ANEMIA Etiology
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Transcript of ANEMIA Etiology
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Eti0logical Classification Of Anemia
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OBJECTIVES
Definition
General Presentation
Classification
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What is Anemia?
Anemia refers to a state in which the level of hemoglobin in the blood is below the normal range appropriate for that age and sex.
WHO Definition Male less than 13 g/dl Female less than 12 g/dl Pregnant less than 11 g/dl
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Factors responsible forAnemic State
Volume lossReduced red cell massReduced hemoglobinRed cell / Hemoglobin defectImpaired red cell / hemoglobin
production
Ultimately, the oxygen-carrying capacity ofblood is reduced.
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PALLORSites to look for:
Palpebral conjunctiva Skin Creases of palms and hands Nails Mucous membranes
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Presentation
Usually non-specific symptoms:
Tiredness Lightheadedness Breathlessness Lassitude
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Non-specific signs:
Pallor Tachypnoea Raised jugular venous pressure Postural hypotension Tachycardia Flow murmurs
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Etiological Classification Of Anemia
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3 major categories
1) Marrow production defects (Hypoproliferation)
2) Red cell maturation defects (Ineffective erythropoiesis)
3) Decreased red cell survival (Blood loss/Hemolysis)
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Hypoproliferative Anemias
Marrow damage:• Infiltration (leukemia,lymphoma) /
fibrosis• Aplasia• Drugs (anti-retrovirals)
Fe def.
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Disturbance of proliferation and differentiation of stem cells:
• Pure red cell aplasia
• Anemia of renal failure
• Anemia of endocrine disorders (hypoTH, DM)
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Unknown / multiple mechanisms
• Anemia of chronic inflammations
1. Chr. Microbial infections (OM, bac endocarditis, lung abscess)
2. Chr. Immune disorders (RA, regional enteritis)
3. Neoplasms (HL, ca lung/breast)
• Myelophthisic anemias
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Maturation Disorders
Cytoplasmic defects:
• Defecient heme synthesis fe def.
• Defective globin synthesis thalassemia
• Myelodysplastic syndromes sideroblastic anemia
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Nuclear defects:
• Folate def.
• Vit. B12 def.
• Drug toxicity (mtx, alkylating agents)
• Refractory anemia (myelodysplasia)
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Blood loss
Blood loss:
• Acute trauma
• Chronic lesions of g.i.t. gynaecologic disturbance
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Hemolytic Anemia
Intrinsic abnormalities of red cells
1. Hereditary
a) Red cell membrane disorders
• Disorders of membrane cytoskeleton:Spherocytosis Elliptocytosis
• Disorders of lipid synthesis:selective increase in membrane
lecithin
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b) Red cell enzyme deficiencies
• Glycolytic enzymes:PK def.Hexokinase def.
• Enzymes of HMP shunt:G6PD Glutathione synthetase
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c) Disorders of hemoglobin synthesis
• Deficient globin synthesis:Thalassemia syndromes
• Hemoglobinopathies (str. abnormality):
Sickle cell anemiaUnstable hb
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2. Acquired
a) Membrane defect:PNH
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Extrinsic abnosmalities of red cells
1. Antibody mediated
• Isohemagglutinins:Transfusion reactionsErythroblastosis fetalis
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• Autoantibodies:Idiopathic (primary)Drug-associatedSLEMalignant neoplasmsMycoplasmal infection
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2. Mechanical trauma to red cells
• Microangiopathic Hemolytic Anemias (MAHA)
TTPDIC
• Cardiac traumatic hemolytic anemia
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3. Infections: Malaria Hookworm
4. Chemical injury: Lead poisoning
5. Sequestration in Mononuclear PhagocyteSystem:
Hypersplenism