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Introduction and Anemia (Pdf) Systemicist Pathology.. Lecture #1 Title : Introduction and Anemia Done by: Dema Mhmd Khdier A man may die, nations may rise and fall…….But an idea lives on Complete Blood Count (CBC ) : A quantitative assessment of each of the blood’s cellular elements including: • RBCs • WBCs • Platelets Red Blood Cell Count (RBC):The number of red cells in a specified volume of blood [106/μL = M/μL] Hemoglobin (HGB): The amount of hemoglobin in a specified volume of blood (g/dl) Hematocrit ( HCT) Packed Cell Volume (PCV): The ratio of the volume of red cells to the volume of whole blood % MEAN CORPUSCULAR VOLUME (MCV): • The most important RBC index. • The average volume per red cell. • Directly measured using [fL] (femtoliter or 10-15 liter) MEAN CORPUSCULAR HEMOGLOBIN (MCH): • Hemoglobin content per RBC • Normal range is 26-33 picogram • MCH correlates linearly with MCV MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC): • Concentration of Hb in a given volume of packed RBCs. • Normal range is 32-36 gm/dl. RED CELL DISTRIBUTION WIDTH (RDW): • Measures the variation in size of RBCs (anisocytosis). • Normal range is 12-15%. RETICULOCYTE COUNT: • Reticulocyte is an newly released RBC (<36 hours) • Normal reticulocyte count is less than 1.5%. High reticulocyte count • Hemolysis • Acute blood loss Low reticulocyte count • Bone marrow disease •Temporary depression of BM by infection or cytotoxic drugs Pale cells (central pallor >1/3 dia) are referred to as hypochromic cells without central pallor are called hyperchromic Normal peripheral blood RBCS are normochromic normocytic. Anemia: Anemia is a reduction in the O2 carrying capacity of blood. Reduction in the volume of red blood cells (hematocrit (Hct)) or packed cell volume (PCV) or concentration of hemoglobin (Hb) when compared to similar values from a reference population. Definition: • Hb <13 g/dl (male) • Hb<12 g/dl (female) Anemia is not a diagnosis but a sign of disease.( imp) FUNCTIONAL CLASSIFICATION OF ANEMIAS 1- Blood Loss 2- Hemolytic Anemia 3- Decrease Red cell production: – Marrow aplasia – Defective DNA or Hemoglobin synthesis – Marrow Infiltration: Myelophthisic anemia – Marrow replacement by primary neoplasm MORPHOLOGIC CLASSIFICATION OF ANEMIAS: 1 . Microcytic (MCV < 80 fl): • Iron deficiency • Thalassemia • Anemia of Chronic Disease (usually normocytic) • Sideroblastic Anemias - Hereditary - Lead poisoning 2. Normocytic (MCV 80-100 fl). • Acute blood loss • Hemolysis ( lysis of red blood cells) • Anemia of Chronic Disease (may be microcytic) • Hypersplenism • Bone Marrow Failure. 3. Macrocytic (MCV >100 fl). • Megaloblastic Anemias - B12 and folate deficiency - Drugs/Toxins • Non- Megaloblastic Anemias – Chemotherapy - Drugs/Toxins – AplasticAnemias - Hypothyroidism - Sideroblastic Anemias (Acquired) – Myelodysplasias - Liver diseases Iron deficiency anemia: Iron metabolism : The normal total body iron mass is about 2.5 g for women and 3.5 g for men. • Approximately 80% of functional body iron is present in hemoglobin, the remainder is found in myoglobin and iron-containing enzymes • The iron storage pool: hemosiderin and ferritin bound iron in the liver, spleen, bone marrow, and skeletal muscle: contains on average 15% to 20% of total body iron. Ferritin is a protein found inside the cells that controls the storage and release of iron. Ferritin • Serum ferritin level is a good measure of iron stores reflects the state of iron in the body, so the Iron is transported in the plasma bound to the protein transferrin. more it is in the serum, this indicates an increase in iron in the body and vice versa. • Transferrin is about 33% saturated with iron • The normal total iron-binding capacity of serum is 300 to 350 μg/dL. • Total iron binding capacity TIBC is calculated by measuring serum iron and serum unsaturated iron binding capacity and summing these values. IRON DEFICIENCY ANEMIA Causes: • Increase demands (Pregnancy or infancy) • Malabsorption: – Celiac disease • Poor nutritional intake (Most imp. cause in developing world) • Blood loss (Most imp. cause in Western world) – Gastrointestinal (Peptic ulcer, colonic cancer, hemorrhoids) –Female genital tract(menorrhagia or cancer) – Urologic, pulmonary (hemoptysis) lab findings: • Low serum Ferritin and Iron • Low Transferrin saturation • Increase in TIBC Peripheral blood findings: •Hypochromic microcytic anemia. •Anisocytosis and pokilocytosis. •Low reticulocyte count. MEGALOBLASTIC ANEMIA Disorder related to reduction of DNA synthesis that impairs nuclear maturation. • Nuclear/cytoplasmic Asynchrony • Ineffective erythropoiesis: Megaloblasts undergo apoptosis in the bone marrow. • Granulocyte and platelet precursors are also affected • Hallmark: Cellular Gigantism. MEGALOBLASTIC ANEMIA • Blood: RBCs: Egg-shape Macro ovalocytes. Neutrophils: Hyper segmented. Platelets: Large platelets. • Bone marrow: Hypercellular, megaloblastic erytheroid progenitor, Giant metamyelocytes,abnormal large Megakaryocytes Menorrhagia: excessive flow pf blood in menstruation Etiology : • Vit B12 deficiency • Folic acid deficiency • Both Urologic: part of health about urinary tract Manifestations. Hemoptysis: coughing up of blood • GI: Atrophy of mucosal lining • CNS: Demylination of posterior and lateral columns of the spinal cord (in vit B12 deficiency only), severity not related to degree of anemia. CAUSES OF VITAMIN B12 DEFICIENCY: • Poor vitamin B12 intake • Pernicious anemia - Autoimmune: ant parietal cell/anti-intrinsic factor antibody • Chronic Malabsorption – After gastrectomy – Crohn’s disease CAUSES OF FOLATE DEFICIENCY • Increased requirement -Hemolytic anemias - Pregnancy • Drugs -Phnytoin -Methotrexate • Poor folic acid intake -Dietary lack • Malabsorption - Celiac disease - Tropical Spru اكن يف فيديوهات كثرية عن موضوع ا لني يا ابلتفصيل سواء امسوسزي أو ابثوما أو سكيتيش ... شوفومه اذا احتجتوا من اللينك اليل ن زلته ع قروبمك https://mega.nz/folder/lgsk1BiJ#q8sC6SVFW7kuwk5DeQuFIQ/file/goUDya7C سنوات Which of the following is not microcytic anemia? Chemotherapy ☑ Which of the following best describes thalassemia induced anemia : Mild anemia, microcytosis, hypochromic☑ Pregnant with a poor diet in acid the 3rdntrimester , her MCV is <80 , microcytic . (deficiency in iron) ☑ Finding least likely to be found with drug : : Microcytic anemia☑ Concentration of Hb in a given volume of packed red blood cells is referred to: MCHC ✔ What will be the lab findings in case of Iron Deficiency Anemia: Low transferrin, high TIBC ✔ Hypersegmented neutrophils is a characteristic for: Folic acid deficiency ✔ Megaloblasts result from the impaired synthesis of DNA An anemic patient is found to have hypochromic, microcytic red cells. Additional tests reveal the serum iron levels, the total iron-binding capacity, and the transferrin saturation to be reduced. A bone marrow biopsy reveals the iron to be present mainly within macrophages. The correct diagnosis is: Anemia of chronic disease Which is incorrect fe store in female doesn't same to male store life hack: you can’t be sad if you are asleep. The End .
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