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    Red Blood Cells and Anemias: Jonathan Ben-Ezra, M.D

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    The document discusses red blood cells, hemoglobin, anemias, and the causes, symptoms, and treatments of various types of anemia. It provides details on iron deficiency anemia, megaloblastic anemia, hereditary spherocytosis, sickle cell anemia, and thalassemia. The types and causes of anemia are classified and laboratory tests to diagnose different anemias are outlined.

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    Red Blood Cells and Anemias: Jonathan Ben-Ezra, M.D

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    iloveit52252
    13 views33 pages
    The document discusses red blood cells, hemoglobin, anemias, and the causes, symptoms, and treatments of various types of anemia. It provides details on iron deficiency anemia, megaloblastic anemia, hereditary spherocytosis, sickle cell anemia, and thalassemia. The types and causes of anemia are classified and laboratory tests to diagnose different anemias are outlined.

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    The document discusses red blood cells, hemoglobin, anemias, and the causes, symptoms, and treatments of various types of anemia. It provides details on iron deficiency anemia, megaloblastic anemia, hereditary spherocytosis, sickle cell anemia, and thalassemia. The types and causes of anemia are classified and laboratory tests to diagnose different anemias are outlined.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    13 views33 pages

    Red Blood Cells and Anemias: Jonathan Ben-Ezra, M.D

    Uploaded by

    iloveit52252
    The document discusses red blood cells, hemoglobin, anemias, and the causes, symptoms, and treatments of various types of anemia. It provides details on iron deficiency anemia, megaloblastic anemia, hereditary spherocytosis, sickle cell anemia, and thalassemia. The types and causes of anemia are classified and laboratory tests to diagnose different anemias are outlined.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 33

    Red Blood Cells and Anemias

    Jonathan Ben-Ezra, M.D.


    Professor of Pathology
    MCV Campus of VCU
    Blood

    Red Blood Cells (RBCs)


    White Blood Cells (WBCs)
    Platelets
    Plasma
    RBCs, WBCs, and Platelets Produced in
    Bone Marrow
    Approximately 5L of blood in adult
    Red Blood Cells
    Carry Oxygen to
    Tissues
    Biconcave Disk
    Containing
    Hemoglobin
    Life Span of 120 days
    12
    4.4-5.9 x 10 RBCs/L
    (M)
    12
    3.8-5.2 x 10 RBCs/L
    (F)
    Hemoglobin

    Oxygen Carrying Molecule


    Tetramer of 2 alpha chains and two beta
    chains (2 2) attached to Heme pocket
    Heme comprised of protoporphyrin ring and
    iron
    13-18 g/dl (M)
    12-16 g/dl (F)
    Hematocrit
    Percentage of blood
    which is comprised of
    RBCs
    40-52% (M)
    35-47% (F)
    Anemia

    Reduction in Oxygen Carrying Capacity of


    Blood
    Not enough production by Bone Marrow
    Too much peripheral destruction (hemolytic
    anemia)
    Reticulocyte count (0.8- 2.5%)
    cell which still has mRNA
    Reticulocyte
    MCV (Mean Cell Volume)

    80- 100 fl
    Microcytic Anemia
    Normocytic Anemia
    Macrocytic Anemia
    Hypoproliferative Anemia

    Microcytic
    iron deficiency anemia
    thalassemia
    sideroblastic anemia
    anemia of chronic disease
    Macrocytic
    Megaloblastic anemia
    reticulocytosis
    Hemolytic Anemia

    Hemoglobinopathy (e.g. sickle cell)


    Membrane Abnormality (e.g. hereditary
    spherocyosis)
    Enzyme Defect (e.g. G6PD deficiency)
    Autoimmune hemolytic anemia
    Trauma (e.g. DIC, TTP)
    Infection (e.g. malaria)
    Anemia
    Easy fatigability
    Dyspnea on exertion
    Faintness/ Vertigo

    Pallor
    Rapidly bounding pulse
    Dependent edema
    Systolic murmurs
    Iron Deficiency Anemia

    Iron absorbed in GI tract, transported by


    transferrin to BM
    Iron absorbed by pinocytosis by RBC
    precursors
    After 120 days, RBC phagocytosed in
    spleen
    iron is reused
    hemoglobin converted to bilirubin
    Iron Deficiency
    Increased Need
    Early childhood and adolescence (growth spurts)
    Pregnancy (extra 3.8 mg/day over baseline)
    Lactation
    Poor Intake/Absorption
    Milk baby
    Achlorhydria
    Inflammatory bowel disease
    Iron Deficiency
    Menstruating women
    GI bleeding (most common pathologic cause)
    Tissue loss
    Urinary Loss
    Iatrogenic
    IRON DEFICIENCY IN A MALE ALWAYS
    NEEDS TO BE WORKED UP!!!
    Iron Deficiency Anemia

    Hypochromic microcytic anemia


    low iron, high transferrin, low ferritin
    small ragged RBC precursors
    lack of stainable iron
    Iron Deficiency Anemia
    Prussian Blue Stain
    of Bone Marrow

    Iron Present No Iron Present


    Therapy of Iron Deficiency
    Anemia of chronic disease

    Impaired Fe utilization
    low Fe, low transferrin, high ferritin
    Increased iron stores
    Megaloblastic Anemia

    B12 binds with intrinsic factor, absorbed in


    terminal ileum
    Schilling test
    7-12 year supply
    Folate is not stored in body
    Megaloblastic Anemia

    Macrocytic anemia with hypersegmented


    neutrophils
    Neurologic symptoms (dorsal columns)
    Nuclear/cytoplasmic asynchrony in BM
    Ineffective erythropoiesis
    High indirect bilirubin
    Very high LDH
    Megaloblastic Anemia
    Laboratory Evidence of
    Hemolysis

    Increased bilirubin
    low serum haptoglobin
    Hemoglobinemia/ Hemoglobinuria
    Hemosiderinuria
    Increased LDH
    Increased reticulocyte count
    Hereditary Spherocytosis

    Defect of spectrin-Protein 4.1 interaction or


    in ankyrin
    decreased deformability
    sluggish transversing of splenic cords
    Clinical triad of anemia, splenomegaly, and
    jaundice
    Spherocytes on smear
    Osmotic fragility test
    Hereditary Speherocytosis
    Enzyme Deficiencies

    G6PD
    Pyruvate Kinase
    Autoimmune Hemolytic Anemia

    Antibody attaching to RBCs


    Direct or indirect Coombs test
    May be associated with thrombocytopenia
    (Evans syndrome)
    Idiopathic, drugs, infection
    Treatment
    treat underlying cause
    steroids
    Autoimmune Hemolytic Anemia
    Sickle Cell Anemia

    Autosomal recessive -hemoglobinopathy


    Symptomatic at 6 months
    Irreversible sickling upon deoxygenation
    pain crises
    infarcts of spleen (asplenia), kidneys, brain
    Hemolytic vs. aplastic crisis (Parvovirus
    B19)
    Sickle Cell Anemia
    Thalassemia

    Imbalance of globin chain production


    - vs. -thalassemia
    anemia due to both decreased production
    and increased hemolysis in spleen
    - thalassemia has decreased/absent Hgb A,
    increased Hgb F, and increased Hgb A2
    Treatment- hypertransfusion with chelation,
    splenectomy, bone marrow transplantation
    Combination of History and
    Smear
    24 year old VCU
    student with spiking
    fevers every day
    Recently returned
    from trip to Africa

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