Vous êtes sur la page 1sur 18

1.

Kehilangan darah
Uterus
: Polimetrorhagi, Post partum
hemorrhagi
Gastro Int
: Varices oesofagus, ulkus peptikum, minum
aspirin, gastrektomi, ca lambung / sekum / kolon / rektum , cacing
tambang, kolitis, hemorrhoid, devertikulosis.
Hematuria, Hemoglobinuria
Hemosiderosis Pulmonum
2. Kebutuhan meningkat
Kehamilan , pertumbuhan
Prematuritas
3. Malabsorpsi
Gastrektomi, penyakit coeliac
4.Diet buruk

Anemia Hipokrom Mikrositer


Iron Studies
Ferritin

N/

N/

Iron

N/

TIBC

N/

% Saturation

N/

Def Fe

An.Peny
Kronik

Hb Studies
Thalasemia

BMP
Sideroblastik
Anemia

ERITROPOESIS
INTRA CELLULER PROCESS IN ALL TISSUES
HEMO PROTEIN OXYGEN TRANSPORT
FOUR HAEM FOUR POLYPEPTIDE CHAIN
Hb BM : 64.500
MYOGLOBIN 17.000 SINGLE POLYPEPTIDE CHAIN + 1 HAEM GROUP
FERRITIN SOLUBLE PROTEIN
APO FERRITIN : 480.000
HEMOSIDERIN AMORF INSOLUBLE STORAGE COMPOUND IRON
CONTENT MENINGKAT DARI FERRITIN
TRANSFERRIN GLOBULIN BM 80.000
= BIND 1.3 ug Iron / mg PROTEIN
= 2.3 gr / l PLASMA CONCENTRASI
= DI PRODUKSI DI HEPAR

KELUAR 1mg
ABSORPSI

JARINGAN
1 mg
TRANSFERIN
20 MG

20 MG

SUM-SUM TL

SEL RE

(macrofag )
20 MG

HEMOGLOBIN
YANG BEREDAR

20 MG

Urine, Sweat
Faeces

Mens

Pregnant

Growth

Total

Adult

0,5 - 1

0,5 1

Post Meno/
Mens

0,5 - 1

0,5 1

12

Pregnant

0,5 1

12

1,5 2,5

Children

0,5

0,6

1,0

Female

0,5 1

0,5 - 1

0,6

1 2,5

Doudenum & Less Jejenum


Factor Favouring
Ferrous Form
In Organic iron
Acids, Hcl, Vit C
Solobilising Agent, sugar,
amino acid
Iron Def
Increased Eritropoesis

Factor Reducing
Ferric Form
Organic Iron
Alkali Antacid
Pancreatic Secretions
Precipitating Agent
Fosfat
Iron Excess
Decreased Eritropoesis
Infection

JUMLAH BESI RATA RATA DEWASA


( gr )

( gr )

% Total

Hb

2,4

1,7

65

Ferritin /
Hemosiderin

1,0

0,3

30

Myoglobin

0,15

0,12

3,5

Haem Enzym
Catalase. Peroxidase. Flavo
protein

0,02

0,015

0,5

Transferin Bound
Iron

0,004

0,003

0,1

KARAKTERISTIK ANEMIA DEF .Fe


&
ANEMIA PENYAKIT KRONIK
Normal
Morfologi
S.I ( Mmol / L )
TIBC
% Transferin SAT
% Sideroblast
Serum Ferritin
R.E Iron
Eritrosit Protoforferin
(uMol/L )
Plasma Copper ( Mmol/L )

Anemia Def . Fe An . Peny


kronik

NN
206 8
58 4.5
35 15
40 60
100 60
(+)
< 700

Hypo Mikro
30
450
< 15
15 30
< 10
(-)

N / Hypo N
< 12.0
44.8 9
10 25
5 20
>200

16 - 31

Batas normal :
Pria
Wanita
Anak anak
Defisiensi besi
Kelebihan besi ( Iron over load )

40 340
14 150
7 140
0 12
340 - > 20.000

Metoda Penilaian Cadangan Besi


Serum Ferritin
Serum Iron
Sarurated Transferin
Biopsi sum sum tulang
( Hemosiderin )
Biopsi Hati ( RES Store )
Liver CT Scan
Test Ekskresi Desferoksamin
Phlebotomi Berulang sampai
terjadi Def Besi

Penilaian Kerusakan Jaringan


Disebabkan Kelebihan beban Besi
Jantung
Klinis, x foto Thorax, EKG,
Ekokardiografi.
Hati
Test Faal hati. Biopsi hati
Endokrin
G.T.T, Test pelepasan
Gonadotropin , Hypofise

Kausal:
Def. Vit. B 12
Def. As. Folat
Abnormalitas Metabolisme Vit B 12 atau Folat
Cacat sintesa DNA
Def Enzim Congenital
DidapatTerapi Hidroksi, Sitosin Arabinosa

Intake dalam makanan


Makanan utama
Pemasakan
Cadangan tubuh
Penyerapan
Batas penyerapan
Bentuk fisiologi intrasel
Terapi

Vit B 12

Folat

7 30 ug
Produk hewan
Sedikit pengaruh
2 3 mg
Ileum
2 3 ug
Metil dan Adenosil
Kobalamin
Hidroksi Kobalamin

600 1000 ug
Hati, sayuran hijau, ragi
Mudah rusak
10 12 mg
Duodenum Jejunum
50 80 %
Polyglutamat tereduksi
As Folat

DNA
dATP

dGTP

dCTP

dTTP
dTDP

DHF
Poliglutamat
THF
Poliglutamat
THF
B12
Metil THF

5.10 metilen THF


poliglutamat

dTMP
dUMP

metionin
homosistein
Membran sel

Metil THF

Plasma
Folat makanan di usus halus

KAUSAL DEF.VIT B. 12
Veganisme
Malabsorbsi
- Lambung
-Anemia Pernisiosa
-Intrinsik faktor def kongenital
-Gastrektomi total / partial
- Intestinal
-Intestinal stagnant loop syndr
-Divertikulosis Jejunal
-Blind loop
-Striktura
-Kronik tropical Sprue
-Reseksi Ileum / Peny Crohn
-Malabsorpsi selektif
congenital dengan proteinuria

* KAUSAL DEF.AS FOLAT


1.

2.

3.

4.
5.
6.

Nutrisional
-umur tua, poor, scorbut,
gastrektomi parsial
Malabsorpsi
-Tropical Sprue
-Peny coeliac
-Reseksi jejunum yang luas
-Peny Crohn
Pemakaian berlebihan
a.Fisiologikehamilan,laktasi
b.PatologiAn.hemolitik,
meilosklerosis, keganasan dll
Pembuangan folat urine >>>CHF
Terapi obat konvulsan
Campuran : peny hati,alkoholisme

ANEMIA MEGALOBLASTIK

HEMATOLOGIC FINDING
-Hb ( 7 8 ) g/dl, Eri ,
Ht ( 5 15 ) %
-Indek hematologi
-MCV > Normal ( 95-130 ) fl
-MCH ( 33 56 ) pg
-MCHC Normal
-Lekosit Lekopenia
-Trombosit
-Morfologi
-EriMacro ovalocyte,
anisositosis, poikilositosis,
cabot ring, basofilik, Howell
Jolly Bodies.
-LekositNetropenia,
Hipersegmentasi Shift to the
Right
-Red cell survival time: (1/4 ) Nml

- Sum Sum Tulang


-Eritroid
hiperplasia:megaloblastosis
-Metarubrisit Megalosit
-ratio inti sitoplasma asinkron
-Granulopoesis abnormal
-giant matamyelosit dan
hipersegmentasi.
-Megakariosit inti irreguler
-Adanya Eritro Fagositosis
-Hemosiderin

PERIPHERAL BLOOD IN PERNICIOUS


There are two late
megalobalst with nuclear
rossete formation and
basophil stippling
The red cells show
macrocytosis, anisocytosis
and poikilocytosis
Multi lobed neutrophil
polymorph

1. Macrocytic

erytrocyte from
anemia pernicious
with Howell Jolly
bodies.
2. Hypochromia and
microcytosis

NON HEMATOLOGI FINDING

Analisa asam lambung


-Histamin Fast Achlorhydria
-Pepsin ( - ) : renin ( - ),Vol asam total
-Total Gastric Failure
-Asam bebas ( - ) / : PH
-Ekskresi faktor intrinsik sangat
Serum B 12 dan Asam folat
Serum Iron : TIBC N / S.I
LDH Isoenzim LDH1 lebih tinggi dari LDH2
Autoantibodi ( 3 tipe )
-Anti parietal cell antibodi
-Anti Intrinsik faktor antibodi block
-Anti Intrinsik faktor antibodi binding
Cytogenetik ( abnormal kromosom non spesifik )