Anemia

disease

1. Anemia Prepared by: Shkar Yasin Rawezh Khasraw Shkar Fayaq Gashtyar Baxtyar

2. Outline Definition Normal RBC destruction Classification Hemolytic anemia Diagnosis and treatment

3. Haematopoiesis Blood cellular components formation derived from haematopoietic stem cells.

4. “WITHOUT BLOOD” Decreasing number of RBC , haemoglobin or haematocrit below normal range for age and sex Normal HB range between (13.5 – 17.5) for men, (12-15.5) for women Infants have higher HB level

5. Normal red cell distruction

6. Classification:

7. Tests show increased RBC destructrion Serum unconjugated bilirubin Urobilinogen in urine Stercobilinogen in feces Raised LDH level Serum haptoglobin Hemoglobinuria , hemoglobinemia , hemosedrinuria in intravascular hemolysis.

8. Intravascular h aemolysis

9. Intravascular haemolysis Mismatched blood transfusion. G6PD with oxidant stress Red cell fragmentation syndrome Cold autoimmune haemolytic anemia Paroxysmal nocturnal haemoglobinuria

10. Hereditory Spherocytosis Abnormality of RBC’s membrane AD Jaundice (extravascular haemolysis ) Spleenomegaly Reticulocytosis (5-20%0

11. Investigation Osmotic fragility Negative direct antiglobulin CBC

12. Hereditary Elliptocytosis AD, defect in cytoskeletal membrane 90% not anemic ,10% have same clinical manifestation as Spherocytosis

13. Treatment of spherocytosis and elliptocytosis Surgery Vitamins Blood transfusion

14. G6PD Deficiency Anemia

15. G6PD deficiency anemia Due to point mutation or deletion of enzyme G6PD causing less activity of the enzyme than normal. Oxidant stress examples: D rugs Infections F avism

16. Diagnosis of G6PD Blood test for G6PD enzyme level Blood film during crises showing blister and bite cells

17. irregularly contracted cells and blister cells

18. Clinical manifestations Asymptomatic between crises During crises patient experience Yellowish skin Shortness of breath dark urine Haemoglobinemia Haemosiderinuria

19. Thalassemia Inherited blood disorder. Thalassemia is an AR genetic disorder. Inadequate Hb production

20. slideplayer.com ThalassemiaGerald A. Soff

21. C lassifications Beta thalassemia Alpha thalassemia

22. Beta thalassemia Major Severe form of beta thalassemia Presence of two abnormal genes Caused by mutation of HBB gene on chromosome 11

23. pathophysiology

24. Clinical manifestation: anemia Iron overload Pallor Jaundice Skull deformity, mongoloid face Cardiac dysfunction or failure

25. Blood picture Hypochromic microcytic anemia Decrease MCV, MCH HB electrophoresis .

26. Treatment: symptomatic relieve Blood tranfusion Iron chelating drugs like D eferoxamine Speleenectomy Bone marrow transplantation

27. Betathalassemia minor Presence of one abnormal gene Slight reduced Hb level RBC count. Blood film shows anisocytosis , hypochromia , target and tear cells

28. Diagnosis of beta thalassemia minor Increased HbA2 4 to 7 percent TIBC is normal

29. Clinical features+ diagnosis of HBH disease Microcytic hypochromic anemia Spleenomegaly Mild jaundice Pallor

30. Golf ball appearance

31. Prevention Premarital screening Prenatal diagnosis Pre implantation genetic diagnosis

32. Sickle cell anemia Inherited Structural abnormality S ubstitution of glutamic acid by valine

33. Clinical manifestation Episodes of pain (crisis) Painful swelling of hand and fit Frequent infection Delayed growth due to lowering O2 Vision problems

34. Complications Stroke Acute chest syndrome Pulmonary hypertension Blindness Leg ulcer

35. Investigation and diagnosis Blood film: normochromic, microcytic, retoculocytosis 10-20% Sickling test HbS 80-95% in severe cases

36. Iron deficiency anemia Iron deficiency is cause defect in hemoglobin synthesis , result in the RBC is smaller than normal (microcytic , hypochromic)

37. Cause of iron deficiency anemia Inadequate iron intake Mal absorption of iron Increase iron requirement Increase iron loss Chronic blood loss Subtotal or complete gastrectomy

38. Sings and syntom General fatigue weakness Pale skin shortness of breath dizziness tongue swelling  cold hands and feet tachycardia brittle nails headaches

39. Diagnosis of iron deficiency anemia Blood film Microcytic and hypochromic CBC

40. treatment Diet: meat , vegetable ,nuts Iron supplement

41. What is megaloblastic anemia? Hematological disorder Deficency of folic acid and vit.B12

42. Vitamin B12 Imprtant for synthesis DNA

43. Folic acid Important in synthesis DNA

44. Cause of M egaloblastic anemia B12 deficiency Folic acid deficiency

45. B . Cause of vit.B12 deficiency Inadequate dietary intake Mal absorption 1.gastric cause 2.intestinal cause

46. A. Cause of folic acid deficiency Alcoholism Malnutrition Excessive cooking Drug: phenytoin, barbiturate Increase requirement : pregnancy ,lactation

47. Clinical manifestations: Fatigue Weakness Body ache Vertigo

48. Beefy tongue Diarrhea Anorexia Weight loss

49. Diagnosis? Laboratory finding: Blood film: MCV increase Film: Normochromic, Anisocytosis poikilocytosis , macrocytosis , tear drop cells

50. 2. CBC RBC count reduce Heamoglobin reduce Mcv increase MCH increase MCHC normal or reduce

51. 3. Bone marrow finding: Hypercellular marrow. Erythropoisis , with megaloblastic maturation. Giant metamyelocytes .

52. 4.Biochemical finding: Vitamin B12 reduce Folate acid reduce Unconjugate bilirubin increase Serum iron and fertin may be normal or elevated

53. treatment 1.treatment of B12 deficiency DIET

54. 2. medication: 1000 ug B12 IM once a week for 8 weeks

55. 2.Treatment of folic acid deficiency A. diet : vegetable, nuts, meat

56. B. medication 5mg/day for 2 – 4 months

57. REFERENCE Hoff brand essential heamatology 7 th edition Essential of clinical medicine (PROF.DR.MAGDY ISHAK) 2018 22edtion DAVIDSON principle and practic of medicine( BRIAN.R WALKER)2018 22edition DACIDSON ESSENTIAL OF MEDICINE (J.ALASTAIR INNES)2018 2 edition First aid usmle 2018 WWW.HEALTHCARE.COM WWW.MYOCLINIC.COM Google image