The document defines anaemia and describes its classification and types. It is classified into morphological anaemia, based on changes seen in red blood cells, and etiological anaemia, based on the underlying cause. The key types of morphological anaemia are normocytic normochromic, microcytic hypochromic, and macrocytic normochromic. Etiological anaemia includes anaemia due to blood loss, nutritional deficiencies, bone marrow failure, and haemolytic anaemia. Common causes, clinical features, laboratory findings, and treatments are discussed for different types of anaemia.

2. • Definition
1) It is a pathological condition in which the
haemoglobin level of the blood goes down below the
lower limit of the normal range of the age and sex of
the individual.
OR
2) It is a pathological condition in which the RBC
charring capacity of blood is decrease.
OR
3) It is a pathological condition in which the RBC count
or haemoglobin concentration or both goes down.

3. CLASSIFICATION
Mainly two types :
1. Morphological anaemia :-
based on absolute indices of morphological changes
seen in RBC in peripheral blood smeared .
Which is follow by pathologist.
2. Etiological anaemia:-
based on cause of anaemia . Which is follow by
clinician to know the cause so that can be treated.

4. Morphological Anaemia
• Based on the value of absolute indices of
morphological changes in RBC. like change in size ,
shape and concentration of Hb.
• On the base of change in RBC ; three subtypes of
morphological anaemia is there:-
1. Normocytic normochromic
2. Microcytic hypochromic
3. Macrocytic normocromic
• Absolute indices are three:
1. M.C.V = Mean corpuscular volume.
2. M.C.H =Mean corpuscular haemoglobin.
3. M.C.H.C=Mean corpuscular haemoglobin
concentration.

6. ATEOLOGICAL ANAEMIA
 This classification is based on the etiology (cause) of anaemia.
1. Due to blood loss(post haemorrhagic)
• acute blood loss :
Like in accident, surgery ,APH ,PPH , etc…
• Chronic blood loss:
Eg. Piles ,peptic ulcer , hook-warm infection, etc….
2. Due to deficiency of haemopoatic factor OR Nutritional anaemia
eg: Fe –deficiency anaemia
Vit-B12 or folic acid deficiency anaemai.
3. APLASTIC ANAEMIA
caused by bone marrow failure

7. 4. Haemolytic anaemia:
It is divided in to two subtypes
A) Intracorpuscular : thalassaemias ,
haemoglobinopthis
B)Extracorpuscular: malaria, haemolytic disease of
new born, incompatible blood

8. Clinical feature of Anaemia
Lassitude
Fatigue
Palpitation
Breathlessness on exertion
Dimness of vision
Insomnia
Angina
Tingling sensation
Pallorness of skin , mucous membrane, conjunctiva
Trechycardia

10. Systolic murmur
oedema
Amenorrhea
Menorrhagia
Attacks of giddiness
Headache
Drowsiness
Flatulence of abdomen after eating
( In mild anaemia there may not be any symptoms)

11. Anisocytosis : Increase variation in size of RBC.
normal size of RBC= 6.7-7.7 μ (normocyte)
o average -7.2 μ
• Larger than 8μ is
called- Macrocyte.
• Smaller than 6μ is
Called- Microcyte.

12. Poikilocytosis : increase variation in shape of RBC.
eg. Sickle shaped or oval shaped.

13. Hypochromasia :central pallor area of RBC is
increased more than 1/3rd . seen in Fe
deficiency anaemia, thalassaemias ,
sideroblastic anaemia.

14.  Most common type of anaemia.
 More common in vegetarian people than non-veg
people.
 because non-vegetarian food is rich in iron.
• Contain heam-Fe which is ferrous form of iron does not need
HCL of gastric juice and vitamin for absorption.
• Easily absorbed.
• Absorbed in duodenum and upper jejunum.
 In vegetarian Fe is in ferric form.
Need HCL of gastric juice and vitamin to convert into ferrous
form.
15

15. Source of iron :-
 Non –vegetarian food rich in iron :
liver , kidney , egg-yolk, meat , fish fat.
 Vegetarian food rich in iron:
cereal pulse base diet is rich in iron.
dark green vegetable like spinach , leafy vegetables , dry
fruits , whole pulses like channa, rajma , bajra etc… ,
jiggery , dates , banana , apple etc..
 Daily requirement= 18 mgm/day ( in adult)
Daily loss = 0.5 to 1.0 mgm/day
16

16.  Body iron store in hair , nails , sweat etc..
 Absorption :-
-> depend upon need of body.
-> controlled by mucosal block.
-> in anaemic person more absorption.
-> increased by vit-C , gastric juice,
-> decreased by milk , antacids , phylates , tannin
etc..

17. AETIOLOGY
1. Blood loss.
Acute chronic
-accident - piles
-APH - hook warm infection
-PPH - bleeding from peptic ulcer
-menorrhagia - intestinal malignancy
- apistexis
 In India malaria and hook worm infection are most
common cause for chronic blood loss

18. 2. Increase requirement of iron:
eg. Growing age , pregnancy , lactation etc..
3. Inadequate dietary intake:
eg. Due to poverty , anorexia(in TB, cancer) , vegetarian diet
4. Decrease absorption of iron:
eg. Partial or total gastectomy, achlohydria ,
intestinal malabsorbtion in coeliac disease

19. Lab Diagnosis
1) Hb – decreased
2) RBC count – decreased
3) PCV – decreased
4) Absolute indices-
M.C. V
M.C.H ALL are decreased
M.C.H.C
5) P.s – anisocytosis and Poikilocytosis.
microcytic hypochromic RBC
6) Reticulocyte count – may be normal , decreased or
slightly increased(normal in adult->0.2-2% , in
infants 2-6%, total 24000-48000/cumm)

20. 7) WBC count - normal
8)Differential count – normal
9)Platelet count – normal or slightly increased
in case of bleeding.
10)Bone marrow biopsy – hyper cellular due to
erytheiod hyperplasia
11)Parssian blue stain – Negative.(shows
absence of iron store in REcell of bone
marrow)
12)Biochemical findings –
A. Serum iron level -> decreased(normal 18-
180μgm/day)

22. Difference
Heam iron
 It is in ferrous form
 Can be easily absorbed
 Soluble
 Vit-C and HCL is not
needed.
 High bio availability
 Found in non-veg food i.e
red meat
NON HEAM IRON
 It is in ferric form.
 Has to be converted in to
ferrous form and then
absorbed
 Insoluble
 Gastric HCL make is soluble
& vit-C convert it in ferrous
form.
 Low bio availability
 Found in vegetarian food.

23. Etiology & Pathogenesis:-
Deficiency of vit-B12(cobalamine) & / or folic acid
Impaired DNA synthesis
Delayed maturity of nucleus of RBC precursor
Slow division of cell.
(the cytoplasmic development progress normally)

24. • It leads to formation of large nucleated RBC precursor
: Megalobasts.
• Megaloblastas are morphologically & functionally
abnormal so that RBCs are formed from them released
into the peripheral blood is also abnormal in
size(macrocyte ).

25. Cause
 B-12 deficiency.
due to:
1. inadequate dietary intake- more common in
vegetarian and breast feed baby.
2. Malabsorption – due to lack of intrinsic factor ,
gastractomy , disease of small intestine like
Clohn’s disease.
3. Increase demand – eg.pregnancy , lactation ,
infancy etc…

26. source
• Non-veg food like kidney, liver, heart , muscle meat
etc are rich in B12.
• Fish , egg , cheese & milk also rich in B12.
• Vegetable are poor in source(B12)
Daily requirement : 2-4μg
Absorption : in distal Ilium.
 Storage :
 Mainly in liver -> 2mgm
 Kidney
 Heart 2mgm
 Brain

27. function
• DNA synthesis.
• Myelination of peripheral nerves , spinal
cord and cerebrum.

28. Folic acid deficiency
(same as B-12 deficiency)
due to:
1. inadequate dietary intake- more common in
vegetarian and breast feed baby.
2. Malabsorption – due to lack of intrinsic factor ,
gastractomy , disease of small intestine like Clohn’s
disease.
3. Increase demand – eg.pregnancy , lactation , infancy
etc…

29. Diet : Non-veg food is rich in folic acid than
vegetarian food .
 Daily requirement :100 – 200 mg/ day
Absorption :whole of small intestine
Nervous manifestation : numbness ,
weakness , ataxia , diminished reflexes
 Atrophic gastritis in stomach is seen.

30. Lab diagnosis
 RBC count : decreased
 PCV : decreased
 Absolute indices :-
• M.C.V → increased
• M.C.H → increased
• M.C.H.C → normal or slightly decreased
 Reticulocyte count → decreased
 P.S → anisocytosis & poikilocytosis.
• RBCs shows 2 characteristic changes
a) Macrosytosis
b) Ovalocytosis

31. e
• Tear drop cells may be seen.
• Basophilic stipping of RBC.
 WBC count : TLC ( total leukocyte count)
slightly decrease
 D.C ( differential count)
• Neutrophils → hyper segmented nucleus )
(lobes more than 5)
 Platelet : slight thrombocytopenia with
Megathrombocytes.
 Pancytopaenia is characteristic feature.

32.  Biochemical findings :
• Serum B-12 level are decreased : >100 ng/litter
(normal 200-900 ng/litter )
• Serum iodate : >4 μg/litter
(normal 6-12 μg/litter)
• Megaloblastic erythroid hyperplasia.
• This abnormality of RBC , destroy in bone marrow and
seen in 2 forms
a) Abnormal mitosis
b) Degenerated giant mitocyte(wbc)

33. Bone marrow finding
• Bone marrow is hypercellular due to
megaloblastic erythroid hyperplasia.
• They may shows abnormal mitosis.
• Giant metamylocytes are also seen

34. • Also known as Addison’s megaloblastic
anaemia.
• Uncommon in India
• Age incidence :- middle and old age people
• When occur in children called - juvenile
pernicious anaemia.
• Both sex are similarly affected.

35. aetiology
• Deficiency of intrinitsic factor.
• Atrophy of gastric mucosa due to
prodenetion of autoimmune antibodies
against parietal cell and intrinsic fator
• Antibodies are found in serum and gastric
juice of the patient
 Pathological changes in gastric mucos :
Certain mucosal atrophy affecting acid and
pepsin secreting cells of stomach.
 Result : deficiency of intrinsic factors leads to
megaloblastic anaemia and subsent
combined degeneration of spinal cord and
peripheral neuropathy.

36. Classification ( according to cause)
Haemolytic anaemia
Intracorpuscular Extracorpuscul
- thalassaemia - Infection
- enzymatic deficiency - drugs & chemical
in RBC -miscellaneou
-Defect in cell mambrane

37. Aetiology – pathogenesis
Increase haemolysis of RBCs
Decrease life span of RBC
Increased destruction of RBC
Increased release of haem
Increased formation of bilirubin
(uncongugated)
goes to liver
Congugated bilirubin
Goes to intestine

38. CAUSES :
1. Intracorpuscular cause
 Mainly three intacorpuscular causes
A. Thalassaemia and haemoglobinopathy
B. Enzymatic deficiency in RBCs . Eg -> G-6PD deficiency &
P.K deficiency & haemoglobinopthisis
C. Defect in cell-membrane
 eg. Hereditory sperocytosis & hereditory
eliptocytosis.
 It is a qualitative disorder of HB . Decreased of HB
synthesis leads to abnormal HB.

39. • Defect in the popypeptide chain of HB.
• over 100 abnormal Hbs are known. Hb-S, Hb-C Hb-D,
Hb-E etc..
• Out of all this Hb-s is most common. Which cause
sickle cell anaemia.
THALASSAEMIA
 Quontative defect of haemoglobin.
 Hereditary disorder.
 Defect : reduced ret of synthesis of one or more of
globin peptide chains.
 Two types: α & β

40. Lab diagnosis
• Hb : decreased
• RBC :decreased
• PCV : decreased
• MCV
• MCH normal
• MCHC
• Peripheral blood smear :
• normocytic normochromic.
• Polychorm cell is may seen.
• RBC lies much apart from each other
 WBC : normal
 Platelets : normal

41. • Reticulocyte : increased up to 20-30 %
• Bone marrow : hyper cellular of erythroid
hyparplasia
• Electrophoresis : separation of Hbs.
Abnormal Hbs may be detected (Hb-s)
• Osmotic fragility of RBC – increased
• Sickle cell for Hb-S may be positive.
• G-6PD deficiency may be seen.
• Blood bilirubin level : increased.
• Urobilinogen in urine : increased
• Sterkobilirogen in stool : increased.

42.  Characterised by pancytopaenia
 Anaemia
 Leucopaenia
 Thrombocytopaenia
Cause atrophy of bone marrow

43. classification
-
chemical - infection drugs
insect killer - AIDS Eg.cytotoxic drugs
- aersenic cals - hepatitis -Like methotexatic
Chloramphenico ;
Aplastic Anaemia
PRIMARY SECONDARY

44. Clinical featurs
• Anemia
• Haenmorrhages : of thrombocytopaenia
bleeding from gums , vagina ,bowels etc..
• Infections of leukopaenia

45. Lab diagnosis
 Hb : decreased
 P.S : normocytic normochromic .
 RBC : decreased
 PCV : decreased
 MCV : increased
MCH : normal
MCHC : increased
 Rticulocyte : nil
 Leukopaenia : neutrophils decreased, relative
lymphocytosis

46. • Platelet : increased (thrombocytopaenia)
• Bone marrow : dry tap
• Tryphling biopsy : hypocellular
Bone marrow is aplastic . Replaced by fat with
patchy areas of cell
Sever decreased f myeloid cells
Megakareyocyte and erythroid cells.
Pancytopaenia : marrow consist chiefly of
lymphocytes and plasma cells….
