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Anemia

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Anemia

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  1. Anemia Kristine Krafts, M.D.

  2. Anemia Outline • Background facts about blood • Anemia: general information • Anemia: specific types

  3. Anemia Outline • Background facts about blood

  4. Normal blood cells

  5. Complete Blood Count (CBC) Hematocrit RBC Hemoglobin

  6. Complete Blood Count (CBC) MCV MCHC hypochromic normochromic microcytic normocytic macrocytic

  7. Additional Red Blood Cell Properties Size variation Shape anisocytosis poikilocytosis

  8. Normal red blood cells

  9. Anemia Outline • Background facts about blood • Anemia: general information

  10. An (without) -emia (blood): a reduction below normal in hemoglobin or red blood cell number.

  11. Symptoms of Anemia Pale skin, mucous membranes Jaundice (if hemolytic) Tachycardia Breathlessness Dizziness Fatigue

  12. Anemia Outline • Background facts about blood • Anemia: general information • Anemia: specific types

  13. Three Ways to Get Anemic Loseblood Destroy too much blood • Extracorpuscular reasons • Intracorpuscular reasons Make too little blood • Too few building blocks • Too few erythroblasts • Not enough room

  14. Three Ways to Get Anemic Loseblood

  15. Anemia of Blood Loss • Cause: traumatic, acute blood loss • At first, hemoglobin is normal! • After 2-3 days, see reticulocytes • Chronic blood loss is different (it causes iron deficiency anemia). Things you must know

  16. Reticulocytes

  17. Three Ways to Get Anemic Lose blood Destroy too much blood • Extracorpuscular reasons • Intracorpuscular reasons

  18. Hemolytic Anemias • Intracorpuscular vs. extracorpuscular • Chronic vs. acute • Signs of destruction: ↑ bilirubin, ↑ LDH, ↓ haptoglobin • Signs of production: ↑ reticulocytes, nucleated red cells in blood

  19. Reticulocytes (supravital stain)

  20. Three Ways to Get Anemic Lose blood Destroy too much blood • Extracorpuscular reasons

  21. Microangiopathic Hemolytic Anemia Things You Must Know • Physical trauma to red cells • Schistocytes • Find out why!

  22. Red cells snagged on fibrin strand

  23. Schistocytes

  24. Triangulocyte

  25. Causes of MAHA • Artificial heart valve • Malignancy • Obstetric complications • Sepsis • Trauma

  26. Autoimmune Hemolytic Anemia • Warm AIHA • IgG • Spleen • Spherocytes • Cold AIHA • IgM, complement • Intravascular hemolysis • Agglutination Things You Must Know

  27. Warm AIHA

  28. Warm AIHA

  29. Warm AIHA

  30. Cold AIHA

  31. Cold AIHA

  32. patient red cells + AHG = agglutination Direct antiglobulin test (DAT)

  33. Three Ways to Get Anemic Lose blood Destroy too much blood • Extracorpuscular reasons • Intracorpuscular reasons

  34. Sickle Cell Anemia • Hemoglobinopathy (qualitative defect in hemoglobin) • Single amino acid substitution in beta chain of hemoglobin • Can be heterozygous or homozygous • Sickle cells are nasty: • Fragile (burst easily) • Get stuck in vessels Things You Must Know

  35. Hemoglobin

  36. Point mutation in  chain gene abnormal  chains (substitution of valine for glutamate) Hgb S Nasty! Aggregates and polymerizes on deoxygenation Red cell becomes sickle shaped Sickles clog up vessels… …plus, they are fragile

  37. Sickle cell anemia

  38. Sickle cell anemia: foot lesion

  39. Sickle cell anemia: spleen

  40. Clinical Findings in Sickle Cell Anemia • Blacks (8% are heterozygous) • Severity of disease is variable • Chronic hemolysis, vaso-occlusive disease, and  infections (autosplenectomy) • Treatment: prevent triggers, vaccinate, transfuse

  41. Thalassemia Things You Must Know • Quantitativedefect in hemoglobin • Can’t make enough α or β chains • Variable disease severity • Hypochromic, microcytic anemia with increased RBC and target cells

  42. α β γ δ birth Hgb F = α2γ2 Hgb A2 = α2δ2 Hgb A = α2β2 Hemoglobin chain development

  43. Thalassemia

  44. Thalassemia: Medullary expansion

  45. Hereditary Spherocytosis Things You Must Know • Tons of spherocytes • Spectrin defect • Splenectomy is curative

  46. z

  47. Hereditary spherocytosis

  48. Splenomegaly in hereditary spherocytosis