Anemic syndrome, anemia

Fedor Šimko

ÚPF LFUK, Bratislava

Disclimer slide –prednáška je určená len na

výučbové potreby medikov LFUK v Bratislave

Fedor Šimko

Anemic syndrome is a pathologic

condition, which is characterized

by a decreased number of

erythrocytes and of hemoglobin

concentration bellow normal

values under the condition of

normal blood volume

Anemia is frequently a

concomitant condition of other

diseases

Anemia arises as a

misbalance between

production and destruction of

erythrocytes

Physiologic values:

Hemoglobin 125-165 g/l

Erythrocytes 3,8-5,3 mil/mm3

Hematocrit 0,39-0,49

Decisive value is

hemoglobin:

- Mild anemia: 125-110g/l

- Moderate anemia: 80-110 g/l

- Severe anemia: bellow 80 g/l

Signs and symptoms of anemia

(general – tissue hypoxia + specific)

- Fatigue /lassitude, dizziness,

- Palor of skin/mucous membranes (+ warm extremities)

- Tachycardia, Systolic murmur - functional

- Angina pectoris, palpitations

- Breathlessness on exertion

- Dyspepsia

- Neurologic – sleepiness/insomnia, headache, vertigo

Signs and symptoms of anemia– are

similar to heart failure

differences:

-By HF cold extremities

-By HF cyanosis periph. + central

- By HF gallop rhythm

- By HF edemas

- By HF low blood pressure

Classification of anemia

Anemia due to

increased blood loss

Anemia due todecreased production

Posthemorrhagic:- Acute

- Chronic

Hemolytic:

- corpuscular

- extra-corpuscular

Deficiency of building

substances- Sideropenic (Fe2+ deficiency)

- Megaloblastic (B12 /folic acid

deficiency)

inhibited bone marrow

cell production

Anemia due to increased blood loss

Posthemorrhagic:

Acute – hypovolemia, shock (SBP bellow 80

mmHg, immeasurable DBP, paleness, tachycardia, cold

and sticky sweat on the forehead, weak (thread) pulse,

somnolence / sopor – but – in the first hours normal

blood picture, anaemia later- after 6-48 hours +

leukocytosis/thrombocytosis (stress reaction)

Determinant of clinical picture – speed of blood loss +

extent of blood loss

Anemia: normocytic, normochromic (6-72 hours after)

Anemia due to increased blood loss

Posthemorrhagic

Chronic- Weeks after acute bleeding or

- Primary chronic (bleeding in GIT, urogenital tract, hemoptysis/hemoptoe,

anticoagulative/antiaggregative treatment)

-Anemia: microcytic, hypochromic, sideropenic ( Fe 2+ decline)-Sick skin

-Red tongue

-Extreme fatigue

-Nervousness

-Nails of a concave shape (watch glass nails)

-Mouth ragades

Anemias due to increased blood loss

Hemolytic:

Abnormal/damaged erythrocytes are

prematurely lysed in spleen (less than 120 days)

1. Anaemia: normocytic, normochromic, reticulocytosis

2. Icterus – haemolytic / yelowish

3. Splenomegaly

- Biochemistry: unconjugatd bilirubine, pleiochromic stool -

dark, urobilinogen in urine

hypersideremia, LDH, hemoglobinemia, hemoglobinuria

Hemolytic crisis (dyspnoea, stenocardia, vomits, lumbar

pain, fever, dark urine and dark stool)

Corpuscular - inherited

Alteration of the cell space / cell membrane-hereditary spherocytosis

-ovalocytosis

Enzymopathies - shortage of ATP, cell oedema

Hemoglobinopathies – change of adult/fetal Hb

ratio or abnormal Hb-talasemia

-drepanocytosis

Anemias due to increased blood loss

Hemolytic:

Extracorpuscular - acquired

Based on immune system alterations -

antibodies-cold / warm antibodies

-by neoplastic/infectious diseases, drugs, Rh factor, cold

Based on alterations out of immune system Burns, trauma, radiation

Marching a.

Consumptive a.

Night / sleep a.

Anemias due to increased blood loss

Hemolytic:

Anemias due toblunted blood cell production

Shortage of substances- Sideropenic (Fe2+ deficit)

- Megaloblastic (B12 / folic acid deficit)

Bone marrow depression – aplastic a.

Sideroblastic a.

Deficiency of building substancesSideropenic (Fe 2+ deficit) – most frequent anaemia

Resorbtion of Fe2+ - duodenum / upper ileum – meat, liver, egs

Apoferritin -ferritin – transferrin – bone marrow + depots

Etiology: Insufficient supply (alcoholic, vegetarians, tropic areas, newborns)

Increased losses – posthemorhagic

Ferrum malabsorbtion

High consumption – gravidity, neoplasmas (macrophages)

Sideroachrastic – disturbance in ferrum utilisation

Anemias due to blunted blood cell production

Deficiency of building substancesSideropenic (Fe 2+ deficit)

Anemia: microcytic, hypochromic, sideropenic (Fe2+ reduced

level)

Manifestations of anemia + sideropenia!- Sick skin

- Red tangue

- Extreme fatigue

- Nervousness

- Nails of a concave shape ( nails - watch glass shaped)

- Mouth ragades

Anemias due toblunted blood cell production

Deficiency of building substances

Megaloblastic (B12 /folic acid deficiency)-disturbed DNA synthesis

B12 resorbtion – distal ileum - meat, liver, eggs

Folic acid- duodenum /jejunum – meat, liver, leaf vegetable

Intrinsic factor (IF) - (parietal ventricular cells + HCl) B12 + IF–

complex binding to receptor

Etiology: Absorption disturbance of B12 – atrophic gastritis ( low production of IF)

Insufficient supply of B12 (alcoholics, vegetarians, tropical countries)

High consumption of B12 – tumour cells, bacterias, diphilobotrius latus

Disturbed utilisation of B12 - hepatopathies

Anemias due to blunted blood cell production

Deficiency of building substances

Megaloblastic anemia (B12 /folic acid deficiency)

Anemia: megaloblasts in bone marrow (containing nucleus), low

number of Ery in blood, thrombocytopenia, leukopoenia

manifestations:-Anemia

-Atrophy of GIT- atrophic gastritis, Hunter glossitis

-Neurologic manifestations – funicular myelosis (degeneration of back

and lateral spinal cords)

Anemias due toblunted blood cell production

Anemia due to bone marrow depression:

Aplastic anemia

Unknown etiology

Pancytopenia

Anemia

Leukopenia

Thrombycytopenia

Manifestations

Fatigue + other signs of anemia

Hemorrghagic diathesis

Severe and repeated infections - sepsis

Combinations of several pathogenetic

mechanisms

Etiology:

Hepathopathies

Nephropathies

Serious infections

Neoplastic diseases

Secondary anemias in case of organ and

systemic diseases

Anemias

Diagnostics!

Differencial diagnostics!!

Therapy!!!

Dispensarization and repeated

investigation