Prepared By Bachelor In Medical Science Students of Management and Science University
  
( MSU Shah Alam Campus ).

SUBJECT  : 

PATHOPHYSIOLOGY OF HAEMOPOIETIC & LYMPHOID  SYSTEM ( QPT 20803 )

FACULTY : INTERNATIONAL MEDICAL SCHOOL ( IMS )

EVALUATED  BY : MISS NAJIHAH BINTI MOHD BISRI

OBJECTIVE : TO CREATE AWARENESS AND GIVE MORE INFORMATION TO THOSE SUFFERING BY ANEMIA

OR THOSE WHO SUSPECTED HAVING ANEMIA. IT IS IMPORTANT TO UTILIZE THE INFORMATION PROVIDED 

IN THIS BLOG THUS TO INCREASE SOMEONE'S LIFE EXPECTANCY.

TAGLINE : EAT IRON, KICK ANEMIA

NURFARZANA IZZATI BINTI MD KAMAL

                                 -Did you know that annually iron deficiency anemia killed 183400 people ?-

JAISHREE POOPATHI

-Sickle cell is neither witchcraft nor a death sentence-

VITHIYA YOGANATHAN

-SOMETIMES PAIN HELPS YOU TO RISE UP EVEN STRONGER-







NISHANTHINI RAJAN'

- GROW STRONGER FROM THE PAIN, DONT LET IT DESTROY YOU-

TREATMENT FOR ANEMIA

Treatment :

Anemia treatment depends on the cause.

·         Iron deficiency anemia. Treatment for this form of anemia usually involves taking iron supplements and making changes to your diet.

If the underlying cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and stopped. This may involve surgery.

·         Vitamin deficiency anemias. Treatment for folic acid and B-12 deficiency involves dietary supplements and increasing these nutrients in your diet.

If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may need vitamin B-12 shots. At first, you may receive the shots every other day. Eventually, you'll need shots just once a month, which may continue for life, depending on your situation.

·         Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate red blood cell production and ease fatigue.

·         Aplastic anemia. Treatment for this anemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can't make healthy blood cells.

·         Anemias associated with bone marrow disease. Treatment of these various diseases can include medication, chemotherapy or bone marrow transplantation.

·         Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells.

Depending on the severity of your anemia, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure. In certain cases, removal of the spleen can be helpful.

·         Sickle cell anemia. Treatment for this anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors also may recommend blood transfusions, folic acid supplements and antibiotics.

A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell anemia.

·         Thalassemia. This anemia may be treated with blood transfusions, folic acid supplements, medication, removal of the spleen (splenectomy), or a blood and bone marrow stem cell transplant.

DIAGNOSIS

Anemia Test No. 1: Complete Blood Count (CBC)

If you’re experiencing symptoms of anemia , the most common diagnostic test is a complete blood count, known as a CBC. A CBC involves taking a small blood sample and analyzing its components, including the red blood cells, white blood cells, and platelets. “It tests at all the elements of the blood, but mainly looking at the red blood cells because a low red blood cell count can mean anemia.

The CBC also measures levels of hematocrit (the percentage of red blood cells found in whole blood) and hemoglobin (an oxygen-carrying protein in the blood). Low levels of either hematocrit or hemoglobin can indicate an anemic condition.The complete blood count is the main test used to make a general diagnosis of anemia.

Anemia Test No. 2: Reticulocyte Count

One such diagnostic test is a reticulocyte count, which measures the number of immature red cells in the blood. These cells are produced by bone marrow, and a high reticulocyte count could mean that your symptoms of anemia are due to blood loss, either through hemorrhaging, heavy menstrual periods, or sources of blood loss.

“If your bone marrow is responding very well and producing lots of red blood cells, then the reticulocyte count should be high because the red blood cell factory is working overtime to make up for those lost red blood cells,” said Liu.

A low reticulocyte count, on the other hand, means that your bone marro is not producing enough red blood cells. This is most commonly caused by a nutritional deficiency.  Folate deficiency can also be a cause of a low reticulocyte count, though it’s less common in the Western world because many foods, such as bread, are fortified with folate. People who have cancer or are undergoing radiation therapy may also experience low reticulocyte counts, as well as those whose kidney function is impaired.

Once the cause of the low reticulocyte count has been determined, your doctor can decide how to treat your anemia, Liu said. If a low reticulocyte count is caused by nutritional gaps, you can take supplements of appropriate vitamins, such as iron, B12, and folate. If your reticulocyte production has been suppressed due to kidney problems, a physician may treat you with injections of erythropoietin, a hormone produced by the kidneys that tells the bone marrow to produce more red blood cells.

Anemia Test No. 3: Blood Smear

Another test that helps search for anemia causes is a blood smear. This test, which is performed by spreading a drop of blood on a slide and staining it with a special dye, can detect irregularities in red blood cells, white blood cells, and platelets. Abnormal red blood cells can tell your doctor more about your anemia. For example, unusually large red blood cells can indicate anemia caused by a vitamin deficiency, while crescent-shaped red blood cells can mean you have sickle-cell anemia, an inherited disease.

The treatments that your physician prescribes after a blood smear will depend on the test results. If your blood smear reveals vitamin deficiencies, changes in diet or taking vitamin supplements may be the only treatment you need. There is no cure for sickle-cell anemia, but patients are often told to stay hydrated and in good health because being in less-than-ideal physical condition can cause painful episodes, known as “sickle cell crises” that occur when misshapen red blood cells form clumps in the bloodstream.People with moderate to severe sickle-cell anemia may also be prescribed a drug called hydroxyurea to prevent episodes of pain.

Anemia Test No. 4: Iron Panel

If your doctor suspects that your anemia is due to an iron deficiency, she may order an iron panel, a blood test that measures the level of iron in your blood. This test is often used when your doctor believes that your iron deficiency is caused by blood loss, such as bleeding in the gastrointestinal tract.

Treatment for iron deficiency involves taking iron supplements, usually in pill form. Those who cannot tolerate oral iron supplements can also take it intravenously or by an injection into the muscle.

COMPLICATION OF ANEMIA

WHAT HAPPEN WHEN ANEMIA GETTING WORSE ?

There are many complications when anemia is not being treated. Like some other disease who are left untreated, it may lead into more health disease. In this case :

Anemia may lead into lack of Growth and Development,Infections, Severe Fatigue, Pregnancy complications, Heart Problems and it will be end with with a death.

Growth and Development may be lessen. The patient may get the below normal weight and may caused delayed sexual maturation. As for results and treatment, the patient must be given hormone theraphy.Renal may also get afffected and prolonged to be chronic tubulo-intertitial nephritis. On the other hand, the bones of hip joint may required to be replaced due to vaso-occlusion episodes that may be happening. If it prolonged, it may lead into chronic infarction.

Infection also might happen when there is less immunity being transport throughout the body system. These condition more happen in the common tissue like bone, lungs and kidney which can cause vaso-occlusion. Priapism(painful erection) may also happen due to vaso-occlusion. Eye also may get retinopathy due to the infection.

Severe fatigue can indicate that the patient have a severe condition of anemia. Less task can be done due to the tiredness because lack of oxygen and energy to proceed and complete everyday routine task. This long term fatigue also may eventually leads into clinical depresssion.

Pregnancy complication may happen to the mothers who have folate deficiency anemia. They are more likely to have premature birth and underweight. This is because they will have an impaired placental blood flow, intrauterine growth retardation, preclampsia and fetal death. However if the baby is born with an anemic mother, they themselves may have problems with anemia later on in infancy.

Heart problems may arise awhile after. Arrhythmia (a rapid and irregular heart beat) may arise when the body need to compensate the loss of oxygen and nutrient in the circulation of blood. This will eventually complicate the heart and makes the heart enlarged, happen to have congestive heart failure and leads to cardiac arrest.

Respiratory system also get affected. Shortness of breath, chest pain and hypoxia due to less oxygen circulate in the body may cause death in some times. Death is the final destination if the anemia is not treated. Some anemia such as sickle cell anemia can be serious and lead into life threatening conditions. Losing of blood may lead into acute,chronic anemia and may cause fatal.

      TYPES OF ANEMIA AND ITS CAUSES

• Iron deficiency anemia. This is the most common type of anemia worldwide. Iron deficiency anemia is caused by a shortage of 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.
• Without iron supplementation, this type of anemia occurs in many pregnant women. It is also caused by blood loss, such as from heavy menstrual bleeding, an ulcer, cancer and regular use of some over-the-counter pain relievers, especially aspirin.
• Vitamin deficiency anemia. In addition to iron, your body needs folate and vitamin B-12 to produce enough healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production.
  Additionally, some people may consume enough B-12, but their bodies aren't able to process the vitamin. This can lead to vitamin deficiency anemia, also known as pernicious anemia.
• Anemia of chronic disease. Certain diseases — such as cancer, HIV/AIDS, rheumatoid arthritis, kidney disease, Crohn's disease and other chronic inflammatory diseases — can interfere with the production of red blood cells.
• Aplastic anemia. This rare, life-threatening anemia occurs when your body doesn't produce enough red blood cells. Causes of aplastic anemia include infections, certain medicines, autoimmune diseases and exposure to toxic chemicals.
• Anemias associated with bone marrow disease. A variety of diseases, such as leukemia and myelofibrosis, can cause anemia by affecting blood production in your bone marrow. The effects of these types of cancer and cancer-like disorders vary from mild to life-threatening.
• Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases increase red blood cell destruction. You can inherit a hemolytic anemia, or you can develop it later in life.
• Sickle cell anemia. This inherited and sometimes serious condition is an inherited hemolytic anemia. It's caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular blood cells die prematurely, resulting in a chronic shortage of red blood cells.
• Other anemias. There are several other forms of anemia, such as thalassemia and malarial anemia.

Erythropoiesis and its regulation

Because of the inability of erythrocytes (red blood cells) to divide to replenish their numbers, the old ruptured cells must be replaced by totally new cells. They meet their demise because they don’t have the usual specialized intracellular machinery, which controls cell growth and repair, leading to a short life span of 120 days.

This short life span necessitates the process erythropoiesis, which is the formation of red blood cells. All blood cells are formed in the bone marrow. This is the erythrocyte factory, which is soft, highly cellar tissue that fills the internal cavities of bones.

During intrauterine development, the early stages of life, erythrocytes are produced first by the yolk sac and then by the developing spleen during the third month of gestation, until the bone marrow is formed in the seventh month and takes over erythrocyte production exclusively.

ERYTHROCYTE DIFFERENTIATION

Erythrocyte differentiation takes place in 8 stages. It is the pathway through which an erythrocyte matures from a hemocytoblast into a full-blown erythrocyte. The first seven all take place within the bone marrow. After stage 7 the cell is then released into the bloodstream as a reticulocyte, where it then matures 1-2 days later into an erythrocyte. The stages are as follows:

1. Hemocytoblast, which is a pluripotent hematopoietic stem cell
2. Common myeloid progenitor, a multipotent stem cell
3. Unipotent stem cell
4. Pronormoblast
5. Basophilic normoblast also called an erythroblast.
6. Polychromatophilic normoblast
7. Orthochromatic normoblast
8. Reticulocyte

REGULATION OF ERYTHROPOIESIS

Thinking logically you might suspect that because the primary function of erythrocytes is to transport O2 in the blood, the primary stimulus for erythrocyte production is low O2 levels. You would be correct, but low O2 levels do not stimulate erythropoiesis by acting directly on the bone marrow.

Instead, it stimulates the kidneys to secrete the hormone erythropoietin into the blood, and this hormone in a domino effect stimulates the bone marrow to produce erythrocytes.

Erythropoietin acts on derivatives of undifferentiated cells that have already been committed to becoming red blood cells (RBC’s), stimulating the proliferation and maturation of these cells into mature RBCs.

This increase in erythropoietic activity elevates the number of circulating RBCs, thereby raising the O2 carrying capacity of the blood and restoring the delivery of O2 to the body tissues to normal. Once the O2 level in the tissues of the kidneys is brought back to normal, erythropoietin secretion is turned down until it is needed again. This is an example of a negative feedback mechanism.

                                   

NORMAL MORPHOLOGY OF RED BLOOD CELL

The erythrocyte, commonly known as a red blood cell (or RBC), is by far the most common formed element: A single drop of blood contains millions of erythrocytes and just thousands of leukocytes. Specifically, males have about 5.4 million erythrocytes per microliter (µL) of blood, and females have approximately 4.8 million per µL. In fact, erythrocytes are estimated to make up about 25 percent of the total cells in the body. As you can imagine, they are quite small cells, with a mean diameter of only about 7–8 micrometers (µm). The primary functions of erythrocytes are to pick up inhaled oxygen from the lungs and transport it to the body’s tissues, and to pick up some (about 24 percent) carbon dioxide waste at the tissues and transport it to the lungs for exhalation. Erythrocytes remain within the vascular network. Although leukocytes typically leave the blood vessels to perform their defensive functions, movement of erythrocytes from the blood vessels is abnormal.

Shape and Structure of Erythrocytes

Erythrocytes are biconcave disks; that is, they are plump at their periphery and very thin in the center . Since they lack most organelles, there is more interior space for the presence of the hemoglobin molecules that, as you will see shortly, transport gases. The biconcave shape also provides a greater surface area across which gas exchange can occur, relative to its volume; a sphere of a similar diameter would have a lower surface area-to-volume ratio. In the capillaries, the oxygen carried by the erythrocytes can diffuse into the plasma and then through the capillary walls to reach the cells, whereas some of the carbon dioxide produced by the cells as a waste product diffuses into the capillaries to be picked up by the erythrocytes. Capillary beds are extremely narrow, slowing the passage of the erythrocytes and providing an extended opportunity for gas exchange to occur. However, the space within capillaries can be so minute that, despite their own small size, erythrocytes may have to fold in on themselves if they are to make their way through. Fortunately, their structural proteins like spectrin are flexible, allowing them to bend over themselves to a surprising degree, then spring back again when they enter a wider vessel. In wider vessels, erythrocytes may stack up much like a roll of coins, forming a rouleaux, from the French word for “roll.”