ANAEMIA

Dr. Mahmudul Huque. MBBS(DMC), MD (EM)

Normal values for

Indices Hb (g/dl) MALE

peripheral

blood

FEMALE 11.5-16.5 g/dl

13-18 g/dl
Infant (1yr): 8-10 g/dl Children: 10-13 g/dl

PCV (L/L) RCC (10^12/L)

MCV (fl) MCH (g/dl) MCHC (pg)
Reticulocytes(%)

0.42-0.53 4.5-6.0
80-96 27-33 32-35 0.5-2.5

0.36-0.45 3.9-5.0

ANAEMIA

Decreased level of Hb in blood below reference level for age and sex with plasma level not above normal value.
Always consider volume change Dehydration Pregnancy bleeding

Various types of Anaemia classified in terms of MCV

Decreased MCV (<80fl) - Hypochromic Microcytic Increased MCV (>96fl) Macrocytic Megaloblastic Normoblastic Normal MCV- Normochromic Normocytic

Signs & Symptoms of Anaemia

SYMPTOMS
(All non-specific)

Fatigue Headaches Faintness Breathlessness Angina Intermittent claudication Palpitation Pica

SIGNS

Pallor, Universal feature. Paper white lower palpabral conjunctiva if severe. Tachycardia Systolic flow murmur Cardiac failure

Signs observed in :

Lower palpebral conjunctiva. Dorsal surface of tongue. Palm and sole. Whole body skin. In infants: Skin.

Pallor

Some specific signs

Specific Signs in IDA

Koilonychia Brittle nails, hair Atrophy of tongue papilla Angular stomatitis Plumer Vinson Syndromedysphagia and glossitis Pica

Contd.

Specific Signs in hemolytic anemia

Anaemia Mild Jaundice Splenomegali, Leg ulcers Leg ulcer

Specific Signs in sickle cell disease

Specific Signs in thalassaemia

Bone deformities Mongoloid facie

Contd.

Specific Signs in Aplastic anemia

Bleeding Infection

Specific Signs in Folate deficiency

Foetal neural tube defects

Lemmon yellow colour glossitis Neurological features.

Specific Signs in B12 deficiency

Pathophysiology of RBC Cell Size

Pathophysiology of RBC Cell Size

RBC in marrow must require a minimum amount of Hb before its release into circulation, Otherwise in marrow they continue to divide. Which results in :

If component of Hb is less, MCV Fe deficiency Faulty globin chain In Thalassaemia Haem In sideroblastic anaemia

Contd.
If cell division is less, MCV. As in : Vit B12 Deficiency, Folate deficiency Cytotoxic drugs.

If Lipid, MCV. As in : Hyperlipidemia Pregnancy Hypothyroidism Liver disease

Hypochromic Microcytic

Iron Deficiency Anaemia most common cause Thalassaemias defect in globin synthesis Sideroblastic Anemia Chronic Disease Anemia

Macrocytic Anaemia

Megaloblastic

Vit. B12 deficiency Folate deficiency

Normoblastic

Alcoholism Liver disease Increased Reticulocyte Count

Hemolysis or Haemorrhage

Normochromic Normocytic

Acute blood loss Chronic disease anemia Renal failure Connective tissue diseases Marrow infiltration/fibrosis Endocrine disease Aplastic anemia Hemolytic anemia

Aeitological Classification

Haemorrhagic Anaemia
Haemolytic Anaemia Dyshaemopoietic Anaemia

Haemorrhagic Anaemia

Acute Haemorrhage : Accidental trauma Surgical operation

Chronic Haemorrhage : GIT lesion eg. Bleeding peptic ulcer, hookworm infestation, bleeding piles. Gynaecological disturbance eg. Menorrhagia.

Haemolytic Anaemia

INHERETED HAEMOLYTIC ANAEMIA

ACQUIRED HAEMOLYTIC ANAEMIA

INHERETED HAEMOLYTIC ANAEMIA

Membrane defect

Hereditary Spherocytosis Hereditary Elliptocytosis Hereditary Xerocytosis

Haemoglobin abnormalities

Thalassaemia Sickle cell anaemia G6PD deficiency Pyruvate deficiency

Metabolic abnormalities

Hypersplenism

ACQUIRED HAEMOLYTIC ANAEMIA

Autoimmune Haemolytic Anaemia

Warm AHA Cold AHA Drug induced haemolytic anaemia March hemoglobinuria Mechanical.

Alloimmune Haemolytic Anaemia

Dyshaemopoietic Anaemia
Deficiency of essential elements of erythropoiesis Iron deficiency Anaemia Megaloblastic Anaemia Nutritonal Anaemia (in PEM) Anaemia with Scurvy

Bone marrow disturbance Aplastic Anaemia Sideroblastic Anaemia Anaemia with renal failure Anaemia with endocrine disorders

CAUSES

Iron Deficiency Anaemia

blood loss:

Gastrointestinal ulcers , Hookworm infestation, Schistosome, malignancy, NSAID use Uterine e.g. menorrhagia Urinary tract
Repeated pregnancy, Lactation prematurity Puberty & growth period. Malabsorption e.g. gastrectomy, coeliac disease Achlorohydra dietary iron deficiency

increased demands:

others:

Contd. B12 Deficiency

Inadequate dietary intake

Gastric & small bowel disease

Pernicious anaemia

Folate deficiency
Decreased vegetable intake

Pregnancy
Drugs Methotrexate, Pills, phenytoins

INVESTIGATIONS

Complete blood count (CBC) Peripheral Film Red cell indices (MCV, MCH, MCHC) Bone marrow examination Reticulocyte count Serological investgations
Serum iron Serum ferritin TIBC Percentage saturation Hb electrophoresis

Blood films findings

Microcytic Hypochromic

Macrocytic

Contd.

Haemolytic Anaemia with broken up RBC

Target cells

Elliptocytes

Tear Drop cells

Peripheral blood film

Microcytic-Hypocromic
Iron deficiency Anaemia Thalassemia Target cells Sideroblastic anaemia Sideroblast in marrow

Macrocytic
Hypersegmented polymorph B12 deficiency

Micro + Macrocyte
Dimorphic in both Folate + B12 deficiency

Contd.

Increased Reticulocytes Hyperactive bone marrow Haemolysis Fragmented RBC Pancytopenia Aplastic Anaemia

THANK YOU