1. Kehilangan darah Uterus : Polimetrorhagi, Post partum hemorrhagi Gastro Int: Varices oesofagus, ulkus peptikum, minum aspirin, gastrektomi, ca lambung / sekum / kolon / rektum , cacing tambang, kolitis, hemorrhoid, devertikulosis. Hematuria, Hemoglobinuria Hemosiderosis Pulmonum2. Kebutuhan meningkat Kehamilan , pertumbuhan Prematuritas3. Malabsorpsi Gastrektomi, penyakit coeliac4.Diet buruk

Anemia Hipokrom Mikrositer

Iron Studies

Def Fe An.Peny Hb Studies BMP Kronik Thalasemia Sideroblastik Anemia

FerritinN / NN / IronNN / TIBCN / NN% SaturationNN /

ERITROPOESISINTRA CELLULER PROCESS IN ALL TISSUESHEMO PROTEIN OXYGEN TRANSPORTFOUR HAEM FOUR POLYPEPTIDE CHAINHb BM : 64.500MYOGLOBIN 17.000 SINGLE POLYPEPTIDE CHAIN + 1 HAEM GROUPFERRITIN SOLUBLE PROTEINAPO FERRITIN : 480.000HEMOSIDERIN AMORF INSOLUBLE STORAGE COMPOUND IRON CONTENT MENINGKAT DARI FERRITINTRANSFERRIN GLOBULIN BM 80.000= BIND 1.3 ug Iron / mg PROTEIN= 2.3 gr / l PLASMA CONCENTRASI= DI PRODUKSI DI HEPAR

KELUAR 1mg ABSORPSI JARINGAN 1 mg TRANSFERIN

20 MG 20 MG

20 MG 20 MGSUM-SUM TLSEL RE (macrofag )HEMOGLOBINYANG BEREDAR

Doudenum & Less Jejenum

Factor FavouringFactor ReducingFerrous FormIn Organic ironAcids, Hcl, Vit CSolobilising Agent, sugar, amino acidIron DefIncreased EritropoesisFerric FormOrganic IronAlkali AntacidPancreatic SecretionsPrecipitating AgentFosfatIron ExcessDecreased Eritropoesis Infection

JUMLAH BESI RATA RATA DEWASA

KARAKTERISTIK ANEMIA DEF .Fe &ANEMIA PENYAKIT KRONIK

Batas normal :PriaWanitaAnak anakDefisiensi besiKelebihan besi ( Iron over load )

40 34014 1507 1400 12340 - > 20.000

Metoda Penilaian Cadangan BesiSerum FerritinSerum Iron Sarurated TransferinBiopsi sum sum tulang ( Hemosiderin )Biopsi Hati ( RES Store )Liver CT ScanTest Ekskresi DesferoksaminPhlebotomi Berulang sampai terjadi Def BesiPenilaian Kerusakan JaringanDisebabkan Kelebihan beban BesiJantung Klinis, x foto Thorax, EKG, Ekokardiografi.Hati Test Faal hati. Biopsi hatiEndokrin G.T.T, Test pelepasan Gonadotropin , Hypofise

Kausal:Def. Vit. B 12Def. As. FolatAbnormalitas Metabolisme Vit B 12 atau FolatCacat sintesa DNA Def Enzim CongenitalDidapatTerapi Hidroksi, Sitosin Arabinosa

DNA

dATP dGTP dCTP dTTP dTDP DHF Poliglutamat dTMP THF 5.10 metilen THF dUMP Poliglutamat poliglutamat

THF metionin B12 Metil THF homosistein

Membran sel

Metil THF Plasma Folat makanan di usus halus

KAUSAL DEF.VIT B. 12 * KAUSAL DEF.AS FOLATVeganismeMalabsorbsi - Lambung-Anemia Pernisiosa-Intrinsik faktor def kongenital-Gastrektomi total / partial - Intestinal-Intestinal stagnant loop syndr-Divertikulosis Jejunal-Blind loop-Striktura-Kronik tropical Sprue-Reseksi Ileum / Peny Crohn-Malabsorpsi selektif congenital dengan proteinuriaNutrisional-umur tua, poor, scorbut, gastrektomi parsialMalabsorpsi-Tropical Sprue-Peny coeliac-Reseksi jejunum yang luas-Peny CrohnPemakaian berlebihana.Fisiologikehamilan,laktasib.PatologiAn.hemolitik, meilosklerosis, keganasan dllPembuangan folat urine >>>CHFTerapi obat konvulsanCampuran : peny hati,alkoholisme

ANEMIA MEGALOBLASTIKHEMATOLOGIC FINDING-Hb ( 7 8 ) g/dl, Eri , Ht ( 5 15 ) % -Indek hematologi-MCV > Normal ( 95-130 ) fl-MCH ( 33 56 ) pg-MCHC Normal-Lekosit Lekopenia-Trombosit -Morfologi-EriMacro ovalocyte, anisositosis, poikilositosis, cabot ring, basofilik, Howell Jolly Bodies.-LekositNetropenia, Hipersegmentasi Shift to the Right-Red cell survival time: (1/4 ) Nml- Sum Sum Tulang-Eritroid hiperplasia:megaloblastosis-Metarubrisit Megalosit-ratio inti sitoplasma asinkron-Granulopoesis abnormal-giant matamyelosit dan hipersegmentasi.-Megakariosit inti irreguler-Adanya Eritro Fagositosis-Hemosiderin

PERIPHERAL BLOOD IN PERNICIOUSThere are two late megalobalst with nuclear rossete formation and basophil stipplingThe red cells show macrocytosis, anisocytosis and poikilocytosisMulti lobed neutrophil polymorph

1. Macrocytic erytrocyte from anemia pernicious with Howell Jolly bodies.2. Hypochromia and microcytosis12

NON HEMATOLOGI FINDINGAnalisa asam lambung-Histamin Fast Achlorhydria-Pepsin ( - ) : renin ( - ),Vol asam total -Total Gastric Failure-Asam bebas ( - ) / : PH -Ekskresi faktor intrinsik sangat -Serum B 12 dan Asam folat Serum Iron : TIBC N / S.I LDH Isoenzim LDH1 lebih tinggi dari LDH2Autoantibodi ( 3 tipe )-Anti parietal cell antibodi-Anti Intrinsik faktor antibodi block-Anti Intrinsik faktor antibodi binding-Cytogenetik ( abnormal kromosom non spesifik )