WHO definition of Anaemia, Grading of Anaemia, IRON DEFICIENCY ANAEMIA, Clinical manifestations

1. Anaemia
Pharmacotherapeutics-1
Presented by
M.ashritha
20z51t0010
Pharm.d 2nd year

2. Introduction
• Anaemia is a condition in which there is a deficiency
of red blood cells orHaemoglobin in the blood,
resulting in pallor and weariness.
• Anaemia is not a disease it is a clinical manifestation
of disease.
• Anaemia can be temporary or long term (chronic).
• In many cases it’s mild,but anaemia can also be
serious and life-threatening.

3. WHO definition of Anaemia
•World Health Organization (WHO) has
defined anemia as Hb<13.0g/dl for men
and <12.0g/dl for women.
•For pregnant women <11.0g/dl.

4. Grading of Anaemia

5. IRON DEFICIENCY ANAEMIA
•Iron deficiency anaemia is the most common
Nutrition deficiency in the world. This is the most
common type of Anaemia caused by shortage of iron in
the body.
• It is the condition in which blood lacks adequate healthy
red blood cells.
• The name implies IDA is due to insufficient iron.Iron is a
key part of RBC without iron,body can’t produce enough
of a substance in RBC that enables them to carry
oxygen(haemoglobin).As a result,IDA may leave the
person tired and short of breath.

6. IDA:

7. Clinical manifestations

9. Symptoms of IDA:

10. Other symptoms include:
• Being
pale(or)yellow”sallow”skin.
• Pounding (or)”whooshing”in the
ears.
• Sore(or)smooth tongue.
• Glossal Pain.
• Reduced Salivary flow.
• Pagophagia-Craving & chewing
ice.
• koilonychia

12. Etiology:
• Decreased dietary intake(heme vs. Non heme).
• Malabsorptive syndrome
1. After gastrectomy.
2. Atrophic gastritis.
3. Achlorhydria.
• Situations that increase the demand of iron
1. Frequent blood donations.
2. Endurance sports.
3. Infancy& adolescence.
4. Menstruation
5. Pregnancy

13. Etiology
• Blood loss –DX tool : Fecal occult blood test.
• Peptic ulcer.
• Hiatal Hernia.
• Alcoholic Gastritis.
• Carcinoma Colon.
• Hookworm infection
• Hemorrhoids.

14. Pathophysiology
• Iron stores are exhausted indicated by decrease in S.Ferritin.
• Abnormal RDW can be the first Hematologic indication of a
developing iron deficiency in non-anaemic patients.
• Bonemarrow sideroblasts are absent.
• Macrophage iron is not seen.
• Long standing negative iron flow eventually leads to the last
stage of iron deficiency.
• Blood loss can shorten the time for this stage to develop.

15. CASE SHEET

16. Patient Profile Form
• Name: Srinu.CH
• Age : 42yrs
• Sex. : Male
• IP.NO : 211101134
• Address: Rayapole,Siddipet.
• DOA : 01/11/21
• DOD : 09/11/21
• Allergic to: Nill
• Department :Medicine
• Consultant : Dr.Karthik

17. • C/C:
Dizziness since 6 days.
Abdominal discomfort since 6 days.
History of Present illness :
Patient was apparently asymptomatic & Normal 6days ago.
He has dizziness since 6days.and Abdominal discomfort Since
6days.
History of Medical illness :
Not a K/C/O HTN,DM,Asthma,epilepsy,CVS (or)CNS problem.
History of surgical illness:
Not-significant.

18. Personal History :
1. Single(✓)Married
2. Appetite- Normal(✓)/Lost
3. Veg/Non-Veg(✓)/Eggtarian
4. Bowel-Regular(✓)/Irregular/Constipation
5. Micturation -Normal(✓)/Abnormal
6. Known Allergies-No(✓)/Yes
7. Habits/Addictions
• Alcohol-regular/Occasional/teetotaler
• Tobacco-Snuff/Chewable/Smoking-Pack years
• Drug use-No(✓)/Yes
• Betel nut No(✓)/Yes

19. F/H:
Not significant
Physical Examination
• A) General
• Pallor-No/Yes(✓)
VITAL: BP:
PR:
01/11/21 02/11/21 03/11/21 04/11/21 05/11/21 06/11/21 07/11/21 08/11/21 09/11/21
80/60 110/70 100/60 90/60 120/80 100/60 120/70 90/60 100/60
01/11/21 02/11/21 03/11/21 04/11/21 05/11/21 06/11/21 07/11/21 08/11/21 09/11/21
96 100 72 86 79 78 85 76 72

20. Temperature:
01/11/21 02/11/21 03/11/21 04/11/21 05/11/21 06/11/21 07/11/21 08/11/21 09/11/21
98.2F 97.5F 98.7F 98.5F 98.6F 98.7F 98.5F 98.6F 98.6F
RR:
01/11/21 02/11/21 03/11/21 04/11/21 05/11/21 06/11/21 07/11/21 08/11/21 09/11/21
22 - - - - - - - 20

21. •CVS: S1,S2 +
•RS :. BAE+
•Abdomen:
Soft/Non tender
•Central Nervous System:
NAD
•ProvisionalDiagnosis:
Anaemia

22. LAB INVESTIGATIONS
Date:01/11/21 CBP
Test Description Result Units Reference Range
Hb 3.8 gm/dl M:12.0-18.0,F:11.5-16.5
Erthyrocyte 2.6 mil/cumm 3.5-5.5
WBC 7,100 cell/cumm 4,000-11,000
Neutrophils 57 % 30-70
Eosinophils 03 % 1-6
Lymphocytes 30 % 20-50
Monocytes 10 % 2-8
Basophils 00 % 0-1
PC 3,85,000 lakh/cumm 1,50,000-4,50,000
PCV 29.3 vol% M:42-45,F:35-45

23. CBP Changes:
• 02/11/21
• Hb:6.4
• 03/11/21
• Hb:5.7
• RBC:3.20
• 04/11/21
• Hb:6.3
• 07/11/21
• Hb:8.3
• RBC:3.9

24. Biochemistry
Test Description Results Units Reference Range
Serum Iron 60 ug/dl Male:60-160Ug/dl
Female:35-145Ug/dl
TIBC 305 ug/dl 250-400ug/dl
TRANSFERRIN 213 ug/dl 200-360ug/dl
Peripheral smear:
RBC- microcytic hypochronic aniso prokilocytosis.

25. Biochemistry:
Test Description Results Units Reference Range
Serum folic Acid
SR. VITAMIN B12 144.90. pg/mL N:190-950pg/mL
D:<190pg/mL
CRP 3.19 mg/L <6.0mg/L
D-DIMER <100 ng/mL <500ng/mL
SR.FERRTIN 1.57 ng/mL M:239-336.2ng/mL
F:11.0-306.8ng/mL
5.66. ng/mL 3.0-17.0ng/mL

26. BLOOD TRANSFUSION:
•01/11/21
•Starting time:11.45pm
•Ending time:2:00am
•08/11/21
•Starting time:7:15pm
•Ending time:11:00pm

27. •Final Diagnosis
Iron deficiency Anaemia

28. Day wise
assessment

29. Date Day On
examina
tion
Patient
complain
ts
Drug Frequency
01/11/21 01 BP:80/60
PR:96
T:98.2°F
RR:22
No Complaints Tab:Bandyplus
Syp:Elemental
F
Inj.PAN
STAT
T/D
SOS
02/11/21 02 BP:110/70
PR:100
T:97.5°F
No Complaints Syp:Elemental
F
Inj:PAN
Inj:Optineuron
CST

30. 03/11/21 03 BP:100/60
PR:72
T:98.7F
No Complaints Tab:
Bandyplus
Syp:
Elemental F
Inj:PAN
Inj:
Optineuron
Tab:Mulmina
plus
Tab:Neurokind
LC
CST
OD
OD
OD
04/11/21 04 BP:90/60
PR:86
No Complaints Syp:Elemental
F
Inj:PAN
Inj: Optineuron
Tab:Mulmina
plus
Tab: Neurokind
LC
CST

31. 05/11/21 05 BP:120/80
PR:79
No
Complaint
s
Syp: Elemental
F
Inj:PAN
Inj: Optineuron
Tab:Mulmina
plus
Tab: Neurokind
LC
CST
06/11/21 06 BP:100/60
PR:78
No Complaints Syp: Elemental
F
Inj:PAN
Inj: Optineuron
Tab:Mulmina
plus
Tab: Neurokind
LC
CST

32. 07/11/21 07 BP:120/70
PR:85
No Complaints Syp: Elemental
F
Inj:PAN
Inj: Optineuron
Tab: Mulmina
plus
Tab: Neurokind
LC
CST
08/11/21 08 BP:90/60
PR:76
No Complaints Syp: Elemental
F
Inj:PAN
Inj: Optineuron
Tab: Mulmina
plus
Tab: Neurokind
LC
CST
09/11/21 09 BP:100/60
PR:72
RR:20
T:98.6°F
No Complaints Syp: Elemental
F
Inj:PAN
Tab:Mulmina
plus
Tab: Neurokind
LC
CST

45. PLAN

48. DRUG INTERACTION
• Drug-Drug Interactions
PANTOPRAZOLE+CYANOCOBALAMIN
Pantoprozile decreases levels of CYANOCOBALAMIN by
inhibition of GI absorption.
• DRUG-FOOD INTERACTION
Folic Acid+Alcohol may results to decrease in serum folate
concentration.
• INVERMERTIN+ALCOHOL
Bioavailability may increase.

50. •
REFERENCE
Medscape
Drug Today