Anemia

dr Putra Hendra SpPD

UNIBA

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 Artery

White blood
cells

Platelets

Red blood
cells
 DARAH
Terdiri dari sel-sel darah dan plasma darah
Composition of Blood

19-4
• Mengangkut O2 & CO2
• Mengangkut sisa metabolisme
• Maintain temperature, pH, and fluid volume
• Mempertahankan volume darah yang hilang
• Prevent infection- antibodies and WBC
• Transport hormones
 eritrosit
 Masa hidup 100-120 hari di
sirkulasi.

 Dihancurkan di hati & limpa.

 Dihasilkan dari pembelahan &

diferensiasi sel induk (stem cell) di
sumsum tulang: 2 juta/detik!

 Eritropoietin (EPO)dihasilkan di
ginjal berperan untuk pembentukan
eritrosit di sstl.

 Faktor lain :
 Fe (besi)
 Asam amino
 Vit. B12 & asam folat
Proses hemopoiesis
Erythropoiesis
9
 Tidak ada nukleus yang
jelas
Reticulum of RNA
Deep blue staining
Light blue cytoplasm
Cell size about 10 µ
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 Faktor yang diperlukan untuk hematopoiesis
normal (pembentukan darah)
I. Dietary factors (extrinsic factor): - protein
- iron
- copper, Mn
- vit C, folic acid, vit B12
(intrinsic factor) : - gastric mucosa ~ enzym pencernaan.

II. Liver factor : - folic acid

- Vit B12  stored and released to circulation.

III. Renal factor stimulus bone marrow  erythropoiesis

(erythropoietin)
vit B12 stimulus  proerythroblast
IV. Others factor
Thyroid & corticoid, Fe, Cu, VitC  normoblasts  reticuloyte

red blood cells

circulate 120 days

wears out

bile pigments

digestion area
 Pengaruh aklimatisasi akut
terhadap eritropoiesis

Pada ketinggian 18000 kaki (5500m)

eritropoetin segera di-
sekresikan
 Faktor limpa

Penyaring darah merah yang abnormal.

Organ ini mengandung banyak
trombosit dan berperan
Dalam sistim imun.
 Mechanism of Transport
HEMOGLOBIN

* 4 Heme Molecules
* 4 Oxygen Molecules

*Oxygenated Hemoglobin
Bright Red (systemic)
*Deoxygenated Hemoglobin
Blue (venous circulation)
Hemoglobin (Hb)

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Pabrik darah (Bone Marrow)

Sternum, pelvis, vertebrae, long

bones, skull bones, Tibia (paed)
From stem cells (pleuripotent)
75% of marrow for WBC
25% of BM for Red cells
Erythrod / Granulocyte Ratio 1:3
E:G ratio increases in Anemia
Large white areas are marrow fat
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Figure 19.5 Red Blood Cell
Turnover

Figure 19.5
Formation & Destruction of RBCs
 ANEMIA
Definisi Anemia:
 Sindroma klinis yang disebabkan penurunan massa
eritrosit total dalam tubuh.
 Keadaan dimana massa eritrosit dan atau massa
hemoglobin tidak dapat memenuhi fungsinya untuk
menyediakan oksigen bagi jaringan tubuh
 Penurunan di bawah normal kadar Hb, hitung eritrosit,
dan hematokrit

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 Klasifikasi anemia
 Menurut kadar Hb

 Menurut morfologi

 Menurut waktu: akut/khronis

 Menurut patofisiologi/causa
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 Klasifikasi menurut kadar Hb
(WHO)

 Ringan  kadar Hb 9-11 gr %

 Sedang  kadar Hb 7-8 gr%

 Berat  kadar Hb < 7 gr%

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 Klasifikasi Anemia secara
morfologi
1. Anemia Hipokromik-Mikrositik.

Anemia Normokromik-
2. Normositik

Anemia Makrositik
3.

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Anemia menurut kausa
(Patofisiologi)

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 Anemia?
(patofisiologi)
Production? Survival/Destruction?
1. Kegagalan produksi sel darah
merah: 2. Peningkatan destruksi sel darah
A. Gangguan sel induk merah:
hematopoesis  Anemia Hemolitik (Malaria)
 Anemia Aplastik 3.Kehilangan darah (Blood Loss)
B. Gangguan sintesis DNA  Anemia karena perdarahan akut
 Anemia Megaloblastik (trauma, Operasi)
C. Gangguan sintesis Hemoglobin
 Anemia karena perdarahan khronis
(Hb)
(ankylostomiasis)
 Anemia Defisiensi Besi,
Thalasemia
D. Gangguan sintesis eritropoetin
 Anemia karena GGK
E. Gangguan karena mekanisme
lain: …..
 Anemia karena penyakit kronis,
 anemia sideroblastik
 Anemia karena infiltrasi
Types of Anemia

A • Hemopoetic

B • Hemolytic

C • Hemorrhagic
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 Pendekatan diagnostik Anemia:

 Anamnesis:
onset /bleeding tendency / routine medicinal /
occupation / hobby / travel history / family / diet / GI
symptoms / menstruation cycle / history of previous
pregnancy-delivery / alcohol consumption , etc

 Pemeriksaan fisik :
conjunctiva & lips (pallor) / mouth (cheilosis) / tongue
(glossitis) / gum / nails (koilonychia) , hair (signa de
bandera, alopecia) , jaundice , petechiae , liver & spleen
, lymphenodes ,rectal / vaginal toucher , feet
(ulcer,arthritis)

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Clinical Signs to be looked for

 Skin / mucosal pallor,

 Skin dryness, palmar
creases
 Bald tongue, Glossitis
 Mouth ulcers, Rectal exam
 Jaundice, Purpura
 Lymph adenopathy
 Hepato-splenomegaly
 Breathlessness
 Tachycardia, CHF
Bleeding, Occult Blood
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
 Not pale conjunctiva

Pale conjunctiva
Koilonychia - spoon shaped nail
Iron deficiency anemia
 glossitis Angular stomatitis

Nutritional deficiency anemia

 Measurements of Anemia
 Hemoglobin = grams of hemoglobin per 100 mL of whole
blood (g/dL)
 Hematocrit = percent of a sample of whole blood occupied by
intact red blood cells
 RBC = millions of red blood cells per microL of whole blood
 MCV = Mean corpuscular volume
 If > 100 → Macrocytic anemia
 If 80 – 100 → Normocytic anemia
 If < 80 → Microcytic anemia
 RDW = Red blood cell distribution width
 = (Standard deviation of red cell volume ÷ mean cell
volume) × 100
 Normal value is 11-15%
 If elevated, suggests large variability in sizes of RBCs
 The Three Primary Measures
Measurement Normal Range
A. RBC count (RCC) 5 million 4 to 5.7
B. Hemoglobin 15 g% 12 to 17
C. Hematocrit (PCV) 45 38 to 50

A x 3 = B x 3 = C - This is the rule of thumb

Check whether this holds good in a given result
If not -indicates micro or macrocytosis or hypochro.

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 The Three Derived Indicies

Measurement Normal Range

A. RBC 5 million 4 to 5.7
B. Hemoglobin 15 g% 12 to 17
C. Hematocrit 45 % 38 to 50

MCV (C ÷ A) x 10 = 90 fl
MCH (B ÷ A) x 10 = 30 pg
MCHC (%) (B ÷ C) x 100 = 33%
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 Mean Cell Volume (MCV)

RBC size is measured indirectly by

 The Mean Cell Volume (MCV) and RDW

MCV

Microcytic Normocytic Macrocytic

< 80 fl 80 -100 fl > 100 fl

< 6.5 µ 6.5 - 9 µ

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>9µ
 Anemia Workup - MCV

MCV

Microcytic Normocytic Macrocytic

Iron Deficiency (IDA) Chronic diseases, CKD Megaloblastic anemias
Chronic Infections Early IDA Liver disease/alcohol
Thalassemias Hemoglobinopathies Hemoglobinopathies
Hemoglobinopathies Primary marrow disorders Metabolic disorders
Sideroblastic Anemia Combined deficiencies Marrow disorders
Increased destruction Increased destruction
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 Red cell Distribution Width - RDW

MCV

Microcytic Normocytic Macrocytic

Left Mean 90 Right

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Severe Hypochromia

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Microcytic Hypochromic - IDA

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Hipokromik-Mikrositik

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Makrositik
 makrosit-oval
(Anemia megaloblastik ditandai oleh makrosit oval ini)

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