Anemia, Classification, Clinical Manifestations (General vs Specific Sign & Symptoms), Lab Investigations (Normal vs Abnormal Lab values) and Treatment

1. Presented at:
College Of Nursing
Shifa Tameer-e-Millat University
By: Muhammad Farooq
RN, BSN, Dip Card.

3.  At the end of this presentation, the audience will
know:
 What is Anemia
 Causes of Anemia
 What are different Types/classification of Anemia
 Clinical feature of anemia
 Diagnosis/investigation Of Anemia
 Treatment Of Anemia

5.  Taken from Greek language (an meaning absence
& hemia meaning blood), the term Anemia is use
to describe a reduction in the hemoglobin
concentration or in the number of circulating
RBCs below the level considered normal for the
person's age, sex and locality.

6. Normal reference values of Hb%
Population
Normal Hb% (at sea level)
Newborn
14-22 g/dl
Children
11-13 g/dl
Non-pregnant women
12-16 g/d
Pregnant women
11-15 g/d
Men
14-18 g/dl
Geriatric Age
(Both Genders)
12 – 16 g/dl

7. Normal Values of RBC Count
Population
RBCs Count (at sea level)
Newborns–6 months
4.0–5.5 mil/µl
Children
4.0–4.9 mil/µl
Female
3.8 – 5.4 mil/µl
Male
4.4 – 5.4 mil/µl

8. Causes Of
Anemia

9.  There are many diseases, conditions and other
factors causes anemia, few of which are:
 Nutritional deficiencies i.e. Iron, vit B12, folate etc.
 Hemolytic disorders e.g. Hypersplenism
 Acute or chronic Blood loss e.g. from G.I Tract,
Hemorrhage
 Bone marrow disorder
 Chronic Diseases e.g. Renal failure, Liver disease and
Malignancies

10. Causes Of Anemia (Cont….)
 Infections and inflammation e.g. Malaria, Cl.
Tetani
 Toxicity (from drugs, metals and poisons)
e.g. Lead Poisoning
 Autoimmune disorders .e.g. SLE,
 Heredity defect e.g. Thalassemia

12. Classification Of Anemia
 Classification of anemia can be made the bases of
 RBCs Morphology
 Etiology

13. Morphological Classification
 In morphological approach anemia is classified by the
size or volume of RBC which is expressed as Mean
Corpuscular or Mean Cell Volume(MCV).
 On the basis of MCV, following are the types of
anemia:
 Microcytic Anemia (MCV<76fl)
 Macrocytic Anemia (MCV >98fl)
 Normocytic Anemia (MCV b/w 76 – 98 fl)

14. Microcytic Anemia
(<76 fL)
Macrocytic Anemia
(>98fL)
Normocytic Anemia
(76-98 fL)
1) Iron Deficiency
anemia
Vit. B12 & folate
deficiency
Vit B2 & B6
2) Thalassemia
Alcoholism
Hemolytic Anemia
3) Sideroblastic Anemia
Acute Blood Loss
Post Hemorrhagic
Anemia
4) Lead Poisoning Anemia
Liver disease
Sickle Cell Anemia
5) Chronic Disease Anemia
Aplastic Anemia
Anemia in Pregnancy

15. Etiological Classification
 Etiological Classification of Anemia include
 Anemia due to impaired RBC production
 Anemia due to excessive destruction
 Anemia due to Blood loss

16. Clinical Features Of Anemia

17. Clinical Manifestations
 The clinical features of Anemia can result from
following factors.
1.
Tissue Hypoxia
2.
Compensatory Mechanism
3.
Rate of blood loss/destruction of RBCs
4. Causes of Anemia

18. Symptoms of Tissue Hypoxia
Largely affect Central Nervous System,
Cardio-vascular system and Muscular
system as their Oxygen requirement is
high than other.

19. Neurological Symptoms:
 Dizziness, fainting, lack of concentration
 Blurred or diminished vision
 Headache, tinnitus, Vertigo
 Paraesthesia in the fingers and toes
 Insomnia, irritability, confusion

20. Cardio Vascular Symptoms
 Dyspnea
 Palpitation
 Angina
On exertion or
at rest (in sever cases)
 Intermittent claudication
 Heart Failure (high output)
 Orthostatic Hypotension
CV Signs includes
 Tachycardia, bounding pulse
 Loud HS with S3 over mitral or tricuspid area
 Systolic murmur
 Raised JVP

21. Musculoskeletal symptoms
 Exercise intolerance
 Easy fatigability
 Tiredness
 Generalized Muscular weakness

22. Other Features
 Pallor of the skin, sclera and mucous membranes
 Jaundice
 Lymphadenopathy
 Hepatosplenomegally
 Bony Pain
 Petechiae
 Hair Loss
 Anorexia, Weight Loss

23. Compensatory Mechanism
1. Increase Cardiac Output (to maximize O2 delivery to tissue)
 Tachycardia, bounding pulse
2. Increase Erythropoiesis
 Liver and Yellow Bone marrow
3. Increase Plasma Volume
4. Redistribution of blood to more vital organs
 By selective vasoconstriction to non-vital organs

24. Specific Symptom due to
Underlying Cause

25. Iron Deficiency Anemia
 People with an iron deficiency may experience these
symptoms:
1.
Pica habit
2.
Koilonychias (spoon shape nails)
3.
Red beefy tongue due to loss of papillae
4.
Angular stomatitis/ cheilitis
5.
Esophageal Web
6.
Dysphagia, Odynophagia
7.
RLS (Restless Leg Syndrome) in fewer cases
PlummerVinson
Syndrome

26. Pernicious/ vit. B12 Deficiency Anemia
 Paraesthesia and Numbness in hand and feet
 Dementia, disorientation
 Difficulty in walking
 Sore tongue
 Easy bruising or bleeding, including bleeding gums
 Mood changes or Depression

27. Sickle Cell Anemia
1.
Leg Sore
2.
Swelling of hand and feet
3.
Sever Joint pain
4. Splenomegaly & LUQ Abdominal Pain
5.
Susceptibility to infection
6. Delayed Growth in children
7.
Retinopathy (visual disturbance)

28. Thalassemia (Major)
 Bony pain
 Bossing of head
 Delayed Growth
 Splenomegaly
 Hepatomegaly

29. Aplastic Anemia
 Frequent or prolonged infections
 Unexplained or easy bruising
 Nose & Gums bleeding
 Prolonged bleeding from cuts
 Skin rash

30. How To Diagnose Anemia

31. How To Diagnose Anemia
History
Physical examination
Lab investigations

32. History Taking
 Diet (pure vegetarian)
 Fever
 Family history
 Related symptom
 Sign of other cytopenia

33. History Taking (Cont….)
 Last CBC
 Previous diagnosis as anemia or transfusion
 Medical history e.g. Chronic illness, drug use or abuse
 Surgical Hx: Partial or complete gastrectomy
 Previous jaundice, dark urine
 Blood loss
 Menstruation, Blood donation, GI loss, Concealed
bleeding

34. Physical Examination
 Skin, sclera & Mucous membrane (for pallor)
 Lymph node enlargement
 Hepatosplenomegaly
 Watch for the specific feature for suspected disease
 Gum, Lips (Bleeding, cheliosis)
 Nail fold (Koilonychea)
 Facial or skull Bones abnormality

35. Lab Investigations

36. Lab Investigations
1) Complete Blood Count:
 Hemoglobin level
 Hematocrit Rate (M:40 – 52%, F: 35 – 46%)
 RBC Count (M: 4.5 – 6.5, F: 4.0 – 5.4 mil/mm3)
 MCV (76 – 98 fL) = (Hct/RBCs*10)
 MCH (27 – 32 pg) & MCHC (32 – 36%)
 WBCs and platelets

37. Lab Investigations
 S. Ferritin (M: 18-270 μg/L F: 18-160 μg/L)
 TIBC (250–370 μg/dl)
 Serum iron (M: 65–177 μg/dl, F: 50–170 μg/dl)
 Reticulocyte Count (<2%)
 Peripheral Blood Smear
 Hemoglobin Electrophoresis

38. Other Lab Investigations
 Bone marrow aspiration
 Liver and Renal Function Test
 Coombs Test
 Vit & mineral deficiencies
 Hormonal Deficiencies

39. How To Treat Anemia

40. Treatment
 Depends on Type, cause and severity
 Goal is to increase Oxygenation to tissue and to treat the
underlying cause
 Certain modes of treatment include:
 Dietary Changes or Supplemental Diet
 Medicine
 Procedures
 Surgical Measurement

41. Treatment
 Dietary Changes & Supplements
 To correct the deficient vitamin or mineral, the low level
causes anemia.
 Diet Rich in Minerals & Vitamins (B12, Vit C, folate)
 Oral or Injectable supplement of these substance
 Medicine including
 Antibiotics / Anti-parasitic for infection or infestation
 Hormones (Erythropoietin, Progesterone and
Androgen)

42. Procedures
 Blood Transfusion
 Usually used to treat severely anemic patients as in
thalassemia major or sickle cell disease or to replace the
blood loss after injuries or surgeries.
 For multiple transfusion, Iron Chelation agent
(Deferasirox) should be given to prevent iron over dose.
 Allogeneic Bone Marrow Transplant
 Surgical Measurement include repair or removal of G.I part
causing blood loss and splenectomy.