Anemia

Anemia

Definition
1. A reduction in the total circulating erythrocyte mass
Classification
1. On the basis of cause
  1. blood loss
  2. Inadequate production of normal blood cells
  3. Excessive destruction of blood cells
2. On the basis of morphology
  1. Normocytic
  2. Microcytic
  3. Macrocytic
Blood cells
1. Types
  1. Red blood cells - Erythrocytes
    1. Structure
      1. Anucleated
      2. Biconcave
    2. Function
      1. Gas exchange
    3. Erythropoiesis
  2. White blood cells
  3. Platelets
Types
1. Aplastic anemia
  1. Disorder of hemopoietic stem cells
  2. Results in pancytopenia
  3. Inherited
2. Anemia with chronic renal failure
  1. Normocytic normochromic anemia
  2. Normal bone marrow
3. Megaloplastic anemia
  1. Impaired DNA synthesis
    1. Causes
      1. Vitamin B12 deficiency (pernicious anemia)
      2. Folic acid
4. Pernicious anemia
  1. Causes
    1. Vitamin B12 deficiency
    2. Poor diet
    3. Low absorption
      1. Gastrocectomy
      2. Defective intestinal absorption
      3. Neoplasm in ileum
5. Folic acid deficiency
  1. Causes
    1. inadequate dietary intake
    2. Pregnancy
    3. Alcoholics
6. Iron deficiency anemia
  1. Causes
    1. Decreased iron intake
    2. Excessive loss
      1. Menstrual bleeding
    3. Increased iron demand
  2. Management
    1. Iron supplements
      1. Ferrous sulfate
        Absorption
        Duodenum
        Upper jejunum
        Excretion
        Urine
        Sweat
        Sloughing of intestinal mucosa
        Menses in women
      2. Ferrous gluconate
        Adverse reactions
        Diarrhea
        Constipation
        Vomiting
        Nausea
        Epigastric pain
      3. Ferrous fumarate
        Orally absorbed
        Excretion
        Feces
        Urine
        Bile
        Sweat
Clinical presentation
1. Symptoms
  1. Iron deficiency anemia
    1. Fatigue
    2. Pica
    3. Spoon nails
    4. Palpitations
  2. Vitamin B12 deficiency
    1. Early graying of the hair
    2. Burning sensations in the tongue
  3. Aplastic anemia
    1. Fatigue
    2. Malaise
    3. Pallor
    4. Mucosal bleeding
    5. purpura
    6. Petechiae
  4. Sickle cell anemia
    1. Fatigue
    2. Arthritis
    3. Swelling of peripheries
2. Physical examination
  1. Systemic examination
    1. Cardiomegaly
    2. Tenderness
    3. Splenomegaly
    4. Hepatomegaly
  2. The skin and mucosal membrane
    1. Conjuctiva
    2. Nail defects
    3. Jaundice
    4. Ulcerations
    5. Angiomas
    6. Purpura
    7. Abnormal pigmentations
    8. Pallor
  3. General appearance
    1. Chronic illness
    2. Underdevelopment
    3. Malnutrition
Diagnosis
1. Red blood cell indices
  1. Mean corpuscular volume
    1. Definition
      1. The Average volume of RBC in a specimen
    2. Normal range
      1. 80-100fL
    3. Interpretation
      1. If low: Microcytic
        Microcytic anemia
      2. If high: Macrocytic
        Macrocytic anemia
      3. if Normal: Normocytic
  2. Mean corpuscular hemoglobin
    1. Definition
      1. Amount of hemoglobin in an average RBC
    2. Normal range
      1. 27-33 pg/cell
  3. Mean corpuscular hemoglobin concentration
    1. Definition
      1. Average concentration of hemoglobin in an average RBC
    2. Normal range
      1. 33-36 g/dL
    3. Interpretation
      1. If low: Hypochromic
      2. If high: Hyperchromic
      3. If normal: Normochromic
  4. Red cell distribution width
    1. Definition
      1. Measures the variation in RBCs size or RBC volume
    2. Normal range
      1. 11-15%
    3. Interpretation
      1. If elevated: Anisocytosis
2. Iron studies
  1. Ferritin
    1. Intracellular storage form of iron
    2. Normal range: 10-120μg/L
  2. Serum iron
    1. Refers to ferric ions bound to serum transferrin
    2. Normal range: 9-30 μmol/L
  3. Transferrin
    1. iront transport protein in the plasma
    2. Normal range: 2-4 g/L
  4. Transferrin saturation
    1. Value of serum iron/by the total iron-binding capacity
    2. Normal range: 25-50%
3. Peripheral smear
  1. Procedure
4. Red cell folate
  1. Normal range: 317-1422 nmol/L packed cells
5. Vitamin B12
  1. Normal range:148-616 μmol/L
6. Diagnostic tests
  1. Sensitivity
  2. Specificity
  3. Positive predicted value
  4. Negative predicted value

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