Microcytosis is a term used to describe red blood cells that are smaller than normal. Anemia is when you have low numbers of properly functioning red blood . Download/Embed scientific diagram | Esfregaço sangüíneo ilustrando anemia microcítica e hipocrômica (HE, x). from publication: Farmacologia do Sistema . 20 jul. A anemia geralmente e anemia hipocromica normocitica, embora microcitose seja comumente observada, com presenca de pontilhado.
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Anemia is defined as the reduction in circulating red-cell mass below normal levels. Anemia is a very common condition which is widespread in the human population.
Circulating red blood cells RBCs contain a protein known as hemoglobin, that protein has four polypeptide chains and one heme ring that contains iron in reduced form. Iron is the main component of hemoglobin and is the prime carrier of oxygen. Decreased iron reserves in the body affect the production of hemoglobin which, subsequently hinders the transport of oxygen to organ systems of the body.
Anemia reduces the oxygen-carrying capacity of the blood and leads to tissue hypoxia. Usually, it is diagnosed by hematocrit the ratio of packed RBCs to blood volume and the hemoglobin concentration. Microcytic, hypochromic anemia, as the name suggests, is the type of anemia in which the circulating RBCs are smaller than the usual size of RBCs microcytic and have decreased red color hypochromic. The most common cause of this type of anemia is decreased iron reserves of the body which may be due to multiple reasons.
This may be due to decreased iron in the diet, poor absorption of iron from the gut, acute and chronic blood loss, increased demand of iron in certain situations like pregnancy or recovering from a major trauma or surgery. Hypochromic microcytic anemia is more common in premenopausal females because they lose blood with each menstrual cycle. The male population is usually resistant to anemia due to circulating testosterone levels.
After the female population, pre-school aged children suffer the most from anemia because of lack of iron in their primary diet. Human milk contains 0. On the other hand, cow milk contains double the amount of iron, but that iron has poor bioavailability. An adult human being requires 1 mg to 2 mg per day of iron. The normal western diet contains approximately 10 mg to 20 mg of iron. The cause of low non-heme iron bioavailability is due to its interactions with tannins, phosphates and other food constituents.
An average male contains 6grams of iron while a female contains 2. This diet is usually sufficient to maintain a healthy iron pool. Ingested iron is freed from other food constituents by gastric HCL while ascorbic acid vitamin C prevents precipitation of ferric.
Iron is subsequently absorbed from the duodenum and upper parts of the jejunum through an iron transporter called ferroportin while transferrin protein carries this iron in the blood. Iron is stored in the form of ferritin a ubiquitous iron protein which is found predominantly in the liver, spleen, bone marrow and skeletal muscles.
In the liver, it is stored in parenchymal cells while in other tissues it is stored in macrophages. This process of iron absorption from the gut is controlled by hepcidin, a protein which regulates the amount of iron absorbed from the diet.
Hypochromic microcytic anemia is caused by any factor which reduces the body’s iron stores. Hemoglobin is a globular protein which is a major component of RBCs it is manufactured in the bone marrow by erythroid progenitor cells.
It has four globin chains two of which are alpha globin chains while the other two are beta globin chains, these four chains are hipoocromica to porphyrin ring haeme the center of which contains iron in the form of ferrous reduced iron capable of binding four molecules of oxygen.
Reduced iron stores halt the production of hemoglobin chains, and its concentration begins to decrease in the newly formed RBCs since the red color of RBCs is due to hemoglobin the color of the newly formed RBCs begins to fade thus the name, hypochromic.
As the newly produced RBCs contain less amount of hemoglobin, they are relatively of small size when compared to normal RBCs, thus the name, microcytic. Iron deficiency hypochromic microcytic anemia is caused due to disruption of iron supply in diet due to decreased iron content in the diet, pathology the small intestines like sprue and chronic diarrhea, gastrectomy, and deficiency of vitamin C in the diet.
It may be due to acute or chronic blood loss and also due to suddenly increased demands of pregnancy or major trauma and surgery. Reduced hemoglobin in the RBCs decreases the amount of oxygen delivered to the peripheral tissues leading to tissue hypoxia. Normal RBCs contain a central zone of pallor which is usually the one-third of the size of RBC; however, in hypochromic microcytic anemia, that size increases and hemoglobin is usually only present in the peripheral rim of the RBCs.
Normal bone marrow stored iron gives a black-blue color on reaction with Prussian blue dye but, in hypochromic microcytic anemia that stainable iron is markedly decreased or even absent in severe cases. Poikilocytes in the form of small, elongated red cells pencil cells are also characteristically seen. In some cases, pica may be present. The patient may also have complained of food stuck inside the chest due to esophageal webs along with a swollen tongue glossitis this along with anemia is defined a Plummer-Vinson syndrome which is a rare manifestation of iron deficiency.
On physical exam, a patient may present with pallor evident on hands as well as conjunctivitis, tachycardia, increased respiratory rate, exhaustion, koilonychia spoon-shaped nails. Severe anemia may also lead to the production of signs and symptoms of angina due to decreased delivery of oxygen to cardiac myocytes. The first test to perform is complete blood count CBC which will indicate towards the presence of anemia after a thorough physical exam.
These parameters comment on the quantity of hemoglobin inside the RBCs they are both usually decreased in hypochromic microcytic anemia. The Next test to perform is iron studies which take a look at transferrin saturation, total iron binding capacity, and ferritin.
TIBC is usually increased in iron deficiency anemia, while transferrin saturation is markedly decreased in iron deficiency anemia. However, a low or normal ferritin level does not exclude the diagnosis of iron deficiency anemia because ferritin is an acute phase reactant hippocromica and its level increase during the time of infections.
Hipocromiac iron levels fall, transferrin levels increase in compensation. The peripheral smear will show small sized RBCs with pencil cells. Jipocromica microcytic cells will have a large zone of central pallor and a small peripheral rim of hemoglobin. After the anemmia of hypochromic microcytic anemia is established, iron replacement therapy hipocromcia be commenced. Therapy includes mg of ferrous sulfate three times a day orally.
Of this, up to 10 mg of iron can be absorbed from the gut and is the preferred initial treatment. Nausea and constipation are the side effects which limit the compliance of this therapy.
Compliance can be increased by gradually increasing the dose of the treatment while monitoring the patient for side effects. The impact of this treatment usually appears after 3 weeks, while the full effects will be evident by 2 months. The parenteral dose is usually the iron deficit plus one extra gram of iron to replenish the iron reserves of the body.
The differential diagnosis of hypochromic microcytic anemia can be thalassemias, anemia of chronic disease, lead poisoning, and X-linked sideroblastic anemia. To access free multiple choice questions on this topic, click here.
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Anemia, Microcytic Hypochromic Hammad S. Author Information Authors Hammad S. Introduction Anemia is defined as the reduction in circulating red-cell mass below normal levels. Etiology Microcytic, hypochromic anemia, as the name suggests, is the type of anemia in which the circulating RBCs are smaller than the usual size of RBCs microcytic and have decreased red color hypochromic.
Pathophysiology An adult human being requires 1 mg to 2 mg per day of iron. History and Physical The typical history indicates: Reduced dietary intake of iron. Evaluation The first test to perform is complete blood count CBC which will indicate towards the presence of anemia after a thorough physical exam. Parenteral iron products may be used when: Oral drugs produce unrelenting side effects. There is continued blood loss which cannot be corrected by oral supplementation.
Differential Diagnosis The differential diagnosis of hypochromic microcytic anemia can be thalassemias, anemia of chronic disease, lead poisoning, and X-linked sideroblastic anemia. Questions To access free multiple choice questions on this topic, click here. Comparison of haematology and biochemistry parameters in healthy South African infants with laboratory reference intervals.
Appropriateness of the study of iron deficiency anemia prior to referral for small bowel evaluation at a tertiary center. PMC ] [ PubMed: Can soluble transferrin receptor be used in diagnosing iron deficiency anemia and assessing iron response in infants with moderate acute malnutrition?
Damineni SC, Thunga S. J Aneemia Diagn Res. Similar articles in PubMed. Automated measurement of red blood cell microcytosis and hypochromia in iron deficiency and beta-thalassemia trait. Arch Pathol Lab Med. Correct assessment of iron depletion and iron deficiency anemia. Epub Jun 3. Ochratoxin A-induced iron deficiency anemia. Review Molecular basis of inherited microcytic anemia due to defects hipocromicca iron acquisition or heme synthesis.
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