• ANEMIA:

• Anemia is a condition characterized by abnormally low

levels of healthy red blood cell or hemoglobin.
• Causes of Anemia:
– Excessive blood loss due to acute or chronic hemorrhage
– Reduced production of RBC due to lack of some factors
which are necessary for RBC production
– Excessive red blood cell destruction in comparison to the
production of blood cells
• Symptoms:
Most common symptom of anemia are a
result of decrease of oxygen on the cells i.e.
hypoxia.
• The following are the most common
symptoms of anemia-
• Headache
• Irritability
• Abnormal paleness or lack of color of the
skin.
 Symptoms(Cont.)

• Increased heart rate

• Breathlessness
• Dizziness or vertigo, Especially when standing
• Lack of energy
• Sore or swollen tongue(glossitis)
• Jaundice
• Enlarged spleen or liver(Splenomegaly or
hepatomegaly)
• TREATMENT OF ANEMIA:
• 1) Treatment of the causative diseases
• 2) Vitamin and mineral supplements
• 3) Change in diet
• 4) Blood transfusion
• 5) Bone marrow transplant
• 6) Surgery
• 7) Antibiotic therapy
• COMMON TYPES OF ANEMIA:
• Iron deficiency anemia
• Megaloblastic anemia-
a) Folic acid deficiency anemia
b) Vitamin B12 deficiency anemia
• Hemolytic anemia
- Sickle cell anemia
• Thalassemia
• Aplastic anemia
• Chronic anemia
• 1) Iron deficiency anemia:
• Iron deficiency anemia is the most common
form anemia in the world.
• If the supply of iron to the bone marrow is
insufficient for the requirement of
hemoglobin synthesis, iron deficiency anemia
occurs.
• Defective synthesis of haemoglobin, resulting
in red cells that are smaller than normal
(microcytic) and contain reduced amounts of
haemoglobin (hypochromic).
• CAUSES OF IRON DEFICIECY ANEMIA:
• Iron deficiency anemia may be caused by the
following:
• 1) Diets low in iron:
• Iron is obtained from foods in our diet; however,
only 1 mg of iron is absorbed for every 20 mg of iron
ingested. A person unable to have a balanced iron
rich diet may suffer from some degree of iron
deficiency anemia.
• 2) Body changes:
• An increased iron requirement and increased red
blood cell production is required when the body is
going through changes like child growth and
adolescence or during pregnancy and lactation.
• 1mg of iron is absorbed for every 20mg iron ingested
• 27mg of ------------------------------27X20=540mg
 CAUSES OF IRON DEFICIECY ANEMIA(cont.)

• 3) GI abnormalities:
• Malabsorption of iron is common after some forms of
gastrointestinal surgeries(Most of the iron taken in by
foods is absorbed in the upper small intestine) Any
abnormalities in the gastrointestinal tract could alter
iron absorption and result in iron deficiency anemia.
• .
• 2) Megaloblastic/macrocytic anemia
Megaloblastic anemia is an anemia (of macrocytic classification)
that results from inhibition of DNA synthesis in red blood cell
production.

The defect in red cell DNA synthesis is most often due to

hypovitaminosis, specifically a deficiency of vitamin B12 or folic
acid and/or intrinsic factor .

Loss of any of these can lead causes abnormal and diminished

DNA and, consequently, failure of nuclear maturation and cell
division
As a result erythroblastic cells of the bone marrow continue to grow
without division/or little division, into large, odd-shaped cells called
megaloblasts/macrocyte.

The cell itself has a flimsy membrane and is often irregular, large, and
oval instead of the usual biconcave disc. The cells are stiff and
nonflexible

These poorly formed cells, after entering the circulating blood, are
capable of carrying oxygen normally, but their fragility causes them to
have a short life, one half to one third normal.

Therefore, it is said that deficiency of either vitamin B12 or folic acid

causes maturation failure in the process of erythropoiesis.
• Sickle cell anemia:
• Sickle cell anemia is an
inherited blood disorder .
• This is the most common type
of hemoglobinopathy in which
there is a substitution of
amino acid glutamic acid on
position 6 present in the chain
of the HbA, by valine; giving
rise to an abnormal Hb, i.e.
hemoglobin S. 
• This is caused by single
mutation in the gene of beta
globin chain. (the 6th amino
acid of the chain being
changed from gultamic acid
to valine)
•When this hemoglobin is exposed to
low concentrations of oxygen, it
precipitates into long crystals inside the
red blood cell.
•These crystals elongate the cell and give
it the appearance of a sickle rather than
a biconcave disc
•The precipitated hemoglobin also
damages the cell membrane, so that the
cells become highly fragile, leading to
serious anemia.
• cluster together, they block and clog
small blood vessels and thus stop the
movement of oxygen-carrying blood.
Sickle cells die after about 10 to 20 days, unlike
normal hemoglobin cells, which live for up to 120
days. This results in a chronic short supply of RBC
as the bone marrow can't make new red blood
cells fast enough to replace the dying ones,which
causes anemia.
4)Thalassemia
Thalassemia is an inherited disorder. It leads to the decreased
production and increased destruction of red blood cells.

In thalassemia the genetic defect, which could be either

mutation or deletion, results in reduced rate of synthesis or
no synthesis of one of the globin chains that make up
hemoglobin.
This can cause the formation of abnormal hemoglobin
molecules, thus causing anemia, the characteristic presenting
symptom of the thalassemia.
• i) α- Thalassemia:
• In α- Thalassemia there is an imbalance in
the production of the α chain of globin.
• α- Thalassemias result in decreased alpha-
globin production, therefore fewer alpha-
globin chains are produced, resulting in an
excess of ß chains in adults

• ii) β- Thalassemia
• In β - Thalassemia there is an imbalance in
the production of the β chain of amino acid.
5) APLASTIC ANEMIA:
• Bone marrow aplasia means lack of functioning
bone marrow.
• Aplastic anemia occurs when the bone marrow
produces too few of all three types of blood
cells (such as RBC, WBC and platelet) due to
aplasia of bone marrow.
• A reduced number of red blood cells cause
hemoglobin to drop.
• A reduced number of WBC makes the patient
susceptible to infection.
• A reduced number of platelets cause the blood
not to clot as easily.