Pallor

general approach to pallor

1. Done by : Dr. Nawras PALLOR

2. PALLOR pallor is a pale color of the skin and mucous membrane due to reduce in amount of oxyhemoglobin ther e are many causes of pallor : Anemia : which is the most common cause Leukemia Heart disease Sleep deprivation Shock : whether it is septic , Anaphylactic, Cardiogenic, Neurogenic and hypovolemic shock - syncope =decrease in the blood supply to the brain=hypotension leading to pallor .

3. PALLOR Also in case of endocrine defect including: long steady diabetic patient lead to keratin deposition in the skin Hypothyroidism with or without anemia hypopituitarism leads to decrease in the melanin stimulatory hormone Pallor is seen in : * Palm creases * Conjunctiva. * And mucous membranes

4. ANEMIA is a reduction in the number of RBCs, the quantity of hemoglobin, or the volume of RBCs Hb level below than 10 g/dl is considered as a significant level to assess anemia Because the main function of RBCs is oxygenation, anemia results in varying degrees of hypoxia depending on the degree of anemia and the rapidity of development but its independent on the cause. symptom of anemia : like fatigue ,headache ,dizziness Palpitation , dimness of vision and others signs : the most important is pallor and others like : Tachycardia, cardiac dilation, edema and murmurs

5. physical finding of ANEMIA Severe Pallor

6. Koilonychia

7. Smooth shiny tongue

8. Types of ANEMIA

9. Iron Deficiency ANEMIA The most common type Etiology Inadequate dietary intake Found in 30% of the world’s population Malabsorption Absorbed in duodenum GI surgery Blood loss 2 ml blood contain 1mg iron GI, GU losses

10. Investigation Blood film : Hemoglobin level reduced, mean corpuscular volume reduced ,blood film: hypochromic microcytic,poikilocytosis bone marrow aspiration : iron stores is empty plasma iron serum ferritin reduced and the total binding capacity increased. gastrointestinal tract endoscopy. patients with intravascular red cell destruction should have urine test for hemosiderin Lack of iron in bone marrow aspirate normal

11. Megaloblastic Anemia The causes of this type of anemia is deficiency of both B12 and folic acid that are important for D synthesis . Any disorder in the DNA will cause abnormalities in rapidly proliferative tissue including the hematopoietic tissue. Diagnosis : - Hb , mcv blood film :oval macrocytosis , poikilocytosis and hypersegmented neutrophil . - Platlet count and leucocyte tend to be low. -bone marrow show hypercellularity,megaloblastic changes in erythroid series. - plasma LDH elevated due to increase in the destruction of RBC

12. Megaloblastic Anemia Common forms of megaloblastic anemia is : Cobalamin deficiency ( vitamin B 12 ) known as pernicious anemia Inadequate diet ,intrinsic factor deficiency (congenital or due to gastoctomy disease of the terminal ileum(e.g. Crohn’s disease), may be removed from gut by bacterial proliferation and arasite 2. folate deficiency - Poor intake - malabsorption ( Coeliac disease) - increase demand(pregnancy)or drugs.

13. Hemolytic Anemia Various abnormalities lead to decrease in the life span of the RBC & development of anemia when the marrow output no longer compensates increasing in BM actiivity will be reflected as increasing in reticulocye count in periphral blood the catabolic pathways for heamoglobin degredation are overloaded and a modest increase in unconjucated bilirubine in the blood and increase absorption urobilinogen from the gut that excreted in urine there is no colour change in urine sine it is color less also jaundice may developed .

14. Hemolytic Anemia CAUSES OF HEMOLYTIC ANEMIA * CONGENITAL * AQUIRED membrane abnormalities : hereditory spherocytosis Or elliptocytosis h emoglobinopathies : in lack of Hb chain synthesis (thalassemia) or in amino acid substitution or alternation of Hb chain like in sickle cell anemia membrane defect : G6PD def. - IMMUNE : Autoimmune disease like SLA - NON IMMUNE : like : burn , artificial cardiac valve , infections , malaria , drugs , dyserthropoietic like in paroxysmal nocturnal hemoglobinuria

15. Aplastic Anemia the basic problm in this type of anemia is failure of stem cell to avarying dgree , producing hypoplasia of marrow elements Etiology : * Congenital:Chromosomal alterations *Acquired :Results from exposure to ionizing radiation, chemical agents, viral and bacterial infections investigation : A full blood count demonstrate a pancytopenia , neutropenia is the most marked aspect of leukopenia , RBCs are normocytic – normochromic , platelet production is severely affected bone marrow aspiration should be done for assessment of cellularity

16. Anemia of chronic disease This is a commen type of anemia ,especially in hospital papulation characterized by : Anemia occurs in he setting of chronic infection , inflammation , or neoplasia Anemia is not related o bleeding , hemolysis or marrow infiltration Anemia is mild , with normal MCV and normocytic – noromchromic RBC the serum iron is low but iron stors is normal or increased

17. Anemia of chronic disease * Correlates with non specific symptoms of CRF *several mechanism are implicated including: - Relative deficiency of erythropoietin - diminished erythropoiesis due to toxic effect of uremia on marrow precursor cell. - reduce red cell survival. - increased blood loss due to capillary fragility and poor platelet formation. - reduced dietary intake and absorption of iron. Example is anemia due to chronic renal failure :