Origins of the Cellular Elements.

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2 Blood Life-sustaining fluid Circulates through heart and vessels Delivers oxygen and nutrients to tissues Removes waste to the lungs, kidneys and liver Clots outside the body

3 Origins of the Cellular Elements.

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5 Red Blood Cells (erythrocytes) Anuclear Disc shape Binds oxygen to the Fe-complex, haemoglobin Hb = 4 haem rings conjugated to globin Red cell parameters: Red cell count (RCC), Haemoglobin (Hb), Haematocrit (Hct), Red cell indices: mean corpuscular volume (MCV), Mean corpuscular haemoglobin (MCH) Mean corpuscular haemoglobin concentration (MCHC) Red cell distribution width (RDW)

6 FULL BLOOD COUNT Haemoglobin L 11.6 g/ dl Red blood cell count ^12/L Haematocrit L 34.9 % MCHC 33.2 g/dl MCV 80.8 fl MCH 27.5 pg RDW 12.6 % Platelets ^9/L White Blood Cells *H ^9/L

7 Evaluating the full blood count Red blood cells: Number, size (aniso-), shape (poikilo-), degree of haemoglobinization (-chromasia), distribution on a slide, inclusion bodies, etc Anaemia: Hb: g/dl Hct: %l/l Morphology Rouleaux, Agglutination

8 Laboratory tests for anaemia FBC levels of red blood cells, white blood cells, platelets, and hemoglobin. other factors such as average size, variability in size, volume, and haemoglobin concentration morphology Reticulocyte count Coombs-test Haptoglobin LDH Bilirubin Vit B12 and folate Iron profile Hb-electrophoresis BMA&T

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10 Anaemia a condition in which there is a deficiency of red cells or of haemoglobin in the blood, resulting in pallor and weariness. Tiredness even though you've slept well lack the energy for normal activities, May be an underlying cause of memory or mood problems.

11 Anaemia Classification Cause Acquired and hereditary causes Morphological classifications Bone marrow findings Most common types Etc.

12 What causes anaemia? There are more than 400 types of anaemia, which are divided into three groups: caused by blood loss caused by decreased or faulty red blood cell production caused by destruction of red blood cells

13 Anaemia caused by faulty red cell production With this type of anemia, the body may produce too few blood cells or the blood cells may not function correctly. Red blood cells may be faulty or decreased due to abnormal red blood cells or a lack of minerals and vitamins needed for red blood cells to work properly. these causes of anemia include the following: Sickle cell anemia Iron-deficiency anemia Vitamin deficiency Bone marrow and stem cell problems Other health conditions

14 Morphological classification of anaemia

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16 Most common causes of anaemia Iron deficiency anaemia Anaemia of chronic disorders. Thalassaemia Aplastic anaemia Haemolytic anaemia Sickle cell anaemia Pernicious anaemia/ megaloblastic anaemia Fanconi anaemia

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18 Anaemia Symptoms range from none to mild to lifethreatening and may include: Weakness Dizziness Pale skin Headache, particularly with exercise Numbness or coldness in hands and feet Low body temperature Shortness of breath Difficulty concentrating Leg cramps Insomnia

19 Heart related symptoms less oxygen in their blood, which means the heart must work harder to pump enough oxygen to their organs. Cardiac-related symptoms include arrhythmia (an abnormal heart rhythm), shortness of breath, and chest pain. Fatigue and loss of energy Unusually rapid heartbeat, particularly with exercise Shortness of breath

20 Risk factors for anaemia Women and people with chronic diseases have the greatest risk of anaemia. Chronic diseases such as kidney disease can affect the body s ability to make red blood cells A diet low in iron, folate, or vitamin B12 also increases risk. Growing phases some types of anaemia are hereditary.

21 MICROCYTIC HYPOCHROMIC ANAEMIAS

22 MHA

23 MHA

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27 Iron deficiency anaemia The most common form of anaemia worldwide

28 Anaemia caused by blood loss can occur slowly over a long period of time, and can go undetected. It commonly results from the following: Gastrointestinal conditions such as ulcers, hemorrhoids, gastritis (inflammation of the stomach), and cancer Use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, which can cause ulcers and gastritis Menstruation and childbirth in women, especially if menstrual bleeding is excessive and if there are multiple pregnancies

29 Iron deficiency anaemia: Causes-1 Occurs when the rate of loss or use of iron is more than its rate of absorption and use. The reasons for this are Chronic blood loss: excessive menstruation or bleeding into or from the gut as a result of a peptic ulcer, gastritis, haemorrhoids or in children, worm infestation. Increased use of iron: In pregnancy, due to the growth of the foetus or Breast feeding children undergoing rapid growth spurts in infancy and adolescence. Decreased absorption of iron after a partial or total removal of the stomach; lack of stomach acid; chronic diarrhoea; or malabsorption.

30 Fe-deficiency anaemia: Causes-2 Low Iron Intake A diet that's low in iron can cause anemia (vegetarians) Iron from plants and supplements isn't absorbed as well as the iron in red meat. Digestive concerns such as Crohn s disease, celiac disease, or even having gastric bypass surgery can interfere with iron absorption. some foods and medicines can hinder iron uptake when taken with iron-rich foods. They include: Dairy Other calcium-rich foods Calcium supplements Antacids Coffee Tea

31 Stages of Fe deficiency

32 Anaemia in Children About one in seven children develop anaemia by age 2, most often because they don t have enough iron in their diet. Without treatment, a severe case of anaemia could permanently affect brain development.

33 Iron deficiency: Signs and Symptoms tiredness, weakness, shortness of breath and sometimes, a fast heartbeat. smooth, shiny and inflamed tongue - glossitis. Angular stomatitis (erosion, tenderness and swelling at the corners of the mouth) may also occur. pica, a craving for strange foods such as starch, ice paper and clay. Upward curvature of the nails/ koilonychia or spoon-nails

34 Iron deficiency: Treatment Treatment for iron-deficiency anaemia will depend on the cause and severity of the condition may include dietary changes and supplements, medicines, and surgery. Severe iron-deficiency anaemia may require treatment in hospital, blood transfusions, iron rejections, or intravenous iron therapy.

35 Fe- treatment Ferrous iron is more easily absorbed than ferric iron. It's best taken with food, especially orange juice and other foods rich in vitamin C. Don't mix with calcium, coffee, or tea, which can block absorption. Some people may need folic acid or vitamin B12 supplements, too.

36 Fe and pregnancy About half of pregnant women have iron-deficiency anaemia. They should get about 30milligrams of iron each day in their diet. prenatal vitamin also may contain iron.

37 Iron overload Be careful when treating an Fedeficiency Symptoms of iron overload include fatigue, vomiting, diarrhoea, headaches, irritability and joint problems.

38 Anaemia of chronic disorders Most common anaemia in hospitalised patients Associated with many disorders, including Liver Kidney Malignancies Chronic conditions, such as DM, RA, Lupus, etc. Hypothyroidism Old age

39 ACD Chronic illness or infection can cause the body to make fewer red blood cells. This can result in a mild drop in haemoglobin. NNA- MHA some drugs and medical treatments can also put you at risk for anaemia.

40 Anaemia caused by chronic lead poisoning A blue-black line on the gums referred to as a lead line Abdominal pain Constipation Vomiting Seizures in severe cases, especially in children

41 Anaemia caused by chronic lead poisoning Treated by discontinuing exposure to lead and administering a chelator that binds and draws lead out of the body. Where the household is suspected as the source of lead poisoning, calling the local environmental health department is essential. Old lead water piping used to be a problem in older houses.

42 Thalassemia: Overview inherited blood disorders affecting HAEMOGLOBIN The two major types of thalassaemia are alpha- and beta thalassaemia. The most severe form of alpha thalassaemia is known as alpha thalassaemia major or hydrops fetalis, while the severe form of beta thalassaemia is known as thalassaemia major or Cooley's anaemia. Usually leads to an IRON OVERLOAD

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44 Thalassemia: Overview affect both males and females and occur most often in people of Italian, Greek, Middle Eastern, Asian, and African descent. Severe forms are usually diagnosed in early childhood and are lifelong conditions.

45 Thalassemias: Signs and Symptoms Symptoms of thalassemias are caused by a lack of oxygen in the blood stream. The severity of symptoms depends on the severity of the disorder: People who have alpha or beta thalassaemia minor can have mild anaemia, which can make you feel tired. People with beta thalassaemia intermedia have mild to moderate anaemia. They may also have other health problems including: slowed growth and delayed puberty; bone problems; and an enlarged spleen. People with haemoglobin H disease or beta thalassaemia major have severe thalassaemia. Symptoms occur within the first two years of life and include severe anaemia and other serious health problems Pale and listless appearance Poor appetite Dark urine Slowed growth and delayed puberty Jaundice Enlarged spleen, liver and heart Bone problems

46 Thalassemia treatment depends on the type and severity of the disorder. People who are carriers or who have alpha or beta thalassaemia need little or no treatment. Three standard treatments are used to treat moderate and severe forms of thalassaemia, these include blood transfusions, iron chelation therapy, and folic acid supplements.

47 MACROCYTIC ANAEMIAS - Oval macrocytes: Megaloblastic anaemia, including Pernicious Anaemia - Round macrocytes

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49 Oval macrocytes

50 Vit B12 and Folate: Sources The body needs both vitamin B12 and folate to make red blood cells. An autoimmune disorder or digestive problem also can prevent your body from absorbing enough B12. Animal-based foods and fortified breakfast cereals are good sources of B-12. It is found in animal foods, including meat, fish, eggs, milk, and other dairy products. Folate is in leafy green vegetables, fruits, dried beans, and peas, and is added to breads, pastas, and cereals as folic acid.

51 Megaloblastic anaemia Because the body has large stores of vitamin B-12, a deficiency takes many years to establish. Folate stores: 3-6 months

52 Pernicious anaemia

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54 Pernicious anaemia/b12 deficiency Pernicious anaemia is a condition in which the body can't make enough healthy red blood cells because it doesn't have enough vitamin B12 Due to a lack of intrinsic factor (a protein made in the stomach). However, other conditions and factors can also cause vitamin B12 deficiency, e.g. small intestine can't properly absorb vitamin B12 which may be due to the wrong bacteria in the small intestines; certain diseases that interfere with vitamin B12 absorption, e.g. Crohns, certain medicines; C2H5OH, etc. surgical removal of part of the small intestine; and tapeworm and parasite infections. Deficient diet, pregnancy, etc

55 Pernicious anemia: Risks You are at higher risk for pernicious anaemia if you have a family history of the condition. had part or all of your stomach removed. certain autoimmune disorders that involve the endocrine glands, such as Addison's disease, type 1 diabetes, Graves' disease, and vitiligo. had part or all of your small intestine removed. certain intestinal diseases or disorders that prevent your body from properly absorbing vitamin B12. Take medicines that prevent your body from properly absorbing vitamin B12. Are a strict vegetarian who doesn't eat any animal or diary products and doesn t take a vitamin B12 supplement, or if you eat poorly overall.

56 Megaloblastic anaemia- Symptoms and signs Sometimes: asymptomatic. it is usually found incidentally when blood tests are ordered for another reason. Apart from the symptoms of anaemia (fatigue, dizziness, etc.), the vitamin B12 deficiency may also have some serious symptoms such as Symptoms in the digestive tract include nausea and vomiting, heartburn, abdominal bloating and gas, constipation or diarrhoea, loss of appetite, and weight loss. An enlarged liver A smooth, beefy red tongue Infants who have vitamin B12 deficiency may have poor reflexes or unusual movements, such as face tremors. During early pregnancy, sufficient folic acid can help prevent the fetus from developing neural tube defects such as spina bifida.

57 Pernicious anaemia- severe Neurological problems A tingling, "pins and needles" sensation in the hands or feet Loss of sense of touch, An unsteady, wobbly gait and difficulty walking Clumsiness and stiffness of the arms and legs Dementia, Nerve damage depression, and memory loss. A severe deficiency can result in more serious neurological symptoms, including severe weakness, spasticity, paraplegia, and fecal and urinary incontinence. heart murmurs, fast heartbeats, arrhythmias, an enlarged heart(cardiomegaly), or even heart failure. It is important to note that not all people who have vitamin B-12 deficiency and neurological symptoms will also have anaemia.

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59 Megaloblastic anaemia

60 Megaloblastic anaemia: Treatment Pernicious anaemia is easy to treat with vitamin B12 pills or shots as well as diet changes. Life-long treatment is needed. Complications caused by untreated pernicious anemia may be reversible with treatment. Eating foods high in vitamin B12 and folic acid can help prevent B12 deficiency caused by a poor diet vitamin

61 NORMOCYTIC NORMOCHROMIC ANAEMIAS

62 NNA Forms of anaemia in which the average size and haemoglobin content of the red blood cells are within normal limits Usually microscopic examination of the red cells shows them to be much like normal cells. In other cases there may be marked variations in size and shape, but these are such as to equalize one another, thus resulting in normal average values. The normocytic anemias are a miscellaneous group of anaemias

63 NNA A mild normochromic, normocytic anaemia is a common finding and usually a consequence of other diseases, including anaemia of chronic disorders associated with chronic infection, all forms of inflammatory diseases, and malignant disease; mechanism unknown but likely to involve multiple factors other disorders, including renal failure, hypothyroidism, hypopituitarism, marrow failure (aplastic anaemia, infiltration, pure red-cell aplasia), acute blood loss, and polymyalgia rheumatica. Bone marrow infiltrations, etc myeloma, etc. Treatment is that of the underlying condition after exclusion of underlying blood dyscrasias and

64 Anaemia caused by haemolysis/ red cell destruction Jaundice (yellow skin and eyes) Brown or red urine Leg ulcers Failure to thrive in infancy Symptoms of gallstones

65 Anaemia caused by sudden haemolysis Abdominal pain Brown or red urine Jaundice (yellow skin and eyes) Small bruises under the skin Seizures Symptoms of kidney failure

66 Aplastic anaemia rare disorder in which the bone marrow doesn t make enough blood cells to supply the body. It affects about three in one million people. caused by ~50% unknown cause high doses of radiation, certain chemical exposures: pesticides, arsenic, and benzene Viruses: hepatitis, EBV, CMV, parvovirus B19, and HIV autoimmune disorder in which your body attacks the bone marrow. Medicines, e.g. chloramphenicol About one in five cases is inherited.

67 AA : Symptoms and signs The most common symptoms of aplastic anaemia are Fatigue Shortness of breath Dizziness Headache Coldness in your hands or feet Pale skin, gums and nail beds Chest pains

68 AA : Treatment Prevent or limit complications, relieve symptoms, and improve quality of life. includes blood transfusions, blood and marrow stem cell transplants, and medication. In some cases, a cure may be possible. Blood and marrow stem cell transplants Removing a known cause, such as exposure to a toxin, may also cure the condition.

69 FA: Overview a rare, inherited blood disorder that leads to bone marrow failure. At least 13 faulty genes are associated with FA. can also affect many of the body's organs, tissues, and systems. are at higher risk of some cancers and other serious health problems. FA is an unpredictable disease. The average lifespan for people with FA is between 20 and 30 years. The most common causes of death related to FA are bone marrow failure, leukemia, and solid tumours.

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71 Fanconi Anaemia Signs and symptoms The symptoms of FA include Anaemia Bone marrow failure Birth defects Developmental or eating problems

72 Fanconi Anaemia-Treatment is based on a person's age and how well or poorly the person's bone marrow makes new blood cells. The four main types of treatment for FA are Blood and marrow stem cell transplant Androgen therapy Synthetic growth factors Gene therapy

73 Haemolysis: Destruction of red cells red blood cells are fragile and cannot withstand the routine stress of the circulatory system, they may rupture prematurely, causing haemolytic anaemia. Hereditary and acquired causes. Sometimes there is no known cause. Haemolytic anaemia can affect people of all ages, races and sexes.

74 Haemolytic anaemia Inherited haemolytic anaemias include Sickle cell anaemia Thalassaemias Hereditary spherocytosis Hereditary elliptocytosis Glucose-6-phosphate dehydrogenase (G6PD) deficiency Pyruvate kinase deficiency Acquired haemolytic anaemias include Immune haemolytic anaemia (e.g. Haemolytic disease of the newborn) Autoimmune haemolytic anaemia Alloimmune haemolytic anaemia Drug-induced haemolytic anaemia Mechanical haemolytic anaemias Paroxysmal nocturnal haemoglobinuria Stressors, eg infections drugs, snake or spider venom, or certain food substances can also damage red blood cells and lead to haemolytic anaemia Vascular grafts, prosthetic heart valves, tumours, severe burns, exposure to certain chemicals, severe hypertension, and clotting disorders

75 Haemolytic anaemia: S & S The most common symptom of all types of anaemia is fatigue. can also cause shortness of breath, dizziness, headache, coldness in your hands or feet, pale skin, gums and nail beds, as well as chest pain. Jaundice Pain in the upper abdomen Leg ulcers and pain A severe reaction to a blood transfusion

76 Haemolytic anaemia: Treatment mild haemolytic anaemia may not need treatment severe haemolytic anaemia usually need ongoing treatment. include blood transfusions, medicines, plasmapheresis, surgery, blood and marrow stem cell transplants and lifestyle changes.

77 Sickle cells

78 Sickle cell Anaemia SCA is an inherited disorder abnormal form of hemoglobin that causes red blood cells to sickle shape and become stuck together. That can make it difficult for them to pass through blood vessels, leading to pain and damage to body tissues. The red blood cells also has a limited life span SCA is more common in people whose families descended from Africa, South or Central American, Caribbean islands, Mediterranean countries, India and Saudi Arabia.

79 SCA The clumps of sickle cells block blood flow in the blood vessels that lead to the limbs and organs. Blocked blood vessels can cause pain, serious infections, and organ damage. In sickle cell anaemia, a lower-than-normal number of red blood cells occurs because sickle cells don't last very long. Sickle cells usually die after about 10 to 20 days and the body can't reproduce red blood cells fast enough to replace the dying ones, which causes anaemia.

80 SCA- Symptoms and signs Linked to anaemia and pain. Fatigue Susceptibility to infection Delayed growth and development in children Episodes of sudden and severe pain throughout the body is called a "sickle cell crisis", and often affects the bones, lungs, abdomen, and joints limbs chest

81 SCA- Treatment Sickle cell anaemia has no widely-available cure. However, treatments can help relieve symptoms and treat complications. The goals of treating sickle cell anaemia are to relieve pain, prevent infections, eye damage and strokes, and control complications. Bone marrow transplants may offer a cure in a small number of sickle cell anaemia cases. Supportive treatment Folate Transfusions Hydroxyurea etc

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