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dr. Ketut Ariawati, SpA(K)Lab/SMF Ilmu Kesehatan Anak FK UNU/!SU" San#lah

enpasar

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LEARNING MATERIAL

1. Defnition Anemia

2. Clinical maniestation o anemia3. Mechanisms o anemia

4. Erythopoietic response

5. Classifcation o anemia

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I. IN$!%U&$I%N

- Each mililiter of the blood contains 5 billions

of RBC

- Each RBC contains hundreds of millions

of

molecule hemoglobin

- Anemia is generally defined as a reduction in red

cell mass or blood hemoglobin (Hb) concentration

- Anemia is defined as Hb concentration two !

below the mean for normal "o"ulation for age andgender

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erythrocytes

biconcave discs

one-third hemoglobinoxyhemoglobindeoxyhemoglobin

can readily squeeze

through capillaries

lack nuclei and

mitochondria

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circulate for about 120 days

macrophages in spleen and

liver destroy worn out R!s

hemoglobin is broken down

into hemeand globin

iron from heme returns to

red bone marrow

bilirubinand biliverdin

excreted in bile

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-. $he spe+i*i+ smptms ass+iated with anemia

+hrni+it and underlin# disease

a% ym"toms of acute hemorrhage are largely relatedto hy"oolemia (hy"otension synco"e shoc.)

b% A reduction in the o'ygen-carrying ca"acity of theblood results in tissue hy"o'ia (fatigue

dys"neucognitif abnormalities and ischemic)

c% Cardioasculer manifestations of anemia includetachycardia "al"itations and congestie heartfailure

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&. A number * adaptie phsil#i+ respnses t

anemia

$% Cardiac out"ut rises due to an accelerated heart rateand increased entricular stro.e olume

% Acute blood loss hy"oolemiaasoconstriction

*% Cerebral flow is "resered while renal blood flow /+% &he .idney retain salt and water leading to

e'"ansion of intraasculer olume

5% &he unloading of o'ygen in tissue is enhanced by anincreased in RBC leels of *-di"hos"hoglycerateand a right shift in the o'yhemoglobin dissociationcure

0% Renal "eritubular cells detect anemia by sensingo'ygen content

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111% ,ECHA21, 34 A2E,1A

A. emrrha#e

- loss of RBCs through bleeding initial focus

- bleeding secondary to trauma surgery or an

underlying disease (gastrointestinal tract menstruasi)-. emlsis

- hemolysis # a shortened RBC surial time note'"lained by bleeding ( $6 days)

&. e+reased prdu+tin * !-&s- 2utritional deficiencies of iron itamin B$ folic acid

- 7idney disease

- 2on hematologic systemic illness

- 8rimary bone marrow disorder

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19% :AB3RA&3R; E9A:

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2. &LASSIFI&A$I%N %F AN'MIA -6 $'

'!6$!%"%I'$I& !'S"%NS'

A. %eriew

- reticulocyte countdifferentiate anemia due to

defectie "roduction RBC and anemia to decreased

surial of RBC- reticulocyte

differ biochemically and mor"hologically than

mature RBC

"ersist in circulation for $- day RBC mature

counted manually with a microsco"e or an

automated fluorescent cell counter (flow cytometer)

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2I. &LASSIFI&A$I%N %F AN'MIA -6 !-& SI7'

A. Mi+r+ti+ anemia

- microcytosis ,C9 is less than >6 f:

- reflects a deficiency in the synthesis of Hb

- clinically to subdiide into inherited acDuired causes

$% inherited causes # F thalassemia Hb E

disease inherited sideroblastic

% aDuired causes # iron deficiency AC! lead

"oisoning medication

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-. Ma+r+ti+ anemia

- macrocytosis ,C9 is greater than $66 f:

- diided into megaloblastic and nonmegaloblastic

causes

$% megaloblastic # im"aired !2A syntesis

(,C9 G $$6 f:)

% nonmegaloblastic # ariety of causes

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-. Nrm+ti+ anemia

- characteri@ed falls within the normal range

(>6-$66f:)

- the greatest diagnostic challenge because they mayreflect an underlying systemic illness

- "atients with hy"o"roliferatie normocytic anemia

(a low reticulocyte) reDuire bone marrow

as"iration for diagnosis

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AN'MIA

5hat is the M&2

M&2 89:;99 *L

Nrm+ti+ anemia

'leated

!eti+ul+te +unt