Anemia AND Anemia Heart Disease,本文档由医学百事通高端医生网专家制作 在线咨询医生网址:http:/www.12320bst.com,2,Chest Hospital,Definition,Anemia is defined as a decrease in the circulating RBC, hemoglobin or the hematocrit ,and a corresponding decrease in the oxygen-carrying capacity of the blood.Normal values of the hemogram (In sea level): TEST WOMEN MENHCT (%) 37-48 40-50Hb (g/L) 110-150 120-160RBC Count(1012/L) 3.5-5.0 4.0-5.5,PS: The HB of Newborn is170-200g/L.,3,Chest Hospital,Diagnosis,WOMEN MEN PREGNANT,Hb (g/L) 110 120 100,WOMEN, Anemia isnt a diagnosis,it is a sign of the presence of disease. Correct diagnosis: include underlying cause of the anemia They can be altered by the plasmatic volumes . The mean normal value depends on :altitude of residence,age and gender. Difference between women and men values are due to androgen hormones.,4,Chest Hospital,Diagnosis,First step : detection of the presence of anemia,and the severity. Second step: laboratory investigation of the morphological classification. Third step: investigation of the pathogenesis of anemia.,5,Chest Hospital,Diagnosis,Classification according to severity,First step:,6,Chest Hospital,Diagnosis,cell morphological type MCV（fl） MCH(pg) MCHC (%) Macrocytic anemia 100 34 3236Normocytic anemia 80100 27 34 3236Microcytic hypochromic anemiaSimple microcyticanemia,(80-100),(32-36),(27-34),80 27 32,80 27 3236,Second step:cell morphological classification,PS: According to Bone marrow proliferative degree and peripheral RBC morphology .,7,Chest Hospital,Diagnosis,Third step: according to etiology/pathogenesis 1.Blood loss-acute hemorrhagechronic hemorrhage2. Increased RBC destruction-hemolytic anemia(HA),The chronic hemorrhage often combine with IDA, caused by ITP,bronchiectasis,tuberculosis,tumor,etc.,8,Chest Hospital,Diagnosis,RBC internal defect (1)RBC membrane defect acquired: PNHhereditary : hereditary spherocytosis(2) enzyme deficiency: G6PD deficiency (3) Hb abnormality: hemoglobinopathy, Thalassemia (4) porphyrin metabolism : porphyrinopathyExopathic immunologic (AIHA), chemical, biological, or phisical factors,Usually 6.5 m diameter Microspherocytes: 4 m diameter Lacks area of central pallor. Additional causes:Immunologic reactionPhysical trauma,(dacryocyte),(spherocyte),(elliptocyte),(stomatocyte),9,Chest Hospital,Diagnosis,3. Decresed RBC production,BM stem cells abnormality AABM injured by abnormal tissues/cells LeukemiaCell dysmaturity(deficiency of essential substances )(1). DNA dyssynthesis Megaloblastic anemias (2). Hb dyssynthesis IDA4. Abnormality in haematopoiesis modulation AA,10,Chest Hospital,Diagnosis,Complete diagnosis 1. Anemia2. Degree of anemia3. Classification of anemia 4. Cause of anemia,11,Chest Hospital,Clinical manifestations,1.The clinical manifestations is related to tissue hypoxia which decreases work tolerance.2.The Related factor:Cause of anemiaDegree of decrease of oxygen carrying capacity Degree of decrease of blood volumeSpeed of anemia genesisCompensation and tolerance of blood and others3.The associated manifestations of the underlying disorders.,12,Chest Hospital,Clinical manifestation,SkinPallor can be the most evident sign mucous membranes of mouth and lips, nail bed, palpebral conjunctiva Neuromuscular systemheadache, vertigo, tinnitus, faintness, lack of mental concentration, muscular weakness Gastrointestinal system common in anemic patients anorexia, nausea, vomiting, glossitis, atrophy of papillae of tongue(mirror surface tongue), etc.The dysphagia(Plummer Vinson Syndrome) and pica can be seen in chronic IDA patients. Genitourinary system slight proteinure is common. Other signsmild fever, basal metabolic rate be increased.,13,Chest Hospital,Clinical manifestation,Cardiorespiratory system:2,3-diphosphoglyceric acid (2,3-DPG)affect hemoglobin bind and release of oxygen. In chronic anemia, 2,3-DPG concentration increased making the oxygen dissociation curve right,oxygen affinity of hemoglobin falls compensate for oxygen deficit.General symptoms(accelerated breath, short breath) are noticeable after exertion. In severe or HBC is less than 7g/dl -cardiac output is increased and heart murmurs are common sign in anemia.,14,Chest Hospital,History Taking and Examination,History: 1.symptoms and their duration 2.past history(Gastrectomy, haemorrhoids, peptic ulcer, jaundice, bleeding disorder ) 3.hereditary background, menses and childbearing history 4.diet habit, exposure to risk factors(such as chemicals or toxins)Examination: Jaundicemay point to hemolytic anemia, liver disease Hepatomegalysuggeste liver disease, lymphoma, leukemia Splenomegalyleukemia, hemolytic anemia, liver disorder sternal tendernessshows leukemia flating of finger nailmean iron defiency anemia,