Anemia Assignment

By Dr Sumayyah

What is Anemia?

Anemia is a condition in which the number of red blood cells

or their oxygen carrying capacity is insufficient. The WHO
criteria for anemia in nonpregnant females is <12 g/dL
hemoglobin and < 14 g/dL hemoglobin in men.

Causes:

Common causes of anemia include:

● Blood Loss
● Abnormal rbc destruction
● Defect in erythropoiesis
● Iron, Cobalamin (B12) and Folate deficiency

Symptoms:

Common symptoms of anemia include:

● Fatigue
● Shortness of breath
● Dizziness
● Brittle Nails
● Hair Loss
● Headache
 ● Arrhythmia

Classification

● RBC Morphology

1. Normocytic Anemia

Anemia of acute hemorrhage

It is the restoration of blood volume with intracellular and
extracellular fluid that dilutes the remaining red blood cells.

Hemolytic Anemia
It is caused by destruction of red blood cells, increased
hemoglobin catabolism & decreased levels of hemoglobin.

Anemia of chronic disease

It is a multifactorial anemia that involves chronic inflammatory
conditions that includes infection, autoimmune disease or
cancer.

2. Hypochromic/ Microcytic Anemia

Iron deficiency anemia

It involves depletion of iron stores due to blood loss,
decreased intake and impaired absorption.

Thalassemia
It is a blood disorder caused by mutations in DNA that are
responsible for producing hemoglobin.

3. Macrocytic Anemia

Vit B12 deficiency

In this deficiency homocysteine cannot be converted to
methionine, and thus, methyl-THF cannot be converted to
THF. Homocysteine levels accumulate & pyrimidine bases
cant be formed causing megaloblastic anemia.

Folate deficiency
This deficiency caused impairment of cell division,
accumulation of toxic metabolites & impartment of methylation
reactions required for regulation of gene expression.

● Physiologic Abnormality

1. Erythropoiesis defect
Precipitation of free alpha chains into erythroid precursors in
the bone marrow causing membrane damaged and premature
cell death.

2. Hemolytic Anemia
Destruction of red blood cells, increased hemoglobin
catabolism and decreased levels of hemoglobin.

● Basis of Etiology
 1. Increased RBC destruction due to intra or extra red blood
cell defects
Intra red blood cell defect involves destruction within the
vessels. This may be due to autoimmune disease, trauma or
stress. Extra red blood cell defect involves destruction due to
macrophages in the liver and spleen.

2. Increased blood loss

3. RBC defective formation

Defective formation can be due to autoimmune disease,
vitamin deficiency or bone marrow cancer.

● Based on category

1. Increased destruction of RBC

This can be due to infection, vitamin deficiency, immune
disorders or G6PD deficiency.

2. Anemia due to blood loss in hemorrhage

This is due to rapid decrease in rbc, causing hemoglobin to go
below 7g/dL and the body having inadequate time to
compensate.

3. Nutritional deficiency
Vitamins like B12, Folate or Iron are necessary for red blood
production. Their deficiency causes defects in their production
leading to anemia.
 4. Drug toxicity
This is when the drug triggers the immune system to attack
the body’s own rbc.

5. Infections
The systemic inflammatory response causes reduced
production of rbc and increased destruction of rbc.

6. Infiltration of bone marrow cells by cancer cells

Bone marrow cancer disrupts the production of rbc which
leads to anemia.

7. Hereditary/acquired defect in rbc

Mutation in genes disrupts the production of rbc causing
anemia.

8. Aplastic Anemia
Hematopoietic stem cell failure causes loss of red blood cell
precursors, hypoplasia or aplasia of bone marrow leading to
anemia.

9. Thalassemia
This disorder affects the hemoglobin gene and erythropoiesis,
leading to a decreased production in hemoglobin leading to
anemia.

● RBC Indices
 1. Normocytic
MCV is 80 to 100 fl
MCHC = 32 to 36%

This is caused by chronic, non haematological disease.

2. Macrocytic
MCV = >100 fl

This is caused by abnormal large production of rbc which

have an abnormal function leading to anemia.

3. Microcytic and hypochromic

MCV = <80 fl.
MCHC = <32%

Disruption in iron supply in diet causes anemia.