Khosrow Mahdavi MD FACP - University of California, … Mahdavi MD FACP Classification. Decreased...
Transcript of Khosrow Mahdavi MD FACP - University of California, … Mahdavi MD FACP Classification. Decreased...
Anemia, Classification,
Pathophysiology, Diagnosis.
Khosrow Mahdavi MD FACP
Classification.
Decreased production of red cells 1-Stem cell failure /Aplastic anemia: a-Idiopathic b-Radiation c-Viruses d-drug induced. e-Myelodysplasia./Myeloproliferative status f-Myeolophethesia g-Cytotoxic therapy
Classification
Erythroid progenitor cell failure a-Pure red cell aplasia (Virus, drug, Thymoma, Antibodies ). b-Endocrinopathies. c-Aquired Sidoblastic anemia (Rx.Copper defficiency,etc).
Classification
Failure due to neutritional factors; a-Vit. B12 defficiency. b-Folate defficiency c-N2O induced,Megaloblastic anemia. d-Rx.Pemetrexate, Methotrexate,Phenytoin etc. e-Iron deficiency f- othere
Classification
Anemia of chronic disease. Anemia of renal failure Anemia assosiated environemental factors
(Lead). Acquired Thallassemia Erythropoietin antibodies. Erythroid
progenitor cell failure
Classification; Hereditary:
Stemcellfailure , Pluripotential; Fanconi’s Shwachman syndrom Dyskeratosis Congenita.
hereditary
Erythroid progenitor Cell Failure; Diamond Blackfan Syndrome Congenital dyserythropoietic Syndromes
Fuctional impairment multiple causes
Selective Malabsorbtion of B12 Congenital Intrinsic Factor Deficiency Transcobalamin II deficiency Impaired Cobalamin Metabolism (MMA) Folate Metabolism Purine and Pyrimidine Atransferrinemia Hereditary Sidrolastic anemia Thalassemias
Increased Rate of RBC distruction Aquired
Aquired: 1-Macroangiopatic : March hemoglobulinuria ,Artificial Valve 2-Microangiopatic : DIC ,TTP, Vasculitis, 3-Parasites and microorganisms : Malaria ,Babesosis, Bartonella
Increased RBC distruction Aquired
Antibody Mediated:
1-Warm Autoimmune Hemolytic anemia 2-Cryopathic ; 3-Transfusion Reaction :early and delied
Increased RBC Distruction aquired
Hypersplenism
Membrane disorders Spur cell, acantocytosis ,stomatocytosis Chemical injery Arsenic, Copper, Chlorate, Spider,Scorpion, Snake venums etc. Physical injery Heat.,radiation oxygen
Hereditary Increased Rate of RBC distruction
Hemoglobinopathies. Sickel Cell , Unstable hemoglobins. Red cell membrane a)Cytoskeletal
(HereditarySphorocytosis,Elyptocytosis ,Pyropokilocytosis ) B)Lipid membrane; Abetalipoproteinemia,hereditary stomatocytosis. c)Abnormal erythrocyte antigen (McLeod,Rh deficiency) d)Abnormal transport (Xerocytosis) Red cell Enzyne disorders (PK,G6PD,Nucleotidase )
Porphyria (congenital erythroporphyria)
Loss and redistribution
Acute Blood Loss.
Splenic Sequestration
Relative anemia
Macroglobulinemia. Pregnancy Athletes Post space flight
Diagnosis/
Reticulocytes.
RDW
MCV
Do not forget Hx,Px, and the rest of the CBC and Chemistry panel
Differential Diagnosis Low Retic count
Microcytic : MVC <80
Iron deficiency Thalassemia, minor Sidroblastic anemia Lead poisoning
D/D Macrocytic Anemia Low Retic
Megaloblastic anemia Folate deficiency Vitamin B 12 deficiency Drug Induced Non megaloblastic Liver disease Hypothyroid
D/D Nc/Nc Low Reic count
Early Fe Deficiency Aplastic Anemia Myelophthisic Endocrine disorder Anemia of chronic disease. Renal failure , Uremia Mixed Nutritional deficiency
Vitamin B 12 Deficiency ,Causes
Impaired absorption: Classic PA Gastrectomy (Partial or total) Pancreatic Deficiency Bacterial overgrowth (Blind Loop) Terminal Ilium conditions Tapeworm infection . Congenital Transcobalamin II deficiency
Nutritional
Causes of Folate deficiency
Relative dietary insuficiency’ Pregnancy Lactation Hemolytic conditions Malignancies Exfoliative dermatitis Malabsorbtion; Short bowel Crohn’s disease Sprue Antifolate Medicines Methotrexate Sulfa components. Etc.
Hemolytic Anemia
Immune mediated. Other extrinsic to RBCs Impaired RBC membrane Erythrocyte enzyme deficiencies Hemoglobinopathies
Hemolytic anemia
Immune hemolytic anemia;
Warm antibodies, Cold antibodies.
Hemolytic anemia
Extrinsic factors ; DIC TTP HELLP (Preeclampsia, Eclampsia) Cardiac Valve Splenomegaly Infection
Hemolytic anemia
Impaired RBC Membrane : Inherited : Spherocytosis. Eliptocytosis. Pyropoikilocytosis Aquired: PNH (Proxysmal Nocturnal Hemoglobinuria) Spur cell (Acantocytes)
Hemolytic anemia
RBC, Enzymopathies; G6PD deficiency Othere Hemoglobinopathies; Sickle Cell anemia. Thalassemia
Autoimmune Drug Induced Hemolytic Anemias
Hapten: Penicilline, Cephalothis . . . Immune complex:Quinine Quinidine
Phenacetine Rifampin INH Tetracycline Chlorpromazine
Anti-RBC antibody: Methyldopa,Levodopa, Procainamide ,Ibuprofen, Interferon-a