HEMATOLOGY: NONMALIGNANT DISORDERS

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"Make each day useful and cheerful and prove that
you know the worth of time by employing it well.
Then youth will be happy, old age without regret
and life a beautiful success."
Louisa May Alcott
1832-1888, Author
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Anemia

• Dr. Venkatesh M. Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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C.B.C

• Haemoglobin - 152.5, 14 2.5 - g/dl
• PCV - 0.47 0.07, 0.42 0.05 - l/l ()
• Haematocrit, effective RBC volume - better
• RBC count - 5.5 1, 4.8 1 x1012/l
• MCHC - Hb/PCV - 30-36 - g/dl
• Hb synthesis within RBC
• MCH - Hb/RBC - 29.5 2.5 pg/l
• Average Hb in RBC
• MCV - PCV/RBC 85 8 - fl

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Blood Smear - Normal
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Normal White Blood Cells
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RBC disorders (Anemias)

• Anemia is decreased red cell mass affecting
  tissue oxygenation
• Low Hb lt13.5 (males), lt11.5 (females)
• Acquired disorders
• Congenital disorders

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Acquired RBC disorders

• Decreased Production
• Aplastic, Hypoplastic anemias
• Deficiency anemias Iron, B12, Folate etc.
• Lack of erythropoiesis - Kidney disease
• Marrow disease, malignancy, radiation
• Increased loss/destruction
• Blood loss anemias - parasites, bleeding
• Hemolytic anemias - Autoimmune (cold warm
  antibody) mechanical, drugs toxins.

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Congenital RBC Disorders

• Membrane Disorders
• Spherocytosis, Elliptocytosis
• Hemoglobin Disorders
• Hemoglobinopathies - Sickle cell, HbC etc.
• Thalassemia Syndromes - ?, ?, ?
• Enzyme disorders
• G6PD, PK deficiency

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Microcytic Anemia (IDA)
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Iron Deficiency Anemia

• Most abundant metal, common deficiency..!
• Limited absorption and no excretory mech.
• Recycling of iron dead cells to new cells
• 1mg/day ? 3-6G body ? 1mg/day

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Iron Metabolism

• 10 of the 10 to 20 mg of dietary iron is
  absorbed each day to balance the 1 to 2 mg daily
  loss.
• Iron is absorbed in Jejunum.
• Stored as Ferritin Hemosiderin.
• Laboratory tests
• Serum iron(1mg/l)
• Serum iron binding capacity (3mg)
• Serum ferritin (gt20ug)

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Causes of Iron deficiency Anemia

• Chronic Blood loss parasites, ulcers, hernia,
  drugs (NSAID), Carcinoma, colitis, diverticulosis
  etc. Rarely hematuria.
• Increased need Pregnancy, children
• Malabsorption gastrectomy, coeliac disease.
• Poor diet Contributory but rarely the sole
  cause.

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Clinical Features

• Anemia
• Pallor, Weakness, Lethargy
• Breathlessness on exertion
• Palpitations may lead to heart failure - edema
• IDA
• Angular cheilosis, atrophic glossitis,
• dysphagia, koilonychia, gastric atrophy.

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Angular cheilitis Glossitis
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Iron Deficiency Anemia
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IDA on Treatment
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Iron Deficiency Anemia
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IDA on Treatment
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'General Exam Stress-Busting Tips

• Don't keep things bottled up. Confiding in
  someone you trust and who will be supportive is a
  great way of alleviating stress and worry.
• Keep things in perspective. The exams might seem
  like the most crucial thing right now, but in the
  grander scheme of your whole life they are only a
  small part.

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Megaloblastic anemia

• Vitamin B12/Folic acid deficiency
• Low DNA synthesis Nuclear immaturity - less
  division more cell size - Macrocytosis
• Megaloblasts Abnormal destruction - ?RBC
• DNA defect all cell lines affected
  -pancytopenia
• Multi System disease ?cell division -
  Epithelia.
• Pernicious anaemia
• autoimmune, VitB12 absorption deficiency -
  Gastric atrophy CNS damage.

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Megaloblastic anemia

• Vitamin B12/Folic acid deficiency
• Second most common type of anemia.
• Vit B12 Synthesised only by microorganisms
  animal food dairy Pr
• Folate only in Plant foods uncooked.
• Vegetarianism ..?

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Megaloblastic Anemia
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Megalobl - Pathogenesis

• Decreased Vit B12 / Folate
• Decreased DNA Synthesis
• Delayed maturation of erythroblasts (Nucleus)
• Increased cell size (macrocytes)
• Normal hb content (Normochromia)
• Decreased RBC number
• Decreased WBC number (pancytopenia)
• Anemia Pancytopenia.

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Macrocytic Anemia (Meg.)
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Megaloblastic Anemia
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CWM-20353-Meg.An
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CWM-20353-Meg.An
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Make rest a necessity, not an objective. Only
rest long enough to gather strength Jim Rohn
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Blood Loss anemias

• All have Polychromasia (Marrow response)
• Acute blood loss
• Hemolytic anemias ( Jaundice)
• Immune Auto immune Allo immune
• Mechanical - Valve, DIC
• Hereditary Sickle, Thalassemia
• Infection Clostridia, malaria.

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Hemolytic anemias

• Laboratory evaluation
• Blood smear Morphology very important
• CBC, Bilirubin levels
• Direct and indirect Coombs test (antibody)
• Hemoglobin electrophoresis abnormal Hb.
• Tests for parasites.
• Kidney Liver function tests important

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Spherocytosis Polychromasia
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Sickle Cell Disease
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Spherocytosis Polychromasia
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Schistocytes Hemolytic anemia
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Hemolytic Anemia - nRBC
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Target cells (Liver Disease/IDA)