Pathology of Anaemia 2009

8/14/2019 Pathology of Anaemia 2009

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Pathology ofPathology of

AnemiaAnemia

. -r Azza Abdel-r Azza Abdelziz Aliziz Ali


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Anemia

During the 2nd m of gestation

erythropoiesis occur in the

liver till birth then starts in

the bone marrow.


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In adult erythropoiesis occur in

the bone marrow. Blood contains:

Red blood cells White blood cells

Plasma Platelets


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Haemoglobin is found in red

blood cells and gives themtheir colour. It carries

most of the oxygen in thebody.


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Proerythroblast(Pronormoblast)

BasophilicNormoblast

PolychromatophilicNormoblast

OrthochromatophilicNormoblast

Reticulocyte

Erythrocyte

Early Intermediate Late

Steps in Erythropoiesis


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Reduction below normal limits ofthe total circulating red cell mass(size and/or count) or Hb contentinthe peripheral blood.

Reduction below normal in thevolume of packed red cells, asmeasured by the hematocrit, or a

reduction in the hemoglobin

Anemia


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Red cell indicesRed cell indices

Hemoglobin:13.517 in male, 1215 in

female (gm\dl).

Hematocrite = Volume of RBCs /Total blood volume %: 39-49 % in

male & 33-43% in female. RBCscount(106/ul): 4.3-5.9 in male &

3.5-5 in female.


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Red cell indicesRed cell indicesMean Cell Volume (MCV) =

Hematocrite/ RBCs count.

(Normal 80 - 100 fL).Accordingly, anemia can be classified

as:Microcytic = Low MCV

Normal MCV Normocytic=

Macrocytic= High MC-r Azza Abdel


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Anemia

Red cell indicesRed cell indicesMean Cell Hemoglobin Concentration

MCHC = Hemoglobin/ Hematocrite

(Normal 32-36 g/dL)concentration of HB in a given volume

of packed RBCs.

hypochromic = Low MCHC

normochromic = Normal MCHC

hyperchromic = High MCHC. -r Azza Abdel


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Anemia

Anemia:ClassificationAnemia:Classification

Morphologic Microcytic

Normocytic

Macrocytic

Pathophysiologic Decreased production (Defective

hemopoiesis)

Increased destruction


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Anemia

Low Hb = AnemiaLow Hb = AnemiaMCVMCV

LowLowmicrocyticmicrocytic

Normalnormocytic

HighHighmacrocyticmacrocytic

Measure Ferritin

Low Normal/high

Iron defAnemia

Anemia ofchronic disease/Congenital Hb dis

Reticulocyte count

high low Anemia of chronic disea

Renal failureMarrow failure

Hemolytic anemia

or blood loss

Measure B12 + folate

LowMegaloblasticanemia

Normal


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Anemia

Causes of AnemiaCauses of Anemia

1. Impaired red blood cellproduction. 2. Loss of red blood cells. 3. Increased destruction of red

blood cells (hemolytic anemia).

4. Other causes. Children, pregnant women, and

adolescents are the most likely to


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1- Impaired Red Cell Production

I.Disturbance of proliferation and

differentiation of stem cells:

aplastic anemia, pure red cell aplasia,anemia of renal failure, anemia of

endocrine disorders.


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II. Disturbance of proliferation and

maturation of erythroblasts

q Defective DNA synthesis: deficiency or

impaired use of vitamin B12 and folic

acid (megaloblastic anemias)q Defective hemoglobin synthesis:

Deficient heme synthesis: ironiron

deficiencydeficiency Deficient globin synthesis:

thalassemias


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2- Bloodloss:

Acute: occur suddenly such as

trauma, accidents and child

birth.Chronic: occur over a long time:

Lesions of gastrointestinaltract, gynecologic

disturbances.


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3- Increased destruction of redblood cells

Intrinsic:A)Hereditary:

Red cell membrane as spherocytosis. Red cell enzyme deficiencies as G6PD

Deficientglobin as thalassemia, Abnormal globin sickle cell anemia.B) Acquired: Membrane defect:

paroxysmal nocturnal hemoglobinuria


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Anemia

3- Increased destruction of redblood cells

Extrinsic (extracorpuscular):

Antibody mediated as transfusion

reactions, erythroblastosis fetalis. Mechanical trauma to red cells as

Microangiopathic hemolytic anemias

Infections: malaria

Chemical injury: lead poisoning

Others


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Anemia

Hemolytic anemias

A shortened red cell life span (normal =120 days); that is, premature destructionof red cells

Elevated erythropoietin levels andincreased erythropoiesis in the marrowand other sites, to compensate for theloss of red cells

Accumulation of the products ofhemoglobin catabolism, due to anincreased rate of red cell destruction


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Anemia

4.Anemia due to other causes :1- endocrine disorders2- renal failure3- Infections4- liver disease

5- malignant disease6- collagen diseases


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Pathophysiologic effects of

anemia:

Decreased Oxygen Consumption.

Increased Tissue Perfusion.

Increased Cardiac Output.

Increased Red Cell Production.

Uncorrected Tissue Hypoxia.

. -r Azza Abdel


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General manifestations of Anemias

1- Peripheral blood - Change in red cell

- Increased reticulocytic count2- Hemopoiesis

Compensatory hyperplasia of the red bonemarrow.

Extramedullary hemopoiesis in the liver, spleen

and lymph nodes.3- Tissue changes

Peripheral pallor in the skin, mucus membranes

and viscera.


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Anemia-r Azza Abdel


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Anemia-r Azza Abdel


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Complications of Anaemia

qMore likely to get infections

qImpaired childhood development

qIncreased maternal morbidity andmortality

qDecreased work capacity

qIncreased incidence of low birthweight


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Clinically,Pallor (pale colour)is the main sign to look for

It can affect the: Conjunctiva

Tongue and inner lips Palms of the hands


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Anemia

Iron Deficiency Anemia:

Deficiency of iron is probably the mostcommon nutritional disorder in the

world

Common in developing world,

Parasitic Worm infestation +

Malnutrition Common in adolescent girls, and women

of childbearing age


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Anemia-r Azza Abdel

I M t b li


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Anemia-r Azza Abdel

Iron Metabolism

I M t b li


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Iron Metabolism There is no regulated pathway for iron

excretion, which is limited to the 1 to 2 mgper day lost by shedding of mucosal and skinepithelial cells.

The average daily diet contains approximately10 to 20 mg of iron, most in the form ofheme contained in animal products, with theremainder being inorganic iron in vegetables.

About 20% of heme iron (1% to 2% ofnonhemeiron) is absorbable, so the averagediet contains sufficient iron to balance fixeddaily losses. The total body iron content is


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Anemia

IDA - Etiology

Blood loss Bleeding Parasites,

Gynecologic, ulcers

Increased need

Pregnancy, children

Poor diet / poor absorption

Malnutrition (greens & meat),

malabsorption, intestinal


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Anemia

IDA - Pathogenesis:

Decreased Iron stores

Decreased Hb Synthesis

Delayed maturation of erythroblasts(cytoplasmic)

Decreased cytoplasm, more division(microcytes)

Decreased hb content (hypochromia)

Cli i l F


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Anemia

Clinical Features: General features of Anemia

Pallor, Weakness, Lethargy,

Breathlessness on exertion

Palpitations heart failure pedaledema

Special features in IDA:

Angular cheilitis, atrophic glossitis,

Oesophageal atrophy/web dysphagia,

Koilonychia, brittle nails, gastric


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Angular cheilitisAngular cheilitis


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Koilonychia in Iron def.Koilonychia in Iron def.


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Hypochromic Microcytic RBCHypochromic Microcytic RBC

. -r Azza Abdel


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Response to iron therapyResponse to iron therapy

. -r Azza Abdel


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Pathology of Anaemia 2009