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ANEMI .
Prof. Adi Koesoema Aman SpPK(KH).
Dr. Tapisari Tambunan SpPK(K)
Divisi Hematologi Departement Patologi
Klinik FK USU / RSUP H.A.Malik , Medan
Definition of Anaemia
Decrease in the number of circulating red
blood cell mass and there by O2 carrying
capacity
Most common hematological disorder by far
Almost always a secondary disorder
As such, critical for all practitioners to know
how to evaluate / determine its cause / treat
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The
M EDUWAY
Signs and Symptoms of Anemia
To Care For Patients
Gastrointestinal System
Anorexia
Nausea
Vascular and Renal Systems
Low skin temperature
Pallid skin, mucous
membranes, and conjunctivae
Edema, swollen legs
Immune System
Impaired T-cell and
macrophage function
Cardiorespiratory System
Exertional dyspnea
Tachycardia, palpitations
Cardiac enlargement, hypertrophy
Increased pulse pressure,
systolic ejection murmur
Risk of life-threatening cardiac
failure
Genital Tract
Menstrual problems
Loss of libido
Adapted from Ludwig H, Fritz E. Semin Oncol. 1998;25:2-6; Ludwig H, Strasser K. Semin Oncol. 2001;28:7-14.
What is Anemia
Important to remember
Anemia is a clinical sign of disease
It is not a single disease by itself
Need to look for the underlying cause !
Will we ignore a fever with out investigation ?
Its diagnosis is not that simple !! Well make it
Its very common and imp. in our practice
Drug Rx. depends on the cause
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Causes of Anaemia
1. Decreased production of Red Cells
- Hypo proliferative, marrow failure
2. Increased destruction of Red Cells
- Hemolysis (decreased survival of
RBC)
3. Loss of Red Cells due to bleeding
- Acute / chronic blood loss
(hemorrhagic) .
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2.
3.
4.
Hypoproliferative Anaemias
Nuclear
breakdown
Failure of cell
maturation
Cytoplasmic
breakdown
Haem defect
Globin defect
Fe
Sickle cell A
Megaloblastic Anaemia
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Phorph
IDA, SA
Thalassemia
HEME IRON
HEMOGLOBIN
MYOGLOBIN
ENZIM : SITOKROM, KATALASE, PEROKSIDASE
BESI (IRON)
Total Besi
dalam tubuh
4 5 gr
Reaksi
redox enzimatik
CADANGAN
Ferritin
Tansferin
Hemosiderin
HEMOLYTIC ANEMIA
Causes
INTRACORPUSCULAR HEMOLYSIS
Membrane Abnormalities
Metabolic Abnormalities
Hemoglobinopathies
EXTRACORPUSCULAR HEMOLYSIS
Nonimmune
Immune
HEMOLYTIC ANEMIA
Membrane Defects
Microskeletal defects
Hereditary spherocytosis
HEMOLYTIC ANEMIA
Causes
INTRACORPUSCULAR HEMOLYSIS
Membrane Abnormalities
Metabolic Abnormalities
Hemoglobinopathies
EXTRACORPUSCULAR HEMOLYSIS
Nonimmune
Immune
Microangiopathic Hemolytic
Anemia
Causes
Vascular abnormalities
Thrombotic thrombocytopenic purpura
Renal lesions
Malignant hypertension
Glomerulonephritis
Preeclampsia
Transplant rejection
Vasculitis
Polyarteritis nodosa
Rocky mountain spotted fever
Wegeners granulomatosis
Microangiopathic Hemolytic
Anemia
Causes - #2
Vascular abnormalities
AV Fistula
Cavernous hemangioma
Class of Antibody
Number & Spacing of antigenic sites on cell
Availability of complement
Environmental Temperature
Functional status of reticuloendothelial system
Manifestations
Intravascular hemolysis
Extravascular hemolysis
Aplastic Anemia
Failure of the bone marrow percursors to produce mature
cells. Characterized by hypocellular marrow and pancytopenia.
Etiology:
Acquired: More common
Inherited: Fanconi anemia
Acquired:
1.
Drugs
- Cytotoxic drugs
- Antibiotics
- Chloramphenicol
- Anti-inflammatory
- Anti-convulsant
- Sulphonamides
- 2-3 months usually between exposure and the development of aplastic
anemia.
Pathogenesis
Potential mechanisms:
Pathogenesis (Cont)
The latest theory is: there is an intrinsic derangement
of hemopoietic proliferative capacity, which is consistent
with life. The immune mechanism attempt to destroy
the abnormal cells (self cure) and the clinical course and
complications depend on the balance. If the immune
mechanism is strong, there will be severe pancytopenia.
If not, there will be myelodysplasia.
Forms of disease:
Inevitable: dose related e.g. cytotoxic drugs, ionizing radiation.
The timing, duration of aplasia and recovery depend on the
dose. Recovery is usual except with whole body irradiation.
7%
8%
9%
75%
Alcohol
deficiency
Modified fromIron
Principles
of Geriatric Medicine and Gerontology 4
53%
17%
30%
10%
9%
4%
3%
th
1%
ed. 1999 1%
Malignancy
Metastatic carcinoma
Tuberculosis
Hematologic malignancies
Infective endocarditis
Leukemia
Lymphoma
Myeloma
Rheumatoid disease
Hypothyroidism
Protein-energy malnutrition
Polymyalgia rheumatica
Acute and chronic hepatitis
Decubitus ulcer
Sensitivity (%)
Specificity (%)
Likelihood
ratio*
< 200
94
71
3.2
< 45
85
92
11.1
< 15
59
99
54.5
ACD
Serum iron
Reduced
Reduced
TIBC
Increased
Reduced
Transferrin saturation
Reduced
Normal
Serum ferritin
Reduced
Normal or
Increased
Plasma transferrin
receptor
Increased
Normal
Transferrin receptor /
ferritin index
High
Low
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