Anemia. Erythrocytopenia, Erythropenia

Anemia
Structure and Function of RBC or Erythrocyte
Types and Causes
Diagnose
CBC ( Complete Blood Count)
Treatment

1. Anemia Dr. Sami

2. Definition of Anemia : Anemia, also spelled anaemia and sometimes called erythrocytopenia , is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood or a lowered ability of the blood to carry oxygen . When anemia comes on slowly, the symptoms are feeling tired, weakness, shortness of breath, and a poor ability to exercise.

3. What are Red Blood Cells? Red blood cells (RBCs), also referred to as red cells , red blood corpuscles , haematids , erythroid cells or erythrocytes ( from Greek erythros for "red" - cyte translated as "cell" in modern usage ), Red blood cell deliver oxygen (O2) to the body tissues—via blood flow through the circulatory system . RBCs take up oxygen in the lungs, release it into tissues while squeezing through the body's capillaries . (in humans or other animals not having nucleus in red blood cells)

4. Structure: The cytoplasm of erythrocytes is rich in hemoglobin , (an Iron Rich Protein) that can bind oxygen and is responsible for the red color of the cells and the blood. Each human red blood cell contains approximately 270 million of these hemoglobin molecules . The cell membrane is composed of proteins and lipids , and this structure provides properties essential for physiological cell function such as deformability ( Ability to Change Shape) and stability while traversing the circulatory system and specifically the capillary network.

5. In humans, mature red blood cells are flexible and oval biconcave disks . They lack a cell nucleus, DNA and most organelles (Mitochondria and ER) , to accommodate maximum space for hemoglobin ; they can be viewed as sacks of hemoglobin , with a plasma membrane as the sack.

6. RBC Size: A typical human red blood cell has a disk diameter of approximately 6.2–8.2 µm and a thickness at the thickest point of 2–2.5 µm and a minimum thickness in the centre of 0.8–1 µm , being much smaller than most other human cells . Women have about 4–5 million red blood cells per microliter (cubic millimeter) of blood and men about 5–6 million. 4,000–11,000 white blood cells and about 150,000–400,000 platelets per microliter.

7. Human red blood cells take on average 60 seconds to complete one cycle of circulation . Hemoglobin is responsible for the transport of more than 98% of the oxygen in the body . The red blood cells of an average adult human male store collectively about 2.5 grams of iron , representing about 65% of the total iron contained in the body . 4g in male 3.5g in female 3g or less in children

8. Approximately 2.4 million new erythrocytes are produced per second in human adults. The cells develop in the bone marrow and circulate for about 100–120 days in the body before their components are recycled by macrophages . Each circulation takes about 60 seconds (one minute ). Approximately 84% of the cells in the human body are 20–30 trillion red blood cells . Nearly half of the blood's volume (40% to 45%) is red blood cells.

9. Life Cycle: Creation: Erythropoiesis: is the process by which new red blood cells are produced; it lasts about 7 days. Through this process red blood cells are continuously produced in the bone marrow of large bones . (In the embryo, the liver is the main site of red blood cell production.) The production can be stimulated by the hormone erythropoietin (EPO), synthesized by the kidney . Just before and after leaving the bone marrow, the developing cells are known as reticulocytes ; these constitute about 1% of circulating red blood cells

10. Functional lifetime The functional lifetime of a red blood cell is about 100–120 days , during which time the red blood cells are continually moved by the blood flow push (in arteries), pull (in veins) and a combination of the two as they squeeze through microvessels such as capillaries.

11. Senescence (Growing Old) The aging red blood cell undergoes changes in its plasma membrane , making it susceptible to selective recognition by macrophages and subsequent phagocytosis in the mononuclear phagocyte system (spleen, liver and lymph nodes), thus removing old and defective cells and continually purging the blood. This process is termed eryptosis , red blood cell programmed death. This process normally occurs at the same rate of production by erythropoiesis, balancing the total circulating red blood cell count.

12. Anaemia: Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues . Having anemia, also referred to as low hemoglobin, can make you feel tired and weak . There are many forms of anemia, each with its own cause . Anemia can be temporary or long term and can range from mild to severe . In most cases, anemia has more than one cause

13. Types of Anemia: On the base of cell size. If the cells are small, it is called microcytic anemia. if they are large, it is called macrocytic anemia. if they are normal sized, it is called normocytic anemia.

14. Types on the base of Causes: Blood Loss or Iron Deficiency Anemia: Bleeding , either from losing a large amount of blood quickly (for instance, in a serious accident) or losing small amounts of blood over a long period of time. The body loses more iron with blood loss than it is able to replace with food. This can happen to women having heavy menstrual periods or in people who have inflammatory bowel disease. Not getting enough iron in the diet

15. Decreased or Impaired RBCs: Bone marrow and stem cell problems if they don’t work right, or if they’re replaced by other cells such as cancer cells, pt. might get anemia. Anemia caused by bone marrow or stem cell problems includes : 1:Aplastic anemia Occurs when body stops producing enough blood cells When bone marrow was injured by medications, radiation, chemotherapy, or infection. Other malignancies that commonly effect the bone marrow include multiple leukemia . Sometimes , there’s no clear cause of aplastic anemia.

16. 2: Lead poisoning. Lead is toxic to bone marrow, causing to have fewer red blood cells . Lead poisoning can happen when adults come into contact with lead at work , for example, or if children eat chips of lead paint . it can also get it if your food comes into contact. 3: Thalassemia Inherited disease happens with a problem with hemoglobin formation or less hemoglobin in blood. body make really small red blood cells-though you can make enough of them to be asymptomatic, or it can be severe .

17. Hemolytic anemia: This type of anemia can be caused by inherited or acquired diseases that This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases increase red blood cell destruction

18. Sickle cell anemia. This genetic form of anemia happens because the shape of the red blood cells is faulty. They are sickle shaped , which means that they can clog the blood vessels and cause damage. They may break down more quickly than healthy RBCs or become lodged in small blood vessels . This blockage can reduce oxygen levels and cause pain further down in the bloodstream.

19. Vitamin-deficiency anemia can happen when pt aren’t getting enough vitamin B12 and folate (B9) . we need these two vitamins to make red blood cells. This kind of anemia can be caused by : Dietary deficiency : If we eat little or no meat, we might not get enough vitamin B12 . If we overcook vegetables or don’t eat enough of them, we might not get enough folate. Megaloblastic anemia: Megaloblastic anemia is a condition in which the bone marrow produces unusually large, structurally abnormal, immature red blood cells When we don’t get enough vitamin B12, folate, or both Pernicious anemia : When body doesn’t absorb enough vitamin B12

20. Fanconi anemia This type of anemia is also rare and it is genetic . It happens because the bone marrow does not make enough red blood cells. There are physical signs of this condition, such as abnormal bone structure . About 50 % of people with this condition are diagnosed by the time that they turn 10 years old.

21. Anemia associated with other chronic conditions usually happens when your body doesn’t have enough hormones to make red blood cells ( hormone erythropoietin ( EPO) Conditions that cause this type of anemia include: Advanced kidney disease Hypothyroidism Old age Long-term diseases, such as cancer, infection, lupus, diabetes, and rheumatoid arthritis

22. Who is most likely to develop anemia? Anyone can develop anemia, although the following groups have a higher risk : Women : Blood loss during monthly periods and childbirth can lead to anemia Children , ages 1 to 2 : The body needs more iron during growth spurts . Infants : Infants may get less iron when they are weaned from breast milk or formula to solid food. Iron from solid food is not as easily taken up by the body. People over 65 : People over 65 are more likely to have iron-poor diets and certain chronic diseases.

23. Risk Factors: The following factors increase the risk. having been born prematurely being between 6 months and 2 years menstruating being pregnant and giving birth having a diet low in vitamins , minerals, and iron regularly taking medications that inflame the stomach lining, such as ibuprofen

24. having a family history of inherited anemia, such as sickle cell anemia or thalassemia having an intestinal disorder that affects the absorption of nutrients, such as Crohn’s disease losing blood , due to surgery or trauma, for example having a chronic illness, such as AIDS, diabetes, kidney disease , cancer, rheumatoid arthritis, heart failure, or liver disease

25. Signs and Symptoms: Dizziness , lightheadness, or feeling like you are about to pass out Fast or unusual heartbeat Pale or yellowish skin Cold hands and feet Headache Pain, including in your bones, chest, belly, and joints Problems with growth, for children and teens Shortness of breath Tiredness or weakness

26. Complications: Extreme fatigue. Severe anemia can make you so tired that you can't complete everyday tasks. Pregnancy complications. Pregnant women with folate deficiency anemia can be more likely to have complications, such as premature birth.

27. Heart problems. Anemia can lead to a rapid or irregular heartbeat (arrhythmia). When pt is anemic heart pumps more blood to make up for the lack of oxygen in the blood. This can lead to an enlarged heart or heart failure. Death . Some inherited anemias, such as sickle cell anemia, can lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal. Among older people, anemia is associated with an increased risk of death.

28. Diagnose: History CBC

29. CBC White blood cells (WBCs). WBCs help in Immunity. 4,500 to 11,000 cells per microliter (cells/mcL) if they are too many of them , it could be a sign of inflammation, infection, a medical reaction, or another health condition . If it’s low , you could be at a higher risk for infection . A medication, a viral infection, or a bone marrow disease could also cause a low count .

30. Red blood cells (RBC). Normal Values: 4.5 million to 5.9 million cells/ mcL for men; 4.1 million to 5.1 million cells/ mcL for women A high RBC count may be due to: Dehydration Stress High altitude Smoking, Cardiovascular disease, Polycythemia vera , A low RBC count may be caused by a number of conditions, including : Anemia, Malnutrition, Pregnancy, Hemolysis , which is the breakdown of red blood cells Chronic kidney failure

31. Hemoglobin ( Hb or Hgb ) Normal Values 14 to 17.5 grams per deciliter (gm/ dL ) for men; 12.3 to 15.3 gm/ dL for women If hemoglobin level is lower than normal , you have anemia . If hemoglobin level is higher than normal , it may be the result of : Polycythemia vera — a blood disorder in which your bone marrow makes too many red blood cells Lung disease Dehydration Living at a high altitude Heavy smoking

32. Hematocrit ( Hct ). Normal Values: For men, 38.3 to 48.6 percent For women, 35.5 to 44.9 percent This test tells how much of blood is made up of red blood cells A person who has a low hematocrit is referred to as being anemic Higher than normal hematocrit levels represent abnormally elevated red blood cell counts . High hematocrits can be seen in people living at high altitudes and in chronic smokers . lung disease, certain tumors, polycythemia

33. Mean corpuscular volume (MCV). 80 to 96femtoliters ( fL ) 10 −15   litres If results show that red blood cells are larger than normal , it may indicate : A vitamin B12 deficiency A deficiency in folic acid, another type of B vitamin Liver disease Hypothyroidism If results show that red blood cells are smaller than normal , it may indicate : Iron-deficiency anemia or other types of anemia

34. Platelets 150,000 to 450,000 platelets/ mcL A high platelet count can happen when something causes the bone marrow to make too many platelets . When the reason is unknown, it is called primary, or essential, thrombocytosis . When excess platelets are due to an infection or other condition, it is called secondary thrombocytosis . Some temporary conditions can cause a higher than normal platelet count . recovering from a recent injury recovering from blood loss after surgery using birth control pills

35. Prevention Many types of anemia can't be prevented. But we can avoid iron deficiency anemia and vitamin deficiency anemias by eating a diet that includes a variety of vitamins and minerals, including: Iron . Iron-rich foods include beef and other meats, beans, lentils, iron-fortified cereals, dark green leafy vegetables and dried fruit. Folate . This nutrient, and its synthetic form folic acid, can be found in fruits and fruit juices, dark green leafy vegetables, green peas, kidney beans, peanuts, and enriched grain products, such as bread, cereal, pasta and rice. Vitamin B-12 . Foods rich in vitamin B-12 include meat, dairy products, and fortified cereal and soy products. Vitamin C . Foods rich in vitamin C include citrus fruits and juices, peppers, broccoli, tomatoes, melons and strawberries. These also help increase iron absorption.

36. Treatment: Anemia treatment depends on the cause: Iron deficiency anemia. Treatment for this form of anemia usually involves taking iron supplements and changing your diet . If the cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and the bleeding stopped . This might involve surgery.

37. Vitamin deficiency anemias. Treatment for folic acid and vitamin B12 deficiency involves dietary supplements and increasing these nutrients in diet. If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you might need vitamin B-12 shots. At first, you might have the shots every other day. Eventually, you'll need shots just once a month, possibly for life, depending on your situation.

38. Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease . If symptoms become severe , a blood transfusion or injections of a synthetic hormone normally produced by kidneys (erythropoietin) might help stimulate red blood cell production and ease fatigue.

39. Aplastic anemia. Treatment for this anemia can include blood transfusions to boost levels of red blood cells . Pt might need a bone marrow transplant if pt bone marrow can't make healthy blood cells.

40. Hemolytic anemias . Managing hemolytic anemias includes avoiding suspect medications, treating infections and taking drugs that suppress your immune system , which could be attacking red blood cells. Severe hemolytic anemia generally needs ongoing treatment.

41. Sickle cell anemia: Treatment typically involves oxygen therapy, pain relief medication, and intravenous fluids, but it can also include antibiotics, folic acid supplements, blood transfusions, and a cancer drug called hydroxyurea

42. Thalassemia. Most forms of thalassemia are mild and require no treatment . More-severe forms of thalassemia generally require blood transfusions, folic acid supplements, medication, removal of the spleen, or a blood and bone marrow stem cell transplant.