Anemia

বি. ফার্ম (সম্মান) পার্ট-১ এর সিলেবাস অনুযায়ী প্রণিতঃ

Falling the count of RBC and Hb percentage below normal. Normally, red cell production and destruction has a delicate balance. Deviation of this balance leads to anemia.

Classification:
A) According to variation in size and Hb content:1. Microcytic anemias (Hypochromic or normochromic type)i. Cause- Iron deficiency
ii. Effect-RBC count low and decreased size leads to low Hb content
iii. Feature-
#Color index lower than normal
#Mean corpuscular Hb (MCH) < normal #MCH conc. (MCHC) < normal #Mean corpuscular volume (MCV) < normal #Cells pale, only colored at periphery
2. Macrocytic anemias (Hypochromic or normochromic type) i. Cause- Deficiency of folic acid and vit. B12. Special type is pernicious anemia.
ii. Effect- defect in maturation factors lead to defect in cell divisions and cell maturation, so the number of cell reduced and size is increased.
iii. Feature-
Þ Color index > normal, about 1.2 (% Hb/ % red cells)
Þ MCH > normal (29.5 micro microgm) (Hb gm/L blood ¸ red cells million/cu mm)
Þ MCHC > normal {(Hb gm/100 ml blood ¸ Vol. of packed RBC/100 ml blood)X 100}, 35%
Þ MCV > normal, -135 (Vol. of packed RBC ml/L blood ¸ red cells million/cu mm), 87 cu m (normal value)
Þ Cells deep red, larger in size, > normal size (8m)
Þ decrease fragility
Þ decrease leucocyte
Þ Bone marrow hyperplastic
Þ Pernicious anemia- subacute combined degeneration of nervous system

B) According to cause

1. Hemorrhagici. following sustained loss of blood- injury, ulcer, piles
ii. persistent hemorrhage- from g.i.t, hook worm infection

2. Dyshemopoietic- defective formation of RBC
i. Nutritional deficiencies-
a. Iron deficiencies-
b. Protein deficiencies-
c. Vit B12 deficiencies-
d. Folic acid deficiencies-
e. Vit C deficiencies-
ii. Absorption deficiencies due to g.i.t disorders-
iii. Lack of storage-
iv. Lack of release factor-
v. Excessive demand on part of the body-
vi. Endocrine deficiencies-

3. Hemolytic- excessive destruction of RBC
Normally RBC destroyed by RE cells- situated in liver, spleen and bone marrow.
i. abnormal formation of red cells as in spherocytosis, thalassemia and sickle cell anemia.
Þ Spherocytosis- RBC are small, spherical and fragile
Þ Thalassemia- RBC fragile, Hb of F-type instead of A-type
Þ Sickle cell anemia- RBC sickle shape, Hb of S-type
ii. due to circulating hemolysin, as in congenital hemolytic anemia & paroxysmal Hburia.
iii. incompatibilities of blood groups, mismatched transfusions, Rh incompatibilities
iv. specific parasitic infections- malaria
v. bacterial infections- septicemia
vi. chemical agents- arsphenamine, coal-tar derivatives, lead poisoning
vii. snake venoms cause acute anemia due to hemolysis
viii. drugs- cytotoxic drugs as phenyl hydrazine HCl, quinine in malaria

4. Aplastic or non-functioning of bone marrow
lack of utilization of hemopoietic factors by bone marrow. Drugs depress bone marrow- chloromycetin, benzol. Radium salts, radioactive materials, X-rays cause bone marrow hypoplasia. Severe infections also depress bone marrow.