Aspek Umum Anemia



Anemia

Infolabmed.com- Anemia juga dapat diartikan sebagai suatu kondisi dimana kadar hemoglobin dalam darah turun di bawah nilai normal. Meskipun nilai normal bervariasi menurut laboratorium, nilai umumnya adalah <13,5 g/dL pada pria dewasa dan <11,5 g/dL pada wanita dewasa. Dari usia 2 tahun hingga pubertas, hemoglobin <11,0 g/dL mengindikasikan anemia. Bayi baru lahir memiliki kadar hemoglobin yang tinggi, yaitu 14,0 g/dL, dan dianggap sebagai batas bawah Hb saat lahir.

Gambaran klinis anemia

1. Kecepatan permulaan

Anemia yang memburuk dengan cepat menimbulkan lebih banyak gejala daripada dengan permulaan lambat karena lebih sedikit waktu untuk adaptasi oleh system kardivaskular dan kurva disosiasi O2 hemoglobin. 

2.  Derajat berat

Anemia ringan sering tidak menunjukan gejala atau tanda tetapi biasanya terdapat gejala jika hemoglobin kurang dari 9-10 g/dL. Walaupun demikian,bahkan anemia berat (kadar hemoglobin sampai 6,0g/dL) dapat menunjukan gejala yang sangat sedikit pada usia muda yang sehat selain anemia

3.    3. Usia

Orang tua kurang dapat mentoleransi anemia dibandingkan anak muda karena efek kekurangan oksigen terhadap organ organ jika kompensasi kardiovaskular normal terganggu

4.4. Kurva disosiasi O2 hemoglobin

Anemia secara umum dikaitkan dengan peningkatan 2.3-DPG dalam sel darah merah dan pergeseran kurva disosiasi O2 ke kanan , sehingga oksigen lebih mudah dilepaskan ke jaringan. Adaptasi ini khususnya sangat jelas pada bebrapaanemia yang mengenai metabolisme eritrosit secara langsung atau yang terkait dengan hemoglobin dengan afinitas rendah

Gejala

Gejala yang muncul pada pasien yang terkena anemia biasanya adalah nafas terengah-engah khususnya pada saat berolahraga, lemas, letargi, berdebar-debar, dan sakit kepala. Pada subjek yang lebih tua, gejala gagal jantung, nyeri dada atau klaudikasi intermiten atau kebingungan mungkin ada. Gangguan penglihatan karena pendarahan retina mungkin menjadi penyulit pada anemia yang sangat berat, khususnya dengan permulaan cepat.

 

Tanda anemia dapat dibagi menjadi tanda umum dan spesifik. Tanda umum meliputi pucat pada selaput lendir yang terjadi hika kadar hemoglobin dibawah 9-10 g/dL. Sebaliknya, warna kulit bukan tanda yang dapat diandalkan. Peredaran darah yang hiperdinamik mungkin tampak sebagai takikardia, denyut nadi yang melonjak, pembesaran jantung dan bising aliran sistolik khususnya pada apeks. Pada orang tua, mungkin terdapat gambaran gagal jantung kongestif. Pendarahan retina jarang ditemukan.

 

Pengukuran hitung leukosit dan trombosit membantu membedakan anemia “murni” dari “pansitopenia” (hitung eritrosit, neutrophil, dan trombosit dibawah normal) yangmenunjukan gangguan sumsum tulang belakang yang lebih bersifat umum (missal hipersplenisme). Pada anemia yang yang disebabkan oleh hemolysis atau pendarahan, hitung neutrophil dan trombosit sering meningkat dan mungkin terdapat leukosit abnormal atau prekusor neutrophil.

 

Factor yang mengganggu respon retikulosit pada anemia :

  • Penyakit sumsum tulang, misal hypoplasia, infiltrasi oleh karsinoma, limfoma, myeloma, leukemia akut, tuberkolosis           
  • Defisiensi zat besi, vit B12 atau folat
  • Kekurangan eritroprotein, misal penyakit ginjal
  • Penurunan konsumsi O2 jaringan, misal miksedema, defisiensi protein
  • Eritropoiesis inektif, misal talasemia mayor, anemia megaloblastik, mielodisplasia, mielofibrosis
  • Penyakit radang kronik atau keganasan.

 

Sumber :  Hoffbrand,A. Moss,P. 2011. Essential Haematology,6th Ed. Jakarta:Penerbit Buku Kedokteran ECG.                                                                                                      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