Anemia

Physiology Project

Kazan State Medical University

By:Mahi

ANAEMIADefinition:

Anemia is defined as a decreased O2 carrying capacity due to quantitative and qualitative Reduction in RBC counts and Hemoglobin levels.

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ANAEMIA ANAEMIA is labelled

when Hb is less than 13gm/dl in Males 11 gm/dl in Females 15gm/dl in Newborn.

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MORPHOLOGICAL CLASSIFICATION:

normochromic

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Etiological Classification

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DUE TO DECREASED RBC PRODUCTION.

IRON DEFICIENCY ANAEMIA.

In women of reproductive age group (20-45 yrs)

In periods of active growth of infancy, childhood & adolescence

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IRON METABOLISM Total body contains 4-5 gms Forms –

Haemoglobin 70% Storage iron 20-23% 2/3rd

Ferritin & 1/3rd Haemosiderin.

Myoglobin in red muscles 5% Intracellular enzymes 2-3%

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DAILY REQUIREMENTS & SOURCES

5-10 mg/day in Males 20 mg/day in

Females. 40 mg/day in

Pregnant & lactating women.

Meat, liver, egg, green leafy veg, Jaggery & whole wheat.

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IRON ABSORPTION

Mainly in duodenum & upper jejunum.

MECHANISM Transport across brush

borders Haeme iron Non-haeme iron.

Fate in Enterocytes. Transport in plasma.

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IRON ABSORPTION Transport across brush

borders. Absorption of Haeme

form Absorption of Non-

haeme form Fate in Enterocytes. Transport in plasma.

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Factors affecting iron absorption

Form of dietary iron – haem iron Non-haem iron – ferrous form (Fe2+) > ferric form

(Fe3+) Meat & fish ,Human breast milk ,Acid gastric

juice – enhances absorption. Dietary factors – Phytates , phosphates, calcium,

egg white, phenols, tea, coffe wine reduces. Iron stores in body – Negative feedback effect.

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STORAGE OF IRON As ferritin As haemosiderin.

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REGULATION OF BODY IRON Mucosal block theory of absorption. Saturation of apoferritin & apotransferrin Decresed rate of apoferritin synthesis. Role of specific iron receptors in brush borders.

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APPLIED ASPECTS. Iron deficiency- iron

deficiency Anaemia Iron excess –

Haemosiderin accumulation – Haemosiderosis – damages tissue – Haemochromatosis.

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CAUSES OF IRON DEFICIENCY ANAEMIA.

Inadequate dietary intake.

Increased loss of iron. Increased demand of

iron. Decreased absorption.

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Megaloblastic Anaemia Megaloblast –

abnormally large cells of Erythroid series.

Caused by defective DNA synthesis due to deficiency of Vit B12 & Folic acid.

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Vit B 12 (Extrinsic Factor) Vit B12 –

Cyanocobalamin or extrinsic factor.

Daily need – 1-2 μg. Sources – Milk, Meat,

Liver of Animals Also synthesized by

bacterial Flora.

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Vit B 12 (Extrinsic Factor) Absorption – need

Intrinsic Factor Of Castle , a glycoprotein secreted by parietal cells of gastric mucosa.

With it form Intrinsic Factor- Cyanocobalamin complex

Bound to sp receptors in ileum & absorbed by Endocytosis.

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Vit B 12 (Extrinsic Factor) Transport – in blood

transported by combining with Transcobalamin-II

Storage – In liver & Muscle

Role – required for synthesis of DNA & maturation of nucleus & cell.

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Folic Acid Folic acid –

Pteroylglutamic acid. Daily requirement –

100 μg. Sources – leafy veg,

pulses, yeasts, liver. From breakdown of

Polyglutamate to Monoglutamates.

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Aetiology. Due to vit B12

deficiency Causes –

Inadequate dietary intake

Malabsorption due to gastric cause

Intestinal Cause.

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Addisonian Pernicious Anaemia.

Aetiology – vit B12 deficiency due to failure of secretion of Intrinsic Factor by stomach due to Autoimmune Atrophy of Gastric Mucosa.

Features. Features of

Megaloblastic anaemia Anti-intrinsic factor

antibodies. Schilling test.

(abnormal vit B12 absorption test corrected by addition of Intrinsic Factor)

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Clinical Features: General features of Anemia

Pallor, Weakness, Lethargy,

Breathlessness on exertion

Palpitations heart failure pedal edema

Special features :

Angular cheilitis, Atrophic glossitis,

Oesophageal atrophy/web Dysphagia,

Koilonychia, brittle nails, gastric atrophy.

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Special features :

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LAB FINDINGS Blood picture & red cell

indices. Hb Decreased RBC – Microcytic,

Hypochromic in iron deficiency

Megaloblastic in vit B12 & FOLIC ACID deficiency

Red cell indices – MCV,MCH & MCHC Decreases

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BONE MARROW FINDINGS. Iron deficiency

anaemia Marrow Cellularity –

Erythroid Hyperplasia. Erythropoiesis –

Normoblastic Marrow Iron –

Deficient.

Megaloblastic anaemia.

Marrow cellularity – Megaloblastic Hyperplasia.

Marrow iron – by Prussian Blue staining increase in size & no of iron granules.

By:Mahi

THANK YOU

By:Mahi