Anemia

Anemia is defined as a reduction of the

total circulating red cell mass below
normal limits

haemolytic anaemia
3. Uncertain origin
uraemia, widespread malignant diseases
Megaloblastic anemia

Anemia reduces the oxygen-carrying

capacity of the blood, leading to tissue
hypoxia
Diagnosis
- Reduction in the hematocrit
- Reduction in the hemoglobin
concentration
Classification
1. Based on red cell morphology
a) Red cell size
- Microcytic
- Normocytic
- Macrocytic
b) Degree of hemoglobinization
- Hypochromic
- Normochromic
2. Based on underlying mechanism
a) Blood loss
- Acute
- Chronic
b) RBC destruction
- Intracorpuscular abnormalities
- Extracorpuscular abnormalities
c) Impaired RBC production

Iron deficiency

B12 and folate deficiency

Anemia of chronic disease

Aplastic anemia

Marrow replacement
Iron Deficiency Anemia
Hypochromic microcytic anemia
Etiology
- dietary lack
- impaired absorption
- increase req
- chronic blood loss
Peripheral smear findings
- microcytic hypochromic cells
- anisocytosis
- poikilocytosis
- pencil shaped cells
- tear drop cells
Investigations
- Blood count
- Peripheral smear
- Iron studies
- bone marrow study (pearl rxn of
hemosiderin)

Etiology
Impairment of DNA syn producing
abnormally large ;
Megaloblasts (erythroid precursor)
Macocyte (red cell)
Basic cellular defect
- nuclear cytoplasmic asynchrony
- Impaired DNA synthesis due to
deficiency of either vitamin B12 or folate.
This leads to deranged nuclear maturation
Peripheral smear findings
1.
Pancytopenia
2.
Macro ovalocytes
3.
Hypersegmented neutrophils
Investigations
1. Complete blood count Hb low,
hematocrit is low, MCV is increased (>100
fl) normal MCV 80 -100 Fl
2. Peripheral smear
3. Serum vitamin B12 and folate assay
4. Bone marrow examination
Hypercellular marrow, megaloblasts, giant
metamyelocytes, giant band forms
Anemia of chronic disease
Etiology
- Impaired red cell production associated
with chronic diseases
- Reduction in proliferation of erythroid
progenitors
- Impaired iron utilization
1.Chronic microbial infections
Osteomyelitis
Bacterial endocarditis
Lung abscess
2. Chronic immune mediated disorders
Rheumatoid arthritis
Regional enteritis
3.Neoplasms
Carcinoma of lung, breast, Hodgkin
lymphoma
Peripheral smear

Anti anaemia
IDA
Iron therapy (PO, parenteral)
Oral iron therapy :
1. Ferrous sulphate
2. Ferrous gluconate (Ferglucon)
3. Ferrous fumarate (Furamin BC)
(ferrous fumarate, riboflavin, folic acid,
ascorbic acid)
Parenteral :
- intolerance to oral
- impaired iron abs from GIT
- IBD
1. Inj. iron dextran (inferon) IM, IV
2. Inj. iron sorbitol citric acid complex IM
Megaloblastic anemia
1. B12 ( liver, kidney, green veg)
Cyanacobalamin oral, parenteral
2. Folic acid
Hemolytic anemia
Alcoholic
Liver disease
Renal dialysis
Oral, tablet form
Drug interaction
Vitamin C + Iron
absorption
Alcohol + Iron
absorption

= Increase iron

= Increase iron

Tetracycline + Iron = Chelation = Reduced

absorption of both
Iron + Haemopoietic vitamins/minerals =
Better haemopoiesis, more effective
treatment of anaemia
Hook worm (IDA)
- Nematodes
- Necator americanus
- Ancylostoma duodenale
Lab diagnosis
- stool exam : non bile stained segmented
eggs

BM iron stores : , IDA : X

Chronic renal insufficiency :
- Burr cells
Liver disease :
Spur cell
1. Diminished production
deficiency of iron, B12 & folic acid
depressed haemopoiesis (bone marrow
depression, decrease erythropoietin)
2. Excessive red cell destruction

Treatment
- Albendazole/Mebendazole
- Pyrantel pamoate
- Iron therapy
- Blood transfusion (extreme)
Prevention
Education
Improved sanitation
Controlled disposal of human feces
Wearing shoes in endemic areas