Anemia (Syptoms and Signs)

5/28/2018 Anemia (Syptoms and Signs)

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A N E M I A


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SYMPTOMS AND SIGNS OF ANEMIA

* Symptoms:-Shortness of breath (particularly on exercise)

-Weakness

-Lethargy

-Palpitation-Head aches

* In Older Subject:-Cardiac failure

-Angina pectoris-Confusion

-Intermittent claudication


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SYMPTOMS

* General:-Pallor of mucous membrane (less than 9 d/dl)-Tachycardia

-Cardiomegali

-Syst flow murmur (especially at the apex)

-Retinal hemorhages (unusual)

-In the elderly: congestive hearth failure

* Specific:-Koilonychia (spoon nails)iron def.

-Jaundicehemolytic or megaloblastic anemia-Leg ulcerssickel cell A

-Bone deformitiesthalasssemia major

-Neugopathyvit. B12 def.


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Classification based on red cell indices

Normocytic, normochromic

Macrocytic

Microcytic, hypochromic


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Microcytic, hypochromic

MCV < 80 flMCH < 27 pg

Clinically:

- Iron def.

- Thalassemia- Anemia of chronic disease (some cases)

- Lead poisoning

- Sideoblastic anemia (some cases)


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Normocytic, Normochromic

MCV : 80 - 95 flMCH : > 26 pg

Clinically:

- Hemolitic Anemia

- Anemia of chronic disease (some cases)- After acut blood loss

- Renal disease

- Mixed deficiencies

- Bone marrow failure


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Macrocytic

MCV : > 95 flHypersegmented Neutrophil

Five Lobes

Clinically:

- Megaloblastic : vit B12 or folate def.- Non megaloblastic:

^ Alcohol

^ Liver disease

^ Myelodysplasia^ Aplastic anemia


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Anemia with the varation in size

(anysocytosis) and Shape (poikilocytosis)

( 1 )

Red cell abnormalities Causes

-Macrocyte - liver disease

- alcoholism-Target cell - iron def. , liver dis

- hemoglobinopathy

- post splenectomy

-Stomotocyte - liver disease, alcoholism

-Pencil cell - iron def.-Ecchinocyte - liver disease

- post splenectomy


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Anemia with the varation in size

(anysocytosis) and Shape (poikilocytosis)

( 2 )

Red cell abnormalities Causes

-Microspherocyte - hereditary spherocytosis

- AIHA, septicemia

-Fragments - DIC, microangiopatiHUS,TTP Burs,cardiac valve

-Elliptocyte - hereditary elliptocytosis

-Tear drop - Myelofibrosis, extramedullary

hemopoiesis-Basket cell - Oxydant damage e.g. G6PD

-Sickle cell - Iron deficiency

-Microcyte - Hemoglobinopathy


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Reticulocyte count

Normal : 0.5 - 1.5 %reticulocyte :

Anemia

Hemolytic anemia

After an acut major hemorrhagic

Within 2 3 days

Reaches a maximum in 6 10 days

Remains raised until th Hb returns to normal level


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Factor impairing the normal

reticulocyte response to anemia

Marrow diseaseHipoplasia

Infiltration by carcinoma

Lymphoma, myeloma, acut leukemia

Deficiency of iron, Vit. B12, Folic acid

Lack of erythropoietin eg. Renal disease

Reduced tissue O2 consumption e.g mixooedema, protein def.

In effective erythropoiesis, thalassemia nyelodisplasia

Chronic inflammatory or malignant disease


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Leukocyte and Platelet Count

Measurement of these help to distingguish pure

anemia from pancytopenia (marrow hypoplasia,

hypersplenisme)


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Biopsi

1. Site : posterior iliac crest2. Stains : haematoxylin and eosin, reticulin (silver stain)

3. Indication:

- Suspicion of polycythemia vera

- Nyelofibrisis and other myeloproliferative disorders

- Aplastic anemia

- Malignant lymphoma

- Secondary carcinoma

- Cases of splenomegali or pyrexia of undetermined

- Any case where aspiration give cause a dry tap4. Special test : Immunophenotyping


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Assesment of erythropoiesis

Normal erythropoiesis

Decrease erythropoiesis (eg. Aplastic anemia)

Increase erythropoiesis (eg. Hemolytic anemia)

In effective erythropoiesis (Megaloblastic anemia)


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T h e r a p y

Underlying disease

Hematinic :

- Ferrum- Vit. B12- Folic Acid


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Anemia (Syptoms and Signs)

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