Disorders of Red Blood Cells

DISORDERS OF RED BLOOD
CELLS
MADE BY
DR . SUNIL KUMAR
GOOD MORNING
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ANAEMIA
• Anaemia may be defined as a state in which
the blood haemoglobin ( Hb) level is below
the normal range for the patient’s age and
sex(males<12gm/dL and females < 10gm/dL) .
ETIOLOGY
1. Decreased or ineffective marrow production .
• Inadequate iron , B12 or folate , trace elements
(zinc, cobalt ) .
• Hypoplasia of bone marrow
• Infiltration by malignant cells .
2. Peripheral causes ( increased RBC destruction or
loss)
• Blood loss
• Haemolysis
• Hypersplenism .
CLASSIFICATION
• Anaemia can be classified according to morphology
of erythrocytes , i.e cytometric classification .
CYTOMETRIC CLASSIFICATION
• Microcytic hypochromic anaemia
• Normocytic normochromic anaemia
• Macrocytic normochromic anaemia
• Macrocytic hypochromic anaemia (dimorphic)
ETIOLOGICAL
CLASSIFICATION
• Iron deficiency , thalassaemias and haemolytic
anaemia .
• Aplastic anaemia
• Folate deficiency , vitamin B12 deficiency ,
hypothyroidism
IRON DEFICIENCY ANAEMIA
• Hb is normally the largest iron compartment of the
body . Hb at birth is about 20 g /decilitre and it gets
reduced to 10 g / decilitre at 3 months of age . In
man , normal . Hb level is about 14 g / decilitre and
in females about 12 g / decilitre .
IRON METABOLISM
• Iron taken in diet is absorbed at all parts of GI tract
especially duodenal mucosa . Acid medium favours
iron absorption . Only 10% of the ingested iron is
absorbed . Normal serum iron level is 50-150mg/dL.
ETIOLOGY
 Increased iron utilization (increased
demand ) :
• Post natal growth spurt
• Adolescent growth spurt
 Physiologic iron loss :

• Menstruation
•
 Pathologic iron loss
• Genitourinary bleeding
• Pulmonary haemosiderosis
 Decreased Iron Intake

• Cereal rich diet
• Malabsorption
STAGES IN IRON
DEFICIENCY ANAEMIA
• There are three stages in the development
of iron deficiency anaemia
1. Negative iron balance
2. Iron deficient erythropoiesis
3. Iron deficiency anaemia
CLINICAL FEATURES
• Patients may have angular stomatitis ,
atrophic glossitis , koilonychia , brittle
hair , pruritus , pica , dysphagia due to
post – cricoid web ( Plummer – Vinson
Syndrome ) , or menorrhagia .
ORAL MANIFESTATIONS
• Mucosal pallor
• Dysphagia ( Plummer Vinsion
Syndrome )
• Angular stomatitis
• Atrophic glossitis
• Migratory glossitis
INVESTIGATIONS
 Haemoglobin level : When Hb is greater than 10g/dl
symptoms of anaemia develop only on exertion or
on exposure to hypoxia or high altitude . In Hb level
is less than 7 g/decilitre , patient is even
symptomatic even at rest .
 Microcytic , hypochromic RBC in the peripheral
smear .
 Raised platelet count may suggest bleeding
 Serum ferretin level is low . It is often less than 12
microgram/litre.
DIFFERENTIAL DIAGNOSIS
• Anaemia of chronic disease
• Thalassaemias
• Haemoglobinopathies
• Chronic liver disease
• Chronic renal disease

MANAGEMENT
• Treat the underlying cause
• Iron replacement by ferrous sulphate 200mg TID
orally . Oral therapy is cheapest and safest.
Continue until Hb is normal and for 6 – 8 months to
replenish stores .
• PARENTERAL IRON THERAPY : It is given
for those who are unable to absorb iron from the GI
tract or to those who have intolerance to oral iron .
100mg of iron Intramuscular ( IM) increase the Hb
level by 4 % but the total dose of iron should not
IRON DEXTRAN INTRAVENOUS
( In Intramuscular Intolerance )
• 500mg of the compound is given with 100 ml of
sterile saline ; and infused after a test dose of 1 ml
and if there is no adverse reaction . Side effects are
fever , chills , arthralgia , lymphadenopathy ,
splenomegaly , aseptic meningitis , anaphylactic
shock , rarely sarcomas at the site of injection , and
haemochromatosis .
• Oral iron therapy ( 200mg TDS )
raises Hb by 1% .
• One week of oral therapy raises Hb

by 1g %
• Parenteral iron ( 100 mg ) , raises Hb

by 4 %

Disorders of Red Blood Cells

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Disorders of Red Blood Cells

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DISORDERS OF RED BLOOD

 Physiologic iron loss :

 Decreased Iron Intake

• Chronic liver disease

• Chronic renal disease

• One week of oral therapy raises Hb

• Parenteral iron ( 100 mg ) , raises Hb

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