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ANEMIA

Measurement of transferrin
Smear: ovalocytes/ pencil form

RBC, Hb
Clinical Symptoms:
Hemoglobin levels:
<12 g/dL: male
<11 g/dL: female

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o
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Classification is based on:

Morphology
Etiology

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Types of Anemia
2.

Relative Anemia
false anemia
RBC: normal, Plasma Volume:
Secondary to an unrelated condition
Transient
Cause: any condition that results to
HEMODILUTION
Example: pregnancy, volume overload
(plasma transfusion)

Absolute Anemia
true anemia
RBC: , Plasma Volume: Normal
Indicative of true decrease in RBC and
Hemoglobin

delivery of cells in the circulation


Bone marrow fails to respond
(reticulocytopenia)
Impaired/ defective production
loss of red cells in the circulation
Bone marrow can respond (reticulocytosis)
Bleeding, accelerated destruction
(hemolysis)

A.

IMPAIRED/ DEFECTIVE PRODUCTION ANEMIA

1.

Iron Deficiency Anemia


Most common in the US

Prevalent in:
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Infants & children


Pregnant women
Excessive menstrual flow
Elderly with poor diets (loss of acidity)
Malabsorption syndrome
Chronic blood loss (GI bleeding, hookworm
infection)

Laboratory Findings
-

Microcytic, Hypochromic
Serum iron, ferritin, Hb/ Hct, RBC indices,
reticulocyte count
TIBC (Total Iron Binding Capacity)

Anemia of Chronic Disease


Anemia of Inflammation
Due to inability to use iron for haemoglobin
production
Impaired release of storage iron associated
with increased hepcidin levels
Associated with persistent infections,
chronic inflammatory disorder (cancer, SLE,
RA)
2nd most common anemia
Most common type of anemia among
hospitalized patients

Hepcidin
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Mechanism

Fatigue
Dizziness
Pica (appetite for non-nutritive food like
clay & wood)
Stomatitis (cracks along the corners of the
mouth)
Glossitis (sore tongue)
Koilonychia (spooning of the nails)

Liver hormone
Positive APR
hepcidin iron absorption
Functions:
Iron regulation
Influence intestinal iron absorption
Release of storage iron from
macrophage

Laboratory Findings:
-

3.

Normocytic, normochromic
Prolongation: slight microcytic,
hypochromic
ESR (normal: 20 mm/hr)
Normal/ elevated ferritin
serum iron, TIBC (as it does not feels the
need to bind iron due to normal or
ferritin)

Sideroblastic Anemia
Caused by blocks in the protoporphyrin
pathway resulting in defective
haemoglobin synthesis and iron overload
Ringed Sideroblast (immature RBC)
Mitochondrial region
Periphery of the nucleus
Siderocytes (mature RBC w/ sideroblastic
inclusions)

Stains for Pappenheimer bodies:


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o

Wright Stain
Perls Prussian Blue (best)

2 Types of Sideroblastic Anemia


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Primary
Irreversible
Cause of clock is unknown
Present w/ RARS (Refractory Anemia w/
Ringed Sideroblast)
Secondary
Reversible
Caused by alcohol, anti-tuberculosis drugs,
chloramphenicol

Laboratory findings:
4.

Microcytic, hypochromic
ferritin, serum iron
TIBC

Lead Poisoning
Caused by multiple blocks in the
protoporphyrin pathway
Common on children exposed to lead
based paint

Clinical Symptoms
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Abdominal pain
Muscle weakness
Gum lead line

Laboratory findings
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Normocytic, normochromic
With coarse basophilic stipplings

2 areas affected in the protoporphyrin pathway

5.

Step # 2
Accumulation of d-ALA excreted in the urine
Step # 7
Blocking of heme synthetase (ferrochelatase)
iron overload free radicals destruction of
cells

Porphyrias
Inherited disorder characterized by
blockage in the protoporphyrin pathway
Heme precursors before the block
accumulate in the tissues & large amount
are excreted in the urine & feces

Clinical Symptoms
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Photosensitivity
Abdominal pain
CNS disorder (short/long term memory loss,
psychosis)
Flourice of skin and teeth

B. ANEMIA CAUSED BY DEFECTS OF DNA METABOLISM

MEGALOBLASTIC ANEMIA
1.

Vitamin B12 Deficiency


Defect on parietal cells that secrete
intrinsic factors