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Submitted byMd.Fokhrul Islam FahadID - 091893

25th Batch

Shamima AkhterID - 091872

Md.Abid HassanID – 091852

Sadia Afrin ApornaID – 091911

Md.Firoze SultanID - 091844

Submitted to

Md.Shah AzizLecturer of Phytochemistry -2University of Development Alternative (UODA)Dhanmondi,Dhaka

Course Name: Phytochemistry - 2

Course Code : PHARM 1205University of Development Alternative (UODA)

Dhanmondi ,Dhaka

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ANAEMIASANAEMIAS

ByBy

MD.FOKHRUL ISLAM FAHADMD.FOKHRUL ISLAM FAHAD

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Definition of Anaemia

Anaemia may be defined as a reduction of Anaemia may be defined as a reduction of hemoglobin concentration per unit volume of hemoglobin concentration per unit volume of peripheral blood ,which is usually associated with peripheral blood ,which is usually associated with the reduction of RBCthe reduction of RBC

Parameters of AnaemiaParameters of Anaemia Hematocrit – Percentage of blood volume as RBCsHematocrit – Percentage of blood volume as RBCs Hemoglobin – Concentration of hemoglobin in bloodHemoglobin – Concentration of hemoglobin in blood Mean Corpuscular Volume (MCV) – Average size of Mean Corpuscular Volume (MCV) – Average size of

RBCRBC Mean Corpuscular Hemoglobin (MCH) – Average Mean Corpuscular Hemoglobin (MCH) – Average

hemoglobin content of RBChemoglobin content of RBC RDW – range of deviation around averageRDW – range of deviation around average

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Causes of AnaemiaCauses of Anaemia

Excessive blood loss due to acute & chronic Excessive blood loss due to acute & chronic hemorrhage.hemorrhage.

Reduced production of RBC due to lack of Reduced production of RBC due to lack of some factors which are necessary for RBC some factors which are necessary for RBC Production .Production .

Certain disease & infections may produce Certain disease & infections may produce anaemia.anaemia.

Destruction of bone marrow.Destruction of bone marrow. Excessive blood cell destruction in Excessive blood cell destruction in

comparison to the production of blood .comparison to the production of blood .

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Mechanisms of AnaemiaMechanisms of Anaemia

Marrow production defects Marrow production defects ((hypoproliferationhypoproliferation))

Low reticulocyte countLow reticulocyte count Little or no change in red cell morphology (a Little or no change in red cell morphology (a

normocytic, normochromic anemia normocytic, normochromic anemia Red cell maturation defects (Red cell maturation defects (ineffective ineffective

erythropoiesiserythropoiesis)) Slight to moderately elevated reticulocyte count Slight to moderately elevated reticulocyte count Macrocytic or microcytic anemiaMacrocytic or microcytic anemia

Decreased red cell survival (Decreased red cell survival (blood loss/ blood loss/ hemolysishemolysis). ).

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Symptom of AnaemiaSymptom of Anaemia

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CLASSIFICATION OF ANAEMIAS

There are several types of anaemia:There are several types of anaemia:1.1. HEMORRHAGIC ANAEMIAHEMORRHAGIC ANAEMIA

2.2. APLASTIC ANAEMIAAPLASTIC ANAEMIA

3.3. MEGALOBLASTIC ANAEMIAMEGALOBLASTIC ANAEMIA

4.4. PERNICIOUS ANAEMIAPERNICIOUS ANAEMIA

5.5. HEMOLYTIC ANAEMIAHEMOLYTIC ANAEMIA

6.6. SICKLE CELL ANAEMIASICKLE CELL ANAEMIA

7.7. IRON DEFICIENCY ANAEMIAIRON DEFICIENCY ANAEMIA

8.8. SECONDARY ANAEMIA (RENAL)SECONDARY ANAEMIA (RENAL)

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1. HEMORRHAGIC ANAEMIA 1. HEMORRHAGIC ANAEMIA (BLOOD LOSS) (BLOOD LOSS)

ACUTEACUTE: Sudden loss of blood: Sudden loss of blood RBC Count decreased for 1 – 3 RBC Count decreased for 1 – 3

daysdays RBCs are restored in 3 – 6 weeksRBCs are restored in 3 – 6 weeks CHRONIC BLOOD LOSSCHRONIC BLOOD LOSS:: They cannot absorb Fe enough to They cannot absorb Fe enough to

form Hbform Hb Have Hypochromic, Microcytic Have Hypochromic, Microcytic

Anaemia.Anaemia.

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2. APLASTIC 2. APLASTIC ANAEMIA:ANAEMIA:

Aplastic Anaemia is characterized Aplastic Anaemia is characterized by bone marrow aplasiaby bone marrow aplasia

Aplastic anaemia occurs when the Aplastic anaemia occurs when the bone marrow produces too few of bone marrow produces too few of all three types of blood cells all three types of blood cells (RBC,WBC & platelets(RBC,WBC & platelets

It is also characterized by the It is also characterized by the occurance of anaemia ,leucopenia occurance of anaemia ,leucopenia & thrombocytopenia& thrombocytopenia

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CAUSES OF APLASTIC CAUSES OF APLASTIC ANAEMIA:ANAEMIA:

Lack of functioning Red Bone Marrow, the Lack of functioning Red Bone Marrow, the hemopoietic tissue.hemopoietic tissue.

History of specific infectious disease such as History of specific infectious disease such as infectious hepatitisinfectious hepatitis

By taking certain medications such as antibiotic By taking certain medications such as antibiotic & anticonvulsants& anticonvulsants

By taking drugs which regularly cause bone By taking drugs which regularly cause bone marrow depression, such as busulphan, marrow depression, such as busulphan, vincristine, N-musterd etcvincristine, N-musterd etc

Exposure to certain toxins, eg.heavy metalsExposure to certain toxins, eg.heavy metals Exposure to radiations , eg. X-ray, B-ray, Y-ray Exposure to radiations , eg. X-ray, B-ray, Y-ray

& neutrons& neutrons History of an autoimmune diseaseHistory of an autoimmune disease Inherited conditionInherited condition

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TREATMENT OF APLASTIC TREATMENT OF APLASTIC ANAEMIA:ANAEMIA:

The offending drug ,if any,should be The offending drug ,if any,should be stopped immediatelystopped immediately

Recurrent blood transfusion (whole blood) Recurrent blood transfusion (whole blood) is essentialis essential

Vigourous antibiotics (broad spectrum) Vigourous antibiotics (broad spectrum) should be started immediately to prevent should be started immediately to prevent secondary infection secondary infection

Steroids e.g prednisolone 60mg/day may Steroids e.g prednisolone 60mg/day may be used for 6 weeks .Plus-bone marrow be used for 6 weeks .Plus-bone marrow stimulating agent –oxymetholone therapy -stimulating agent –oxymetholone therapy -2.5mg/kg.body wt.may be given up 3-6 2.5mg/kg.body wt.may be given up 3-6 month month

Platelet transfusion for bleeding are Platelet transfusion for bleeding are required required

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3. MEGALOBLASTIC ANAEMIA:3. MEGALOBLASTIC ANAEMIA:

Deficiency of Vit BDeficiency of Vit B12 12 and or Folic and or Folic Acid.Acid.

Intrinsic Factor can also be Intrinsic Factor can also be deficient.deficient.

Production of Erythrocytes Production of Erythrocytes becomes slow.becomes slow.

They remain large, hve odd They remain large, hve odd shapes and are called shapes and are called ‘Megaloblasts’.‘Megaloblasts’.

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B12 metabolismB12 metabolism

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MEGALOBLASTIC ANAEMIA:MEGALOBLASTIC ANAEMIA:

Intestinal Sprue or Intestinal Sprue or Malabsorption Syndrome can Malabsorption Syndrome can also cause this.also cause this.

Megaloblasts are over sized, Megaloblasts are over sized, anisocytic.anisocytic.

They have fragile membranes They have fragile membranes and rupture easily.and rupture easily.

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CAUSES OF MEGALOBLASTIC CAUSES OF MEGALOBLASTIC ANAEMIA:ANAEMIA:

Nutritional deficiency of vitamin B12 & Nutritional deficiency of vitamin B12 & folic acid due to less intake.folic acid due to less intake.

Lack of intrinsic factors in gastric secretion Lack of intrinsic factors in gastric secretion which is needed to absorb vitamin B12 from which is needed to absorb vitamin B12 from the gastrointestinal tract.the gastrointestinal tract.

It is also associated with the type 1 It is also associated with the type 1 diabetes ,thyroid disease.diabetes ,thyroid disease.

This anaemia is caused due to increased This anaemia is caused due to increased demand of nutrition during demand of nutrition during pregnancy,malignancy,leukemia lymphoma pregnancy,malignancy,leukemia lymphoma & Inflammatory disorders etc.& Inflammatory disorders etc.

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Megaloblastic AnaemiaMegaloblastic Anaemia

Macrocytic RBCMacrocytic RBC Hypersegmented Hypersegmented

NeutrophilNeutrophil

TREATMENT: TREATMENT: Vitamin B12 Vitamin B12 Folic Acid if it Folic Acid if it is nutritional.is nutritional.

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4. HEMOLYTIC ANEMIAS4. HEMOLYTIC ANEMIAS

Mostly heriditary.Mostly heriditary. Cells are fragile, rupture easily as Cells are fragile, rupture easily as

they move through the capillaries.they move through the capillaries. The life span of erythrocytes is The life span of erythrocytes is

reduced.reduced.

HERIDITARY SPHEROCYTOSIS:HERIDITARY SPHEROCYTOSIS: Small spherical erythrocytes.Small spherical erythrocytes. Cannot be compressed even slightlyCannot be compressed even slightly Rupture and are lysed very easily.Rupture and are lysed very easily.

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5. Pernicious anemia5. Pernicious anemia

The fundamental defect in The fundamental defect in pernicious anaemia is a failure pernicious anaemia is a failure of secretion of intrinsic factor by of secretion of intrinsic factor by the stomach due to permanent the stomach due to permanent atrophy of the gastric mucosa.atrophy of the gastric mucosa.

Gastric atrophy is the end result Gastric atrophy is the end result of complex interaction between of complex interaction between genetic & autoimmune Factors.genetic & autoimmune Factors.

This type of Anaemia is occurred This type of Anaemia is occurred due to vitamin B12 deficiency.due to vitamin B12 deficiency.

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Pernicious anemiaPernicious anemia

Diagnostic features Diagnostic features Serum Serum antibodies antibodies to intrinsic factor/parietal cells to intrinsic factor/parietal cells

are highly specific for pernicious anemia.are highly specific for pernicious anemia. ↑↑ serum serum homocysteine and methyl malonic homocysteine and methyl malonic

acidacid levels ( levels (more sensitive more sensitive than serum vitamin than serum vitamin B12 levels)B12 levels)

Clinical CourseClinical Course atherosclerosis and thrombosis atherosclerosis and thrombosis

((↑↑homocysteine) homocysteine) ↑↑ incidence of gastric cancerincidence of gastric cancer

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6. SICKLE CELL ANEMIA6. SICKLE CELL ANEMIA Affects 0.3 to 1% of West African & Affects 0.3 to 1% of West African &

African blacks.African blacks. The Beta chains of Hemoglobin are The Beta chains of Hemoglobin are

defective.defective. They have Hb SThey have Hb S Sickling occurs when Hb loses Oxygen.Sickling occurs when Hb loses Oxygen. A vicious circle of events occurs: A vicious circle of events occurs:

Oxygen tension Oxygen tension Sickling Sickling Rupture of Rupture of Erythrocytes Erythrocytes Further Further Oxygen tension Oxygen tension

This is called a crisis in sickle cell This is called a crisis in sickle cell disease.disease.

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Sickle cellsSickle cells

Molecular aggregation Molecular aggregation of Hgb-Sof Hgb-S

SS, SC, S-thalSS, SC, S-thal rarely S-traitrarely S-trait

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ERYTHROBLASTOSIS FETALISERYTHROBLASTOSIS FETALIS

Rh Isoimmunisation causes this Rh Isoimmunisation causes this diseasedisease

Antigen antibody reaction causes Antigen antibody reaction causes lysis of erythrocytes.lysis of erythrocytes.

Seen in Neonates and is also Seen in Neonates and is also called Icterus Gravis Neonatorum.called Icterus Gravis Neonatorum.

Excess Bilirubin enters the brain, Excess Bilirubin enters the brain, causing ‘kernicterus’causing ‘kernicterus’

Can become fatal.Can become fatal.

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IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA

The most common type of anemiaThe most common type of anemia.. Caused by nutritional deficiency of Iron.Caused by nutritional deficiency of Iron. Erythrocytes are smaller and have less Erythrocytes are smaller and have less

Hb.Hb. So they are called Microcytic & So they are called Microcytic &

Hypochromic.Hypochromic. Treated by taking Iron rich diets.Treated by taking Iron rich diets. Dark green leafy vegetables: esp Dark green leafy vegetables: esp

Drumstick leaves.Drumstick leaves. Meats like Liver & spleen.Meats like Liver & spleen.

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IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA Facts and FiguresFacts and Figures

Most common cause of anemiaMost common cause of anemia 500 million cases worldwide500 million cases worldwide Prevalence is higher in less developed countriesPrevalence is higher in less developed countries

Unique Physical Exam findingsUnique Physical Exam findings CheilosisCheilosis

fissures at the corners of the mouthfissures at the corners of the mouth KoilonychiaKoilonychia

spooning of the fingernailsspooning of the fingernails

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Iron def. AnemiaIron def. Anemia

Low Retic countLow Retic count High RDWHigh RDW Due to chronic blood Due to chronic blood

lossloss Diet deficiencyDiet deficiency

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Increased demand for iron Increased demand for iron and/or hematopoiesisand/or hematopoiesis Rapid growth in infancy Rapid growth in infancy

or adolescenceor adolescence PregnancyPregnancy Erythropoietin therapyErythropoietin therapy

Increased iron lossIncreased iron loss Chronic blood lossChronic blood loss MensesMenses Acute blood lossAcute blood loss Blood donationBlood donation Phlebotomy as treatment Phlebotomy as treatment

for polycythemia verafor polycythemia vera

Decreased iron intake or Decreased iron intake or absorptionabsorption Inadequate dietInadequate diet Malabsorption from Malabsorption from

disease (sprue, Crohn's disease (sprue, Crohn's disease)disease)

Malabsorption from Malabsorption from surgery (post-surgery (post-gastrectomy)gastrectomy)

Acute or chronic Acute or chronic inflammationinflammation

Causes of Iron DeficiencyCauses of Iron Deficiency

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IRON RICH DIETSIRON RICH DIETS

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SECONDARY ANEMIA(RENAL)SECONDARY ANEMIA(RENAL)

Renal Diseases can cause Renal Diseases can cause decreased decreased ErythropoietinErythropoietin..

Erythropoietin is essential for Erythropoietin is essential for proper production of erythrocytes proper production of erythrocytes (Erythropoiesis)(Erythropoiesis)

Renal disease thus causes Anemia.Renal disease thus causes Anemia.

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ANEMIA: EFFECTS ON CVSANEMIA: EFFECTS ON CVS

Decreased Blood ViscosityDecreased Blood Viscosity Decreased Peripheral Resistance.Decreased Peripheral Resistance. Increased blood flow to tissuesIncreased blood flow to tissues Increased Venous Return.Increased Venous Return.

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So increased Cardiac Output.So increased Cardiac Output. Hypoxia causes peripheral Hypoxia causes peripheral

vasodilatation which further vasodilatation which further increases blood flowincreases blood flow

Higher work load on the heartHigher work load on the heart Cardiac Reserve decreases.Cardiac Reserve decreases.

ANEMIA: EFFECTS ON CVSANEMIA: EFFECTS ON CVS

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Anemia is a decrease in either Hb or Anemia is a decrease in either Hb or RBCs.RBCs.

Types of Anemia:Types of Anemia: HemorrhagicHemorrhagic AplasticAplastic MegaloblasticMegaloblastic PerniciousPernicious HemolyticHemolytic Sickle CellSickle Cell Iron deficiencyIron deficiency Secondary (Renal)Secondary (Renal)

REVIEWREVIEW

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Questions?

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