Review

Anemia
Autor : Joseph E Maakaron, MD
Pembimbing : dr. Budi Prakoso SP.PD
Oleh : I Wayan Agus Ardika/07700124

Definisi
penurunan sel darah merah. Fungsi adalah
untuk memberikan oksigen dari paru-paru ke
jaringan dan karbon dioksida dari jaringan ke
paru-paru. Hal ini dicapai dengan
menggunakan hemoglobin (hb).

Patofisiogy
Kehilangan darah volume intravaskuler
transportasi O2
hipoksia hipovolemiahipotensi

 Aktifitas simpatis
pelepasan norepinephrine pelepasan
ADHreabsorpsi cairan di tubulus ginjal
pelepasan renin
angiotensin 1 angiotensin
2aldosteronpenyerapan Na di ginjal
volume intravasculer
tekanan darah

Etiologi

Faktor dasar :
Kehilangan darah
Penghancuran RBC
produksi RBC

(hemolisis)

Faktor genetik

Hemoglobinopathies
Thalassemia
Enzim kelainan jalur glikolitik
Cacat dari sitoskeleton RBC
anemia dyserythropoietic kongenital
Penyakit nol Rh
xerocytosis herediter
Abetalipoproteinemia
anemia Fanconi

Faktor Gizi

Kekurangan zat besi

Kekurangan Vitamin B 12
Defisiensi folat
Kelaparan dan malnutrisi umum

Faktor fisik
Trauma
Luka bakar
Frostbite

Faktor dari penyakit kronis dan

keganasan

Penyakit ginjal
Penyakit Hati
Infeksi kronis
Neoplasia
penyakit pembuluh darah Kolagen

Faktor infeksi
Viral - Hepatitis , mononukleosis infeksiosa ,
sitomegalovirus
Bakteri - Clostridia , gram negatif sepsis
protozoa - Malaria , leishmaniasis ,
toksoplasmos

Faktor lain
Thrombotic thrombocytopenic purpura (TTP)
Hemolytic-uremic syndrome

Anamnesa

Riwayat penyakit darah

Riwayat tranfusi darah
Riwayat penyakit keluarga
Riwayat terapi
Riwayat perdarahan

Tabel 1 . Mikrositik hipokromik Anemia ( MCV < 83 , MCHC < 31)

Total IronBinding Capacity Bone Marrow Iron
(TIBC)

Comment

Iron deficiency

Responsive to iron therapy

Chronic
inflammation

++

Unresponsive to iron therapy

Thalassemia
major

++++

Reticulocytosis and indirect

bilirubinemia

Thalassemia
minor

N-

++

Elevation of fetal hemoglobin and

Hb A2, target cells, and
poikilocytosis

Lead poisoning N

++

Basophilic stippling of RBCs

Sideroblastic

++++

Ring sideroblasts in marrow

Hemoglobin

++

Hemoglobin electrophoresis

Condition

Serum Iron

= decreased; = increased; 0 = absent; +'s indicate the amount of stainable iron in bone marrow
specimens, on a scale of 0-4; N = normal.

Tabel 2. Makrositik Anemia (MCV> 95)

Megaloblastic bone marrow

Deficiency of vitamin B-12

Deficiency of folic acid
Drugs affecting deoxyribonucleic acid
(DNA) synthesis
Inherited disorders of DNA synthesis

Nonmegaloblastic bone marrow

Liver disease
Hypothyroidism and hypopituitarism
Accelerated erythropoiesis
(reticulocytes)
Hypoplastic and aplastic anemia
Infiltrated bone marrow

Tabel 3. Berbagai Bentuk sel darah merah

Microcyte

Smaller than normal (< 7 m diameter). See Table 1.

Macrocyte

Larger than normal (>8.5 m diameter). See Table 2.

Hypochromic

Less hemoglobin in cell. Enlarged area of central pallor. See Table 1.

Spherocyte

Loss of central pallor, stains more densely, often microcytic. Hereditary spherocytosis
and certain acquired hemolytic anemias

Target cell

Hypochromic with central "target" of hemoglobin. Liver disease, thalassemia,

hemoglobin D, and postsplenectomy

Leptocyte

Hypochromic cell with a normal diameter and decreased MCV. Thalassemia

Elliptocyte

Oval to cigar shaped. Hereditary elliptocytosis, certain anemias (particularly vitamin

B-12 and folate deficiency)

Schistocyte

Fragmented helmet- or triangular-shaped RBCs. Microangiopathic anemia, artificial

heart valves, uremia, and malignant hypertension

Stomatocyte

Slitlike area of central pallor in erythrocyte. Liver disease, acute alcoholism,

malignancies, hereditary stomatocytosis, and artifact

Tear-shaped RBCs

Drop-shaped erythrocyte, often microcytic. Myelofibrosis and infiltration of marrow

with tumor. Thalassemia

Acanthocyte

Five to 10 spicules of various lengths and at irregular intervals on surface of RBCs

Echinocyte

Evenly distributed spicules on surface of RBCs, usually 10-30. Uremia, peptic ulcer,
gastric carcinoma, pyruvic kinase deficiency, and preparative artifact

Sickle cell

Elongated cell with pointed ends. Hemoglobin S and certain types of hemoglobin C

Normocyic normochromic anemia

Kehilangan darah
Hemolisis
Penurunan produksi

Evaluasi kehilangan darah

Perdarahan -> anemia
HCT menurun dlm 24-48 jam hingga vol.
plasma terganti
Deff. Iron -> SDM mikrositik hipokromik
Test serum iron level dan TIBC dilakukan
beberapa minggu setelah perdarahan

Evaluasi hemolisis
Masa hidup SDM 120 hari
Hemolisis -> masa hidup <40 hari -> produksi
SDM meningkat/ destruksi SDM

Terapi
Tranfusi darah (PRC) -> terapi paliatif
Perdarahan aktif
Kondisi dan gejala anemia yang parah

Terapi ferrous sulfate

Untuk meningkatkan kadar besi
Terapi nutrisi dan diet
Untuk defisiensi iron, vitamin b 12, dan asam
folat

 Splenectomy
Autoimmune hemolytic anemias dan pada
herediary hemolytic disorders
Bone marrow and stem cell transplantation
Leukimia, lyphoma, hodgkin disease, multiple
myeloma, myelofibrosis, and aplastic disease
Istirahat

Medikamentosa
Tujuan pengobatan pada tahap akut ialah
mengembalikan hemodinamik dan mengganti
SDM yang hilang.

Darah dan produksi

PRC
Fresh frozen plasma
Platelets
Faktor IX
Recombinant factor VIII

Mineral
Vitamin
Elektrolit
Vasopressors
Histamin (h2) agonis
glucocorticoid

Prognosis
Tergantung pada penyebab
Tingkat keparahan anemia
Kecepatan penanganan

 Terima kasih