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The term is derived from ancient Greek ” bloodlessness “it is defined as a low haemoglobin concentration that is below the normal range appropriate for age and sex. which is <13.5g/dl for male and <11.5g/dl for female.
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• Anaemia may be due to
DECREASED MARROW PRODUCTION
lack of iron,vitB12,folate.Hypoplasia
invasion by malignant cells.
PERIPHERAL CAUSESblood loss
haemolysishypersplenism
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MICROCYTIC iron deficiency
thalassemia sideroblastic anaemia of chronic disease
MACROCYTIC megaloblastic
normoblastic liver disease
hypothyroidism hyperlipidaemia
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Alcoholpregnancy
cytotoxic drugsreticulocytosis(haemolysis)
MDS,marrow infiltration
NORMOCYTIC anaemia of chronic disease
acute blood loss hypothyroidism hemolytic
aplastic
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HAEMOLYTICCONGENITAL
hereditary spherocytosis hereditary elliptocytosis
.thalassemia
.sickle-cellG-6-PD deficiencypyruvate kinase deficiency
ACQUIREDIMMUNEautoimmune, warm/cold
alloimmune (transfusion reaction, organ transplantation)
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NON IMMUNEPNH mechanical(prosthetic heart valve,march & microangiopathichaemoglobinuria)Infection;falciparum malaria,sepsisChemicals,drugs(dapsone.sulphonamide)sec to other disease e.g renal or liver failure
Extra-vascular;sickle-cell,hereditary spherocytosis
intra-vascular;G6PD,acquired haemolytic anaemias
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SYMPTOMSFatigue dyspnoea palpitationsheadachedizzinesangina
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SIGNSmucous membrane pallortachypnoea postural hypotension high volume pulse
severe anaemia<8g/dltachycardia systolic flow murmurs raised JVP
ankle oedemaheart failure
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IRON DEFICIENCYkoilonychiaatrophic glossitis rarely post-cricoid webs.
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Thalassemic facies, bossing of skull, prominent malar eminence, skeletal deformities.
Hepatosplenomegalygrowth retardationintermittent feverhaemochromatosis resulting incirrhosis,cardiac failure,endocrinopathies.
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MEGALOBLASTIC ANAEMIA
sore mouth smooth tongueangular cheilosisvitiligogrey hairweight losspyrexiaparesthesia
,dorsal column loss, subacute combined degeneration of cord
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HAEMOLYTICmild jaundicehepatosplenomegaly (extravascular hemolysis)
haemosiderinuria (intravascular haemolysis)
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ACUTE SYNDROMES.Precipitated by infection ,hypoxia,dehydration and acidosis.
Vaso-occlusive crises. acute severe bone pain. tachycardia, sweating, fever
sequestration crises sudden splenomegaly/hepatomegaly. aplastic crises. sudden lethargy,pallor
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HEREDITARY SPHEROCYTOSIS
• mostly asymptomatic with chronic compensated haemolytic state
• there may be acute crisis. • Haemolytic crisis• Megaloblastic crisis• aplastic crisis• pigment gallstones in 50% causing
cholecystitis
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Haemoglobinuria only at night.
Venous thrombosis at unusal sites(hepatic,mesenteric,cerebral) may have
thrombocytopenia,neutropenia
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Acute drug induced haemolysis presenting with haemoglobinuria, withanalgesics.aspirin.phenacetinantimalarialsantibiotics,sulphonamide,ciprofloxacinmisc.vit K.quinidine.
Chronic compensated haemolysis. Infection or acute illness.
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Low Hb
Low MCV<76fl Normal MCV High MCV>96fl
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Low/norm MCV
Blood film & retic count Hh retic(haemolysis)
Norm/low retic
Low MCH
Low ferritin
Iron deficiency
Target cells,
Basophilic stippling
Hb electrophoresis
High HbA2 Norm HbA2
B-thalassemia Alpha-thalassemia
dimorphic
Bone marrow
sideroblastic
Ferritin norm/high
ACD
Bone marrow
Iron stores adequate?
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Osmotic fragility test +v
Blood film
spherocytes No spherocytes fragmentation
DCT + DCT _
autoimmune Hereditary spherocytosis
haemolysis
malaria
Hereditary
enzymopathies
microangiopathic
traumatic
clostridium
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A)iron deficiency anaemiaB)sideroblastic anaemiaC)anaemia of chronic diseaseD)thalassemia
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Ans) sideroblastic anaemia
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A)hypothyroidismB)pregnancyC)haemolysisD)anaemia of chronic disease
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Ans) anaemia of chronic disease
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A) thalassemia
B) Leukemia
C) Infective endocarditis
D) sickle cell anaemia
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•Ans Sicle cell anaemiaAns Sicle cell anaemia
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