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Objectives:
Define blood testing
Significance of blood testing
What is CBC?
Normal Ranges
Direct measurements
Indirect measurements
Anemias
Classification
Brief description
Blood Testing
Blood Sample
Complete Blood Count (CBC)
WBC’s (4000-10800 cells/mm3 )
Plateltes (150,000-400,000 cells/mm3)
RBC’s (Male: 4.6–5.9, Female: 4.2–5.4 million cells/mm3 )
Direct measurements
RCC (Red cells Count)
Hb Concentration (g/dl)
What is anemia?
Diagnostic basis of classification
Types and Classification
Etiology or Causes of disease
Compare and contrast different types of
anemias
Polycythemia
Why polycythemia occurs
Anemias
Diagnostic Classification
1. Kinetic Approach
Production vs. destruction or loss
Reticulocyte Production Index (RPI)
2. Morphological Approach
Red blood cell size
Microcytic (Cells Smaller than normal size i.e. MCV< 80 fl)
Normocytic (Cells Normal sized i.e. MCV = 80-100 fl)
Macrocytic (Cells bigger than normal size i.e. > 100 fl)
Concentration of Hb
Hyperchromic (Increased Hb Concentration)
Normochromic (Normal Hb Concentration)
Hypochromic (Decreased Hb Concentration- cells paler
than normal)
Anemia
Anemia means deficiency of hemoglobin in the blood
Cause
Too few red blood cells or
Too little hemoglobin in the cells.
Classification
1. Aplastic or Hypoplastic Anemia
2. Nutritional Anemia
3. Hemolytic Anemia
Aplastic or Hypoplastic Anemia
Aplastic Loss of bone marrow function
Hypoplastic Reduced bone marrow function
Anemia due to lack of functioning of Bone Marrow or bone
marrow aplasia. Aplastic anemia patients have lower counts of all
three blood cell types: termed pancytopenia.
Characterstics:
Decreased Red blood cells
Diminished immunity
Tendency to bleed
Aplastic Anemia
– Causes
– Drugs e.g. (Cytotoxic drugs, some anti convulscent drugs etc)
– Radiations (X-Rays)
– Chemicals (Benzene and its derivatives)
– Viral diseases
– Invasion of bone marrow (fibrosis or Leukemia)
Hereditary
Congenital hypoplastic anemia (or constitutional aplastic anemia) a
type of aplastic anemia which is primarily due to a congenital disorder
(defects or damage to a developing fetus).
Examples include:
Fanconi anemia (Caused by short Stature, Skeletal Abnormalities)
Diamond-Blackfan anemia (Congenital Erythroid Aplasia- Characterized by anemia
with decreased erythroid progenitors in bone marrow)
Acquired
Pure Red cell Aplasia (PRCA)
Sideroblastic anemia (Sideroachrestic anemia)1 The body has iron available, but
cannot incorporate it into hemoglobin
Myelophthisic anemia2 (Normal marrow space is replaced by nonhematopoietic or
abnormal cells). Cause e.g. tumors
Nutritional Anemia
1. Nutritional Anemia
Type of anemia that can be directly attributed to nutritional
disorders
Iron Deficiency Anemia (Microcytic)
Megaloblastic Anemia (Macrocytic)
Iron Deficiency Anemia (Microcytic)
Sideropenic Anemia, cells are smaller in size and paler in colour
Causes:
Parasitic Infections
e.g. Hook worms
Normal Requirement, Deficient intake
Weight reducing diets, Vegetarian diets
High Requirements, Normal or deficient intake
Pregnancy
Chronic blood loss (peptic ulcers, menorrhagia,
haemorrhoids, GI carcinoma)
Low iron absorption or malabsorption
GI abnormalities
Increase in pH (removal of part of stomach)
Loss of absorbing surface area (intestine removal)
Nutritional Anemia
Megaloblastic Anemia (Macrocytic)
Inhibition of DNA synthesis during erythropoiesis
Large, immature RBCs (Megaloblasts)
Characterstics:
Immature, fragile cells,
Life span b/w 40-50 days
Size larger than normal cells,
Might contain nucleus
Causes:
Hypovitminosis (B12, B9)
Antimetabolites that inhibit DNA synthesis e.g.
Purine & Pyrimidine Antagonists (6-Mercaptopurine,
Cytosine)
Nutritional Anemia
Vitamin B12 deficiency Anemias
Deficient intake in diet (vegetarians)
Deficient intrinsic factor (Gestractomy & Pernicious Anemia)
Selective B-12 malabsorption (removal of Terminal ileum)
Increased needs: pregnancy, infant, rapid cellular proliferation.
Pernicious Anemia
Most common form of Vitamin B12 deficiency Anemias
Occurs more often in females
Cause:
Autoimmune disease results in production of antibodies
directed against Intrinsic Factor (IF)* and parietal cells in
stomach.
Impaired absorption of vitamin B-12 due to the absence of
intrinsic factor as a result of loss of gastric parietal cells.
Treatment
IV injections of Vitamin B-12
Complications of B-12 deficiency anemia
Appear before the signs of anemia
Includes Irreversible neurological damage commonly in spinal
cord (B-12 needed for formation and maintenance of Myelin by
schwann cells)
Nutritional Anemia
Vitamin B9 (Folic Acid) deficiency Anemias
Deficiency causes megaloblastic anemia but not
associated with neurological damage
Causes
Dietary Deficiency e.g. in infants absence or delay of
establishing mix diets.
Alcoholism
Anorexia (Loss of appetite)
Pregnancy (Raised requirement)
Malabsorption from jejunum (tropical sprue)
Interference with Folate metabolism
Folic acid Antagonists (Methotrexate)
Trimethoprim (Antimicrobial agent)
Deficiency Causes neural tube defects during
pregnancy*
Folic acid Metabolism
Hemolytic Anemias
1. Hemolytic Anemias
Occur when RBCs are destroyed in circulation or removed
prematurely from circulation because of abnormal cells or
overactive spleen
Hereditary or Congenital hemolytic Anemias
Hemolytic anemia which is primarily due to congenital
disorders
Types include:
Genetic conditions of RBC Membrane
Hereditary spherocytosis (Sphere shaped RBCs)
Hereditary elliptocytosis (Elliptical RBCs) (Also known as ovalocytosis)
Genetic conditions of RBC metabolism (enzyme defects)
Glucose-6-phosphate dehydrogenase deficiency (G-6-PD)
Pyruvate kinase deficiency (No energy)
Hemoglobinopathies / genetic conditions of hemoglobin
Sickle cell anemia
Thalassaemia
Hemolytic Anemias
Acquired hemolytic anemia
No familial or racial factors have been identified
Causes:
Chemical Agents:
These agents may cause excessive or early hemolysis
Some Drugs, if taken for long time & in large doses e.g.
Sulphonamides
Chemicals faced in general or work environment e.g.
lead, arsenic compounds
Toxins produced by certain microbes.
e.g. streptococcus pyogenes
Autoimmunity
Production of antibodies against self antigens
Blood transfusion Reactions
Parasitic Disease e.g. malaria
Physical damage to cells by e.g. artificial heart valves, dialysis
machines.