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Dental Students
2014
Outline
Clinical features of anaemia
Classification
Microcytic
Normocytic
Macrocytic
Data examples
Haemolytic anaemia
Definition of anaemia
Anaemia is defined as a reduction in the
haemoglobin concentration of the blood
This results in a decreased oxygen carrying
capacity
Symptoms of anaemia
Signs of anaemia
Pallor
Tachcardia, bounding pulse (hyperdynamic
circulation)
Signs of congestive cardiac failure
Pulmonary oedema
Peripheral oedema
Conjunctival pallor
Classification of Anaemia
Microcytic
Normocytic
Macrocytic
Haemolytic
Classification of Anaemia:
Microcytic Hypochromic
MCV <80fl
MCH <27pg
?? Ferritin level (also check CRP/ESR)
Microcytic anaemia
Ferritin <20ug/L
Iron deficiency
Microcytic anaemia
Ferritin >20ug/L
Thalassaemia
Anaemia of chronic disease (some cases)
Lead poisoning
Malabsorption
Coeliac disease
Autoimmune disorder
Intolerance of proteins in wheat, barley, rye
Villous atropy
Anti-tTG Ab/duodenal biopsy at OGD
Crohns disease
Inflammatory bowel disease
Tropical sprue
Villous atrophy, Carribean/Far & Middle East
Symptoms of GORD
Malaena/blood PR
Altered bowel habit
Family Hx bowel carcinoma
Menorrhagia
Duration of menses, flooding, clots
Management
Oral Fe replacement therapy
Galfer tablet twice daily for 3 months
Re-check FBC & ferritin
Supplement for 3 months after correction
Non-compliance
GI symptoms
Poor compliance
Malabsorption
Ongoing blood loss
Wrong diagnosis-thalassaemia trait
Mixed deficiency-associated vitamin B12 or folate
deficiency
Another cause for the anaemia, e.g. malignancy,
inflammation
Microcytic anaemia
Ferritin >25ug/L
Thalassaemia
Sideroblastic anaemia
Anaemia of chronic
disease (usually
normocytic)
Lead poisoning
(usually normocytic)
Consider referral to
haematologist
Refer to haematologist
Assess exposure
history: measure
urinary lead
Thalassaemia Trait
Hb is a tetramer of 2 alpha & 2 beta globin chains
Thalasseamia is a genetic disorder of unbalanced
Hb synthesis resulting in:
underproduction of one globin chain
unmatched globins precipitate causing RBC membrane
damage & premature haemolysis
Usually non-Caucasians
Microcytic anaemia
High red cell count
Normal MCHC
Microcytic Anemias
MCV < 80 fl
++
++++
Hemoglobinopathy
Lead poisoning
++
++
++++
Sideroblastic
Classification of Anaemia:
Normocytic Normochromic
MCV 80-100fl
MCH >26pg
Normochromic normocytic
anaemia
Classification of Anaemia:
Macrocytic
MCV >100fl
Megaloblastic
vitamin B12 or folate deficiency
Non-megaloblastic
alcohol, liver disease
myelodysplasia
aplastic anaemia
Vitamin B12
7-30mg
Animal produce only
Little effect
1-2mg
2-3mg (enough for 2-4yrs)
Ileum
Intrinsic factor
2-3mg
Hydroxocobalamin
Pernicious Anaemia
Autoimmune attack on the gastric mucosa
leading to atrophy of the stomach
Lack of gastric intrinsic factor secretion
Females> males
Associated autoimmune diseases
Thyroid, vitiligo, Addisons disease
Folic Acid
200-250mg
Most liver, greens, yeast
Easily destroyed
100-150mg
10-12mg (4mths supply)
Drugs-anticonvulsants
Mixed-liver disease, alcoholism, intensive care
Haemoglobin (g/dl)
Haematocrit (PCV) (%)
Red cell count (x 1012/L)
Mean cell haemoglobin
(pg)
Mean cell volume (fl)
Mean cell haemoglobin
concentration (g/dl)
7.5 (11.5-16.5)
0.30 (0.37-0.47)
2.35 (3.8-5.8)
22 (27-32)
65 (76-100)
26 (32-36)
Haemoglobin (g/dl)
Haematocrit (PCV) (%)
Red cell count (x 1012/L)
Mean cell haemoglobin
(pg)
Mean cell volume (fl)
Mean cell haemoglobin
concentration (g/dl)
8.2 (11.5-16.5
0.25 (0.37-0.47)
2.7 (3.8-5.8)
34 (27-32)
120 (76-100)
34 (32-36)
Haemolytic anemia
Decreased erythrocytes in circulating blood (anemia)
because of their acclerated destruction (hemolysis)
A red blood cell survives 90 to 120 days (on average) in
the circulation, therefore about 1% of human red blood
cells break down each day.
The spleen (part of the reticulo-endothelial system) is the
main organ which removes old and damaged RBCs from
the circulation.
In health the breakdown and removal of RBCs from the
circulation is matched by the production of new RBCs in
the bone marrow.
Abnormal Haemoglobin
Sickle cell anemia
Thalassaemia
Physical destruction
Prosthetic heart valve
Drugs/MAHA
MAHA
Micro Angiopathic Hemolytic Anemia
Reticulocytosis
No definite nucleus
Reticulum of RNA
Deep blue staining
Laboratory diagnosis of
Haemolytic Anaemia
Reticulocyte count - increased
Blood film:
Polychromasia
Spherocytes
RBC fragments (schistocytes)
Immune-mediated haemolysis:
Direct Coombs test
Decreased Haptoglobin
Increased unconjugated bilirubin
Increased LDH
Urinary haemosiderin
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