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ANEMIA(without blood)

Prof Dr Waqas Hameed

FATE OF RBC

Fate of RBC

Globin

- recycled

Heme

- Pyrole ring opened

- Free iron bound toTRANSFERRIN

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Old RBC

MACROPHAGE

(spleen, bone marrow)

Heme + Globin Recycled

Fe++ + ProtoporphyrinRecycled

BILIVERDIN

(Green compound)

BILIRUBIN

Bilirubin+

Albumin

Bilirubin-AlbuminComplex

B

L

O

O

D

 Albumin

HEPATOCYTE

Bilirubin + Ligandin

BL

O

O

D

 

Bilirubin-Albumin Complex

L

I

V

E

R

 

Biliribun + Uridine diphosphoglucoronic acid

Biliribun diglucoronide

Gucoronyl Transferase

B

I

L

E

 

Biliribun diglucoronide

UROBILINOGEN STERCOBILINOGEN STERCOBILIN

FECES

U

R

O

B

I

L

I

N

O

G

E

N

KIDNEY

Urobilinogen

Urobilin

Anemia

• Qualitative or Quantitative deff. of Hemoglobin

Deff. of Hemoglobin in blood 

 too little Hb

 too few RBC’s 

Most common blood disorder

Normal RBC  – NORMOCYTIC NORMOCHROMIC

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Anemia - Classification

• Blood Loss Anemoa – Hemorrhagic

•  Aplastic Anemia – Deficient production

• Megaloblastic Anemia

• Hemolytic Anemia

Blood Loss Anemia

• Hemorrhage

• Plasma replaced – 1 to 3 days

• Low conc. of RBC’s 

Chronic Blood Loss

• Not enough iron absorbed

• Microcytic Hypochromic

Aplastic Anemia

• Bone Marrow Aplasia

• Exposure to GAMMA Ray Radiation  – nuclear bomb

• Excessive x-ray treatment

• Industrial chemicals

• Drugs – chloramphenicol

Megaloblastic Anemia

• Vit B12 deff. & Folic Acid deff.

• Required for final maturation of RBC

• Essential for DNA synthesis

• MACROCYTES produced

• Carry O2 normally – fragile cell membranes

• Short life

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Pernicious Anemia

• Parietal cells  – INTRINSIC FACTOR (glyocprotein) 

Vit B12 in diet

Intrinsic Factor

 – Parietal Cells

of Stomach

Vit B12

+

Intrinsic Factor  

 Absorbed from

Distal Ileum 

Vit B12  protected from digestion

Megaloblastic Anemia

• Gastric Atrophy

• Chronic Atrophic Gastritis – autoimmune

• Blocking antibodies

• Gastric bypass surgery

• Tropical Sprue – Folic acid absorption ↓ 

Normocytic Anemia

• Hb – ↓ 

• RBC size (MCV) – normal

CAUSES

•  Acute blood loss

•  Aplastic anemia

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Blood Picture

• ↓ RBC

• ↓ Hb (smaller reduction)

• ↑ MCV

• ↑ MCH• MCHC - normal

IRON DEFF. ANEMIA

• MICROCYTIC HYPOCHROMIC

CAUSES 

• Inadequate diet

• Inadequate absorption• Chronic blood loss

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Blood Picture

• ↓ RBC

• ↓ ↓ Hb

• ↓ MCV

• ↓ MCH

• ↓ MCHC

HEMOLYTIC ANEMIA

• Hereditary Spherocytosis

• Sickle Cell anemia

• Erythroblastosis Fetalis 

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SICKLE CELL ANEMIA

• Hemoglobinopathy

• Valine replaces Glutamic acid residue at 6th 

position in one of the two β-polypeptide chains

• Low O2  – RBC’s assume sickle shape 

 Anemia

(signs & symptoms)

• Weakness

• Fatigue

• General Malaise

• Dyspnea (shortness of breath on exertion)

• ↑ Cardiac output – palpitations

• Cardiac failure

PALLOR

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POLYCYTHEMIA

↑ Quantity of Red Blood cells

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Polycythemia

• Secondary Polycythemia

• Polycythemia Vera

Secondary Polycythemia

• High altitude – Hypoxia

• RBC count – 30% above normal (6-7 million/mm3)

PHYSIOLOGICAL POLYCYTHEMIA

• Natives of high altitude (14,000 – 17,000 feet)

Polycythemia Vera

• RBC count – (7-8 million/mm3)

• Hematocrit: 60-70%

• Genetic aberration

•  Abnormal response to erythropoietin

• Viscosity of blood -increased 

• Sluggish blood flow through

peripheral vessels

• Cyanotic tint (blueish) - skin

•