ERYTHROCYTE II(Anemia Polycythemia)

Dr. Shaikh Mujeeb AhmedAssistant ProfessorAlMaarefa College

HMIM BLOCK 224

Objectives• Classify anemia• Differentiate between different types of anemia• Write normal values for RBC, Hb, HCT [PCV], MCV,

MCH, MCHC• Define Polycythemia • Differentiate between Primary Secondary

Polycythemia• Summarize the effect of anemia & polycythemia on

the body

What is Anemia?• Anemia means - Decreased hemoglobin - Decreased RBC count - Decreased Hematocrit [PCV]• Therefore, decreased O2 carrying capacity of

blood.

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ANEMIA

• Nutritional Anemia It is caused by dietary deficiency of

factors needed for Erythropoiesis. 1. Dietary Deficiency of Iron Iron deficiency anemia is called

microcytic hypochromic anemia as RBC is small with less Hemoglobin.

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CAUSES OF ANEMIA

2. Megloblastic Anemia• It is due to deficiency of vitamin B12 or folic

acid. • Vitamin B12 is essential for normal RBC

maturation. • Vitamin B12 deficiency leads to Megloblastic

Anemia [RBC size is large].

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Nutritional Anemia

• Pernicious Anemia - It is due to deficiency of Intrinsic factor

produced by Parietal cells of stomach. - Intrinsic factor is necessary for absorption of

Vitamin B12. - Vitamin B12 is absorbed from intestinal tract

[terminal ileum] when Vitamin B12 is bound to intrinsic factor.

- Pernicious Anemia is megloblastic anemia.6

Anemia

3. Aplastic Anemia It is caused by failure of bone marrow to produce

RBC even though all necessary nutrients for Erythropoiesis are available.

Causes of Aplastic Anemia -Excessive exposure to X-ray -Exposure to radiation, e.g. bomb blast -Chemotherapy for Cancer -Drugs

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ANEMIA

4. Hemolytic Anemia It is caused by rupture [breakdown] of RBC. Causes of Hemolytic Anemia -Malaria -Sickle Cell Anemia [Hemoglobin β chain is defective

where valine replaces glutamate at position 6 in this amino acid chain].RBC is sickle shaped

-Mismatched blood transfusion -Drugs

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ANEMIA

5. Renal Anemia Anemia in Renal [kidney] disease is due to

decreased Erythropoietin secretion from the kidney. It leads to decreased RBC production.

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ANEMIA

6 .Hemorrhagic Anemia - It is caused by losing a lot of blood. - Acute Loss of blood e.g. car accident. - Chronic Loss of blood e.g. bleeding peptic

ulcer, excessive menstrual flow.

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ANEMIA

How to diagnose microcytic hypochromic anemia [iron deficiency] and macrocytic [megloblastic] which is vitamin B12 deficiency anemia?

We see • Hemoglobin, RBC, PCV [Hematocrit]• MCV [Mean Cell Volume] • MCH [Mean Concentration of Hemoglobin]• MCHC [Mean Cell Hemoglobin Concentration]

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ANEMIA

We will define MCV, MCH, MCHC• MCV – it is the volume of average RBC - Normal MCV = 90 fL or 90 μ3

[MCV > 95 fL are called macrocyte] [MCV < 80 fL are called microcyte]• MCH – it is mean concentration of Hemoglobin in each RBC. - Normal MCH = 30 picogram [pg] • MCHC – it is hemoglobin present per 100ml of RBC - Normal MCHC = 30 gram/100ml of RBC

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ANEMIA

Microcytic Hypochromic Anemia Or Iron Deficiency Anemia

• In iron deficiency anemia Hemoglobin

RBC Hematocrit MCV MCH MCHC

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ANEMIA

Macrocytic [Megloblastic] AnemiaVitamin B12 or folic acid deficiency

Hemoglobin RBC

Hematocrit MCV MCH Normal MCHC Normal It is called Macrocytic Normochromic Anemia.

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ANEMIA

NORMAL VALUEs & FORMULAE FOR CALCULATION OF MCV, MCH, MCHC

• Mean Corpuscular Volume (fl)• 78 – 98 (fl)

• Mean Corpuscular Hemoglobin (pg)• 27 – 33 pg.• Mean corpuscular Hb concentration• 30 – 35%

𝑀𝐶𝑉=𝑃𝐶𝑉 𝑋 10𝑅𝐵𝐶

𝑀𝐶𝐻=𝐻𝑏 𝑋 10𝑅𝐵𝐶

𝑀𝐶𝐻𝐶=𝐻𝑏𝑋 100𝑃𝐶𝑉

• A patient came with a history of fatigue, weakness. His blood analysis was done

RBC count 3.6 × 106 / mm3

Hb concentration 7.0 g / 100ml PCV 25% MCV 69.4 fL [femtoliter] Normal 90 fL MCH 19.4 pg [picogram] Normal 30 pg MCHC 28 g / dl Normal 34 g/dl

What is Diagnosis ? Microcytic Hypochromic Anemia [Iron deficiency Anemia]

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CLINICAL EXAMPLE

• Polycythemia is characterized by increased number of RBC and increased Hematocrit.

Types of Polycythemia 1. Primary Polycythemia 2. Secondary Polycythemia

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POLYCYTHEMIA

• Primary Polycythemia is tumor like condition of bone marrow, where, there is increased production of RBC.

• RBC count may reach 11 million/mm3 (normal is 5 million cells/mm3) .

• Hematocrit may be 70-80% [normal 42-45%].

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Primary Polycythemia

• Side Effects - As there is increased viscosity of blood, it

causes blood to flow very slowly, which may reduce O2 delivery to tissues.

- Increased viscosity causes increased peripheral resistance which may cause increased blood pressure.

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Primary Polycythemia

• Secondary Polycythemia is due to decreased O2 delivery to the tissues.

• It occurs in people living at high altitude as O2 available in the air is less.

• It occurs in people with chronic lung disease called Cardiac [heart] failure due to decreased O2 delivery to the tissues.

• RBC count may be 6 to 8 million/mm3.21

Secondary Polycythemia

• Relative Polycythemia occurs when there is body fluid loss e.g. diarrhea, heavy sweating.

• There is body fluid loss, but no loss of erythrocytes.

• This is not true Polycythemia as RBC are not increased, but only plasma volume is decreased.

• As RBC are concentrated in small plasma volume, this condition is called Relative Polycythemia.

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Relative Polycythemia

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Effect of Anemia • In Anemia, blood viscosity is decreased to 1.5 times

of water [normal viscosity 2.5 – 3 times of water].• Therefore, there is decreased peripheral resistance,

it causes increased blood flow and increased venous return to heart, therefore, increased cardiac output increase heart rate.

• Anemia causes hypoxia [decrease O2 delivery to tissues], therefore, increased cardiac output.

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APPLIED

Effect of Polycythemia• In Polycythemia, there is increased viscosity,

therefore, blood flow is sluggish [slow].• Increased viscosity leads to increased

peripheral resistance, therefore, increased blood pressure can occur [in 1/3rd of polycythemic people].

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APPLIED

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THANK YOU