Anemia: Visão Geral

Descrição Geral

Definição

A anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types é uma deficiência quantitativa de Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange, o componente portador de oxigénio dos GV. A anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types é constatada quando os níveis de Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange são aproximadamente:

• < 13,5 g/dL em homens adultos
• < 12 g/dL em mulheres adultas
• < 11 g/dL em crianças

Os níveis normais podem variar de acordo com a faixa de referência do laboratório.

Epidemiologia

• Encontrada em pacientes de todas as idades, desde bebés a idosos.
• Mais MAIS Androgen Insensitivity Syndrome comum em mulheres do que em homens
• Prevalência:
  • > 20% dos indivíduos que têm > 85 anos de idade
  • A anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types por deficiência de ferro ligeira é comum em mulheres em idade reprodutiva.
• As hemoglobinopatias são mais MAIS Androgen Insensitivity Syndrome comuns em certas etnias:
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types falciforme: Descendência negra ou africana
  • Esferocitose hereditária: Descendência europeia
  • Talassemia: Descendência mediterrânica e do sudeste asiático

Revisão de anatomia e fisiologia

• Os GV são produzidos na medula óssea.
• Células estaminais hematopoiéticas pluripotentes → célula estaminal mielóide comum → proeritroblasto → eritrócito
• A produção de GV é estimulada pela eritropoietina, que é produzida nos rins.
• Os GV são filtrados através do baço: os GV senescentes, rígidos ou anormais, incapazes de se adaptar para passaar através das fendas estreitas do baço, são retidos e eliminados.

Etiologia

A anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types pode ser causada por:

• Perda de sangue
• Diminuição da produção de GV
• Aumento da destruição de GV

Classificação da anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types de acordo com a etiologia

Classificação

A anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types é mais MAIS Androgen Insensitivity Syndrome comumente classificada nos subtipos microcítica, normocítica ou macrocítica, com base no tamanho dos GV. O VCM reflete o tamanho dos GV e é reportado no hemograma.

Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types microcítica

A anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types microcítica é caracterizada por pequenos GV, logo com um baixo VCM. Estas características são geralmente devido a uma diminuição da Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange dentro dos GV. As causas incluem:

• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types por deficiência de ferro:
  • A causa mais MAIS Androgen Insensitivity Syndrome comum de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types
  • Causas:
    • Perda crónica de sangue pelo trato GI
    • Hemorragia menstrual intensa crónica
    • Má absorção de ferro na doença gastrointestinal crónica (por exemplo, doença de Crohn ou celíaca)
    • Ferro ingerido na dieta é insuficiente
    • Gravidez
• Talassemia
• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types da doença crónica (fases avançadas)
• Intoxicação por chumbo
• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types Sideroblástica

Mnemónica:

Para lembrar as causas da anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types microcítica, utilize a Mnemónica TAILS:

• Thalassemia (Talassemia)
• Anemia of chronic disease ( Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types da Doença Crónica)
• Iron deficiency anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types ( Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types por deficiência de ferro)
• Lead poisoning (Intoxicação por chumbo)
• Sideroblastic anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types ( Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types Sideroblástica)

Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types normocítica

As anemias normocíticas têm um VCM normal. Normalmente, a contagem de reticulócitos é usada para ajudar a orientar o diagnóstico diferencial. (Os reticulócitos são “novas” células sanguíneas em circulação e o seu valor reflete a taxa de produção de novos GV). As causas de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types normocítica incluem:

Anemias hemolíticas:

• Terão uma contagem de reticulócitos > 3%: indica o funcionamento normal da medula óssea
• Causada por defeitos intrínsecos das hemácias:
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types falciforme
  • Deficiência de G6PD G6PD Pentose Phosphate Pathway
  • HPN
  • Esferocitose hereditária
• Causas devido a defeitos extrínsecos:
  • Anemias hemolíticas autoimunes (por exemplo, LES)
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica microangiopática (por exemplo, PTT, síndrome hemolítico uremico (SHU), CID)
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica macroangiopática (por exemplo, válvulas cardíacas protésicas ou estenose aórtica)
  • Infeções (por exemplo, malária)

Anemias não hemolíticas:

• Terão a contagem de reticulócitos < 3%: indica que a medula óssea não está responder ao fator de stress, levando à subprodução de GV
• Causas:
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types da doença crónica (estadios iniciais), geralmente DRC
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types de insuficiência cardíaca ( IC IC Inhaled Anesthetics)
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types por deficiência endócrina (por exemplo, hipotiroidismo ou insuficiência adrenal)
  • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus
  • Obesidade
  • Neoplasia
  • Anemias aplásicas
  • Perda de sangue < 1 semana atrás (medula óssea está a funcionar corretamente, mas ainda não teve tempo suficiente para recuperar a perda de sangue)

Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types macrocítica

As anemias macrocíticas têm um VCM elevado, ou seja, GV grandes. As causas incluem:

• Anemias megaloblásticas (o problema está na medula óssea):
  • Deficiência de vitaminas necessárias para a síntese adequada do DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure (devido à ingestão insuficiente ou má absorção):
    • Défice de vitamina B₁₂
    • Deficiência de folato
  • Causas mais MAIS Androgen Insensitivity Syndrome raras:
    • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types de Diamond-Blackfan: aplasia Aplasia Cranial Nerve Palsies eritróide congénita que geralmente se apresenta na infância; os leucócitos e plaquetas estão normais
    • Acidúria orótica: doença autossómica recessiva que apresenta atrasos físicos e intelectuais na infância, resultantes de defeitos no metabolismodo ácido orótico.
• Anemias não megaloblásticas (o problema está fora da medula óssea); pode ser devido a:
  • Doença hepática
  • Distúrbios relacionados com o abuso de álcool
  • Reticulocitose
  • Drogas (várias)

Outras formas de classificar a anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types

• Aguda ou crónica
• Defeitos hereditários ou adquiridos
• Primária ou secundária

Apresentação Clínica

Antecedentes

Detalhes importantes quando se considera o diagnóstico de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types:

• Antecedentes de disturbio alimentar
• Antecedentes de cirurgia gástrica ou intestinal
• História familiar de doenças hematológicas
• Fármacos que causam ou agravam a hemorragia
• Fármacos que possam causar anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica
• História de viagens recentes
• História de dieta especial que possa levar a uma deficiência vitamínica (por exemplo, dieta vegan)
• Quantidade de álcool consumida

Sintomatologia e exame físico

Os sintomas desenvolvem-se com base na taxa e na gravidade da diminuição de Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange. A anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types é frequentemente assintomática e encontrada apenas em estudos laboratoriais.

Diagnóstico

O processo diagnóstico normalmente começa com a avaliação do hemograma completo, do VCM e da contagem de reticulócitos, que são os melhores parâmetros a ser avaliados simultaneamente para começar a direcionar o caso para o diagnóstico diferencial. Estudos adicionais podem ser obtidos com base na apresentação clínica do paciente.

Estudos serológicos

• Resultados do Hemograma:
  • Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange diminuída (componente dos GV)
  • Hct diminuído (relação entre o volume de GV e o volume de sangue, expressa em percentagem)
  • VCM: ajuda a direcionar o diagnóstico diferencial
  • Pancitopenia: geralmente vista na anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types megaloblástica
  • Factores que elevam a Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange e podem mascarar a anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types subjacente:
    • Hábitos tabágicos
    • Hemoconcentração devido a hipovolemia
    • Altitude elevada
• Avaliação de reticulócitos:
  • Contagem de reticulócitos:
    • Os reticulócitos são GV imaturos em circulação
    • Pode ser expresso como uma percentagem de todos os GV ou como um número absoluto
  • ↑ da contagem de reticulócitos indica:
    • Hemólise
    • Recuperação de hemorragias
    • Remoção de um tóxico da medula óssea (por exemplo, droga)
    • Repleção de nutrientes deficitários
  • A contagem de reticulócitos corrigida:
    • Demonstra uma resposta adequada vs inadequada da medula óssea
    • Cálculo: Contagem de reticulócitos × (Hct do paciente/ Hct de referência)
• Estudos da Cinética do ferro:
  • Inclui:
    • Ferro sérico
    • Transferrina e saturação da transferrina
    • Ferritina
    • Capacidade total de ligação do ferro
  • ↓ do valor de ferro total no corpo → anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types por deficiência de ferro
• Exames laboratoriais quando há suspeita de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica:
  • Haptoglobina: ↓ com a hemólise
  • Lactato desidrogenase: ↑ com a hemólise
  • Bilirrubina indireta: ↑ com a hemólise
  • Teste de Coombs direto: deteta anticorpos ligados aos GV, como na eritroblastose fetal (devido à incompatibilidade de Rh)
  • Teste de Coombs indireto: deteta anticorpos contra GV não reconhcidos como próprios, que estão presentes na anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica autoimune.
• Outros testes Testes Gonadal Hormones serológicos:
  • Função renal e função hepática
  • Hormona estimulante da tiroide (TSH)
  • Valor de vitamina B₁₂
  • Valor do Folato

Esfregaço de sangue periférico

Um esfregaço de sangue periférico pode ser útil para estabelecer a causa subjacente de uma anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types.

Testes Testes Gonadal Hormones adicionais com base na apresentação clínica

• Valores de cobre para estudo de deficiência
• Eletroforese de hemoglobinas
• Eletroforese de proteínas
• EDA e colonoscopia: para avaliação de possível causa oculta de hemorragia GI, especialmente se > 50 anos
• Biópsia de medula óssea:
  • Importante considerar se outras linhas celulares estão alteradas
    • Leucopenia
    • Trombocitopenia
  • Alterações encontradas
    • Sideroblastos em anel: anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types sideroblástica ou intoxicação por chumbo
    • Medula óssea hipocelular (não há aspiração de medula óssea – Dry tap Dry Tap Hairy Cell Leukemia): anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types aplásica
    • > 20% de blastos: leucemia

Tratamento

Reposição celular

• Permitir que o organismo reponha os próprios GV:
  • Suplementação de nutrientes em falta
  • Parar possíveis hemorragias
  • Tratar a doença subjacente.
• Transfusão de GV para manter a Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange
  • > 7 g/dl na maioria dos pacientes
  • > 8 g/dL em pacientes com doenças cardiovasculares

Educar o paciente sobre o estilo de vida

Se os fatores do estilo de vida contribuem para a anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types, a educação do paciente pode ser feita a respeito de:

• Hábitos alcóolicos
• Hábitos tabágicos
• Ingestão e suplementação dietética adequada

Tratar a causa subjacente

• Substituição oral de nutrientes por deficiência:
  • Ferro
  • Vitamina B₁₂
  • Folato
• Abordar doenças de má absorção (por exemplo, doença celíaca).
• Tratar causa de hemorragia se patológica, por exemplo:
  • Neoplasia:
    • Cancro do endometrio
    • Cólon, gástrica, ou outra neoplasia GI
  • Doença da úlcera péptica
  • Doença inflamatória intestinal (por exemplo, colite ulcerosa)
  • Doença diverticular grave
• Tratar doenças crónicas subjacentes, se possível (por exemplo, considerar administração de eritropoietina para DRC).
• Tratar endocrinopatias, se presentes (por exemplo, levotiroxina no hipotiroidismo).
• Avaliar o risco/benefício de fármacos de longo duração que possam agravar a anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types.

Comparação dos Tipos de Anemia Comuns

Anemias não hemolíticas

• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types por deficiência de ferro: o tipo de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types mais MAIS Androgen Insensitivity Syndrome comum no mundo. A anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types por deficiência de ferro é devido à diminuição do ferro disponível, ou a um aumento da perda de ferro (por exemplo, por hemorragia GI não conhecida), ou a um aumento da necessidade de ferro (por exemplo, gravidez). O tratamento é feito com suplementação de ferro e/ou tratamento da causa subjacente.
• Talassemia: causa hereditária de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types microcítica hipocrómica. A talassemia é uma deficiência das cadeias alfa (⍺) ou beta (𝛽) globina, resultando em eritropoiese ineficaz e hemólise. As apresentações clínicas variam de portadores assintomáticos a anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types grave com esperança de vida reduzida.
• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types megaloblástica: subtipo de anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types macrocítica que surge devido a falha na sintese de ácidos nucleicos nos percursores eritróides: Esta síntese deficitária leva à produção ineficaz de GV e a hemólise intramedular. As causas mais MAIS Androgen Insensitivity Syndrome comuns são as deficiências de vitamina B₁₂ e ácido fólico, que podem ser devido à baixa ingestão de alimentos ricos nestes nutrientes, condições de má absorção subjacentes e fármacos. A apresentação clínica inclui anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types, sintomas GI e neurológicos.
• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types aplásica ( AA AA Amyloidosis): doença rara que está associada risco de vida. É caracterizada por pancitopenia e hipocelularidade da medula óssea, na ausência de células anormais, refletindo os danos nas células-estaminais hematopoiéticas. A anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types aplásica pode ser adquirida ou hereditária. São conhecidas múltiplas causas, incluindo danos autoimunes nas células estaminais, fármacos, produtos químicos, radiação, infeções viricas, doenças imunológicas, gravidez, anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types de Fanconi, e síndrome de Down.
• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types Sideroblástica: Este grupo heterogéneo de doenças da medula óssea é caracterizado pelo acumular anormal de ferro nas mitocôndrias dos precursores eritróides. O ferro acumulado aparece em grânulos numa distribuição em forma de anel à volta do núcleo (sideroblastos em anel). As anemias sideroblásticas podem ocorrer devido a defeitos hereditários na síntese do heme ou podem ser adquiridas por alcoolismo, intoxicação por chumbo, fármacos ou deficiências vitamínicas. Os valores de ferro sérico estão normalmente elevados.

Anemias hemolíticas

As anemias hemolíticas são resultado da destruição ou eliminação prematura dos GV. Especificamente, podem acontecer devidos a danos causados por um lúmen vascular estreito (hemólise intravascular) ou por um aumento do clearance esplénico (hemólise extravascular). A filtração esplénica pode resultar de alterçãoes intrínsecas dos GV (por exemplo, membranas anormais, enzimas ou Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange) ou pelo presença de anticorpos extrínsecos nos GV do sistema imune (por exemplo, incompatibilidade ABO).

Exemplos de anemias hemolíticas:

• Esferocitose hereditária: causada por deficiência de uma proteína do citoesqueleto na membrana do GV Esta deficiência resulta na perda da estabilidade da membrana e da deformabilidade do GV, tornando-se este numa forma esférica (esferócito). Estas células são predispostas à degradação esplénica, levando a hemólise extravascular. Os achados físicos incluem icterícia e esplenomegalia, enquanto os exames laboratoriais são consistentes com a anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica. O tratamento definitivo para a esferocitose é a esplenectomia.
• Deficiência de G6PD G6PD Pentose Phosphate Pathway: Esta anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica intravascular recessiva ligada ao X é devida a uma alteração hereditária na enzima G6PD G6PD Pentose Phosphate Pathway, que gera a nicotinamida adenina dinucleotídeo fosfato ( NADPH NADPH Nicotinamide adenine dinucleotide phosphate. A coenzyme composed of ribosylnicotinamide 5′-phosphate (nmn) coupled by pyrophosphate linkage to the 5′-phosphate adenosine 2. Pentose Phosphate Pathway), que protege as hemácias de lesões oxidativas. Os pacientes têm hemólise episódica quando as células estão perante slgum fator de stress oxidativo.
• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types falciforme: hemoglobinopatia autossómica recessiva. A doença deve-se uma mutação única no gene Gene A category of nucleic acid sequences that function as units of heredity and which code for the basic instructions for the development, reproduction, and maintenance of organisms. Basic Terms of Genetics da beta-globina. A Hb Hb The oxygen-carrying proteins of erythrocytes. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Gas Exchange anormal polimeriza quando se encontra desoxigenada, levando à deformação dos GV em forma de foice. Estes GV anormais são facilmente hemolisados e causam frequentemente obstrução microvascular associada a isquemia de órgãos, crises dolorosas graves e complicações sistémicas. As células falciformes geralmente podem ser vistas no esfregaço de sangue periférico.
• Anemia hemolítica auto-imune: tipo raro de anemia hemolítica caracterizada pela produção de autoanticorpos contra os GV, levando à destruição destes no baço. A anemia hemolítica auto-imune é classificada como “quente” ou “fria”, dependendo da reatividade térmica dos autoanticorpos. A etiologia é diversificada e inclui infeções, doenças autoimunes, distúrbios linfoproliferativos e fármacos.
• Hemoglobinúria paroxística noturna (HPN): anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica crónica adquirida rara e grave, com exacerbações periódicas. A HPN muitas vezes surge posteriormente a um diagnóstico de falência da medula óssea/ anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types aplástica, mas também pode surgir de novo. O defeito subjacente é uma mutação somática numa célula estaminal hematopoiética multipotente, no gene Gene A category of nucleic acid sequences that function as units of heredity and which code for the basic instructions for the development, reproduction, and maintenance of organisms. Basic Terms of Genetics PIGA ligado ao X, seguida de expansão clonal das células estaminais mutantes. Esses GV anormais sofrem principalmente hemólise intravascular e podem fazer parte de uma tríade clínica que também inclui pancitopenia e trombose venosa.