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Prof\ Sameh Shamaa Prof Of medical Oncology and Internal medicine Mansoura Faculty Of Medicine
Anemia
Def : Reduction in the concentration Of HB in the peripheral blood below the normal for the age and sex of the patient: <13 gm. /100 ml for adult male <11.5 gm./100 ml for adult female & infant <14 gm. /100 ml for new born
False Anemia
HB concentration
Normal
True Anemia
False Anemia
1- Preg. 2nd trimester 2- Large spleen 3- immunoglobulin
Classification
Depends on: I- Aetiology. 2- morphology of RBCs both are complementary
I- Anemia due to excess red cell loss: a) Post- haemorrhagic anemia - Acute haemorrhagic Anemia - Chronic Haemorrhagic Anemia b) Haemolytic anemia - corpuscular defect - Extra corpuscular defect
II- Anemia due to impaired red cell formation a) disturbance of B.M function due to deficiency of substances essential for erythropoiesis: - Substance essential for HB synthesis: - Iron deficiency anemia - Protein deficiency - Substance necessary for DNA synthesis : - Folic acid - B12
b) disturbance of B.M. function Not due to deficiency. of substances essential for erythopoiesis - due to B.M. infiltration - Aplastic Anemia
III- Anemia due to other causes : 1- endocrine disorders 2- renal failure 3- Infections 4- liver disease 5- malignant disease 6- collagen diseases
Clinical Picture
The symptoms and signs are due to: I: The anemia itself. II: The disorder causing the anemia.
1) History:
a) Present History : - Age and sex - Occupation - Rate of onset - History or blood loss - History or bleeding tendency
- History suggestive of hemolysis - History of drug intake - G.I.T symptoms - Bony pains - C.N.S paraesethia - Fever - Diet b) Social History c) Menstrual and Gynecologic History d) Family History
2) Examination:
a) -
General examination: Built Skin purpura, ecchymosis Conjunctiva Mouth Nails Blood pressure Bones Legs
B) C.V. examination : - Hypertension - Signs are usually secondary to anemia. - Presence of organic heart disease may suggest rheumatic activity or bacterial endocarditis C) Abdominal examination : - Splenomegaly - Hepatomegaly - Abdominal mass
3) Investigations :
I- Determination of the morphologic type : - Microcytic and or hypochromic . - Normochromic (Normocytic or microcytic). - Macrocytic (Megaloblastic or Normoblastic ).
According to : a) MCV b) MCHC c) Reticulocytic count
(Thalassemia)
- repair of certain anemias e.g tretment with B12 or folic - stopage of toxins fore erythropoises. e.g alcohol, chloramphenicol. - Rcent unnoticed Hemorrhage.
Hb electrophoresis
repeat coomb,s
If ve A, B, C
Do marrow aspiration
Marrow Biopsy
Infilteration Fibrosis Aplastic Normal
-Metastasis Medullany fibrosis aplastic anemia -CLL -ALL. Anemia with N. B.M -AML. -M.M. -NHL.
AREGENERATIVE MEGALOBLASTIC
AREGENERATIVE MEGALOBLASTIC
2) If no evident cause: Seach for pernicious anemia *schilling test *gastric acidity test + gastric endoscopy *folic and B12 serum levels If low B12,normal folic acid,+ve schilling= Pernicious anemia
AREGENERATIVE MEGALOBLASTIC
If not pernicious anemia: we have the following possibilities:
-low B12, N. folic= may be diphylobothrium L -low folic acid----> do malabsorption tests -N. B12 and folic----->refractory anemia
Thank You