ANAEMIA2012.12.06 Paj sir’s lecture note

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Anaemia- british styleAnemia – american styleAcording to WHO(1960) proposed a

cut off value for hb content for anaemia.It is 12%

How ever excluded from this group are1.pregnant(15-49years)2.children(6-59 months)

For srilanka today,peak or the maximum apears around to 9-11 months in children

If you want to look at anaemia in

pregnant,you find it 35%

In children 6-60months – 33% anaemia

At the time of birth we have sufficient iron storage . It lasts at in 6th month

Breast milk is poor source of iron only help untill 6th month.iron in breast milk is in the form of heme iron.

There are two types of iron 1.mainly inorganic iron 2.heme iron

Of these two iron is absorbed through

carrier system..The percentage of absorption is depend on body state.

In anaemic condition it willl increase absorption.those people who are normal will absorb low amount relative to anaemic patients.

So absorption is governed by body state.Iron is carried by a protein-transferrin,not

as ferus state,but as feric state

When it is absorbed to

enterocyte once,it is converted to Fe3+ by a protein,-ceruloplasmin.

Fe2+ Fe3+Ceruloplasmin is a beautiful blue

colour protein.So iron in ferus state absorbs and

is converted to feric state and is loaded to transferin.(a protein)

Apo-transferin-produce in liver

Fe3+ loaded.Can loaded 2 atoms,then it

transported to sites where iron is required; principal site is bone marrow.liver is also a site.

Erythroblast ae born in bone marrow,iron for synthesis of heme and then corperated into hemoglobin

Also goes to other places where heme proteins are produced.

1.myoglobin-in muscle.2.cytochroms-in mitochindria,electrone transport system on inner surface of mitochondria.(Mitochondria originates from maternal side,so genatic disorders from mother)

Excess iron stored in liver as feritin.another form is hemosidarin.but most is in the form of feritin.

Everyday on an average we relase 1mg of iron to iron pool.

Fe2+ Fe3+ why is this reaction is so important???If you have iron in ferrus state it will be

more active and begins to produce oxygen free radicles.

Oxygen free radicles are sometime important as to attack invading pathogens.

Free radicles are caused to oxidation of sevarel components 1.oxidation of nucleic acids-cause to cancer 2.phospholipids-reduction in cell membrane function. 3.protein-make an inactive condtion.

Skin-wrinkling of the skin.in skin

abundantly present protein is collagen.

In wrinkling 2 sulper amino acids are oxidized forming disulfied linkage-SH- -S-S-

Free radicles oxidise protein,PUFA,nucleic acids.so they are toxic.ceruloplasmin is a protective agent makinf it less toxic.

Iron is transported by apo-transferrin.

what happen in iron deficiency???

The body will try to bring as much as possible iron from storage.

But we release only 1mg.so in growing

child,adolecent and pregnant 1mg is insufficient.so become anaemia.

Howrcome do we overcome this???1.liver starts to produce more an more

apotransferrin.so in iron deficiency anaemia apotransferrin is increased.

What about iron we put out into blood.they are carried by ferritin.infact level of ferritin in blood plasma is an indicator of iron store.

What about heme??? Maximum percentage of heme iron absorption is 30%.absorption of inorganic iron is 10%.

Heme iron from animal sources.(liver o,organ meats).

Fish – almost black colour is due to lot of heme

iron.Myoblobin present in red colour.

If you are a vegiterian maximum absorption is 10%.but average value is 3%-5%.so have to provide vit.c.

Iron deficiency is found in all over the world. Special reasons, 1.iron is found in richly surface on the earth. 2.plant-iron in ferric state.so it is unavailable.

We can only absorb iron only in Fe2+ form.so bioavailability is low.

If you are a vegan-no iron come from heme.so vitamin c should be 60mg per day.smokers should get 100mg per day,due to produce oxygen free radicles by components such as CO,arsenic.

We usualy use in curries surviving

agents(tamerin,lime,goraka,bilin). These agents give acidic ph helping in iron absorption.

Never ever use aluminium pots.otherwise aluminium jump into them.So use clay pots.

In green leaves vegitables also in legums iron is bound to phytic acid.so they are not bioavailable.

How do we release them??? Soaking themwtare absorbs.It triggers growth of seeds.(germination).so trace elmants are released.Bound to phytic acid is a self defence.

There is an enzyme called phytase to release those nutrients.Amylase is to berakdown starch.

Are there any form of anaemias??? Yes!But the main thing is iron deficiency

anaemia.If you have malaria,those parasite

enter your body having a luxury day :DBut people who are in anaemic

condition,parasites can not grow.In addition toirion deficiency ther are

also folate def and vit b 12 def.folate and vit.B12 are involve I DNA synthesis.when deficiency (one or both) dna replication will be affected.Without DNA replication no cell division.So reducing cell division.

So what will happen???

Number of enterocyte will be reduced and affect in absorption of nutrients.Malabsorption accures.

So not only anaemia but also undernutrition condition occures.

How do you know it??? 1.take a blood sample from

finger pit. 2.get a blood picture.can be seen macrocytic and microcytic RBCs.This says number of RBCs and Hb content is less.

Clinical feature-involve with nerve

transmission. In vit B12 deficiency.Dismatching signals through nerves.It will damage the nerve covering-mayalin sheath.So what will happen???-Not proper covering the nerve fiber-signal will become weak and leak.

Vitamin B 12 is most stable.can be in 125c’Folic acid-50% of iron deficiency are also in folic acid

deficiency.Folic acid deficiency is caused mainly due

to poor processing.Folic acid is heat unstable.So it is called

labile.acidic pH is good for it.

What are the other bad affects???

1.growth retardation folate & 2.malabsorption B12 defi.

Anaemic women placenta is large.But small fetus.Small for date babies.How do we define- infant is less than 2.5kgThese infant ,in their middle and old age will be affected in 1.DM 2.hypertension.Their imunity is reduced

Children and workers as tea pluckers

and ruber tappers-increased absence of days and reduced work output.School children-increased absence of school is due to illness. 1.common cold 2.cough low immunity 3.diarrhoea

Fe- 1.Need to transport oxygen.They

require O2 and also for production in heme protein .Need for mitochondria for production of citochromefor energy production.

2. mayoglobin in red muscle.

Darker red in muscle.What is the reason???Continuos 24hr energy rquirement.

In anaemia growth rate is reduced.Any other form of anaemia??? Yes !Thalassemia – commmonest form is

beta thalassemia.Their Hb A amount is low.So how do they overcome-by Hb A2 and Hb F.

Also they will have alfa-4.they are not functional Hbs.Abnormal proteins. ‘’heinz bodies’’-dark pigment insoluble proteins.

Sickle cell anaemia-sickling of

RBCs giving hypoxia.Normally RBCs are rolled over

and creeped through blood vessels.but due to sickle shape it damage blood vessles and blocks the blood flow.

Sickling can be seen only in oxygen deficinecy.

Maleria - patasites enter good helath peoplefor their multiplication.they would finaly burst RBCs.leading hemolysis anaemia.-hemolytic anaemia.

Iron is something that retains in

body strongly. How do we loss it??? Skin,feces….No in urine no in bile. Only through removed of cells.dead cells.

Synthesis of heme.1.succinyl CoA+glycine rate limitting stepDelta.amino lenolenic acid inhibited by heme (surplace

free)

PorphobilinogenThere is a feedback type inhibitionTransferrin – loaded with iron.maximux

is 2 atoms of iron.There is a normal saturated rate of

transferrin.In iron deficiency this rate will be reduced.