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ANEMI .
Adapted from Ludwig H, Fritz E. Semin Oncol. 1998;25:2-6; Ludwig H, Strasser K. Semin Oncol. 2001;28:7-14.
What is Anemia
Important to remember
Anemia is a clinical sign of disease
It is not a single disease by itself
Need to look for the underlying cause !
Will we ignore a fever with out investigation ?
Its diagnosis is not that simple !! Well make
it
Its very common and imp. in our practice
Drug Rx. depends on the cause
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Causes of Anaemia
1. Decreased production of Red Cells
- Hypo proliferative, marrow failure
2. Increased destruction of Red Cells
- Hemolysis (decreased survival of
RBC)
3. Loss of Red Cells due to bleeding
- Acute / chronic blood loss
(hemorrhagic) .
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ADA 3 PENYEBAB UTAMA
ANEMI
1. KEHILANGAN DARAH YG BERLEBIHAN
BESI (IRON)
Hemoglobin
Myoglobin
Haemoglobin 68,3 %
Ferritin 12,7 %
Hemosiderin 11,7 %
Myoglobin 3,3 %
Enzim besi 0,19 %
Transferrin 0,17 %
HEMOLYTIC ANEMIA
Causes
INTRACORPUSCULAR HEMOLYSIS
Membrane Abnormalities
Metabolic Abnormalities
Hemoglobinopathies
EXTRACORPUSCULAR HEMOLYSIS
Nonimmune
Immune
HEMOLYTIC ANEMIA
Membrane Defects
Microskeletal defects
Hereditary spherocytosis
Membrane permeability defects
Hereditary stomatocytosis
Increased sensitivity to complement
Paroxysmal nocturnal hemoglobinuria
HEMOLYTIC ANEMIA
Causes
INTRACORPUSCULAR HEMOLYSIS
Membrane Abnormalities
Metabolic Abnormalities
Hemoglobinopathies
EXTRACORPUSCULAR HEMOLYSIS
Nonimmune
Immune
Microangiopathic Hemolytic
Anemia
Causes
Vascular abnormalities
Thrombotic thrombocytopenic purpura
Renal lesions
Malignant hypertension
Glomerulonephritis
Preeclampsia
Transplant rejection
Vasculitis
Polyarteritis nodosa
Rocky mountain spotted fever
Wegeners granulomatosis
Microangiopathic Hemolytic
Anemia
Causes - #2
Vascular abnormalities
AV Fistula
Cavernous hemangioma
Intravascular coagulation
predominant
Abruptio placentae
Disseminated intravascular coagulation
IMMUNE HEMOLYTIC ANEMIA
General Principles
All require antigen-antibody reactions
Types of reactions dependent on:
Class of Antibody
Number & Spacing of antigenic sites on cell
Availability of complement
Environmental Temperature
Functional status of reticuloendothelial system
Manifestations
Intravascular hemolysis
Extravascular hemolysis
Aplastic Anemia
Failure of the bone marrow percursors to produce mature
cells. Characterized by hypocellular marrow and
pancytopenia.
Etiology:
Acquired: More common
Inherited: Fanconi anemia
Acquired:
1. Drugs
- Cytotoxic drugs - Antibiotics
- Chloramphenicol - Anti-inflammatory
- Anti-convulsant - Sulphonamides
- 2-3 months usually between exposure and the development of
aplastic anemia.
Aplastic Anemia: (Cont.)
Acquired:
Radiations
Chemicals e.g., Benzene and pesticides
Viruses:
Hepatitis A, Non-A and Non-B
Herpes simplex
E-B virus
Parvovirus: Transient
Important clinically in patients with hemolytic anemias
5-10% of cases of AA in the West and 10-20% in the Far East.
2-3 months between exposure to the virus and the
development of AA.
Immune: SLE, RA (rheumatoid arthritis)
Pregnancy
Idiopathic: 75%
PNH
Pathogenesis
Potential mechanisms:
Special Considerations
Multifactorial often with multiple medical problems
& polypharmacy.
Onset of symptoms is usually insidious & frequently
nonspecific.
Anemia in the elderly has increased consequences.
RBC indices often unreliable.
Myelosuppression more common & severe.
Quality of life issues may be more pronounced.
Anemia in the Elderly
Time of Diagnosis
Annual medical examination 7%
Onset of acute medical problem 8%
Follow up of a chronic medical problem 9%
Following admission to hospital 75%
Anemia in the Elderly
Multiple diagnoses 53%
No diagnosis 17%
Single diagnosis 30%
Anemia of chronic 10%
disease
Malnutrition 9%
Infection 4%
Postoperative bleeding 3%
Alcohol 1%
Modified fromIron deficiency
Principles of Geriatric Medicine and Gerontology 4 th
ed. 1999 1%
Anemia in the Elderly
Diseases Associated with Anemia of Chronic
Disease
Acute infections Malignancy
Chronic infections Metastatic carcinoma
Tuberculosis Hematologic malignancies
Infective endocarditis Leukemia
Chronic urinary tract infection Lymphoma
Chronic fungal infection Myeloma
Chronic inflammatory disorders Chronic renal insufficiency
Rheumatoid disease Hypothyroidism
Collagen vascular disease Protein-energy malnutrition
Polymyalgia rheumatica
Acute and chronic hepatitis
Decubitus ulcer
Anemia in the Elderly
Sensitivity & Specificity of Serum Ferritin in Iron Deficiency
Anemia
< 45 85 92 11.1
< 15 59 99 54.5
Anemia in the Elderly
Iron Def. ACD