Download to read offline
basic haematological prperties of Anemiam 2.ppt
- 1.
- 2. Functions of erythrocytes ā¢Transport of respiratory gases ā¢ Large surface area : volume ratio ā¢ Flexible biconcave disc ā¢ Haemoglobin for exchange of gases ā¢ Capable of glycolysis for the source of energy for cell survival
- 3. Erythrocyte disorders ā¢ Qualitative ā¢Haemoglobin defect (Anemia, Thalassaemia, sickle cell anemia etc) ā¢ Membrane & enzyme abnormalities (G6PD, eliptocytosis, stomato-ovalocytosis) ā¢ Quantitative ā¢ Increased (polycythemia) inherited / acquired ā¢ Decrease (inherited / acquired hypoplasia) ā¢ Bleeding
- 4. Anaemia ā¢ Reduction in circulation haemoglobin ā¢Nutritional deficiency anaemias ā Iron deficiency ā B12 & folate deficiency anaemia ā Protein deficiency anaemia ā Scurvy & other element deficiency Iron anaemia deficiency B12 & folate deficiency
- 5. Nutritional deficiency anaemia clinicalapplication Angular Cheilosis Koilonychia Glossitis Marrow iron stores Plummer-Vinson syndrome
- 6. Anaemia; Globin chaindefects ā¢ Thalassaemias ā Reduced globin chain synthesis ā¢ Alpha and Beta chain synthesis defects ā¢ Haemoglobinopathies ā Abnormal globin chain synthesis Sickle cell disease Thalassaemia
- 7. Anaemia; Globin chaindefects X-ray appearance of Thalassaemic patient Hemoglobin electrophoresis for the diagnosis of thalassaemai
- 8. Anaemia; Membrane andenzyme defects ā¢ Membrane defects ā Elliptocytosis ā Hemolysis ā Stomato-ovalocytosis ā Without haemolysis ā¢ Red cell enzymopathies ā¢ G6PD ā Hemolysis after oxidant stress ā¢ Blood loss Elliptocytosis G6PD deficiency
- 9. Anaemia; Reduced erythroidbone marrow ā¢ Marrow failure ā¢ Marrow infiltration Trephine biopsy (Aplastic Anemia) Marrow infiltration Normal trephine
- 10. C.B.C ā¢ Haemoglobin -15Ā±2.5, 14 Ā±2.5 - g/dl ā¢ PCV - 0.47 Ā±0.07, 0.42 Ā±0.05 - l/l (%) ā Haematocrit, effective RBC volume - better ā¢ RBC count - 5.5 Ā±1, 4.8 Ā± 1 x1012/l ā¢ MCHC - Hb/PCV - 30-36 - g/dl ā Hb synthesis within RBC ā¢ MCH - Hb/RBC - 29.5 Ā± 2.5 pg/l ā Average Hb in RBC ā¢ MCV - PCV/RBC 85 Ā± 8 - fl
- 11.
- 12.
- 13. ANEMIA Symptoms : Pallor Jaundice Fatigue Palpitation Dyspnea Vertigo Pepticulcer Glossitis Dysphagia etc
- 14. Classification of Anemia I.Etiologic Classification 1. Impaired RBC production 2. Excessive destruction 3. Blood loss II. Morphologic Classification 1. Macrocytic anemia 2. Microcytic hypochromic anemia 3. Normochromic normocytic anemia III. Kinetic Classification IV. Physiologic Classification
- 15. Impaired RBC Production 1.Abnormal bone marrow 1.1 Aplastic anemia 1.2 Myelophthisis : Myelofibrosis, Leukemia, Cancer metastasis 2. Essential factors deficiency 2.1 Deficiency anemia : Fe, Vit. B12, Folic acid, etc 2.2 Anemia in renal disease : Erythropoietin 3. Stimulation factor deficiency 3.1 Anemia in chronic disease 3.2 Anemia in hypopituitarism 3.3 Anemia in hypothyroidism
- 16. Excessive Destruction ofRBC(cont.) Hemolytic anemia 1. Intracorpuscular defect 1.1 Membrane : Hereditary spherocytosis Hereditary ovalocytosis, etc. 1.2 Enzyme : G-6PD deficiency, PK def., etc. 1.3 Hemoglobin : Thalassemia, Hemoglobino- pathies
- 17. Excessive Destruction ofRBC 2. Extracorpuscular defect 2.1 Mechanical : March hemolytic anemia MAHA (Microangiopathic HA) 2.2 Chemical/Physical 2.3 Infection : Clostridium tetani 2.4 Antibodies : HTR, SLE 2.5 Hypersplenism
- 18. Blood Loss 1. Acuteblood loss : Accident, GI bleeding 2. Chronic blood loss : Hypermenorrhea Parasitic infestation
- 19. Macrocytic Anemia MCV >94 MCHC > 31 1. Megaloblastic dyspoiesis 1.1 Vit. B12 deficiency : Pernicious anemia 1.2 Folic acid deficiency : Nutritional megaloblas- tic anemia, Sprue, Other malabsorption 1.3 Inborn errors of metabolism : Orotic aciduria, etc. 1.4 Abnormal DNA synthesis : Chemotherapy, Anticonvulsant, Oral contraceptives
- 20. Macrocytic Anemia MCV >94 MCHC > 31 2. Non-Megaloblastic dyspoiesis 2.1 Increased erythropoiesis : Hemolytic anemia response to hemorrhage 2.2 Increased membrane surface area : Hepatic disease, Obstructive jaundice, Post- splenectomy 2.3 Idiopathic : Hypothyroidism, Hypoplastic and Aplastic anemia
- 21. Microcytic Hypochromic Anemia MCV< 80 MCHC < 31 1. Fe deficiency anemia : Chronic blood loss, Inadequate diet, Malabsorption, Increased demand, etc. 2. Abnormal globin synthesis : Thalassemia with or without Hemoglobinopathies 3. Abnormal porphyrin and heme synthesis : Pyridoxine responsive anemia, etc. 4. Other abnormal Fe metabolism :
- 22. Normocytic Normochromic Anemia MCV82 - 92 MCHC > 30 1. Blood loss 2. Increased plasma volume : Pregnancy, Overhydration 3. Hemolytic anemia : depend on each cause 4. Hypoplastic marrow : Aplastic anemia, RBC aplasia 5. Infiltrate BM : Leukemia, Multiple myeloma, Myelofibrosis, etc. 6. Abnormal endocrine : Hypothyroidism, Adrenal insufficiency, etc. 7. Kidney disease / Liver disease / Cirrhosis
- 23. Kinetic Classification ofAnemia 1. Insufficient erythropoiesis Stem cells , Hypoplastic marrow, Infiltrated BM 2. Ineffective erythropoiesis - Megaloblastic anemia - Thalassemia - Sideroblastic anemia 3. Uncompensated hemolytic disease with continued bleeding
- 24. Physiologic Classification ofAnemia 1. RPI (Reticulocyte Production Index) < 2 (Ineffective erythropoiesis) 1.1 Hypoproliferative anemia 1.2 Maturation disorder 2. RPI > 3 (Effective erythropoiesis) 2.1 Hemolytic anemia 2.2 Blood loss anemia
- 25. Physiologic Classification ofAnemia 1. RPI (Reticulocyte Production Index) < 2 (Ineffective erythropoiesis) 1.1 Hypoproliferative anemia (normocytic normochromic, N/N) - Hypoplastic anemia - Idiopathic/ Chemical/ Infectious / Drug --> Maturation arrest - Myelophthisic anemia (Marrow infiltration) - Refractory anemia (Dysmyelopoietic syndrome)
- 26. 1.1.1 N/N andnormal RDW a) BM failure b) Decrease marrow stimulation - Endocrine disease - Anemia of chronic disease - Renal disease 1.1.2 Abnormal RBC morphology & RDW a) Oval macrocyte :- Refractory dysmyelo- poietic b) Dacrocytes/ tear drops :- Myelophthisic Physiologic Class. of Anemia RPI < 2
- 27. 1.2 Maturation disorder 1.2.1Microcytic, high RDW a) Siderblastic (Microcytic dimorphic RBC) b) Fe def. (Microcytic hypochromic RBC) 1.2.2 Microcytic, normal RDW a) Heterozygous, thalassemia syndrome b) Anemia of chronic disease 1.2.3 Macrocytic a) Liver disease b) Folate def. c) Vit. B12 def. d) Hemolytic anemia (Normocyte polychromasia) Physiologic Class. of Anemia RPI < 2
- 28. Physiologic Classification ofAnemia 2. RPI > 3 (Effective erythropoiesis) 2.1 Hemolytic anemia - Intrinsic hereditary disorder - Extrinsic acquired disorder 2.2 Blood loss - Acute blood loss - Chronic blood loss (without treatment --> micro- cytic, hypochromic anemia)
- 29. Evaluation of Anemia A.Hematologic 1. Hematocrit (VPRC preferred) 2. Hemoglobin concentration 3. RBC indices : MCV, MCH, MCHC 4. Leukocyte count 5. Reticulocyte count 6. Platelet count 7. ESR (Erythrocyte sedimentation rate) 8. Stained blood smear : RBC morphology
- 30. Evaluation of Anemia B.Urine analysis 1. Appearance : Color, pH, Clarity, sp gr 2. Test for protein, Bence Jones protein 3. Bilirubin, Uribilinogen 4. Occult blood 5. Microscopic examination C. Stool 1. Appearance : Color, consistency 2. Occult blood 3. Examination for ova, parasites
- 31. Evaluation of Anemia D.Serum or Plasma 1. BUN 2. Creatinine, if urea N is abnormal 3. Bilirubin : Direct, indirect 4. Protein 5. SI (Serum iron), TIBC (Total iron binding capacity) E. Special tests in hematology Hb typing / Ham acid test / Coombsā test, G-6PD, Ferritin, Sucrose test, Autohemolysis test, Haptoglobin, etc.