1. ANAEMIA Outi Vehviläinen, MD Ilembula 14.12.2012

2.  I Definition  II Pathofysiology  III Aethiology Aenemia

3.  Anaemia is defined as a condition in which the Hb concentration in peripheral blood is lower than normal for age, sex and pregnancy state of the subject. I Definition

4.  Newborn infants140  6 months – 6 years110  6-14 years120  Adult males130  Adult females non pregnant120 pregnant110 I Definition: normal haemoglobin

5.  Anaemia reduces the oxygen-carrying capacity of the blood.  The body compensates this: ◦ 1.increasing the release of oxygen from Hb to the tissues ◦ 2.increasing cardiac output ◦ 3.enhancing blood flow to vital tissues ◦ 4.increasing respiration  Severity of anaemia is passing through three stages ◦ 1.compensated ◦ 2.decompensated ◦ 3.lifethreatening anaemia II Pathophysiology

6.  The major compensatory mechanism in mild to moderate anaemia is the increase of oxygen release to tissue by up to 40%.  Cardiac output is raised by an increase in stroke volume at rest  Exaggerated tachycardia on exertion  Vasodilation  PATIENT:breathlessness on exertion 1. Compensated anaemia

7.  Hb below 70 g/l  Increased cardiac output  Stroke volume and heart rate are raised at rest  Peripheral vasodilation  PATIENT: breathlessness at rest, tachycardia 2. Decompensated anaemia

8.  Respiratory distress with tachypnea  Oxygen supply to the myocardium is insufficient and no further increase in cardiac output is possible  High output cardiac failure develops  PATIENT: severely breathless, may complain of angina  Cardiomegaly,pulmonary oedema, hepatomegaly,peripheral oedema,sometimes ascites 3. Life-threatening anaemia

9. 1. Blood loss a. Acute b. Chronic (hookworms, schistosomiasis) 1. Decreased red cell production a. Nutritional deficienciesb. Depressed bone marrow funtion Iron Secondary anaemias FolateHIV/AIDS Vitamin B 12tuberculosis Variousother chronic infections protein-energychronic hepatic disease vitamin Achronic renal disease vitamin Ccarcinomatosis vitamin E, riboflavin, pyridoxine, CuAplastic anaemia drugs and chemicals infiltration idiopathic irradiation congenital Thalassaemias alfa thalassaemias beta thalassaemias 3. Increased red cell desctrution a. Abnormalities of red cells b. Abnormal haemolysis Haemoglobin Immune haemolysis sickle-cell disease autoimmune Enzymes fetomaternal G6PD deficiency incompatibility Membrane incompatible blood transfusion elliptocytosis Non-immune haemolysis ovalocytosis infections (e.g. malaria) spherocytosis hypersplenism drugs and chemicals venoms burns mechanical III Aetiology of anaemia

10. 1) Blood loss 2) Decreased red cell production 3) Increased red cell desctrution III Aetiology of anaemia

11. 1.Blood loss a. Acute haemorragia b. Chronic -hookworms, -schistosomiasis - menorrhagia - peptic ulcers III Aetiology of anaemia

12. 2.Decreased red cell production a. Nutritional deficiencies b. Depressed bone marrow function Iron Secondary anaemias Folate HIV/AIDS Vitamin B 12 tuberculosis Variousother chronic infections protein-energy chronic hepatic disease vitamin Achronic renal disease vitamin Ccarcinomatosis vitamin E, riboflavin, pyridoxine, Cu Aplastic anaemia drugs and chemicals infiltration idiopathic irradiation congenital Thalassaemias alfa thalassaemias beta thalassaemias III Aetiology of anaemia

13. 3. Increased red cell desctrution a. Abnormalities of red cells b. Abnormal haemolysis Haemoglobin Immune haemolysis sickle-cell disease autoimmune Enzymes fetomaternal incompatibility G6PD deficiency incompatible blood transfusion Membrane elliptocytosis Non-immune haemolysis ovalocytosis infections (e.g. malaria ) spherocytosis hypersplenism drugs and chemicals venoms burns mechanical III Aetiology of anaemia

14.  Inadequate intake  Chronic blood loss: ◦ Hookworm ◦ Schistosomiasis causing hematuria (S.haematobium) and ulcers and polyps in the colon (S.mansoni).  HAEMATOLOGY: Anaemia with microcytic hypochromic red cells (MCV reduced ) III Aetiology 2. Decreased red cell production: Nutritional deficiency Iron deficiency

15. Clinical signs: ◦ increased suspectibility to infections ◦ mild splenomegaly ◦ depression of mood ◦ glossitis and angular cheilosis ◦ sterility ◦ retarded growth and development in childhood ◦ in pregnancy: fetal growth retardation, premature delivery and low birthweight  HAEMATOLOGY: Anaemia with macrocytosis (MCV increased)  PHYSIOLOGICAL HIGH DEMANDS: IN PREGNANCY  PATHOLOGICALLY HIGH DEMANDS: IN MALARIA HEMOLYSIS III Aetiology 2. Decreased red cell production: Nutritional deficiency Folate deficiency

16. 1. Blood loss a. Acute b. Chronic (hook worms, schistosomiasis) 1. Decreased red cell production a. Nutritional deficienciesb. Depressed bone marrow funtion Iron Secondary anaemias Folate HIV/AIDS Vitamin B 12 tuberculosis Variousother chronic infections protein-energychronic hepatic disease vitamin Achronic renal disease vitamin Ccarcinomatosis vitamin E, riboflavin, pyridoxine, CuAplastic anaemia drugs and chemicals infiltration idiopathic irradiation congenital Thalassaemias alfa thalassaemias beta thalassaemias 3. Increased red cell desctrution a. Abnormalities of red cells b. Abnormal haemolysis Haemoglobin Immune haemolysis sickle-cell disease autoimmune Enzymes fetomaternal G6PD deficiency incompatibility Membrane incompatible blood transfusion elliptocytosis Non-immune haemolysis ovalocytosis infections (e.g. malaria ) spherocytosis hypersplenism drugs and chemicals venoms burns mechanical III Aetiology of anaemia

17. Thank you!