Anemia is defined as a reduction in red blood cells or hemoglobin. It has many potential causes including blood loss, decreased bone marrow production, and genetic disorders. Symptoms include fatigue, palpitations, and shortness of breath. Diagnosis involves a complete blood count, peripheral smear, and identifying the underlying cause through history, examination, and additional testing. Treatment depends on the specific cause but may include iron supplementation, B12/folate, blood transfusions, or immunosuppressive drugs.

1. ANEMIA
• Defined as collection of signs and symptoms of reduced
oxygen delivery to tissues as a result of a reduction in the
number of red cells and/or reduction in blood concentration of
hemoglobin.
• Also defined as hemoglobin<13g/dl for men and <12g/dl for
women (WHO)
• For children 6mo.-6 yrs Hb < 11g/dl and those aged 6-14 Hb
<12g/dl

2. classification
• According to etiology
• According to size of RBC

3. ETIOLOGY
• Peripheral causes
 Blood loss
 Increased RBC destruction
 hypersplenism
• Decreased or ineffective marrow production
 Lack of B12 or folate
 Hypoplasia
 Invasion by malignant cells

4. Genetic
• Hemoglobinopathies
• Thalassemias
• Enzyme abnormalities of the glycolytic pathways
• Defects of the RBC cytoskeleton
• Congenital dyserythropoeteic anemia
• Fanconi anemia
• Hereditary xerocytosis
• Hereditary spherocytosis

5. Cont.
• Nutritional etiologies; iron deficiency, vitamin B12
deficiency, folate deficiency,starvation and
generalised malnutrition.
• Chronic diseases and malignancies eg renal, hepatic,
neoplasia
• Infectious etiologies eg viral hepatitis, infectious
mononucleosis, CMV,bacterial infections, malaria,
toxo, leishmaniasis.
• Thrombotic thrombocytopenic purpura and hemolytic
uremic syndrome.

6. presentation
Take history;
 family history
 occupation
 prior medical treatment
 drugs
 obstetric and gyn history
 GIT and GUS history
 dietary history

7. symptoms
• Lassitude
• Fatigue
• Breathlessness on exertion
• Palpitations
• Throbbing in the ears and head
• Dizziness
• Tinnitus
• Headache
• paraesthesias

8. Clinical examination
• Pallor
• Jaundice
• Coarseness of hair
• Nail defects
• Tachycardia
• Cardiac dilation
• Systolic flow murmur
• Oedema

9. Work up
• Peripheral smear; anisocytosis
 poikilocytosis
 hypochromia
 target cells
 reticulocytes
 basophilic stippling
 howell-jolly bodies
 spherocytes
• CBC;
 MCV; microcytic if <84 & macrocytic if >84
• MCH, MCHC,Hb levels
• Bilirubin levels

10. Iron deficiency anemia
• Commonest
• Due to;-loss of iron due to bleeding esp. GI
• -inadequate diet
• -malabsorption
• Symptoms are mainly those of anemia

11. Characteristic features
• Angular stomatitis
• Glossitis
• Brittle finger nails
• Nail cracking
• Koilonychia
• pica

12. Diagnostic features
• Reduced Hb
• Reduced MCV <76fl
• Erythrocyte count is normal or reduced than Hb
• Normal leucocyte count differential
• Normal or raised platelet count
• Raised plasma transferrin
• Reduced plasma iron
• Reduced serum ferritin
• Total iron binding capacity increased
• Empty bone marrow iron stores
• Blood film; hypochromia, microcytosis, oval
&elliptical cells, poikilocytes in severe cases.

13. Diagnosis of the cause
• Fecal occult blood
• Barium meal
• Barium enema
• Endoscopy
• Stool analysis for hookworm eggs
• Urinalysis for schistosomiasis

14. management
• Ferrous sulphate 200mg (contains 60mg elemental
iron) tds for 3-6 months
• Vitamin C 500 units to enhance absorption
• Ferrous gluconate 325mg daily(35mg of elemental
iron)
• Parenteral iron therapy- iron sorbitol

15. Megaloblastic anaemia
• Causes
 Vitamin B12 deficiency
 Addisonian pernicious anemia
 Folate deficiency

16. Diagnostic features
• Hb often reduced & may be very low
• Raised MCV>120 fl
• Erythrocyte count is low for degree of anemia
• Low reticulocyte for degree of anemia
• Low, normal or reduced leucocyte count
• Low, normal or reduced platelet count
• Blood film; oval macrocytosis, poikilocytosis, red
cell fragmentation, neutrophil hypersegmentation
• Elevated serum iron
• Increased iron binding capacity

17. Cont.
• Bone marrow;-increased cellularity, megaloblastic
changes in the erythroid series, giant metamyelocytes,
dysplastic megakaryocytes, increased iron in stores,
pathological non- ring sideroblasts
• Elevated serum ferritin
• Elevated plasma LDH (markedly) due to massive
destruction of marrow cells from dyserythropoesis

18. Vitamin B12 deficiency
• Source is animal food stuffs.
• Daily requirement is 1-2ug daily.
• Causes;
 Inadequate diet (true vegans)
 Intrinsic factor deficiency eg due to pernicious
anemia, gastrectomy
 Diseases of terminal ileum eg Crohn’s disease

19. Folate deficiency
• Daily requirement is 100ug
• Causes
 Diet-poor intake of vegetables
 Malabsorption eg coeliac disease
 Increased demand e.g in pregnancy
 Drugs e.g anticonvulsants, cytotoxic drugs

20. management
• Parenteral hydroxocobalamin 1000ug bid for 1st wk
& then 1000ug weekly for a further 6 doses. Then
every 3 months for life
• Ferrous sulphate may be given with above to avoid
depletion of iron stores due to rapid regeneration of
blood
• Folic acid tabs 5mg daily then weekly as maintenance

21. Hemolytic anemia
• Causes; congenital & acquired
 Membrane abnormalities eg hereditary spherocytosis,
hereditary elliptocytosis
 Haemoglobinopathies e.g sickle cell, thalassaemias
 Red cell enzyme defects eg G6PD deficiency
 Immune e.g isoimmune, autoimmune , alloimmune
 Non-immune e.g artificial cardiac valves, burns,
microangiopathic, infections, drugs

22. Anemia of chronic disease
• Pathogenesis involves abnormalities of iron
metabolism & erythropoeisis
• Occurs in the setting of chronic infection, chronic
inflammation or neoplasia
• Is not related to bleeding, hemolysis or marrow
infiltration
• Is generally mild in the range of 8.5-11.5 g/dl &
usually normocytic normochromic or reduced MCV
• Serum iron is low but iron stores are normal or
increased

23. Aplastic anemia
Syndrome of bone marrow failure characterized by
peripheral pancytopenia and marrow hypoplasia
Causes; drugs e.g chloramphenicol, phenylbutazone.
 exposure to radiation & chemicals e.g benzene
 Infectious e.g hepatitis, EBV, HIV, parvovirus &
mycobacteria
 Transfusional graft vs host disease
 pregnancy
 Anorexia
 Severe nutritional deficiencies (B12 & folate)

24. Cont.
 Primary idiopathic
 Congenital eg fanconi anemia, dyskeratosis congenita
 Paroxysmal nocturnal hemoglobinuria- acquired
genetic defect affecting the PIGA gene& limited to
the stem cell compartment. Mutations of this make
the hematopoietic cells sensitive to increased
complement lysis

25. Work up
• CBC- pancytopenia
• Blood film- tear drop poikilocytes&
leucoerythroblastic changes suggest infiltrative
process
• Hb electrophoresis- elevated fetal Hb
• Biochemical profile
• Serology for Hep, HIV
• Fluoresence activated cell sorter (FACS) profiling-for
PNH
• Bone marrow biopsy &aspiration

26. management
• Blood transfusion
• Treat infections due to prolonged neutropenia
• Hematopoietic cell transplantation
• Immunosuppressive therapy using anti-thymocyte
globulin & cyclosporin-A