im so pale

Vegetarians

Diagnosing Anemia

Epidemiology of Anemia

Anemia

Pharmacology of Drugs for Anemias

including

history taking

possible exposure to toxic household chemicals (laundry starch or clay)

Exercise intolerance, syncope, easy fatigue

Pagophagia or Cold intolerance

Family history

History of fever

Patients occupation, age,sex, ethnicity and hobbies, prior medical history any medications

Multiple pregnancy menorrhagia

physical examination

Rectal and pelvic exam as a tumor in these regions could be causing anemia

Tachycardia, cardiomegaly, murmurs

Examine optic fundi and check for Neuropathy

Hepatomegaly, adenopathy

Underdevelopment, malnutrition and Bone tenderness

Skin and mucous membrane

bruises

cheliosis

purpura

kolonichiya

petechiae

smooth or beefy tongue

jaundice

telengectasia

pallor

clinical presentations

depends on the onset of anemia , cause and the individual

acute onset anemia

chronic onset anemia

dyspnea

lightheadedness

tachycardia

headache

vertigo

weakness

syncope

fatigue

treatment provided by

blood transfusions

supplements/ drugs

used to treat

Patient with severe anemia

include

```
Iron deficiency
```

```
Folate/ vitamin B9 deficiency
```

```
Vitamin B12 deficiency
```

```
Erythropoietin deficiency
```

Human Erythropoietin

ex.

Darbepoetin

cyanocobalamin

hydroxocobalamin

ex.

many drugs can treat iron deficiency anemia

the difference between them is

the iron formulations

recommended dose

150 – 180 mg/ day

examples

Non-toxic

excreted in urine/ feces.

Classified based on

Types

What is

A reduction in the total circulating erthrocytes mass

Blood loss

Decresed production of RBCs

Increse destruction of RBCs

1- Aplastic anemia

2- Chronic renal Faliure

3- Megaloblastic

4- Iron deficiency

Chronic disorder of stem cells in bone marrow

Pancytopenia

Reduce erthropoiten

Reduce RBCs number

Vit B12

Folic acid

Imparied IF production

poor diet

Gastrectomy

Pregnancy

Inadequate dietary intake

Alcoholism

Poor diet

Excessive blood loss

Burr cells

Worldwide

Qatar

30% of women

37% of pregnant women

40% of children

60% of children in africa

29% of women

23.5% of children

More common in non-qatari and low income families.

Half as prevalent in men

Sensitivity and specificity

Anemia tests

Include

Gold standard

Bone marrow iron staining

RBC indices (MCV-MCH-MCHC-RDW)

Sensitivity = 73.8%, specificity = 92%

Iron study (serum ferritin)

Sensitivity = 60%, specificity = 96 -98%

Blood film

Sensitivity = 80%, specificity = 92.3%

Specificity is the true -ve rate used to rule in disease

Sensitivity is the true +ve rate used to rule out disease

Blood loss or bleeding tendencies

initial investigations

such as

peripheral blood smear

Fecal occult blood test

Complete Blood Count

which is

a thin film of blood that is examined under microscope to know the morphology of RBCs, WBCs, and platelets

is used to

role out colon cancer or polyps

measures the number of

RBCs

WBCs

Platelets

Hemoglobin

Hematocrit

Confirmatory tests

such as

bone marrow biopsy

is needed when

the cause of anemia cannot be diagnosed from other tests

carbonyl iron 100%

ferrous fumarate 33%

ferrous sulfate 20%

ferric ammonium citrate 18%

iron studies

ferrous gluconate 12%

red cell folate

serum vitamin B12

click to edit

hypochromic-microcytic anemia

risk factors

Women

Infants and children

Vegetarians

frequent blood donors

occur when

click to edit

Iron Metabolism

Daily requirement

20 mg

10% absorbed

Children and pregnant woman

have

higher iron requirment

Iron forms

Fe3+ (less soluble, ferric)

Fe2+ (more soluble, ferrous)

transfer into Fe2+ by

Duodenal Cyt B

click to edit

Absorption

Heme iron Fe2+

uses

Heme Carrier Protein 1 (HCP1)

Non-heme iron (Fe3+)

uses

Divalent Metal Transporter 1 (DMT1)

increase with

Ascorbic acid and cysteine

HCL

decrease with

gastrointestinal diseases

Achlorohydria : The deficiency of HCL

Transport

1- Fe2+ exit the enterocyte

Ferroportin 1

2- Convert into Fe3+

Ferroxidase

3- One molecule of transferrin transport 2 ferric atoms

Liver

Bone marrow

Storage

Ferritin

index of body iron stores

Primarily intracellular Protein

Hemosiderin

Insoluble form of Ferritin

commonly found in macrophages

Regulated by

Hepciden

synthesized from

Liver

Moa

Block ferroportin

↓ concentration of iron in plasma

↓ of iron absorption in the intestine

In small intestine ( Duodenum)

RBC synthsis

Start as

PHSC

IL-3, SCF, Erthropoietin

Burst forming unit-erthroid

Erthropoietin

Colony forming unit Erthroid

Late stage

Proerthroblast

Basophil erthroblast

Polychromatophil erythroblast

Orthochromatophil erthroblast

Reticulocytes

24-48h

RBCs

Hematopiesis

Largest precursors

excessive Ribosomes

cytoplasm is pinkish due to the presence of Hb

RBC abnormalities

Poikilocytosis

Anisochromia

Anisocytosis

Variation
in RBCs size

Variation in shape

Variation in
color

Microcyte

Macrocyte

Megaloblast

Target Cell

Spherocyte

Stomatocyte

Sickle Cell

Acanthocyte

Elliptocyte

Schistocyte

Teardrop

Burr Cell

Hypochromia

Hyperchromia