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Anaemia
Anaemia is present when the haemoglobin level in the blood is below the lower extreme of the normal range for the age and the sex of the individual.
Mechanism of anaemia
Blood loss Decreased red cell lifespan (haemolysis)
Congenital defects ( Hb SS, Spherocytosis) Acquired defect (malaria)
Pooling and destruction of red cells in an enlarged spleen (hypersplenism) Increased plasma volume (pregnancy)
Normal
Macrocyte
Elliptocyte
Pattern of staining
Hypochromic Hyperchromic& polychromatic
Target cells
Clasification of anaemia
Hypochromic microcytic anaemia Normochromic and normocytic Macrocytic anaemia Aplastic anaemia- patients present as repeated oral ulceration or oropharyngeal infections
Iron stain
Normal
Anaemia of chronic disorder There is a defect in the iron transfer from the bone marrow macrophages to the erythroblasts. The treatment is the treatment of the underlying disorder
Macrocytic anaemia
* Red cells are larger than small lymphocytes. * Mean corpuscular volume is larger than 98fl
Normoblastic erythropoiesis
Megaloblastic erythropoiesis
Megaloblastic anaemia
Characterised by the distinctive cytological and functional abnormalities in peripheral blood and bone marrow cells due to impaired DNA synthesis Most commomnly secondary to Vit B12 or folate deficiency Is a cause of significant ill health in the world
Metabolism of Folate
Essential for normal haemopoiesis Requred for large number of reactions involving transfer of one carbon units from one compound to another Glutamates family Sources: plant & animal tissue eg: liver kidney yeast fresh green vegetables Minimal daily requirement is 100-200 Qg Absorbtion is at the duodenum and jejunum Tissue stores: liver 5-20 mg, and is adequate for 4 months
Clinical manifestations
Vitamin B12 deficiency Macrocytic magaloblastic anaemia Glossitis Peripheral neuropathy and subacute combined degeneration of the spinal cord Folate deficiency Macrocytic megaloblastic anaemia Glossitis
Causes of deficiency
Vitamin B12
Decreased intake: Nutritional deficiency Impaired absorbtion: Gastric: Pernicious anaemia Gastrectomy Intestinal: Ileal lesions Fish tape worm
Folate
Decreased intake: Nutritional deficiency Impaired absorbtion: Coeliac disease Increased demand Pregnancy, haemolytic anaemia,
Response to treatment
Sense of well being in 2-3 days time Return of appetite Glossitis rapidly relieved Blood: MCV gradually falls, HSN disappear in 2 weeks If diagnosis of Vit B12 or Folate deficiency is doubtful always start treatment with Vit B12 and folate simultaneously. Never treat with folate alone as neurological symptoms of Vit B12 deficiency will worsen if treated with folate alone.
Aplastic anaemia
Serious and chronic disorder Reduction in the amount of haemopoietic tissue Inability to produce normal numbers of mature cells Hypo-cellularity can be patchy
Classification
Ideopathic Secondary to drug idiosyncracy:
chemical exposure infectious hepatitis pancreatic insufficiency Constitutional : associated with inherited defects of DNA repair eg-Fanconys anaemia
Clinical features
Anaemia
Pallor, fatiguability
Neutropenia
Infections, sore throat
Thrombocytopenia
Bleeding gums Echymosis
Blood film:
**Hb and Blood film Rouloux formation Macrocytic or normochromic anaemia **WBC/DC: Neutropenia/leucopenia **platelet count: Thrombocytopenia **ESR
Aplastic anaemia
Normal bone marrow Bone marrow in aplastic anaemia