Anemia

dr Putra Hendra SpPD

UNIBA

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DARAH
Terdiri dari sel-sel darah dan plasma darah

Composition of Blood

19-3
19-3

 Deliver O2
Remove metabolic wastes
Maintain temperature, pH, and fluid volume
Protection from blood loss- platelets
Prevent infection- antibodies and WBC
Transport hormones

eritrosit

Masa hidup 100-120 hari di sirkulasi.

Dihancurkan di hati & limpa.

Dihasilkan dari pembelahan & diferensiasi

sel induk (stem cell) di sumsum tulang: 2
juta/detik!

Eritropoietin (EPO)dihasilkan di ginjal

berperan untuk pembentukan eritrosit di sstl.

Faktor lain :
Fe (besi)
Asam amino
Vit. B12 & asam folat

Proses hemopoiesis

Erythropoiesis

Factors required for normal haematopoiesis

(formation of normal blood cells)
I.

Dietary factors (extrinsic factor): - protein

- iron
- copper, Mn
- vit C, folic acid, vit B12
(intrinsic factor) : - gastric mucosa ~ enzym pencernaan.

II.

Liver factor : - folic acid

- Vit B12 stored and released to circulation.

III.

Renal factor stimulus bone marrow erythropoiesis

(erythropoietin)
vit B12 stimulus proerythroblast

IV. Others factor

Thyroid & corticoid, Fe, Cu, VitC normoblasts reticuloyte
red blood cells
circulate 120 days
wears out
bile pigments
digestion area

Pengaruh aklimatisasi akut terhadap eritropoiesis

Pada ketinggian 18000 kaki (5500m) eritropoetin segera disekresikan

Faktor limpa
Penyaring darah merah yang abnormal.
Organ ini mengandung banyak trombosit dan
berperan
Dalam sistim imun.

Mechanism of Transport
HEMOGLOBIN
* 4 Heme Molecules
* 4 Oxygen Molecules
*Oxygenated Hemoglobin
Bright Red (systemic)
*Deoxygenated Hemoglobin
Blue (venous circulation)

Hemoglobin (Hb)

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Figure 19.5 Red Blood Cell

Turnover

Figure 19.5

Formation & Destruction of RBCs

ANEMIA
Definisi Anemia:

Sindroma klinis yang disebabkan penurunan massa

eritrosit total dalam tubuh.
Keadaan dimana massa eritrosit dan atau massa
hemoglobin tidak dapat memenuhi fungsinya untuk
menyediakan oksigen bagi jaringan tubuh
Penurunan di bawah normal kadar Hb, hitung eritrosit,
dan hematokrit

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Klasifikasi anemia

Menurut kadar Hb

Menurut morfologi

Menurut patofisiologi
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Klasifikasi menurut kadar Hb

(WHO)

Ringan kadar Hb 9-11 gr %

Sedang kadar Hb 7-8 gr%

Berat

kadar Hb < 7 gr%

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Klasifikasi Anemia secara

morfologi
1.

Anemia Hipokromik-Mikrositik.

2.

Anemia NormokromikNormositik

3.
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Anemia Makrositik

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Anemia?

Production?

Survival/Destruction?

The key test is the ..

Types of Anemia

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Klasifikasi Anemia
Berdasarkan patofisiologi:
I. Kegagalan produksi sel darah merah:
A. Gangguan sel induk hematopoesis
Anemia Aplastik
B. Gangguan sintesis DNA
Anemia Megaloblastik
C. Gangguan sintesis Hemoglobin (Hb)
Anemia Defisiensi Besi, Thalasemia
D. Gangguan sintesis eritropoetin
Anemia karena GGK
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Lanjutan..anemia berdasarkan patofisiologi

E. Gangguan karena mekanisme lain:
Anemia karena penyakit kronis,
anemia sideroblastik
Anemia karena infiltrasi sumsum tulang
II. Peningkatan destruksi sel darah merah:
Anemia Hemolitik
III. Kehilangan darah (Blood Loss)
Anemia karena perdarahan akut
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Screening Tests Anemia

Clinical

Anemia

Signs and symptoms of

Look

for bleeding all possible sites

Look

for the causes for anemia

Routine
Cut

Hemoglobin examination

off marks for Hb

US

< 13.5 g

WHO < 12.5 g

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Pendekatan diagnostik Anemia:

Anamnesis:

onset /bleeding tendency / routine medicinal /

occupation / hobby / travel history / family / diet /
GI symptoms / menstruation cycle / history of
previous pregnancy-delivery / alcohol
consumption , etc

Pemeriksaan

fisik :

conjunctiva & lips (pallor) / mouth (cheilosis) /

tongue (glossitis) / gum / nails (koilonychia) , hair
(signa de bandera, alopecia) , jaundice ,
petechiae , liver & spleen , lymphenodes ,rectal /
vaginal toucher , feet (ulcer,arthritis)

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Clinical Signs to be looked for

Skin / mucosal pallor,

Skin dryness, palmar
creases
Bald tongue, Glossitis
Mouth ulcers, Rectal exam
Jaundice, Purpura
Lymph adenopathy
Hepato-splenomegaly
Breathlessness
Tachycardia, CHF
Bleeding, Occult Blood
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Not pale conjunctiva

Pale conjunctiva

Koilonychia - spoon shaped nail

Iron deficiency anemia

glossitis

Angular stomatitis

Nutritional deficiency anemia

Measurements of Anemia

Hemoglobin = grams of hemoglobin per 100 mL of whole

blood (g/dL)
Hematocrit = percent of a sample of whole blood occupied
by intact red blood cells
RBC = millions of red blood cells per microL of whole blood
MCV = Mean corpuscular volume
If > 100 Macrocytic anemia
If 80 100 Normocytic anemia
If < 80 Microcytic anemia
RDW = Red blood cell distribution width
= (Standard deviation of red cell volume mean cell
volume) 100
Normal value is 11-15%
If elevated, suggests large variability in sizes of RBCs

The Three Primary Measures

Measurement

Normal

A.

RBC count (RCC)

B.

Hemoglobin

C.

Hematocrit (PCV)

Range

5 million

15 g%

4 to 5.7

12 to 17

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38 to 50

A x 3 = B x 3 = C - This is the rule of thumb

Check whether this holds good in a given result
If not -indicates micro or macrocytosis or hypochro.

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The Three Derived Indicies

Measurement

Normal

A.

RBC

5 million

B.

Hemoglobin

15 g%

C.

Hematocrit
50

45 %

MCV C A x 10
=
MCH B A x 10
=
MCHC (%) B C x 100
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Range
4 to 5.7
12 to 17
38 to

90 f
30 pg
=
33%

Mean Cell Volume (MCV)

RBC size is measured indirectly by
The Mean Cell Volume (MCV) and RDW

MCV

Microcytic

Normocytic

Macrocytic

< 80 fl

80 -100 fl

> 100 fl

< 6.5

6.5 - 9
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Anemia Workup - MCV

MCV

Microcytic

Normocytic

Macrocytic

Iron Deficiency (IDA)

Chronic diseases, CKD

Megaloblastic anemias

Chronic Infections

Early IDA

Liver disease/alcohol

Thalassemias

Hemoglobinopathies

Hemoglobinopathies

Hemoglobinopathies

Primary marrow disorders Metabolic disorders

Sideroblastic Anemia

Combined deficiencies

Marrow disorders

Increased destruction

Increased destruction

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Red cell Distribution Width RDW

MCV

Microcytic

Normocytic

Macrocytic

Left

Mean 90

Right

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Severe Hypochromia

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Microcytic Hypochromic - IDA

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Bandingkan ukuran sel eritrosit dengan inti limfosit

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Hipokromik-Mikrositik

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Makrositik
makrosit-oval
(Anemia megaloblastik ditandai oleh makrosit oval ini)

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