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Anemia,classification of anaemia, Hb, RBC indicie

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Haematology Lecture of M. Abdur Rahim Medical College, Dinajpur, Bangladesh

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Anemia,classification of anaemia, Hb, RBC indicie

  1. 1. . ANAEMIA Dr.MD. SAIDUZZAMAN Lecturer (Pathology) M. Abdur Rahim Medical College, Dinajpur
  2. 2. • Anaemia ( from Greek word anaimia, meaning lack of blood) • Anaemia is present when the haemoglobin level in the blood is below the lower extreme of the normal range for the age & sex of the individual. Definition Dr. SAYID
  3. 3. Anemia is not a disease but a sign of some underlying disease Dr. SAYID
  4. 4. Dr. SAYID
  5. 5. Dr. SAYID
  6. 6. Haemoglobin  Hb is a conjugated protein of metaloporphyrin.  It is the red pigment inside the RBC.  Heam- 4% Globin- 96%  Molecular weight is 68000. Dr. SAYID
  7. 7. Dr. SAYID
  8. 8. Functions of Haemoglobin • Transport oxygen from lung to tissues • Transport CO2 to lungs • Maintains acid base balance ( As a Buffer) • Reserves Fe & Proteins Dr. SAYID
  9. 9. Disadvantages if haemoglobin present in plasma. Increase viscosity. Increase osmotic pressure. Rapid destruction by reticuloendothelial system. Haemoglobinuria ( excretion through kidney) Dr. SAYID
  10. 10. Adult Male • 13 – 18 g/dl Adult Female • 11.5 - 16.5 g/dl Full term baby (Cord blood) • 13.5 – 19.5 g/dl Infant (1 year) 8 – 10 g/dl Child 10 - 13 g/dl Dr. SAYID Normal Hb Level
  11. 11.  Testosterone stimulate Erythropoisis, for that Hb level is higher than female. 1st day at birth Hb level is high, then reduce from 3rd month to 1 year. Then Hb raise slowly through childhood to adult. Dr. SAYID
  12. 12. Grading of anemia Mild Upto 11 g/dl Moderate 11- 9 g/dl Severe < 9 g/dl Dr. SAYID
  13. 13. Synthesis of Hemoglobin  2 succinyl – CoA + 2 glysine Pyrrole  4 Pyrrole Protoporphyrin IX  Protoporphyrin IX + Fe2+ Heme  Globin 4 polypeptide chains ( 2 Alpha+ 2 Beta)  Heme + Globin Hemoglobin Dr. SAYID
  14. 14. Attachment of Haeme to Globin. • 4 units of Haem attached to 1 unit of Globin. • So 1 Haemoglobin molecules contains 4 Iron Atoms which carry 4 molecules of oxygen. Dr. SAYID
  15. 15. Attachment of Haeme to Globin. • Globin helps the Fe to remain Fe++ form combine O2 loosely. • Carbonic anhydrase remain only into RBC, help CO2 transport as bicarbonate form. Dr. SAYID
  16. 16. Hb A - 2α+2β HbA2 - 2α+2δ Hb-F – 2α+2γ Hb Bart’s Hb Gower - 1 Hb-Gower -2 Hb Portland Types of Hb Adult Fetal Embryonic Normal Dr. SAYID
  17. 17. Types of Hb Hb - S Hb - C Hb – D Panjub Abormal Hb - E Dr. SAYID
  18. 18. Hb A - 2α+2β 98% HbA2 - 2α+2δ 2% Hb-F - 2α+2γ 0-1 % Sickle Cell Haemoglobin Hb-M Hb C Physiological Pathological Dr. SAYID
  19. 19. FETAL HAEMOGLOBIN • Normally present in fetal RBC (70% Hb-F & 30% Hb-A) • Disappear in 2-3 months after birth. • Structure – 4 polypeptide chains (2 α + 2 γ) • Characteristics. – Affinity for oxygen –more – Carry 20-30% more O2 than Hb-A – Resistance to action of alkalies – Life span – less. Dr. SAYID
  20. 20. Classification of Anaemia 1. Morphological Classification 2. Etiological (causes) Dr. SAYID
  21. 21. 1. Morphological Classification Based mainly on MCV & MCHC. MCH may be include. Microcytic hypochromic anaemia MCV, MCHC & MCH are below normal Normocytic Normochrochromic anaemia • MCV, MCHC & MCH are within normal Macrocytic Anaemia • MCV is above normal • MCHC is normalDr. SAYID
  22. 22. Haematocrit / Packed cell volume (PCV) • Def: PCV is the volume of RBC in relation to that of whole blood. • Hematocrit literally means blood separation. • It expressed as the volume of red blood cells per litre of whole blood. • It may be also expressed as %. Dr. SAYID
  23. 23. Haematocrit / Packed cell volume (PCV) 1. Macrohematocrit method (Wintrobe Method) 2. Microhematocrit method Dr. SAYID
  24. 24. Components of Whole Blood Withdraw blood and place in tube 1 2 Centrifuge Plasma (55% of whole blood) Formed elements WBC and platelets (<1% of whole blood) Erythrocytes (45% of whole blood) Dr. SAYID
  25. 25. Haematocrit –Normal value Men 0.40 to 0.54 l/l (40 – 54%) Women 0.37 to 0.47 l/l (37 – 47%) Infant/child 0.30 to 0.43 l/l (30 - 43%) Newborn 0.53 to 0.65 l/l (53 - 65%) Dr. SAYID
  26. 26. High Hematocrit Level Some factors may cause a rise in hematocrit value such as: • Polycythemia • Heart or kidney problems • Intake of anabolic steroids • Dehydration • Diarehea • Lung problems • Burns • Smoking • High altitudes Dr. SAYID
  27. 27. Low Hematocrit Levels Low hemoglobin levels due to: • Anemia • Hemolysis • Nutritional deficiencies • Bleeding • Pregnancy Dr. SAYID
  28. 28. Indication of Hematocrit estimation 1. Screening test for anaemia 2. For calculation of red cell indices Dr. SAYID
  29. 29. Mean Corpuscular Volume (MCV) • It is defined as the Average (or mean) volume of red cell • It Provides information on red cell size • It is measured in femtolitres. • Normal range= 90±5fl • 1fL= L Dr. SAYID
  30. 30. Mean Corpuscular Volume (MCV) • Cells of normal size (MCV is 76-96 fl) are called normocytic, smaller cells are microcytic, and larger cells are macrocytic Dr. SAYID
  31. 31. Mean Corpuscular Volume (MCV) • Formula: • Normal range: 76 – 96 fl MCV HCT (%) ─────────────── RBC count (millions/mm3) Dr. SAYID
  32. 32. Interpretation of MCV values Low MCV values (<76fl): are found in -  Microcytic anaemias particularly: Iron deficiency anaemia Anaemia of chronic disease like chronic infection, RA, malignancy, Renal failure. Thalassaemia Sideroblastic anaemiaDr. SAYID
  33. 33. Interpretation of MCV values  Raised MCV values: are found in- Macrocytic anaemias  Megaloblastic macrocytic anaemia  Normoblastic macrocytic anaemia Marked reticulocytosis Chronic alcoholism-CLD Increased erythropoiesisDr. SAYID
  34. 34. Low Dr. SAYID
  35. 35. Mean corpuscular hemoglobin (MCH) • Average mass/weight/amount of Hemoglobin per Red Blood Cell. • The MCH is not generally considered in the classification of anemia's. Dr. SAYID
  36. 36. Mean corpuscular hemoglobin (MCH) • Formula:  Normal range = 27-32 picograms (pg)  1pg= Dr. SAYID
  37. 37. Mean corpuscular hemoglobin (MCH)  Low MCH values: are found in:  Microcytic hypochromic anaemias  Red cells are microcytic and normochromic.  Thalassaemia minor Dr. SAYID
  38. 38. Mean corpuscular hemoglobin (MCH)  Raised MCH values: found in : Macrocytic normochromic anaemia Dr. SAYID
  39. 39. MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC) • The average concentration of hemoglobin in red cells. • It is expressed in percentage. • Normal value= 31-35 % or g/dl (or 33.3%) Dr. SAYID
  40. 40. MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC) or Dr. SAYID
  41. 41. MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC)  Low MCHC values are found in:  Iron deficiency anemia Other conditions in which the red cells are microcytic and hypochromic.  An increased MCHC can occur in:  Marked spherocytosis.Dr. SAYID
  42. 42. Summary of red cell indices in common anaemias Anemia MCV MCH MCHC Normocytic normochromic N N N Microcytic hypochromic D D D Macrocytic normochromic I I N Dr. SAYID
  43. 43. Why we need to assess Anemias based on red blood cell indices? Suppose a patient, after undergoing a CBC, comes to a clinician, with the results of MCV, MCHC and MHC as under: Ans: Microcytic Hypochromic anaemia. RBC index Value Normal Value MCV 70 fl 76-96 fl MCH 23 pg 27-32 pg MCHC 28 g/dl 31-35 g/dl Dr. SAYID
  44. 44. Morphological Classification  Microcytic hypochromic anemias a) Iron deficiency anemia (Most common) b) Thalassemia c) Anaemia of chronic disease like chronic infection, RA, malignancy, Renal failure. d) Sideroblastic anaemia Dr. SAYID
  45. 45. Microcytic hypochromic Anaemia  Many RBCs smaller than normal (MCV<76 fl)  The RBCs are usually hypochromic (MCH<27 pg)  Increased zone of central pallor  Cells are various in shape & size
  46. 46. Normal Microcytic Dr. SAYID
  47. 47. Normal IDA Deficiency of globin synthesis Dr. SAYID
  48. 48. Normocytic Normochromic Anaemia a) Acute blood loss b) Haemolytic anaemias c) Anaemia due to depression of erythropoiesis Dr. SAYID
  49. 49. • Normocytic Normochromic anemia: – Hemolysis – Bone marrow failure – Renal failure – Liver disease – Endocrine disorders – Myeloplastic anemias Dr. SAYID
  50. 50. Put a normal BP Normal Normocytic Dr. SAYID
  51. 51. Macrocytic Anaemia • The average size of RBCs are larger than normal (MCV>96fL) • {MCHC is normal or high} • Can be divided in to 2 types Megaloblastic anaemia Non megaloblastic/Normoblastic anaemiaDr. SAYID
  52. 52. Macrocytic Anaemia 1. Megaloblastic macrocytic anemia • Vitamin B12 deficiency anemia • Folic acid deficiency anemia • Abnormal metabolism of folate and vit B12 2. Normoblastic macrocytic anaemia a) Post-haemorrhagic anaemia b) Haemolytic Anaemia c) Aplastic Anaemia d) Leukaemia e) Liver disease Dr. SAYID
  53. 53. Macrocytic Anaemia Microcytic Anaemia Normal Dr. SAYID
  54. 54. MACROCYTE Larger than Normal >8.5 µm diameter Dr. SAYID
  55. 55. Normal Macrocytic
  56. 56. Normocytic Normochromic Macrocytic Normochromic Microcytic Hypochromic Macrocytic Hypochromic Dr. SAYID
  57. 57. Dr. SAYID
  58. 58. AETIOLOGICAL Classification 1. Impaired red cell production a. Deficiency of essential elements of erythropoisis - Iron deficiency (Most common causes) - Vit B12 deficiency - Folic acid deficiency - CDA (deficiency of iron & folic acid) - Vit-C deficiency - Protein-calorie malnutrition Dr. SAYID
  59. 59. AETIOLOGICAL Classification 1. Impaired red cell production a. Depression of erythropoiesis - Anaemia with chronic disorder like renal failure, liver diseasees, connective tissue diseases. - Disseminated malignancy - Leukaemia, lymphoma, secondery carcinoma - Endocrine disorders,eg. Myxoedema - Aplastic anaemia - Thalassaemia Dr. SAYID
  60. 60. AETIOLOGICAL Classification 2. Haemolytic Anaemia A) Intra corpuscular disease, eg-Thalassaemia B) Extra corpuscular disease, eg-Autoimmune haemolytic anaemia Dr. SAYID
  61. 61. AETIOLOGICAL Classification 2. Blood loss A) Acute blood loss - Trauma, Surgical operation B) Chronic blood loss - Bleeding peptic ulcer - Piles (Haemorrhoids) - Menorrhagia - Hookworm infection - Haematuria - Ulcerative colitis - Carcinoma stomuch or colon - Hiatus hernia - Oesophagial varices - Aspirin and other NSAIDs Dr. SAYID
  62. 62. Dr. SAYID
  63. 63. Infection Lack of Concentration Weakness Irritability Palpitation Fatigue Dizziness Symptoms Dr. SAYID
  64. 64. Other symptoms: HEADACHE Dr. SAYID
  65. 65. HAIR LOSS Dr. SAYID
  66. 66. BRITTLE NAILS Dr. SAYID
  67. 67. DIFFICULTIES IN CONCENTRATE Dr. SAYID
  68. 68. Dr. SAYID
  69. 69. Sign of Anaemia • Common- Pallor • Less common a) High cardiac outpur b) CCF Dr. SAYID
  70. 70. Site of examination of Anaemia 1.Lower palpebral conjunctiva 2.Dorsal (upper) surface of tungue 3.Palm & sole 4.Whole body skin Dr. SAYID
  71. 71. Lower palpebral conjunctiva Dr. SAYID
  72. 72. Dorsal (upper) surface of tungue Dr. SAYID
  73. 73. Palm & sole Dr. SAYID
  74. 74. Whole body skin Dr. SAYID
  75. 75. Lab Investigation • Table: Laboratory Tests in Anemia Diagnosis • i. Complete blood count (CBC) • A. Red blood cell count • 1. Hemoglobin • 2. Hematocrit • B. Red blood cell indices • 1. Mean cell volume (MCV) • 2. Mean cell hemoglobin (MCH) • 3. Mean cell hemoglobin concentration (MCHC]Dr. SAYID
  76. 76. Injectable Iron Human Recombinant Erythropoietin Treatment ParenteralOral Iron Blood transfusion Dr. SAYID
  77. 77. Increase your intake of iron Iron from animal sources is more easily absorbed than iron from plant foods. Vitamin C increases the uptake of iron, so add foods containing vitamin C (eg. orange juice, tomato salad) Lack of vitamin B12 can contribute to anemia, intake of foods containing vitamin B12, such as beef, eggs, cheese and milk. Increase your intake of folate by adding these foods to your diet: green leafy vegetables, Brussels sprouts, broccoli, whole grains Diet Guide For Anemia Dr. SAYID
  78. 78. Oral Iron Therapy • Ideal dose – 100 mg per day (prophylactic) • Ferrous gluconate, ferrous fumarate, ferrous succinate, ferrous sulphate, ferrous ascorbate citrate. • Rise in Hb – 0.8 gm / dl / week • Side effects - GI upset most common Dr. SAYID
  79. 79. The World Health Organisation states… ‘Transfusion should be prescribed ONLY for conditions for which there is NO OTHER TREATMENT’ Dr. SAYID
  80. 80. Essential for Hb formation. Lack of anemia cause Fe deficiency anemia. Vit c needs for iron abspn. Essential for Hb formation. Lack of iron cause Fe deficiency anemia. Vit-c needs for iron absorpson. IRON : AN ESSENTIAL ELEMENT Dr. SAYID
  81. 81. IRON RICH FOODS Dr. SAYID
  82. 82. Dr. SAYID
  83. 83. Dr. SAYID
  84. 84. Dr. SAYID
  85. 85. Dr. SAYID
  86. 86. Dr. SAYID
  87. 87. Dr. SAYID
  88. 88. Dr. SAYID
  89. 89. Dr. SAYID
  90. 90. Dr. SAYID
  91. 91. Dr. SAYID
  92. 92. Dr. SAYID
  93. 93. Dr. SAYID

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