ANEMIA :

CLINICAL APPROACH AND MANAGEMENT

Dairion Gatot, Savita Handayani, Heny Syahrini, Andri Mardia

Divisi Hematology -Onkology Medic

Internal Departement of Medical Faculty of North Sumatera University /
Haji Adam Malik General Hospital,
Medan 2018
 ANEMIA

 Is defined as a condition in which the

haemoglobin concentration is below reference
range for the age, sex, method & altitude

 Deficient in O2 carrying capacity  hypoxia

CUT OFF POINT ANAEMIA IN INDONESIA

Pre school age 11 g/dL

School age 12 g/dL
Pregnant women 11 g/dL
3 month post partum 12 g/dL
Female 12 g/dL
Male 13 g/dL
 Prevalence

• Anaemia is thought to affect 1.62 billion people on a

daily basis (WHO); this is 24% of the world’s
population.

• Anaemia affects both developing and developed

nations.

• Women (both pregnant and non-pregnant) and

children suffer most from the condition.
 Cause of Anemia
 Decreased RBC production :
- Insufficient production
- Inefficient production (erythropoiesis)

 Increased RBC loss or destruction exceeds the maximal

capacity of bone marrow RBC production :
- Reduced RBC lifespan
- Excessive Loss of RBC
 Signs and symptoms of anemia
Central nervous system Immune system
 Debilitating fatigue  Impaired T-cell and
 Dizziness, vertigo macrophage function
 Depression
 Impaired cognitive function Cardiorespiratory system
 Exertional dyspnoea
 Tachycardia, palpitations
Gastro-intestinal system  Cardiac enlargement,
 Anorexia hypertrophy
 Nausea  Increased pulse pressure,
systolic ejection murmur
 Risk of life-threatening cardiac
Vascular system
 Low skin temperature failure
 Pallor of skin, mucous
Genital tract
membranes and conjunctivae  Menstrual problems
 Loss of libido

Adapted from Ludwig H. Semin Oncol. 1998;25(suppl 7):2-6.

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 Signs and symptoms of anemia

The signs and symptoms of anemia range from slight

fatigue to life threatening reactions depending upon :
– Rate of onset
– Severity
– Ability of the body to adaptive
 Diagnosis of Anemia

1. Patient history
2. Patient physical examination
3. Hematologic laboratory findings

Identification of the cause of anemia is important so

that appropriate therapy is used to treat the anemia.
 Diagnosis of Anemia
1. History
- Symptoms of anemia (Acute vs. Chronic)
- The severity of cerebral and circulatory symptoms relative to
the severity of anemia.
- The possibility of chronic blood loss (GI, Gynecological).
- The possibility of episodes of hemolysis.
- The presence of neurological symptoms.
- Prior therapy of anemia.
- Use of other medications and exposure to toxins.
- Dietary history.
- Family history.
- Social history
- Underlying disease.
- Effect of symptoms (Quality of Life)
 Diagnosis of Anemia
2. Clinical Presentation and Physical Examination
• General findings might include
– Skin pallor
– Hepato or splenomegaly
– Heart abnormalities
•Specific findings may help to establish the underlying
cause:
– In vitamin B12 deficiency there may be signs of
malnutrition and neurological changes
– In iron deficiency there may be severe pallor, a smooth
tongue, and esophageal webs
– In hemolytic anemias there may be jaundice due to the
increased levels of bilirubin from increased RBC
destruction
 Angular cheilosis Koilonychia

Leg ulcer (HbSS)

 Diagnosis of Anemia
3. Laboratory Investigations
 Initial Tests :
- CBC (Hb, RBC indices, RDW, WBC, Platelets)
- Reticulocyte count
- Peripheral blood smear (PBS)

 Specific Tests :
- Iron Studies (s-ferretin, iron profile).
- Vitamin B12 and Folate levels.
- Hemoglobin electrophoresis.
- Work up for hemolysis.
- Renal Function Test.
- Liver Function Test.
- Endocrine Evaluation.
- Bone marrow examination.
 CLASSIFICATION OF ANAEMIA

Morphologic classification :
1. Macrocytic anaemia
2. Microcytic hypochromic anaemia
3. Normocytic anaemia.
Macrocytic Microcytic hypochromic

Normocytic normochromic
Penggolongan menurut Morfologi
volumetrik
Mikrositik Normositik
hipokrom normokrom Makrositik

MCV < 80 fL 80 – 100 fL > 100 fL

MCH ≤ 27 pg > 27 pg > 27 pg
MCHC < 30 g/dL  30 g/dL  30 g/dL

MCV= (Ht/Eritosit)x10 fL
MCH=(Hb/Eritrosit)x10 pg
MCHC=(Hb/Ht)x100 g/dL
HYPOCHROMIC, MICROCYTIC ANEMIAS
NORMOCHROMIC, NORMOCYTIC ANEMIAS
MACROCYTIC ANEMIAS
 Treatment of Anemia

 Specific treatment of underlying disorder caused anemia.

 Replacement of missing factors (iron, vitamin B12, folate, Epo)

 In many chronic anemias regular blood transfusions are needed

(thalassemia, myelodysplastic syndrome)

 Blood transfusion is usually needed in acute blood loss or if the

patient has severe symptoms or in heart failure
 Blood transfusion