ANEMIA

SYMPTOMS AND SIGNS OF ANEMIA

* Symptoms:
-Shortness of breath (particularly on exercise) -Weakness -Lethargy -Palpitation -Head aches

* In Older Subject:
-Cardiac failure -Angina pectoris -Confusion -Intermittent claudication

SYMPTOMS
* General:
-Pallor of mucous membrane (less than 9 d/dl) -Tachycardia -Cardiomegali -Syst flow murmur (especially at the apex) -Retinal hemorhages (unusual) -In the elderly: congestive hearth failure

* Specific:

-Koilonychia (spoon nails) iron def. -Jaundice hemolytic or megaloblastic anemia -Leg ulcers sickel cell A -Bone deformities thalasssemia major -Neugopathy vit. B12 def.

Classification based on red cell indices

Normocytic, normochromic Macrocytic Microcytic, hypochromic

Microcytic, hypochromic
MCV < 80 fl MCH < 27 pg Clinically: - Iron def. - Thalassemia - Anemia of chronic disease (some cases) - Lead poisoning - Sideoblastic anemia (some cases)

Normocytic, Normochromic
MCV : 80 - 95 fl MCH : > 26 pg Clinically: - Hemolitic Anemia - Anemia of chronic disease (some cases) - After acut blood loss - Renal disease - Mixed deficiencies - Bone marrow failure

Macrocytic
MCV : > 95 fl Hypersegmented Neutrophil Five Lobes Clinically: - Megaloblastic : vit B12 or folate def. - Non megaloblastic: ^ Alcohol ^ Liver disease ^ Myelodysplasia ^ Aplastic anemia

Anemia with the varation in size (anysocytosis) and Shape (poikilocytosis) (1)
Red cell abnormalities -Macrocyte -Target cell Causes - liver disease - alcoholism - iron def. , liver dis - hemoglobinopathy - post splenectomy - liver disease, alcoholism - iron def. - liver disease - post splenectomy

-Stomotocyte -Pencil cell -Ecchinocyte

Anemia with the varation in size (anysocytosis) and Shape (poikilocytosis) (2)
Red cell abnormalities -Microspherocyte -Fragments -Elliptocyte -Tear drop Causes - hereditary spherocytosis - AIHA, septicemia - DIC, microangiopati HUS,TTP Burs,cardiac valve - hereditary elliptocytosis - Myelofibrosis, extramedullary hemopoiesis - Oxydant damage e.g. G6PD - Iron deficiency - Hemoglobinopathy

-Basket cell -Sickle cell -Microcyte

Reticulocyte count
Normal : 0.5 - 1.5 % reticulocyte : Anemia Hemolytic anemia After an acut major hemorrhagic Within 2 3 days Reaches a maximum in 6 10 days Remains raised until th Hb returns to normal level

Factor impairing the normal reticulocyte response to anemia

Marrow disease Hipoplasia Infiltration by carcinoma Lymphoma, myeloma, acut leukemia Deficiency of iron, Vit. B12, Folic acid Lack of erythropoietin eg. Renal disease Reduced tissue O2 consumption e.g mixooedema, protein def. In effective erythropoiesis, thalassemia nyelodisplasia Chronic inflammatory or malignant disease

Leukocyte and Platelet Count

Measurement of these help to distingguish pure anemia from pancytopenia (marrow hypoplasia, hypersplenisme)

Biopsi
1. Site : posterior iliac crest 2. Stains : haematoxylin and eosin, reticulin (silver stain) 3. Indication: - Suspicion of polycythemia vera - Nyelofibrisis and other myeloproliferative disorders - Aplastic anemia - Malignant lymphoma - Secondary carcinoma - Cases of splenomegali or pyrexia of undetermined - Any case where aspiration give cause a dry tap 4. Special test : Immunophenotyping

Assesment of erythropoiesis
Normal erythropoiesis Decrease erythropoiesis (eg. Aplastic anemia)

Increase erythropoiesis (eg. Hemolytic anemia)

In effective erythropoiesis (Megaloblastic anemia)

Therapy
Underlying disease Hematinic : - Ferrum - Vit. B12 - Folic Acid