anemic syndrome, anemia · anemia: normocytic, normochromic (6-72 hours after) anemia due to...
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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