ANAEMIA

BY SWAATHI R
FINAL YEAR MBBS
 DEFINITION
It is a condition of reduction in
haemoglobin concentration of the blood
below the normal level in relation to age
and sex
Physiological regulation of red cell
production
Classification of anemia
ANEMIA

MICROCYTIC: MACROCYTIC: NORMOCYTIC:

MCV (<80 FL) (MCV >=100 FL)

Iron deficiency Megaloblastic Recent bood loss

anemia anemia Aplastic anemia
Thalassemia Alcoholism Myelopthisic anemia
Sideroblastic anemia Liver disease Hypothyroidism
Anemia of chronic Hypothyroidism Chronic renal failure
disease Myelodysplastic Anemia of chronic
syndrome disease
 MILD-9 to 12g/dl
 MODERATE- 6 to 9 g/dl
 SEVERE- <6g/dl
Functional classification
Common causes

 Nutritional anemia
 Hookworm infestation
 Chronic malaria ,chronic kala azar ,tuberculosis
 Chronic duodenal ulcer
 haemorrhoids
 Thalassemia
 Tropical sprue
 SYMPTOMS
Weakness,fatigue,lassitude
Light headedness
Giddiness
Fainting or syncope
Anorexia
Palpitation
Breathlessness
Chest pain
Insomnia
Intermittent claudication
Menstrual irregularities
 PHYSICAL EXAMINATION
 Pallor
 Icterus
 Lymphadenopathy
 Tachycardia
 Cardiac murmur
 Hepatomegaly
 Splenomegaly
 Edema of feet
 Petechial spots
 Pheripheral neuropathy
SITES TO LOOK FOR PALLOR

Lower palpebral conjunctiva

normal – red
anaemia- pink
Tongue - tip and dorsum
Mucous membrane of the palate(soft palate)
Nail –beds (press the pulp to see the redness of
nailbed)
Palmar creases ,soles and general skin surfaces
Vagina
SIGNS
ACUTE ANAEMIA CHRONIC HAEMOLYIC
ANAEMIA ANAEMIA:
 hypovolemia Tachycardia acute back pain
dominates the clinical pallor of skin and mucous haemoglobinuria
picture. membrane signs of renal failure
 10-15% loss –vascular signs of cardiac failure
instability cardiacdilatation
 greater than 30% loss- edema
postural hypotension haemic murmur over
and tachycardia pulmonary area
 greater than 40% loss-
signs of hypovolemic
shock including
dyspnoea,confusion,diap
horesis,hypotension and
tachycardia.
 PALLOR AND ANAEMIA

waxy appearance of skin and mucous

membrane.
 Itdepends upon thickness and quality of
skin ,quality and amount of blood in
capillaries.
 There are many causes of pallor and anaemia
is commonest of them.
 DIFFERENTIAL DIAGNOSIS
1.Peripheral circulatory failure or shock
2.Acute myocardial infarction
3.Very severe aortic stenosis or mitral stenosis
4.Myxoedema(pallor >anaemia)
5.Nephrotic syndrome
6.Panhypopituitarism
7.Vasovagal attack,fear,exposure to cold,intense
emotion
8.Edematous conditions
IRON DEFICIENCY ANEMIA
 Most common nutritional disorder in the world
 Common in females
ETIOLOGY
Dietary lack
Impaired absorption
Increased requirement
Chronic blood loss
Clinical feautures
 Angular stomatitis
 Atrophic glossitis
 Koilonychia
 Brittle hair
 Pruritis
 Plummer vinson syndrome
 menorrhagia
Megaloblastic anemia Less intake of vitB12 and folic acid
Red bone marrow produces abnormal rbc

Pernicious anemia Inability of stomach to absorb vit B12 in intestine

Hemolytic anemia RBC plasma membrane ruptures-

toxins,parasites.antibodies

thalassemia Ineffective erythropoiesis and hemolysis due to

reduced rate of production of one or more globin
chains
Sickle cell anemia Hereditary blood disorder,characterised by red blood
cells that assume an abnormal,rigid,sickle shape

Aplastic anemia Destruction by red bone marrow

Caused by toxins,radiations
Anemia and cvs

 Infective endocarditis
 Hemoptysis
 Mitral stenosis
 Congestive cardiac failure
 Prosthetic valve hemolysis
 Chronic disease
 INVESTIGATIONS
 1.COMPLETE BLOOD COUNT
red blood cell count
haemoglobin
haematocrit
reticulocyte count
Red blood cell indices
mean cell volume
mean cell haemoglobin
mean cell haemoglobin concentration
red cell distribution width
White blood cell count
cell differential
nuclear segmentation of neutrophils
Platelet count
Cell morphology
cell size ,Hb content, anisocytosis, poikilocytosis, polychromasia
2. IRON SUPPLY STUDIES
serum iron
total iron binding capacity
serum ferritin
3. MARROW ELIMINATION
Aspirate
M/E ratio
cell morphology
iron stain
Biopsy
cellularity
morphology
parameter IDA ACD Thalassemia Sidrobastic
trait anemia

MCV/MCH /N -
Serrum N N
ferritin

Serrum iron N

Transferrin N

TIBC N N
PERIPHERAL SMEAR:

Microcytic Macrocytic normocytic

Treatment
 TRAETMENT OF MEGALOBLASTIC ANEMIA:
Cyanocobalamin 100-1000 micro gm daily for 2
weeks then weekly until the haematocrit values are
normal then monthly for life
Folic acid 3-5 milli gm orally daily

 TREATMENT OF ANEMIA IN CHRONIC KIDNEY DISEASE:

Erythropoietin is indicated when hb below 10g/dl and
iron is to be given according to serum ferritin level
Erythropoetin stimulating agent:
 epoetin-alpha
 darbepoetin-alpha
 TREATMENT OF APLASTIC ANEMIA:
The treatment of choice in young adults is bone
marrow transplantation
In elderly:Immunosuppression with antithymocyte
globulin and cyclosporins
Androgens oxymetholone 2-3 mg/kg orally in adults
have shown occasional success as maintenance theraphy

 TREATMENT OF ANEMIA IN CHRONIC DISEASE:

Erythropoietin 50-150 U/Kg 3 times/week sc
INDICATIONS FOR BLOOD
TRANSFUSION
 Hb <7 g/dl in asymptomatic patients
 Hb <10 g/dl in cases of increased risk of ischemia (IHD,pulmonary
disease)
 Transfusion for a predetermined therapeutic program such as
bone marrow suppression (eg.PNH,aplastic anemia)
 Symptomatic anemia resulting in
tachycardia
mental state changes
angina/ECG changes of ischemia
shortness of breath,light headedness ans dizziness on mild
exertion.
THANK YOU