ERYTHROCYTE II (Anemia Polycythemia). HMIM BLOCK 224. Dr. Shaikh Mujeeb Ahmed Assistant Professor AlMaarefa College. Objectives. Classify anemia Differentiate between different types of anemia Write normal values for RBC, Hb , HCT [PCV], MCV, MCH, MCHC Define Polycythemia - PowerPoint PPT Presentation
ERYTHROCYTE II(Anemia Polycythemia)Dr. Shaikh Mujeeb AhmedAssistant ProfessorAlMaarefa CollegeHMIM BLOCK 224ObjectivesClassify anemiaDifferentiate between different types of anemiaWrite normal values for RBC, Hb, HCT [PCV], MCV, MCH, MCHCDefine Polycythemia Differentiate between Primary Secondary PolycythemiaSummarize the effect of anemia & polycythemia on the body
What is Anemia?Anemia means - Decreased hemoglobin - Decreased RBC count - Decreased Hematocrit [PCV] Therefore, decreased O2 carrying capacity of blood.3ANEMIANutritional Anemia It is caused by dietary deficiency of factors needed for Erythropoiesis. 1. Dietary Deficiency of Iron Iron deficiency anemia is called microcytic hypochromic anemia as RBC is small with less Hemoglobin. 4CAUSES OF ANEMIA 2. Megloblastic AnemiaIt is due to deficiency of vitamin B12 or folic acid. Vitamin B12 is essential for normal RBC maturation. Vitamin B12 deficiency leads to Megloblastic Anemia [RBC size is large].5Nutritional AnemiaPernicious Anemia - It is due to deficiency of Intrinsic factor produced by Parietal cells of stomach. - Intrinsic factor is necessary for absorption of Vitamin B12. - Vitamin B12 is absorbed from intestinal tract [terminal ileum] when Vitamin B12 is bound to intrinsic factor. - Pernicious Anemia is megloblastic anemia.6Anemia3. Aplastic Anemia It is caused by failure of bone marrow to produce RBC even though all necessary nutrients for Erythropoiesis are available. Causes of Aplastic Anemia -Excessive exposure to X-ray -Exposure to radiation, e.g. bomb blast -Chemotherapy for Cancer -Drugs 7ANEMIA4. Hemolytic Anemia It is caused by rupture [breakdown] of RBC. Causes of Hemolytic Anemia -Malaria -Sickle Cell Anemia [Hemoglobin chain is defective where valine replaces glutamate at position 6 in this amino acid chain].RBC is sickle shaped -Mismatched blood transfusion -Drugs8ANEMIA
5. Renal Anemia Anemia in Renal [kidney] disease is due to decreased Erythropoietin secretion from the kidney. It leads to decreased RBC production.
10ANEMIA6 .Hemorrhagic Anemia - It is caused by losing a lot of blood. - Acute Loss of blood e.g. car accident. - Chronic Loss of blood e.g. bleeding peptic ulcer, excessive menstrual flow. 11ANEMIAHow to diagnose microcytic hypochromic anemia [iron deficiency] and macrocytic [megloblastic] which is vitamin B12 deficiency anemia?We see Hemoglobin, RBC, PCV [Hematocrit]MCV [Mean Cell Volume] MCH [Mean Concentration of Hemoglobin]MCHC [Mean Cell Hemoglobin Concentration] 12ANEMIAWe will define MCV, MCH, MCHCMCV it is the volume of average RBC - Normal MCV = 90 fL or 90 3 [MCV > 95 fL are called macrocyte] [MCV < 80 fL are called microcyte]MCH it is mean concentration of Hemoglobin in each RBC. - Normal MCH = 30 picogram [pg] MCHC it is hemoglobin present per 100ml of RBC - Normal MCHC = 30 gram/100ml of RBC13ANEMIAMicrocytic Hypochromic Anemia Or Iron Deficiency AnemiaIn iron deficiency anemia Hemoglobin RBC Hematocrit MCV MCH MCHC14ANEMIAMacrocytic [Megloblastic] AnemiaVitamin B12 or folic acid deficiency Hemoglobin RBC Hematocrit MCV MCH Normal MCHC Normal It is called Macrocytic Normochromic Anemia.
15ANEMIANORMAL VALUEs & FORMULAE FOR CALCULATION OF MCV, MCH, MCHCMean Corpuscular Volume (fl)78 98 (fl)
Mean Corpuscular Hemoglobin (pg)27 33 pg.Mean corpuscular Hb concentration30 35%
A patient came with a history of fatigue, weakness. His blood analysis was done RBC count 3.6 106 / mm3 Hb concentration 7.0 g / 100ml PCV 25% MCV 69.4 fL [femtoliter] Normal 90 fL MCH 19.4 pg [picogram] Normal 30 pg MCHC 28 g / dl Normal 34 g/dl
What is Diagnosis ?Microcytic Hypochromic Anemia [Iron deficiency Anemia]
17CLINICAL EXAMPLEPolycythemia is characterized by increased number of RBC and increased Hematocrit.Types of Polycythemia 1. Primary Polycythemia 2. Secondary Polycythemia
18POLYCYTHEMIAPrimary Polycythemia is tumor like condition of bone marrow, where, there is increased production of RBC.RBC count may reach 11 million/mm3 (normal is 5 million cells/mm3) .
Hematocrit may be 70-80% [normal 42-45%].19Primary PolycythemiaSide Effects - As there is increased viscosity of blood, it causes blood to flow very slowly, which may reduce O2 delivery to tissues. - Increased viscosity causes increased peripheral resistance which may cause increased blood pressure.
20Primary PolycythemiaSecondary Polycythemia is due to decreased O2 delivery to the tissues. It occurs in people living at high altitude as O2 available in the air is less. It occurs in people with chronic lung disease called Cardiac [heart] failure due to decreased O2 delivery to the tissues.RBC count may be 6 to 8 million/mm3.21Secondary PolycythemiaRelative Polycythemia occurs when there is body fluid loss e.g. diarrhea, heavy sweating.There is body fluid loss, but no loss of erythrocytes.This is not true Polycythemia as RBC are not increased, but only plasma volume is decreased.As RBC are concentrated in small plasma volume, this condition is called Relative Polycythemia.22Relative Polycythemia23
Effect of Anemia In Anemia, blood viscosity is decreased to 1.5 times of water [normal viscosity 2.5 3 times of water].Therefore, there is decreased peripheral resistance, it causes increased blood flow and increased venous return to heart, therefore, increased cardiac output increase heart rate.Anemia causes hypoxia [decrease O2 delivery to tissues], therefore, increased cardiac output.
24APPLIEDEffect of PolycythemiaIn Polycythemia, there is increased viscosity, therefore, blood flow is sluggish [slow].Increased viscosity leads to increased peripheral resistance, therefore, increased blood pressure can occur [in 1/3rd of polycythemic people].25APPLIED26THANK YOU