Anemia

Definition
 Anemia - insufficient Hb to carry out O2 requirement
to tissues.
 WHO definition : Hb conc.  11 gm %
 For developing countries : cut off level suggested is
10 gm %
- WHO technical report Series no. 405, Geneva 1968
Centre for disease control, MMWR 1989;38:400-4
WHO Classification of Anaemia

Degree Hb% Hematocrit (%)

Moderate 7-10.9 24-37%

Severe 4-6.9 13-23%

Very Severe <4 <13%

 Symptoms
Irritability
Lack of
Concentration
Fatigue
Infection

Palpitation Weakness

Dizziness
 Clinical Features
Pallor of skin
And m/m
Soft ejection
systolic
murmur Edema

Signs
Platynychia
Tachycardia Koilonychia

Glossitis
Stomatitis
Causes of Anemia

Microcytic
Hypochromic Macrocytic

 Iron Deficiency  Megaloblastic

Anemias (Folic acid/
 Thalassemia
B12deficiencies)
syndromes
 Liver Disease
 Sideroblastic anemia
 Reticulocytosis
Causes of Anemia

Normocytic,
normochromic
 Hemorrhage or blood  Hemoglobinopathies, (SS,
loss SC, CC)
 Hereditary Spherocytosis
 Unstable hemoglobins
 Autoimmune hemolytic
 Infections anemia
 Chronic disease  Some enzymatic
deficiencies
 Normal Levels
Hb 13.5 – 14 gm %

R.B.C. 4.5 – 4.7 million/cu mm

Serum Iron 50 – 150 μg / dL

TIBC 300 – 360 μg / dL

Transferrin saturation 25 – 50 %
S. Ferritin level 30 μg / Lit
Red Cell protoporphyrin 30 μg / dL

Erythropoietin 15.20 U / Lit

MCV 76 – 100 fL

MCH 27 – 33 pg
MCHC 33.37 gm / dL

PCV 32 – 40 %
 Laboratory Evaluation

Initial Testing:

 CBC w/ differential (includes

RBC indices)
 Reticulocyte count
 Peripheral blood smear
 Laboratory Evaluation
Bleeding
 Serial HCT or HGB
Iron Deficiency
 Iron Studies
Hemolysis
 Serum LDH, indirect bilirubin, haptoglobin, coombs,
coagulation studies
Bone Marrow Examination
Others-directed by clinical indication
 hemoglobin electrophoresis
 B12/folate levels
 Laboratory Evaluation
IDA Thalassemia Chronic Diseases

Serum Iron Decreased Normal / Increased Decreased

TIBC Increased Normal Decreased or N

Transferrin Decreased N or Increased N or Decreased

Saturation

Serum Ferritin Decreased N or Increased N

Marrow Iron Decreased / N or Increased N

absent
Therapeutic test with Rise in Hb No rise in Hb No rise
oral iron
 Iron Deficiency Anemia
Causes

Decreased iron intake:

• Dietary deficiency
• Decreased absorption

Increased iron loss:

• GI bleeding
• Excessive menstrual flow
• Acute blood loss
 Modalities of Management

Blood
Oral Iron Parenteral transfusion

Human Recombinant
Injectable Iron Erythropoietin
 Macrocytic Anemia
2 Categories

Megaloblastic:
• Almost always caused by
B12/folate deficiency
• Megaloblastic features.

Non-megaloblastic:
• Alcoholism
 Hemolytic Anemia

Inherited:

• RBC membrane defects

(spherocytosis, elliptocytosis..)
• RBC Enzyme defects (G6PD
deficiency)
• Hemoglobinopathies (SCA)
• Thalassemias
 Hemolytic Anemia

Acquired:

• Immune related (AIHA)

• MAHA (microangiopathic
hemolytic anemia)
• Infection related (malaria)
• Drug related
 Hemolytic Anemia

Diagnosis
• Hemoglobinemia/hemoglobinuria (when
hemolysis is intravascular, or so brisk
extravascularly that macrophages
cannot keep up)
• Reticulocytosis
• Indirect hyperbilirubinemia
• Increased LDH
• Decreased haptoglobin
• Direct antiglobulin test (DAT)
 Hemoglobinopathies

A collective term for the inherited disorders

of Hb synthesis
 Disorders
of globin synthesis e.g.
Thalassemia
 Structural
Hb variants e.g. Sickle cell
anemia, HbC
 Thalassemia
 Genetic disorders; lack or sed synthesis of globin
chains
 Two types :  &  thalassemia
  chains encoded by 2 pairs of genes on
chromosome 16
  chains encoded by single pair of genes on
chromosome 11
  thalassemia more common and presents as either
°(major) or + (minor)
 Diagnosis of Thalassemia

 Hb estimations
 Peripheral smear
 sed MCV
 sed MCH
 HbA2 ( 22)
 Sickle Cell Disease
 Structural Hb variant
 Exists in homo & heterozygous forms
 Under hypoxic conditions, HbS
polymerizes, gels or crystallizes.
  hemolysis of cells, &
thrombosis of vessels in
various organs
 In long standing cases,
multiple organ damage.
Thank You