The pathophysiology of anemia and the basis of its clinical investigation. Pruebas que evalúan el estado del hierro: Hierro del compartimiento funcional: Ferremia: Capacidad total de saturación de hierro (CTSH). Transcript of Clasificacion de anemias. Disminución de la capacidad transportadora de oxigeno de la sangre. Adaptaciones fisiológicas.
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Gastrointestinal investigations for clasifiicacion in the elderly: In pernicious anemia, pepsinogen I levels are low, gastric pH is high and gastric acid secretion does not respond to stimulation with histamine or pentagastrin. However, when the hemoglobin decreases and the bone marrow does not have regenerative capacity, the expected increase in reticulocytes fails, despite the increase in erythropoietin plasma level hypo-regenerative anemia [ 12 ].
Digestive diseases potentially causing anemia have been studied in clzsificacion, but other causes of anemia have been included in the text and tables. Pathogenic mechanisms involved in the production of anemia are very simple: A prospective study of bidirectional endoscopy clasificaicon and upper endoscopy in the evaluation of patients with occult gastrointestinal bleeding.
Anemia is a syndrome, not a disease, and therefore, the etiology must always be investigated and therapy must be directed mainly to the causal disease, and not only to restoring a normal hemoglobin concentration. The hematologist must revise the blood smear if primitive disease of bone marrow is suspected.
In recent years, the importance of serum soluble transferrin receptor has been recognized in differential diagnosis of IDA and ACD. Characteristics of marrow production and reticulocyte maturation in normal man in response to anemia. Therefore, when the bone marrow shows a normal regenerative capacity, there should be an inverse relationship between the decrease in hemoglobin and the increased number of reticulocytes regenerative anemia.
Anemia: Pathophysiology, Classification, Clinical Investigation
Based on these pathogenic mechanisms, anemia can be divided into two types. The ratio of anfmias number of myeloid to erythroid precursors the M: The anemia of chronic disorders. The hematologist should examine a blood smear if any clasificafion erythrocyte indices have been detected. The most likely causes of normocytic anemia are ACD, renal failure and primitive hematological diseases least frequently. Nutritional Anemias and Anemia of Chronic Disease 4.
The clinical history should emphasize the causes of blood loss, including non-gastrointestinal diseases, recent history of gastrointestinal symptoms, gastrointestinal surgery, use of nonsteroidal anti-inflammatory drugs, acetylsalicylic acid and anticoagulant therapy, family history of hematologic diseases and colorectal neoplasia[ 53 – 55 ]; all symptoms should be recorded, and not only the gastrointestinal ones. The few exceptions are in strict vegetarians and hereditary transcobalamin II deficiency a very claeificacion disease.
In such cases, the reticulocyte production index is decreased. Several diseases of the claaificacion may produce chronic or acute bleeding: Serum antibodies against intrinsic factor and parietal cells are not sensitive or specific enough to confirm the diagnosis.
Classification of anemia for gastroenterologists
What proportion of patients referred to secondary care with iron deficiency anemia have colon cancer? To resolve this problem, hematological analyzers provide the erythrocyte distribution curve, with an index of dispersion: The severity of clinical symptoms bears less relationship to the severity of the anemia than to the length of time over which the condition develops.
Generally, anemia must be fairly severe hemoglobin IV. Physiologic compensation for decreased rbc mass Each physiologic mechanism will be discussed below.
Common misconceptions in the diagnosis and management of anemia in inflammatory bowel disease. It has been said that all damage to the body from any pathologic state in the end is caused by hypoxia at some level. Therefore, we should keep in mind ACD as the most likely diagnosis in elderly and inpatients, and as the second most likely diagnosis in outpatients under 65 years of age[ 68 ]. When progenitor red cells are impaired selectively, bone marrow erythroblasts are much reduced or absent, while other hematological cellular lines remain normal.
In the absence of intake of any of the drugs mentioned above or alcohol, the most frequent cause of microcytic anemia is nutritional deficiency[ 50 ].
Last, but not least, the liver plays an essential role in the control of iron metabolism through the hepcidin pathway, and accounts for most vitamin B12, folate and iron stores. A bone marrow report of absent stainable iron is not diagnostic of iron deficiency. We review the World Health Organization definition of anemia, its morphological classification microcytic, macrocytic and normocytic and pathogenic classification regenerative and hypo regenerativeand integration of these classifications.
Association between the activation of macrophages, changes of iron metabolism and the degree of anaemia in patients with malignant disorders. Beutler has proposed a lower limit of hemoglobin g less in African Americans than in Caucasians. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases.
It is rare, but it should be noted that gastric or intestinal lymphoma sometimes presents as mild anemia with nonspecific gastrointestinal symptoms. Marrow biopsy is not usually performed just to measure the M: Disorders of iron metabolism.
Sickle cell disease is restricted to blacks. If there are no family antecedents of microcytosis, it is necessary to investigate acquired causes of non-iron deficiency microcytosis, mainly ACD and sideroblastic anemia. Unconjugated bilirubin is not water soluble and therefore will not be excreted in the urine, despite its elevation in the serum. Support Center Support Center.
Interpretation of laboratory tests is included, from the simplest blood count, routine biochemistry to the more specific iron metabolism, vitamin B12, folic acid, reticulocytes, erythropoietin, bone marrow examination and Schilling test. The WHO criterion has been accepted widely for diagnosis and publication, but its universal application has been questioned mainly because of racial differences.
Redistribution of blood flow In anemia selective vasoconstriction of blood vessels subserving certain nonvital areas allows more blood to flow into critical areas. Microcytic anemia Faced with microcytic anemia, the three main diagnostic possibilities include iron deficiency anemia IDAthalassemia, and anemia of chronic disorders ACD.
The laboratory tests needed to confirm the diagnosis include serum iron, transferrin, transferrin saturation, ferritin, urea and creatinine. The main donor sites who sacrifice their aerobic lifestyle are the skin and kidneys.
Su capacidad de reserva en el organismo frente a una dieta desprovista de el, no supera los tres meses. En la tabla 2 se resumen la principales causas.
The bleeding can be intense, with a sharp drop of hematocrit and obvious clinical signs; or of small intensity and chronic, with progressive decrease in hematocrit and MCV, which may go unnoticed. In the absence of aemias acid, homocysteine levels increase rapidly because it cannot be converted into methionine. Anemia can be classified as microcytic, normocytic or macrocytic, depending on MCV.