Download PM Anemia and Leukemia 1

Anemia
Premed 2
Pathophysiology
Normal blood smear
Anemia
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Decrease in whole red cell mass
Causes:
1.Excessive blood loss
2. decreased in RBC production
3. increased RBC loss
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Anemia Caused by Blood Loss
Red blood cells can be lost through bleeding,
which can occur slowly over a long period of
time, and can often go undetected. This kind of
chronic bleeding commonly results from the
following:
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Gastrointestinal conditions such as ulcers,
hemorrhoids, gastritis (inflammation of the
stomach) and cancer
Use of nonsteroidal anti-inflammatory drugs
(NSAIDS) such as aspirin or Motrin
Menstruation and childbirth in women,
especially if menstrual bleeding is excessive and
if there are multiple pregnancies
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Anemia Caused by Decreased or Faulty Red
Blood Cell Production
The body may produce too few blood cells or
the blood cells may not work properly. In either
case, anemia can result. Red blood cells may be
faulty or decreased due to abnormal red blood
cells or the a lack of minerals and vitamins
needed for red blood cells to work properly.
Conditions associated with these causes of
anemia include the following:
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Sickle cell anemia
Iron deficiency anemia
Vitamin deficiency
Bone marrow and stem cell problems
Other health conditions
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Sickle cell anemia is an inherited disorder that
affects African-Americans. Red blood cells
become crescent-shaped because of a genetic
defect. They break down rapidly, so oxygen does
not get to the body's organs, causing anemia.
The crescent-shaped red blood cells also get
stuck in tiny blood vessels, causing pain.
Iron-deficiency anemia
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Major cause in adults: chronic blood loss
menorrhagia ( heavy menses)
bleeding from GIT
Dietary deficiency is common after 6 months of
age in infants
Pallor, fatigue, dyspnea on exertion
Iron-deficiency anemia
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Low hemoglobin
Low hematocrit
Low RBC count
Hypochromic, microcytic RBC on smear
Low serum iron
High total iron binding capacity(TIBC)
Low iron store; low ferritin
Iron deficiency anemia
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Vitamin deficiency anemia may occur when
vitamin B-12 and folate are deficient. These two
vitamins are needed to make red blood cells.
Conditions leading to anemia caused by vitamin
deficiency include the following:
Megaloblastic anemia
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Presence of large, abnormal-looking erythroid
precursor cells or MEGALOBLASTS in the
bone marrow
Cause: low vitamin B12 or folic acid
Decrease DNA synthesis decrease DNA
replication and nuclear division
Impaired RBC production
Megaloblastic anemia
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Pancytopenia
low RBC
low platelets
low WBC
Oval macrocytosis (“ big RBC”)
Hypersegmented neutrophils (more than 5 lobes)
Megaloblastic hyperplasia of the bone marrow
Hypersegmented neutrophils
Megaloblast
Megaloblastic anemia
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Vitamin B12 deficiency
Pernicious anemia
Lemon-yellow skin
Stomatitis
Glossitis
Demyelination of the
posterior and lateral columns
of the spinal cord
Ataxic gait, hyperreflexia,
impaired position and
vibration reflexes
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Labs:
Antibodies against Intrinsic
factor
Abnormal Schilling test
Megaloblastic anemia
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Folate deficiency
Seen in alcoholics
Pregnancy
Fad dieters
Contraceptive pills
Dilantin
Chemotherapy agents
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Same presentation as
B12 deficiency
NO NEUROLOGIC
DEFICITS
Anemia of Chronic disease
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Second most common form
May be due to rheumatoid arthritis, kidney
disease, chronic infection
Normochromic, normocytic
In chronic disease: it may be similar to IDA, but
the TIBC is low
Aplastic anemia
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Most common cause: toxic exposure
radiation
chemicals – benzene
antibiotics – chloramphenicol
cancer drugs
viruses – hepatitis C and Parvovirus
Aplastic anemia
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Hypocellular bone marrow
Loss of hematopoietic cells
Peripheral pancytopenia
Hemolytic anemias
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Immune hemolytic anemias
cold agglutinin disease
Hemolytic disease of the newborn
Membrane skeletal protein abnormalities
Hereditary spherocytosis
Enzyme deficiency HA
G6PD deficiency
Pyruvate kinase deficiency
Hemoglobinopathies
Hemoglobin S disorder : Sickle cell anemia
Thalassemias: alpha and beta
Hemolytic anemias
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Shortened life span of RBC
Increased destruction
Increased unconjugated bilirubin
Pigment-containing stones
Increased urobilinogen
Hemoglobinemia, hemoglobinuria
Disappearance of serum haptoglobulins
Hemosiderosis
Increased erythropoiesis
reticulocytosis
IHA: Hemolytic disease of the
newborn
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Erythroblastosis fetalis
Maternal antibodies attack the D antigen of the Rh
blood group
Mom: Rh (-) or “ d”
Baby: Rh (+) or “D”
Also seen in ABO incompatibility
Mom O, Baby A or B
Mom A, Baby B or AB
Mom B, Baby A or AB
Hemolytic disease of the newborn
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Kernicterus:
unconjugated bilirubin
accumulates in the basal
ganglia and the CNS
Hydrops fetalis
stillbirth
Enzyme deficiency HA
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Most common form
X-linked
Common in 10% of African Americans; Mediterrenean
Acute , self-limited
Hemoglobinemia, hemoglobinuria
Triggering factors:
infections
primaquine
sulfonamides
Heinz bodies
Enzyme deficiency HA
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Pyruvate kinase deficiency
Anemia is chronic and sustained
Autosomal recessive
No spherocytes seen
Hemoglobinopathies
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Abnormal hemoglobin structure
Most commonly involved: Hemoglobin S
Point mutation in codon 6 of the beta-globin
gene
Valine is substituted for glutamic acid
Hemoglobinopathies
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Result: Hemoglobin S polymerizes at low oxygen
tension  sickle cells  RBC membranes stiffen
hemolysis/ obstruction of the blood vessels
Severe Hemolytic anemia
Chronic leg ulcers
Painful crises: limbs, back, chest, abdomen
Infarctions: lungs and spleen  autosplenectomy
Aplastic crisis: fall in hemoglobin
Salmonella osteomyelitis
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Thalassemia occurs when the red cells can't
mature and grow properly. Thalassemia is an
inherited condition that typically affects people
of Mediterranean, African, Middle Eastern, and
Southeast Asian descent. This condition can
range in severity from mild to life-threatening;
the most severe form is called Cooley's anemia
Thalasemias
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Deficient production of either alpha or betaglobin chains
Beta-thalasemia: most common form; defect in
the genes coding for Beta-globin gene
Beta-thalassemia major
(Mediterrenean or Cooley anemia)
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Decrease hgb synthesis
Short rbc lifespan (due to
insoluble, excess alphachains)
Ineffective RBC
production
Enlarged spleen
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Skull, facial bones and
long bones distortion
Microcytosis,
hypochromic anemia
Hemosiderosis
Increase Hgb F
throughout life
Beta-thalassemia major:
target cells
Other forms of thalassemias
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Beta-thalassemia minor
Increase in Hgb A2
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Alpha-thalassemia
Most common in
Southeast Asia
May be asymptomatic or
fatal.