1. ANEMIA COPLICAITONS

Aymen fathi zemmal (10110068)

2. CONTENTS
SOEPEL
 introduction
 ANEMIA, difinition, types, causes, pathophysiology,
clinical features.
 Complications.
 Investigations and diagnosis.
 Management and treatment.
 Prognosis.
 References.


3. SOEPEL
Saleh ahmed 86 years old mele saudi from oneiza
unembloyed, feeling severe pain tightness of chest
started since 3 years, every two months come to
hospital to transfute 3 to 4 blood units his chest
pain sudden not continuous and not radiated ,sharp
relieved by blood transfusion.
 His past history
medical: hypertension, DM2, since 4 years, heart
attack, edema due to nephropathy, develop episodes of mild

jaundice.
surgical: left eye lazer.
medications: all orally for hypertension, DM2,
diuretics,

4. No allergies.
 Family history: informant is his son 68 years old with DM2

and his dauter and most of family members have DM2 and
hypertension.
that’s why should we alwaysadvice
to
avoid mariage from relatives.
o
social history: 1 packet
half of packet
1
cigareete.
review of systems:
Respiratory: due to his last episode most doctors to make sure
of lungs by auscultation. Due to multiple chest pain shortness of
breath and hypoxia.
GI: little neausea, no vomiting, no loss of wieght, urination is
normal. There is change in bowel habit 1 to 2 per day.
dark bloody feces with mucus.

5. SOEPEL
Hitory taking
 GE: vital signs and alarm signs.
 Abdominal examination and respiratory
examination.

 Elaboration:DD: colon polyp, diverticulitis and
colorectal carcinoma.
 Plan:
investigation: CBC, ECG, stool,
edonscopy
to look for UGI bleeding
LGI bleeding.
elaboration:blood transfusion, hydroxycarbamide,
learning goals: anemia complications.

6. GENERAL ASPECTS

Blood consist of

erythrocytes 120 days.
White cells.
Platelets 2 days.
Plasma.



blood formation where does it occur(hematopoeisis)?
 Bone marrow.
 Liver.
.spleen.
Lymph nodes. Thymus.
what occur in patient of anemia? Which is affect in
function?
hemoglobin performs the main function of RBCs by carrying
oxygen to tissues and returning CO2 from the tissues to lungs.
the convave shape allow the RBCs to uptake O2 and release CO2.
Normal value of hemoglobin is ………………….

7. charac
teristi
cs

Anemia:is present when there is decrease
level of hemoglobin in blood depending on
the sex and age of the individual.
Clinical features:
Symptoms:
Common is fatigue, headache and
faintness.
After complication or long term
disease:
 Breathlessness.
 Angina.
 Interminet claudication.
 Palpitations.
Main
fraction
of body
weight
Volum
e in
adult
body
PH
8%
Female:4-5 L.
Male: 5-6 L.
7.35- 7.45
hemog Female: 12-16 g/dl.
lobin Male:13-18 g/dl.

8. CLINICAL FEATURES

9. CLINICAL FEATURES
 Signs






pallor of extremeties, face, conjuctive.
Central cyanosis of tongue and lips.
Cholinychia (spoon shape of nails).
Tachycardia.
Systolic flow murmur.
Cardiac failure.

10. TYPE AND CAUSES OF ANEMIA
 Microcytic
anemia:
most cause is iron deficiency due to
1- limited ability of body to absorb iron.
2- frequent loss of iron due to hemorrhage.
chronic disease ex: infection tuberculosis, chronic inflammatory
disease chron’s disease.
Sideroblastic anemia: inherited or acquired.
 Normocytic
anemia: seen in chronic disease such as
1- endocrine disorders( hypopituitarism, hypothyroidism and
hypoadranalism)
2- hematological disorders(aplastic anemia wether primary
congenital or secondary due to chemical or certain drugs.
3- seen acutely following blood loss.

12.  Macrocystic
anemia:
1-megaloblastic anemia:
defect in DNA synthesis in bone marrow
thereby affecting: B12 metabolism or causeing
deficiency leading to perncicious anemia
. Folic acid dificiency or abnormal folate
metabolism.
2- non-megaloblastic anemia:
physiological cause:





Alcohol excess.
Liver disease.
Hypothyroidism.
Hematolological disease.
Drugs.

13. 
Which type of anemia?

14.  Sickle
cell anemia:
single base mutation of adenine to thymine.
Mostly in african population.
Inherited from both parents.

15. COMPLICATIONS OF ANEMIA
Long term problems lead to complications:
 every organ is involved.

growth and development: children below normal
weight > delayed sexueal maturation > hormone
therapy.
 Bones: hip joint replacement may be required due
to vaso-occlusion episodes leading to chrinic
infarcts.
 Infection: more common in the tissues which vasoocclusion occur ex: bones, lungs and kidney.
 Respiratory: shortness of breath, chest pain and
hypoxia > death


16. Leg ulcers.
 Cardiac problems: cardiomegaly.
arrhythmias and iron
overloaded cordiomegaly.
myocardial infarction due to thrombotic
episodes not secondary to atheroma.

o
o
o
neurological: in 25% of patients.
Cholelithiosis: pigment stones occur as a result of
chronic hemolysis.
Liver: chronic hepatomegaly.

17. COMPLICATIONS
o
Renal: chronic tubulo-interstitial nephritis
Priapism: unwanted painful erection due to vasoocculsion.
 Eye: retinopathy > yearly eye check is required.
 Pregnancy: impaired placental blood flow causes
spontaneous abortion.
intrauterine growth retardation.
preclampsia and fetal death
o

18. INVESTIGATIONS
blood counts.
 Blood films.
 Sickle solubity test
 Hb electrophoresis: always needed to confirm the
diagnosis.


19. MANAGEMENT AND TREATMENT

Patient survive longer with better treatment.
Blood transfusion should be given only for clear
indications. Ex: surgery, heart failure , painful
episodes without complications and in cases of
complications.
 Hydroxycarbamide is first drug for sickle anemia to
reduce the episodes of pain.
 Bone marrow transplantation.


20. PROGNOSIS
Some patients with Hb SS die in the first few years
of life.
 There is indivisual variation in the severity of the
disease.
 Some patients have normal lifespan with few
complication.


21. REFERENCES