1. ANAEMIA
2012.12.06
Paj sir’s lecture note
jumbz

2.  Anaemia- british style
 Anemia – american style
 Acording to WHO(1960) proposed a
cut off value for hb content for
anaemia.It is 12%
 How ever excluded from this group
are
1.pregnant(15-49years)
2.children(6-59 months)
 For srilanka today,peak or the
maximum apears around to 9-11
months in children

3.  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

4.  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

5.  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)

6.  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.

7.  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.

8.  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.

9.  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

10.  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).

11.  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.

12.  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 them
wtare 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

13.  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 :D
 But 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.

14.  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.

15.  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.

16.  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
2.5kg
These infant ,in their middle and old
age will be affected in
1.DM
2.hypertension.
Their imunity is reduced

17.  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.

18.  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

19.  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.

20.  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.

21.  Synthesis of heme.
 1.succinyl CoA+glycine
 rate limitting step
 Delta.amino lenolenic acid
 inhibited by heme (surplace free)
 Porphobilinogen
 There is a feedback type inhibition
 Transferrin – 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.