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Reaksi
redox enzimatik
HEME IRON
BESI (IRON)
FEP) .
Erythropiesis
Megaloblastic B12,Folate,
Iron deficiency
KLASIFIKASI ANEMI
I . W.H.O .
1. ANEMI DEFISIENSI .
2. ANEMI HEMOLITIK .
MCV < 80 fL
MCV > 100 fL MCV 80
Hemoglobin below the normal reference level for the age and sex of the individual Reference range:
1-3 days: 14.5 - 22.5g/dl 6 months to 2 years: 10.5 - 13.5g/dl Adult Men: 13-18 g/dl Adult Women: 11.5-15.5g/dl
Clinical Features
(symptoms):
Infants Irritability, restlessness Anorexia, sleepiness Behavioral changes
School going children
Clinical Features
(symptoms):
Common Fatigue/Muscle weakness Headache/Lack of concentration Faintness/dizziness
Exertional dyspnoea/palpitation
Angina/intermittent claudication
Clinical Features
(signs):
Non-specific pallor, tacycardia, flow mummer
Specific koilonychia, angular stomatitis, glossitis neuropathy, dementia, paraplegia jaundice, bone deformities, leg ulcer
History:
Physiological
Comorbids
Microcytic Anemia
Iron deficiency
Hemoglobinopathy Sideroblastic
Lead poisoning
Occasionally chronic
disease
If no obvious cause
Serum Ferritin:
< 15ug/l : Iron deficiency
Serum TIBC Iron Iron Decrease Increased deficiency d ThallasemiaIncreased Normal Increased
Evaluation continued..
Peripheral smear
Hypochromi c
Target cells
Basophilic stippling Diamorphi
Sideroblastic anemia
Bone marrow exam
Rx of iron deficiency:
Adults
Ferrous sulphate/gluconate/fumarate Iron polymaltose complex Elemental iron 200mg/day
Parental Iron
Fruits
Dried fruit Juices Most fresh fruits
Grains
High reticulocyte
hemolysis, bleeding or nutritional response to folate/B12/iron
Evaluation continued...
Macrocytes present
With megaloblast MCV>120
Intramuscular:1000 mcg alternate days to a total of 3-5 mg 1000 mcg every 3 months Intranasal: Nascobal
Cell Megaloblastic .