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ANAEMIA
• Guided By : Respected S K Sharma Sir.
• Dept. of Hematology
• PGIMER , CHD
Red cell membrane - The matrix of the red cell membrane is formed by
the double layer of the phospholipid. Proteins traverse the lipid
bilayer at places and at other areas, these traverse the membrane
only partially.
• Composition :
Lipid constitute = 40%
Protein constitute = 50%
Carbohydrate =10%
• Monosaccharide are attached to the lipids and proteins and are
present on the outer surface of membrane, on the cytoplasmic
side of the membrane is the network of structural proteins that
form the cytoskeleton of the red cells.
• Cytoskeleton of the red cells :- The cytoskeleton is made up of
spectrin,actin,band 2.1 Band 3, band 4.1,ankyrin and other
proteins. Interconnection of network proteins with the cell
membrane proteins imparts the cell a biconcave shape and
deformability so that the cell can pass through tiny capillaries.
• Red cell antigen:
Blood group antigens are present on both
carbohydrate and protein fractions of the cell
membrane.
• Destruction of the red blood cells :
Old/aged red cells are destroyed in the R.E system i.e
in spleen
SIGN & SYMPTOMS OF ANEMIA
-Fatigue -Loss of sexual drive
-Weakness -Mild fever
-Fainting -Irritation
-Breathlessness -Weight loss
-Heart palpitation -Pallor skin
-Coldness in hand and feet -Dry skin
-Insomnia -Brittle nails
-Vertigo (giddiness) -Glossitis
-Headache -Sclera jaundice
-Ringing in the ear (tinnitus) -Hypertension
-Difficulty concentration -Dyspnoea
-Chest pain -Blurred vision
-Mental confusion
SIGN & SYMPTOMS OF ANEMIA
AN
ANEMIC
PATIENT
CLASSIFICATION OF ANEMIA
• ANEMIA CAN BE CLASSIFIED
(A) Morphological classification
(B) Kinetic classification
(C) Etiological classification
• MORPHOLOGICAL CLASSIFICATION
Morphological classification deals with the size and haemoglobin
concentration of the erythrocytes.
• ROLE OF RED CELL INDICES IN CLASSIFICATION
Red cell indices are useful in the diagnosis of anemia. Morphology
of the red cells can be quickly determined by red cell indices or
William constant.
RED CELL INDICES ARE :-
• MCV (mean cell volume)
• MCH (mean cell Hb)
• MCHC (mean cell Hb concentration)
William’s constant:- Wintrobe's introduced calculation for
determining the size and Hb concentration.
They are calculated from------1)Hb
2)PCV
3)Total RBC count
MCV (Mean cell volume) :- it is the average volume of the red cells and has
the unit of femtolitre (fl)
Calculation : PCV X 10
RBC in millions/ul
Normal range = 80-96 fl
Increased value : macrocytic anemia
Decreased value: microcytic anemia
MCH ( mean cell haemoglobin)
It is the weight of Hb of the average sized red cells .it has the unit of picogram
(pg)
Calculation = Hb in g/dl
RBC in millions/ul
MCHC
INTRACORPUSCULAR DEFECT
HEREDITARY DEFECT
ACQUIRED DEFECT
HEREDITARY DEFECT
• ENZYME DEFECIENCY (enzyme pathology)
1.G6PD deficiency :- primaquine type drug sensitivity,
congenital non spherocytic hemolytic anemia(Dacie type I)
2.PK deficiency (pyruvate kinase) :- congenital non spherocytic
HA (Dacie type II)
• ACQUIRED DEFECT:
• PNH ( Paroxysmal nocturnal haemoglobinuria)
• Vitamin B12 deficiency
• Secondary to liver disease Infections
EXTRA CORPUSCULAR DEFECT
• Hereditary ( none known)
• Acquired
ACQUIRED DEFECT
1. Iso antibodies
(a) Transfusion reaction (incompatible blood ABO,Rh)
(b) HDN (haemolytic disease of new born)
2. Auto antibodies
(a) Idiopathic
(b) Secondary
3. Autohemolysis
(a) paroxysmal cold haemoglobinuria (PCH)
4. Infections
(a) bacterial (clostridia welchi)
(b) parasitic (malarial)
(c) viral
5. Chemical agents :- e.g. benzene
6. Burns
7.Hyperspleenism
8.Lead poisoning
9. Drug induced hemolytic anemia
10.None immune mechanism
(a) mechanical hemolytic anemia
(b) cardiac hemolytic anemia
(c) micro angiopathic hemolytic anemia
(d) march haemoglobinuria
11. Immune mechanism AIHA (Autoimmune hemolytic anemia )
-Warm antibody type (react at 37C)
-Cold antibody type (react at <32C)
HEREDITARY SPHEROCYTOSIS
HEREDITARY OVALOCYTOSIS
SPURIUS ANEMIA OR DILUTIONAL ANEMIA
• This is the term used when red cell concentration decreases due to
haemodilution as in third trimester of pregnancy; however it is not
A disease entity but needs to be differentiated from anemia.
This is due to increase in plasma volume .
thalassemia
Extravascular Intravascular
80-90% destruction mainly in spleen In circulation releasing Hb in plasma
LAB FINDINGS ---
Haemoglobinemia
Haemosiderinuria
Serum haptoglobin level decreases
S.Bilirubin (unconjugated)
IMMUNE HAEMOLYTIC ANEMIA
• Immune haemolytic anemia are those anemia in which hemolysis is
mediated by auto antibodies or alloantibodies. Hemolysis is both
intravascular and intravascular.
• Further classification are
1. Auto immune hemolytic anemia :-auto antibodies produced by the
patient’s immune system are directed against the red cell surface antigen.
There are two types of antibodies. They are
(a) Warm antibody type –antibodies react at 37C. These are mainly of
IgG type and do not fix complement. e.g. CLL, SLE,rheumatoid
arthritis.
(b) Cold antibody type –these react with RBC at lower temp.(<32C)
e.g paroxysmal cold haemoglobinuria,infectious mononucleosis.
2. Allo immune hemolytic anemia
(a) hemolytic transfusion reaction – ABO ,Rh mismatched
patient’s serum contain naturally occuring IgM antibodies.
These antibody coat the donar red cell with complement and
activation to C9 results in intravascular hemolysis.
(b) HDN –when mother is Rh-ve and foetus is Rh+ve
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