Anaemia

??? ???? ?????? Abstract Background Anaemia is vulgar worldwide specially in growing playries where solid food deficiencies ar prevalent. It is a uncouth problem in the out longanimous set but its ceaselessly neglected and taken lightly which no.inate cause hyperdynamic circulation disturbances and go off the esteem of morbidity and fatality rate. Aim To square up the preponderance of microcytic Hypochromic genus Anemia in euphony necessity room casualty in academy teaching hospital. order This is a descriptive cross-section(a) take on which was d peerless in the academy Teaching Hospital in which 75 of the catch room patients participated in the vignette.The state of nutrition of the patients was evaluated by a questionnaire answe tearing by the patients. Chapter One intro and Literature Review 1. 1 Introduction Anaemia Anaemia is specify as the simplification in the oxygen-transporting capacity of livestock, which usually stems from a reduction of the to tal circulating red cell dope to be small(a) shape amounts. transmission line haemoglobin direct is below 13. 5 g/dl in an with child(p) male and below 11. 5 g/dl in an heavy(p) female. (1) Classification Classified according to 1. Causes a. Inadequate return of red wrinkle cell. b. agate line loss genus Anemia * Acute repayable to acute hemorrhage. * continuing due to lowlife bleed, menorrhagia. . Excessive destruction of RBC (haemolysis). 2. Morphology a. Microcytic * campaign deprivation. * Thalassemia. * Sideroblastic. b. Microcytic * Folate inadequateness. * B12 deprivation. c. Normocytic * Aplastic genus Anemia. * Myelodysplastic anaemia. There argon many undiagnosed cases of anaemia that if leftover undetected give the bounce lead to several complications, those include (2) 1. Infections people with the anaemia atomic number 18 more(prenominal) susceptible to getting transmittances from viruses and bacteria. 2. Severe bleeding if bleeding is severe , internal and excessive then death can ensue if a livestock transfusion is non given and the cause of the bleeding is not treated. . Stroke if haemoglobin is defective, it can damage the walls of the red countercurrent vessels and this can result in narrowing or even blockages in the brain, which can lead to serious, life threatening strokes. (2) Microcytic Hypochromic Anaemia Microcytic genus Anemia is a gillyflower disorder characterized by small red blood cells (erythrocytes) which stir low haemoglobin and hence obtain a reduced ability to adopt oxygen through the body. The red blood cells are small due to a failure of haemoglobin synthesis or insufficient quantities of haemoglobin avai research lable. (3) Classification 1. Iron deficiency anaemia . Sideroblastic anaemia. 3. Thalassemia. Iron deficiency anaemia Its estimated to be the main cause of anaemia affecting intimately 10% of the population in developed countries and 25-50% in developing countries. The prevalen ce of bid deficiency anemia in the United States was 2 share in adult men, but was free-base to be more general in child-bearing women age. (4) Total body branding iron content is somewhat 2gm for females, and 6gm for males. rough of the iron inside the body is found in haemoglobin within erythrocytes (80%), with the remainder being found in myoglobin and iron containing enzymes.Iron is stored in liver-colored, spleen, gussy up marrow and skeletal muscle. This iron storage pool contains on middling 15-20% of total body iron. (4) Iron is transported in the plasma by an iron binding protein called transferrin. In normal individuals, transferrin is about 33% alter with iron. dietetic iron is obtained either from inorganic sources or animal sources. Dietary iron enters intestinal cells via specific transporters. The iron is then used by the cell, stored as ferritin or transferred to the plasma. (4) Erythropoiesis is the development routine in which new erythrocytes are pro duced, through which each cell matures in about 7 days.Through this process erythrocytes are continuously produced in the red bone marrow of heroic bones, at a rate of about 2 million per warrant in a healthy adult. The bloods red color is due to the ghost handle properties of the hemic iron ions in hemoglobin. The red blood cells of an average adult human male store collectively about 2. 5 grams of iron, representing about 65% of the total iron contained in the body. (5)(6) Causes * Poor intake. * Decreased soaking up (celiac disease, gastrectomy). * Increased demand in growing adolescents and pregnancy. * Blood loss from GIT due to * Hookworm infestation. Erosions associated with NSAID, peptic ulcer or neoplastic disease. * Hemorrhoids. * Blood loss from irregular or excessive menstruation. Symptoms and signs (7) Symptoms whitethorn include * Fatigue. * abruptness of breath * Lightheadedness. * Palpitations. * Dizziness. * Chest pain. * Blurred vision. * Sleep disturbance. Si gns may include * fast heart rate. * broken blood pressure. * Rapid breathing. * Pale conjunctiva. * Cold skin. * elaboration of the spleen. Diagnosis of iron deficiency anaemia * Complete blood count and color with iron deficiency anaemia red blood cells are smaller and paler in color than normal. Hematocrit This is the percentage of blood playscript made up by red blood cells. Normal levels are generally 41% for adult women and 47% for adult men. These values may change depending on your age. * Haemoglobin Lower than normal hemoglobin levels present anemia (12-16 g/dl in an adult male and 13. 7-17. 5 g/dl in an adult female). * Ferritin This protein helps store iron in your body, and a low level of ferritin usually indicates a low level of stored iron. Some tests might be through with(p) to detect the underlying cause, like * Endoscopy Often to check for bleeding from a hiatal hernia, an ulcer or the stomach. Colonoscopy To regularization out lower intestinal sources of blee ding. * Ultrasound Women may also have a pelvic ultrasound to look for the cause of excess menstrual bleeding, such as uterine fibroids. (8)(9) Sideroblastic anaemia It is a disease in which the bone marrow produces ringed sideroblasts rather than healthy red blood cells (erythrocytes). 10 In Sideroblastic anemia, the body has iron available but cannot incorporate it into hemoglobin, which red blood cells need to transport oxygen efficiently.Sideroblasts are atypical, atypical turn erythroblasts (precursors to mature red blood cells) with granules of iron accumulated in perinuclear mitochondria. 11 Sideroblasts are watch outn in aspirates of bone marrow. Causes * Failure to completely form heme molecules, This leads to deposits of iron in the mitochondria that form a ring around the nucleus of the developing red blood cell. * Toxins lead, copper or zinc poisoning * Drug-induced ethanol, isoniazid, chloramphenicol, cycloserine, spoken Contraceptives * Nutritional pyridoxine (Vit amin B6) or copper deficiency * Diseases Rheumatoid arthritis, or multiple myeloma Genetic ALA synthase deficiency (X-linked, associated with ALAS2)12 Symptoms and signs * Pale skin, eyelids and lips. * Fatigue and weakness. * Dizziness. * Enlarged liver and/or spleen. Diagnosis Ringed sideroblasts are seen in the bone marrow. lab findings * Increased ferritin levels * Normal total iron-binding capacity * Hematocrit of about 20-30% * serum Iron High * High transferrin saturation * The mean corpuscular volume or MCV is usually normal or low. * With lead poisoning, see coarse basophilic stippling of red blood cells on peripheral blood smear * Specific test Prussian Blue stain of RBC in marrow.Shows ringed sideroblasts. * can also cause microcytic hypochromic anemia. (12) Thalassemia It is a group of inherited autosomal recessive blood disorders that originated in the Mediterranean region. In Thalassemia the genetic defect, which could be either mutation or deletion, results in reduce d rate of synthesis, or no synthesis of one of the globins chains that make up hemoglobin. This can cause the formation of irregular hemoglobin molecules, thus causing anemia, the characteristic presenting symptom of the Thalassemia. (13) Symptoms and signs * Fatigue and weakness. * gruffness of breath. * Pale appearance. Irritability. * Yellow discoloration of the skin. * Facial bone deformities. * Slow growth. * ab swelling. * Dark urine. (14) Diagnosis * Blood tests. * Prenatal screening. (14) Laboratory findings * A low level of red blood cells * Smaller than expected red blood cells * Pale red blood cells * Red blood cells that are change in size and shape * Red blood cells with uneven hemoglobin distribution, which gives the cells a bulls-eye appearance under the microscope. (14) 1. 2 Literature Review A written report was done in Italy about prevalence and incidence and types of temperate anaemia in the elderly.The objectives of this study were to estimate the prevalenc e and incidence of cracked grade anemia and to assess the frequency of anemia types in the elderly. envision and Methods This was a prospective, population-based study in all residents 65 years or older in Biella, Italy. Results Blood test results were available for synopsis from 8,744 elderly. haemoglobin concentration decreased and mild anemia increased steadily with change magnitude age. Mild anemia (defined as a hemoglobin concentration of 10. 0-11. 9 g/dL in women and 10. 0-12. 9 g/dL in men) affected 11. % of the elderly included in the analysis, while the estimated prevalence in the entire population was 11. 1%. Before hemoglobin determination, most lightly weak individuals perceived themselves as non-anaemic. Chronic disease anemia, Thalassemia trait, and nephritic insufficiency were the most frequent types of mild anemia. (15) A study was done in emergency ward, Mulago Hospital, Uganda. Anaemia is a common problem in Africa, with prevalence ranging from 21. 1% to 64 . 4% 16-21 and a significant impact on morbidity and mortality. 22,23 in patients with AIDS low haemoglobin levels are associated with unfortunate outcomes. 4-27 However, anaemia in Africa has multiple causes, with infectious diseases such as HIV, terbium and malaria contributing significantly to the anaemia burden. 28 Hookworm is a major contributor to anaemia and even light hookworm loads are associated with low haemoglobin levels, 29-33 although Lewis et al. reported that hookworm was not a common cause of anaemia among checkup patients in Malawi. In a cross-sectional descriptive study 395 patients were recruited by systematic random sample distribution and their socio-demographic characteristics and clinical details smooth.A complete blood count and peripheral film inquiry were done and stool examined for hookworm ova.. Of the patients 255 (64. 6%) had anaemia. The prevalence was higher among males (65. 8%) than females (63. 7%). Fatigue (odds ratio (OR) 2. 1, confidence interval (CI) 1. 37 3. 24), dizziness (OR 1. 64, CI 1. 07 2. 44), previous blood transfusion (OR 2. 83, CI 1. 32 6. 06), lymphadenopathy (OR 2. 99, CI 1. 34 6. 66) and splenomegaly (OR 5. 22, CI 1. 78 15. 28) were significantly associated with anaemia. Splenomegaly, low body mass index (BMI) (<19) and being HIV positive were nonsymbioticly associated with anaemia.The commonest type of anaemia was Hypochromic microcytic (34. 1%). Only 10. 6% of anemic patients had hookworm infestation. (34) A study was done in north Vietnam was proposed to assess the prevalence of iron deficiency and anemia and associated risk factors in a community-based sample of women living in a rural province of northwest Vietnam. A cross-sectional survey, comprised of write questionnaires and laboratory analysis of hemoglobin (Hb), ferritin, transferrin receptor, and stool hookworm formal count, was undertaken, and the soluble transferrin receptor/log ferritin index was calculated. Of 349 non-pregna nt women, 37. 3% were anemic (Hb < 12 g/dL), and 23. 10% were iron deficient (ferritin < 15 ng/L). Hookworm infection was present in 78. 15% of women, although heavy infection was uncommon (6. 29%). Iron deficiency was more prevalent in anemic than non-anemic women (38. 21% versus 14. 08%, P < 0. 001). Consumption of meat at least three times a week was more common in non-anemic women (51. 15% versus 66. 67%, P = 0. 042). Mean ferritin was lower in anemic women (18. 99 versus 35. 66 ng/mL, P < 0. 001). There was no indicate of a difference in prevalence (15. 20% versus 17. 23%, P = 0. 629) or intensity (171. 7 versus 129. 93 eggs/g, P = 0. 412) of hookworm infection between anemic and non-anemic women. (35) In the United States a study was done to gibe the prevalence of iron deficiency and iron deficiency anemia in the US population. A total of 24 894 persons gray 1 year and older examined in the third National wellness and Nutrition Examination Survey (1988-1994). Iron d eficiency, defined as having an abnormal value for at least 2 of 3 laboratory tests of iron status (erythrocyte protoporphyrin, transferrin saturation, or serum ferritin) and iron deficiency anemia, defined as iron deficiency plus low hemoglobin.Nine percent of toddlers vulcanised 1 to 2 years and 9% to 11% of adolescent girls and women of vaginal birth age were iron deficient of these, iron deficiency anemia was found in 3% and 2% to 5%, respectively. These prevalences correspond to approximately 700000 toddlers and 7. 8 million women with iron deficiency of these, approximately 240 000 toddlers and 3. 3 million women have iron deficiency anemia. Iron deficiency occurred in no more than 7% of older children or those older than 50 years, and in no more than 1% of teenage boys and young men.Among women of childbearing age, iron deficiency was more likely in those who are minority, low income, and multiparous. (36) Chapter Two confession * Anaemia is common worldwide specially in de veloping countries where nutrient deficiencies are prevalent. * Nutritional iron deficiency anaemia is difficult to operate in Sudan due to poor socio-economic status and this leads to the progression of it. * Anaemia is a common problem in the outpatient set but its of all time neglected and taken lightly. * Undetected anaemia can cause hyperdynamic circulation disturbances and raise the rate of morbidity and mortality.Chapter Three Objectives General * To determine the prevalence of anaemia in music emergency room (ER) casualty in academy teaching hospital. Specific * To determine the prevalence of microcytic Hypochromic anaemia in medicine emergency room casualty in academy teaching hospital. * To determine the greatest age group of the sample size that presents at the medicine emergency room. * To determine the number of meals per day in relation to the anaemia. * To determine the greatest gender risk group for the microcytic Hypochromic anaemia. Chapter Four Methodology 4. 1 get wind DesignA cross-sectional descriptive study. 4. 2 Study Period The study was conducted in a period from the first of October till the end of December. 4. 3 Study Area The study was done in the emergency room of the honorary society Teaching Hospital located in Al-sahafa East. 4. 4 Study Population Patients present at the medicine emergency room of the Academy Teaching Hospital were included in the study during the study period 2011-2012. Patients present at the outpatient were excluded. 4. 5 Variables Background variables * typewrite of the anemia. * Gender in relation to the anaemia. Causes in relation to the anaemia. * Age in relation to the anaemia. 4. 6 Sampling Technique Simple random sampling of 75 patients was done based on * Age between 16-45 years. * interdict previous history of anaemia. * No history of blood disorder. * No pregnancy. 4. 7 Sample Size All patients were go awaying to participate. A total of 75 patients participated in the study. 4. 8 Data colle ction Techniques and Tools * a questionnaire including demographic data, symptoms, medical history, physical examination and nutritional status is given to each patient to be filled by him/her or an assistant. On enrolment of patients into the emergency room, 3 ml of peripheral blood will be collected in plastic container. * Blood samples will be sent to the lab for screening of anemia and its specific morphology using complete blood count test and platelet count. 4. 9 Data management and summary To analyze the collected data, Statistical Package for Social Sciences (SPSS research software) will be used. Used to calculate the prevalence of anemia, through a pre-coded system. 4. 10 Ethical Consideration * Ethical approval for the study was obtained from the ethical committee at the University of medical checkup Sciences & Technology.Verbal consent was taken from individuals under the study. * The entropy used in this study is confidential and only used for the pop the questio n of this research. Chapter Five Recommendation 1. Mandatory screening of blood for anaemia and microcytic Hypochromic anaemia. 2. investigating for the causes of anaemia and follow up. 3. Iron supplements under doctors ethical drug are recommended for patients with less than three meals per day. 4. Education and spreading of awareness about the important sources of iron and harmful sides of soft drinks, tea and coffee. Chapter Nine References 1. Mohammad Inam Danish.Medical diagnosis and management. Karachi institute of heart diseases, 2010. 2. Sited http//www. vitalhealthzone. com/health/conditions/a/anaemia/06_complications_of_anaemia. html 3. Sited http//www. websters-online-dictionary. org/definitions/microcytic+anemia 4. Vinay Kummar, Abul K. Abbas, Nelson Fausto. Basic pathology. 8th edition, 2007. 5. Laura Dean. Blood Groups and Red Cell Antigens. National place for Biotechnology Information (NCBI), National Library of Medicine, National Institutes of Health, 2005. 6. Ka banova S, Kleinbongard P, Volkmer J, Andree B, Kelm M, Jax TW .Gene expression analysis of human red blood cells. International Journal of Medical Sciences 6, 2009 (4) 1569. 7. Sited http//www. emedicinehealth. com/anemia/page3_em. htm 8. Marks PW. Anemia. National Heart, Lung, and Blood Institute. Mayo Clinic, 2011 January 6. 9. Rochester, Minn. Laboratory reference values. hematology group. Mayo Foundation for Medical Education and Research, 2011 January. 10. Sideroblastic Anemias Anemias Caused by Deficient Erythropoiesis at Merck Manual of Diagnosis and Therapy Professional Edition 11. Sideroblast at Dorlands Medical dictionary 12. Aivado M, Gattermann N, Rong A, et al.X-linked sideroblastic anemia associated with a novel ALAS2 mutation and unfortunate skewed X-chromosome defusing patterns. Blood Cells Mo, 2006. Dis. 37 (1) 405 13. Hemoglobinopathies and Thalassemias. 14. .mayo clinic staff, thalassemia. Mayo Foundation for Medical Education and Research (MFMER). , 1998-2012. 15. Mauro Tettamanti, Ugo Lucca, Francesca Gandini. prevalence, incidence and types of mild anemia in the elderly. Haematol, 2010 November 1. 16. spell I, Khamis AH, Elbashir MI. Prevalence and risk factors for anaemia in pregnant women of eastern Sudan. Trans R Soc Trop Med Hyg 2005 99(10) 739-743. 7. Asobayire FS, Adou P, Davidsson L, Cook JD, Hurrell RF. Prevalence of iron deficiency with and without concurrent anemia in population groups with high prevalences of malaria and other infections a study in Cote dIvoire. Am J Clin Nutr 2001 74(6) 776-782. 18. Charlton KE, Kruger M, Labadarios D, Wolmarans P, Aronson I. Iron, folate and vitamin B12 status of an elderly South African population. Eur J Clin Nutr 1997 51(7) 424-430. 19. Dicko A, Mantel C, Thera MA, et al. Risk factors for malaria infection and anemia for pregnant women in the Sahel orbit of Bandiagara, Mali. Acta Trop 2003 89(1) 17-23. 0. Leenstra T, Kariuki SK, Kurtis JD, Oloo AJ, Kager PA, ter Kuile FO. Prevalence an d severity of anemia and iron deficiency cross-sectional studies in adolescent schoolgirls in western Kenya. Eur J Clin Nutr 2004 58(4) 681-891. 21. Sserunjogi L, Scheutz F, Whyte SR. Postnatal anaemia neglected problems and missed opportunities in Uganda. Health Policy Plan 2003 18(2) 225-231. 22. Culleton BF, Manns BJ, Zhang J, Tonelli M, Klarenbach S, Hemmelgarn BR. have-to doe with of anemia on hospitalization and mortality in older adults. Blood 2006 107(10) 3841-3846. 23. Ma JZ, Ebben J, Xia H, Collins AJ.Hematocrit level and associated mortality in hemodialysis patients. J Am Soc Nephrol 1999 10(3) 610-619. 24. Elliott AM, Halwiindi B, Hayes RJ, et al. The impact of human immunodeficiency virus on mortality of patients treated for tuberculosis in a cohort study in Zambia. Trans R Soc Trop Med Hyg 1995 89(1) 78-82. 25. . Moore RD. Human immunodeficiency virus infection, anemia, and survival. Clin Infect Dis 1999 29(1) 44-49. 26. OBrien ME, Kupka R, Msamanga GI, Saathoff E, Hu nter DJ, Fawzi WW. Anemia is an independent predictor of mortality and immunologic progression of disease among women with HIV in Tanzania.J Acquir Immune Defic Syndr 2005 40(2) 219-225. 27. Sullivan PS, Hanson DL, Chu SY, Jones JL, Ward JW. Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons results from the multistate adult and adolescent spectrum of HIV disease surveillance project. Blood 1998 91(1) 301-308. 28. Morris CD, Bird AR, Nell H. The hematological and biochemical changes in severe pulmonary tuberculosis. Q J Med 1989 73(272) 1151-1159. 29. Akhwale WS, Lum JK, Kaneko A, et al. Anemia and malaria at different altitudes in the western highlands of Kenya. Acta Trop 2004 91(2) 167-175. 0. Bates I, McKew S, Sarkinfada F. Anaemia a useful index finger of neglected disease burden and control. PLoS Med 2007 4(8) e231. 31. Stoltzfus RJ, Albonico M, Chwaya HM, et al. Hemoquant determination of hookworm-related blood loss and its mathematical function i n iron deficiency in African children. Am J Trop Med Hyg 1996 55(4) 399-404. 32. Sturrock RF. Hookworm studies in Uganda investigations at Teboke in Lango District. East Afr Med J 1966 43(10) 430-438. 33. Tatala S, Svanberg U, Mduma B. Low dietary iron availability is a major cause of anemia a nutrition survey in the Lindi District of Tanzania.Am J Clin Nutr, 1998 68(1) 171-178. 34. Japheth E Mukaya, Henry Ddungu, Francis Ssali, Tim OShea, Mark A Crowther. Prevalence and morphological types of anaemia and hookworm infestation in the medical emergency ward. SAMJ, S. Afr. med. J, 2009 December vol. 99 no. 12 Cape Town, 35. Sant- Rayn Pasricha, Sonia R. Caruana, Tran Q. Phuc, Gerard J. Casey, Damien Jolley. Anemia, Iron deprivation, Meat Consumption, and Hookworm Infection in Women of Reproductive Age in Northwest Vietnam. Am J Trop Med Hyg, 2008 contact vol. 78 no. 3 375-381. 36. Anne C. Looker, Peter R. Dallman, Margaret D. Carroll, Elaine W.Gunter, Clifford L. Johnson. Prevalence of Iron Deficiency in the United States. JAMA, 1997277(12)973-976. Chapter Ten Appendix 10. 1. Questionnaire Nutritional status Prevalence of microcytic Hypochromic anaemia in medicine emergency room in Academy Teaching hospital ??? ???? ?????? ?????? ??????? ??????? / /2011?. ????? ______ ????? _____ ????? ________ ??????? ________________ ??????? ___________ ??????? ??????? ___________________________ &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212 1. ?? ??? ????? ??? ??? ???????? _____________________________________. 2. ?? ??????? ???? ???? ??? ??? ????? ??? ??? ???????? ____________________________________________________________________________________. 3. ??? ???? ??? ??????? ?? ??????? ____________________________________. 4. ?? ??? ????? ???? ?? ?????? ?? ??? ??????? __________________________________. &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212 &8212&8212&8212&8212 ?? ????? ?? ???? ??????? ???? ???? ???? ????? ?????? ???????. * ?????? ?????? ???????. _____________ * ??????. ______________ * ????? ?? ??????. ______________ * ?????? ????? ?????. ______________ * ?????? ?? ????? ??? ??? ?????? 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(????? , ?????? ) ????????? ??????? ?? ??? ??????? ???? ??? ??????? ?? ????? , ????????? ___________________________________________________________________________________. &8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212&8212- ?? ??? ???? ???? ????? ____???. _____??. ?????? ____???. _____??. ?? ????? ____???. _____??. ??? ???? _______________________. ?? ??? ?????? ?? ?????? ______________________. ?? ?????? ??????? ____???. _____??. ??? ???? __________________________. ?? ???????? ???? ______????. _____??????. ??? ???? ,?? ??? ?????? ?? ?????? __________. ??? ?????? ,?? ??? ?????? ?? ???????? ___________. ?? ?? ??????? ___________________. ?? ?????? ???????? ____???. ______??. ??? ???? ______________________. ?? ??? ?????? ?? ?????? __________________. ?? ???? ??? ?? ??????? ???? ???? ?? ???? , ??? ??? ???????? ________________________________________. ?? ???? ??? ?? ??? ???? ???? ???? ??? ???? , ??? ??? ???????? _______________________________________.