By the end of the class student should… • Define anemia • Classify anemia and give the common cause of each category of anemia • Define polycythemia • Name the various blood indices, give their formulas for calculation. • List the types and causes of polycythemia
A 30 yrs old house wife complained of Easy fatigue, Unusually rapid heart beat, particularly with exercise, Shortness of breath and headache, particularly with exercise, Difficulty concentrating, Dizziness, Leg cramps, Insomnia. hunger for strange substances such as paper, ice, or dirt (pica).
Quantitative and qualitative reduction in RBC count / decrease in the Hb content leading to a decrease in oxygen carrying capacity of the blood.
Features of Anemic patients: • Tiredness, Easy Fatiguable, Generalized muscular Weakness • Pallor: nail bed, Conjunctiva, mucous Membrane ,skin • Dyspnoea in exertion • Angina in older people • Haemic murmurs(due to increased velocity of Blood Flow ) • Amenorrhoea may develop • Anorexia in some people.
WHO classification: Men women pregnancy (n>13) (n>12) (n>11) Mild: 11-12.9 10-11.9 10-10.9 Moderate : 8-11 8-10 7-10 Severe: < 8 < 8 <7 Survival is difficult below 2 gm %
Classification based on the etiology: (whitby)
Decreased RBC production • Increased red cell destruction
Decreased RBC production • Stem cell failure -Aplastic anemia • Progenitor failure -Chronic diseases (renal disease) • Precursor failure -Megaloblasticanemia -Iron deficiency anemia -Thalassemia
Increased red cell destruction • Acquired cause -Blood loss -Hypersplenism -Antibody mediated • Hereditary cause -Membrane defects -Enzyme defects
1.Hemorrhagic Anemia : Acute: sudden loss of blood Eg :from wounds Chronic: slow loss of blood Eg: piles, peptic ulcers.
2.Aplastic Anemia: Abnormal Hemopoiesis Causes: • X-ray radiations • Hyper sensitivity of bone marrow to chemicals or drugs.
3.Hemolytic Anemia : Excessive destruction of RBC • Antigen antibody reaction • Hypersplenism • infection :Eg malaria • Drugs/poisons • Erythroblastosis foetalis
4.Nutritional deficiency: Iron deficiency Megaloblastic Anemia : Vit B12, folic acid Pernicious Anemia : intrinsic factor causing Vitamin B12 deficiency
Pernicious Anemia: • MacrocyticNormochromic/ hypochromic • Soreness and inflammation of tongue. • Loss of appetite. • Tingling and numbness in hands and feet . • Psychological disturbances.
Folic acid deficiency anaemia. macrocytic anemia
Iron deficiency anaemia • Microcytic Hypochromic. • Increased physiological demand, inadequate iron intake, pathological blood loss • Nails : dry ,soft, spoon shaped ,later develop longitudinal striations • Tongue: angry red. • CVS and respiratory system: breathlessness,palpations,repeated chest infection. • Nervous system: Irritability,headache,generalized body ache.
Thalasemia • Genetically determined. • Decreased synthesis of one or more polypeptide chain • Decreased synthesis of alpha or beta polypetide chain.
Morphological /Wintrobe’s classification: Normocytic Macrocytic Microcytic
POLYCYTHEMIA Primary Polycythemiavera Secondary Appropriate increase in erythropoitin - high altitude -CHD -chronic pulmonary disease -chronic smokers
Inappropriate increase in erythropoitin -renal, liver, brain tumors Apparent (relative) polycythemia Dehydration
References • Comprehensive Textbook of Medical physiology (Vol 2 first edition) G K Pal • Text book of medical physiology (Vol 2 6 th edition) A K Jain • Essentials of medical physiology (6 th edition) K Sembulingamand PremaSembulingam AEJ