Haem11 Anemia Introduction.

Any fool can know.

The point is to understand !

-- Albert Einstein

Know Pathology – you know medicine.

Without Pathology, Medicine is quackery…!

….. foundation of clinical medicine

Shashidhar Venkatesh MurthyA/Prof & Head of Pathology

College of Medicine & Dentistry

Clinical Pathology:

RBC Disorders: Introduction

CPC : Term2 Week1 - Haem 1/2.

System : Haematology - RBC Disorders.

Topic : 1: Anemia Intro 2: IDA & ACD 3: MBA 4: Haemolytic 5: Others.

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CPC 2.1: Tired woman...

Increasing lethargy, SOB, dyspnea, ankle swelling…

Palpitations, chest pain on exertion, relieved on rest.

Fever some times. Loss of appetite, some loss of weight

Hypothyroidism- thyroxine, NSAID for osteoarthritis.

Bruises easily, Pale, mild jaundice.

Stomatitis, glossitis,

PNS: 4/5 lower limb, Romberg +ve,

Reflexes , Babinski +ve, sensation

63y Ayr – Increasing lethargy, dyspnea, edema - 1year

Difficulty walking – weakness & unsteadiness. - 2week

Initially treated with iron tablets.

Differntial Diagnosis:

Megaloblastic anemia

Pernicious anemia

Hypothy. – macro. An.

Malignancy, Aplastic,

Refractory anemia.

GI bleeds,

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CPC scenarios:

2014: I.H. 16 year old girl from Bamaga; attending boarding school in

Charters Towers Presents to GP: “I’m feeling very short of breath

when I play netball”. Accompanied by boarding house teacher

(female)

2012: Mrs. IS, 68y old pensioner, rural near Ingham. Husband, a

butcher. She is on warfarin for 10y, for atrial fibrillation. HPTN on

Aldomet. She feels tired and is pale yellow and gets angina while going

for a regular evening walk.

What if “The patient” is a …?

• 64y woman (occult GI loss, hypothyroidism, chronic disease)

• 40y woman (mennorhagia)

• 40y man (occult malignancy, haematological malignancy)

• 65y man with Stage 4 renal failure (discuss renal anaemia)

• 74y man with no PMH of note (B12 def., occult GI malignancy)

CPC2.1: Tired woman: Lab results:

1. Where is the primary pathology (diagnosis?)

2. What psychiatric symptoms in Vit B12 deficiency?

3. FBC in Haemolytic?, Folate def.?, ACD? Acute / Chronic blood loss?

“Success is going from failure to

failure without loss of enthusiasm” !

– Winston Churchill

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CPC 2.1: RBC disorders

2014 Term 2 CPC 1

Title: Haematopoetic 1/2 Anaemia

System: Haematopoietic system Aim: To educate students in:

Clinical, pathological & population studies of patients with anaemia (RBC disorders)

Objectives: 1. Demonstrate competency in history taking & clinical examination of patients with anaemia and related illnesses.

2. Describe the pathophysiology of the acute anaemic process and the common causes and important other rare causes of anaemia, particularly in the tropics and Indigenous populations.

3. Outline the basic sciences relating to bone marrow, red blood cell production and turnover of iron, routine blood test parameters, measurement of iron stores, and precursors important for red cell production.

4. Demonstrate an understanding of the complications of anaemia and anaemia as a presentation for other pathologies and as an illness in itself.

MB2:HRM: Week 2&3 RBC

Learning Objectives: Diseases of RBC

Anaemia: Overview, Classification, pathogenesis,

diagnosis, clinical features & complications.

Study TOP 10 ANEMIA

Major (detailed)

1. Iron Deficiency anemia.

2. Megaloblastic anemia.

3. Imm. Hemolytic (Warm/Cold)

4. Anemia of Chronic Disease.

5. Aplastic Anemia

Minor (brief note)

1. Myelodysplastic/Refractory An

2. Sickle Cell Anemia

3. Thalassemia syndromes.

4. G6PD deficiency anemia.

5. Hereditary Spherocytosis.

Whatever you think, that you will be.

If you think yourselves weak,

weak you will be.

If you think yourselves strong,

strong you will be!

-- Swami Vivekananda

….. foundation of clinical medicine

Shashidhar Venkatesh MurthyA/Prof & Head of Pathology

College of Medicine & Dentistry

RBC & Anemia: Pathophysiology

Normal RBC

RBC Histogram

8 μ

8 μ

Capillary 5-10 μ

Only healthy elastic

RBC can squeeze

through capillary.

L

8 μ

Band

N

12-14μ

Reticulocyte

(immature)

MCV >100

Retic.

Persisting RNA

Definition of Anemia:

“Anemia is decreased red cell mass affecting tissue

oxygenation”

Diagnosed using Hematocrit or Hb. levels

(Low Hb* or Low HCT)

Types:

Decreased production – Deficiency anemia.

Increased loss/destruction – Hemolytic anemia.

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Pathogenetic Classification of Anemia:

Decreased Production:

Nutrient Deficiency.

Iron def (IDA) / Megaloblastic (MBA)

Hemopoietic cell defect:

Anemia of chronic disorders (ACD)

Aplastic anemia (AA).

Dysplastic anemia. Myelodysplastic Syndromes

Increased loss / destruction:

Blood loss anemia – Acute / Chronic - bleeding.

Hemolytic anemia – Congenital / Acquired.

Acquired / External injury.

Immune AIHA (Warm/Cold) Mechanical, Drugs & Parasites

Congenital / Internal RBC defect Defective Membrane (Spherocytic an)

Defective Hemoglobin (Sickle cell an.)

Deficient Enzyme (G6PD)13

2

2

2

•Cell Mem

•Hb.

•Enzymes

Top 6 Anemias:

1. Iron Def. A

2. Megaloblastic

3. Anem. Of Chronic Dis.

4. Aplastic An.

5. Immune Hemolytic – Warm

6. Immune Hemolytic - Cold

RBC development:

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Bone Marrow

MCV

90

MCV

110

Proerythroblast

(Pronormoblast)

Basophilic

Normoblast

Polychromatophilic

Normoblast

Orthochromatophilic

Normoblast

Reticulocyte

Erythrocyte

BLAST Early Intermediate Late Retic. RBC

Anemia Pathogenesis:

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DNA: B12, Folate

Hb: Iron Iron Metabolism: “limited”,10%,

Recycle, Ferritin, Transferrin,

Hepcidin, forms Hb in cytoplasm.

Megaloblastic anemia

Iron Deficiency anemia

Hemolytic anemia

Immune

Mechanical

Infection

Drugs

Defective*

Aplastic anemia

Dysplastic anemia

We are here for you….

[email protected] (Shashi)

[email protected] (Daisy)

Need personal help?

Email us for an appointment or call,

Office Tel: 4781 4566 (Shashi)

Office Tel: 4781 5626 (Daisy)

When your thinking is brilliant, you will be

brilliant, but if your thinking is not brilliant

you will not be brilliant, no matter how

brilliant you may think you are….!-- Christian D. Larson

Fake it until you make it…!

-- Mohd. Ali. Boxer.