Anemia_ types_clinical significance.pptx

Anemia

1. Anemia Dr. E. Muralinath, C. Kalyan & M. Bharat

2. Extrinsic hemolytic anemia: B. Intrinsic hemolytic anemia. a) It is the type of anemia caused by destruction of RBCs by external factors. Healthy b)The hemolysis of RBCs takes place by factors outside the blood cells namely antibodies, chemicals and drugs.   Extrinsic hemolytic anemia is also termed as autoimmune hemolytic anemia.   Common causes of external hemolytic anemia: i . Liver failure ii. Renal disorder   Etiological classification of anemia Hemorrhagic anemia Acute loss of blood Normocytic, normochromic Chronic loss of blood Microcytic, hypochromic Hemolytic anemia

3. hemolytic anemia: i . Liver failure ii. Renal disorder iii. Hypersplenism iv. Burns v. Infections – hepatitis, malaria and septicemia vi. Drugs – Penicillin, antimalarial drugs and sulfa drugs vii. Poisoning by lead, coal and tar viii. Presence of isoagglutinins like anti Rh xi. Autoimmune diseases – rheumatoid arthritis and ulcerative colitis

4.     Normocytic normochromic Intrinsic hemolytic anemia: Hereditary disorders Sickle cell anemia: Sickle shape   Thalassemia: Small and irregular   Nutrition deficiency anemia Iron deficiency     Microcytic, hypochromic Protein deficiency   Macrocytic, hypochromic Vitamin B12     Macrocytic, normochromic/hypochromic Folic acid   Megaloblastic, hypochromic   Aplastic anemia Bone marrow disorder

5. Normocytic, normochromic Anemia of chronic diseases i. Non­infectious inflammatory diseases – rheumatoid arthritis ii. Chronic infections – tuberculosis iii. Chronic renal failure iv. Neoplastic disorders – Hodgkin’s disease     Normocytic, normochromi a The β­thalassemia is very common among these two. In normal hemoglobin, number of α and β polypeptide chains is equal. 2) In thalassemia, the production of these chains become imbalanced due to defective synthesis of globin genes. This causes the precipitation of the polypeptide chains especially in the immature RBCs, resulting in disturbance in erythropoiesis. 3) The precipitation also happens in mature red cells, leading to hemolysis

6. α-Thalassemia α­thalassemia happens in fetal life or infancy. In this α­chains are less, absent or abnormal. In adults, 2) β­chains are in excess and in children, γ­chains are in excess. This results in defective erythropoiesis and hemolysis. The infants may be stillborn or may get death immediately after birth.   β-Thalassemia In β­thalassemia, β­chains are less in number, absent or abnormal with an excess of α­chains. 2) The α­chains precipitate causing defective erythropoiesis and hemolysis.    

7. 3. Nutrition Deficiency Anemia 1) Anemia that happens because of deficiency of a nutritive substance essential for for erythropoiesis is termed as nutrition deficiency anemia. 2) The substances which are necessary for erythropoiesis are iron, proteins and vitamins like C, B12 and folic acid. The types of nutrition deficiency anemia are:   Iron deficiency anemia : Iron deficiency anemia is the most common type of anemia. It develops because of inadequate availability of iron for hemoglobin synthesis. RBCs are microcytic and hypochromic.   Causes of iron deficiency anemia: i. Loss of blood ii. Decreased intake of iron iii. Poor absorption of iron from intestine iv. Enhanced demand for iron in conditions like growth and pregnancy.

8. Features of iron deficiency anemia brittle nails, spoon­shaped nails (koilonychias), 2) brittle hair, atrophy of papilla in tongue dysphagia (difficulty in swallowing).   Protein deficiency anemia Because of de ficiency of proteins, the synthesis of hemoglobin is decreased. The RBCs are macrocytic and hypochromic. iii. Hypersplenism iv. Burns v. Infections like hepatitis, malaria and septicemia vi. Drugs such as penicillin, antimalarial drugs and sulfa drugs vii. Poisoning by chemical substances like lead, coal and tar viii. Presence of isoagglutinins like anti­Rh ix. Autoimmune diseases such as rheumatoid arthritis and ulcerative colitis.

9. Intrinsic hemolytic anemia: It is the type of anemia happened by destruction of RBCs due to the defective RBCs. There is production of unhealthy RBCs, which are short lived and are de structed very soon. Intrinsic hemolytic anemia is often inherited and it includes sickle cell anemia and thalassemia. Due to the abnormal shape in sickle cell anemia and thalassemia, the RBCs become more fragile and susceptible particularly for hemolysis.     Sickle cell anemia Sickle cell anemia is an inherited blood disorder, manifested by sickle­shaped red blood cells. It is also termed as hemoglobin SS disease or sickle cell disease. It is common in people of African origin. Sickle cell anemia is because of the abnormal hemoglobin known as hemoglobin S (sickle cell hemoglobin). In this, α­chains are normal and β­chains are abnormal. The molecules of hemoglobin S polymerize into long chains and precipitate inside the cells. Because of this, the RBCs get sickle (crescent) shape and become more fragile resulting in hemolysis . Sickle cell anemia happens when a person inherits two abnormal genes (one from each parent). In children, hemolyzed sickle cells aggregate and Inhibit the blood vessels, resulting in infarction (stoppage of blood supply). The infarction is common in small bones. 5) The infarcted small bones in hand and foot leading to varying length in the digits. 6) This condition is termed as hand and foot syndrome. Jaundice also happens in these children.

10. Thalassemia Thalassemia is an inherited disorder, manifested by by abnormal hemoglobin. It is also termed as Cooley’s anemia or Mediterranean anemia. It is more common in Thailand and to some extent in Mediterranean countries.   Thalassemia is of two types: i. α­thalassemia ii. β­thalassemia. : ;

11. E. Megaloblastic anemia Pernicious anemia or Addison’s anemia Pernicious anemia is the anemia because of deficiency of vitamin B12. It is also termed as Addison’s anemia. It is due to atrophy of the gastric mucosa because of autoimmune destruction of parietal cells. The gastric atrophy leads to reduced production of intrinsic factor and poor absorption of vitamin B12, which is the maturation factor for RBC. RBCs are larger and immature with almost normal or slightly low hemoglobin level. Synthesis of hemoglobin is almost normal in this type of anemia. So, cells are macrocytic and n ormochromic/hypochromic. Before knowing the cause of this anemia, it was very difficult to treat the patients and the disease was considered to be fatal. So, it was treated as pernicious anemia. 5) Pernicious anemia is common in old age and it is more common in females compare to males. It is associated with other autoimmune diseases namely disorders of thyroid gland, Addison’s disease, etc. Characteristic features of this type of anemia include lemon yellow color of skin (due to anemic paleness and mild jaundice) and red sore tongue. Neurological disorders namely paresthesia (abnormal sensations like numbness, tingling, burning, etc.), progressive weakness and ataxia (muscular incoordination) are also seen in extreme conditions.

12. Megaloblastic anemia Megaloblastic anemia occurs because of the deficiency of another maturation factor termedas folic acid. Here, the RBCs are not matured. 2) The DNA synthesis is also defective, so the nucleus is in immature stage only. . 3) The RBCs are megaloblastic and hypochromic. Features of pernicious anemia happen in megaloblastic anemia also. Whatever it may be , neurological disorders may not develop.   4. Aplastic Anemia Aplastic anemia occurs because of the disorder of red bone marrow. Red bone marrow is reduced and replaced by fatty tissues. Bone marrow disorder occurs in the following conditions: i. Repeated exposure to X­ray or gamma ray radiation. ii. Presence of bacterial toxins, quinine, gold salts, benzene, radium, etc. iii. Tuberculosis. iv. Viral infections like hepatitis and HIV infections. In aplastic anemia, the RBCs are normocytic and normochromic.

13. 5. Anemia of Chronic Diseases 1) Anemia of chronic diseases is the second common type of anemia (next to iron deficiency anemia). 2) It is manifested by short lifespan of RBCs, caused by disturbance in iron metabolism or resistance to erythropoietin action. 3) Anemia develops after few months of sustained disease. RBCs are normocytic and normochromic.   Common causes anemia of chronic diseases: i. Non­infectious inflammatory diseases namely rheumatoid arthritis (chronic inflammatory autoimmune disorder affecting joints).   ii. Chronic infections such as tuberculosis (infection caused by Mycobacterium tuberculosis ) and abscess (collection of pus in the infected tissue) in lungs.   iii. Chronic renal failure, in which the erythropoietin secretion decreases (since erythropoietin is necessary for the stimulation of bone marrow to produce RBCs, its deficiency causes anemia).   iv. Neoplastic disorders (abnormal and disorganized growth in tissue or organ) such as Hodgkin’s disease (malignancy involving lymphocytes) and cancer of lung and breast. RBCs are generally normocytic and normochromic in this type of anemia. Whatever it may be , in progressive disease associated with iron deficiency the cells become microcytic and hypochromic.

14. SIGNS AND SYMPTOMS OF ANEMIA SKIN AND MUCOUS MEMBRANE Color of the skin and mucous membrane becomes pale. Paleness is related to constant and prominent in buccal and pharyngeal mucous membrane, conjunctivae, lips, ear lobes, palm and nail bed. Skin is deprived of the elasticity and becomes thin and dry. Thinning, loss and early grayness of hair occur. The nails become brittle and easily breakable.   CARDIOVASCULAR SYSTEM There is an enhancement in heart rate (tachycardia) and cardiac output. The dilatation of Heart takes place and cardiac murmurs are produced. The velocity of blood flow is enhanced. .   RESPIRATION There is an increase in rate and force of respiration. Sometimes, it leads to breathlessness and dyspnea (difficulty in breathing). Oxygen­hemoglobin dissociation curve is shifted to right.   DIGESTION Anorexia, nausea, vomiting, abdominal discomfort and constipation are common. In pernicious anemia, there is atrophy of papillae in tongue. In aplastic anemia, necrotic lesions appear in mouth and pharynx.  

15. METABOLISM Basal metabolic rate increases in severe anemia.   KIDNEY Renal function is disturbed. Albuminuria is common.   REPRODUCTIVE SYSTEM In females, the disturbance of menstrual cycle takes place. . There may be menorrhagia, oligomenorrhea or amenorrhea .   NEUROMUSCULAR SYSTEM Common neuromuscular symptoms include enhanced sensitivity to cold, headache, lack of concentration, restlessness, irritability, drowsiness, dizziness or vertigo (especially while standing) and fainting. Muscles become weak and the patient feels less energy and fatigued quite frequently and in a quite easy manner.

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