ANAEMIA Outi Vehviläinen, MD Ilembula 14.12.2012.
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Transcript of ANAEMIA Outi Vehviläinen, MD Ilembula 14.12.2012.
ANAEMIA
Outi Vehviläinen, MDIlembula 14.12.2012
I DefinitionII PathofysiologyIII Aethiology
Aenemia
Anaemia is defined as a condition in which the Hb concentration in peripheral blood is lower than normal for age, sex and pregnancy state of the subject.
I Definition
Newborn infants 1406 months – 6 years1106-14 years 120Adult males 130Adult females non pregnant 120 pregnant 110
I Definition: normal haemoglobin
Anaemia reduces the oxygen-carrying capacity of the blood.
The body compensates this:◦ 1.increasing the release of oxygen from Hb to the tissues◦ 2.increasing cardiac output◦ 3.enhancing blood flow to vital tissues◦ 4.increasing respiration
Severity of anaemia is passing through three stages◦1.compensated◦2.decompensated◦3.lifethreatening anaemia
II Pathophysiology
The major compensatory mechanism in mild to moderate anaemia is the increase of oxygen release to tissue by up to 40%.
Cardiac output is raised by an increase in stroke volume at rest
Exaggerated tachycardia on exertionVasodilation
PATIENT:breathlessness on exertion
1. Compensated anaemia
Hb below 70 g/lIncreased cardiac outputStroke volume and heart rate are raised at
restPeripheral vasodilation
PATIENT: breathlessness at rest, tachycardia
2. Decompensated anaemia
Respiratory distress with tachypneaOxygen supply to the myocardium is
insufficient and no further increase in cardiac output is possible
High output cardiac failure develops
PATIENT: severely breathless, may complain of angina
Cardiomegaly,pulmonary oedema, hepatomegaly,peripheral oedema,sometimes ascites
3. Life-threatening anaemia
1. Blood loss a. Acute b. Chronic (hookworms, schistosomiasis)
1.Decreased red cell production a. Nutritional deficiencies b. Depressed bone marrow
funtionIron Secondary anaemiasFolate HIV/AIDSVitamin B 12 tuberculosisVarious other chronic infections protein-energy chronic hepatic disease vitamin A chronic renal disease vitamin C carcinomatosis vitamin E, riboflavin, pyridoxine, Cu Aplastic anaemia
drugs and chemicalsinfiltrationidiopathicirradiationcongenital
Thalassaemiasalfa thalassaemiasbeta thalassaemias
3.Increased red cell desctrutiona. Abnormalities of red cells b. Abnormal haemolysis Haemoglobin Immune haemolysis sickle-cell disease autoimmune Enzymes fetomaternal G6PD deficiency incompatibility
Membrane incompatible blood transfusion elliptocytosis Non-immune haemolysis ovalocytosis infections (e.g. malaria)
spherocytosis hypersplenism drugs and chemicals venoms burns mechanical
III Aetiology of anaemia
1) Blood loss 2) Decreased red cell
production3) Increased red cell
desctrution
III Aetiology of anaemia
1. Blood loss a. Acute haemorragia
b. Chronic -hookworms,
-schistosomiasis- menorrhagia- peptic ulcers
III Aetiology of anaemia
2.Decreased red cell production a. Nutritional deficiencies b. Depressed bone marrow function
Iron Secondary anaemiasFolate HIV/AIDSVitamin B 12 tuberculosisVarious other chronic infections protein-energy chronic hepatic
disease vitamin A chronic renal disease vitamin C carcinomatosis vitamin E, riboflavin, pyridoxine, Cu
Aplastic anaemiadrugs and chemicalsinfiltrationidiopathicirradiationcongenital
Thalassaemiasalfa thalassaemiasbeta thalassaemias
III Aetiology of anaemia
3.Increased red cell desctrutiona. Abnormalities of red cells b. Abnormal haemolysis Haemoglobin Immune haemolysis sickle-cell disease autoimmune Enzymes fetomaternal incompatibility G6PD deficiency incompatible blood transfusion Membrane
elliptocytosis Non-immune haemolysis ovalocytosis infections (e.g. malaria)
spherocytosis hypersplenism drugs and chemicals venoms burns mechanical
III Aetiology of anaemia
Inadequate intakeChronic blood loss:
◦Hookworm◦Schistosomiasis causing hematuria
(S.haematobium) and ulcers and polyps in the colon (S.mansoni).
HAEMATOLOGY: Anaemia with microcytic hypochromic red cells (MCV reduced)
III Aetiology2. Decreased red cell production: Nutritional
deficiencyIron deficiency
Clinical signs:◦ increased suspectibility to infections◦mild splenomegaly◦depression of mood◦glossitis and angular cheilosis◦sterility◦ retarded growth and development in childhood◦ in pregnancy: fetal growth retardation,
premature delivery and low birthweight
HAEMATOLOGY: Anaemia with macrocytosis (MCV increased)
PHYSIOLOGICAL HIGH DEMANDS: IN PREGNANCY PATHOLOGICALLY HIGH DEMANDS: IN MALARIA
HEMOLYSIS
III Aetiology2. Decreased red cell production: Nutritional deficiency
Folate deficiency
1. Blood loss a. Acute b. Chronic (hook worms, schistosomiasis)
1. Decreased red cell production a. Nutritional deficiencies b. Depressed bone marrow funtion
Iron Secondary anaemias
Folate HIV/AIDSVitamin B 12 tuberculosisVarious other chronic infections protein-energy chronic hepatic disease vitamin A chronic renal disease vitamin C carcinomatosis vitamin E, riboflavin, pyridoxine, Cu Aplastic anaemia
drugs and chemicalsinfiltrationidiopathicirradiationcongenital
Thalassaemiasalfa thalassaemiasbeta thalassaemias
3. Increased red cell desctrutiona. Abnormalities of red cells b. Abnormal haemolysis Haemoglobin Immune haemolysis sickle-cell disease autoimmune Enzymes fetomaternal G6PD deficiency incompatibility
Membrane incompatible blood transfusion elliptocytosis Non-immune haemolysis
ovalocytosis infections (e.g. malaria) spherocytosis hypersplenism
drugs and chemicals venoms burns mechanical
III Aetiology of anaemia
Thank you!