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ERYTHROCYTE II (Anemia Polycythemia). HMIM BLOCK 224. Dr. Shaikh Mujeeb Ahmed Assistant Professor AlMaarefa College. Objectives. Classify anemia Differentiate between different types of anemia Write normal values for RBC, Hb , HCT [PCV], MCV, MCH, MCHC Define Polycythemia

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Erythrocyte ii anemia polycythemia

ERYTHROCYTE II(Anemia Polycythemia)

HMIM BLOCK 224

Dr. ShaikhMujeeb Ahmed

Assistant Professor

AlMaarefa College


Objectives
Objectives

  • Classify anemia

  • Differentiate between different types of anemia

  • Write normal values for RBC, Hb, HCT [PCV], MCV, MCH, MCHC

  • Define Polycythemia

  • Differentiate between Primary Secondary Polycythemia

  • Summarize the effect of anemia & polycythemia on the body


Anemia
ANEMIA

  • What is Anemia?

  • Anemia means

    - Decreased hemoglobin

    - Decreased RBC count

    - Decreased Hematocrit [PCV]

  • Therefore, decreased O2 carrying capacity of blood.


Causes of anemia
CAUSES OF ANEMIA

  • Nutritional Anemia

    It is caused by dietary deficiency of factors needed for Erythropoiesis.

    1.Dietary Deficiency of Iron

    Iron deficiency anemia is called microcytic hypochromic anemia as RBC is small with less Hemoglobin.


Nutritional anemia
Nutritional Anemia

2.Megloblastic Anemia

  • It is due to deficiency of vitamin B12 or folic acid.

  • Vitamin B12 is essential for normal RBC maturation.

  • Vitamin B12 deficiency leads to Megloblastic Anemia [RBC size is large].


Anemia1
Anemia

  • Pernicious Anemia

    - It is due to deficiency of Intrinsic factor produced by Parietal cells of stomach.

    - Intrinsic factor is necessary for absorption of Vitamin B12.

    - Vitamin B12 is absorbed from intestinal tract [terminal ileum] when Vitamin B12 is bound to intrinsic factor.

    - Pernicious Anemia is megloblastic anemia.


Anemia2
ANEMIA

3. Aplastic Anemia

It is caused by failure of bone marrow to produce RBC even though all necessary nutrients for Erythropoiesis are available.

Causes of Aplastic Anemia

-Excessive exposure to X-ray

-Exposure to radiation, e.g. bomb blast

-Chemotherapy for Cancer

-Drugs


Anemia3
ANEMIA

4. Hemolytic Anemia

It is caused by rupture [breakdown] of RBC.

Causes of Hemolytic Anemia

-Malaria

-Sickle Cell Anemia [Hemoglobin β chain is defective where valine replaces glutamate at position 6 in this amino acid chain].RBC is sickle shaped

-Mismatched blood transfusion

-Drugs


Anemia4
ANEMIA

5. Renal Anemia

Anemia in Renal [kidney] disease is due to decreased Erythropoietin secretion from the kidney. It leads to decreased RBC production.


Anemia5
ANEMIA

6 .Hemorrhagic Anemia

- It is caused by losing a lot of blood.

- Acute Loss of blood e.g. car accident.

- Chronic Loss of blood e.g. bleeding peptic ulcer, excessive menstrual flow.


Anemia6
ANEMIA

  • How to diagnose microcytic hypochromic anemia [iron deficiency] and macrocytic [megloblastic] which is vitamin B12 deficiency anemia?

    We see

  • Hemoglobin, RBC, PCV [Hematocrit]

  • MCV [Mean Cell Volume]

  • MCH [Mean Concentration of Hemoglobin]

  • MCHC [Mean Cell Hemoglobin Concentration]


Anemia7
ANEMIA

We will define MCV, MCH, MCHC

  • MCV – it is the volume of average RBC

    - Normal MCV = 90 fL or 90 μ3

    [MCV > 95 fL are called macrocyte]

    [MCV < 80 fL are called microcyte]

  • MCH – it is mean concentration of Hemoglobin in each RBC.

    - Normal MCH = 30 picogram [pg]

  • MCHC – it is hemoglobin present per 100ml of RBC

    - Normal MCHC = 30 gram/100ml of RBC


Anemia8
ANEMIA

Microcytic Hypochromic Anemia

Or Iron Deficiency Anemia

  • In iron deficiency anemia

    Hemoglobin RBC

    Hematocrit

    MCV

    MCH

    MCHC


Anemia9
ANEMIA

Macrocytic [Megloblastic] Anemia

Vitamin B12 or folic acid deficiency

Hemoglobin RBC

Hematocrit

MCV

MCH Normal

MCHC Normal

It is called Macrocytic Normochromic Anemia.


Normal values formulae for calculation of mcv mch mchc
NORMAL VALUEs & FORMULAE FOR CALCULATION OF MCV, MCH, MCHC

  • Mean Corpuscular Volume (fl)

  • 78 – 98 (fl)

  • Mean Corpuscular Hemoglobin (pg)

  • 27 – 33 pg.

  • Mean corpuscular Hb concentration

  • 30 – 35%


Clinical example
CLINICAL EXAMPLE

  • A patient came with a history of fatigue, weakness. His blood analysis was done

    RBC count 3.6 × 106 / mm3

    Hb concentration 7.0 g / 100ml

    PCV 25%

    MCV 69.4 fL [femtoliter] Normal 90 fL

    MCH 19.4 pg [picogram] Normal 30 pg

    MCHC 28 g / dl Normal 34 g/dl

  • What is Diagnosis ?

  • Microcytic Hypochromic Anemia [Iron deficiency Anemia]


Polycythemia
POLYCYTHEMIA

  • Polycythemia is characterized by increased number of RBC and increased Hematocrit.

    Types of Polycythemia

    1. Primary Polycythemia

    2. Secondary Polycythemia


Primary polycythemia
Primary Polycythemia

  • Primary Polycythemia is tumor like condition of bone marrow, where, there is increased production of RBC.

  • RBC count may reach 11 million/mm3 (normal is 5 million cells/mm3) .

  • Hematocrit may be 70-80% [normal 42-45%].


Primary polycythemia1
Primary Polycythemia

  • Side Effects

    - As there is increased viscosity of blood, it causes blood to flow very slowly, which may reduce O2 delivery to tissues.

    - Increased viscosity causes increased peripheral resistance which may cause increased blood pressure.


Secondary polycythemia
Secondary Polycythemia

  • Secondary Polycythemia is due to decreased O2 delivery to the tissues.

  • It occurs in people living at high altitude as O2 available in the air is less.

  • It occurs in people with chronic lung disease called Cardiac [heart] failure due to decreased O2 delivery to the tissues.

  • RBC count may be 6 to 8 million/mm3.


Relative polycythemia
Relative Polycythemia

  • Relative Polycythemia occurs when there is body fluid loss e.g. diarrhea, heavy sweating.

  • There is body fluid loss, but no loss of erythrocytes.

  • This is not true Polycythemia as RBC are not increased, but only plasma volume is decreased.

  • As RBC are concentrated in small plasma volume, this condition is called Relative Polycythemia.


Applied
APPLIED

Effect of Anemia

  • In Anemia, blood viscosity is decreased to 1.5 times of water [normal viscosity 2.5 – 3 times of water].

  • Therefore, there is decreased peripheral resistance, it causes increased blood flow and increased venous return to heart, therefore, increased cardiac output increase heart rate.

  • Anemia causes hypoxia [decrease O2 delivery to tissues], therefore, increased cardiac output.


Applied1
APPLIED

Effect of Polycythemia

  • In Polycythemia, there is increased viscosity, therefore, blood flow is sluggish [slow].

  • Increased viscosity leads to increased peripheral resistance, therefore, increased blood pressure can occur [in 1/3rd of polycythemic people].



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