ANEMIA
Anemia is a condition in which the number of red cells or the
amount of hemoglobin is less than normal.
Anemia is a pathophysiological condition in which the body
cannot meet its demands for oxygen.
Charact
eristic Features of ALL anemias:
1. Pallor
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Classification of anemia based on three main causes:
1. Blood Loss
2. Increased destruction of RBC
3. Decreased production of RBC
I) Causes of anemia: Due to blood loss:
1. GIT bleeding
2. Menorrhagia
3. Accident and trauma
II) Due to increased destruction of RBC
1. Hereditary spherocytosis
2. Thalassemia
3. Sickle cell anemia
III) Due to decreased or defective production of RBC
a) Megaloblastic anemia
b) Iron deficiency anemia
c) Aplastic anemia
d) Leukemia
ANEMIA : Classification by volume of RBC
MCV –Mean Corpuscular Volume
Microcytic anemia (MCV <80)
• iron deficiency anemia
• thalassemia syndromes
• anemia of chronic disease
• sideroblastic anemia
Normocytic anemia (MCV 80-100)
• anemia of blood loss
• hemolytic anemia
Macrocytic anemia (MCV >100)
• megaloblastic anemia
Iron Deficiency Anemia
Definition:
Iron deficiency anemia is due to deficiency of iron intake thereby
causing defective heme synthesis.
It is the most common nutritional disorder.
Causes of Iron deficiency anemia
1. Dietary deficiency or lack
2. Milk fed infants
3. Malnutrition
4. Impaired absorption
5. Sprue, steatorrhea, chronic diarrhea
6. Phytates, tannates, oxalates etc.
7. Chronic blood loss due to:
8. Hematemesis, hematuria and hemoptysis
9. Hook worm infestation
10. Increased demand: in children, pregnancy, lactation
Iron Deficiency Anemia
Symptoms:
Pallor
Weakness, fatigue, or lack of stamina
Breathlessness
Headache – frontal
Difficulty concentrating
Irritability, apathy
Dizzines
Craving for substances that are not food (pica) [Link],raw rice,
Signs:
Rapid heart beat- Tachycardia
Brittle nails (Koilonycia- spoon nails)
Cracked lips (Angular stomatitis)
Smooth sore tongue (Glossitis)
Decreased appetite (especially in children)
Decreased rate of growth
Laboratory findings
1. Peripheral blood:
• Hemoglobin % decreased - less than 8 gm%
• Hematocrit (PCV) decreased
• MCV, MCH, MCHC –decreased
2. Peripheral smear:
• Microcytic - small
• Hypochromic - pale
• Anisocytosis – variation in size of RBC
• Poikilocytosis- variation in shape
3. Bone marrow shows:
Hypercellularity
Absence of bone marrow iron
4. Reticulocyte count: Low
Treatment of IDA
1. Diet rich in iron- green vegetables, dates, jaggery
2. Iron supplements: Oral iron therapy
3. Iron injections
4. Blood transfusion
Megaloblastic Anemia
Definition:
Megaloblastic anemia is characterised by defective DNA
synthesis.
Since DNA synthesis depends on Vit B12 (Cyanocobalamin) and
Folic acid, the deficiency of either or both causes megaloblastic
anemia
Megaloblasts are seen in the bone marrow.
The characteristic macrocytic hyperchromic RBCs are seen.
Causes of Megaloblastic Anemia
Deficiency of Vit B12 due to:
1. Decreased intake: Pure vegetarians, malnutrition
2. Impaired absorption:
3. Gastric : deficiency of Intrinsic Factor (IF) causing
Pernicious anemia
4. Intestinal : loss of absorptive surface
5. Increased demand: Pregnancy, lactation
Deficiency of folic acid:
1. Decreased intake -alcoholism
2. Impaired absorption
3. Increased loss – Hemodialysis
4. Increased demand - Pregnancy
Clinical features:
1. Pallor and other common symptoms of anemia
2. Classic triad presentation: Weakness, sore throat and
paresthesias
[Link]: Painful red “beefy” tongue
Neurological manifestations:
1. Bilateral peripheral neuropathy: Glove and socks numbness or
paresthesia
2. Demyelination of spinal cord
3. Ataxia: uncordinated gait
4. Serum homocysteine is raised – risk of atherosclerosis and
thrombosis
Laboratory findings
Peripheral blood smear shows:
• RBC changes: Anisocytosis is seen.
• RBCs are large –macrocytic and oval in shape - - macro-
ovalocytes seen
• No central pallor seen
Features of erythropoietic disorder:
• Basophilic stippling
• Cabot’s rings
• Howell-Jolly bodies
• Nucleated RBCs
Bone marrow findings:
• Hypercellular marrow
• All stages of megaloblastic changes seen
• Hypersegmented neutrophils seen- very characteristic.
• Megakaryocytes are large
• Reticulocyte count increased
• Bone marrow iron increased
Diagnosis
• MCV increased
• Perpheral smear
• Bone marrow
• Serum cobalamin and folic acid levels
• Schilling Test: for cobalamin
• Figlu Test; for folic acid
• Deoxyuridine Suppression Test
• Treatment
• Diet rich in Vit B12 and Folic acid
• Injection Vit B12
• Life long treatment for complications
Aplastic Anemia
Definition: Hematopoietic stem cell disorder characterised by
Pancytopenia and hypocellular bone marrow.
Lab findings: Decreased Hemoglobin, PCV and Reticulocyte
count.
Pancytopenia characterized by
(1) anemia
(2) neutropenia
(3) thrombocytopenia
Bone marrow shows: Hypocellularity
Etiology:
65% idiopathic
Chemicals/drugs
(benzene, chloramphenicol, alkylating agents, antimetabolite)
Whole body irradiation
Viral hepatitis
• Aplastic Anemia
Pathogenesis : markedly hypoplastic bone marrow
Clinical features: -
1. may occur at any age
2. variable initial manifestations
(depending on the affected cell line)
3. no splenomegaly
- normocytic and normochromic RBCs
- no reticulocytosis
4. Diagnosis: Bone marrow biopsy
Hypocellular due to stem cell failure