OVERVIEW OF ANAEMIA

Gwaram, B A
Clinical Haematology Unit, Dept of Medicine,
AKTH, Kano.

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 Introduction - Erythropoeisis
• Bone marrow
– Pluripotent stem cells
– Chemical regulation
• Cytokines
• Erythroid specific growth factor
• Erythropoietin (EPO)
– Life span
• Reticulocyte- 4 days
• RBC –120 days
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 Introduction - Haemoglobin
Hb-reversibly binds and
transports O2 from lungs to
tissues. - 4 globin chains &
heme containing iron
Iron-key element in the
production of hemoglobin-
absorption is poor
Transferrin - iron
transporter
Ferritin - iron binder,
measure of iron stores,
*also acute phase reactant*
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 Definition
• Anaemia is present when there is a
decrease in the level of Hb in the blood
below the reference level for the age and
sex of the individual in that environment.
• Also there is anemia when there are
values of hemoglobin, hematocrit or RBC
counts which are more than 2 standard
deviations below the mean
– HGB<13.5 g/dL (men) <12 g/dL (women)
– HCT<41% (men) <36% (women)
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 Definition

However, clinically anaemia is said to be

present when there are
cardiopulmonary manifestations of
decreased oxygen carrying capacity of
blood.

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 Epidemiology
• Anaemia affects 1.62 billion people i.e
about 24.8% of the global population
• The highest prevalence is in pre-school
children and the lowest in men
• The most affected group are the non
pregnant women
• In Nigeria 54.5% of pregnant women are
reported to have anaemia as well as 95%
of children 2-11yrs
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 Physiology
Severity of anaemia depends not only on the
Hb level but also on
-age
-cardiac and respiratory function
-speed of onset of the anaemia
-plasma volume
*(remember O2 dissociation curve)
Hence there are 3 stages of anaemia :-

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 Physiology
• Compensated anaemia (Hb >7g/dl) –
plasma vol expand to keep the total blood
vol normal (pallor , DOE)
• Decompensated anaemia (Hb <7g/dl ≥
5g/dl) - Increase CO, SV and HR with
decrease blood vol. Vasodilatation and
increase peripheral blood flow dominate
clinical signs (warm hands, collapsing
pulse, wide pulse press, ESM, pulsating
retinal veins)
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 Physiology
• Life threatening anaemia (Hb <5g/dl) –
Severe anaemia with circulatory
congestion.
Symptoms of tissue hypoxia (cardiac pain)
and signs of heart failure.
Signs of resp distress (nasal flaring,
indrawing chest, grunting or deep
breathing)
Signs of congestion (pulm oedema,
peripheral oedema, raised JVP)
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 Aetiology
• Aetiology of anaemia
- Blood loss
- Increase red cell destruction
- Decrease red cell production
- Faulty red cell production

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 Classification
• The various types of anaemia are classified in
terms of red cell indices particularly MCV and
sometimes MCH.
• Although there may be many clinical situations in
which a combination of abnormalities is present
in the indices, the categories below serve as a
useful diagnostic aid:-
Microcytic Hypochromic – Fe def anaemia
Thalassaemia
Sideroblastic anaemia
ACD

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 Classification
Normocytic Normochromic –
Acute blood loss
ACD
Haemolytic anaemia
Renal failure
Infection
Inflammation
Neoplasm
Marrow infiltration and fibrosis
Endocrine diseases
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 Classification
Macrocytic Normochromic –
B12 def anaemia
Folate def anaemia
Aplastic anaemia
Hypothyroidism
CLD
Alcohol
Reticulocytosis
MDS
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 Clinical presentation
Symptoms Signs
Fatique Pallor/ jaundice
Headache Tachycardia
Faintness Systolic flow mummur
Breathlessness Cardiac failure
Angina Retinal haemorrhage
Int claudication Papilloedema
Palpitation Lymphadenopathy
Tinnitus Hepatosplenomegaly
Pica Glossitis/mouth ulcers
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 Clinical presentation
Other signs and symptoms specific to the
cause of the anaemia may be present :-
Weakness in the lower limbs
Leg ulceration
Koilonychia
Jaundice
Lymphadenopathy
Splenomegaly
Body swelling
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 Diagnosis
• Diagnosis and management of anaemia
should be based on knowledge of the
epidemiology of anaemia and relevant
conditions in the locality
• Management should be planned to make
the most effective possible use of the
health care resources available
• The rate at which anaemia develops
usually determines the severity of the
symptoms
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 Diagnosis
• COMBINED INFORMATION FROM
CLINICAL HISTORY, PHYSICAL
EXAMINATION AND CBC LEADS TO
APPROPRIATE MANAGEMENT OF
MOST PATIENTS.

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 Diagnosis
Clinical assessment
History
Biodata- area of res, occup, socio economic status
Family hx of anaemia, Anaemia since childhood
Parity and Obs hx
Hx of bleeding
Drugs, alcohol
Past medical hx
Physical examination- look for
Signs of anaemia and clinical decompensation
Signs of the underlying cause
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 Laboratory investigations
• Full blood count
• Blood picture
• Reticulocyte count
• Iron studies
• Serum folate and B12 levels, auto antibodies
( IF and GPC)
• BMA/ biopsy
• Test for haemolytic anemia
• Others- LFT, E/U&Cr, Renal scan, serum
electrophoresis, TFT etc
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Coulter CBC

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 Blood Picture

Microcytes Basophilic stippling

Macrocytes Rouleaux
Dimorphic RBC Reticulocytosis
Polychromasia Heinz bodies
Spherocytes Howell –Jolly bodies
Pencil/ rod RBC H bodies
Elliptocytes Fragmented
Teardrop Sickle cells
Target cells Crenated cells
Burr cells Acanthocytes
Bite cells Leucoerythroblastic picture
Hyposplenic blood picture Blasts
Platelet size Activated lymphocytes

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 Reticulocyte count
For example the RPI is
calculated as follows -
Reticulocyte count 9%
Hb content 7.5 g%
Correction for Anaemia
= 9 x (7.5 ÷ 15) = 9 x 0.5 = 4.5
%
Correction for incr life span
4.5 ÷ 2 = 2.25 %
Thus, the RPI is 2.25
RPI > 2 = Haemolytic
RPI< 2 = Hypoproliferative
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 Iron studies
Serum iron level
TIBC
Serum ferritin
BM Iron

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Tests in megaloblastic anaemia
Abnormalities in nucleic
acid metabolism
LOW Serum/RC folate
and B12 levels
Autoantibodies in MA
80-90 +ve GPCAb and
55 +ve IFAb in px with
pernicious anaemia

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Tests for haemolytic anaemia
• Hall mark- falling Hb, reticulocytosis,
indirect hyper bilirubinaemia ± nucleated
RC
Hb electrophoresis
Enzyme assays - G6PD def, PK def
RC fragmentation - DIC
DAT
Blood film and cultures
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Tests for haemolytic anaemia
• Plasma haptoglobulin (2 glycoprotein,
combines with Hb)
• Plasma haemopexin  (-glycoprotein carries
haem portion of Hb)
• Plasma L.D.H 
•  urinary urobilinogen
•  feacal stercobilinogen
• Haemoglobinaemia
• Haemoglobinuria
• Haemosiderinuria
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 Principles of treatment of Anaemia
• The management of anaemia will vary
according to the cause, time course and
degree of compensation to the anaemia
• The general principles of treatment are:-
1- Treat underlying cause
2- Optimize all the components of the O2
delivery system to improve the O2
supply to the tissue
Hb concentration
Degree of saturation of Hb by O2
Cardiac output
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 Treatment

- Decompensated and life threatening anaemia

need urgent intervention in the form of blood
transfusion (packed cells)
- Replacement of deficient nutrients eg Fe, vit
B12, folate
- Treatment of underlying cause in cases of
ACD and those due to infection and
inflammation
- Chemotherapy in neoplasms
- Epo in CKD and SCA

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Principles of prevention of Anaemia

• HEALTH EDUCATION
• SUPPLEMENTATION PROGRAMMES
• DIETARY MODIFICATION
• CONTROL OF VIRAL, BACTERIAL AND
PARASITIC INFECTIONS
• FOOD FORTIFICATION

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Thank you for listening

Fac of Int Med, NPMCN Rev

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