blood: 1. One of them is contributed to qualitative abnormalities where there is a defect (abnormality) in the RBC’s function. In this case, RBC numbers could be normal but the RBC's are defective and cannot carry oxygen properly leading to anemia development.

13. 2. The other situation is of a quantitative nature. That is, RBC’s numbers are very low leading to decreased oxygen delivery and to anemia development In certain conditions anemia can also arise due to quantitative and qualitative defects. In certain conditions anemia can also arise due to quantitative and qualitative defects.

14. From the above we can define the Anaemia as : Reduction in the haemoglobin concentration of the blood.

15. Clinical features of anaemia: Symptoms: –Shortness of breath particularly on exercise. –Weakness. –Lethargy. –Palpitation. –Headache. –Cardiac failure. –Visual disturbance.

16. Signs: Pallor of mucous membranes (conjunctiva, tongue, palm of the hands). Pallor of mucous membranes (conjunctiva, tongue, palm of the hands). Nails are delicate and break easily. Nails are delicate and break easily. Heir is thin. Heir is thin. Angular stomatitis. Angular stomatitis. Rough skin. Rough skin.

17. Signs: Retinal haemorrhage. Retinal haemorrhage. Spoon nails (iron deficiency anaemia). Spoon nails (iron deficiency anaemia). Jaundice (haemolytic anaemia, megaloblastic anaemia). Jaundice (haemolytic anaemia, megaloblastic anaemia). Leg ulcer (sickle cell anaemia). Leg ulcer (sickle cell anaemia). Bone deformations (thalassaemia major). Bone deformations (thalassaemia major).

18. Classification of anaemia: There are two main systems to classify anemia: 1. The Morphological system is one based on the morphological characteristics of RBC. 2. The other system, referred to as the Pathological system, is based on the pathological etiology leading to anemia development.

19. A. Depends on the morphology of RBC under the microscope: –Normocytic normochromic anaemia: due to acute blood loss, like traffic accident, surgery, delivery, renal failure and liver diseases. –Microcytic hypochromic anaemia: due to iron deficiency, thalassemia, and sideroblastic anaemia. –Macrmocytic normochromic anaemia: due to deficiency of Folic acid and Vitamin B12.

23. B. Pathophysiology (causes of anaemia): Anemia is classified pathologically to two types: 1. Those caused by the presence of abnormal RBC's, i.e., blood contains defective RBC's (qualitative). 2. Those caused due to decreased RBC mass (quantitative).

24. 1- Qualitative defects 1- Qualitative defects Under this classification, a group of anemias are included, all of which have abnormal structure and/or function of hemoglobin, whether in the heme (rare), or the globin part (more common). Under this classification, a group of anemias are included, all of which have abnormal structure and/or function of hemoglobin, whether in the heme (rare), or the globin part (more common).

25. These groups include anemias such as: 1. Defective iron metabolism known as Iron Deficiency Anemia (IDA). 2. Defective vitamin B12 and folic acid metabolisms (Pernicious anemia, and Megaloblastic anemia, respectively). 3. Abnormal globin chain synthesis (Hemoglobinopathies). 4. Decreased or absent synthesis of globin chains (Thalassemias). 5. Anemias caused by bone marrow failure (e.g., Aplastic anemia) and/or other systems (e.g., renal or endocrine systems).

26. 2- Quantitative defects: These are the anemias caused by decreased Red Blood Cell Mass (RBCM). These are the anemias caused by decreased Red Blood Cell Mass (RBCM). They are classified to two major groups: A- Relative, or B- Absolute. They are classified to two major groups: A- Relative, or B- Absolute.

27. A- Relative anemia It is a condition where RBC mass is normal but the plasma volume is increased. It is a condition where RBC mass is normal but the plasma volume is increased. This naturally leads to a “dilution” effect on the total RBCM mimicking anemia. This naturally leads to a “dilution” effect on the total RBCM mimicking anemia. Such anemia is seen in pregnancy, the introduction of vast amounts of fluids intravenously, or hyperproteinemia. Such anemia is seen in pregnancy, the introduction of vast amounts of fluids intravenously, or hyperproteinemia.

28. B- Absolute anemia This anemia is caused due to a true decrease in RBC mass. This anemia is caused due to a true decrease in RBC mass. The decrease in red blood cells could be caused by: The decrease in red blood cells could be caused by: 1- Decreased RBC production from the bone marrow 2- Normal production (from BM) but increased RBC destruction 3- Decreased production with increased destruction, simultaneously.

30. IRON DEFICIENCY ANAEMIA. Iron deficiency is the most common cause of anaemia in every common country of the world, and it is the most important cause of microcytic hypochromic anaemia. Iron deficiency is the most common cause of anaemia in every common country of the world, and it is the most important cause of microcytic hypochromic anaemia.

31. Nutritional and metabolic aspects of the iron: Iron in the body is about 2.5-3 g. Iron in the body is about 2.5-3 g. Iron in the Haemoglobin of the RBC represents a greatest percent of body constitutes (60-70%). Iron in the Haemoglobin of the RBC represents a greatest percent of body constitutes (60-70%). Iron presents in the body in two forms: Iron presents in the body in two forms: - Ferrittin. - Ferrittin. - Haemosiderin. - Haemosiderin.

32. Ferrittin: Ferrittin: –It is a soluble iron form. –Found in the liver, plasma, and placenta. –It is protein and iron compound. –It is soluble, non-stainable and can be measured by Radio Immuno Assay (RIA). –Males have higher values than females (100 ng/ml for male and 30 ng/ml for female).

33. Haemosiderin: It is insoluble iron form. It is insoluble iron form. Found in liver, spleen and bone marrow. Found in liver, spleen and bone marrow. It is stainable with haematoxylin and eosin. It is stainable with haematoxylin and eosin.

34. Transferrin: –Is the plasma protein responsible for carrying the iron. –It is produced in the liver. –1 molecule of transferrin binds two atoms of iron. –Total iron binding capacity of transferrin is 300µg.

35. Dietary iron:  Iron presents in meat and liver…  The daily consumption is 10-15 mg.  Body absorbed only 5-10 % of taken iron, but the proportion can be increased to 20-30 % in iron deficiency and pregnancy.  Absorption as ferrous chloride in duodenum and upper part of the jejunum.  HCl in the stomach converts ferric to ferrous to facilitate absorption. HCl HCl Fe+3 Fe+2 Fe+3 Fe+2

36. Causes of iron deficiency anaemia: 1.Chronic blood loss, especially uterine and gastrointestinal tract. 2.Increased demands, during pregnancy, infancy, growth, lactation and menstruated women. 3.Malabsorption especially in the cases of gastroectomy. 4.Poor diet, like in developing countries.

37. Clinical features: 1.When ID is developing, the RE stores (hemosiderin and ferritin) become completely depleted before anemia occurs. 2.At an early stage, no clinical abnormalities. 3.Later, patient may develops general symptoms and signs of anemia. 4.Angular stomalitis. 5.Spoon or ridged nails in severe case of IDA. 6.Dysphagia..