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Pathology ofPathology of
AnemiaAnemia
. -r Azza Abdel-r Azza Abdelziz Aliziz Ali
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Anemia
During the 2nd m of gestation
erythropoiesis occur in the
liver till birth then starts in
the bone marrow.
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Anemia
In adult erythropoiesis occur in
the bone marrow. Blood contains:
Red blood cells White blood cells
Plasma Platelets
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Anemia
Haemoglobin is found in red
blood cells and gives themtheir colour. It carries
most of the oxygen in thebody.
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Anemia
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Proerythroblast(Pronormoblast)
BasophilicNormoblast
PolychromatophilicNormoblast
OrthochromatophilicNormoblast
Reticulocyte
Erythrocyte
Early Intermediate Late
Steps in Erythropoiesis
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Reduction below normal limits ofthe total circulating red cell mass(size and/or count) or Hb contentinthe peripheral blood.
Reduction below normal in thevolume of packed red cells, asmeasured by the hematocrit, or a
reduction in the hemoglobin
Anemia
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Red cell indicesRed cell indices
Hemoglobin:13.517 in male, 1215 in
female (gm\dl).
Hematocrite = Volume of RBCs /Total blood volume %: 39-49 % in
male & 33-43% in female. RBCscount(106/ul): 4.3-5.9 in male &
3.5-5 in female.
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Red cell indicesRed cell indicesMean Cell Volume (MCV) =
Hematocrite/ RBCs count.
(Normal 80 - 100 fL).Accordingly, anemia can be classified
as:Microcytic = Low MCV
Normal MCV Normocytic=
Macrocytic= High MC-r Azza Abdel
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Anemia
Red cell indicesRed cell indicesMean Cell Hemoglobin Concentration
MCHC = Hemoglobin/ Hematocrite
(Normal 32-36 g/dL)concentration of HB in a given volume
of packed RBCs.
hypochromic = Low MCHC
normochromic = Normal MCHC
hyperchromic = High MCHC. -r Azza Abdel
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Anemia
Anemia:ClassificationAnemia:Classification
Morphologic Microcytic
Normocytic
Macrocytic
Pathophysiologic Decreased production (Defective
hemopoiesis)
Increased destruction
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Anemia
Low Hb = AnemiaLow Hb = AnemiaMCVMCV
LowLowmicrocyticmicrocytic
Normalnormocytic
HighHighmacrocyticmacrocytic
Measure Ferritin
Low Normal/high
Iron defAnemia
Anemia ofchronic disease/Congenital Hb dis
Reticulocyte count
high low Anemia of chronic disea
Renal failureMarrow failure
Hemolytic anemia
or blood loss
Measure B12 + folate
LowMegaloblasticanemia
Normal
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Anemia
Causes of AnemiaCauses of Anemia
1. Impaired red blood cellproduction. 2. Loss of red blood cells. 3. Increased destruction of red
blood cells (hemolytic anemia).
4. Other causes. Children, pregnant women, and
adolescents are the most likely to
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Anemia
1- Impaired Red Cell Production
I.Disturbance of proliferation and
differentiation of stem cells:
aplastic anemia, pure red cell aplasia,anemia of renal failure, anemia of
endocrine disorders.
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Anemia
II. Disturbance of proliferation and
maturation of erythroblasts
q Defective DNA synthesis: deficiency or
impaired use of vitamin B12 and folic
acid (megaloblastic anemias)q Defective hemoglobin synthesis:
Deficient heme synthesis: ironiron
deficiencydeficiency Deficient globin synthesis:
thalassemias
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Anemia
2- Bloodloss:
Acute: occur suddenly such as
trauma, accidents and child
birth.Chronic: occur over a long time:
Lesions of gastrointestinaltract, gynecologic
disturbances.
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Anemia
3- Increased destruction of redblood cells
Intrinsic:A)Hereditary:
Red cell membrane as spherocytosis. Red cell enzyme deficiencies as G6PD
Deficientglobin as thalassemia, Abnormal globin sickle cell anemia.B) Acquired: Membrane defect:
paroxysmal nocturnal hemoglobinuria
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Anemia
3- Increased destruction of redblood cells
Extrinsic (extracorpuscular):
Antibody mediated as transfusion
reactions, erythroblastosis fetalis. Mechanical trauma to red cells as
Microangiopathic hemolytic anemias
Infections: malaria
Chemical injury: lead poisoning
Others
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Anemia
Hemolytic anemias
A shortened red cell life span (normal =120 days); that is, premature destructionof red cells
Elevated erythropoietin levels andincreased erythropoiesis in the marrowand other sites, to compensate for theloss of red cells
Accumulation of the products ofhemoglobin catabolism, due to anincreased rate of red cell destruction
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Anemia
4.Anemia due to other causes :1- endocrine disorders2- renal failure3- Infections4- liver disease
5- malignant disease6- collagen diseases
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Anemia
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Anemia
Pathophysiologic effects of
anemia:
Decreased Oxygen Consumption.
Increased Tissue Perfusion.
Increased Cardiac Output.
Increased Red Cell Production.
Uncorrected Tissue Hypoxia.
. -r Azza Abdel
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General manifestations of Anemias
1- Peripheral blood - Change in red cell
- Increased reticulocytic count2- Hemopoiesis
Compensatory hyperplasia of the red bonemarrow.
Extramedullary hemopoiesis in the liver, spleen
and lymph nodes.3- Tissue changes
Peripheral pallor in the skin, mucus membranes
and viscera.
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Anemia-r Azza Abdel
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Anemia-r Azza Abdel
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Anemia
Complications of Anaemia
qMore likely to get infections
qImpaired childhood development
qIncreased maternal morbidity andmortality
qDecreased work capacity
qIncreased incidence of low birthweight
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Anemia
Clinically,Pallor (pale colour)is the main sign to look for
It can affect the: Conjunctiva
Tongue and inner lips Palms of the hands
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Anemia
Iron Deficiency Anemia:
Deficiency of iron is probably the mostcommon nutritional disorder in the
world
Common in developing world,
Parasitic Worm infestation +
Malnutrition Common in adolescent girls, and women
of childbearing age
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Anemia-r Azza Abdel
I M t b li
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Anemia-r Azza Abdel
Iron Metabolism
I M t b li
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Anemia
Iron Metabolism There is no regulated pathway for iron
excretion, which is limited to the 1 to 2 mgper day lost by shedding of mucosal and skinepithelial cells.
The average daily diet contains approximately10 to 20 mg of iron, most in the form ofheme contained in animal products, with theremainder being inorganic iron in vegetables.
About 20% of heme iron (1% to 2% ofnonhemeiron) is absorbable, so the averagediet contains sufficient iron to balance fixeddaily losses. The total body iron content is
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Anemia
IDA - Etiology
Blood loss Bleeding Parasites,
Gynecologic, ulcers
Increased need
Pregnancy, children
Poor diet / poor absorption
Malnutrition (greens & meat),
malabsorption, intestinal
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Anemia
IDA - Pathogenesis:
Decreased Iron stores
Decreased Hb Synthesis
Delayed maturation of erythroblasts(cytoplasmic)
Decreased cytoplasm, more division(microcytes)
Decreased hb content (hypochromia)
Cli i l F
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Anemia
Clinical Features: General features of Anemia
Pallor, Weakness, Lethargy,
Breathlessness on exertion
Palpitations heart failure pedaledema
Special features in IDA:
Angular cheilitis, atrophic glossitis,
Oesophageal atrophy/web dysphagia,
Koilonychia, brittle nails, gastric
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Anemia
Angular cheilitisAngular cheilitis
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Anemia
Koilonychia in Iron def.Koilonychia in Iron def.
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Anemia
Hypochromic Microcytic RBCHypochromic Microcytic RBC
. -r Azza Abdel
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Anemia
Response to iron therapyResponse to iron therapy
. -r Azza Abdel
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hank youhank you
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