Anemia - Sem

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    ANEMIA

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    Definition

    According to Cawson Scully, Anemia is

    not a disease in itself and may be a

    feature of many diseases but the

    different type of anemia have many

    clinical features in common

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    CLASSIFICATION

    (Based on the pathogenesis)

    Blood loss anemia Iron deficiency anemia; Plummer Vinsonsyndrome

    Hemolytic anemia Glucose 6 Phosphate Dehydrogenase; druginduced; immune mediated

    Hemoglobinopathies or disorders of hemoglobin Sickle cellanemia; Thalassemia; Cooleys anemia

    Hypoproliferative anemia Vitamin B12 deficiency;

    Pernicious anemia; Folic acid deficiency; Aplastic anemia

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    Causes ofanemia Blood loss Menorrhagia, Any gastrointestinal lesion (e.g. ulcer

    or carcinoma), lesion of the urinary tract, trauma

    Impaired absorption of hematinics

    Increased demands for hematinics especially pregnancy

    Poor intake of Hematinics Aplastic anemia and Leukemia

    Hemolytic anemias

    Miscellaneous mechanisms, including drugs and chronic disease

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    Clinical features of anemia

    Sometimes none

    General lassitude

    Cardiorespiratory

    DyspnoeaCongestive cardiac

    failure

    Murmurs

    Angina pectoris

    Cutaneous

    Pallor

    Brittle nails

    Koilonychia (irondeficiency)

    Oral

    Sore mouth

    Oral ulceration

    Angular stomatitis

    Glosstitis

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    In general anesthetic

    The main danger is when a general anesthetic is

    given, as it a vital to ensure full oxygenation

    Myocardium may be unable to respond to the

    demands of anesthesia Whenever possible therefore the cause of the

    anemia should be corrected preoperatively, but at

    least the hemoglobin level must be raised, if

    necessary by transfusion.

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    In general anesthetic

    Elective operations under general anesthesia

    should not usually be carried out when the

    hemoglobin is less than 10 g/dl

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    In general anesthetic

    In an emergency, anemia can be corrected

    by whole blood transfusion, but this should

    only be given to a young and otherwise fit

    patient

    Transfusion risks include fluid overload, and

    viral infections such as hepatitis and HIV

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    In general anesthetic

    Packed red cells avoid the risk of fluid

    overload and can be given in emergency to

    the elderly patient or those with incipient

    congestive cardiac failure. A diuretic given at

    the same time further reduces the risk of

    congestive cardiac failure.

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    In general anesthetic

    The patient should be stabilized at least 24

    hours preoperatively and it should be noted

    that hemoglobin estimation are unreliable for

    12 hours post-transfusion. Nitrous oxide is

    possibly contraindicated in vitamin B12,

    deficiency

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    Iron Deficiency Anemia

    Women of child bearing age and older are

    therefore mainly affected

    Excessive menstrual losses or

    gastrointestinal blood loss are the main

    causes. Very many children are mildly iron

    deficient because of the high demands for

    growth, especially during adolescence.

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    Iron Deficiency Anemia

    By contrast, iron deficiency in an adult male

    almost invariably indicates blood loss, usually

    from the gastrointestinal or genitourinary

    tracts. The same holds true for post-

    menopausal women

    Symptoms ascribed to iron deficiency do not

    always respond to iron replacement

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    IRONDEFICIENCY ANEMIA

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    Laboratory findings during the development of iron deficiency anemia

    MCVHb MCHC Serum

    ferriti

    n

    Transferrinsaturation*

    Marrow ironstores

    Normal N N N N 33% N

    Mild iron deficiency anaemiaq

    N orq

    Nq

    >16%

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    Treatmentofiron deficiency

    The best treatment of iron deficiency is an

    iron salt by mouth but the cause of the

    deficiency should be found and eliminated

    Ferrous gluconate 250 mg/day can be given

    if ferrous sulphate is not tolerated

    FeSO4200mg 3 times/ day

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    Treatmentofiron deficiency

    Oral iron may need to be given for 3 months

    or more to replenish marrow iron stores

    Parenteral iron has no advantages except,

    for example, when inflammatory bowel

    disease is aggravated by oral iron

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    PLUMMERVINSONSYNDROME

    Dysphagia; Xerostomia

    Depapillated tongue

    Koilonychia

    Angular stomatitis

    Pallor and fatigue dyspnea

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    Vitamin B12 Deficiency

    Pernicious (Addisonian) anemia is the most

    common type of macrocytic anemia and

    typically affects women in the middle age or

    over particularly of Northern Europeandescent

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    Pernicious anemia

    It is caused by a specific defect of absorption of

    Vitamin B12 not by malnutrition

    Autoantibodies against gastric parietal cells and / or

    intrinsic factor or both are found and the disease issometimes seen with other autoimmune diseases,

    especially hypothyroidism, or less often, diabetes,

    mellitus, vitiligo, Addisons disease or

    hypothyroidism

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    Causes of vitamin B12 deficiency

    Poor intake

    Poverty

    Strict vegetarians

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    Causes of vitamin B12 deficiency

    Malabsorption

    Defect in intrinsic factor production Congenital

    Autoimmune (pernicious anemia)

    Gastrectomy

    Illeal diseaseCoeliaa disease

    Tropical sprue

    Crohns disease

    Blind loop syndrome

    Resections

    Fish tapeworm

    Transcobalamin II deficiency

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    Causes of vitamin B12 deficiency

    DrugsColchicine

    Neomycin

    Nitrous oxide

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    Causes of folate deficiency

    Poor intake

    Poverty

    Old age Alcoholism

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    Causes of folate deficiency

    Malabsorption

    Coeliac disease

    Crohns disease Other malabsorption states

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    Causes of folate deficiency

    Increased demandsInfancyPregnancyChronic

    hemolysisMalignant diseaseExfoliative skin

    lesionsChronic dialysis

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    Causes of folate deficiency

    Increased demands

    Infancy

    Pregnancy Chronic hemolysis

    Malignant disease

    Exfoliative skin lesions

    Chronic dialysis

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    Oral aspects of the deficiency anemias

    sore or burning, but otherwise normal tongue

    Atrophic glossitis

    Moellers glossitis and other colour changes

    Candidosis

    Angular stomatitis (cheilitis)

    Aphthous stomatitis

    PatersonK

    elly syndrome (Plummer

    Vinson)

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    Anemia associated with systemic disease

    Chronic inflammation (infections or

    connective tissue disease).

    Neoplasms including leukaemia. Acute

    leukaemia is an important cause of

    anaemia and should always be considered

    when anaemia is seen in a child.

    Liver disease.

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    Anemia associated with systemic disease

    very rarely : Hypothyroidism

    Hypopituitarism Hypoadrenocorticis

    Uraemia

    HIV infection

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    Aplastic Anemia

    Bone-marrow aplasia is a rare disease

    causing refractory normochromic, normocytic

    anemia, leucopenia and thrombocytopenia

    Drugs are an important cause but many

    cases are idiopathic, though probably viral or

    immunologically mediated

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    Aplastic Anemia

    The prognosis is poor and 50

    per cent of patients die within 6

    months usually fromhemorrhage or infection

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    Causes of aplastic anaemia

    Idiopathic

    Genetic

    Fanconis anaemia

    Dyskeratosis congenita

    Drugs

    Phenylbutazone

    Chloramphenicol

    Sulphonamides

    Gold Penicillamine

    Anticonvulsants

    Cytotoxic agents

    Chemicals

    Benzene

    Toluene

    Heavy metals

    Glue-sniffing Viruses

    Hepatitis

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    Principles ofmanagement

    Removal of the cause. Even when this isdecoverable, as in the case of drugs, such aschloramphenicol, marrow damage may still beirreversible

    Isolation and antibiotics to control infection Androgenic steroids. (Corticosteroids are of

    questionable