NAMA PENGAJAR:DR RAJYAGURU KIRANKUMAR M SUBJECT:PRINCIPLES OF PATHOPHYSIOLOGY RNB:10304 GROUP:JULAI 2011 SEMESTER:1 YEAR 1 NAME:MAHANUM BT ZAMBAHARI MATRIX NUMBER:57254211427

ANEMIA Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100ml and in women as hemoglobin of less than 12.0 gram/100ml. These definitions may vary slightly depending on the source and the laboratory reference used.

CAUSES ANEMIA.
Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Red blood cells are made in the bone marrow.Anemia is caused essentially through two basic pathways. Anemia is either caused: 1. by a decrease in production of red blood cell or hemoglobin, or 2. by a loss or destruction of blood. As more common classifications of anemia (low hemoglobin) is based on the MCV, or the volume of individual red blood cells. 1. If the MCV is low (less than 80), the anemia is categorized as microcytic anemia (low cell volume). 2. If the MCV is in the normal range (80-100), it is called a normocytic anemia (normal cell volume). 3. If the MCV is high, then it is called a macrocytic anemia (large cell volume).

Looking at each of the components of a complete blood count (CBC), especially the MCV, a physician can gather clues as what may be the most common reason for anemia.

CAUSES OF ANEMIA DURING PREGNANCY.

Anemia in pregnancy is common and it is most often caused by an iron deficiency. Iron is a mineral that everyone needs. Pregnant women need more iron for a variety of reasons. The biggest reason is that iron helps your body make new blood to carry the oxygen and nutrients to the baby during pregnancy. By the end of pregnancy you will have a 30-50% increase in your blood in your body than when you began the pregnancy. Your need for iron will increase 100% over your requirements pre-pregnancy. Towards the end of pregnancy your baby will also be storing iron for his or her first six months of life. Babies generally do not get much iron from their mother's diets during this time and depend upon their own stores of iron.

Causes of common types of anemia

Iron deficiency anemia. Iron deficiency anemia is caused by a shortage of the element iron in your body. Your bone marrow needs iron to make hemoglobin. Without adequate iron, your body can't produce enough hemoglobin for red blood cells.

Vitamin deficiency anemias. In addition to iron, your body needs folate and vitamin B12 to produce sufficient numbers of healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production. Additionally, some people may eat enough B-12, but their bodies aren't able to process the vitamin. This can lead to vitamin deficiency anemia.

Anemia of chronic disease. Certain chronic diseases such as cancer, HIV/AIDS, rheumatoid arthritis, Crohn's disease and other chronic inflammatory diseases can interfere with the production of red blood cells, resulting in chronic anemia. Kidney failure also can cause of anemia.

Aplastic anemia. This very rare, life-threatening anemia is caused by a decrease in the bone marrow's ability to produce red blood cells. Causes of aplastic anemia include infections, drugs and autoimmune diseases.

Anemias associated with bone marrow disease. A variety of diseases, such as leukemia and myelodysplasia, can cause anemia by affecting blood production in your bone marrow. The effects of these types of cancer and cancer-like disorders vary from a mild alteration in blood production to a complete, life-threatening shutdown of the bloodmaking process. Other cancers of the blood or bone marrow, such as multiple myeloma, myeloproliferative disorders and lymphoma, also can cause anemia.

Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases can cause increased red blood cell destruction. Hemolytic anemias can be inherited or you can develop them later in life.

Sickle cell anemia. This inherited and sometimes serious anemia is caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular-shaped red blood cells die prematurely, resulting in a chronic shortage of red blood cells.

Other anemias. There are several other, rarer forms of anemia, such as thalassemia and anemias caused by defective hemoglobin.

Vitamin-deficiency anemia may occur when vitamin B-12 and folate are deficient. These two vitamins are needed to make red blood cells. Conditions leading to anemia caused by vitamin deficiency include:
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Megaloblastic anemia: Vitamin B-12 or folate or both are deficient Pernicious anemia: Poor vitamin B-12 absorption caused by conditions such as Crohn's disease, an intestinal parasite infection, surgical removal of part of the stomach or intestine, or infection with HIV

Dietary deficiency: Eating little or no meat may cause a lack vitamin B-12, while overcooking or eating too few vegetables may cause a folate dificiency

Other causes of vitamin deficiency: pregnancy, certain medications, alcohol abuse, intestinal diseases such as tropical sprue and celiac disease

SIGN AND SYMPTOM depending on the cause of your anemia, but may include:
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Fatigue Pale skin A fast or irregular heartbeat Shortness of breath Chest pain Dizziness Cognitive problems Cold hands and feet Headache

Initially, anemia can be so mild it goes unnoticed. But signs and symptoms increase as anemia worsens.

TREATMENT
Medical treatment of anemia varies widely and depends on the cause and the severity of anemia. If anemia is mild and associated with no symptoms or minimal symptoms, a thorough investigation by a doctor will be done in the outpatient setting (doctor's office). If any cause is found, then appropriate treatment will be started. For example, if anemia is mild and is found to be related to low iron levels, then iron supplements may be given while further investigation to determine the cause of the iron deficiency is carried out. On the other hand, if anemia is related to sudden blood loss from an injury or a rapidly bleeding stomach ulcer, then hospitalization and transfusion of red blood cells may be required to relieve the symptoms and replace the lost blood. Further measures to control the bleeding may occur at the same time to stop further blood loss. Blood transfusion may be required in other less critical circumstances as well. For example, an individual who is receiving chemotherapy for a cancer may be expected by the treating physician to have bone marrow problems related to the chemotherapy. Therefore, the doctor may check blood counts routinely, and if the levels get to a low enough level, he or she may order a red blood cell transfusion to help with the symptoms of anemia.

PREVENTION OF ANEMIA
As the name implies, iron deficiency anemia is due to insufficient iron. Without enough iron, your body can't produce enough hemoglobin, a substance in red blood cells that enables them to carry oxygen. As a result, iron deficiency anemia may leave you tired and short of breath. You can usually correct iron deficiency anemia with iron supplementation. Sometimes, additional treatments for iron deficiency anemia are necessary, especially if you're bleeding internally. You can reduce your risk of iron deficiency anemia by choosing iron-rich foods. Choose iron-rich foods Foods rich in iron include:
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Beans Dark green leafy vegetables, such as spinach Dried fruit, such as raisins and apricots Eggs Iron-fortified cereals, breads and pastas Peas Poultry Red meat Seafood

Your body absorbs more iron from meat than it does from other sources. If you choose to not eat meat, you may need to increase your intake of iron-rich, plant-based foods to absorb the same amount of iron as someone who eats meat.

Choose foods containing vitamin C to enhance iron absorption You can enhance your body's absorption of iron by drinking citrus juice or eating other foods rich in vitamin C at the same time that you eat high-iron foods. Vitamin C in citrus juices, like orange juice, helps your body to better absorb dietary iron. Vitamin C is also found in:
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Broccoli Grapefruit Kiwi Leafy greens Mangoes Melons Oranges Peppers Strawberries Tomatoes

Preventing iron deficiency anemia in infants To prevent iron deficiency anemia in infants, feed your baby breast milk or iron-fortified formula for the first year. Cow's milk isn't a good source of iron for babies and isn't recommended for infants under one year. Iron from breast milk is more easily absorbed than the iron found in formula.

Left untreated, anemia can cause numerous complications, such as:

Severe fatigue. When anemia is severe enough, you may be so tired that you can't complete everyday tasks. You may be too exhausted to work or play. Heart problems. Anemia can lead to a rapid or irregular heartbeat an arrhythmia. Your heart must pump more blood to compensate for the lack of oxygen in the blood when you're anemic. This can even lead to congestive heart failure.

Death. Some inherited anemias, such as sickle cell anemia, can be serious and lead to lifethreatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal.

Thalassemia
Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form of hemoglobin, the protein in red blood cells that carries oxygen. The disorder results in excessive destruction of red blood cells, which leads to anemia. See also:
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Hemolytic anemia Sickle cell disease

Causes, incidence, and risk factors

Alpha thalassemia occurs when a gene or genes related to the alpha globin protein are missing or changed (mutated). Beta thalassemia occurs when similar gene defects affect production of the beta globin protein.

Alpha thalassemias occur most commonly in persons from southeast Asia, the Middle East, China, and in those of African descent. Beta thalassemias occur in persons of Mediterranean origin, and to a lesser extent, Chinese, other Asians, and African Americans. There are many forms of thalassemia. Each type has many different subtypes. Both alpha and beta thalassemia include the following two forms:
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Thalassemia major

Thalassemia minor

You must inherit the defective gene from both parents to develop thalassemia major. Thalassemia minor occurs if you receive the defective gene from only one parent. Persons with this form of the disorder are carriers of the disease and usually do not have symptoms. Beta thalassemia major is also called Cooley's anemia. Risk factors for thalassemia include:
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Asian, Chinese, Mediterranean, or African American ethnicity Family history of the disorder

Symptoms
The most severe form of alpha thalassemia major causes stillbirth (death of the unborn baby during birth or the late stages of pregnancy). Children born with thalessemia major (Cooley's anemia) are normal at birth, but develop severe anemia during the first year of life. Other symptoms can include:
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Bone deformities in the face Fatigue Growth failure Shortness of breath Yellow skin (jaundice)

Persons with the minor form of alpha and beta thalassemia have small red blood cells (which are identified by looking at their red blood cells under a microscope), but no symptoms.

Signs and tests

Red blood cells will appear small and abnormally shaped when looked at under a microscope. A complete blood count (CBC) reveals anemia. A test called hemoglobin electrophoresis shows the presence of an abnormal form of hemoglobin.

A test called mutational analysis can help detect alpha thalassemia that cannot be seen with hemoglobin electrophoresis.

Treatment
Treatment for thalassemia major often involves regular blood transfusions and folate supplements. If you receive blood transfusions, you should not take iron supplements. Doing so can cause a high amount of iron to build up in the body, which can be harmful. Persons who receive significant numbers of blood transfusions need a treatment called chelation therapy to remove excess iron from the body. Bone marrow transplant may help treat the disease in some patients, especially children.

Expectations (prognosis)
Severe thalassemia can cause early death due to heart failure a, usually between ages 20 and 30. Frequent blood transfusions with therapy to remove iron from the body helps improve the outcome. Less severe forms of thalassemia usually do not result in a shorter life span.

Complications
Untreated, thalassemia major leads to heart failure and liver problems, and makes a person more likely to develop infections. Blood transfusions can help control some symptoms, but may result in too much iron which can damage the heart, liver, and endocrine system.

Calling your health care provider

You or your child has symptoms of thalassemia You are being treated for the disorder and new symptoms develop

Prevention
Genetic counseling and prenatal screening may be available to those with a family history of this condition who are planning to have children.