Anemia Kristine Krafts, M.D.. Background facts about blood Anemia: general information Anemia: specific types Anemia Outline

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  • AnemiaKristine Krafts, M.D.

  • Background facts about bloodAnemia: general informationAnemia: specific typesAnemia Outline

  • Background facts about bloodAnemia Outline

  • Normal blood cells

  • Complete Blood Count (CBC)RBC Hemoglobin Hematocrit

  • MCVMCHCmicrocyticnormocyticmacrocyticnormochromichypochromicComplete Blood Count (CBC)

  • Size variationAdditional Red Blood Cell PropertiesShapeanisocytosispoikilocytosis

  • Normal red blood cells

  • Background facts about bloodAnemia: general information

    Anemia Outline

  • An (without) -emia (blood): a reduction below normal in hemoglobin or red blood cell number.

  • Symptoms of AnemiaPale skin, mucous membranesJaundice (if hemolytic)TachycardiaBreathlessnessDizzinessFatigue

  • Background facts about bloodAnemia: general informationAnemia: specific typesAnemia Outline

  • Lose bloodDestroy too much bloodExtracorpuscular reasonsIntracorpuscular reasonsMake too little bloodToo few building blocksToo few erythroblastsNot enough roomThree Ways to Get Anemic

  • Lose blood

    Three Ways to Get Anemic

  • Anemia of Blood LossCause: traumatic, acute blood lossAt first, hemoglobin is normal!After 2-3 days, see reticulocytesChronic blood loss is different (it causes iron deficiency anemia).Things you must know

  • Reticulocytes

  • Lose bloodDestroy too much bloodExtracorpuscular reasonsIntracorpuscular reasonsThree Ways to Get Anemic

  • Intracorpuscular vs. extracorpuscularChronic vs. acuteSigns of destruction: bilirubin, LDH, haptoglobinSigns of production: reticulocytes, nucleated red cells in bloodHemolytic Anemias

  • Reticulocytes (supravital stain)

  • Lose bloodDestroy too much bloodExtracorpuscular reasonsThree Ways to Get Anemic

  • Microangiopathic Hemolytic AnemiaPhysical trauma to red cellsSchistocytesFind out why!Things You Must Know

  • Red cells snagged on fibrin strand

  • Schistocytes

  • Triangulocyte

  • Artificial heart valveMalignancyObstetric complicationsSepsisTraumaCauses of MAHA

  • Warm AIHAIgGSpleenSpherocytesCold AIHAIgM, complementIntravascular hemolysisAgglutinationAutoimmune Hemolytic AnemiaThings You Must Know

  • Warm AIHA

  • Warm AIHA

  • Warm AIHA

  • Cold AIHA

  • Cold AIHA

  • patient red cells+AHG=agglutinationDirect antiglobulin test (DAT)

  • Lose bloodDestroy too much bloodExtracorpuscular reasonsIntracorpuscular reasonsThree Ways to Get Anemic

  • Hemoglobinopathy (qualitative defect in hemoglobin)Single amino acid substitution in beta chain of hemoglobinCan be heterozygous or homozygousSickle cells are nasty:Fragile (burst easily)Get stuck in vesselsSickle Cell AnemiaThings You Must Know

  • Hemoglobin

  • Point mutation in chain gene

    abnormal chains (substitution of valine for glutamate)

    Hgb S Aggregates and polymerizes on deoxygenation Red cell becomes sickle shaped Sickles clog up vessels plus, they are fragileNasty!

  • Sickle cell anemia

  • Sickle cell anemia: foot lesion

  • Sickle cell anemia: spleen

  • Clinical Findings in Sickle Cell AnemiaBlacks (8% are heterozygous)Severity of disease is variableChronic hemolysis, vaso-occlusive disease, and infections (autosplenectomy)Treatment: prevent triggers, vaccinate, transfuse

  • ThalassemiaQuantitative defect in hemoglobinCant make enough or chainsVariable disease severityHypochromic, microcytic anemia with increased RBC and target cellsThings You Must Know

  • Hemoglobin chain developmentbirthHgb F = 22Hgb A2 = 22Hgb A = 22

  • Thalassemia

  • Thalassemia: Medullary expansion

  • Hereditary SpherocytosisTons of spherocytesSpectrin defectSplenectomy is curativeThings You Must Know

  • z

  • Hereditary spherocytosis

  • Splenomegaly in hereditary spherocytosis

  • Glucose-6-Phosphate Dehydrogenase Deficiency G6PD peroxides cell lysisOxidant exposureBite cells (removal of Heinz bodies)Self-limitingThings You Must Know

  • Some patients asymptomaticOthers have episodic hemolysisTriggers: broad beans (favism), drugs (antibiotics, aspirin)Spontaneous resolutionClinical Findings in G6PD Deficiency

  • Child with G6PD deficiency: jaundiced sclera

  • They cant reduce nastiesNasties attack hemoglobin bondsHeme breaks away from globinGlobin denatures, sticks to red cell membrane (Heinz body)Spleen bites out Heinz bodiesWhy Do G6PD-Deficient Red Cells Die?

  • G6PD deficiency: Heinz bodies

  • G6PD deficiency: bite cells

  • Lose bloodDestroy too much bloodExtracorpuscular reasonsIntracorpuscular reasonsMake too little bloodToo few building blocks

    Three Ways to Get Anemic

  • Iron-Deficiency AnemiaThings You Must Know Most important cause: GI bleeding Microcytic, hypochromic anemia Must find out why patient is iron deficient!

  • Hemoglobin

  • Iron-deficiency anemia

  • Atrophic glossitis in iron-deficiency anemia

  • Koilonychia in iron-deficiency anemia

  • Decreased iron intakebad dietbad absorptionIncreased iron lossGI bleedmenseshemorrhageIncreased iron requirementpregnancyCauses of Iron Deficiency

  • Anemia of Chronic DiseaseInfections, inflammation, malignancyIron metabolism disturbedNormochromic, normocytic anemiaAnemia usually mildThings You Must Know

  • Megaloblastic AnemiaThings You Must KnowDefective DNA synthesisNuclear/cytoplasmic asynchrony B12/folateMacrocytic anemia with oval macrocytes and hypersegmented neutrophils

  • FH4methylene FH4FH2methyl FH4dUMPdTMPDNAB12Need B12 to make DNA!

  • retarded DNA synthesis unimpaired RNA synthesis

    BIG cells! immature nucleusmature cytoplasmMegaloblastic Anemia

  • Megaloblastic anemia

  • Megaloblastic anemia

  • Atrophic glossitis in megaloblastic anemia

  • homocysteine homocysteine

    endothelial damage

    atherosclerosisthrombosisWhat else is B12 good for?methionine methionine

    myelin damage

    subacute combined degeneration

  • Lose bloodDestroy too much bloodExtracorpuscular reasonsIntracorpuscular reasonsMake too little bloodToo few building blocksToo few erythroblasts

    Three Ways to Get Anemic

  • Aplastic AnemiaPancytopeniaEmpty marrowMost are idiopathicThings You Must Know

  • Blood smear in aplastic anemia

  • Empty bone marrow in aplastic anemia

  • Empty bone marrow in aplastic anemia

  • IdiopathicDrugsVirusesPregnancyFanconi anemiaCauses of Aplastic Anemia

  • Lose bloodDestroy too much bloodExtracorpuscular reasonsIntracorpuscular reasonsMake too little bloodToo few building blocksToo few erythroblastsNot enough roomThree Ways to Get Anemic

  • Bone marrow full of fibrosis

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