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I'm so pale
lab investigation
Red blood indices
Mean corpuscular volume (CV)
The average volume of RBCs
Normal range: 80-100fL
Mean corpuscular Hemoglobin (MCH)
The average amount of Hb per BC
Normal range: 27-31 picograms
Red Blood cell distribution width RDW
The measure of variation of RBCs diameter
Normal RDW: 11.5-14.5%
Fecal occult blood test
Fecal immunochemical testing
Utilize specific antibodies to detect globin
Stool guaiac test
Blood loss in the gastrointestinal tract
Iron studies
check for
Serum iron test
Transferrin test
Total iron-binding capacity
Unsaturated iron-binding capacity
Transferrin saturation
Serum ferritin
Red cell folate
it measures
the body’s store of folic acid
A low RCF level
means
deficiency of vitamin B9.
B12 serum levels
Performed in cases of
megaloblastic anemia
nervous system symptoms
Peripheral Blood Smear
A thin film of blood which is examined under a microscope
Bone Marrow Biopsy
Procedure of taking sample of bone marrow to examine the normal production of the cells
Contraindicated in patient with hemorrhagic or bone disorders
Anemia
low O2 carrying capacity
reduced RBC concentration
decreased production of RBC
megaloblastic anemia
#
impairment inDNA synthesis
folic acid deficiency
vitamin B12 deficiency
megaloblastic RBC
hypersegmanted neutrophils
aplastic anemia
Chronic disorder of hemopoietic stem cells
Pancytopenia
causes
65% idiopathic
Drugs or chemicals
Fanconi Anemia
radiation
ron deficiency anemia
caused
poor diet
blood loss
pregnancy
inability to absorb iron
hypochromic
microcytic
Peripheral blood smear
mild hyperplasia.
Bone marrow
in chronic renal failure
decreased EPO
in chronic disease
depress erythropeisis
increased destruction
sickle cell anemia
thalassemia
Clinical Features
pica
atrophic glossitis
alopechia
koilonychia
Plummer-Vinson syndrome
riks factors
chronic diseases
pregnancy
diet
more common women than men
Managment of Anemia
Chronic Renal Insufficiency
Darbepoetin
3 times longer half life
Two extra carbohydrate chains
Human Erythropoeitin
Sickle Cell Anemia
Hydroxyurea
Increase Production of HbF
Inhibits DNA Synthesis
Adverse effects
Secondary leukemia
Myelosuppression
Skin Ulcer
Treating Deficiencies
Folate Supplements
Folate deficiency
pregnancy
Alcoholism
Dihydrofolate reductase inhibitors
Vitamin B12 supplements
Oral Cyanocobalamin
Iron Supplements
150 to 180 mg/day
Ferrous sulfate
iron metabolism
Storage
Ferritin
Hemosederin
Absorption & transportation
non heme iron
Divalent metal transporter1
after reduction to Fe2+ by duodenal cytochrome B
Heme iron
Heme carrier protein
then either will be temporarily stored in ferritin form or leave the cell by ferroportin as transferrin form
Excretion
Intestine & feces
Erythropoiesis
Early stage
Myeloid progenitor to BFU-E
IL-3 (differentiation)
SCF (proliferation)
EPO (maturation + prevention of apoptosis)
BFU-E into CFU-E
Continuous EPO
Late stage
decreasing in size
increase in cytoplasm ratio
nucleus condense
1- Proerythroblast
main RBC precursor
Large nucleus
( open configuration DNA )
2- Basophil erythroblast
A lot of RNA in the cytoplasm
hematoxolin ( blue)
Nucleoli lost
3- Polychromatic erythroblast
Hb and RNAs in the cytoplasm ( blue and red )
4- Orthochromatic erythroblast
alot of Hb in the cytoplasm ( red )
low multiplication capacity
5-Reticulocyte
6-erythrocyte
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