Anemia2 deficiency anemias
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Transcript of Anemia2 deficiency anemias
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“No doubt knowledge is valuable,but above it is Character”
Knowledge without character is dangerous!
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….. foundation of clinical medicine
Shashidhar Venkatesh MurthyA/Prof & Head of PathologyCollege of Medicine & Dentistry
Clinical Pathology: RBC Disorders: Deficiency Anemia
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Pathogenetic Classification of Anemia: Decreased Production: Nutrient Deficiency.
Iron def (IDA) / Megaloblastic (MBA) Hemopoietic cell defect:
Anemia of chronic disorders (ACD) Aplastic anemia (AA). Dysplastic anemia. Myelodysplastic Syndromes
Increased loss / destruction: Blood loss anemia – Acute / Chronic - bleeding. Hemolytic anemia – Congenital / Acquired.
Acquired / External injury. Immune AIHA (Warm/Cold) Mechanical, Drugs & Parasites
Congenital / Internal RBC defect Defective Membrane (Spherocytic an) Defective Hemoglobin (Sickle cell an.) Deficient Enzyme (G6PD)
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Top 6 Anemias:1. Iron Def. A2. Megaloblastic3. Anem. Of Chronic Dis.4. Aplastic An.5. Immune Hemolytic – Warm6. Immune Hemolytic - Cold2
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Proerythroblast(Pronormoblast)
BasophilicNormoblast
PolychromatophilicNormoblast
OrthochromatophilicNormoblast
Reticulocyte
Erythrocyte
BLAST Early Intermediate Late Retic. RBC
Anemia Pathogenesis:
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DNA: B12, Folate
B12/Folate Metabolism:R Binders, Stomach, IF, Colon, Methionine, Homocysteine – DNA synthesis – cell division.
Megaloblastic anemia
Hb: Iron Iron Metabolism: “limited”,10%, Recycle, Ferritin, Transferrin, Hepcidin, forms Hb in cytoplasm.
Iron Deficiency anemia
Hemolytic anemiaImmuneMech.Infection
Aplastic anemia Dysplastic anemia
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Our destiny is in our hands, What we think and do in the present
determines what shall happen to us in the future.
-- Christian D. Larson
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Iron Deficiency - Megaloblastic
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Causes: Bleeding, Nutrition,
Increased needs. Pathogenesis:
Iron - Hb - MCV Morphology:
Microcytic, Hypochromic Pencil cells.
Clinical Features: glossitis, chelitis, stomatitis. koilonychia, dysphagia
Causes:• Nutrition, gastritis, intestinal
disorders, Cancer therapy. Pathogenesis:
• DNA Cells - all cells. Morphology:
• Macrocytic, Normochromic• Pancytopenia*
Clinical Features:• glossitis, chelitis, stomatitis.• Mild Jaundice & Bruising
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Microcytic Anemia (IDA)
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Normal
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Iron Deficiency Anemia:
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1.Microcytic, Hypochromic – excess cell division, low Hb.2.Anisopoikilocytosis. – varying supply, abnormal hemopoiesis.3.Pencil forms. - ? cause
L
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Macrocytic Anemia (Meg.):
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NormalHN
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Megaloblastic Anemia:
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1. Oval Macrocytes, Pancytopenia: cell division.
2. Anisopoikilocytosis: Hemolysis.
3. Hypersegmented neutrophils: Large cells / Megaloblasts (in bone marrow).
Megaloblastic Bone Marrow Normal
Hypersegmented Neutrophils
MacrocyteMegaloblast
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Pernicious Anemia: Vit B12
Autoimmune atrophic gastritis in aged. IF & Parietal cell antibody (Type I,II,III)
Reduced Tetra-hydrofolate (FH4) Decreased DNA synthesis.
Other causes of Vit B12 def. (not pernicious) Gastrectomy Achlorhydria Chronic Pancreatitis Ileal resection Mal absorption syndromes. Tapeworm infestation Malignancy, pregnancy, hyperthyroidism etc.
Clinical: MBA+ neurological deficits (spinal dorsal tract)
Loss of proprioception.
B12 Animal/bacteriaFolate Green Veg
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Nothing can stop the man with the right mental attitude from achieving his goal;
nothing on earth can help the man with the wrong mental attitude!
-- Thomas Jefferson
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Haemopoiesis in deficiency anemias
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Macrocytic, pancytopeniaMicrocytic hypochromic
Iron Deficiency Normal Megaloblastic
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Anemia of Chronic Disease: Etiology:
Chronic Infections, inflammations, malignancy & anemia of renal disease*.
Pathogenesis: IFN, TNF, IL block iron
transfer from macrophage store to RBC.
Erythropoietin*. Morphology:
Mild Microcytic, Hypochromic.
Clinical Features: Mild anemia, resistant to
iron therapy.
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Aplastic Anemia: BM Failure
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Dysplasia Normal BM Aplasia
Clinical Features:1. RBC - Anemia,2. WBC - Infections3. PLT - Bleeding
Stem cell damage• Drugs, Immune• Viral Infections.
Stem Cell Cancer:Myelodysplastic Sy.Leukemia
Normocytic Pancytopenia
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Learning Objectives: Diseases of RBC Anaemia: Overview, Classification, pathogenesis,
diagnosis, clinical features & complications. - common
Study TOP 10 ANEMIAMajor (detailed)
1. Iron Deficiency anemia.2. Megaloblastic anemia.3. Imm. Hemolytic (Warm/Cold)4. Anemia of Chronic Disease.5. Aplastic Anemia
Minor (brief note)6. Myelodysplastic Syndrome7. Sickle Cell Anemia8. Thalassemia syndromes.9. G6PD deficiency anemia.10. Hereditary Spherocytosis.
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