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Anemia New D
Anemia New D
SKIN COLOR
HEMOGLOBIN CONCENTRATION
STATE OF CONSTRICTION
DILATATION OF PERIPHERAL
VESSELS
ANEMI
A
REDUCTION IN BLOOD
HEMOGLOBIN CONCENTRATION
FUNCTION OF THE
RED CELL
TO DELIVER AND
RELEASE ADEQUATE
QUANTITIES OF
OXYGEN TO THE
TISSUES TO MEET
THEIR METABOLIC
DEMANDS.
Hgb
(g/dl)
Htc
6-23
MOS
2-5 YRS
<10
<31
<11
<34
6-12 YRS
<12
<37
HEMOGLOBIN
LEVEL
AND SYMPTOMS
Hgb (g)
9-11
SYMPTOMS
6.0
Little to no
dysfunction
Extertional
dyspnea
Some weakness
3.0
Dyspnea at rest
5-7
2-1.5
Cardiac failure
EVALUATION OF THE
ANEMIC PATIENT
HISTORY
PHYSICAL
EXAMINATION
LABORATORY TESTS
CBC
RBC INDICES
RETICULOCYTE COUNT
EXAMINATION OF THE PERIPHERAL
SMEAR
MCV
NV =
80 -
100 f
RED BLOOD
CELL
INDICES
MCHC
NV
32 36
CORRECTED RC OR
RETICULOCYTE INDEX
(%)
NV
1 1.5 %
RETICULOCYTOSIS
HEMOLYTIC ANEMIA
IRON
RETICULOCYTOPE
NIA
BONE MARROW FAILURE
APLASTIC ANEMIA
LEUKEMIA
PERIPHERAL SMEAR
HYPOCHROMIA
MICROCYTOSIS
ANISOPOIKILOCYTOSIS
TARGET CELLS
THROMBOCYTOSIS
THROMBOCYTOPENIA
CHEMICAL STUDIES
DECREASED SERUM IRON
INCREASED TOTAL IRON BINDING
CAPACITY
TRANSFERRIN SATURATION IS BELOW
15 %
SERUM IRON BELOW 5O ug / dl
CLASSIFICATION OF ANEMIA
ACCORDING TO
FUNCTIONAL DISTURBANCES
1.DISORDERS OF EFFECTIVE
PRODUCTION
2. DISORDERS WITH RAPID
ERYTHROCYTE DESTRUCTION
OR RC LOSS
RC
DISORDERS OF EFFECTIVE
RC PRODUCTION
DEPRESSED
NET RATE OF RC
PRODUCTION
DISORDERS OF ERYTHROCYTE
MATURATION
INEFFECTUAL ERYTHROPOIESIS
ABSOLUTE FAILURE OF
ERYTHROPOIESIS
ADDITION
AL
STUDIES
CONFIRMATO
RY STUDIRS
INITIAL SCREENING
and PRESUMPTIVE
DIAGNOSIS
ANEMIA
HISTORY
PHYSICEL EXAMINATION
NON-HEMATOLOGICAL
DISEASES:
(Renal, Thyroid, Metabolic,
Others)
Hb
ELECTROPHOR
ESIS
Bone Marrow
Aspirate/Blop
sy
Test for unstable
Hbs
CYTOGENETIC
STUDIES
Indirect bilirubin
LDH, Heptogloblin,
Serum B12
Serum, RBC Folate
Serum ferritin, iron,
TIBC
Circulating
transferrin
Receptor
Serum Lead and RBC
ZPP
RBC Enzyme
Panel
Membrane protein
studies
IRON DEFICIENCY
ANEMIA
MOST COMMON
CAUSE OF
ANEMIA
COMMON IN AGES
MONTHS
6 24
FORMS OF IRON
ACCORDING TO ITS
STABLE OXIDATIVE
STATES
FERROUS (
FERRIC
Fe 2+ )
( Fe 3+ )
IRON BINDING
AGENTS (CHELATORS)
DESFERRIOXAMINE
TRANSFRRRIN
DISTRIBUTION OF
IRON
AVERAGE ADULT - 3 - 5 g
(BALANCE =DIETARY UPTAKE AND
LOSS)
ETIOLOGY OF IRON
DEFICIENCY
A. INADEQUATE SUPPLY OF IRON
1 . LACK OF IRON STORES AT BIRTH (LBW,
PT, TWIN OR MULTIPLE BIRTHS, SEVERE IDA
IN MOTHER, FETAL BLD LOSS, BLEEDING
FROM THE 1ST FEW DAYS OF LIFE)
2. INADEQUATE INTAKE-DEFICIENT
DIETARY IRON
ETIOLOGY OF IRON
DEFICIENCY
B . IMPAIRED ABSORPTION
1. CHRONIC OR RECURRENT
DIARRHEA
2. MALABSORPTON SYNDROME
3 . GASTROINTESTINAL
ABNORMALITIES
ETIOLOGY OF IRON
DEFICIENCY ANEMIA
C.EXCESSIVE DEMANDS
FOR IRON FOR GROWTH
AS SEEN IN PT, LBW,
INFANTS, ADOLESCENT AND
PREGNANCY
ETIOLOGY OF
IRON DEFICIENCY
ANEMIA
D . BLOOD LOSS
1. ACUTE OR CHRONIC
HEMORRHAGE
2 . PARASITIC INFECTION
(HOOKWORM TRICHURIS trichiura)
PHYSICAL STATE
(BIOAVAILABILITY) HEME > Fe 2+
> Fe 3 +
INHIBITORS
PHYTATES , TANNINS , SOIL ,
LAUNDRY STARCH , IRON OVERLOAD
COMPETITORS
COBALT, LEAD , STRONTIUM
FACILITATORS
ASCORBATE, CITRATE , AMINO ACIDS
ROLE OF IRON
DNA SYNTHESIS
HOST OF METABOLIC
PROCESSESS
OF
IRON DEFICIENCY
ANEMIA
1.ANEMIA
2.GROWTH AND DEVELOPMENTAL
RETARDATION
3.EPITHELIAL CHANGES
4.MISCELLANEOUS
1.PRELATENT IRON
DEFICIENCY
2.LATENT
IRON DEFICIENCY
3.FRANK
IRON
DEFICIENCY
STAGES OF IRON
DEFICIENCY
PRELATENT
IRON
DEFICIENCY
RARELY DETECTED
STAGES OF IRON
DEFICIENCY
STAGES OF IRON
DEFICIENCY
IRON DEFICIENCY ANEMIA
ASSOCIATED WITH
ERYTHROCYTE,
MICROCYTOSIS AND
HYPOCHROMIA
EFFECTS OF IRON
DEFICIENCY
ANEMIA
EPITHELIAL CHANGES
MISCELLANEOUS
EFFECTS OF IRON
DEFICIENCY
ANEMIA
IMPAIRS TISSUE OXYGEN
WEAKNESS, FATIGUE,
PALPITATIONS AND
LIGHTHEADEDNESS
REACTIVE THROMBOCYTOSIS
EFFECTS OF IRON
DEFICIENCY
EFFECTS OF IRON
DEFICIENCY
EPITHELIAL CHANGES
ANGULAR STOMATITIS
GLOSSITIS
FLATTENED AND ATROPHIC LINGUAL
PAPILLAE
PLUMMER- VINSON
(FORMATION OF POSTCRICOID ESOPHAGEAL
WEB)
KOILONYCHIA OR SPOONING OF THE
FINGERNAILS
EFFECTS OF
IRON
DEFICIENCY
MISCELLANEOUS
PICA (CONSUME LAUNDRY STARCH, ICE AND
SOIL CLAY)
MASSIVE HEPATOSPLENOMEGALY
POOR WOUND HEALING AND BLEEDING
DIATHESIS
ZINC DEFICIENCY
LEAD INTOXICATION
PSEUDOTUMOR CEREBRI
DIAGNOSI
S
IN INFANTS: HIGH INDEX OF
SUSPICION
1.PREMATURITY
2.BLOOD LOSS
3.FED EXCLUSIVELY ON MILK
4.CHRONIC DIARRHEA
PREVENTION
1.ADMINISTRATION
OF IRON TO
EXPECTANT MOTHERS
2.EARLY INTRODUCTION OF SOLID
FOOD
3.SUPPLEMENTAL IRON : 1O 15 MG
OF ELEMENTAL IRON / DAY ( 6 -8
WKS OF AGE )
TREATMENT OF IRON
DEFICIENCY ANEMIA
SPECIFIC TREATMENT
OF IRON DEFICIENCY
ANEMIA
1.ORAL SUPPLEMENTATION
2.PARENTHERAL IRON
REPLACE MENT
TREATMENT
( ORAL IRON )
POOR RESPONSE
TO ORAL IRON
NONCOMPLIANCE
ONGOING BLOOD LOSS
INSUFFICIENT DURATION OF
THERAPY
HIGH GASTRIC pH
INHIBITORS OF IRON
ABSORPTION/UTILIZATION
INCORRECT DIAGNOSIS
INHIBITORS OF IRON
ABSORPTION
LEAD INTOXICATION
ALUMINUM INTOXICATION
(HEMODIALYSIS)
CHRONIC
INFLAMMATION
NEOPLASIA
PARENTHERAL IRON
REPLACEMENT
INDICATIONS
1.POORLY
2.RAPID REPLACEMENT
IRON
STORES
3.GI
IRON ABSORPTION IS
COMPROMISED
IRON DEXTRAN
ADMINISTERED BY
IM
OR IV
ROUTE
Z- TRACK INJECTION TO
MINIMIZE SC LEAK
10 -15 % - TRANSIENT
ARTHRALGIA
RETICULOCYTOSIS IN IO DAYS
COMPLETE CORRECTION IN 3 -4
WKS
TREATMENT
( BLOOD TRANFUSION )
INDICATION :
SEVERE ANEMIA
SIGNS OF CARDIAC
DECOMPENSATION
" AN OUNZE OF
PREVENTION IS BETTER
THAN A POUND OF CURE .
"
SYSTEMIC DEFECTS
IN IRON DEFICIENCY
ANEMIA OF CHRONIC
INFLAMMATION:
ERYTHROPOIETIN
CONSEQUENCES OF IRON
OVERLOAD
1.HEART
2.LIVER
3.ENDOCRINE