A N E M I a Kuliah

A N E M I ADr.Erwin Taher SpPKBagian Patologi KlinikFakultas Kedokteran UISU M E D A N

-Pria : Kadar Hb < 14 gr/dl atau Hct < 42 % Wanita : Hb < 12 gr/dl atau Hct < 37 %.

-Evaluasi lanjutan anemia, didasari : (1) indeks retikulosit (2) penilaian blood film dan indeks eritrosit meliputi MCV, MCH dan MCHC (3) penentuan stadium (akut/kronis anemi)

*Retikulosit Indeks :

Retikulosit count RI = Observered Hct / 2 X normal Hct

RI < 2% inadequate RBC productionRI > 2% Excessive RBC destruction or loss

Hematokrit (vol %)MCV = X 10 ...... (FL) Eritrosit (juta/mm3)

Hemoglobin (gr/dl)MCH = X 10 .. (Pgr) Eritrosit (juta/mm3)

Hemoglobin (gr/dl)MCHC= X 100 ( % ) Hematokrit (vol%)

Classification of AnemiaA.Relative1. Macrroglobulinemia2. Pregnancy3. Athletes4. Postflight astronauts

B.Absolute1. Decreased red cell productiona. Stem cell failure(1) aplastic anemia(2) anemia of leukemia and of myelodysplastic syndb. Progenitor cell failure(1) pure red cell aplasia(2) anemia of renal failure

(3) Anemia of chronic disease(4) Endocrine disorder (e.g.,hypothyroidisme)c. Precursor cell failure(1) megaloblatic anemia(2) iron-deficiency anemia(3) thalasemia(4) hemoglobinopathy(5) hereditary enzymes deficiency2.Increased Red cell Destruction or lossa. Hereditary(1) membrane defects (e.g.,hereditary spherocytosis)(2) globin defects (e.g., sickle cell anemia)(3) enzyme defects (e.g.,PK def or G6PD def)b. Acquired(1) Macroangiopathy (traumatic)

(2)microangiopathy(3)antibody mediated(4)hyperspleenisme(5)acute blood loss(6)paroxysmal nocturnal hemoglobinuriamanual hematology, williams ,p.28, 6 th ed, 2003

Anemia (excessive destruction or loss) :trauma ; GI bleeding ; genitourinary (menorrhagia / gross hematuri) ; internal atau retroperitoneal bleeding.

Pada perdarahan akut, biasanya didapati manifestasi :hipovolemia, retikulositosis.

Pada perdarahan kronik, selalu disertai :defisiensi besi dan gambaran mikrositer hipokrom.

Anemia ( Hemolisis )(1)-hiperspleenisme (pansitopenia)(2)-Autoimmune Hemolitik anemia Coombs test positive,spherocytes

2 tipe autoantibodi yang menyebabkan lisisWarm antibodi (IgG) : Idiopathy, Limfoma, CLL, SLE, Drugs (methyldopa, penicilin, quinidine, INH, Sulfonamid)Cold antibodi (IgM) : infeksi mycoplasma, mononucleosis, Idiopathy.

(3) Mechanical trauma micro/macroangiopathy hemolitic, schistocytes : vasculitis, malignant hipertensi, graft rejection, HUS, DIC, eclampsi.

(4) Direct toxic effect infection (malaria, clostridia, toxoplasma )

(5) Kelainan membran sel eritrosit : spur cells (cirrhosis, anorexia nervosa) ; PNH; hereditary elliptocytosis

(6) Kelainan intrasellular : G6PD def, PK def, Hb pathy, Thalasemia, sickle cell

Abnormalitas Laboratorium-Blood Film :Peningkatan RI, polikromasi,RBCs nucleated-Blood Film : spherocytes, elliptocytes, target, sickle cell (tergantung pada gangguan yang mendasari)-Peningkatan billirubin indirect dan LDH-Peningkatan Hb plasma, penurunan haptoglobin-hemoglobinuria, hematuria,hemosiderinuria-Coombs test (+)-Osmotic Fragility Test -Hb elektroforesis