Malabsorption Syndrome

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Hematology

-Hematocrit (Hct) :

.male (42%-54%)

.female (38%-46%)

.1year old age (20%-41%)

-Microcytic (MCV <80) , most commonly :

.iron deficiency

.thalassemia

.sideroblastosis

.lead poisoning

.anemia of chronic disease

-Mactocytic (MCV >100) , most commonly :

.vit B12

.folic acid deficiency

.liver disease

.chemotherapeutic agents (methotrexate or zidovudin AZT or phenytoin)

.hypothyroidism

-Normocytic (normal MCV) , most forms :

.hemolysis

.aplastic anemia

-Hemolytic Anemia (Hymolysis) :

.Hereditary spherocytosis

.Hereditary elliptocytosis

.Thalassemia

.Sickle cell anemia

.Glucose-6-phosphate deficiency

-Death from anemia is most often from decreased oxygen delivery to the heart,resulting in the development of myocardial ischemia

-Anemia is considered when RBCs count :

.< 4.5 million in males

.< 3.9 million in females

Or Hemoglobin ( Hb ) content :

.< 13.5 gm % in males

.< 11.5 gm % in females

**MICROCYTIC ANEMIA

Iron Deficiency Anemia

-Is defined as a decrease in the amount of red blood cells (RBCs) or hemoglobin in the blood due to not enough iron

-Is the commonest type of anemia in Jordan / The average daily iron intake is 10-20 mg / Iron absorbed in duodenum / Alcohol increases iron absorption (tea drink are NOT) / Ferrous iron absorbed better than ferric

-Causes :

.poor diet may cause IDA in babies or children

.malabsorption (coeliac disease)

.Pregnancy

.iron absorption

.blood loss

.parasitosis

-Symptoms :

.High iron binding capacity

.Low serum ferritin

.Missed menstrual cycle

.Glossitis

.Angular cheilitis (inflammatory lesions at the mouth's corners)

.Koilonychia (spoon-shaped nails) or nails that are weak or brittle

.Pruritus (itchiness)

.Insomnia

.Restless legs syndrome

-Treatment of iron deficient anemia is (Elemental iron is mandatory at a dose of 4-6 mg/kg/day orally)

Anemia Of Chronic Disease

-This is associated with many disease , including chronic infection (TB,osteomyelitis),vasculitis,rheumatoid arthritis,malignancy,renal failure. It can be either microcytic or normocytic.

-The serum ferritin level is normal or elevated

-The serum iron level and total iron binding capacity TIBC are both low & reticulocyte count is low

Sideroblastic Anemia

-Is a form of anemia in which the bone marrow produces ringed sideroblasts rather than healthy red blood cells (erythrocytes)

-The ferritin level is elevated

-The serum iron level is high and TIBC total is low

-Causes :

.alcohol use (M.C.C of sideroblastic anemia)

.pyridoxine deficiency, lead poisoning

.myelodysplastic syndromes (MDS)

.Genetic syndromes

-Symtpoms :

.skin paleness

.fatigue, dizziness

.enlarged spleen and liver

.Heart disease, liver damage

.kidney failure can result from iron buildup in these organ

Thalassemia

-Is a form of inherited autosomal recessive blood disorder characterized by abnormal formation of hemoglobin. The abnormal hemoglobin formed results in improper oxygen transport and destruction of red blood cells / Thalassemia are not acquired anemia

-Features :

.Bone marrow hyperplasia

.Hair on end appearance

.Hypochromic microcytic RBCs

.Splenomegaly

.Hemolytic anemia resulting from imbalance of alpha and beta globin chains

.Patient becomes symptomatic in the second 6 months

.Facial deformities are present from expansion of the bone marrow

.Hypochromic microcytic anemia

-Treatment of thalassemia syndromes :

.Transfusion is unnecessary if the hemoglobin remains above 10 g/dl

+Beta-thalassemia trait (minor) :

.Mild anemia is usually present

.Peripheral smear is usually abnormal

.Mean corpuscular volume is usually low

.Hemoglobin A2 is usually elevated

.Beta-thalassemia (major) usually manifests at the age of (8 months)

.Skull X-ray show "hair on end" appearance

.Blood film shows hypochromic and microcytic picture

.Hepatosplenomegaly is a feature

.It is inherited disease

**MACROCYTIC ANEMIA

Date: 2016-04-22; view: 429